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PubMed1988

International trends in cardiovascular diseases in the elderly.

The only available statistical data on cardiovascular diseases which are relatively reliable and internationally comparable are those on mortality. Cardiovascular diseases constitute the leading cause of death in the elderly, especially in industrialized countries. In recent years, the majority of these countries have recorded a decreasing trend in cardiovascular mortality in the elderly as well as in younger people. Data on morbidity are not sufficiently standardized to allow international comparisons, and even within a country chronologically comparable statistical series rarely exist, especially population-based data. The U.S.A. and Japan, two of the countries which have maintained such data series and which have registered the most rapid mortality decline, do not show similar improvements in the morbidity level for cardiovascular diseases. Cardiovascular diseases, therefore, seem to continue to impose a great burden on society in general and on the elderly population in particular, despite some improvements in survival.

Adult↗
PubMed2005

Complications of chronic kidney disease: anemia, mineral metabolism, and cardiovascular disease.

This article focuses on the importance of three major complications of chronic kidney disease: (1) anemia, (2) calcium-phosphorus regulation and bone disease, and (3) cardiovascular risk profiling and treatment. The arguments for early and effective intervention have been amply made with respect to these three complications. Substantive trial data are sorely need to provide the definitive evidence that effective treatment of these complications results in better outcomes.

Anemia↗
PubMedDate not supplied

Cost effectiveness of screening for cardiovascular disease with measures of coronary calcium.

Cardiovascular disease is the leading cause of morbidity and mortality with annual costs of care exceeding 300 billion US dollars. Although screening tools are advocated for many cancers, the use of subclinical disease tests for cardiovascular disease are considered controversial. Health care payers and many governmental agencies apply cost-effectiveness analysis for the evaluation of new technology being considered for routine application in the US and Europe. Cost-effectiveness analysis by definition provides a comparative analysis of clinical and economic outcome data when evaluating new technology in relation to existing modalities. The current report provides a description of the framework upon methods applied in cost-effectiveness analysis as well as available data on the subject of cardiovascular screening, most notably using the evaluation of coronary calcium screening with electron beam tomography. The current report will also present several decision analytic models on the cost of atherosclerotic imaging including the evaluation of serial monitoring for disease progression and the development of cost-effectiveness models employing intermediate outcomes. Based on this review, there is an unfolding body of evidence that explores both the clinical and economic consequences of screening for atherosclerotic diseases. Although further evidence is required from prospectively designed randomized controlled trials, it appears that the current evidence from small series and decision analytic models supports cardiovascular screening of asymptomatic individuals and that the current results reveal enhanced cost effectiveness when compared with the routine evaluation using a Framingham risk assessment.

Calcinosis↗
PubMed1965

THE UNIVERISTY OF MANITOBA FOLLOW-UP STUDY: A PROSPECTIVE INVESTIGATION OF CARDIOVASCULAR DISEASE. I. GENERAL DESCRIPTION--MORTALITY AND INCIDENCE OF CORONARY HEART DISEASE.

A prospective study of cardiovascular disease was initiated in 1946 whereby 3983 healthy North American males, 91% under age 40, were subjected to periodic electrocardiograms and medical examinations between 1948 and 1963. The health of all but five of the 3773 survivors was known in 1963. There were 210 deaths: aircraft accidents accounted for 45%, cardiovascular disease 20%, cancer 11% and other causes 23%. The aggregate mortality closely resembled that of the Canadian Life Table 1955-57 (Male). Extra deaths were observed under age 40 owing to a high frequency of flying accidents. At older ages the mortality was lower than expected because congenital and chronic diseases were excluded at entry. One hundred and forty-three developed coronary heart disease. The case fatality rate was 31%. The incidence rate for coronary heart disease rose progressively from 0.277 per thousand per year for ages 25-34 to 26.5 at ages 60-69.

Accidents↗
PubMed1998

Epidemiology of cardiovascular disease in chronic renal disease.

