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PubMed2000

Reduced or modified dietary fat for prevention of cardiovascular disease.

BACKGROUND: Reduction or modification of dietary fat can improve total cholesterol levels, but may also have a variety of effects, both positive and negative, on other cardiovascular risk factors. OBJECTIVES: The aim of this systematic review was to assess the effect of reduction or modification of dietary fats on total and cardiovascular mortality and cardiovascular morbidity over at least 6 months, using all available randomized clinical trials. SEARCH STRATEGY: The Cochrane Library, MEDLINE, EMBASE, CAB Abstracts, CVRCT registry and related Cochrane Groups' trial registers were searched through spring 1998, SIGLE to January 1999. Trials known to experts in the field and biographies were included through May 1999. SELECTION CRITERIA: Trials fulfilled the following criteria: 1) randomized with appropriate control group, 2) intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions), 3) not multi factorial, 4) healthy adult humans, 5) intervention at least six months, 6) mortality or cardiovascular morbidity data available. Inclusion decisions were duplicated, disagreement resolved by discussion or a third party. DATA COLLECTION AND ANALYSIS: Rate data were extracted by two independent reviewers and meta-analysis performed using random effects methodology. Meta-regression and funnel plots were used. MAIN RESULTS: Twenty seven studies were included (40 intervention arms, 30,901 person-years). There was no significant effect on total mortality (rate ratio 0.98, 95% CI 0.86 to 1.12), a trend towards protection form cardiovascular mortality (rate ratio 0.91, 95% CI 0. 77 to 1.07), and significant protection from cardiovascular events (rate ratio 0.84, 95% CI 0.72 to 0.99). The latter became non-significant on sensitivity analysis. Trials where participants were involved for more than 2 years showed significant reductions in the rate of cardiovascular events and a suggestion of protection from total mortality. The degree of protection from cardiovascular events appeared similar in high and low risk groups, but was statistically significant only in the former. REVIEWER'S CONCLUSIONS: The findings are suggestive of a small but potentially important reduction in cardiovascular risk in trials longer than two years. Lifestyle advice to all those at high risk of cardiovascular disease (especially where statins are unavailable or rationed), and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates.

Cardiovascular Diseases↗
PubMed2006

Cardiovascular disease risk factors in patients with confirmed cardiovascular disease.

OBJECTIVE: To assess the magnitude of the problem of cardiovascular risk factors in hospitalized patients, and to establish cardiovascular disease (CVD) risk factor profiles. METHODS: The study included 476 confirmed CVD patients selected by a multi stage stratified cluster random sampling technique in Tabriz Heart Center (Shaheed Madani Hospital), Tabriz, Iran from February 2004 to May 2005. After obtaining demographic information and performing physical examination, biochemical parameters were measured. Data was analyzed using the Statistical Package for Social Science version 10.05, where p value of <0.05 was considered significant. RESULTS: Obesity was the most common abnormality (93.5%) followed by diabetes mellitus (58.4%), low high-density lipoprotein cholesterol (HDL-c) (45.4%), low physical activity (41.6%), high total cholesterol (40.1%), high triglyceride (37.2%), high low-density lipoprotein cholesterol (30.7%), diastolic hypertension (28.4%), high systolic blood pressure (24.8%) and smoking (20%). Of the total number of patients, 93% had one risk factors for CVD, 43% had 2, 16% had 3, and 5% had 4 risk factors. The prevalence of lipid disorders in females was more than males except for low HDL-c (p<0.05). Between lipid profiles, only TG showed a correlation between age (p<0.05). It was noticed that obesity accompanied by lipid profile abnormalities as low serum levels of HDL-c and high level of TG, TC, and LDL-c were more seen in obese patients (p<0.05). CONCLUSION: This study revealed a high prevalence of risk factors in CVD patients; thus, urgent lifestyle modification is recommended.

Adolescent↗
PubMed2002

ABCA1 as a New Therapeutic Target for Treating Cardiovascular Disease.

Atherosclerotic cardiovascular disease remains the leading cause of morbidity and mortality in western societies. Although cholesterol is a major cardiovascular disease risk factor, therapeutic interventions to lower plasma cholesterol levels have had limited success in reducing coronary events, underscoring the need for other treatment strategies. A promising therapeutic target is an ATP binding cassette transporter called ABCA1, a cell membrane protein that is the gatekeeper for secretion of excess cholesterol from macrophages into the high-density lipoprotein (HDL) metabolic pathway. Mutations in ABCA1 cause Tangier disease, a severe HDL-deficiency syndrome characterized by accumulation of cholesterol in tissue macrophages and prevalent atherosclerosis. Thus, ABCA1-activating drugs have the potential to mobilize cholesterol from macrophages of atherosclerotic lesions, making them powerful agents for preventing and reversing cardiovascular disease. (c) 2002 Prous Science. All rights reserved.

