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PubMed1997

Higher prevalence and greater severity of coronary disease in short versus tall men referred for coronary arteriography.

The incidence of myocardial infarction is higher in short individuals than in tall ones. To test whether the prevalence and severity of coronary disease is greater in short than in tall individuals, we compared a group of short men (height < [mean height - one SD]) to a group of tall men (height > [mean height + one SD]) drawn from a sample of 1046 consecutive men referred for coronary arteriography. Short men had a higher frequency of > or = 50% diameter stenosis; more diseased vessels (1.61 +/- 1.09 vs 1.15 +/- 1.11, p = 0.0004); a higher frequency of three-vessel disease (26.8% vs 16.1%, p = 0.04); and more total occlusions (40.1% vs 27.3%, p = 0.03). By multivariate analysis, height independently predicted > or = 50% lesions in the right coronary artery (p = 0.01) and left anterior descending artery (p = 0.06); three-vessel disease (p = 0.04); total occlusion (p = 0.04); and the number of diseased vessels (p = 0.005). This higher prevalence and greater severity of coronary disease may explain the higher incidence of and deaths caused by myocardial infarction previously reported in short men.

Aged↗
PubMed2002

History of coronary heart disease.

Coronary heart disease, in the mid-twentieth century has become the most frequently occurring lethal disease. Coronary vessels, that is, coronary arteries tend to develop atherosclerotic plaques already at an early stage. The onset and course of this development has often been a mute one, without pain, rendering thereby the recognition of coronary artery disease difficult--far into the twentieth century. The many experiments and investigations performed during the "Renaissance" brought no results. An exact description and depiction of damaged coronary vessels as primary cause of occluded coronary arteries became possible towards the beginning of the twentieth century only.

Cardiology↗
PubMed1997

Giant left main coronary artery aneurysm in association with severe atherosclerotic coronary disease.

Aneurysms of the coronary arteries occur in 1.5-4.9% of coronary angiograms. Only a few cases of a giant aneurysm of the left main coronary artery in conjunction with severe atherosclerotic coronary disease have been reported. This report details the exceptional case of a 72-year-old patient with a giant "true saccular" aneurysm branched on the left main coronary artery. The development of an aneurysmal dilatation in conjunction with progression of coronary arteriosclerosis, observed from two different angiographic studies at an interval of 25 years, is very illustrative for evolutive atherosclerotic heart disease. This finding may support the hypothesis that atherosclerosis may be the common etiology for coronary aneurysmal dilatation.

Aged↗
PubMed1997

Cardiac risk of noncardiac surgery: influence of coronary disease and type of surgery in 3368 operations. CASS Investigators and University of Michigan Heart Care Program. Coronary Artery Surgery Study.

BACKGROUND: The influence of prior coronary artery bypass surgery (CABG) versus medical therapy for reducing the risk of postoperative cardiac complications after noncardiac surgery continues to be debated. To further clarify this controversy we studied 24,959 participants in the Coronary Artery Surgery Study (CASS) database with suspected coronary disease by identifying those who required noncardiac surgery during more than 10 years of follow-up. METHODS AND RESULTS: CASS registry enrollees were either treated with CABG or medical therapy after initial entry. During follow-up, patients who required noncardiac operations were evaluated for hospital death or out-of-hospital death within 30 days of noncardiac surgery and nonfatal postoperative myocardial infarction (MI). At a mean follow-up of 4.1 years, 3368 patients underwent noncardiac surgery, with abdominal (36%), urologic (21%), orthopedic (15%), and vascular being most common. Abdominal, vascular, thoracic, and head and neck surgery each had a combined MI/death rate among patients with nonrevascularized coronary disease >4%. Among 1961 patients undergoing higher-risk surgery, prior CABG was associated with fewer postoperative deaths (1.7% versus 3.3%, P=.03) and MIs (0.8% versus 2.7%, P=.002) compared with medically managed coronary disease. Contrariwise, 1297 patients undergoing urologic, orthopedic, breast, and skin operations had mortality of <1% regardless of prior coronary treatment. Prior CABG was most protective in patients with advanced angina and/or multivessel coronary artery disease. CONCLUSIONS: In patients with known coronary artery disease, noncardiac surgeries involving the thorax, abdomen, vasculature, and head and neck are associated with the highest cardiac risk, which is reduced among patients with prior CABG.

