Prevalence Of Coronary Heart Disease Risk Factors Research Articles

Metabolic Syndrome as a Risk for Coronary Heart Disease in Indonesia: A Longitudinal Study 2007-2014

Introduction: Indonesia has a serious burden of cardiovascular disease, especially coronary heart disease (CHD). The prevalence of CHD has not in fact increased; however, there has been a significant increase in the prevalence of CHD risk factors. Several of these occurring together could cause metabolic syndrome, whose prevalence is relatively high in Indonesia, and consequently increase the risk of CHD. This study aims to obtain the risk of CHD in patients with metabolic syndrome in Indonesia. Methods: This is a retrospective cohort study with a median followed up of 6.8 years, secondary data from the Indonesian Family Life Survey (IFLS) waves 4 and 5 (2007-2014), and a study population of 6,571 respondents aged 40-69 years. The Joint Interim Statement criteria were used to define metabolic syndrome, with the omission of one component. Results: The prevalence of metabolic syndrome was 20%; the highest component was low HDL at 69.1%, followed by hypertension at 59.7%, and central obesity at 39.7%. The incidence of CHD was 2.72%, with an incidence rate 34per 100,000 person-years. Multivariate analysis found that the relative risk (RR) hazard ratio (HR) was 2.16 (95% CI 1.564-2.985). Conclusion: Subjects with metabolic syndrome had a two times higher risk of developing CHD, as adjusted by sex, age, smoking status, and physical activity.

Randomized controlled trials investigating the relationship between dietary pattern and high-sensitivity C-reactive protein: a systematic review.

Elevated serum concentration of high-sensitivity C-reactive protein (hsCRP), a biomarker of systemic inflammation, is associated with increased risk for coronary heart disease (CHD) and cardiovascular events (CVEs). Because elevations in hsCRP often occur in parallel with elevations in low-density lipoproteins (LDLs) and both biomarkers are reduced by hydroxymethylglutaryl-CoA reductase inhibitors (ie, statin drugs), efforts to determine nonpharmacological treatments to lower hsCRP remain limited. Dietary modifications in particular are rarely discussed as viable clinical interventions yet merit investigation. This systematic review was performed to assess the relationship between dietary patterns and hsCRP among individuals enrolled in randomized controlled trials. National Library of Medicine (ie, MEDLINE) and Google Scholar searches were performed using the search terms "C-reactive protein," "CRP," "dietary pattern," and/or "diet" to identify articles published between January 2000 and October 2017. Data were extracted and analyzed according to PRISMA guidelines. Identified abstracts were reviewed and cross-referenced for relevance to dietary pattern. Full-text manuscripts were then abstracted for their principal findings. Fifty-six manuscripts met inclusion criteria for detailed review. Clinical trials of dietary interventions to reduce hsCRP are mixed in quality and findings. Several specific dietary patterns may reduce hsCRP, including low-fat, low-carbohydrate, Mediterranean, Portfolio, Paleolithic, and the Dietary Approaches to Stop Hypertension (DASH) diets. However, results were mixed for the majority of dietary patterns (eg, low-glycemic load diets). Information available to date suggests that a wide variety of dietary patterns may impact serum hsCRP, although studies are mixed in quality. The efficacy of dietary patterns for the treatment of elevated hsCRP as a strategy for primary prevention of CHD may be best elucidated in randomized clinical trials in healthy participants with elevated hsCRP but low or normal traditional risk factors, or by using more aggressive dietary modifications in high-risk patients. Given current incidence and prevalence of CHD risk factors, additional randomized controlled trials of this type are justified and needed.

