Prevalence Of Most Risk Factors Research Articles

Magnitude of risk factors for chronic noncommunicable diseases in adolescents and young adults in Brazil: A population-based study.

Estimate the magnitude and factors associated with risk factors for chronic noncommunicable diseases in adolescents and young adults in Brazil. Cross-sectional study that analyzed data from the 2019 National Health Survey. The population of interest was adolescents and young adults aged 15 to 24 years. Data were collected through individual interviews during home visits. Dependent variables included major risk factors for chronic noncommunicable diseases. Demographic and socioeconomic characteristics were used as independent variables. Multiple Poisson regression models were used to assess the relationship between independent variables and risk factors. A total of 10,460 individuals (5,001 men and 5,459 women) were included. Regardless of sex, the most prevalent risk factors were insufficient fruit and vegetable consumption (92.6%) and leisure-time physical inactivity (43.3%). The prevalence rates of tobacco smokers, alcohol consumption once a month or more, and alcohol abuse were 8.9%, 28.7%, and 18.5%, respectively. Regular consumption of soft drinks and/or artificial juices was described by 17.2%. The prevalence of overweight was 32.5%. Young adults, males, and individuals with lower educational levels, of black race/skin color, with lower household income, and residents of urban areas had a higher prevalence for most risk factors. Differences in the determinants were found for some factors. Inequalities between Brazilian regions were recorded for seven of the nine factors analyzed. The most socioeconomically developed regions had the highest prevalence of most risk factors. The high magnitude of risk factors indicates a potential increase in the burden of chronic noncommunicable diseases in a future scenario for Brazil.

Increasing age as a major determinant of major adverse outcomes in patients with atrial fibrillation: the EURObservational research programme in atrial fibrillation general long-term registry

Abstract Introduction Increasing age is a well-known determinant for incident atrial fibrillation (AF) as well as for adverse outcomes. With a progressively ageing population in Europe (and elsewhere), contemporary data are needed to investigate the impact of age in relation to major adverse events in AF patients. Purpose To evaluate the impact of increasing age on major adverse outcomes in a contemporary European AF cohort. Methods Patients enrolled in the EORP-AF Long Term General Registry were categorized by age: <65, 65–74, 75–84, and ≥85 years. Any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death, CV death, all-cause mortality were considered as outcomes. Results Among the 9762 patients included in this analysis, 2946 (30.2%) were <65 years, 3288 (33.7%) were 65–74 years, 2954 (30.3%) were 75–84 years and 574 (5.9%) were ≥85 years. With increasing age categories, there was a progressively higher prevalence of most risk factors and comorbidities. Accordingly, both mean CHA2DS2-VASc and HAS-BLED scores were progressively higher across the age categories (both p<0.0001). At discharge, use of any oral anticoagulant (OAC) drug was lower in patients ≥85 years compared to those aged 65–74 or 75–84 years (83.6% vs. 89.4% and 88.8%, respectively) but significantly higher than in those <65 years (80.2%) [p<0.001]. Rate of all major adverse events progressively increased across the age categories, being higher in those aged ≥85 (all p<0.001). Kaplan-Meier curves showed an increasing cumulative risk across the age groups for all the outcomes (p<0.0001) (Figure 1). A fully adjusted Cox regression analysis demonstrated a progressively increasing association between age categories and the risk of all major adverse outcomes (Table 1). Conclusions In a large contemporary cohort of European AF patients, increasing age was a major determinant of major adverse outcomes. Figure 1. Kaplan-Meier Curves for All-Cause Death Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies supported its activities with unrestricted grants.

Enfermedad cardiovascular y diabetes

Según la Organización Mundial de la Salud (OMS), de los 57 millones de muertes globales/año, en el mundo, el 71% se debe a enfermedades no transmisibles y, dentro de ellas, más de la mitad a enfermedad cardiovascular. La hipertensión, el tabaquismo, la glucemia alta, la inactividad física, el sobrepeso y la obesidad, y los niveles altos de colesterol se encuentran entre los principales factores de riesgo de muerte a nivel mundial. La mayoría de estos factores se asocia con la incidencia de enfermedad cardiovascular (ECV) y diabetes mellitus (DM), y los pacientes con DM tienen una alta prevalencia de la mayoría de los factores de riesgo.

