[Show abstract][Hide abstract] ABSTRACT: SUMMARY: The WHO MONICA Project is designed to measure the trends in mortality and morbidity from coronary heart disease (CHD) and stroke, and to assess the extent to which they are related to changes in known risk factors in different populations in 27 countries. Risk-factor data are collected from population samples examined in at least two population surveys (one at the beginning of the study and the other at the end). The results of the baseline population surveys are presented. In populations studied, the proportion of smokers varied between 34-62% among men and 3-52% among women. The population median of systolic blood pressure varied between 121-146 mmHg in men. In women the figures were 118 mmHg and 141 mmHg respectively. In diastolic blood pressure, the variation of median was from 74 mmHg to over 91 mmHg among men and from 72-89 mmHg among women. The third major risk factor considered was total cholesterol, with the population median ranging between 4.1-6.4 mmol/l among men and 4.2-6.3 mmol/l among women. Caution is required when making cross-sectional comparisons between the risk-factor levels as the MONICA Project was not designed for this purpose. Nevertheless, these data demonstrate clearly the large variety of baseline risk-factor patterns in populations studied in the MONICA Project.
MeSH Terms: Adult; Australia; Blood Pressure; Body Weight; China; Cholesterol/blood; Coronary Disease/etiology*; Data Interpretation, Statistical; Europe; Female; Humans; Male; Middle Aged; Population Surveillance*; Quality Control; Risk Factors; Smoking/statistics & numerical data; USSR; World Health Organization;
[Show abstract][Hide abstract] ABSTRACT: Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1.
We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage.
At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001).
Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.).
New England Journal of Medicine 03/2012; 366(15):1404-13. · 54.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the development in frequency and clustering of hypertension, hypercholesterolaemia, high body mass index (BMI), physical inactivity and tobacco smoking in the period 1964-1992, and to evaluate any sex and age differences.
Five cross-sectional investigations on cardiovascular risk factors performed in 1964, 1978, 1982-1984, 1986-1987 and 1991-1992 comprising random samples in a suburban area of Copenhagen, Denmark. Physical activity during leisure time and smoking habits were assessed by self-administered questionnaire. Blood pressure, weight, height and serum total cholesterol were measured according to WHO standards.
A total of 8644 persons aged 30, 40, 50 and 60 years participated with an equal number of men and women. Women had fewer risk factors than men and younger persons had fewer risk factors than older persons. In the period 1964-1992 there was a decreasing number of risk factors. The 50 year olds show a sex difference in the period 1982-1992, whereas there was no sex difference among the 60 year olds. Tobacco smoking was the most common risk factor. BMI > 27.5 has become more and more frequent throughout the period, especially in men. The BMI has conquered third place in all age groups. The association of BMI > 27.5 and sedentary leisure time physical activity has become the most frequent.
Clustering among risk factors decreased over time in both sexes. The association of elevated BMI and sedentary leisure time activity may contribute to the rising frequency of chronic disease such as diabetes mellitus and cardiovascular disease.
[Show abstract][Hide abstract] ABSTRACT: Secular trends in AMI rates were analyzed in relation to physical activity levels. The population attributable risk of physical inactivity was calculated. Participants were randomly selected subjects from a suburb of Copenhagen, Denmark, screened during the years 1964-1991. Occupational physical activity and in leisure time were assessed 1964, 1974, 1976, 1982, 1987 and 1991 by self-administered questionnaire along with smoking habits and alcohol consumption. Blood pressure, weight, height and serum lipids were measured according to WHO-standards. Mortality data were obtained from death certificates, from hospital records or autopsies. Acute myocardial infarctions (AMI) 1964-1994 were included. 13.925 men and women aged 30, 40, 50 and 60 years, were drawn as random samples from a background population of 300.000 inhabitants. A cohort born in 1914 was examined in 1964 and 1974, a cohort born in 1936, was examined in 1976 and 1987; Monica (Monitoring trends and determinants in cardiovascular diseases) I cohort were examined in 1982 and 1987; MONICA II in 1986, and MONICA III in 1991. Mean physical activity level at leisure adjusted for age and sex increased over time (P < 0001). 25% of the men were sedentary, and more women reported a sedentary lifestyle than men. The overall trend was from 1964 to 1992 a decline in physical activity at work (P < 0001) in both gender and all age groups. The difference in AMI incidence rates between leisure time physical activity (LTPA) levels increased over time. No change was found in AMI rates comparing sedentary in different time periods. A remarkable decrease over time in the AMI incidence rate was found in physically active during leisure time. Population attributable risk (PAR) exceeded 40% in both genders in the late 1980s. In conclusion the difference in AMI rates between LTPA subgroups has increased over time. The low AMI rates observed among the most physically active reveal a substantial potential for the prevention of AMI through physical activity. A population attributable risk of more than 40% for physical inactivity suggests a potential for primary prevention through increased physical activity.
