Cerebrovascular Disease Morbidity Research Articles

АСПЕКТЫ ПРИМЕНЕНИЯ АНТИТРОМБОТИЧЕСКОЙ ТЕРАПИИ В СОСУДИСТОЙ НЕВРОЛОГИИ

The development of Acute Cerebrovascular Events – ACV is one of the main causes of mortality and disability. Currently, in developed countries, due to the development of new technologies and improvement of medical care and prevention, there is a tendency to decrease the mortality and morbidity of cerebrovascular disease (CVD). Timely and adequate use of antithrombotic therapy in patients in this category for primary and secondary prevention of ACV is an extremely important aspect of management and reliably reduces the risks of recurrent cerebrovascular accidents, increases survival and contributes to a more favorable prognosis for the recovery of impaired functions and quality of life in the long term.

The Prospective Associations of Egg Consumption with the Risk of Total Cerebrovascular Disease Morbidity among Chinese Adults

Studies investigating the relationship between egg consumption and the risk of cerebrovascular disease (CED) have yielded inconsistent results. This study evaluated the association between egg consumption and the risk of CED among Chinese adults. Data were obtained from China Kadoorie Biobank, Qingdao. A computerised questionnaire was used to collect information regarding egg consumption frequency. CED events were tracked through linkage with the Disease Surveillance Point System and the new national health insurance databases. Cox proportional hazards regression analyses were used to evaluate associations between egg consumption and CED risk controlling for potential confounders. After a median follow-up of 9.2 years, 865 and 1083 CED events among men and women, respectively, were documented. More than 50% of participants consumed eggs daily with an average age of 52.0 (10.4) years at baseline. No association between egg consumption and CED were identified in the whole cohort and women. However, a 28% lower risk of CED was observed in those who consumed eggs at a higher frequency (HR = 0.72, 95% CI: 0.55-0.95) and a significant trend for the association (p for trend = 0.012) in a multivariable model in men. Higher frequency of egg consumption was associated with a lower risk of total CED events among men but not women in Chinese adults. The beneficial effect on women warrants further investigations.

Obstructive sleep apnea predicts pathologic response to neoadjuvant therapy in resected pancreatic ductal adenocarcinoma.

Obstructive sleep apnea predicts pathologic response to neoadjuvant therapy in resected pancreatic ductal adenocarcinoma.

Significant correlation of ischemic stroke with peripheral artery disease in type 2 diabetes mellitus patients

Background: Atherosclerotic disease is not only increased in incidence in type 2 diabetic patients, but its course is also accelerated. Stroke is one of the major causes of morbidity and mortality among the elderly population. The relationship between ischemic stroke and PAD (peripheral artery disease) has been poorly investigated in India. So, we studied the risk of stroke in PAD patients with type 2 diabetes. The aims and objectives of the study were to study the prevalence of PAD in patients with type 2 diabetes mellitus and to study the correlation of stroke in PAD patients with type 2 diabetes.Methods: Hospital based cross-sectional study was conducted among the 124 patients admitted with type 2 diabetes (age >25 years) from December 2019 to October 2021 in the various units of department of medicine/surgery, KPS institute, GSVM medical college, Kanpur. Color Doppler of limbs and carotid artery was done in study population. Clinical sign and symptoms, history of stroke or diagnostic investigation were used for evaluate cerebrovascular events.Results: In our study based on doppler ultrasound, the prevalence of PAD was found in 31 patients (25%) out of 124 with men having a higher prevalence (24 out of 74; 77.4%), as compared to women (7 out of 50; 22.6%) (p=0.020). The prevalence of stroke was 32.3% in PAD patients and 11.8% in non-PAD patients (p=0.009).Conclusions: By using Doppler, we found evidence of PAD in 25% of type 2 diabetics (M>F). The prevalence of stroke was 32.3% in PAD patients and 11.8% in non-PAD patients (p=0.009). PAD is associated with an increased risk of cerebrovascular disease morbidity and mortality. Clinician should identify a PAD patient with diabetes to elicit symptoms, complications like stroke to decrease mortality or morbidity.

