Interstate differences in trends in coronary mortality and risk factors in Australia

Mortality from coronary heart disease has declined by approximately 50% in Australia over the past 20 years and now accounts for approximately 25% of all deaths. Most of the decline in mortality from all causes in each State of Australia over the period 1972-1988 is due to the decline in mortality from coronary heart disease. In Tasmania, the rate of decline in mortality from all causes is significantly less in both sexes (P less than 0.01) than in the mainland States, and the discrepancy is due to a lesser decline in mortality from coronary heart disease (P less than 0.01). Trends in deaths related to hypertension show no differences between Tasmania and the other States, which suggests that the discrepancy with coronary heart disease is due to factors other than the prevalence and/or treatment of hypertension. Analysis of trends data on cigarette smoking prevalence, and cross-sectional data on plasma cholesterol levels and diet, shows that Tasmanian differences in food intake (including fat and cholesterol), in plasma cholesterol levels and (to a lesser extent) in cigarette smoking are consistent with, but are unlikely to explain completely, the slower rate of decline in mortality from coronary heart disease.     

Coronary risk factor prevalence in a high incidence area: results from the Belfast MONICA Project.

Northern Ireland remains at the top of the world mortality league for ischaemic heart disease. The Province is providing a centre for the World Health Organisation's MONICA Project. Registration of coronary heart disease events began in 1983 and the first of three population surveys took place in 1983-4. A total of 2,361 men and women aged 25-64 years was screened. Subjects were shorter and heavier than their fellow citizens in Great Britain. The estimated mean cholesterol levels in the 25-64-year-old population (5.80 mmol/l in males and 5.85 mmol/l in females) were similar to those reported from Great Britain. Although mean systolic blood pressures were lower, mild diastolic hypertension was considerably more common; cigarette smoking levels were similar. The results were consistent with those expected for an area with a high coronary heart disease mortality, with more than 80% of subjects being at increased risk in terms of the three major factors (cigarette smoking, hypertension and raised cholesterol). Public concern about coronary heart disease has grown and recently the Department of Health and Social Services (NI) has launched a 10-year prevention programme which will primarily employ a population approach.     

Change in physician perspective on cholesterol and heart disease. Results from two national surveys

The National Heart, Lung, and Blood Institute sponsored national telephone surveys of practicing physicians in 1983 (N = 1610) and 1986 (N = 1277) to assess attitudes and practices regarding elevated serum cholesterol levels. The 1983 survey was conducted just before the release of the results of the Lipid Research Clinics Coronary Primary Prevention Trial, which showed that a reduction in the blood cholesterol level reduced coronary heart disease. In 1986, 64% of physicians thought that reducing high blood cholesterol levels would have a large effect on heart disease, up considerably from 39% in 1983. Whereas in 1983, physicians attributed considerably less preventive value to reducing the cholesterol level than to reducing blood pressure or smoking, this disparity was substantially smaller in 1986. The median range of blood cholesterol at which diet therapy was initiated was 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1986, down from 6.72 to 7.21 mmol/L (260 to 279 mg/dL) in 1983; the median for drug therapy was 7.76 to 8.25 mmol/L. (300 to 319 mg/dL) in 1986 and 8.79 to 9.28 mmol/L (340 to 359 mg/dL) in 1983. In 1986, 87% of physicians surveyed felt that medical evidence warranted the recommended treatment levels set forth in the 1984 National Institutes of Health Consensus Conference on Lowering Blood Cholesterol. These changes indicate that by 1986, physicians were more convinced of the benefit of lowering high blood cholesterol levels and were treating patients accordingly. The data also suggest areas for continued educational initiatives.     