Bone Diseases↗
PubMed1993

Use of intracoronary ultrasound imaging for assessing left main coronary artery disease.

Coronary angiography has many limitations for the assessment of coronary artery disease. Intracoronary ultrasound imaging may overcome some of these limitations by providing direct visualization of the luminal area and plaque morphologic features. Although the size of the currently available intracoronary ultrasound catheters precludes their use in many diseased coronary vessels, lesions in the relatively large vessels, such as the left main coronary artery, can be readily assessed. Intracoronary ultrasound imaging was performed in five patients in whom the status of the left main coronary artery was unclear after conventional coronary angiography. Qualitative assessment of atherosclerotic involvement and quantitative analysis of the absolute luminal area and the percentage of area of stenosis were performed. No complications were associated with the intracoronary ultrasound procedure. In all five patients, the ultrasound studies provided additional information on which a clinical decision could be made. Intracoronary ultrasound imaging is useful for assessing disease of the left main coronary artery in selected patients in whom current angiographic techniques have provided equivocal results.

Aged↗
PubMed1994

Dietary iron intake and risk of coronary disease among men.

BACKGROUND: We prospectively studied iron intake in relation to the incidence of coronary disease in a 4-year follow-up of 44,933 men (with no previous history of cardiovascular disease) aged 40 to 75 years in 1986 who completed a food frequency questionnaire at baseline. METHODS AND RESULTS: We documented 844 incident cases of coronary disease (249 nonfatal myocardial infarctions, 137 coronary disease fatalities, and 458 bypass operations or angioplasties). After adjustment for established risk factors, there was no significant association between total iron intake and risk of coronary heart disease. Men in the highest quintile of total intake (median, 37 mg/d) had a relative risk (RR) of fatal coronary disease or nonfatal myocardial infarction of 0.73 (95% confidence intervals [CI], 0.51, 1.06) compared with men in the lowest quintile of intake (median, 11 mg/d). Dietary intake of heme iron--mainly from red meat--also was not significantly associated with risk of coronary heart disease. However, incidence of fatal coronary disease or nonfatal myocardial infarction was higher among men in the top quintile of heme iron intake compared with men in the lowest quintile (RR, 1.42; 95% CI, 1.02, 1.98). This association remained after adjustment for dietary cholesterol and fats. Heme iron but not total iron intake was positively correlated with serum ferritin among 123 members of the cohort who participated in a validation study. CONCLUSIONS: These results do not support the hypothesis that dietary iron in general increases coronary risk in men; they are consistent, however, with an increased risk of myocardial infarction among men with higher intake of heme iron, which is itself positively associated with iron stores.

Adult↗
PubMed2002

Pathomorphology of myocardial bridges and their role in the pathogenesis of coronary disease.

The hearts of patients who died of coronary disease and had myocardial bridges were studied by postmortem coronary angiography, cardioventriculography, and complex pathomorphological analysis. The relationship between the incidence and pathomorphology of myocardial bridges, on the one hand, and the type of blood supply, segmentary topography of the major coronary arteries, geometry of the left ventricle, and coronary changes in different forms of coronary disease, on the other, was analyzed. Diagnostic criteria were developed and the main components of the etiology, patho- and thanatogenesis in coronary patients with coronary arteries not affected by atherosclerosis are presented.

Adult↗
PubMed2004

Acute and chronic psychological stress in coronary disease.

PURPOSE OF REVIEW: Coronary artery disease (CAD) is the leading cause of death in the United States and other developed countries. Along with a number of other factors thought to contribute to the high prevalence of CAD in developed societies (longer life expectancy, obesity, sedentary lifestyles), various psychological and social factors appear to promote the development or worsening of heart disease. It is well recognized that stress can be harmful to the cardiovascular system. The combination of the preexisting vulnerability and the major stressor are believed to result in cardiac arrhythmias and/or plaque rupture leading to death. RECENT FINDINGS: Recently, the epidemiologic evidence of a link between stress and CAD is very convincing, yet the biopsychosocial pathway that would explain how stress can lead to disease is less clear. Different types of psychological stress have been found to be associated with increased cardiovascular events. Evidence regarding the efficacy of psychosocial interventions is also presented. SUMMARY: It is suggested that, taken as a whole, evidence for a psychological and social impact on CAD morbidity and mortality is convincing.

