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PubMed2000

Dietary habits and cardiovascular risk in the Spanish population: the DRECE study (I). Diet and Cardiovascular Events Risk in Spain.

BACKGROUNDS/AIMS: To investigate dietary habits and their evolution with regard to cardiovascular risk status in Spain. METHODS: Cross-sectional study performed in two phases in 1991 and 1996 in 43 primary care clinics. One thousand and two hundred people classified as 'with cardiovascular risk' and 600 'without risk' were studied. Each participant answered a food frequency questionnaire. RESULTS: The risk group did not change oil, cereals and dairy products consumption, decreased egg, legume and meat, and increased fish, fruits and vegetables intake. The control group differed in increasing dairy products and not decreasing eggs and vegetables consumption. A small decrease in energy intake happened, from 11,315. 1 to 10,941.5 kJ in the risk group (p < 0.05). Carbohydrates intake showed a not statistically significant falling trend from 41.3 to 40.6% in people at risk and 41.8 to 40.7% in those without risk. Protein intake increased in both groups up to 16.5% and fat consumption kept at around 42.9% in both groups. The decrease in saturated fat and increase in polyunsaturated fat were statistically significant in people at risk (p = 0.000). High cholesterol intakes were found. CONCLUSION: People with cardiovascular problems changed their dietary habits in a 'healthier' way than people without risk.

Adolescent↗
PubMed2000

Dietary habits and cardiovascular risk in the Spanish population: the DRECE study (II) micronutrient intake. Dieta y Riesgo de Enfermedades Cardiovasculares en España.

OBJECTIVE: To evaluate the dietary micronutrient intake in the adult Spanish population participating in the DRECE study. METHODS: The cross-sectional study was performed in two stages in 1991 and 1996 in 43 primary care clinics. One thousand two hundred people 'with cardiovascular risk' and 600 'without risk' answered a food frequency questionnaire. RESULTS: Significant increases in vitamin C, retinol, lycopenes, beta-cryptoxanthin and vitamin E intakes were found. Vitamin A, alpha-carotenoid and lutein intakes decreased. Vitamin B(12), B(6) and folic acid intakes increased in people with cardiovascular risk, whereas only the last two increased in the control group. Nearly 100% of the people consumed the recommended dietary allowances for vitamins B(12) and B(6) and >70% for folic acid. Calcium, iron, and zinc intake increased in both groups, but magnesium and selenium intake increased only in people at risk. Vitamin A, B(1) and zinc intakes have decreased, and >50% of the people do not consume the recommended dietary allowance. CONCLUSION: Antioxidant vitamins and vitamin B(12), B(6) and folic acid intakes seem to be adequate in the adult Spanish population, no significant differences appear regarding their cardiovascular risk status. Vitamin A, B(1) and zinc intakes are not appropriate.

Adolescent↗
PubMed1996

Rationale and design of a large study to evaluate the renal and cardiovascular effects of an ACE inhibitor and vitamin E in high-risk patients with diabetes. The MICRO-HOPE Study. Microalbuminuria, cardiovascular, and renal outcomes. Heart Outcomes Prevention Evaluation.

OBJECTIVE: To describe the rationale and design of a large international study (microalbuminuria, cardiovascular, and renal outcomes [MICRO] in the HOPE [Heart Outcomes Prevention Evaluation] study) of an ACE inhibitor and vitamin E for the prevention of diabetic nephropathy (DN) and cardiovascular disease (CVD) in patients with diabetes and microalbuminuria (MA). RESEARCH DESIGN AND METHODS: A total of 3,657 diabetic subjects, including 1,129 with MA, are randomly allocated to receive the ACE inhibitor ramipril (or placebo) and vitamin E (or placebo) for 4 years in a two-by-two factorial design. Diabetic subjects are a subset of the 9,541 subjects enrolled in the HOPE study. RESULTS: The development of DN in microalbuminuric diabetic subjects and the development of MA in normoalbuminuric subjects, as well as cardiovascular death, myocardial infarction, and storke, are the main outcomes. The correlation of changes in albuminuria with changes in carotid atherosclerosis documented in a subset of subjects will also be analyzed. CONCLUSIONS: The effect of both an ACE inhibitor and vitamin E on the progression of renal and CVD in patients with diabetes is being assessed in the MICRO-HOPE study.

