World Health Organization Monitoring Trends Research Articles

Temporal Trends of the Incidence of Ischemic Heart Disease in Iran Over 15 Years: A Comprehensive Report from a Multi-Centric Hospital-Based Registry.

BackgroundWe sought to explore the temporal trend of ischemic heart disease (IHD) incidence rate (IR) in a large city of Iran.MethodsThe study population comprised hospitalized patients who were living in Isfahan, Iran, with first or recurrent IHD during the period of 2001 to 2016. To identify patients, clinical diagnostic codes were applied according to the International Classification of Diseases 10 (ICD-10: I20.0, I21–I25) and the “World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease” diagnostic categories (WHO-MONICA). Using a direct method, we calculated age-, sex-, and place-of-residence-adjusted incidence rates based on multiple reference populations. To examine the long-term trend for the IR, a bootstrap robust zero-truncated negative binomial regression model was used.ResultsA total of 102,254 hospitalized patients, with a mean (SD) age of 61.85 (12.79), were registered between 2001 and 2016. After an initial reduction from 2006 to 2010, crude and adjusted IRs of IHD increased between 2010 and 2016. We further observed a significant increasing long-term temporal trend in the IR with an average annual change of 1.42% to 3.36% over the study period.ConclusionOur findings showed a decreasing trend in the IR of IHD between 2006 and 2010, possibly attributed to the comprehensive community-based interventions named “Isfahan Healthy Heart Program” performed from 2001 to 2007, followed by an increase in the adjusted IR of IHD between 2010 and 2016 in Isfahan; this indicates the importance of continuing the preventive measures to preclude the risk factors of cardiovascular diseases in our population.

Acute Myocardial Infarction Incidence, Mortality and Case Fatality in Santa Clara, Cuba, 2007–2008

INTRODUCTION: Information on acute myocardial infarction incidence and mortality is essential for determining the efficacy of the health system's cardiovascular disease prevention activities; however, in Cuba, sufficient data related to acute myocardial infarction are lacking, particularly at the local level. OBJECTIVE: Describe acute myocardial infarction incidence, mortality and case fatality rates from January 2007 through December 2008 in persons aged 45-74 in the municipality of Santa Clara, Villa Clara Province, Cuba. METHODS: A retrospective descriptive study was conducted. The World Health Organization MONItoring Trends and Determinants in CArdiovascular Disease Project (MONICA) methodology was used, but only in part, since out-of-hospital case fatalities were not investigated, resulting in insufficient data for such cases. Cases of acute myocardial infarction covered under MONICA definition 1 were included (non-fatal definite, fatal definite, fatal possible, and unclassifiable deaths). Hospitalized patients were followed for 28 days. Incidence, mortality and case fatality rates in the population were calculated by age group (45-54, 55-64 and 65-74 years) and sex. Age-standardized incidence and mortality rates were calculated using the direct method, with the world population as a reference. RESULTS: A total of 482 cases of acute myocardial infarction were registered. The percentage of cases of non-fatal definite, fatal definite, fatal possible and fatal with insufficient data were 32%, 18.3%, 26.3% and 13.9% respectively. The cumulative age-standardized incidence per 100,000 population was 433 (95% CI 365-501) in men and 195 (95% CI 152-237) in women, while mortality per 100,000 population was 242 (95% CI 192-292) in men and 120 (95% CI 87-153) in women. Case fatality was 56.4% in men and 62.6% in women. Most fatal cases (65.6%) occurred out of hospital, a trend that was more marked in men (73.9%) than in women (51%). CONCLUSIONS: Case fatality from acute myocardial infarction in Santa Clara residents was high, especially in women. Two thirds of fatalities occurred out of hospital, a higher proportion of these deaths in men. It is recommended that the AMI registry be completed by investigating out-of-hospital case fatalities with insufficient data; expanding it to include the 35-44 age group; and that the supply of cardiac marker enzyme immunoassay test kits in Santa Clara be stabilized.

