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PubMed1999

Changes in body mass index and its relationships to other cardiovascular risk factors among Japanese population: results from the 1980 and 1990 national cardiovascular surveys in Japan.

Few studies have attempted to investigate the changes in body mass index (BMI) and its relationship to other cardiovascular factors in Asian populations, including Japanese. Data from two national cross-sectional surveys on circulatory disorders in 1980 and 1990 in Japan were used in this study. The sample consisted of 10,556 participants in the 1980 survey and 8,385 in the 1990 survey, aged > or = 30 years. The results show that after adjusting for age, smoking, alcohol consumption (ALC) and daily life physical activity (PA), mean BMI increased 0.49 kg/m2 (95% confidence interval: 0.34-0.65) in men aged 30-59 and 0.61 kg/m2 (0.37-0.86) in those aged > or = 60 from 1980 to 1990. In women, however, mean BMI decreased 0.24 kg/m2 (-0.39 0.09) in those aged 30-59 and increased 0.38 kg/m2 (0.12-0.64) in those aged > or = 60. BMI was significantly associated with hypertension, diabetes and hypercholesterolaemia. In both genders, cu-smokers had lower mean BMI than never smokers, while among the cu-smokers, mean BMI was positively associated with the number of cigarettes smoked per day. In men, BMI was positively associated with ALC and negatively associated with PA, while in women, BMI was negatively associated with ALC and positively associated with PA. The results suggest that BMI has significantly increased in men and in elderly women. BMI, even in the Japanese population who are characterized by relative low BMI, is significantly associated with several cardiovascular risk factors.

Adult↗
PubMedDate not supplied

Cardiovascular observation unit: meeting the expanding needs of an integrated cardiovascular center.

By developing a flexible unit that can easily manage a diverse cardiac population, the Cardiovascular Center as well as the Medical Center reduced expenses and increased operational efficiency. In addition to the economic and operational benefits, patients and their families have been impacted favorably by the unit's design and operation. As cardiovascular administrators search for ways to reduce expenses and increase operational efficiencies, they should consider the positive effects of a unit similar to our CVOU within their institution.

Adult↗
PubMed2000

Serum total cholesterol and cardiovascular mortality in Israeli males: the CORDIS Study. Cardiovascular Occupational Risk Factor Determination in Israeli Industry.

BACKGROUND: The degree to which serum total cholesterol predicts cardiovascular disease is uncertain. While most authors have placed TC among the most powerful risk indicators of CVD, some have claimed that it predicted CVD in women only, or even not at all. OBJECTIVE: To determine the predictive value of serum total cholesterol relative to diabetes, smoking, systolic blood pressure and body mass index (kg/m2), for cardiovascular disease mortality in 3,461 occupationally active Israeli males. METHODS: A prospective follow-up was carried out for the years 1987-1998 to determine the effect of age, smoking habits, a history of diabetes, SBP, BMI and TC, at entry, on CVD mortality. RESULTS: There were 84 CVD deaths during a total of 37,174 person-years follow up. The hazard ratios (95% confidence intervals) for CVD mortality with respect to variables at entry were: diabetes 5.2 (2.1-13.2), age 2.2 (1.7-2.9), smoking 1.3 (1.0-1.8), SBP 1.4 (1.1-2.0), TC 1.5 (1.0-2.1) and BMI 1.2 (0.7-2.2). Among non-obese, non-diabetic, normotensive subjects the hazard ratio of TC adjusted for age and smoking was 1.16 (1.09-1.22) per 10 mg/dl. In the remaining subjects it was 1.04 (0.98-1.12) only. There was a significant interaction between TC and diabetes, hypertension or obesity (P = 0.003). CONCLUSIONS: In this population of Israeli males we found an interaction between TC and other risk indicators for CVD. Confirmation is required for the unexpected finding that the predictive value of TC for CVD mortality among non-diabetic, non-obese and normotensive subjects exceeded that among subjects with either of these risk factors.

Adult↗
PubMed2002

No association of plasma prothrombin concentration or the G20210A mutation with incident cardiovascular disease: results from the Cardiovascular Health Study.