Albuminuria↗
PubMedDate not supplied

The effects of the child and adolescent trial for cardiovascular health intervention on psychosocial determinants of cardiovascular disease risk behavior among third-grade students.

PURPOSE: The Child and Adolescent Trial for Cardiovascular Health is a multi-site study of a school-based intervention designed to reduce or prevent the development of risk factors for cardiovascular disease. The goal was to change (or prevent) related risk behaviors and the psychosocial variables that theoretically influence those behaviors. DESIGN: A nested design was used in which schools served as the primary unit of analysis. Twenty-four schools participated at each of four sites (Austin, San Diego, Minneapolis, and New Orleans). Each site had 10 control and 14 intervention schools. SETTING AND SUBJECT: Ninety-six schools (with more than 6000 students) in the four sites were randomized to three treatment conditions: control, school-based interventions, and school-plus-family interventions. The sample included approximately equal numbers of males and females and was 67.5% white, 13.9% African-American, 13.9% Hispanic, and 4.7% other. MEASURES: The psychosocial determinants included improvements in dietary knowledge, intentions, self-efficacy, usual behavior, perceived social reinforcement for healthy food choices, and perceived reinforcement and self-efficacy for physical activity. RESULTS: The findings indicated significant improvements in all the psychosocial determinants measured (p < .0001). The results revealed a greater impact in the school-plus-family intervention schools for two determinants, usual dietary behavior and intentions to eat heart-healthy foods. CONCLUSIONS: These findings support theory-based interventions for changing selected psychosocial determinants of cardiovascular disease risk behavior among children.

Cardiovascular Diseases↗
PubMed1996

Differences in generalists' and cardiologists' perceptions of cardiovascular risk and the outcomes of preventive therapy in cardiovascular disease.

OBJECTIVE: To compare generalists' and cardiologists' estimates of baseline cardiovascular risk and the outcomes of preventive therapy. DESIGN: Cross-sectional mail survey using written case simulations of typical patients from primary prevention trials for hypercholesterolemia and isolated systolic hypertension, and tertiary prevention studies of coronary artery bypass surgery for chronic stable angina with left main coronary stenosis. PARTICIPANTS: Nationally representative sample of 599 practicing family physicians, general internists, and cardiologists selected from the American Medical Association masterfile. Among eligible physicians, 84 (44%) of 191 family physicians, 77 (40%) of 194 general internists, and 66 (34%) of 194 cardiologists responded. MEASUREMENTS: Estimates of risk at baseline and after therapy, and whether therapy generally would be recommended. RESULTS: For both primary prevention case simulations (scenarios), cardiologists provided lower, more accurate estimates of baseline cardiovascular risk and of absolute therapeutic benefit than either family physicians or general internists. The range of the generalists' estimates was extremely wide. Perceptions of relative risk reduction and treatment recommendations for the primary prevention scenarios did not differ among specialties. Overall, generalists who would not recommend primary preventive therapy in these scenarios appeared to give more accurate estimates than did generalists who would recommend such therapy. CONCLUSIONS: Many generalists have inflated perceptions of cardiovascular risk without treatment and of the benefit of risk-modifying medical treatment. Further study should assess the reasons for these misperceptions and their effect on counseling about primary preventive therapy.

Adult↗
PubMed2000

[Smoking and prevention of cardiovascular diseases in Italy. Research Group of the Cardiovascular Epidemiologic Observatory].

