Major Coronary Heart Disease Risk Research Articles

Knowledge and practice of adults attending primary health care centers regarding major coronary heart disease risk factors in Basrah city

Introduction: Cardiovascular diseases (CVDs) are common in the general population, affecting the majority of adults past the age of 60 years. The prevalence of coronary heart disease (CHD) is approximately one-third to one-half that of total CVD. Knowledge of CHD risk factors has been identified as a prerequisite for changes in behavior and is often targeted by prevention programs. Objective: The study aimed to study the knowledge of risk factors and the practice of CHD related behaviors among individuals > 18 years of age attending PHC centers in Basrah city center and to find out the sociodemographic factors that affect such knowledge and practice. Methods: The study involved 423 male and female aged 18 years and above, attending 6 primary health care centers in Basrah city. Data were collected through direct interview of the participants by the investigators, using a special questionnaire form prepared for the purpose of the study. Results: The results of the study showed that 77.3% of the participants had good level of knowledge (know at least 7 risk factors). The most common knowledgeable risk factors by the participants were stress, smoking, fatty diet and obesity in descending order. Older age groups, high educated persons, governmental employees and participants with history of coronary heart disease related illness were more likely to have higher knowledge score. Practicing diet modification and regular exercise were prevalent in 23.5% and 12.8% of the participants respectively. Conclusions: The knowledge level of risk factors for CHD in selected PHC centers in Basrah seems to be good, however, the practice of CHD preventive behaviors was quite poor, this necessitates the need for public health education programs.

The strength of the multivariable associations of major risk factors predicting coronary heart disease mortality is homogeneous across different areas of the Seven Countries Study during 50-year follow-up

Objectives: To compare the magnitude of multivariable coefficients and hazard ratios of four cardiovascular risk factors across five worldwide regions of the Seven Countries Study in predicting 50-year coronary deaths.Material and methods: A total of 13 cohorts of middle-aged men at entry (40–59 years old) were enrolled in the mid-1900s from five relatively homogeneous groups of cohorts (areas): USA, Finland and Zutphen – the Netherlands, Italy and Greece, Serbia, Japan for a total of 10,368 middle-aged men. The major risk factors measured at baseline were age, number of cigarettes smoked, systolic blood pressure and serum cholesterol. Cox proportional hazards models were solved for 50-year (45 years for Serbia) deaths from coronary heart disease (CHD), and the multivariable coefficients were compared for heterogeneity.Results: The highest levels of risk factors and CHD death rates were found in Finland and Zutphen – the Netherlands and the lowest in Japan. All four risk factors were predictive for long-term CHD mortality in all regions, except serum cholesterol in Japan where the mean levels and CHD events were lowest. Tests of heterogeneity of coefficients for single risk factors in predicting CHD mortality were non-significant across the five areas. The same analyses for the first 25 years of follow-up produced similar findings.Conclusions: The strength of the multivariable associations of four major traditional CHD risk factors with long-term CHD mortality appears to be relatively homogeneous across areas, pending needed further evidence.

Trends in the Prevalence of Coronary Heart Disease in the U.S.: National Health and Nutrition Examination Survey, 2001-2012.

This study evaluated recent trends in the prevalence of coronary heart disease in the U.S. population aged ≥40 years. A total of 21,472 adults aged ≥40 years from the 2001-2012 National Health and Nutrition Examination Survey were included in the analysis. The analysis was conducted in 2015. Coronary heart disease included myocardial infarction, angina, and any other type of coronary heart disease, which were defined as a history of medical diagnosis of these specific conditions. Angina was also defined as currently taking anti-angina medication or having Rose Angina Questionnaire responses that scored with a Grade ≥1. Trends from 2001 to 2012 were analyzed overall, within demographic subgroups, and by major coronary heart disease risk factors. Between 2001 and 2012, the overall prevalence of coronary heart disease significantly decreased from 10.3% to 8.0% (p-trend<0.05). The prevalence of angina significantly decreased from 7.8% to 5.5% and myocardial infarction prevalence decreased from 5.5% to 4.7% (p-trend <0.05 for both groups). Overall coronary heart disease prevalence significantly decreased among women, adults aged >60 years, non-Hispanic whites, non-Hispanic blacks, adults who did not complete high school, adults with more than a high school education, and adults who had health insurance (p-trend <0.05 for all groups). The overall prevalence of coronary heart disease including angina and myocardial infarction decreased significantly over the 12-year survey period. However, this reduction was seen mainly among persons without established coronary heart disease risk factors. There was no change in coronary heart disease prevalence among those with specific coronary heart disease risk factors.