Biomarkers for Transient Ischemic Attack: A Brief Perspective of Current Reports and Future Horizons.

Cerebrovascular disease is the leading cause of long-term disability in the world and the third-leading cause of death in the United States. The early diagnosis of transient ischemic attack (TIA) is of great importance for reducing the mortality and morbidity of cerebrovascular diseases. Patients with TIA have a high risk of early subsequent ischemic stroke and the development of permanent nervous system lesions. The diagnosis of TIA remains a clinical diagnosis that highly relies on the patient’s medical history assessment. There is a growing list of biomarkers associated with different components of the ischemic cascade in the brain. In this review, we take a closer look at the biomarkers of TIA and their validity with a focus on the more clinically important ones using recent evidence of their reliability for practical usage.

ЭПИДЕМИОЛОГИЧЕСКИЙ АНАЛИЗ УРОВНЯ РАСПРОСТРАНЁННОСТИ И ЗАБОЛЕВАЕМОСТИ НАСЕЛЕНИЯ ЦЕРЕБРОВАСКУЛЯРНЫМИ БОЛЕЗНЯМИ В КЫРГЫЗСКОЙ РЕСПУБЛИКЕ

Objective: Assessing the dynamics of the long-term trend of prevalence and primary incidence of cerebrovascular diseases (CVD) among different populations of the Kyrgyz Republic (KR). Methods: The main source of information for assessing the incidence of the population of CVD was data from the National Medical Information Center (NMIC) of the Ministry of Healthcare. Retrospective epidemiological study of the prevalence and primary incidence of CVD in the long-term dynamics of 2002-2017 was conducted. Calculated the growth rate (reduction) using the method of the smallest squares to align the dynamic series; a comparative analysis of morbidity rates in groups of age groups and in the context of nine administrative and territorial units of the KR with the calculation of the average multi-year incidence levels (AMIL). Results: In the long-term dynamics (from 2002 to 2017) there is a moderate trend towards an increase in prevalence rates (the rate of growth compared to 2002 was 1.3%) and AMIL 843.9. Among strokes that determine the incidence of CVD, ischemic stroke (60.8%) has the highest proportion. In the long-term dynamics, there is a pronounced tendency to increase unspecified strokes (the growth rate was 10.3%), AMIL incidence – 23.0±2,80/0000. There is a marked upward trend in the incidence of the disease of the studied pathology among children (the rate of increase was 47%). In the 9 administrative territories of the KR there is a fairly strong difference between the AMIL and the CVD among the child population, ranging from 1.00/0000 to 20.90/0000 cases, i.e. territorial differences reach up to 20.9 times; adults and adolescents – from 211.10/0000 to 3127.80/0000 (differences up to 14.8 times). Of the nine administrative territories of the KR, the largest proportion of AMIL morbidity among adults and adolescents is observed in Bishkek, and among children – in the Osh region. AMIL prevalence and primary incidence of strokes in men are statistically, significantly higher than in women. In the long-term dynamics, there is an increase in mortality rates from ischemic strokes with a rate of increase compared to 2002 year – 37.5%, along with a decrease in mortality from hemorrhagic and unspecified strokes. The largest proportion of CVD cases over the past year (2017) is over the age of 70 (32%). Conclusion: The actuality of the problem of CVD in the KR is due to a moderate trend of growth rates of prevalence with the highest proportion of ischemic stroke. The expressed growth trend is caused by unspecified strokes. The largest proportion of AMIL morbidity of adult and adolescent CVD is observed in Bishkek, and among children – in the Osh region. Strokes are more common in males. Keywords: Cerebrovascular diseases, epidemiological analysis, stroke, long-term dynamics.

