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饮用水硬度与心血管疾病死亡率关系的研究

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中华预防医学杂志 1983年第3期17卷 129-133页

作者：全国饮用水硬度与健康专题科研协作组北京市卫生防疫站

1957年,日本学者提出脑卒中死亡率与河水的硫酸盐和碳酸盐的比值有密切关系,1960年前后,美、英和瑞典等国的学者亦相继提出饮水硬度与心血管疾病死亡率呈明显的负相关,认为软水可能是心血管疾病的危险因

关键词：给水心血管疾病/死亡率

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WEATHER AND DEATH IN BIRMINGHAM, ALABAMA

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ENVIRONMENTAL RESEARCH 1976年第3期12卷 340-354页

作者： STATES, SJ UNIV PITTSBURGH DEPT BIOL PITTSBURGH PA 15260 USA

The relationship between weather and daily mortality was examined for 21,000 deaths occurring over a 4 yr period in the subtropical climate of Birmingham, Alabama, USA. Eight weather parameters were correlated with daily mortality using multiple, simple and partial correlation techniques. The relationship between weather and daily total mortality was quite significant. The effect of weather increased with age and was much more intense among the white than the nonwhite population. The weather-mortality relationship was also examined separately for each sex, but no difference was apparent. When the effect of weather examined for various causes of death, it was found that weather exerts a strong influence on mortality from circulatory and especially respiratory causes, but a relatively minor influence on cancer mortality and deaths due to accidents and violence. The relationship between weather and mortality involved weather conditions existing on the day of death and those prevailing during the several days prior to death. The weather-mortality association was particularly significant during the autumn.

关键词：年龄因素亚拉巴马大气压心血管疾病/死亡率脑血管障碍/死亡率大陆人口群湿度死亡率呼吸道疾病/死亡率季节性别因素温度天气青少年成年人老年人儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Heart rate variability associated with particulate air pollution

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AMERICAN HEART JOURNAL 1999年第5期138卷 890-899页

作者： Pope, CA Verrier, RL Lovett, EG Larson, AC Raizenne, ME Kanner, RE Schwartz, J Villegas, M Gold, DR Dockery, DW Brigham Young Univ Provo UT 84602 USA Harvard Univ Sch Med Beth Israel Deaconess Med Ctr Inst Prevent Cardiovasc Dis Boston MA USA Marquette Med Syst Milwaukee WI USA Hlth Canada Ottawa ON K1A 0L2 Canada Univ Utah Sch Med Salt Lake City UT USA Harvard Univ Sch Med Brigham & Womens Hosp Channing Lab Boston MA USA Harvard Univ Sch Publ Hlth Boston MA 02115 USA

Background Epidemiologic studies have linked fine particulate air pollution with cardiopulmonary mortality, yet underlying biologic mechanisms remain unknown. Changes in heart rate variability (HRV) may reflect changes in cardiac autonomic function and risk of sudden cardiac death. This study evaluated changes in mean heart rate and HRV in human beings associated with changes in exposure to particulate air pollution. Methods Repeated ambulatory electrocardiographic monitoring was conducted on 7 subjects for a total of 29 person-days before, during, and after episodes of elevated pollution. Mean HR, the standard deviation of normal-to-normal (NN) intervals (SDNN), the standard deviation of the averages of NN intervals in all 5-minute segments of the recording (SDANN), and the square roof of the mean of squared differences between adjacent NN intervals (r-MSSD) were calculated for 24-hour and 6-hour time segments. Associations of HRV with particulate pollution levels were evaluated with fixed-effects regression models. Results After controlling for differences across patients, elevated particulate levels were associated with (1) increased mean HR, (2) decreased SDNN, a measure of overall HRV, (3) decreased SDANN, a measure that corresponds to ultralow frequency variability, and (4) increased r-MSSD, a measure that corresponds to high-frequency variability. The associations between HRV and particulates were small but persisted even after controlling for mean HR. Conclusions This study suggests that changes in cardiac autonomic function reflected by changes in mean HR and HRV may be part of the pathophysiologic mechanisms or pathways linking cardiovascular mortality and particulate air pollution.

