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PubMed1995

Cardiovascular disease and vitamins. Concurrent correction of 'suboptimal' plasma antioxidant levels may, as important part of 'optimal' nutrition, help to prevent early stages of cardiovascular disease and cancer, respectively.

Epidemiological surveys provided abundant evidence that under steady-state conditions diets rich in antioxidants (from vegetables/fruits and suitable vegetable oils) reduce the relative risk of premature death from CVD and cancer. Material relative risks seem to disappear at 'optimal' antioxidant plasma levels in the order of > or = 50 micromol/l vitamin C, > or = 30 micromol/l lipid-standardized vitamin E (alpha-tocopherol/cholesterol ratio > or = 5.1-5.2), > or = 2.2 micromol/l vitamin A, and > or = 0.4 micromol/l beta-carotene or > or = 0.4-0.5 micromol/l alpha-plus beta-carotene. Levels 25-35% below these thresholds predict an at least 2-fold higher risk. 'Suboptimal' levels of any single antioxidant may increase the relative risk independently. Accordingly, 'suboptimal' levels of several antioxidants predict a further increase of risk. Data on habitual voluntary multivitamin supplements providing an adequate supply of either vitamins A, C or E, and of beta-carotene in smokers, indicates that steady-state 'optimization' reduces more or less regularly the relative risk of CVD and cancer respectively. Simple counting of multivitamins regardless of their composition did not reveal any risk reduction. The antioxidant-related health benefits seem to depend on an adequacy of all antioxidants, and possibly of nonantioxidant nutrients as well. Thereby, an overall 'optimal' antioxidant defense system may be more important than excess of any particular 'magic bullet' antioxidant. Although antioxidants may represent a crucially important fraction within a health-maintaining diet, any nonantioxidant conutrients remain to be identified which could condition the health benefits of antioxidants. In randomized antioxidant intervention trials during 5-6 years in middle-aged to elderly subjects in China and Finland, only earlier stages of CVD and cancer respectively were prevented by rectifying previously poor levels. Correspondingly, the incidence of prostate cancer (developing mostly not until the male menopause) was reduced by correction of a previously poor vitamin E status in Finland. In contrast, irreversible precancerous lesions (such as esophageal dysplasia), clonically established common cancers (highly probable for the lung of elderly heavy smokers) as well as (presumably advanced, complicated) vascular lesions of chronic smokers did not respond favorably. (ABSTRACT TRUNCATED)

Antioxidants↗
PubMed1999

Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study.

BACKGROUND: Hyperuricemia is associated with risk for cardiovascular disease and death. However, the role of uric acid independent of established risk factors is uncertain. OBJECTIVE: To examine the relation of serum uric acid level to incident coronary heart disease, death from cardiovascular disease, and death from all causes. DESIGN: Community-based, prospective observational study. SETTING: Framingham, Massachusetts. PATIENTS: 6763 Framingham Heart Study participants (mean age, 47 years). MEASUREMENTS: Serum uricacid level at baseline (1971 to 1976); event rates per 1000 person-years by sex-specific uric acid quintile. RESULTS: During 117,376 person-years of follow-up, 617 coronary heart disease events, 429 cardiovascular disease deaths, and 1460 deaths from all causes occurred. In men, after adjustment for age, elevated serum uric acid level was not associated with increased risk for an adverse outcome. In women, after adjustment for age, uric acid level was predictive of coronary heart disease (P = 0.002), death from cardiovascular disease (P = 0.009), and death from all causes (P = 0.03). After additional adjustment for cardiovascular disease risk factors, uric acid level was no longer associated with coronary heart disease, death from cardiovascular disease, or death from all causes. In a stepwise Cox model, diuretic use was identified as the covariate responsible for rendering serum uric acid a statistically nonsignificant predictor of outcomes. CONCLUSIONS: These findings indicate that uric acid does not have a causal role in the development of coronary heart disease, death from cardiovascular disease, or death from all causes. Any apparent association with these outcomes is probably due to the association of uric acid level with other risk factors.

Age Distribution↗
PubMed2006

Metabolic syndrome and cardiovascular disease in older people: The cardiovascular health study.