Low Levels of Antibodies Against Phosphorylcholine Predict Development of Stroke in a Population-Based Study From Northern Sweden

Natural immunoglobulin M antibodies specific for phosphorylcholine (anti-PC) have been implicated in atherosclerosis. We have shown previously that high levels of anti-PC predict a slower progression of atherosclerosis in humans and that low levels of anti-PC are associated with higher risk for cardiovascular disease. Here we determine the association between anti-PC and the incidence of stroke. Using a nested case control study design, we examined 227 incident cases (125 men and 102 women) of first-time stroke and 455 age- and sex-matched controls identified during a 13-year time period (1985 to 1999) within the population-based cohorts of the Västerbotten Intervention Project (VIP) and the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (WHO MONICA) project in Northern Sweden. Odds ratios of stroke with 95% CIs with adjustments for age, gender, smoking, serum cholesterol, diabetes, body mass index, and blood pressure were determined. Anti-PC levels were measured using ELISA. A significant association between low levels of anti-PC at baseline and incident stroke was seen for the whole group of anti-PC levels below the 30th percentile (multivariately adjusted odds ratio, 1.62; CI, 1.11 to 2.35). Analyses of gender-specific associations indicated fairly strong associations for females, especially at the lowest 30th percentile (multivariately adjusted odds ratio, 2.65; CI, 1.41 to 4.95). No associations were noted for men. Low anti-PC is a novel independent risk marker for development of stroke. Measurements of anti-PC could be used to identify immunodeficient subjects at an increased risk for stroke. The possibility that such subjects might be targets for novel modes of treatment such as immunotherapies deserves further investigation.

Impact of Growth Hormone Therapy on Quality of Life in Adults with Turner Syndrome

GH and/or oxandrolone are used to promote growth in Turner syndrome (TS). The aim of this study was to compare quality of life (QoL) in TS women with controls and determine the impact of growth promoting therapy on QoL in TS women. This was a cross-sectional, case-control study. The study was conducted at an outpatient clinic at Sahlgrenska University Hospital, Göteborg, Sweden. PATIENTS included 111 TS women (age range 18-59 yr) and 111 randomly selected, age-matched women (25-54 yr) from the World Health Organization Monitoring Trends and Determinants for Cardiovascular Disease project (Göteborg, Sweden) served as controls. QoL was estimated by the Psychological General Well-Being scale (anxiety, depressed mood, positive well-being, self-control, general health and vitality) and the Nottingham Health Profile (physical mobility, pain, sleep, energy, social isolation, and emotional reactions). TS women reported more social isolation than controls (P < 0.001). After age adjustment, significantly less pain (<0.05) was reported attributable to GH treatment within TS. No significant difference in any other subscales used could be shown. In TS, QoL was negatively affected by higher current age and age at diagnosis and positively affected by better body balance, fine motor function, and higher bone mineral density. Social isolation was more commonly reported in the whole TS cohort than in the population. Except for less pain, no significant impact on QoL attributable to GH treatment could be found, despite the mean +5.1 cm final height.

Stroke in Isfahan, Iran: Hospital Admission and 28-Day Case Fatality Rate

Background: In Isfahan, a city in the middle of Iran, a community intervention trial has been started for cardiovascular disease prevention and control via reducing its risk factors and improvement of relevant healthy behavior. A surveillance system was needed to monitor vascular diseases, especially stroke, during and following this community intervention program. Methods: A prospective study on hospitalized stroke patients was done in Isfahan, Iran, from 2000 to 2003. All hospitalized stroke events were recorded via a system adopted from the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) project, yet ignoring the MONICA age limitation. The age-adjusted hospital admission rate was calculated. Patients and/or their families were followed and asked regarding the patients’ survival status. Results: The age-adjusted hospital admission rate in Isfahan was increasing from 2000 to 2003 (rising from 84.16 to 103.23/100,000). The 28-day case fatality rates were nearly the same during these years and were about 32%. Ischemic stroke events made up the majority of cases (about 70%), and intracerebral hemorrhage events had the second highest prevalence (25%). Conclusions: This study showed that the stroke hospital admission rate might be increasing in Isfahan. A community-based stroke incidence study is needed to elucidate stroke epidemiology in Isfahan, Iran, as a Middle East country.

Thrombolysis for stroke in India: Miles to go...