Scandinavian Journal of Medicine and Science in Sports 09/2003; 13(4):224-30. · 3.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The incidence rate of a first myocardial infarction declined 3-5% annually in the Danish WHO MONICA population in the period from 1982 to 1991. The aim of this study was to investigate whether levels of the most commonly considered biological traits associated with cardiovascular risk have changed in the Danish MONICA population during this period.
Data from 6,695 men and women of 30, 40, 50 and 60 years of age, examined in the Danish WHO MONICA surveys in 1982-1984, 1986-1987, and 1991-1992, were analysed to estimate temporal trends in body height and weight, blood pressure, and serum total, HDL, and LDL cholesterol, and triglyceride.
Body height increased by 0.1% per year and the body mass index by 0.4% per year in women. The diastolic blood pressure increased 0.4% per year in women and 0.6% per year in 60-year-old men. HDL cholesterol declined 0.4% per year. Body mass indices in men, diastolic blood pressures in men < 60 years of age, systolic blood pressures, total and LDL cholesterol and triglyceride did not change.
The levels of biological risk factors in the Danish WHO MONICA study population did not show trends during the 1980s that contribute to explain the declining incidence of myocardial infarction in the population.
[Show abstract][Hide abstract] ABSTRACT: Objectives. This report analyzes cigarette smoking over 10 years in populations in the World Health Organization (WHO) MONICA Project (to monitor trends and determinants of cardiovascular disease).
Methods. Over 300 000 randomly selected subjects aged 25 to 64 years participated in surveys conducted in geographically defined populations.
Results. For men, smoking prevalence decreased by more than 5% in 16 of the 36 study populations, remained static in most others, but increased in Beijing. Where prevalence decreased, this was largely due to higher proportions of never smokers in the younger age groups rather than to smokers quitting. Among women, smoking prevalence increased by more than 5% in 6 populations and decreased by more than 5% in 9 populations. For women, smoking tended to increase in populations with low prevalence and decrease in populations with higher prevalence; for men, the reverse pattern was observed.
Conclusions. These data illustrate the evolution of the smoking epidemic in populations and provide the basis for targeted public health interventions to support the WHO priority for tobacco control.
American Journal of Public Health 02/2001; 91(2):206–212. · 4.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Data from 6695 men and women of ages 30, 40, 50, and 60 years, examined in the Danish WHO MONICA surveys in 1982-84, in 1986-87, and in 1991-92, were analyzed to estimate secular trends in body height and weight, blood pressure, and serum total, HDL-, and LDL-cholesterol, and triglyceride. Body height increased 0.1% per year, and body mass index increased 0.4% per year in women. Diastolic blood pressure increased 0.4% per year in women and 0.6% per year in 60-year-old men. HDL cholesterol declined 0.4% per year. Body mass indices in men, diastolic blood pressures in men <60 years of age, systolic blood pressures, total- and LDL cholesterol and triglyceride did not change. The levels of biological risk factors in the Danish WHO MONICA study population did not show trends during the 1980s that help explain the declining incidence of myocardial infarction in the population.
Journal of Clinical Epidemiology 05/2000; 53(4):427-34. · 5.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To study the importance of inflammation and fibrinolysis for evolution of ischaemic heart disease in a cohort of initially healthy subjects.
Nested case-control study. Follow-up periods 7-15 years.
Included in the study were 133 cases with coronary heart disease and 258 controls.