Journal Article↗
PubMed2005

Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America.

BACKGROUND: Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. METHODS AND RESULTS: This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. CONCLUSIONS: The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.

Ambulatory Care↗
PubMed2000

Periodontal disease: link to cardiovascular disease.

Poor oral hygiene that leads to dental infections could contribute to adverse medical outcomes such as cardiovascular disease. Twelve studies of varying degrees of design rigor have associated dental conditions, such as periodontal disease, missing teeth, and edentulousness, with either coronary heart disease or a cerebral vascular accident. Six of the studies were longitudinal so that the demonstration of the oral health parameters as significant predictors of the cardiovascular event would elevate the dental parameter to the status of a risk factor. Because dental diseases (especially periodontal disease) are treatable, the dental component is a modifiable risk factor; therefore, maintaining good oral health should receive the highest priority for a healthy life.

Bacterial Infections↗
PubMed1985

Recent trends in coronary heart disease and other cardiovascular diseases in Italy.

Trends in death rates from coronary heart disease (CHD) in Italy in the period 1970-1979 suggest a continuous rising of mortality in males until 1976-1977 followed by a plateau or a slight decrease in the next 2 years; whereas an 11.5% decrease has been observed in females aged 35-74. Looking at the whole group of cardiovascular diseases it appears that a continuous and clear decline in stroke mortality (-14.6% in males and -22.0% in females aged 35-74) explains almost completely the overall decrease of cardiovascular mortality observed during the period 1970-1979 which corresponds to -8.4% in males and -24.3% in females. Limited and unrepresentative data from population samples studied between 1960 and 1980 suggest an increasing incidence of CHD which is compatible with parallel changes of some risk factor levels. In the 1970s a continuous increase of fat consumption and of cigarette consumption has been balanced by an increase of prevalence of controlled hypertensives, by an increase of leisure physical activity, by an increasing availability of coronary care units and consumption of beta-blockers. It is likely that in the late 1970s a plateau was reached in the coronary epidemic.

Adult↗
PubMed2003

Folate and vitamin B-12 and risk of fatal cardiovascular disease: cohort study from Busselton, Western Australia.

OBJECTIVE: To test the hypothesis that the incidence of fatal coronary heart disease and cardiovascular disease in a general population is related to serum and red cell folate and vitamin B-12 concentrations. DESIGN: Cohort study with follow up of 29 years. SETTING: Busselton, Western Australia. PARTICIPANTS: 1419 men and 1531 women aged 20 to 90 years, who were alive more than three years after their participation in the 1969 Busselton health survey. 2314 (78.4%) had no cardiovascular disease at the initial survey. MAIN OUTCOME MEASURES: Hazard ratios for fatal coronary heart disease and cardiovascular disease in men and women according to baseline concentrations of serum and red cell folate and serum vitamin B-12. RESULTS: 213 men and 159 women died from coronary heart disease, and 342 men and 302 women died from cardiovascular disease. Serum and red cell folate concentrations showed a moderate positive correlation (r=0.26, P<0.001) but otherwise serum and red cell folate and serum B-12 concentrations were not strongly correlated with each other or with other standard risk factors. After age and standard risk factors were adjusted for, there was no independent association between folate and B-12 concentrations and death from coronary heart disease or cardiovascular disease in the full cohort or the subcohort with no cardiovascular disease at baseline. The multivariate adjusted hazard ratio for death from cardiovascular disease in the lowest versus the highest category of red cell folate concentration was 1.05 (95% confidence interval 0.77 to 1.43) in men and 1.10 (0.81 to 1.51) in women. CONCLUSIONS: These findings do not support the hypothesis that lower folate and B-12 concentrations increase the risk of fatal cardiovascular disease in a general population. The routine use of these vitamins for preventing cardiovascular disease should await evidence from clinical trials.

Adult↗
PubMedDate not supplied

Associations between renovascular disease and prevalent cardiovascular disease in the elderly: a population-based study.

