#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Primary prevention of ischemic heart disease in middle-aged men living in Prague: Results of twenty-year research


Authors: F. Boudík 1;  J. Reissigová 2;  K. Hrach 2;  M. Tomečková 1,2;  J. Bultas 1;  Z. Anger 1;  M. Aschermann 1;  J. Zvárová 2
Authors‘ workplace: II. interní klinika 1. lékařské fakulty UK a VFN, Praha, přednosta prof. MUDr. Aleš Linhart, DrSc. 1;  EuroMISE centrum-Kardio, Ústav informatiky Akademie věd ČR, Praha, ředitelka prof. RNDr. Jana Zvárová, DrSc. 2
Published in: Vnitř Lék 2006; 52(4): 339-347
Category: Original Contributions

Overview

Introduction:
Ischemic Heart Disease (IHD) represents the most frequent cause of mortality and morbidity in the Czech Republic. The aim of this study is to analyze long-term mortality of cardiovascular disease (CVD), identify its predictors and verify the validity of Framingham risk function for Czech patients.

Design and methods:
The twenty-year study (STULONG) of primary prevention of risk factors of atherosclerosis in 1419 men aged 38 to 53 years living in Prague was started in 1975. Results: CVD mortality analysis showed a higher risk of death for heavy smokers vs. non-smokers or light smokers (p < 0.0001), hypertensive patients vs. patients with normal blood pressure (p < 0.0001), men with hypercholesterolemia vs. men with normal cholesterol level (p = 0.0432), and a lower risk for university graduates vs. men with elementary education (p = 0.0006). Between 1980 and 1984, age-specific CVD mortality rates of men from STULONG study were higher (p = 0.0132) than national CVD mortality rates; between 1985 and 1994, they were insignificantly lower. Framingham risk function underestimated absolute ten-year risk of IHD in all risk quintiles (p < 0.0001) with discrimination of 63%.

Conclusion:
CVD mortality observed within STULONG study was significantly affected by known risk factors (hypertension, smoking, hypercholesterolemia, lower education); Framingham risk function underestimated absolute ten-year risk of IHD.

Key words:
primary prevention of Ischemic Heart Disease – Cardiovascular disease


Sources

1. Loyd-Jones DM, Larson MG, Beiser A et al. Lifetime risk developing artery coronary disease. Lancet 1999; 353: 89-92.

2. Beller GA. Coronary heart disease in the first 30 years of the 21st century: challenges and opportunities. Circulation 2001; 103: 2428-2435.

3. Wilson S, Johnston A, Robson J et al. Predicting coronary risk in the general population-is it necessary to measure high-density lipoprotein cholesterol? J Cardiovascular Risk 2003; 10: 137-141.

4. The Joint British Societies Coronary Risk Prediction Charts. Heart 1998; 80(Suppl. 2): S1-S29.

5. Pedersen TR, Kjekshus J, Berg K et al. Randomised trial cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383-1389.

6. Shepherd J, Cobbe SM, Ford I et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 1995; 333: 1301-1307.

7. Stamler J, Lindberg HA, Berkson DM et al. Prevalence and incidence of coronary heart disease in strata of the labor force of a Chicago industrial corporation. J Chron Dis 1960; 11: 405-420.

8. Kannel WB, McGee D, Gordon T. A general cardiovascular risk profile: the Framingham Study. Am J Cardiol 1976; 38: 46-51.

9. Boudík F, Goldsmith JR, Teichman V et al. Epidemiology of chronic bronchitis in Prague. Bull Wld Hlth Org 1970; 41: 711-722.

10. Brown MS, Goldstein JL. Editorial: Heart attacks: gone with the century? Science 1996; 272: 629.

11. Anderson KM, Wilson PW, Odell PM et al. An updated coronary risk profile. A statement for health professionals. Circulation 1991; 83: 356-362.

12. Newman SC. Biostatistical Methods in Epidemiology. New York: Wiley 2001.

13. Fleming TR, Harrington DP. Counting process and Survival analysis. S.Wiley, Chichester, 1991.

14. Wilson PW, D'Agostino RB, Levy D et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837-1847.

15. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 2002; 105: 310-315.

16. Thomsen TF, McGee D, Davidsen M et al. A cross-validation of risk-scores for coronary heart disease mortality based on data from the Glostrup Population Studies and Framingham Heart Study. Int J Epidemiol 2002; 31: 817-822.

17. Bastuji-Garin S, Deverly A, Moyse D et al. The Framigham prediction rule is not valid in an European population of treated hypertensive patients. J Hypertens 2002; 20: 1973-1980.

18. Hense HW, Schulte H, Lowel H et al. Framingham risk function overestimates risk of coronary heart disease in men and women from Germany - results from the MONICA Augsburg and the PROCAM cohorts. Eur Heart J 2003; 24: 937-945.

19. Empana JP, Ducimetiere P, Arveiler D et al. Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations? The PRIME Study. Eur Heart J 2003; 24: 1903-1911.

20. Deanfield JE, Mason RP, Nissen SE et al. A call for early detection and treatment of coronary artery disease: A meeting report. Clin Cardiol 2001; 24(Suppl I): I3-I6.

21. Guyton JR. Clinical assessment of atherosclerotic leasions. Clinical assessment of atherosclerotic lesions: emerging from angiographic shadows. Editorial. Circulation 2002; 106: 1308-1309.

22. Boudík F, Anger Z, Aschermann M et al. Dipyridamole body surface potential mapping: noninvasive differentiation of syndrome X from coronary artery disease. J Electrocardiol 2002; 35: 181-191.

23. Emberson J, Whincup P, Morris R et al. Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. Eur Heart J 2004; 25: 484-491.

24. Emberson JR, Whincup PH, Morris RW et al. Re-assessing the contribution of serum total cholesterol, blood pressure and cigarette smoking to the aetiology of coronary heart disease: impact of regression dilution bias. Eur Heart J 2003; 24: 1719-1726.

25. Magnus P, Beaglehole R. The real contribution of the major risk factors to the coronary epidemics: time to end the “only-50%” myth. Arch Intern Med 2001; 161: 2657-2660.

26. Steptoe A, Marmot M. The role of psychobiological pathways in socio- economic inequalities in cardiovascular disease risk. Eur Heart J 2002; 23: 13- 25.

27. Marmot MG, McDowall ME. Mortality decline and widening social inequalities. Lancet 1986; 2: 274-276.

28. Kromhout D, Menotti A, Kesteloot H et al. Prevention of coronary heart disease by diet and lifestyle: evidence from prospective cross-cultural, cohort, and intervention studies. Circulation 2002; 105: 893-898.

29. Stampfer MJ, Hu FB, Manson JE et al. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 2000; 343: 16-22.

30. Stamler J, Stamler R, Neaton JD et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA 1999; 282: 2012- 2018.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 4

2006 Issue 4

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#