Sleep disturbances and a risk of myocardial infarction

The aim of the study was to investigate the influence of sleep disturbances on the 8-year risk of myocardial infarction (MI) in men aged 25 to 64 years old. Screening of male inhabitants of one of Novosibirsk districts, aged 25 to 64 years, was performed within the framework of the WHO MONICA-psychosocial program in 1994. The cohort was followed up during 8 years (1994 - 2002) to determine end-points (MI). The statistical analysis was performed using SPSS- 10 software package. The relative risk (RR) of MI was evaluated using Cox proportional regressive model. Only one third of the 25 to 64-year-old male subjects with the first MI referred to their sleep as "good" whereas two thirds had sleep disturbances. The 8-year RR of MI in men aged 25 to 44 was 9.25 times higher in those whose sleep was estimated as '"poor" vs. those with "good" sleep, i. e. in this age group sleep disturbances were one of the most important MI risk factors; in 45 to 64 age group these differences were insignificant. RR of IM in men with sleep disturbances was higher in widowers, divorced men, men with low social support level, men with only primary education, working class men, and pensioners. The results demonstrate that sleep disturbances present a social problem and contribute greatly to the risk of MI in men of young age group.     

Study of the influence of vital exhaustion on myocardial infarction risk in a male population aged 25 to 64 years

The aim of the study was to investigate the influence of vital exhaustion (VE) on the 8-year risk of myocardial infarction (MI) in men aged 25 to 64 years old. A random representative sample of male inhabitants of one of Novosibirsk districts, aged 25 to 64 years, was included in the WHO MONICA-psychosocial program. Within 8 years (1994-2000) all the cases of MI in the cohort were studied using the WHO Acute Myocardial Infarction Register project. The statistical analysis was performed using SPSS-10 software package. The relative risk (RR) of MI was evaluated using a Cox proportional regressive model. The prevalence of VE in subjects with MI was 65.8%. The 8-year RR of MI in men aged 25 to 64 years was 2.16 times higher (p < 0.05) in presence of VE and was the highest in widowers, divorced men, subjects with incomplete secondary or primary education, men of hard or moderate physical labor, and pensioners. The results show that RR of MYis associated with VE, which, in its turn, is directly related to social and economic status.     

An 8-year study of depression effects on myocardial infarction risk in a population of 25-64 year old men

AIM: To study depression effects on the risk of myocardial infarction (MI) for 8 years in men aged 25-64 years. MATERIAL AND METHODS: A random representative sample of men (n = 657) at the age between 25 and 64 living in Novosibirsk were screened in 1994 in the scope of WHO program "MONICA-psychosocial". The response was 82.1%. WHO "Register of Acute Myocardial Infarction" detected 58 cases of MI in the control period 1994-2002. Statistics were obtained with the program set SPSS-10. Cox regression model was used for estimation of a relative MI risk (RMIR). RESULTS: RMIR in 25-64-year-old men for 8 years was 2-fold higher in men with depression than without it, in the age group of 55-64-old men--5-fold. Depression was in 65.8% MI patients. The highest RMIR was in men with depression engaged in hard labour, retired, poorly educated, divorced, widowed. CONCLUSION: Risk of MI in men is related to depression due to social and economic status.     

20-year monitoring of acute cardiovascular diseases in population of large industrial city in West Siberia (epidemiological study)

AIM: To reveal trends in incidence rates of acute cardiovascular diseases (ACD) in a large industrial city of the West Siberia. MATERIALS AND METHODS: Studies on WHO programs "Acute Myocardial Infarction Register" and "MONICA" have been performed in three districts of Novosibirsk. The diagnostic categories were detected without difference. The observation covered stable population of 500,000 residents aged 25-64 years. Trends in the myocardial infarction (MI) mortality, morbidity and lethality were analysed for 1977-1996. RESULTS: The above trends were stable except for 1986 when MI mortality, morbidity and lethality decreased and 1988 and 1994 when they went up. The reduction was due to 7-year prevention program while the rise was consequent to discontinuation of the preventive measures. Major risk factors of ischemic heart disease, according to screenings conducted in 1984, 1988 and 1994 remained at about the same level. Social stress closely correlates with a rise in MI morbidity and mortality. The latter in 1994 grew owing to higher rates of MI mortality and morbidity among the oldest men and females of different age groups. CONCLUSION: Urgent intensification of prophylactic measures is needed both at the populational level and the level of high risk strategy.     

