The precancer risk of betel quid chewing, tobacco use and alcohol consumption in oral leukoplakia and oral submucous fibrosis in southern Taiwan

In areas where the practise of betel quid chewing is widespread and the chewers also often smoke and drink alcohol, the relation between oral precancerous lesion and condition to the three habits is probably complex. To explore such association and their attributable effect on oral leukoplakia (OL) and oral submucous fibrosis (OSF), a gender–age-matched case–control study was conducted at Kaohsiung, southern Taiwan. This study included 219 patients with newly diagnosed and histologically confirmed OL or OSF, and 876 randomly selected community controls. All information was collected by a structured questionnaire through in-person interviews. A preponderance of younger patients had OSF, while a predominance of older patients had OL. Betel quid chewing was strongly associated with both these oral diseases, the attributable fraction of OL being 73.2% and of OSF 85.4%. While the heterogeneity in risk for areca nut chewing across the two diseases was not apparent, betel quid chewing patients with OSF experienced a higher risk at each exposure level of chewing duration, quantity and cumulative measure than those who had OL. Alcohol intake did not appear to be a risk factor. However, cigarette smoking had a significant contribution to the risk of OL, and modified the effect of chewing based on an additive interaction model. For the two oral premalignant diseases combined, 86.5% was attributable to chewing and smoking. Our results suggested that, although betel quid chewing was a major cause for both OL and OSF, its effect might be difference between the two diseases. Cigarette smoking has a modifying effect in the development of oral leukoplakia

Smoking and drinking in relation to oral potentially malignant disorders in Puerto Rico: a case-control study

<p>Abstract</p> <p>Background</p> <p>Oral cancer incidence is high on the Island of Puerto Rico (PR), particularly among males. As part of a larger study conducted in PR, we evaluated smoking and drinking as risk factors for oral potentially malignant disorders (OPMDs).</p> <p>Methods</p> <p>Persons diagnosed with either an OPMD (n = 86) [oral epithelial dysplasia (OED), oral hyperkeratosis/epithelial hyperplasia without OED] or a benign oral tissue condition (n = 155) were identified through PR pathology laboratories. Subjects were interviewed using a standardized, structured questionnaire that obtained information, including detailed histories of smoking and drinking. Odds ratios (ORs) for smoking and drinking in relation to having an OPMD, relative to persons with a benign oral tissue condition, were obtained using logistic regression and adjusted for age, gender, education, fruit/vegetable intake and smoking or drinking.</p> <p>Results</p> <p>For persons with an OPMD and relative to individuals with a benign oral tissue condition, the adjusted OR for current smoking was 4.32 (95% CI: 1.99-9.38), while for former smokers, the OR_adjwas 1.47 (95% CI: 0.67-3.21), each OR_adjrelative to never smokers. With regard to drinking, no adjusted ORs approached statistical significance, and few point estimates exceeded 1.0, whether consumption was defined in terms of ever, current, level (drinks/week), or beverage type.</p> <p>Conclusions</p> <p>In this study, conducted in Puerto Rico, current smoking was a substantial risk factor for OPMDs while former smokers had a considerably reduced risk compared to current smokers. There was little evidence suggesting that alcohol consumption was positively associated with OPMD risk.</p

Myocardial infarction in the population of some Russian regions and its prognostic value

