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PubMedDate not supplied

Comparison of risk factors of macrovascular complications. Peripheral vascular disease, cerebral vascular disease, and coronary heart disease in Japanese type 2 diabetes mellitus patients.

Although macroangiopathies such as peripheral vascular disease (PVD), cerebral vascular disease (CVD), and coronary heart disease (CHD) can often be observed in patients with diabetes mellitus, they are not specific for diabetes mellitus. Moreover, it is unclear whether their progressive mechanism is different. In the present study, we compared the risk factors among the diabetic macrovascular complications. Univariate analyses showed that in all patients, age at examination, duration of diabetes, thrombin-antithrombin III complex (TAT) level, fibrinogen level, lipoprotein (a) (Lp(a)) level, total cholesterol (T-Chol) level, and existence of microagiopathy were risk factors for PVD. Age, duration of diabetes, insulin level, TAT level, fibrinogen level, HDL cholesterol (HDL-Chol) level, hypertension, and nephropathy were risk factors for CVD. Only fibrinogen level was a risk factor for CHD. Moreover, Lp(a) level was a risk factor for PVD and CVD in male patients, but not in females. On the other hand, insulin level was a risk factor for CVD in female patients, but not in males. Multivariate analyses showed that TAT level, T-Chol level, and neuropathy were independent variables for PVD and that age, TAT level, and HDL-Chol level were independent variables for CVD. On the other hand, only fibrinogen level was the independent variable for CHD in males. Our results suggest that the progressive mechanism of PVD and CVD might be different from that of CHD and might differ according to gender in Japanese diabetic patients.

Blood Glucose↗
PubMed1998

Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women.

OBJECTIVE: To study abnormalities in the resting ECG as independent predictors for all cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in a population based random sample of men and women, and to explore whether their prognostic value is different between sexes. DESIGN AND SUBJECTS: An age and sex stratified random sample was selected from the total Belgian population aged 25 to 74 years. Baseline data were gathered and resting ECGs were classified according to Minnesota code criteria. The sample was then followed for at least 10 years with respect to cause specific death. Results are based on observations from 5208 men and 4746 women free from prevalent CHD at the start of the follow up period. RESULTS: Although the prevalence of major abnormalities in general was comparable between sexes, women had more ischaemic findings, ST segment changes, and abnormal T waves on their baseline ECG, while men showed more arrhythmias, bundle branch blocks, and left ventricular hypertrophy. Fitting the multiplicative effect on subsequent mortality between all ECG classifications under study and sex indicated that the prognostic value of ECG changes was equal in women and men. Independently of other risk factors and other major ECG changes, almost all ECG classifications were significantly related to all cause, CVD, and CHD mortality. The most predictive ECG findings for CVD death were ST segment depression (risk ratio (RR) 4.71), major ECG findings (RR 3.26), left ventricular hypertrophy (RR 2.79), bundle branch blocks (RR 2.58), T wave flattening (RR 2.47), ischaemic ECG findings (RR 2.35), and arrhythmias (RR 2.15). The prognostic value of major ECG findings for CVD and CHD death was more powerful than well established cardiovascular risk factors. CONCLUSIONS: Abnormalities in the baseline ECG are strongly associated with subsequent all cause, CVD, and CHD mortality. Their predictive value was similar for men and women.

Adult↗
PubMed2006

Tumor necrosis factor-alpha downregulates the voltage gated outward K+ current in cultured neonatal rat cardiomyocytes: a possible cause of electrical remodeling in diseased hearts.