OBJECTIVES: To assess the prospective association between metabolic syndrome (MetS) and cardiovascular disease (CVD) in older people and to evaluate the effect of lowering the threshold for impaired fasting glucose (IFG) on the prevalence of IFG and MetS and the risk of CVD. DESIGN: Prospective cohort study. SETTING: Four field centers in U.S. communities. PARTICIPANTS: Three thousand five hundred eighty-five subjects in the Cardiovascular Health Study free of diabetes mellitus and CVD at baseline (mean age 72, 62% female, 14% black). MEASUREMENTS: Baseline measures of MetS components and adjudicated incident CVD events. MetS (2001) was defined first using the original criteria from the Third Adult Treatment Panel Report of the National Cholesterol Education Program (> or =3 of the following: large waist circumference (women >88 cm, men >102 cm), elevated triglycerides (> or =1.70 mmol/L), low high-density lipoprotein cholesterol (men <1.04 mmol/L, women <1.30 mmol/L), elevated fasting glucose (6.1-6.9 mmol/L), and high blood pressure (> or =130/85 mmHg or self-reported use of medications for hypertension). Subjects were also classified according to the revised definition of the MetS (2005) that applies the lower threshold for fasting glucose (5.6-6.9 mmol/L). RESULTS: During follow-up (median 11 years), 818 coronary heart disease (CHD), 401 stroke, and 554 congestive heart failure (CHF) events occurred. Age- and race-adjusted hazard ratios (HRs) for CHD, stroke, and CHF were 1.30 (95% confidence interval (CI) = 1.07-1.57), 0.94 (95% CI = 0.73-1.21), and 1.40 (95% CI = 1.12-1.76) for women and 1.35 (95% CI = 1.10-1.66), 1.51 (95% CI = 1.08-2.12), and 1.47 (95% CI = 1.14-1.90) for men, respectively. Overall, women and men with MetS (2005) were 20% to 30% more likely to experience any CVD event than subjects without MetS (2005). Using the lower cut-point for IFG resulted in a near tripling in IFG prevalence (16% to 46%) and an additional 9% classified with MetS (2005) but HRs similar to those estimated from the original MetS (2001) criteria. High blood pressure was the component most strongly associated with incident CHD. CONCLUSION: Results from this study of an elderly, population-based cohort provide support for earlier investigations in primarily middle-aged populations that link the presence of MetS with the development of CVD and further underscore the importance of recognizing and treating its individual components, particularly high blood pressure.

Black or African American↗
PubMed1997

Clinical review 91: Female sex hormones and cardiovascular disease in women.

Cardiovascular disease is the leading cause of mortality in women, a fact that is underappreciated by women and physicians. Clinical and experimental data underscore the cardioprotective effects of female sex hormones, particularly estrogen. Indeed, the loss of female sex hormones after menopause contributes to the striking increase in the incidence of cardiovascular morbidity and mortality after menopause. Estrogen replacement therapy improved lipoprotein profiles in the postmenopausal women, but this accounts for less than half of the cardioprotective effects of estrogen replacement therapy. Addition of progestins to estrogen therapy in women appears not to significantly attenuate the cardioprotective effects of estrogen replacement therapy despite experimental data suggesting otherwise. This review addresses potential mechanisms, other than influences on lipoproteins, by which estrogen and progesterone exert their cardiovascular protective effects. Particular emphasis is directed to genomic and nongenomic effects of estrogen and progesterone that are exerted directly on cardiovascular tissue.

Blood Vessels↗
PubMed2006

Garlic and cardiovascular disease: a critical review.

