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Black-white differences in subclinical cardiovascular disease among older adults: the Cardiovascular Health Study. CHS Collaborative Research Group.

Cardiovascular and all-cause mortality are higher in black than white Americans, but racial differences in clinical and subclinical cardiovascular disease (CVD) have not been examined in older adults. Clinical and subclinical CVD and its risk factors were compared in 4926 white and 244 black men and women aged 65 years and older. Black participants had lower socioeconomic status and generally higher prevalences of CVD and its risk factors, except for adverse lipid profiles. Common carotid wall thickness was greater in black than white women, and ankle-arm blood pressure ratios were lower in black women and men (p < 0.01). After adjustment for CVD risk factors, common carotid walls were significantly thicker and ankle-arm ratios were lower in blacks than whites of both sexes, while internal carotid walls were significantly thinner in black women. Racial differences in clinical and subclinical CVD in older adults are similar to those reported in younger populations and do not appear to be explained by CVD risk factors.

Aged↗

[Epidemiology of cardiovascular diseases: role of ovarian hormones].

Cardiovascular diseases represent the major cause of mortality in industrialized countries, including Switzerland, and affect a large percentage of hospitalized patients and patients seen in outpatient clinics. Recently, a decline in the incidence of cardiovascular diseases has been observed, associated with a general improvement in prognosis. This has been attributed to progress achieved in the treatment of many cardiovascular diseases, and to a better identification and treatment of various risk factors. Differences in the clinical manifestations of cardiovascular diseases have been observed between men and women. Women seem to be protected until the time of menopause. In this review, various epidemiological aspects of cardiovascular diseases in men and women are discussed.

Adult↗

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↗

[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↗

Low prevalence of influenza vaccination among people with cardiovascular disease--BRFSS.

BACKGROUND: People with cardiovascular disease are at high risk of complication from influenza. However, little is known about influenza vaccine coverage among this population. METHODS: Using 2002 Behavioral Risk Factor Surveillance System data, the authors studied the prevalence of influenza vaccination in the previous 12 months among participants aged > or = 18 years with cardiovascular disease or hypertension. RESULTS: After adjustment for age, gender, race/ethnicity, and education, the prevalence of influenza vaccination ranged from 35.9% to 42.6%. The prevalence was particularly low among participants with cardiovascular disease aged 18-49 years (range, 23.9% to 42.2%). The prevalence of influenza vaccination varied considerably between states among people with hypertension (range, from 30.2% to 45.9%) and those with other cardiovascular diseases (range, from 37.0% to 51.5%). CONCLUSIONS: Influenza vaccination levels are low among people with cardiovascular disease, especially those less than 50 years old. They should be encouraged to receive an annual influenza vaccination to avoid cardiovascular complications from influenza.

Adolescent↗

Incidence of cardiovascular disease in older Americans: the cardiovascular health study.

OBJECTIVES: To estimate incidence rates of major cardiovascular disease (CVD) in older Americans. DESIGN: Longitudinal cohort study using prospectively collected data on cardiovascular events. SETTING: Four U.S. communities in the Cardiovascular Health Study (CHS). PARTICIPANTS: Five thousand eight hundred eighty-eight participants in CHS, aged 65 or older at enrollment, including 3,393 women (581 African American) and 2,495 men (343 African American). MEASUREMENTS: At semiannual contacts, participants reported any occurrence of clinical CVD. Medical records were obtained and adjudicated to confirm diagnosis of CVD. RESULTS: During 10 years of follow-up, incidence of coronary heart disease (CHD) per 1,000 person-years was 39.6 (95% confidence interval (CI)=36.4-43.1) in men and 22.3 (95% CI=20.4-24.2) in women. Cumulative event rates for CHD and myocardial infarction for women aged 75 and older at baseline were similar to those for men aged 65 to 74. The overall incidence of stroke was similar for men and women (14.7 (95% CI=13.0-16.6) and 13.7 (95% CI=12.4-15.1) per 1,000 person-years, respectively), but the risk of stroke increased with age more rapidly in women, resulting in a greater cumulative event rate for stroke in women than in men aged 75 and older. The incidence of congestive heart failure increased 9% with each year of age over 65 and was greater than 6% per year in Caucasian men and women aged 85 and older at baseline. Rates were similar in African Americans and Caucasians. CONCLUSION: The occurrence of new CVD in older Americans is high, indicating that preventive efforts need to be maintained into older ages.

