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PubMed1996

Reliability of data from proxy respondents in an international case-control study of cardiovascular disease and oral contraceptives. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.

STUDY OBJECTIVES: To evaluate the reliability of data supplied in a case-control study by proxy respondents for cases who were too ill to do so themselves. DESIGN: A hospital based, case-control study of the current use of oral contraceptives (OC) and cardiovascular diseases. Data from "true" controls matched to a subset of cases were compared with those supplied by proxy respondents about the true controls. SETTING: Hospitals in 21 centres from Africa, Asia, Europe, and Latin America. PATIENTS AND PARTICIPANTS: For a subset of cases, 403 pairs of controls-one "true" and one proxy-were interviewed. "True" controls were matched by age, place, and time of admission and were admitted with 1 of 27 permissible diagnoses not associated with OC use. Proxy controls were either relatives or friends of true controls. MAIN RESULTS: Levels of concordance between data from proxy and true controls were high for most variables regarding recent events, including current OC use, but were greatly diminished when detailed information, particularly from the past, was required. Husbands were usually the best proxy, although this was question-specific. The sensitivity and specificity of proxy responses were 93% (95% confidence intervals: 77%, 99%) and 100% (98%, 100%) respectively, for current use of OC. Assuming the misclassification of current OC use by proxy cases is similar to that produced by proxy controls, the estimated impact of using proxy data on risk estimates associated with current OC use was to bias the overall estimate of risk of stroke by less than 3% and the risks of both acute myocardial infarction and venous thromboembolism by less than 1%. CONCLUSIONS: Friends or relatives, and particularly husbands, provided reliable information when used as proxy respondents for young women. The estimated impact of misclassification by proxy respondents on overall risk estimates in the WHO collaborative study was less than that which would have arisen if information from proxy respondents had not been used.

Adult↗
PubMed1988

Blood rheology associated with cardiovascular risk factors and chronic cardiovascular diseases: results of an epidemiologic cross-sectional study.

As part of an epidemiologic cross-sectional study to determine cardiovascular (CV) risk factors in the population (total serum cholesterol, smoking, blood pressure, and body weight) hemoglobin (Hb) and plasma viscosity (PV) were measured. A two-stage cluster sample of 5,312 persons, aged twenty-five to sixty-four (available 5,069) was selected from a mixed urban-rural target population of 282,279 inhabitants, from which 4,022 (79.3%) participated in the study. Patients with chronic myocardial infarction (MI), cerebral infarction (CI), angina pectoris (AP), and peripheral arterial disease (PAD) were identified by questionnaire. The results show that there is no age or sex dependency of PV in healthy participants, while hemoglobin shows the well-known sex difference. In contrast, PV increases continuously with age in the total population. In men, increased PV is found in untreated hypertension, in hypercholesterolemia, and in smokers. In women, it is raised in hypercholesterolemia and in gross obesity. Male MI patients and patients of both sexes after CI in particular show statistically significantly elevated PV. Finally, in male patients with chronic AP or patients of both sexes with PAD, PV is elevated and a tendency to higher Hb values is seen. These results confirm smaller clinical trials suggesting that blood fluidity is pathologically altered in patients with CV risk factors or diseases. Since impaired blood fluidity may worsen the hemodynamic situation, in particular in patients with limited vasomotor reserve, hemorheologic parameters may be of prognostic relevance. Therapeutic implications of these findings should be considered.

Adult↗
PubMed1985

Intervention on cardiovascular disease risk factors in Finnmark county: changes after a period of three years. The Cardiovascular Disease Study in Finnmark County, Norway.

In Finnmark county in Norway, 12 329 males and females aged 20-49 years participated in two screening examinations with an interval of 3 years. The primary health service attempted, without receiving any extra resources, to reduce the risk of cardiovascular disease by means of a personal intervention programme among high-risk individuals and a health education programme directed at all residents in the county. During these 3 years the serum total-cholesterol (cross-sectionally) level decreased on average by about 0.3 mmol/l due to: firstly, a decrease among persons recommended a follow-up examination and secondly a decrease among household members of persons followed-up. The effect of a recommendation to attend a follow-up examination because of high blood pressure was doubtful. Cigarette consumption (cross-sectionally) decreased 12% for males and 4% for females. The joint decrease (improvement) in risk factors indicates a possible health benefit of about 20%, calculated in terms of myocardial infarction over 10 years.

Adult↗
PubMed2005

Long-term impact of a community pharmacist intervention on cholesterol levels in patients at high risk for cardiovascular events: extended follow-up of the second study of cardiovascular risk intervention by pharmacists (SCRIP-plus).

