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PubMedDate not supplied

A school-based intervention to teach third grade children about the prevention of heart disease.

Coronary heart disease continues to be a leading cause of death in adults. Because many risk factors for heart disease make their first appearance in childhood, early intervention is an attractive strategy for this disease. A convenience sample of 58 third grade children participated in a year-long, quasi-experimental study to compare a school-based educational program, HeartPower!, to the standard health education curriculum. Variables examined included knowledge, hypercholesterolemia, obesity, sedentary lifestyle, hypertension, exposure to cigarette smoke, and parental participation. The students who participated in the HeartPower! Program showed improvement (p < 0.05) in their knowledge of healthy lifestyles. Modest improvements in hypertension and exposure to tobacco smoke were observed. These results indicate that focused instruction on important health issues may be preferable to a broad approach.

Child↗
PubMed1986

Outcome of pregnancy in 110 patients with organic heart disease.

Organic heart disease is still one of the main causes of maternal and fetal mortality. The outcome of pregnancy in 110 patients with organic heart disease ranging from class I to IV (New York Heart Association Classification) was studied. The incidence of intrauterine growth retardation in the study group was examined with regard to severity of the disease. Birth weight was compared to that in a matched control group, and no statistically significant difference between the two groups was found.

Abortion, Spontaneous↗
PubMed1998

Women and heart disease.

Coronary heart disease and other vascular diseases account for approximately half of all deaths in women. Although the underlying pathophysiological processes (atherosclerosis and thrombosis) are similar, deaths and other clinical end-points are significantly delayed compared to men. The reason for this sex-related delay in the expression of vascular disease remains a matter of debate but may be largely attributable to the actions of endogenous oestrogens: coronary heart disease manifestations are extremely rare in premenopausal women but increase after the menopause. These observations have lead to speculation that oestrogen-replacement therapy might continue to retard the development of cardiovascular disease in the post-menopausal years (primary prevention). The cardioprotective benefits of oestrogens include a favourable impact on plasma lipids, anti-platelet effects, preservation of endothelium-mediated vasodilatation and antioxidant effects. Several observational studies support this thesis but the results of prospective randomised controlled trials are still awaited. Secondary preventative measures such as aspirin, beta-blockade, ACE inhibition and HMG-CoA reductase inhibitors seem to be equally effective for women as men. However, there remains evidence that physicians are less likely to use such interventions in women at high risk.

Estrogens↗
PubMed1993

Lipoprotein oxidation: the 'fruit and vegetable gradient' and heart disease.

Coronary heart disease is a major cause of premature death in Western societies. Oxidation of low density lipoproteins by oxygen free radicals provides a molecular link to the development of atherosclerosis. Free radical oxidations can usually be protected against by appropriate antioxidants. Recent studies suggest epidemiological correlations exist between the levels of plasma antioxidant vitamins and mortality from heart disease.

Free Radicals↗
PubMed1997

Left ventricular hypertrophy and coronary microcirculation in hypertensive heart disease.

Hypertensive heart disease is a major factor for left ventricular hypertrophy, the development of ischaemic syndromes, including coronary macro- and microangiopathy, and heart failure. Coronary microcirculation is impaired very early in the process of hypertensive heart disease, giving suspect that impaired coronary reserve is an early indicator for the conversion from the normal into the pathologic status. Alterations at the level of the interstitium with accumulation of collagen, of the intramyocardial resistance vessels with remodelling or hypertrophy of the vessel wall, of the endothelium with reduced vasodilators and increased vasoconstrictors as well as of the capillaries with a reduction in their numbers may all be involved in the process of the impaired coronary reserve. Therapeutic interventions by antihypertensive therapy can improve coronary reserve.

Coronary Circulation↗
PubMed1999

Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study.