The risk of cardiovascular disease in patients with chronic renal disease appears to be far greater than in the general population. For example, among patients treated by hemodialysis or peritoneal dialysis, the prevalence of coronary artery disease is approximately 40% and the prevalence of left ventricular hypertrophy is approximately 75%. Cardiovascular mortality has been estimated to be approximately 9% per year. Even after stratification by age, gender, race, and the presence or absence of diabetes, cardiovascular mortality in dialysis patients is 10 to 20 times higher than in the general population. Patients with chronic renal disease should be considered in the highest risk group for subsequent cardiovascular events. Cardiac failure is more common in chronic renal disease patients than in the general population, and is an independent predictor of death in chronic renal disease. Among hemodialysis and peritoneal dialysis patients, the prevalence of cardiac failure is approximately 40%. Both coronary artery disease and left ventricular hypertrophy are risk factors for the development of cardiac failure. In practice, it is difficult to determine whether cardiac failure reflects left ventricular dysfunction or extracellular fluid volume overload. Patients who develop clinical manifestations of cardiac failure should be evaluated for cardiovascular disease.

Cardiovascular Diseases↗
PubMed1990

Tracking of health and risk indicators of cardiovascular diseases from teenager to adult: Amsterdam Growth and Health Study.

Cardiovascular disease is recognized as a serious public health problem. Because the underlying pathological processes start shortly after birth, tracking of recognized cardiovascular disease indicators during childhood and adolescence can help in developing preventive pediatric strategies. A prospective follow-up of both genetic and behavioral lifestyle parameters (serum cholesterol, blood pressure, percentage body fat, maximal oxygen uptake (VO2max), smoking, physical inactivity, and type A behavior) was designed. In the Amsterdam Growth and Health Study a population of 93 males and 107 females was measured annually from 1977 to 1980 and a fifth measurement was made in 1985. In that way longitudinal data covering a period of 8 years was collected for a group of adolescents/adults between 13 and 21 years of age. Analyses of these parameters provided the following results: The stability over the 9 years of tracking cardiovascular disease indicators, measured as the interperiod correlations, is fairly high. It varies from 0.4 to 0.8 in percentage body fat, cholesterol, and VO2max. Blood pressure values are low (between 0.3 and 0.4). The probability of 13-year-olds having relatively high values of cardiovascular disease indicators on the basis of a quartile distribution with that at age 21 indicated a moderate to high predictive value. According to the literature, the levels of subjects that are continuously relatively high over the years are more in the direction of optimal health than risk values. The exception is for percentage body fat. Interrelation of the seven cardiovascular disease indicators in constantly relatively high-risk and relatively low-risk groups during the teenage period, measured during young adulthood (21.5 years), appeared to be weak: only males and females with a high percentage body fat and a low VO2max showed significantly high total cholesterol, low high-density lipoprotein cholesterol, and high total cholesterol/high-density lipoprotein cholesterol levels. From the three environmental cardiovascular disease indicators (smoking, physical activity, and type A/B behavior) measured in 1985, only physical activity was significantly correlated among males and females with high-density lipoprotein cholesterol, percentage body fat, and VO2max. It can be concluded that measurement of percentage body fat in the early teenage period seems to be the most important cardiovascular disease indicator in predicting risk levels in the young adult. The amount of physical activity measured at young adult age is the only behavioral parameter to show a significant interrelation with other cardiovascular disease risk indicators.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2001

Postprandial blood glucose as a risk factor for cardiovascular disease in Type II diabetes: the epidemiological evidence.

That cardiovascular disease occurs more frequently in patients with Type II (non-insulin-dependent) diabetes mellitus has been recognized for a long time. However, the extent to which hyperglycaemia contributes to atherosclerosis and cardiovascular disease is still not clear. Epidemiological studies published in recent years suggest that postprandial blood glucose might be an independent risk factor of cardiovascular disease. The main results of these studies, which are reviewed in this article, are that subjects from the general population with mild to moderate hyperglycaemia, following oral glucose load, but not in the fasting state, showed an increased cardiovascular risk. Furthermore, the post-challenge as well as postprandial glucose concentrations of subjects with Type II diabetes were found to be directly associated to incident cardiovascular disease independently of fasting glucose. Also, the correction of fasting hyperglycaemia or HbA1 c or both, disregarding the specific correction of postprandial hyperglycaemia was not found to significantly reduce the incidence of cardiovascular disease in patients with Type II diabetes. Finally, the strict control of both preprandial and postprandial hyperglycaemia yielded a substantial reduction of cardiovascular disease in Type II diabetes. Trials specifically designed to address this issue are needed to determine whether postprandial hyperglycaemia plays an independent and causative role in cardiovascular disease in patients with Type II diabetes.