Black or African American↗

Associations of health, dietary and job-related factors, and mental problems with cardiovascular diseases in aging.

BACKGROUND: While cardiovascular diseases are prevalent in aging population, associations between different factors and cardiovascular diseases are less studied or inconsistency still exists. AIM: To determine which factors measured at baseline predicted overall cardiovascular diseases and hypertension, and which factors were currently associated with these conditions. METHODS: Based on a sample of aging and retired food industry employees (N = 100, mean age 62 years) associations of health, dietary and job-related factors and mental problems with overall cardiovascular morbidity and hypertension were assessed with independent samples t-test, chi2 test and binary logistic regression analyses. Data were derived from health examinations and self-completed questionnaires in 1989 and 2000. RESULTS: Added medical findings, related to cardiovascular diseases, appeared as predictor of overall cardiovascular morbidity, while elevated blood pressure together with high systolic and diastolic pressure, dyslipidemia and elevated blood pressure together, added medical findings, and inability to enjoy daily activities predicted hypertension. According to our analyses most significant current associations with overall cardiovascular morbidity were feeling of weakness, dyspnoea, hopelessness about the future, cardiac arrhythmia, chronic mental stress and lower HDL cholesterol, and with hypertension metabolic syndrome, lower HDL cholesterol, hopelessness about the future and muscular fatigue on exertion. CONCLUSIONS: Health factors were most important predictors of hypertension during a long-term period, while health factors together with mental problems had significant current associations with overall cardiovascular morbidity including hypertension.

Aged↗

The links between diabetes and cardiovascular disease.

The aim of this study was to review current studies relevant to the link between impaired glucose tolerance (IGT), diabetes, and cardiovascular disease. Cardiovascular disease is a major cause of the reduction in life expectancy in patients with diabetes. Seventy-five percent of diabetic patients die prematurely of cardiovascular complications. Both prediabetes and diabetes highly pre-dispose to cardiovascular alterations. IGT and even the upper-normal of nondiabetic glucose values are associated with an increased cardiovascular risk. The risk of heart disease is increased up to 15 years prior diagnosis of diabetes. Patients with chronic or acute cardiovascular disease and no previous diagnosis of diabetes frequently present with either IGT or diabetes. Patients with cardiovascular disease and no previous diagnosis of diabetes need to be screened for diabetes with an oral glucose tolerance test. In acute coronary syndromes, lowering glucose levels to the near-normal range with insulin is highly beneficial. Early and rigorous improvement of metabolic control is highly supportive in improving the cardiovascular outcome in patients with dysglycemia. Preventive treatment strategies, which include multiple approaches, are required to overcome the burden of cardiovascular disease in diabetes and IGT.

Cardiovascular Diseases↗

Cardiovascular disease and global health: threat and opportunity.

The transition in global health from infectious to chronic disease, especially cardiovascular disease, poses a threat to the economies of the less developed world. As a more sophisticated workforce becomes a highly valued and harder-to-replace economic investment, the increasing prevalence of cardiovascular risk factors becomes a threat to economic development. The next two decades offer a critical period for intervention to blunt the impact of these diseases. The response of the global assistance community has been inadequate and without impact. A new global health assistance paradigm is needed to support long-term prevention strategies to combat this epidemic.

Adult↗

The role of nitric oxide in cardiovascular diseases.