Health and longevity in relation to CHD risk factors in a tribal population of India

High prevalence of Coronary Heart Disease (CHD) in parallel with economic development is observed among South Asian Countries. It is very much surprise to observe a tribal population of Kerala (Kurichias), India are having lengthy longevity who are free from age-associated chronic problems. Hence, we conducted a survey to evaluate the prevalence of obesity, central obesity, hypertension, dyslipidemia & smoking habits in a random simple of 410 (225 male +185 female) subjects. The prevalence (age standardized to the world population of Segi 95% CI and the discussion paper of World Health Organization) was: obesity 2.87 (1.22-4.53), central obesity 3.71 (2.27-5.15), hypertension 2.70 (1.92-3.38), hypercholesterolemia 0.71 (0.66-0.76), hypertriglyceridemia 2.60 (1.18-4.02) and low high density lipoprotein cholesterol 1.24 (1.07-1.42). The metabolic and anthropometric measurements in the study sample showed lower compared to other Indian and Western studies. The low prevalence of CHD risk factors in Kurichias could be attributed to the stress free economic activities and intake of coarse variety of grain and leading a healthy longevity. Keywords: Health, Longevity, CHD, Tribal, dietary, obesity, Lipids.

The prevalence of coronary heart risk factors among medical students at a teaching hospital

Introduction: Saudi Arabia is experiencing alarming rates of cardiovascular disease (CVD). Providing consistent data on the magnitude of CVD among the young population of Saudi Arabia will help in controlling the risk factors and avoiding their consequences. Objective: To estimate the prevalence of risk factors of coronary heart disease (CHD) among medical students at King Abdulaziz University, Jeddah, Saudi Arabia. Materials and methods: A cross-sectional study was performed during the academic year 2012– 2013. Ethical considerations were followed and a multistage stratified random sampling was used to select 214 medical students in their fourth, fifth and sixth clinical years. Data were collected through interview questionnaires, measurements and laboratory investigations. SPSS (Statistical Product and Service Solutions) version 16 (SPSS Inc., Chicago, IL, USA) was used for both descriptive and analytical statistics. CHD risk per cent in 30 years was calculated using the Framingham algorithm based on body mass index. Results: The most common risk factors of CHD were daily intake of high-fat diet (73.4%), low physical activity (57.9%), overweight or obesity (31.2%) and daily consumption of fast food (13.1%). Hypercholesterolaemia (17.2%) and hypertension (9.3%) were also prevalent risk factors. Smoking prevalence was low (2.8%). Males had significantly higher mean scores for most CHD risk factors compared with females (P <0.05). Conclusions: A high prevalence of CHD risk factors prevailed in the current study, especially among males. Intervention programmes to raise the health awareness of adolescents about CHD risk factors and encouragement to adopt healthy dietary behaviour and promote physical exercise should be initiated.

Abstract 227: Estimating the Value of Effective Lipid Management in China

Background: Increasingly sedentary lifestyles and dietary changes associated with economic development in China, combined with progress in the treatment of infectious disease have resulted in a shift in the disease burden - the so-called epidemiological transition. Cardiovascular disease (CVD), including coronary heart disease (CHD) and other non-communicable diseases now play an increasingly important role in the disease burden faced by China. However, little is known about the future burden of CHD morbidity and mortality, as well as the cost-effectiveness of particular CHD-prevention policies in China. Objectives: To estimate the impact of aging and epidemiological transition on the burden of CHD morbidity and mortality over the next 15 years in China and to estimate the net value of effective lipid management. Methods: First, we estimate the prevalence of CHD and other risk factors based on the China Health and Nutrition Survey. Next, using prediction from the literature regarding trends in demographic and cardiovascular risk factors, such as elevated low-density lipoprotein cholesterol (LDL-C), we model how CHD risk will evolve between 2015 and 2030. We then estimate how expanded use of statins for lipid management over the next 15 years would alter the prevalence of elevated LDL-C as a risk factor, and determine how this would dampen the future growth in CHD burden. Accounting for the costs of statin use, we assess the net value of a policy that expands statin utilization for lipid management in China. Results: We find that - left unchecked - rising prevalence of CHD risk factors and the aging of the Chinese population will lead to the incidence of heart attacks rising from 4 million in 2015 to over 6 million in 2030. Similarly, the number of CHD deaths will rise from 1.3 million in 2015 to over 2 million in 2030. Treating all hyperlipidemia patients with statins would avert 10.5 million heart attacks and 3.5 million CHD deaths between 2015 and 2030. Based on current estimates of treatment costs in China and the cost of statins, we predict that such a policy would produce a net social value of $176 to $226 billion over the next 15 years. Conclusions: In light of its aging population and continued economic development, China faces near-certain increases in the incidence of CHD morbidity and mortality. Preventative measures such as effective lipid management may reduce the CVD burden substantially and also provide large social value to the society. At a time when the Chinese government is taking steps towards a more systematic approach to health care delivery, primary and secondary prevention of CVD should be high on the agenda.