10-year dynamics of attitude to health problems in the male population of Novosibirsk (epidemiological study based on the WHO MONICA program)

AIM: To evaluate changes for a decade in the attitude of men in Novosibirsk to health problems. MATERIAL AND METHODS: WHO program MONICA has covered males aged 25-64 years (a representative sample from the population in one of the districts of Novosibirsk city). A total of 3 trials were made (in 1984, 1988 and 1994) which included questioning, registration of ECG, arterial pressure, height, body mass, biochemical tests of the blood. RESULTS: Attitude of men to their health depended on their age. There was a trend to evaluate their health as more and more poor in men at the age of 25-43 and 35-44 years. In the group of 45-54-year-olds positive assessment of health was encountered 1.9 times more frequently, but the difference was not significant. At the age 55-64 years a growing number of men tend to assess their health as good. Since 1994 alcoholics among the elderly men grew in number as a response to the social and economic crisis. CONCLUSION: The change in health evaluation from negative to positive in older men may relate to less intensive work.     

Effects of hostility on the risk of arterial hypertension, myocardial infarction, stroke in a sample of males aged 25-64 years (epidemiological trial on the base of WHO program MONICA)

AIM: To study effects of hostility on the risk of arterial hypertension (AH), myocardial infarction (MI) and stroke in males aged 25-64 years. MATERIALS AND METHODS: A screening study of the population was performed in 1994 according to WHO program MONICA-psychosocial. The response in a random representative sample of 25-64-year-old males (n = 657) living in Novosibirsk was 82.1%. New cases of MI, AH and stroke were registered in the control periods 1994-2000, 1994-2002. Computer program package SPSS-10 was used for statistic processing. Cox regression model of the relative risk (RR) was employed. RESULTS: Hostility was rather prevalent among the examinees (76.9%). MI risk for 8 years was 4.65 times higher in hostile men. Hostility was not associated with higher risk of AH and stroke. Hostility was seen more frequently in men with poor education, workers and retired persons. These groups are also at the highest risk of MI. CONCLUSION: Hostility raises MI risk in unstable society but had no effect on the risk of AH and stroke.     

Five-year trends in main risk factors of coronary heart disease among open population of Tyumen

AIM: To study five-year trends in main risk factors of coronary heart disease (CHD) among 35-54-year-old population of Tyumen. MATERIAL AND METHODS: Five-year monitoring of 1597 males and females aged 35-54 years was performed as two cardiological screening trials. The risk factors were assessed both by standard and extended WHO criteria. RESULTS: Risk factors studied had the following prevalence trends: a rise in the rate of obesity (7.2-14.5%), hypercholesterolemia by standard criteria (14.4-27.8%) and hypertriglyceridemia (5.8-16.7%) among men aged 35-44 years; a rise of the rate of isolated systolic arterial hypertension by extended criteria (3.5-8.8%), smoking (10.6-19.2%), hypo-alphacholesterolemia (3.9-11.6%) among women aged 35-44 years; a rise in the rate of isolated systolic arterial hypertension (3.9-14.7%), a decrease of diastolic arterial hypertension rate by extended criteria (49.0-31.3%) among women aged 45-54 years. Five-year monitoring revealed that among 45-54-year-old men the number of those who smoke irregularly significantly increased (7.3-21.5%), while the number of non-smokers fell (44.3-21.5%). CONCLUSION: Tyumen population is characterized by a high prevalence of the risk factors with a negative 5-year trend. The results of the screenings give grounds for conduction of a large-scale prophylactic program in an open Tyumen population with a focus on priorities of prophylactic interventions.     

