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PubMed2002

Overweight is an independent risk factor for cardiovascular disease in Chinese populations.

In the last decade of the 20th century, cardiovascular disease was the leading cause of death in China, accounting for one-third of the total deaths. In comparison with western populations, the mean body weight or body mass index (BMI) of the Chinese population was lower, but showed an increasing trend. Whether the variation within lower levels of BMI or waist circumference was associated with other risk factors of cardiovascular disease, and whether they contribute independently to the risk of cardiovascular disease in the Chinese population, was investigated in this study. In keeping with a uniform study design, in each of 14 study populations at different geographical locations and with different characteristics, the incidence rates of stroke, coronary heart disease (CHD) and the causes of death were monitored in approximately/= 100000 residents from 1991 to 1995 using the MONICA procedure. Risk factors were surveyed in a random cluster sample of 1000 subjects (35-59 years of age) from each population under surveillance using internationally standardized methods and a centralized system to ensure quality control. Among the risk factors, body weight, height, and waist and hip circumferences were measured. Cross-sectional stratified analyses were used to analyse the relationship of BMI (kg m(-2)) or waist circumference to other metabolic risk factors. Ten cohorts among the 14 study populations with 24734 participants were surveyed from 1982 to 1985 as a baseline for further study and were followed-up for 9 years taking the events of stroke, CHD and different causes of death as end-points. Cox regression models were used to explore the association of BMI with the relative risks of stroke, CHD and total death. The survey in 14 random samples with a total number of 19 741 subjects showed that the mean BMI (20.8-25.1) and waist circumference (67.8-86.7 cm) were much lower than those of western populations. There was, however, variation in the anthropometric measurements among populations within China. Thus, rates of overweight varied from 2.7% to 48.1% and obesity from 0% to 9.5% on the basis of the World Health Organization (WHO) classification, but these values were lower than those found in western populations. Data from the 10 cohort samples compared with baseline data in the early 1980s showed that the mean BMIs increased significantly in eight populations during the early 1990s with the differences ranging from 0.5 to 2.5 kg m(-2). Despite the lower level of BMI and the lower rate of overweight, cross-sectional analyses showed that the prevalence of hypertension, high fasting serum glucose, high serum total cholesterol and low high-density lipoprotein cholesterol (HDL-C) and their clustering were all raised with increases in BMI or waist circumference. The prospective cohort study showed that the BMI was one of the independent risk factors for stroke and CHD in Chinese populations. Hence, in a Chinese population characterized by lower levels of BMI and great variability in rates of overweight, variation of BMI was significantly related to the prevalence of other metabolic risk factors and their clustering. Overweight was one of the independent risk factors for stroke and CHD, both at population and individual levels. Given the increasing trends of BMI in the last 10 years, during the period of economic transition there is a need to encourage the population to adopt healthy dietary habits and to increase their physical activity. Health education and health promotion are important for the prevention and non-pharmacological therapy of cardiovascular disease in China.

Adult↗
PubMed2006

Bupropion for smokers hospitalized with acute cardiovascular disease.

PURPOSE: Smoking cessation after myocardial infarction reduces cardiovascular mortality, but many smokers cannot quit despite state-of-the-art counseling intervention. Bupropion is effective for smoking cessation, but its safety and efficacy in hospitalized smokers with acute cardiovascular disease is unknown. METHODS: A five-hospital randomized double-blind placebo-controlled trial assessed the safety and efficacy of 12 weeks of sustained-release bupropion (300 mg) or placebo in 248 smokers admitted for acute cardiovascular disease, primarily myocardial infarction and unstable angina. All subjects had smoking counseling in the hospital and for 12 weeks after discharge. Cotinine-validated 7-day tobacco abstinence, cardiovascular mortality, and new cardiovascular events were assessed at 3 months (end-of-treatment) and 1 year. RESULTS: Validated tobacco abstinence rates in bupropion and placebo groups were 37.1% vs 26.8% (OR 1.61, 95% CI, 0.94-2.76; P=.08) at 3 months and 25.0% vs 21.3% (OR, 1.23, 95% CI, 0.68-2.23, P=.49) at 1 year. The adjusted odds ratio, after controlling for cigarettes per day, depression symptoms, prior bupropion use, hypertension, and length of stay, was 1.91 (95% CI, 1.06-3.40, P=.03) at 3 months and 1.51 (95% CI, 0.81-2.83) at 1 year. Bupropion and placebo groups did not differ in cardiovascular mortality at 1 year (0% vs 2%), in blood pressure at follow-up, or in cardiovascular events at end-of-treatment (16% vs 14%, incidence rate ratio [IRR]1.22 (95% CI: 0.64-2.33) or 1 year (26% vs 18%, IRR 1.56, 95% CI 0.91-2.69). CONCLUSIONS: Bupropion improved short-term but not long-term smoking cessation rates over intensive counseling and appeared to be safe in hospitalized smokers with acute cardiovascular disease.