Nitric oxide (NO) is a gaseous lipophilic free radical cellular messenger generated by three distinct isoforms of nitric oxide synthases (NOS), neuronal (nNOS), inducible (iNOS) and endothelial NOS (eNOS). NO plays an important role in the protection against the onset and progression of cardiovascular disease. Cardiovascular disease is associated with a number of different disorders including hypercholesterolaemia, hypertension and diabetes. The underlying pathology for most cardiovascular diseases is atherosclerosis, which is in turn associated with endothelial dysfunctional. The cardioprotective roles of NO include regulation of blood pressure and vascular tone, inhibition of platelet aggregation and leukocyte adhesion, and prevention smooth muscle cell proliferation. Reduced bioavailability of NO is thought to be one of the central factors common to cardiovascular disease, although it is unclear whether this is a cause of, or result of, endothelial dysfunction. Disturbances in NO bioavailability leads to a loss of the cardio protective actions and in some case may even increase disease progression. In this chapter the cellular and biochemical mechanisms leading to reduced NO bioavailability are discussed and evidence for the prevalence of these mechanisms in cardiovascular disease evaluated.

Arteriosclerosis↗

Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease 2- to 3-fold. The factors responsible for this association remain largely unknown. METHODS AND RESULTS: We analyzed data from participants, > or =50 years of age, of the Third National Health and Nutrition Examination Survey (n=6629) to determine whether C-reactive protein (CRP) and other systemic inflammatory markers are present in participants with chronic airflow obstruction and are associated with cardiac injury. Participants with severe airflow obstruction had circulating leukocyte, platelet, and fibrinogen levels that were 460/ microL (95% confidence interval [CI], 30 to 890/ microL), 39 510/ microL (95% CI, 21 730 to 57 290/ microL), and 41.63 mg/dL (95% CI, 19.87 to 63.39 mg/dL) higher, respectively, than in those without airflow obstruction. They were also 2.18 times (95% CI, 1.46 to 3.27) more likely to have an elevated circulating CRP level. Moderate airflow obstruction was associated with smaller but still significant increases in these levels. Moderate and severe airflow obstruction was associated with increased occurrence of ischemic changes on electrocardiograms of participants. In the presence of both highly elevated CRP and moderate or severe airflow obstruction, the Cardiac Infarction Injury Score was 2.68 and 5.88 U higher, respectively, than in those without airflow obstruction and with low CRP, which suggests an additive effect of CRP and COPD on the risk of cardiac injury. CONCLUSION: Low-grade systemic inflammation was present in participants with moderate to severe airflow obstruction and was associated with increased risk of cardiac injury. This may in part explain the high rates of cardiovascular complications in COPD.

Aged↗

Cardiovascular disease and osteoporosis.

Cardiovascular disease (CVD) and osteoporosis (OP) are public health problems with numerous epidemiological links and important economic consequences. Recent studies have demonstrated that CVD and cardiovascular mortality are associated with reduced bone mineral density (BMD) and bone fractures. These two conditions may be sustained by similar or common pathophysiological mechanisms and risk factors. There are several matrix proteins, such as type 1 collagen, proteoglycan, osteopontin, and osteonectin, which are found in bone and vascular matrix components. Matrix proteins play an important role both in bone formation and in the development of atherosclerosis. Estrogens also play a role in both CVD and OP through their effects on cytokines, such as IL-1, IL-6 and TNF-alpha and osteoprotegerin (OPG). The lack of estrogens induces an increase in these cytokines and a decrease in OPG, both implicated in the mechanisms of bone loss and atherogenesis. An additional link between CVD and OP seems to be related to the action of some drugs, such as bisphosphonates, statins and raloxifene. Several studies suggest that the mechanism of action of these drugs at cellular level may not be mutually exclusive, acting either in bone or in atherosclerotic plaque. However, further studies are necessary to define the relationship between CVD and OP more specifically and to understand the complex interaction of similar or common risk factors and genetic or molecular determinants.

Atherosclerosis↗

Genetic polymorphism of CYP2D6 in patients with cardiovascular disease -- a cohort study.