Acute Disease↗
PubMed2000

Effect of pravastatin on coronary disease events in subgroups defined by coronary risk factors: the Prospective Pravastatin Pooling Project.

BACKGROUND: Previous trials have had insufficient numbers of coronary events to address definitively the effect of lipid-modifying therapy on coronary heart disease in subgroups of patients with varying baseline characteristics. METHODS AND RESULTS: The data from 3 large randomized trials with pravastatin 40 mg were pooled and analyzed with the use of a prospectively defined protocol. Included were 19 768 patients, 102 559 person-years of follow-up, 2194 primary end points (coronary death or nonfatal myocardial infarction), and 3717 expanded end points (primary end point, CABG, or PTCA). Pravastatin significantly reduced relative risk in younger (<65 years) and older (>/=65 years) patients, men and women, smokers and nonsmokers, and patients with or without diabetes or hypertension. The relative effect was smaller, but absolute risk reduction was similar in patients with hypertension compared with those without hypertension. Relative risk reduction was significant in predefined categories of baseline lipid concentrations. Tests for interaction were not significant between relative risk reduction and baseline total cholesterol (5% to 95% range 177 to 297 mg/dL, 4.6 to 7.7 mmol/L), HDL cholesterol (27 to 58 mg/dL, 0.7 to 1.5 mmol/L), and triglyceride (74 to 302 mg/dL, 0.8 to 3.4 mmol/L) concentrations, analyzed as continuous variables. However, for LDL cholesterol, the probability values for interaction were 0.068 for the prespecified primary end point and 0.019 for the expanded end point. Relative risk reduction was similar throughout most of the baseline LDL cholesterol range (125 to 212 mg/dL, 3.2 to 5.5 mmol/L) with the possible exception of the lowest quintile of CARE/LIPID (<125 mg/dL) (relative risk reduction 5%, 95% CI 19% to -12%). CONCLUSIONS: Pravastatin treatment is effective in reducing coronary heart disease events in patients with high or low risk factor status and across a wide range of pretreatment lipid concentrations.

Aged↗
PubMed2004

Predictors of heart failure among women with coronary disease.

BACKGROUND: Although heart failure is common among women with coronary disease, the risk factors for developing heart failure have not been well studied. We determined the risk factors for developing heart failure among postmenopausal women with established coronary disease. METHODS AND RESULTS: This is a prospective cohort study using data from the Heart and Estrogen/progestin Replacement Study (HERS), a randomized, blinded, placebo-controlled trial of 4.1 years' duration, and subsequent open-label observational follow-up for 2.7 years (HERS II), performed at 20 US clinical centers between 1993 and 2000. Of the 2763 postmenopausal women with established coronary disease in the HERS trial, we studied the 2391 women with no heart failure at baseline by self-report and physical examination. The primary outcome of this analysis was incident heart failure defined by hospital admission or death from heart failure. During the 6.3+/-1.4-year follow-up, 237 women (10%) developed heart failure. Nine predictors were identified: diabetes (defined as a self-reported history of diabetes on treatment), atrial fibrillation, myocardial infarction, creatinine clearance <40 mL/min, systolic blood pressure >120 mm Hg, current smoking, body mass index >35 kg/m2, left bundle-branch block, and left ventricular hypertrophy. Randomization to estrogen/progestin was not associated with heart failure (hazard ratio=1.0; 95% CI, 0.7 to 1.3). Diabetes was the strongest risk factor (adjusted hazard ratio=3.1; 95% CI, 2.3 to 4.2). Diabetic women with elevated body mass index or depressed creatinine clearance were at highest risk, with annual incidence rates of 7% and 13%, respectively. Among diabetic women, hyperglycemia was associated with heart failure risk (adjusted hazard ratio=3.0; 95% CI, 1.2 to 7.5 for fasting glucose >300 mg/dL compared with fasting glucose 80 to 150 mg/dL). CONCLUSIONS: We identified 9 predictors of heart failure in postmenopausal women with coronary disease. Diabetes was the strongest risk factor, particularly when poorly controlled or with concomitant renal insufficiency or obesity.

