Community-based epidemiological study on hypertension in Pu-Li, Taiwan

Prevalence of cardiovascular risk factors in Taiwanese healthcare workers

The aim of this study was to investigate the prevalence of cardiovascular risk factors in a sample of Taiwanese healthcare workers. Two thousand thirty-four hospital employees, 30 yr of age and older, were recruited and underwent physical examinations and laboratory testing in December 2003. The study subjects were classified into four job categories, i.e., physicians, nursing staff, medical technicians, and non-medical workers. Various cardiovascular risk factors, including blood biochemical parameters, body-mass index (BMI), and blood pressure were measured for each worker. The odds ratios of having abnormal cardiovascular risk factors as a function of certain jobs were estimated from multivariate logistic regression. Overweight and obesity were independently associated with an increased prevalence of cardiovascular risk factors. Additionally, compared to non-medical workers, medical technicians had a significantly greater prevalence of hypertension, with an odds ratio of 1.74 (95% CI=1.05-2.91). The results suggest a need for managing hypertensive disorders among medical technicians, and urged that the health conditions of hospital employees should not be overlooked.

Secular trends in coronary heart disease mortality, hospitalization rates, and major cardiovascular risk factors in Taiwan, 1971-2001

BACKGROUND

While mortality from coronary heart disease (CHD) has declined substantially in most developed countries in recent decades, discordant rising trends have been observed in many developing and newly developed countries. In this study, we examined the trends of CHD mortality and its hospitalization rate, and correlated the trends with changes in major cardiovascular risk factors in Taiwan.

METHODS

Mortality data during the period 1971-2001 were obtained from official vital statistics. Hospitalization rates were calculated using information extracted from the National Health Insurance Database, which was available from 1996 to 2001. Changes in major cardiovascular risk factors were obtained from official statistics and review of previous epidemiologic studies.

RESULTS

In 2001, the age-standardized CHD mortality in Taiwan was 28.7 per 100,000 for men and 15.5 per 100,000 for women. For both men and women, age-adjusted CHD mortality increased slowly but steadily from 1971 to 1992, but after that, a downward trend was observed. Hospitalization rates for CHD, however, increased substantially from 1996 to 2001. Levels of per-capita cigarette consumption, dietary fat intake, body mass index, and prevalence of hypertension and diabetes had all increased over the past three decades.

CONCLUSIONS

The overall cardiovascular risk profile has worsened in the general population in Taiwan. The decline in CHD mortality observed in recent years was most likely attributable to the improvement in acute cardiac care and medical treatment among patients with CHD. We anticipated that CHD incidence and prevalence would continue to rise in Taiwan.

Impact of the high-risk and mass strategies on hypertension control and stroke mortality in primary health care

Stroke has been the second leading cause of death in Taiwan in recent years. Following a 6-month pilot study in Yu-Chi in 1993, a 3.5-year hypertension control programme was performed to examine the effectiveness of combined high-risk and mass strategies in a rural community with limited medical resources. All Yu-Chi residents aged 40 years and older were invited to participate in the programme. The high-risk strategies included hypertension screening, home visits, and follow-up for the hypertensives. The mass strategies included health education and village-based campaigns. Changes over time in the participants' hypertension knowledge, behaviour, and blood pressure control status were evaluated. A comparison of the stroke mortality between the intervention community and a neighbourhood reference community before and after the intervention programme was performed. A total of 4977 residents were screened and 3761 completed the first and second rescreening. The hypertension knowledge and behaviour scores in the hypertensives significantly improved, systolic and diastolic blood pressure and waist-to-hip ratio significantly reduced, and the rates of hypertension treatment and control increased significantly at 1 and 3.5 years after intervention. In contrast, blood pressure levels increased significantly in the normotensives. Between 1994 and 1997, stroke mortality rate decreased by 39.9 and 4.8% in the intervention and reference communities, respectively. The results indicated that the community-based hypertension control programme was effective. The immediate decline in stroke mortality appeared to be mostly related to the high-risk strategies.

Analysis of risk factors that may be associated with progression from ocular hypertension to primary open angle glaucoma

BACKGROUND

As a multifactorial disease, glaucoma may be associated with pressure-dependent and pressure-independent factors. Ocular hypertension (OHT) may develop into primary open angle glaucoma (POAG) for many patients. Groups with OHT and POAG were compared for pressure-dependent and independent risk factors. A high prevalence of any factor(s) could indicate a contribution to progression from OHT to POAG.

METHODS

A sample of patients with POAG (n = 438) and with OHT (n = 301) were selected from those attending a tertiary referral private glaucoma practice, and data were collected regarding age and intraocular pressure at the time of diagnosis, sex, family history of glaucoma, systemic hypertension, diabetes, Raynaud's phenomenon, migraine and myopia.

RESULTS

After multivariate analysis, older age at time of diagnosis (chi(2)(5) = 73.89, P < 0.001), myopia (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.0-2.2; P < 0.05), a family history of glaucoma (OR = 1.6, 95% CI 1.1-2.3; P < 0.01) and a high intraocular pressure (chi(2)(4) = 16.96; P = 0.002) were found to be more prevalent among those with POAG. No other significant differences could be found between the two groups.