Epidemiologic studies show an inverse correlation between garlic consumption and progression of cardiovascular disease. Cardiovascular disease is associated with multiple factors such as raised serum total cholesterol, raised LDL and an increase in LDL oxidation, increased platelet aggregation, hypertension, and smoking. Numerous in vitro studies have confirmed the ability of garlic to reduce these parameters. Thus, garlic has been shown to inhibit enzymes involved in lipid synthesis, decrease platelet aggregation, prevent lipid peroxidation of oxidized erythrocytes and LDL, increase antioxidant status, and inhibit angiotension-converting enzyme. These findings have also been addressed in clinical trials. The studies point to the fact that garlic reduces cholesterol, inhibits platelet aggregation, reduces blood pressure, and increases antioxidant status. Since 1993, 44% of clinical trials have indicated a reduction in total cholesterol, and the most profound effect has been observed in garlic's ability to reduce the ability of platelets to aggregate. Mixed results have been obtained in the area of blood pressure and oxidative-stress reduction. The findings are limited because very few trials have addressed these issues. The negative results obtained in some clinical trials may also have resulted from usage of different garlic preparations, unknown active constituents and their bioavalability, inadequate randomization, selection of inappropriate subjects, and short duration of trials. This review analyzes in vitro and in vivo studies published since 1993 and concludes that although garlic appears to hold promise in reducing parameters associated with cardiovascular disease, more in-depth and appropriate studies are required.

Animals↗
PubMed2003

Effect of hormone replacement therapy on cardiovascular disease: current opinion.

Cardiovascular disease (CVD) is increasingly being recognised as having a profound effect on women, especially after menopause. Lack of oestrogen has been targeted as one of the reasons for increased incidence of CVD in postmenopausal women. Oestrogen has been found to have favourable effects on lipid profile, tone of vascular smooth muscle cells and fibrinogen levels. Several observational studies have supported these experimental findings, consistently demonstrating reduced cardiovascular risks in users of hormone replacement therapy (HRT). However, evidence from recent clinical trials has challenged this widespread belief. Heart and Estrogen/Progesterone Replacement Study II, Estrogen Replacement and Atherosclerosis trial and more recently, Women's Health Initiative, have shown that HRT has no role in primary and secondary prevention of CVD and most authorities currently do not advocate HRT for the prevention of CVD.

Aged↗
PubMed2003

Adequate nutrient intake can reduce cardiovascular disease risk in African Americans.

Cardiovascular disease kills nearly as many Americans each year as the next seven leading causes of death combined. The prevalence of cardiovascular disease and most of its associated risk factors is markedly higher and increasing more rapidly among African Americans than in any other racial or ethnic group. Improving these statistics may be simply a matter of improving diet quality. In recent years, a substantial and growing body of evidence has revealed that dietary patterns complete in all food groups, including nutrient-rich dairy products, are essential for preventing and reducing cardiovascular disease and the conditions that contribute to it. Several cardiovascular risk factors, including hypertension, insulin resistance syndrome, and obesity, have been shown to be positively influenced by dietary patterns that include adequate intake of dairy products. The benefits of nutrient-rich dietary patterns have been specifically tested in randomized, controlled trials emphasizing African American populations. These studies demonstrated proportionally greater benefits for African Americans without evidence of adverse effects such as symptoms of lactose intolerance. As currently promoted for the prevention of certain cancers and osteoporosis, regular consumption of diets that meet recommended nutrient intake levels might also be the most effective approach for reducing cardiovascular disease risk in African Americans.

Black People↗
PubMed1999

The prevention of cardiovascular disease in blacks.

Cardiovascular disease (CVD) in black patients involves a complex interplay of risk, geographic, socioeconomic, and cultural factors. Modifiable risk factors such as high blood pressure, diabetes, cigarette smoking, high blood cholesterol, and physical inactivity contribute to the excess CVD mortality and morbidity in blacks. Health perceptions, health care seeking behavior, and willingness to submit to long-term preventive therapies are significantly influenced by cultural and socioeconomic factors. Early detection and control of these risk factors are particularly important because blacks tend to have multiple cardiovascular risks. The importance of churches and religious organizations in the black community should be harnessed by long-term strategies of CVD prevention. Emphasis on training of minority health care professionals who are most likely to practice in medically underserved areas should involve minority health professional schools. In the final analysis, CVD prevention in blacks should focus on control of risk factors; however, the role of environmental factors should be recognized, including socioeconomic status on access to health care and prevention. Long-term strategies of CVD prevention must involve active collaboration of health care providers and researchers to develop and test effective strategies. Churches and other religious organizations are effective but underutilized partners in CVD prevention in blacks.

Black People↗
PubMed2025

Epigenetic mechanisms underlying variation of IL-6, a well-established inflammation biomarker and risk factor for cardiovascular disease.

