Prevalence of cardiovascular disease risk factors in blacks and whites: the Minnesota Heart Survey.

Two cross-sectional surveys were conducted in 1985 and 1986 to measure the prevalence of coronary heart disease (CHD) risk factors in Blacks and Whites. A home interview was followed by a survey center visit. Participation rates were 78 per cent and 90 per cent for the home interview and 65 per cent and 68 per cent for the survey center visit. Adjusted for age and education, systolic and diastolic blood pressure was 3 to 4 mmHg higher in Blacks. Hypertension was more prevalent in Blacks than Whites (44 per cent vs 28 per cent); serum total cholesterol was approximately 0.4 mmol/l lower in Black than White men and 0.08 mmol/l lower in Black than White women. Among men, more Blacks than Whites were current cigarette smokers (44 per cent vs 30 per cent); however, White smokers smoked more cigarettes per day (26 vs 17). Similar differences were noted for women, although the prevalence and quantity of cigarette consumption was less than men. The excess prevalence of these CHD risk factors in Blacks, especially among women, may explain their elevated CHD and stroke mortality rates in the Twin Cities.     

Stroke incidence and case fatality in Shiga, Japan 1989-1993

BACKGROUND: This paper describes incidence rates and case-fatality for sub-types of stroke using data collected in Takashima, Shiga, Japan, from 1989 to 1993 and compares these with similar registers in other parts of Japan. METHODS: Registered patients included all residents of the county who experienced a first-ever stroke. Stroke was defined as sudden onset of neurological symptoms which continued for a minimum of 24 hours or led to death. Almost all such patients are hospitalized in this country. Early case fatality was defined as patients who died within 28 days of stroke onset. Diagnosis of stroke type was based on clinical symptoms as well as computed tomography (CT) scans. RESULTS: Age-adjusted incidence rates for stroke per 100,000 population aged 35 years and older were 268.7 for men and 167.5 for women. The age-specific incidence rate of both cerebral infarction and cerebral haemorrhage increased with advancing age. The occurrence of cerebral infarction in men was twice as high as in women. The 28-day case fatality for all sub-types of stroke was 16.1% in men and 15.8% in women. Case fatality for cerebral infarction, cerebral haemorrhage, and subarachnoid haemorrhage was 10.7%, 22.4% and 28.6% respectively. CONCLUSIONS: Takashima County has a moderately high stroke incidence rate and case fatality compared with other similar studies in Japan. The incidence rate of cerebral infarction in men is twice that in women, while other sub-types of stroke showed smaller differences. In order to decrease the incidence of stroke in Japan, greater efforts at primary prevention will be necessary, in particular, it is important to prevent cerebral infarction in men.     

High mortality from renal disease and infection in Aboriginal central Australians with diabetes

Abstract: Few studies have examined the consequences of the high prevalence of diabetes in Aboriginal communities. We aimed to determine the rates and causes of mortality in all Aboriginal central Australians with diagnosed diabetes, identified by a previous study (n = 374). Cohort members were followed from 1 January 1984, or the date of diagnosis (to 31 December 1986), to 31 December 1991 or death. Death certificates, medical notes and autopsy reports were examined for cause of death. There were 130 deaths in 2280.7 person–years of follow-up. Standardised mortality ratios for Aboriginal people with diabetes, compared to the Northern Territory Aboriginal population, were 209 (95 per cent confidence interval (CI) 158 to 273) for men and 169 (CI 129 to 218) for women. The difference in ratios for men and women was not statistically significant when adjusted for age (P = 0.2). The eight-year survival rates for men and women diagnosed between 1984 and 1986 were 55.8 per cent (CI 32.6 to 73.7) for men and 80.3 per cent (CI 64.8 to 89.5) for women. Renal disease was the direct cause of death in 22.3 per cent Infection accounted for 20.8 per cent of deaths and ischaemic heart disease for 13.8 per cent Forty-four per cent of death certificates made no mention of diabetes. Diabetes confers an additional risk of death on a population whose mortality is already markedly worse than that of other Australians. Unlike Western diabetic populations, infections and renal disease were more common causes of death than macrovascular disease. Diabetes amplifies the effect of the community prevalence of infection and renal disease.     

