Aged ; Female ; Hemophilia A ; complications ; Hemorrhage ; etiology ; Humans ; Mediastinal Diseases ; etiology

BACKGROUNDSome dietary patterns are risk factors for acute myocardial infarction (AMI). Chinese traditional food and habits vary from other cultures. The present study determined whether different dietary patterns were associated with AMI in Chinese people.

METHODSWe conducted a case-control study. There were 1312 cases of first AMI and 2235 control subjects who did not have previous angina, diabetes mellitus, hypertension or stroke. Controls were matched to cases on age and gender. Diet was measured with a validated, 19 item food frequency questionnaire. We identified three major dietary patterns using factor analysis: vitamin and microelement pattern (high intake of vegetables, fruits and tofu), carbohydrate pattern (high in grain), and fat and protein pattern (high in meat, fish, eggs and fried foods).

RESULTSAfter adjusting for all risk factors, the vitamin and microelement pattern was inversely associated with AMI risk (global P value, 0.0001). Compared with the first quartile, the adjusted ORs of AMI were 0.81 (95%CI: 0.66 - 1.00) for the second quartile, 0.67 (95%CI: 0.54 - 0.82) for the third, and 0.70 (95%CI: 0.56 - 0.88) for the fourth. Several dietary frequencies (serves per week) including vegetables, fruits and tofu were closely associated with decrease of AMI risk. Carbohydrate pattern showed weak relationship with AMI. We observed a U-shaped association between frequencies of fat and protein pattern and AMI risk. Excessive fat intake increased the AMI risk. The adjusted OR of AMI associated with the higher level of green vegetables was 0.37 (95%CI: 0.24 - 0.57) in women and 0.65 (95%CI: 0.51 - 0.82) in men (P value for heterogeneity, 0.0140).

CONCLUSIONSUnhealthy dietary intake can increase the AMI risk. Improving intake of vegetables, fruits and tofu have the potential to partially prevent the rising epidemic of cardiovascular disease in China.

Aged ; Case-Control Studies ; China ; epidemiology ; Feeding Behavior ; Female ; Fruit ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; epidemiology ; Risk Factors ; Soy Foods ; Vegetables

BACKGROUNDMost data about psychological factors relating to acute myocardial infarction (AMI) were obtained from studies carried out in western countries. Results from small descriptive cross-sectional studies in China were inconclusive. The aim of this study was to explore possible associations between psychological risk factors and AMI among the Chinese population with a large-scale case-control study.

METHODSThis study was part of the INTER-HEART China study, itself part of the large international INTER-HEART study of cardiovascular risk factors. In this case-control study, 2909 cases and 2947 controls were recruited from 17 cities. Psychological stress, negative life events, depression and controllability of life circumstances were assessed.

RESULTSCases reported more psychological stress at home or work and odds ratios (ORs) were 3.2 (95%CI 2.1 - 4.9) for permanent stress and 2.1 (95%CI 1.5 - 2.8) for several periods of stress respectively. More cases experienced depression compared with controls (19.6% vs. 9.3%) and ORs were 2.2 (95%CI 1.9 - 2.6). Subjects with 1, 2 and 3 or more depressive symptoms had increased risk of AMI by 2.1, 2.2 and 2.6 fold, respectively, i.e., more depressive symptoms were associated with higher risks of AMI (P for trend < 0.0001). Women had a greater risk of AMI from depression (OR 3.0, 95%CI 2.2 - 4.0) compared to men (OR 2.0, 95%CI 1.6 - 2.4), P for interaction = 0.0364. Negative life events in subjects were associated with increased risk of AMI, OR 1.7 (95%CI 1.4 - 2.0) for one event and 1.8 (95%CI 1.3 - 2.4) for two or more events. High levels of controllability of life circumstances reduced the risk for AMI (OR 0.8, 95%CI 0.7 - 1.0).

CONCLUSIONSSeveral psychological factors were closely associated with increased AMI risk among Chinese population. Psychological stress had a greater AMI risk in men but depression was more significant among women.