Geographic Variation in Morbidity and Mortality of Cerebrovascular Diseases in Korea during 2011-2015

Little is known about within-country variation in morbidity and mortality of cerebrovascular diseases (CVDs). Geographic differences in CVD morbidity and mortality have yet to be properly examined. This study examined geographic variation in morbidity and mortality of CVD, neighborhood factors for CVD morbidity and mortality, and the association between CVD morbidity and mortality across the 245 local districts in Korea during 2011-2015. District-level health care utilization and mortality data were obtained to estimate age-standardized CVD morbidity and mortality. The bivariate Pearson correlation was used to examine the linear relationship between district-level CVD morbidity and mortality Z-scores. Simple linear regression and multivariate analyses were conducted to investigate the associations of area characteristics with CVD morbidity, mortality, and discrepancies between morbidity and mortality. Substantial variation was found in CVD morbidity and mortality across the country, with 1074.9 excess CVD inpatients and 73.8 excess CVD deaths per 100,000 between the districts with the lowest and highest CVD morbidity and mortality, respectively. Higher rates of CVD admissions and deaths were clustered in the noncapital regions. A moderate geographic correlation between CVD morbidity and mortality was found (Pearson correlation coefficient = .62 for both genders). Neighborhood level indicators for socioeconomic disadvantages, undersupply of health care resources, and unhealthy behaviors were positively associated with CVD morbidity and mortality and the relative standing of CVD mortality vis-à-vis morbidity. Policy actions targeting life-course socioeconomic conditions, equitable distribution of health care resources, and behavioral risk factors may help reduce geographic differences in CVD morbidity and mortality in Korea.

P.3.f.008 - The report on current state and effectiveness of occupational therapy with mentally disabled people in Korea

Little is known about within-country variation in morbidity and mortality of cerebrovascular diseases (CVDs). Geographic differences in CVD morbidity and mortality have yet to be properly examined. This study examined geographic variation in morbidity and mortality of CVD, neighborhood factors for CVD morbidity and mortality, and the association between CVD morbidity and mortality across the 245 local districts in Korea during 2011-2015.District-level health care utilization and mortality data were obtained to estimate age-standardized CVD morbidity and mortality. The bivariate Pearson correlation was used to examine the linear relationship between district-level CVD morbidity and mortality Z-scores. Simple linear regression and multivariate analyses were conducted to investigate the associations of area characteristics with CVD morbidity, mortality, and discrepancies between morbidity and mortality.Substantial variation was found in CVD morbidity and mortality across the country, with 1074.9 excess CVD inpatients and 73.8 excess CVD deaths per 100,000 between the districts with the lowest and highest CVD morbidity and mortality, respectively. Higher rates of CVD admissions and deaths were clustered in the noncapital regions. A moderate geographic correlation between CVD morbidity and mortality was found (Pearson correlation coefficient = .62 for both genders). Neighborhood level indicators for socioeconomic disadvantages, undersupply of health care resources, and unhealthy behaviors were positively associated with CVD morbidity and mortality and the relative standing of CVD mortality vis-à-vis morbidity.Policy actions targeting life-course socioeconomic conditions, equitable distribution of health care resources, and behavioral risk factors may help reduce geographic differences in CVD morbidity and mortality in Korea.

Associations between airflow obstruction and the risks of morbidity on major chronic diseases in Chinese adults: a prospective cohort study

Objective: To examine the prospective associations between airflow obstruction (AFO) and risks of major chronic diseases morbidity in Chinese adults. Methods: Samples of this study were from the China Kadoorie Biobank. A total of 486 996 participants aged 30 to 79 years (mean 51.5 years) at the baseline study, were included after excluding those who self-reported of having heart disease, stroke and cancer at baseline. AFO was defined under the Global Initiative on Obstructive Lung Disease (GOLD) criteria and forced expiratory volume per one second in percentage of the expected one (FEV(1)% P). Cox regression models were used to investigate the associations of AFO with incidence rates of ischemic heart disease, cerebrovascular disease and lung cancer after adjusted for potential confounders. Results: Over a period of 7 years through the follow-up program, the incident cases of ischemic heart disease, cerebrovascular disease and lung cancer appeared as 24 644, 36 336 and 3 218, respectively. Compared with people without AFO, the HR (95% CI) of GOLD-1 to GOLD-4 were 0.89 (0.78-1.01), 1.05 (0.98-1.12), 1.29 (1.18-1.40) and 1.65 (1.42-1.91) respectively for ischemic heart disease. The HR (95%CI) of GOLD-1 to GOLD-4 were 0.96 (0.70-1.26), 1.12 (0.96-1.31), 1.38 (1.14-1.65) and 1.48 (1.05-2.02) respectively for lung cancer. No statistically significant differences in the associations between GOLD level and cerebrovascular disease morbidity were found. However, each 10% decrease in FEV(1)% P was associated with 7.2% (95%CI: 6.4%-8.0%), 3.6% (95%CI: 3.0%-4.3%) and 10.5% (95%CI: 8.4%-12.6%) increased the risks of ischemic heart disease, cerebrovascular disease and lung cancer respectively. The results were persistant when stratified by smoking status. Conclusion: Higher degree of AFO seemed to be associated with the risks of ischemic heart disease, cerebrovascular disease and lung cancer morbidity among the Chinese adults.

