An ecological study of determinants of coronary heart disease rates: a comparison of Czech, Bavarian and Israeli men.
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BACKGROUND: The large differences in cardiovascular disease rates between Eastern and Western Europe have largely developed over the last few decades, and are only partly explained by classical risk factors. This study was set up to identify other potential determinants of these differences. METHODS: This was an ecological study comparing random samples of men aged 45-64 years selected from three cities representing populations with different rates of cardiovascular mortality: Pardubice (Czech Republic), Augsburg (Bavaria, Germany), and Jerusalem (Israel). In total, 191 (response rate 70%), 153 (70%) and 162 (62%) men, respectively, participated. All centres followed the same study protocol. Lifestyle, anthropometry and biochemical risk factors were assessed by identical questionnaires, standardized medical examination, and central analyses of fasting blood samples. RESULTS: The mortality rates in the study populations, as well as the prevalence of coronary heart disease in study samples, were highest in Czech, intermediate in Bavarian and low in Israeli men. This pattern was replicated across the three samples by mean blood pressure (P < 0.001), cigarette smoking (not significant), triglycerides (P < 0.05), fibrinogen or D-dimer levels (P < 0.05). On the other hand, the prevalence of diabetes and obesity were similar; total and high density lipoprotein (HDL)-cholesterol, apolipoprotein B, lipoprotein (Lp(a)) and glucose did not differ between Czech and Bavarian men; and Czechs had particularly low levels of serum insulin and factor VIIc. Israelis had low fasting glucose and total cholesterol, as well as HDL-cholesterol levels and a high Lp(a) (each P < 0.001) compared with the two other samples. Striking differences were found for plasma homocysteine (10.5 in Czechs versus 8.9 mumol/l in Bavarians, P < 0.001) and for alpha-carotene (geometric mean in Czechs 16, Bavarians 21 and Israelis 30 micrograms/l), beta-carotene (60, 110 and 102 micrograms/l), and lycopene (84, 177 and 223 micrograms/l), respectively; all P-values < 0.001). Adjustment for obesity or smoking did not change these estimates. There were no differences in the levels of tocopherol and retinol. CONCLUSIONS: Czech men had high levels of blood pressure, triglycerides, fibrinogen and D-dimer but many other traditional risk factors, as well as indicators of metabolic disorders and vitamins A and E, did not differ between the study samples. The low levels of carotenoids and high concentrations of homocysteine in Czech men seem to reflect their low dietary intakes of fruit and vegetables. The results provide indirect support for the importance of dietary factors in the East-West morbidity and mortality divide. (+info)
Ricettsioses studies. 2. Natural foci of rickettsioses in east Slovakia.
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Natural foci of Q fever and of spotted fever group rickettsiae in the Kosice district of east Slovakia are described and discussed. It was established that the natural focus of Q fever was a secondary one. Cattle were observed to be the main source of human infection and a high proportion of synanthropic rodents was found to be infested with Coxiella burnetii. The natural focus of spotted fever group rickettsiae was shown to be of a primary character, such rickettsiae circulating among ticks and small mammals. It is suggested that natural foci of spotted fever group rickettsiae in east Slovakia may be connected with the natural distribution of Dermacentor ticks. (+info)
Atherosclerosis of the aorta and coronary arteries in five towns. Material and methods.
(3/95)
This chapter outlines the way in which the problems of obtaining and assessing population-related material and analysing the data were tackled. Some of the limits of the approach used, namely, the examination of nearly all deaths from several demographically defined communities, are discussed. (+info)
Atherosclerosis of the aorta in five towns.