Prothrombin is a key factor in blood clotting, a process intimately involved in thrombotic disease. We assessed prothrombin levels and G20210A genotype in a case-control study within the Cardiovascular Health Study. Cases included angina, myocardial infarction, stroke, and the presence of MRI-detectable infarcts (n approximately 250 each). Population-based controls free of clinical cardiovascular disease (CVD) (n approximately 500) and a subset free of clinical and subclinical CVD (n approximately 250) were used for comparison. The 20210 A allele, frequency 2.9%, was associated with higher mean prothrombin levels: 166.3 vs. 139.5 microg/ml (P <0.001). Significant correlates of prothrombin included gender, plasma lipids, other vitamin K-dependent proteins, and inflammatory markers, but not race, smoking, hypertension, diabetes, measures of subclinical CVD, or markers of procoagulant activity. Compared to controls, neither genotype nor prothrombin level was associated with any CVD case group. We conclude that, in the elderly, neither prothrombin level nor 20210 genotype were associated with either CVD risk factors or events. This is consistent with the lack of association of prothrombin levels with measures of underlying CVD or procoagulant markers.

3' Untranslated Regions↗
PubMed1992

Isolated systolic hypertension and subclinical cardiovascular disease in the elderly. Initial findings from the Cardiovascular Health Study.

OBJECTIVE: To assess the association between isolated systolic hypertension (ISH) and subclinical disease in adults aged 65 years and above. DESIGN: Medicare eligibility lists were used to obtain a representative sample of 5201 community-dwelling elderly persons for the Cardiovascular Health Study, a National Heart, Lung, and Blood Institute--sponsored cohort study of risk factors for coronary heart disease and stroke. In this cross-sectional analysis of baseline data, we excluded 3012 participants who were receiving antihypertensive medications, had clinical cardiovascular disease, or had a diastolic blood pressure of at least 90 mm Hg. MAIN OUTCOME MEASURES: For electrocardiogram: myocardial infarction, left ventricular hypertrophy, and left ventricular mass as measures of myocardial damage and strain; for echocardiography: left ventricular mass, fractional shortening, and Doppler flow velocities as measures of cardiac systolic and diastolic function; and for carotid sonography: carotid arterial intima-media thickness as a measure of atherosclerosis. RESULTS: Among the 2189 men and women in this analysis, 195 (9%) had ISH (systolic blood pressure, greater than or equal to 160 mm Hg) and 596 (23%) had borderline ISH (systolic blood pressure, 140 to 159 mm Hg). Systolic blood pressure was associated with myocardial infarction by electrocardiogram (P = .02). Borderline and definite ISH were strongly associated with left ventricular mass (P less than .001). While there was little association with cardiac systolic function, borderline and definite ISH were associated with cardiac diastolic function (P less than .001). Isolated systolic hypertension was also strongly associated with increased intima-media thickness of the carotid artery (P less than .001). CONCLUSIONS: While cohort analyses of future repeated measures will provide a better assessment of risk, both borderline and definite ISH were strongly related to a variety of measures of subclinical disease in elderly men and women.

Aged↗
PubMed2005

The SaM (Screening and Monitoring) approach to cardiovascular risk-reduction in primary care--cyclic monitoring and individual treatment of patients at cardiovascular risk using the electronic medical record.

BACKGROUND: Cardiovascular disease (CVD) prevention suffers from a major gap between clinical evidence (information) and clinical practice (implementation). Insufficient control risk factor levels and under-utilization of aspirin, statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are well-known examples. METHODS: The SaM (Screening and Monitoring) approach was devised by a family physician in order to facilitate closure of this gap. It does so by providing solutions to problems in the fields of information and implementation. A simple manipulation of the electronic medical record used in the practice serves to facilitate cyclic monitoring of patients with cardiovascular risk factors. Technological and human resources available in the primary care setting are used. The approach is described in the first part of the article. The second part presents results obtained by employing the approach on one family physician's patient population. RESULTS: The final results demonstrate a marked improvement over time in risk factor levels and use of medications in accordance with indications. The values achieved are superior to those reported in the literature. Blood pressure in hypertensive patients 134/75 mmHg; haemoglobin A1c 7.27%; low-density lipoprotein-cholesterol in patients with CVD or diabetes, 97 mg/dl; patients with CVD receiving anti-thrombotic medication, 94%; dyslipidaemic patients with CVD or diabetes receiving lipid-lowering drugs, 90%; post myocardial infarction patients receiving beta-blockers, 76%; hypertensive diabetics or patients with chronic heart failure (CHF) receiving ACE-inhibitors/angiotensin receptor blockers, 86%. CONCLUSIONS: In this one-practice pilot-study, the SaM approach was employed with marked improvement in risk factor levels and use of appropriate medications. This may translate into reductions in morbidity and mortality in a larger population.

