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PubMed1998

Combined oral contraceptives, smoking, and cardiovascular risk.

STUDY OBJECTIVE: To assess age specific incidence and mortality of stroke, acute myocardial infarction (AMI), and idiopathic venous thromboembolism (VTE) associated with use of modern low dose combined oral contraceptives (OCs) and the interaction with smoking. DESIGN: Hospital-based case-control study. SETTING: Hospitals in Oxford region in the United Kingdom, which covered a defined population, during the period 1989-1993. METHODS: Relative risk estimates from the WHO Collaborative Study and observed incidence rates from the Oxford region were used to estimate age specific incidence of each disease among women without cardiovascular risk factors and model total cardiovascular incidence and mortality. RESULTS: Among women who did not use OCs, smoke nor had any other cardiovascular risk factors, total incidence of stroke and AMI were less than 2 events per 100,000 woman years in those aged 20-24 years and rose exponentially with age to 8 events per 100,000 among women aged 40-44 years. Incidence of idiopathic VTE among women who did not use OCs rose linearly with age (from 3.3 per 100,000 at ages 20-24 years to 5.8 per 100,000 at ages 40-44 years). The increased risk of idiopathic VTE associated with OC use among non-smokers constituted over 90% of all cardiovascular events for women aged 20-24 years and more than 60% in those aged 40-44 years. Fatal cardiovascular events were dominated by haemorrhagic stroke and AMI, and among OC users who smoked these two diseases accounted for 80% of cardiovascular deaths among women aged 20-24 years, rising to 97% among those aged 40-44 years. Cardiovascular mortality associated with smoking was greater than that associated with OC use at all ages. Attributable risk associated with OC use was 1 death per 370,000 users annually among women aged 20-24 years, 1 per 170,000 at ages 30-34 years, and 1 per 37,000 at ages 40-44 years. Among smokers, the cardiovascular mortality attributable to OC use was estimated to be about 1 per 100,000 users annually among women aged less than 35 years, and about 1 per 10,000 users annually among those above the age of 35 years. CONCLUSION: The incidence of fatal cardiovascular events among women aged less than 35 years is low. The VTE risk associated with OC use is the largest contributor to OC induced adverse effects. The potentially avoidable excess VTE risk associated with the newer progestogens desogestrel and gestodene would account for a substantial proportion of total cardiovascular morbidity in this age group. For women over age 35 years the absolute risks associated with OC use and smoking are greater because of the steeply rising incidence of arterial diseases. The combination of smoking and OC use among such women is associated with particularly increased risks. Any potential reduction in AMI or stroke risk with use of third generation OCs would be a more important consideration among older compared with younger women, particularly if they smoke. However, the mortality associated with smoking is far greater than that associated with OC use (of any type) at all ages.

Adult↗
PubMed1997

Hypertension and borderline isolated systolic hypertension increase risks of cardiovascular disease and mortality in male physicians.

BACKGROUND: The objective of this study was to examine whether definite hypertension and borderline isolated systolic hypertension predict subsequent cardiovascular disease and mortality. METHODS AND RESULTS: This was a prospective cohort study with a mean follow-up of 11.7 years. The subjects were a group of 18,682 apparently healthy US men, aged 40 to 84 years, participating in the Physicians' Health Study, a randomized trial of low-dose aspirin and beta-carotene. The main outcome measures were total cardiovascular disease, myocardial infarction, stroke, cardiovascular death, and all-cause mortality. Hypertension was associated with substantially increased risks of total cardiovascular disease (relative risk [RR] 1.92; 95% confidence interval [CI], 1.70 to 2.18), myocardial infarction (RR,1.78; 95% CI, 1.49 to 2.13), stroke (RR, 2.19; 95% CI, 1.78 to 2.69), and cardiovascular death (RR, 2.10; 95% CI, 1.68 to 2.63). Borderline isolated systolic hypertension was associated with significantly increased risks of cardiovascular disease (RR, 1.32; 95% CI, 1.09 to 1.59), stroke (RR, 1.42; 95% CI, 1.04 to 1.93), and cardiovascular death (RR, 1.56; 95% CI, 1.13 to 2.15), as well as a possible but non-significant increased risk of myocardial infarction (RR, 1.26; 95% CI, 0.95 to 1.67). Hypertension and borderline isolated systolic hypertension were associated with significantly increased risks of 41% and 22%, respectively, for all-cause mortality. CONCLUSIONS: Hypertension as well as borderline isolated systolic hypertension are associated with elevated risks of cardiovascular diseases, especially stroke and cardiovascular death. Hypertension is associated with an increased risk of myocardial infarction, and borderline isolated systolic hypertension predicts a possible but more modest increase in risk. These data add to the existing evidence that hypertension is a major cardiovascular risk factor and extend the findings to borderline isolated systolic hypertension.

