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At least 793 records · Page 44Linked to original sources
PubMed1998

Cardiovascular disease in patients with dysvascular amputation.

Cardiovascular diseases are the most common causes of morbidity and mortality in individuals with peripheral vascular disease (PVD). Among patients who have undergone lower extremity amputation as a result of PVD, the prevalence of concomitant cardiovascular disease may be as high as 75%. Comorbid heart disease may complicate the postamputation course of recovery, delay initiation of rehabilitation training, and inhibit the achievement of maximal functional independence. A variety of methods have been used to assess cardiac status and risk in amputation patients undergoing physical training; these have included clinical evaluation, resting electrocardiography, and continuous dynamic electrocardiography during either standard physical therapy exercise or adapted ergometry. Several conditioning training programs have been developed to improve the cardiovascular fitness of patients with dysvascular amputation, the results of which have been favorable. These assessment and intervention strategies have extensive applicability in the clinical management of patients with dysvascular amputation.

Amputation, Traumatic↗
PubMed2004

Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk.

BACKGROUND: Increasing evidence suggests a continuous relationship between blood glucose concentrations and cardiovascular risk, even below diagnostic threshold levels for diabetes. OBJECTIVE: To examine the relationship between hemoglobin A1c, cardiovascular disease, and total mortality. DESIGN: Prospective population study. SETTING: Norfolk, United Kingdom. PARTICIPANTS: 4662 men and 5570 women who were 45 to 79 years of age and were residents of Norfolk. MEASUREMENTS: Hemoglobin A1c and cardiovascular disease risk factors were assessed from 1995 to 1997, and cardiovascular disease events and mortality were assessed during the follow-up period to 2003. RESULTS: In men and women, the relationship between hemoglobin A1c and cardiovascular disease (806 events) and between hemoglobin A1c and all-cause mortality (521 deaths) was continuous and significant throughout the whole distribution. The relationship was apparent in persons without known diabetes. Persons with hemoglobin A1c concentrations less than 5% had the lowest rates of cardiovascular disease and mortality. An increase in hemoglobin A1c of 1 percentage point was associated with a relative risk for death from any cause of 1.24 (95% CI, 1.14 to 1.34; P < 0.001) in men and with a relative risk of 1.28 (CI, 1.06 to 1.32; P < 0.001) in women. These relative risks were independent of age, body mass index, waist-to-hip ratio, systolic blood pressure, serum cholesterol concentration, cigarette smoking, and history of cardiovascular disease. When persons with known diabetes, hemoglobin A(1c) concentrations of 7% or greater, or a history of cardiovascular disease were excluded, the result was similar (adjusted relative risk, 1.26 [CI, 1.04 to 1.52]; P = 0.02). Fifteen percent (68 of 521) of the deaths in the sample occurred in persons with diabetes (4% of the sample), but 72% (375 of 521) occurred in persons with HbA1c concentrations between 5% and 6.9%. LIMITATIONS: Whether HbA1c concentrations and cardiovascular disease are causally related cannot be concluded from an observational study; intervention studies are needed to determine whether decreasing HbA1c concentrations would reduce cardiovascular disease. CONCLUSIONS: The risk for cardiovascular disease and total mortality associated with hemoglobin A1c concentrations increased continuously through the sample distribution. Most of the events in the sample occurred in persons with moderately elevated HbA1c concentrations. These findings support the need for randomized trials of interventions to reduce hemoglobin A1c concentrations in persons without diabetes.

Aged↗
PubMed2005

Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease.

Adherence to lifestyle recommendations for prevention of cardiovascular disease remains a critical issue. We examined the association of anxiety and depression with healthy behaviors in a large population of subjects at risk of cardiovascular disease. We studied 1612 consecutive subjects referred for evaluation of cardiovascular risk factors. Separated scores reflecting unhealthy behaviors (physical inactivity, smoking and poor diet) were combined to produce a global unhealthy lifestyle score. The Hospital Anxiety and Depression scale (HAD) was used to assess both anxiety and depression. Both anxiety and depression were significantly associated with physical inactivity in both sexes and with an unhealthy diet in men but not in women. Anxiety and depression were both significantly correlated to smoking habits in men whereas only depression was related to smoking in women. In both sexes, the global score reflecting unhealthy lifestyles was positively associated with the degree of anxiety and depression. In multivariate analysis, both anxiety and depression appeared as independent determinant of unhealthy lifestyle in both sexes, with a stronger influence for depression. Depression and to a lesser extent anxiety are associated with a cluster of unhealthy behaviors in subjects at risk of cardiovascular disease, suggesting the difficulty of modifying lifestyle in patients with anxious-depressive disorders.