Aim. To study the prevalence of myocardial infarction (MI) in the population of Russian regions and its contribution to cardiovascular events.Material and methods. The analysis material was representative samples of the population aged 35-64 years from 11 Russian regions,  examined within the multicenter study “Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions  of Russian Federation”. The response rate was about 80%. The study used a community-based  systematic stratified multiply random sample. During the study, information on prior MI was obtained using a standard questionnaire. Anthropometry and measurement of blood pressure (BP) and heart rate (HR) with an automatic BP monitor were performed. Resting electrocardiography (ECG) was performed, followed by Minnesota coding. Major and minor QQS waves and STT segments were considered as ischemic  ECG abnormalities. Biochemical parameters were determined using an Arkhitect 000 Clinical Chemistry Analyzer. The median prospective  follow-up was 6,21 [5,25; 6,75] years. A composite endpoint (CE) was analyzed, including cardiovascular death and non-fatal MI. During the follow-up period, 363 all-cause deaths were detected,  of which 134 were from cardiovascular diseases, while 196 — CEs. Statistical analysis was carried out in R 3.6.1 environment.Results. The MI prevalence among the Russian population was 2,9%; 5,2% for men and 1,5% for women,  increasing  with age. Men with prior MI were  more likely to take statins and beta-blockers  than women as follows: 39,0% vs 25,6% and 29,3% vs 27,1%, respectively. MI newly diagnosed within the follow-up  period was associated with the following risk factors (RFs): smoking, increased BP, HR, triglycerides and glucose.  For individuals with prior MI, a significant relationship was found only with smoking.  Multiple comparison  of the contribution of RFs, ECG abnormalities,  and prior MI showed  that the inclusion of ischemic ECG abnormalities in the analysis significantly increases  the risk of cardiovascular events in individuals without prior MI compared with individuals without both MI and ECG changes.  A high CE risk was noted in patients with prior MI: relative risk (RR), 4,73 (2,92-7,65); the addition of ischemic ECG abnormalities increased the RR to 5,75 (3,76-8,8).Conclusion. The RR of CEs in patients  with prior MI without or with ischemic ECG changes  is 4,73 and 5,75 times higher than in patients without MI and ECG abnormalities. The risk factors  identified  in this case cannot explain such an increase  in CEs. It is obvious  that people  with prior MI need  rehabilitation. The presence of RFs in patients with newly diagnosed  MI indicates insufficient primary prevention, which suggests  that strengthening preventive measures to eliminate conventional risk factors in patients with newly diagnosed  MI will help reduce the risk of recurrent MI or cardiovascular  mortality

Non-High Density Lipoprotein Cholesterol: A Modern Benchmark for Assessing Lipid Metabolism Disorders

Aim. To perform a population analysis of Non-High Density Lipoprotein Cholesterol level (non-HDL-c) in Russian population and to evaluate its association with cardiovascular events.Material and Methods. The material consisted of results obtained from 11 regions of the ESSE-RF1 Study and from 4 regions of the ESSE-RF2 Study. Study protocols were identical. The studies were performed in 2012-2014 and 2017, respectively. Endpoints were assessed in 19041 people aged 35-64 years. The median follow-up was 6.5 years in ESSE RF (1) and 3.8 years in ESSE RF(2). Analysis was performed for three lipid variables: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-HDLC in two samples: the general population sample and the same sample without individuals with coronary heart disease (CHD), myocardial infarction (MI) and/or stroke history and not taking statins (the population sample of "without a history of cardiovascular diseases [CVD]". The analysis of nonlinear associations was performed using the generalized additive Cox model. The combined cardiovascular endpoint was represented by cardiovascular death and nonfatal MI and stroke. Traditional and laboratory FRs, socio-demographic parameters were analyzed. The significance level for all tested hypotheses was set to be 0.05.Results. The prevalence of elevated non-HDL-C level (&gt;3.7 mmol/l) was found to be 74.6%. No gender differences were found: there was 74.6% for men and 74.5% for women. Both mean values and prevalence of elevated non-HDL-C were increased with age in women, and its level was slightly decreased in men after 55 years old. Almost all analyzed RFs were significantly associated with elevated non-HDL-C in these two population samples. In both samples elevated total CH and elevated LDL-C were associated with all-cause mortality after correction for all RFs. On the contrary, the non-HDL-C was associated with CVD combined end pints. It has been shown that the risk of these end points increases uniformly with increase in levels of non HDL cholesterol, no nonlinear associations were found.Conclusion. The results of a population-based analysis of non-HDL-C performed in the Russian population for the first time confirmed that elevated non-HDL-C levels contribute significantly to determining the risk of cardiovascular events in the medium term. It can be assumed that the new risk scales (SCORE2 and SCORE OP) proposed by the European Society of Cardiology and the European Society of Preventive Cardiology, which include non-HDL C instead of TC, will allow adequate assessment of 10-year cardiovascular risk for Russians. However, continued monitoring of endpoints in order to obtain stable associations is required