Alcohol consumption as a major risk factor for the rise in liver cancer mortality rates in Japanese men

BACKGROUND: Age-adjusted liver cancer mortality rates have been increasing for both men and women in Japan since 1970; however, increases in mortality rates in men are much greater than those in women. Hepatitis C virus infections and heavy alcohol consumption are considered to be the major risk factors of liver cancer deaths in Japanese. The purpose of this study is (1) to examine the pattern of liver cancer mortality by gender and birth year to compare those with the pattern of other alcohol-related mortality and (2) to estimate the attributable risk per cent of heavy alcohol consumption for liver cancer deaths in Japanese men. METHODS: Age-specific liver cancer mortality rates by gender were compared with those of cirrhosis mortality rates. Then male-to-female mortality rate ratios were calculated by birth cohort and compared with cirrhosis mortality rate ratios and oesophageal cancer mortality rate ratios. The attributable risk per cent of alcohol consumption for liver cancer death was calculated, using female liver cancer mortality rates as standard rates. RESULTS: Examination of both gender and birth cohort mortality rates revealed that male-to-female liver cancer mortality rate ratios by birth cohort correspond well with those rate ratios for liver cirrhosis and oesophageal cancer mortality. The attributable risk per cent of alcohol consumption for liver cancer deaths in Japanese men was 70%. CONCLUSION: Alcohol consumption is more important than hepatitis C virus infections as a major cause of liver cancer deaths in Japanese men.     

Preventing stroke in people with atrial fibrillation: a cross-sectional study

BACKGROUND: The annual stroke rate in atrial fibrillation is around 5 per cent with increased risk in those with hypertension, diabetes, left ventricular dysfunction and other cardiovascular risk factors. This study set out to identify the patients with atrial fibrillation and modifiable risk factors for stroke. METHOD: Analysis of practice computer data taken from eight general practices (81 811 patients) in the south of England. 944 patients with a diagnosis of atrial fibrillation, of whom 782 (82.8 percent) were aged 65 years and over. RESULTS: The age standardised prevalence of diagnosed atrial fibrillation was 1.23 per cent (1.28 percent for men and 1.18 percent for women). It was much more prevalent in the older population, 8.28 percent and 6.66 percent for males and females over 65, respectively. Cardiovascular co-morbidities were more frequent with increasing age. Blood pressure (BP) was recorded in over 95 per cent of patients with atrial fibrillation though there was scope for improving control; 25 per cent of men and 31 per cent women had a BP over 150/90. Inconsistent recording of ECG and echocardiography made it hard to identify patients with left ventricular dysfunction. Forty six percent of men and 37 percent of women were either being prescribed Warfarin, or had contraindications to its use; of those on Warfarin 75.9 percent have an international normalized ratio in range. Forty four per cent were treated with aspirin. People at high risk of stroke were no more likely to be treated with Warfarin or aspirin than those at moderate risk. CONCLUSIONS: The rate of use of Warfarin remains low, and there is scope for better recording and management of risk factors particularly BP.     

Mortality in patients with meticillin-resistant Staphylococcus aureus bacteraemia, England 2004-2005

A population-based study was undertaken to determine the short term risk of death in English patients diagnosed with meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia. All patients with an MRSA-positive blood culture taken in 2004 and 2005 in England identified through routine surveillance were matched to the national registry of deaths. The study found an overall case fatality (all-cause) within 7 days of MRSA-positive blood culture diagnosis of 20%, rising to 38% within 30 days. Risk of death was highest on the day subsequent to the blood specimen being drawn (4%). Seven-day case fatality rates in women were 16% higher than for men (odds ratio: 1.16; 95% confidence interval: 1.04-1.29), although no significant difference was discernable by day 30. Risk of death increased with rising age, with 28% (425/1513) of patients aged ≥85 years dying within 7 days and 57% (859/1513) within 30 days. A seasonal pattern in case fatality rates was evident, highest in the winter and lowest in the summer. The age-standardised mortality ratios within the first week were 180 and 225 times as high for men and women, respectively, as for the general population. This declined rapidly after 10 weeks to approximately 9 for both sexes. An estimated 5.53 deaths per 100,000 population followed MRSA bacteraemia in 2004 and 2005, although no inference on causality or attributable mortality could be made through this study. The stable, elevated risk of death observable after 10 weeks compared with that in the general population gave an indication of the background risk of death unrelated to MRSA infection.     