Risk factors of coronary heart disease among medical students in King Abdulaziz University, Jeddah, Saudi Arabia

BackgroundNowadays, Cardiovascular Diseases (CVDs) represents an escalating worldwide public health problem. Providing consistent data on the magnitude and risk factors of CVDs among young population will help in controlling the risks and avoiding their consequences.ObjectiveThe objective was to estimate the prevalence of risk factors of Coronary Heart Disease (CHD) among medical students during their clinical clerkship (4th - 6th years).MethodsA cross-sectional study was done during the educational year 2012–2013 at King Abdulaziz University (KAU), Jeddah. Ethical standards were followed and a multistage stratified random sample method was used for selection of 214 medical students. Data was collected through an interviewing questionnaire, measurements and laboratory investigations. Both descriptive and analytical statistics were done by SPSS version 21. CHD risk percent in thirty years was calculated using Framingham algorithm for each student, then the risk among all students was determined.ResultsThe commonest risk factors of CHDs were daily intake of high fat diet (73.4%), physical inactivity (57.9%), overweight/or obesity (31.2%) and daily consumption of fast food (13.1%). Hyper-cholesterolemia (17.2%) and hypertension (9.3%) were also prevalent risk factors. Smoking prevalence was low (2.8%). Males had significantly higher mean scores for most of CHD risk factors compared to females (p < 0.05). Systolic Blood pressure was higher among males (119.47 ± 11.17) compared to females (112.26 ± 9.06). A highly statistical significant difference was present (Students’t test = 4.74, p < 0.001). Framingham Risk Score revealed that CHD risk percent in thirty-years among all students was 10.7%, 2.3% and 0.5% for mild, moderate and severe risk, respectively.ConclusionAn alarmingly high prevalence of CHD risk factors was prevailed among medical students, especially among males. However, a low prevalence of smoking may indicate the success of “Smoke-free Campus” program. Screening risk factors of CHD among medical students and implementation of intervention programs are recommended. Programs to raise awareness about CHD risk factors, encourage young adult students to adopt a healthy dietary behavior and promote physical exercise should be initiated.

The Relationship Between Religious Service Attendance and Coronary Heart Disease and Related Risk Factors in Saskatchewan, Canada

Research suggests that attending religious services could provide small yet important protective benefits against coronary heart disease (CHD) and CHD risk factors (e.g., diabetes, hypertension). The extent to which these benefits apply to Canada deserves study because approximately one-third of adult Canadians attend religious services at least monthly. Therefore, the objective of this study is to examine the association between frequency of religious service attendance and prevalence of (1) CHD, (2) diabetes, and (3) hypertension in Canada. We used the Saskatchewan sample (n=5,442) of the Canadian Community Health Survey (CCHS-4.1) and built multivariable logistic regression models to evaluate associations between religious service attendance and self-reported CHD, diabetes, and hypertension. After controlling for demographic, socioeconomic and health behavior variables, the association between religious service attendance and prevalence of CHD was not significant (OR=0.82; 95% CI 0.61-1.11). However, persons who attended religious services more than once a week exhibited lower prevalence odds of diabetes (OR=0.60; 95% CI 0.45-0.80) and hypertension (OR=0.82; 95% CI 0.68-0.99) compared to persons who attended less than once a year. The findings of this study are the first to suggest religious service attendance may be associated with a lower prevalence of CHD risk factors in Canada.