Stroke is a major health problem worldwide and is more recent published data show a treatment range of associated with high mortality and dependence. In the 5-11% of incident ischemic stroke in USA and West next 30 years the burden of stroke will grow mostly in European nations. The proportion of patients developing countries rather than in developed receiving thrombolysis therapy in acute stroke is countries. World Health Organization Monitoring Trends pathetically low in India. The only incidence study of and Determinants in Cardiovascular Disease (WHO stroke in India determined an incidence of 163 per 100,000 MONICA) project data showed relatively large populations per year (Dr. N. C. Borah personal geographical differences in stroke-related case-fatality communication). The expected number of incident rates, with the rates in less developed countries among ischemic strokes in India is 14, 43, 528 per year (assuming the highest in the world. ischemic stroke account for 80% of all strokes and Indian The major development in the treatment of acute population in 2005: at 1,107 millions). Anticipated cost ischemic stroke has been the introduction of thrombolysis savings and health benefits (in terms of average QALYs) therapy (intravenous tissue plasminogen activator, tPA), of thrombolysis therapy in India, even if a small proportion which has radically changed the perception and of patients are treated, will be enormous. The Indian management of stroke patients. Cochrane mata-analysis regulatory authority has approved tPA for use in acute shows that thrombolysis therapy reduces death or ischemic stroke. There are centers with infrastructure and dependence by an odds ratio (OR) of 0.66 (95% confidence resources to give tPA widespread across the country. It interval (CI) 0.53-0.83) with no significant increase in is feasible to give intravenous tPA for acute ischemic stroke adverse effects (OR 1.13; CI 0.86-1.48) for patients treated in India as shown by Padma and her colleagues in this within 3h of the onset of an ischemic stroke. This issue of the journal and also by others. However there translates to one extra patient being alive and independent are several barriers for safe and effective implementation for every seven patients treated. The safety of routine of thrombolysis therapy in acute ischemic stroke in India. clinical use of tPA within 3h of stroke onset has been Most of the centers with infrastructure and resources confirmed in the Safe Implementation of Thrombolysis to give thrombolysis therapy are in urban India, where as in Stroke-Monitoring Study (SISTS-MOST). This study 80% of the population lives in rural India where the was designed to control for symptomatic intracerebral resources to give thrombolysis therapy are virtually nonhemorrhage, mortality and independence when compared to randomized controlled trials. Thrombolysis therapy has a very favorable economic profile; the therapy results in a net cost savings. When compared with standard acute stroke care, thrombolysis therapy provides, on average, greater health benefits (in terms of average quality adjusted life years, QALYs) at reasonable medical costs. The anticipated savings that would result from even modest, feasible increase in use of thrombolysis therapy is likely to be enormous. In spite of good clinical efficacy and favorable economic profile, even in industrialized nations thrombolysis therapy is underutilized, only a very small proportion, 2%, of stroke patients are actually being treated. A existent. Indian Collaborative Acute Stroke Study, urban hospital-based, has shown 7-24% of patients present to hospital within three hours of onset of stroke (unpublished data, 2004). One of the major reasons for the late arrival is delay in transportation. There is hardly any ambulance service for transportation of the patients from rural India. Even in urban India transportation to the nearest hospital may not be in time. In an urban hospital-based study in northwest India one of the factors for early arrival to stroke unit was living within a 10-km radius from the hospital. The knowledge of stroke is quite low among the population. In a study in northwest India, majority (73%) of the subjects (including both patients and

Measuring Accuracy of Discharge Diagnoses for a Region-Wide Surveillance of Hospitalized Strokes

Measuring the impact of stroke through population-based stroke registers is complex and costly. The aim of the present study is to assess the validity of hospital discharge diagnoses (all ages) and to estimate the total number of hospitalized stroke events in the Veneto region (Northeastern Italy, 4,500,000 inhabitants). All discharges covering a 1-year period (1999) from Veneto hospitals with International Classification of Diseases, 9th Revision codes 342, 430 to 434, and 436 to 438 were identified. A stratified sample was extracted and submitted to retrospective clinical record review according to the World Health Organization MONItoring trends and determinants in CArdiovascular disease stroke project. Using the positive predictive value (PPV) for validated acute stroke of each code to adjust for inaccuracy of discharge diagnoses, an estimate of hospital strokes was obtained. 4015 admissions were reviewed. Codes 430, 431, 434, and 436 as primary diagnoses had the highest PPV, which sharply decreased in the other diagnostic levels. Code 342 also showed a high PPV. The probability of suspected events meeting the stroke definition increased with age and was highest for patients admitted to neurological wards and for fatal events. Overall 9400 strokes (first-ever and recurrent) were estimated to be hospitalized in 1999, with an attack rate of 208 per 100,000. Our data indicate that once validation studies are undertaken on a sample of all hospitalized events, hospital discharge records can provide a valuable source of information on the actual burden of strokes on hospital services.