Prevalence of coronary artery disease risk factors in patients undergoing coronary artery bypass surgery in West Azerbaijan province

Background and aims: Coronary artery disease (CAD) is one of the main causes of death worldwide and coronary artery bypass grafting (CABG) surgery accounts for 1.4% of all operating room procedures. Considering the importance of the above-mentioned issue, the present study aimed to assess CAD risk factors in CABG patients to provide more accurate information for health authorities. Methods: To this end, data of all patients with isolated primary on-pump CABG were collected from March 2014 to March 2016. The major risk factors of CAD were recorded as a history of cigarette smoking, dyslipidemia, hypertension, diabetes mellitus (DM), advanced age, a family history of CAD, obesity, and male gender. Statistical analyses were performed by SPSS using a t test, as well as the chi-square and Fisher exact tests, and the P value less than 0.05 was considered statistically significant. Results: During a 24-month period, 895 patients underwent isolated primary on-pump CABG in the only open-heart surgery center in the West Azerbaijan province of Iran. The mean age of the patients was 60.4±10.3 years (within the range of 40 to 93 years). In addition, most of the patients amounting to 525 cases (58.7%) were in the age group of 55-70 years and had two or more risk factors. Further, 98.8% of males (age ≥45) and 68.2% of females (age ≥ 55) were old, and 73.3% and 26.7% of the patients were men and women, respectively. Furthermore, risk factors such as hypertension, cigarette-smoking, DM, hyperlipidemia, obesity, and family history were observed in 53.3%, 47.9%, 37.8%, 28.5%, 61.1%, and 19.3% of the patients, respectively. As regards gender, the prevalence of coronary risk factors like hypertension (60.7 vs. 50.6%, P=0.005), DM (51.9 vs. 32.6%, P=0.001), hypercholesterolemia (43.5 vs. 23%, P=0.001), and obesity (68.2 vs. 58.5%, P=0.005) were higher in women but other factors such as smoking (19.2 vs. 58.4%, P=0.001) and positive family history (14.6 vs. 21%, P=0.01) were higher in men. Conclusion: Overall, the prevalence of most risk factors was more common among under 55-year group, especially in women, and this is a warning for increasing CADs in the future

Sensorineural and conductive hearing loss in infants diagnosed in the program of universal newborn hearing screening

ObjectiveThe aim of this study was to analyze infants diagnosed with sensorineural or conductive hearing deficit and to identify risk factors associated with these defects. Material and methodsA retrospective analysis of infants diagnosed with hearing deficit based on the database of the universal newborn hearing screening program and medical records of the patients. Results27 935 infants were covered by the universal neonatal hearing screening program. 109 (0.39%) were diagnosed with hearing deficit and referred for treatment and rehabilitation. 56 (51.4%) children were diagnosed with conductive, 38 (34.9%) with sensorineural and 15 (13.8%) with mixed type of hearing deficit. Children with sensorineural hearing deficit more frequently suffered from hyperbilirubinemia (p < 0.05), while infants with conductive hearing loss were more frequently diagnosed with isolated craniofacial anomalies (p < 0.05). The prevalence of other risk factors did not differ between the groups. Sensorineural hearing deficit occurred almost 3 times more often bilaterally than unilaterally (p < 0.05). In other types of hearing deficit, the difference was not significant. In children with conductive and mixed type of hearing loss the impairment was mainly mild while among those with sensorineural hearing deficit in almost 45% it was severe and profound (p < 0.05). When analyzing the consistency between hearing screening test by means of otoacoustic emissions and the final diagnosis of hearing deficit we found that the highest agreement rate was observed in children with sensorineural hearing loss (p < 0.01). ConclusionsThe prevalence of most risk factors of hearing deficit was similar in children with sensorineural, conductive and mixed type of hearing loss, only hyperbilirubinemia seemed to predispose to sensorineural hearing deficit and isolated craniofacial malformations seemed to be associated with conductive hearing loss. Sensorineural hearing deficit usually occurred bilaterally and was severe or profound, while conductive and mixed type of hearing deficit were most often of mild degree. Most children with the final diagnosis of sensorineural hearing deficit had positive result of hearing screening by means of otoacoustic emissions.