Adult↗
PubMed1993

Epidemiology of cardiovascular disease risk factors in Catalonia (Spain).

Cardiovascular disease is one of the most important public health problems in developed countries. We have studied the epidemiology of the following cardiovascular disease risk factors in a random sample (n = 704) of the adult population of Catalonia (Spain): hypercholesterolemia (> or = 6.1) mmol/l or 240 mg/dl), hypertension (SBP > or = 160 and/or DBP > or = 95 mmHg), low HDL-cholesterol concentrations (< 0.9 mmol/l or 35 mg/dl), hypertriglyceridemia (> 2.8 mmol/l or 250 mg/dl), obesity (BMI > 30), smoking and history of diabetes and coronary heart disease. Two percent of participants had hypertriglyceridemia, 3% had a history of coronary heart disease, 4% a history of diabetes, 6% low HDL-cholesterol concentrations, 12% were obese, 20% had hypertension, 24% had hypercholesterolemia and 36% were smokers. 58% of hypertensive individuals had been previously detected, 46% were currently on treatment, and 21% had their blood pressure controlled (SBP < 160 and DBP < 95 mmHg). Correlation and multiple regression analyses were used to investigate the association between cardiovascular risk factors. Multiple linear regression analysis showed independent correlations between risk factors. Prevalence of hypercholesterolemia, obesity and diabetes was higher and prevalence of smoking was lower in hypertensives than normotensives. The odds ratio was 3.68 (95% CI = 2.07-6.54) for hypercholesterolemia, 3.26 (95% CI = 1.52-7.02) for obesity, 3.81 (95% CI = 1.09-7.02) for diabetes and 0.40 (95% CI = 0.22-0.70) for smoking. The adjusted odds ratio was statistically significant for hypercholesterolemia (OR = 2.74, 95% CI = 1.01-3.75). The prevalence of cardiovascular risk factors was similar to that observed in other Mediterranean communities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1976

Cardiovascular-disease mortality trends and oral-contraceptive use in young women.

Analysis of mortality trends in 21 countries indicates that, since oral contraceptives first became available, changes in mortality from non-rheumatic heart-disease and hypertension (I.C.D. 400-429), cerebrovascular disease (I.C.D. 430-439), and all non-rheumatic cardiovascular diseases (I.C.D. 400-469) among women aged 15-44 years have been strongly associated with changes in the prevalence of oral-contraceptive use in each country. This relationship is highly specific for women of reproductive age. The relative risks of death from heart-disease and hypertension, cerebrovascular disease, and all cardiovascular diseases for women using oral contraceptives compared with non-users were estimated to be 5 to 1,2 to 1, and 3 to 1 respectively. These findings suggest that the range of vascular diseases affected by oral-contraceptive use and the size of the associated risks may be greater than previously recognised. Furthermore, the increased risks of cardiovascular disease might exist not only with the pills containing high oestrogen doses, but also with the new "lower dose" pills.

Adolescent↗
PubMed2002

Perinatal growth failure: the road to obesity, insulin resistance and cardiovascular disease in adults.

A continuum of increasing risk of adulthood diseases, such as cardiovascular disease, type 2 diabetes and hypertension, with decreasing size at birth is now well-reported and a number of different hypotheses have been proposed. Birthweight links with disease risk markers such as insulin resistance are apparent from childhood, particularly when low birthweight is followed by rapid postnatal weight gain and childhood obesity. Such growth patterns follow fetal growth restraint, associated with maternal-uterine factors such as primiparity, smoking, maternal genes or variations in maternal diet. The fetal metabolic and hormonal responses to intrauterine growth restraint and to rapid postnatal growth are likely to be key to the early pathogenesis of adulthood disease. Thrifty fetal genotypes may enhance these adaptations and improve perinatal survival but predispose to adulthood disease. Their historical selection could explain high prevalences of type 2 diabetes in some ethnic groups, and their identification could allow targeting of potential interventions.