Blood Glucose↗
PubMed1996

[Trends in mortality from cardiovascular diseases in Andalucia: 1975-1992].

BACKGROUND: Decrease in mortality due to cardiovascular diseases during last years seems to be a widespread phenomenon in industrialized countries. This study analyses the evolution of mortality due to cardiovascular diseases in Andalucía, Spain, from 1975 to 1992. The analysis has been carried out for ischemic heart diseases, cerebrovascular diseases and cardiovascular diseases as a whole. PATIENTS AND METHODS: Data of mortality have been obtained from the Natural Movement of the Population. From these data, both the annual standardized rates for age and sex through the direct method and percentage differences between 1975 and 1992, have been estimated. RESULTS: Decrease in mortality due to cardiovascular diseases for men was of 33.5% between 1975 and 1992, with 13.8% in the ischemic cardiopathy and 46.0% for cerebrovascular diseases. For women, reduction was of 33.8, 29.3 and 42.4% respectively. CONCLUSIONS: In Andalucía and for the period analyzed, mortality due to cardiovascular diseases is clearly decreasing. Such a reduction has been produced mainly for the cerebrovascular diseases, and it is remarkable the low percentage of the average decrease due to ischemic heart disease for men during the last years.

Cardiovascular Diseases↗
PubMed2006

[Lifestyle to prevent cardiovascular disease in NIDDM].

Major risk factors for cardiovascular diseases (myocardial infarction, angina pectoris, brain infarction) are age, male, smoking, high LDL-cholesterol, low HDL-cholesterol, high blood pressure, and diabetes mellitus. In Japanese population at large, healthy life-style to prevent cardiovascular diseases are; quit smoking, walking faster, saturated fat intake ranging 4.5-7 en%, lesser intake of trans fatty acids, cholesterol intake less 750 mg/day (male) and 600 mg/day (female), eat fish everyday, eat more folic acid, B6, and B12, eat grain, eat soybean products. However, it is not known whether this recommendation is also applied to NIDDM to prevent cardiovascular diseases. Based on reported evidences, to prevent cardiovascular diseases, NIDDM should quit smoking, eat fish everyday, and increase physical activity.

Arteriosclerosis↗
PubMed2001

The heart SNPs a beat: polymorphisms in candidate genes for cardiovascular disease.

Several environmental risk factors of cardiovascular disease are well established, but genetic risk alleles contributing to the disease in the general population are hotly debated. New strategies focusing on polymorphism discovery in candidate disease genes followed by tests of association to genes across the genome offer a pioneering approach to identifying risk alleles. Several hundred candidate genes for cardiovascular disease have been screened for common polymorphisms and these variants may provide susceptibility alleles which largely contribute to risk of cardiovascular disease in the general population. However, the impact of common susceptibility alleles for disease management will depend on many years of future investigation.

Cardiovascular Diseases↗
PubMed2005

The clinical epidemiology of cardiovascular disease in chronic kidney disease.

PURPOSE OF REVIEW: To review recent publications concerning the epidemiology and management of cardiovascular disease in the stages of chronic kidney disease. RECENT FINDINGS: Chronic kidney disease is a state of increased risk for atherosclerotic and cardiomyopathic disease. The mechanisms of cardiovascular disease probably change with the different stages of chronic kidney disease. Both proteinuria and decreased glomerular filtration rate are probably independent cardiovascular disease risk factors, although the impact of the latter is modest. Traditional risk factors are important predictors of cardiovascular disease in chronic kidney disease. Recent randomized controlled trials and cohort studies have supported interventions for smoking cessation, blood pressure control, renin-angiotensin system blockade, the correction of lipid abnormalities, and utilizing antiplatelet agents. Some uraemia-related risk factors predict the development of cardiovascular disease, particularly hypoalbuminaemia, inflammation, anaemia, and homocysteinaemia. However, randomized controlled trials of anaemia correction and of an increased quantity of dialysis were negative. SUMMARY: The role of oxidant stress, divalent ion abnormalities, various lipid abnormalities and other potential factors require further investigation. To determine whether these uraemia-related factors are markers of cardiovascular disease risk or are actually cardiotoxic requires additional randomized controlled trials.