Clinical outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction according to sex and race.

Female sex and South Asian race have been associated with poor clinical outcomes following primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) but remain understudied in large real-world series. We therefore investigated the association of sex and race with clinical outcomes following PPCI. We conducted a prospective study of all patients undergoing PPCI for STEMI between January 2009 and December 2011 at a large UK cardiac centre. Clinical characteristics and outcomes were compared according to sex and race using Chi-square test, independent samples Student's t-test and Mann-Whitney U-test. Primary and secondary outcomes were 12-month major adverse cardiovascular events (MACEs) - defined as all-cause mortality, myocardial infarction and unplanned revascularization, analysed using Cox proportional hazard models adjusting for cardiovascular risk factors. Three thousand and forty-nine patients were included. Women ( n=826) were older than men ( n=2223) (median age 69 vs. 60 years, p <0.01). Mortality (hazard ratio 1.48 (1.15-1.90)) and MACE (hazard ratio 1.40 (1.14-1.72)) were higher in women in univariable analysis. However, there were no significant sex-differences in mortality or MACE after age-stratification alone. Multivariable analysis also showed no significant differences in outcomes between sexes. South Asians ( n=297) were younger but had a higher prevalence of most risk factors than White patients ( n=2570). Mortality and MACE did not differ significantly between South Asian and White patients in univariable or multivariable analysis. MACE and mortality was not greater in women, or in South Asian patients following PPCI after adjustment for cardiovascular risk factors including age, which was most strongly associated with both outcomes.

A demonstration project: Providing colon cancer screening to homeless people—Capitalizing on community partnerships.

e18009 Background: Homeless people encounter many barriers to healthcare and preventative services, while having an increased prevalence of most risk factors for cancer. A group of homeless adults (40) receiving services from Preble Street in Portland Maine were successfully provided access, support and coaching to participate in colon cancer screening using Fecal Immunochemical Test (FIT) over a period of six weeks. Maine Medical Center Cancer Institute (MMCCI) recruited a Physician champion, while Preble Street gathered multiple internal and external community partners and together help plan the project identify resources needed, plan for data collection and address potential barriers for participation. Methods: Community partners (MMCCI, Preble Street, Casco Bay Surgery, NorDx, MaineHealth Care Partners and Homeless Health Partners Case Managers, Me Health LRC, and Maine Medical Center Magnet Council) created a detailed protocol to be used to overcome barriers and facilitate screening. The combination of a simple screening tool and caseworker relationship proved to be an effective strategy. Community Partners were used to identify barriers in the process, monitor all test results and navigate patients testing positive to colonoscopy. Small incentives of $10 food cards were provided for those participating in the screening event. Results: Of the 40 participants who were screened 8 (20%) tested positive and are in colonoscopy follow-up, with ages ranging from 50-74 years. The majority of participants 28 (70%) reported never having a provider conversation about colon cancer screening. Conclusions: Providing cancer prevention education and access to screening can have a positive impact on early detection in the homeless population. Identifying practical barriers and solutions are essential to improving cancer screening participation for homeless people.

The results of newborn hearing screening by means of transient otoacoustic emissions – has anything changed over 10 years?

