PubMed · 849627
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L T Sheffield, T J Reeves, H Blackburn, M H Ellestad, V F Froelicher, D Roitman, S Kansal. 1977. The exercise test in perspective.. https://doi.org/10.1161/01.cir.55.5.681
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The peroxisome proliferator-activated receptor (PPAR) family of genes plays a major role in metabolic regulation. Unfortunately, the results of two recent, large event trials of PPAR agonists have been mixed. High rates of crossover to statin use confound the interpretation of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial, which found a less than expected reduction in coronary and stroke events with fenofibrate. Of concern, nonsignificant increases in coronary and sudden deaths, thrombotic events, and pancreatitis occurred in the fenofibrate group. The PROspective pioglitAzone Clinical Trial In macroVascular Events (PROACTIVE) also found a reduction in coronary and stroke events with pioglitazone compared with placebo in a population with diabetes and cardiovascular disease, but this benefit was counterbalanced by an increase in congestive heart failure as well as symptomatic edema. Further research is needed to determine the role of PPAR agonists in the prevention of cardiovascular disease.
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AIMS: The link between low socioeconomic status (SES) and coronary heart disease (CHD) is well established, but there is a paucity of data whether a similar relation exists for heart failure (HF). METHODS AND RESULTS: A total of 6999 men 47-55 years old, without a prior stroke or myocardial infarction, from a population sample of 9998 men, were investigated during 1970-73. Over a 28-year follow-up, 1004 men (14.3%) were discharged from hospital or died with a diagnosis of HF. There was an inverse relationship between SES, measured as an occupational class, and future risk of HF. Compared with men in the highest occupational class, men with intermediate non-manual occupations had a multiple-adjusted hazard ratio (HR) of 1.28, 95% confidence interval (CI) 0.98-1.67, lower officials and foremen had an HR of 1.57 (1.22-2.03), semiskilled and skilled workers 1.48 (1.15-1.89), and unskilled workers 1.72 (1.34-2.20). Results were similar if only men with a principal diagnosis of HF (n=516) were considered, irrespective of whether a diagnosis of acute myocardial infarction or coronary revascularization had been recorded at any time. CONCLUSION: Low SES is an independent risk factor for long-term risk of HF in men.