Adult↗
PubMed1998

Prospective study of hyperhomocysteinemia as an adverse cardiovascular risk factor in end-stage renal disease.

BACKGROUND: Retrospective and case-control studies show that hyperhomocysteinemia is an independent risk factor for atherosclerosis in patients with end-stage renal disease. We studied prospectively the association between total homocysteine and cardiovascular outcomes. METHODS AND RESULTS: In all, 167 patients (93 men, 74 women; mean age, 56.3+/-14.7 years) were followed for a mean duration of 17.4+/-6.4 months. Cardiovascular events and causes of mortality were related to total homocysteine values and other cardiovascular risk factors. Cox regression analysis was used to identify the independent predictors for cardiovascular events and mortality. Fifty-five patients (33%) developed cardiovascular events and 31 (19%) died, 12 (8%) of cardiovascular causes. Total plasma homocysteine values ranged between 7.9 and 315.0 micromol/L. Levels were higher in patients who had cardiovascular events or died of cardiovascular causes (43.0+/-48.6 versus 26.9+/-14.9 micromol/L, P=.02). The relative risk (RR) for cardiovascular events, including death, increased 1% per micromol/L increase in total homocysteine concentration (RR, 1.01; CI, 1.00 to 1.01; P=.01). CONCLUSIONS: These prospective observations confirm that hyperhomocysteinemia is an independent risk factor for cardiovascular morbidity and mortality in end-stage renal disease, with an increased RR of 1% per micromol/L increase in total homocysteine concentration. Interventional studies are needed to evaluate the possible effects of modifying this risk factor in these patients.

Adult↗
PubMed2005

Role of smoking in global and regional cardiovascular mortality.

BACKGROUND: Smoking is a major cause of cardiovascular disease mortality. There is little information on how it contributes to global and regional cause-specific mortality from cardiovascular diseases for which background risk varies because of other risks. METHOD AND RESULTS: We used data from the American Cancer Society's Cancer Prevention Study II (CPS II) and the World Health Organization Global Burden of Disease mortality database to estimate smoking-attributable deaths from ischemic heart disease, cerebrovascular disease, and a cluster of other cardiovascular diseases for 14 epidemiological subregions of the world by age and sex. We used lung cancer mortality as an indirect marker for accumulated smoking hazard. CPS-II hazards were adjusted for important covariates. In the year 2000, an estimated 1.62 (95% CI, 1.27 to 2.04) million cardiovascular deaths in the world, 11% of total global cardiovascular deaths, were due to smoking. Of these, 1.17 million deaths were among men and 450,000 among women. There were 670,000 (95% CI, 440,000 to 920,000) smoking-attributable cardiovascular deaths in the developing world and 960,000 (95% CI, 770,000 to 1,200,000) in industrialized regions. Ischemic heart disease accounted for 54% of smoking-attributable cardiovascular mortality, followed by cerebrovascular disease (25%). There was variability across regions in the role of smoking as a cause of various cardiovascular diseases. CONCLUSIONS: More than 1 in every 10 cardiovascular deaths in the world in the year 2000 were attributable to smoking, demonstrating that it is an important preventable cause of cardiovascular mortality.

Adult↗
PubMed2005

Cardiovascular complications of diabetes mellitus in sub-Saharan Africa.