ObjectivesUniversal newborn hearing screening (UNHS) has become the standard of care in many countries. The aim of this study was to evaluate the results of UNHS after ten years of the program in Poland and to compare them with the results of 2003. MethodsIn the study, we analyze the results of UNHS in the University Hospital in Poznan, Poland. Between 01.01.2013 and 31.12.2013, 6827 children were examined by means of otoacoustic emissions. ResultsRisk factors (RF) were identified in 772 (11.3%) newborns, which is significantly less than 10 years ago (p < 0.05). The most frequent RF were: ototoxic medications, treatment in neonatal intensive care unit (NICU) and prematurity < 33 weeks of gestation. In 2003, the most frequent were ototoxic medications and prematurity, less frequent was treatment in NICU and more common was low Apgar score.In 51 (6.6%) newborns with RF, the result of OAE was positive either unilaterally or bilaterally. In infants without RF the result was positive unilaterally in 22 (0.4%) and bilaterally in 14 (0.2%) patients. These results are significantly lower than in our former study.The relative risk of positive result was the highest in infants with complex congenital anomalies (RR = 44.99), craniofacial anomalies (RR = 17.46) and mechanical ventilation for > 5 days (RR = 10.69). In our previous study, the highest RR of positive test results was in infants with family history, congenital malformations and low Apgar score.We found that most predictive as to the final diagnosis was bilaterally positive OAE test. In most patients, the second check confirmed the diagnosis, independently of RF.The number of false positive tests at the 1st level of screening is significantly lower now than 10 years ago, probably due to better staff training. ConclusionsLong term monitoring and the appropriate management of hearing deficit in children is essential. UNHS seems to be the most efficient way of finding children who require treatment of hearing impairment. The prevalence of most risk factors of hearing deficit has significantly changed over the years. The number of false positive results has significantly decreased over the years thanks to better staff training.

Geographic epidemiology of cardiometabolic risk factors in middle class urban residents in India: cross-sectional study.

ObjectiveTo determine epidemiology of cardiovascular risk factors according to geographic distribution and macrolevel social development index among urban middle class subjects in India.MethodsWe performed cross-sectional surveys in 11 cities in India during years 2005–2009. 6198 subjects aged 20–75 years (men 3426, women 2772, response 62%) were evaluated for cardiovascular risk factors. Cities were grouped according to geographic distribution into northern (3 cities, n = 1321), western (2 cities, n = 1814), southern (3 cities, n = 1237) and eastern (3 cities, n = 1826). They were also grouped according to human social development index into low (3 cities, n = 1794), middle (5 cities, n = 2634) and high (3 cities, n = 1825). Standard definitions were used to determine risk factors. Differences in risk factors were evaluated using χ2 test. Trends were examined by least squares regression.FindingsAge–adjusted prevalence (95% confidence intervals) of various risk factors was: low physical activity 42.1% (40.9–43.3), high dietary fat 49.9% (47.8–52.0), low fruit/vegetables 26.9% (25.8–28.0), smoking 10.1% (9.1–11.1), smokeless tobacco use 9.8% (9.1–10.5), overweight 42.9% (41.7–44.1), obesity 11.6% (10.8–12.4), high waist circumference 45.5% (44.3–46.7), high waist–hip ratio 75.7% (74.7–76.8), hypertension 31.6% (30.4–32.8), hypercholesterolemia 25.0% (23.9–26.9), low HDL cholesterol 42.5% (41.3–43.7), hypertriglyceridemia 36.9% (35.7–38.1), diabetes 15.7% (14.8–16.6), and metabolic syndrome 35.7% (34.5–36.9). Compared with national average, prevalence of most risk factors was not significantly different in various geographic regions, however, cities in eastern region had significantly lower prevalence of overweight, hypertension, hypercholesterolemia, diabetes and metabolic syndrome compared with other regions (P < 0.05 for various comparisons). It was also observed that cities with low human social development index had lowest prevalence of these risk factors in both sexes (P < 0.05).ConclusionsUrban middle–class men and women in eastern region of India have significantly lower cardiometabolic risk factors compared to northern, western and southern regions. Low human social development index cities have lower risk factor prevalence.

