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PubMed1991

Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease. The Caerphilly and Speedwell collaborative heart disease studies.

BACKGROUND: Recent studies have suggested that hemostatic factors and white blood cell count are predictive of ischemic heart disease (IHD). The relations of fibrinogen, viscosity, and white blood cell count to the incidence of IHD in the Caerphilly and Speedwell prospective studies are described. METHODS AND RESULTS: The two studies have a common core protocol and are based on a combined cohort of 4,860 middle-aged men from the general population. The first follow-up was at a nearly constant interval of 5.1 years in Caerphilly and 3.2 years in Speedwell; 251 major IHD events had occurred. Age-adjusted relative odds of IHD for men in the top 20% of the distribution compared with the bottom 20% were 4.1 (95% confidence interval, 2.6-6.5) for fibrinogen, 4.5 (95% confidence interval, 2.8-7.4) for viscosity, and 3.2 (95% confidence interval, 2.0-4.9) for white blood cell count. Associations with IHD were similar in men who had never smoked, exsmokers, and current smokers, and the results suggest that at least part of the effect of smoking on IHD is mediated through fibrinogen, viscosity, and white blood cell count. Multivariate analysis shows that white blood cell count is an independent risk factor for IHD as is either fibrinogen or viscosity, or possibly both. Jointly, these three variables significantly improve the fit of a logistic regression model containing all the main conventional risk factors. Further, a model including age, smoking habits, fibrinogen, viscosity, and white blood cell count predicts IHD as well as one in which the three hemostatic/rheological variables are replaced by total cholesterol, diastolic pressure, and body mass index. CONCLUSION: Jointly, fibrinogen, viscosity, and white blood cell count are important risk factors for IHD.

Blood Viscosity↗
PubMed2004

Focused screening for occult carotid artery disease: patients with known heart disease are at high risk.

OBJECTIVES: Stroke puts a major financial burden on our healthcare system. However, carotid duplex scanning performed as a screening test for occult carotid artery stenosis (CAS) currently is not reimbursed by Medicare. The goals of this study were to develop a cost-effective stroke screening program, to determine the prevalence of potential causes of stroke in this population, and to define a population at high risk in which screening would be most effective. METHODS: In a community-based stroke screening program, patients were eligible if they were older than 60 years and had a history of either hypertension, heart disease, or cigarette smoking, or a family history of stroke. Screening included blood pressure determination, an electrocardiographic rhythm strip, and a previously validated modified carotid duplex ultrasound examination to detect CAS 50% or greater. The relationships between standard demographic risk factors and screening outcomes were analyzed. RESULTS: Screening was performed in 610 patients. Unilateral or bilateral CAS was detected in 66 patients (10.8%). The finding of occult CAS was more prevalent than that of new hypertension (2.6%) or new atrial fibrillation (0.5%). Patients with known hypertension were significantly more likely to have CAS than were those without hypertension (12.7% vs 7.8%; P =.05). Patients with heart disease were significantly more likely to have CAS than were those without heart disease (18.2% vs 8%; P <.0001). Patients with both risk factors were significantly more likely to have occult carotid artery disease than were patients without either risk factor (22.1% vs 8.5%; P <.0001). Multivariate analysis with logistic regression revealed a history of heart disease as an independent predictor of occult carotid artery disease (odds ratio 95% confidence interval, 1.4-4.4). Type of heart disease was not a significant factor in predicting occult CAS. Direct cost of the screening, including community outreach, nurses, technicians, support staff, and miscellaneous expenses, was less than $75 per patient. CONCLUSIONS: In a screening program for treatable causes of potential stroke, CAS was the most commonly diagnosed disease. More than one of every five patients with known hypertension and heart disease had occult CAS. Known heart disease of any type was a significant independent predictor of occult CAS. Screening for treatable causes of potential stroke can be cost-effective. This information could help to further target populations to screen for occult CAS and to justify reimbursement for screening carotid duplex scanning examinations.

Aged↗
PubMed2006

Periodontal disease and coronary heart disease.

