Does cigarette smoking have an independent effect on coronary heart disease incidence in the elderly?

In order to evaluate the effects of cigarette smoking on coronary heart disease (CHD) in elderly persons in the Honolulu Heart Program, 1,394 men between ages 65 and 74 were followed during an average 12-year period for new cases of nonfatal myocardial infarction and fatal CHD. Incidence rates increased progressively in individuals classified at baseline as never, former, and current smokers, respectively. The absolute excess risk associated with cigarette smoking was nearly twice as high in elderly compared with middle-aged men.     

Do coronary heart disease risk factors measured in the elderly have the same predictive roles as in the middle aged. Comparisons of relative and attributable risks.

Risk factors for the 12-year incidence of definite coronary heart disease (CHD) among 3440 men who were middle-aged (51 to 59 years old) and 1419 men who were elderly (65 to 74 years old) at baseline examination were examined for differences in predictive values in terms of both relative risk and attributable (excess) risk of the highest versus the lowest quartile or appropriate categories. In multivariate models using Cox life-table regression procedures, serum cholesterol level, cigarette smoking, systolic blood pressure, and history of treatment for diabetes were significant predictors of incident CHD for both age groups. Alcohol consumption when modeled as drinker versus nondrinker showed a protective effect in both younger and older men. There was no dose relationship, however, among elderly drinkers. While the relative risks for the variables studied were similar between the two age groups, the excess risk was typically between 1.5 to 2.0 times higher for the older than the middle-aged men. In contrast, the detrimental effect of adiposity as measured by body mass index appeared to decline after age 65 for both measures of risk. This may partly be attributed to diminished adiposity overall in the older age group. The implications of these results are that serum cholesterol level, smoking, hypertension, diabetes, and possibly alcohol consumption continue to be important predictors for CHD when measured after age 65, and that the public health impact of these risk factors, in terms of excess risk, may be more important in the elderly.     

Pulmonary function as a predictor of coronary heart disease

The role of pulmonary function as an independent predictor of coronary heart disease was examined in 1965-1983 in a cohort of Japanese-American men. As part of the Honolulu Heart Program, the authors measured pulmonary function in 5,924 men aged 45-68 years who were free of coronary heart disease at baseline examination and followed them for 15-18 years for the development of nonfatal myocardial infarction and fatal coronary heart disease. Per cent predicted forced expiratory volume in one second (%PFEV1) was significantly inversely related to coronary heart disease incidence in the total cohort after adjusting for age (p less than 0.0001) and then for all known coronary heart disease risk factors (p = 0.0004). However, when examined by smoking status, %PFEV1 was a predictor of coronary heart disease only among past and current smokers, and not for men who had never smoked cigarettes (p = 0.36). The association between pulmonary function and coronary heart disease can be explained by cigarette smoking, which leads to both lung impairment and coronary heart disease incidence.     

How many Australian deaths from heart disease and stroke could be avoided by a small reduction in population cholesterol levels?

Aim:  To quantify the number of premature deaths from coronary heart disease and ischaemic stroke that potentially could be avoided annually among the Australian population if a sustained 10% reduction in the mean population level of low-density lipoprotein cholesterol were to be achieved.
Methods:  Data were obtained on the number of deaths from coronary heart disease and stroke in the Australian population, subdivided into age and sex strata, and on the mean population level of low-density lipoprotein cholesterol. Published relative risks (95% CI) from a meta-analysis of lipid-lowering therapy were used to calculate the reduction in the relative risk for coronary heart disease and stroke associated with a 5%, 10% and 15% reduction in low-density lipoprotein cholesterol. The expected number of deaths from coronary heart disease and ischaemic stroke avoidable with a 10% reduction in low-density lipoprotein cholesterol was modelled. Secondary analyses were performed assuming reductions in low-density lipoprotein cholesterol of 5% and 15%.
Results:  A 10% reduction in low-density lipoprotein cholesterol would prevent 2279 deaths from coronary heart disease (95% CI: 2025–2531 deaths) and 641 deaths from ischaemic stroke (95% CI: 440–881 deaths). The projected benefits are greatest among the elderly, although some benefit would be expected in all age and sex groups and among individuals with a broad range of baseline levels of low-density lipoprotein cholesterol.
Conclusions:  A small leftward shift in the low-density lipoprotein cholesterol distribution of the adult Australian population has the potential to save about 3000 lives from coronary heart disease and stroke annually. Achieving this goal will require the active participation of key public health, food industry and government stakeholders.     