Subjects with ischaemic heart disease identified in 1991 by the Danish National Hospital Register. Protein concentration of C-reactive protein (CRP) and tissue-type plasminogen activator (t-PA) were measured with ELISA methods in stored serum samples.
CRP and t-PA concentrations were both significantly higher in cases than in controls (P < 0.001 and P < 0. 001). This difference between cases and controls for CRP and t-PA was present in both men (CRP: P = 0.022; t-PA: P = 0.001) and women (CRP: P = 0.013; t-PA: P = 0.005) and it was present in both the 7-9 years follow-up cohort (CRP: P = 0.014; t-PA: P = 0.001) and the 15 years follow-up cohort (CRP: P = 0.027; t-PA: P = 0.012). The best predictor of CRP was t-PA, whilst the best predictor of t-PA was triglycerides. In a logistic regression analysis model, t-PA still came out as independent predictor of coronary heart disease, whilst such a significance disappeared for CRP. With the use of ROC curves we determined that AUC for t-PA was 0.62, and for CRP 0.59, indicating that none of these two analytes has a high prognostic power in predicting future coronary events in an initially healthy population.
We conclude that moderate increases in serum concentrations of CRP and t-PA are present for up to 15 years before the presence of clinical overt coronary heart disease; that a low-grade inflammation is determined by other risk factors and that t-PA is an independent risk factor for evolution of coronary heart disease.
Journal of Internal Medicine 03/2000; 247(2):205-12. · 5.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hypertension is an essential risk factor for development of cardiovascular diseases. Prospective studies show a reduction in risk of myocardial infarction with reduction of blood pressure. In Denmark there was a decrease in ischaemic heart disease mortality during the period (1968-1992) with around 34% in 30-65 year old men and 30% in women.
To assess the changes in casual blood pressure between 1964 and 1991 in seven cross-sectional population studies.
Centre of Preventive Medicine, University of Copenhagen, DK-2600 Glostrup.
10359 subjects, equal numbers of men and women, age exactly 30, 40, 50 and 60 years drawn as random samples from a background population of 300000 inhabitants and surveyed in 1964-1974 and five cross-sectional studies 1976, 1978, 1982-1984, 1986-1987 and 1991.
Blood pressure was measured according to WHO criteria by one technician in each survey. Alcohol consumption and physical activity were measured by a self-administered questionnaire. The weight and height were measured by standardized methods. Data on mortality from ischaemic heart disease were obtained from death certificates recorded by the National Board of Health.
Blood pressure increased with increasing age in both genders and was significantly higher in men than in women. Median blood pressure in 50 year old men in 1964 was 135/85 mmHg and in 1991 it was 123/79, whereas in women in 1964 it was 140/85, against 119/74 in 1991. The prevalence of hypertensives among 30 and 40 year olds declined throughout the period. The performance of blood pressure measurements, technical variation, examination programme, seasonal variation and inter-observer variation were potential bias sources and influenced blood pressure levels, but cannot be shown to be responsible for the declining trend in blood pressure and hypertension. Women became a little more physical active in leisure time and men less active. Women consumed less alcohol than men, but the amounts slightly increased by the end of the period. Body mass index >25 was seen less frequently in women than in men and this increased in men over the period. Sale of antihypertensive drugs increased in Denmark over the 1964-1991 period. There seems to be good agreement between the changes in blood pressure in the population and the decline in mortality from stroke and coronary heart disease in Denmark, which is influenced by other risk factors as well.
Blood pressure distributions have shifted towards lower values in 1964-1991. Prevalence of hypertension declined up to 1983. Risk factor changes as well as treatment for hypertension contribute to this.
