Clustering and interrelationships of coronary heart disease risk factors in schoolchildren, ages 6-19

Clustering and interrelationships of common and easily identifiable risk factors in 951 children (ages 6-19) from the Cincinnati Lipid Research Clinic's Princeton School of District Study were assessed. Several patterns of partial correlation coeffieients appeared after multiple regression analysis with adjustment for age, sex, Quetelet index, and race. Systolic blood pressure (SBP) was positively correlated with plasma cholesterol and triglyceride, and with saturated fat intake. Plasma high density lipoprotein cholesterol (C-HDL) was positively associated with occupation of the head of the household and inversely associated with cigarette smoking and sucrose intake. Using multiple regression equations, from 29-41% of the variance for SBP and diastolic blood pressure (DBP) could be explained by the measured variables, with age, skinfold thickness, Quetelet, occupation, and education of the head of the household recurrently appearing in the regression equatons. Low density lipoprotein cholesterol (C-HDL) was the variable for which the lowest amount of variance could be explained in the four race-sex groups. Discriminant function analysis allowed an assessment of interrelationships of C-LDL-C-HDL aggregate groups to other risk factor mean residuals. The variables which contributed significantly to the discrimination between lipoprotein groups were Quetelet index, skinfold thickness, and DBP. Children in the highest C-LHL-lowest C-HDL quintile group had by far the highest residual Quetelet index and skinfold thickness, along with above average SBP, while those in The lowest C-LDL-highest C-HDL quintile group had the lowest residual Quetelet index, skinfold thickness, and SBP. Common risk and anti-risk factors for coronary heart disease (CHD) in children cluster, allowing identification of groups of children putatively at relatively high and low CHD risk as adults.     

Ten-year trends of heart disease risk factors in the Halifax County MONICA population. MONItoring of trends and determinants in CArdiovascular disease

OBJECTIVE: To investigate trends in heart disease risk factors (RFs) in the general population of Halifax County, Nova Scotia during a 10-year period. DESIGN: Two independent random samples of the population of Halifax County were surveyed in 1985 and 1995; age ranges were 25-64 years and 25-74 years. Blood pressure, cholesterol and body weight were measured. Smoking and health history were obtained by questionnaire. MAIN RESULTS: Participation rate was 66.3% in 1985 and 1995. All RFs were negatively correlated with education attainment. RF changes from 1985 to 1995 were related to education level. Among survey participants, mean body mass index increased from 26.7 kg/m2 to 27.6 kg/m2 (P + 0.005) for men, and from 25.5 kg/m2 to 27.3 kg/m2 (P < 0.00001) for women. Average smoking rate increased from 32.0% to 34.6% (not significant) in men and from 27.7% to 29.1% (not significant) in women. Age-specific smoking rate increased by 13% (P = 0.14) in younger women and decreased by 10% in older women. (P = 0.00). Mean levels of blood cholesterol decreased by 0.2 mmol/L (P = 0.002) in men and 0.1 mmol/L (P = 0.20) in women. Systolic blood pressure increased by 6.3 mmHg (P < 0.0001) in men and by 7.9 mmHg (P < 0.0001) in women, being steepest in the lower education group. Mortality predicted from RFs declined between the survey years, but less than the observed mortality. This discrepancy may result from the effect of medical care or the delayed effect of RF changes. CONCLUSIONS: Some risk factors show a disturbing trend, indicating that an increased effort or a change in strategy is needed to combat the risk of ischemic heart disease.     

Cardiovascular fitness, physical activity and selected coronary heart disease risk factors in adults

This article considers the mechanism for construction of movements in biological systems as a means of reducing excess degrees of freedom of a motor organ. It is suggested that each type of excess of degrees of freedom is reduced by one of the hierarchically coordinated systems of motor control. Detailed consideration is given to mechanisms for reducing the dynamic excess of a motor organ, the kinematic excess associated with polyarticular motor organs, and the kinematic excess of the desired trajectory. A functional scheme is developed for a motor control system which reduces these excess degrees of freedom, and the control processes for various types of movement were studied by computer modeling.     

Relationship between obesity and risk factors of coronary heart disease in nondiabetics

We analysed the data of 395 nondiabetic obese (BMI 25-42.2, impaired glucose tolerance, IGT, 257 and normal glucose tolerance, NGT, 138) and 482 nonobese subjects (BMI 15.9-24.9, IGT 170 and NGT 312). The blood pressure, plasma glucose, insulin, triglyceride and total cholesterol in obese were higher than that in nonobese, while HDL-c level was lower after controlling for age and sex (P < 0.001). This difference remained to be significant even after the adjustment of age, sex, insulin and 2-hours plasma glucose. Therefore, it was suggested that obesity was easy of access to coronary heart disease risk factors independent of hyperglycemia and hyperinsulinemia.     