BACKGROUND: Inflammatory cytokines have been reported to contribute to the progression of cardiac remodeling in various heart diseases and a remarkable prolongation of the monophasic action potential duration and reductions in the expression of Kv4.2 and K+ channel-interacting protein-2 (KChIP-2) in a rat autoimmune myocarditis model have been documented. In this study, the effect of tumor necrosis factor-alpha (TNF-alpha) on cultured cardiomyocytes was evaluated, focusing on the change in the voltage-gated outward K+ current and expression of related molecules. METHODS AND RESULTS: Cardiomyocytes isolated from 1-day-old Lewis rats were cultured for 72 h and treated with TNF-alpha (50 ng/ml) for an additional 48 h. The myocytes treated with TNF-alpha showed a 22% reduction in the peak K+ current, which consisted of a transient outward K+ current (Ito) and 1.4-fold enhancement of the cell-capacitance in comparison with the control. Among the cardiac ion channel related molecules evaluated in this study, Kv4.2 and KChIP-2 mRNA exhibited remarkable reductions (p < 0.05). CONCLUSIONS: Treatment with TNF-alpha induced reductions in Ito as well as cellular hypertrophy in neonatal cultured myocytes, which indicates that TNF-alpha might play a role in promoting electrical remodeling of cardiomyocytes under inflammatory conditions.

Action Potentials↗
PubMed1993

Atherosclerosis and coronary heart disease.

Coronary heart disease is the largest cause of morbidity and mortality in the UK. The disease develops by the interaction of a variety of environmental agents in people who may be genetically susceptible. Some of the environmental agents can be favourably altered by adjustments to lifestyle, particularly by stopping smoking, increasing exercise levels and controlling the diet. Coronary heart disease is manifested by a number of symptoms due to the partial or complete occlusion of the coronary arteries by a fibrous plaque. The processes of plaque formation can begin very early on in life and progress through various stages. The process may be initiated by injury to the endothelial lining but can also occur in areas without obvious injury. Diagnosis of coronary heart disease is largely by electrocardiographic measurements and a variety of imaging modalities and laboratory investigations. Treatment centres upon the medical control of the symptoms, or surgical intervention in the form of a coronary bypass operation or by coronary angioplasty.

Arteriosclerosis↗
PubMed1995

Ventricular tachyarrhythmias, myocardial ischemia, and sudden cardiac death in patients with hypertensive heart disease.

Hypertensive heart disease is increasingly considered to be a strong and independent risk factor for sudden cardiac death. Ventricular tachyarrhythmias in these patients are common and mainly the result of electrophysiologic abnormalities and increased electrical vulnerability of the hypertrophic myocardium. However, proarrhythmia in the hypertrophic heart often is facilitated and aggravated by electrolyte disturbances, the sympathoadrenergic tone, transient blood pressure crisis, and especially by the occurrence of myocardial ischemia. Myocardial ischemia in the setting of hypertensive heart disease may result from stenotic lesions in large and/or small coronary artery vessels and, in the absence of both, will result from the altered cellular oxygen supply and consumption in the hypertrophic myocardium. Recent studies have shown that acute and transient myocardial ischemia are common in many hypertensives, often fail to be symptomatic, and that the dynamic interaction of left ventricular hypertrophy, transient myocardial ischemia, and ventricular tachyarrhythmias may provide a crucial link for the high incidence of sudden cardiac death in patients with hypertensive heart disease.

Antihypertensive Agents↗
PubMed1986

Eight-year follow-up results from the Rome Project of Coronary Heart Disease Prevention. Research Group of the Rome Project of Coronary Heart Disease Prevention.

The Rome Project of Coronary Heart Disease Prevention is a primary preventive trial carried out among 6,027 working men ages 40-59; 3,131 constituted the treatment group and the remaining 2,896 the control group. The preventive action aimed at reducing mean levels of serum cholesterol (generally through dietary prescription and, in a small number of subjects, by drug treatment), high blood pressure (by drugs), smoking habits (by advice to reduce or stop smoking), overweight (by means of diet), and sedentary lifestyle by increased physical activity). The treatment was carried out during a 6-year period and consisted of individual sessions administered to about one-third of higher-risk subjects, while mass education was administered to all men allocated to treatment. No intervention was offered to the control group. The mean changes in levels of the main coronary risk factors in the treatment vs the control group were computed in different ways. Net changes in the treatment group after 6 years, after adjustment for several confounding variables, were -0.71% for body weight, +0.77% for the cigarette consumption, -3.00% for systolic blood pressure, -5.39% for serum cholesterol, and -18% for the estimated multivariate coronary risk. After 8 years of observation, mortality from all causes was lower by 9.8% (one-tailed P = 0.140) in the treatment than in the control group, whereas mortality from coronary heart disease was lower by 23.7% (one-tailed P = 0.059). The incidence of fatal plus nonfatal coronary heart disease events (hard criteria), which could be measured only for the first 6 years, was reduced by 30.9% (one-tailed P = 0.005) in the treatment as compared with the control group.

