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Biomedical subjects

G De Backer

Publications and source records attributed to G De Backer.

At least 55 records · Page 3Linked to original sources
PubMed2000

Lipid lowering drugs and recurrences of life-threatening ventricular arrhythmias in high-risk patients.

OBJECTIVES: To evaluate a possible effect of lipid lowering drugs on recurrences of ventricular arrhythmias (VA) after implantable cardioverter defibrillator (ICD) implantation. BACKGROUND: In patients with coronary artery disease (CAD), lipid lowering drugs reduce total and sudden cardiac death. Because the mechanism is not completely understood, we studied whether these drugs have a favorable influence on the occurrence of life-threatening VA in patients with CAD and ICD implants. METHODS: We conducted an observational study in 78 patients with CAD and life-threatening VA, treated with an ICD. After ICD implantation, 27 patients were on treatment with lipid lowering drugs (group I) and 51 were not (group II). Patients were studied for the following end points: recurrences of VA requiring ICD intervention, cardiac death and hospitalization. RESULTS: After a mean follow-up of 490 +/- 319 days, 35 patients (45%) had recurrences of VA requiring ICD intervention. In multivariate analysis, the use of lipid lowering drugs (chi-square 6.33, p = 0.012) and poorly tolerated sustained monomorphic ventricular tachycardia as initial presentation (chi-square 4.84, p = 0.028) remained as independent predictors of recurrences of VA. Patients in groups I and II had similar baseline clinical characteristics, but patients in group I had a lower incidence of recurrences of VA (6/27 or 22% vs. 29/51 or 57%, p = 0.004) and of the combined end points of cardiac death and hospitalization (4/27 or 15% vs. 23/51 or 45%, p = 0.015) compared with patients in group II. CONCLUSIONS: This is the first observation that the use of lipid lowering drugs is associated with a reduction of recurrences of VA in patients with CAD and ICD implants. These data require confirmation in a prospective randomized trial.

Aged↗
PubMed2000

Postprandial response to a fat tolerance test in young adults with a paternal history of premature coronary heart disease - the EARS II study (European Atherosclerosis Research Study).

BACKGROUND: The European Atherosclerosis Research Study (EARS) I had shown that fasting plasma concentrations of apolipoprotein B (apo B) and triglycerides were the most discriminant variables between offspring with a paternal history of coronary heart disease (CHD) and controls. The EARS II study was undertaken to investigate whether a paternal history of CHD was associated with differences in postprandial lipemia. DESIGN: Male subjects with a paternal history of CHD (cases, n = 407) and age-matched male controls (n = 415) were recruited from 14 European universities. All subjects had an oral fat tolerance test. RESULTS: In the sample as a whole, the postprandial triglyceride responses did not significantly differ between the two groups. However, in the upper tertile of fasting triglycerides, cases displayed a higher area under the curve (5.71 vs. 4.49 mmol.h L-1, P < 0.001), a higher peak (1.76 vs. 1.43 mmol L-1, P < 0.001) and a more delayed time to peak (3.15 vs. 2.91 h, P < 0.05) than controls. In the upper tertile, fasting apo B levels (P < 0.05) and triglyceride area under the curve (P = 0.002) significantly discriminated cases from controls in a multivariate analysis. Cases had also higher Lp C-III:B levels at 4 h than controls (11.2 vs. 9.9 mg dL-1, P < 0.01) and this difference remained significant after adjustment for apo B and triglyceride levels. CONCLUSIONS: These results indicate that in subjects with a moderate elevation of fasting triglycerides, an impaired postprandial response to a fat load constitutes an early biological expression of a paternal history of premature CHD.

Administration, Oral↗
PubMed2000

Overweight and obesity: a major challenge for coronary heart disease secondary prevention in clinical practice in Europe.