BACKGROUND: Cardiovascular disease, the major cause of mortality and morbidity in modern societies, is set to overtake infectious diseases in the developing world as the most common cause of death. The increasing prevalence of major and emerging cardiovascular risk factors accounts for the growing burden of cardiovascular disease in the world. Diabetes in all its forms is one of the main cardiovascular risk factors. Two of 3 diabetic patients will die as a result of cardiovascular complications, and approximately 30% of patients treated in cardiovascular intensive care units have diabetes. METHODS AND RESULTS: This review on the cardiovascular complications of diabetes in sub-Saharan Africa is a bibliographical MEDLINE search of published data over the past 2 decades. Diabetes-related cardiovascular disease complications are considered to be rare in Africa but are on the rise and are regularly associated with classic cardiovascular risk factors. Coronary heart disease may affect 5% to 8% of type 2 diabetic patients and cardiomyopathy, up to 50% of all patients. Close to 15% of patients with stroke have diabetes, and up to 5% of diabetic patients present with cerebrovascular accidents at diagnosis. Peripheral vascular disease prevalence varies across sites from 4% to 28%. CONCLUSIONS: It is obvious that diabetes mellitus and related cardiovascular complications are gaining more importance in sub-Saharan Africa. The relative contribution of putative risk factors is not well defined, and further research is therefore needed.

Africa South of the Sahara↗
PubMed2002

Prevalence of cardiovascular risk factors before kidney transplantation.

CONTEXT: Assessing the prevalence of cardiovascular risk factors is an essential step in developing risk profiles and individualizing interventions to reduce the cardiovascular morbidity and mortality of kidney transplant recipients. OBJECTIVE: To examine the prevalence of pretransplant modifiable, potentially modifiable, and nonmodifiable cardiovascular risk factors in patients who received kidney transplants between January 1, 1994, and December 31, 1996. DESIGN: An exploratory, retrospective nested case-control design was employed to assess pretransplant cardiovascular risk factors in kidney transplant recipients with documented posttransplant cardiovascular events (n = 12) and kidney transplant recipients with no documented posttransplant cardiovascular events (n = 66). Data were analyzed using frequencies, unpaired t tests, and chi 2 analyses. RESULTS: Significantly higher means of body mass index values greater than 25 kg/m2 (32.3 +/- 5.8 kg/m2 vs 28.8 +/- 3.4 kg/m2) and serum total cholesterol levels greater than 200 mg/dL (254.5 +/- 5.7 mg/dL vs 242.3 +/- 39.3 mg/dL) were noted in patients with documented cardiovascular events compared to those with no documented cardiovascular events, respectively. Diabetes was more prevalent in patients with documented cardiovascular events (33%); these patients were also predominantly African American men who had a higher prevalence of family and personal histories of cardiovascular disease (17% and 33%).

Adult↗
PubMed2006

Screening children to identify families at increased risk for cardiovascular disease.

OBJECTIVES: Atherosclerotic cardiovascular disease is the leading cause of death in the United States. Atherosclerosis begins early in life; however, children and young and middle-aged adults are not universally screened for the presence of modifiable cardiovascular disease risk factors. The purpose of this study was to investigate whether cardiovascular disease risk-factor assessment in children can identify families who are at increased risk for cardiovascular disease. PARTICIPANTS AND METHODS: Family Strategies Concentrating on Risk Evaluation is a community-based participatory research study designed to stratify cardiovascular disease risk in a cohort of children and their parents. Eligible families, consisting of > or = 1 child and > or = 1 biological parent, are recruited through community and faith-based educational and screening programs. In a single, fasted study visit, participants undergo assessment of cardiovascular disease risk factors: obesity, hypertension, dyslipidemia, and metabolic syndrome. Associations of cardiovascular disease risk factors between children and their parents were assessed. RESULTS: Data were analyzed from 94 families: 108 parents (mean age: 38.5 +/- 7.5 years), 141 children (mean age: 10.5 +/- 3.4 years), and 170 child-parent pairs. Child-parent association was strong for many risk factors: BMI, waist circumference, systolic blood pressure, triglycerides, and total cholesterol. Several discrete-defined risk factors in children were found to be significant predictors of the presence of the same risk factors in their parents. Parents of children with hypertension, obesity, or hypertriglyceridemia had 15 times, 6 times, or 5 times increased odds, respectively, of having the same risk factors. CONCLUSIONS: Identification of several clinically apparent and silent cardiovascular disease risk factors in children predicts elevated cardiovascular disease risk in their parents. Because children access primary care more frequently than adults, children can potentially serve as the index case to identify families at increased risk for cardiovascular disease.