Endothelial dysfunction and the role of hypertension in Nepalese subjects with major coronary risk factors

Background and Aims: Hypertension is one of the major coronary heart disease risk factors. Endothelial dysfunction is thought to be the preclinical vascular changes in the pathogenesis of atherosclerosis and it its major manifestation; coronary heart disease. This study was designed to assess the endothelial function in subjects with major coronary risk factors including hypertension.Methods: The study was conducted in a tertiary referral centre in Central Nepal. A cross-sectional study was conducted on the cohort of 100 subjects with at least one out of six major coronary heart disease risk factors. JNC 7 criteria were used to define hypertension. Brachial artery flow-mediated dilation was measured using high-resolution ultrasound. Endothelial dysfunction was defined as flow-mediated dilation value &lt;9.99%. The association between endothelial dysfunction and hypertension was assessed by univariate and multivariate analysis.Results: Out of 100 subjects with coronary risk factors (mean age 46.75±9.95 years, mean number of risk factors 2.81± 1.17), 65% subjects were hypertensive and 35% were non-hypertensive. Hypertension as a risk factor was evident in 80.39% and 48.98% subjects with abnormal and normal endothelial response respectively (p = 0.001). In addition, 63.08% and 28.57% subjects with and without hypertension had endothelial dysfunction respectively (p=0.01). Hypertension was the only coronary risk factor associated with endothelial dysfunction in a multivariate model (p=0.04).Conclusion: Hypertension was strongly associated with endothelial dysfunction and it could be the best predictor of endothelial dysfunction and subsequent coronary heart disease in coronary heart diseases risk factor cohorts.Nepalese Heart Journal 2016; 13(1): 13-18

Work productivity loss and indirect costs associated with new cardiovascular events in high-risk patients with hyperlipidemia: estimates from population-based register data in Sweden.

ObjectivesTo estimate productivity loss and associated indirect costs in high-risk patients treated for hyperlipidemia who experience cardiovascular (CV) events.MethodsRetrospective population-based cohort study conducted using Swedish medical records linked to national registers. Patients were included based on prescriptions of lipid-lowering therapy between 1 January 2006 and 31 December 2011 and followed until 31 December 2012 for identification of CV events and estimation of work productivity loss (sick leave and disability pension) and indirect costs. Patients were stratified into two cohorts based on CV risk level: history of major cardiovascular disease (CVD) and coronary heart disease (CHD) risk equivalent. Propensity score matching was applied to compare patients with new events (cases) to patients without new events (controls). The incremental effect of CV events was estimated using a difference-in-differences design, comparing productivity loss among cases and controls during the year before and the year after the cases’ event.ResultsThe incremental effect on indirect costs was largest in the CHD risk equivalent cohort (n = 2946) at €3119 (P value <0.01). The corresponding figure in the major CVD history cohort (n = 4508) was €2210 (P value <0.01). There was substantial variation in productivity loss depending on the type of event. Transient ischemic attack and revascularization had no significant effect on indirect costs. Myocardial infarction (€3465), unstable angina (€2733) and, most notably, ischemic stroke (€6784) yielded substantial incremental cost estimates (P values <0.01).ConclusionsIndirect costs related to work productivity losses of CV events are substantial in Swedish high-risk patients treated for hyperlipidemia and vary considerably by type of event.

Acute Coronary Syndrome in an Intensive Care Unit of a Tertiary Referral Centre in Central Nepal: The Spectrum and Coronary Risk Factors.

