Ethnic composition, age and sex, together with location and standard of housing as determinants of HTLV-I infection in an urban Trinidadian community

The presence of antibody to human T-cell leukaemia virus (HTLV-I) has been assessed in 2,143 men and women who represent 83 percent of all adults aged 35 to 69 years resident in a defined urban community in Trinidad. Individuals of African descent had a higher sero-positivity rate (7.0 percent) than those originating from India (1.4 percent), Europe (0 percent) or of mixed descent (2.7 percent). Women were infected more frequently than men, and the prevalence of infection increased with age in both sexes. Sero-positivity rates were significantly increased in adults who lived in housing of poor quality (p less than 0.001) or close to water courses (p less than 0.025). These data and others raise the possibility that one route of HTLV-I transmission may be via insect vectors under particular domestic circumstances.(AU)

Alcohol consumption: protection against coronary heart disease and risks to health

In a prospective cardiovascular study of 1341 Trinidadian men aged 35-69 years undertaken between 1977 and 1986, the baseline prevalance rates of cardiac and arterial disease and diabetes mellitus were increased in the 118 (8.8 percent) who had been but were no longer regular drinkers. This finding suggested that awareness of these disorders was a discouragement to drinking alcohol. When this group and all with coronary heart disease (CHD) or diabetes at entry were excluded, a significant inverse trend was found between alcohol consumption in the week before recruitment and risk of CHD across the subsequent average follow-up of 7.5 years. Men who had taken 5-14 drinks had about half the CHD risk of those who had had no alcohol, even after allowance for age, ethnicity, smoking, blood pressure and serum cholesterol concentration. The overall morbidity and mortality experience in this community indicated a protective effect of alcohol against CHD, but adverse health consequences from multiple causes in drinkers who were alcohol dependent. (AU)

High density lipoprotein cholesterol concentration as a predictor of coronary heart disease in West Indian men

Study objective- The aim of the study was to determine whether the inverse association between high density lipoprotein cholesterol concentration and risk of coronary heart disease described in people of European stock was also present in other racial groups. Design- The study was a prospective population survey. Cardiovascular risk factors were examined, including fasting serum lipid estimation (obtained at recruitment). Setting- This was a community based study within a defined survey area in Trinidad. Participants- All men aged between 35 and 69 years within the survey area were identified and followed between 1977 and 1986. Analysis was confined to those of African, Asian Indian, and mixed decent who were free of coronary heart disease at entry (n=960, 69 percent of age eligible men in the survey population). Measurements and main results- 64 men developed coronary heart disease during the study period. A strong inverse curvilinear relation was found between high density lipoprotein cholesterol and coronary heart disease incidence (p<0.005), independent of age or other relevant characteristics including low density lipoprotein cholesterol. Conclusions- A low serum concentration of high density lipoprotein cholesterol is a risk factor for coronary heart disease in non-whites as well as in whites. (AU)

Ethnicity and other characteristics predictive of coronary heart disease in a developing community; principal results of the St. James survey, Trinidad

A ten year community survey was undertaken to investigate the high coronary heart (CHI) incidence among people of Indian (South Asian) descent in Trinidad, West Indies. Of 2491 individuals aged 35-69, 2215 (89 percent) were examined and 2069 (83 percent) found to be clinically free of CHD at baseline. After exclusion of 71 of minority ethnic groups, 786 African, 598 Indian, 147 European and 467 adults of mixed descent were followed for CHD morbidity and mortality. In both sexes, adults of Indian origin had higher prevalence rates of diabetes mellitus, a low concentration of high density lipoprotein(HDL) cholesterol, and recent abstinence from alcohol than other ethnic groups. Indian men also had larger skinfold thicknesses than other men. In participants free of CHD at entry, the age-adjusted relative risk of a cardiac event believed due to CHD, was at least twice as high in Indian men and women as in other ethnic groups. In men, blood pressure, diabetes mellitus and low-density lipoprotein(LDL) cholesterol concentration were positively and independently related to risk of CHD, wheras alcohol consumption and HDL cholesterol concentration were inversely associated with risk after allowing for age and ethnic group. The ethnic contrast in CHD persisted when these characteristics were taken into account. In the smaller sample of women, only ethnic groups were predictive of CHD as defined. The failure of point estimates of risk to explain the high CHD incidence in Indians calls for focus on age of onset of risk and examination of other potential risk factors such as insulin concentration. (AU)

Adult male all-cause, cardiovascular and cerebrovascular mortality in relation to ethnic group, systolic blood pressure and blood glucose concentration in Trinidad, West Indies

