AIMS:Presentation with an acute coronary syndrome (ACS) on chronic aspirin therapy is an independent predictor of adverse short-term outcomes. Whether this finding applies to chronic thienopyridine use, and with the contemporary invasive management of ACS, is unknown.METHODS AND RESULTS:In ACUITY, 13819 patients with moderate and high-risk ACS were studied; patients transferred from an outside hospital were excluded from the present analysis, given uncertain preadmission antiplatelet status. Endpoints included major adverse cardiovascular events (MACE: death, myocardial infarction, or unplanned revascularization), major bleeding, and net adverse clinical events (NACE). Among 11313 study patients, 31 % were naive for antiplatelet agent, 49% were receiving aspirin alone, and 20% were on dual antiplatelet therapy. Chronic antiplatelet users were older and had a higher risk profile. After adjusting for baseline differences, chronic antiplatelet therapy (single or dual) was not associated with an increased incidence of 30-day MACE, bleeding, or NACE. However, patients on chronic aspirin or dual antiplatelet therapy at presentation had significantly higher 1-year rates of MACE [odds ratio (95% confidence interval) = 1.17 (1.01–1.36), P = 0.03 and 1.29 (1.02–1.64), P = 0.03, respectively]. Patients presenting on dual antiplatelet therapy had significantly greater adjusted MACE at 1-year than those on aspirin alone [odds ratio (95% confidence interval) = 1.34 (1.15–1.56), P < 0.0001].CONCLUSION:Contrary to earlier studies, prior antiplatelet therapy was not associated with an increased risk of adverse outcomes at 30 days in invasively managed patients. Such use did, however, independently predict 1-year ischemic MACE, with outcomes worse for patients presenting on chronic dual antiplatelet therapy compared with aspirin alone.
INTRODUCTION:The mortality of circulatory diseases of the German population varies considerably across regions. The comparison of the regional distributions of cardiovascular risk factors can provide clues to the reasons for cardiovascular mortality differences. The aim of this study was to determine whether indirect measures of fat distribution within subgroups of comparable body mass indices (BMIs) differ by region in Germany.METHODS:We included six German population-based epidemiological studies conducted between 1997 and 2006 that included a detailed assessment of anthropometric measures including overall 15 215 people aged 45–74 years. We calculated mean values of BMI, waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). We estimated mean regional differences of WC, HC, and WHR within narrow ranges of BMI.RESULTS:BMI distributions across the study populations were very similar. However, body fat distributions as measured by WC within subgroups of similar BMIs differed considerably across regions. For example, among people with a BMI of 24.0–25.9, estimated WCs were on average 3.4 and 6.7 cm higher among men and women in Saxony-Anhalt than among men and women in Bavaria, respectively.CONCLUSION:We provide evidence that the BMI distributions across six population-based surveys in Germany are very similar and that body fat distributions among people with comparable BMIs show relevant regional differences. Our observed WC differences might contribute to regional cardiovascular disease risk differences in Germany. Our findings may trigger further similar analyses across European populations to explain large area variations of cardiovascular disease burden.
Background: Heartwatch is a secondary prevention programme of coronary heart disease (CHD) in primary care in Ireland. The aim was to further examine the effect of the Heartwatch programme on cardiovascular risk factors and treatments of patients with a follow-up of 3.5 years. Design: Prospective cohort study of 12,358 patients with established CHD (myocardial infarction, percutaneous cardiac intervention, coronary artery bypass graft) recruited by participating general practitioners; patients invited to attend on a quarterly basis, with continuing care implemented according to defined clinical protocols. Methods: Changes in risk factors and treatments at 1, 2, 3 and 3.5-year follow-up from baseline were made using paired t-test for continuous and McNemar's test for categorical data. Results: Important changes in systolic and diastolic blood pressure, total and low-density lipoprotein cholesterol and smoking status were observed at 1, 2, 3 and 3.5 years (P < 0.0001) with significant increase in proportions of patients within the target. However, changes in body mass index were small, with no significant improvement in waist circumference. There was a significant increase in prescription of secondary preventive medications and good patient compliance. Males were more likely to be within the target for systolic blood pressure, total cholesterol, waist circumference and exercise level at 3.5 years, but less likely for body mass index. Conclusion: Studies of cardiac rehabilitation without any follow-up programmes show that over time patients revert in part to previous lifestyle habits; this primary care-delivered programme has shown sustained improvements in major risk factors, particularly smoking, blood pressure and cholesterol, and treatments for CHD. Weight management presents a greater challenge.