Adolescent↗
PubMed1995

The antioxidant vitamins and cardiovascular disease. A critical review of epidemiologic and clinical trial data.

PURPOSE: To review prospective epidemiologic studies and randomized trials regarding the role of antioxidant vitamins (vitamins E and C and beta-carotene) in the prevention of cardiovascular disease, with emphasis on differences in results obtained by these two types of studies. DATA SOURCES: Computerized and manual searches of the literature on antioxidant vitamins and cardiovascular disease. STUDY SELECTION: Prospective epidemiologic studies and randomized trials that included 100 or more participants and provided quantified estimates of antioxidant vitamin intake. DATA SYNTHESIS: Comparisons of relative risk reductions (RRR) across observational studies and randomized trials, including assessment of dose-response relations. RESULTS: All three large epidemiologic cohort studies of vitamin E noted that high-level vitamin E intake or supplementation was associated with a significant reduction in cardiovascular disease (RRR range, 31% to 65%), as measured by various fatal and nonfatal cardiovascular end points. To obtain these reductions, vitamin E supplementation must last at least 2 years. Less consistent reductions were seen in studies of beta-carotene (RRR range, -2% to 46%) and vitamin C (RRR range, -25% to 51%). Considerable biases in observational studies, such as different health behaviors of persons using antioxidants, may account for the observed benefit. By contrast, none of the completed randomized trials showed any clear reduction in cardiovascular disease with vitamin E, vitamin C, or beta-carotene supplementation. The trials were not specifically designed to assess cardiovascular disease, did not provide data on nonfatal cardiovascular end points, may have had insufficient treatment durations, and used suboptimal vitamin E doses. The completed trials were of adequate size to indicate that the true therapeutic benefit of vitamin E and other antioxidants in reducing fatal cardiovascular disease (a survival benefit as long as 5 years) is probably more modest than the epidemiologic data suggest. CONCLUSION: The epidemiologic data suggest that antioxidant vitamins reduce cardiovascular disease, with the clearest effect for vitamin E; however, completed randomized trials do not support this finding. Much of this controversy should be resolved by the ongoing large-scale and long-term randomized trials designed specifically to evaluate effects on cardiovascular disease.

Antioxidants↗
PubMed1999

Homocyst(e)ine and cardiovascular disease: a critical review of the epidemiologic evidence.

PURPOSE: To review epidemiologic studies on the association between homocyst(e)ine level and risk for cardiovascular disease and the potential benefits of homocysteine-decreasing therapies. DATA SOURCES: Computerized and manual searches of the literature on total homocysteine levels and cardiovascular disease. STUDY SELECTION: Prospective studies and major retrospective epidemiologic studies evaluating the association between homocyst(e)ine levels and cardiovascular disease and the association between blood levels or dietary intake of folate, vitamin B6, and vitamin B12 and cardiovascular disease. DATA EXTRACTION: Relevant data on patient population, plasma homocyst(e)ine levels, duration of follow-up, and main results were extracted from studies that met the inclusion criteria. DATA SYNTHESIS: The designs and results of studies included in this review are summarized. A formal meta-analysis was not performed because the studies were heterogeneous in method and design. CONCLUSIONS: Results of epidemiologic studies suggest that moderately elevated plasma or serum homocyst(e)ine levels are prevalent in the general population and are associated with an increased risk for cardiovascular disease, independent of classic cardiovascular risk factors. Simple, inexpensive, nontoxic therapy with folic acid, vitamin B6, and vitamin B12 reduces plasma homocyst(e)ine levels. Although the association between homocyst(e)ine levels and cardiovascular disease is generally strong and biologically plausible, the data from the prospective studies are less consistent. In addition, epidemiologic observations of an association between hyperhomocyst(e)inemia and cardiovascular risk do not prove the existence of a causal relation. Therefore, the effectiveness of folate, vitamin B6, and vitamin B12 in reducing cardiovascular morbidity and mortality requires rigorous testing in randomized clinical trials. Several such trials are under way; their results may greatly affect cardiovascular morbidity and mortality, given the simplicity and low cost of vitamin therapy.