Increasing trends of acute myocardial infarction in Spain: the MONICA-Catalonia Study

To assess coronary mortality and morbidity secular trends in Spain. Acute coronary events occurring in both sexes at ages 35-74 years between 1985 and 1997, were monitored in a geographical area of Catalonia, through a population-based registry. Information was collected from annual discharge lists of 78 hospitals and from death certificates, and validated following the methods and quality control of the World Health Organization MONItoring Trends and Determinants in CArdiovascular Disease Project (MONICA). Registration included 19 119 valid events (14 221 in men, 4898 in women) of which 30% were fatal and 41% were definite acute myocardial infarctions. Average attack rates were 315 per 100 000 (95% CI 300-329) and 80 (75-86) in men and women, respectively. Incidence (first-ever event) rates were 209 (194-224) and 56 (52-60) per 100 000. Attack rates increased annually by 2.1% (0.3-4.1) and 1.8% (-0.9 to +4.6). Average 28-day case fatality was 46% (44-47) in men decreasing significantly by 1.4 and 53% (51-55) in women with no change. Fatal trends remained stable. Nationwide morbidity statistics showed similar trends. Acute coronary syndromes are rising in Spanish men.

Are changes in mortality from stroke caused by changes in stroke event rates or case fatality? Results from the WHO MONICA Project.

Mortality from stroke has been declining over recent decades in most countries, except in Eastern Europe. In this analysis, based on the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (WHO MONICA) Project, we explored to what extent these trends are due to changes in stroke event rate and to changes in case fatality. The WHO MONICA Project collected standardized data from 14 populations in 9 countries. All acute strokes occurring in men and women 35 to 64 years of age were included. Registration was carried out between 1982 and 1995, resulting in time spans from 7 to 13 years. Trends in event rates and case fatality were calculated as average annual percentage change. Up to 6-fold differences were observed in stroke mortality. Mortality declined in 8 of 14 populations in men and in 10 of 14 populations in women. An increase in mortality was observed in Eastern Europe. In the populations with a declining trend, about two thirds of the change could be attributed to a decline in case fatality. In populations with increasing mortality, the rise was explained by an increase in case fatality. In most populations, changes in stroke mortality, whether declining or increasing, were principally attributable to changes in case fatality rather than changes in event rates. Whether this was due to changes in the management of stroke or changes in disease severity cannot be established on the basis of these results.

Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and Morbidity in Augsburg Elderly.

To evaluate prevalence, sociodemographic characteristics, and risk factors of restless legs syndrome (RLS) in a population-based survey of the elderly, using standard diagnostic criteria. Population-based studies of RLS are rare and have not yet used standard definition criteria. The Memory and Morbidity in Augsburg Elderly (MEMO) Study is a follow-up project of the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Survey-Augsburg, Germany, 1989-1990, evaluating neurologic diseases and their risk factors in a German population 65 to 83 years of age. Two RLS-trained physicians assessed the prevalence of RLS based on the four minimal standard criteria (International Restless Legs Syndrome Study Group, 1995) using standardized questions in face-to-face interviews. They also obtained information on medical history, medications, depression (Center of Epidemiologic Studies Depression Scale), and quality of life (Short Form 36) and performed a standardized neurologic examination for each participant. The study population included 369 participants (173 women and 196 men). The overall prevalence of RLS was 9.8% (n = 36) and higher in women (13.9% versus 6.1%; p = 0.02). In women, the prevalence did not change with age, whereas men showed a nonsignificant inverse trend with increasing age. RLS-positive individuals took more benzodiazepines and estrogen compared with non-RLS cases, but the differences were not statistically significant. Participants with RLS had higher incidence of depression (p = 0.012) and lower self-reported mental health scores (p = 0.029) than did non-RLS cases. RLS is a frequent syndrome in the elderly with considerable impact on self-perceived mental health, affecting women about twice as often as men.

Effect of smoking cessation and tobacco type on the risk of cancers of the upper aero-digestive tract in Brazil.

Tobacco smoking has long been identified as the most important risk factor for upper aero-digestive tract cancers. To investigate the effect of different tobacco types and the benefit of smoking cessation, we analyzed data from a case-control study of 784 cases of mouth, pharynx, and larynx cancers and 1,578 non-cancer controls in three metropolitan hospital areas in Brazil. Subjects were interviewed as to their smoking and drinking habits, demographics, environmental exposures, occupational history, health characteristics, and diet. Controlling for total tobacco and alcohol consumption, risks for ex-smokers compared with current smokers decreased substantially with time since cessation of the habit. Compared with never smokers, ex-smokers of >20 years had a relative risk (RR) of 1.98 [95% confidence interval (CI) = 1.0-3.8] for all upper aerodigestive tract cancers. RRs for long-term (>20 years) ex-smokers tended to be lower for mouth (RR = 1.61) and pharynx (RR = 1.52) than for larynx (RR = 3.63) cancers. The benefit of quitting was strongest for commercial cigarettes (RR = 1.45, 95% CI = 0.7-3.0) for ex-smokers of >10 years, as compared with smoking of black tobacco (RR = 2.57, 95% CI = 1.4-4.6), cigars (RR = 2.59, 95% CI = 0.6-11.6), and pipe tobacco (RR = 3.40, 95% CI = 1.3-8.8).