AIMS: To evaluate the management of overweight and obesity in coronary artery disease patients in Europe. METHODS AND RESULTS: The EUROASPIRE Study is a multicentre epidemiological study involving nine European countries. The major cardiovascular risk factors and their management were collected from hospital records and measured at least 6 months after hospitalization during a specific interview. A total of 4863 consecutive records from men and women with coronary artery disease, under 71 years of age, were reviewed. Interviews were obtained for 3569 (73%). Body mass index was computed from height and weight noted in the medical records and measured at interview. Management of overweight and obesity was recorded at interview. At least 6 months after hospitalization, 75% of women and 80% of men were overweight and 33% of women and 23% of men were obese. Height noted in medical records was over-estimated, inducing an under-estimation of obesity in 16% of men and 33% of women. Advice from a nutritionist was offered in less than 20% of obese patients. The same trends were observed in all participating countries. CONCLUSIONS: Prevalences of overweight and obesity are high in coronary artery disease patients in Europe. A systematic measurement of height and weight is a prerequisite to a better management of this common modifiable risk factor.

Aged↗
PubMed2000

Prevalences of ECG findings in large population based samples of men and women.

OBJECTIVE: To obtain accurate estimates of the prevalence of ECG abnormalities in the general population and to describe them in relation to age, sex, and some lifestyle related factors. DESIGN: The results were obtained from the records of 47 358 men and women participating in four large Belgian epidemiological studies during the past 30 years. All tracings were read and coded by two trained cardiologists on the basis of Minnesota code criteria. RESULTS: Prevalences of coronary heart disease and abnormal ECG findings rose exponentially with age in both sexes, with the exception of atrioventricular block and the Wolff-Parkinson-White (WPW) syndrome. Major ECG findings were observed in 6.0% of all men and 4.3% of women, resulting in a significant adjusted sex ratio of 1.66 (95% confidence interval 1.46 to 1.88). The prevalence of minor ECG changes was slightly higher among men (10.4% v 9.5% in women). The occurrence of ischaemia-like findings on the ECG was comparable between men and women (9.0% v 9.8%). Independent of age, smoking, obesity, diabetes, employment status, positive history of angina or infarction, and region, there were significantly higher prevalences of Q/QS patterns, left ventricular hypertrophy, left axis deviation, arrhythmias, and atrial fibrillation or flutter in men than in women. Right bundle branch block and WPW syndrome both occurred 3.5 times more often in men, while the prevalence of left bundle branch block was comparable between the sexes. CONCLUSIONS: The large sample size allowed a precise description of the most important ECG abnormalities. These are not rare in the adult population and most are strongly age related. Sex differences occur with some, but not all, abnormalities. The less common ECG abnormalities were more often observed among men.

Adult↗
PubMed2000

Trends and regional differences in coronary risk factors in two areas in Belgium: final results from the MONICA Ghent-Charleroi Study.

OBJECTIVE: To study regional differences and trends in coronary risk factors and in predicted coronary risk calculated on the basis of multiple logistic function equations for the general population aged 25-64 years in two areas in Belgium during the period 1985-1992. DESIGN: A comparison of cross-sectional data on coronary risk factors between two cities and different survey periods. METHOD: In the cities of Ghent (in Flanders) and Charleroi (in Walloonia) in Belgium, three consecutive cross-sectional age-stratified and sex-stratified random samples of 2000 subjects each were selected from the general population. We studied their coronary risk factors between 1985 and 1992. The field work was carried out according to the protocol of the international WHO-MONICA project. RESULTS: We observed a significant decrease in the prevalence of smoking among men in the two cities over the three surveys, while a gradual increase in diastolic blood pressure for all subgroups in Ghent was seen (this was statistically significant for men aged 45-64 years and women aged 25-44 years). The overall coronary risk predicted on the basis of multiple-logistic-function equations did not however, exhibit significant trends over time in either city. Comparisons between the two centres revealed significantly higher mean serum levels of total cholesterol in Charleroi than in Ghent (for all subgroups except women aged 45-64 years) and significantly higher mean systolic blood pressures in Charleroi for all subgroups defined in terms of age and sex. Prevalences of hypertension in Ghent were significantly lower than those in Charleroi for individuals aged 25-44 years, while the prevalence of obesity in all subgroups in Ghent was also significantly lower. The overall predicted coronary risk in Charleroi was also significantly higher, except for men aged 45-64 years. The differences in mean predicted risk ranged from 5.0% for men aged 45-64 years to 21.2% for women aged 45-64 years. CONCLUSIONS: From the data in this article it seems that the trends in overall coronary risk profiles in Ghent and Charleroi are not in accordance with the observed trends in incidence of coronary heart disease (CHD) in these two cities. On the other hand, the differences in predicted coronary risk between the two cities are in the same direction as the observed differences in incidence of CHD between the two cities, but are however too small to explain fully the observed difference in incidence of CHD between the two centres.