Gender differences in management after acute myocardial infarction: not 'sexism' but a reflection of age at presentation

OBJECTIVE: To test whether women receive less intensive treatment and fewer risk stratification tests following acute myocardial infarction (MI), than men. METHODS: A retrospective study of medical records in all district general hospitals and tertiary referral centres for cardiology in Wales was performed. Patients (n = 1595, of which 989 were men) admitted to hospital over 4 months with a diagnosis of acute MI had their case notes reviewed for treatment, stratification of risk factors and secondary prevention. Data were analysed for differences in treatment between men and women and whether these could be attributed to age at presentation. RESULTS: Women were older than men at presentation [mean age 75 (SD 11) versus 66 (12) years, p < 0.01]; fewer women received thrombolysis (34 versus 44 per cent) and low molecular weight heparin (63 versus 71 per cent) (both p < 0.001); and women had higher 30 day mortality (28 versus 17 per cent, p < 0.001). Fewer women received cardiac catheterization, investigations to identify high risk, drugs for secondary prevention on discharge and referral to cardiac rehabilitation. However, intensities of treatment, investigation and secondary prevention were strongly related to age and, after adjusting for age, gender differences remained only for thrombolysis and exercise testing. CONCLUSION: Although women receive fewer investigations and treatments than men, this potential gender bias can be explained by age. The lower use of treatment and investigation among older patients draws attention to the lack of direct evidence of effectiveness for these patients. Further studies are needed to confirm effectiveness of investigations and treatments in older patients.     

Women, work and coronary heart disease: prospective findings from the Framingham heart study.

This study examined the relationship of employment status and employment-related behaviors to the incidence of coronary heart disease (CHD) in women. Between 1965 and 1967, a psychosocial questionnaire was administered to 350 housewives, 387 working women (women who had been employed outside the home over one-half their adult years), and 580 men participating in the Framingham Heart Study. The respondents were 45 to 64 years of age and were followed for the development of CHD over the ensuing eight years. Regardless of employment status, women reported significantly more symptoms of emotional distress than men. Working women and men were more likely to report Type A behavior, ambitiousness, and marital disagreements than were housewives; working women experienced more job mobility than men, and more daily stress and marital dissatisfaction than housewives or men. Working women did not have significantly higher incidence rates of CHD than housewives (7.8 vs 5.4 per cent, respectively). However, CHD rates were almost twice as great among women holding clerical jobs (10.6 per cent) as compared to housewives. The most significant predictors of CHD among clerical workers were: suppressed hostility, having a nonsupportive boss, and decreased job mobility. CHD rates were higher among working women who had ever married, especially among those who had raised three or more children. Among working women, clerical workers who had children and were married to blue collar workers were a highest risk of developing CHD (21.3 per cent).     

Prevalence and management of coronary heart disease in primary care: population-based cross-sectional study using a disease register