Lipoprotein(a) levels, apo(a) isoform size, and coronary heart disease risk in the Framingham Offspring Study

The aim of this study was to assess the independent contributions of plasma levels of lipoprotein(a) (Lp(a)), Lp(a) cholesterol, and of apo(a) isoform size to prospective coronary heart disease (CHD) risk. Plasma Lp(a) and Lp(a) cholesterol levels, and apo(a) isoform size were measured at examination cycle 5 in subjects participating in the Framingham Offspring Study who were free of CHD. After a mean follow-up of 12.3 years, 98 men and 47 women developed new CHD events. In multivariate analysis, the hazard ratio of CHD was approximately two-fold greater in men in the upper tertile of plasma Lp(a) levels, relative to those in the bottom tertile (P < 0.002). The apo(a) isoform size contributed only modestly to the association between Lp(a) and CHD and was not an independent predictor of CHD. In multivariate analysis, Lp(a) cholesterol was not significantly associated with CHD risk in men. In women, no association between Lp(a) and CHD risk was observed. Elevated plasma Lp(a) levels are a significant and independent predictor of CHD risk in men. The assessment of apo(a) isoform size in this cohort does not add significant information about CHD risk. In addition, the cholesterol content in Lp(a) is not a significant predictor of CHD risk.

Prevalence of Coronary Heart Disease Risk Factors and Screening for High Cholesterol Levels Among Young Adults, United States, 1999-2006

Previous studies have reported low rates of screening for high cholesterol levels among young adults in the United States. Although recommendations for screening young adults without risk factors for coronary heart disease (CHD) differ, all guidelines recommend screening adults with CHD, CHD equivalents, or 1 or more CHD risk factors. This study examined national prevalence of CHD risk factors and compliance with the cholesterol screening guidelines among young adults. National estimates were obtained using results for 2,587 young adults (men aged 20 to 35 years; women aged 20 to 45 years) from the 1999-2006 National Health and Nutrition Examination Surveys. We defined high low-density lipoprotein cholesterol (LDL-C) as levels higher than the goal specific for each CHD risk category outlined in the National Cholesterol Education Program Adult Treatment Panel III guidelines. About 59% of young adults had CHD or CHD equivalents, or 1 or more of the following CHD risk factors: family history of early CHD, smoking, hypertension, or obesity. In our study, the overall screening rate in this population was less than 50%. Moreover, no significant difference in screening rates between young adults with no risk factors and their counterparts with 1 or more risk factors was found even after adjustment for sociodemographic and health care factors. Approximately 65% of young adults with CHD or CHD equivalents, 26% of young adults with 2 or more risk factors, 12% of young adults with 1 risk factor, and 7% with no risk factor had a high level of LDL-C. CHD risk factors are common in young adults but do not appear to alter screening rates. Improvement of risk assessment and management for cardiovascular disease among young adults is warranted.

Eligibility of Individuals With Subclinical Coronary Artery Calcium and Intermediate Coronary Heart Disease Risk for Reclassification (from the Framingham Heart Study)

Coronary artery calcium (CAC) predicts risk for coronary heart disease (CHD) events and perhaps CAC testing may further stratify risk in individuals at intermediate CHD risk. We sought to determine the percentage of participants at intermediate CHD risk who could potentially be reclassified as having a high CHD risk based on the presence of a high CAC score and the prevalence, treatment, and control of CHD risk factors in this group. Framingham Heart Study Offspring and Third Generation cohort participants underwent multidetector computed tomography (n = 3,529, mean age 51 years, 48% women). High CAC was defined as >or=90th age- and gender-specific percentiles based on a healthy reference group or by an absolute modified Agatston score of 100 HU. Prevalence of CHD risk factors (hypertension, hypercholesterolemia, high low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, smoking, and obesity), their treatment, and control was compared between nondiabetic participants with and without high CAC. Of the 595 participants at intermediate CHD risk, 22% had CAC >or=90th percentile and 39% had CAC >or=100 and could be eligible for reclassification as having a high CHD risk based on the presence of a high CAC score. There were no statistically significant differences in prevalence, treatment, and control of risk factors between those with and without high CAC. In conclusion, prevalence of CHD risk factors did not differ between intermediate-risk participants with and without high CAC. Approximately 25% of intermediate-risk individuals have high CAC scores and may be eligible for reclassification into a higher-risk category.

