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PubMed2006

The anti-inflammatory effect of exercise: its role in diabetes and cardiovascular disease control.

Chronic low-grade systemic inflammation is a feature of chronic diseases such as cardiovascular disease and type 2 diabetes. Regular exercise offers protection against all-cause mortality, primarily by protection against atherosclerosis and insulin resistance and there is evidence that physical training is effective as a treatment in patients with chronic heart diseases and type 2 diabetes. Regular exercise induces anti-inflammatory actions. During exercise, IL-6 (interleukin-6) is produced by muscle fibres. IL-6 stimulates the appearance in the circulation of other anti-inflammatory cytokines such as IL-1ra (interleukin-1 receptor antagonist) and IL-10 (interleukin-10) and inhibits the production of the pro-inflammatory cytokine TNF-alpha (tumour necrosis factor-alpha). In addition, IL-6 enhances lipid turnover, stimulating lipolysis as well as fat oxidation. It is suggested that regular exercise induces suppression of TNF-alpha and thereby offers protection against TNF-alpha-induced insulin resistance. Recently, IL-6 was introduced as the first myokine, defined as a cytokine, that is produced and released by contracting skeletal muscle fibres, exerting its effects in other organs of the body. Myokines may be involved in mediating the beneficial health effects against chronic diseases associated with low-grade inflammation such as diabetes and cardiovascular diseases.

Atherosclerosis↗
PubMed1995

Psychiatric illness and cardiovascular disease risk.

Studies evaluating the risk of cardiovascular disease in the psychiatrically ill yield mixed results. Phobic anxiety in men is associated with an increased risk for cardiovascular disease, particularly sudden coronary death. This finding is in need of replication in women, and hypotheses regarding the potential mechanisms for this association warrant pilot testing. Other than this finding, there is only weak evidence supporting an association between psychiatric illness and risk for cardiovascular disease. This is surprising in light of the strong evidence that psychiatric illness in general is associated with elevated rates of cigarette smoking. In addition, there may also be higher rates of hypertension, hypercholesterolemia, and physical inactivity in some psychiatric disorders. Why the high rates of cigarette smoking and possibly other cardiovascular disease risk factors have not translated into consistently detectable elevated cardiovascular disease risk in individuals with psychiatric diagnoses is not apparent. Weaknesses in study designs and variations in assessment methods may partially explain the inconsistent results. Future studies of cardiovascular disease in the psychiatrically ill should be prospective, use nonclinical samples of men and women, have clear diagnostic criteria, determine order of onset of the two disorders if they coexist, and control for variability in known cardiovascular disease risk factors.

Cardiovascular Diseases↗
PubMed1992

Epidemiological aspects of cardiovascular disease in the elderly.

BACKGROUND: Cardiovascular disease is the leading cause of death in the elderly in industrialized societies. However, in the elderly, unlike middle-aged subjects, little attention has been paid to strategies for reducing morbidity and mortality from this disease. OBJECTIVES: To review studies of risk factors for cardiovascular diseases in the elderly and the evidence, if any, of risk factor modification. FINDINGS: Overall, the evidence suggests that the established risk factors for cardiovascular disease in middle-aged subjects persist into old age. Several studies have shown that serum cholesterol is positively associated with a risk of coronary heart disease. In the very elderly, U-shaped distributions have been reported for the relationship between cholesterol and total mortality, probably as a result of other confounding factors. At present there is little experimental evidence of benefits from lowering cholesterol in the elderly. In contrast, several randomly allocated, placebo-controlled trials have established the benefits of blood pressure reduction (systolic or diastolic) up to the age of 84 years. A high blood pressure in the very old probably remains a risk factor, but prospective studies have reported non-linear relationships. Smoking has been reported to be a risk factor in the elderly in some, but not all studies. CONCLUSIONS: At present, only the treatment of high blood pressure can be definitively recommended in the elderly. The effects of both dietary and pharmacological modification of cholesterol need to be investigated.

Aged↗
PubMed2002

Stress and cardiovascular disease.

After defining what cardiovascular disease is, the author describes the biological consequences of stress which are relevant to this kind of illness, the evidence for the relation between stress and cardiovascular disease, and predisposing factors (personality type, lifestyle, cardiac reactivity, working conditions, personal interaction and certain emotional states), and lastly provides a summary of explanatory mechanisms.