STUDY OBJECTIVE: To determine the effect of a community pharmacist intervention in patients at high risk for coronary heart disease on low-density lipoprotein cholesterol (LDL) levels 1 year after completion of the Second Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP- plus ). METHODS: Patients who completed the original study were invited to make a single return visit to their community pharmacy so that the pharmacist could measure their fasting LDL level using a point-of-care device. The primary outcome was change in LDL level from the 6-month (final) visit to the extended follow-up evaluation. RESULTS: Of the 359 patients who completed the original 6-month visit, data were collected for 162 (45%) patients. The mean +/- SD LDL level at completion of the original study was 107.9 +/- 33.6 mg/dl (2.79 +/- 0.96 mmol/L) (an increase of 2.7 mg/dl [0.07 mmol/L], 95% confidence interval -19.3-7.3 [-0.5-0.19]). Sixty-one (38%) patients were at the target LDL level (< 96.7 mg/dl [< 2.50 mmol/L]). CONCLUSION: The LDL reduction was maintained 1 year after completion of the extended follow-up. Since most patients were still not at the target LDL level, this finding suggests that continuing intervention is necessary to help patients reach this target.

Aged↗
PubMed2003

Managing cardiovascular risk reduction in elderly adults. By promoting and monitoring healthy lifestyle changes, health care providers can help older adults improve their cardiovascular health.

Primary care practitioners must explore the most effective techniques for promoting cardiovascular risk reduction in older adults. Managing lifestyle modification risk factors, such as smoking cessation, obesity, sedentary lifestyle, and nutrition is discussed in this article. Other risk factor modification efforts, often not highlighted, include managing homocysteinemia, and sedentary behavior. These factors are presented as equally important modifiable coronary heart disease risks.

Aged↗
PubMed1999

[Cardiovascular risk factors in Italy: an interpretation with reference to th National Health Plan 1998-2000. Research Group of the Cardiovascular Epidemiologic Observatory].

The data submitted were collected throughout 1998 in 34 cardiology centers or divisions within the Cardiovascular Epimediological Observatory (Osservatorio Epidemiologico Cardiovascolare), in a general population sample of 3222 men and 3192 women aged 35 to 74 years. Each center screened 200 individuals (100 men and 100 women) randomly selected from the electoral rolls. The data constitute an updated reference benchmark for the health status of the Italian population at the end of the Nineties. It also represents a useful source of information for attainment of the objectives pursued by the National Health Plan 1998-2000: a healthier diet, increased physical activity and reduced smoking. The proportion of hypertensives receiving adequate treatment and the high prevalence of individuals with "undesirable" cholesterol levels are problems that should be dealt with following the preventive actions indicated in the National Health Plan for 1998-2000.

Adult↗
PubMedDate not supplied

[Management of essential arterial hypertension and cardiovascular risk levels. Observation in general medicine: national PHENOMEN study. Evaluation and stratification of cardiovascular risk based on the 2000 ANAES recommendations in a population of hypertensive patients].

OBJECTIVE: To define the prevalence of cardiovascular risk (CVR) levels in a population of hypertensive patients (whether treated or not) monitored by General Practitioners, using the stratification system proposed by the ANAES in 2000. METHODS: Between January and July 2001, a nation-wide survey was carried out based on a representative sample of 8,177 General Practitioners spread evenly throughout all of the 22 administrative regions in France. The evaluation of CVR levels took into account blood pressure readings as well as CVR factors and indicators. RESULTS: This survey covered 16,358 patients (53.2% men, 46% women; mean age = 62.5 +/- 11.9 years; BMI = 27.3 +/- 4.5 kg/m2) with a mean history of hypertension of 7 +/- 7 years. The most common CVR factors were dyslipidemia (59.5%), smoking (19%) and diabetes (16%). Concomitant target organ damage was recorded in 17% and heart disease in 21.8%. One patient in four had more than three CVR factors; respectively 56.5%, 30.9% and 12.5% of the patients had mild, moderate or severe hypertension. More than 50% of the patients were classified as being at "high" or "very high" CV risk. The distribution of risk levels was similar throughout the country with a North-South gradient of the high/very high levels. Only 17% of the patients being treated had completely normal blood pressure (< 140/190 mmHg), although 19% more count as normal if the limit values are included. CONCLUSION: The main objective of this large-scale, nation-wide epidemiological survey was to evaluate how well CVR is being managed in a representative sample of patients with high blood pressure. In general, none of the risk factors is adequately controlled, especially in populations considered as being at high CVR. Moreover, the notion of CVR has only been partially assimilated by General Practitioners.

