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Epidemiology of ischemic heart disease and peculiarities of atherosclerosis in male residents of Yakutsk
Abstract
Aim. To study trends in prevalence, risk factors (RF) and mortality of ischemic heart disease (IHD), contribution of RF to risk of death due to IHD and other cardiovascular diseases (CVD) among male population of Yakutsk; to determine characteristics of atherosclerosis among native male population and migrants. Material and methods. A clinicopathological epidemiological trial covered male population of Yakutsk. It was performed by standard techniques within the scope of the cooperative program. Results. The analysis of the trends for the last 10 years demonstrates a marked rise in the incidence rates of arterial hypertension (AH), overweight and hypercholesterolemia. CVD mortality reached 38.4% of overall mortality. Such factors as AH, smoking, IHD, ischemic ECG changes and overweight contribute much to the integral risk of CVD death. A comparative morphometric analysis of atherosclerosis development in 1965-1968 and 1985-1988 showed accelerated development of atherosclerosis both among native population and migrants in 1985-1988. There are population differences in development of atherosclerosis in males from native population and migrants. The effects of trace elements on formation of atherosclerosis components in the Far North were evaluated. Conclusion. Present-day epidemiological situation in relation to IHD and other CVD necessitates further monitoring of the situation, activation of primary and secondary IHD prevention among population of the Far North.
... Our findings may account for increased death rate of atherosclerosis-related diseases recorded in both ethnic populations. Negative tendencies in the development of atherosclerosis in Russia can be ascribed to changing social and economical factors in the post-socialist transition period [6,24] . In addition, there is evidence that a long-term residence in the far North does not necessarily lead to adaptation and does not diminish the risk of atherosclerosis-related cardiovascular diseases [25]. ...
We have analyzed the development of aortic and coronary atherosclerosis over 40 years in native and non-native males of Yakutsk by comparing the data obtained in 1963-1965, 1985-1987 and 2001-2003. The research was carried out in compliance with the WHO program for the atherosclerosis epidemiology studies using autopsy material. Subjects (361 natives and 692 non-natives) included in the research died of external causes at the age of 20-59 years and had no history of chronic diseases, which was confirmed by post-mortem examination. The prevalence and the extent of raised atherosclerotic lesions (fibrous plaques, complicated lesions and calcinosis) in the aorta and coronary arteries were determined by visual planimetry after staining with Sudan IV. An accelerated development of aortic and coronary atherosclerosis was revealed in both populations throughout the entire period of 40 years with more severe manifestations in non-native males. The severity of atherosclerosis increased considerably in native and non-native males aged over 40 years. The rate of the increase in the extent of raised atherosclerotic lesions tended to be greater in native than in non-native males.
Despite the unconditional success achieved in the treatment and prevention of AMI over the past 40 years, mortality in this disease remains high. Hence, it is necessary to develop novel drugs with mechanism of action different from those currently used in clinical practices. Studying the molecular mechanisms involved in the cardioprotective effect of adapting to cold could contribute to the development of drugs that increase cardiac tolerance to the impact of ischemia/reperfusion. An analysis of the published data shows that the long-term human stay in the Far North contributes to the occurrence of cardiovascular diseases. At the same time, chronic and continuous exposure to cold increases tolerance of the rat heart to ischemia/ reperfusion. It has been demonstrated that the cardioprotective effect of cold adaptation depends on the activation of ROS production, stimulation of the β2-adrenergic receptor and protein kinase C, MPT pore closing, and KATP channel.
The aim of the article was to study for 12 months the adherence to drug therapy and the incidence of cardiovascular risk factors in Yakutia patients who underwent Q-positive myocardial infarction.
Materials and methods . The analysis included 113 patients from Yakutsk with Q-positive acute myocardial infarction, the average age is 59 [51;64] years old.
Results . The following conclusions are obtained: The majority of patients of Yakut nationality who underwent Q-positive myocardial infarction have a high incidence of cardiovascular risk factors. Among the examined patients of this category after 6 months was received a low adherence to prescription drugs: clopidogrel /ticagrelor (by 9.9%), ACE inhibitors / sartans (by 18%), β-adrenoblockers (by 24.6%), statins (by 46.7%). For the 12th month after a second consultation, there was an increased adherence to taking the statins by 33.3% and beta-blockers by 17.8%. AH is a well-controlled risk factor, in most patients there is an effective reduction in high blood pressure values from the first months. The mean of total cholesterol, cholesnerol — LDL and the frequency of hypercholesterinemia, hypercholesterinemia LDL for 12 months after a recent MI is decreased, but the target values were not achieved due to low adherence to taking statins.