Change in risk factors for coronary heart disease during 10 years of a community intervention programme (North Karelia project)

A comprehensive community based programme to control cardiovascular diseases was started in North Karelia, Finland, in 1972. Reductions in smoking, serum cholesterol concentrations, and blood pressure were among the central intermediate objectives. The effect of the programme during the 10 year period 1972-82 was evaluated by examining independent random population samples at the outset (1972) and five (1977) and 10 (1982) years later both in the programme and in a matched reference area. Over 10 000 subjects were studied in 1972 and 1977 (participation rate about 90%) and roughly 8000 subjects in 1982 (participation rate about 80%). Analyses were conducted of the estimated effect of the programme on the risk factor population means by comparing the baseline and five year and 10 year follow up results in the age range 30-59 years. The effect of the programme (net reduction in North Karelia) at 10 years among the middle aged male population was estimated to be a 28% reduction in smoking (p less than 0.001), a 3% reduction in mean serum cholesterol concentration (p less than 0.001), a 3% fall in mean systolic blood pressure (p less than 0.001), and a 1% fall in mean diastolic blood pressure (p less than 0.05). Among the female population the reductions were respectively, 14% (NS), 1% (NS), 5% (p less than 0.001), and 2% (p less than 0.05). During the first five years of the project (1972-7) the programme effectively reduced the population mean values of the major coronary risk factors. At 10 years the effects had persisted for serum cholesterol concentrations and blood pressure and were increased for smoking.     

Change in public perspective on cholesterol and heart disease. Results from two national surveys

The National Heart, Lung and Blood Institute, Bethesda, Md, and the Food and Drug Administration, Washington, DC, sponsored two national probability telephone surveys (N = 4000) of adults to assess attitudes and knowledge about heart disease risk from high blood cholesterol levels and the public's efforts to lower blood cholesterol levels. The first survey was conducted in 1983, before release of the results from the Lipid Research Clinics Coronary Primary Prevention Trial, which showed that a reduction in the blood cholesterol level reduced coronary heart disease; the second survey was conducted in 1986. The percentage of adults who believed that reducing high blood cholesterol levels would have a large effect on heart disease increased from 64% in 1983 to 72% in 1986, so that the importance attached to reducing high blood cholesterol levels approached that attributed to reducing smoking and high blood pressure. In 1983, 35% of adults reported that they had their cholesterol level checked vs 46% in 1986. In both years, diet changes were most frequently chosen (greater than 60%) as ways to control the blood cholesterol level; reducing dietary fat was believed to be as important as reducing dietary cholesterol. By 1986, 23% of adults reported that they made dietary changes specifically to lower their blood cholesterol level, up from 14% in 1983. These comparative data show gains in public awareness and action relating to high blood cholesterol level risk. The data can be used to develop education programs.     

糖调节受损人群下肢血管病变患病率及相关因素分析

目的:探讨糖调节受损(IGR)人群下肢血管病变(PVD)的患病率及相关影响因素。方法:以681例IGR人群为研究对象,收集相关临床资料、体格检查、生化检查结果及多普勒超声血流仪测定踝臂指数(ABI),以ABI≤0.9诊断有PVD,分为PVD组和非PVD组,并对两组进行分析。结果:681例IGR人群中检出ABI≤0.9者49例,患病率为7.2%。两组年龄、收缩压、低密度脂蛋白胆固醇、甘油三酯、空腹胰岛素、胰岛素抵抗指数、吸烟率比较差异均有统计学意义(P<0.05),Logistic回归分析发现,年龄、收缩压、低密度脂蛋白胆固醇是糖调节受损下肢血管病变的独立危险因素。结论:下肢血管病变在糖尿病前期IGR阶段已发生,且发生率较高,增龄、吸烟、高血压、血脂紊乱及胰岛素抵抗是下肢血管病变的重要危险因素。     

上海县心血管病监测区人群危险因素水平的变化

参照世界卫生组织(WHO)心血管病人群监测方案,于1983年和1986年秋季,在上海县监测区进行两次心血管病危险因素的抽样调查,结果显示三个主要危险因素——高血压、高血脂和吸烟的水平均有明显的下降,其差异在统计学上有非常显著的意义,提示与监测区内同时进行心血管病的防治和人们生活习惯的改变有关。     