Alcohol, tobacco and breast cancer – collaborative reanalysis of individual data from 53 epidemiological studies, including 58 515 women with breast cancer and 95 067 women without the disease

Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58 515 women with invasive breast cancer and 95 067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19–1.45, P<0.00001) for an intake of 35–44 g per day alcohol, and 1.46 (1.33–1.61, P<0.00001) for ⩾45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5–8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98–1.07, and for current smokers=0.99, 0.92–1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver

DO ALL TRADITIONAL RISK FACTORS ASSOCIATE SAME WITH MORTALITY IN SENIOR POPULATION?

Aim. To evaluate the impact of traditional risk factors (RF) to overall and cardiovascular mortality of the population ≥75 year old.Material and methods. The results are acquired in the prospective cohort study “Stress, ageing and health”. Totally, 455 Moscovites assessed, age ≥75 y.o. The traditional RF were evaluated: arterial hypertension, smoking, obesity and dyslipidemia. The follow up on mortality lasted for 8 years. Totally, 239 deaths registered, of those 169 cardiovascular. Statistics was done with STATA 14.1.Results. After stratification by sex and age, with the mortality from all cases in the 75-79 y.o. cohort, only current smoking status associated significantly (p=0,0001), and with cardiovascular mortality — current smoking and abdominal obesity, with relative risks 2,91 and 1,92, respectively. Also, in the ≥80 y.o. group, there were no RF influencing significantly the mortality.Conclusion. Among all traditional RF, in the age strata 75-79 y.o., only current smoking associated significantly with the all-cause mortality, and with cardiovascular — also abdominal obesity. Among the persons of ≥80 y.o., traditional RF lose their impact for both all-cause and cardiovascular mortality

OBESITY IN RUSSIAN POPULATION — PREVALENCE AND ASSOCIATION WITH THE NON-COMMUNICABLE DISEASES RISK FACTORS

Aim. Evaluation of the prevalence of obesity and association with the risk factors of chronic non-communicable diseases of the inhabitants of selected regions of Russia, by the data from ESSE-RF study.Material and methods. Representative selections investigated, of the inhabitants of 13 regions of Russia, totally 21768 participants, males n=8 304, females n=13 464, age 25-64 y. o., under the circumstances of the study “Epidemiology of cardiovascular diseases (ESSE-RF)”, with response ~80%. Standard questionnaire, consisting 12 modules, was developed based upon adapted international methods. For the risk factors prevalence assessment, the standard epidemiological methods were applied. Body mass (BM) was evaluated in the categories of body mass index (BMI) (Ketle index: BMI — Body mass, kg / height, m2). BM as BMI was evaluated as insufficient (BMI &lt;18,5), normal (18,5≤ BMI ≤24,9), overweight (25,0≤ BMI ≤29,9), obesity grade I (30,0 ≤BMI ≤34,9), obesity grade II (35,0 ≤BMI ≤39,9) and obesity grade III (BMI ≥40,0). Abdominal obesity (AO) was assessed with the criteria: for males waist circumference (WC) ≥102 cm and for females ≥88 cm.Results. Mean BMI value among the participants was 27,6 kg/m2, with no gender difference. BMI increases with the age only in women. WC — 87,8 cm ±0,1, among males it was significantly higher than in females (92,9 cm vs 84,1 cm, p&lt;0,001), increasing with age. The prevalence of obesity was higher among females comparing to males: by BMI — 30,8% vs 26,9%, p&lt;0,001; by AO — 38,4% vs 24,3%, p&lt;0,001. The prevalence of obesity in female inhabitants of rural regions was significantly higher comparing to citizens (p&lt;0,001), and in the group of higher education, there was no difference among males wither by BMI (p&lt;0,005), or by AO (p&lt;0,001). There was no clear geographic gradient of the risk factors. The prevalence of obesity increases linearly with the age, in males from 14,3% to 36,3%, p&lt;0,001, and in females from 10,7% to 52,3%, p&lt;0,001. AO was more prevalent in women comparing to men in every of analyzed age group, and with the age this difference gets more profound. In the multifactorial model the associations of risk factors were analyzed, with any type of obesity. Close relation was found for obesity and raised levels of glucose and triglycerides, with alcohol overconsumption. Most significant associations were found for obesity and AH in both genders — OR: 2,71 and 2,52 in men and women, respectively. There was linear increase of AH prevalence with mean SBP and DBP, together with BM.Conclusion. In Russian population, obesity is associated most closely with alcohol overconsumption, increased glucose level, lipid disorders and especially strongly — with systemic hypertension, the factors that increase prevalence with age. Burden of this closely interrelated factors on healthcare system will increase with the portion of elderly inhabitants of the country. State of affairs demand for a complex approach based on the governmental politics on the control of populational levels of bodyweight, beginning at elementary school, with mass-media involvement, as the groceries manufacturers, regional governments