BACKGROUND: Several epidemiological studies have demonstrated an association between periodontal disease and coronary heart disease (CHD). The association could be a result of confounding by mutual risk factors. The present study was undertaken in a Danish population to reveal the significance of common risk factors. METHODS: The investigation was conducted as a case-control study comprising 250 individuals: 110 individuals with verified CHD from a Department of Cardiovascular Medicine and 140 control individuals without CHD from the Copenhagen City Heart Study. Information on diabetic status, smoking habits, alcohol consumption, physical activity, school attendance, household income, body weight and height, triglyceride, and serum cholesterol was obtained. Full-mouth probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP), and alveolar bone level (ABL) on radiographs were registered. ABL was stratified into ABL1=ABL 2 to 4 mm. Multiple logistic regression models with stepwise backward elimination were used allowing variables with P<0.15 to enter the multivariate analysis. RESULTS: The CHD group had a significantly lower outcome with respect to PD, BOP, CAL, and ABL. For participants<60 years old, only risk factors such as smoking and diabetic status entered the multivariate analysis. For the ABL3 group, there was a significant association with CHD for participants<60 years old, the odds ratio being 6.6 (1.69 to 25.6). For participants>or=60 years old, there was no association. CONCLUSIONS: The present study showed a positive association between periodontal disease and CHD in agreement with several other studies. The association was highly age dependent and could only be attributed to diabetes and smoking to some extent.

Age Factors↗
PubMed1991

Development of cardiac failure by coronary small vessel disease in hypertensive heart disease?

In essential hypertension, ventricular function is determined primarily by the degree of hypertrophy (myocardial factor) and by organic complications in the coronary artery (coronary factor). Ventricular function is inversely correlated with ventricular size and systolic wall stress, inasmuch as ventricular function diminishes when these two variables increase. Even the young hypertensive heart of normal size with no angiographic abnormalities appears to be prone to ischemia, because the coronary reserve is seriously limited even in the absence of coronary stenosis. Unlike ventricular distensibility, myocardial compliance may be normal, even in the presence of pronounced myocardial hypertrophy. As myocardial compliance decreases, systolic wall stress increases and ventricular function is reduced. The hypertensive heart, the most common form of an irregular hypertrophy of the ventricular wall, is found in 14% of such cases. Analysis of the degree of hypertrophy shows that the hypertrophy can be inappropriately high (high mass-to-volume ratio, reduced wall stress), appropriate, or inappropriately low (normal mass-to-volume ratio, increased wall stress). One of the profound mechanisms influencing both myocardial and coronary function in hypertensive heart disease is the pressure-dependent development of smooth vascular hypertrophy (media) or coronary resistance vessels. Consequently, the oxygen supply to the myocardium is impaired and secondary lesions occur such as fibrosis, increased myocardial and perivascular collagen content and scars within the heart muscle. Diastolic dysfunction develops, as well as an increase in myocardial stiffness, thus promoting the transition from the concentric (compensated) to the eccentric or dilated (decompensated) state, with the consequence of the occurrence of cardiac failure. On the basis of both functional and morphological criteria, evidence is presented in this report that coronary small vessel disease is one of the underlying mechanism for the development of cardiac failure in hypertensive heart disease.

Cardiomegaly↗
PubMed1992

Plasma triglyceride and high density lipoprotein cholesterol as predictors of ischaemic heart disease in British men. The Caerphilly and Speedwell Collaborative Heart Disease Studies.

OBJECTIVE: To assess the roles of plasma triglyceride and high density lipoprotein (HDL) cholesterol concentrations in predicting ischaemic heart disease. DESIGN: Two prospective cohort studies with common core protocols. SETTING AND PARTICIPANTS: Both cohorts are 100% samples of middle aged men. In Caerphilly the 2512 men were living within a defined area. In Speedwell the 2348 men were registered with local general practitioners. MAIN OUTCOME MEASURES: Fasting blood samples were taken at initial examination and plasma lipid concentrations were measured. Major ischaemic heart disease events were assessed from hospital notes, death certificates, and electrocardiograms. RESULTS: At first follow up, after an average of 5.1 years in Caerphilly and 3.2 years in Speedwell, 251 major ischaemic heart disease events had occurred. Men with triglyceride concentrations in the top 20% of the distribution had a relative odds value for ischaemic heart disease of 2.3 (95% confidence interval (95% CI) 1.3 to 4.1) compared with men in the bottom 20%, after adjusting for both plasma total and HDL cholesterol, and non-lipid risk factors. Men in the lowest 20% of the distribution of HDL cholesterol concentration had a relative odds value of 1.7 (95% CI 1.0 to 2.8) compared with the top 20%, after adjustment was made for total cholesterol and triglyceride concentrations, and non-lipid risk factors. These relations were not caused by beta blockers, which were being taken by 5% of the men. CONCLUSIONS: Plasma triglyceride concentration predicts major ischaemic events after allowance is made for total and HDL cholesterol concentrations and other risk factors. In these populations, triglyceride is a more important predictor than total cholesterol concentration.