Black or African American↗
PubMed2004

Apolipoprotein E polymorphism and carotid atherosclerosis in patients with coronary disease.

BACKGROUND: Apolipoprotein (apo) E polymorphism plays a role in the development of coronary disease, but their involvement in carotid atherosclerosis is controversial. The aim of this study was to evaluate the role of apo E polymorphism in the development of subclinical carotid atherosclerosis in patients with coronary disease. METHODS: In 226 consecutive patients with coronary disease, apo E genotypes were performed by PCR and restriction analysis. Intima-media thickness (IMT) and the presence of atherosclerotic plaques in carotid arteries were evaluated by two-dimension ultrasonography. RESULTS: Apo E allele frequencies were: 3=0.70, 4=0.22 and 2=0.08. The only patient with 2/4 genotype was excluded for the analysis. The patients were divided in three groups according to apo E genotype: E2 (2/2, 2/3), E3 (3/3) and E4 (4/4, 4/3). Patients of E4 group had higher values of low-density-lipoprotein (LDL) cholesterol and apo B than patients of E2 group (P< or =0.01). Carotid IMT mean was not different in E3 (0.81+/-0.21 mm), E4 (0.83+/-0.23 mm) and E2 groups (0.76+/-0.17 mm) (P=0.52). Mean differences of IMT in E3 group were not different from those of E2 or E4 groups after adjusting for age and gender in a first analysis, and for age, gender and LDL cholesterol levels in a second one. The number of plaques in apo E3 group was similar to that in apo E2 or apo E4 groups, after adjusting for the same variables. CONCLUSIONS: A relationship between subclinical carotid atherosclerosis and apo E polymorphism is not found in patients with coronary disease.

Aged↗
PubMed1993

Intravascular ultrasound study of angiographically mildly diseased coronary arteries.

OBJECTIVES: We hypothesized that intravascular ultrasound may identify significant coronary artery narrowing in the mildly diseased coronary artery of patients with insignificant or one- or two-vessel coronary artery disease. BACKGROUND: Necropsy studies have revealed that coronary angiography may underestimate stenosis severity in vessels that appear mildly diseased. Intravascular ultrasound has been shown to detect atherosclerotic changes in angiographically normal coronary arteries and to correlate better with histologic findings. METHODS: In 20 patients, we performed intravascular ultrasound imaging (3.5F catheter, 30-MHz transducer) in 37 coronary arteries that were considered mildly diseased (<50% diameter narrowing) by qualitative angiography. The angiographic diagnosis was no significant coronary artery disease in eight patients, one-vessel disease in seven and two-vessel disease in five. Each vessel, except for the left main coronary artery, was divided into proximal, mid and distal segments. Percent area narrowing and minimal lumen diameter were subsequently quantified by both ultrasound and quantitative angiography. RESULTS: Mean maximal arterial area narrowing by ultrasound in the 67 segments studied was 36 +/- 20% (range 0% to 80.2%) and 19 +/- 23% (range 0% to 82%) by quantitative angiography of these same segments (p < 0.001, paired t test). Mean minimal lumen diameter of the segment was 3.3 +/- 0.9 mm by ultrasound and 2.7 +/- 0.8 mm by quantitative angiography. In 10 patients there were 19 angiographically mildly diseased segments where the percent arterial area narrowing by ultrasound was > or = 50%. Intravascular ultrasound revealed that the more proximal (reference) segment had > 25% intimal thickening in 12 of the 19 underestimated segments. In six stenosed segments (32%), total vessel area increased compared with that of the adjacent proximal vessel segment because of compensatory dilation. CONCLUSIONS: Intravascular ultrasound identifies potentially significant coronary artery disease in vessels that appear to be only mildly diseased by angiography.

Constriction, Pathologic↗
PubMed1986

Hyperemic myocardial perfusion imaging for noninvasive detection of coronary disease in man: comparison of treadmill exercise and intravenous dipyridamole infusion.