Atherosclerosis↗
PubMed2005

Effects of physical activity on life expectancy with cardiovascular disease.

BACKGROUND: Physical inactivity is a modifiable risk factor for cardiovascular disease. However, little is known about the effects of physical activity on life expectancy with and without cardiovascular disease. Our objective was to calculate the consequences of different physical activity levels after age 50 years on total life expectancy and life expectancy with and without cardiovascular disease. METHODS: We constructed multistate life tables using data from the Framingham Heart Study to calculate the effects of 3 levels of physical activity (low, moderate, and high) among populations older than 50 years. For the life table calculations, we used hazard ratios for 3 transitions (healthy to death, healthy to disease, and disease to death) by levels of physical activity and adjusted for age, sex, smoking, any comorbidity (cancer, left ventricular hypertrophy, arthritis, diabetes, ankle edema, or pulmonary disease), and examination at start of follow-up period. RESULTS: Moderate and high physical activity levels led to 1.3 and 3.7 years more in total life expectancy and 1.1 and 3.2 more years lived without cardiovascular disease, respectively, for men aged 50 years or older compared with those who maintained a low physical activity level. For women the differences were 1.5 and 3.5 years in total life expectancy and 1.3 and 3.3 more years lived free of cardiovascular disease, respectively. CONCLUSIONS: Avoiding a sedentary lifestyle during adulthood not only prevents cardiovascular disease independently of other risk factors but also substantially expands the total life expectancy and the cardiovascular disease-free life expectancy for men and women. This effect is already seen at moderate levels of physical activity, and the gains in cardiovascular disease-free life expectancy are twice as large at higher activity levels.

Cardiovascular Diseases↗
PubMed1998

Emergence of Western diseases in the tropical world: the experience with chronic cardiovascular diseases.

Our knowledge of the disease burden components of tropical populations is fragmentary. Historically, the infectious diseases have been emphasized but, as some populations have undergone socio-economic changes, vital statistics have described a change in the pattern of disease. The picture is of a decline in infectious and a rise in chronic non-communicable disease. We focus here on the emergence of chronic cardiovascular diseases, and use hypertension as the paradigmic example. Early blood pressure surveys showed a virtual absence of hypertension among rural Africans and moderate prevalences in the Caribbean. Prevalence was highest among US and UK blacks. In a recent comparative study of blood pressure and its determinants in Nigeria, Jamaica and the US there was a steep gradient in prevalence from 15% through 26% to 33%. Body mass index and salt intake were the major determinants, accounting for 70% of the variance in hypertension prevalence. Additional information on mechanism comes from the exploration of the renin-angiotensin system across these populations. Angiotensinogen levels rise steadily from Africa to the US and are modestly associated with body mass index (BMI), and even more modestly with polymorphisms of the angiotensinogen gene. 30% of the variation in angiotensin-converting enzyme levels is attributable to the insertion/deletion polymorphism, and angiotensin-converting enzyme levels are modestly related to BMI and blood pressure. Thus, the steep gradient in prevalence is not attributable to the genetics as manifested in the renin-angiotensin system. The usefulness of these and other data on cardiovascular diseases include planning for primordial prevention in Africa and amelioration of existing epidemics in the Caribbean, the US and the UK. Additional long term surveillance data to define the burden and distribution of causes are necessary in Africa. Lastly, education and advocacy to transfer the information to policy makers and planners is required.

Africa↗
PubMed1991

Cocaine: the newest risk factor for cardiovascular disease.