Prevalence of coronary heart disease and major cardiovascular risk factors in Thailand

BACKGROUND: Coronary heart disease (CHD) is expected to become one of the major health problems in developing countries such as Thailand where prevalence data are scarce. This study reports the prevalence of CHD, as indicated by electrocardiogram (ECG) Minnesota coding, and its risk factors in Thailand. METHODS: In 1991 we conducted a cross-sectional ECG survey in a multistage random sample of the Thai population, aged > or =30. All major cardiovascular risk factors were measured. Standard supine 12-lead ECG data were collected; amplitudes and intervals were measured manually and entered into a computer. Abnormal tracings were verified by five cardiologists, and agreement among at least three of them was accepted as final. RESULTS: The total sample included 3822 men and 4967 women aged > or =30 years. The age-standardized prevalence rate of CHD was 9.9/1000 (men 9.2/1000, women 10.7/ 1000). The age-standardized level of major cardiovascular risk factors among men and women respectively were: total cholesterol 4.8 mmol/l (187.3 mg/dl), 5.1 mmol/l (197.7 mg/dl); hypercholesterolaemia (> or =6.2 mmol/l) 12.2%, 16.9%; systolic blood pressure (mmHg) 117.8, 117.7; diastolic blood pressure (mmHg) 76.9, 75.8; body mass index (kg/m2) 21.7, 22.8; fasting blood sugar 4.8 mmol/l (87.9 mg/dl), 5.0 mmol/l (90.3 mg/dl); hypertension (> or =160/95 +/- on antihypertensive drugs) 6.3%, 8.1%; smoking 65.1%, 8.5%; diabetes mellitus (> or =7.8 mmol/l) 2.4%, 3.7%; obesity (>25 kg/m2) 15.2%, 27.2%. CONCLUSIONS: Most of the age-adjusted mean values and proportion of major cardiovascular disease risk factors as well as the prevalence of total CHD in the Thai population were much lower than the median of those values found in developing countries.     

Management of risk factors after coronary heart disease in European countries

BACKGROUND: Despite clinical and epidemiological evidence of benefits from sustained management of vascular risk factors following coronary heart disease, the implication of physicians in secondary prevention remains limited. In 1994, several European scientific societies published jointly guidelines for the prevention of coronary heart disease in clinical practice, ranking as the highest priority the reduction of risk factors in coronary patients. METHODS: The European Society of Cardiology launched at the same period a study on the prevalence and management of vascular risk factors of coronary patients in Europe, the EUROASPIRE project. Six months after a coronary event 3,569 patients, from a total population of 4,863 affected individuals recruited in hospitals of 9 European countries, were interviewed and examined to estimate the levels and management of their vascular risk factors. RESULTS: At least six months after discharge, one patient out of five kept on smoking, one out of four was still obese, one out of two had high blood pressure levels and 44% total cholesterolemia over 5.5 mmol/L. More than 8 smoking patients out of 10 attempted to stop smoking and 8 obese patients out of 10 attempted to lose weight. More than 40% of patients, treated or not for hypertension, had systolic blood pressure levels over 140 mm Hg, and almost one patient out of two, treated or not treated for dyslipemia, a total cholesterolemia over 5.5 mmol/L. CONCLUSIONS: Given the high prevalence of vascular risk factors in coronary patients, efficient secondary prevention aiming at the reduction of the levels of these risk factors, may have a major impact on the decrease of morbidity and mortality of these patients. Thus, joined European efforts to elaborate, diffuse and evaluate secondary prevention strategies towards physicians and patients should be rapidly developed to facilitate the achievement of such benefits for coronary patient health.     

Culture, socioeconomic status, and coronary heart disease risk factors in an African American community

In this paper, cultural influences are examined in the relationship between socioeconomic status and health. Cultural definitions of material lifestyles are investigated as a correlate of disease risk in an African American community in the rural South. A new technique--called "cultural consensus analysis"--is used to test for a cultural model of lifestyles indicative of success. Survey data are then used to operationalize the degree to which individuals adhere in their own behavior to that cultural model; this measure is referred to as "cultural consonance in lifestyle." Cultural consonance in lifestyle is more strongly associated with hypertension and smoking (but not serum lipids) than are conventional measures of socioeconomic status (occupation, income, and education). These results suggest that the extent to which individuals are unable to live in accordance with cultural norms regarding lifestyles may contribute to the risk of coronary heart disease in the African American community.     