BACKGROUND: Current definitions of hypertension are based on levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP), but not on pulse pressure (PP). We examined whether PP adds useful information for predicting coronary heart disease (CHD) in the population-based Framingham Heart Study. METHODS AND RESULTS: We studied 1924 men and women between 50 and 79 years of age at baseline with no clinical evidence of CHD and not taking antihypertensive drug therapy. Cox regression, adjusted for age, sex, and other risk factors, was used to assess the relations between blood pressure components and CHD risk over a 20-year follow-up. The association with CHD risk was positive for SBP, DBP, and PP, considering each pressure individually; of the 3, PP yielded the largest chi(2) statistic. When SBP and DBP were jointly entered into the multivariable model, the association with CHD risk was positive for SBP (HR, 1.22; 95% CI, 1.15 to 1.30) and negative for DBP (HR, 0. 86; 95% CI, 0.75 to 0.98). Four subgroups were defined according to SBP levels (<120, 120 to 139, 140 to 159, and >/=160 mm Hg). Within each subgroup, the association with CHD risk was negative for DBP and positive for PP. A cross-classification of SBP-DBP levels confirmed these results. CONCLUSIONS: In the middle-aged and elderly, CHD risk increased with lower DBP at any level of SBP>/=120 mm Hg, suggesting that higher PP was an important component of risk. Neither SBP nor DBP was superior to PP in predicting CHD risk.

Aged↗
PubMed1978

Left ventricular performance in various heart diseases with or without heart failure:--an appraisal by quantitative one-plane cineangiocardiography.

Quantitative one-plane cineangiocardiography in right anterior oblique position for evaluation of LV performance was carried out in 62 patients with various heart diseases and in 13 subjects with normal LV. Parameters for evaluating both pump and muscle performances were derived from volume and pressure measurements. Of 31 patients with either systolic hypertension or LV myocardial diseases (coronary artery disease or idiopathic cardiomyopathy), 14 had clinical evidence of LV failure before the study. It was found that mean VCF and EF were most sensitive indicators of impaired LV performance among the various parameters. There was a close correlation between mean VCF and EF, yet discordant changes of both parameters were noted in some patients. Furthermore, wall motion abnormalities were not infrequently observed in patients with coronary artery disease or primary cardiomyopathy. Therefore, assessment of at least three ejection properties (EF, mean VCF and wall motion abnormalities) are considered to be essential for full understanding of derangement of LV function in heart disease. This is especially true of patients with coronary artery disease. LV behavior in relation to different pathological stresses or lesions, such as chronic pressure or volume load, myocardial disease and mitral stenosis, was also studied and possible cause of impaired LV myocardial function in mitral stenosis was discussed.

Adolescent↗
PubMed1987

Forecasting coronary heart disease incidence, mortality, and cost: the Coronary Heart Disease Policy Model.

A computer simulation model was developed to project the future mortality, morbidity, and cost of coronary heart disease (CHD) in the United States population. The model contains a demographic-epidemiologic (DE) submodel, which stimulates the distribution of coronary risk factors and the conditional incidence of CHD in a demographically evolving population; a "bridge" submodel, which determines the outcome of the initial CHD event; and a disease history (DH) submodel, which simulates subsequent events in persons with a previous CHD event. The user of the model may simulate the effects of interventions, either preventive (i.e., risk factor modification) or therapeutic, upon mortality, morbidity, and cost for up to a 30-year period. If there were no future changes in risk factors or the efficacy of therapies after 1980, baseline projections indicate that the aging of the population, and especially the maturation of the post-World War II baby-boom generation, would increase CHD prevalence and annual incidence, mortality, and costs by about 40-50 per cent by the year 2010. Unprecedented reductions in risk factors would be required to offset these demographic effects on the absolute incidence of CHD. The specific forecasts could be inaccurate, however, as a consequence of erroneous assumptions or misestimated baseline data, and the model awaits validation based on actual future data.

Adult↗
PubMed2006

[Rheumatic fever and rheumatic heart disease].

Rheumatic heart disease, the sequel of acute rheumatic fever, is a very common cause of cardiovascular mortality and morbidity all over the world, and is the predominant indication for cardiac surgery in the industrialized countries. Diagnosis of rheumatic chronic carditis may sometimes be difficult because valvular regurgitation may not always be detected by routine clinical auscultation. A recent report from the World Health Organization Expert Committee recognizes the usefulness of echocardiography Doppler in providing supporting evidence for diagnosis of rheumatic carditis in the presence of equivocally pathological murmur, and recommends that patients with subclinical carditis should be managed as rheumatic heart disease until proven otherwise, because the disease still represents a major health problem. The aim of this review is to give an update on the disease by underlining changes made by the World Health Organization on disease diagnosis and patient management.