Coronary Heart Disease Attributable to Passive Smoking: CHD Policy Model

Passive smoking is a major risk factor for coronary heart disease (CHD), and existing estimates are out of date due to recent and substantial changes in the level of exposure. To estimate the annual clinical burden and cost of CHD treatment attributable to passive smoking. Annual attributable CHD deaths, myocardial infarctions (MI), total CHD events, and the direct cost of CHD treatment. A Monte Carlo simulation estimated the CHD events and costs as a function of the prevalence of CHD risk factors, including passive-smoking prevalence and a low (1.26) and high (1.65) relative risk of CHD due to passive smoking. Estimates were calculated using the CHD Policy Model, calibrated to reproduce key CHD outcomes in the baseline Year 2000 in the U.S. At 1999-2004 levels, passive smoking caused 21,800 (SE=2400) to 75,100 (SE=8000) CHD deaths and 38,100 (SE=4300) to 128,900 (SE=14,000) MIs annually, with a yearly CHD treatment cost of $1.8 (SE=$0.2) to $6.0 (SE=$0.7) billion. If recent trends in the reduction in the prevalence of passive smoking continue from 2000 to 2008, the burden would be reduced by approximately 25%-30%. Passive smoking remains a substantial clinical and economic burden in the U.S.

Angina Pectoris

Coronary heart disease (CHD) remains the leading cause of death in the United States, accounting for 26.6% of all deaths in 2005, with an age-adjusted male to female mortality ratio of 1.5.1 Although the CHD mortality rate has steadily declined since its peak in the 1960s, morbidity from CHD has shown opposite trends, with increasing rates of revascularization and an increasing prevalence of angina pectoris, now estimated at 9.1 million (4.6 million women [3.9%]; 4.4 million men [4.4%]).2 In stark contrast to CHD mortality rates, age-adjusted prevalence rates for angina in the United States are higher among women than men.2 Anginal symptoms tend to persist despite medical therapy and revascularization, lead to substantial functional disability, and be associated with high healthcare costs even in the absence of obstructive coronary artery disease (CAD).3,4 Article p 1526 In 1990, Kalin and Zumoff showed in a large ecological study that the male:female CHD mortality ratio was quite constant across countries despite widely varying CHD mortality rates between countries, suggesting an inherent gender difference.5 Similar data for angina have not been available. The study by Hemingway et al6 in this issue was thus undertaken to determine whether differences in angina rates by gender are similarly constant in countries that greatly differ in the prevalence of CHD risk factors and prevalence of CHD. The authors conducted a meta-analysis of cross-sectional and prospective cohort studies of 74 populations within 31 countries encompassing around 40 000 individuals (nearly 50% women). All studies ascertained angina by Rose questionnaire. Countries were categorized by their male:female myocardial infarction mortality ratio, their geographical region, and their level of economic development. Angina prevalence varied approximately 20-fold between countries, ranging from 0.73% to 14.4% in women and 0.76% to 15.1% in men. Female and male angina prevalence …

Shrinking cardiovascular risk through bariatric surgery: application of Framingham risk score in gastric bypass

