Despite recent declines in mortality, cardiovascular diseases are the leading cause of death in the United States today. It appears that many of the major risk factors for coronary disease have been identified. Researchers are still learning about different modifiable factors that may influence cardiovascular diseases. Socioeconomic status may provide a new focus. The principal measures of SES have been education, occupation, and income or combinations of these. Education has been the most frequent measure because it does not usually change (as occupation or income might) after young adulthood, information about education can be obtained easily, and it is unlikely that poor health in adulthood influences level of education. However, other measures of SES have merit, and the most informative strategy would incorporate multiple indicators of SES. A variety of psychosocial measures--for example, certain aspects of occupational status--may be important mediators of SES and disease. The hypothesis that high job strain may adversely affect health status has a rational basis and is supported by evidence from a limited number of studies. There is a considerable body of evidence for a relation between socioeconomic factors and all-cause mortality. These findings have been replicated repeatedly for 80 years across measures of socioeconomic level and in geographically diverse populations. During 40 years of study there has been a consistent inverse relation between cardiovascular disease, primarily coronary heart disease, and many of the indicators of SES. Evidence for this relation has been derived from prevalence, prospective, and retrospective cohort studies. Of particular importance to the hypothesis that SES is a risk factor for cardiovascular disease was the finding by several investigators that the patterns of association of SES with coronary disease had changed in men during the past 30 to 40 years and that SES has been associated with the decline of coronary mortality since the mid-1960s. However, the declines in coronary mortality of the last few decades have not affected all segments of society equally. There is some evidence that areas with the poorest socioenvironmental conditions experience later onset in the decline in cardiovascular mortality. A number of studies suggest that poor living conditions in childhood and adolescence contribute to increased risk of arteriosclerosis. Some of these studies have been criticized because of their nature, and others for inadequate control of confounding factors.(ABSTRACT TRUNCATED AT 400 WORDS)

Socioeconomic factors and cardiovascular disease: a review of the literature.

https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/165063/1/T999900135.pdf

Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents

Objective To conduct a comprehensive systematic review and meta-analysis of studies assessing the effect of alcohol consumption on multiple cardiovascular outcomes. Design Systematic review and meta-analysis. Data sources A search of Medline (1950 through September 2009) and Embase (1980 through September 2009) supplemented by manual searches of bibliographies and conference proceedings. Inclusion criteria Prospective cohort studies on the association between alcohol consumption and overall mortality from cardiovascular disease, incidence of and mortality from coronary heart disease, and incidence of and mortality from stroke. Studies reviewed Of 4235 studies reviewed for eligibility, quality, and data extraction, 84 were included in the final analysis. Results The pooled adjusted relative risks for alcohol drinkers relative to non-drinkers in random effects models for the outcomes of interest were 0.75 (95% confidence interval 0.70 to 0.80) for cardiovascular disease mortality (21 studies), 0.71 (0.66 to 0.77) for incident coronary heart disease (29 studies), 0.75 (0.68 to 0.81) for coronary heart disease mortality (31 studies), 0.98 (0.91 to 1.06) for incident stroke (17 studies), and 1.06 (0.91 to 1.23) for stroke mortality (10 studies). Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 1–2 drinks a day, but for stroke mortality it occurred with ≤1 drink per day. Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)). Conclusions Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.

https://www.bmj.com/content/bmj/342/bmj.d671.full.pdf

Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis

Background Alcohol consumption has both adverse and beneficial effects on survival. We examined the balance of these in a large prospective study of mortality among U.S. adults. Methods Of 490,000 men and women (mean age, 56 years; range, 30 to 104) who reported their alcohol and tobacco use in 1982, 46,000 died during nine years of follow-up. We compared cause-specific death rates and rates of death from all causes across categories of base-line alcohol consumption, adjusting for other risk factors, and related drinking and smoking habits to the cumulative probability of dying between the ages of 35 and 69 years. Results Causes of death associated with drinking were cirrhosis and alcoholism; cancers of the mouth, esophagus, pharynx, larynx, and liver combined; breast cancer in women; and injuries and other external causes in men. The mortality from breast cancer was 30 percent higher among women reporting at least one drink daily than among nondrinkers (relative risk, 1.3; 95 percent confidence interval,...

Alcohol Consumption and Mortality among Middle-Aged and Elderly U.S. Adults

There is a lack of consensus among studies on the possible risks of stroke from cigarette smoking; because of this a meta-analysis was conducted. All published data on the association were sought and the relative risk for each study obtained whenever possible. The pooled relative risks were calculated by using estimates of the precision of the individual relative risks to weight their contribution to the meta-analysis. Thirty two separate studies were analysed. The overall relative risk of stroke associated with cigarette smoking was 1.5 (95% confidence interval 1.4 to 1.6). Considerable differences were seen in relative risks among the subtypes: cerebral infarction 1.9, cerebral haemorrhage 0.7, and subarachnoid haemorrhage 2.9. An effect of age on the relative risk was also noted; less than 55 years 2.9, 55-74 years 1.8, and greater than or equal to 75 years 1.1. A dose response between the number of cigarettes smoked and relative risk was noted, and there was a small increased risk in women compared with men. Ex-smokers under the age of 75 seemed to retain an appreciably increased risk of stroke (1.5); for all ages the relative risk in ex-smokers was 1.2. The meta-analysis provides strong evidence of an excess risk of stroke among cigarette smokers. Stroke should therefore be added to the list of diseases related to smoking.

https://www.bmj.com/content/bmj/298/6676/789.full.pdf

Meta-analysis of relation between cigarette smoking and stroke.