Adult↗
PubMed1994

Vascular effects of omega-3 fatty acids: possible therapeutic mechanisms in cardiovascular disease.

Dietary consumption of omega-3 polyunsaturated fatty acids (PUFAs) found in seafood and fish oils is associated with a decrease in coronary heart disease and overall cardiovascular mortality. Omega-3 PUFAs exert a number of physiologic effects, including relaxation of vascular smooth muscle, lowering of blood pressure, interference in phosphatidylinositol signaling, a reduction in platelet aggregation and growth factors, a decrease in atherogenic lipoproteins, a reduction in thrombotic factors, alterations in eicosanoid metabolism, a decrease in platelet and macrophage activating factors, and an increase in thrombolytic substances. These factors may provide a therapeutic means of reducing cardiovascular disease. This article reviews the vascular effects of omega-3 PUFAs and discusses the hypolipidemic, antihypertensive, antiatherosclerotic, antiinflammatory, and antithrombotic actions of the omega-3 PUFAs. Specific nursing implications are addressed.

Blood Pressure↗
PubMed2006

Cardiovascular disease mortality and its association with socioeconomic status: findings from a population-based cohort study in rural Vietnam, 1999-2003.

INTRODUCTION: Cardiovascular disease is an emerging epidemic in Vietnam, but because cause of death and other routine data are not widely available, it is difficult to characterize community-based disease patterns. Using 5-year data from an ongoing cause-specific mortality study conducted within a demographic surveillance system in Vietnam's Bavi district, this article estimates the rates of adult cardiovascular disease mortality in relation to the mortality rates of other noncommunicable diseases in rural northern Vietnam and examines the association of cardiovascular disease with certain demographic and socioeconomic factors. METHODS: All causes of death of adults aged 20 and older occurring from 1999 through 2003 (n = 1067) were determined by using an established demographic surveillance system and data collected by trained interviewers who asked caretakers or relatives of the deceased individuals about signs and symptoms of disease during quarterly household visits. Deaths were classified as cardiovascular disease, cancer, or other noncommunicable diseases. These records were linked to demographic and socioeconomic data. RESULTS: Of the 1067 adult deaths that were recorded, there was an overall noncommunicable disease mortality rate of 7.8 per 1000 person-years. Cardiovascular disease accounted for 33% of male and 31% of female deaths. Compared with cancer and other noncommunicable causes of death in a Cox proportional hazards model, higher cardiovascular disease mortality rates were observed among men, older age groups, and those without formal education. CONCLUSION: To date, cohort studies and population-based mortality data in Vietnam have been scarce; this study provides insights into the public health aspects of cardiovascular disease in transitional Vietnam. The rates of cardiovascular disease mortality in this rural Vietnamese community were high, suggesting the need for both primary prevention and secondary treatment initiatives. The demographic surveillance system is an important tool for characterizing such an epidemic.

Adult↗
PubMed2005

[Cardiovascular disease epidemiology and risk factors in primary care].