Cocaine-related cardiovascular events escalated during the 1980s as cocaine became purer, cheaper, and easier to obtain. Cocaine abuse is a risk factor for myocardial ischemia and/or infarction, cardiac arrhythmias, pulmonary edema, ruptured aortic aneurysm, cerebral infarction, infective endocarditis, vascular thrombosis, myocarditis, and dilated cardiomyopathy. As medical and social complications of cocaine have become evident, and with the growing negative image of cocaine, the number of first-time users has begun to decline. Cocaine abuse is seen on all levels of our society and has emerged as an issue of significant medical and public health importance. All routes and forms of cocaine abuse are potentially cardiotoxic and can be lethal. Fatal cardiac complications can occur in a first-time user. All physicians should be alert for cocaine abuse when confronted with unexplained cardiac symptoms. Cocaine is the newest and sometimes unrecognized risk factor for cardiovascular disease in young individuals otherwise free of cardiovascular risk factors.

Cardiovascular Diseases↗
PubMedDate not supplied

Glycemic control and cardiovascular disease in type 2 diabetes: a review.

Cardiovascular disease is the major cause of morbidity and mortality in people with Type 2 diabetes, and risk of atherosclerotic disease is markedly increased in people with diabetes compared to people with normal glucose tolerance. The excess risk can not be completely explained by increased prevalence of other cardiovascular disease risk factors such as hypertension and hyperlipidaemia in people with diabetes. This review examines the role of hyperglycemia and glycemic control in cardiovascular disease in people with Type 2 diabetes. The results of prospective observational studies and randomized controlled trials are summarized. We conclude that control of hypertension and hyperlipidemia are important to reduce risk of cardiovascular disease in people with diabetes and may be more easily achieved than tight glycemic control.

Cardiovascular Diseases↗
PubMed2004

Comparison of ankle-brachial pressure index and pulse wave velocity as markers of the presence of coronary artery disease in subjects with a high risk of atherosclerotic cardiovascular disease.

Recently, a measurement device that can simultaneously measure the ankle-brachial pressure index (ABI) and brachial-ankle pulse wave velocity (PWV) has become available. The present study compares the applicability of ABI and PWV as markers for predicting the prevalence of coronary artery disease (CAD) in subjects with a high risk of atherosclerotic cardiovascular disease. The ABI and brachial-ankle PWV were measured in 472 consecutive subjects who subsequently underwent coronary angiography for diagnosis or exclusion of CAD. The prevalence of CAD in the lowest ABI quartile was higher than those in the other 3 ABI quartiles, whereas the prevalence in the lowest brachial-ankle PWV quartile was lower than those in the other 3 brachial-ankle PWV quartiles. A multivariate logistic regression analysis demonstrated that the lowest ABI quartile was a significant independent variable for the prevalence of CAD and that the lowest brachial-ankle PWV quartile was a significant independent variable for the absence of CAD in a population. Thus, a low ABI is an independent marker for an additive risk of CAD, whereas a low brachial-ankle PWV may be used as an independent marker for excluding the risk of CAD among subjects with a high risk of atherosclerotic cardiovascular disease.

Aged↗
PubMed2004

Insulin resistance-associated cardiovascular disease: potential benefits of conjugated linoleic acid.

Type 2 diabetes and associated cardiovascular disease have reached global epidemic proportions. Recent data from the World Health Organization Multinational Study of Vascular Disease in Diabetes indicate that cardiovascular disease is the leading cause of mortality (52% of deaths) in individuals with type 2 diabetes. Although insulin resistance plays a critical role in the pathogenesis of type 2 diabetes-related cardiovascular disease, other related risk factors often cluster in a single patient; the combination of insulin resistance and these risk factors is known as the metabolic syndrome. According to the World Health Organization definition, this constellation of risk factors includes hypertension, elevated plasma triacylglycerol, reduced HDL cholesterol, central obesity, and microalbuminuria. The Multiple Risk Factor Intervention Trial showed that, although diabetes or insulin resistance is an independent risk factor for cardiovascular disease mortality, these other components of the metabolic syndrome confer additive risk. Thus, to effectively address cardiovascular disease in persons with diabetes, intervention would ideally target all these factors. Conjugated linoleic acid could represent a candidate agent. The therapeutic potential of conjugated linoleic acid against insulin resistance-associated cardiovascular disease is discussed on the basis of the reported effects of conjugated linoleic acid on individual components of the metabolic syndrome.

Albuminuria↗