50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study

Comprehensive long-term data on atrial fibrillation trends in men and women are scant. We aimed to provide such data through analysis of the Framingham cohort over 50 years. We investigated trends in incidence, prevalence, and risk factors for atrial fibrillation and its association with stroke and mortality after onset in 9511 participants enrolled in the Framingham Heart Study between 1958 and 2007. We analysed trends within 10 year groups (1958-67, 1968-77, 1978-87, 1988-97, and 1998-2007), stratified by sex. During 50 years of observation (202,417 person-years), 1544 cases of new-onset atrial fibrillation occurred (of whom 723 [47%] were women). Between 1958-67 and 1998-2007, age-adjusted prevalence of atrial fibrillation quadrupled from 20·4 to 96·2 cases per 1000 person-years in men and from 13·7 to 49·4 cases per 1000 person-years in women; age-adjusted incidence increased from 3·7 to 13·4 new cases per 1000 person-years in men and from 2·5 to 8·6 new cases per 1000 person-years in women (ptrend<0·0001 for all comparisons). For atrial fibrillation diagnosed by electrocardiograph (ECG) during routine Framingham examinations, age-adjusted prevalence per 1000 person-years increased (12·6 in 1958-67 to 25·7 in 1998-2007 in men, ptrend=0·0007; 8·1 to 11·8 in women, ptrend=0·009). However, age-adjusted incidence of atrial fibrillation by Framingham Heart Study ECGs did not change significantly with time. Although the prevalence of most risk factors changed over time, their associated hazards for atrial fibrillation changed little. Multivariable-adjusted proportional hazards models revealed a 74% (95% CI 50-86%) decrease in stroke (hazards ratio [HR] 3·77, 95% CI 1·98-7·20 in 1958-1967 compared with 1998-2007; ptrend=0·0001) and a 25% (95% CI -3-46%) decrease in mortality (HR 1·34, 95% CI 0·97-1·86 in 1958-1967 compared with 1998-2007; ptrend=0·003) in 20 years following atrial fibrillation onset. Trends of increased incidence and prevalence of atrial fibrillation in the community were probably partly due to enhanced surveillance. Measures are needed to enhance early detection of atrial fibrillation, through increased awareness coupled with targeted screening programmes and risk factor-specific prevention. NIH, NHLBI, NINDS, Deutsche Forschungsgemeinschaft.

Association of Demographic and Socioeconomic Factors With Risk Factors for Chronic Kidney Disease.

Objectives:The goal of this study was to examine the association of various demographic and socioeconomic factors with risk factors for chronic kidney disease (CKD).Methods:We used nationally representative pooled data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2007–2013. We estimated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation. We defined CKD as a GFR <60 mL/min/1.73 m2, and 1304 of the 45 208 individuals included in the KNHANES were found to have CKD by this definition. The outcome variable was whether individual subjects adhered to the CKD prevention and management guidelines recommended by the Korea Centers for Disease Control and Prevention. The guidelines suggest that individuals maintain a normal weight, abstain from alcohol consumption and smoking, manage diabetes and hypertension, and engage in regular exercise in order to prevent and manage CKD.Results:This study found that individuals with CKD were more likely to be obese and have hypertension or diabetes than individuals without CKD. In particular, male and less-educated CKD patients were less likely to adhere to the guidelines.Conclusions:Although the prevalence of CKD, as indicated by the KNHANES data, decreased from 2007 to 2013, the prevalence of most risk factors associated with CKD fluctuated over the same time period. Since a variety of demographic and socioeconomic factors are related to the successful implementation of guidelines for preventing and managing CKD, individually tailored prevention activities should be developed.

