Current smoking and the risk of non-fatal myocardial infarction in the WHO MONICA Project populations.

BACKGROUND: Cohort studies have shown that smoking has a substantial influence on coronary heart disease mortality in young people. Population based data on non-fatal events have been sparse, however. OBJECTIVE: To study the impact of smoking on the risk of non-fatal acute myocardial infarction (MI) in young middle age people. METHODS: From 1985 to 1994 all non-fatal MI events in the age group 35-64 were registered in men and women in the WHO MONICA (multinational monitoring of trends and determinants in cardiovascular disease) project populations (18,762 events in men and 4047 in women from 32 populations from 21 countries). In the same populations and age groups 65,741 men and 66,717 women participated in the surveys of risk factors (overall response rate 72%). The relative risk of non-fatal MI for current smokers was compared with non-smokers, by sex and five year age group. RESULTS: The prevalence of smoking in people aged 35-39 years who experienced non-fatal MI events was 81% in men and 77% in women. It declined with increasing age to 45% in men aged 60-64 years and 36% in women, respectively. In the 35-39 years age group the relative risk of non-fatal MI for smokers was 4.9 (95% confidence interval (CI) 3.9 to 6.1) in men and 5.3 (95% CI 3.2 to 8.7) in women, and the population attributable fractions were 65% and 55%, respectively. CONCLUSIONS: During the study period more than half of the non-fatal MIs occurring in young middle age people can be attributed to smoking.

Changes in estimated coronary risk in the 1980s: data from 38 populations in the WHO MONICA Project. World Health Organization. Monitoring trends and determinants in cardiovascular diseases.

The World Health Organization (WHO) MONICA Project is a 10-year study monitoring trends and determinants of cardiovascular disease in geographically defined populations. Data were collected from over 100,000 randomly selected participants in two risk factor surveys conducted approximately 5 years apart in 38 populations using standardized protocols. The net effects of changes in the risk factor levels were estimated using risk scores derived from longitudinal studies in the Nordic countries. The prevalence of cigarette smoking decreased among men in most populations, but the trends for women varied. The prevalence of hypertension declined in two-thirds of the populations. Changes in the prevalence of raised total cholesterol were small but highly correlated between the genders (r = 0.8). The prevalence of obesity increased in three-quarters of the populations for men and in more than half of the populations for women. In almost half of the populations there were statistically significant declines in the estimated coronary risk for both men and women, although for Beijing the risk score increased significantly for both genders. The net effect of the changes in the risk factor levels in the 1980s in most of the study populations of the WHO MONICA Project is that the rates of coronary disease are predicted to decline in the 1990s.

A prospective study on reproducibility of the spread of spinal anesthesia using plain 0.5% bupivacaine.

This prospective study was carried out to determine whether a spinal block with plain 0.5% bupivacaine spreads similarly when repeated in the same patient. During a 14-month period, 50 patients underwent from two to five spinal anesthesias using identical anesthetic technique, including the same premedication, the same volume of injected plain 0.5% bupivacaine, the same site of injection and the same position of the patient. Plain 0.5% bupivacaine was injected with the patient lying in the lateral horizontal position. Thereafter, the patients were turned to the supine horizontal position. Pinprick analgesia was recorded 60 minutes after the injection. Regression analysis showed that the reproducibility of the maximal analgesic segmental spread of the second anesthesia on the basis of the initial anesthesia was highly significant (p less than 0.0001). The blocking results of the patients who underwent from three to five anesthesias within the study period were in accordance with the spread of the first anesthesia. If a higher or lower spread of anesthesia is desirable, a modification or another local anesthetic for the spinal anesthesia may be preferred.