关键词：自主神经系统/病理生理学心血管疾病/病因学心血管疾病/死亡率心血管疾病/病理生理学昼夜节律心电描记术便携式心脏/神经支配心脏/病理生理学心率预后问卷调查回顾性研究危险因素季节犹他/流行病学成年人老年人老年人 80以上女(雌)性人类男(雄)性

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Cardiovascular mortality of Chinese in New York City

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JOURNAL OF URBAN HEALTH-BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE 1999年第1期76卷 51-61页

作者： Fang, J Madhavan, S Alderman, MH Yeshiva Univ Albert Einstein Coll Med Dept Epidemiol & Social Med Bronx NY 10461 USA

To determine cardiovascular disease mortality among Chinese migrants in New York City and compare it to both that of residents in China and whites in New York City, mortality records for 1988 through 1992 for New York City and the 1990 US census data for New York City were linked. Age-specific death rates for urban China, reported by the World Health Organization, were used for comparison. The results show that male and female Chinese residents in New York City had lower mortality rates for all causes and total cardiovascular disease than did either New York City whites or Chinese in China. Coronary heart disease deaths among New York City Chinese were intermediate between Chinese in China (lowest) and New York City whites (highest). Stroke death rates for New York City Chinese were substantially lower than those in China and, in general, were similar to those for New York City whites. However, New York City Chinese had higher death rates for hemorrhagic stroke and lower for atherosclerotic stroke than did New York City whites. In conclusion, cardiovascular mortality rates among Chinese migrants in New York City fall below those of both Chinese in China and whites in New York City.

关键词：年龄因素亚洲大陆世系人群心血管疾病/人种学心血管疾病/死亡率脑出血/死亡率脑血管障碍/死亡率中国/人种学冠心病/死亡率人种群/统计学和数值数据欧洲大陆世系人群/统计学和数值数据颅内动脉硬化/死亡率纽约市/流行病学登记性别因素美国/流行病学城市卫生/统计学和数值数据世界卫生组织成年人老年人女(雌)性人类男(雄)性中年人

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Improving patient outcomes by pooling resources (The Texas heart care partnership experience)

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第3A期85卷 43A-51A页

作者： Hillert, B Remonte, S Rodgers, G Yancy, CW Kaul, AF Texas Med Assoc Heart Care Partnership Subcomm Cardiovasc Dis Austin TX USA Doctors Hosp Dallas TX USA Austin Heart Austin TX USA SW Med Sch Dallas TX USA Med Outcomes Management Inc Foxboro MA USA Univ Rhode Isl Coll Pharm Kingston RI 02881 USA

The morbidity and mortality associated with cardiovascular disease presents an enormous humanistic and economic burden in the United States. In Texas, cardiovascular disease has been the leading cause of death since 1950. Risk-factor modification has been targeted in the secondary prevention of cardiovascular disease, including lipid management, smoking cessation, improved control of blood pressure, physical activity, weight management, the use of a nti platelet agents/anticoagulants, angiotensin-converting enzyme (ACE) inhibitors in congestive heart failure, beta blockers after myocardial infarction, and estrogen replacement therapy. The Heart Care Partnership (HCP) is a multifaceted interactive program designed to improve risk-factor management in the secondary prevention of cardiovascular disease through physician education, participation, and consensus development in addition to practice improvement processes and patient education. Development and implementation of the Texas HCP was a joint effort of the Texas Medical Association, the Texas Affiliate of the American Heart Association, and Merck & Co. This program helps hospitals improve the quality of care and outcomes for patients with heart disease. Program resources include educational workshops, quality improvement processes, and patient educational materials. HCP workshops address the treatment gap, define optimal care, and help define institution-specific plans for treating heart disease. Quality-improvement processes provide hospitals with baseline data and tools to improve and measure outcomes over time. The HCP workshops are provided as a combination of lectures, interactive discussions, and small group planning sessions designed to encourage audience participation. Upon completing the HCP program, participants are able to (1) describe the evidence-based medicine supporting secondary prevention of cardiovascular disease;(2) identify and prioritize cardiovascular disease risk factors for secondary preven

关键词：心脏病学/组织和管理心血管药物/治疗应用心血管疾病/死亡率心血管疾病/预防和控制卫生资源/组织和管理结果评价(卫生保健)/组织和管理回顾性研究学会医学得克萨斯人类

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DETECTION AND CHARACTERIZATION OF HYPERLIPOPROTEINEMIA IN MIDDLE-AGED MEN

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UPSALA JOURNAL OF MEDICAL SCIENCES 1976年第3期81卷 159-166页