CORONARY HEART DISEASE IN PERSONS OLDER THAN 55 YEARS. PREVALENCE AND PROGNOSIS

Aim. To study prevalence of various types of coronary heart disease (CHD) and their prognostic value in men and women older than 55 y.o.Material and methods. We used the data from selections of previously diagnosed persons. Totally 1875 included, with response at 64% level. All persons were questionnaired by the standard survey, that included social and demographic data, anamnesis, Rose questionnaire, behaviour. All patients underwent ECG 12 leads. ECG analysis was done with Minnesota conding system.Results. Every 4th male and every 3rd female revealed angina pectoris by the Rose questionnaire, and 9,5% men and 2,7% women had anamnesis of infarction. Ischemic changes on ECG more often in women — 15,6% vs. 10,0% (p&lt;0,001); and infarction itself 2 times more often affects men — 7,1% vs. 3,2% (p&lt;0,001). For men rhythm disorders are more common, i.e. left bundle branch block (p&lt;0,03). Overall CHD prevalence does not significantly differ between genders and is 34,6% for men and 36,0% for women. The most severe forms in account of life threatening are rhythm disorders, ischemic changes and atrial fibrillation. At the same time, for cardiovascular mortality all parameters were significant, including heart failure. By the severity of prognosis all values are spread with the same manner as for general mortality.Conclusion. CHD in older age is highly prevalent and very diverse. In women less severe forms are marked comparing to men. Epidemiologic criteria for CHD on ECG can be regarded as diagnostic and as candidates for patients stratification by the mortality risk from cardiovascular diseases and from all causes

Hypertension and dietary patterns of the adult population. Results of the Russian epidemiological study ESSE-RF

Aim. To study the associations of dietary patterns with HTN in the adult population.Material and methods. The analysis was carried out on the data of representative samples of male and female population from 13 regions of Russia. The age ranged from 25 to 64 years (n=19,520; men, 7329; women, 12191). The response rate was approximately 80%.Results. Men with blood pressure (BP) &gt;140/90 mm Hg more often consume meat and sausage products (OR, 1,08 [95% CI, 1,02-1,16]; p=0,011), less often — fresh vegetables/fruits (0,94 [0.89-0.96]; p=0,028), dairy products: milk, kefir (0,92 [0,87-0,97]; p=0,0041), sour cream (0,90 [0,84-0,96]; p=0,0021), cottage cheese (0,92 [0,85-0,99]; p=0,034) and sweets (0,91 [0,86-0,96]; p=0,00071). Women with BP &gt;140/90 mm Hg less often consume fresh vegetables/fruits (0,95 [0,90-0,99]; p=0,032), milk, kefir (0,95 [0,91-0,99]; p=0,040), cottage cheese (0,95 [0,90-0,99]; p=0,047), cheese (0,92 [0,88-0,97]; p=0,00083) and sweets (0,89 [0,850,93]; p&lt;0,00001). Persons with HTN more often consume fish products, fresh vegetables/fruits, less often — sweets, sugar and dairy products. Consumption of meat and sausage products does not differ in persons with/without HTN, as well as the habit of adding more salt. People taking antihypertensive medications (AHM) consume less salt. Men consume pickles less often, but not meat and sausage products; excess salt intake decreased (0,90 [0,83-0,98]; p=0,018). Women taking AHM consume meat and sausage products, but without affecting the salt level in diet. In persons taking AHM: among men (by 13%) and among women (by 10%), the consumption of fresh vegetables/fruits is higher and sugar — lower. Among people taking AGHM the cardioprotective type of diet is more common: by 12% among women and by 33% among men; a healthy diet is more common (by 29%) only among men. Women taking AHM and not reaching the target BP more often consume meat and sausage products (1,14; [1,06-1,22]; p=0,00044), and men — high-fat dairy products (1,20 [1,03-1,39]; p=0,022).Conclusion. People with hypertension are more likely to consume vegetables/fruits than those without hypertension, but the intake of high-sodium foods remains unchanged