Cardiovascular Diseases↗
PubMed2005

A comparison of lipid variables as predictors of cardiovascular disease in the Asia Pacific region.

PURPOSE: Many guidelines advocate measurement of total or low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglycerides (TG) to determine treatment recommendations for preventing coronary heart disease (CHD) and cardiovascular disease (CVD). This analysis is a comparison of lipid variables as predictors of cardiovascular disease. METHODS: Hazard ratios for coronary and cardiovascular deaths by fourths of total cholesterol (TC), LDL, HDL, TG, non-HDL, TC/HDL, and TG/HDL values, and for a one standard deviation change in these variables, were derived in an individual participant data meta-analysis of 32 cohort studies conducted in the Asia-Pacific region. The predictive value of each lipid variable was assessed using the likelihood ratio statistic. RESULTS: Adjusting for confounders and regression dilution, each lipid variable had a positive (negative for HDL) log-linear association with fatal CHD and CVD. Individuals in the highest fourth of each lipid variable had approximately twice the risk of CHD compared with those with lowest levels. TG and HDL were each better predictors of CHD and CVD risk compared with TC alone, with test statistics similar to TC/HDL and TG/HDL ratios. Calculated LDL was a relatively poor predictor. CONCLUSIONS: While LDL reduction remains the main target of intervention for lipid-lowering, these data support the potential use of TG or lipid ratios for CHD risk prediction.

Adult↗
PubMed2006

Cardiovascular disease in HIV infection.

Cardiovascular disease has been well documented in patients with Human Immunodeficiency Virus infection, especially after the introduction of highly active antiretroviral therapy. At present, HIV infection is one of the leading causes of acquired cardiovascular disease including heart failure. Some of the changes observed in these patients include left ventricular systolic dysfunction, dilated cardiomyopathy, congestive heart failure, myocarditis, lipodystrophy, dyslipidemia, insulin resistance, accelerated atherosclerosis including myocardial infarction, prothrombotic state, pericardial effusion, pulmonary hypertension, autonomic dysfunction, and malignancy. This article summarizes the main findings in the principal HIV-associated cardiovascular manifestations in order to stimulate its early recognition so helping in early intervention and therapy.

Cardiovascular Diseases↗
PubMed2001

Cardiovascular disease in end-stage renal disease patients.

This study evaluates risk factor monitoring in end-stage renal disease (ESRD) patients with cardiovascular disease. Death rates from cardiovascular disease in ESRD patients are 20 to 40 times higher than in the general population, and 72% of ESRD patients with an acute myocardial infarction (AMI) are dead within 2 years of follow-up. Patients who have sustained an AMI rarely receive definitive testing to assess coronary circulation, and cardiac catheterization rates and revascularization rates are low, even after the high-risk event of an AMI. Risk factor intervention to treat lipid disorders in the ESRD population has received little attention, with the USRDS reporting that in 1998, 58% of dialysis and 64% of transplant patients had no lipid monitoring performed within a year. Of those tested, only 33% of dialysis and 27% of transplant patients had two or more tests within 1 year. Glycemic control monitoring in the form of HbA1c, recommended for diabetes management, is also underutilized in ESRD patients, with fewer than half receiving a single test within 1 year and only 10% receiving three or more tests. This raises concerns that diabetic glycemic control monitoring may be suboptimal in the ESRD population. The use of diabetic eye examinations and diabetic glucose monitoring is also low, as are influenza vaccination rates. These data suggest that the clinical care of cardiovascular disease in the ESRD patients needs more attention.

Adult↗
PubMed1979

[Geochemistry and cardiovascular diseases (author's transl)].

Cardiovascular diseases are often found to be associated with certain physicochemical characteristics of the environment - namely, the hardness of the water and the types of rock and soil underlying the area. Areas supplied with soft water usually have higher cardiovascular death rates than do areas supplied with hard water. Evidence linking cardiovascular diseases with the geochemistry of rocks and soils is more limited. The nature of these associations is still speculative but it is possible that certain trace elements are involved, some being beneficial and others harmful. Further epidemiological studies to identify these various trace elements are desirable.

Aged↗
PubMed1988

Prevention of cardiovascular disease among the elderly.

