Cerebral complications of cardiovascular disease.
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Brain↗
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Women and cardiovascular disease. Clinical brief.
1. Cardiovascular disease is the leading cause of death for White and Black women in the United States. Women's heart disease deaths are declining more slowly than men's mortality rates. 2. Gender differences in risk factors, presentation, and management of coronary artery disease have been noted in research. Individual risk factor management and treatment of disease is critical for providing gender appropriate care. 3. The occupational health professional's role is to accurately assess the woman's risk and to consult with and refer to an appropriate specialist.
Age Distribution↗
Inflammatory markers and cardiovascular disease (The Health, Aging and Body Composition [Health ABC] Study).
This study investigates the association of several inflammatory markers with subclinical and clinical cardiovascular disease in older men and women. Data are from the baseline assessment of 3,045 well-functioning persons aged 70 to 79 years, participating in the Health, Aging and Body Composition study. The study sample was divided into 3 groups: "cardiovascular disease" (diagnosis of congestive heart failure, coronary artery disease, peripheral artery disease, or stroke), "subclinical cardiovascular disease" (positive findings on the Rose questionnaire for angina or claudication, ankle-brachial index <0.9, or electrocardiographic abnormalities), and "no cardiovascular disease." Serum levels of interleukin (IL)-6, C-reactive protein (CRP), tumor necrosis factor (TNF)-alpha, and the soluble receptors IL-6 soluble receptor, IL-2 soluble receptor, TNF soluble receptor I, and TNF soluble receptor II were assessed. Of those with IL-6 levels in the highest compared with the lowest tertile, the odds ratio (OR) for subclinical cardiovascular disease was 1.58 (95% confidence interval [CI] 1.26 to 1.97) and for clinical cardiovascular disease was 2.35 (95% CI 1.79 to 3.09). A similar association was found for TNF-alpha (OR 1.48, 95% CI 1.16 to 1.88 and OR 2.05, 95% CI 1.55 to 2.72, respectively). In adjusted analyses, CRP was not significantly associated with overall subclinical or clinical cardiovascular disease, although additional analyses did find a strong specific association between CRP and congestive heart failure (OR 1.64, 95% CI 1.11 to 2.41). Of the soluble cytokine receptors, only TNF soluble receptor I showed a significant association with clinical cardiovascular disease. Thus, our findings suggest an important role for IL-6 and TNF-alpha in clinical as well as subclinical cardiovascular disease. In this study, CRP had a weaker association with cardiovascular disease than the cytokines.
Aged↗
[Gender aspects of socioeconomic and psychosocial risk factors of cardiovascular diseases].
Socioeconomic and psychosocial factors exert influence on health as well as the development, the progression and the prevention of diseases. Social factors regarding cardiovascular diseases have been widely researched. Whilst characteristics of classic type A behaviour increase cardiovascular risk among men, characteristics of type B behaviour represent a protective value, especially among women. Depression--a disease that is particularly prevalent among women and is associated with socioeconomic factors--negatively influences the development of cardiovascular diseases, triggers cardiovascular events and influences rehabilitation. Lifestyle factors, which are positively or negatively correlated with cardiovascular disease, show a gender-specific prevalence and are related to psychosocial factors. More women than men report healthy nutrition, whereas more men report partaking in physical exercise. Obesity is--depending on the occupational group and the social level--more prevalent among women compared to men.
Coronary Disease↗
The coordination of heart beat and respiration during ergometric stress in patients with functional cardiovascular diseases.
Patients with functional cardiovascular diseases were tested during a rectangular ergometric stress protocol for the reaction of the frequency coordination (n = 82) and the phase coordination (n = 52) of heart beat and respiration. The ratios of the pulse and respiratory frequency converged increasingly with the duration of the exercise, caused by a similar reaction of the respiratory rates.
Adolescent↗
Review of the American Heart Association's guidelines for cardiovascular disease prevention in women.
