The Prevalence of Coronary Heart Disease and Associated Factors in an Australian Rural Community1

Welborn, T.; Cumpston, G. N.; Cullen, Kevin J.; Curnow, D. H.; McCall, M. G.; Stenhouse, N. S.

doi:10.1093/oxfordjournals.aje.a120965

Cited by 102 publications

(38 citation statements)

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“…13 Persons with coronary heart disease (CHD) were identi®ed by doctor-con®rmed positive Rose questionnaires for angina pectoris andaor past myocardial infarction, or by de®nite ECG abnormalities using the Minnisota Code. 14 …”

Section: Methodsmentioning

confidence: 99%

Body mass index and alternative indices of obesity in relation to height, triceps skinfold and subsequent mortality: the Busselton Health Study

Welborn

Knuiman

2000

Int J Obes

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OBJECTIVES: The ideal index for leanness and obesity in epidemiological studies should correlate strongly with body weight and with a direct measure of fat while minimizing the in¯uence of height. The preferred index is expected to show meaningful associations with subsequent mortality. Our aims were to compare weighta aheight, weighta aheight 2 (body mass index or BMI), and weighta aheight 3 as candidates for this index. DESIGN: We analysed cross-sectional data from surveys of 6948 adults (3334 men (mean age 43 y, mean BMI 24.8 kga am 2 ), and 3614 women (mean age 42 y, mean BMI 24.3 kga am 2 )) in Busselton, Australia whose weight, height, triceps skinfold, and cardiovascular risk factors were measured from 1966 through to 1978. In these same subjects we studied the mortality risks of indices of obesity using Cox regression analysis for survival time from ®rst survey to death, or to follow up at the end of December 1995, after adjustment for age. Subjects dying within 5 y of the baseline survey were excluded from the analysis to avoid the bias of concurrent illness. We also studied subgroups including never smokers, subjects with no heart disease, and subjects`60 years of age at ®rst survey. RESULTS: In men, weighta aheight 2 met the criteria for a satisfactory index in that there was a very strong correlation with triceps skinfold, and a negligible correlation with height. For women, weighta aheight was as good a measure as weighta aheight 2 , with both having strong correlations with triceps skinfold, and minimal correlations with height. Weighta aheight 2 as a predictor of mortality in men of all ages showed the typical U-shaped associations that were similar and consistent and of variable statistical signi®cance. The signi®cances of the hazard ratio curves were the strongest for cardiovascular disease deaths (all men P 0.001; men without heart disease at baseline P`0.001; never smoking men P 0.007). In never smoking men there was a near linear positive relationship with all-cause mortality (P 0.018). In women weighta aheight 2 showed no consistent associations with mortality. There was a shallow Ushaped relationship with all-cause mortality (P 0.087), also seen in never smoking women (P 0.075). In assessing ideal' weight for height in this population, a weighta aheight 2 of 25 kga am 2 (range 22.5 ± 27.5 kga am 2 ) is appropriate. Weighta aheight and mortality showed very similar patterns in men to weighta aheight 2 with quite similar levels of statistical signi®cance. In women much more pronounced U-shaped curves were apparent in all groups and subgroups, with a signi®cant all-cause mortality trend for all women (P 0.029) and never smoking women (P 0.034). In assessing`ideal' weight for height a weighta aheight of 42.5 kga am (range 35 ± 50 kga am) appears appropriate for men and women. CONCLUSIONS: Weighta aheight 2 is an appropriate index of leanness and obesity in males at all ages, whereas weighta aheight is at least as good an index for females. In mortality studies weighta aheight 2 and weighta ahei...

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Section: Methodsmentioning

confidence: 99%

Body mass index and alternative indices of obesity in relation to height, triceps skinfold and subsequent mortality: the Busselton Health Study

Welborn

Knuiman

2000

Int J Obes

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“…*' Coronary heart disease was determined from the Rose Questionnaire for angina and myocardial infarction and the electrocardiogram together with a selfreported confirmation that their doctor had said they had heart disease. 22 Mortality follow-up from the 1978 survey to 1994 was available. Deaths among survey participants were identified by linkage to the Death Register for Western Australia and through relatives.…”

Section: Methodsmentioning

confidence: 99%

Multivariate risk estimation for coronary heart disease: the Busselton Health Study