Abstract 122: Characteristics of Patients with Multivessel Coronary Disease Treated with Percutaneous Intervention Versus Bypass Surgery and Preliminary Mortality Outcomes: A Province-wide Field Evaluation

Introduction: Wide variation in choice of revascularization treatment for patients with multivessel coronary disease has been observed and outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass surgery (CABG) are increasingly examined. Our publicly funded cardiology evaluation unit was mandated by the Quebec Ministry of Health to evaluate the practice of multivessel revascularization and its outcomes across Quebec’s 8 tertiary cardiac centers offering both PCI and CABG. Methods: Hospital records were used to identify all multivessel (≥2 myocardial territories) interventions by PCI and isolated CABG in each center in 2010-12. Primary PCI patients were excluded. A maximum of 300 patients treated with CABG and 300 patients treated with PCI in each center were randomly selected for chart review by our evaluation unit. Results: The study cohort included 2018 PCI patients and 2274 isolated CABG patients. Median age was 66 years for both PCI (interquartile range, IQR: 59-76) and CABG (IQR: 59-72) and prevalence of most risk factors and comorbidities was very similar. However, compared to CABG patients, there were more females in the PCI group (27% vs 17%), more cardiogenic shock (2.2% vs 0.6%), more patients with previous PCI (27% vs 16%) and previous valve surgery (1.2% vs 0.1%), and more patients with interventions in only 2 myocardial territories (89% vs 31%). The PCI group was more likely than the CABG group to have acute myocardial infarction (AMI) (32% vs 18%) but less likely to have heart failure on admission (9% vs 18%). Almost 1 in 5 (19%) PCI patients were treated for left main disease. Diabetes was present in 29% of PCI patients vs 37% of CABG patients. Compared to CABG, PCI patients had a shorter median delay between admission and intervention (0 vs 2 days) as well as between intervention and discharge (1 vs 6 days) and were more likely to be transferred out to another hospital (37% vs 14%). However, mortality before discharge or transfer from tertiary cardiac centers was higher for PCI than CABG patients both with AMI (3.1% vs 0.7%) and without AMI (1.0% vs 0.5%). The differences of all reported comparisons were statistically significant (p&lt; 0.001) except for in-hospital mortality without AMI (p=0.25). Conclusions: Patients with multivessel disease who were treated with PCI were more likely to present with acute symptoms, have more cardiogenic shock and more previous valve surgery but have less extensive coronary disease, less diabetes and less heart failure. Age and other risk factors and comorbidities were very similar in the 2 groups. Crude mortality during the index surgical hospital admission was higher for PCI despite a shorter length of stay. To gain more insight into these results, it will be important to link to medico-administrative data to examine 30-day and 1-year mortality and to adjust appropriately for potential confounders.

Decreasing prevalence but increasing importance of left ventricular dysfunction and reoperative surgery in prediction of mortality in coronary artery bypass surgery: Trends over 18 years

The number of patients referred for coronary artery bypass grafting (CABG) has fallen, whereas their risk profile appears to be increasing. We evaluated changes in the predictors of hospital mortality among patients undergoing CABG during a span of 18 years. Data were collected prospectively for all patients undergoing isolated CABG (n=23,445) from 1991 to 2008. To examine the effect of time on patients' risk profiles and outcomes, we divided patients into 3 time cohorts (1991-1996, n=8280; 1997-2002, n=9801; 2003-2008, n=5364). We used multivariable logistic regression model to identify predictors of mortality in the entire cohort and in each time cohort. Hospital mortality declined from 2.4% (1991-1996) to 1.2% (2003-2008; P<.0001). Urgent or emergency surgery, left ventricular dysfunction, reoperative CABG, increased age, female gender, hypertension, cardiogenic shock, congestive heart failure, peripheral vascular disease, left main disease, and earlier year of operation (1991-1996) were independent predictors of hospital mortality. The prevalence of most risk factors for mortality increased over the 18-year period of this study. In contrast, the prevalence of severe left ventricular dysfunction and reoperative CABG decreased significantly; however, their associated odds of mortality increased with time. Whereas the prevalence of most risk factors increased with time, left ventricular dysfunction and reoperative CABG became significantly less common. However, the odds of mortality associated with these 2 predictors increased, indicating that although they occur less commonly, these 2 risk factors paradoxically play an increasingly important role in determining patient outcomes.