Adult↗
PubMed1994

[Pathological classification and clinical implications on rheumatic heart disease with giant heart].

Between Jan. 1982 and July, 1993, 102 patients with rheumatic giant heart disease (cardio-thoracic ratio > or = 0.8) underwent valve replacement. Heart functional class III was in 54 patients, and class IV in 48. Early mortality was 8.8%, late mortality 3.6%. We classified the patients into five types, based on the valvular lesions, dilated degree of each atrial and ventricular chamber: Type I, giant left atrium (LA); Type II, obvious enlargement of LA and left ventricle (LV); Type III; obvious enlargement of LA, right atrium and ventricule (RA and RV); Type IV; all chambers obviously dilated; Type V, giant LA and RA. Clinical results showed that this kind of classification can reflect kinds of diseased valves, pathophysiological changes and clinical characteristics, and postoperative early and late outcomes, also can offer useful suggestions to operative method selection, and has great clinical significance for perioperative management.

Adolescent↗
PubMed1979

[Frequency of peripheral arterial occlusive disease in patients with coronary heart disease with and without infarction (author's transl)].

In 107 consecutive patients the frequency of peripheral arterial occlusive disease in coronary heart disease was assessed by selective coronary angiography and sonographic Doppler pressure estimation. Among 75 patients with coronary heart disease 21 (28%) had arterial occlusive disease, among 32 patients without coronary heart disease only one (3%). There was no statistically significant correlation between the severity of both diseases. 40 out of 75 patients with coronary heart disease had suffered from cardiac infarction. Infarction frequency showed a highly significant correlation with increasing severity of the coronary heart disease, but none with increasing severity or frequency of arterial occlusive disease. When there was no arterial occlusive disease all degrees of severity of coronary heart disease were found. Analysing the literature it becomes evident that coronary heart disease is frequently an isolated or premature manifestation of arteriosclerosis.

Adolescent↗
PubMed1995

[The usefulness of portable 24-hour polygraphic monitoring--evaluation of autonomic nervous activity of the patients with ischemic heart disease by using heart rate variability during sleep].