Adult↗
PubMed2005

[Rho/Rho kinase signal transduction pathway in cardiovascular disease and cardiovascular remodeling].

The small guanosine triphosphatase Rho and its target, Rho kinase, play important roles in both blood pressure regulation and vascular smooth muscle contraction. Rho is activated by agonists of receptors coupled to cell membrane G protein, such as angiotensin II and phenylephrine. Once Rho is activated, it translocates to the cell membrane where it, in turn, activates Rho kinase. Activated Rho kinase phosphorylates myosin light chain phosphatase, which is then inhibited. This sequence stimulates vascular smooth muscle contraction, stress fiber formation,and cell migration. In this way, Rho and Rho kinase activation have important effects on several cardiovascular diseases. Currently available substances that specifically inhibit this signaling pathway could offer clinical benefits in several cardiovascular, as well as noncardiovascular diseases, such as arterial hypertension, pulmonary hypertension, cerebral or coronary spasm, post-angioplasty restenosis, and erectile dysfunction.

Cardiovascular Diseases↗
PubMed2006

Estimated prevalence of cardiovascular disease and distribution of cardiovascular risk in New Zealanders: data for healthcare planners, funders, and providers.

AIMS: New Zealand cardiovascular risk management guidelines advocate targeted risk assessment based primarily on age, gender, and ethnicity--and recommend drug management for people with a 5-year absolute cardiovascular disease (CVD) risk greater than 15%. To inform service planning and healthcare delivery for district health boards and primary healthcare organisations in New Zealand, we have produced population estimates of CVD prevalence and 5-year absolute CVD risk. METHODS: The 1993 Auckland Heart and Health Study provided the data for estimating CVD prevalence and absolute CVD risk distributions using the Framingham CVD risk prediction equation. These estimates were applied to population projections for 2005 based on 2001 New Zealand Census data. RESULTS: Of the projected 2.09 million people aged over 35 years in New Zealand in 2005, approximately 1.5 million (72%) meet national criteria for formal CVD risk assessment. About 151,000 (7%) are estimated to have suffered a non-fatal heart attack or stroke or have angina. A further 262,000 (13%) are estimated to have a 5-year CVD risk greater than 15% based on New Zealand CVD risk charts. This represents around 1 in 5 adults over the age of 35 years in New Zealand for whom pharmacological interventions are recommended according to the New Zealand CVD risk guidelines for the prevention of new or further CVD events. CONCLUSIONS: The latest published data available on the burden of CVD risk in New Zealand is now over 10 years old and does not include Maori, Pacific, and other non-European ethnic groups. Current data on the risk profile of adult New Zealanders is required for more accurate service planning. However the information reported here provides a reasonable estimate of the magnitude of the task. Although systematic identification and management of CVD risk in New Zealanders with raised CVD risk will be a major undertaking for healthcare services, it has the potential to produce significant health-gains while reducing health disparities.

Adult↗
PubMed2005

Cardiovascular risk factors and risk behaviors in railway workers. Professional stress and cardiovascular risk.

