M Kornitzer

Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women

Objective To study abnormalities in the resting ECG as independent predictors for all cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in a population based random sample of men and women, and to explore whether their prognostic value is different between sexes. Design and subjects An age and sex stratified random sample was selected from the total Belgian population aged 25 to 74 years. Baseline data were gathered and resting ECGs were classified according to Minnesota code criteria. The sample was then followed for at least 10 years with respect to cause specific death. Results are based on observations from 5208 men and 4746 women free from prevalent CHD at the start of the follow up period. Results Although the prevalence of major abnormalities in general was comparable between sexes, women had more ischaemic findings, ST segment changes, and abnormal T waves on their baseline ECG, while men showed more arrhythmias, bundle branch blocks, and left ventricular hypertrophy. Fitting the multiplicative effect on subsequent mortality between all ECG classifications under study and sex indicated that the prognostic value of ECG changes was equal in women and men. Independently of other risk factors and other major ECG changes, almost all ECG classifications were significantly related to all cause, CVD, and CHD mortality. The most predictive ECG findings for CVD death were ST segment depression (risk ratio (RR) 4.71), major ECG findings (RR 3.26), left ventricular hypertrophy (RR 2.79), bundle branch blocks (RR 2.58), T wave flattening (RR 2.47), ischaemic ECG findings (RR 2.35), and arrhythmias (RR 2.15). The prognostic value of major ECG findings for CVD and CHD death was more powerful than well established cardiovascular risk factors. Conclusions Abnormalities in the baseline ECG are strongly associated with subsequent all cause, CVD, and CHD mortality. Their predictive value was similar for men and women.

A double blind study of 2 mg versus 4 mg nicotine-gum in an industrial setting

In a double blind randomised trial to aid smoking cessation a 2 mg nicotine gum (n = 101) was compared with a 4 mg gum (n = 98), in smokers of at least 15 cigarettes/day. The trial involved blue and white collar workers and took place at their working place (industrial setting). Intervention during the one year follow-up period was minimal. At 3 months 36.2% of the 2 mg nicotine gum group reported to have stopped smoking, against 44.8% in the 4 mg group (non-significant difference). At one year in the 2 and 4 mg groups respectively 22.3 and 32.2% reported smoking abstinence (non significant difference). However in a sub-group with a higher nicotine-dependence score, only 18.5% were abstainers at one year in the 2 mg nicotine gum group against 32.9% in the 4 mg nicotine gum, which is a significant difference at the p = 0.05 level. This is however a post-hoc finding and should be taken with caution.

Physical Activity and Physical Fitness Levels of Belgian Males Aged 40-55 Years

Physical activity during leisure time and on the job have been measured with standardized interview techniques in 1,513 normal men, aged 40-55 years, who were regularly employed in different industries. Physical fitness was simultaneously estimated by measuring the work load at which a heart rate of 150 bpm was reached on a standardized exercise test. The median energy expenditure from leisure time activities above the basal metabolic rate was 195 kcal/day; 19% of these activities were classified as heavy, 37% as moderate and 43% as light intensity. The median energy expenditure from job physical activity was 1,676 kcal/day including basal metabolic rate. The median physical fitness level was 125 W. The leisure time activity score was significantly related to physical fitness through the light and the heavy intensity subscores. Independently, job physical activity was also significantly related to physical fitness. However, both activity scores accounted for only 2% of the variance in physical fitness. The data illustrate an overall low energy expenditure profile of middle-aged normal men and a low order relationship between physical activity pattern and physical fitness.

The Belgian heart disease prevention project. Modification of the coronary risk profile in an industrial population.

The Belgian Heart Disease Prevention Project is a controlled, multifactorial prevention trial involving 19,390 males aged 40–59 years employed by 30 Belgian industries. These industries were paired and randomized into a control or intervention unit. In each intervention factory, the subjects from the two highest deciles of a coronary risk-score distribution curve were given individual advice twice a year. A health education campaign was also organized in each intervention factory. In the control group, 10% of randomly chosen subjects had the same baseline examination as the whole of the intervention group. After 2 years, high-risk subjects and random samples of the control and intervention group were compared regarding the coronary risk profile by means of a multiple logistic function (MLF). In the intervention high-risk group, the MLF showed a decrease of 20%, and in the control group there was an increment of 12.5% (p < 0.001). Comparing the random samples an increment of 25% was found in the control group vs a drop of 2.26 in the intervention group (p < 0.001). The coronary risk profile can be altered in a middle-aged male working population through mass media health education supplemented by face-to-face counseling in high-risk subjects.