INTRODUCTION AND OBJECTIVES: To study the prevalence of and risk factors for cardiovascular disease in primary care. PATIENTS AND METHOD: A cross-sectional study was carried out at an urban health center in Barcelona, Spain. In total, 2248 patients > or =15 years old were selected randomly from medical records. The study investigated cardiovascular diseases such as ischemic heart disease, cerebrovascular disease and peripheral arterial disease, and cardiovascular risk factors such as age, sex, smoking, high blood pressure, hypercholesterolemia, hypertriglyceridemia, and diabetes mellitus. RESULTS: The patients' mean age was 49.1 (18.9) years and 53.5% were male. Cardiovascular risk factor prevalences were: smoking, 35.2%; high blood pressure, 33.7%; hypercholesterolemia, 21.9%; hypertriglyceridemia,12.7%; and diabetes mellitus, 15.8%. Overall, 57.9% of patients had at least 1 cardiovascular risk factor. Significantly more males presented with each risk factor (P<.05), apart from high blood pressure. The prevalence of all risk factors, except smoking, increased with age until 74 years and then stabilized, except high blood pressure, which continued to increase. Around 10% had cardiovascular disease, with myocardial ischemia in 5.5%, cerebrovascular disease in 3.7%, and peripheral arterial disease in 2.4%. All except cerebrovascular disease were significantly more common in males (P<.05). The prevalence of cardiovascular disease was low in individuals <55 years old, particularly women, and increased with age for all forms of disease. Some 68.3% were > or =65 years old. CONCLUSIONS: The high prevalence of cardiovascular risk factors was confirmed. Cardiovascular disease was more common in males and the elderly.

Adolescent↗
PubMed1996

Randomized trials of dietary antioxidants in cardiovascular disease prevention and treatment.

The hypothesis that antioxidant vitamins might reduce cardiovascular disease risk is based on a large body of basic and human epidemiologic research. Basic research provides a plausible mechanism by which antioxidants might reduce the risk of atherosclerosis. A large number of descriptive, case-control and cohort studies provide data suggesting that consumption of antioxidant vitamins is associated with reduced risks of cardiovascular disease. These data raise the question of a role of antioxidants, such as vitamins C and E, and beta-carotene, in the primary prevention of cardiovascular disease, but do not provide a definitive answer. Randomized trial data will be essential in establishing whether or not there is a causal effect of antioxidants in reducing the risk of cardiovascular disease. For many hypotheses randomized trials are neither necessary nor desirable; however, when searching for small to moderate effects, large-scale randomized trials of adequate dose and duration, in which investigators allocate subjects at random to either active treatment or placebo will provide valuable information about whether there is a causal relationship, and provide reliable estimates of effect size. Results from several large-scale randomized trials of antioxidants are summarized in this paper. At present, there is not sufficient data available to define clearly the role of antioxidants in primary or secondary prevention of cardiovascular disease. Additional trial data should be forthcoming in the near future which will aid in individual clinical decision-making and in the establishment of guidelines for the general public.

Antioxidants↗
PubMed2002

The relation of atherosclerotic cardiovascular disease to retinopathy in people with diabetes in the Cardiovascular Health Study.

AIMS: To describe the association of retinopathy with atherosclerosis and atherosclerotic risk factors in people with diabetes. METHODS: 296 of the 558 people classified as having diabetes by the American Diabetes Association criteria, from a population based cohort of adults (ranging in age from 69 to 102 years) living in four United States communities (Allegheny County, Pennsylvania; Forsyth County, North Carolina; Sacramento County, California; and Washington County, Maryland) were studied from 1997 to 1998. Lesions typical of diabetic retinopathy were determined by grading a 45 degrees colour fundus photograph of one eye of each participant, using a modification of the Airlie House classification system. RESULTS: Retinopathy was present in 20% of the diabetic cohort, with the lowest prevalence (16%), in those 80 years of age or older. Retinopathy was detected in 20.3% of the 296 people with diabetes; 2.7% of the 296 had signs of proliferative retinopathy and 2.1% had signs of macular oedema. The prevalence of diabetic retinopathy was higher in black people (35.4%) than white (16.0%). Controlling for age, sex, and blood glucose, retinopathy was more frequent in black people than white (odds ratio (OR) 2.26, 95% confidence interval (CI) 1.01, 5.05), in those with longer duration of diabetes (OR (per 5 years of diabetes) 1.42, 95% CI 1.18, 1.70), in those with subclinical cardiovascular disease (OR 1.49, 95% CI 0.51, 4.31), or coronary heart disease or stroke (OR 3.23, 95% CI 1.09, 9.56) than those without those diseases, in those with higher plasma low density lipoprotein (LDL) cholesterol (OR (per 10 mg/dl of LDL cholesterol) 1.12, 95% CI 1.02, 1.23), and in those with gross proteinuria (OR 4.76, 95% CI 1.53, 14.86). CONCLUSION: Data from this population based study suggest a higher prevalence of retinopathy in black people than white people with diabetes and the association of cardiovascular disease, elevated plasma LDL cholesterol, and gross proteinuria with diabetic retinopathy. However, any conclusions or explanations regarding associations described here must be made with caution because only about one half of those with diabetes mellitus were evaluated.