BACKGROUND AND AIMS: Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality worldwide, yet the underlying molecular mechanisms remain less understood. Chronic low-grade inflammation is a complex immune response contributing to the pathophysiology of cardiovascular disease. This response is signaled in part by interleukin-6 (IL-6), a pleiotropic, pro-inflammatory cytokine. Phenotypic variance in circulating IL-6 level may be explained in part by DNA methylation which is increasingly being associated with cardiovascular effects. METHODS: In this study we evaluated methylated DNA (CpG sites) associated with blood IL-6 levels across &#x223c;4,400 ancestrally diverse individuals (81&#xa0;% self-reported White; 9&#xa0;% Black or African American, 8&#xa0;% Hispanic or Latino/a, and 2&#xa0;% Chinese American). RESULTS: We identified 178 CpG sites associated with IL-6 (p<0.05/&#x223c;395,000). Among the sites, cg04437762 is located within the transcription unit of IL6R, a current therapeutic target for inflammatory disease, and cg26692003 and cg00464927 were significant for IL6 and IL6ST trans-CpG-gene transcripts. Functional gene expression downstream of methylation identified cellular response to IL-6 and B-cell regulation and activation pathways. Four genes were linked with both a genetic component of cardiovascular disease and an IL-6 associated CpG site. Three CpG sites identified through Mendelian randomization analyses supported inference of a causal effect on IL-6 levels, including the LYN gene that regulates immune cell signaling and has been previously associated with atherosclerosis. CONCLUSIONS: Overall, we identified several novel IL-6-CpG sites and downstream pathways affected by methylation. Follow-up functional studies including the regulation of IL-6 would complement current knowledge of CVD pathophysiology and potential therapeutic targets.

Humans↗
PubMed2006

[Women and cardiovascular disease].

More women die of cardiovascular disease than men; in women, cardiovascular mortality is 1.5 times greater than cancer mortality. The pathophysiology of cardiovascular disease has female-specific aspects such as fragile coronary arteries and microvascular ischaemia. Women with acute coronary syndromes are more likely to present with atypical symptoms such as dyspnoea, nausea or fatigue. With regard to diagnostic tests in women, exercise ECG can be difficult to interpret and a normal coronary angiogram does not exclude coronary heart disease. Myocardial perfusion scintigraphy may be considered for high-risk women who are clinically suspected of having coronary heart disease and have a normal or inconclusive exercise ECG and angiogram. Women are less likely to be treated according to guidelines than men, and their prognosis after a myocardial infarction or a coronary intervention is worse. Female-specific aspects such as gestational hypertension and diabetes allow for early detection and treatment of women at risk for cardiovascular disease.

Cardiovascular Diseases↗
PubMed2001

Diabetes, hypertension, and cardiovascular disease: an update.

Cardiovascular diseases (CVDs) are the major causes of mortality in persons with diabetes, and many factors, including hypertension, contribute to this high prevalence of CVD. Hypertension is approximately twice as frequent in patients with diabetes compared with patients without the disease. Conversely, recent data suggest that hypertensive persons are more predisposed to the development of diabetes than are normotensive persons. Furthermore, up to 75% of CVD in diabetes may be attributable to hypertension, leading to recommendations for more aggressive treatment (ie, reducing blood pressure to <130/85 mm Hg) in persons with coexistent diabetes and hypertension. Other important risk factors for CVD in these patients include the following: obesity, atherosclerosis, dyslipidemia, microalbuminuria, endothelial dysfunction, platelet hyperaggregability, coagulation abnormalities, and "diabetic cardiomyopathy." The cardiomyopathy associated with diabetes is a unique myopathic state that appears to be independent of macrovascular/microvascular disease and contributes significantly to CVD morbidity and mortality in diabetic patients, especially those with coexistent hypertension. This update reviews the current knowledge regarding these risk factors and their treatment, with special emphasis on the cardiometabolic syndrome, hypertension, microalbuminuria, and diabetic cardiomyopathy. This update also examines the role of the renin-angiotensin system in the increased risk for CVD in diabetic patients and the impact of interrupting this system on the development of clinical diabetes as well as CVD.