作者： HEDSTRAND, H VESSBY, B UNIV UPPSALA HOSP INST GERIATR S-75014 UPPSALA SWEDEN UNIV UPPSALA HOSP DEPT INTERNAL MED S-75014 UPPSALA SWEDEN

Serum lipoprotein (LP) concentrations were determined and LP patterns were classified in 261 middle-aged men, recruited from a health examination survey, with serum lipid values above the 80th percentile of the same population. Individuals with hyperlipoproteinemia (HLP) and normolipidemic controls were characterized also regarding family history of cardiovascular disease, socio-economic factors and clinical and laboratory variables. Subjects with HLP type IV-V and IIB were overweight and showed hyperuricemia and hyperinsulinemia compared with normolipidemic controls and subjects with HLP type IIA. The latter showed elevated erythrocyte sedimentation rate. Despite being overweight, subjects with HLP type III showed normal fasting values of insulin and uric acid in serum and normal early insulin response to i.v. glucose. The glucose tolerance did not differ significantly between the groups. Men with HLP types IV-V had predominantly sedentary occupations, in contrast to those with type IIA. There were significantly more smokers in the groups with HLP type IIB and IV-V than in the control group. Individuals with different types of HLP tend to show different metabolic profiles but also different socioeconomic and clinical patterns, suggesting that exogenous factors are of importance in the expression of the LP abnormalities.

关键词：年龄因素血压体重心血管疾病/遗传学心血管疾病/死亡率高脂血症/血液高脂血症/流行病学高脂血症/病理生理学胰岛素/血液脂类/血液脂蛋白类/血液婚姻强体力活动吸烟社会经济因素瑞典人类男(雄)性中年人

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Risks associated with renal dysfunction in patients in the coronary care unit

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第3期36卷 679-684页

作者： McCullough, PA Soman, SS Shah, SS Smith, ST Marks, KR Yee, J Borzak, S Henry Ford Hlth Syst Dept Internal Med Div Cardiovasc Dis Div Nephrol & Hypertens Detroit MI USA Henry Ford Heart & Vasc Inst Detroit MI USA

OBJECTIVES The purpose of this study was to quantify the impact of baseline renal dysfunction on morbidity and mortality in patients in the coronary care unit (CCU). BACKGROUND The presence of renal dysfunction is an established independent predictor of survival after acute myocardial infarction and revascularization procedures. METHODS We analyzed a prospective CCU registry of 12,648 admissions by 9,557 patients over eight years at a single, tertiary center. Admission serum creatinine was available in 9,544 patients. Those not on long-term dialysis were classified into quartiles of corrected creatinine clearance, with cut-points of 46.2, 63.1 and 81.5 ml/min per 72 kg. Dialysis patients (n = 527) were considered as a fifth comparison group. RESULTS Baseline characteristics, including older age, African-American race, diabetes, hypertension, previous coronary disease and heart failure, were incrementally more common across increasing renal dysfunction strata. There were graded increases in the relative risk for atrial and ventricular arrhythmias, heart block, asystole, development of pulmonary congestion, acute mitral regurgitation and cardiogenic shock across the risk strata. CONCLUSIONS Survival analysis demonstrated an early mortality hazard for those with renal dysfunction, but not on dialysis, for the first 60 months, followed by graded decrements in survival across increasing renal dysfunction strata. Baseline renal function is a powerful predictor of short- and long-term events in the CCU population. There is an early hazard for in-hospital and postdischarge mortality for those with a corrected creatinine clearance <46.2 ml/min per kg, but not on dialysis. (J Am Coll Cardiol 2000;36:679-84) (c) 2000 by the American College of Cardiology

关键词：心律失常心性/病理生理学心血管疾病/死亡率心血管疾病/病理生理学冠心病重症监护病房血流动力学肾/病理生理学心肌梗死/并发症前瞻性研究登记危险因素存活率分析时间因素心室功能障碍左/病因学老年人女(雌)性人类男(雄)性中年人

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Prognostic implications of ejection fraction from linear echocardiographic dimensions: The Strong Heart Study

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AMERICAN HEART JOURNAL 2003年第3期146卷 527-534页

作者： Devereux, RB Roman, MJ Palmieri, V Liu, JE Lee, ET Best, LG Fabsitz, RR Rodeheffer, RJ Howard, BV Cornell Med Ctr New York NY USA Univ Oklahoma Hlth Sci Ctr Oklahoma City OK USA Missouri Breaks Ind Res Timber Lake SD USA NHLBI Bethesda MD 20892 USA MedStar Res Inst Washington DC USA Mayo Clin Rochester MN USA