Conclusion . Due to the low adherence to drug therapy and the insufficient correction of risk factors for CVD after MI there was noted repeated hospitalizations for repeated ACS, decompensation of CHF, and fatal cases/outcomes, regardless of ethnicity, which requires intensification of the measures for dispenserization, at the primary level health.
In elderly Framingham men and women, systolic blood pressure and cigarette smoking status, as well as a subject's age and sex, strongly influenced the risk of developing cardiovascular disease during ten years of follow-up. Multivariable proportional hazards models were used to assess the roles of several primary risk factors and to examine their secondary effects. The first three factors were noted in both sexes, separately and combined, but the risk function for blood pressure was steeper in men than in women (hazard ratio, HR, 1.53 per 20 mmHg, 95 per cent confidence interval, CI, 1.33 to 1.75 in men; HR = 1.19, 95 per cent CI 1.07 to 1.33 in women). Systolic pressure measured ten years earlier also contributed to CVD risk (HR = 1.16 per 20 mmHg, 95 per cent CI 1.04 to 1.30). even after accounting for current level. Smoking was associated with a 64 per cent elevation in risk, male sex with a 51 per cent increase, and each 5 years increment in age with a 22 per cent increase. Body mass index measured 10 years ago had a modest association, but current body mass index did not. Among diabetic subjects, total serum cholesterol had an asymmetrical U-shaped risk function, the risk increasing to either side of sex-specific median values; diabetes per se, however, was not significant in the final model. In non-diabetic subjects, there was little change in CVD risk up to the median cholesterol values and a modest increase thereafter. None of the risk functions was age dependent.
In France, differences in cardiovascular risk factor distribution have been observed which might be responsible for some disparities in cardiovascular mortality between social categories. The goal of the study was thus to assess the differences in coronary heart disease (CHD) and cerebrovascular diseases (CVD) mortality according to social category, and to determine their trends over the last 20 years in France.
Mortality data for CHD, CVD, diseases of the circulatory system (CS) and all causes mortality (TM) were based on death certificates for 1970, 1980 and 1990, and categorized by sex, age group (35-44 and 45-54 years), region and social category.
Among active men, from 1970 to 1990, the overall decrease observed for all causes of death was significantly slower among employees and workers for CHD, CS and TM (P < 0.001), but not for CVD. In 1990, the highest mortality rates were observed among employees and workers for CHD, CVD and CS mortality. In women, no such trend was observed for CHD, CVD or CS mortality. No statistically significant difference between social categories was observed in 1990 for CHD and CVD. In the whole active population, a negative trend for the mortality rates was observed between 1970 and 1990 whatever the cause in both sexes. The ratio between mortality rates among non-active versus active people increased during the two decades in both sexes.
In men, the inequalities have increased over the last two decades for CHD and have not been reduced for CVD. The category of employees and workers were found to be at special risk for premature cardiovascular disease mortality. Among women, the trends were less clear, although the tendencies were the same. An increasing disparity between active and non-active people suggests that a health-related selection process towards unemployment might have contributed to the decreasing mortality rates observed among employees and workers.
Deaths are coded to the International Classification of Diseases (ICD) category, 'Symptoms, Signs, and ill-defined Conditions' when there is insufficient information for cause of death determination. Due to difficulties of diagnosis of coronary heart disease (CHD) death and since CHD is the leading cause of death among US adults, CHD is the most likely cause of ill-defined deaths.
Vital statistics and census data were used to create annual age-adjusted ill-defined rates, unrevised CHD rates, and CHD rates revised to include ill-defined deaths for US African Americans and whites, ages 35-74 years, during 1968-1988. Ill-defined and CHD mortality trend analyses were conducted.
In 1968, African American/white ratios of ill-defined mortality were 5 among men and 7 among women; following steep declines in ill-defined mortality among African Americans, ratios were 3 among men and 2 among women in 1988. In 1968, approximately 3% and 1% of all deaths among African Americans and whites, respectively, were certified to ill-defined causes; in 1988, approximately 1.5% of deaths among African Americans were coded ill-defined, with no change among whites. Revised CHD rates showed substantially higher excess CHD mortality among African Americans than whites compared to unrevised CHD rates. Declines in revised CHD mortality steepened throughout the study period among men, and among women began to decelerate after 1978.
Ill-defined mortality was of sufficient magnitude to potentially contribute to substantial underestimation of racial disparities in CHD mortality. Also, temporal changes in ill-defined mortality may have affected CHD trends which are used to evaluate the efficacy of public health interventions.