Psychotropic drugs in Australia: consumption patterns

This paper reviews studies of psychotropic drug use in Australia, analyses results from the Australian Health Surveys and compares the findings with those from other countries. It identifies subpopulations with high rates of drug use, which may consequently be at greater risk of drug-related harm. The levels of consumption of psychotropic agents in Australia were estimated from the results of studies conducted in community and institutional settings between 1970 and 1986. In the absence of more recent data national prevalence rates were derived from analysis of data provided by the Australian Health Surveys (AHS) of 1977-1978 and 1983-1984, and comparisons were made with rates available from other countries. While the prevalence of current and frequent use of drugs for nervous conditions was found to have decreased in most age groups over this period, it was consistently higher in females than in males, and increased with age. An analysis of the 1983-1984 AHS data revealed that the consumption of "medicines for nervous conditions" fell by 35% but that no change occurred in the prevalence of persons taking sleeping medicines. This fall appeared to occur in both rural and urban populations. Further analysis of data relating to the consumption of hypnotic agents revealed that changes occurred in the patterns of use within age and gender subgroups. Significant differences were observed between Australian States in consumption rates of sleeping medicines (chi 2 = 282.2; df = 7; P less than 0.01) and of medicines for nervous conditions (chi 2 = 289.7; df = 7; P less than 0.01). There were high rates of use of medicines for sleep in South Australia and of medicines for nervous conditions in Queensland. The prevalence of use of both drugs for sleep (rs = 0.71; P less than 0.05) and drugs for nervous conditions (rs = 0.77; P less than 0.05) was related to the rate of consultations with doctors. Preliminary surveys of various non-British subpopulations including Aborigines were inconclusive. These results have implications for reducing the harm associated with the use of psychotropic agents, particularly hypnotics and drugs for nervous conditions, in Australia.     

Labetalol: potent antihypertensive agent that blocks both alpha- and beta-adrenergic receptors.

Labetalol was administered as the sole antihypertensive agent to 20 ambulatory patients with mild to moderate hypertension. The mean systolic and diastolic blood pressures (+/- standard error of the mean) with the patients sitting fell significantly (P < 0.001), from 145.5 +/- 3.2 and 103.7 +/- 1.6 mm Hg respectively at the start of labetalol therapy (after a period free of antihypertensive medication) to 125.7 +/- 2.0 and 87.2 +/- 1.1 mm Hg by the end of the trial. The diastolic blood pressure was well controlled (90 mm Hg or less) with labetalol therapy in 90% of the patients. The medication was well tolerated, and no orthostatic fall in the diastolic blood pressure was observed. Pharmacologically labetalol most closely resembles a combination of a nonselective beta-adrenergic blocker like propranolol and a postsynaptic alpha-adrenergic blocker like prazosin.     

冠心病血管重建术后危险因素的控制情况分析

目的了解冠心病患者接受经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）术后危险因素的控制情况,分析其与循证医学指南的差距.方法选择药物洗脱支架对血管重建影响的研究DESIRE单中心注册中出院后随访时间在30 d以上的所有患者,分析其入院时与随访时吸烟、体重、血压、血糖、血脂等危险因素指标的变化.结果在DESIRE注册的3763例患者中,共有3017例患者接受30 d以上的随访（随访率80.2%）,中位数随访时间为670（35～1930） d.入院时与随访时的吸烟率分别为43.5%（937/2156）和9.5%（276/2915,P《0.000 1）,入院时有吸烟的患者随访时的吸烟率仍高达18.5%（170/917）,入院时无吸烟的患者随访时的吸烟率为6.1%（71/1168）.24.3%（264/1087）的超重或肥胖患者随访时的体重高于入院时的体重.48.3%（143/296）的糖尿病患者随访时的平均空腹血糖水平高于入院时的血糖水平.在合并高血压的患者中,有33.1%（469/1419）和31.9%（453/1419）的患者在随访中收缩压与舒张压高于入院时的水平.与入院时相比,随访中有36.4%（111/184）的患者高密度脂蛋白胆固醇降低,54.1%（98/181）和56.8%（121/213）的患者低密度脂蛋白胆固醇与甘油三酯升高.结论冠心病患者血管重建术后危险因素控制还远不理想.应尽快加强冠心病血管重建术后的二级预防干预与宣传教育,努力缩小循证指南与临床实践的差距.     