Age of Onset↗
PubMedDate not supplied

Ageing, lifestyle modifications, and cardiovascular disease in developing countries.

Developing countries face the double menace of still prevalent infectious diseases and increasing cardiovascular disease (CVD) with epidemic proportions in the near future, linked to demographic changes (expansion and ageing), and to urbanisation and lifestyle modifications. It is estimated that the elderly population will increase globally (over 80% during the next 25 years), with a large share of this rise in the developing world because of expanding populations. Increasing longevity prolongs the time exposure to risk factors, resulting in a greater probability of CVD. As a paradox, increased longevity due to improved social and economical conditions associated with lifestyle changes in the direction of a rich diet and sedentary habits in the last century, is one of the main contributors to the incremental trend in CVD. The variable increase rate of CVD in different nations may reflect different stages of "epidemiological transition" and it is probable that the relatively slow changes seen in developing populations through the epidemiological transition may occur at an accelerated pace in individuals migrating from nations in need to affluent societies (i.e. Hispanics to the USA, Africans to Europe). Because of restrained economic conditions in the developing world, the greatest gains in controlling the CVD epidemic lies in its prevention. Healthy foods should be widely available and affordable, and healthy dietary practices such as increased consumption of fresh fruits and vegetables, reduced consumption of saturated fat, salt, and simple sugars, may be promoted in all populations. Specific strategies for smoking and overweight control may be regulation of marketed tobacco and unhealthy fast food and promotion of an active lifestyle. Greater longevity and economic progress are accompanied by an increasing burden of CVD and other chronic diseases with an important decrease in quality of life, which should question the benefit of these additional years without quality.

Adolescent↗
PubMed2000

Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index.

BACKGROUND: Visceral adipose tissue is associated with increased risk for cardiovascular disease risk factors and morbidity from cardiovascular diseases. Waist measurement and waist-to-height ratio (WHtR) have been used as proxy measures of visceral adipose tissue, mainly in adults. OBJECTIVE: To validate body mass index (BMI), waist circumference and WHtR as predictors for the presence of cardiovascular disease risk factors in children of Greek-Cypriot origin. SUBJECTS AND METHODS: A total of 1,037 boys and 950 girls with mean age 11.4+/-0.4 y were evaluated. Dependent variables for the study were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholestrol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and systolic (SBP) and diastolic (DBP) blood pressure. RESULTS: When children were divided into two groups according to the 75th percentile for BMI, waist circumference and WHtR, all dependent variables had higher mean values in the highest percentile groups in WHtR groups and almost all variables in BMI and waist circumference groups. Adjusted odds ratios for predicting pathological values of cardiovascular disease risk factors were slightly higher for the highest WHtR group for predicting lipid and lipoprotein pathological values and for the highest BMI groups in predicting high blood pressure measurement. Using stepwise multiple regression analysis to explain the variance of the dependent variables, waist circumference was the most significant predictor for all variables both for boys and girls, whereas BMI had the lowest predictive value for the detection of cardiovascular disease risk factors. CONCLUSION: Waist circumference and WHtR are better predictors of cardiovascular disease risk factors in children than BMI. Further studies are necessary to determine the cutoff points for these indices for an accurate prediction of risk factors.

Adipose Tissue↗
PubMed1999

Update on aspirin in the treatment and prevention of cardiovascular disease.