Adult↗
PubMed2000

Are the WOSCOPS clinical and economic findings generalizable to other populations? A case study for Belgium. The WOSCOPS Economic Analysis Group. West of Scotland Coronary Prevention Study.

AIMS: As the West of Scotland Coronary Prevention Study (WOSCOPS) was conducted in Scotland, a country well-known for its high cardiovascular risk, the generalizability of its findings on pravastatin's clinical and economic effects has been questioned. This study examines the legitimacy of this concern, using Belgium as a case study. METHODS AND RESULTS: Local information on the prevalence and clustering of risk factors in individual patients was used in a risk equation to estimate the reference risk in Belgium. In contrast to prevailing beliefs, this risk was shown to coincide with the trial population's risk. As the relative risk reduction documented in a trial should apply across populations, the health benefits observed in WOSCOPS can clearly be extrapolated. This information in combination with local costs was then used to assess the economic efficiency of primary prevention with pravastatin in Belgium by means of a previously developed model. In parallel with the original estimates for the United Kingdom, the cost-effectiveness ratios remain well within the range of what is considered strong to moderate evidence for adoption and appropriate utilization, over a wide range of input values. CONCLUSION: This study demonstrates that the clinical and economic findings from WOSCOPS can indeed be generalized to other populations.

Anticholesteremic Agents↗
PubMed2000

Recent findings on return to work after an acute myocardial infarction or coronary artery bypass grafting.

OBJECTIVE: To examine during recent years the rate of work resumption after an acute myocardial infarction or coronary artery bypass surgery, and to analyse variables that predicted return to work. SETTING: Referral centre for cardiac rehabilitation at the university hospital in Gent. PATIENTS: 227 consecutive patients (90 after a first AMI; 137 after a first CABG) were selected for participation. All patients were less than 60 years old and in a social state that still allowed return to work. During hospitalisation, a set of questionnaires, validated as well as self-developed, was presented, measuring psychological and social variables. Medical variables were collected from the medical records. One year later, a follow-up questionnaire was sent by mail, measuring return to work, reasons for not returning, morbidity, and psychological well-being. RESULTS: Return to work was observed in 185/222 (83.3%) of the total study group; 75/86 (87.2%) of the AMI patients and 110/136 (80.8%) of the CABG patients. The mean delay for return to work was 14.8 weeks. After one year, patients who returned to work, showed more positive affect, less negative affect, less somatic complaints and less cognitive complaints. This better psychological profile was not affected by the morbidity score. Variables predicting return to work in CABG patients were different from those in AMI patients. Only two medical variables could be retained in CABG patients (good left venticular function and a larger degree of revascularisation). Mainly psychological variables had predictive power (trust, job security, positive expectations concerning return, no attribution to stress, less somatic complaints, less physical exertion of the job). CONCLUSIONS: Return to work remains one of the main issues in cardiac rehabilitation after AMI or CABG. If resumption is sufficiently emphasized, a high success rate can be achieved. This approach should include a psychosocial strategy starting already during hospitalisation.

Coronary Artery Bypass↗
PubMed1999

The Selvester 32-point QRS score for evaluation of myocardial infarct size after primary coronary angioplasty.

In patients treated successfully with primary angioplasty for a first myocardial infarction, the Selvester 32-point score correlates well with infarct size measured with quantitative thallium-201 perfusion imaging. Therefore, it is a useful parameter for infarct sizing, particularly in patients with anterior infarction or reduced ejection fraction at discharge.