Cardiovascular disease (CVD) is the leading cause of death of women in the United States and most of the developed world. The latest available data from the World Health Organization indicate that 16.6 million people around the globe die of CVD each year. World deaths from coronary heart disease (CHD) in 2002 totalled 7.2 million. One in seven women in Europe will die of CHD; in the United Kingdom > 1.2 million women are living with CHD. Despite advances in diagnosing and treating CHD, the disease accounts for the majority of CVD deaths in women in the United States, with more than 240,000 dying annually. Although coronary heart disease is the predominant cause of mortality for adult women in the United States, screening for coronary risk factors and coronary risk reduction interventions remains underused in women. In February of 2004, the American Heart Association published the first evidence-based guidelines for CVD prevention in women, consisting of a set of clinical recommendations tailored to a woman's individual level of risk.
Cardiovascular Diseases↗
Influenza vaccination of persons with cardiovascular disease in the United States.
People who have cardiovascular disease are at increased risk of hospitalization or death associated with influenza infection, and are included among the high-risk groups for whom annual influenza vaccination is recommended. To measure the progress toward the national year 2000 and 2010 objectives of a 60% annual influenza vaccination of adults with high-risk conditions aged 18 to 64 years, we analyzed data from the 1997 to 2001 National Health Interview Surveys (NHIS) regarding persons with cardiovascular disease. The NHIS is an annual, cross-sectional survey representative of the U.S., noninstitutionalized, civilian population. Estimated percentages of persons with heart disease reporting influenza vaccination were relatively stable during the 1996-97 through 2000-2001 influenza seasons, with the highest levels in most groups occurring in 1999-2000: 49.2% (95% confidence interval [CI], 44.1%-54.3%) among persons aged 50 to 64 years; and 22.7% (95% CI, 18.2%-27.2%) among persons aged 18 to 49 years. Influenza vaccine coverage among adults aged 18 to 64 years with cardiovascular disease is substantially below the national objective. Multiple strategies are needed to improve vaccination coverage, such as increasing the awareness of and demand for vaccination by persons with heart disease; increasing implementation by providers of practices that have been shown to increase vaccination levels; and adopting of influenza vaccination by primary care providers and specialists as a standard of care for persons diagnosed with cardiovascular disease.
Adolescent↗
[Cardiovascular diseases, medical apocalypse of the 21st century?].
The aim of this article is to bring forward and realise the size of cardiovascular diseases and the burden of its numbers that concern practising doctors in Lower Silesia, in Poland, Europe and the world. Every fourth patient knocking at the GP's door comes with a problem with the circulatory system. These diseases are the reason for every second in hospitalization or referral to a specialist. The most common diagnosis is not the common cold but arterial hypertension. Three of the most common diseases in patients over 65 years old are: hypertension, ischaemic heart disease, and atherosclerosis of the brain arteries. Poland belongs to the group of developed countries with an emerging economy, where degenerative diseases dominate, and cardiovascular diseases account for the biggest problems within the Health System. Nearly half of male deaths (46%) and over half of female deaths (56%) are the consequence of cardiovascular diseases. 80% of people around the world live in developing economies, where cardiovascular diseases cause 23% of all deaths. Every fifth person lives in a developed country and has a 50% chance of dying because of cardiovascular diseases. Will these diseases become "the number one killer" of the 21st century? 27% lost healthy life years are due to arterial hypertension, ischeamic heart disease, and congestive heart failure so their epidemiology is being regarded in this article.
Adult↗
Neurotrophin presence in human coronary atherosclerosis and metabolic syndrome: a role for NGF and BDNF in cardiovascular disease?