WHO MONICA Project and its Connections to the North Karelia Project.

The World Health Organization's MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) Project was established after the increase in mortality from coronary heart disease had turned to a decline in some countries. Its objective was to measure the trends in cardiovascular mortality and coronary heart disease and cerebrovascular disease morbidity, and to assess the extent to which these trends were related to changes in known risk factors and health care measured at the same time in defined populations in different countries. Thirty-one centers in 21 countries carried out the monitoring over a period of 10 years in the 1980s and 1990s. The project provided information on disease rates, risk factors, and treatment for the first time in most of the study populations. The results answered some of the initial questions and opened new questions on the complexity of the associations between disease trends and their determinants. MONICA had a major impact in training cardiovascular epidemiologists and in creating measurement standards for international use.

Epidemiology of peripheral artery disease.

New data on the epidemiology of peripheral artery disease (PAD) are available, and they should be integrated with previous data. We provide an updated, integrated overview of the epidemiology of PAD, a focused literature review was conducted on the epidemiology of PAD. The PAD results were grouped into symptoms, diagnosis, prevalence, and incidence both in the United States and globally, risk factors, progression, coprevalence with other atherosclerotic disease, and association with incident cardiovascular morbidity and mortality. The most common symptom of PAD is intermittent claudication, but noninvasive measures, such as the ankle-brachial index, show that asymptomatic PAD is several times more common in the population than intermittent claudication. PAD prevalence and incidence are both sharply age-related, rising >10% among patients in their 60s and 70s. With aging of the global population, it seems likely that PAD will be increasingly common in the future. Prevalence seems to be higher among men than women for more severe or symptomatic disease. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease, with some differences in the relative importance of factors. Smoking is a particularly strong risk factor for PAD, as is diabetes mellitus, and several newer risk markers have shown independent associations with PAD. PAD is strongly associated with concomitant coronary and cerebrovascular diseases. After adjustment for known cardiovascular disease risk factors, PAD is associated with an increased risk of incident coronary and cerebrovascular disease morbidity and mortality.

Around-the-clock ambulatory blood pressure monitoring is required to properly diagnose resistant hypertension and assess associated vascular risk.

Diagnosis of resistant hypertension (RH) is currently based upon awake-time office blood pressure (BP). An increasing number of studies have documented abnormally elevated sleep-time BP in most RH patients, indicating that diagnosis of true RH cannot be determined solely by comparison of office BP with either patient awake-time BP self-measurements or awake-BP mean from ambulatory monitoring (ABPM), as is customary in the published literature. Moreover, the ABPM-determined sleep-time BP mean is an independent and stronger predictor of cardiovascular and cerebrovascular disease (CVD) risk than either daytime office/ABPM-derived awake or 24-hour means. Results of the recently completed MAPEC (Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares) prospective outcomes study, which included a large cohort of RH patients, established that time of treatment relative to circadian rhythms constituted a critically important yet often neglected variable with respect to BP control. The study found that bedtime versus morning ingestion of the full dose of ≥1 BP-lowering medications resulted in both better therapeutic normalization of sleep-time BP and reduced CVD morbidity and mortality, including in RH patients. Accordingly, ABPM is highly recommended to properly diagnose and manage true RH, with a bedtime hypertension medication regimen as the therapeutic scheme of choice.