CONCLUSION

Patients who have OHT may be at higher risk of developing POAG if they also have myopia, a family history of glaucoma or are of older age.

Chin-Shan Community Cardiovascular Cohort in Taiwan-baseline data and five-year follow-up morbidity and mortality

A cohort consisting of 3602 residents (82.8% of the target population) aged 35 years and older was established in 1990 in the Chin-Shan Community, a suburb 20 miles outside of metropolitan Taipei, Taiwan. The long-term objective was to investigate the prospective impact on cardiovascular health in a society undergoing transition from a developing to a developed nation. This article presents the study design, selected baseline risk factors of cardiovascular diseases (CVD), and CVD events at the 5-year follow-up evaluation with an emphasis on sociodemographic differences. The multivariate logistic regression analyses revealed that white-collar individuals were more likely than blue-collar workers to have dyslipidemia including high-density lipoprotein cholesterol (HDL-C) levels <35 mg/dl [odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.2-2.4] and low-density lipoprotein cholesterol (LDL-C) levels >/=160 mg/dl (OR = 1.3, 95% CI = 1.0-1.7). However, they were at slightly lower risk for stroke and CVD/sudden death, and at moderately higher risk for coronary artery disease and diabetes, although both these trends were not significant. Men were more likely than women to have HDL-C levels <35 mg/dl (OR = 1.8, 95% CI = 1.4-2.2), but they were less likely to have LDL-C levels >/=160 mg/dl (OR = 0.7, 95% CI = 0.6-0.8). The risk of CVD/sudden death was higher for men than for women during the follow-up period (OR = 1.9, 95% CI = 1.3-2.9). This could be due to risk factors such as a much higher prevalence of tobacco (61.9% vs. 4.5%) and alcohol (43.7% vs. 6.4%) use in men. In conclusion, individuals of higher socioeconomic status have a higher prevalence of dyslipidemia but slightly lower 5-year incidence of CVD events.

The association of body fat distribution with lifestyle and reproductive factors in women aged 45-54 in Kinmen County, Republic of China

This community-based cross-sectional study was conducted in Kinmen County, R.O.C. The purpose of this study was to investigate the factors that influence Chinese women's body fat distribution, including demographic, lifestyle, reproductive, and anthropometric variables. Participants were 1310 women aged 45-54 years. We measured waist/hip ratio (WHR), age, education level, occupation, alcohol consumption, diet, physical exercise, smoking, age at menarche, parity, menopausal status, age at menopause, and obesity (body mass index, BMI). Lower BMI, premenopausal status, and higher education level were primary correlated factors of gynecoid pattern body fat distribution. Higher BMI and postmenopausal status were the main correlated factors of android pattern body fat distribution. Lifestyle factors did not show any significant association with body fat distribution. As in Western countries, overall obesity and menopausal status are the determinants of body fat distribution. Controlling overall obesity is the key factor that can be addressed in public education programs to reduce the risk of high WHR, which plays an important role in the development of some chronic diseases.

Characteristics of non-participants and reasons for non-participation in a population survey in Kin-Hu, Kinmen

The aim was to characterize non-participants and to investigate reasons for non-participation in a health survey in Kin-Hu township, Kinmen, Republic of China. The non-participants represented 25.6% of the target population of 4,451 registered residents aged 30 and older. Baseline demographic characteristics and two-year mortality for the participants and non-participants were compared. A house-to-house visit was attempted to all of the non-participants for reasons of refusal. The mean age of the non-participants was significantly older than that of the participants (54.3 versus 48.5 years, p < 0.001). The response rate for women was significantly higher than that for men (77.2% versus 71.6%, p < 0.001). The probability of death was significantly different between the two groups (1.2% versus 8.8% for participants and non-participants, respectively, p < 0.001). Major reason for not having participated in the health survey was 'not notified or informed of the examination' (32.7%). These data suggest that non-participants were less healthy.

A population-based epidemiological study on cardiovascular risk factors in Kin-Chen, Kinmen

We conducted a population survey of cardiovascular risk factors in Kin-Chen, Kinmen (Quemoy), an island under military control for 40 years and the focal point of confrontation between mainland China and Taiwan. During the period 1992-1994, all residents > or = 30 years of age in Kin-Chen, the largest township in Kinmen, were invited to participate. The response rate was 60.3% (3826/6346). The prevalence of hypertension (> or = 160/95 mmHg and/or under treatment) was 25.2% in men and 17.6% in women. The rate for smoking was 41.5% in men and 2.9% in women. The prevalence of diabetes was 6.7% in men and 6.4% in women. Mean values for systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were 135.3 mmHg, 85.5 mmHg, 5.3 mmol/l, 1.1 mmol/l, 3.5 mmol/l and 1.4 mmol/l in men; and 128.0 mmHg, 79.5 mmHg, 5.2 mmol/l, 1.0 mmol/l, 3.3 mmol/l and 1.5 mmol/l in women, respectively. The unexpectedly high prevalence of hypertension in Kin-Chen male may reflect the effect of more than 40 years of military control and discipline. The high serum cholesterol level in Kin-Chen relative to mainland China and the low triglyceride level relative to Taiwan and Beijing, suggest further study of the contributions of diet and other psychosocial or environmental factors.