The development of atherosclerotic cardiovascular disease is a common comorbidity in patients with the metabolic syndrome, a concurrence of cardiovascular risk factors in one individual. While multiple growth factors and adipokines are identified in atherosclerotic lesions, as well as neurotrophins implicated in both cardiac ischemia and lipid and glucose metabolism, the potential role of neurotrophins in human coronary atherosclerosis and in the metabolic syndrome still remains to be elucidated. Here we describe and discuss our results that represent a novel attempt to study the cardiovascular and metabolic biology of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and mast cells (MC). The local amount of NGF, the immunolocalization of p75 neurotrophin receptor (p75NTR) and the number of MC were correlatively examined in coronary vascular wall and in the surrounding subepicardial adipose tissue, obtained from autopsy cases in humans with advanced coronary atherosclerosis. We also analyzed the plasma levels of NGF, BDNF and leptin and the number of MC in biopsies from abdominal subcutaneous adipose tissue in patients with a severe form of the metabolic syndrome. The results demonstrate that NGF levels are decreased in atherosclerotic coronary vascular tissue but increased in the subepicardial adipose tissue, whereas both tissues express a greater number of MC and a stronger p75NTR immunoreactivity, compared to controls. Metabolic syndrome patients display a significant hyponeurotrophinemia and an increased number of adipose MC; the later correlates with elevated plasma leptin levels. In effect, we provide the first evidence for (i) an altered presence of NGF, p75NTR and MC in both coronary vascular and subepicardial adipose tissue in human coronary atherosclerosis, and (ii) a significant decrease in plasma NGF and BDNF levels and an elevated amount of plasma leptin and adipose MC in metabolic syndrome patients. Together our findings suggest that neuroimmune mediators such as NGF, BDNF, leptin and MC may be involved in the development of cardiovascular disease and related disorders.
Animals↗
Association between leg length and offspring birthweight: partial explanation for the trans-generational association between birthweight and cardiovascular disease: findings from the British Women's Heart and Health Study.
Low birthweight individuals not only have increased risk of cardiovascular disease themselves, but cardiovascular disease risk is also increased in their parents. The mechanisms underlying these trans-generational associations are not fully understood. We hypothesise that, in part, they reflect the trans-generational effects of poor maternal environmental circumstances in early childhood. Adverse environmental factors acting early in the mother's life will not only influence her own predisposition to cardiovascular disease but will also result in adverse consequences - low birthweight and increased cardiovascular disease risk in later life - for her offspring. Adult leg length is a valid indicator of early life environmental circumstances, in particular of infant nutrition. If our hypothesis is correct, then adult leg length should be positively associated with offspring birthweight. In this study of 4286 randomly selected women aged 60-79 years from 23 towns across England, Scotland and Wales, the magnitude of the association between leg length and offspring birthweight was greater than the association between trunk length and offspring birthweight. After control for potential confounding factors, offspring birthweight increased by 89.8 g [95% confidence interval 66.1, 113.5 g] for each standard deviation increase in maternal leg length, and by 55.2 g [32.2, 78.1 g] for each standard deviation increase in maternal trunk length. The association between leg length and offspring birthweight was unaffected by adjustment for maternal birthweight, but the association between trunk length and offspring birthweight was attenuated to 38.0 g [1.0, 74.9 g]. These findings support the hypothesis that adverse early childhood environmental circumstances affect not only the vitality and health of the woman in later life but also the birthweight of her offspring, and suggest that the trans-generational association between birthweight and cardiovascular disease is in part explained by early childhood maternal environmental circumstances.
Aged↗
Drug therapy for cardiovascular disease in the aged.
Cardiovascular diseases and their treatment in the aged are discussed under the headings of ischemic heart disease, hypertension, cardiac failure (with special reference to the use of diuretics and digoxin), infective carditis and thyroid disorders. Advanced age modifies the approach to treatment; the choice of drugs and the dosage must be adjusted accordingly. Possible drug interactions should also be considered. A rehabilitation program is of great benefit for many elderly cardiac patients. It should be planned individually and involve psychologic and environmental factors as well as medical therapy. After successful treatment of the acute episode, even the aged patient can undertake rewarding activities in his remaining lifetime.
Adrenergic beta-Antagonists↗
Drinking water and cardiovascular disease.