Angioplasty, Balloon, Coronary↗
PubMed1999

Associations between haptoglobin polymorphism, lipids, lipoproteins and inflammatory variables.

The haptoglobin allele frequencies and the phenotype distribution were determined in 741 male Caucasian workers, aged 35 to 59 years. The association of the haptoglobin polymorphism with various clinical and biochemical parameters was investigated. Furthermore a possible interaction with the apo E polymorphism on lipid and lipoprotein traits was analysed. The frequency of Hp1 and Hp2 was found to be 0.401 and 0.599, respectively. The observed distribution of Hp types (Hp 1-1, 15.5%; Hp 2-1, 49.3%; Hp 2-2, 35.2%) was in Hardy-Weinberg equilibrium. Age, body mass index, smoking, alcohol intake and blood pressure were comparable between the three Hp groups. Subjects with Hp 2-2 had significantly higher serum total and free cholesterol concentration compared to those in other haptoglobin types (P = 0.006 and P = 0.003). Similarly, apo B levels were significantly higher among Hp 2-2 individuals (P = 0.02). No significant differences were demonstrated between the Hp phenotypes in HDL cholesterol, apo A-I, apo E, Lp(a), cholesteryl esters, fibrinogen and C-reactive protein concentrations, although for the latter an increase was noticed in Hp 2-2. The effects of Hp type and apo E type on Lp(a) and on free cholesterol levels were found to be significantly multiplicative, with the highest free cholesterol values observed in subjects having Hp 2-2 and the apo epsilon4 allele. Significantly lower Lp(a) levels were observed in individuals carrying Hp 1-1 and an epsilon2 allele than in subjects without the epsilon2 allele. In conclusion, haptoglobin polymorphism may play an important role in the regulation of lipoprotein metabolism and could contribute to the risk of coronary heart disease. Larger samples are needed to clarify the clinical relevance of the gene-gene (Hp-apo E) interaction on lipids and lipoproteins.

Adult↗
PubMed1999

Risk of cytomegalovirus infection among educators and health care personnel serving mentally disabled children.

AIM: To determine the risk of cytomegalovirus (CMV) infection for personnel providing services to young disabled children. METHODS: The prevalence and incidence of CMV in a group of educators were compared with a group of nurses working in homes for the elderly. RESULTS: The prevalence was measured in 283 educators and 294 nurses. Both groups were comparable for well-established risk factors for CMV infection. The prevalence of seropositivity was 15.9% in the educators and 18.4% in the nurses. After a 1-year period 182 of the educators and 157 of the nurses who were initially seronegative for CMV were retested for serologic evidence of CMV infection. The annual conversion rate was 1.03% in educators and 1.42% in nurses. CONCLUSION: The prevalence of CMV antibodies among both educators and nurses did not differ and was lower to that observed in American studies of comparable populations. Annual seroconversion rates were not different between these groups.

Adult↗
PubMed1999

Parental history of premature coronary heart disease mortality and signs of ischemia on the resting electrocardiogram.

OBJECTIVES: Here we explore the association between a family history of premature coronary heart disease (CHD) death and ischemic electrocardiogram (ECG) findings in the offspring. BACKGROUND: In the general population, signs of ischemia are found on the resting ECG in about 10% of middle-aged men and women. Their independent predictive value for CHD morbidity and mortality has been shown in several studies. METHODS: Our results are based on cross-sectional data from three large epidemiological studies performed in Belgium during the past two decades: the Belgian Heart Disease Prevention Project (n = 8,145), the Belgian Interuniversity Research on Nutrition and Health survey (n = 7,625) and the MONICA project (n = 3,193). A parental history of fatal CHD was considered premature if the father died from CHD before age 60 or the mother before age 70. Ischemic ECG findings were defined according to Minnesota Code criteria I(1-3), IV(1-3), V(1-3) or VII1. RESULTS: Subjects with a parental history of premature CHD death were found to have experienced significantly more frequently symptomatic CHD. After exclusion of symptomatic individuals, no major differences in lifestyle-related risk factors were found between the groups with and without a parental history of premature fatal CHD. After multivariate adjustment for age, smoking, body mass index and sex, the odds ratios (and 95% confidence interval [CI]) for ECG ischemia associated with a positive parental history of premature death were 1.42 (1.10-1.82), 1.47 (1.16-1.88) and 1.37 (0.78-2.41) in the three studies. Additional adjustment for systolic blood pressure, total cholesterol and, if available, lifestyle-related factors did not alter the magnitude of the odds ratios. Overall, in men aged 45 to 64 years, ECG ischemia was significantly more frequent (36% excess) in those with positive parental history. CONCLUSIONS: Subjects in whom one or both parents died prematurely from cardiac-related diseases have signs of ischemia more frequently on their electrocardiogram, and this is independent of other risk factors.