Introduction: Acute coronary syndrome is the major leading cause for coronary care unit admission. Its spectrum comprises a variety of disorders including unstable angina, non ST elevation and ST elevation myocardial infarction.Methods: An observational study was designed to study the spectrum of acute coronary syndrome and associated coronary heart disease risk factors in subjects admitted in intensive care unit from August 2009 to September 2010. Details including coronary risk factors and the categories and outcomes of acute coronary syndrome were analyzed.Results: A total of 57 subjects were included in the study. The majority (63.1%) were males. The mean age was 64.54±13.8 years. Five (8.8%) patients were ≤45 years and 29 (50.88%) patients were ≥65 years. Majority of the patients were smokers (50.87%). The other major coronary heart disease risk factors were diabetes (43.85%), hypertension (36.87%), dyslipidemia (26.32%) and previous history of coronary heart disease (31.58%). Coronary heart disease figured prominently in the family history as well (26.32%). ST elevation myocardial infarction was the major category (42.11%) followed by non-ST elevation myocardial infarction and unstable angina (31.58% and 26.32% respectively). Myocardial infarction complicated with cardiogenic shock had very high mortality (83.33%). Conclusions: The ST elevation myocardial infarction was the major clinical form of acute coronary syndrome admitted in intensive care unit. Prevention should be targeted on modifiable risk factors such as the management of risk factors. In addition, the improvement in cardiology service with the establishment of CCU and cathlab might alter the mortality and morbidity in ACS management.Keywords: acute coronary syndrome; coronary risk factors; intensive care unit.

Obesity, adiposity, and dyslipidemia: A consensus statement from the National Lipid Association

The term "fat" may refer to lipids as well as the cells and tissue that store lipid (ie, adipocytes and adipose tissue). "Lipid" is derived from "lipos," which refers to animal fat or vegetable oil. Adiposity refers to body fat and is derived from "adipo," referring to fat. Adipocytes and adipose tissue store the greatest amount of body lipids, including triglycerides and free cholesterol. Adipocytes and adipose tissue are active from an endocrine and immune standpoint. Adipocyte hypertrophy and excessive adipose tissue accumulation can promote pathogenic adipocyte and adipose tissue effects (adiposopathy), resulting in abnormal levels of circulating lipids, with dyslipidemia being a major atherosclerotic coronary heart disease risk factor. It is therefore incumbent upon lipidologists to be among the most knowledgeable in the understanding of the relationship between excessive body fat and dyslipidemia. On September 16, 2012, the National Lipid Association held a Consensus Conference with the goal of better defining the effect of adiposity on lipoproteins, how the pathos of excessive body fat (adiposopathy) contributes to dyslipidemia, and how therapies such as appropriate nutrition, increased physical activity, weight-management drugs, and bariatric surgery might be expected to impact dyslipidemia. It is hoped that the information derived from these proceedings will promote a greater appreciation among clinicians of the impact of excess adiposity and its treatment on dyslipidemia and prompt more research on the effects of interventions for improving dyslipidemia and reducing cardiovascular disease risk in overweight and obese patients.

Effect of Correcting for Long-Term Variation in Major Coronary Heart Disease Risk Factors: Relative Hazard Estimation and Risk Prediction in the Atherosclerosis Risk in Communities Study

To examine the effect of correcting coronary heart disease (CHD) risk factors for long-term within-person variation on CHD risk. By using 5533 men and 7301 women from the Atherosclerosis Risk in Communities (ARIC) study, we compared models incorporating risk factors measured at a single visit and models incorporating additional measurements for systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol taken 3 years before baseline. The largest change away from null was observed for systolic blood pressure, ie, hazard ratio (HR) 1.38 to 1.69 (+81%) in women and HR 1.26 to 1.41 (+56%) in men. HRs also decreased for age (-32% in women, -9% in men), race (-67% in women), the presence of diabetes (-13% in men and women), and medication use for hypertension (-27% in women, -26% in men) and cholesterol (-97% in women, HR 1.06-0.93 in men). The area under the ROC curve did not improve significantly in men or women, whereas reclassification was only significant in women (net reclassification improvement 5.4%, p = 0.016). Modeling long-term variation in CHD risk factors had a substantial impact on HR estimates, with new effect estimates further from the null for some risk factors and closer for others including age and medication use, but only improved risk classification in women.

