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Recent decrease of cardiovascular disease risk factors in the Czech population
Monday 10 October 1994: Poster Abstracts Epidemiology
significantly and positively and HDL significantly negatively associated with IMT and plaque occurrence. There were no significant relationships between intake of saturated fat and IMT and plaque occurrence. Other cardiovascular risk factors like age, male gender, blood pressure, smoking (only plaque) were all significantly associated with IMT and the occurrence of plaques. Conclusions: This population-based study provides no support for the widely held opinion that intake of saturated fat increases the risk of atherosclerosis by increasing the concentration of atherogenic serum cholesterol fractions. The low rate of misclassification by the diet assessment method and the substantial sample size should make the conclusions sufficiently robust. Recent decrease of cardiovascular disease risk factors 1 in the Czech population &&&g& SkodovB Z, Valenta Z, PfSa Z, L.ub.for Atherosclerdsis Research, Inst. for Clinical and Experimental VideGsti 800, 140 00 Prague 4, Czech Republic
Medicine,
The mortality for cardiovascular disease in the Czech population is among the highest in the world and it ranged around 500 in men and 350 in women per 100000 during last decade. High frequency of hypercholesterolemia, hypertension, obesity and smoking seem to be responsible for these alarming data. In the present study, a dramatic drop in total serum cholesterol concentration has been documented together with a significant decrease in BMI in a 1% sample of the Czech population in six districts (MONICA Project). Total serum cholesterol decreased from 6.24 + 1.20 mmol/l (1988) to 5.91 * 1.29 mmoI/l (1992) in men in all age groups between 25-64 years and in women from 6.16 * 1.20 mmoI/l to 5.87 f 1.28 mmol/l in all age groups except for the group between 55 and 64 years. This highly significant decrease (P < 0.001) was accompanied by a well documented drop in body mass index and a decrease in animal fat consumption, No significant changes were observed in other risk factors such as blood pressure and smoking. As no significant population primary intervention of risk factors appeared between 1988 and 1992, only Iiberalization of prices leading to a decrease in dairy and meat product consumption is suggested as the main effect inducing the above beneficial changes. Epidemiological study of serum lipids in Japan: the 1 Hidaka study US, Miki T, Kawahara J, Hsieh ST, Hirouchi H, Taniguchi T*, Ishikawa Y*, Saito K*, Sano H*, Yokohama M*, Dept. of Int. Med., Hidaka Hospital, 81 Iwanaka, Hidaka-cho, kinosaki-gun, Hyogo, Japan 669-53; *Dept of Int. Med., Kobe Univ., Kobe, Japan 650
The mortality from coronary heart disease (CHD) in Japan is lower than that in western countries. This is believed to be due to the lower level of serum cholesterol, which again is considered due to the low-fat diet in Japan. As Japan becomes westernized, it is expected that the mortality and morbidity of CHD will increase. To elucidate the influence of nutrition on serum lipid levels, we conducted an epidemiological survey of circulatory diseases and nutrition in Hidaka, a typical Japanese agricultural area. The study has been conducted since 1968. Nutrient intake has been examined in residents over 20 years of age. Serum TC and Tg were measured enzymatically. The dietary intake, obtained through dietary recall interviews conducted by dietitians, was transformed into nutritional elements using Japanese standard tables. Serum TC levels increased significantly from 168.2 + 36.8 mg/dl in 1978 to 197.9k36.4 mg/dl in 1993 (mean f SD, P < 0.001). Serum Tg levels did not change significantly. The total caloric intake increased significantly from 1665 + 364 kcal in 1978 to 2026 -C492 kcal in 1993 (P < 0.001). The intake of
13
protein and fat also increased, from 53.0 rt 12.2 g and 28.6 f 11.6 g in 1978 to 77.0 + 18.4 g and 46.6 f 14.5 g in 1993 respectively (P < 0.001, P < 0.001). Dietary habits have been westernized in Hidaka and we expect that the incidence of CHD will soon increase. Serum insulin level and atherosclerosis risk factors 1 mT, Honda H, Nagashima M, Kobahashi Y, Fukuo Y, Terashi A, 2nd Dept. of Internal Medicine, Nippon Medical School, 3-5-5 Iidabashi, Chiyodaku, Tokyo, Japan