Risk of arterial hypertension and social support

The aim of the study was to investigate the effect of social support on the 8-year risk of arterial hypertension (AH) in men aged 25 to 64. The researchers studied a random representative sample of male residents of a Novosibirsk district aged 25 to 64 years. The level of social support was evaluated by Berkman-Syme method. All the cases of AH which occurred in the cohort within 8 years (1994-2002) were investigated. The statistical analysis was performed using SPSS-11.5 software package. The relative risk (RR) of AH was evaluated using a Cox proportional regressive model. Within these 8 years the RR of AH was higher: 1) in men aged 25 to 64 years with low and medium close contact index (CCI) compared to men with high CCI (8.5 times); 2) in subjects with low social contact index (SCI) compared to subjects with high or medium SCI (4.8 times). In men aged 55 to 64 years the RR of AH was 15.9 times higher in men with low CCI. The highest rate of AH was found in men with low CCI and SCI belonging to the groups of widowers, divorced people, subjects with incomplete secondary or primary education, as well as in pensioners and people with low level of social support. The results show that AH risk in men aged 25 to 64 years is associated with low level of social support.     

The prevalence of the metabolic syndrome among arab americans

OBJECTIVE: To estimate the prevalence of the metabolic syndrome in Arab Americans by age, sex, and BMI and to examine the association between insulin resistance and each of the components of the metabolic syndrome. RESEARCH DESIGN AND METHODS: We studied a representative, cross-sectional, population-based sample of 542 Arab Americans aged 20-75 years. The metabolic syndrome was defined by Adult Treatment Panel III (ATP III) and World Health Organization (WHO) diagnostic criteria. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR). RESULTS: The age-adjusted prevalence of the metabolic syndrome was 23% (95% CI 19-26%) by the ATP III definition and 28% (24-32%) by the WHO definition. Although the prevalence increased significantly with age and BMI in both sexes by both definitions, differences in estimates were noted. With ATP III, the age-specific rates were similar for men and women aged 20-49 years but were significantly higher for women aged >/=50 years. With WHO, rates were higher for men than women aged 20-49 years and similar for those aged >/=50 years. The most common component of the metabolic syndrome in men and women was low HDL cholesterol with the ATP III and the presence of glucose intolerance and HOMA-IR with the WHO. Strong associations between HOMA-IR and individual components of the metabolic syndrome were observed. After fitting a model with HOMA-IR as the outcome, waist circumference, triglyceride level, and fasting plasma glucose level were significantly associated with HOMA-IR. CONCLUSIONS: The metabolic syndrome is common among Arab Americans and is related to modifiable risk factors.     

Migraine and coronary heart disease in women and men

OBJECTIVE: We evaluated migraine as an independent risk factor for subsequent coronary heart disease (CHD) events among women in the Women's Health Study (WHS) and men in the Physicians' Health Study (PHS). BACKGROUND: Although several studies have suggested that migraine is associated with increased risk of stroke, there are few and conflicting data on whether migraine predicts risk of future CHD events. METHODS: The WHS is an ongoing randomized, double-blind, placebo-controlled trial of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer in 39876 women health professionals aged > or =45 years in 1993, and the PHS is a completed randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in the primary prevention of cardiovascular disease and cancer in 22071 men physicians aged 40 to 84 years in 1982. Primary endpoints were defined as major CHD (nonfatal myocardial infarction [MI] or fatal CHD) and total CHD (major CHD plus angina and coronary revascularization). RESULTS: After adjusting for other CHD risk factors, female health professionals and male physicians reporting migraine were not at increased risk for subsequent major CHD (women: relative risk [RR], 0.83; 95% confidence interval [CI], 0.53 to 1.29; men: RR, 1.02; 95% Cl, 0.79 to 1.31) or total CHD (women: RR, 1.01; 95% Cl, 0.76 to 1.34; men: RR, 0.98; 95% Cl, 0.82 to 1.18). When considered separately, there was also no increase in risk of MI or angina. CONCLUSION: These prospective data suggest that migraine is not associated with increased risk of subsequent CHD events in women or men.     