Portable 24-hour polygraphic monitorings were performed on 109 cases with neurological or cardiovascular disorders, sleep disturbances and metabolic diseases to clarify its usefulness and limitations. Moreover, an evaluation of autonomic nervous activity was done in different stages of sleep in normal young (n = 9), normal middle-aged subjects (n = 8) and patients with ischemic heart disease (n = 7) using power spectral analysis of heart rate. The parameters recorded in this study were electroencepharogram(EEG), electrooculogram, electromyogram of chin muscles, electrocardiogram, respiratory curve, walking pulse and body position. Using polygraphic monitoring, the patients with cardiac arrhythmia showed abnormal EEG in 20% and those with neurological events in 86.7%. The improvement of sleep structure was found after pacemaker implantation in the patients with bradyarrhythmias (75%). Time spans of slow wave sleep and REM sleep of patients with ischemic heart disease decreased significantly from 120.9 +/- 40.6 min to 79.1 +/- 25.3 min, 112.8 +/- 16.5 min to 63.6 +/- 23.6 min, respectively (p < 0.05). RR50, that is number of R -R intervals greater than 50msec compared to the preceding R-R interval, decreased significantly in each stage of sleep in the patients with ischemic heart disease compared to normal subjects (stage 2: 18.3 +/- 6.1/min to 3.8 +/- 3.0/min, p < 0.01; SWS: 7.8 +/- 8.0/min to 3.2 +/- 2.5/min, p < 0.05; REM: 17.9 +/- 6.0/min to 4.4 +/- 4.3/min, p < 0.01). The HF power in all stages of sleep showed a trend of the decrease in the patients with ischemic heart disease. In REM sleep, the LF power in patients with ischemic disease was lower significantly compared to that in normal middle-aged subjects (6.1 +/- 3.2 to 12.1 +/- 4.1, p < 0.05). The L/H ratio also decreased significantly (1.08 +/- 0.30 vs. 2.35 +/- 1.03, p < 0.05). The slope of 1/fx above 0.15Hz in IHD patients was less in stage 2 (-0.404 +/- 0.280 vs. -0.849 +/- 0.183, p < 0.01) and in REM sleep (-0.294 +/- 0.368 vs. -0.665 +/- 0.291, p < 0.05). Above results suggest the involvement of a decrease of sympathetic activity in addition to decrease of parasympathetic activity especially in REM sleep in the patients with ischemic heart disease. In conclusion, polygraphic monitoring is useful for a detection of abnormality of EEG and an evaluation of autonomic activity in cardiovascular disorders.

Adult↗
PubMed1990

Prevalence of coronary heart disease in Scotland: Scottish Heart Health Study.

Data from 10,359 men and women aged 40-59 years from 22 districts in the Scottish Heart Health Study were used to describe the prevalence rates of coronary heart disease in Scotland in 1984-1986 and their relation to the geographical variation in mortality in these districts. Prevalence was measured by previous history, Rose chest pain questionnaire, and the Minnesota code of a 12 lead resting electrocardiogram. The prevalence of coronary heart disease in Scotland was high compared with studies from other countries that used the same standardised methods. A history of angina was more common in men (5.5%) than in women (3.9%), though in response to the Rose questionnaire 8.5% of women and 6.3% of men reported chest pain. A history of myocardial infarction was three times more common in men than women, as was a Q/QS pattern on the electrocardiogram. There were significant correlations between the different measures of coronary prevalence. District measures of angina correlated well with mortality from coronary heart disease, and these correlations tended to be stronger in women than in men. There was no significant correlation between mortality from coronary heart disease and measures of myocardial infarction. The study provides data on the prevalence of coronary heart disease in men and women that are valuable for the planning of cardiological services.

Adult↗
PubMed2003

Determinants of appropriate lipid management in patients with ischaemic heart disease. Cracovian Program for Secondary Prevention of Ischaemic Heart Disease.

UNLABELLED: Although several randomised clinical trials have documented the efficacy of lipid-lowering therapy in improving clinical outcomes in hyperlipidemic subjects with ischaemic heart disease (IHD), such therapy is underutilized worldwide. Not much is known about the effects of the hospital setting (university vs. community) on lipid management in patients after hospitalization due to ischaemic heart disease. The combined effect of age, sex, education, risk factors, hospital as well as practice setting in the post-discharge period on lipid management in IHD patients is also unknown. Therefore the aim of this study was to evaluate factors influencing lipid management during and after hospitalization due to IHD. The primary outcome measure was "appropriate lipid management", defined as: (a) being discharged on lipid-lowering medication or having a documented LDL cholesterol level <3.4 microM/l within the first 24 h of hospitalization, and (b) (for patients with hypercholesterolemia) being prescribed a lipid-lowering drug at the time of the interview 6-18 months after discharge. METHODS AND RESULTS: We reviewed the hospital records of 1051 consecutive patients with a discharge diagnosis of acute myocardial infarction (N=290), unstable angina (N=247), percutaneous coronary intervention (N=259) or coronary artery bypass surgery (N=255) who were hospitalized at three university (N=533) or three community (N=518) cardiac departments. Overall, 42.2% of the study population met the criteria for appropriate lipid management during hospitalization. Admission to the university hospital, percutaneous coronary intervention, a history of myocardial infarction, the presence of hypertension, the absence of diabetes mellitus, and younger age were all associated with an increased probability of receiving proper treatment during hospitalization. During the follow-up interview (6-18 months after discharge), 10.4% patients had a LDL cholesterol level of <2.6 microM/l. The use of lipid-lowering agents in the group with hypercholesterolemia was 40.8%. Patients who met the criteria for appropriate lipid management during hospitalization were more often prescribed a lipid-lowering drug at the time of interview compared with persons who did not meet those criteria (62.5% vs. 23.5%; P<0.0001). Patients undergoing percutaneous coronary interventions, treated in hospital outpatient clinics, obese patients as well as those better educated were more likely to be treated appropriately than the other groups. CONCLUSIONS: Proper lipid management during hospitalization is the most important factor related to lipid management in the post-discharge period. There is the potential for a further reduction of coronary risk, especially in patients hospitalized in community hospitals, not undergoing coronary interventions and those being under the care of general practitioners.