Socioeconomic inequalities in coronary heart disease and stroke mortality among Australian men, 1979-1993

BACKGROUND: During the 1970s in Australia, mortality from coronary heart disease (CHD) and stroke was higher among lower socioeconomic groups and inequalities were widening. This analysis examines subsequent trends in socioeconomic inequalities, with reference to socioeconomic patterns in major cardiovascular risk factors. METHODS: Socioeconomic status was defined by occupation. Age-standardized mortality rates were calculated for men aged 25-64, using death registration data and labour force estimates for 1979-1993. Risk factor data were taken from three cross-sectional population surveys conducted in 1980, 1983 and 1989. RESULTS: Men in manual occupations were at least 35 percent more likely to die from CHD than men in professional occupations and 60 percent more likely to die from stroke. Their 5-year population risk of a coronary event was 30 percent higher. Since 1979, both groups experienced reductions in coronary risk and mortality. CONCLUSIONS: Socioeconomic inequalities in CHD mortality continued to widen during the early 1980s, stabilized thereafter and persisted into the 1990s. Decreases in blood pressure and smoking prevalence contributed most to declines in coronary risk and to socioeconomic differentials.     

Birthweight-specific trends in perinatal mortality by hospital category in South Australia, 1985-1990

OBJECTIVE: To investigate differences by birthweight in risk of perinatal death between level 3 hospitals (which provide care for high risk pregnancies and neonatal intensive care) and other hospitals in South Australia, using perinatal data for the 1985-1990 period. DESIGN: Analysis of birthweight-specific trends in risk of perinatal death by hospital category for singleton births, adjusting for risk factors. SUBJECTS: 114 725 singleton births of at least 400 g birthweight (or at least 20 weeks' gestation) born in hospitals in the 1985-1990 period and notified to the perinatal data collection. MAIN OUTCOME MEASURE: The relative odds of a perinatal death, as opposed to a live birth which survived the neonatal period. RESULTS: Births at level 3 hospitals had a higher crude risk of perinatal death than those at other hospitals, but this was due to the higher frequency of low birthweights at level 3 hospitals. For birthweights under 2000 g, and especially for the very low birth-weights, there was a higher risk at non-level-3 than level 3 hospitals. There was also the unexpected finding that births at level 3 hospitals in the 2500-2999 g range had a comparatively high risk of perinatal death. There was little difference in risk for births of higher birthweight. CONCLUSIONS: The greatly reduced risk of perinatal death in level 3 hospitals for babies with birthweights under 2000 g seems likely to be due to the specialist services in these hospitals. Further investigation is required to determine why babies in the 2500-2999 g range of birthweights had a comparatively high risk of perinatal death at these hospitals. This appears to be due, at least in part, to an excess contribution of deaths from congenital abnormalities. Also, it seems that the higher prevalence of complications in pregnancy in level 3 hospitals, and the transfers for induction of labour after intrauterine fetal death, would have made a contribution. These same factors may also have affected the risk in level 3 hospitals for higher birthweight births.     

The effect of age on risk factors for ischemic heart disease: the Manitoba Follow-Up Study, 1948-1993

PURPOSE: The purpose of this paper is to determine the age-specific relationships between risk factors at age 40 through 75 years and ischemic heart disease (IHD), and to determine the effects of aging on these relationships in a cohort of 3983 Canadian males. METHODS: The Manitoba Follow-Up Study is the prospective investigation of cardiovascular disease as it develops in a cohort of 3983 young men. Over a period of 45 years, from 1948 to 1993, 1094 study members (27%) developed clinical evidence of IHD. Blood pressure, body weight, smoking, and presence of diabetes mellitus have been recorded at regular intervals throughout the follow-up period. Using measurements from examinations every 5 years between ages 40 and 75 years, age-specific Cox proportional hazard models were fit to relate these risk factors to IHD. RESULTS: The adjusted relative risk of IHD for systolic blood pressure, diastolic blood pressure and smoking were found to significantly (p < 0.001) decline with advancing age. The adjusted relative risk for body mass index and presence of diabetes mellitus for ischemic heart disease did not vary with age (p > 0.05). After age 65 years, these risk factors were of little value for the prediction of IHD. CONCLUSIONS: The relative risk and statistical significance of blood pressure and smoking, as risk factors for IHD, decline with age.     