Adrenergic beta-Antagonists↗
PubMed2002

Effect of pravastatin-induced LDL-cholesterol reduction on coronary heart disease and cerebrovascular disease in Japanese: Hokuriku lipid coronary heart disease study-pravastatin atherosclerosis trial (Holicos-PAT).

The purpose of Holicos-PAT was to investigate the efficacy of serum lipid lowering by pravastatin against coronary heart disease (CHD) and cerebrovascular disease (CVD) in the Japanese population. Hypercholesterolemic men and women (n = 2,232), aged 40-70 years, were followed up for 5 years, while they were receiving pravastatin (group P, n = 1,422) or only diet therapy (group C, n = 810). The primary endpoint was CHD (a composite of onset or worsening of angina pectoris, performing CABG or PTCA, non-fatal myocardial infarction, death from CHD including heart death or sudden death). The secondary endpoints were comprised of CVD, total mortality, variation of serum lipid and apoprotein levels, and a relationship between the LDL-C level and occurrence of CHD. For several reasons (proving to meet the exclusion criteria after registration, etc.), 1,290 cases of group P and 749 cases of group C were used as subjects for the primary analysis. The mean follow-up period was 4.5 years in group P and 4.2 years in group C for events of CHD. The mean LDL-C level (SD) in group P was 176 (29) mg/dl and decreased to 134 (29) mg/dl one year later. This effect continued during the follow-up period.CHD events occurred in 9.2/1000 patient-years for men and 2.4/1000 patient-years for women without a history of CHD.CHD events occurred in 55.3/1000 patient-years for men and 23.6/1000 patient-years for women with a history of CHD, which was 6 times higher in men and 10 times higher in women than in those without a history of CHD, respectively. The adjusted relative risk ratio of group P to group C for CHD events was 0.74 (95%CI: 0.47-1.19). In the patients with a history of CHD, the ratio was 0.55 (95%CI: 0.30-1.00). The effect was apparent in the patients with a history of CHD. The incidence of myocardial infarction in Japanese patients with hypercholesterolemia living in the Hokuriku district was apparently lower, than the worldwide incidence, indicative that pravastatin may have a tendency to inhibit the occurrence of events of arteriosclerotic disease.

Adult↗
PubMed1978

Relation of lipids, weight and physical activity to incidence of coronary heart disease: the Puerto Rico heart study.

The 2 1/2 year incidence of coronary heart disease was examined in relation to antecedent serum cholesterol and fasting triglyceride levels, physical activity status and relative weight in a cohort of 8,171 urban and rural men 45 to 64 years old participating in the Puerto Rico Heart Program. In this population with a low incidence rate of coronary heart disease, risk of coronary disease was related to serum cholesterol in both urban and rural groups, but this trend was statistically significant only in the urban population. Neither the urban nor the rural population showed a substantial or statistically significant association of serum triglyceride levels with incidence of coronary heart disease. Correlations among relative weight and serum triglyceride and serum cholesterol levels were noted. Despite small differences in incidence of coronary heart disease between urban and rural groups, values for serum cholesterol, triglycerides and relative weight were all significantly higher in the urban men. Only physical activity levels were higher in the rural men. Multivariate analysis, performed to sort out the net effects of these interrelated variables, revealed that serum cholesterol is related to the risk of coronary heart disease even when all variables are taken into account. Low levels of physical activity were significantly associated with a greater incidence of coronary heart disease only in urban men (P less than 0.05). Overweight, which was associated with higher lipid values and less physical activity, was not related to the development of coronary heart disease in either the urban or the rural cohort.