Outcome With Calcium Channel Antagonists After Myocardial Infarction: A Community-Based Study

Objectives. We sought to estimate the risk of death and recurrent myocardial infarction associated with the use of calcium antagonists after myocardial infarction in a population-based cohort study.Background. Calcium antagonists are commonly prescribed after myocardial infarction, but their long-term effects are not well established.Methods. Patients 25 to 69 years old with a suspected myocardial infarction were identified and followed up through a community-based register of myocardial infarction and cardiac death (part of the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease [MONICA] Project in Newcastle, Australia). Data were collected by review of medical records, in-hospital interview and review of death certificates.Results. From 1989 to 1993, 3,982 patients with a nonfatal suspected myocardial infarction were enrolled in the study. At hospital discharge, 1,001 patients were treated with beta-adrenergic blocking agents, 923 with calcium antagonists, 711 with both beta-blockers and calcium antagonists and 1,346 with neither drug. Compared with patients given beta-blockers, patients given calcium antagonists were more likely to suffer myocardial infarction or cardiac death (adjusted relative risk [RR] 1.4, 95% confidence interval [CI] 1.0 to 1.9), cardiac death (RR 1.6, 95% CI 1.0 to 2.7) and death from all causes (RR 1.7, 95% CI 1.1 to 2.6). Compared with patients given neither beta-blockers nor calcium antagonists, patients given calcium antagonists were not at increased risk of myocardial infarction or cardiac death (RR 1.0, 95% CI 0.8 to 1.3), cardiac death (RR 0.9, 95% CI 0.6 to 1.2) or death from all causes (RR 1.0, 95% CI 0.7 to 1.3). No excess in risk of myocardial infarction or cardiac death was observed among patients taking verapamil (RR 0.9, 95% CI 0.6 to 1.6), diltiazem (RR 1.1, 95% CI 0.8 to 1.4) or nifedipine (RR 1.3, 95% CI 0.7 to 2.2) compared with patients taking neither calcium antagonists nor beta-blockers.Conclusions. These results are consistent with randomized trial data showing benefit from beta-blockers after myocardial infarction and no effect on the risk of recurrent myocardial infarction and death with the use of calcium antagonists. Comparisons between beta-blockers and calcium antagonists favor beta-blockers because of the beneficial effects of beta-blockers and not because of adverse effects of calcium antagonists.

Sex differences in awareness and control of hypertension in France

To assess the prevalence, awareness, treatment and control of hypertension for men and women living in three French regions. A cross-sectional population survey. Subjects in the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease population surveys of Bas-Rhin, the urban community of Lille and Haute-Garonne, France. We studied 1924 men and 1874 women aged 35-64 years. Hypertension was defined as a systolic blood pressure > or = 160 mmHg, a diastolic blood pressure > or = 95 mmHg, being administered antihypertensive drug treatment or any combination of the foregoing. Treated hypertensive subjects were considered controlled if their systolic blood pressure was < 160 mmHg and their diastolic blood pressure was < 95 mmHg. The prevalence of hypertension was 40.2, 43.8 and 27.7% among men in Lille, Bas-Rhin and Haute-Garonne, respectively. For women, the corresponding values were 31.5, 33.8 and 18.9%. Among hypertensive men, 51.8% were aware of their condition, 30.0% were being administered drug treatment and 9.2% were controlled; the respective values for hypertensive women were 69.8, 51.2 and 25.3% (P < 0.001). Awareness of hypertension was associated with antihypertensive treatment more commonly in Haute-Garonne (81.0% for men and 84.7% for women). The percentages of treated subjects in whom adequate control of the blood pressure had been achieved were only 30.7% for men and 49.4% for women. Women have a better awareness of hypertension than do men and their hypertension is controlled better but the low rate of control for both sexes calls for further improvements.