Arteriosclerosis↗
PubMed2003

[Cardiovascular risk among patients of general practices, who are not in current acute care].

INTRODUCTION: Cardiovascular diseases are the first in the Hungarian mortality statistics. Numerous factors are known that may be involved as risk factors in the development of these diseases, and the risk is multiplied when they occur simultaneously. The recommendations of the European and Hungarian professional societies regard the early exploration of these risk factors and the estimation of cardiovascular risk as extremely important, since the intervention to be introduced depends on the extent of the risk. METHODS: The study was aimed to assess, by using a professionally accepted risk estimation method, the extent of cardiovascular risk in the adult population aged between 18 and 60 years and previously not treated for cardiovascular risk(s) or diseases. 48 family doctors' practices of four counties participated in the study; a total of 1320 individuals were enrolled. During the study targeted recording of medical history, physical examination and the determination of certain parameters of carbohydrate and lipid metabolism were performed. Afterwards the participants' cardiovascular risk was calculated for 10 years, based on the parameters obtained (age, sex, smoking habits, systolic blood pressure, total cholesterol level, status of carbohydrate metabolism). RESULTS: Frequency of high and very high cardiovascular risk was 12.44% in the population (22.59% in men and 4.89% in women, 17.72% in middle-aged and 0.75% in younger patients). Distribution of cardiovascular risk levels was less favourable in men than in woman (p < 0.001), and in middle-aged patients than in younger ones (p < 0.001). The distributions of each risk factors were similar: significant differences were demonstrated in smoking habit, systolic blood pressure and plasma cholesterol between men and women as well as between middle and younger aged patients, however significant difference in alterations of carbohydrate metabolism was found just between middle- and younger aged groups. CONCLUSIONS: Cardiovascular risk is reasonably high in adult population previously not treated with cardiovascular risks or disease. Distribution of risk levels is less favourable in men than in women, and middle-aged patients compared to younger aged patients. These results show that there is a need for the increase of the frequency of patients' preventive visits to physicians, since this can allow the identification of risk factors as early as possible, the recognition of increased cardiovascular risk and the use of the necessary and adequate intervention.

Adult↗
PubMed2003

Framingham Heart Study risk equation predicts first cardiovascular event rates in New Zealanders at the population level.

AIM: To establish the population-level predictive validity of the Framingham Heart Study risk equation used to derive cardiovascular disease risk-prediction charts for New Zealand management guidelines on raised blood pressure and dyslipidaemia. METHODS: During 1992-3, standard cardiovascular risk factors were measured in a cohort of 6354 people (4638 men and 1716 women) aged 35-74 years with no history of cardiovascular disease, who were either enrolled on Auckland general electoral rolls or employed by a nationwide multi-industry corporation. Five-year cardiovascular event rates were predicted for the cohort using a Framingham risk equation and were compared with observed five-year cardiovascular event rates for hospitalisation and mortality. RESULTS: Incident cardiovascular hospitalisations or death were reported for 411 cohort participants (325 men and 86 women) during five years of follow up. There was good agreement between observed and predicted five-year cardiovascular event rates in all five-year age/sex categories up to 69 years. The risk equation tended to underestimate risk slightly in men and overestimate risk slightly in women up to 69 years, while in 70- to 74-year-olds it was accurate for men. Its accuracy in older women is uncertain. CONCLUSION: A Framingham Heart Study risk equation used to estimate incident cardiovascular events in individuals without previous cardiovascular disease accurately predicts five-year risk of hospitalisation or death from a first cardiovascular event in New Zealand men aged 35-74 and women aged 35-69 years at the population level.

Adult↗
PubMed2005

Cardiovascular diseases in Croatia and other transitional countries: comparative study of publications, clinical interventions, and burden of disease.