The effects of low-dose aspirin on cardiovascular disease have been tested in randomized trials in 3 types of populations: (1) patients with a history of cardiovascular disease; (2) patients with evolving acute myocardial infarction (MI), and (3) apparently healthy subjects. In a very wide range of patients with prior occlusive cardiovascular disease, aspirin reduces the risks of nonfatal MI, nonfatal stroke, and vascular death. Initiating aspirin therapy within 24 hours after the onset of symptoms of an acute MI also confers conclusive reductions in the risk of nonfatal reinfarction, nonfatal stroke, and total cardiovascular death. In primary prevention trials, aspirin has been shown to reduce the risk of a first MI in men, but the data on stroke and total cardiovascular death are not sufficient to allow firm conclusions to be drawn; randomized data from studies in women are not yet available. The Women's Health Study, an ongoing large-scale trial in female health care professionals, will provide the data necessary to assess the balance of benefits and risks of aspirin in primary prevention. Until then, the decision to use aspirin in primary prevention should be based on the clinical judgment of the physician and considered as an adjunct in the management of other cardiovascular disease risk factors.

Aspirin↗
PubMed1993

The use of aspirin in cardiovascular disease.

Aspirin has many uses in cardiovascular disease. It is used for primary prophylaxis; as an adjunctive therapy in angina, acute myocardial infarction, and thrombolytic therapy; and to promote vessel patency after angioplasty and coronary artery bypass grafting. This article reviews the recent research findings on the use of aspirin in cardiovascular disease and discusses remaining questions and nursing implications.

Aspirin↗
PubMed2004

Modulating the hypoxia-inducible factor signaling pathway: applications from cardiovascular disease to cancer.

Humans, like other complex aerobic organisms, possess highly evolved systems for the delivery of dioxygen to all the cells of the body. These systems are regulated since excessive levels of dioxygen are toxic. In animals hypoxia causes an increase in the transcription levels of specific genes, including those encoding for vascular endothelial growth factor and erythropoietin. At the transcriptional level, the hypoxic response is mediated by hypoxia-inducible factor (HIF), an alpha,beta-heterodimeric protein. HIF-beta is constitutively present, but HIF-alpha levels are regulated by dioxygen. Under hypoxic conditions, levels of HIF-alpha rise, allowing its dimerization with HIF-beta and enabling transcriptional activation. Under normoxic conditions both the level of HIF-alpha and its ability to enable transcription are directly controlled by its post-translational oxidation by oxygenases. Hydroxylation of HIF-alpha at either of two conserved prolyl residues enables its recognition by the von Hippel-Lindau tumour suppressor protein which targets it for proteasomal degradation. Hydroxylation of an asparaginyl residue in the C-terminal transactivation domain of HIF-alpha directly prevents its interaction with the coactivator p300 from the transcription complex. Hydroxylation of HIF-alpha is catalysed by members of the iron (II) and 2-oxoglutarate dependent oxygenase family. In humans, three prolyl-hydroxylase isozymes (PHD1-3, for prolyl hydroxylase domain enzymes) and an asparaginyl hydroxylase (FIH, for factor inhibiting HIF) have been identified. Recent studies have identified additional post-translational modifications of HIF-alpha including acetylation and phosphorylation. Modulation of the HIF mediated hypoxic response is of potential use in a wide range of disease states including cardiovascular disease and cancer. Here we review current knowledge of the HIF pathway focusing on its regulation by dioxygen and discussion of potential targets and challenges in attempts to modulate the pathway for medicinal application.

Animals↗
PubMedDate not supplied

The prevention of cardiovascular disease worldwide: whose task and WHO's task?

Cardiovascular disease is the commonest chronic illness in both developed and developing countries, causing the most deaths and the greatest impact on morbidity. The superiority of disease prevention over treatment was appreciated at least 5,000 years ago in China. The link between the existence of disease in society and the political and social circumstances of a country was emphasised by Virchow in the nineteenth century. The scientific basis and methods for prevention of cardiovascular disease are known. What are lacking are the will and the means to implement change. The well-intentioned often have a dominant sense of entitlement in the pursuit of the common goal of disease prevention. There is a failure of many organisations to acknowledge the importance of other groups within society in achieving the common goal. Doctors, particularly cardiovascular physicians and cardiologists, must play a much greater role in linking with the public, other health workers, epidemiologists, media, industry, academia and politicians. Too many vested interests obstruct progress in the prevention of cardiovascular disease.

Age Distribution↗