ABSTRACT
BACKGROUND: Fibrinogen and factor VII activity are known to be related to atherosclerosis and coronary heart disease, but population differences in clotting factors and modifiable characteristics that influence their levels have not been widely explored. METHODS: This paper examines correlates of plasma fibrinogen concentration and factor VII activity in 2443 men and women aged 35-64 in random samples selected from the residents in two districts in urban Warsaw (618 men and 651 women) and from rural Tarnobrzeg Province (556 men and 618 women) screened in 1987-1988, and assesses which characteristics might explain urban-rural differences. Fibrinogen and factor VII activity were determined using coagulation methods. RESULTS: Fibrinogen was 12.9 mg/dl higher in men and 14.1 mg/dl higher in women in Tarnobrzeg compared to Warsaw. Factor VII activity was higher in Warsaw (9.2% in men and 15.3% in women). After adjustment for selected characteristics, fibrinogen was higher in smokers compared to non-smokers by 28 mg/dl in men and 22 mg/dl in women. In women, a 15 mg/dl increase in HDL-cholesterol was associated with a 10 mg/dl decrease in fibrinogen (P < 0.01). After adjustment for other variables, a higher factor VII activity in Warsaw remained significant (a difference of 9.4% in men and 14.8% in women). Lower fibrinogen in Warsaw remained significant only in women (15.4 mg/dl difference). CONCLUSIONS: The study confirmed that sex, age, BMI, smoking and blood lipids are related to clotting factors. However, with the exception of gender differences and smoking, associations between clotting factors and other variables were small and of questionable practical importance.
Subject(s)
Body Constitution/physiology , Coronary Artery Disease/blood , Factor VII/metabolism , Fibrinogen/metabolism , Life Style , Adult , Biomarkers/blood , Coronary Artery Disease/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Poland/epidemiology , Population Surveillance , Retrospective Studies , Risk Factors , Rural Population , Urban PopulationABSTRACT
There has been a large amount of progress in the methods of prevention and treatment of ischaemic heart disease (IHD), but the effect of these changes on mortality due to IHD has not been assessed. This paper presents the complex analysis of 10-year trends of incidence, case fatality and mortality due to myocardial infarction (MI) and changes in medical care in the acute phase of MI in residents of one province of Poland-Tarnobrzeg Voivodship, which was the target population of the POL-MONICA Kraków Project (over 280,000 men and women at age 25-64 years). In men, the incidence of MI, which was 335/100,000 in 1984, increased in 1986 to 463/1,000,000 and then was stable until 1993 when it felt to 362/100,000. Mortality from MI, which was 149/100,000 in 1984, increased to 212/100,000 in 1986 and then was stable until 1992, before falling to 173/100,000 in 1993. There were large fluctuations in the incidence and mortality from MI in women i.e. from 58/100,000 to 116/100,000 and from 21/100,000 to 55/100,000 respectively. In 1993 the incidence was 82/100,000 and mortality was 32/100,000. After adding sudden deaths and other fatal events attributed to IHD the mortality figures increased over the ten years of observation by an average of 29% in men and by 28% in women. The average total MI case fatality was 47% in men and 40% in women, with 86% of all deaths due to MI occurring out of hospital. Case-fatality of MI managed in hospital was 11% on average.
Subject(s)
Myocardial Infarction/drug therapy , Myocardial Infarction/epidemiology , Adrenergic beta-Antagonists/therapeutic use , Adult , Aged , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Female , Fibrinolytic Agents/therapeutic use , Humans , Incidence , Longitudinal Studies , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Poland/epidemiology , Risk Assessment , Survival Rate , World Health OrganizationABSTRACT
Different combinations of serum enzymes activity determinations are used in the diagnostics of myocardial infarction. The goal of the present paper was: 1) to assess the frequency of determinations of asparagine aminotransferase (AspAT) and to compare it with the frequency of determinations of creatinine phosphokinase (CPK) in patients hospitalized due to ischaemic heart disease in district hospitals, and 2) to assess to what extent the parallel determination of both enzymes effected to diagnostic classification of events according to The WHO MONICA Project. The analysis was done in 7406 hospitalized events registered with the clinical diagnosis of ischaemic heart disease (1810 myocardial infarctions, 402 acute coronary heart disease and 5194 other forms of ischaemic heart disease), registered in POL-MONICA Kraków Project in 1988-1993. Serum activity of AspAT was determined in over 90% events with either myocardial infarction or acute coronary heart disease. Number of determinations of CPK increased since 1990 and then, fluctuated from 15% to 36%. In 718 hospitalized events with clinical diagnosis of ischaemic heart disease, for whom both CPK and AspAT were determined, there was 96% observed agreement between diagnostic classification of events based on complains, ecg and alternatively: 1) both AspAT and CPK and 2) CPK only. Potential agreement beyond chance-kappa was 0.94 (almost perfect agreement). The parameters of the agreement were worse when AspAT only was used in the second option. The results indicate that efforts to increase the number of determinations of CPK in myocardial infarction diagnostics should be undertaken. At least for a part of events with myocardial infarction diagnosis confirmed by ecg and CPK tests, determination of AspAT is not necessary.