Prevalence of undiagnosed diabetes in three American Indian populations. A comparison of the 1997 American Diabetes Association diagnostic criteria and the 1985 World Health Organization diagnostic criteria: the Strong Heart Study

OBJECTIVE: In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus of the American Diabetes Association (ADA) recommended three new sets of criteria for the diagnosis of diabetes that were different from those established by the World Health Organization (WHO) in 1985. One of these three methods was based on a fasting plasma glucose value only. This article compares ADA criteria with WHO criteria by applying them to three subgroups of American Indians in the Strong Heart Study who had no known diabetes. RESEARCH DESIGN AND METHODS: The Strong Heart Study is a prospective epidemiological study of vascular disease in three American Indian populations aged 45-74 years. During the baseline examination from 1988 to 1991, participants without diagnosed diabetes underwent a fasting glucose test and a 2-h oral glucose tolerance test. These values were used to compare the ADA and WHO diagnostic criteria. RESULTS: By using fasting and 2-h glucose values, prevalence rates of undiagnosed diabetes were 15.9% according to WHO criteria and 14.4% according to ADA criteria. The overall agreement rate was 65%, and the weighted kappa statistic was 0.474, which indicates moderate agreement. The age-specific analysis showed that, among participants between 45 and 54 years of age, the prevalence rates of undiagnosed diabetes were 13.4% according to WHO criteria and 12.7% according to ADA criteria. Among those aged 55-74 years, the rates were 18.7% according to WHO criteria and 16.3% according to ADA criteria. Thus, the difference in the prevalence rates when using WHO and ADA criteria, although generally small in this population, was three times higher in the older group (2.4%) than the difference in the younger group (0.7%). CONCLUSIONS: The Strong Heart Study found that prevalence rates of undiagnosed diabetes determined by ADA criteria and WHO criteria were similar in its American Indian population. The data suggest that the difference between the two criteria may increase as age increases. Longitudinal data will be needed to evaluate further the utility of the two criteria.     

Anthropometric obesity indices in relation to age and gender in Japanese adults

The body mass index (BMI), waist circumference, waist to hip ratio, waist to height ratio and skinfolds (near-umbilical and iliac areas) in three age groups (35-44, 45-54 and 55-64 years) were compared in 3117 men and 997 women in Tokyo. In both genders, height was significantly shorter, while the waist to hip ratio and waist to height ratio were significantly higher, in the older groups. In the men, there were no significant differences in BMI and waist circumference among the three age groups, but the iliac skinfold was significantly thinner in each older group, and the paraumbilical skinfold was thinner in the group aged 55-64 years. In the women, the paraumbilical skinfold was significantly thicker in each older group, while waist circumference and the iliac skinfold were significantly larger or thicker in the group aged 55-64 years, and BMI was larger in the groups aged 45-54 and 55-64 years. There were age-related discrepancies between BMI and other obesity indices in the different genders, in that only the waist to height ratio and waist to hip ratio increased with age in both genders.     

Age-Stratified Sex-Related Differences in the Incidence,Management, and Outcomes of Acute Myocardial Infarction

ObjectiveTo assess the impact of female sex on the incidence, management, and outcomes of myocardial infarction (MI) in different age groups.MethodsPatients admitted with ST-elevation MI (STEMI) and non–ST-elevation MI (NSTEMI), between January 1, 2003, and December 31, 2015, were identified in the National Inpatient Sample. We compared STEMI and NSTEMI rates, management patterns, and in-hospital morbidity and mortality in men and women stratified into 4 age groups (<45, 45 to 64, 65 to 84, and ≥85 years of age).ResultsA total of 6,720,639 weighted hospitalizations for MI (79.8% NSTEMI, and 20.2% STEMI) were included. The incidence rate of hospitalizations for MI was lower in women than men across all age groups. Women were less likely than men to undergo coronary angiography, revascularization, or to use circulatory-support devices. These differences were consistent across all age groups. Adjusted odds of death for women (vs men) varied by age: odds ratio (95% confidence interval) 1.08 (0.97 to 1.20), 1.05 (1.02 to 1.08), 0.92 (0.91 to 0.94), and 0.86 (0.85 to 0.88) for NSTEMI, and 1.15 (1.04 to 1.27), 1.22 (1.18 to 1.26), 1.09 (1.06 to 1.11), and 0.97 (0.94 to 0.99), for STEMI, in age groups (<45, 45 to 64, 65 to 84, and ≥85), respectively. The magnitude of differences in complications between men and women was higher in younger and middle-age patients.ConclusionCompared with men, women have lower incidence of MI and less likelihood of undergoing invasive treatment regardless of age. However, post-MI outcomes are age specific. The negative impact of female sex on most outcomes was most pronounced in young and middle-aged women.     