Knuiman

Bartholomew

1998

Australian and New Zealand Journal of Public Health

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ortality from coronary heart disease (CHD) inAustralia has been M falling for more than 20 years, but the rates remain high and a cause for concern. Risk factors associated with increased morbidity and mortality from CHD include hypertension, smoking, elevated serum total cholesterol, low high-densitylipoprotein (HDL) cholesterol, diabetes, obesity, left ventricular hypertrophy and previous history of CHD. Moderate levels of alcohol consu.mption are associated with decreased morbidity and mortality from CHD.CHD is a multifactorial disease and risk should be estimated by assessing all cardiovascular risk factors simultaneously. A simple method for obtaining an integrated or composite risk score is to categorise an individual as being 'at risk' or 'not at risk' according to whether the risk factor exceeds some arbitrary threshold, and then to add up the number of factors with 'at risk' values. This method is easily applied in practice and will identify high-risk subjects.However, CHD occurs in individuals with moderate elevations of several risk factors as well as in individuals who have extreme elevations of few risk factors, and therefore this simple composite score may fail to identify high-risk subjects with multiple risk factors at moderately elevated values which do not exceed the thresholds.A more effici'ent approach is to use a continuous multivariate risk score which does not use thresholds and will recognise that an individual with borderline elevation of two or three risk factors may be at the same risk as another individual with a serious elevation of one of them. ' Investigators from the Framingham Heart Study in the United States have developed risk scores for predicting the development of CHD4.5 and handbooks and programs for calculators have been de~eloped.~.' The best known of these scoring systems calculates risk based on age, sex, systolic or diastolic blood pressure, plasma total cholesterol, ECG evidence of left ventricular hypertrophy, diabetes and smokmg status. More recently published equations have also included HDL cholesterol.* A number of other studies have produced risk scoring systems for men.'-'* There are few risk scores developed for women. No CHD risk scores have been developed from Australian data.The development of several risk scores has been partly motivated by the belief that risk scores developed from one population may not be applicable to another population. A review of 15 published estimated logistic risk functions for CHD morbidity/mortality found that there were differences in the odds ratios between studies and the authors concluded that the 'use of a scoring system derived from logistic regression to produce a measure of risk for a different population may be more misleading than advantageous'.13 However, some evaluations of risk scores derived from one population and applied in other settings produced findings that do not support this vie^.'^'^-'^ Nevertheless, locally derived scores would be more acceptable to clinicians and general practitioners and thus more lik...

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“…Definite angina pectoris or myocardial infarction implies "doctor-confirmed" in that when positive responses were given to the questionnaire, a history also had to be obtained that ), coronary heart disease (-----), and stroke ( ...... ) by age in Type 2 and Type 1 diabetic subjects. The open squares indicate the observed prevalence rates for total macrovascular disease the patient had seen his doctor about the chest pain, and the doctor had given a cardiac diagnosis [10]. In rural Western Australia this technique improves the specificity of the questionnaire, 71% having ECG changes (65% frank, 6% borderline) compatible with coronary heart disease [10].…”

Section: Subjectsmentioning

confidence: 99%

“…The open squares indicate the observed prevalence rates for total macrovascular disease the patient had seen his doctor about the chest pain, and the doctor had given a cardiac diagnosis [10]. In rural Western Australia this technique improves the specificity of the questionnaire, 71% having ECG changes (65% frank, 6% borderline) compatible with coronary heart disease [10]. The chest pain questionnaire is a valid technique for identifying a disease-rich group within one population and for demonstrating the association of coronary heart disease with major risk factors [11].…”

Section: Subjectsmentioning

confidence: 99%

Clinical macrovascular disease in Caucasoid diabetic subjects: logistic regression analysis of risk variables

et al. 1984

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Summary.A cross-sectional study of 1084 Caucasoid diabetic subjects in rural Western Australia revealed a high rate of clinical macrovascular disease (46%), including coronary heart disease (13%), stroke (8%), and peripheral vascular disease (38%). Age was the major time-related variable for total macrovascular disease and for peripheral vascular disease, with identical prevalence rates in Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes when age was taken into account. In 179 Type t diabetic subjects, logistic regression analysis showed no associated risk factors other than age. In 905 Type 2 diabetic subjects the independent risk factors for total macrovascular disease, identified by a forward stepwise selection procedure, were age as the major contributor, with plasma creatinine levels and plasma glucose levels (all p < 0.001), high-density lipoprotein cholesterol levels, serum total cholesterol levels, and the (supine-erect) systolic blood pressure difference (all p < 0.05). There were no direct associations with percentage desirable weight, cigarette smoking or male sex. Type 2 diabetic subjects demonstrated a very strong negative association between high-density lipoprotein cholesterol levels and coronary heart disease, and significant associations were found also between plasma glucose levels and coronary heart disease (p < 0.01), and glycosylated haemoglobin levels and peripheral vascular disease (p < 0.001).

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The Prevalence of Coronary Heart Disease and Associated Factors in an Australian Rural Community1

Cited by 102 publications

References 0 publications

Body mass index and alternative indices of obesity in relation to height, triceps skinfold and subsequent mortality: the Busselton Health Study

Body mass index and alternative indices of obesity in relation to height, triceps skinfold and subsequent mortality: the Busselton Health Study

Multivariate risk estimation for coronary heart disease: the Busselton Health Study

Clinical macrovascular disease in Caucasoid diabetic subjects: logistic regression analysis of risk variables

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