BACKGROUND: Cigarette smoking is one of the most important risk factors for chronic diseases. Major epidemiological studies provide consistent evidence that cardiovascular risk is 3-fold among smokers compared to non-smokers, incidence increases with the number of cigarettes smoked daily and cardiovascular risk is less among subjects who have stopped smoking. METHODS: To support evidence of a time decreasing trend of smoking habits in Italy, data from two observational studies carried out in different Italian regions, the RIFLE Project (1978-1987), the Cardiovascular Epidemiological Observatory (1998), and data collected from the "Multiscopo" ISTAT Investigation on Italian families (1980-1997) have been analyzed. RESULTS: During the 1950's, the prevalence of smokers among adult men was about 80%, it decreased to 50% in the 1980's and now is about 30-40%. Contemporarily, the prevalence of smokers among adult women has increased, from 17% in the 1980's to 23% nowadays. The habit is more common in Central-Southern Italy compared to the North and is less frequent among married subjects, and male graduates. Learned women smoke more than those who have not received any education. Men begin smoking at 17-18 years, and this trend seems to have remained stable; on the contrary, women have changed their habits and now start smoking at 17 years compared to 25-30 in previous generations. Almost all smokers would like to stop smoking, more than 60% have tried at least once, but on average have lasted only for about 1 year. Passive smoking exposure varies from 1 hour in Northern Italy to 2 hours in the South. CONCLUSIONS: Although smoking habits, at least in men, reveal a decreasing trend, about 30-40% of adult men continue to smoke. Preventive intervention, especially focused on the younger generations, could be useful to contrast this attitude at an early stage.

Adult↗
PubMed1994

[Large scale multicenter cooperative study for cardiovascular therapy (Japan Multicenter Investigation for Cardiovascular Drugs/Therapies, J-MIC)--results and perspectives].

With rapidly progressing therapeutic methods in the cardiovascular medicine, scientific evaluations for newly developed cardiovascular drugs and therapies have become mandatory. We have launched five large scale multicenter cooperative studies, namely, Japan Multicenter Investigation for Cardiovascular Drugs/Therapies, J-MIC (I), (B), (M), (S), and (K). The aims of studies include to investigate: the best therapeutic approach in patients with acute myocardial infarction who underwent thrombolytic therapy with or without any adjunctive treatment (I), the long-term comparative study (3 years) of nifedipine (extended release tablet) with ACE inhibitor in patients with essential hypertension and ischemic heart disease (B), the long-term effect (3 years) of trapidil and/or ethyl icosapentate in patients with ischemic heart disease with or without arteriosclerotic obstructive disease in terms of progression or regression of atherosclerotic changes in coronary as well as peripheral arteries (M), the efficacy and safety of pravastatin to prevent post-PTCA restenosis (S), and regression of atherosclerotic lesion of coronary arteries in patients with familial hypercholesterolemia by LDL apheresis (K).

Cardiovascular Agents↗
PubMed1993

[Early diagnosis of silent atherosclerosis and detection of cardiovascular risk factors. A new strategy for the approach of cardiovascular prevention].

The authors present a new strategy for cardiovascular disease prevention based on risk factor detection in occupational medicine and silent atherosclerosis detection in a specialized investigation centre. Employees from several firms in the Paris region were searched, in their working place, for cardiovascular risk factors, including blood cholesterol measurement. The subjects at risk thus selected underwent non-invasive explorations aimed at an early detection of silent atherosclerosis. Extracoronary plaques in the carotid, aorta and femoral arteries were detected by high-resolution ultrasonography, and coronary calcifications by ultrafast CT. The prevalence of arterial lesions and their relationship with risk factors were analysed in a subgroup of 208 untreated male subjects with high blood cholesterol level: 74 percent of these subjects had extracoronary plaques and 65 percent had coronary calcifications. This high prevalence of silent arterial lesions suggested that hypercholesterolaemia, even when moderate, has an early but inconsistent atherogenic effect. Moreover, extracoronary plaques and coronary calcifications were related to risk factors other than blood lipids, and among these factors age was predominant. The simultaneous detection of extracoronary and coronary lesions has demonstrated that extracoronary ultrasonography of several arteries is a good diagnostic test predicting the presence of coronary calcifications in the absence of coronary symptoms. Detection of silent atherosclerosis in subjects at risk therefore is an original and helpful complement to risk factor detection. It should better refine and individualize the diagnosis of risk and evaluate the effects of preventive cardiovascular treatments on atherosclerosis.