Effect of Correcting for Long-Term Variation in Major Coronary Heart Disease Risk Factors: Relative Hazard Estimation and Risk Prediction in the Atherosclerosis Risk in Communities Study

Effect of Correcting for Long-Term Variation in Major Coronary Heart Disease Risk Factors: Relative Hazard Estimation and Risk Prediction in the Atherosclerosis Risk in Communities Study

Number of Coronary Heart Disease Risk Factors and Mortality in Patients With First Myocardial Infarction

Few studies have examined the association between the number of coronary heart disease risk factors and outcomes of acute myocardial infarction in community practice. To determine the association between the number of coronary heart disease risk factors in patients with first myocardial infarction and hospital mortality. Observational study from the National Registry of Myocardial Infarction, 1994-2006. We examined the presence and absence of 5 major traditional coronary heart disease risk factors (hypertension, smoking, dyslipidemia, diabetes, and family history of coronary heart disease) and hospital mortality among 542,008 patients with first myocardial infarction and without prior cardiovascular disease. All-cause in-hospital mortality. A majority (85.6%) of patients who presented with initial myocardial infarction had at least 1 of the 5 coronary heart disease risk factors, and 14.4% had none of the 5 risk factors. Age varied inversely with the number of coronary heart disease risk factors, from a mean age of 71.5 years with 0 risk factors to 56.7 years with 5 risk factors (P for trend < .001). The total number of in-hospital deaths for all causes was 50,788. Unadjusted in-hospital mortality rates were 14.9%, 10.9%, 7.9%, 5.3%, 4.2%, and 3.6% for patients with 0, 1, 2, 3, 4, and 5 risk factors, respectively. After adjusting for age and other clinical factors, there was an inverse association between the number of coronary heart disease risk factors and hospital mortality adjusted odds ratio (1.54; 95% CI, 1.23-1.94) among individuals with 0 vs 5 risk factors. This association was consistent among several age strata and important patient subgroups. Among patients with incident acute myocardial infarction without prior cardiovascular disease, in-hospital mortality was inversely related to the number of coronary heart disease risk factors.

Management of Familial Hypercholesterolemias in adult patients: Recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia

Cardiovascular disease is the leading cause of morbidity and mortality in the United States.1 Hypercholesterolemia, specifically elevated level of low-density lipoprotein (LDL) cholesterol, is a major coronary heart disease (CHD) risk factor.2 While environmental factors such as diet and physical activity have important roles in determining an individual’s level of circulating cholesterol, there is also a genetic component. The familial hypercholesterolemias (FH) are a group of inherited genetic defects resulting in severely elevated serum cholesterol concentrations.

IMproving the imPlemEntation of cuRrent guidelines for the mAnagement of major coronary hearT disease rIsk factors by multifactorial interVEntion. The IMPERATIVE renal analysis

IntroductionThe short-term effects of multifactorial intervention for cardiovascular disease (CVD) prevention on renal function and serum uric acid (SUA) levels in patients with stage 3 chronic kidney disease (CKD) and multiple CVD risk factors are unclear. The aim of the study was to prospectively assess these effects.Material and methodsThis post hoc analysis of 5 "best practice" studies involved patients with multiple CVD risk factors. Estimated glomerular filtration rate (eGFR) was assessed using the Modification of Diet in Renal Disease (MDRD) formula. Among the 4,153 patients, 1,235 (29.7%) had stage 3 CKD (eGFR between 30 and 59 ml/min/1.73 m2). A baseline visit was followed by a concerted effort from previously trained physicians to improve adherence to lifestyle advice and optimize drug treatment, including a statin, for all vascular risk factors. After 6 months eGFR and SUA levels were re-evaluated.ResultsThe intervention improved compliance to lifestyle measures and increased the use of evidence-based medication, including a statin. There was also a 5.6% increase in eGFR (p < 0.001) in patients with stage 3 CKD and a 6.1% reduction in SUA levels (p < 0.001). Among patients with stage 3 CKD, 127 (10.3%) improved to stage 2 CKD and 9 (0.7%) advanced to stage 4 CKD by the end of the 6-month study period. There were no major side-effects.ConclusionsMultitargeted intervention, including a statin, may improve renal function and reduce SUA levels within 6 months, thus offsetting 2 potential CVD risk factors in high-risk patients.