In a prospective survey of 1342 Trinidadian men aged 35 to 69 years at recruitment, age-adjusted mean blood pressures were highest in those of African descent, intermediate in Indians and men of Mixed origin, and lowest in Europeans. Age-adjusted fasting blood glucose concentrations were highest in Indians and lowest in men of European descent. Relative risks of all-cause, cardiovascular and cerebrovascular mortality increased progressively with increasing systolic pressure, whereas for fasting blood glucose concentration the associations were U-shaped. No ethnic differences were apparent in relative risk. For systolic pressure, mortality from all-causes and cardiovascular diseases respectively were about two and three times higher at 180mmHg or more than at pressures below 130 mmHg. For blood glucose, all-cause and cardiovascular mortality were about four times higher at fasting concentrations greater than 7.7 mmol/l than in the lowest risk group (4.2-4.6 mmol/l), All-cause population attributable mortality rates for systolic pressures of 130 mmHg or more were 1.3 to 2.8 times higher in Indian men than in other groups. For blood glucose in excess of 4.6 mmol/l, population attributable mortality was between 2.9 and 6.9 times higher in Indians than in other groups. The findings emphasized the high mortality in men of Indian descent, partly due to an apparent underlying predisposition to cardiovascular disease, and partly to their high prevalence of diabetes mellitus. (AU)

High total and cardiovascular disease mortality in adults of Indian descent in Trinidad, unexplained by major coronary risk factors

A prospective survey has been undertaken of a total community of 1343 men and 1149 women, aged 35-69 years at recruitment, living in Port-of Spain, Trinidad. By comparison with adults of African descent, age-adjusted relative risks of death from all causes and from cardiovascular diseases were significantly increased in those of Indian origin (0.5 and 0.3, respectively). Adults of European descent had an all-cause and cardiovascular mortality relative risk of 0.8 and 2.1, respectively. These ethnic differences in risk were not explained by systolic blood pressure, fasting blood glucose concentration, serum high-density lipoprotein or low-density lipoprotein concentration, or smoking habits. Differences in risk of cardiovascular death between Indian and European men seemed to be accounted for by the high prevalence of diabetes in Indians (19 percent) but other ethnic contrasts in mortality were unrelated to diabetes mellitus. (AU)

Ethnic differences in all-cause and cause-specific mortality among adults in Trinidad: The St. James Cardiovascular Survey - abstract

The St. James Cardiovascular Survey was established in 1977 to examine the relations of conventional risk factors to subsequent all-cause and cause-specific morbidiy and mortality among adults aged 35-69 years at recruitment. Up to April 30, 1985, 178 deaths were recorded among 1,343 male subjects and 80 deaths among 1,079 female subjects. After adjusting for age differences, risk of death from all causes was significantly associated with ethnic group in men (xý of 3 = 16.8, p<0.001) and women (xý of 3 = 13.2, p < .005). Risk was 55 percent and 45 percent higher for Indian men women relative to African men and women. Risk for Mixed subjects was lowest compared to African (40 percent lower in males, 60 percent lower in females). Cardiovasular diseases and malignant neoplasms were the major causes of death in men (70 percent) of total deaths) and women (62 percent of total deaths). Among men, cardiovascular disease was the principal cause of death in all ethnic groups but made a greater contribution to total mortality amon Indian (60 percent) and European (70 percent) men than in the African and Mixed (37 percent) men than in Indians (9 percent) and Europeans (7 percent). A similar pattern was observed in women. After adjusting for age, risk of death from heart disease was more than twice as high for Indian men as for African. Ethnic group was not associated with mortality from either cerebrovascular disease or malignant (AU)

Obesity in women in an urban Trinidad community: prevalence and associated characteristics

Triceps skinfold, body mass index (BMI), blood pressure, blood/glucose concentration and serum lipoprotein concentrations were measured in 590 (80 percent) of 738 women aged 35-69 years resident within a defined area of Port of Spain, Trinidad. A triceps skinfold of 32 mm or more (the 70th percentile of overall distribution) was found in 36 percent of women of African descent and 28 percent of women of other ethnic origin. Respective figures for a BMI of 30.0 kg/mý or more were 32 percent and 27 percent at ages 46 to 64 years. Obesity was associated with an increase in blood pressure, increased fasting blood glucose, LDL cholesterol and VLDL triglyceride concentrations, and a reduction in HDL cholesterol concentration. Obese women had an increased tendency to a history of early menarche, multiparity and children of high birth weight. These findings suggested that, irrespective of ethnic origins, the effects of obesity on health in this female population resembled those in white North American women. (AU)