Background Although echocardiography is commonly used to assess left ventricular (LV) systolic function, few data are available concerning the prognostic significance of LV ejection fraction (EF) calculated from linear echocardiographic measurements or 2-dimensional (2-D) wall motion scores in population-based samples. Methods Echocardiography was used in the second Strong Heart Study (SHS) examination to calculate LV EF in 2948 American Indians without prevalent coronary heart disease;2923 had 2-D wall motion scores. Results Mildly and severely reduced LV EF occurred in 10% and 2% of participants, was associated with older age, male sex, higher systolic pressure, heart rate and markers of renal disease and inflammation. During 37 +/- 9 months follow-up, cardiovascular death occurred in 2%, 5% and 12% of participants with normal, mildly reduced and severely reduced EF;all cause mortality rates were 6%, 10% and 32% (both P < .001). In Cox proportional hazards analyses, adjusting for covariates, cardiovascular death was higher with mildly reduced EF (risk ratio [RR] 2.9, 95% Cl 1.6-5.4, P = .0007) and especially with severely reduced EF (RR 6.9, 95% Cl 3.0-15.9, P < .0001);all-cause mortality was increased with severe LV dysfunction (RR 4.8, 95% Cl 2.8-8.1, P < .001) and marginally with mildly reduced EF (odds ratio 1.4, 95% Cl 0.95-2.15, P = .08). Segmental LV dysfunction and mildly and severely reduced EF from 2-D wall motion scores were associated with 3.3-fold (95% Cl 1.1-9.4, P = .02), 3.5-fold (95% Cl 2.1-5.8) and 3.8-fold (95% Cl 1.9-7.6) (all P <.001) increased rates of cardiovascular death. Conclusions LV EF from linear echocardiographic measurements as well as segmental LV dysfunction and EF from 2-D wall motion scores strongly and independently predict cardiovascular mortality. Reduced EF by simple echocardiographic method has estimated population-attributable risks of about 35% for cardiovascular death and 12% for all-cause mortality in a population-based

关键词：心血管疾病/死亡率死亡原因超声心动描记术心率印第安人北美洲心肌收缩预后统计数据每搏输出量/生理学心室功能障碍左/人种学心室功能障碍左/病理生理学心室功能障碍左/超声检查老年人女(雌)性人类男(雄)性中年人

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Are we asking too much of our trials?

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AMERICAN HEART JOURNAL 2002年第1期143卷 1-3页

作者： Skali, H Solomon, SD Pfeffer, MA Brigham & Womens Hosp Cardiovasc Div Dept Med Boston MA 02115 USA Harvard Univ Med Sch Boston MA 02138 USA

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Cardiovascular mortality patterns in Turkey:: What is the evidence?

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SOZIAL-UND PRAVENTIVMEDIZIN 2000年第1期45卷 46-51页

作者： Razum, O Akgün, S Tezcan, S Heidelberg Univ Dept Trop Hyg & Publ Hlth D-69120 Heidelberg Germany

In Turkey, reliable cause-specific mortality data are not available. It is thus unknown whether ischaemic heart disease (as in western Europe and the US) or stroke (as in the Far East) is the prevailing cause of cardiovascular death. This information, however is required for planning cardiovascular prevention programmes. We analyse available Turkish national cause-of-death data as well as patterns of cardiovascular mortality in a hospital in Ankara and among Turkish migrants in Germany. According to national statistics, the ischaemic heart disease-re-stroke ratio would be 0.3 among men aged 45-64 years, lower than that in Japan. Hospital and migrant data show this ratio to be 2-4. We demonstrate the implausibility of the national data by assessing the precision of cause-of-death assignment. We then discuss to what degree mortality experience among migrants is representative for their country of origin. Our findings suggest that the pattern of cardiovascular mortality in Turkey is closer to that in western Europe and the US than to that in the Far East. Finally, we discuss options for improving cardiovascular surveillance in Turkey.

关键词：心血管疾病/死亡率死亡原因冠心病/死亡率文化交叉比较横断面研究移民(移出和移入)/统计学和数值数据发病率人群监测卒中/死亡率土耳其/流行病学成年人老年人女(雌)性人类男(雄)性中年人

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