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Biomedical subjects

R Mulcahy

Publications and source records attributed to R Mulcahy.

At least 73 records · Page 4Linked to original sources
PubMed1985

Diet and 20-year mortality from coronary heart disease. The Ireland-Boston Diet-Heart Study.

In a prospective epidemiologic study of 1001 middle-aged men, we examined the relation between dietary information collected approximately 20 years ago and subsequent mortality from coronary heart disease. The men were initially enrolled in three cohorts: one of men born and living in Ireland, another of those born in Ireland who had emigrated to Boston, and the third of those born in the Boston area of Irish immigrants. There were no differences in mortality from coronary heart disease among the three cohorts. In within-population analyses, those who died of coronary heart disease had higher Keys (P = 0.06) and modified Hegsted (P = 0.02) dietary scores than did those who did not (a high score indicates a high intake of saturated fatty acids and cholesterol and a relatively low intake of polyunsaturated fatty acids). These associations were significant (P = 0.03 for the Keys and P = 0.04 for the modified Hegsted scores) after adjustment for other risk factors for coronary heart disease. Fiber intake (P = 0.04) and a vegetable-foods score, which rose with increased intake of fiber, vegetable protein, and starch (P = 0.02), were lower among those who died from coronary heart disease, though not significantly so after adjustment for other risk factors. A higher Keys score carried an increased risk of coronary heart disease (relative risk, 1.60), and a higher fiber intake carried a decreased risk (relative risk, 0.57). Overall, these results tend to support the hypothesis that diet is related, albeit weakly, to the development of coronary heart disease.

Adult↗
PubMed1985

Readability of literature written for cardiac patients.

The readability of 28 books and leaflets available to cardiac patients at a Dublin hospital was assessed. Mean required reading age was 14.3 years, and only 21% of the texts had a reading age of 12 or less. Fifty percent of 1088 cardiac patients attending the hospital had no more than an elementary school education and therefore would have been able to read at most one-fifth of the available patient literature.

Coronary Disease↗
PubMed1985

Natural history and prognosis of unstable angina.

One hundred patients admitted to coronary care with unstable angina were followed for a period of 1 year. A conservative approach to treatment was adopted. Routine beta blockers, calcium antagonists, and anticoagulants were not employed. Patients with persistent pain following admission were treated with nitrates only and with symptomatic treatment. One death and nine nonfatal infarctions occurred within the first 28 days after admission. A total of eight deaths, 14 nonfatal infarctions, and three readmissions for unstable angina occurred during the follow-up period of 1 year. Of the various initial factors studied, persistence of pain and the magnitude and extent of ECG ST-T changes were the only predictors of an unfavorable outcome. Non-smokers and those with a previous history of angina on effort had a significantly higher incidence of persistence of pain. The withdrawal of beta blockers on admission and the late administration of beta blockers to those with persistent pain did not appear to influence outcome.

Adrenergic beta-Antagonists↗
PubMed1985

Is a family history of coronary heart disease an independent coronary risk factor?

The importance of a positive family history as a primary risk factor for coronary heart disease was examined in a case history study. Of 792 consecutive male patients aged under 60 years who survived a first episode of unstable angina or myocardial infarction, 326 had a negative family history, 298 had a positive history, and in 168 a family history could not be established with certainty. There was no significant difference in the distribution of the three primary coronary risk factors--cigarette smoking, hypertension, and hypercholesterolaemia--between those with and those without a positive family history. The 133 subjects with a positive family history of premature coronary heart disease (occurrence in near relatives under 60 years) were significantly younger than those with a negative family history. It is concluded that there is little evidence to confirm a positive family history as an important independent risk factor for coronary heart disease, although there may be familial aggregation of subjects with a high susceptibility to the effects of the three primary risk factors, cigarette smoking, hypertension, and hyperlipidaemia.

Cholesterol↗
PubMed1984

Mortality from coronary heart disease-trends for the Republic of Ireland.

A study of certified mortality between 1968 and 1981 indicates that mortality from all causes commenced to decline from the mid 1970s in the Republic of Ireland. This trend was apparent for both sexes and for all ages except for men aged 55-64 years. A similar trend of lesser magnitude is suggested for coronary heart disease mortality in males, but not in females. The decrease in the percentage of male cigarette smokers in the population which is also reflected in a marked decline of smoking among male coronary patients, may be related to the trends in mortality.

