Relatively high coronary death and event rates in Turkish women: Relation to three major risk factors in five-year follow-up of cohort
Introduction
Various studies have shown the coronary mortality and morbidity rates in industrialized populations. In particular, the MONICA Project of the World Health Organization has been monitoring coronary death rates and coronary event rates in many cities of the Western world [1]. With the exception of Japan and China, the Project involves communities having high levels of plasma cholesterol. Turkish adults were shown to have comparatively low cholesterol levels [2]and low high-density lipoprotein cholesterol levels [3], which might affect the contribution of major risk factors to coronary events or mortality. Moreover, the scarcity of prospective studies published on risk factors in women has been underlined [4].
It was therefore of interest to study in a longitudinal fashion the original cohort of the Turkish nationwide cardiac survey conducted in 1990. The survey, based on a representative sample of over 3600 Turkish adults, examined the prevalence of heart diseases as well as the risk factors for coronary heart disease. A follow-up of five years demonstrated high coronary death rates in Turkish women approaching that in Turkish men. The purpose of this paper is 1) to analyze the mortality and morbidity results of the follow-up survey of a Turkish cohort, 2) to delineate the relation of coronary deaths and events to systolic and diastolic blood pressure as well as to plasma cholesterol levels and smoking at baseline of the study.
Section snippets
Population and methods
The survey on the prevalence of cardiac disease and risk factors in adults in Turkey comprised 3687 men and women 20 years of age or over residing in 59 communities scattered over all seven geographical regions of the country. Surveyed in the summer of 1990 was a random sample of the Turkish adult population, representatively stratified for sex, age, geographical regions and for rural-urban distribution [5]. In the summer of 1994, the cohort of the Marmara region constituting one-quarter of the
A. Rates of death, coronary death and nonfatal coronary events
A total of 119 deaths (67 in men, 52 in women) were recorded during a mean follow-up of 4.73 years. Of these, 45 were classified as being due to coronary heart disease (24 in men and 21 in women) and ten deaths in each gender were of indeterminate nature, while 54 deaths were designated as not due to CHD (33 men, 21 women). These comprised 16 due to cerebrovascular accidents, 23 due to various malignancies, five due to accidents, one suicide and nine deaths from other causes.
The total period in
Discussion
The present paper is part of the only Turkish study in the field of cardiovascular epidemiology which follows a population-based cohort. Several limitations of the study exist which include the relatively small number of coronary deaths and events, the loss to follow-up of about one-third of the original cohort which might introduce a type two error, and uncertainty regarding assertion of diagnosis in a limited group of cases. The former is related in part to the comparatively young mean age of
Acknowledgements
We appreciate the dedicated work of Drs I. Keleş, K. Dönmez, G. Kahraman, B. Ökçün and E. Ince, the coworkers in the survey teams, and the assistance in biostatistical evaluation of Prof. Mustafa Şenocak, Cerrahpaşa Medical Faculty, Istanbul University. We thank the Pfizer and Sandoz pharmaceutical companies (Istanbul) for partial financial support.
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