Adult↗
PubMed2006

The future of cardiovascular imaging and non-invasive diagnosis. A joint statement from the European Association of Echocardiography, the Working Groups on Cardiovascular Magnetic Resonance, Computers in Cardiology, and Nuclear Cardiology, of the European Society of Cardiology, the European Association of Nuclear Medicine and the Association for European Paediatric Cardiology.

Advances in medical imaging now make it possible to investigate any patient with cardiovascular disease using multiple methods which vary widely in their technical requirements, benefits, limitations and costs. The appropriate use of alternative tests requires their integration into joint clinical diagnostic services where experts in all methods collaborate. This statement summarises the principles that should guide developments in cardiovascular diagnostic services.

Cardiovascular Diseases↗
PubMed1993

Cardiovascular function and neurologic outcome after cardiac arrest in dogs. The cardiovascular post-resuscitation syndrome.

We studied cardiovascular changes and neurologic outcome at 72 h in 42 healthy dogs after normothermic ventricular fibrillation cardiac arrest (no blood flow) of 7.5, 10, or 12.5 min duration, reversed by standard external cardiopulmonary resuscitation (CPR) (< or = 10 min) and followed by controlled ventilation to 20 h and intensive care to 72 h. We found no difference in resuscitability, mortality, neurologic deficit scores, or overall performance categories between the three insult groups. There was no major pulmonary dysfunction. During controlled normotension post-CPR, all dogs presented a transient reduction in cardiac output. In the 12.5-min cardiac arrest group the decrease in cardiac output persisted beyond 12 h post-CPR (P < 0.01) and was associated with more severe arrhythmias (P < 0.05) and worse morphologic myocardial damage (P < 0.01). Both cardiac and neurologic malfunction at 72 h correlated with arrest time. Only cardiac malfunction correlated with CPR time. Neurologic recovery correlated with mild (inadvertent) pre-arrest hypothermia, diastolic arterial pressure during CPR and absence of cardiovascular impairment at 12 h post-CPR. We conclude that prolonged cardiac arrest in previously healthy dogs is followed by persistent cardiovascular derangements that correlate with impaired neurologic recovery.

Animals↗
PubMed1992

Assessing the use of medications in the elderly: methods and initial experience in the Cardiovascular Health Study. The Cardiovascular Health Study Collaborative Research Group.

The Cardiovascular Health Study (CHS), a cohort study of risk factors for coronary heart disease and stroke, recruited 5201 community-dwelling adults aged 65 years or older. To assess the prevalence of medication use at baseline, we used the method of medication inventory and transcribed information about drug names and doses from prescription bottles. Using a specially-written computer program, persons without a knowledge of drug nomenclature coded 10,511 (89%) of the 11,846 medicines entered. We compared the results of the medication inventory and answers to questions on specific medications for reliability and validity. The use of beta-blockers and beta-agonists assessed by the method of medication inventory, but not by the method of directed recall, was associated with a significant effect on mean heart rate. Among 5197 participants with medication data, 76.1% were taking at least one medicine, and the mean number of drugs per person was 2.28. Among those with a reported history of high blood pressure, participants with cardiovascular disease (CVD) were more likely to be treated, and they were more likely to be taking beta-blockers and calcium-channel blockers than those without CVD. Daily aspirin use was also more common among those with CVD (30.5% of women and 43.2% of men) than among those without CVD (14.0% of women and 14.0% of men). The prevalence of post-menopausal estrogen use differed significantly among the four clinical centers (range = 5.5%-22.5% of women). We conclude that this method of assessing medications was easy to use and provided estimates of exposure to drugs that may affect risk of cardiovascular disease.

Aged↗
PubMed2002

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗
PubMed2001

Prevention of cardiovascular disease and the future of cardiovascular disease epidemiology.

