Risk of myocardial infarction in relation to plasma levels of homocysteine and inflammation-sensitive proteins: a long-term nested case-control study.
ABSTRACT Several studies have found that the homocysteine plasma level is associated with cardiovascular disease. The authors previously described a relationship between concentrations of fibrinogen and other inflammation-sensitive plasma proteins, namely, alpha1-antitrypsin, ceruloplasmin, haptoglobin, and orosomucoid (alpha1-acid glucoprotein) and the incidence of myocardial infarction (MI). Whether levels of these proteins are related to homocysteine has not been clarified. The aim of this study was to investigate whether a supposed relationship between homocysteine in plasma and the occurrence of MI is modified by these inflammation-sensitive proteins. A nested case-control study was designed, comprising 241 cases of MI, with a mean age of 48 years at baseline, and 241 controls matched for age, month of examination, and duration of follow-up. The mean homocysteine concentration did not differ between cases and controls and there was no association between the baseline homocysteine level and the time lapse before the occurrence of the MI. For the cases, there was no correlation between homocysteine and any of the measured proteins, but for the controls, homocysteine was weakly but significantly negatively correlated to haptoglobin and ceruloplasmin and slightly positively correlated to albumin. For the separated groups of cases and controls there was no association between the number of inflammation-sensitive proteins in the top quartiles and homocysteine concentration. In this population-based, prospective cohort study the occurrence of MI had no relationship to homocysteine baseline plasma level. Furthermore, there was no strong association between homocysteine and the concentrations of any of these inflammation-sensitive proteins.
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ABSTRACT: To assess to what extent intra-urban variations and time trends of mortality in ischaemic heart disease are related to incidence of disease. Incidence and mortality data were retrieved from the myocardial infarction register in Malmö. Age- and sex-adjusted incidence varied between the 17 city areas from 469 to 681/10(5) (P=0.003), and mortality from 286 to 446/10(5) (P=0.017). Socio-demographic risk factors for ischaemic heart disease were more prevalent in high rate areas. About 70% of the variance in mortality was explained by the variance in incidence. From 1986 to 1992, incidence declined by 3.6%/year in men (P=0.004) and by 0.9%/year in women (P=0.31). Mortality decreased by 4.1%/year in men (P=0.01) and by 1.9%/year in women (P=0.15). Incidence and mortality changes were statistically significant only in men>65. In younger age groups, incidence and mortality decreased in men but increased in women. In this urban population, there were large intra-city differences in mortality from ischaemic heart disease. During the period 1986 1992 there was a parallel decline in mortality and incidence. There were, however, substantial variations both in terms of residence and subject.European Heart Journal 12/1998; 19(12):1795-801. · 14.10 Impact Factor
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ABSTRACT: To describe the size, overlap and mortality of four cardiovascular risk groups, in order to give a scientific background for the prevention of cardiovascular disease in a representative urban population. Section of Preventive Medicine, Department of Medicine, Malmö University Hospital, Malmö, Sweden. Between 1974 and 1984 22444 men born between 1949 and 1921, constituting 75% of the total male population in these age groups, took part in a comprehensive screening examination aimed at detecting risk factors for cardiovascular disease. Those at high-risk of developing cardiovascular disease were referred to their general practitioner or to special clinics for hypertension, hyperlipidaemia and diabetes. The follow-up, which lasted until the end of 1991, averaged 12.2 years. Total death (n = 1450) and death from ischaemic heart disease (IHD) (n = 471). Hypertension was found in 13%, hypercholesterolaemia in 19% and diabetes mellitus in 2.6% of the subjects; 49% of the subjects smoked. Multiple risk factors were found in over 17% of the total cohort. Despite the intervention, all-cause mortality during follow-up was increased three-fold in smokers and in men with hypercholesterolaemia, four-fold in hypertensive men and five-fold in men with diabetes, compared to men with no risk factors. The vast majority of deaths (81%) occurred in men who smoked, had hypertension or had high serum cholesterol. Ischaemic heart disease (IHD) was increased five-fold in smokers, seven-fold in men with hypercholesterolaemia, nine-fold in hypertensive men and 12-fold in men with diabetes. Again, the vast majority of IHD deaths (86%) occurred in the first three categories. Combinations of risk factors substantially increased total mortality as well as IHD mortality. The large proportion (64%) of the population with risk factors for cardiovascular disease and the substantially (5-12-fold) increased IHD mortality in those risk groups, calls for actions aimed at preventing premature IHD deaths. Such action should include measures directed towards the whole population and comprehensive treatment programmes for high-risk individuals, including intervention to stop smoking. The substantial overlap between risk factors calls for one high-risk clinic caring for all risk groups.Journal of Internal Medicine 07/1996; 239(6):489-97. · 6.46 Impact Factor