Background: Type 2 diabetes and diabetic dyslipidemia are high-risk conditions for cardiovascular disease. However, the description of the distribution of blood lipids in diabetic patients has not been based on population-based surveys. The aim of this study was to describe diabetic dyslipidemia in a large unselected sample of patients from the Swedish National Diabetes Register. Methods: Blood lipid profiles and clinical characteristics in 75,048 type 2 diabetic patients (57% men) were studied. Results: Pronounced hypertriglyceridemia (triglycerides >4.0mmol/l) was seen in 3.4% of the patients. Total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C) and non-HDL-C were generally higher, and LDL-C/HDL-C and Non-HDL-C/HDL-C ratios were lower in women. Mean TC, LDL-C as well as HDL-C values were lower in patients treated with lipid-lowering agents, whereas triglycerides was higher than in the untreated patients. In patients not treated with lipid-lowering agents all blood lipids increased in women and decreased in men (except HDL-C) at higher ages. Patients with LDL-C/HDL-C ratio ≥ 3 were slightly younger, less frequently used lipid-lowering drugs and had not so often a history of coronary heart disease or stroke. Conclusion: The distribution of blood lipids in this large sample of unselected type 2 diabetic patients challenges the previous conception of diabetic dyslipidemia, and calls for new studies to explain the roles of LDL-C and HDL-C as strong cardiovascular risk factors in type 2 diabetes.
Background: A reference set of data of normal values of newly developed cardiopulmonary parameters of exercise testing in an 8-18-year-old population is lacking.Patients and methods: Cardiopulmonar...
Background: Multivariable risk prediction equations attempt to quantify an individual’s cardiovascular risk. Those borne from the Framingham Heart Study remain the most well-established and widely used. In February 2008, a new Framingham risk equation was published. We sought to determine the differences between the most commonly used Framingham equation from 1991 and the 2008 version through their application to a contemporary Australian population. Methods and results: The two risk equations were applied to 7329 individuals from the Australian Diabetes, Obesity and Lifestyle study. All individuals were aged 30–74 years and free of cardiovascular disease. Differences in median risk scores were analyzed through the Wilcoxon’s signed rank test. Compared with the 1991 equation, median cardiovascular risk scores derived from the 2008 equation increased by 7 and 24% over 5 years, among males and females, respectively. The differences were statistically significant across all age-groups for both males and females, P value of less than 0.001. The performance of the equations in predicting cardiovascular outcomes were compared using event rates. The discriminative ability was increased using the 2008 equation; however the difference was non-significant [area under the receiver operating characteristic curve: 1991 equation 0.74 (0.69–0.80); 2008 equation 0.76 (0.71–0.81)]. Conclusion: Earlier Framingham equations have been suggested to over-predict cardiovascular risk in low-risk populations and under-predict risk in high-risk groups. This is the first comparative validation of the previous 1991 and most recent 2008 equations. This study highlights the need to validate and calibrate cardiovascular risk prediction equations using the population-specific outcome data.