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Fatty streak was always present in both the thoracic aorta and the abdominal aorta in the youngest subjects studied (aged 10-14 years). Fibrous plaque was present in a small proportion of these young subjects, but a rapid increase in prevalence occurred as early as the fourth decade. Complicated and calcified lesions appeared as early as the age of 20-25 years but a rapid increase in prevalence was seen after age 40 for complicated lesions and after age 50 for calcified lesions. There were differences in the prevalence of severe lesions among the five towns. There was little increase in the extent of atherosclerosis in the thoracic aorta before the age of 40 and in the abdominal aorta before the age of 20. The increase was more rapid after those ages. When atherosclerosis had affected about 50% of the intimal surface of the thoracic aorta and 70% of the intimal surface of the abdominal aorta, the increase slowed down considerably. In contrast to other types of lesion, the extent of fatty streak increased only up to 30 years of age, when it occupied 25-30% of the intimal surface. Then it declined and in the older age groups did not exceed 4-5% in men or women. The extent of fibrous plaque and complicated lesions was at all ages greater in men than in women, while the extent of fatty streak and calcified lesions in older age groups was greater in women. There were marked differences in the extent of atherosclerotic lesions in the five towns. (+info)
Atherosclerosis of the coronary arteries in five towns.
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Two atherosclerotic lesions (fatty streak and fibrous plaque) were seen in coronary arteries as early as in the 10-14 age group. Then their frequency increased with age, more rapidly in the left anterior descending coronary artery than in the left circumflex artery. After the age of 55 years fatty streak was still the sole type of lesion in 0.3% of men and an even higher proportion of women. In contrast to the findings in the aorta, the mean extent of fatty streak in the average coronary artery did not exceed 3-4% in all age groups. Fibrous plaque was found in over 90% of men over 40 and women over 50 years of age. The extent of fibrous plaque was greatest by about the age of 65 years in both sexes and showed little change thereafter. The first complicated and calcified lesions appeared in a small proportion of subjects after the age of 20. The frequency of complicated lesions did not exceed 50%, being much lower than that of calcified lesions. Complicated lesions occupied a very small area (mean extent 0.6% in men and 0.3% in women); the extent of calcified lesions in older age groups reached 9-10% of the intimal surface in both sexes. Coronary stenosis appeared after age 20 years in men and 10 years later in women, and its frequency increased with age. There were considerable inter-town differences in the prevalence and extent of atherosclerotic lesions. (+info)
High and low atherosclerosis groups.
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Aortic and coronary atherosclerosis were studied in two groups, the "high atherosclerosis group" and the "low atherosclerosis group". The latter may be considered as showing basic levels of atherosclerosis in the different communities. The development of lesions in the two groups occurred in parallel, but earlier in the high group. Sex differences in the two groups were similar to those in the whole material. Generally speaking, inter-town comparisons were similar in each group and similar to those for deaths from all causes, a notable exception being the prevalence of coronary stenosis. The findings indicate that the groups can be used as reference groups, but only for material drawn from the same source. (+info)
Atherosclerosis and sudden death.
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The prevalence of complicated and calcified lesions and coronary stenosis, the mean heart weight, and the extent of atherosclerosis in the aorta and coronary arteries were greater in the "sudden heart death" group than in the high atherosclerosis group. In the "other sudden death" group, which included sudden deaths without myocardial infarction or coronary occlusion, all the above variables, except heart weight, were found to be lower than in the low atherosclerosis group and were close to those in the standardized average atherosclerosis group. The mean heart weight in the "other sudden death" group was lower than in the "sudden heart death" group but significantly higher than in the three reference atherosclerosis groups. (+info)
Atherosclerosis in relation to cholelithiasis and cholesterolosis.
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The frequency of cholelithiasis and cholesterolosis was remarkably similar in Prague and Malmo subjects. When the possible effects of associated hypertension or diabetes mellitus were taken into account, subjects with cholelithiasis showed the same extent of raised and calcified lesions of the coronary arteries, the same prevalence of large myocardial scars, and the same distribution of heart weight as subjects without cholelithiasis. In general, they showed rather fewer raised and calcified lesions of the aorta, less coronary stenosis, and fewer fresh myocardial infarctions than subjects without cholelithiasis. Subjects with cholesterolosis were similar to those without this condition in respect of raised lesions of the aorta and coronary arteries. Men with cholesterolosis had slightly more aortic calcification and slightly less coronary calcification. Women with cholesterolosis had slightly less coronary stenosis than those without cholesterolosis. There was a slight tendency for those with cholesterolosis to show an increased frequency of fresh myocardial infarction and large myocardial scars and to have a higher heart weight. (+info)