(P1-3) Frequency of Cerebrovascular Diseases and Risk Factors in Emergency Department in Banja Luka

IntroductionCerebrovascular disease include all disorders in which a part of brain is transiently or persistently damaged by ischemia or bleeding and/or where one or more blood vessels of brain are primarily damaged by pathological processes. The research confirmed the influence of risk factors.ObjectiveThe primary objective was to measure frequency of patients with cerebrovascular diseases in the Emergency Service during the period from September 1, 2008 to March 1, 2009. The secondary objective was to prove co-morbidity between the risk factors and cerebrovascular diseases.MethodNumerical indicators for patients with cerebrovascular diseases are extracted retrospectively by statistical work-up for the six-month period. The data indicating the risk factors predisposing cerebrovascular diseases are obtained through the (hetero)anamnesis.ResultsFrom the overall number of 24,600 patients, 127 patients had a diagnosis of cerebrovascular diseases. The frequency of cerebrovascular diseases is linearly increasing with age; after the age of 50, frequency is doubled. The frequency of cerebrovascular diseases is higher in women than in men, the role of heredity is significant, and risk factors influenced development of cerebrovascular diseases as follows: 50.40% of patients had hypertension, 16.54% diabetes mellitus, 48.82% smoking cigarettes, 40.94% obesity, 20.47% alcohol abuse, 11.02% migraine-like headaches, 30.71% cardiovascular diseases and 22.05% hyperlipidemias.ConclusionCerebrovascular diseases are increasing in developing countries. The main reason is poor control of risk factors. In the majority of cases it is possible to produce decrease of frequency of cerebrovascular diseases by elimination and reduction of risk factors through the change of life style. Pre-hospital urgent concept of therapy and improving of organization of emergency service will contribute to decreasing mortality and morbidity of cerebrovascular diseases.

Cerebrovascular disease morbidity on the territory of the municipality of Doljevac

Cerebrovascular diseases have drawn great public attention recently due to a high death rate and an even higher disability rate. The aim of the research was to determine the basic descriptive-epidemic characteristics of patients with cerebrovascular diseases, to assess the incidence rate according to the gender and age, as well as mortality and the disease prognosis after one-year follow up period. A prospective survey was conducted, and the study included all registered patients with cerebrovascular diseases from the municipality of Doljevac in the period from 2005-2007, who were monitored for 1 year since the onset of the disease. During the period monitored, there were a total of 230 patients suffering from this disease. The average standardised incidence rate in both genders was 274.67. Ischemic brain stroke occurred in 146 (63.4%) subjects, the intracerebral haemorrhage in 39 (17%) and the subarachnoid haemorrhage occurred in 9 (3.9%). The 90-day lethality was 14.8%; 1-year lethality was 21.7%. Out of 123 patients (53.4%), who were recorded to have various degree of disability, 44 (35.8%) were independent in everyday activities, 41 (33.3%) needed assistance while walking and maintaining personal hygiene, whereas 38 (30.9) were bedridden. After a year of monitoring, 30 (13.1%) patients suffered a recurrent brain stroke. Cerebrovascular disease morbidity rate was found to be increasing. However, there were no statistically significant differences in morbidity by diagnosis and the disease outcome between genders.