Objective: B-type natriuretic peptide (BNP) was recently demonstrated to be a potential stimulator of angiogenesis and arteriogenesis. The correlation between BNP level and collateral formation in patients with coronary artery disease (CAD) has not been reported.Methods and results: The study included 311 consecutive patients who underwent coronary angiography were divided into three groups according to coronary angiography and collateral formation: normal group (100 patients with normal coronary angiographic findings); poor collateral group (116 patients with at least one coronary stenosis of >= 75% without visible collateral circulation); and good collateral group (95 patients with at least one coronary stenosis of >= 75% with well-developed collateral circulation). Collateral score was analyzed using the Cohen-Rentrop classification. Plasma BNP levels were 45.77 +/- 4.66 pg/ml, 116.40 +/- 28.15 pg/ml, and 254.20 +/- 42.85 pg/ml for patients in normal, poor collateral, and good collateral groups, respectively. Plasma BNP levels in the latter were significantly higher than in the normal group (p < 0.01) and poor collateral group (p < 0.05). There were no significant differences between the good collateral group and poor collateral group when compared with left ventricular ejection fraction (LVEF), left ventricular dimensions at end diastole (LVEDd), age, severity of angiographic disease, and other cardiovascular risk factors. After adjustment in the multiple ordinal logistic regression model, plasma BNP levels showed a strong independent association with collateral Cohen-Rentrop score (chi(2) = 5.636, OR = 1.002, 95% CI 1.000-1.004, p = 0.018).Conclusions: An elevated level of BNP in plasma is independently associated with collateral development; patients with good collaterals tend to have a higher BNP level.
Background: Ankle brachial index (ABI) has been increasingly used in general practice to identify individuals with low ABI at high cardiovascular risk. However, there has been no consensus on the clinical significance of high ABI. The aim of our study was to compare aortic stiffness as a marker of cardiovascular risk in individuals with low (<1.0), normal (1.0–1.4), and high ABI (>1.4).Methods: A total of 911 individuals from the Czech post-MONICA study (a randomly selected 1% representative population sample, aged 54 ± 13.5 years, 47% of men) were examined. ABI was measured using a handheld Doppler and aortic pulse wave velocity (aPWV) using the Sphygmocor device.Results: Of the 911 individuals, 28 (3.1%) had low ABI and 23 (2.5%) high ABI. There was a U-shaped association between aPWV and ABI. aPWV was significantly higher in individuals with low and high ABI compared with the normal ABI group (11.1 ± 2.8, 8.3 ± 2.3, p < 0.001; 10.8 ± 2.5, 8.3 ± 2.3 m/s, p < 0.001, respectively). In a model adjusted for age, sex, systolic, diastolic, mean blood pressure and examiner, aPWV remained increased in both extreme ABI groups compared with the normal ABI group. In logistic regression analysis, aPWV together with glucose level, male sex, and a history of deep venous thrombosis were independent predictors of high ABI, while cholesterol was not.Conclusion: This is the first study showing increased aortic stiffness in individuals with high ABI, presumably responsible for increased left ventricular mass described previously in this group. These findings suggest increased cardiovascular risk of high ABI individuals.
BACKGROUND:Dietary surveys indicate that New Zealanders have a low intake of trans-fatty acids (TFA) with little derived from industrial sources. This observational cross-sectional study in New Zealand patients with surgical coronary artery disease assesses the plasma levels of TFA and the association of TFA levels with clinical markers of vascular disease. METHODS:390 patients with severe coronary artery had fasting blood tests taken. Plasma levels of four TFA derived from hydrogenated vegetable oils and ruminant animal products were measured by gas chromatography. Relations between plasma TFA levels and the recent occurrence of myocardial infarction, the presence of polyvascular disease, and serum levels of C-reactive protein (CRP) were assessed. RESULTS:The median TFA level was 0.85% by weight of total fatty acids (IQR 0.59-1.79%), with skewed distribution to the right. For the lowest (<0.74%), middle (0.74-1.07%), and highest (>1.07%) thirds of total TFA, respectively, the proportion of patients with polyvascular disease was 10%, 16%, and 27% (p = 0.0004). Plasma CRP also increased by tertile of TFA (median 2.0, 2.9, 3.2 mg/l, p = 0.007). The association with polyvascular diseases and CRP remained significant after adjustment for risk factors. Significant associations were present between plasma TFA from both ruminant and hydrogenated vegetable oil sources and these markers of cardiovascular risk. CONCLUSIONS:There is an association between relatively low plasma levels of total TFA, mostly derived from ruminant sources, and an increased risk of polyvascular disease and increased CRP in patients with severe coronary artery disease. These high-risk patients may benefit from a targeted approach to minimize all sources of TFA in the diet.