Demographics of the prevalence, incidence, and management of coronary heart disease in the elderly and in women.

Cardiovascular disease constitutes an expanding problem in the elderly because of the increasing size of the aged population. Atherosclerosis, hypertension, and diabetes are responsible for the predonderance of cardiovascular disease, which causes 70% of all deaths beyond age 75. Coronary heart disease (CHD) is the most common and most lethal cardiovascular event in both sexes, exacting a large toll in disability and deteriorated quality of life in old age. Unrecognized myocardial infarctions are especially common and are as serious as symptomatic infarctions. beyond age 65, women are as vulnerable to cardiovascular death as men. The predisposing modifiable risk factors for coronary disease, stroke, peripheral arterial disease, and cardiac failure are similar in young and old and in men and women. These include hypertension, dyslipidemia, impaired glucose tolerance, physical indolence, and cigarette smoking. An attenuated risk ratio for some risk factors is offset by a greater incidence of cardiovascular events in advanced age so that the attributable risk and the potential benefit of treatment rise with age. Because the major risk factors predict CHD as efficiently in the elderly as in the young, and the decline in cardiovascular mortality has included the elderly, preventive efforts in the elderly may have substantial potential benefit. At advanced age, total cholesterol levels are considerably higher in women than in men. Some 10 million elderly, two-thirds of whom are women, may require investigation and treatment for elevated lipid levels, as determined by National Heart, Lung, and Blood Institute (NHLBI) guidelines. Because of the preponderance of women in the elderly population, trials of the efficacy of correcting risk factors in general, and lipids in particular, should include women.     

Coronary heart disease risk factors and attributable risks in African-American women and men: NHANES I epidemiologic follow-up study.

OBJECTIVES: This study assessed associations of risk factors with coronary heart disease incidence in African Americans. METHODS: The participants in the NHANES I Epidemiologic Follow-Up Study included in this analysis were 1641 Black and 9660 White persons who were aged 25 to 74 years when examined and who did not have a history of coronary heart disease. Average follow-up for survivors was 19 years. RESULTS: Significant, independent risk factors for coronary heart disease were age, systolic blood pressure, and smoking in Black women and age, systolic blood pressure, serum cholesterol, low education, and low family income in Black men. In this cohort, 19% of incident coronary heart disease in Black women and 34% in Black men might be prevented if systolic blood pressure were below 140 mm Hg. In Black men, attributable risk for low education (46%) was even higher than that for elevated blood pressure. CONCLUSIONS: Elevated systolic blood pressure and smoking were predictive of coronary heart disease incidence in African Americans. Estimates of population attributable risk were highest for elevated systolic blood pressure in women and education less than high school in men. Further studies of serum lipids, education, and coronary heart disease in Black women are needed.     

Evidence based secondary prevention of coronary artery disease in the elderly--2006

Eighty percent of coronary deaths occur in people above 65 years of age. Fifty percent of deaths in persons above 85 years of age is due to coronary artery disease. The overall aging of the population and the improvement in survival of patients with coronary artery disease has been creating a growing large population of elderly adults who are elegible for secondary prevention. Multiple clinical trials and research trials have revealed evidence based information confirming the usefulness and effectiveness of secondary prevention of coronary artery disease in the elderly patient. The secondary prevention beneficial results have been obtained by addressing and controlling the predisposing items recognized a coronary risk factors. Secondary preventive measures, including lifestyle modifications and pharmacotherapy, modifying risk factors in elderly patients, have been shown to reduce morbidity and mortality from coronary artery disease. Evidence based data on prevention in elderly patients with coronary artery disease concerning smoking cessation, treatment of hypertension, control of hyperlipidemia, improved dietary patterns, physical activity, moderation in alcohol intake, management of diabetes, weight management, use of antiplatelet agents, beta blockers and renin-angiotensin-andosterone blockers is summarized. Emphasis has been given to AHA/ACC consensus statements on the prevention of coronary artery disease.     