Aged↗
PubMed1990

Cardiovascular risk factors and health behavior: some preliminary findings from the Cardiovascular Diseases and Alimentary Comparison Study.

This paper presents some preliminary findings from one particular Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study data collection center. The population and the environment of the Western Isles, Scotland, from where the subjects were drawn, are described. The methodology was as according to the CARDIAC Study protocol. The results show that in this population there is a high mean serum total cholesterol level, a high prevalence of smokers, and a high mean body mass index. However, knowledge, attitudes, and reported behavior change regarding diet were encouraging. Much further data processing work remains to be done.

Adult↗
PubMed1990

Cardiovascular, pulmonary, and cancer rehabilitation. 2. Cardiovascular considerations in the rehabilitation of the disabled.

This self-directed learning module addresses core concepts in the application of principles of cardiac rehabilitation for the physically disabled population. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section contains general and athletic conditioning programs for the disabled, rehabilitation of the disabled with coexisting cardiac disease (including modified exercise tolerance testing, cardiac demands of rehabilitation programs, and cardiac precautions), and peripheral circulatory dysfunction (arterial, venous, and lymphatic).

Bibliographies as Topic↗
PubMed1990

Cardiovascular, pulmonary, and cancer rehabilitation. 1. General principles of cardiovascular rehabilitation.

This self-directed learning module highlights advances in this topic area. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in Physical Medicine and Rehabilitation. This section reviews the anatomy of the heart, physiology of exercise training, pathophysiology and clinical aspects of cardiac conditions frequently encountered in rehabilitation, cardiac evaluation techniques, physical conditioning for normal persons, and rehabilitation of the patient with heart disease. Advances that are covered in this section include indications for cardiac rehabilitation following coronary artery bypass graft compared with percutaneous transluminal coronary angioplasty and exercise testing and physical conditioning of patients on long-term beta-adrenergic blockade or with severe left ventricular dysfunction.

Bibliographies as Topic↗
PubMed1990

[The pathomorphology and pathogenesis of acute cardiovascular failure in swine. 3. Histopathologic findings in the myocardium of swine with transport-related cardiovascular insufficiency].

Quantitative pathohistological investigations were performed on 300 samples of five different myocardial regions from 50 pigs with had suffered stress-related myocardial insufficiency on their transport to the slaughterhouse (transport exhaustion). The findings were compared to 1,200 myocardial samples from 200 clinically intact pigs for slaughter. Animals with transport-related damage exhibited with significance more and more severe inflammatory and degenerative myocardial alterations, such as round-cell infiltration, fiber necrosis, calcification, and fat infiltration. Many of these lesions had been manifest already prior to transport. Myocardially predamaged pigs were less capable than others of sustaining transport stress and were more predisposed to cardiac failure. Stress-related cardiovascular insufficiency, consequently, depended not only on direct stress but also on the general health condition of the myocardium. Causes and pathogenetic relevance of these alterations are discussed in some detail.

Acute Disease↗
PubMed1989

[Basic principles of the prevention of cardiovascular diseases in light of knowledge and opinions of the Polish community. I. Knowledge of the causes of the spreading epidemic of cardiovascular diseases].

The study was carried out in October 1986, using interview method by means of standardized questionnaire. The interview comprised a random sample of the whole country population aged above 15 years and including 2000 subjects. The largest group was formed by respondents aged 20--30 years, representatives of urban population, having education level below secondary, employed as manual workers. About 34% of men and 41% of women were, to a great extent, interested in cardiovascular problems (CVD). The main source of information on CVD were mass media. About 95% of respondents thought that CVD prevalence was very high. Among factors likely to influence CVD mortality, the respondents mentioned environmental contamination, nervous work, obesity, smoking and consumption of alcohol.

Adolescent↗
PubMed1986

Concentrations of sex-hormone binding globulin and corticosteroid binding globulin in serum in relation to cardiovascular risk factors and to 12-year incidence of cardiovascular disease and overall mortality in postmenopausal women.