Objective: To determine if the improved risk factor profile at 1 year attributed to the Choice of Health Options In prevention of Cardiovascular Events (CHOICE) program was maintained at 4 years. Design: Single-blind randomized controlled trial with post-hoc 47 ± 6 months follow-up (76% complete). Setting: Australian tertiary referral hospital. Patients: Two hundred and eight acute coronary syndrome survivors. Interventions: Acute coronary syndrome survivors not accessing cardiac rehabilitation (CR) were randomized to control (n = 72) or CHOICE (n = 72) comprising the tailored risk factor reduction packaged as a clinic visit and 3 months phone support. A contemporary CR reference group were also recruited (n = 64). Blinded risk assessment occurred at baseline, 1 and 4 years. Main outcome measures: Total cholesterol, systolic blood pressure, smoking status, physical activity. Results: One year improvements in all the modifiable risk factors achieved in CHOICE were maintained at 4 years. CHOICE and control were well-matched at baseline. At 4 years, there was a trend towards lower total cholesterol in CHOICE compared with controls (mean 4.0 ± 0.1 vs. 4.2 ± 0.1 mmol/l, P = 0.05), significantly better systolic blood pressure (mean 132.2 ± 2.1 vs. 136.8 ± 2.0 mmHg, P = 0.01), physical activity scores (1200 ± 209 vs. 968 ± 196 metabolic equivalent min/week, P = 0.02) and proportion with three or more risk factors above national targets (20 vs. 42%, P = 0.02). Participants in CHOICE were at higher baseline risk than CR but at 4 years they had similar risk factor profiles. Conclusion: Participants in CHOICE maintained favorable changes in coronary risk profile at 4 years compared with control, indicating that CHOICE is an effective long-term intervention among those not accessing facility-based CR.
Objective: The aim of the present study was to evaluate developments in 30 years mortality risk that may be associated with developments in population systolic blood pressure (SBP) and to evaluate possible secular trends in BP-associated mortality risk in the untreated population.Design: The Copenhagen City Heart Study is a prospective longitudinal epidemiological study. The present analysis comprised participants from survey 1 (1976-78) and 3 (1991-94).Methods: BP measurements and other methods were fully standardized and unchanged throughout the observation period. Questionnaires were completed by the participants and double checked by the technicians while they were interviewing the participants.Results: 18 077 persons participated. Age, systolic BP, diastolic BP, cholesterol, BMI, diabetes, gender and habitual physical activity were significant predictors of all-cause death in all age groups. Risk factor adjusted risk for all-cause death was significantly lower in survey 3 compared with survey 1. Among elderly people, there was no development in mortality risk. In the age groups 40-49 years and 50-59 years there were survey differences indicating a significant trend towards longer life expectancy compared with their age-matched counterparts in survey 1. The association between BP and mortality remained unchanged.Conclusion: A declining risk of all-cause death was observed in the younger and middle-aged cohorts of the population. The decrease in systolic BP and decline in mortality risk in the same age groups points to a role of systolic BP in age-cohort differentiated improvements of life expectancy. The effect of systolic BP on mortality did not change during follow-up.