Body Weight↗
PubMed1997

Hazards, risks, and threats of heart disease from the early stages to symptomatic coronary heart disease and cardiac failure.

The epidemiologic approach to investigation of atherosclerotic cardiovascular disease has provided many insights into the preclinical and clinical spectrum of the disease. The hazard of developing atherosclerotic cardiovascular disease is substantial with coronary heart disease (CHD), the most common and most lethal feature. The outlook in those who manage to survive the initial episode is also serious, with a 10-year mortality rate of 37% for persons with angina and a 55% rate for those sustaining a myocardial infarction. Fifteen percent of persons developing CHD present with a fatal event, and 38% of infarctions go unrecognized. The presence of atherosclerosis in one vascular territory imposes an increased risk of its appearing in another area at two to six times the general population rate. The major cardiovascular risk factors adversely affect all arterial vascular territories so that correction of risk factors targeted at one particular atherosclerotic outcome may also favorably influence the other risk factors. Coronary disease is the most prevalent lethal hazard of hypertension, dyslipidemia, glucose intolerance, and cigarette smoking. These risk factors cluster and optimal therapy must improve the whole risk profile. Women share the same risk factors for CHD as men. Although women have a lower absolute risk for most risk factors, a high total/HDL cholesterol ratio, left ventricular hypertrophy, and diabetes each tend to eliminate the female advantage. Menopause also promptly escalates risk threefold. Although women tend to have a lower incidence than men, the initial attack is just as highly lethal in women, and their subsequent outlook as survivors is at least as serious as for men. Sudden death is a pre-eminent feature of coronary disease and cardiac failure. Coronary disease increases sudden death risk 3.3-fold and cardiac failure 4.8-fold. Sudden death incidence varies in relation to the same cardiovascular risk factors as coronary heart disease, with no unique risk factors identified. However, multivariate combinations of these in a profile can identify high-risk candidates for sudden death as well as coronary attacks in general. The key to prevention of sudden death is to prevent coronary attacks and cardiac failure. Despite aggressive cardiac revascularization and treatment of hypertension, congestive heart failure (CHF) has not decreased in prevalence, and innovations in the treatments of overt failure have not substantially improved survival. Median survival is only 1.7 years for men and 3.2 years for women. The conditional probability of developing CHF can be estimated using a logistic function comprised of age, systolic pressure, vital capacity, heart rate, ECG-left ventricular hypertrophy (LVH), glucose intolerance, x-ray enlargement, and presence of CHD and heart murmurs. Eighty percent of CHF events occur in persons in the upper quintile of multivariate risk. Continued clinical, metabolic, and epidemiologic research have expanded and refined atherosclerosis risk factors. The lipid connection is now concerned with the apoprotein makeup of the lipids, subfractions of lipids, and Lp(a). The diabetic influence is now focused on insulin resistance. Ambulatory monitoring is being used to evaluate blood pressure and silent ischemia. Fibrinogen and leukocyte counts have emerged as possible indicators of unstable lesions. Prospects for primary and secondary prevention are good if public health measures, health education, and preventive medicine are implemented based on existing knowledge of correctable or avoidable risk factors. The potential for more effective prevention continues to expand, and great advances have already been made in countries where aggressive preventive measures have been implemented to correct the major established risk factors.

Age Factors↗
PubMed2000

Periodontal disease and coronary heart disease risk.