Risk of Primary and Recurrent Acute Myocardial Infarction From Lipoprotein(a) in Men and Women

Objectives. This study sought to examine whether lipoprotein(a) concentrations were risk factors for a first acute and recurrent myocardial infarction.Background. There is conflicting evidence concerning the risk of acute myocardial infarction from lipoprotein(a). No studies have examined the risk of recurrent acute myocardial infarction from lipoprotein(a), and few have addressed the risk in women.Methods. This was a population-based case-control study of 893 men and women 35 to 69 years old participating in the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Project in Newcastle, Australia in 1993 to 1994. Case and control patients were classified into those with and without a previous myocardial infarction, and median lipoprotein(a) concentrations were compared after adjusting for other variables. Quintiles of lipoprotein(a) concentration were also examined.Results. Compared with control subjects without a previous myocardial infarction, median lipoprotein(a) concentrations increased from case patients with a first myocardial infarction (15 mg/liter higher, 95% confidence interval [CI] −36 to 60) to control patients with a previous myocardial infarction (159 mg/liter higher, 95% CI 40 to 278) and case patients with a previous myocardial infarction (60 mg/liter higher, 95% CI −16 to 136, p < 0.01, test for trend). Women had significantly higher lipoprotein(a) concentrations than men (median 71 mg/liter higher, 95% CI 23 to 118). The highest quintile of lipoprotein(a) (>550 mg/liter) was a significant risk factor for a first acute myocardial infarction (odds ratio [OR] 1.77, 95% CI 1.03 to 3.03); but in those with a previous myocardial infarction, the highest quantile was not associated with recurrent myocardial infarction (OR 0.84, 95% CI 0.30 to 2.37).Conclusions. High lipoprotein(a) concentrations may be a marker of vascular or tissue injury or may be associated with other genetic or environmental factors that cause acute myocardial infarction. Currently, lipoprotein(a) measurement cannot be recommended for assessment of risk for acute myocardial infarction.

Determinants of plasma fibrinogen: relation to body weight, waist-to-hip ratio, smoking, alcohol, age, and sex. Results from the second MONICA Augsburg survey 1989-1990.

In the second World Health Organization MONItoring Trends and Determinants in CArdiovascular Disease (MONICA) Augsburg survey in 1989-1990 (n = 4,940), the association between nephelometric plasma fibrinogen level and lifestyle-related potential determinants was assessed in 4,434 subjects aged 25-74 years (89.8% of participants). Irrespective of pregnancy and the use of oral contraceptives, crude fibrinogen values were consistently higher in women than in men of all ages (age-standardized difference, 12.2 mg/dl; 95% confidence interval, 7.0-17.4 mg/dl). Fibrinogen concentrations were positively correlated (p less than or equal to 0.0001) with age, body mass index, and waist-to-hip ratio in both sexes and with cigarette smoking in men and were negatively correlated with alcohol consumption in both sexes. In multiple linear regression analyses using categorized determinants as independent variables, a strongly J-shaped relation for body mass index in women and a linear association for waist-to-hip ratio in men were revealed. Smoking had a dose-dependent effect on fibrinogen concentration in men but a lesser effect in women. For alcohol consumption a U-shaped association was found, particularly in men. The curvilinear relations were confirmed in multiple polynomial regression models using continuous determinant variables. The potential epidemiological impact of a determinant was assessed by calculating differences in adjusted fibrinogen concentrations associated with the 10th and 90th percentile values of the determinant distributions actually observed among the study participants. This impact on the population fibrinogen level was most pronounced for age in both sexes, followed by body mass index, cigarette smoking, and alcohol consumption in women and by smoking, waist-to-hip ratio, and alcohol consumption in men.(ABSTRACT TRUNCATED AT 250 WORDS)

The benefits of ??-blockade at the time of myocardial infarction

Data from the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (WHO MONICA) project, collected in Perth, are described. Patients taking a beta-blocker at the time of onset of myocardial infarction are a high-risk group, but univariate analysis of the data showed that the overall survival of patients on beta-blockers at 28 days was the same as for those not taking beta-blockers. A multiple logistic regression model analysis showed that the patients treated with beta-blockers had a survival advantage at 28 days, with a relative risk of death of 0.5. The mechanism of benefit is unclear. It does not appear to be an anti-arrhythmic effect, because beta-blockers did not affect survival in the first 24 h following a myocardial infarction, nor did they affect ventricular fibrillation. The effect may be due to a reduction in myocardial necrosis. Furthermore, an analysis of the incidence of coronary disease and type of drugs prescribed in Perth has indicated that beta-blockers may be contributing to a decrease in mortality due to coronary events.