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PubMed1996

Symptoms of chronic bronchitis and the risk of coronary disease.

BACKGROUND: Experimental and epidemiological studies show a positive association between coronary disease and various infections in different organs, both viral and bacterial and both acute and chronic. Most attention has been paid to dental infections and infections in the respiratory tract. We have studied how chronic respiratory infection predicts coronary disease. METHODS: We defined chronic respiratory infection by the occurrence of symptoms of chronic bronchitis. We also analysed whether any association with coronary disease incidence and mortality is independent of the known major cardiovascular risk factors and whether it is similar among persons in different occupations. Our cohort study was a 13-year follow-up of 19,444 randomly selected eastern Finnish men and women born between 1913 and 1947 and examined in either 1972 or 1977. FINDINGS: During follow-up, there were 1419 first coronary events, either fatal or non-fatal, and 614 coronary deaths. Among men, the age-adjusted and study-year-adjusted risk ratio of long lasting-symptoms of chronic bronchitis (during as much as 3 months in a year) was 1.52 (95% CI 1.33-1.75) for coronary disease and 1.74 (CI 1.43-2.11) for coronary death. Among women the risk ratios were 1.38 (1.07-1.78) and 1.49 (0.98-2.27), respectively. Inclusion of smoking, serum cholesterol, and systolic blood pressure into the models decreased risk ratios to 1.36 (1.17-1.56) and 1.55 (1.26-1.90) in men and to 1.34 (1.04-1.74) and 1.41 (0.92-2.16) in women, respectively. The risk of coronary disease associated with the symptoms of chronic bronchitis was similar among blue-collar and white-collar workers but the association was not found among farmers. INTERPRETATION: Symptoms of chronic bronchitis predicted the risk of coronary disease independently from the known major cardiovascular risk factors. If the observed association is causal, prevention and improved management of chronic infections may have played a role in the decrease in coronary disease mortality observed in eastern Finland in the past two decades.

Adult↗
PubMed2006

[Aortic stenosis and coronary disease. Analysis of risk factors].

OBJECTIVE: To analyze clinical laboratorial aspects of the presence of coronary disease in patients with aortic stenosis and evaluate the influence of risk factors in the development of obstructive coronary disease. METHODS: We studied 65 patients who had severe aortic stenosis with an indication for surgery, ages 51 to 85 years, 40 of them women. The coronary angiography assessment resulted in two groups: 26 (40%) with obstructive coronary disease and 39 (60%) with no coronary artery lesion. Personal antecedents for coronary disease (smoking, dyslipidemia, diabetes mellitus, arterial hypertension, family antecedents, sedentarism, and alcoholism) were analyzed. Additionally, the following assessments were made: electrocardiogram, echocardiogram with Doppler, and laboratory tests (blood glucose, total cholesterol and fractions, triglycerides, Apo-A1 and B, fibrinogen, lipoprotein (a) and fraction of triglycerides and cholesterol removal in both groups. RESULTS: In the age analysis, the group with obstructive coronary disease belonged to an older age range with statistical significance (p<0.0001). Signs of ischemia of the anterior wall identified on the electrocardiogram showed a significant relationship with the obstruction of an anterior interventricular artery (p<0.002). The univariate analysis showed a significant difference between the groups regarding averages of the aortic (p= 0.041), HDL (p=0.042), and fibrinogen (p=0.047) gradients. The group with coronary disease presented an average gradient and HDL level lower than the group without obstructive coronary disease. For the fibrinogen variable, the average in the group with no coronary disease was lower compared to that of the coronariopathy group. The multivariate logistic regression analysis showed fibrinogen levels as an independent variable for coronary disease (p<0.039). CONCLUSION: Fibrinogen was an independent risk factor for the association between obstructive coronary disease and aortic stenosis.

Aged↗
PubMed2003

[Nutritional epidemiology of coronary disease].

The nutritional epidemiology of coronary disease is complex because nutrition is composed of a large number of factors which are susceptible to interfere with each other and to affect the coronary risk after a long period of exposure. The methodology of nutritional studies relies on known and validated enquiry techniques, but they are difficult to perform in the general population. The lipid nutritional hypothesis of coronary disease was centred on cholesterol and the saturated fatty acids. This lipid theory has allowed great advances in the pathophysiological and therapeutic areas. The concepts of a French paradox and global diet have allowed research in nutritional epidemiology to be refocused on other nutrients (lipids and non-lipids) and on alimentary fashions and lifestyle in general. The success of proposed diets at the population level depends strictly on correctly validated scientific data, and on the cultural and social context of where the prevention messages warrant dissemination.