Atherosclerotic renovascular disease (RVD) is a suspected contributor to the morbidity and mortality of cardiovascular disease (CVD) through its potential effects on blood pressure and excretory renal function as well as through its associations with other forms of CVD. However, population-based data regarding the associations between the presence of RVD and prevalent CVD are lacking. The Cardiovascular Health Study (CHS) is a prospective, multicenter cohort study of CVD among elderly Americans. As part of an ancillary study, participants in the Forsyth County, North Carolina, cohort of the CHS were invited to undergo renal duplex sonography (RDS) to establish the presence or absence of RVD (defined as any focal peak systolic velocity >/= 1.8 m/second or the absence of a Doppler-shifted signal from an imaged artery). Demographic, risk factor, and prevalent CVD data were obtained from the CHS coordinating center and matched with ancillary study participants. Eight hundred thirty-four CHS participants (including 525 women [63%], 309 men [37%], 194 African-Americans [23%], and 635 Caucasians [76%]) with a mean age of 77.2 +/-4.9 years underwent RDS examination. RVD was present in 57 participants (6.8%). Overall, clinical and/or subclinical manifestations of CVD were present in 603 participants (72.3%) at the time of RDS. Participants with RVD demonstrated a significantly greater prevalence of angina (p = 0.002), previous myocardial infarction (p < 0.001), >/= 25% diameter-reducing internal carotid artery stenosis (p = 0.010), increased carotid intimal medial thickness (p = 0.003), and major electrocardiographic abnormalities (p = 0.013). Following adjustment for demographics and cardiovascular risk factors, the presence of RVD demonstrated a significant and independent association with prevalent coronary artery disease but not with prevalent cerebrovascular or lower extremity vascular disease. These results suggest important population-based associations between RVD and both clinical and subclinical manifestations of CVD, especially coronary artery disease.

Aged↗
PubMed2003

Peripheral differential leukocyte counts and subsequent mortality from all diseases, cancers, and cardiovascular diseases in Taiwanese.

BACKGROUND AND PURPOSE: A higher total leukocyte count has been reported to predict all-cause mortality in men, but data are limited for this relation in women and for the relation between differential leukocyte counts and all-cause mortality in both men and women. This study was designed to analyze these relationships in Taiwanese. METHODS: A total of 8447 subjects were enrolled from participants in a physical check-up program at National Taiwan University Hospital from 1995 to 1997. Information on mortality was obtained from a national mortality databank that was updated to the end of 2001. Data were analyzed by Student's t test and Cox regression analysis. RESULTS: Among the 245 deaths, 88 were due to cancer and 62 were due to cardiovascular diseases. Cox regression analysis revealed an inverse association between lymphocyte count and all-cause mortality in the study group as a whole (all subjects, p < 0.01, hazard ratio = 0.73). This inverse association was mainly due to an inverse association between lymphocyte count and cancer mortality (p < 0.05, hazard ratio = 0.64), especially the mortality from hepatoma (p = 0.010, hazard ratio = 0.29). The latter hazard ratio of 0.29 indicates that, in all subjects, every decrease of 1.0 x 10(9)/L in lymphocyte count increased the risk of mortality from hepatoma by 3.45-fold during an average follow-up period of 65.5 months. There was a positive association between total leukocyte count and all-cause mortality in men (p < 0.05, hazard ratio = 1.10), mainly due to both the neutrophil and monocyte counts having positive associations with the cardiovascular mortality (both p < 0.05, hazard ratio = 1.23 and 1.22, respectively). The latter hazard ratio of 1.22 indicates that, in men, every increase of 0.1 x 10(9)/L in monocyte count increased the risk of cardiovascular mortality by 1.22-fold. CONCLUSIONS: In Taiwanese adults of both genders, a lower lymphocyte count is associated with cancer mortality, especially mortality from hepatoma. In Taiwanese men, higher neutrophil and monocyte counts are associated with cardiovascular mortality.

Adolescent↗
PubMed1997

Aging or disease? Cardiovascular reactivity in Finnish men over the middle years.

Cardiovascular responses to psychological events may mediate the influence of stress on cardiovascular disease. In this study the authors asked whether cardiovascular responses to psychological challenge changed with age and whether such changes were intrinsic to aging or could be attributed to the influence of disease and medications. Cardiovascular reactivity to mental challenge was examined in 902 men ranging in age from 46 to 64 years who participated in the Kuopio Ischemic Heart Disease Risk Factor Study. A battery of 4 tasks was used to induce cardiovascular responses. Current disease status, age, and medication use were entered into hierarchical regression analyses to assess their relation with measures of cardiovascular reactivity. Age and hypertension contributed independent, approximately equal, but small amounts of variance in the cardiac and vascular reactivity indexes. Medications also influenced reactivity independently of age and disease. Performance on the tasks was more consistently altered by age than by disease or medication. Cardiac and vascular reactivity increased with increasing age and the presence of hypertension. The authors conclude that both age and disease state must be considered when examining cardiovascular reactivity as a risk factor for disease.