Blood pressure in a national birth cohort at the age of 36 related to social and familial factors, smoking, and body mass

Blood pressure was measured in a birth cohort of 5362 subjects at the age of 36. The prevalence of hypertension in men (blood pressure greater than 140/90 mm Hg) was almost twice that in women, although women received treatment more often. Deaths of fathers of subjects from hypertensive and ischaemic heart disease were associated with significantly higher mean systolic and diastolic pressures in both sexes. Cigarette smoking was not strongly associated with blood pressure in men and not associated at all in women. Of the social factors, low social class of family of origin was associated with high blood pressure in both sexes; but the strongest association was with current body mass, and birth weight also contributed. Differences in blood pressures between the sexes may have been related to protective biological factors, such as endogenous sex hormones, in women and also to differences in types of employment, smoking habits, and body mass. Differences in blood pressures related to the social class of family of origin may reflect long term influences of class differences on diet, exercise, and educational achievement. The importance of measuring secular trends in obesity and blood pressures is emphasised.     

Trends in mortality, morbidity, and risk factor levels for stroke from 1960 through 1990. The Minnesota Heart Survey.

OBJECTIVE--The Minnesota Heart Survey is a population-based study designed to monitor and explain trends in cardiovascular mortality, morbidity, and risk factors. DESIGN--Surveillance time-trends study. METHODS--The following trends were examined among men and women aged 25 to 74 years living in Minneapolis-St Paul, Minn: (1) stroke mortality from 1960 through 1990; (2) risk factors in population-based surveys conducted in 1973 through 1974, 1980 through 1982, and 1985 through 1987; and (3) morbidity in a 50% sample of hospitalized discharges for acute-stroke in 1970, 1980, and 1985. RESULTS--Stroke mortality in Minneapolis-St Paul declined slowly from 1960 through 1972 (average fall, 2.4% per year), dropped sharply from 1972 through 1984 (average fall, 6.5% per year), but exhibited little change thereafter (average fall, 1.5% per year). The average level of cardiovascular disease risk factors fell from 1973-1974 to 1985-1987, with the exception of body mass index. In particular, hypertension diagnosis, treatment, and control levels improved substantially between 1973-1974 and 1980-1982, although there was little improvement after 1980-1982. While discharge rates for hospital-coded acute stroke declined substantially between 1970 and 1985 in both sexes, no clear trend was observed in definite stroke rates as validated using standard clinical criteria. Twenty-eight-day case fatality rates of definite stroke improved significantly from 1970 to 1985. CONCLUSIONS--The substantial decline in stroke mortality of more than 50% from 1960 through 1990 appears to have been attributable to both primary and secondary prevention. These data suggest that the long decline in stroke mortality and morbidity in Minneapolis-St Paul has plateaued, although improved detection of stroke with computed tomography prevents an unequivocal conclusion.     

Obesity: A public health problem in Ireland?

We examined the prevalence of different categories of body weight in a random sample of men and women aged 35 to 64 years studied in 1985 in County Kilkenny, Ireland. The largest group was those classified as overweight — 51.1% of men and 44.7 % of women. There were 13.7 % of men and 19.2% of women in the obese category. The obese were older but the distribution by social class did not differ significantly from the non-obese. Obese women had significantly more children born alive and a higher prevalence of positive angina questionnaire than those who were not obese. Serum total cholesterol was higher in obese men and HDL cholesterol was lower in obese men and obese women. Systolic and diastolic blood pressures were significantly higher in obese men and women but smoking status was similar. In a multiple logistic regression analysis, systolic blood pressure in men and diastolic in women remained significantly associated with obesity; there was an inverse association between obesity and HDL cholesterol in women and between obesity and HDL-cholesterol as a proportion of total cholesterol in men.     

Effect of intravenous infusion of insulin in diabetics with acute myocardial infarction

Diabetes mellitus is associated with a high mortality after myocardial infarction. To see whether this may be decreased by improved diabetic control the effect of an insulin infusion regimen was studied in patients with acute myocardial infarction. From April 1982 to April 1983, 33 diabetics were admitted with acute myocardial infarction. Those being treated with diet alone or oral hypoglycaemic drugs continued with this unless control was poor, when they were changed to a "sliding scale" regimen of subcutaneous insulin injections thrice daily. Those already receiving insulin were maintained on thrice daily subcutaneous injections. From April 1983 to April 1984, 29 diabetics had acute myocardial infarction. Those receiving treatment with oral hypoglycaemic drugs or insulin were changed to continuous intravenous infusion of insulin, the aim being to maintain the blood glucose concentration at 4-7 mmol/I (72-126 mg/100 ml). Those being treated with diet alone continued with this if blood glucose concentrations were acceptable. Total mortality fell from 42% in the first year to 17% in the second (p less than 0.05). Over the same period mortality among non-diabetic patients with myocardial infarction did not change significantly. There was a significant fall in cardiac arrhythmias (expressed as the percentage of patients in whom arrhythmias were recorded) from 42% to 17% (p less than 0.05). The most significant fall in the incidence of complications occurred in those who had been receiving oral hypoglycaemic drugs on entry to the study (87% to 50%, p less than 0.05).     