To assess the atherogenic role of insulin resistance syndrome, cardiovascular disease risk factors were investigated in native inhabitants of Hachijo island, Japan, in November 1993 and compared with the same measures in 1988. 82 men (62.4 2 10.6 years) were selected. Systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and fasting levels of serum total cholesterol (TC) and HDL-C, Tg, uric acid (UA), fructosamine (FA) and serum insulin (IRI) were measured. Routine ECG were also obtained. The serum insulin level correlated significantly with BMI (r = 0.452, P < O.OOl),SBP (r= 0.260, P = 0.02), DBP(r = 0.318, P=O.O04), UA (r=O.232, P=O.O4), TC (r=0.320, P=O.OW), Tg (r = 0.444, P < 0.001) and HDL-C (r = -0.307, P = 0.005) but not with age or FA level. IRI levels did not differ between subjects with abnormal and normal ECGs. Compared with 1988, blood pressure had tended to increase and FA had increased significantly in hyper-insulinemia. Over 5 years, the body weight of 19 men had increased and of 18 men had decreased. Amongst the former, SBP and DBP had increased significantly (P = 0.007, 0.04 respectively) and TC tended to increase (P = 0.072). 8 out of 37 men developed abnormal ECGs during the 5 years of follow-up. These men had a greater weight increase than those whose ECGs remained unchanged (BMI = 26.8 + 2.2 vs 24.1 f 2.5 kg/m2 in 1988). Associations of hyperinsulinemia with clinical and 1401 laboratory variables in a random elderly population I&&wg_Q, Strandberg TE, VaIvanne J, Saamla M, Sairanen S, Tuomilehto J, Tilvis RS, Geriatric Unit, Ilniv. qf Helsinki, FIN00290 Helsinki, Finland
Hyperinsulinemia is a marker of insulin resistance and it has been shown to be an independent risk factor of coronary heart disease (CHD). Its associations with several clinical conditions has been widely studied in young and middle-aged populations, whereas data on random elderly populations am scanty. Therefore, we studied random cohorts of 65, 75, 80 and 85-year-olds (N = 1057, M/F 41%/59%) in the Helsinki and Vantaa Aging Studies. Blood pressure (BP), body mass index (BMI), plasma lipids and insulin (FI), as well as subjective and objective health scores (O-10) and lifestyle were determined. Statistical analyses were performed separately in diabetics (DM, history, drugs or fasting blood glucose 26.7 mmoliI, n = 186) and normoglycemic subjects (NG, n = 871). In the total population FI was positively correlated with triglvcerides (r= 0.325). BMI (r = 0.265). blood elucose (r = O.ids) and systolic BP.(r=O.l35), and negatively-with HDLcholesterol (r=-O.148) and an objective health score (r=0.122). These correlations were significant also in non-diabetic subjects. In diabetics there were no correlations with systolic BP and objective health score. According to stepwise logistic regression analyses, triglycerides, BMI, blood glucose and health score emerged as significant determinants of FI (multiple R2 = 0.214). In addition, systolic and diastolic BP were independent determinants in non-diabetics (R2 = 0.190), whereas in diabetics only triglycerides and BMI were independent determinants (R2= 0.123).
Atherosclerosis X, Montreal, October I994
significantly and positively and HDL significantly negatively associated with IMT and plaque occurrence. There were no significant relationships between intake of saturated fat and IMT and plaque occurrence. Other cardiovascular risk factors like age, male gender, blood pressure, smoking (only plaque) were all significantly associated with IMT and the occurrence of plaques. Conclusions: This population-based study provides no support for the widely held opinion that intake of saturated fat increases the risk of atherosclerosis by increasing the concentration of atherogenic serum cholesterol fractions. The low rate of misclassification by the diet assessment method and the substantial sample size should make the conclusions sufficiently robust. Recent decrease of cardiovascular disease risk factors 1 in the Czech population &&&g& SkodovB Z, Valenta Z, PfSa Z, L.ub.for Atherosclerdsis Research, Inst. for Clinical and Experimental VideGsti 800, 140 00 Prague 4, Czech Republic
Medicine,
The mortality for cardiovascular disease in the Czech population is among the highest in the world and it ranged around 500 in men and 350 in women per 100000 during last decade. High frequency of hypercholesterolemia, hypertension, obesity and smoking seem to be responsible for these alarming data. In the present study, a dramatic drop in total serum cholesterol concentration has been documented together with a significant decrease in BMI in a 1% sample of the Czech population in six districts (MONICA Project). Total serum cholesterol decreased from 6.24 + 1.20 mmol/l (1988) to 5.91 * 1.29 mmoI/l (1992) in men in all age groups between 25-64 years and in women from 6.16 * 1.20 mmoI/l to 5.87 f 1.28 mmol/l in all age groups except for the group between 55 and 64 years. This highly significant decrease (P < 0.001) was accompanied by a well documented drop in body mass index and a decrease in animal fat consumption, No significant changes were observed in other risk factors such as blood pressure and smoking. As no significant population primary intervention of risk factors appeared between 1988 and 1992, only Iiberalization of prices leading to a decrease in dairy and meat product consumption is suggested as the main effect inducing the above beneficial changes. Epidemiological study of serum lipids in Japan: the 1 Hidaka study US, Miki T, Kawahara J, Hsieh ST, Hirouchi H, Taniguchi T*, Ishikawa Y*, Saito K*, Sano H*, Yokohama M*, Dept. of Int. Med., Hidaka Hospital, 81 Iwanaka, Hidaka-cho, kinosaki-gun, Hyogo, Japan 669-53; *Dept of Int. Med., Kobe Univ., Kobe, Japan 650