Aging↗
PubMed2003

The role of estrogen and estrogen-related drugs in cardiovascular diseases.

The cardiovascular effects of estrogen have recently become a focus of basic and clinical cardiovascular medicine because of the multiplicity of its beneficial effects. Various basic and clinical studies have revealed that estrogen has potent cardiovascular effects against ischemic or non-ischemic injury of the heart and vessels, leading to the concept that administration of estrogen may reduce cardiovascular disease in postmenopausal women. Indeed, among the groups of the postmenopausal women who have a higher risk of cardiovascular diseases, the hormone therapy has been associated with improved outcomes for cardiovascular events. Estrogen binds to the estrogen receptor, which is a member of the steroid hormone family of nuclear receptors and is the estrogen response element in target genes, leading to the transcriptional regulation of many genes. In addition to these genomic effects of estrogen, it has been recently reported that estrogen can have rapid "nongenomic" effects. In contrast to such data, recent clinical prevention trials in postmenopausal women treated with a combination of estrogen and progestins have not revealed any beneficial effects on cardiovascular morbidity or mortality, and estrogen itself increases the risk of endometrial and breast cancer. Under these circumstances, a selective estrogen receptor modulator (SERM), which exerts estrogenic agonistic or antagonistic actions on various tissues, has been recently introduced for new hormone therapy because it reduces the adverse effects of estrogen. Here, we summarize the effects of estrogen and SERM on the cardiovascular system and discuss cellular mechanisms that may be involved.

Animals↗
PubMed2006

'Relaxin' the stiffened heart and arteries: the therapeutic potential for relaxin in the treatment of cardiovascular disease.

Although originally characterised as a reproductive hormone, relaxin has emerged as a multi-functional endocrine and paracrine factor that plays a number of important roles in several organs, including the normal and diseased cardiovascular system. The recent discovery of the H3/relaxin-3 gene, and the elusive receptors for relaxin (Relaxin family peptide receptor; RXFP1) and relaxin-3 (RXFP3/RXFP4) have led to the re-classification of a distinct relaxin peptide/receptor family. Additionally, the identification of relaxin and RXFP1 mRNA and/or relaxin binding sites in the heart and blood vessels has confirmed that the cardiovascular system is a target for relaxin peptides. While evidence for the production of relaxins within the cardiovascular system is limited, several studies have established that the relaxin genes are upregulated in the diseased human and rodent heart where they likely act as cardioprotective agents. The ability of relaxin to protect the heart is most likely mediated via its antifibrotic, anti-hypertrophic, anti-inflammatory and vasodilatory actions, but it may also directly stimulate myocardial regeneration and repair. This review describes relaxin and its primary receptor (RXFP1) in relation to the roles and effects of relaxin in the normal and pathological cardiovascular system. It is becoming increasingly clear that relaxin has a number of diverse physiological and pathological roles in the cardiovascular system that may have important therapeutic and clinical implications.

Cardiovascular Diseases↗
PubMed2006

Leukocyte telomere length and cardiovascular disease in the cardiovascular health study.

The telomere length of replicating somatic cells is inversely correlated with age and has been reported to be associated cross-sectionally with cardiovascular disease (CVD). Leukocyte telomere length, as expressed by mean terminal restriction fragment (TRF) length, was measured in 419 randomly selected participants from the Cardiovascular Health Study, comprising a community-dwelling cohort recruited in four US communities. The authors investigated associations between TRF length and selected measures of subclinical CVD/risk factors for CVD (data were collected at the 1992/1993 clinic visit) and incident CVD (ascertained through June 2002). In these participants (average age = 74.2 years (standard deviation, 5.2)), mean TRF length was 6.3 kilobase pairs (standard deviation, 0.62). Significant or borderline inverse associations were found between TRF length and diabetes, glucose, insulin, diastolic blood pressure, carotid intima-media thickness, and interleukin-6. Associations with body size and C-reactive protein were modified by gender and age, occurring only in men and in participants aged 73 years or younger. In younger (but not older) participants, each shortened kilobase pair of TRF corresponded with a threefold increased risk of myocardial infarction (hazard ratio = 3.08, 95% confidence interval: 1.22, 7.73) and stroke (hazard ratio = 3.22, 95% confidence interval: 1.29, 8.02). These results support the hypotheses that telomere attrition may be related to diseases of aging through mechanisms involving oxidative stress, inflammation, and progression to CVD.