The contribution of major risk factors and job strain to occupational class differences in coronary heart disease incidence: the MONICA Brianza and PAMELA population-based cohorts

ObjectivesWe investigated the contribution of major coronary heart disease (CHD) risk factors and job strain to occupational class differences in CHD incidence in a pooled-cohort prospective study in northern Italy.Methods2964...

Effects of Consumption of Pomegranate Juice on Carotid Intima–Media Thickness in Men and Women at Moderate Risk for Coronary Heart Disease

This randomized, double-blind, parallel trial assessed the influence of pomegranate juice consumption on anterior and posterior carotid intima-media thickness (CIMT) progression rates in subjects at moderate risk for coronary heart disease. Subjects were men (45 to 74 years old) and women (55 to 74 years old) with > or =1 major coronary heart disease risk factor and baseline posterior wall CIMT 0.7 to 2.0 mm, without significant stenosis. Participants consumed 240 ml/day of pomegranate juice (n = 146) or a control beverage (n = 143) for up to 18 months. No significant difference in overall CIMT progression rate was observed between pomegranate juice and control treatments. In exploratory analyses, in subjects in the most adverse tertiles for baseline serum lipid peroxides, triglycerides (TGs), high-density lipoprotein (HDL) cholesterol, TGs/HDL cholesterol, total cholesterol/HDL cholesterol, and apolipoprotein-B100, those in the pomegranate juice group had significantly less anterior wall and/or composite CIMT progression versus control subjects. In conclusion, these results suggest that in subjects at moderate coronary heart disease risk, pomegranate juice consumption had no significant effect on overall CIMT progression rate but may have slowed CIMT progression in subjects with increased oxidative stress and disturbances in the TG-rich lipoprotein/HDL axis.

Association of sports activities in leisure time and incident myocardial infarction in middle-aged men and women from the general population: the MONICA/KORA Augsburg cohort study

To examine sex-specific associations between sports activities in leisure time and incident myocardial infarction (MI) in a representative population sample in Germany. Cohort study. The study was based on 3501 men and 3475 women (aged 45-74 years) who participated in one of the three MONICA Augsburg surveys between 1984 and 1995 and were followed up until 2002. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models. A total of 295 cases of incident MIs among men and 91 among women were registered during a median follow-up period of 8.6 years. In both sexes, moderate and high level of sports activities in leisure time were associated with a reduced risk of incident MI after age and survey adjustment; the HRs of MIs associated with a moderate and high level of sports activities in leisure time were 0.68 (0.49-0.96), and 0.71 (0.50-0.99) for men and 0.42 (0.21-0.84), and 0.18 (0.04-0.74) for women. Further adjustment for other major coronary heart disease risk factors attenuated the HRs: in moderately and highly active men, the HRs were not significant anymore (HRs 0.78 and 0.84, respectively), but the HRs remained significantly reduced in moderately and highly active women (HR 0.49; 95% CI, 0.24-1.00 and HR 0.21; 95% CI, 0.05-0.87, respectively). Moderate or high levels of sports activities in leisure time are associated with a significantly reduced risk of MI in women, but not men from the general population.

