Aims: To examine the effect that within-person variation has on the estimated risk associations between cigarette smoking, physical inactivity, and increased body mass index(BMI) and the development of cardiovascular ...Aims: To examine the effect that within-person variation has on the estimated risk associations between cigarette smoking, physical inactivity, and increased body mass index(BMI) and the development of cardiovascular disease(CVD) in middle aged Britishmen. Methods and results: In total, 6452 men aged 40-59 with no prior evidence of CVD were followed for major CVD events(fatal/non-fatal myocardial infarction or stroke)and all-cause mortality over 20 years; lifestyle characteristics were ascertained at regular points throughout the study. A major CVD event within the first 20 years was observed in 1194 men(18.5%). Use of baseline assessments of cigarette smoking and physical activity in analyses resulted in underestimation of the associations between average cumulative exposure to these factors and major CVD risk. After correction for within-person variation, major CVD rates were over four times higher for heavy smokers(≥40 cigarettes/day) compared with never smokers and three times higher for physically inactive men compared with moderately active men. Major CVD risk increased by 6%for each 1 kg/m2 increase in usual BMI. If all men had experienced the risk levels of the men who had never regularly smoked cigarettes, were moderately active, and had a BMI of ≤25 kg/m2(6%of the population), 66%of the observed major CVD events would have been prevented or postponed(63%before adjustment for within-person variation). Adjustment for a range of other risk factors had little effect on the results. Similar results were obtained for all-cause mortality. Conclusion: Failure to take account of within-person variation can lead to underestimation of the importance of lifestyle characteristics in determining CVD risk. Primary prevention through lifestyle modification has a great preventive potential.展开更多
To examine trends over time in rates of different forms of diagnosed coronary heart disease among British men, during a period in which mortality due to coronary heart disease has been declining. Design: Prospective c...To examine trends over time in rates of different forms of diagnosed coronary heart disease among British men, during a period in which mortality due to coronary heart disease has been declining. Design: Prospective cohort study covering the period 1978- 80 to 1998- 2000. Participants: 7735 men, aged 40- 59 at entry, randomly selected from one general practice in each of 24 British towns. Main outcome measures: Trends in the rates of major coronary events, first diagnosed angina and first diagnosed coronary heart disease(any fatal or non-fatal documented event or diagnosis). Events were ascertained from NHS central registers and reviews of medical records from general practices. Results: Over the 20 year period, 1561 major coronary events occurred; 1087 and 1816 men had new diagnoses of angina and coronary heart disease, respectively. The age adjusted annual relative changes were - 3.6% (95% confidence interval - 4.8% to- 2.4% , P< 0.001) for all major coronary events, 2.6% (1.1% to 4.0% , P< 0.001) for first diagnosed angina and- 0.8% (- 1.8% to 0.3% , P=0.18) for first diagnosed coronary heart disease. The fall in major coronary events occurred across all categories of event(fatal and nonfatal, first and recurrent). Similarly, first diagnosed angina increased for both uncomplicated angina and angina after myocardial infarction. The age adjusted annual relative change in case fatality at 28 days of first major coronary events was - 1.4% (- 3.1% to 0.4% , P=0.12). Conclusions: Among British middle aged men, a substantial decline in the rate of major coronary events over the past two decades seems to have been largely offset by an increase in the incidence of diagnosed angina. Overall there was little change in the incidence of first diagnosed coronary heart disease. A continuing need exists for resources and services for coronary heart disease in general, and for new angina in particular.展开更多
文摘Aims: To examine the effect that within-person variation has on the estimated risk associations between cigarette smoking, physical inactivity, and increased body mass index(BMI) and the development of cardiovascular disease(CVD) in middle aged Britishmen. Methods and results: In total, 6452 men aged 40-59 with no prior evidence of CVD were followed for major CVD events(fatal/non-fatal myocardial infarction or stroke)and all-cause mortality over 20 years; lifestyle characteristics were ascertained at regular points throughout the study. A major CVD event within the first 20 years was observed in 1194 men(18.5%). Use of baseline assessments of cigarette smoking and physical activity in analyses resulted in underestimation of the associations between average cumulative exposure to these factors and major CVD risk. After correction for within-person variation, major CVD rates were over four times higher for heavy smokers(≥40 cigarettes/day) compared with never smokers and three times higher for physically inactive men compared with moderately active men. Major CVD risk increased by 6%for each 1 kg/m2 increase in usual BMI. If all men had experienced the risk levels of the men who had never regularly smoked cigarettes, were moderately active, and had a BMI of ≤25 kg/m2(6%of the population), 66%of the observed major CVD events would have been prevented or postponed(63%before adjustment for within-person variation). Adjustment for a range of other risk factors had little effect on the results. Similar results were obtained for all-cause mortality. Conclusion: Failure to take account of within-person variation can lead to underestimation of the importance of lifestyle characteristics in determining CVD risk. Primary prevention through lifestyle modification has a great preventive potential.
文摘To examine trends over time in rates of different forms of diagnosed coronary heart disease among British men, during a period in which mortality due to coronary heart disease has been declining. Design: Prospective cohort study covering the period 1978- 80 to 1998- 2000. Participants: 7735 men, aged 40- 59 at entry, randomly selected from one general practice in each of 24 British towns. Main outcome measures: Trends in the rates of major coronary events, first diagnosed angina and first diagnosed coronary heart disease(any fatal or non-fatal documented event or diagnosis). Events were ascertained from NHS central registers and reviews of medical records from general practices. Results: Over the 20 year period, 1561 major coronary events occurred; 1087 and 1816 men had new diagnoses of angina and coronary heart disease, respectively. The age adjusted annual relative changes were - 3.6% (95% confidence interval - 4.8% to- 2.4% , P< 0.001) for all major coronary events, 2.6% (1.1% to 4.0% , P< 0.001) for first diagnosed angina and- 0.8% (- 1.8% to 0.3% , P=0.18) for first diagnosed coronary heart disease. The fall in major coronary events occurred across all categories of event(fatal and nonfatal, first and recurrent). Similarly, first diagnosed angina increased for both uncomplicated angina and angina after myocardial infarction. The age adjusted annual relative change in case fatality at 28 days of first major coronary events was - 1.4% (- 3.1% to 0.4% , P=0.12). Conclusions: Among British middle aged men, a substantial decline in the rate of major coronary events over the past two decades seems to have been largely offset by an increase in the incidence of diagnosed angina. Overall there was little change in the incidence of first diagnosed coronary heart disease. A continuing need exists for resources and services for coronary heart disease in general, and for new angina in particular.