AIM: To determine the number of publications on cardiovascular diseases in the MEDLINE database, the rate of medical doctors and clinical interventions in cardiology, and health and socioeconomic indicators for Croatia, and to compare them with those for Slovenia, Hungary, the Czech Republic, and Austria. METHODS: PubMed was used in search for publications on cardiovascular diseases published in 1991-2004. Rates per million population and proportions of publications on cardiovascular diseases in the MEDLINE database were calculated. Gross domestic product (GDP) per capita was used as a socioeconomic indicator, whereas human resources in medicine were presented as the rate of medical doctors per million population. Standardized death rates from cardiovascular diseases and ischemic heart disease were used as indicators of cardiovascular health. Clinical interventions in cardiology, such as coronary angiograms, percutaneous transluminal coronary angioplasties (PTCA), and coronary bypass surgeries (CABG) were expressed per million population per year. RESULTS: Croatia had the lowest GDP per capita among the analyzed countries. The standardized death rate from cardiovascular diseases in Croatia was 91.7 per 100,000 population aged 0-64 in 2001, which was higher than that in Slovenia and Austria (P<0.001), similar to that in the Czech Republic, and lower than that in Hungary (P<0.001). Cardiovascular scientific output in Croatia was the lowest among investigated countries, ie, 1.1 per million population in 2003 (P<0.001). Despite a significantly lower number of medical doctors in comparison with Hungary and the Czech Republic (P<0.001), Croatia experienced a similar increment in the amount of clinical interventions in cardiology. CONCLUSION: In contrast to high cardiovascular mortality rates, cardiovascular scientific production in Croatia was significantly lower than in other investigated countries. A positive trend in cardiovascular medicine was recorded in clinical practice, but has yet to be followed by scientific production.

Adolescent↗
PubMed2004

Cardiovascular risk and rheumatoid arthritis: from mechanisms of atherosclerosis to therapeutic approach.

Large epidemiological studies showed that one of the most important causes of death in patients with rheumatoid arthritis (RA) is represented by cardiovascular disease. Thus, the presence of RA is associated with an increased risk of the occurrence of stable angina, myocardial infarction, heart failure and stroke. However, studies performed during the last years failed to bring us clear evidence regarding the role of traditional cardiovascular risk factors (hyperlipidemia, diabetes mellitus, hypertension, smoking and obesity) in the pathogenesis of cardiovascular disease in these patients. Recently, the role of inflammation and its mediators not only in the atherosclerosis plaque development but also in the mechanisms of vulnerable plaque was clearly demonstrated. From this point of view, recent studies showed that inflammatory cells and mediators of inflammation are both markers of an increased cardiovascular risk and unfavorable cardiovascular outcome, and also cardiovascular risk factors that act in an active manner in the processes that promote atherosclerosis. Taking into account the fact that RA is a systemic inflammatory status, recent reports demonstrated the involvement of inflammation mediators in connection with prothrombotic factors and endothelial dysfunction in the development of cardiovascular disease in RA patients. There are only scarce data in the literature regarding the benefice of cardiovascular risk reduction therapies in this group. Further studies are required for the refinement of the cardiovascular risk stratification algorithms and for the improvement of the cardiovascular risk management in rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1997

Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden.

OBJECTIVE: To investigate the overall and the cardiovascular mortality in rheumatoid arthritis (RA) in Northern Sweden. To analyze the effect of traditional risk factors and factors associated with rheumatoid disease and its treatment on the progression of cardiovascular disease (CVD) and on mortality by all causes. METHODS: A cohort of 606 patients with seropositive RA were followed from 1979 to the end of 1994 or to the death of the patient. Standardized mortality ratio and survival curves were estimated with the population of Vasterbotten as reference. Sex, age at disease onset, treatment with corticosteroids, use of disease modifying antirheumatic drugs (DMARD) and hormone replacement therapy (HRT), hypertension, diabetes mellitus, HLA types, and cause of death were recorded from disease onset. Cox's proportional hazards regression was used to identify important predictors for death and cardiovascular event during followup. RESULTS: The standardized mortality ratio in both sexes was significantly higher (1.57) for all underlying causes together, for CVD (1.46) and for ischemic heart disease (IHD) (1.54) compared to the reference population. The death rate increased over time. In multiple Cox regression analyses, male sex, higher age at disease onset, and former cardiovascular event increased the death rate. Male sex, high age at disease onset, and hypertension increased the risk of cardiovascular event. Diabetes mellitus, treatment with corticosteroids, DMARD, or HRT did not influence the risks of death or first cardiovascular event. CONCLUSION: The overall mortality and death due to CVD and IHD were in both sexes increased in seropositive RA. Male sex and high age at disease onset predicted death and cardiovascular event. Except for hypertension, which increased the risk for cardiovascular event, neither of these traditional cardiovascular risk factors nor corticosteroid treatment influenced mortality by all causes or by cardiovascular event.