BACKGROUND: Patients with coronary heart disease are at high risk of further coronary events. Hence, one of the main priorities in the National Service Framework for Coronary Heart Disease strategy is the identification and treatment of patients with pre-existing coronary heart disease. We aimed to determine the prevalence of established coronary heart disease in a large primary care population and to compare the management of risk factors in these patients with the standards given in the National Service Framework. METHODS: A population-based cross-sectional study was carried out using data collected from primary care. Sixty-three general practices (total list size 378,021) in four primary care groups in SW London took part. Data collection was confined to 103,613 patients over 44 years of age. We calculated age- and sex-specific and age-standardized prevalence rates, and age-adjusted relative risks for men and women. RESULTS: A total of 6,778 patients with coronary heart disease were identified (8 per cent of men and 5 per cent of women over 44 years of age). There was a history of myocardial infarction in 30 per cent (1204/3991) of men and 22 per cent (613/2787) of women (relative risk 1.57; 1.37-1.81). Coronary revascularization procedures had been performed in 27 per cent (1068/3991) of men and 11 per cent (312/2787) of women (2.02; 1.73-2.35). Most patients had been assessed for hypertension (89 per cent (3538/3991) of men; 90 per cent (2500/ 2787) of women), but in many patients blood pressure was poorly controlled (26 per cent (902/3538) of men; 27 per cent (678/2500) of women). Total cholesterol had been recently measured in 51 per cent (2018/3991) of men and 44 per cent (1218/2787) of women and was elevated in 44 per cent (881/ 2018) of men and 59 per cent (716/1218) of women (0.74; 0.69-0.79). Statins were prescribed to 49 per cent (1967/3991) of men and 38 per cent (1064/2787) of women (1.06; 1.00-1.12). Aspirin was prescribed to 65 per cent (2586/3991) of men and 59 per cent (1631/2787) of women (1.08; 1.03-1.14). Beta-blockers were prescribed to 20 per cent (181/913) of men and 15 per cent (72/499) of women with a history of myocardial infarction (1.11; 0.85-1.44). CONCLUSIONS: Most patients with coronary heart disease in primary care were being treated with aspirin but less than half with statins or beta-blockers. More men than women were treated with aspirin and statins, even though women had higher cholesterol levels than men. Men were also more likely to have a confirmed diagnosis and to have undergone a coronary revascularization procedure. There is considerable scope for improving the secondary prevention of coronary heart disease and addressing gender inequalities in primary care.     

TRENDS IN CARDIOVASCULAR RISK FACTORS IN AUSTRALIA, 1966–1983: EVIDENCE FROM PREVALENCE SURVEYS

A review of published data from cardiovascular risk factor surveys among adults in Australia from 1966 to 1983 suggests that: — prevalence of cigarette smoking decreased significantly by up to 1.4 per cent per year among men but increased among younger women; — serum cholesterol mean levels decreased significantly by 0.03 - 0.04 mmol/1 per year among men and 0.04 - 0.07 mmol/1 per year among women; — systolic blood pressure mean levels decreased significantly by 0.05 - 0.3 mmHg per year among men and 0.2 - 0.6 mmHg per year among women; — diastolic blood pressure showed no significant or consistent changes among men but some decrease among women. During the same period death rates from ischaemic heart disease (IHD) declined by over 40 per cent. The changes in risk factor levels are estimated to account for about half of the decline in IHD mortality for men and about three quarters of the decline for women.     

Establishing efficient interview periods for gonorrhea patients.

From February through December 1978, venereal disease casefinders in Polk County, Iowa used an expanded interview period of at least 120 days to interview 983 gonorrhea patients for sexual partner information. We grouped patients according to sex and clinical findings and evaluated the percentage of all new cases identified by time intervals within the expanded interview period. Ninety-one per cent of all untreated, infected sexual partners of symptomatic males were identified by using an interview period which spanned the interval from date of treatment to 15 days before symptom onset. In contrast, the traditional 30-day interview period missed 23 per cent of those untreated, infected partners named by women with pelvic inflammatory disease (PID), 34 per cent of those partners named by women with uncomplicated gonorrhea, and 29 per cent of those named by asymptomatic men. The Polk County data suggest the importance of basing interview periods upon a patient's sex and clinical presentation.     

