The Ontario Health Survey was conducted in 1990 by the Ontario Ministry of Health to assess the health status of the province's population. Self reports of health status and problems, treatment, and risk factor profiles were collected by interviewer and self-completed questionnaires. The present report addresses the prevalence and distribution patterns of cardiovascular disease and selected risk factors and is based on data from 44,000 residents of Ontario aged 18 years and older. Data collected from the survey demonstrate that the incidence of circulatory disease was 3% and heart disease was 4% in the population of Ontario. As well, the prevalence rates for selected cardiovascular risk factors were: high blood pressure (10%), diabetes (3%), smoking (31%), obesity (25%), and inactivity (72%) and are reported as a function of age category and sex. These findings are compared with the prevalence of risk factors in other regions of Canada. This information provides a basis for the development, implementation, and evaluation of comprehensive programs that are aimed at reducing cardiovascular risk factors and mortality and morbidity from cardiovascular disease.
Hypertension and related diseases are a global burden of cardiovascular disorders. Ischemic heart disease and cardiovascular disease rank fourth and fifth among the 10 leading causes of mortality worldwide. A generation from now, these diseases will be an epidemic for which we should be ready and against which we should attempt to find the best preventive measures. In Canada, the percentage of cardiovascular deaths increases with age. After the age of 50 years, these deaths actually exceed 50% of total mortality. Cardiovascular diseases also have the highest financial health care costs. The newest guidelines from national and international societies have a unifying goal of controlling cardiovascular burden. Guidelines of the international societies are written for a worldwide audience, including countries with very variable health care systems. However, the supreme goal is universal - to lower blood pressure and other risk factors to reduce the risk of cardiovascular disease with its fatal consequences.
In Sweden, as in many other European countries, traffic noise is an important environmental health issue. At present, almost two million people are exposed to average noise levels exceeding the outdoor national guideline value (55 dB(A)). Despite efforts to reduce the noise burden, noise-related health effects, such as annoyance and sleep disturbances, are increasing. The scientific interest regarding more serious health effects related to the cardiovascular system is growing, and several experimental and epidemiological studies have been performed or are ongoing. Most of the studies on cardiovascular outcomes have been related to noise from road or aircraft traffic. Few studies have included railway noise. The outcomes under study include morning saliva cortisol, treatment for hypertension, self-reported hypertension, and myocardial infarction. The Swedish studies on road traffic noise support the hypothesis of an association between long-term noise exposure and cardiovascular disease. However, the magnitude of effect varies between the studies and has been shown to depend on factors such as sex, number of years at residence, and noise annoyance. Two national studies have been performed on the cardiovascular effects of aircraft noise exposure. The first one, a cross-sectional study assessing self-reported hypertension, has shown a 30% risk increase per 5 dB(A) noise increase. The second one, which to our knowledge is the first longitudinal study assessing the cumulative incidence of hypertension, found a relative risk (RR) of 1.10 (95% CI 1.01 - 1.19) per 5 dB(A) noise increase. No associations have been found between railway noise and cardiovascular diseases. The findings regarding noise-related health effects and their economic consequences should be taken into account in future noise abatement policies and community planning.
Merging data from existing electronic patient records, and electronic hospital discharge and cause of death registers, is a fast and relatively inexpensive method for comparing different treatments with regard to clinical outcome. This study compared the effects of antihypertensive treatment with candesartan or losartan on cardiovascular disease (CVD) using Swedish registers. Patients without previous CVD who were prescribed candesartan (n=7329) or losartan (n=6771) for hypertension during 1999-2007 at 72 Swedish primary care centers were followed for up to 9 years. Both medications were given according to current recommendations, and there was no difference observed in achieved blood pressures. The authors have previously shown that candesartan lowered the risk of all CVD (primary composite end point) more so than losartan (adjusted hazard ratio, 0.86; 95% confidence interval, 0.77-0.96). Candesartan also had a significantly better effect with regards to reducing the development of heart failure, cardiac arrhythmias, and peripheral arterial disease. In the present analysis, the authors found that candesartan, compared with losartan, reduced the risk of all CVD, irrespective of sex, age, previous antihypertensive treatment, baseline blood pressure, and presence of diabetes. These clinical findings may reflect differences between candesartan and losartan in their binding characteristics to the angiotensin type 1 receptor.
We present the results from three surveys conducted in 1988, 1991 and 1994 in Hedmark comparing risk factors for cardiovascular disease among men and women age 40-42 years. The data are compared with the results for persons in the same age group from the counties Vestfold, Rogaland and Nordland, and examined in the same periods. In 1991 the average levels of total cholesterol and infarction risk score were the same in Hedmark and the three other counties, but in 1994 Hedmark compared less favourably. While the mean levels of total cholesterol showed minimal difference between rural and urban municipalities in Hedmark, triglycerides and systolic blood pressure were higher in the rural areas. Adjustment of the results in Hedmark for lower attendance rate among unmarried, divorced and widowed persons in 1991 and 1994 than in 1988 does not affect other risk factors than smoking. We discuss possible explanations of the less favourable results and the implications for primary prevention of cardiovascular diseases.
In western societies cardiovascular disease accounts for approximately one of every three deaths, and is a major contributor to chronic debiliation. During the last years our knowledge of factors that contribute to the development and progression of this disease has increased markedly. Elevated serum total cholesterol, hypertension and cigarette smoking are "traditional", well-known risk factors. In addition, low serum levels of high density lipoprotein (HDL) cholesterol predispose to development of disease, whereas in epidemiological studies the role of increased triglycerides is more controversial. During the last years derangements in several haemostatic components in persons who develop cardiovascular disease have been observed. Such alterations include increased plasma concentrations of fibrinogen, Factor VII coagulant activity and plasminogen activator inhibitor-1 (PAI-1). Furthermore, interactions between lipoproteins and haemostatic factors are gradually being disclosed. Serum triglycerides have been shown to correlate both to PAI-1 and to Factor VII. The lipoprotein (a), first described by Berg in 1963, also appears to be a link between lipoprotein metabolism and fibrinolytic function. In addition, linkages are observed between high triglycerides, low HDL cholesterol, reduced glucose tolerance, hyperinsulinemia, obesity, low physical activity, reduced fibrinolytic capacity and increased Factor VII. This clustering of risk factors has been suggested to be a coronary risk syndrome and has been called Reavens syndrome, syndrome X and insulin-resistance syndrome. A more descriptive name, athero-thrombogenic syndrome (ATS), has recently been suggested, thereby indicating that both atherosclerosis and thrombosis contribute to its development.(ABSTRACT TRUNCATED AT 250 WORDS)