THE RISK OF RADIATION-INDUCED CEREBROVASCULAR DISEASE IN CHERNOBYL EMERGENCY WORKERS

The paper deals with estimating radiation risks of non-cancer diseases of the circulatory system among the Chernobyl emergency workers based on data from the Russian National Medical and Dosimetric Registry. The results for the cohort of 61,017 people observed between 1986 and 2000 are discussed. These are essentially updated results for the similar cohort that was studied by authors earlier in 1986-1996. Newly discovered is the statistically significant dose risk of ischemic heart disease [ERR Gy = 0.41, 95% CI = (0.05; 0.78)]. Confirmation is provided for the existence of significant dose risks for essential hypertension [ERR Gy = 0.36, 95% CI = (0.005; 0.71)] and cerebrovascular diseases [ERR Gy = 0.45, 95% CI = (0.11; 0.80)]. In 1996-2000, the assessed ERR Gy for cerebrovascular diseases was 0.22 with 95% CI = (-0.15; 0.58). Special consideration is given to cerebrovascular diseases in the cohort of 29,003 emergency workers who arrived in the Chernobyl zone during the first year after the accident. The statistically significant heterogeneity of the dose risk of cerebrovascular diseases is shown as a function of the duration of stay in the Chernobyl zone: ERR Gy = 0.89 for durations of less than 6 wk, and ERR Gy = 0.39 on average. The at-risk group with respect to cerebrovascular diseases are those who received external radiation doses greater than 150 mGy in less than 6 wk [RR = 1.18, 95% CI = (1.00; 1.40)]. For doses above 150 mGy, the statistically significant risk of cerebrovascular diseases as a function of averaged dose rate (mean daily dose) was observed: ERR per 100 mGy d = 2.17 with 95% CI = (0.64; 3.69). The duration of stay within the Chernobyl zone itself, regardless of the dose factor, had little influence on cerebrovascular disease morbidity: ERR wk = -0.002, with 95% CI = (-0.004; -0.001). The radiation risks in this large-scale cohort study were not adjusted for recognized risk factors such as excessive weight, hypercholesterolemia, smoking, alcohol consumption, and others.

Anti-Smoking Declaration

The number of deaths from cardio- and cerebro-vascular diseases (CVDs) rivals that from cancer in Japan. In the year 2000, heart disease, including coronary artery disease, claimed the lives of 147,000 Japanese persons, while cerebrovascular disease took the lives of 133,000 people, and cancer deaths were 295,000. Vascular diseases are clearly a major cause of deaths in adults. Further, a significant number of patients suffer from a variety of CVD-related illnesses. The prevention of these diseases and the improvement of quality of life through the reduction of morbidity and mortality is the ultimate goal for all researchers and physicians in cardiovascular disease. Reducing the number and severity of risk factors for heart disease and stroke should be the immediate goal of the Japanese Circulation Society (JCS).The JCS has been strongly involved in efforts to reduce the risk factors of hypertension, obesity, hyperlipidemia, and diabetes mellitus. Smoking is a well-recognized risk factor, and, for example, is associated with an increased risk of 1.7 to 3.0 times for coronary artery disease, 1.7 to 8.0 times for stroke, and 1.4 to 10.0 times for sudden death. For patients with CVDs, the longer the history of smoking, the more it aggravates the severity of the disease itself, and has greater affects on the activities of daily living by reducing oxygen availability in the patient. Passive smoking recently has been accepted as a major risk of coronary artery disease, stroke, and cancers. The prevalence of smoking in teenagers and women is now increasing in Japan, giving the prospect of serious consequences for the incidence, morbidity, and mortality of CVDs in the future. In particular, the combination of smoking and the oral contraceptive pill multiplies the risk of CVDs. Therefore, a national campaign to quit smoking and to eliminate passive smoking is needed. In terms of primary prevention, the excellent cost-benefit ratio of a non-smoking policy will help control the present spiraling increase in medical expenditures.Non-smoking measures are extremely important for the prevention and treatment of CVDs. A survey in 2002, however, revealed a high prevalence of smoking by Japanese physicians in the circulatory field (14% of men and 13% of women physicians). This prevalence is worse than in the United States 20 years ago. As for medical institutions recognized by the JCS, the same survey shows that only 5% completely ban smoking, and only 5% run a smoking cessation clinic in their cardiovascular departments. These figures clearly show that the importance of smoking issues is not recognized, and that cardiovascular physicians in Japan have been slow to act against tobacco use.The Japanese Circulation Society, as the leading professional association for cardiovascular specialists in Japan, hereby declares that we will vigorously fight against smoking by working to ban smoking, encouraging smoking cessation, and preventing passive smoking exposure. This effort will begin within our own membership. The JCS will promote the importance of these counter measures to the public. The JCS has defined 10 specific targets for this effort to decrease smoking and its negative effects and will focus on 3 audiences: the JCS and its membership, hospitals and medical schools, and the general public.

Does prompt treatment of hypertension after blood pressure check-ups reduce morbidity of cerebrovascular diseases?