UNLABELLED: The research considers the hypothesis that stressful professions, such as engine driver, influence the morbidity and mortality through cardiovascular diseases and favour some harmful habits with an impact upon cardiovascular morbidity. METHODS: There were selected for study 496 engine drivers, males, and a control group of 305 males. They were questioned about: name, address, family history, pathological personal history, alcohol intake, smoking, diet habits, physical activity, sleeping hours and stress perception. There were measured: height, weight, blood pressure. There were determined: fasting plasma glucose, cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. RESULTS: Hypertension was registered in 23.5% of the engine drivers and in only 9.5% the control group (P<0.05). Dyslipidemia was noted in 57.4% of the engine drivers and 52.45% of the control group. Prevalence of smoking and overweight was higher in the control group. Unhealthy dietary patterns and physical inactivity were present in both groups, the circadian rhythms were altered only for engine drivers and questionnaires for stress perception showed higher irritability in the control group. CONCLUSIONS: The prevalence of some risk factors is higher for engine drivers, but for the others it is not. Also it seems that professional stress favours some harmful habits such as tobacco smoking, but the control group smokes more and they are inactive individuals with a great amount of irritability. The results do not totally sustain the idea we started from, that engine driver is a stressful profession; it seems that the effort/reward imbalance is more important than job-demand itself.

Adult↗
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↗
PubMed1987

Cardiovascular risk factors from birth to 7 years of age: the Bogalusa Heart Study. Predictive value of parental measures in determining cardiovascular risk factor variables in early life.

Parent-child associations of height, weight, subscapular skinfold thickness, blood pressure, and serum lipids and lipoproteins were observed in a cohort of 440 infants and their parents in Bogalusa, LA. The infants were examined according to a standardized protocol six times from birth to 7 years of age, and the parents were examined when the child was 2 years old. Regression analyses were performed with the value of the cardiovascular risk factor variable for the child as the dependent variable and race, sex of child, and either mother's value, father's value, or both mother's and father's values as the independent variables. The most significant relationship between parents and their children was for height (P less than .005 at all ages of the child) and weight (P less than .05 from age 1 year for father's regression coefficient and at all ages for mother's regression coefficient). Regression coefficients for parental serum lipids and lipoproteins tended to increase with the child's age. Child-father regression coefficients and child-mother regression coefficients were generally significant (P less than .05) after age 2 years for total cholesterol. Less association was noted for triglycerides and lipoproteins. Parental diastolic BP was a poor predictor of children's values; the regression coefficients for systolic BP were higher and more significant. The longitudinal nature of this cohort study allows for examination of the changing patterns of familial association with aging and may provide insight as to the best age for examining children for cardiovascular risk factors to determine their relative risk for heart disease.

Adult↗
PubMed1998

[Cardiovascular effects of anesthesia. Management of cardiovascular therapy during the perioperative period].

General anesthesia changes circulatory haemodynamics in three ways: a decrease in sympathetic tone, a decrease in VO2, and a change in baroreceptor reflex function. These effects may have important consequences in patients with cardiovascular disease whose stability depends on these different factors. In addition, the anaesthesia should be adapted to the intensity of the surgical stimuli which tend to increase sympathetic activity, produce tachycardia and increase the blood pressure which may cause decompensation of some cardiac diseases (coronary artery disease for example). Drugs used in the treatment of cardiac disease may interfere with anaesthesia but they are usually continued in order to operate patients under stable cardiovascular conditions.

Anesthesia, General↗
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↗
PubMed1995

Guidelines for training in adult cardiovascular medicine. Core Cardiology Training Symposium (COCATS). Task Force 7: training in cardiovascular research.

It is vital to the future intellectual health of cardiovascular medicine and the welfare of patients with cardiovascular disease that all future cardiologists be familiar with the principles and tools of research. Training in research requires the intense involvement of productive and established investigators. Those trainees preparing for a career in investigative cardiology require a carefully developed but flexible educational plan that will permit them to be successful in their research careers over an extended period.

Adult↗
PubMed1995

Surveillance and ascertainment of cardiovascular events. The Cardiovascular Health Study.

While previous prospective multicenter studies have conducted cardiovascular disease surveillance, few have detailed the techniques relating to the ascertainment of and data collection for events. The Cardiovascular Health Study (CHS) is a population-based study of coronary heart disease and stroke in older adults. This article summarizes the CHS events protocol and describes the methods of surveillance and ascertainment of hospitalized and nonhospitalized events, the use of medical records and other support documents, organizational issues at the field center level, and the classification of events through an adjudication process. We present data on incidence and mortality, the classification of adjudicated events, and the agreement between classification by the Events Subcommittee and the medical records diagnostic codes. The CHS techniques are a successful model for complete ascertainment, investigation, and documentation of events in an older cohort.