Adolescent↗
PubMed2002

Comparative cardiovascular development: improving the conceptual framework.

Immature vertebrates-either as an embryo in an egg, as free-living larva, or as an in utero fetus, are clearly not just small versions of adults. Their cardiovascular physiology (and doubtlessly other aspects of physiology) differs from that of adults both qualitatively and quantitatively. Yet, comparative cardiovascular physiologists have been relatively conservative in constructing a new (or at least modified) conceptual framework for the understanding of developmental cardiovascular physiology. We recommend that this framework rely less on the established cardiovascular truisms for adult cardiovascular physiology that are proving to be less useful and in instances even inaccurate for interpreting development of the heart and vasculature. We have suggested that three methodologies in particular be incorporated to a greater extent in studies of comparative cardiovascular development: (a) emphasis on multivariate approaches; (b) differentiation between absolute (extrinsic) and relative (intrinsic) time for development, and; (c) employment of time lines for both intra- and interspecific comparisons of the ontogeny of cardiovascular processes. While certainly none of these approaches are novel and others have previously dwelt at length on their importance in other contexts, we feel that the emerging framework for investigating cardiovascular physiological development would benefit from incorporating these and other approaches into experimental design as well as data analysis. Failing to do so results in a heavy dependence on analytical approaches typically used for adults, and thus under-appreciates the novelty and complexity of the developing vertebrate cardiovascular system.

Animals↗
PubMed2006

Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program.

CONTEXT: A nationwide systematic preparticipation athletic screening was introduced in Italy in 1982. The impact of such a program on prevention of sudden cardiovascular death in the athlete remains to be determined. OBJECTIVE: To analyze trends in incidence rates and cardiovascular causes of sudden death in young competitive athletes in relation to preparticipation screening. DESIGN, SETTING, AND PARTICIPANTS: A population-based study of trends in sudden cardiovascular death in athletic and nonathletic populations aged 12 to 35 years in the Veneto region of Italy between 1979 and 2004. A parallel study examined trends in cardiovascular causes of disqualification from competitive sports in 42,386 athletes undergoing preparticipation screening at the Center for Sports Medicine in Padua (22,312 in the early screening period [1982-1992] and 20,074 in the late screening period [1993-2004]). MAIN OUTCOME MEASURES: Incidence trends of total cardiovascular and cause-specific sudden death in screened athletes and unscreened nonathletes of the same age range over a 26-year period. RESULTS: During the study period, 55 sudden cardiovascular deaths occurred in screened athletes (1.9 deaths/100,000 person-years) and 265 sudden deaths in unscreened nonathletes (0.79 deaths/100,000 person-years). The annual incidence of sudden cardiovascular death in athletes decreased by 89% (from 3.6/100,000 person-years in 1979-1980 to 0.4/100,000 person-years in 2003-2004; P for trend < .001), whereas the incidence of sudden death among the unscreened nonathletic population did not change significantly. The mortality decline started after mandatory screening was implemented and persisted to the late screening period. Compared with the prescreening period (1979-1981), the relative risk of sudden cardiovascular death in athletes was 0.56 in the early screening period (95% CI, 0.29-1.15; P = .04) and 0.21 in the late screening period (95% CI, 0.09-0.48; P = .001). Most of the reduced mortality was due to fewer cases of sudden death from cardiomyopathies (from 1.50/100,000 person-years in the prescreening period to 0.15/100,000 person-years in the late screening period; P for trend = .002). During the study period, 879 athletes (2.0%) were disqualified from competition due to cardiovascular causes at the Center for Sports Medicine: 455 (2.0%) in the early screening period and 424 (2.1%) in the late screening period. The proportion of athletes who were disqualified for cardiomyopathies increased from 20 (4.4%) of 455 in the early screening period to 40 (9.4%) of 424 in the late screening period (P = .005). CONCLUSIONS: The incidence of sudden cardiovascular death in young competitive athletes has substantially declined in the Veneto region of Italy since the introduction of a nationwide systematic screening. Mortality reduction was predominantly due to a lower incidence of sudden death from cardiomyopathies that paralleled the increasing identification of athletes with cardiomyopathies at preparticipation screening.