Relationship between Two Job Stress Models and Coronary Risk Factors among Japanese Part‐Time Female Employees of a Retail Company

The objective of this study was to explore the associations between two major job stress models (job strain and effort-reward imbalance) and coronary heart disease (CHD) risk factors (blood pressure; total, high- (HDL) and low-density lipoprotein (LDL) cholesterol; and triglycerides) in Japanese part-time female employees of a retail company. The study population was either 35 yr old or between 40 and 63 yr old. Data collection was carried out in 2002; a total of 1,401 subjects participated in a medical examination and completed a questionnaire. After adjusting for other covariates (age, relative weight, tobacco use, alcohol consumption, lack of exercise, education, marital status, history of child bearing, medical treatment for disease, and occupation), a significant association was found between the effort-reward imbalance, a "high-cost and low-gain" condition at work, and a high prevalence of low HDL cholesterol (Odds ratio=4.4). A weak but unexpected association was found between job strain and low prevalence of low HDL cholesterol. In explanatory analysis with individual components of the two models, associations were evident between high extrinsic effort and high prevalence of low HDL cholesterol and low prevalence of high triglyceride, high job control and low prevalence of high systolic blood pressure, and high job demands and low prevalence of high systolic and diastolic blood pressure. In this cross-sectional study of Japanese part-time working women, a significant association was found between effort-reward imbalance and unfavorable HDL cholesterol profiles. The findings did not support the hypothesis that job strain is associated with CHD risk factors.

Distribution of C-reactive protein and its relation to risk factors and coronary heart disease risk estimation in the National Health and Nutrition Examination Survey (NHANES) III.

The authors examined the distribution of, and risk factors associated with, the inflammatory marker C-reactive protein (CRP) among a large sample of non-institutionalized American adults aged 30-74 years of age, and its relation to estimated 10-year coronary heart disease risk. The population studied comprised 4472 men and 5212 women aged 30-74 years, without coronary heart disease, who had CRP measurements in the Third National Health and Nutrition Examination Survey (NHANES III). The 10-year risk of coronary heart disease was estimated from Framingham risk factor algorithms among those with CRP levels of less-than-or-equal0.21 mg/dL, >0.21 to <0.5mg/dL, 0.5 to <1.0 mg/dL, and greater-than-or-equal1.0 mg/dL. Mean (SD) levels of CRP were 0.41 (0.64) mg/dL in men and 0.55 (0.91) mg/dL in women. Levels of at least 1 mg/dL were measured in 6.4% of men and 12.9% of women. CRP levels were highest among non-Hispanic black men and Mexican-American women. According to multiple logistic regression analysis, cigarette smoking and increased age, body mass index, and systolic blood pressure in men, and body mass index and diabetes in women, were strongly associated with a greater likelihood of CRP levels of greater-than-or-equal1.0 mg/dL (p<0.001). Among persons with CRP levels of less-than-or-equal0.21 mg/dL, >0.21 to <0.5 mg/dL, 0.5 to <1.0 mg/dL and greater-than-or-equal1.0 mg/dL, the 10-year estimated risk of coronary heart disease were 13.4%, 17.6%, 19.6%, and 21.1% among men, respectively, and 2.7%, 3.6%, 4.1% and 4.3% among women, respectively (both p<0.001 across CRP categories); higher risks across CRP groups were also found among ethnic/gender subgroups. CRP remained a significant predictor of coronary heart disease risk in unadjusted and age-adjusted analyses. Conclusion. Elevation of CRP is associated with several major coronary heart disease risk factors and with unadjusted and age-adjusted projections of 10-year coronary heart disease risk in both men and women. (c)2001 CHF, Inc. Presented at the Fifth International Conference on Preventive Cardiology, Osaka, Japan, May, 2001.

Is Hypercholesterolemia a Risk Factor and Should it Be Treated in the Elderly?