Acute Disease↗
PubMed2000

Social distribution of cardiovascular disease risk factors: change among men in England 1984-1993.

OBJECTIVE: To investigate change in the social distribution of some of the main risk factors for cardiovascular disease in men in England during a period when inequality in cardiovascular disease mortality widened DESIGN: Age standardised comparison of the social distribution of seven known risk factors for cardiovascular disease (body mass index, waist to hip ratio, systolic and diastolic blood pressure, consumption of fresh green vegetables, leisure time exercise, cigarette smoking and levels of social support) in two large cross sectional representative samples of the English population. SUBJECTS: Men aged 20-64 years in the 1984 Health and Lifestyle Survey (excluding Scotland and Wales) first sweep and the 1993 Health Survey for England. MAIN OUTCOME MEASURES: Mean values of continuous variables; age adjusted proportions of categorical variables; change in the relative index of inequality for each risk factor. RESULTS: The overall prevalence of cardiovascular disease risk factors improved during the period in which cardiovascular disease mortality was falling. The social distribution of cardiovascular disease risk factors, in contrast, did not become more extreme. Increases in the relative index of inequality for angina from 1.75 to 1.86, for eating vegetables less than once a day from 1.76 in 1984 to 1.96 in 1993, and an apparently larger increase in inequality of social support, from 1.92 to 2.53 were not statistically significant. In most cases the degree of inequality in risk factors tended to narrow non-significantly: for example the relative index of inequality fell from 5.02 in 1984 to 3.07 in 1993 for systolic blood pressure, from 5.60 to 4.29 for current smoking and from 6.24 to 4.19 for eating other than wholemeal bread as the main form of bread in the diet. The two statistically significant changes in inequality were in the direction of narrowing inequality: from a relative index of inequality of 2.12 to 0.90 for diastolic blood pressure (p<0.01) and from 19.3 to 0.87 (p<0.01) for psychological distress as indicated by the General Health Questionnaire. CONCLUSIONS: Healthier lifestyle options have not been adopted at a significantly faster rate by middle class than working class people over this time period. At the population level the change in risk factors is consistent with falling cardiovascular mortality. The change in the social distribution of risk factors within the population, however, shows little or no relation to the pattern of widening inequality in cardiovascular mortality. This may be because the effect is lagged, or because the adoption of healthier behaviour confers greater benefits on those in higher socioeconomic status groups.

Adult↗
PubMed1988

Serum copper and zinc and the risk of death from cancer and cardiovascular disease.

To investigate the association of serum copper and zinc with mortality from cancer and cardiovascular disease, the authors performed a case-control analysis of data obtained in a Dutch prospective follow-up study. Cancer (n = 64) and cardiovascular disease (n = 62) deaths and their matched controls were taken from a cohort of 10,532 persons examined in 1975-1978. Trace elements were measured in baseline serum samples, which had been stored during the six to nine years of follow-up. The adjusted risk of death from cancer and cardiovascular disease was about four times higher for subjects in the highest serum copper quintile (greater than 1.43 mg/liter) compared with those with normal levels. The excess mortality observed in subjects with low copper status suggests a U-shaped relation. No significant change in the risk of death from cancer and cardiovascular disease was found for subjects with low or high baseline levels of serum zinc. However, a protective effect of a high zinc status on the risk of cancer and cardiovascular disease is compatible with the data. For definitive conclusions, analysis of larger prospective data sets is recommended.

