ABSTRACT
Introduction: accurate estimates of the incidence of cardiovascular diseases [CVD] comprising of acute myocardial infarction [AMI], unstable angina pectoris [UAP], sudden cardiac death [SCD], and stroke are very important for public health. However, such information is scarce, especially for middle- and low-income countries
Methods: the Isfahan Cohort Study [ICS] prospectively followed up 6504 individuals, 51.8% women, aged 35 years and over, 6323 initially free of CVD, from urban and rural areas in three districts in central Iran including Isfahan, Najafabad, and Arak. A panel of specialists in cardiology and neurology decided on the diagnosis of the occurred events based on patients hospital records, verbal autopsy, and death certificates
Results: after 32893 person-years of follow-up, 427 new cases of CVD events [229 in men] were registered. Confirmed cases of AMI, stroke, UAP, and SCD were 57, 43, 93, and 36 in men and 32, 48, 100, and 18 in women, respectively. The corresponding crude incidence rates were 352, 265, 352, and 220 per 100000 person-years in men and 186, 279, 584, and 104 in women, respectively. No significant differences were found in age at the time of events occurrence between men and women and between different event types except for SCD and stroke in women that in average the former occurred nine years later. CVD mortality rate was 331 per 100000 person-years in men and 203 in women
Conclusion: we found substantially high incidence rates for almost all CVDs and mortality. These findings need urgent consideration by health policy makers specifically for women
ABSTRACT
Objective To examine the dose-response relationship of smoking status with carotid atherosclerosis in 959 relatively healthy Chinese men. Methods 959 older Chinese men were selected from Guangzhou Biobank Cohort Study (GBCS) on cardiovascular disease. Personal histories were collected and fasting plasma glucose and lipids, blood pressure, and common carotid artery intima-median thickness (CCA-IMT) were measured. Results ( 1 ) Composition of the cases:39.1% were non-smokers, 25.7% were former smokers and 35.2% were current smokers. The mean (95% confidence interval) carotid IMT was 0.78 (0.77-0.79) mm. 18.4% of the subjects had carotid IMT equal to or thicker than 1.0 mm while 34.1% had carotid plaque. (2)After adjusting for age, sex,physical activity, body mass index, fasting glucose, triglyceride, high-density lipoprotein cholesterol,systolic and diastolic blood pressure, compared to never smokers, current smokers had significantly increased risk for thicker IMT and carotid plaque [odds ratio (OR) = 1.82, 95% GI: 1.30-2.55 and OR=1.95, 95%CI: 1.38-2.75, respectively, all P＜0.001]. The risk for thicker IMT and carotid plaque increased with the increasing amount (cigarettes/day) and duration of smoking (years) as well with cigarette pack-years (P for trend all ≤0.01 ). Conclusion An elevated risk with a clear doseresponse relationship was found between cigarette smoking and carotid atherosclerosis. Quitting smoking or reducing the amount of smoking may lower the risk of atherosclerosis, preventing and controlling the occurrence of cardiovascular diseases, and reducing the related cardiovascular mortalities.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the relative effects of degree and distribution of body fat with several cardiovascular disease (CVD) risk factors in elderly Chinese subjects.</p><p><b>METHODS</b>One hundred and thirty-five elderly Chinese individuals (age range, 60-65 y) without any history of significant renal, hepatic or cardiac disease were recruited. Seated blood pressure, anthropometric and fasting plasma biochemical parameters were measured. Student's t-test was used to compare the differences in biochemical and anthropometric markers between cohorts.</p><p><b>RESULTS</b>Males were heavier (64.6 +/- 8.6, 57.2 +/- 8.2kg, P < 0.001), taller (1.65 +/- 0.06, 1.51 +/- 0.05 m, P < 0.001) and their greater body fat was predominantly deposited centrally (Waist-to- hip ratio, 0.91 +/- 0.06, 0.88 +/- 0.07, P < 0.05). Females were more generally obese with increased body mass index (BMI, 23.8 +/- 4.6, 25.0 +/- 3.5 kg/m2, P < 0.05) and percentage body fat [26.3% (24.5%-28.1%) vs 37.2% (36.0%-38.9%), P < 0.001] than the males. However, despite an 11% higher proportion of body fat in females, no significant differences were identified in blood pressure, lipid profile, indices of insulin resistance or albumin-to-creatinine ratios.</p><p><b>CONCLUSION</b>It is likely that central adiposity contributes disproportionately to these metabolic disorders in males even though they are much leaner than elderly Chinese females.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Body Mass Index , Cardiovascular Diseases , Obesity , Risk FactorsABSTRACT
<p><b>PURPOSE</b>To review evidence-based management of nephropathy in patients with type 2 diabetes.</p><p><b>DATA SOURCES</b>A literature search (MEDLINE 1966 to 2000) was performed using the key word "diabetic nephropathy". Relevant book chapters were also reviewed.</p><p><b>STUDY SELECTION</b>Well-controlled, prospective landmark studies and expert review articles on diabetic nephropathy were selected.</p><p><b>DATA EXTRACTION</b>Data and conclusions from the selected articles that provide solid evidence to the optimal management of diabetic nephropathy were extracted and interpreted in light of our clinical research experience with many thousands of Hong Kong Chinese patients.</p><p><b>RESULTS</b>Hypertension, long diabetes duration, poor glycaemic control and central obesity are the most important risk factors. Microalbuminuria is a practical marker to predict overt nephropathy in type 2 diabetic patients. Risk factor modification, renal function monitoring and combined therapies are the current integrated approaches to manage patients with diabetic kidney disease. Optimal glycaemic control is the mainstay of treatment but effective antihypertensive therapy is also key to delaying the progression of diabetic nephropathy. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists have important renoprotective actions independent of their blood pressure lowering actions.</p><p><b>CONCLUSIONS</b>Diabetic nephropathy is the leading cause of end-stage renal disease worldwide. Monitoring renal function and screening for microalbuminuria will allow the identification of patients with nephropathy at a very early stage for intervention. Tight glycaemic control and aggressive antihypertensive treatment as well as the use of renin-angiotensin system inhibitors should substantially delay the progression of nephropathy.</p>