BACKGROUND: Cardiovascular diseases are complex diseases that are influenced by both environmental and genetic factors. CYP2D6 found in the brain and the heart is involved in the metabolism of many environmental and some endogenous substances and neurotransmitters responsible for maintaining homeostasis. This raises an interesting hypothesis that it may have a role in the development of or protection against cardiovascular diseases. OBJECTIVE: To study the distribution of genotypes of CYP2D6 among patients with cardiovascular diseases in Malaysia. METHOD: We obtained DNA from 128 patients who were followed up for cardiovascular diseases. Polymerase chain reaction-based methods were used to determine common CYP2D6 alleles. RESULTS: One hundred and twenty-eight patients were enrolled. Most of the patients also had concurrent illnesses. Eleven genotypes were identified in the patients and 41% carried CYP2D6*1/*10. The second most common genotype was homozygous for the wild type gene, followed by homozygous CYP2D6*10/*10 at 14.48 %. A small percentage of the patients were heterozygous CYP2D6*1/*4. One patient was genotyped homozygous CYP2D6*4/*4 predicting a poor metabolizer prevalence of 0.78% (95% CI +/- 1.52%). Analysis using Hardy-Weinberg equilibrium showed that all of the gnotypes were consistent with equilibrium except for CYP2D6*1/*10 (chi(2); P < 0.05). CONCLUSION: Our study suggests a possible involvement of CYP2D6 genotypes in cardiovascular system diseases, which need to be validated by further studies.

Adult↗

Fetal and pediatric origins of adult cardiovascular disease.

Adult-onset cardiovascular disease has its origin in childhood. During the past year there have been a number of articles that have dealt with the effects of fetal nutrition on the development of cardiovascular disease in adult life, identification of the child at high risk for the development of essential hypertension, the effects of passive smoking as a risk factor for coronary artery disease, and strategies for diagnosis and treatment for familial hypercholesterolemia. Two of the most important observations over the past year are that there appears to be a significant relationship between fetal and early childhood nutrition and the risk of developing many of the cardiovascular diseases seen in adult individuals and that environmental tobacco smoking, including smoke at work, results in an increased risk of developing coronary heart disease.

Adult↗

Quantitative retinal venular caliber and risk of cardiovascular disease in older persons: the cardiovascular health study.

BACKGROUND: Small vessel disease may contribute to the risk of cardiovascular disease in older persons. We describe the relation of retinal vascular caliber to incident coronary heart disease (CHD) and stroke in elderly persons. METHODS: Prospective population-based cohort study composed of 1992 men and women aged 69 to 97 years living in 4 US communities. Retinal arteriolar and venular calibers were measured from retinal photographs using a computer-assisted method. Incident CHD and stroke events were ascertained using standardized methods. RESULTS: After 5 years of follow-up, there were 115 incident CHD events and 113 incident stroke events. Participants with larger retinal venular caliber had a higher incidence of CHD (11.7%; 95% confidence interval [CI], 8.7%-15.8%, vs 8.1%; 95% CI, 5.7%-11.6%), comparing largest with smallest venular caliber quartiles, and stroke (8.4%; 95% CI, 6.0-11.7, vs 5.8%; 95% CI, 3.9-8.4). At multivariable analysis, controlling for age, sex, race, arteriolar caliber, systolic and diastolic blood pressure, diabetes, glucose concentration, cigarette smoking, pack-years of smoking, and high-density-lipoprotein and low-density lipoprotein cholesterol levels, larger retinal venular caliber was associated with incident CHD (rate ratio, 3.0; 95% CI, 1.6-5.7, comparing largest with smallest venular caliber quartiles; P(trend) = .001) and incident stroke (rate ratio, 2.2; 95% CI, 1.1-4.3; P(trend) = .02). Additional adjustment for C-reactive protein and common and internal carotid artery intimal-media thickness had minimal effect on these associations. At multivariable analysis, smaller retinal arteriolar caliber was associated with incident CHD (rate ratio, 2.0; 95% CI, 1.1-3.7, comparing largest with smallest arteriolar caliber quartiles; P = .03) but not stroke (rate ratio,1.1; 95% CI, 0.5-2.2; P = .73). CONCLUSION: Larger retinal venular caliber is independently associated with risk of cardiovascular disease in elderly persons.

Aged↗