In Japan, more than 20 million people utilize blood pressure check-up services in their work places or communities every year. To examine the relationship between prompt treatment of hypertension after these blood pressure check-ups and the severity, age at onset, and type of cerebrovascular diseases in these patients, a study was performed with the cooperation of all 174 independent physicians, 17 hospitals, and 4 welfare homes in the city of N.. All patients aged 50 years or more who visited a physician during the study period in this city were included in the study (n=978). Information on hypertensive control before the onset of cerebrovascular diseases was obtained from 668 patients. The results suggests that for those who had received prompt treatment after early detection of hypertension, the disease was less severe and the onset of the disease was delayed. Among our subjects, 47% of the patients claimed to have received prompt treatment after detection of hypertension. As N. is an ordinary Japanese city in terms of the promotion of health check-up programs, this percentage suggests that blood pressure check-up programs for the early detection of hypertension throughout Japan may have contributed to an overall reduction in severity for almost half of the patients with cerebrovascular diseases.

Ecological analysis of the association between mortality and major risk factors of cardiovascular disease. The World Health Organization MONICA Project.

The WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project has been established to measure trends in cardiovascular mortality and coronary heart disease and cerebrovascular disease morbidity and to assess the extent to which these trends are related to changes in known risk factors at the same time in defined communities in different countries. This cross-sectional study is based on data from the early part of the Project and assesses the association between mortality and population risk factor levels. Thirty-five populations of men and women aged 35-64 years are used in correlation analyses between four mortality measures (deaths from all causes, cardiovascular diseases, ischaemic heart disease and stroke) and three cardiovascular risk factors (regular cigarette smoking, blood pressure and total cholesterol). In male populations all-causes mortality and stroke mortality had more than 39% of their variance explained by the three risk factors but all cardiovascular and ischaemic heart disease mortality had less than 25% of their variance explained. For female populations each mortality measure except ischaemic heart disease mortality had more than 33% of their variances accounted for by the three risk factors. For both the male and female populations each of the mortality measures shows strong associations with high blood pressure but the associations with smoking and high cholesterol are generally weaker and much less consistent. This analysis has shown that accepted cardiovascular mortality risk factors measured cross-sectionally at the population level do not reflect well the variation in mortality between populations.

WHO MONICA Project: Risk Factors

The WHO MONICA Project was designed to measure trends and determinants in cardiovascular disease mortality and coronary heart disease and cerebrovascular disease morbidity, and to assess the extent to which these trends are related to changes in known risk factors in 39 collaborative centres in 26 countries. Results of the baseline population surveys are presented. Use of standardized methods allows cross-sectional comparisons to be made of data from the 39 collaborating centres. The proportion of smokers varied between 34-62% among men and 3-52% among women. The median systolic blood pressure (SBP) values varied from 121 mmHg to 145 mmHg in men and from 117 mmHg to 143 mmHg in women. Median diastolic blood pressure (DBP) values varied from 74 mmHg to 91 mmHg in men and from 72 mmHg to 89 mmHg in women. The prevalence of actual hypertension, defined as SBP and/or DBP greater than 159/94 mmHg, or on antihypertensive medication, varied between 8.4% and 45.3% in men and between 12.6% and 40.5% in women. Median serum total cholesterol values varied from 4.1 mmol/l to 6.4 mmol/l in men and from 4.2 mmol/l to 6.4 mmol/l in women. The results show that there is a large variability in the risk-factor patterns among the MONICA populations. They also indicate that populations with low levels of risk factors are in the minority.

Cerebrovascular disease morbidity in the United States, 1970-1983. Age, sex, region, and vascular surgery.

Data from the National Hospital Discharge Survey were reviewed to assess trends in hospital discharge rates for cerebrovascular disease in the United States between 1970 and 1983. Hospital discharge rates showed little consistent change during the 1970's but increased after 1979. Hospital case fatality declined during the same period. Cerebrovascular disease discharge rates were higher among older persons, men, and blacks. Hospital case fatality was higher in older persons and blacks. Rates of cerebral arteriography and endarterectomy of vessels of the head and neck increased between 1979 and 1983. Methodologic problems in monitoring cerebrovascular disease trends are reviewed and recommendations for future research presented.