BACKGROUND:Many studies have shown that individual lifestyle factors are associated with cardiovascular mortality and all-cause mortality. Observational studies of comprehensive programmes have reported risk reductions. The objectives were to assess the long-term all-cause mortality by diagnosis in patients referred to a lifestyle modification programme, aimed at combating coronary heart disease and stroke.METHODS:A randomized trial with 325 patients referred to the centre between 1988 and 1989 for dyslipidemia, hypertension, type 2 diabetes and coronary heart disease; 239 patients were randomized to the programme, 86 randomized to usual care. Cases were admitted to the centre in groups of 30 for a 4-week residential comprehensive activity, in total 114 full-time hours, focusing on food preferences and selections, and physical exercise. The activities were repeated during a 4-day revisit to the centre 1 year and 5 years after the 4-week intervention. Controls were referred back to their doctors, mainly in primary care, for usual care. Main outcome measure was all-cause mortality during 11–12 and 18–19 years after intervention.RESULTS:At follow-up 11–12 years after referral, the relative risk reduction (RRR) was 76% with the intention-to-treat analysis among cases admitted for dyslipidemia (hazards ratio 0.24, confidence interval 0.06–0.89, P = 0.033). After 18–19 years, the RRR was 66% (hazards ratio 0.34, confidence interval 0.13–0.88, P = 0.026). No RRR was found for the other three diagnoses.CONCLUSION:Patients admitted for dyslipidemia reached a real long-term RRR of all-cause mortality. They had by definition a need for this programme.
Background: Although guidelines recommend similar evaluation and treatment for both sexes, differences in approach and outcomes have been reported.Design: Prospective, observational registry.Methods: Consecutive patients at high cardiovascular risk were assessed for risk factors and management at baseline, and followed-up for 2 years.Results: Twenty-two thousand and twenty-eight patients with documented arterial disease (symptomatic) or three or more atherothrombotic risk factors (asymptomatic) completed the 2-year follow-up of the REduction of Atherothrombosis for Continued Health Registry in Europe (women, 31.5%; men, 68.4%). Women patients were 3.3 years (mean) older than men. Few differences were observed between asymptomatic men and women in risk factor profile or management at baseline. Higher proportions of symptomatic women than men had diabetes (P < 0.001), hypertension (P < 0.0001), elevated total cholesterol levels (P < 0.0001) or elevated triglycerides (P < 0.01). A much lower proportion of women than men were current smokers (asymptomatic, 14.6 vs. 29.3%; symptomatic, 11.9 vs. 19.5%, both P < 0.0001). Within the symptomatic population, women received antithrombotic agents (91.8 vs. 94.9%, P < 0.0001) and lipid-lowering agents (68.2 vs. 73.1%, P < 0.0001) less frequently than men. After multivariate adjustment, fewer symptomatic women than men had undergone coronary revascularizations at 2 years (odds ratio, 0.72; 95% confidence interval, 0.61-0.85). There were no differences in primary outcomes, including cardiovascular death/myocardial infarction/stroke (odds ratio, 1.01, 95% confidence interval, 0.93-1.11, P = 0.78), between the sexes.Discussion: Although no differences were found in cardiovascular event rates at 2-year follow-up, secondary prevention could be improved in women, which might further reduce event rates.
Aims: The aim of this study was to compare the strength of associations and discrimination capability of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with cardiovascular disease risk in individuals with type-2 diabetes.Methods and results: Eleven thousand, one hundred and forty men and women were followed for a mean of 4.8 years. The Cox proportional hazard models were used to compute the hazard ratios and 95% confidence intervals (95% CI) for one standard deviation (SD) increase in baseline BMI (SD: 5kg/m(2)), WC (SD: 13cm) and WHR (SD: 0.08) with cardiovascular disease risk. After adjustment, hazard ratio (95% CI) for WC were 1.10 (1.03-1.18) for cardiovascular events, 1.13 (1.03-1.24) for coronary events, and 1.08 (0.98-1.19) for cardiovascular deaths. Estimates for WHR were 1.12 (1.05-1.19), 1.17 (1.08-1.28) and 1.19 (1.09-1.31). BMI was not related to any of these outcomes. Although the receiver operating characteristic curve could not differentiate between anthropometric variables (P values >= 0.24), the relative integrated discrimination improvement statistic showed an enhancement in the discrimination capabilities of models using WHR for cardiovascular outcomes, except for cerebrovascular events.Conclusion: Strengths of associations and discrimination statistics suggested that WHR was the best predictor of cardiovascular events and mortality in patients with type-2 diabetes and BMI the worst.