Aged↗
PubMed1974

Community surveillance for coronary heart disease: the Framingham Cardiovascular Disease Survey. Methods and preliminary results.

The Framingham Cardiovascular Disease Survey was undertaken to test the hypothesis that a short-term surveillance study of a defined population could yield incidence data comparable to those obtained by an elaborate longitudinal study of the same population, at a fraction of the cost. New cases of coronary heart disease (CHD), congestive heart failure (CHF) and stroke occurring from June 15, 1970 through June 14, 1971, were detected by monitoring admissions to hospitals and nursing homes, reporting of new events by local physicians and perusal of death certificates, Necessary data on each case were collected and reviewed by a panel of physicians using strict diagnostic criteria. Incidence rates based on 332 CHD or CHF events were calculated and were found to be consistent with findings of the Framingham Heart Study. A one-year community surveillance study is an economical and reasonably accurate method of determining the incidence of CHD and CHF.

Adult↗
PubMed2005

[Pharmacologic prevention of cardiovascular diseases--2005].

Cardiovascular diseases are the leading cause of death in Western countries, and that is true for Hungary as well, and so will be the case in developing countries in 2025. Cardiovascular diseases kill more than 950000 people only in the USA. 50% of cardiovascular mortality is due to ischemic heart disease, stroke is responsible for 20%. The annual cost of the treatment of cardiovascular illnesses takes more than 330 billion dollars. All these data underline the importance of these illnesses. The aim of cardiovascular prevention is to reduce the incidence of first or recurrent events due to ischemic heart disease, ischemic stroke or peripheral artery disease, especially early deaths and disability. In the following article the medical aspects of cardiovascular prevention are summarized. Lifestyle changes and special treatment of particular risk factors are out of scope of this review.

Adrenergic beta-Antagonists↗
PubMed1993

[Lead--a possible risk factor of increased blood pressure and cardiovascular disease].

Many epidemiological and animal experiment studies support the hypothesis of there being a causal association between lead exposure and increased blood pressure/cardiovascular disease. This study includes 1,052 men and women from Copenhagen County, Denmark, who were examined in 1976 and 1981; in 1987, only the men were examined. Blood lead fell by approximately 40% for the men during the 11-year period and by approximately 30% for the women during the first 5-year period. There was a univariate association between systolic blood pressure and blood lead for both sexes in 1976, but it disappeared at the following examinations. The authors found a significant univariate association between changes in blood lead and changes in systolic blood pressure from 1976 to 1987 in the males. All participants taking part in the study in 1976 were followed with respect to hospital admissions and deaths throughout a follow-up period lasting 14 years. There was a significant univariate association between blood lead levels in 1976 and total mortality, coronary heart disease, and cardiovascular disease. However, with regard to coronary heart disease and cardiovascular disease, the association disappeared when controlling for confounders. Blood lead was a significant predictor of total mortality after control for relevant confounders. This study supports the hypothesis of there being a weak causal association between blood lead and blood pressure, total mortality, coronary heart disease, and cardiovascular disease. The importance of this association is very modest for the individual, but the population attributable risk may be considerable.

Adult↗
PubMed2005

[Total risk for cardiovascular disease. At what point is medical prophylactic medication useful?].

Despite the epidemiological importance of coronary artery disease: cardiovascular events are rare from the individual viewpoint. There is considerable uncertainty when to start medical treatment. A given risk factor modification results in a relative risk reduction independent of the global risk. Therefore the global risk determines the absolute benefit of a preventive measure. The global risk can be estimated using different scoring systems. Using the global risk and the expected relative risk reduction, the number needed to treat (NNT) to avoid one event or cardiac death can be calculated. The NNT is a measure for the usefulness of a preventive intervention. A NNT of <200 appears acceptable for primary prevention. This can be achieved with pharmacological preventive strategies if the global risk of 10 years is > or =20%. As age is one of the most important risk predictors the need for treatment at comparable risk factor constellations is age dependent. Risk stratification with estimation of the NNT is therefore important for the decision to treat or not to treat.

Cardiotonic Agents↗