Coronary risk factors 6-12 months after coronary artery bypass grafting. Comparison of surveys in 1986, 1990 and 1994

OBJECTIVE: To assess coronary risk factors and management 6-12 months after coronary artery bypass grafting. DESIGN: Patient survey by questionnaire after discharge from hospital in 1994 and comparison with similar surveys from 1990 and 1986. SETTING AND PATIENTS: One hundred and ninety-four patients undergoing coronary artery bypass grafting at one hospital campus between 1 March 1993 and 31 August 1993. Replies to questionnaires were received from 175 patients (90%); we had clinical and biochemical data for 166-175 patients (86%-90%). RESULTS: The proportion with hypercholesterolaemia (serum cholesterol levels > or = 6.5 mmol/L) declined from 60% in 1986 to 9% in 1994. Those with diastolic hypertension (> or = 95 mmHg) declined from 23% to 3%. The proportion of current smokers remained low at 6%. The proportion overweight had increased from 32% in 1986 to 47% in 1994. The proportion taking lipid-regulating drugs increased from 2% in 1986 to 37% in 1994. CONCLUSION: Coronary risk factors after coronary artery bypass grafting appear to be better managed in 1994 than in earlier years, but there may still be a need for improvement in lipid disorders and weight.     

Importance of heart failure as a cause of death. Changing contribution to overall mortality and coronary heart disease mortality in Scotland 1979-1992

AIMS: As heart failure is a syndrome arising from another condition, such as coronary heart disease, it is rarely officially coded as the underlying cause of death regardless of the cause recorded by the physician at the time of certification. We sought to assess the true contribution of heart failure to overall mortality and coronary heart disease mortality and to examine how this contribution has changed over time. METHODS AND RESULTS: We carried out a retrospective analysis of all death certificates in Scotland between 1979 and 1992 for which heart failure was coded as the underlying or a contributory cause of death. From a total of 833622 deaths in Scotland between 1979 and 1992, heart failure was coded as the underlying cause in only 1.5% (13695), but as a contributory cause in a further 14.3% (126073). In 1979, 28.5% of male and 40.4% of female deaths attributed to coronary heart disease (coded as the underlying cause of death) also had a coding for heart failure. In 1992 these percentages had risen significantly to 34.1% and 44.8%, respectively (both P<0.001). Mortality rates for heart failure as the underlying or contributory cause of death, standardized by age and sex, fell significantly over the period studied in all ages and in both sexes: by 31% in men and 41% in women <65 years and 15.8% in men and 5.1% in women > or =65 years, respectively (P<0.01 for all changes). CONCLUSIONS: Death from heart failure is substantially underestimated by official statistics. Furthermore, one third or more of deaths currently attributed to coronary heart disease may be related to heart failure and this proportion appears to be increasing. While the absolute numbers of deaths caused by heart failure remains constant, this study is the first to show that standardized mortality rates are declining.     

Modifiable risk factors for coronary heart disease among young people in Addis Ababa

We report results of a cross-sectional survey of modifiable risk factors for coronary heart disease among young people (15-24 years of age) in Addis Ababa, conducted in 1994/95. A city-wide random sample of 1,436 (851 females and 585 males) young people participated in the study. Interviews using structured questionnaires, weight, height and blood pressure measurements were conducted using trained and supervised field workers. Current smoking was 11.8% for males and 1.1% for females. About 34% of the respondents consumed alcoholic beverages regularly, but 7.0% of these took more than 100 grams of alcohol per week. High fat intake and sedentary life-styles were registered in 4.5 and 8.4% of the respondents, respectively. About 6.0% of the females and 0.7% of the males were obese. The prevalence of elevated blood pressure (diastolic BP > 90 mmHG) was 7.1%. The prevalence of modifiable risk factors among young people in Addis Ababa indicates that there is need for initiation of primary preventive activities as soon as possible.     

Prevalence of coronary heart disease risk factors in active children, 7 to 12 years of age

Approximately 50% of the hind legs of cats infected with Brugia malayi and insulted with a beta haemolytic streptococcus became elephantoid in appearance after four to six weeks. This condition was found to be reversible. Collateral lymphatic vessels were seen by lymphography in most of the Brugia-streptococcus-infected legs. The popliteal draining systems in two of three cats, which harboured no worms, appeared normal by lymphography at 18 weeks.     