Cholesterol, Dietary↗
PubMed1989

Age variation in the association between angiographic coronary disease and angina from the Coronary Artery Surgery Study (CASS)

Between July 1974 and May 1979, 19,153 non-randomized patients without prior cardiac surgery and with chest pain were studied angiographically and enrolled in the Coronary Artery Surgery Study (CASS). The primary question addressed by this paper is: for fixed levels of coronary artery disease, are the presence and severity of angina pectoris greater for older than for younger patients? For those with the same extent of disease, older patients were more likely to have angina and to exhibit more severe symptoms. After adjustment for covariates using logistic regression analysis, age was found to be an important, independent predictor of the presence and severity of angina. There are many possible explanations for these findings, although physiologic factors related to aging, the disease process, and deconditioning associated with an increased sedentary life style seem most reasonable. Another possibility has to do with referral patterns for study and the prevalence of angina in the different age groups.

Adult↗
PubMed1991

[Comparative evaluation of nutrition of healthy persons, patients with the preclinical stage of ischemic heart disease and in patients with marked coronary disease].

A total of 92 males aged 28 to 55 years were examined. These included 28 apparently healthy individuals, 45 subjects with preclinical coronary heart disease and 19 patients with Functional Class I-II coronary heart disease. A special questionnaire was used to examine the dietary patterns of the subjects with preclinical coronary heart disease, i.e. those having no typical clinical signs of the disease, but showing signs of myocardial infarction during the maximum exercise testing and minimal coronary arterial changes at selective coronary angiography. The subjects, unlike healthy individuals and CHD patients, were found to have 1 or 2 meals a day, frequently late at night, consume large amounts of sugar and other candies, fatty milk products, butter, eggs; small quantities of vegetables, fruits, and fish, often put additional amounts of salt to their diet. The subjects, as patients with severe CHD but unlike healthy individuals, were shown to have hypercholesterolemia and display high low density lipoprotein and apo-lipoprotein B levels; apo B/apo A being more than 1. The above dietary patterns of subjects with preclinical CHD represent one of the causes of abnormal changes in the blood lipid profile, which result in further CHD development.

Adult↗
PubMed2003

Off-pump long onlay bypass grafting using left internal mammary artery for diffusely diseased coronary artery.

Surgical treatment of a diffusely diseased coronary artery has been considered a relative contraindication for off-pump coronary artery bypass grafting. To our knowledge, long onlay-patch grafting with off-pump coronary artery bypass grafting has not been described. Two sets of Octopus 3 tissue stabilizers were placed longitudinally along the target coronary artery. This allowed us to perform surgical angioplasty and bypass grafting without cardiopulmonary bypass support (double Octopus technique). We report our early experience with off-pump long onlay bypass grafting in patients with a diffusely diseased coronary artery using double Octopus tissue stabilizers. Diffusely diseased coronary artery; off-pump coronary artery bypass grafting; coronary artery reconstruction; coronary artery bypass grafting; onlay patch anastomosis

Aged↗
PubMed1995

[Electron beam tomography in coronary disease. Prevalence and distribution of coronary calcifications and their relationship with coronary risk factors in 650 patients].

OBJECTIVE: The extent of coronary calcification demonstrated by electron beam tomography was correlated with the individual cardiac risk profile. PATIENTS AND METHODS: The possible presence of coronary calcifications was studied by electron beam tomography (EBT) in 650 patients (526 men, 124 women; mean age 54 +/- 10 [28-81] years) with known or suspected coronary heart disease. Depending on the degree of density and the size of the lesion a score was calculated according to an international standard. RESULTS: No calcification was shown to be present in 202 patients (score of 0). A score of more than 0 was calculated in 73.8% of men and 48.4% of women. The average score was 227.8 +/- 24.8 in men, compared with 65.3 +/- 26.5 in women (P < 0.001). There were significantly more calcifications in older patients: Men aged 71-75 years had the highest score, 859.4, while the lowest, 9.6, was in those aged 36 to 40 years. The most important variables for the presence of calcification were age (relative risk per age group: 1.6), male sex (relative risk: 4.3), hypertension (relative risk: 2.4) and nicotine consumption (relative risk: 1.8). The median point score in patients without known risk factors was 1.3, with one known factor it was 7.2, and with three it was 48.0. The vessel segment most affected with calcification was the anterior interventricular branch with an average score of 84. CONCLUSION: Together with an evaluation of the risk profile EBT provided a better assessment of individual risk than conventional examination.

Adult↗
PubMed2001

The topography of intimal thickening and associated remodeling pattern of early transplant coronary disease: influence of pre-existent donor atherosclerosis.