Aged↗
PubMed2000

Reducing the global burden of blood pressure-related cardiovascular disease.

OBJECTIVE: To assist in prioritisation for strategies for the control of cardiovascular disease (CVD) worldwide, by estimating the size of the contribution of elevated blood pressure and, more importantly, the likely effects of its modification. DESIGN: We estimated the size of the disease burden attributable to increased blood pressure in Eastern Asia and describe a method for estimating the likely effects of blood pressure lowering strategies. METHODS: Attributable risk estimates were calculated to assess the likely contribution of increased blood pressure to death from CVD in Asia. Estimates were also made of the possible effects of population-wide (2% lower diastolic blood pressure [DBP] for all) and targeted (7% lower DBP for those with DBP > or =95 mm Hg) blood pressure lowering interventions. These estimates were based on data from several sources, including surveys of blood pressure values in Asian populations, estimates of the incidence of cardiovascular disease in Asia, studies of the associations of blood pressure with cardiovascular disease risks in Asia and elsewhere, and randomized trials of blood pressure lowering treatments. RESULTS: The results suggest that DBP values of 80 mm Hg or more account for about 57% of all stroke deaths and about 24% of all coronary heart disease deaths in Eastern Asian populations. The two intervention strategies proposed would each be expected to avert about 1 in 6 stroke deaths and about 1 in 20 coronary heart disease deaths. This would amount to about 1 million deaths per year throughout Asia by 2020, with about half of those deaths averted in the People's Republic of China. The benefits of the two different approaches would be approximately additive. CONCLUSIONS: Increased blood pressure levels are directly responsible for the majority of stroke deaths (more than 50%) and a substantial minority of deaths from coronary heart disease (about 25%) in Eastern Asia. Both modest population-wide blood pressure reductions and more moderate targeted reductions in those with hypertension could be expected to produce large reductions in the burden of cardiovascular disease in these and other Asian regions.

Adolescent↗
PubMed2005

Forty-year mortality from cardiovascular diseases and their risk factors in men of the Italian rural areas of the Seven Countries Study.

OBJECTIVE: Forty-year cardiovascular mortality and its association with entry risk factor levels are reported for men enrolled in the Italian Rural Areas of the Seven Countries Study of Cardiovascular Diseases. METHODS AND RESULTS: Cardiovascular risk factors were measured in 1712 men aged 40-59 years at entry examination in 1960. Mortality data were collected during 40 years of follow-up. Overall death rate was 83.7%. The main causes of death were cardiovascular diseases, with a preponderance of those of atherosclerotic origin (CVDA, 33.7 % of all causes) including coronary heart disease, stroke and peripheral arterial diseases. Using 14 risk factors measured at baseline, multivariate analysis for CVDA showed that seven of them were strongly and significantly associated with events. The multivariate hazard ratio for 5 years of age was 1.59 (CI 1.43-1.77); for heavy job-related physical activity it was 0.96 (CI 0.79-1.18); for 10 cigarettes smoked per day 1.16 (CI 1.05-1.28); for 20 mm Hg of systolic blood pressure 1.38 (CI 1.25-1.52); for 1 mmol/l of serum cholesterol 1.19 (CI 1.09-1.30); for 0.25 l/m2 of height of vital capacity 0.87 (CI 0.78-0.97); for the presence of corneal arcus 1.36 (CI 1.03-1.79). Risk factors of which the coefficient did not reach statistical significance were family history for cardiovascular diseases, forced expiratory volume, heart rate, mid-arm circumference, subscapular skinfold, body mass index and diabetes. Similar findings were obtained for CHD and partially for stroke mortality. CONCLUSIONS: During a 40-year period classical cardiovascular risk factors were still highly predictive of cardiovascular diseases of atherosclerotic origin in these Italian rural populations.