Coronary heart disease in the elderly

In 1984, 435,759 deaths were attributed to CHD among persons greater than or equal to 65 years of age. CHD was the leading cause of death in this group. Death rates rose steeply with age among the elderly. Men had higher death rates than women, but the male-to-female ratio declined with increasing age. Considerable geographic variation in CHD mortality in the elderly was noted. Since 1968, CHD death rates have declined in persons greater than or equal to 65 years of age in each age, sex, and race group. However, prevalence of self-reported CHD in the elderly population has increased. Prevalence rates increased with age except for a slight decrease above age 75 in men. In 1985, 436,000 persons aged greater than or equal to 65 years were discharged with a principal diagnosis of acute MI. The hospital case fatality rate was 21.8%. Since 1970, hospitalization rates for acute MI have generally increased, while hospital fatality rates have decreased for persons greater than or equal to 65 years of age. Since 1979, utilization of coronary artery bypass surgery and coronary arteriography have dramatically increased among the elderly. In 1980 and 1981, elderly persons made six million visits to physicians' offices for chronic CHD. CHD contributed importantly to the 1980 expenditures of 3.3 billion dollars in men and 4.8 billion dollars in women greater than or equal to 65 years of age for heart disease care. Although mortality rates from CHD in the elderly have decreased since 1968, increasing hospitalization rates and utilization of other health care services emphasize the need for more vigorous efforts at prevention.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of dyslipidemia in open population of Tiumen'

AIM: To evaluate levels of total cholesterol (TC), HDLP cholesterol, triglycerides (TG), occurrence of hypercholesterolemia (HCE), hypertriglyceridemia (HTG) and low HDLP cholesterol in the Tyumen population. MATERIAL AND METHODS: 866 men and women aged 25-64 years have been examined in one-stage cardiological screening within a two-stage epidemiological study of serum lipoproteins by WHO criteria. RESULTS: HCE was registered in 15.6% males and 18.8% females, a low HDLP cholesterol--in 5.3 and 4.2%, HTG--in 5.8 and 4.3% males and females, respectively. A high TC level and HCE occurred more frequently in women over 54 years of age; a low HDLP cholesterol level in insignificant fall in HDLP cholesterol and no age-related changes of this index were found both in males and females; TG were elevated in older males in moderate prevalence of HTG in the population. CONCLUSION: It is shown that Tyumen population is at high risk of cardiovascular diseases. Further studies are needed to specify targeted preventive programs.     

Mean values of risk factors for ischemic heart disease and their percentile distributions in the Alma-Ata population of men aged 20-54]

The authors analyze the results of a one-stage epidemiological study of the open population of men aged 20-54 years (n-2886), carried out with a purpose of revealing coronary heart disease (CHD) and its risk factors (RF). The study was performed with the aid of the standard WHO methods of epidemiological investigations. The prevalence of the main CHD RF (arterial and borderline hypertension, overweight, tobacco-smoking, dyslipoproteinemias) was established. The mean values of RF in different age groups were calculated. The regional 90% cut-off points of RF distributions were defined: the body weight index (30.0), systolic arterial pressure (141 mm Hg), diastolic arterial pressure (95 mm Hg), cholesterol level (6.50 mmol/l, triglycerides (2.15 mmol/l). The 10% cut-off point for alpha-cholesterol amounted to 0.98 mmol/l. The regional values obtained can be used in prophylactic screenings when making up groups to be placed under dispensary observation.     