Parameters of inflammation and infection in a community based case-control study of coronary heart disease

BACKGROUNDnincreased levels of systemic inflammatory markers appear to be related to coronary heart disease (CHD) both in asymptomatic individuals and in subjects with established CHD. Whether these associations are related to confounding coronary risk factors or are explicable through chronic infectious conditions is not clear.nnnOBJECTIVESn(1) to determine whether subjects with stable CHD differ from normal controls in inflammatory markers (CRP, SAA and fibrinogen) and/or in serostatus of four infectious agents (Helicobacter pylori, Chlamydia pneumoniae, CMV and EBV), independent of classical coronary risk factors. (2) To determine whether these inflammatory markers are related to the serostatus against these four infectious agents either in patients with CHD or in normal subjects.nnnMETHODSnin a large epidemiologic survey, 446 out of 16307 men at work, aged 35-59 years, had antecedents of myocardial infarction, CABG or PTCA or had prominent Q/QS waves on their resting ECG. They were compared with double the number (n=892) of men, matched for age, educational level and industry. Inflammatory biomarkers (CRP, fibrinogen and SAA) and antibodies against H. pylori, C. pneumoniae, CMV and EBV were measured, besides classical coronary risk factors.nnnRESULTSnin univariate analyses, cases had higher CRP, fibrinogen and SAA levels than controls, but no differences were observed in serumantibody levels to any of the infectious agents. Markers of previous infections were not related to inflammatory biomarkers. In multivariate analyses CRP was significantly different between cases and controls independent of differences in other coronary risk factors and in the use of lipid lowering drugs and antiplatelet aggregants.nnnCONCLUSIONSnin men at work with CHD, CRP levels are significantly different from controls, independent of known risk factors. No association was found between inflammatory biomarkers and positive serostatus against four infectious agents, neither in the patients nor in the healthy controls.

Working conditions predict incidence of long-term spells of sick leave due to depression: results from the Belstress I prospective study

Background: During the last few years, a high incidence of sick leave due to depression has been reported, resulting in important economic and social impacts. Only a limited number of studies investigating the influence of psychosocial working conditions on sick leave have been prospective and have utilised a valid methodology, while none have studied sick leave due to depression. In this study, the impact of adverse psychosocial working conditions is analysed on the risk for long-term sick leave due to depression. Methods: This study resulted from the large-scale Belstress I study on the relationship between perceived job stress and health problems. Subjects were Belgian employees selected from 11 large companies (nu200a=u200a9396). Using a longitudinal design, the association between the three Karasek stress dimensions (job control, psychological demand, and social support) was explored, separately and combined according to the demand–control and demand–control–support models and the incidence of long-term sick leave for depression as diagnosed by the family physician. Results: After adjusting for age, occupational categories, living situation, and baseline depression score, ‘passive jobs’ (OR 2.67; 95% CI 1.15 to 6.19) and ‘high strain’ jobs (OR 3.23; 95% CI 1.40 to 7.43) predicted sick leave due to depression at follow-up in men. Job control predicted sick leave due to depression in both men (OR 2.43; 95% CI 1.27 to 4.66) and women (OR 2.21; 95% CI 1.05 to 4.68). Conclusions: This study provides evidence that the psychosocial working environment influences long-term sick leave due to depression. Efforts to improve skill discretion and decision authority at work could help prevent depression.