BACKGROUND:Earlier studies have suggested that total testosterone concentrations influence the lipid metabolism. Whether these concentrations are prospectively associated with an adverse lipid profile and an increased risk of incident dyslipidemia has not yet been investigated.METHODS AND RESULTS:Our study population consisted of 1468 men, aged 20–79 years, who were repeatedly examined as part of the population-based Study of Health in Pomerania. Serum total testosterone concentrations measured by the chemiluminescent enzyme immunoassays were categorized into age-specific quartiles. We used generalized estimating equations models to assess the prospective association between total testosterone concentrations and lipid profile components including total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (TG) concentrations, as well as incident dyslipidemia after 5 years of follow-up. Multivariate models revealed that total testosterone concentrations in the lowest quartile were associated with higher TC and TG concentrations in both cross-sectional [TC: 0.23 mmol/l (95% confidence interval, CI, 0.02–0.42); TG: 0.73 mmol/l (95% CI, 0.53–0.94)] and longitudinal analyses [TC: 0.20 mmol/l (95% CI, 0.03–0.27); TG: 0.62 mmol/l (95% CI, 0.43–0.80)], but not with high-density lipoprotein cholesterol or low-density lipoprotein cholesterol concentrations. Baseline prevalence of dyslipidemia was 57.1% with a crude incidence rate of 46.6 per 1000 person-years. Total testosterone concentrations in the lowest quartile predicted dyslipidemia; age-adjusted relative risks (RR) for men in quartiles 1, 2, and 3 as compared to quartile 4 (highest, reference) were 1.28 (95% CI, 1.06–1.54), 1.10 (95% CI, 0.91–1.33), and 1.05 (95% CI, 0.86–1.29), respectively. This effect was particularly strong among men aged 20–39 years (relative risk, 1.51; 95% CI, 1.08–2.10).CONCLUSION:Low total testosterone concentrations are prospectively associated with an adverse lipid profile and increased risk of incident dyslipidemia. These findings are particularly interesting and may contribute to an explanation for the higher cardiovascular disease risk in men with lower total testosterone concentrations.
BACKGROUND:Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase blood pressure (BP) and potentially reduce the efficacy of several antihypertensive drugs. We evaluated the effect of low-dose acetylsalicylic acid (ASA) on BP control in drug-treated hypertensive patients in a primary care population.DESIGN/METHODS:Nine hundred and five successive patients aged 25–91 years (mean 65.5 years) from 15 health centers in south-west Finland were studied. The patients were on antihypertensive monotherapy (45.7%) or on combination therapy (54.3%). Office BP was measured twice with a 2-min interval after at least a 10-min rest using an ordinary sphygmomanometer.RESULTS:Patients receiving ASA (n = 246) showed lower diastolic BP (83.9 ± 9.0 vs. 87.0 ± 9.6 mmHg; P < 0.001) compared with those who were not using any NSAIDs (n = 659). No significant difference in systolic BP was observed between the groups. As a result, pulse pressure was slightly higher in the ASA group (66.9 ± 18.9 vs. 63.3 ± 17.7 mmHg, P = 0.01). Mean arterial pressure was lower in the ASA group (106.2 ± 10.6 vs. 108.1 ± 10.4 mmHg, P = 0.02). In a stepwise linear multivariate model, ASA remained a significant predictor of lower diastolic BP even after the adjustment with the confounding effects of age and sex.CONCLUSION:According to our population-based study low-dose ASA does not have deleterious effects on BP control in drug-treated hypertensive patients.