The Framingham risk score estimates 10-year coronary heart disease (CHD) risk based on gender, age, smoking status, blood pressure, TC, HDL-C, and diabetes mellitus status. It was designed to be independent of weight, and as such it is the ideal model to estimate the impact of bariatric surgery on the change in this risk. Our study evaluates the effect of gastric bypass on the prevalence of CHD risk factors and then utilizes the Framingham risk score to estimate the postoperative reduction in 10-year CHD risk. Retrospectively, 101 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass were reviewed. The 10-year CHD risk was calculated using historic, biometric, and laboratory data. The mean body mass index decreased from 46.9 +/- 5.8 kg/m(2) preoperatively to 28.7 +/- 4.0 kg/m(2) one year postoperatively. All physical and biochemical markers of cardiac risk improved significantly. Systolic blood pressure fell from 143 +/- 20 mmHg to 123 +/- 18 mmHg (14%) and diastolic blood pressure fell from 81 +/- 10 mmHg to 71 +/- 11 mmHg (12%). Total cholesterol declined from 202 to 165 (18%); LDL-C declined from 118 to 97 (18%); and HDL-C increased from 45 to 51 (14%). The overall 10-year CHD risk decreased from 6.7 +/- 5.5% to 3.2 +/- 3.1%, representing an absolute risk reduction of 3.3% or relative risk reduction of 52%. This risk reduction was similar in subgroups based on preoperative CHD risk or on initial BMI. Using the Framingham risk score we show that gastric bypass surgery reduces 10-year coronary risk by more than half. Additionally, to the increasing evidence of the salutary effect gastric bypass surgery has on CHD risk, we contribute assessment of 10-year risk in subjects at stable weight loss and within the Framingham model's validated parameters.

Comparison of the 1997 and 2003 American Diabetes Association Classification of Impaired Fasting Glucose: Impact on Prevalence of Impaired Fasting Glucose, Coronary Heart Disease Risk Factors, and Coronary Heart Disease in a Community-Based Medical Practice

The goals of this study were to assess the effect of the 2003 American Diabetes Association definition of impaired fasting glucose (IFG) on prevalence of IFG, coronary heart disease (CHD) risk factors, and CHD compared with the 1997 IFG definition. Although IFG is viewed as increasing CHD risk, this association is unclear and has not been well studied after changing the IFG criterion, especially in a clinical practice setting. This was a cross-sectional evaluation of 8,295 members (3,763 men and 4,532 women) of a community medical center who were between the ages of 30 and 69 years, without a history of diabetes mellitus, and who had available measurements of fasting plasma glucose and lipid concentrations within the past 2 years. The prevalence of IFG, CHD risk factors, and CHD with the 1997 and 2003 IFG definition was compared. The prevalence of IFG increased from 8% to 35% with the 2003 criterion. Individuals with glucose of 100 to 109 mg/dl had lower prevalence of most CHD risk factors (hypertension, triglyceride > or =150 mg/dl, high-density lipoprotein cholesterol <40 mg/dl, meeting 2 components of the metabolic syndrome criteria, CHD risk > or =10% by Framingham score) compared with individuals with glucose 110 to 125 mg/dl. Individuals identified with the 2003 IFG definition did not have an increase in known CHD when adjusted for covariates (odds ratio 1.4 [95% confidence interval (CI) 0.7 to 2.3] vs. 3.2 [95% CI 1.8 to 5.9]). One-third of the population has IFG with the 2003 definition, yet many of these individuals do not have increased prevalence of CHD risk factors or CHD.

Relationship Between Physical Activity, Fitness, and CHD Risk Factors in Middle-Age Chinese

Background:The impact of physical activity, aerobic fitness, and body composition on coronary heart disease (CHD) risk factors in Hong Kong Chinese adults has not been previously investigated.Methods:The study surveyed 707 randomly selected middle-age Hong Kong Chinese by telephone for Physical Activity Rating (PAR). Three hundred and sixteen respondents (age: 45.1 ± 8.1 y) participated in subsequent aerobic fitness testing (VO2max) and CHD risk factor screening.Results:More than 70% of respondents did not have sufficient levels of physical activity. Fifty percent of the men and 19.5% of the women had two or more CHD risk factors. PAR correlated poorly with VO2max and CHD risk factors. VO2max showed significant associations with CHD risk factors. The adjusted odds ratios of having CHD risk factors for unfit participants ranged from 1.11 to 6.61 as compared to fit participants. Obese but fit individuals demonstrated lower odds of CHD risk factors than the obese and unfit individuals. WC was found to be a stronger predictor for CHD risk factors than BMI.Conclusions:The prevalence of CHD risk factors in middle-age Chinese in Hong Kong was high and was related to levels of aerobic fitness and obesity.