To further understand hyperemic myocardial perfusion imaging, the effects of exercise and intravenous dipyridamole on coronary flow, coronary stenosis luminal area, stenosis flow resistance, and regional myocardial perfusion were evaluated in patients with arteriographically documented coronary artery disease. Coronary hemodynamics were assessed in 24 patients undergoing routine diagnostic catheterization. Coronary flow was measured by coronary sinus thermodilution. Computer assisted stenosis measurements were made. During isometric handgrip coronary sinus flow increased to 1.7 X baseline value, and epicardial coronary arteries constricted to increase predicted stenosis flow resistance by 40%. A 4-minute intravenous dipyridamole infusion (0.56 mg/kg) increased coronary sinus flow to 2.4 X baseline with, on average, no change in the stenotic coronary lumen diameter. During simultaneous isometric handgrip and dipyridamole infusion coronary sinus flow increased to 3.3 X baseline value and stenosis flow resistance increased an average of 36%. Regional myocardial perfusion was assessed in 33 patients by thallium201 myocardial perfusion imaging following maximal treadmill exercise and again following intravenous dipyridamole infusion. Regional thallium201 imaging effects were correlated with measurements of angiographic coronary disease. Sensitivity and specificity for detecting a greater than or equal to 50% stenosis were 85% and 64% (p less than .005), respectively, for dipyridamole and 84% and 68% (p less than .005) for exercise thallium201. In summary, coronary blood flow increases with isometric exercise and is near maximal following intravenous dipyridamole. Quantitative arteriographic techniques demonstrate isometric exercise-induced constriction of coronary stenoses and increased stenosis flow resistance. Stenosis flow resistance increases following intravenous dipyridamole only for severe (greater than or equal to 65%) lesions. Treadmill exercise and intravenous dipyridamole are comparably effective hyperemic stimuli for creating regional perfusion differences for the noninvasive detection of coronary disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Circulation↗
PubMed1986

Effort angina pectoris without electrocardiographic changes in coronary disease patients: correlations between scintigraphic and coronary angiographic findings.

The absence of electrocardiographic changes during angina is an unusual occurrence. In 15 male patients with exercise-induced angina, the electrocardiogram failed to show the usual ischemic ST-T changes. The exercise thallium-201 myocardial imaging was employed as indicator of the ischemia and the results were correlated with coronary angiographic findings. The exercise thallium-201 myocardial imaging showed an exercise-induced reversible defect in 14 patients and a fixed defect in the remaining 1. Out of 15 patients, 13 had defects involving the infero-apical, posterior and postero-lateral segments. The coronary angiography, performed in all patients but 2, showed single-vessel coronary artery disease in 8 patients and double-vessel disease in 5. A significant circumflex or right coronary artery stenosis was found in all cases except 1; 2 patients had a coexistent left anterior descending coronary artery stenosis and 1 an isolated stenosis of this vessel. It is concluded that the myocardial scintigraphy is useful to assess the ischemic myocardial origin of chest pain in the absence of ST-T changes. The silence of the electrocardiogram might be due to the production of ischemia in not well explored areas, such as the inferior and posterior myocardial segments, and possibly to a smaller extension of ischemia.

Adult↗
PubMed1991

Dipyridamole technetium-99m-2-methoxy isobutyl isonitrile tomoscintigraphic imaging for identifying diseased coronary vessels: comparison with thallium-201 stress-rest study.

A same-day double injection protocol employing 99mTc-methoxyisobutyl isonitrile (MIBI) and myocardial single-photon emission computed tomography (SPECT) for detecting coronary artery disease (CAD) was assessed in 30 patients. SPECT was performed 1 hr after a first injection (250 MBq) of 99mTc-MIBI, given after 0.56 mg/kg dipyridamole (DPD) infusion. Patients were then reinjected at rest (750 MBq) and were reimaged 1 hr later. Within 1 wk, all patients underwent a complete stress-rest SPECT thallium study. Of the 330 myocardial segments evaluated, 25 were judged ischemic by both techniques, while persistent defects were demonstrated in 50 and in 47 with 99mTc-MIBI and 201TI, respectively. Six regions were considered for diseased vessels identification. Sensitivity and specificity for CAD were 100% and 75%, respectively, for both 201TI and 99mTc-MIBI. Sensitivity for identification of diseased vessels by 201TI was 68% for LAD, 89% for RCA, and 80% for LCX as opposed to 75%, 89% and 80%, respectively, by 99mTc-MIBI. Specificity was 93% in both cases for LAD, 73% and 63% for RCA, and 53% and 46% for LCX.

Adult↗