The 1993 National Cholesterol Education Program guidelines recommend cholesterol screening for elderly patients with and without known coronary heart disease. This review summarizes clinical trial evidence from the medical literature that addresses cholesterol treatment in the elderly. References were obtained from a MEDLINE search, bibliographies, metaanalyses, and review articles. Randomized, controlled clinical trials, including all lipid intervention trials with elderly participants or subgroup analyses of the elderly designed to measure major cardiovascular disease endpoints, were selected. A MEDLINE search of all clinical trials using key search terms yielded 1360 references. Journal titles and abstracts were reviewed for all references by one of us (K.M.H.). A full journal review was undertaken for 41 references to clinical trials. Five clinical trials fulfilled all criteria and represented unique data. A MEDLINE search (from 1966 to January 2000) and bibliography reviews yielded five important clinical trials with analyses of elderly participants. Data are presented in text form and a summary table. Clinical trial evidence supports treating hyperlipidemia in elderly persons for secondary prevention of coronary heart disease. Evidence from four secondary prevention trials demonstrated that major coronary heart disease risk decreased by 25% to 30% in elderly subjects treated for 5 years. Unanswered questions include cholesterol treatment for primary prevention in the elderly, gender effect, and benefit of treatment in persons older than 70.

Genetic variation in human stromelysin gene promoter and common carotid geometry in healthy male subjects.

A common variant in the promoter of the human stromelysin gene, causing reduced enzyme expression, has been associated with the progression of coronary atherosclerosis. On the other hand, increased stromelysin activity may promote plaque rupture. The present study was undertaken to investigate the relationship between the genetic variation in the human stromelysin gene promoter and common carotid geometry. Forty-two healthy male subjects without major coronary heart disease risk factors were investigated. The polymorphism in the stromelysin gene promoter was studied through polymerase chain reaction amplification with the use of mutagenic primers. Age, blood pressure, lipids, glucose, viscosity, and body mass index were similar in homozygotes for the 5A allele (5A/5A), heterozygotes (5A/6A), and homozygotes for the 6A allele (6A/6A). Serum matrix metalloproteinase-3 levels did not differ significantly among genotypes. Common carotid diameters and intima-media thickness, measured by noninvasive ultrasonography, were significantly larger in 6A/6A subjects (for respective 6A/6A, 5A/6A, and 5A/5A subjects, diameter at the R wave was 0.63+/-0.09, 0.55+/-0.06, and 0.53+/-0.04 cm [mean+/-SD], P<0.005 by ANOVA; intima-media thickness was 765+/-116, 670+/-116, and 630+/-92 microm [mean+/-SD], P<0.05 by ANOVA). Wall shear stress, calculated as blood velocityxblood viscosity/internal diameter, was significantly lower in 6A/6A subjects (for respective 6A/6A, 5A/6A, and 5A/5A subjects, mean wall shear stress was 10.4+/-2.9, 13.5+/-3.5, and 12.6+/-1.9 dyne/cm(2) [mean+/-SD], P<0.05 by ANOVA). The results demonstrate that the gene polymorphism in the promoter region of stromelysin is associated with structural and functional characteristics of the common carotid artery in healthy male subjects without major risk factors for atherosclerosis. Individuals with the 6A/6A genotype (associated with lower enzyme activity) show a triad of events, namely, increased wall thickness, enlarged arterial lumen, and local reduction of wall shear stress, which might predispose them to atherosclerotic plaque localization.

The North-East-South gradient of coronary heart disease mortality and case fatality rates in France is consistent with a similar gradient in risk factor clusters.

In France, the mortality and case fatality rates of coronary heart disease follow a decreasing North-East-South gradient. The aim of the study was to evaluate the contribution of major cardiovascular risk factors to this gradient. To this end, the results of the third population survey of the WHO-MONICA Project conducted in three French geographically contrasted regions (the Urban Community of Lille in the North, the district of Bas-Rhin in the East and the district of Haute-Garonne in the South) are presented. One thousand seven hundred seventy-eight men and 1730 women aged 35-64 years were randomly selected from the electoral rolls. Major coronary heart disease risk factors (hypertension, hypercholesterolemia, low high-density lipoprotein (HDL)-cholesterol, obesity, smoking, physical inactivity, diabetes) were studied. The results show that the distribution of major coronary heart disease risk factors is heterogeneous among geographical areas in France. However, the proportion of subjects with more than three risk factors is higher in the North than in the other regions and the number of subjects with no risk factor is higher in the South than in the other areas. This distribution of risk factors among regions supports the hypothesis that accumulation of coronary heart disease risk factors contributes to the decreasing North-East-South gradient of cardiovascular mortality rates in France.