Adolescent↗
PubMed1995

Doppler echocardiographic assessment of valvular heart disease in patients requiring hemodialysis for end-stage renal disease.

Valvular heart disease accounts for considerable morbidity and some mortality among patients with end-stage renal disease (ESRD). To determine the prevalence and severity of valvular and perivalvular abnormalities, including valvular thickening, stenosis, calcification, regurgitation, and mitral annular calcification (MAC), and the impact of age and duration of dialysis on valvular disease in these patients, we reviewed Doppler echocardiograms in 75 consecutive patients requiring hemodialysis for ESRD. Our results showed that valvular sclerosis, calcification, and MAC were common in patients requiring hemodialysis; valvular regurgitation was both more prevalent and more severe in hemodialysis patients than in "normal subjects"; and age of the patient and duration of dialysis were related to the prevalence of valvular disease in ESRD. These findings suggest that Doppler echocardiography should be frequently used to assess possible valvular heart disease in patients receiving hemodialysis for ESRD, particularly older patients, those who have received dialysis for several years, and those with suspected valvular disease based on history and physical examinations.

Adult↗
PubMed2005

Pregnancy in women with congenital heart disease.

Congenital heart disease is the most common form of structural heart disease affecting women of childbearing age in developed countries. Pregnancy in these patients is associated with an increased risk to both mother and fetus. Appropriate prepregnancy evaluation and counseling is recommended to assess the pregnancy-related maternal and fetal risk and to identify patients who should avoid pregnancy. Once pregnancy occurs, cardiovascular reevaluation is generally recommended; the frequency is individualized. Monitoring during delivery may be necessary and the postpartum period is a concern in select individuals. Data regarding the outcome of pregnancy in patients with operated congenital cardiac defects are available. Individualized care is mandatory.

Adult↗
PubMed1990

Orthotopic heart transplantation for complex congenital heart disease.

Orthotopic heart transplantation has become standard therapy for end-stage cardiomyopathy in children and adults, but there has been much less experience with transplantation for complex congenital heart disease. In this report experience with orthotopic transplantation in seven children with various forms of complex congenital heart disease is reviewed. Diagnoses included hypoplastic left heart syndrome in two (after stage I palliation), left ventricular diverticulum in one, single ventricle in two (dextrocardia, atrial situs inversus, and total anomalous pulmonary venous return in one patient and post-Fontan repair in the second), D-transposition of the great arteries and ventricular septal defect (post-Senning repair and ventricular septal defect closure) in one, and Ebstein's anomaly with biventricular dysplasia in one. Six of the seven were hospital survivors and there has been one late death at 2 1/3 years. Modifications of the standard operative technique to fit the anatomic variations in these defects are reviewed.

Adolescent↗
PubMed1977

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California. Coronary heart disease risk factors in Japan and Hawaii.

Various risk factors were evaluated to explain a significantly greater incidence of coronary heart disease in men of Japanese ancestry resident in Hawaii compared with men resident in Japan. The independent predictors of incidence of coronary heart disease in both Japan and Hawaii were systolic blood pressure, serum cholesterol, relative weight and age. These factors appeared to influence incidence similarly in both areas because in each case the correlation coefficients for Japan and Hawaii did not differ significantly. The hypothesis that the greater incidence in Hawaii could be attributed to differences in levels of these risk factors was tested with the Walker-Duncan method. The four variable multiple logistic function describing the probability of coronary heart disease in Japan was applied to the cohort characteristics observed in Hawaii. The estimated incidence thus obtained was not significantly different from that actually observed in the men resident in Hawaii. Therefore the increased coronary risk profile in Hawaii compared with Japan can account for the greater incidence of coronary heart disease in the former. Current cigarette smoking was significantly related to the risk of coronary heart disease in Hawaii but not in Japan. This difference requires further investigation.

Age Factors↗