Aged↗
PubMed2002

Can cardiovascular risk factors explain the association between education and cardiovascular disease in young women?

We sought to explain the observed variation in the relationship between education and cardiovascular disease (CVD) among young women in countries at different stages of economic development. Data comprised 2,478 cases of acute myocardial infarction (AMI) or stroke and 6,819 age-matched controls from Africa, Asia, Eastern Europe, and Latin America. The risks of AMI associated with lower education observed in Eastern Europe and higher education in non-European countries were reduced by 92% in Eastern Europe and totally abolished in non-European countries by adjustment for standard cardiovascular risk factors. The inverse associations between education and stroke risk in the three non-African regions were attenuated by 22, 47, and 60% after adjustment. In Africa, the slight inconsistent trend towards lower stroke risk in less well educated women was unaffected by adjustment. These data suggest that standard risk factors explain a substantial proportion if not all of the difference in AMI risk associated with education but a lesser proportion of educationally linked stroke risk.

Adult↗
PubMed1995

A regional collaborative effort for CQI in cardiovascular disease. Northern New England Cardiovascular Study Group.

BACKGROUND: The Northern New England Cardiovascular Disease Study Group has met at least three times a year since 1987 to improve the care of patients with cardiovascular disease. ADVANTAGES OF GROUP EFFORT: The group's collaborative nature has allowed members to have explicit discussions about medical decision making and practice and to benchmark with one another. By collaborating, members have been able to accumulate a large enough experience to examine the fine structure of adverse events, learn from them, and institute meaningful changes. IMPROVEMENT STRATEGIES: Focusing on coronary artery bypass grafting (CABG) procedures, the group has used three improvement strategies: (1) Outcomes are monitored across institutions. All members receive reports with information on their experience, their organization's experience, and the regional experience. (2) All members received training in quality improvement tools and techniques. (3) Members conduct comparative process analysis and benchmarking efforts to learn best practices for CABG surgery. RESULTS: The average in-hospital mortality associated with CABG surgery in the region has decreased. The group determined that low output failure is the most common cause of post-CABG death across all hospitals, while other causes of death (for example, stroke, bleeding, arrhythmias) have more uneven distributions across hospitals. Individual hospitals have investigated their more unique causes of death; the group as a whole has undertaken a detailed study of more than 400 deaths to determine why patients die of low output failure and what can be done about it. KEYS TO SUCCESS: Factors contributing to the group's success include the fact that a regionally recognized clinician spearheaded the effort, and a physician "carries the banner" at each institution; data, which are kept confidential, are analyzed and returned in a timely fashion so group members can examine their current, not just their past, practice; and there is an organized forum for data discussion.

Coronary Artery Bypass↗
PubMed2007

Comparison of gadolinium-enhanced cardiovascular magnetic resonance angiography with high-resolution black blood cardiovascular magnetic resonance for assessing carotid artery stenosis.

PURPOSE: Carotid angiography is used to assess stroke risk, but it cannot reliably characterize plaque burden because the vessel remodels during plaque formation. High-resolution black blood cardiovascular magnetic resonance (BBCMR) depicts the outer wall thereby providing a truer estimate of plaque size. We compared carotid stenosis by gadolinium enhancement cardiovascular magnetic resonance angiography (CMRA) versus high-resolution BBCMR. METHODS: Twenty-four subjects (M:F = 20:4; ages 57-83 years) with carotid atherosclerosis underwent CMRA and transaxial BBCMR through the stenosis. Area and diameter stenosis measurements by NASCET criteria using CMRA images were compared to area stenosis measurements based on outer wall and lumen contours drawn on corresponding BBCMR images. RESULTS: Area stenosis by CMRA correlated with area stenosis by BBCMR (r = 0.77; 95% CI: 0.58, 0.89). BBCMR values exceeded corresponding CMRA area measurements in 20 of 24 cases, with the remainder being highly stenotic (> 90%). CONCLUSION: CMRA yields lower estimates of luminal narrowing compared to BBCMR, which delineates the outer wall and accounts for vascular remodeling. BBCMR could serve as a new measure of narrowing to guide management, but prospective studies are needed to better understand the clinical implications of this new scale of disease.

Aged↗