Relative risk of factors for coronary heart disease in population with low cholesterol levels.

We studied the odds ratios of seven leading risk variables in a population essentially having a 'low' cholesterol concentration. In a cross-sectional population-based study of 3689 Turkish adults 20 years of age or over, 90 men and 83 women were diagnosed to have definite or suspected coronary heart disease. The criteria were based on history, cardiovascular examination and on Minnesota coding of electrocardiograms. Potential risk factors studied were: plasma total cholesterol (> or = 240 mg/dl), fasting triglycerides (> or = 200 mg/dl), diabetes mellitus, hypertension (asystolic > or = 160 mmHg, diastolic > or = 95 mmHg, or both, or subjects reporting to take antihypertensive medication), smoking currently or in the past, obesity (body mass index > or = 30 kg/m2), and physical inactivity. Hypertension and lack of physical exercise constituted the most important risk factors in both sexes being valid for all age groups and having high attributable risks; odds ratios in men and women, respectively, were 3.16 and 2.6 for hypertension, and 2.16 and 3.49 for physical inactivity. Hypertriglyceridemia followed these factors in men with an odds ratio of 2.15. In women an additional significant factor was obesity (odds ratio 1.76), while diabetes and hypercholesterolemia revealed to be significant only in those aged 20-59 years, and smoking in women aged 30-59 years. Among men, smoking was a borderline significant risk factor for coronary disease, whereas hypercholesterolemia did not prove to be so. These findings, somewhat at variance with those of industrialized nations, may have significance for policy of cardiovascular disease prevention in third-world populations.

Prevalence of coronary heart disease in Turkish adults.

The prevalence of coronary heart disease was determined by a conducted survey in a random sample of 3689 subjects 20 years of age or older in 59 communities representing the Turkish adult population. Interview with a questionnaire, physical examination of the cardiovascular system and recording of a 12-lead ECG were performed. The latter was coded according to the Minnesota code. Expressed in age-adjusted rates (for 35-64 years), prevalence rates per 100 men were as follows: typical angina 3.7, atypical angina 0.9, electrocardiographic evidence of myocardial infarction and/or ischemia 3.7, any of the stated findings suggesting coronary heart disease 8. Women had a substantially higher rate of atypical angina, positive ECG findings and of any of the stated manifestations for coronary heart disease, whereas they had a significantly lower rate of Q/QS patterns as well as of a history of myocardial infarction. Based on a probability-related point score, age-adjusted clinical coronary heart disease was estimated to prevail in 5.8% of men and 5% of women (P > 0.4) in the sample of the Turkish population. The respective rates in urban residents was 6% and in rural resident 4.8%. Among participants diagnosed coronary heart disease, 63% presented the form of angina without infarction, 27% had evidence of myocardial infarction, 7% 'silent myocardial ischemia' and 3% cardiac failure alone.