Cardiovascular diseases are a major cause of mortality, morbidity and disability of the elderly in both developed and developing countries. Their prevention has two aims: to add life to years and years to life. Observational studies suggest that the risk factors for these diseases in the middle-aged predict their incidence and the mortality due to them among the elderly. Direct evidence on the effectiveness of prevention by controlling these risk factors in the elderly, however, is still largely lacking or inconclusive. Nevertheless, the recent falling mortality trends in several countries indicate that deaths due to cardiovascular diseases can decrease rapidly also among the elderly, although the causes of the trends are not yet all clear. The very large cross-national differences in mortality from coronary heart disease and cerebrovascular diseases are a challenge for the wider application of preventive measures now. For the control of some risk factors, particularly of high blood pressure, further research focused on the elderly is urgently needed.

Age Factors↗
PubMed2000

Secondary prevention with antioxidants of cardiovascular disease in endstage renal disease (SPACE): randomised placebo-controlled trial.

BACKGROUND: Excess cardiovascular mortality has been documented in chronic haemodialysis patients. Oxidative stress is greater in haemodialysis patients with prevalent cardiovascular disease than in those without, suggesting a role for oxidative stress in excess cardiovascular disease in haemodialysis. We investigated the effect of high-dose vitamin E supplementation on cardiovascular disease outcomes in haemodialysis patients with pre-existing cardiovascular disease. METHODS: Haemodialysis patients with pre-existing cardiovascular disease (n=196) aged 40-75 years at baseline from six dialysis centres were enrolled and randomised to receive 800 IU/day vitamin E or matching placebo. Patients were followed for a median 519 days. The primary endpoint was a composite variable consisting of: myocardial infarction (fatal and non-fatal), ischaemic stroke, peripheral vascular disease (excluding the arteriovenous fistula), and unstable angina. Secondary outcomes included each of the component outcomes, total mortality, and cardiovascular-disease mortality. FINDINGS: A total of 15 (16%) of the 97 patients assigned to vitamin E and 33 (33%) of the 99 patients assigned to placebo had a primary endpoint (relative risk 0.46 [95% CI 0.27-0.78], p=0.014). Five (5.1%) patients assigned to vitamin E and 17 (17.2%) patients assigned to placebo had myocardial infarction (0.3 [0.11-0.78], p=0.016). No significant differences in other secondary endpoints, cardiovascular disease, or total mortality were detected. INTERPRETATION: In haemodialysis patients with prevalent cardiovascular disease, supplementation with 800 IU/day vitamin E reduces composite cardiovascular disease endpoints and myocardial infarction.

Aged↗
PubMed1991

Regional obesity and risk of cardiovascular disease; the Framingham Study.

Risk of cardiovascular events was determined over 24 years of surveillance in relation to general adiposity reflected by relative weight and by regional obesity estimated by skinfolds and waist girth per inch of height. Upper quintile values of relative weight, subscapular skinfolds and waist girth were each associated with increased risks of cardiovascular disease in both sexes. Risk of total cardiovascular events increased with the degree of regional, central or abdominal obesity. Mortality from cardiovascular disease was also increased. Increased relative weight and central obesity were both associated with increased risk factors including cholesterol, blood pressure, glucose and uric acid. Changes in weight were mirrored by changes in risk factors with linear trends over a 15 lb range of weight fluctuations. Subscapular skinfold and the ratio of subscapular-to-triceps skinfold, measures of central obesity, were in either sex also associated with an increased probability of coronary attacks in particular. The subscapular skinfold contributed to CHD risk independent of body mass index (BMI). Multivariate analyses taking all the risk factors into account indicate an independent effect of abdominal obesity on stroke, cardiac failure and cardiovascular and all-cause mortality in men. In women, only the subscapular-to-triceps skinfold ratio independently contributes to CHD, cardiovascular and all cause mortality. Regional obesity appears to be an independent contributor to cardiovascular disease at a given level of general adiposity, its effect only partially mediated through promotion of other known risk factors. These data suggest that cardiovascular disease is as closely linked to abdominal as to general adiposity.

Abdomen↗
PubMed1996

Health effects of working in pulp and paper mills: exposure, obstructive airways diseases, hypersensitivity reactions, and cardiovascular diseases.