Abdominal fat depots measured with computed tomography: effects of degree of obesity, sex, and age

Computed tomography scans at the level of L4/L5 were analysed in 66 men and 34 women who presented for routine tomography, stratified into different age categories. Areas of intra-abdominal fat and subcutaneous abdominal fat were calculated from the scans. In men and in women the proportion of the body surface as intra-abdominal fat increased with age (in men from 12.4 per cent in the age group less than 40 years to 18.0 per cent in the age group greater than 65 years; in women from 10.5 per cent to 14.7 per cent in the respective age categories). Only in men this increase with age was independent of the degree of obesity. In women younger than 40 years the proportion of intra-abdominal fat did not increase with increasing BMI while it did in older women and men. The proportion of intra-abdominal fat in 7 adolescents appeared to be 5.4 per cent, considerably lower compared to adult men and women. Subcutaneous fat areas increased with the degree of obesity but not with age. From simple anthropometric measurements, the intra-abdominal fat area was best correlated with the waist circumference in all ages (except for women younger than 40 years) while it showed weaker associations with abdominal skinfolds and circumference ratios. Age and BMI explained 68 and 74 per cent of the variance in intra-abdominal fat area in men and women respectively. Waist added 8 per cent to the explained variance in men but nothing in women. BMI and waist circumference showed similar correlations to total, intra-abdominal and subcutaneous fat areas in all age categories whereas correlations of skinfolds with intra-abdominal fat areas decreased with age.     

Alcohol consumption among men and women with tuberculosis in Tomsk, Russia

Drinking behavior among Russian women remains poorly described. We analyzed gender differences in alcohol use among 374 tuberculosis patients in Tomsk, Siberia. Twenty-six (28.3%) women had lifetime alcohol abuse or dependence, compared with 70.6% of men. Women with alcohol use disorders drank 12.7 +/- 14.0 standard drinks per day and > or = 34.6% drank 2 three days per week. Among individuals with a lifetime alcohol use disorder, age of onset and typical consumption did not differ significantly by gender. We conclude that Russian women with alcohol use disorders consume almost as much alcohol as men and may be at greater risk for negative social and medical consequences.     

Food insufficiency in Queensland

Abstract: To investigate the prevalence of food insufficiency and factors associated with it, two questions assessing household and individual food insufficiency were included in 13 regional health surveys conducted in Queensland in 1993. The surveys used computer–assisted telephone interviewing methodology. Of the 10 451 people interviewed, 9.7 per cent and 6.4 per cent reported household and individual food insufficiency, respectively, and 11.3 per cent reported at least one type. Prevalence was significantly higher in women than men and in urban than rural residents, and decreased monoton–ically with increasing age from 16.6 per cent in 18– to 30–year–olds to 1.7 per cent in over–70–year–olds. Higher prevalence also was associated with lower income, unemployment, single or separated, divorced or widowed status versus married (or de facto), one–adult households, and shared accommodation. Lower prevalence was associated with more education in those aged 50 and under but not in those over 50 years. Using logistic regression to control simultaneously for important sociodemographic factors, we found that risk of food insufficiency was most highly associated with age and income (threefold risk), unemployment and snared accommodation (twofold risk) and one–adult households, and being single versus separated, widowed or divorced (one–and–a–half–fold risk). Some differences in risks existed between men and women and between rural and urban residents, although none excluded the role of chance. Association of the items with lower reported fruit, vegetable and meat intake, poorer health status, and greater underweight supports their validity.     

Predicted and observed cardiovascular disease in South Asians: application of FINRISK, Framingham and SCORE models to Newcastle Heart Project data