Projecting coronary heart disease incidence and cost in Australia: results from the incidence module of the Cardiovascular Disease Policy Model

OBJECTIVE: To project the incidence rates of coronary heart disease and the number of hospitalised incident coronary heart disease cases and hospital costs associated with the first hospital admission, for males and females aged 45-69, up to 2014 in Australia. METHOD: A computer simulation model using a microsimulation technique was developed to simulate individuals' coronary heart disease history over time for a sampled Australian population characterised by major coronary risk factors. Using the simulated incidence rates, population and hospital cost data, the number of hospitalised incident coronary heart disease events and hospital costs associated with the first hospital admission were projected. RESULTS AND CONCLUSIONS: If current cohort-specific coronary risk factor distributions change only by a location shift and the availability and efficacy of current treatment patterns prevail, the model projects declines of 13% and 24% in incidence rates for males and females aged 45-69 respectively by 2014. However, because the population aged 45-69 is projected to increase over the same period, the number of projected hospitalised coronary heart disease events and the hospital costs associated with the first admission will increase by more than 40%. IMPLICATIONS: A modeling strategy which integrates information on coronary risk factor distributions, epidemiologic, demographic and economic data can provide comprehensive projections that assist future health care planning in the area of coronary heart disease.     

Primary prevention remains expensive, notwithstanding the consensus on lowering serum cholesterol levels]

Recently guidelines for cholesterol lowering therapy by means of 'statines' (HMG-CoA reductase inhibitors) were published by the National Organization of Quality Assurance in Hospitals. The part about primary prevention of cardiovascular disease is based on absolute risks for coronary heart disease as calculated by the Framingham Heart Study risk functions and on a cost-effectiveness analysis. However, the function predicts risk of disease such as silent infarction and angina pectoris. The incidence thus produced is higher than any observed clinical incidence. Absolute risk increases exponentially with age, but remaining life expectancy, and thus benefit, decreases. Therefore, decisions about treatment levels are based on arbitrary assumptions. The function is ultimately only used to advise treatment to the smoker, while the better choice is always to stop smoking. The effectiveness is overestimated by using a long time horizon of treatment of 25 years in the cost-effectiveness analysis. Primary prevention of coronary heart disease according to the new guidelines is still very expensive.     

老年高血压患者危险因素分析及干预对策

目的 探讨影响老年高血压患者的危险因素以及干预的对策.方法 共纳入85例老年高血压患者,同时从门诊随机抽取140例无高血压病史的老年人群作为对照组.详细记录所以受试者的基本信息、高血压患病情况及相关影响因素.应用非条件Logistic回归分析进行多因素分析.结果 单因素分析结果表明:两组间男性、冠心病病史、糖尿病史、吸烟史、入院首次SBP、家族高血压病史、饮酒史、LDL-C及HDL-C比较差异有统计学意义;其中冠心病病史、糖尿病史、吸烟史、入院首次SBP、家族高血压病史、饮酒史、LDL与老年高血压发生呈正相关;HDL-C与老年高血压的发生呈负相关(P＜0.05).进一步行多因素分析结果表明:糖尿病史、吸烟史、高血压家族史是老年高血压病患者发生的独立危险因素;而HDL-C是老年高血压病患者发生的保护因素.结论 糖尿病史、吸烟史、高血压家族史是老年高血压病患者发生的独立危险因素;而HDL-C是老年高血压病患者发生的保护因素,应该大力提倡全民健身,同时戒烟限酒,对有上述危险因素的老年人群进行必要的干预,可明显降低高血压的发生率.     

基于加权延迟效应的某农村地区气温与冠心病关联性

  目的  探讨气温指标与冠心病发病的关联，为冠心病的防治提供参考。  方法  利用2010-2016年庆阳农村地区冠心病及气象数据，在考虑气象因素对冠心病发病的短期相关性和滞后效应基础上，构建加权指标估计延迟效应分布，采用广义相加模型分性别、年龄段探讨加权气温指标与冠心病发病的关联。  结果  庆阳农村地区各气温指标对65岁以上男性人群冠心病发病影响均具有统计学意义(均有P < 0.05)，加权24 h变温的效应最大，加权24 h变温每增加1℃，发病风险增大8.775%(95%CI:4.630%~13.084%)；各人群冠心病发病对加权24 h变温均敏感(均有P < 0.05)，且在65岁以上男性、65岁以下男性、65岁以上女性和65岁以下女性四个人群中，其效应值依次递减；加权最高气温和加权气温日较差仅在65岁以上人群中有效应，且男性人群效应高于女性。  结论  温度变化对冠心病发病影响最大，无论是骤冷或是骤热，均会增加冠心病发病风险。65岁以上男性人群冠心病发病对气温变化更敏感，且冠心病人次与气温指标有明显的短期相关性。     