A link between cardiovascular disease (CVD) mortality and the hardness of drinking water (DW) is suggested by about 30 epidemiological studies performed worldwide in the general population since 1957. This review examines the main ecological studies, case-control studies and cohort studies, published between 1960 and 2000. Attention is paid to the problem of interpretation of this typical result of environmental epidemiology. Some studies focused on the role played by inorganic elements known as DW contaminants (mainly, As, Pb) and above all on the role of the magnesium content of DW and its cardioprotective effects. To date, it would be impossible to understand this environmental findings without large intervention studies performed in well-controlled public health programs.
Cardiovascular Diseases↗
Blood levels of homocysteine and increased risks of cardiovascular disease: causal or casual?
BACKGROUND: Accumulating data from epidemiological studies suggest that individuals with elevated blood levels of homocysteine have increased risks of cardiovascular disease. We reviewed the currently available evidence of an association between homocysteine and cardiovascular disease and examined whether the strength of the evidence varies according to study design. METHODS: We used a computerized MEDLINE literature search, 1966 through September 1998, to identify all epidemiological studies that examined the relationship of homocysteine level with risks of coronary heart or cerebrovascular disease. Two measures of plasma homocysteine level and its association with risk of cardiovascular disease were extracted: mean homocysteine level in cases and controls, and relative risk of cardiovascular disease for elevated homocysteine level. RESULTS: A total of 43 studies were reviewed. Most crosssectional and case-control studies indicated higher mean homocysteine levels (either fasting or after methionine load) and/or a greater frequency of elevated homocysteine level in persons with cardiovascular disease as compared with persons without cardiovascular disease. Results of most prospective studies, however, indicated smaller or no association. The few prospective studies that reported a positive association between homocysteine level and risks of cardiovascular disease included patients with preexisting vascular disease. CONCLUSIONS: In contrast to cross-sectional and case-control studies, results of prospective studies indicated less or no predictive ability for plasma homocysteine in cardiovascular disease. Instead, elevated homocysteine level may be an acute-phase reactant that is predominantly a marker of atherogenesis, or a consequence of other factors more closely linked to risks of cardiovascular disease. Randomized trials are necessary to test reliably whether lowering homocysteine levels will decrease risks of cardiovascular disease.
Adolescent↗
Anemia and cardiovascular disease in diabetic nephropathy.
Cardiovascular disease (CVD) is the major cause of morbidity and mortality in people with diabetes and in those with chronic kidney disease (CKD). Diabetes, occurring in epidemic proportions in the United States and worldwide, is also the leading cause of CKD and kidney failure. Identification of modifiable risk factors for CVD in patients with diabetes and CKD is thus of paramount importance. Anemia is increasingly recognized as a potential CVD risk factor in patients with diabetic nephropathy, in whom it is generally more severe and occurs at an earlier stage of CKD. In this review, we discuss the epidemiologic evidence, pathophysiologic mechanisms, and the current research findings, highlighting the role of anemia as a potential modifiable risk factor for CVD in patients with diabetic nephropathy, a particularly vulnerable population for CVD.
Anemia↗
Is an elevated level of serum lipoprotein (a) a risk factor for cardiovascular disease in CAPD patients?
Cardiovascular disease (CVD) is the single most important cause of mortality in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. An increased lipoprotein (a) [Lp(a)] level in HD patients is associated with CVD. However, Lp(a) levels in CAPD patients are controversial, and their association with CVD has not been established. In the present study, prevalent CAPD and HD patients [excluding those who were human immunodeficiency virus (HIV)-positive] attending the Long Island College Hospital from June, 1990 to July, 1995 underwent analysis of lipid profile including Lp(a). Total and low-density lipoprotein cholesterol, triglycerides, apolipoprotein (apo) A, and apo B were all significantly increased in CAPD patients compared to HD patients. Serum Lp(a) levels were also significantly higher in CAPD patients than in HD patients (51 +/- 32 vs 34 +/- 23 mg/dL, p < 0.001). CAPD patients who had a history of myocardial infarction (MI) or coronary artery disease (CAD) at enrollment had significantly higher Lp(a) levels compared to those who did not have a history of MI or CAD. CAPD patients who died of CVD had higher Lp(a) levels than patients who died of non-CVD causes. In the Cox model with backward stepwise selection, a history of CVD was associated with a significantly elevated relative risk (RR) of mortality (RR = 1.84, p = 0.014). Expected survival by all causes of mortality and by cardiac mortality was significantly shorter in patients with a history of CVD than in those without a history of CVD. Thus, elevated Lp(a) is related to increased CVD and therefore may contribute to increased mortality in CAPD patients.