We determined sex-hormone binding globulin (SHBG) and corticosteroid binding globulin (CBG) by radioimmunoassay of serum samples from a group of 253 women, who were 54 or 60 years old when first studied in 1968-69. The SHBG concentration was highly significantly and inversely related to body mass, body mass index, waist-to-hip circumference ratio, and serum triglyceride concentration; CBG concentration was inversely related to body mass and body mass index. The concentration of neither protein was related to whether or not the subject smoked. Decrease in the concentration of SHBG, but not of CBG, was a significant risk factor for 12-year overall mortality. The plot of the 12-year incidence of myocardial infarction vs SHBG concentration was U-shaped. We recommend that SHBG be included when serum androgens or estrogens are being evaluated as risk factors for cardiovascular disease and death.

Adipose Tissue↗
PubMedDate not supplied

[Guidelines for the elaboration of programs for the primary prevention of cardiovascular diseases. The Working Group for Primary Cardiovascular Prevention].

This paper, elaborated by consensus between experts from Scientific Societies and the Health Administration, is aimed at providing general guidelines for the elaboration and prompting of cardiovascular disease primary prevention programmes, through individual risk factors screening and control. It is expected to be helpful for primary care professionals. After reviewing the rationale and logistics of the programmes starting in the Spanish context, an outline for the risk screening and assessment of the individuals attending the health services is set out. The strategies for high risk individuals control and the periodic health examination of low risk subjects are developed, emphasizing the multifactorial approach. Lastly operational criteria for the management of each risk factor taking simultaneously into account the whole risk picture, embracing definition criteria and consensus recommendations, are stated.

Adult↗
PubMed1996

Risk factors for cardiovascular disease in obese and normal school children: association of insulin with other cardiovascular risk factors.

OBJECTIVE: To investigate the level of insulin and other known cardiovascular risk factors in school children and their association with obesity. DESIGN: Cross-sectional study. SUBJECTS: 123 normal and 116 obese school children categorized by weight-for-height, mean age: 10.2 and 10.5 years old respectively. MEASUREMENTS: Family histories of diseases by questionnaires; blood pressure (BP) and waist and hip circumferences by measurements; fasting blood for glucose, insulin, total cholesterol, HDL-cholesterol and triglycerides. RESULTS: The numbers of boys in the normal and obese group were 65 and 58, those of the girls, 53 and 63 respectively. The obese group was more likely to have family histories of obesity, high blood pressure and diabetes; had significantly greater waist-hip-ratio (WHR), higher systolic and diastolic BP, lower HDL-cholesterol, higher triglyceride and fasting insulin levels (with fasting blood sugar in the normal range) than the normal weight group. In a crude analysis, insulin levels were positively correlated with obesity, systolic BP, WHR, age and triglycerides and negatively associated with male gender and HDL-cholesterol. After adjustment using multiple regression, only obesity status, age, gender and triglycerides still remained significantly associated with insulin level. Limitation of utilizing family disease history report for identification of children at risk was discussed. CONCLUSION: These findings suggest that risk to coronary heart disease and hypertension through insulin resistance already operates in school-aged children.

Analysis of Variance↗
PubMed1998

Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.

This report describes the first study to evaluate the risks of cardiovascular disease (CVD) associated with the use of oral and injectable progestogen-only and combined injectable contraceptives. Based on combined data from Africa, Asia, Europe, and Latin America collected in the World Health Organization (WHO) Collaborative Study, odds ratios (OR) for CVD combined, strokes, venous thromboembolism (VTE), and acute myocardial infarction (AMI) were calculated. Among 3697 CVD cases (59% stroke, 31% VTE, and 10% AMI), 53, 37, and 13 women, respectively, were current users of oral and injectable progestogen-only and combined injectable contraceptives. Overall, the adjusted OR for all CVD combined compared with nonusers of any type of steroid hormone contraceptive (SHC) associated with current use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives, respectively, were 1.14 (95% CI: 0.79-1.63), 1.02 (0.68-1.54), and 0.95 (0.49-1.86). No significant changes in OR were apparent for strokes, VTE, or AMI in association with any of these types of contraception. However, a small, nonsignificant increase in OR for VTE was apparent in association with oral and injectable progestogen-only contraceptives. Among women with a history of hypertension, OR for stroke, as compared with that for nonusers of any type of SHC with no history of hypertension, rose from 7.2 (6.1-8.5) among nonusers of any type of SHC to 12.4 (4.1-37.6) among current users of all oral progestogens. Although limited by the small number of cases and control subjects using the types of contraceptives under investigation, these data suggest that there is little or no increased risk of stroke, VTE, or AMI associated with the use of oral or injectable progestogen-only or combined injectable contraceptives. However, further investigation into a possible adverse effect on stroke risk of progestogen-only contraceptives used by women with a history of high blood pressure are indicated.

Adolescent↗