BACKGROUND: With native coronary disease, intimal plaque initially accumulates at focal areas in the artery, often accompanied by compensatory vessel enlargement. With transplant coronary disease, the topography of intimal thickening and associated remodeling pattern are less studied. METHODS: We studied 72 prospectively recruited transplant patients with serial intravascular ultrasound using 4.3F catheters at baseline and at 1-year follow up. We considered 175 ultrasound-recorded segments (mean, 2.4 +/- 1.1 segments per patient) exactly matched on the serial studies by both angiographic criteria and ultrasound criteria, using arterial and venous branch points, pericardium, and sinuses as anatomic landmarks. RESULTS: Eighty-eight segments had no donor disease, and 87 had donor disease (80 eccentric and 7 concentric intimal thickening). Progressive intimal thickening occurred in 48 segments without (55%) and 43 segments with donor disease (48%, p = NS). Thickening from segments without donor disease was mainly eccentric (81%). Thickening from segments with donor eccentric plaque was also mainly eccentric (67%, p = NS compared with segments without donor disease), with further thickening superimposed on the original plaque. Concentric intimal thickening was uncommon. Of the 58 patients who had >1 segment matched, intimal changes were discordant in 34 (59%), with progression in some and lack of progression in other segments. Total vessel area change correlated with intimal area change (r = 0.37 with a slope of 0.79, p < 0.001), including segments with (r = 0.39; slope, 0.69) and segments without (r = 0.37; slope, 1.16) donor disease. CONCLUSION: The intimal thickening of early transplant coronary disease is mainly eccentric and often discordant within each individual patient. Donor eccentric plaque often serves as a nidus for further intimal growth. The topography of intimal thickening in transplant coronary disease resembles that of native coronary disease, but the presence of a pre-existent donor plaque may impede compensatory remodeling as further intimal thickening occurs after transplantation.

Adult↗
PubMed2001

Obesity is independently associated with coronary endothelial dysfunction in patients with normal or mildly diseased coronary arteries.

OBJECTIVES: This study evaluates the impact of obesity on coronary endothelial function in patients with normal or mild coronary artery disease. BACKGROUND: The American Heart Association (AHA) has recently classified obesity as a modifiable risk factor for coronary heart disease. METHODS: A total of 397 consecutive patients with normal or mildly diseased coronary arteries at angiography underwent coronary vascular reactivity evaluation using intracoronary adenosine, acetylcholine and nitroglycerin. Patients were divided into three groups based on the body mass index (BMI): Group 1, patients with a BMI <25 (n = 117, normal weight); Group 2, patients with a BMI 25-30 (n = 149, overweight) and Group 3, patients with a BMI >30 (n = 131, obese). RESULTS: There were no significant differences among the groups in regard to other cardiovascular risk factors, except that overweight but not obese patients were significantly older than normal-weight patients (47 +/- 1 years in Group 1, 53 +/- 1 years in Group 2 and 50 +/- 1 years in Group 3, p < 0.001). The percent change of coronary blood flow to acetylcholine (%delta CBF Ach) was significantly lower in the obese patients than in the normal-weight group (85.2 +/- 12.0% in Group 1, 63.7 +/- 10.0% in Group 2 and 38.1 +/- 9.6% in Group 3, p = 0.009). By multivariate analysis, overweight (odds ratio, 1.55; 95% confidence interval, 1.2-2.0) and obesity (odds ratio, 2.41; 95% confidence interval, 1.5-4.0) status were independently associated with impaired coronary endothelial function. CONCLUSIONS: The study demonstrates that obesity is independently associated with coronary endothelial dysfunction in patients with normal or mildly diseased coronary arteries.

Acetylcholine↗
PubMed2005

Endothelial dysfunction: its role in hypertensive coronary disease.

PURPOSE OF REVIEW: Coronary artery disease is the major cause of death worldwide. Hypertension is a major risk factor for developing coronary disease. It is now recognized that endothelial dysfunction is an early marker of coronary artery disease before structural changes to the vessel wall are apparent on angiography or intravascular ultrasound and that it has a prognostic value in predicting cardiovascular events in hypertensive patients. This review addresses recent developments in hypertension-induced endothelial dysfunction. RECENT FINDINGS: Hyperaldosteronism causes endothelial dysfunction independent of high blood pressure. Exaggerated exercise blood pressure response has been related to endothelial dysfunction. Cyclosporin-A-induced endothelial dysfunction is related to reduced cholesterol content in caveolae. Chronic kidney disease induces changes in caveoli-1 and thus contributes to the reduced nitric oxide bioavailability, and causes oxidative stress independent of the high blood pressure. Asymmetric dimethylarginine plays a role in endothelial dysfunction in hypertensive patients independent of insulin resistance. 20-Hydroxyeicosatetraenoic acid is an independent predictor of hypertension in postmenopausal women. Endothelial dysfunction precedes and predicts the development of hypertension in postmenopausal women. Oral treatment with L-arginine improves endothelial dysfunction in hypertensives and lowers the blood pressure. SUMMARY: The pathophysiology of endothelial dysfunction in hypertension is multifactorial. Recent findings have contributed to our understanding of mechanisms of endothelial dysfunction and support a role for early intervention to prevent irreversible vascular and organ damage.

Angiotensin II↗