Adult↗
PubMed1999

Nutrient and food intakes in selected subgroups of Belgian adults.

In March 1997, official dietary guidelines were for the first time published in Belgium by the National Council on Nutrition. These guidelines are entirely focussed on nutrient intake and do not translate this information into specific 'food-based' recommendations. In this paper, actual intake data for the adult Belgian population are compared to these guidelines. It is concluded that the overall macronutrient intake pattern in Belgium corresponds to the typical Western so-called affluent diet. As a next step, an attempt is made to outline a conceptual framework for developing food-based dietary guidelines on the basis of existing food consumption databases. For that purpose, nutrient and food intake profiles--percentage of consumers and mean intakes for the total population and for consumers only--are studied for subgroups of the population that do or do not comply to predefined dietary goals for total fat intake, fibre intake, and fruit and vegetable intake. Finally, it is shown with an example that these data can be used as a basis for formulating healthy food recommendations towards the general population in terms of specific foods or food groups to be avoided or to be chosen preferably. The food and nutrient intake data used in this paper are from the BIRNH study (Belgian Interuniversity Research on Nutrition and Health, 1980-1984), the only nationwide food consumption survey on an individual level ever carried out in Belgium.

Adult↗
PubMed1999

Sociodemographic and nutritional determinants of obesity in Belgium.

OBJECTIVE: To examine associations between sociodemographic, dietary factors and physical activity and the prevalence of obesity in the Belgian general population. DESIGN: Base-line data from the Belgian Interuniversity Research on Nutrition and Health (BIRNH) study (1979-1984). SUBJECTS: A total of 5837 men and 5243 women aged 25-74y were included in the analysis. The sample was considered representative of the Belgian population. MEASUREMENTS: Using the body mass index (BMI) as the criterion, obesity was defined as a BMI> or =30 kg/m2. Nutritional data were assessed by a 24 h food record. Physical activity level (PAL) was calculated by dividing total caloric intake by an estimation of basal metabolic rate (BMR, predicted from gender, weight and age). Age-adjusted odds ratios (OR) of the prevalence of obesity were estimated by multilogistic regression analysis. RESULTS: Prevalence of obesity was 12.1% in men and 18.4% in women. In both sexes, prevalence of obesity increased gradually in each 10-year age category (P<0.0001) and steeply decreased with level of education. Comparing lowest (Q1) to highest quartile (Q4), after adjustment for age, prevalence of obesity decreased with total carbohydrate intake, as well as total sugar intake in both sexes, and increased with total fat intake only in men. Obesity increased with a high fat to sugar ratio (men: OR(Q4/Q1) = 1.56; confidence interval (CI): 1.25-1.93; women: OR(Q4/Q1) = 1.45; CI: 1.17-1.80). PAL was inversely and very strongly associated with obesity (men: OR(Q4/Q1) = 0.20; CI: 0.15-0.26; women: OR(Q4/Q1) = 0.18; CI: 0.14-0.23). The same associations were observed with the mean BMI. CONCLUSION: This study indicates that prevalence of obesity is particularly high in Belgium. Low level of education and reduced physical activity, increased fat intake and especially elevated fat to sugar ratio appear to be powerful determinants of obesity in this Belgian population.

Adult↗