Lipids and lipoproteins in patients undergoing coronary-artery surgery

Fasting blood samples were obtained from 290 patients who were undergoing elective coronary-artery graft procedures, and cholesterol, triglyceride and high-density lipoprotein cholesterol levels were measured. The 1983 National Heart Foundation of Australia's Risk Factor Prevalence Study was used as a source of age- and sex-matched "control" data. Of these patients, 80% had cholesterol levels of greater than 5.5 mmol/L; in 55% of patients, the level exceeded 6.5 mmol/L. Only 4% of patients who received a graft showed hypertriglyceridaemia alone (triglyceride level, greater than 2 mmol/L). Combined hyperlipidaemia (cholesterol level, greater than 5.5 mmol/L and triglyceride level, greater than 2.0 mmol/L) was present in 52% of subjects. Low-density lipoprotein cholesterol levels exceeded 3.5 mmol/L in 69% of men and in 71% of women. In terms of five 10-year age intervals, mean plasma triglyceride and cholesterol levels were elevated significantly in patients who had undergone a coronary-artery grafting procedure compared with those of subjects in the National Heart Foundation study. The mean high-density lipoprotein cholesterol levels were markedly-lower compared with those of the subjects in the National Heart Foundation study. Of those patients whose plasma cholesterol levels were less than 5.5 mmol/L, 97% of patients had high-density lipoprotein cholesterol levels that were less than the mean level for subjects in the National Heart Foundation study. Thus, a very-high proportion of patients who underwent coronary-artery bypass surgery had lipid abnormalities which required intervention postoperatively.     

Measures of tobacco smoking in Australia 1974-1986 by means of a standard method

Trends in smoking among Australian adults as based upon surveys with a standard method in 1974, 1976, 1980, 1983 and 1986 are presented. The percentage of male cigarette smokers fell from 42.2% in 1974 to 31.9% in 1986 and the percentage of female smokers was 29.5% in 1974 and 28.8% in 1986. Over the period of observation, the percentage of past smokers of both sexes climbed steadily and, in 1986, reached 28.1% of men and 16.8% of women.     

“沙漠人” 的生理特征及其与高血压低发病率的相关性

目的探讨塔克拉玛干“沙漠人”的生理特征及其与高血压低发病率的关系。方法所有资料都是通过现场问卷调查和体格检查获得。被调查人群共469人,其中“沙漠人”359人,男性205人,女性154人,年龄15~99岁。于田县维吾尔族101人,男性55人,女性50人,作为对照人群,年龄20~85岁。数据处理采用SAS 9.1.3统计分析软件,组间比较用t检验。结果（1）结果表明,“沙漠人”男性、女性身高都明显高于对照组,P值分别为0.0317和〈0.0001.“沙漠人”BMI明显小于对照组,P〈005。相反,“沙漠人”男性、女性腰围明显小于对照组,P值分别为0.0027和〈0.0001。（2）“沙漠人”收缩压和舒张压随年龄增长而升高,但均低于对照组,仅18~45岁和〉60岁年龄组的收缩压水平较对照组有明显差异,P值分别为0.0127和00443。（3）“沙漠人”高血压患病率为7.0%（24/359）,明显低于对照组30.7%（31/101）的高血压患病率。（4）“沙漠人”血糖、TG、TC、LDL-C、Apo-A、Apo-B水平低于对照组,P值均〈0.02;18~45岁和〉60岁年龄组的“沙漠人”血液中尿酸水平明显低于对照组,P值分别为0.0010和0.0051。46~60岁年龄组“沙漠人”的HDL-C水平明显高于对照组（P=0.0373）。（5）“沙漠人”血清IgG、IgA和IgM水平低于对照组,仅IgG,IgM有统计学差异。（6）问卷调查结果表明,“沙漠人”日常摄盐量甚低,很少有人吸烟（6/205男性）、无饮酒。结论低血糖、低血脂、低BMI的生理特征和低盐摄入,极少吸烟、无饮酒的生活方式,可能是“沙漠人”高血压患病率低的重要因素。     

Reducing blood cholesterol levels in patients with peripheral vascular disease: dietitian or diet fact sheet?