Adult↗
PubMed1994

Lipids, lipoproteins, women and cardiovascular disease.

The risk factors for cardiovascular disease are related directly or indirectly in women, as in men, to lipid and lipoprotein levels. But women have the advantage of the beneficial effects of either endogenous or exogenous estrogen on these levels throughout most of their lives. Behaviors such as smoking or diseases such as diabetes interfere with the favorable lipid and lipoprotein levels seen in women, and heart disease risk is increased significantly. Oral contraceptives have negative effects on lipids but appear not to increase risk for atherosclerosis in current or past users. Postmenopausal estrogen therapy appears to protect women from heart disease, but the long-term effect on risk is unknown for combination hormone therapy. The monitoring of a women's lipid profile, a major indicator of risk for heart disease, is of paramount importance.

Cardiovascular Diseases↗
PubMed1990

Noncardiac surgery in the elderly patient with cardiovascular disease.

The elderly patient with cardiovascular disease who undergoes noncardiac surgery presents a challenge to the medical-surgical team. A high prevalence of cardiac disease necessitates a preoperative in-depth search for the presence of cardiovascular risk factors and their reversal if possible. Aging is associated with an altered physiologic response to the stress of surgery as well as to anesthetic agents and perioperative medications, requiring that the elderly patient often be treated quite differently than the younger surgical patient. This article provides guidelines for the estimation of the risk of cardiac complication due to noncardiac surgery and discusses the identification and management of acute and chronic cardiovascular problems in the perioperative period.

Aged↗
PubMedDate not supplied

Cardiovascular disease in genotypes for obesity and diabetes.

Cardiovascular diseases represent a major cause of morbidity and mortality in both obese and diabetic patients. The mechanisms by which diabetes or obesity cause the cardiac lesions is poorly understood. A number of risk factors associated with the development of atherosclerotic vascular disease, a precursor of heart disease, are found in diabetes and obesity. There is evidence that diabetes or obesity may even cause a primary cardiomyopathy. The use of animal models with obesity or diabetes with various combinations of risk factors may clarify what each component contributes to the expression of cardiovascular disease. This report summarizes some of the current information on the cardiovascular complications found in various animal models of obesity and diabetes.

Animals↗
PubMed2006

Genetic variants predisposing to cardiovascular disease.

PURPOSE OF REVIEW: The goal of this review is to provide an update on the most recent and relevant findings in the area of genotype-phenotype associations as well as the relationships between genetic factors and cardiovascular disease risk markers and events. In addition, emphasis will be placed on the methodological problems associated with studying the genetics of complex disorders, specifically cardiovascular diseases. RECENT FINDINGS: Genes associated with cardiovascular disease predisposition have been examined, including traditional cardiovascular disease candidate genes, such as ACE, AGT, eNOS, PON and MTHFR, new loci that have recently been added to the growing list of cardiovascular disease candidate genes (i.e. MEF2A, ALOX5, LTA, APOM, PDE4D), and genes that have been shown to be at the intersection of several age-related disorders through interaction with one another or with environmental factors (i.e. APOA5, APOE, PPARgamma, LPL and LIPC). SUMMARY: During the last year, tremendous effort has been made in elucidating new genes associated with cardiovascular disease predisposition. For the most part, however, major breakthroughs have not been made, primarily due to the poor replication of results among studies, as a consequence of poor experimental design. Nevertheless, we have increased our understanding of the complexity of cardiovascular disease and the relevance of gene-environment interactions as the ultimate drivers of the individual predisposition to the disease. It is essential, therefore, that present and future genetic studies in this area take into consideration the inclusion of high-quality environmental data in the analytical process to test the clinical usefulness of a genetic marker as a risk predictor.

Cardiovascular Diseases↗
PubMed2001

[Effects of 8 years community intervention on risk factors of cardiovascular diseases in Fangshan Beijing].