Intake of spirits and beer as well as smoking was measured by questionnaire in a random population sample from two counties of Eastern Finland in 1972. At the same time serum cholesterol, triglycerides and blood pressure were measured in a field examination. The study material consists of 4063 men aged 30-59 years (participation rate 92%). During a 7-yr follow-up 209 of these men had developed an acute myocardial infarction (AMI) and 223 men had died. Reported spirits and beer intake had both a strong positive association with smoking and serum triglycerides, a weak positive association with diastolic blood pressure, but no relationship to serum total cholesterol. Use of spirits at least once a week was associated with a reduced risk of AMI. The relative risk (RR), adjusted for age and conventional coronary risk factors was 0.5 (95% confidence interval (CI), 0.3-0.9). Consumption of beer had no significant relationship to the risk of AMI. Consumption of at least five bottles of beer a week was related to a slightly excessive risk of death from any cause (adjusted RR = 1.5, 95% CI = 1.0-2.1). Spirits intake had no significant association with the risk of death.

Intake of spirits and beer and risk of myocardial infarction and death - a longitudinal study

Atkinson AB, Robertson JIS. Captopril in the treatment of clinical hypertension and cardiac failure. Lancet 1979;ii:836-9. 2 Turini GA, Brunner HR, Gribic M. Improvement of chronic congestive heart failure by oral captopril. Lancet 1979;i:1213-5. 3Liebau G, Riegger AJG, Steilner H. Human dynamic effects of captopril in patients with congestive heart failure and hypertension. Amsterdam, Oxford, Princeton: Excerpta Medica, 1981 :76-86. 4 Brown JJ, Davis DL, Johnstone VW, et al. Renin relationships in congestive cardiac failure, treated and untreated. Am Heart 7 1970;80: 329-42.

https://www.bmj.com/content/bmj/284/6322/1086.full.pdf

Smoking among patients with malignant hypertension.

A hypertension control program was established as part of the more comprehensive North Karelia Project. This project was started in 1972 in response to a petition from the population of North Karelia, a county in Finland, asking for national assistance to reduce the exceptionally high cardiovascular disease mortality and morbidity in the area. The North Karelia Project was carried out from 1972 to 1977.The hypertension control program was implemented mainly in local health centers by physicians and public health nurses, who followed guidelines issued by the project staff and worked under its supervision.Although the target population for the North Karelia Project was the entire population of North Karelia, the project focused on middle-aged men. The hypertension subprogram was introduced in steps. Its objectives included the training of health personnel, establishment of an information system in the county to educate people about hypertension, and organization of the detection, treatment, and followup of hypertensives. A hypertension dispensary was established in each of the 12 health centers in the county. Continuous training of the local public health nurses and physicians faciliated integration of the hypertension program into the operations of the health centers.A central hypertension register and the hypertension control clinics at the health centers were the essential tools in the systematic followup of hypertensives. Some 17,000 hypertensives were on the register by the end of the 5-year project.The main aim in providing health education about hypertension, as well as in treating hypertension itself, was to prevent severe cardiovascular diseases as a whole. Therefore the hypertension control program was integrated into the comprehensive cardiovascular disease control program, and hypertensives received advice concerning smoking and dietary changes as well as about high blood pressure.A survey of health care personnel in North Karelia and in a reference area showed that the care of hypertensives was more systematic in North Karelia and that its health care personnel were more satisfied with the cardiovascular disease care that was provided.

Implementation of a hypertension control program in the county of North Karelia, Finland.

A 5-year follow-up study of a random sample of middle-aged hypertensives indicated that the North Karelia (Finland) Hypertension Detection Project was effective in reducing blood pressure levels. This analysis indicated that the intensification of drug treatment caused marked blood pressure reduction in the community, especially among individuals with previously undetected cases of hypertension. Reduction of blood pressure levels among nontreated persons was observed in this study and may reflect in part the importance of both active case finding and follow-up including health education and preventive services. The community approach used in this study reached and brought under control most of those people who were undetected at the beginning of the study and most of the hypertensives. On the basis of the results, it is concluded that a well-organized hypertension control program can meet the challenge of hypertension care and benefit millions of people throughout the world.

North Karelia (Finland) hypertension detection project. Five-year follow-up of hypertensive cohort.

Arterial hypertension is a common problem in industrialized societies, and a major cause of disability and death in the adult populations. Although elevated blood pressure itself is not an incapacitating condition, a high proportion of severe cardiovascular disease (CVD) is due to hypertension. For these reasons, it has been called the epidemic of the modern world; it is a challenge to medical care and public health [1–6]. During the last 25 years, several potent and relatively harmless drugs for hypertension treatment have been introduced. Studies on long-term blood pressure reduction have made it clear that antihypertensive drug treatment is effective in preventing complications, morbidity, disability and premature death [7–12].

Elo J

Papers

Intake of spirits and beer and risk of myocardial infarction and death - a longitudinal study

Smoking among patients with malignant hypertension.

Implementation of a hypertension control program in the county of North Karelia, Finland.

North Karelia (Finland) hypertension detection project. Five-year follow-up of hypertensive cohort.

Epidemiology and Control of Hypertension in North Karelia, Finland