Background: Obesity has been recognized as an independent risk factor for arterial hypertension.Design: This study was addressed to identify parameters predictive of 24-h mean systolic and/or diastolic blood pressure levels in obesity.Methods: A cohort of 180 euthyroid overweight and obese patients, 79 women and 101 men, aged 20-63 years, normotensive (n = 62) or with recently developed hypertension (n = 118), and never treated with antihypertensive drugs, was examined. Waist circumference, fasting insulin, thyroid stimulating hormone (TSH), free thyroxine (FT) FT3, FT4, glucose, and lipid (cholesterol, high-density lipoprotein cholesterol and triglyceride) serum concentrations, and 24-h urinary aldosterone and catecholamines were measured. Ambulatory blood pressure monitoring (ABPM) was performed and hypertension was confirmed when 24-h mean systolic blood pressure was >= 125 mmHg and/or 24-h mean diastolic blood pressure was >= 80 mmHg, according to the 2007 European Society of Hypertension and European Society of Cardiology Practice Guidelines for the Management of Arterial Hypertension.Results: 24-h noradrenaline (p < 0.01) and adrenaline (p < 0.05) levels were higher in hypertensive than in normotensive subjects. The odds ratio (OR) was determined by several univariate and multivariate logistic regression analyses to evaluate the predictive factors of high 24-h blood pressure mean values. When subjects with high systolic and/or high diastolic blood pressure levels (n = 118) were compared to individuals with normal systolic and diastolic blood pressure levels (n = 62), multivariate analysis showed an independent association of hypertension with male gender and 24-h noradrenaline levels. When subjects with high systolic blood pressure levels (n = 108) were compared with those with normal systolic blood pressure levels (n = 72), multivariate analysis showed an independent association of high systolic blood pressure with noradrenaline levels. Lastly, when subjects with high diastolic blood pressure levels (n = 87) were compared with those with normal diastolic blood pressure levels (n = 93), multivariate analysis showed an independent negative association between high diastolic blood pressure and body mass index.Conclusions: the present study shows that diastolic blood pressure is independently and negatively associated with body mass index in normotensive or with recently discovered hypertension overweight and obese subjects, and never treated with antihypertensive drugs. These results suggest that obesity per se is responsible for a decrease in diastolic blood pressure before hypertensive state becomes stable. This study also confirms that male gender and daily noradrenaline production contribute to hypertension, and to higher systolic blood pressure levels in particular.
Aim: This study is one of the largest ever completed to examine the prevalence of cardiovascular disease (CVD) risk factors among commercial aircrew.Method and results: A retrospective cross-sectional study comparing prevalence of CVD risk factors age, body mass index (BMI), overweight and obesity, current smoking status, hypertension, and diabetes among commercial aircrew and the UK general population. A total of 14,379 subject records were eligible for the study. The age-sex group mean BMI was significantly lower in almost all pilot age groups compared to the general population. Overweight age-sex group prevalence was significantly higher in the <25, 35-44, 45-54, 55-64 age groups for male pilots, and lower for female pilots in the 25-34 and 45-54 age groups. Male and female pilots had significantly lower age-sex-group prevalence of obesity and current smoking compared to the general population. For hypertension, the male <25 and 35-44 year age groups had significantly higher prevalence, and the 45-54 and 55-64 year age groups had significantly lower prevalence than the general population. Age-standardised mean BMI and prevalence of overweight and hypertension were not significantly different from the highest income quintile of the general population. Age-standardised obesity and current smoking prevalence were significantly lower in pilots compared to the highest socio-economic quintile of the general population.Conclusion: Even when comparisons were made with the highest income quintile of the general population to control for socio-economic status, pilots had a significantly lower prevalence of obesity and smoking. This finding is consistent with a strong 'healthy worker effect'.