International Journal of Epidemiology 09/1998; 27(4):614-22. · 9.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of the present study was to examine the possible associations between low molecular weight (LMW) apolipoprotein(a) (apo(a)) isoforms (F,B,S1,S2) and coronary heart disease (CHD). We conducted a nested case-control (prospective) study of five cohorts of white men: The 1936 cohort (baseline 1976, n = 548) and four cohorts from MONICA I born in 1923 (n = 463), 1933 (n = 491), 1943 (n = 504) and 1953 (n = 448) studied at baseline in 1983. At follow up in 1991, 52 subjects had developed a first myocardial infarction and 22 had been hospitalized with angina pectoris. Plasma samples obtained at baseline were stored frozen until 1993-94, when case samples (n = 74) were analyzed together with samples from matched (disease free) controls (n = 190). In a statistical model (conditional logistic regression) including all age groups, cholesterol (or apo B) level (P < 0.01), systolic blood pressure (P = 0.05) and smoking (P = 0.02) predicted CHD. In the statistical model Lp(a) interacted significantly with age (OR = 5.7; 95% CI: 1.4-23.6; P = 0.016), and high Lp(a) (over 45 mg/dl) was associated with significantly increased risk in subjects under 60 years (OR = 3.82; 95% CI: 1.47-9.96), but not in older men (OR = 0.67; 95% CI: 0.235-1.89). Therefore, we studied the impact of Lp(a)/apo(a) and other variables in subjects who had been under 60 years when they became cases. Among the younger subjects the presence of LMW apo(a) isoforms significantly predicted the development of CHD (OR = 3.83; 95% CI: 1.18-12.4). The increased risk pertained to high Lp(a) (above versus below 45 mg/dl: OR = 3.68; 95% CI: 1.03-13.10), and to Lp(a) concentrations when entered into the model as a continuous variable (P = 0.04). Cholesterol or apo B (P < 0.01), smoking (P = 0.02), systolic blood pressure (P = 0.05) and low alcohol consumption (under nine drinks/week) (P = 0.04) were also significant predictors of CHD. We conclude that LMW apo(a) isoforms are significantly associated with increased risk of CHD in men under 60 years.
[Show abstract][Hide abstract] ABSTRACT: Mortality rates in Denmark from ischaemic heart diseases (IHD), other heart diseases and sudden death of unknown cause are presented for the period 1968-1992. In all age groups, mortality from IHD is higher at the beginning of the period than at the end. For other heart disease, the plot of the mortality rate is U-shaped for the age groups 65-84 and > or = 85, whereas for the age group 30-64 it first decreases and is then constant. There are an increasing number of deaths from symptomatic heart disease. For the group of unknown cause, the rates are increasing for all sex and age groups The relationship between deaths from IHD and death from unknown cause varies with period, age, sex and region. For women in Copenhagen in the age group 30-64, the mortality rate from unknown cause is higher than the rate for IHD at the end of period. Vital statistics must therefore be used cautiously in analysing trends for IHD, and even the validity of temporal changes within a country must be questioned.
[Show abstract][Hide abstract] ABSTRACT: The simulation model "Prevent" estimates the effect on mortality of changes of exposures to risk factors taking the multifactorial nature of the associations between risk factors and diseases, time dimensions, and demography into account. The objective of the study is to compare the actual development of ischaemic heart disease mortality in Danmark from 1982 to 1991 with the estimated mortality based on the development of four risk factors. The sources of data used in the study are national population data and mortality rates and prevalences of risk factors from population surveys (Glostrup Population Studies). Relative risk estimates are those implemented in the Dutch version of Prevent based on international literature. The risk factors are: tobacco smoking, hypertension, cholesterol, and alcohol consumption. Results are given for ages below 65 years. The pronounced decline in mortality of ischaemic heart disease in Denmark cannot be foreseen by the model based on the development of the associated risk factors. However, the combined trend of risk factors for the last 10 to 15 years is only modest and does not indicate the dramatic decline in mortality. Prevent is too simple to make a satisfactory forecast of mortality, which however, is not the main purpose of the model. By comparing the development of a reference and an intervention population the effects of unknown factors are to some extent eliminated and the model may therefore give a good impression of the benefits of preventive interventions.