Workers in the pulp and paper industry are exposed to different substances, such as hydrogen sulfide and other reduced sulfur compounds, chlorine, chlorine dioxide, sulfur dioxide, terpenes, and paper dust. The exposure level depends on the process, i.e., sulfite, sulfate, groundwood, bleachery, or paper production. Hitherto, exposures have been poorly described and more studies are certainly needed. Workers with repeated exposure peaks to chlorine, e.g., bleachery workers, seem to have an impaired lung function and an increased prevalence of respiratory symptoms. Exposure to high levels of paper dust, (> 5 mg/m3) causes impaired lung function. Therefore, exposure to respiratory irritants is an important, and probably overlooked, occupational risk among certain groups of pulp and paper workers. Some studies indicate that sulfate workers with high exposure to reduced sulfur compounds have an increased mortality due to ischemic heart disease. However, before any definite conclusions can be drawn, the impact of important confounders, such as shift-work and smoking habits have to be further evaluated.

Air Pollutants, Occupational↗
PubMedDate not supplied

[Hyperlipidemia and hyperglycemia prevalence in obese children: increased risk of cardiovascular disease?].

UNLABELLED: In Venezuela, cardiovascular diseases have represented the first mortality cause since year 1967. Evidence have shown that early lesion of coronary atherosclerosis can be observed at infancy in close association to obesity and diabetes, suggesting that preventive measures should be initiated at that time. OBJECTIVE: To study presence of hyperlipidemia or hyperglicemia in obese children as risk indicators. METHODOLOGY: 121 children (aged 8.7 +/- 3.43 years), with body mass index above 90th percentile for age (Fundacredesa) were studied. Serum cholesterol and its fractions (HDL-C and LDL-C), triglycerides and fasting glucose by enzymatic-colorimetric methods were determined, Cut-off points from Fundacredesa were used for cholesterol and triglycerides, while from National Cholesterol Education Program and American Diabetes Association, were used for LDL-C and HDL-C, and glucose, respectively. Children were grouped by age: Group 1: 2-5.11 years (19%); Group 2: 6-8.11 years (28.1%); and Group 3: elder than 9 years (52.9%). Statistical analysis was performed considering gender and age. RESULTS: Mean values for cholesterol were at risk level in males Group 1. Mean values for HDL-c were at risk level for girls Group 1 and 3 and males Group 3. Mean values for triglycerides were at risk level for girls Group 1 and 3 and males Group 2; but high levels were found in males from Group 1 and 3. LDL-C was at aceptable values for all the groups. No hyperglicemia was found. CONCLUSION: Low and at risk HDL-c and high triglycerides as lipid profile in these obese children indicate a high risk for cardiovascular disease, being males the more affected. A high proportion of the children fulfilled three criteria for Metabolic Syndrome. Dietary control and modification on food pattern and physical activity should be implemented.

Age Factors↗
PubMed2004

The National Action Plan for the Prevention and Control of Non-communicable Diseases and Health Promotion in Pakistan--Cardiovascular diseases.

The National Action Plan for Non-Communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD) incorporates prevention and control of cardiovascular diseases (CVD) as part of a comprehensive and integrated non-communicable Disease (NCD) prevention effort. In this programme, surveillance of cardiovascular risk factors is part of an integrated population-based NCD surveillance system. The population approach to CVD prevention is a priority area in this programme with a focus on broad policy measures and behavioural change communication. The former include revision of the current policy on diet and nutrition to expand its focus on under-nutrition; the development of a physical activity policy; strategies to limit the production of, and access to, ghee as a medium for cooking and agricultural and fiscal policies that increase the demand for, and make healthy food more accessible. The programme focuses attention on improving the quality of prevention programmes within primary and basic health sites and integrates concerted primary and secondary prevention programmes into health services as part of a comprehensive and sustainable, scientifically valid, and resource-sensitive programme for all categories of healthcare providers. It promotes screening for raised blood pressure at the population level and screening for dyslipidaemia and diabetes in high-risk groups only. It highlights the need to ensure the availability of aspirin, beta blockers, thiazides, ACE inhibitors, statins and penicillin at all levels of healthcare. The programme points out the need to conduct clinical end-point trials in the native Pakistani setting to define cost-effective therapeutic strategies for primary and secondary prevention of CVDs. Emphasis is laid on building capacity of health systems in support of CVD prevention and control and building a coalition or network of organizations to add momentum to CVD prevention and control efforts.

Cardiovascular Diseases↗