High triglyceride, low HDL-cholesterol and risk of coronary heart disease

Hypercholesterolaemia is a strong risk factor of coronary artery disease (CAD). The importance of high triglyceride and low HDL cholesterol in predicting risk of CAD is less well-established. This review presents data showing that high triglyceride and low HDL cholesterol are important risk factors of CAD and suggests that combined lipid profiles of triglyceride, HDL cholesterol, and total cholesterol provide more information about risk of CAD than total cholesterol alone. High triglyceride and low HDL cholesterol is the characteristic dyslipidaemia seen in subjects with insulin resistance, a basic abnormality in glucose- and insulin metabolism. Since insulin resistance and raised triglyceride and decreased HDL cholesterol can be identified in children of patients with NIDDM, essential hypertension, and CAD, we suggest that efforts to prevent CAD should include interventions against all these associated abnormalities in glucose-, insulin-, and lipid metabolism and not only high cholesterol.     

Associations between skeletal muscle properties, physical fitness, physical activity and coronary heart disease risk factors in men

High physical fitness and physical activity are associated with favourable lipid levels, especially a high level of high density lipoprotein cholesterol (HDL-C). A person's skeletal muscle properties, metabolism and percentage of different muscle fibres (ST-%), which may modify coronary heart disease (CHD) risk factors, such as serum insulin, obesity and serum sex hormones may also influence his fitness level and leisure-time physical activity. We studied the associations of physical fitness, physical activity and ST-% with serum lipids and lipoproteins in 72 healthy men. Their parameters were compared with those of 20 men with defined CHD. Significant interrelationships between ST-%, fitness and leisure-time physical activity index (LTPAI) were observed. Multiple regression analysis showed that ST-%, fitness and leisure-time physical activity explained about 32% of the variation in HDL-C in the healthy men. In healthy men ST-% correlated positively with fitness (r(s) = 0.62, P < 0.001) and with LTPAI (r(s) = 0.62, P < 0.001). Fitness level also correlated significantly with LTPAI (r(s) = 0.81, P < 0.001). Serum insulin showed negative associations with ST-% (r(s) = -0.63, P < 0.001) and fitness (r(s) = -0.54, P < 0.001) and LTPAI (r(s) = -0.62, P < 0.001). Free fraction of testosterone correlated negatively with serum HDL-C level (r(s) = -0.34, P < 0.01), with fitness (r(s) = -0.41, P < 0.001) and with LTPAI (r(s) = -0.54, P < 0.001). In sedentary men with the lowest fitness and physical activity the mean of ST-% (45%) was similar to that in CHD patients (44%). However, ST-% in men in the highest tertile of physical activity and fitness (68%) was significantly higher than in CHD patients and in men in the lowest tertile of physical activity and fitness. Skeletal muscle enzyme activity in lipid metabolism was significantly lower in both CHD patients and in sedentary and low-fit men than that in fitter and physically active men. The present data imply that skeletal muscle properties are important determinants of risk profiles, such as physical activity, fitness and serum lipid and lipoprotein patterns. Although fitness is a graded, independent predictor of mortality from CHD, a relatively high fitness level is not enough. This was clearly observed in the clustering analysis, in which the healthy men, according to their ST-%, fitness, leisure-time physical activity and serum sex hormone binding globulin (SHBG), fell into three natural groups: (i) Inactive men with lowest ST-% (mean 42%), lowest fitness (10.7 METs) and lowest HDL-C (1.36 mm/l); (ii) Fit men with high ST-% (66%), high fitness (14.5 METs) and moderately high HDL-C (1.54 mol/l); (iii) Active men with high ST-% (66%), highest fitness (14.9 METs) and highest serum HDL (1.83 mmol/l). The results support the idea that both fitness and physical activity give further protection against CHD by modifying risk factors. Our findings also suggest that skeletal muscle properties should be considered in the studies which assess CHD risk factors and their modifications especially in the field of health-related fitness.     

The synergistic effect of smoking and serum cholesterol on coronary heart disease.

Reviews the evidence of a synergistic interaction effect of smoking and elevated serum cholesterol on coronary heart disease (CHD) morbidity and mortality. Methodological issues involved in assessing smoking status, serum cholesterol, and CHD are discussed, and evidence is presented to support the notion that, in part, serum cholesterol, like smoking, is an index of a behavioral risk factor. Such a synergistic interaction is determined to exist, although improvements in methodology are needed to more clearly identify its magnitude. Studies demonstrating that serum cholesterol can be modified by dietary changes and studies exploring the interaction between smoking and cholesterol are evaluated. Possible mechanisms by which smoking and cholesterol may interact to produce CHD are considered. It is suggested that, if smoking cessation and dietary modification behavioral treatments are focused specifically on young and middle-age Americans who smoke and have elevated serum cholesterol, such treatments may increase their effectiveness in lowering the risk of CHD (benefit) without necessarily increasing their effort (cost). (5 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)