The mortality from coronary heart disease (CHD) in Japan is lower than that in western countries. This is believed to be due to the lower level of serum cholesterol, which again is considered due to the low-fat diet in Japan. As Japan becomes westernized, it is expected that the mortality and morbidity of CHD will increase. To elucidate the influence of nutrition on serum lipid levels, we conducted an epidemiological survey of circulatory diseases and nutrition in Hidaka, a typical Japanese agricultural area. The study has been conducted since 1968. Nutrient intake has been examined in residents over 20 years of age. Serum TC and Tg were measured enzymatically. The dietary intake, obtained through dietary recall interviews conducted by dietitians, was transformed into nutritional elements using Japanese standard tables. Serum TC levels increased significantly from 168.2 + 36.8 mg/dl in 1978 to 197.9k36.4 mg/dl in 1993 (mean f SD, P < 0.001). Serum Tg levels did not change significantly. The total caloric intake increased significantly from 1665 + 364 kcal in 1978 to 2026 -C492 kcal in 1993 (P < 0.001). The intake of
13
protein and fat also increased, from 53.0 rt 12.2 g and 28.6 f 11.6 g in 1978 to 77.0 + 18.4 g and 46.6 f 14.5 g in 1993 respectively (P < 0.001, P < 0.001). Dietary habits have been westernized in Hidaka and we expect that the incidence of CHD will soon increase. Serum insulin level and atherosclerosis risk factors 1 mT, Honda H, Nagashima M, Kobahashi Y, Fukuo Y, Terashi A, 2nd Dept. of Internal Medicine, Nippon Medical School, 3-5-5 Iidabashi, Chiyodaku, Tokyo, Japan
To assess the atherogenic role of insulin resistance syndrome, cardiovascular disease risk factors were investigated in native inhabitants of Hachijo island, Japan, in November 1993 and compared with the same measures in 1988. 82 men (62.4 2 10.6 years) were selected. Systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and fasting levels of serum total cholesterol (TC) and HDL-C, Tg, uric acid (UA), fructosamine (FA) and serum insulin (IRI) were measured. Routine ECG were also obtained. The serum insulin level correlated significantly with BMI (r = 0.452, P < O.OOl),SBP (r= 0.260, P = 0.02), DBP(r = 0.318, P=O.O04), UA (r=O.232, P=O.O4), TC (r=0.320, P=O.OW), Tg (r = 0.444, P < 0.001) and HDL-C (r = -0.307, P = 0.005) but not with age or FA level. IRI levels did not differ between subjects with abnormal and normal ECGs. Compared with 1988, blood pressure had tended to increase and FA had increased significantly in hyper-insulinemia. Over 5 years, the body weight of 19 men had increased and of 18 men had decreased. Amongst the former, SBP and DBP had increased significantly (P = 0.007, 0.04 respectively) and TC tended to increase (P = 0.072). 8 out of 37 men developed abnormal ECGs during the 5 years of follow-up. These men had a greater weight increase than those whose ECGs remained unchanged (BMI = 26.8 + 2.2 vs 24.1 f 2.5 kg/m2 in 1988). Associations of hyperinsulinemia with clinical and 1401 laboratory variables in a random elderly population I&&wg_Q, Strandberg TE, VaIvanne J, Saamla M, Sairanen S, Tuomilehto J, Tilvis RS, Geriatric Unit, Ilniv. qf Helsinki, FIN00290 Helsinki, Finland
Hyperinsulinemia is a marker of insulin resistance and it has been shown to be an independent risk factor of coronary heart disease (CHD). Its associations with several clinical conditions has been widely studied in young and middle-aged populations, whereas data on random elderly populations am scanty. Therefore, we studied random cohorts of 65, 75, 80 and 85-year-olds (N = 1057, M/F 41%/59%) in the Helsinki and Vantaa Aging Studies. Blood pressure (BP), body mass index (BMI), plasma lipids and insulin (FI), as well as subjective and objective health scores (O-10) and lifestyle were determined. Statistical analyses were performed separately in diabetics (DM, history, drugs or fasting blood glucose 26.7 mmoliI, n = 186) and normoglycemic subjects (NG, n = 871). In the total population FI was positively correlated with triglvcerides (r= 0.325). BMI (r = 0.265). blood elucose (r = O.ids) and systolic BP.(r=O.l35), and negatively-with HDLcholesterol (r=-O.148) and an objective health score (r=0.122). These correlations were significant also in non-diabetic subjects. In diabetics there were no correlations with systolic BP and objective health score. According to stepwise logistic regression analyses, triglycerides, BMI, blood glucose and health score emerged as significant determinants of FI (multiple R2 = 0.214). In addition, systolic and diastolic BP were independent determinants in non-diabetics (R2 = 0.190), whereas in diabetics only triglycerides and BMI were independent determinants (R2= 0.123).
Atherosclerosis X, Montreal, October I994