CONTEXT: Research has suggested a relationship between periodontal disease and coronary heart disease (CHD), but data on the association between these 2 common conditions are inconclusive due to the possibility of confounding. OBJECTIVE: To evaluate the risk of CHD in persons with periodontitis, gingivitis, or no periodontal disease. DESIGN: Prospective cohort study. SETTING: The First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, conducted in 1982-1984, 1986, 1987, and 1992. PARTICIPANTS: A total of 8032 dentate adults aged 25 to 74 years with no reported history of cardiovascular disease, including 1859 individuals with periodontitis, 2421 with gingivitis, and 3752 with healthy periodontal tissues. MAIN OUTCOME MEASURE: First occurrence of death from CHD or hospitalization due to CHD, or revascularization procedures, obtained from death certificates and medical records, by baseline periodontal status. RESULTS: During follow-up, 1265 individuals had at least 1 CHD event, including CHD fatality (n = 468) or at least 1 hospitalization with a diagnosis of CHD (n = 1022), including coronary revascularization procedures (n = 155). After adjustment for known cardiovascular risk factors, gingivitis was not associated with CHD (hazard ratio, 1.05; 95% confidence interval, 0.88-1.26), while periodontitis was associated with a nonsignificant increased risk for CHD event (hazard ratio, 1. 14; 95% confidence interval, 0.96-1.36). CONCLUSION: This study did not find convincing evidence of a causal association between periodontal disease and CHD risk. JAMA. 2000;284:1406-1410.

Adult↗
PubMed2000

[Application of aortocoronary shunting in patients with ischemic heart disease and congestive heart failure].

In 280 patients with an ischemic heart disease and congestive heart failure the aortocoronary shunting was performed. While doing the heart catheterization there was established complete overlap or significant stricture of 3.9 coronary arteries or branches at average per one patient. Selective operation was done in 242 (86%) patients, urgent--in 28 (10%), reoperation--in 10 (3.6%). Operative mortality was 2.5% (7 patients died).

Aged↗
PubMed1997

Communication and choice in dying from heart disease.

In heart disease palliative care has received less attention than in cancer. In the Regional Study of Care for the Dying, carers of a random sample of deaths in 20 English health districts were interviewed about 10 months after the death. There were 675 respondents for patients dying with heart disease, and we report data on 600 deaths that were not sudden. 54% of patients died in hospital, 30% in their own home, 11% in a nursing or residential home, and 4% in other places. Half the patients were said to have known, or probably known, that they were likely to die; of these, 82% were said to have worked this out for themselves rather than been told by a doctor or nurse. More than one-third of patients (39%) died without an informal carer present. Respondents said that a quarter of the patients had wanted to die earlier: this desire was associated with older age and the number and severity of symptoms. The study suggests the need for health services to give greater attention to palliative care for patients dying with heart disease.

Attitude to Death↗
PubMed2004

Determinants of perceived health in families of patients with heart disease.

BACKGROUND: Heart disease is a severe long-term illness, which often requires lifestyle changes and self-care and affects the life of the whole family. Perceived family health is highly complex. It combines people's values and everyday experiences, such as knowledge about their own health, what they do to promote their health, how their life progresses, and how they feel physically and emotionally. AIM: The aim of this paper is to report a study to describe the perceived health of families of patients with heart disease and to ascertain factors related to family health. METHODS: Data were collected by questionnaire with a convenience sample of 161 family members of patients receiving treatment on two medical wards of a university hospital in southern Finland. Data were analysed using means and medians and tested by parametric and non-parametric tests. A stepwise regression analysis was also used. RESULTS: The most important predictors of family health were family structural factors, effect of illness symptoms on daily life, and family relationships. The strongest predictor was family structural factors. It was found that the better the family structure and relationships, the better the family health. Similarly, the greater the effect of the illness on the patient's daily life, the worse the family health. CONCLUSION: The findings suggest that supporting family functioning in the families of people with heart disease is an important challenge for family nursing.

Adaptation, Psychological↗
PubMed1998

Clinical and haemodynamic correlates of heart rate variability in children with congenital heart disease.

UNLABELLED: Heart rate variability (HRV) represents a noninvasive parameter for studying the autonomic control of the heart. Cardiac patients have a complex autonomic disturbance. The relation of HRV to this abnormality in children with congenital heart disease (CHD) has not yet been examined. The present study examined HRV indices from 24 h Holter recordings in 258 children with an operated or non-operated CHD, to determine their differences as an indicator of the severity of heart disease. The latter was defined clinically as New York Heart Association (NYHA) functional classes I to IV and haemodynamically by invasive parameters. Five time-domain measures (SDNN, SDNNi, SDANNi, rMSSD and pNN50) and three frequency-domain measures (LF, HF and balance LF/HF) were compared with normal ranges. HRV was reduced in children with CHD, except in patients of NYHA class I. The level of reduction depended on the NYHA functional class. None of the measures was significantly related to haemodynamic data. CONCLUSION: Heart rate variability is reduced in children with Congenital heart disease depending on the functional limitation but not on haemodynamic disturbances. Heart rate variability indices are sensitive markers of the clinical state.