[Show abstract][Hide abstract] ABSTRACT: Because of the general in availability of reference standards, there exist no common procedures to assess the quality of blood pressure measurements in epidemiological population surveys. To approach this problem within the collaborative international WHO MONICA Project, a standardized assessment of BP measurement quality was developed and applied to the forty-seven baseline surveys of that project. The entire assessments were carried out in retrospect, that is, only after each population survey had been completed. The assessment was focused on the procedures of quality assurance and control as reportedly applied in each survey, and on quality indicators which were derived from the recorded blood pressure values of each survey. The definitions of specific quality assessment items were based on the MONICA project protocol and on sources in the pertinent literature. The available information on quality assurance and control procedures depended solely on self-reports by local survey organizers and on site visits, and was occasionally found to be at variance with the actual blood pressure recordings. Therefore, quality indicators derived from actual blood pressure recordings were far more informative and comparable between surveys. Each survey was rated as optimal, satisfactory, or unsatisfactory with regard to single quality items and these single scores were used jointly to compute a summary score of blood pressure measurement quality for each survey. This summary score indicated that 39 out of 47 MONICA baseline surveys showed optimal or satisfactory BP measurement quality. Limitations and potentials for improvement of quality assessments became apparent. We conclude that a standardized assessment of BP measurement quality in epidemiological population surveys seems feasible and propose that quality assessment methods similar to the ones suggested here become a routine part of future epidemiological analyses of blood pressure values and hypertension in populations. This should facilitate valid study comparisons.
Journal of Human Hypertension 12/1995; 9(12):935-46. · 2.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A population survey was conducted on 3608 randomly selected Danes aged 30, 40, 50 and 60 years respectively. Of these, 3400 were not in medical treatment for arterial hypertension. The following parameters were investigated: sex, age, serum lipid levels (total cholesterol, HDL cholesterol, triglycerides), presence of diabetes mellitus, height, body mass index (BMI), and average daily consumption of coffee, tobacco and alcohol. Analysis with multiple linear regression showed that all variables with the exception of triglycerides, HDL cholesterol and height were significantly associated with systolic blood pressure. Likewise all factors except diabetes, triglycerides and height were significantly associated with diastolic blood pressure. Further analysis in which the effect of each parameter was corrected for by the effects of the remaining variables, demonstrated that apart from age and sex only BMI and high alcohol consumption were positively associated with differences in blood pressure greater than a few mmHg. However, the variation in both systolic and diastolic blood pressures was only partly accounted for by the parameters studied—in the covariates analysis R2 for systolic blood pressure was 0.28 and R2 for diastolic blood pressure was 0.30. In conclusion, this investigation demonstrated that blood pressure is relatively independent of other factors important in the development of cardiovascular disease. Of the above-mentioned factors with some influence on blood pressure only age, BMI and high alcohol consumption have potential clinical importance.
Journal of Clinical Epidemiology 06/1994; · 5.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Total mortality from cardiovascular disease in Denmark has decreased over the last 20 years for women and the last ten years for men. The possible role of simultaneous changes in serum total cholesterol has been investigated. Secular trends in serum cholesterol, high density lipoprotein cholesterol, and triglycerides, 1964-1987, are presented on the basis of four studies of 30-, 40-, 50- and 60-year-old men and women, some 8737 subjects in all. A significant decrease of 1% per year in total serum cholesterol (p less than 0.05) in both sexes and in all age groups up to 1982 was detected followed by a subsequent stabilization, 1982-1987. The decrease is not a result of methodological bias. The impact of storage at -20 degrees C for 13-24 months compared to immediate analysis of sera was studied as well as differences in analysis methods over time. The fall in population cholesterol levels might be associated with changes in polyunsaturated/saturated fat (P/S) ratio rather than total fat content of the diet, but other lifestyle changes have taken place as well.
International Journal of Epidemiology 04/1991; 20(1):105-13. · 9.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Information about risk factors and cardiovascular disease was collected from 30, 40, 50, and 60 year old representatives of the suburban Danish population (n = 1,504). Reference values for systolic and diastolic blood pressure and total serum-cholesterol are given. A comprehensive risk profile is discussed on the basis of selected risk factors: arterial hypertension, total serum-cholesterol greater than 7.5 mmol/l, smoking of ten cigarettes or more per day, intake of five alcoholic drinks or more per day, lack of physical exercise, and body mass index greater than 25 kg/m2.
The WHO MONICA Project : A worldwide monitoring system for cardiovascular diseases, World Health Statistics Annual edited by Pajak A, Kuulasmaa K, Tuomilehto J, Ruokokoski E, 03/1989: chapter SECTION B: pages 27-149; WHO, Geneva., ISBN: ISBN 92 4 067890 5