Health-care consumption and recurrent myocardial infarction after 1 year of conventional treatment versus short- and long-term cardiac rehabilitation

Background. The objective of the present study was to compare the efficacy of a conventional treatment and short- and a long-term cardiac rehabilitation program in terms of health-care consumption and recurrence of myocardial infarction in coronary heart disease (CHD) patients. Methods. One hundred twenty-eight patients were followed over a 1-year period post-myocardial infarction (MI). The patients in the control group ( n = 54) received conventional treatment (COT) including general education on CHD and risk factor management by their physician. On the other hand, 74 patients agreed to participate in a formal phase 1 and 2 short-term cardiac rehabilitation program (ST-CRP) for a period of 3 months. Of these 74 patients, 37 participated for at least 1 year post-MI in a medically supervised phase 3 long-term cardiac rehabilitation program (LT-CRP). Results. Baseline characteristics, prevalence of CHD risk factors, and short-term cardiovascular disease (CVD) prognosis were similar among groups. After a 1-year follow-up post-MI, the percentage of patients assessed for chest pain or suspicion of cardiac-related problems at the emergency room (ER) and the total number of visits to the ER were similar among groups. However, the percentage of patients and the total number of hospital readmissions were significantly less ( P < 0.05) at 1-year follow-up in the LT-CRP group. The total number and the mean of visits to the ER and hospital readmissions at 3 months were similar among the three groups. However, there were significantly fewer ( P < 0.05) visits to the ER and hospital readmissions for the remainder of the year (between 3 and 12 months) for the patients in the LT-CRP group. Furthermore, patients who received COT had a significantly higher incidence of recurrent MI and fatal MI over the 1-year follow-up in comparison to the patients in the ST- and LT-CRP groups. Conclusion. These results support the recommendation of an ST- or LT-CRP in secondary prevention to lower the incidence of recurrent and fatal MI. However, LT-CRP was more efficient at reducing health-care consumption after a 1-year follow-up post-MI than ST-CRP.

United States coronary mortality trends and community services associated with occupational structure, among blacks and whites, 1984–1998

This paper examines the association between US county occupational structure, services availability, prevalence of risk factors, and coronary mortality rates by sex and race, for 1984–1998. The 3137 US counties were classified into five occupational structure categories; counties with the lowest percentages of the labor force in managerial, professional, and technical occupations were classified in category I (5–16%), counties with the highest percentages were in category V (32–59%). Directly age-adjusted coronary heart disease (CHD) mortality rates, for aged 35–64 years, (from vital statistics and Census data), per-capita services (County Business Patterns), and the prevalence of CHD risk factors (Behavioral Risk Factor Surveillance Surveys data) were calculated for each occupational structure category. CHD mortality rates and the prevalence of risk factors were inversely monotonically associated with occupational structure categories for white men and women but not among black men and women. Numbers of producer services for banking, business credit, overall business services and personnel/employment services were 2–12 times greater in category V versus I counties. Consumer services such as fruit/vegetable markets, fitness facilities, doctor offices and social services were 1.6–3 times greater in category V versus I counties. Residential racial segregation scores remained high in most areas despite declines during 1980–1990; occupational segregation by race and gender were shown indicating continued institutional racism. An ecological model for conceptualizing communities and health and the overall influence of state and national occupational structure is discussed; intervention strategies such as decreased wage disparities and ‘living wage’ standards and development is discussed.

Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada

The Framingham coronary heart disease (CHD) functions overestimate the risk of CHD in countries with a low incidence. Consequently, these functions should be calibrated for the purpose of primary prevention. Calibrated Framingham function charts of overall CHD risk for the Spanish population are presented. Patients and methods. The Framingham functions were calibrated by substituting the prevalence of CHD risk factors and incidence found in Framingham with the same values for Spain. The Framingham function that included high-density lipoprotein (HDL) cholesterol was used. The 10-year probability of developing a CHD event was estimated for several combinations of risk factors and HDL levels ranging from 35 to 59 mg/dl. Color-coded charts were prepared that show the exact probability of CHD corresponding to each combination of risk factors, shown in separate cells on the chart. The event rate and prevalence of CHD risk factors differed considerably between Girona and Framingham. HDL < 35 mg/dL increased risk by approximately 50% and HDL > 60 mg/dL reduced it by 50%. The proportion of cells in which the 10-year probability of developing a CHD event was > 9% was 2.3 times higher and that of cells with a probability > 19% was 13 times lower in the chart calibrated for Spain than in the original Framingham charts. The calibrated Framingham function may help to more accurately estimate the overall risk of CHD in the Spanish population for primary prevention purposes. The calibrated function should be validated, and the development of functions for the Spanish population should be promoted.

Socioeconomic status and the prevalence of coronary heart disease risk factors.

South Asian countries have a high prevalence of coronary heart disease (CHD) in line with their economic development. India, in particular, has a high burden of CHD. Hence, the aim of the present study was to assess the prevalence of CHD risk factors in a semiurban population of Andhra Pradesh, India, in different socioeconomic status (SES) groups. Information was collected on socioeconomic status, physical activity, cigarette smoking, body mass, blood pressure (BP) and serum lipid profiles among a healthy sample of 440 men and 210 women with an age range of 20-70 years. Mean levels of serum cholesterol (SC), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC) and skinfold ratio were found to be higher among women, whereas triglycerides (TG), systolic BP and diastolic BP were higher in men. No statistically significant differences in body mass index (BMI) or pulse rate were observed between the sexes. In men, a significant positive rank correlation (rho = P < 0.05) was observed between SES and SC, TG, systolic and diastolic BP, pulse rate and BMI, but in women, the same trend was found only with SC, TG, skinfold ratio and age. The prevalence (age standardized to the world population of Segi, 95% CI) of obesity was 14.37% (11.06-17.68), hypertension 13.13% (9.11-17.15), hypercholesterolemia 18.56% (13.88-23.24), hypertriglyceridemia 45.98% (36.47-55.49) and low HDLC 31.01% (24.25-37.77). In both sexes, the prevalence of hypercholesterolemia, hypertriglyceridemia and sedentary life style increased among higher SES groups (P < 0.05). Also, an increase in the level of social class was positively associated with mean levels of serum cholesterol and triglycerides in both men and women. The results demonstrate that higher SES groups have greater prevalence of CHD risk factors than lower SES groups. Preventive measures are required to reduce the risk factors among higher SES groups.

Prevalence of coronary heart disease risk factors in Costa Rican adolescents

Purpose: To determine the prevalence of coronary heart disease (CHD) risk factors among Costa Rican adolescents. Methods: The prevalence of high blood pressure, obesity, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, sedentarism, family history of premature CHD, saturated fat intake, diabetes mellitus, and cigarette smoking was determined in 328 adolescents, ages 12–18 years (167 males, 161 females), randomly selected from San José’s urban and rural high schools. Results: Over 70% of the adolescents studied presented one risk factor for CHD. While the prevalence of family history of premature CHD, sedentarism, and cigarette smoking was significantly higher in urban adolescents, low HDL cholesterol and high blood pressure were significantly higher in rural adolescents. Girls demonstrated a significantly higher prevalence of sedentarism and LDL cholesterol >2.9 mmol/L than boys. Elevated saturated fat intake (>10% total energy) was found in 37% of the adolescents. Conclusions: The prevalence of CHD risk factors among Costa Rican adolescents is high; particularly of saturated fat intake, sedentarism and low HDL-C levels. Primary prevention programs are urgently needed, especially among female adolescents and in the urban areas, to reduce the increased prevalence of CHD mortality among Costa Rican adults.