Adult↗
[Cardiovascular diseases and gene polymorphisms].
Cardiovascular diseases rank among the most important mortality causes in the Czech population. Although the unhealthy living style plays a key role in their development and progression, impacts of the hereditary predisposition can not be denied. This article characterizes the gene polymorphisms and results of mutations in general. An overview of the most important findings presented in papers published in the Czech Republic and worldwide follows. Issues of concrete gene polymorphism associations with such pathological conditions as acute or chronic heart failure, essential hypertension or heart rhythm disorders are discussed. Attention is paid to genes that participate on beta-adrenergic signalling, to genes for angiotensin, to ACE-gene and to angiotensin II receptor gene. A table summarizing the most important data is attached to the article.
Angiotensinogen↗
Erythrocyte fatty acids, plasma lipids, and cardiovascular disease in rural China.
Cardiovascular disease (CVD) mortality (coronary heart disease, hypertensive heart disease, and stroke), plasma lipids, and red blood cell fatty acid composition were examined in an ecologic study in 65 rural counties in the People's Republic of China. Means of plasma total cholesterol, triglyceride, low-density-lipoprotein (LDL) cholesterol, and high-density-lipoprotein (HDL) cholesterol concentrations were substantially lower and the ratio of HDL cholesterol to total cholesterol was higher in this Chinese population than in Western populations. Mortality rates for CVD in China were well below Western values. Within China neither plasma total cholesterol nor LDL cholesterol was associated with CVD. A strong inverse correlation between red blood cell oleate concentrations and CVD was observed. However, red blood cell oleate concentrations were not associated with plasma cholesterol but were strongly negatively associated with arachidonate concentrations, suggesting potential diminution of CVD by oleate through reduced platelet aggregability. The results indicate that geographical differences in CVD mortality within China are caused primarily by factors other than dietary or plasma cholesterol.
Adult↗
Cardiovascular disease and mortality in ESRD.
Cardiovascular disease is the major killer in ESRD. Cardiovascular death risk is at least an order of magnitude higher in ESRD patients, even after adjusting for age and diabetic status. Cardiac failure is a rapidly lethal condition in ESRD patients which appears to mediate much of the adverse prognostic impact of ischemic heart disease. Left ventricular abnormalities are present at initiation of dialysis in about 80% of dialysis patients. These are very highly predictive of future ischemic heart disease, cardiac failure, and death after 2 years on dialysis therapy. Regression of these abnormalities improves prognosis. The associations between many classical risk factors like hyperlipidemia, smoking and hypertension and cardiac outcomes in ESRD are inconsistent. Many factors unique to ESRD and its therapy may be important. In our prospective 10 year study of 433 patients starting dialysis, the following were major risk factors for cardiac disease: hypertension (concentric LVH, LV dilatation, de novo ischemic heart disease, de novo cardiac failure, inverse relationship with mortality); anemia (LV dilatation, de novo cardiac failure and death); hypoalbuminemia (de novo ischemic heart disease, de novo cardiac failure and death). LV abnormalities tended to worsen on dialysis and improve after transplantation suggesting that a uremic environment is cardiotoxic. Many risk factors act in concert to produce cardiovascular disease in ESRD. Many can be treated, suggesting that the huge burden of disease can be reduced considerably.
Cardiovascular Diseases↗