Aged ; Case-Control Studies ; China ; Depression ; complications ; epidemiology ; Female ; Humans ; Life Change Events ; Male ; Middle Aged ; Myocardial Infarction ; epidemiology ; etiology ; Risk Factors ; Stress, Psychological ; complications ; epidemiology

BACKGROUNDMany researches report that low socioeconomic status (SES) is associated with a higher risk of coronary heart disease (CHD). This study aimed to determine whether levels of education, family income, and other SES were associated with acute myocardial infarction (AMI) in the Chinese population, and to compare the difference in this association between northern and southern regions in China.

METHODSWe conducted a case-control study. Cases were first AMI (n = 2909). Controls (n = 2947) were randomly selected and frequency matched to cases on age and sex. SES was measured using education, family income, possessions in the household, and occupation.

RESULTSLow levels of education (8 years) were more common in cases compared to controls (53.4% and 44.1%; P = 0.0001). After adjusting all risk factors, the level of education was associated with AMI risk in the Chinese population (P = 0.0005). The odds ratio (OR) associated with education of 8 years or less, compared with more than 12 years (trade school/college/university) was 1.33 (95%CI 1.12 - 1.59), and for education of 9 - 12 years 1.04 (95%CI 0.88 - 1.33). The proportion of higher income population was more in controls than cases (39.4% and 35.3%). Number of possessions and non-professional occupation were only weakly or not at all independently related to AMI. The adjusted OR associated with the lower education was 2.38 (95%CI 1.67 - 3.39) in women, and 1.18 (95%CI 0.99 - 1.42) in men (P = 0.0001, for heterogeneity). The interaction between levels of education and different regions was significant (P = 0.0206, for interaction).

CONCLUSIONSeveral socioeconomic factors including levels of education and income were closely associated with increase of AMI risk in China, most markedly in northeast and southern area. The effect of education was stronger towards AMI in women than men.

Adult ; Aged ; Case-Control Studies ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; epidemiology ; Odds Ratio ; Risk Factors ; Sex Factors ; Social Class

BACKGROUNDThe results from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) indicated that the angiotensin-receptor blocker telmisartan was not inferior to the angiotensin-converting-enzyme inhibitor ramipril in reducing the composite endpoint of cardiovascular death, myocardial infarction, stroke or hospitalization for congestive heart failure in high-risk patients, and telmisartan was associated with slightly superior tolerability. The combination of the two drugs was associated with more adverse events without an increase in benefit. This study aimed to analyze the data from ONTARGET obtained from a subgroup of patients enrolled in China and to evaluate the demographic and baseline characteristics, the compliance, efficacy, and safety of the different treatment strategies in randomized patients in China.

METHODSA total of 1159 high-risk patients were randomized into three treatment groups: with 390 assigned to receive 80 mg of telmisartan, 385 assigned to receive 10 mg of ramipril and 384 assigned to receive both study medications. The median follow-up period was 4.3 years.

RESULTSThe mean age of Chinese patients was 65.6 years, 73.6% of patients were male. The proportion of patients with stroke/transient ischemic attacks at baseline in China was two times more than the entire study population (47.7% vs. 20.9%). In Chinese patients the proportion of permanent discontinuation of study medication due to cough was 0.5% in the telmisartan group, which was much less than that in the combination or the ramipril group. There were no significant differences in the incidence of primary outcome among three treatment groups of Chinese patients. More strokes occurred in Chinese patients than in the entire study population (8.5% vs. 4.5%). Greater systolic blood pressure reduction (-9.8 mmHg), and more renal function failure were noted in the combination treatment group than in the ramipril or telmisartan group (2.6% vs. 1.6% and 1.0%).

CONCLUSIONSThere was no evidence that the results of ONTARGET differed between Chinese patients and the entire study population with respect to the incidence of primary outcome, particularly safety. Compliance with study medications was good. The evidence from ONTARGET indicated that the treatment strategies in ONTARGET were applicable to patients in China.

Aged ; Angiotensin II Type 1 Receptor Blockers ; therapeutic use ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Benzimidazoles ; administration & dosage ; adverse effects ; therapeutic use ; Benzoates ; administration & dosage ; adverse effects ; therapeutic use ; China ; Drug Therapy, Combination ; Female ; Heart Failure ; drug therapy ; Humans ; Male ; Middle Aged ; Ramipril ; administration & dosage ; adverse effects ; therapeutic use

Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.