OBJECTIVE: To study the changes of risk factors of cardiovascular disease in the rural community population after intervention. METHODS: The Beijing Fangshan cardiovascular prevention program was a community-based comprehensive intervention study which was launched from 1991 and ended in 2000 in five communities including three as intervention communities (IC) and two as control communities (CC) in Fangshan, Beijing suburb. The intervention measures were focused on health education and hypertension control. The changes of risk factors of cardiovascular disease in IC and CC were analyzed using random sample in the year 1991, 1995 and 1999, respectively. The risk factors include systolic and diastolic blood pressure (SBP and DBP), body mass index(BMI), serum total cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL), smoking, and drinking. RESULTS: From the year 1991 to 1999, the risk factors of cardiovascular disease such as SBP, DBP, smoking rate and drinking rate were reduced in the population of IC. For male in IC, the decline of SBP, DBP, smoking rate, and drinking rate were 1.6 mmHg, 1.1 mmHg, 14.5% (P < 0.01) and 3.7%, respectively. For female of IC, SBP and DBP declined 4.8 mmHg (P < 0.01) and 3.2 mmHg (P < 0.01), respectively. SBP, DBP and smoking rate in the population of CC had a little reduction while BMI, TC and TG increased in both IC and CC. During the period of 1991 to 1999, most cardiovascular risk factors in the population of IC had net reduction compared to that of CC. CONCLUSIONS: Except for BMI and lipids, rural community intervention, as focused on health education and hypertension control, has resulted in the reduction of most risk factors of cardiovascular disease.

Adult↗
PubMed1966

Residual agglutinins against rickettsial agents in human sera from central and eastern Turkey and their relation to cardiovascular diseases.

Many workers have shown that the recrudescence of rickettsial infections may cause cardiovascular diseases of all kinds. As Turkey is a region where rickettsial infections in man are endemic, the relation between such infections and cardiovascular disease has been further studied there. Sera were collected from patients with cardiovascular diseases and also from healthy people and patients with diseases not affecting the heart, who served as a control group. A considerably higher percentage of positive sera was obtained from the patients with cardiovascular diseases, particularly for R. prowazekii, R. conorii and C. burnetii. It was also found that the highest percentage of positive sera was obtained from people in the 20-40 years age-group. Antistreptolysin-O (ASO) determinations were also made and it was found that, on average, agglutinin-negative sera had the higher ASO titres.

Adolescent↗
PubMed2006

The combined effect of augmentation index and carotid intima-media thickness on cardiovascular risk in young and middle-aged men without cardiovascular disease.

Carotid artery intima-media thickness (IMT) has been used as a surrogate marker of atherosclerosis and is related to cardiovascular risk. Indices of arterial stiffness are also associated with cardiovascular risk and atherosclerosis. The aim of this study was to assess the prognostic value of the combination of surrogate markers of cardiovascular disease measured non-invasively in subjects without cardiovascular disease. In this cross-sectional study, 81 young and middle aged males (39.2+/-6.3 years) without evidence of overt cardiovascular disease or diabetes mellitus were enrolled. High-resolution B-mode ultrasonography and pulse wave analysis were used to measure carotid artery IMT and augmentation index (AI), a measure of arterial stiffness. Framingham risk score (FRS) was used as an estimate of the risk for development of cardiovascular disease. Regional differences were observed in the carotid arteries' IMT regarding their relationship with FRS: combined (average from all sites) IMT and IMT in the carotid bulb (CB), but not in the common (CC) and internal carotid artery (IC), and AI showed significant increases of FRS by their tertiles. However, subjects with both AI and IMT at any site in the highest tertile (AI>15%, CC>0.65 mm, CB>0.8 mm, IC>0.65 mm) had an increased FRS compared to subjects with one or none of these parameters in the highest tertile. In conclusion, young and middle-aged men without overt cardiovascular disease with both high IMT and AI are in high cardiovascular risk, as assessed by FRS. Epidemiological studies are needed to further validate this combination.

Adult↗
PubMed1999

Epidemiology of hypertriglyceridemia and cardiovascular disease.