BACKGROUND: Coronary heart disease is preventable. The improved interpretation of risk factors, in vivo non-invasive measuring of arteries, brain and heart, and proven efficacy of both non-pharmacological and pharmaceutical therapies provides the model for both cardiovascular prevention programmes and new epidemiological studies. METHODS: Risk factors can be subdivided into those related to the development of atherosclerosis with relatively long incubation periods, and risk factors that moderate the changes in atherosclerotic plaque, thrombosis and fibrinolysis, i.e. those with short incubation periods, or proximate risk factors. RESULTS: The level of ApoB containing lipoproteins, low density lipoprotein (LDL) and very low density lipoprotein (VLDL) are the primary determinants of atherosclerosis. Using non-invasive methods of measuring atherosclerosis, we can evaluate the efficacy of intervention to both prevent the development of atherosclerosis and the progression of disease. The importance of proximate risk factors, especially inflammatory markers, is less estimated than long incubation period factors. It is possible that a combination of measures of subclinical atherosclerosis and proximate risk factors may provide the best estimate of the risk of clinical disease, especially among higher risk older individuals. CONCLUSIONS: The measurement of subclinical disease and new proximate risk factors (i.e. inflammation, fibrinolysis) may be useful for comparing reported differences in rates of clinical disease among populations and monitoring the emerging epidemic of cardiovascular disease in countries that currently have low death rates due to cardiovascular disease.

Biomarkers↗
PubMed2000

Diabetes mellitus: subclinical cardiovascular disease and risk of incident cardiovascular disease and all-cause mortality.

Previously diagnosed diabetes mellitus, newly diagnosed diabetes mellitus, and impaired glucose tolerance are important determinants of the risk of clinical cardiovascular disease (CVD). We have evaluated the relation of patients with subclinical CVD, diabetes, and impaired glucose tolerance and "normal" subjects and the risk of clinical CVD in the Cardiovascular Health Study. Diabetes (1343), impaired glucose tolerance (1433), and normal (2421) were defined by World Health Organization criteria at baseline in 1989 to 1990. The average follow-up was 6.4 years (mean age 73 years). Diabetics had a higher prevalence of clinical and subclinical CVD at baseline. Compared with diabetes in the absence of subclinical disease, the presence of subclinical CVD and diabetes was associated with significant increased adjusted relative risk of death (1.5, CI 0.93 to 2.41), relative risk of incident coronary heart disease (1.99, CI 1.25 to 3.19), and incident myocardial infarction (1.93, CI 0.96 to 3.91). The risk of clinical events was greater for participants with a history of diabetes compared with newly diagnosed diabetics at baseline. Compared with nondiabetic nonhypertensive subjects without subclinical disease, patients with a combination of diabetes, hypertension, and subclinical disease had a 12-fold increased risk of stroke. Fasting blood glucose levels were a weak predictor of incident coronary heart disease as were most other risk factors. Subclinical CVD was the primary determinant of clinical CVD among diabetics in the Cardiovascular Health Study.

Aged↗
PubMed1994

Effect of two different therapeutic approaches on total and cardiovascular mortality in a Cardiovascular Study in the Elderly (CASTEL).

Although limited numbers of elderly subjects have occasionally been included in population-based studies, only a few studies have been conducted specifically on elderly hypertensives, and practically none at a population level. We studied 655 hypertensive subjects from a cohort of 2,254 elderly subjects. The intervention consisted of the creation of a Hypertension Outpatients' Clinic under our auspices but with complete co-operation from general practitioners, randomizing the identified hypertensive patients into pre-established therapeutic drug regimens, and early follow-up recording of mortality for 7 years. The drugs used were clonidine (n = 61), nifedipine (n = 146) and the fixed combination of atenolol+chlorthalidone (n = 144); 304 subjects underwent "free therapy" by their personal physicians without any special intervention. There were 1,404 normotensive subjects. Overall 7-year follow-up mortality was 34.9% in the hypertensive subjects receiving "free therapy", 22.5% in those receiving "special care", and 24.2% in the normotensives. Cardiovascular mortality was respectively 23.7%, 12.2%, and 12.0%. Overall and cardiovascular annual cumulative mortality were significantly lower in the << special therapy >> than in the << free therapy >> group. The fixed combination of atenolol and chlorthalidone reduced mortality below that of the normotensives, independent of other cardiovascular risk factors.