Adolescent↗
PubMed1990

Family history of ischemic heart disease with respect to mean twin-pair cholesterol and subsequent ischemic heart disease in the NHLBI twin study.

This study examines the independent and interactive effects of family history scores (FHxS) for the prevalence of ischemic heart disease with plasma lipids and subsequent morbidity and mortality from ischemic heart disease. FHxS were calculated for 514 sets of middle aged male twins who participated in the entry examination of the NHLBI Veteran twin study in 1969-1973. Comparison of the FHxS with the level of plasma total cholesterol and HDL cholesterol (HDLc) paralleled earlier reported findings in young adults; individuals with high total cholesterol in two exams 8-12 years apart had significantly (P less than .01) higher FHxS. The same relationship was noted when using the mean twin-pair cholesterol level at the initial exam when the twins were in their 40s. Using the pair means over two exams as the cotwins aged into their 50s, the association of FHxS with total cholesterol declined and pairs with HDLc persistently in the highest quintile at both exams had significantly (P less than .01) lower FHxS. The changes in the pattern of association of lipid fractions with FHxS with age parallel the reported age decline of total cholesterol as a risk factor for heart disease. Assessment of ischemic heart disease events up to January 1988 revealed a highly significant association (P less than .0001) of later ischemic heart disease events with FHxS. At each level of lipid categorization pairs who later had events had higher FHxS than those without any subsequent heart disease; these differences were significant in all but the low risk lipid groups (low total cholesterol, high HDLc, and low total cholesterol/HDLc ratio). We conclude that FHxS is related to total cholesterol and HDLc but also is an independent predictor of subsequent ischemic heart disease after 14-18 years of follow-up.

Adult↗
PubMed1992

Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study.

OBJECTIVE: To investigate in the prospective Helsinki Heart Study, whether chronic Chlamydia pneumoniae infection, indicated by elevated antibody titers against the pathogen, chlamydial lipopolysaccharide-containing immune complexes, or both, is a risk factor for coronary heart disease. DESIGN AND SETTING: The Helsinki Heart Study was a randomized, double-blind, 5-year clinical trial to test the efficacy of gemfibrozil in reducing the risk for coronary heart disease. Participants were randomized to receive either gemfibrozil (2046 patients) or placebo (2035 patients). Fatal and nonfatal myocardial infarction and sudden cardiac death were the main study end points. Serum samples were collected at 3-month intervals from all patients. PATIENTS: One hundred forty cardiac events occurred during the follow-up period. Serum samples from 103 case patients obtained 3 to 6 months before a cardiac end point were matched with those from controls for time point, locality, and treatment. Samples were tested for markers of chronic chlamydial infection. MEASUREMENTS: Immunoglobulin A (IgA) and G (IgG) antibodies to C. pneumoniae were measured using the microimmunofluorescence method. Lipopolysaccharide-containing immune complexes were measured using two antigen-specific enzyme immunoassays, the lipopolysaccharide-capture and immunoglobulin M (IgM)-capture methods. MAIN RESULTS: Using a conditional logistic regression model, odds ratios for the development of coronary heart disease were 2.7 (95% CI, 1.1 to 6.5) for elevated IgA titers, 2.1 (CI, 1.1 to 3.9) for the presence of immune complexes, and 2.9 (CI, 1.5 to 5.4) for the presence of both factors. If we adjusted for other coronary heart disease risk factors such as age, hypertension, and smoking, the corresponding values would be 2.3 (CI, 0.9 to 6.2), 1.8 (CI, 0.9 to 3.6), and 2.6 (CI, 1.3 to 5.2), respectively. CONCLUSION: The results suggest that chronic C. pneumoniae infection may be a significant risk factor for the development of coronary heart disease.

Adult↗