Adult↗
PubMed1984

Factors affecting dietary compliance in coronary patients included in a secondary prevention programme.

Nutrient intake was altered favourably in the diets of 38 cardiac patients who were followed up for 1 year as part of a rehabilitation programme. Total energy intake was reduced from 3540 kcal (14.9 MJ) to 2484 kcal (10.4 MJ). Fat intake was reduced from 41 to 37 per cent of energy intake with an accompanying increase in P : S ratio from 0.18 to 0.60. Cholesterol intake was reduced from 564 to 332 mg. Carbohydrate was increased from 38 to 41 per cent of energy intake with an increase in fibre intake from 18 to 24 g. The energy contributed by alcohol was reduced from 6 to 5 per cent. Patients varied in their compliance but all patients made some changes in their dietary intake. Changes in body weight, serum cholesterol levels, cigarette-smoking status and levels of physical activity tended to correspond with the recorded changes in nutrient intake. A low level of education, low socio-economic group, lack of understanding of the illness by the patient and inadequate communication were associated with reduced compliance. Initial motivation and anxiety levels in hospital had less effect on compliance.

Adult↗
PubMed1983

Long term effect on mortality of stopping smoking after unstable angina and myocardial infarction.

Subjects who stop smoking cigarettes after myocardial infarction have an improved rate of survival compared with those who continue, but to date it was not known whether the benefit persisted for more than six years. A total of 498 men aged under 60 years who had survived a first episode of unstable angina or myocardial infarction by two years were followed up by life table methods for a further 13 years. Mortality in those who continued to smoke was significantly higher (82.1%) than in those who stopped smoking (36.9%). These differences increased with time. Mortality in those who were non-smokers initially and who continued not to smoke was intermediate (62.1%). The adverse effect of continued smoking was most pronounced in those with unstable angina. Continuing to smoke increased the rate of sudden death to a greater degree in those with less severe initial attacks, while the effect of smoking on fatal reinfarctions was most apparent in those with a more complicated presentation. These findings suggest that stopping cigarette smoking is the most effective single action in the management of patients with coronary heart disease.

Angina Pectoris↗
PubMed1983

Natural history of coronary heart disease: a study of 586 men surviving an initial acute attack.

A total of 586 men who survived an initial attack of unstable angina or myocardial infarction have been followed for up to 15 years. A policy of early mobilization and sustained risk factor advice was employed. A conservative approach to treatment was adopted during the acute and follow-up stages. Drugs were employed only for symptomatic reasons, and only two patients proceeded to coronary artery bypass surgery. Survival at 5, 10, and 15 years was 80%, 61%, and 43%. Older patients and those with more severe initial attacks had a higher mortality, but these factors did not relate to combined fatal and nonfatal recurrence of myocardial infarction. Of 22 studies reviewed, 18 report a higher mortality than does our study. Four studies, none strictly comparable, report a similar 5-year mortality. A conservative approach to management does not appear to be harmful and may be beneficial.

Age Factors↗
PubMed1983

Cigar and pipe smoking related to four year survival of coronary patients.

Six hundred and thirty-four male patients under 60 years who survived a first attack of unstable angina or myocardial infarction were followed for a period of four years. Details of initial and follow-up smoking habits were examined. Patients who continued to smoke cigarettes or cigars had an excess mortality compared with non-smokers, with those who stopped smoking, and with cigarette smokers who changed to pipe smoking. Pipe smokers who continued smoking the pipe had an observed mortality which was greater than that of the non-smokers, but the numbers were small and the results were not statistically significant. The effect of smoking habit on mortality was not influenced by two other determinants of prognosis: age and severity of initial attack. These results confirm that the long-term prognosis of patients after unstable angina or myocardial infarction may be significantly influenced by smoking habits. They are consistent with the hypothesis that cigar and pipe smoking may have an adverse effect after myocardial infarction but further studies are needed to corroborate the association between cigar and pipe smoking and prognosis of coronary heart disease.

Adult↗