Aged↗
PubMed2000

Racial and ethnic differences in the use of cardiovascular procedures: findings from the California Cooperative Cardiovascular Project.

OBJECTIVES: This study used data from the California Cooperative Cardiovascular Project to examine the use of invasive and noninvasive cardiovascular procedures among Whites, African Americans, and Hispanics. METHODS: The use of catheterization, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG) surgery, and several noninvasive tests among all patients 65 years or older with a confirmed acute myocardial infarction in nonfederal hospitals from 1994 to 1995 was studied. RESULTS: African Americans (n = 527) were less likely than Whites (n = 9489) to have received catheterization (adjusted odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.50, 0.76), PTCA (OR = 0.64, 95% CI = 0.49, 0.85), or CABG surgery (OR = 0.42, 95% CI = 0.27, 0.64); somewhat more likely to have received a stress test or an echocardiogram; and equally likely to have received a multiple-gated acquisition scan. Hispanics (n = 689) also were less likely than Whites to have received catheterization (OR = 0.82, 95% CI = 0.68, 0.98) or PTCA (OR = 0.58, 95% CI = 0.45, 0.75). CONCLUSIONS: African Americans were less likely than Whites to undergo costly invasive cardiovascular procedures. In addition, Hispanics were less likely than Whites to have received catheterization and PTCA.

APACHE↗
PubMed1998

Cardiovascular outcomes in type 2 diabetes. A double-blind placebo-controlled study of bezafibrate: the St. Mary's, Ealing, Northwick Park Diabetes Cardiovascular Disease Prevention (SENDCAP) Study.

OBJECTIVE: To determine whether serum lipid intervention, in addition to conventional diabetes treatment, could alter cardiovascular outcomes in type 2 diabetes. RESEARCH DESIGN AND METHODS: There were 164 type 2 diabetic subjects (117 men, 47 women) without a history of clinical cardiovascular disease randomized to receive either bezafibrate or placebo daily on a double-blind basis in addition to routine diabetes treatment and followed prospectively for a minimum of 3 years. Serial biochemical and noninvasive vascular assessments, carotid and femoral artery B-mode ultrasound measurements, and those pertaining to coronary heart disease (CHD)--clinical history, the World Health Organization (WHO) cardiovascular questionnaire, and resting and exercise electrocardiogram (ECG)--were recorded. RESULTS: Bezafibrate treatment was associated with significantly greater reductions over 3 years in median serum triglyceride (-32 vs. 4%, P = 0.001), total cholesterol (-7 vs. -0.3%, P = 0.004), and total-to-HDL cholesterol ratio (-12 vs. -0.0%, P = 0.001), and an increase in HDL cholesterol (6 vs. -2%, P = 0.02) as compared with placebo. There was a trend toward a greater reduction of fibrinogen (-18 vs. -6%, P = 0.08) at 3 years. No significant differences between the two groups were found in the progress of ultrasonically measured arterial disease. In those treated with bezafibrate, there was a significant reduction (P = 0.01, log-rank test) in the combined incidence of Minnesota-coded probable ischemic change on the resting ECG and of documented myocardial infarction. CONCLUSIONS: Improving dyslipidemia in type 2 diabetic subjects had no effect on the progress of ultrasonically measured arterial disease, although the lower rate of "definite CHD events" in the treated group suggests that this might result in a reduction in the incidence of coronary heart disease.

Adult↗
PubMed2006

The future of cardiovascular imaging and non-invasive diagnosis: a joint statement from the European Association of Echocardiography, the Working Groups on Cardiovascular Magnetic Resonance, Computers in Cardiology, and Nuclear Cardiology, of the European Society of Cardiology, the European Association of Nuclear Medicine, and the Association for European Paediatric Cardiology.

Advances in medical imaging now make it possible to investigate any patient with cardiovascular disease using multiple methods which vary widely in their technical requirements, benefits, limitations, and costs. The appropriate use of alternative tests requires their integration into joint clinical diagnostic services where experts in all methods collaborate. This statement summarises the principles that should guide developments in cardiovascular diagnostic services.

Biomedical Research↗