Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all-cause mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984-1992. Monitoring Trends and Determinants in Cardiovascular Diseases.
ABSTRACT The MONICA (Monitoring Trends and Determinants in Cardiovascular Diseases) project in Augsburg provides the first population-based cohort study in Germany to quantify the associations of the risk factors hypertension, hypercholesterolaemia and smoking with incident non-fatal and fatal myocardial infarction and all-cause mortality, and to assess their impact at the population level.
The cohort comprises 1074 men and 1013 women aged 45-64 years; they were followed over 8 years from 1984-1992. In the men, there were 61 non-fatal and fatal myocardial infarctions and 92 all-cause mortality events over this period; in the women the number of deaths from all causes was 45. Incidence rates, hazard rate ratios, population attributable fractions and rate advancement periods were calculated.
Adjusting for confounders, the myocardial infarction hazard rate ratios for men with hypertension, or a total cholesterol/HDL-cholesterol ratio > or =5.5, or smoking > or =20 cigarettes/day, were 2.0 (95% CI 1.2-3.5), 2.9 (95%, CI 1.7-5.0), and 2.7 (95% confidence interval (CI) 1 4-5.0), respectively. The risk factor combination total cholesterol/HDL cholesterol ratio > or = 5.5 and cigarette smoking was particularly hazardous. The three risk factors contributed 65% of the burden of myocardial infarction in the population. The rate advancement period for myocardial infarction associated with hypertension, total cholesterol/HDL cholesterol ratio > or =5.5 or smoking > or =20 cigarettes/day was 8.3, 12.4 and 11.5 years, respectively. In women, these risk factors were similarly predictive of all-cause mortality. Comparing the cohort data from Augsburg with those of two occupational cohorts from Germany reveals higher absolute myocardial infarction risks in the Augsburg population; however, the relative risk estimates in the Augsburg and the two occupational cohorts were very similar.
Our results confirm the important contribution of the classical risk factors to the risk of myocardial infarction and all-cause mortality in Germany. The results pertaining to the concept of rate advancement periods particularly demonstrate the great potential for prevention.
- SourceAvailable from: Jens Klotsche
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- "For example, in Germany only limited data on the prevalence and the distribution of risk factors are available. Most surveys have examined the prevalence and treatment patterns in patients at risk  or in a regionally clustered fashion such as PROCAM or MONICA or others       , and many are partly out of date       . Against the background of the rapidly changing guidelines and treatment environment, a remarkable need exists for comprehensive data from large studies on the prevalence of dyslipidemia, its recognition and control in primary care practice. "
ABSTRACT: OBJECTIVES AND METHODS: DETECT is a cross-sectional study of 55,518 unselected consecutive patients in 3188 representative primary care offices in Germany. In a random subset of 7519 patients, an extensive standardized laboratory program was undertaken. The study investigated the prevalence of cardiovascular disease, known risk factors (such as diabetes, hypertension and dyslipidemia and their co-morbid manifestation), as well as treatment patterns. The present analysis of the DETECT laboratory dataset focused on the prevalence and treatment of dyslipidemia in primary medical care in Germany. Coronary artery disease (CAD), risk categories and LDL-C target achievement rates were determined in the subset of 6815 patients according to the National Cholesterol Education Program (NCEP) ATP III Guidelines. RESULTS: Of all patients, 54.3% had dyslipidemia. Only 54.4% of the NCEP-classified dyslipidemic patients were diagnosed as 'dyslipidemic' by their physicians. Only 27% of all dyslipidemic patients (and 40.7% of the recognized dyslipidemic patients) were treated with lipid-lowering medications, and 11.1% of all dyslipidemic patients (41.4% of the patients treated with lipid-lowering drugs) achieved their LDL-C treatment goals. In conclusion, 80.3% of patients in the sample with dyslipidemia went undiagnosed, un-treated or under-treated.Atherosclerosis 03/2007; 190(2):397-407. DOI:10.1016/j.atherosclerosis.2006.02.025 · 3.97 Impact Factor
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- "The KORA-Survey S4 (previously named KORA-Survey 2000) was performed within the framework of the research platform KORA (Cooperative Health Research in the Augsburg Region). The background and history of this platform was described elsewhere (Keil et al., 1996, 1998). The study base of this survey consisted of all registered residents of German nationality, aged 25–74 years, of the City of Augsburg (Bavaria, Germany) and two surrounding counties. "
ABSTRACT: Nevi can approximate the melanoma risk and demographic changes will increase the meaning of signs of skin aging (SSA). However, little is known about the epidemiology of nevi and SSA in the general adult population. We aimed to estimate the prevalence and age distribution of common and atypical nevi and SSA as well as gender differences in a large population-based sample. Within the Cooperative Health Research in the Augsburg Region (KORA) in Germany, a population-based survey was performed. Data were gathered by interview and the number of pigmented lesions and presence of SSA were obtained by dermatological examination. A total of 2,823 adults (mean age 49 years, 50% women) participated (response 67%). Most subjects (60.3%) exhibited 11 to 50 common nevi and 5.2% had at least one atypical nevus. 51.9% were diagnosed with elastosis (Cutis rhomboidalis nuchae, 18.3%; Morbus Favre Racouchot 1.4%). Ephelides were seen in 16%, lentigines solaris in 62.4%, and lentigines seniles in 33.2%. All signs of skin aging increased significantly with age and so did lentigines solaris, seniles, and actinic keratoses. In contrast, common and atypical nevi and ephelides decreased significantly with age. Signs of skin aging are frequent and increase, in contrast to common and atypical nevi, with age.Journal of Investigative Dermatology 08/2006; 126(7):1490-6. DOI:10.1038/sj.jid.5700269 · 6.37 Impact Factor
European Heart Journal 12/2002; 23(22):1738-52. · 14.72 Impact Factor
- "Better prediction is assumed possible through adjustment of the greatly varying HDL-C values. Elevated atherogenic risk may reliably be assumed for a TC/HDL-C ratio greater than 4·5   . "