BACKGROUND: South Asian populations in the United Kingdom have a high risk of cardiovascular disease (CVD) mortality. Risk prediction models appear to be inaccurate in South Asians. OBJECTIVE: To explore the predictive capacity of the FINRISK, Framingham (1991) and SCORE risk prediction models in the Newcastle Heart Project population (n = 1301). METHODS: Mortality data for England and Wales were used to define the expected ranking of CVD risk by country of birth. CVD mortality in the Newcastle Heart Project sample was examined. Risk factor measures were obtained from the Newcastle Heart Project, where 90 percent of South Asians were born in the Indian Subcontinent. The predicted outcomes for FINRISK were acute myocardial infarction and CHD mortality, for Framingham CHD mortality, myocardial infarction, new angina and coronary insufficiency and for SCORE CHD and non-CHD CVD mortality. RESULTS: The FINRISK model predicted in South Asian men combined, compared with Europeans, a risk ratio of 122 per cent (SMR 142) with substantial subgroup heterogeneity, e.g. 154 per cent in Bangladeshis (SMR 151), 129 per cent in Pakistanis (SMR 148), 99 per cent in Indians (SMR 142). The FINRISK risk ratios for South Asian women combined were 160 per cent (SMR 145), for Bangladeshis 184 per cent (SMR 91), Pakistanis 172 per cent (SMR 111) and for Indians 145 per cent (SMR 158). The Framingham model results were very similar to FINRISK, but the SCORE model showed comparatively low 10 year risk in all South Asian groups. Both the Framingham stroke model and the SCORE non-CHD CVD model predicted comparatively low rates, while national data showed these to be high. Control of the five major risk factors was modelled by FINRISK to reduce risk by about 59 per cent in South Asian men and 67 per cent in South Asian women, with some subgroup heterogeneity, compared to 50 per cent in European men and 48 per cent in European women. The Framingham model results were similar. The absolute rates for each ethnic group varied by model. CONCLUSION: The Framingham and FINRISK models gave similar results, mostly following expected patterns, but the SCORE model did not, probably reflecting its lack of inclusion of HDL and diabetes as risk factors. National mortality data and modelled predictions agreed reasonably well for South Asians combined, and Bangladeshi and Pakistani men, but not for Indian men and Pakistani and Bangladeshi women. The varying rates show the limits of modelling. The models suggest the potential gains from controlling major established risk factors could be substantial in South Asians and greater than in Europeans.     

Analysis of falling mortality rates in Edinburgh and Glasgow

BACKGROUND: The aims of the study were to describe and interpret trends in mortality in Glasgow and Edinburgh METHODS: A comparison was made between observed all-cause and cause-specific mortality rates for 1989-1993 for men and women aged 35-74 and rates predicted on the basis of modelled mortality data for residents of Glasgow and Edinburgh aged 25-74 in quinquennia based on Census years 1961, 1971 and 1981. RESULTS: All-cause mortality rates fell between 1979-1983 and 1989-1993 by a larger amount in Edinburgh than in Glasgow (24.5 versus 14.5 per cent in men; 20.4 versus 10.5 per cent in women). Differences in life expectancy between the cities at age 35 increased by 44 per cent to 4.7 years in men and by 19 per cent to 2.5 years in women. Mortality rates improved in all age and sex groups but trends were least favourable in Edinburgh men and women aged 35-44. Mortality rates in both cities fell by a larger amount than predicted, by 10 per cent in men and 6 per cent in women. CONCLUSIONS: The widening of differences in life expectancy between Glasgow and Edinburgh is mainly due to a historical trend of longevity increasing more quickly in Edinburgh. Although precise explanations are not possible, it seems likely that this difference between the cities is explained in large measure by their consistently and markedly contrasting socio-economic profiles. Comparison of the cities conceals, however, a trend of falling mortality rates in both populations, comprising most of the observed reduction in mortality rates in Glasgow, which appears to result in part from factors operating in the short term. Interpretation of trends in cause-specific mortality rates needs to take account of the possibility of long-term and short-term trends in all-cause mortality in different social groups.     

Coronary arteriography and coronary bypass survey among whites and other racial groups relative to hospital-based incidence rates for coronary artery disease: findings from NHDS.

To assess racial differences in health care utilization for coronary artery disease (CAD) the data of the National Hospital Discharge Survey (NHDS) from 1979-84 were examined. Discharge rates for acute myocardial infarction (AMI) were utilized as a measure of hospital-based incidence and relative need for the designated cardiac procedures. Although 35-74 year old Black men had discharge rates of AMI that were 77 per cent of those observed for White men, they underwent coronary arteriography half as often and were only a third as likely to have coronary artery bypass graft (CABG) surgery. Black women in this age range were hospitalized at a slightly higher rate than White women for AMI, yet experienced a 19 per cent lower rate of coronary arteriography and a 52 per cent lower rate of CABG surgery. These data suggest a racial bias in the pattern of care delivered for CAD in US hospitals at the present time.