Albuminuria↗
PubMed2001

Efficacy and safety of sildenafil citrate for the treatment of erectile dysfunction in men with cardiovascular disease.

Men with cardiovascular disease (CVD) are more likely to have erectile dysfunction (ED) than the general population, as both conditions share risk factors and some drugs used to treat CVD may induce ED as a side-effect. This study was undertaken to assess the efficacy and safety of sildenafil citrate for the treatment of ED in men with CVD who were receiving treatment with beta-blockers and/or angiotensin-converting enzyme inhibitors and/or calcium-channel blockers, but not nitrates. Treatment with sildenafil was associated with significant increases in the mean end-of-treatment scores for the questions from the International Index of Erectile Function that assess the ability to achieve and maintain erections (p = 0.0001). Furthermore, 71% of patients taking sildenafil reported improved erections compared with 24% taking placebo (p = 0.0001). This study also showed that sildenafil was well tolerated in patients with CVD and ED. Besides flushing, no treatment-related cardiovascular adverse events were noted for sildenafil.

Adrenergic beta-Antagonists↗
PubMed2005

Ethnocultural affiliation, gender, and cardiovascular disease risk management.

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in North America. Making behavioural changes following a diagnosis of CVD can attenuate the disease risk. Canada's population is composed of a growing mosaic of persons of various ethnic backgrounds. A person's ethnocultural affiliation and gender can influence the context, process and outcome of their decision-making about health related behaviours. Though several models exist to assist clinicians working with persons facing behavioural change, these models do not include ethnocultural affiliation and gender as fundamental components. The authors contend that ethnocultural affiliation and gender need to be central constructs in new investigations related to behavioural change and that decision-modeling methodology is a useful mechanism to do so.

Canada↗
PubMed1991

[Demographic trends and the burden of cardiovascular diseases].

The current burden of cardiovascular disease in the U.S. population and recent trends in morbidity, mortality and risk factors provide a perspective on heart disease in the 21st century. Projections of demographic trends for populations and predictions of the frequency, distribution and characteristics of cardiovascular disease in the future are offered with numerous reservations and subject to revision. Nonetheless, we can expect to see more patients with cardiovascular disease in the next few decades and these patients are likely to be older and to be from the less well-educated and poorer socioeconomic segments of society. Improvements in treatment for the initial cardiovascular event may result in increased survival of women and men suffering permanent damage or disability. There will also be better opportunities to prevent cardiovascular diseases through modifying risk factors in the general population and in high risk individuals. Non-invasive procedures will also increase opportunities for detecting and reversing preclinical atherosclerosis through hygienic and therapeutic measures.

Cardiovascular Diseases↗
PubMed2005

Erectile dysfunction and subsequent cardiovascular disease.

CONTEXT: The risk factors for cardiovascular disease and erectile dysfunction are similar. OBJECTIVE: To examine the association of erectile dysfunction and subsequent cardiovascular disease. DESIGN, SETTING, AND PARTICIPANTS: Men aged 55 years or older who were randomized to the placebo group (n = 9457) in the Prostate Cancer Prevention Trial at 221 US centers were evaluated every 3 months for cardiovascular disease and erectile dysfunction between 1994 and 2003. Proportional hazards regression models were used to evaluate the association of erectile dysfunction and cardiovascular disease. In an adjusted model, covariates included age, body mass index, blood pressure, serum lipids, diabetes, family history of myocardial infarction, race, smoking history, physical activity, and quality of life. MAIN OUTCOME MEASURES: Erectile dysfunction and cardiovascular disease. RESULTS: Of the 9457 men randomized to placebo, 8063 (85%) had no cardiovascular disease at study entry; of these men, 3816 (47%) had erectile dysfunction at study entry. Among the 4247 men without erectile dysfunction at study entry, 2420 men (57%) reported incident erectile dysfunction after 5 years. After adjustment, incident erectile dysfunction was associated with a hazard ratio of 1.25 (95% confidence interval [CI], 1.02-1.53; P = .04) for subsequent cardiovascular events during study follow-up. For men with either incident or prevalent erectile dysfunction, the hazard ratio was 1.45 (95% CI, 1.25-1.69; P<.001). For subsequent cardiovascular events, the unadjusted risk of an incident cardiovascular event was 0.015 per person-year among men without erectile dysfunction at study entry and was 0.024 per person-year for men with erectile dysfunction at study entry. This association was in the range of risk associated with current smoking or a family history of myocardial infarction. CONCLUSIONS: Erectile dysfunction is a harbinger of cardiovascular clinical events in some men. Erectile dysfunction should prompt investigation and intervention for cardiovascular risk factors.