沈飞地区职工急性冠心病事件的流行病学研究

目的了解沈飞地区2574岁人群1992-2003年急性冠心病事件发病率的分布特点及变化趋势，及可能的影响因素。方法依照北京MONICA研究中心的研究方案，1992-2003年在沈飞地区对2574岁近3万人群开展了心血管病危险因素及发病、死亡的监测工作。以沈飞地区资料为依据，按年度、性别、年龄分别计算急性冠心病事件发病率的变化趋势。结果1992-2003年沈飞地区急性冠心病事件发病率呈轻度上升变化，有统计学意义。男性合计发病率为128．5／10万，大于女性51．4／10万：其差别有统计学意义（P〈0．01）。研究初期与研究末期相比，男性6574岁组每10万人群发病率的绝对增加幅度最大，差率为307．8／10万，男性5564岁组发病率相对增加幅度最大，差率为211％，均有统计学意义。医疗救助率为73．6％，高于北京市平均水平。发病集中在冬、春季，占总发病人数的58％。结论中关村地区中老年男性急性冠心病事件发病率呈显上升，应加强这一人群冠心病防治工作。     

Nutrition and diseases of women: cardiovascular disorders.

Studies of prevention, diagnosis, and intervention for coronary heart disease and hypertension have either been conducted largely in men, or gender differences have not always been fully sought. This has added to a general perception that coronary artery disease is basically a male affliction despite the fact that coronary artery disease is the leading cause of death among women, especially elderly women. Many risk factors among women are similar to men, i.e., high blood pressure (BP), elevated serum cholesterol levels, and cigarette smoking; however, women compared to men have greater incidence of diabetes mellitus, congestive heart failure, and hypertension as they become older. The risk of cardiovascular disorders can be reduced by postmenopausal estrogen replacement, exercising sufficiently, and ceasing smoking. In addition, good nutrition, taking into consideration the proper amount and forms of calories, sodium, potassium, calcium, magnesium, and macronutrients to maintain an ideal lipid profile and BP, is helpful in preventing cardiovascular perturbations.     

Is weight loss a modifier of the cholesterol-heart disease relationship in older persons? Data from the NHANES I Epidemiologic Follow-up Study.

The relationship between cholesterol and 14-year incidence of coronary heart disease was compared for men and women of two age groups, 25 to 64 years and 65 to 74 years. While cholesterol levels of 6.2 mmol/L or higher were associated with a risk of coronary heart disease in the younger group, this was not true for either men or women aged 65 to 74. Further analyses for older persons showed that weight loss modified the cholesterol-heart disease relationship. Those with stable weight showed a positive relationship between cholesterol and coronary heart disease, similar to the younger age group (relative risk [RR] = 1.8 [95% confidence interval: 1.1, 2.9] for men; RR = 1.6 [.7, 3.4] for women). Among those with a weight loss of 10% or more, the relationship of cholesterol to heart disease was inverse (RR = .8 [.5, 1.2] for men; RR = .6 [.3, 1.0] for women). These data suggest that the relationship of cholesterol to coronary disease in healthier older persons may be similar to that in younger persons, and that health status should be considered in analyses of cholesterol risk in old age.     

上海市社区中老年居民慢性病患病调查

目的了解上海市长宁区社区中老年居民慢性病患病情况和分布特征。方法采用横断面现况调查,研究对象为上海市长宁区某街道40～74岁男性和40～70岁女性,分别于2003年和1998年完成了6 488名男性和8 511名女性的健康调查,根据上海市人口普查资料的年龄构成计算慢性病标化患病率,并采用χ2检验比较不同特征人群的慢性病患病率差异。结果男、女性慢性病中高血压患病率最高,标化患病率分别为28.0%、22.6%;分别有40.9%男性和36.5%女性患有高血压、冠心病、糖尿病、慢性阻塞性肺病和脑卒中5种主要慢性病中的一种;体质指数(BMI)≥24者,高血压和冠心病的患病率较高;经常吸烟、饮酒的男性,脑卒中、高血压和慢性阻塞性肺病的患病率较高,而吸烟、饮酒对女性慢性病的影响较小。结论不同特征人群慢性病患病率有一定差异,控制肥胖和戒烟是重要的干预措施。     

Does occupational social class predict coronary heart disease after retirement? A 12-year follow-up study in Sweden