Prevalence, awareness, treatment and control of arterial hypertension in an elderly population in Belgium

Objective: To study the prevalence, awareness, treatment and control of arterial hypertension in the elderly population in Belgium.Study group: An age- and sex-stratified sample of 2212 Belgian subjects aged 65 years or more, selected from the original cohort of the Belgian Interuniversity Research on Nutrition and Health (BIRNH) study; participation in this follow-up study was 72.6%.Methods: Blood pressure (BP) was measured at home by trained technicians using a standard protocol. Isolated systolic hypertension (ISH) was defined as a systolic BP ⩾160 mmu2009Hg and a diastolic BP <95 mmu2009hg. diastolic hypertension was defined as a diastolic bp ⩾95 mmu2009hg. the total hypertensive population was defined as all those with ish, diastolic hypertension and with bps <160–95 mmu2009hg but currently taking anti-hypertensive drugs. awareness and treatment status were investigated through a structured interview.Results: The prevalence of arterial hypertension was 43.9%, higher in women than in men and increasing with age in women; elevated BP was found in 22.3 to 28.6% of the participants varying by age and sex. In the >75-year-old subjects this elevation was in two-thirds of the cases due to ISH; 84% of all female hypertensives were aware of the condition compared to 68% in men. Treatment advice had been given in a majority of the aware subjects and two-thirds of all treated persons was under control. Among a variety of independent variables and besides the gender difference, awareness was only related to smoking and to depression while control differed by region of residence.Conclusion: Arterial hypertension is highly prevalent in this elderly population; awareness and BP control are within acceptable ranges but there is still room for improvement, particularly in elderly men.

Relationship between serum cholesteryl ester composition, dietary habits and coronary risk factors in middle-aged men

Serum cholesteryl palmitate, oleate, linoleate and arachidonate were measured using high performance liquid chromatography in 134 men aged 45-64 years, randomly selected from the population of Ghent, Belgium. No relationship was observed between these cholesteryl esters, expressed as a percentage of their total, and age, serum cholesterol, arterial blood pressure, smoking habits and body mass index. Dietary habits were assessed using a 3-day diary method. No relationship was found between dietary habits and serum lipids. Highly significant correlations were observed between diet and the serum cholesteryl esters. In multivariate analyses dietary variables account for significant proportions of the variances of the serum cholesteryl esters. The results indicate that measurements of cholesteryl esters can be used to differentiate on the population level between subgroups with different dietary habits particularly with respect to fat consumption.

Belgian heart disease prevention project: comparison of self-reported smoking behaviour with serum thiocyanate concentrations.

At the end of a multifactorial cardiovascular preventive trial serum thiocyanate was measured in random samples of 1035 cases and 1087 controls. A cut-off point 0.45 mg/dl (77.6/mumol/l) gave a sensitivity of 82.1% among the cigarette smokers in the control group and a specificity of 91.0% among the non-smokers. When the intervention and control groups are compared in terms of self-reported smoking behaviour non-significant differences in mean thiocyanate concentration are observed for those who never smoked, ex-cigarette smokers, actual cigarette smokers, and in four different cigarette smoking categories. Our results fail to confirm the reported pessimistic views concerning the validity of self-reported smoking behaviour in subjects taking part in intervention trials.

Collaborative overview ('Meta-Analysis') of Prospective Observational Studies of the Associations of Usual Blood Pressure and Usual Cholesterol Levels with Common Causes of Death: Protocol for the Second Cycle of the Prospective Studies Collaboration

Background Many prospective studies have been reported on the associations of blood pressure and blood cholesterol with cardiovascular disease, but few have been large enough to provide reliable estimates of the nature of these associations in different circumstances or to characterize the associations with non-vascular causes of death. Moreover, almost all such reports have related risk to baseline measurements of the risk factor of interest, which can lead to substantial underestimation of the importance of the risk factor due to ‘regression dilution’ bias. Objective By appropriate combination of data on individual participants from all such studies in a systematic ‘meta-analysis’, with correction for regression dilution, to characterize more precisely than has previously been possible the age-specific and sex-specific relevance of blood pressure and blood cholesterol levels to particular causes of death. Methods Information has been made available on about 175 000 deaths (45% due to vascular disease and 20% due to cancer) among more than 1.4 million individuals followed for an average of 14 years in over 60 prospective studies of blood pressure and blood cholesterol (with data on high-density lipoprotein cholesterol available for a substantial subset of individuals). This represents approximately 95% of the data from all relevant studies.