Adolescent↗
PubMed2005

Positron emission tomography-measured abnormal responses of myocardial blood flow to sympathetic stimulation are associated with the risk of developing cardiovascular events.

OBJECTIVES: We sought to assess prospectively whether patients with normal coronary angiograms but with impaired myocardial blood flow (MBF) increases to cold pressor testing (CPT) are at increased risk for cardiovascular events. BACKGROUND: Invasive angiographic assessments of coronary vasomotor function have demonstrated an impairment of endothelium-related coronary flow increases to independently predict future cardiovascular events. It is unknown whether noninvasive positron emission tomography (PET)-measured MBF alterations to sympathetic stimulation with CPT are associated with the risk of developing cardiovascular events. METHODS: A total of 72 patients (44 men, 28 women, age 58 +/- 8 years) referred for diagnostic cardiac catheterization were studied. Myocardial blood flow was measured in absolute units with (13)N-ammonia using PET, at baseline and during CPT in each patient. Cardiovascular events (cardiovascular death, acute coronary syndrome, myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, ischemic stroke, or peripheral revascularization) were assessed as clinical outcome parameters over a mean follow-up period of 66 +/- 8 months. Patients were assigned to three groups: group 1, patients with >/=40% increase in MBF (%DeltaMBF), n = 22; group 2, patients with >0 and <40% increases in MBF, n = 32; and group 3, patients with decreases in MBF (</=0%), n = 18. RESULTS: During follow-up, one of the group 1 patients developed a cerebral stroke. In group 2, 15 cardiovascular events occurred in 9 patients and in group 3, 7 patients experienced 9 cardiovascular events (p </= 0.0001, univariate by log-rank test). Impaired MBF increases in group 2 and group 3 were associated with a significantly higher incidence of cardiovascular events by Kaplan-Meier analysis (p = 0.033, log-rank test). After adjusting for known coronary risk factors, MBF responses to CPT revealed a nonsignificant trend to be independently associated with a higher incidence for cardiovascular events (p = 0.065, multivariate by Cox regression model). CONCLUSIONS: Noninvasive PET-measured impaired MBF increases to sympathetic stimulation are associated with the risk of developing cardiovascular events.

Ammonia↗
PubMed2002

Chromosomal and cardiovascular anomalies associated with congenital laryngeal web.

OBJECTIVE: The purpose of this study was to estimate the frequency of chromosomal and cardiovascular anomalies associated with a congenital laryngeal web. METHODS: We reviewed our experience with 25 patients who underwent intervention for a symptomatic congenital laryngeal web between 1988 and 2000, in order to investigate the frequency of associated chromosomal and cardiovascular anomalies. Twelve patients underwent cytogenetic evaluation, including seven that were tested for a chromosome 22q11 deletion by fluorescence in situ hybridization. RESULTS: Chromosomal abnormalities were detected in seven of the 12 patients in whom cytogenetic evaluation was performed (28% of the entire cohort), including a chromosome 22q11 deletion in six and trisomy 21 in one. Associated cardiovascular anomalies were diagnosed in nine of the 25 patients, most commonly aortic arch anomalies. Of the patients with cardiovascular anomalies, 55% also had chromosomal alterations, and 71% of patients with chromosomal alterations also had a cardiovascular defect, of which four had the triad of a congenital laryngeal web, a chromosome 22q11 deletion, and congenital cardiovascular anomalies. CONCLUSIONS: Chromosomal and cardiovascular anomalies are common in patients with a congenital laryngeal web. A chromosome 22q11 deletion was particularly common, as were the cardiovascular anomalies associated with the chromosome 22q11 deletion syndrome. Accordingly, patients with a congenital laryngeal web should undergo genetic screening, including evaluation for a chromosome 22q11 deletion, and a thorough cardiovascular evaluation, including imaging of the aortic arch. Particular attention should be paid to identifying patients with the triad of a congenital laryngeal web, a chromosome 22q11 deletion, and cardiovascular anomalies, particularly a vascular ring.

Abnormalities, Multiple↗