[Levels of blood pressure and blood glucose in elderly patients with hypertension and diabetes: association with carotid atherosclerosis].

OBJECTIVE: To explore the association between blood pressure and blood glucose levels and carotid atherosclerosis in elderly patients with essential hypertension and type 2 diabetes mellitus (T2DM). METHODS: A total of 670 patients aged 60 years or over with hypertension and T2DM were recruited and categorized by their systolic blood pressure (SBP): tight control, < 130 mm Hg, usual control, 130 - 139 mm Hg, or uncontrolled, ≥ 140 mm Hg; and by their HbA1c level: tight control < 6.5%, usual control 6.5% - 7.5%, or uncontrolled, ≥ 7.5% respectively. Carotid ultrasonography was performed in all subjects for the evaluations of intima-media thickness (IMT) and plaque. RESULTS: Multiple linear regression analyses revealed that IMT was positively correlated with SBP (ß = 0.215, P = 0.002) and HbA1c (ß = 0.149, P = 0.031), whereas IMT was negatively correlated with high-density lipoprotein cholesterol (ß = -0.196, P = 0.002). According to the multivariate logistic regression analysis, SBP ≥ 140 mm Hg (OR = 1.473, 95%CI 1.044 - 2.078 P = 0.027), HbA1c ≥ 7.5% (OR = 1.445, 95%CI 1.031 - 2.027, P = 0.033) and total cholesterol (OR = 1.014, 95%CI 1.004 - 1.024, P = 0.019) were significant risk factors for carotid artery atherosclerotic plaques whereas high-density lipoprotein cholesterol (OR = 0.895, 95%CI 0.805 - 0.994, P = 0.012) was a protective factor for carotid artery atherosclerotic plaques in elderly patients with hypertension and T2DM. CONCLUSION: There is a significant correlation between the levels of blood pressure, blood glucose and carotid atherosclerosis in elderly patients.

[Establishment of the prediction model for ischemic cardiovascular disease of elderly male population under current health care program].

OBJECTIVE: To establish and verify the prediction model for ischemic cardiovascular disease (ICVD) among the elderly population who were under the current health care programs. METHODS: Statistical analysis on data from physical examination, hospitalization of the past years, from questionnaire and telephone interview was carried out in May, 2003. Data was from a hospital which implementing a health care program. Baseline population with a proportion of 4:1 was randomly selected to generate both module group and verification group. Baseline data was induced to make the verification group into regression model of module group and to generate the predictive value. Distinguished ability with area under ROC curve and the predictive veracity were verified through comparing the predictive incidence rate and actual incidence rate of every deciles group by Hosmer-Lemeshow test. Predictive veracity of the prediction model at population level was verified through comparing the predictive 6-year incidence rates of ICVD with actual 6-year accumulative incidence rates of ICVD with error rate calculated. RESULTS: The samples included 2271 males over the age of 65 with 1817 people for modeling population and 454 for verified population. All of the samples were stratified into two layers to establish hierarchical Cox proportional hazard regression model, including one advanced age group (greater than or equal to 75 years old), and another elderly group (less than 75 years old). Data from the statically analysis showed that the risk factors in aged group were age, systolic blood pressure, serum creatinine level, fasting blood glucose level, while protective factor was high density lipoprotein;in advanced age group, the risk factors were body weight index, systolic blood pressure, serum total cholesterol level, serum creatinine level, fasting blood glucose level, while protective factor was HDL-C. The area under the ROC curve (AUC) and 95%CI were 0.723 and 0.687 - 0.759 respectively. Discriminating power was good. All individual predictive ICVD cumulative incidence and actual incidence were analyzed using Hosmer-Lemeshow test, χ(2) = 1.43, P = 0.786, showing that the predictive veracity was good. CONCLUSION: The stratified Cox Hazards Regression model was used to establish prediction model of the aged male population under a certain health care program. The common prediction factor of the two age groups were: systolic blood pressure, serum creatinine level, fasting blood glucose level and HDL-C. The area under the ROC curve of the verification group was 0.723, showing that the distinguished ability was good and the predict ability at the individual level and at the group level were also satisfactory. It was feasible to using Cox Proportional Hazards Regression Model for predicting the population groups.

[A prospective study on 6-year accumulative incidence rate of ischemic cardiovascular disease and related risk factors among the elderly male population under health care programme].

OBJECTIVE: To investigate the 6-year accumulative incidence rate of ischemic cardiovascular disease (ICVD) and its related risk factors. METHODS: Baseline population was all from an elderly population with members all born before 1-1, 1938 and under health care programme. Data was recorded in a database of a hospital and baseline of subjects under research was aged >65 years. People that had had ICVD at baseline were excluded. Risk factors under research would include:age at the baseline study, gender, body mass index, systolic blood pressure, serum cholesterol level, serum triglyceride level, serum high-density lipoprotein level, serum triglyceride level, serum apolipoprotein A1 level, history of diabetes mellitus and cigarette smoking etc. Single factor analysis was carried out using person-years as time of study, then calculating the person-year incidence and the accumulative incidence rate at different levels related to baseline risk factors. Multivariate analysis was under Cox Proportional Hazards Regression Model. RESULTS: Baseline population included 2271 elderly men, with the 6-year cumulative prevalence rate of ICVD as 23.56%, and the person-year prevalence rate was 45.41‰. Single factor analysis showed that the ICVD events positively related to variables which including systolic blood pressure, body mass index, serum cholesterol level and serum triglyceride level, serum apolipoprotein A1 level, status of diabetes mellitus and cigarette smoking. The ICVD events negatively related to variables as serum high-density lipoprotein level and serum creatinine level. Results of multivariate analysis showed that high systolic pressure, diabetes mellitus, serum creatinine level, Body Mass Index were the main risk factors. The serum high-density lipoprotein level served as the main protective factor. CONCLUSION: The aged male population under health care programme was high in the ICVD prevalence rate, suggesting that programmes as controlling blood pressure, blood glucose, and increasing serum high-density lipoprotein levels were effective measures to decrease the ICVD events.