A randomized trial was performed to test the hypothesis that, among patients with peripheral vascular disease, no difference is achieved in the magnitude of the reduction in blood cholesterol levels as a result of advice which is provided by a dietitian and that which is provided by a diet fact sheet. Fifty-nine patients were allocated at random either to a "dietitian" group (n = 31) or to a "diet fact sheet" group (n = 28). Dietary advice which was provided by a dietitian involved two personal interviews; the diet fact sheet was prepared by the NSW Department of Health. Twenty-two and 23 members of each group, respectively, returned for follow-up at three months. The mean cholesterol level fell by 8.5% among the "dietitian" group but only by 1.9% among the "diet fact sheet" group. The difference of 0.47 mmol/L in the total cholesterol level reduction between the two groups was statistically significant (P = 0.02; 95% confidence interval, -0.88 to -0.07 mmol/L). It appears that individual advice which is provided by a dietitian is more successful in leading to a reduction in blood cholesterol levels than is the administration of a diet fact sheet, even though this particular diet fact sheet appears to be excellent and is used widely. In view of the large numbers of patients and of persons in the population as a whole who would benefit from a reduction in blood cholesterol levels, and the expense of individual advice to be provided by a dietitian, explorations of cost-effective methods of providing dietary advice are needed.     

非酒精性脂肪肝与动脉粥样硬化危险因素相关性调查

目的探讨新疆油田职工非酒精性脂肪肝（NAFLD）患病率及其与动脉粥样硬化危险因素的相关性。方法选择2010年12月～2011年12月在明周石油医院进行职工体检者705人，询问病史、吸烟史等，监测血压，测量身高、体重，行腹部超声及血脂、血糖、肝肾功能等生化检查，将其分为NAFLD组及对照组，进行组间对比分析。结果705名入选者，检出NAFLD286例，检卅率为40．6％。NAFLD组患者血三酰甘油、胆固醇水平高于对照组，高密度脂蛋白胆固醇水平低于对照组，差异有统计学意义（P〈0．05或P〈0．01）。NAFLD组合并高血压、糖尿病和糖耐量异常、超重、吸烟者的比例分别为34．3％、30．4％、39．2％、36．3％；对照组为15．5％、10．3％、12．4％、18．6％，两组差异有统计学意义（均P〈0．05）。结论新疆油田职工NAFLD的患病率高于一般人群；NAFLD与动脉硬化有关。     

Cardiovascular-risk reduction: initial diuretic therapy compared with calcium-antagonist (felodipine) therapy for primary hypertension

Drug therapy for hypertension has failed to demonstrate a significant reduction in coronary mortality. We compared a calcium-antagonist agent, felodipine, with diuretic therapy as a first-line antihypertensive treatment in a randomized study, to assess the effects of six months of each regimen on over-all cardiovascular risk. Both regimens lowered blood pressure to less than 85 mmHg by one month. Felodipine alone was sufficient to control blood pressure in 90% of patients, while 50% of patients who were receiving diuretic therapy required a second agent for control. Diuretic therapy produced a 10% fall in serum potassium levels (P less than 0.001) and a three-fold increase in plasma renin activity (P less than 0.005) by one month; and a 6% rise in serum cholesterol levels (P less than 0.05) and a 38% rise in serum triglyceride levels (P less than 0.05) by three months. Felodipine did not influence these measurements, but caused a 43% increase in plasma noradrenaline levels by one month of therapy (P less than 0.025). In both groups, a significant fall occurred in the risk percentile score at six months, as calculated from the Multiple Risk Factor Intervention Trial data. However, the decrease was significantly greater in the felodipine group at six months (45% compared with 29%; P less than 0.05). Thus, when doses were titrated to achieve equivalent effects on blood pressure, felodipine had the advantages over diuretic treatment of being effective as monotherapy, of having fewer metabolic effects, and of reducing cardiovascular risk to a greater degree.