Aged↗
PubMed2006

Nativity and cardiovascular disease screening practices.

Cardiovascular diseases (CVD) are the leading causes of death among Mexican American adults living in the United States. Using data from a modified Behavioral Risk Factor Surveillance Survey and guided by the Anderson Model, this study examined the effect of nativity on CVD screening practices among 423 Mexican American adults living in Chicago. Dependent variables included having had a blood pressure and cholesterol screening and a routine check up in the past 2 years. Multivariate analyses were used to control for sociodemographic factors, while accounting for complex sampling design. Compared to those born in Mexico, US-born Mexican Americans had significantly greater odds of obtaining blood pressure (OR=5.61), and cholesterol screenings (OR=1.60) and having a routine checkup (OR=2.69) in the past 2 years. Health professionals with an agenda to increase screenings for CVD risk factors among Mexican Americans living in northern cities should understand the impact of nativity on screening practices.

Adolescent↗
PubMed1999

Self-report as a selection instrument in screening for cardiovascular disease risk.

INTRODUCTION: Cardiovascular disease (CVD) risk screening may rely partly on self-report information. The accuracy of self-reporting in relation to the actual risk factor status is insufficiently known. DESIGN: Self-report (yes, no, don't know) of presence of hypertension, hyperlipidemia, and overweight was compared to the corresponding risk factor data obtained by physical examination and blood analysis. The examinations carried out in a primary health care setting in Sweden were on a randomized population of 122 men and 127 women aged 20 to 60 years. RESULTS: Unawareness of hyperlipidemia was 71% in women and 56% in men, as compared to 29% or lower for the other risk factors. The sensitivity of self-report was 69% or higher for the other risk factors, with the exception of hypertension in women, where it was 29%. Specificity was generally high, except for hyperlipidemia. CONCLUSION: On a population level, self-reports of hypertension, hyperlipidemia, and overweight provide a feasible selection instrument by which a subpopulation with high risk factor frequency can be identified. However, the rate of misclassification is considerable. For hyperlipidemia, the benefit of self-reporting is presently limited, due to the high unawareness of this risk factor. Individual awareness and accurate knowledge about the presence or absence of risk factors needs to improve before self-reporting can be used as a reliable instrument in risk factor screening.

Adult↗
PubMed2004

Does socioeconomic position moderate the effects of race on cardiovascular disease mortality?

OBJECTIVE: Cardiovascular disease (CVD) rates differ markedly by minority status, with younger Blacks having some of the highest CVD mortality rates in the United States. A major objective of this study was to assess whether socioeconomic position moderates the effects of race or minority status on CVD mortality. DESIGN: The sample included 443 Black and 21,182 White men, and 415 Black and 24,929 White women, 45 years and older, who died of CVD from 1992-1998, and who had lived in the Twin Cities 5-county area. Using individual and neighborhood level measures of socioeconomic position, we hypothesized that socioeconomic position would moderate the effects of race on CVD mortality. Test hypotheses were analyzed using Poisson regression analysis. RESULTS: Socioeconomic position moderated the effects of race on CVD mortality among older men, but not in older women. Older Black men who lived in more impoverished neighborhoods had significantly and disproportionately higher CVD mortality rates than did older White men living in more impoverished neighborhoods; this was not the case among older Black and White men living in less impoverished neighborhoods. Race was independently related to CVD mortality among younger men and women, with younger Black men and women having significantly higher CVD mortality rates than younger White men and women. The Black-White rate for Black women was twice that of White women. CONCLUSION: Socioeconomic position as measured by neighborhood poverty can moderate the effects of race on CVD mortality in older Black and White men. This may not have been as apparent had socioeconomic position not been treated as a major variable of interest, and measured at multiple levels.

Black or African American↗