Epidemiologic studies provide increasing evidence that hypertriglyceridemia is a risk factor for cardiovascular disease. A meta-analysis of 17 population-based studies of triglyceride levels and cardiovascular disease identified a 76% increase in cardiovascular disease risk in women and a 31% increase in men associated with a 1 mmol/L increase in triglyceride levels. Additional epidemiologic studies have shown that plasma triglyceride levels and low-density lipoprotein particle size predict subsequent coronary artery disease. Taken together, the existing epidemiologic data may help identify a group of patients who may benefit from interventions aimed at decreasing triglyceride levels associated with an increased risk of cardiovascular disease.

Female↗
PubMed2002

Role of antibiotics for the prevention of cardiovascular disease.

OBJECTIVE: To evaluate the data regarding the use of antibiotic therapy for the prevention of cardiovascular events. DATA SOURCES: Pertinent literature was identified through a MEDLINE search (1966-September 2001) and through other secondary literature databases and/or bibliographies of pertinent articles. DATA SYNTHESIS: Cardiovascular disease is a common cause of morbidity and mortality among the general population, with well-defined risk factors (e.g., diabetes, hypertension, hyperlipidemia, cigarette smoking, genetic predisposition). Clinical data evaluating the association between the aforementioned risk factors and the development of atherosclerosis and subsequent cardiovascular disease are substantial; however, these risk factors may only partially explain the high prevalence of cardiovascular disease. The presence of Chlamydia pneumoniae within atherosclerotic lesions has been documented and may be an additional risk factor for the development and progression of cardiovascular disease. CONCLUSIONS: The results of primary and secondary prevention trials have shown conflicting evidence with regard to the beneficial effects of antibiotic therapy to reduce cardiovascular events. Currently, the lack of certainty in published data does not support the use of antibiotics for the prevention of cardiovascular disease. Clinicians should continue to emphasize interventions proven to reduce adverse cardiovascular events such as smoking cessation, reduction of hyperlipidemia, and control of hypertension.

Anti-Bacterial Agents↗
PubMed2003

A life span approach to cardiovascular disease risk and aging: the Fels Longitudinal Study.

As the leading cause of chronic disease mortality in developed nations, cardiovascular disease is a widely prevalent condition that is integral to evaluation of aging populations. Chronic diseases such as coronary heart disease, hypertension and type 2 diabetes have been associated with adulthood body composition-namely excess body fat, altered lipid levels and elevated blood pressures. The Fels Longitudinal Study conducted at the Lifespan Health Research Center at Wright State University's School of Medicine has examined these same health status indicators-body composition, blood pressure, lipids, maturation, and hormones-during early life and their relationships to developing risk factors for these chronic diseases in adulthood. Research conducted during the past 10 years has shown health status indicators to track over time from childhood to adulthood. Furthermore, chronic disease risk factors attained during childhood, adolescence or early adulthood may represent an early warning system for future risk of developing cardiovascular disease.

Aging↗
PubMed2006

Circulating markers of endothelial function in cardiovascular disease.

Endothelial dysfunction is a key event in cardiovascular disease. Measurement of endothelial dysfunction in vivo presents a major challenge, but has important implications since it may identify the clinical need for therapeutic intervention, specifically in primary prevention. Several biological markers have been used as indicators of endothelial dysfunction. The soluble adhesion molecules sICAM-1 and sVCAM-1 lack specificity and are increased in inflammatory processes. Both markers are increased in coronary artery disease. sICAM-1 level predicts the risk for cardiovascular disease or diabetes mellitus in healthy individuals. sE-selectin is specific for the endothelium and is increased in coronary artery disease and diabetes mellitus. sE-selectin is also associated with diabetic risk. The endothelium-specific marker, soluble thrombomodulin, is associated with severity of coronary artery disease, stroke or peripheral occlusive arterial disease and is not increased in healthy or asymptomatic subjects. Interestingly, thrombomodulin decreases during treatment of hypercholesterolemia or hyperhomocysteinemia. In contrast, von Willebrand factor is the best endothelial biomarker and predicts risk for ischemic heart disease or stroke.

Animals↗