Long-term observation of the trends in morbidity, lethality and mortality from myocardial infarct in the population aged 25 to 64

The data are provided on long-term observation (for 10 years) of the myocardial infarction (MI) death rate, and incidence among the community using the standard WHO program. The Register of Acute Myocardial Infarction. It is shown that over the first two years of observation, the death rate and mortality tended towards decrease and then got stabilized. The diseases incidence tended towards growth and then got stabilized as well. It is noted that the prehospital death rate and lethality because of MI considerably exceeded the hospital ones and underwent almost no changes over 10 years. It is emphasized that perfection of the assistance rendering to MI patients does not solve the problem of the high death rate because of MI. It is probable that only primary care may solve the problem of reducing the cardiovascular disease incidence and death rate.     

Multimorbidity in Canadians living in the community: Results from the Canadian Longitudinal Study of Aging

ObjectiveTo determine the mean number of chronic diseases in Canadians aged 45 to 85 years who are living in the community, and to characterize the association of multimorbidity with age, sex, and social position.DesignAn analysis of data from the Canadian Longitudinal Study on Aging. The number of self-reported chronic diseases was summed, and then the mean number of chronic health problems was standardized to the 2011 Canadian population. Analyses were conducted stratified on sex, age, individual income, household income, and education level.SettingCanada.ParticipantsA total of 21 241 community-living Canadians aged 45 to 85 years.Main outcome measuresOverall, 31 chronic diseases (self-reported from a list) were considered, as were risk factors that were not mental health conditions or acute in nature. Age, sex, education, and household and individual incomes were also self-reported.ResultsMultimorbidity was common, and the mean number of chronic illnesses was 3.1. Women had a higher number of chronic illnesses than men. Those with lower income and less education had more chronic conditions. The number of chronic conditions was strongly associated with age. The mean number of conditions was 2.1 in those aged 45 to 54; 2.9 in those 55 to 64; 3.8 in those aged 65 to 74, and 4.8 in those aged 75 and older (P < .05, ANOVA [analysis of variance]).ConclusionMultimorbidity is common in the Canadian population and is strongly related to age.     

Polymorphisms in coagulation factors and the risk of recurrent cardiovascular events in men after a first myocardial infarction

Summary.  Background:  The aim of this study was to examine whether genetic predisposition to high levels of coagulation factors influences the risk of developing fatal and non-fatal arterial cardiovascular events in men with a first myocardial infarction (MI). Methods:  We performed a cohort study among 542 MI patients with a mean age of 56 years (range 32–70 years) at the time of the event. All of the men had a first MI between 1990 and 1996 and were followed until 1 September 2004. DNA was analyzed for polymorphisms of fibrinogen, prothrombin (factor II), factor V, factor VII and plasminogen activator inhibitor type 1, all of which are associated with gain of function of the protein. We collected information from hospital files and general practitioners on the occurrence of major arterial events. Results:  In total, 254 major arterial cardiovascular events occurred during a median follow-up period of 11 years (range 0.2–15 years). The point estimates of the relative rates (RRs) of these events for the variant genotypes were all between 0.7 and 1.1 except for the prothrombin 20210A mutation: RR 1.8 (95% confidence interval 0.8–4.1). Conclusion:  These findings suggest that there is no association between coagulation factor polymorphisms, previously associated with plasma levels, and the risk of recurrent cardiovascular events.     

山西地区正常人群定量骨超声检测结果811例分析

目的经体重指数标准化,分不同年龄段进行比较,探讨定量骨超声测定的统一标准。方法采用UBIS5000型定量超声仪,对山西地区811例20～80岁正常成人(女468例,男343例)行跟骨定量超声参数测量。结果跟骨超声振幅衰减(BUA)和刚度(STI)的峰值女性在45～49岁犤BUA为(67.71±4.91)dB/MHz,STI为(86.3±14.5)%犦,BUA峰值男性在50～54岁犤(71.41±7.69)dB/MHz犦。经体重指数校正后,不论男性或女性BUA、STI及超声波传导速度(SOS)峰值均在20～24岁。结论跟骨BUA、SOS和STI随年龄增长而变化,消除体重指数影响后差异仍明显,且随增龄逐年降低,男性变化趋势不如女性明显。