Urban and rural dietary patterns: are there differences? The results of the ESSE-RF epidemiological study

The higher prevalence of alimentary-dependent risk factors for chronic non-communicable diseases in the Russian Federation among rural residents suggests that there are differences in the diets of city and village residents.Aim. To examine the diet differences of city and village adults.Material and methods. The analysis included representative samples from male and female population aged 25-64 years (n=21923, of which 8383 and 13550 are men and women, respectively) from 13 regions of the Russian Federation. The diet features were assessed by the frequency of consumption of themain food groups and individual eating habits: salting, the use of animal fats in cooking.Results. Rural men 18% more often than urban daily consumed meat sausages, 13% — salting and marinades and less often included in the diet meat (23%), fresh vegetables and fruits (28%), “milk, kefir, yogurt” (12%), sour cream (17%), quark (23%) and cheese (14%). Rural women less often consumed meat (19%), dairy products (18%), including cottage cheese (25%) and cheese (26%), but more often — salting (34%) and beans (10%). Rural women more often salt already prepared food — the odds ratio (OR) =1,32; 95% confidence interval (CI) 1,03-1,70 (X2=4,81, p=0,0282). Excess sugar intake among rural men was more common — OR=1,23; 95% CI 1,10-1,37 (X2=13,06, p&gt;0,0001). The women of the village more often added butter to the dishes (sandwich, porridge, mashed potatoes, etc.) than the urban ones — OR=1,14; 95% CI 1,03-1,25 (X2=6,90, p=0,0086), in contrast to men, for whom the consumption of butter did not differ. In general, excess consumption of salt and sugar in the diet of village men was more common than among city men — OR=1,26; 95% CI 1,13-1,42 (X2=15,95, p&gt;0,0001), in contrast to women, among whom no such differences were found (X2=3,02, p=0,0821). The diet, characterized by excessive consumption of salt, sugar and insufficient consumption of vegetables and fruits, was more often present among rural men — OR=1,30; 95% CI 1,12-1,53 (X2=10,92, p=0,0009). In urban and rural women, differences in the frequency of such diet were not found.Conclusion. The urban dietary pattern is characterized by higher consumption of meat, dairy products, vegetables and fruits, while in the rural model, the consumption of beans, salting, sugar and butter is higher.Participants of the ESSE-RF study: Moscow: Zhernakova Yu. V., Boytsov S. A., Saint-Petersburg: RotarO. P., Vladivostok: Kulakova N. V., Nevzorova V. A., Vladikavkaz: Astakhova Z. T., Vologda: Shabunova A. A., Volgograd: Nedogoda S. V., Voronezh: Chernykh T. M., Ivanovo: Belova O. A., Kemerovo: Artamonova G.V., IndukayevaE. V., Krasnoyarsk: Grinshtein Yu. I., Petrova M. M., Orenburg: Libis R. A., Samara: Duplyakov D. V., Tomsk: Trubacheva I. A., Kaveshnikov V. S., Serebryakova V. N., Tyumen: Efanov A. Yu., Medvedeva I. V., Shalaev S. V