AIMS: To examine whether socioeconomic status and coronary heart disease (CHD) risk factors remain significant predictors of CHD among people aged >or=65 years. Previous studies in this age group are few and inconsistent. METHODS: Follow-up study of a simple random sample of Swedish women and men aged >or=65 years interviewed in a national survey 1988-89 and followed up until 31 December 2000, for CHD incidence rates. Cox regression was used to study the association between socioeconomic status (occupation) and CHD, after adjustment for age, sex, physical activity, smoking, BMI, diabetes, and hypertension. Participants with CHD hospitalization two years before the start of the study and those who rated their general health as poor were excluded. RESULTS: Among manual workers and lower-level employees the risk of CHD was significantly higher than among middle-level employees and professionals (49% and 50%, respectively), after adjustment for age and sex. The association between low socioeconomic status and increased CHD risk disappeared after adjustment for the CHD risk factors, which were more prevalent among those with low socioeconomic status. All the CHD risk factors (with the exception of BMI) were associated with increased CHD incidence rates. CONCLUSIONS: Low socioeconomic status remains a significant predictor of CHD among people aged >or=65 years. Healthcare policies among elderly patients should encourage physical activity and smoking cessation in all socioeconomic groups.     

老年高血压合并高脂血症并发缺血性心脏病的高危因素探讨

目的 探讨老年高血压合并高脂血症并发缺血性心脏病的高危因素.方法 选取2009年2月～2011年2月入住某院的老年高血压患者96例,其中并发高脂血症的54例患者为观察组,未并发高脂血症的的42例患者对照组.观察患者年龄、家族史、吸烟史、饮食控制情况、糖尿病史、高血压病史时间、甘油三酯水平、总胆固醇水平、血尿酸水平、血清超敏c反应蛋白水平、心电图、冠状动脉造影等.结果 观察组患者缺血性心脏病发生率明显高于对照组(x2=4.22,P＜0.05)；多因素Logistic回归分析发现老年高血压合并高脂血症患者并发缺血性心脏病的危险性与年龄、吸烟、高甘油三酯血症、高胆固醇血症、高水平超敏c反应蛋白、高尿酸血症有关.结论 年龄、吸烟、高甘油三酯血症、高胆固醇血症、高水平超敏c反应蛋白、高尿酸血症是老年高血压合并高脂血症患者并发缺血性心脏病的高危因素.     

The cost of preventing coronary heart disease

The incidence of coronary heart disease (CHD) can be reduced by preventive measures. We know what it costs to treat CHD, but lack even the most rudimentary estimates of what it might cost to reduce the incidence by means of population wide strategies of prevention. American and Australian experience shows that such strategies achieve results. Even in Britain, where official spending on prevention is relatively small, health publicity has succeeded in bringing about marked reductions in the household consumption of animal fats and in cigarette smoking. Yet we know virtually nothing about the cost of bringing about a given reduction in CHD mortality by preventive measures. Estimates of such costs would be useful in persuading public authorities to spend more on prevention.     

A simulation of the effects of youth initiation policies on overall cigarette use

OBJECTIVES: We developed a simulation model to predict the effects of policies aimed at reducing smoking initiation by youths younger than 18 years. METHODS: The model projected the number of smokers, never smokers, and ex-smokers by age, sex, and racial/ethnic group and the effects of reductions in youth initiation. RESULTS: The model predicted that even if tobacco policies eliminated youth initiation, the number of smokers would not be halved for more than 30 years. If initiation were halved and some of the initiation were delayed rather than eliminated, substantially smaller reductions would result. CONCLUSIONS: Policies that increase cessation rates are needed to reduce the number of current smokers and the more near-term health problems.     

Preventing heart disease: is treating the high risk sufficient?

Monte Carlo simulation was used to assess the effects of several intervention strategies on coronary heart disease mortality rates in a Finnish and a North American cohort. Lowering total serum cholesterol by 4%, smoking by 15%, and diastolic blood pressure by 3% for the whole cohort would be expected to reduce the incidence of non-fatal myocardial infarction by at least 13% and coronary heart disease deaths by at least 18%. Lowering serum cholesterol by 34%, diastolic blood pressure to 90 mmHg, and reducing smoking by 20% in the subset of the population with all three risk factors in the highest quartile would result in a 6-8% reduction in non-fatal myocardial infarction and a 2-9% reduction in deaths from coronary heart disease in these cohorts. These data demonstrate that in populations with a relatively high incidence of heart disease, treating the entire population will produce larger effects than focusing only on high-risk populations.