Sociodemographic patterning of non-communicable disease risk factors in rural India: a cross sectional study

Objectives To investigate the sociodemographic patterning of non-communicable disease risk factors in rural India.Design Cross sectional study.Setting About 1600 villages from 18 states in India. Most were from four large...

Major increase in allergic sensitization in schoolchildren from 1996 to 2006 in northern Sweden

Time trends for allergic sensitization are poorly known. To compare the trends in prevalence of allergic sensitization and associated risk factors in children. Two cohorts of children (age 7-8 years) were invited for skin prick tests (SPTs) 10 years apart, 1996 and 2006. The participation rates were 2148 (88%) and 1700 (90%), respectively. The methods were identical, and 10 common airborne allergens were used. An expanded International Study of Allergy and Asthma in Children questionnaire about symptoms and possible risk factors for allergic conditions was completed by the parents. The prevalence of any positive SPT increased from 21% in 1996 to 30% in 2006 (P < .001). The pattern of sensitization remained similar, and sensitization to cat was most common both years, 13% and 19%, respectively. Sensitization to mites and mold was uncommon in both surveys. A family history of allergy was a significant risk factor for a positive SPT both years (odds ratio, 1.7). Factors that in 1996 had a protective effect, such as rural living and having several siblings, had lost this effect in 2006. The prevalence of most risk factors remained similar, but respiratory infections and smoking among parents decreased significantly. During the same period, there was no significant increase in the prevalence of current wheeze (11.9% to 12.4%, P = .636) or symptoms of rhinitis or eczema. The prevalence of allergic sensitization increased significantly from 1996 to 2006, whereas no increase in clinical symptoms was found. The parallel decrease in parental smoking and respiratory infections indicate a different influence of environmental factors on allergic sensitization and clinical symptoms, respectively.

The course of vascular risk factors and the occurrence of vascular events in patients with symptomatic peripheral arterial disease

Previous studies have documented an undertreatment of vascular risk factors, and patients with symptomatic peripheral arterial disease (PAD) are at increased risk of recurrent vascular events. We examined which baseline variables are related to future vascular events, investigated the course of vascular risk factors, and compared the number of vascular risk factors at baseline and at follow-up to determine whether risk factor management could be further improved. This study involved 461 patients with Fontaine classification II to IV who were enrolled in the SMART study (Second Manifestations of ARTerial disease) from September 1996 to December 2000. Patients underwent a standardized screening program for risk factors and were invited for a follow-up measurement during September 2003 to March 2005, after a mean follow-up of 5.5 years (SD, 1.3 years). In the interim period between baseline and follow-up measurement, patients received usual care. During follow-up, vascular events (mortality, ischemic stroke, and myocardial infarction) and PAD-related events (vascular surgery, interventions, and amputations) were documented in detail. In 2739 person-years of follow-up, 91 vascular events occurred, resulting in a 29.1% (95% confidence interval [CI], 22.8%-35.4%) cumulative incidence proportion of recurrent vascular events. Older age, increased homocysteine levels, impaired renal function, and a history of coronary heart disease at baseline were related to an increased risk of new vascular events. Of the 461 patients, 108 patients died, 20 patients were lost to follow-up, and 333 patients were eligible for follow-up measurement, in which 221 (66%) patients wished to participate. In 8 of the 221 patients, a nonfatal vascular event occurred during follow-up. The prevalence of hypertension increased from 51% to 70% (95% CI, 10%-28%), the prevalence of obesity increased from 54% to 67% (95% CI, 3%-21%), and the prevalence of diabetes mellitus increased from 8% to 16% (95% CI, 2%-14%). At follow-up, fewer patients were current smokers (59% to 37%; 95% CI, -13% to -31%), and fewer patients had increased lipid levels (96% to 73%; 95% CI, -29% to -16%). Medication use increased in all drug categories during follow-up. Age, increased homocysteine levels, impaired renal function, and a history of coronary heart disease were independent risk factors for vascular events in patients with symptomatic PAD. The prevalence of most risk factors, except for smoking and hyperlipidemia, increased over a 5.5-year period even though medication use increased over the same period.

Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations

To establish a surveillance network for cardiovascular diseases (CVD) risk factors in industrial settings and estimate the risk factor burden using standardized tools. We conducted a baseline cross-sectional survey (as part of a CVD surveillance programme) of industrial populations from 10 companies across India, situated in close proximity to medical colleges that served as study centres. The study subjects were employees (selected by age and sex stratified random sampling) and their family members. Information on behavioural, clinical and biochemical determinants was obtained through standardized methods (questionnaires, clinical measurements and biochemical analysis). Data collation and analyses were done at the national coordinating centre. We report the prevalence of CVD risk factors among individuals aged 20-69 years (n = 19 973 for the questionnaire survey, n = 10 442 for biochemical investigations); mean age was 40 years. The overall prevalence of most risk factors was high, with 50.9% of men and 51.9% of women being overweight, central obesity was observed among 30.9% of men and 32.8% of women, and 40.2% of men and 14.9% of women reported current tobacco use. Self-reported prevalence of diabetes (5.3%) and hypertension (10.9%) was lower than when measured clinically and biochemically (10.1% and 27.7%, respectively). There was marked heterogeneity in the prevalence of risk factors among the study centres. There is a high burden of CVD risk factors among industrial populations across India. The surveillance system can be used as a model for replication in India as well as other developing countries.

The Risk of Stroke in Patients With First-Ever Retinal vs Hemispheric Transient Ischemic Attacks and High-grade Carotid Stenosis

The prognosis of amaurosis fugax has been considered to be favorable compared with that of hemispheric transient ischemic attacks. However, this has remained uncertain for patients with significant carotid stenosis as the assessment of progression of the disease has been confounded when patients undergo carotid endarterectomy. In the North American Symptomatic Carotid Endarterectomy Trial, patients with high-grade (70% to 99%) carotid stenosis were randomized to receive either medical or surgical treatment, thus making an unconfounded analysis possible. We identified 129 medically treated patients with high-grade carotid stenosis who had their first-ever transient ischemic attack as the entry event into the trial. Fifty-nine patients with retinal transient ischemic attacks (RTIAs) were compared with 70 patients with hemispheric transient ischemic attacks (HTIAs). Patients with HTIAs were older, with a higher prevalence of most risk factors for stroke. Average time of delay from the onset of transient ischemic attacks to medical treatment was longer for patients with RTIAs than for patients with HTIAs (48.5 vs 15.2 days). Kaplan-Meier estimates of the risk of ipsilateral stroke at 2 years were 16.6% +/- 5.6% for patients with RTIAs and 43.5% +/- 6.7% for patients with HTIAs (P = .002 for the difference in risk between RTIAs and HTIAs). From corresponding Cox's proportional hazards regression analyses, the risk of ipsilateral stroke ranged from 11.2% to 28.9% for patients with RTIAs and from 37.4% to 96.3% for patients with HTIAs across stenoses, spanning 75% to 95%. Overall, the relative risk of ipsilateral stroke (HTIAs compared with RTIAs) was 3.23 (95% confidence interval, 1.47 to 7.12), regardless of the degree of high-grade stenosis. To our knowledge, this study is the first report on the expected outcome for medically treated patients with high-grade (70% to 99%) carotid stenosis in whom the first-ever event was either an RTIA or HTIA. The presence of RTIAs carries a considerable risk of ipsilateral strokes, particularly at higher degrees of stenosis. However, in comparison with HTIAs, patients with RTIAs still have a better prognosis.