Comorbidity↗
PubMedDate not supplied

[The EMEA CHMP guidelines in coronary heart disease and chronic heart failure].

The official regulatory recommendations for drug development and the granting of marketing authorisations are intended for use by pharmaceutical companies and the regulatory agencies. These recommendations are particularly useful in Europe, and allow harmonisation of the regulatory requirements between the different member states, thus facilitating further evaluation of the submission file and the registration process. The European guidelines are issued by the Committee for Human Medicinal Products (CHMP) of the European Agency for the Evaluation of Pharmaceutical Products (EMEA). The key points of the current guidelines regarding applications for phase III trials in coronary heart disease (stable angina, acute coronary syndromes) and chronic heart failure are presented. They are as follows: the definition of selected populations, the choice of criteria for evaluating efficacy and safety, the choice of comparators, and study duration etc.

Cardiovascular Agents↗
PubMed2003

[Parameters of spectral-temporal maps of signal averaged ECG in patients with ischemic heart disease and chronic heart failure].

Signal averaged ECG was registered in 57 patients with chronic heart failure due to ischemic heart disease and either accelerating or stable class III effort angina. Analysis of parameters of spectral-temporal maps showed that high local activity in terminal portion of ventricular and atrial complexes reflected heterogeneity of depolarization of atrial and ventricular myocardium. These changes correlated with presence of atrial and ventricular late potentials and could be used as markers of electrical instability of the myocardium.

Chronic Disease↗
PubMed1994

[Low serum TSH levels in patients with emergent conditions due to ischemic heart disease or congestive heart failure].

We investigated the pathophysiological and clinical significance of thyroid stimulating hormone (TSH) levels in patients within 4 days after onset of ischemic heart disease (IHD) or aggravation of congestive heart failure (CHF) due to myocardial infarction. We classified patients into 3 groups: 1) angina pectoris (AP) group [n = 66, 62 years (Mean)], 2) acute myocardial infarction (AMI) group (n = 58, 65 years) and 3) CHF group (n = 16, 68 years). Soon after admission, blood samples were obtained to measure TSH by the IRMA method. Blood samples for creatine phosphokinase (CPK) were obtained every 3 hours. All patients showed TSH levels that were normal or below normal. Those in whom TSH levels were below normal, were defined as "low TSH" patients. The incidence of low TSH patients in the CHF group (31.3%) was significantly higher (p < 0.05) than that in the AP group (4.5%). In the AMI group, plasma CPK activity of 5037 +/- 1102 U/l (Mean +/- SEM) in low TSH patients were significantly higher (p < 0.05) than that of 1931 +/- 255 U/l in patients with normal TSH levels. These results indicate that in patients with extensive myocardial cell damage, "low TSH" frequently develops during emergency.

Aged↗