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PubMed2005

Vitamin E supplementation in cardiovascular disease and cancer prevention: Part 1.

OBJECTIVE: To review clinical trials evaluating the safety and efficacy of vitamin E supplementation in cardiovascular disease and cancer prevention. DATA SOURCES: Using the MeSH search terms alpha-tocopherol, tocopherols, vitamin E, cardiovascular diseases, cancer, malignancy, and clinical trials, a literature review was conducted to identify peer-reviewed articles in MEDLINE (1966-July 2005). STUDY SELECTION AND DATA EXTRACTION: Published materials including original research, and previous meta-analyses were included. Only English-language articles and trials on vitamin E alone or in combination with other vitamins or minerals were reviewed. Emphasis was placed on prospective, randomized, double-blind, placebo-controlled clinical trials. DATA SYNTHESIS: Eight clinical studies demonstrated contradicting results regarding the benefits of vitamin E in the prevention of cardiovascular disease and cancer. There is enough evidence from large, well-designed studies to discourage the use of vitamin E in the primary prevention of cardiovascular disease. Secondary prevention requires more adequate clinical trials with selected populations to examine protective effects of vitamin E in cardiovascular disease. The findings of the studies reviewed do not provide evidence that vitamin E may reduce the risk of cancer; thus, at the present time, we do not recommend daily vitamin E intake for cancer prevention is not recommended. CONCLUSIONS: Available data do not support the supplementation of vitamin E in cardiovascular disease and cancer prevention.

Cardiovascular Diseases↗
PubMed1990

Perspectives on the relationship between cardiovascular disease and affective disorder.

The relationship of major depression and cardiovascular disease has been the subject of much study. In this paper, the authors review the literature concerning the clinical importance of this relationship in four areas including the diagnosis and treatment of major depression in the setting of cardiovascular disease, the effect of concurrent major depression on the prognosis of cardiovascular disease, and the higher-than-expected rate of cardiovascular death in depressed patients. In addition, they present preliminary data which may suggest a mechanism to explain, in part, this increased rate of cardiovascular death in depression.

Cardiovascular Diseases↗
PubMed1998

Hyperhomocysteinemia is associated with an increased risk of cardiovascular disease, especially in non-insulin-dependent diabetes mellitus: a population-based study.

A high serum total homocysteine (tHcy) level is an independent risk factor for cardiovascular disease. Because it is not known whether the strength of the association between hyperhomocysteinemia and cardiovascular disease is similar for peripheral arterial, coronary artery, and cerebrovascular disease, we compared the three separate risk estimates in an age-, sex-, and glucose tolerance-stratified random sample (n=631) from a 50- to 75-year-old general white population. Furthermore, we investigated the combined effect of hyperhomocysteinemia and diabetes mellitus with regard to cardiovascular disease. The prevalence of fasting hyperhomocysteinemia (>14.0 micromol/L) was 25.8%. After adjustment for age, sex, hypertension, hypercholesterolemia, diabetes, and smoking, the odds ratios (ORs; 95% confidence intervals) per 5-micromol/L increment in tHcy were 1.44 (1.10 to 1.87) for peripheral arterial, 1.25 (1.03 to 1.51) for coronary artery, 1.24 (0.97 to 1.58) for cerebrovascular, and 1.39 (1.15 to 1.68) for any cardiovascular disease. After stratification by glucose tolerance category and adjustment for the classic risk factors and serum creatinine, the ORs per 5-micromol/L increment in tHcy for any cardiovascular disease were 1.38 (1.03 to 1.85) in normal glucose tolerance, 1.55 (1.01 to 2.38) in impaired glucose tolerance, and 2.33 (1.11 to 4.90) in non-insulin-dependent diabetes mellitus (P=.07 for interaction). We conclude that the magnitude of the association between hyperhomocysteinemia and cardiovascular disease is similar for peripheral arterial, coronary artery, and cerebrovascular disease in a 50- to 75-year-old general population. High serum tHcy may be a stronger (1.6-fold) risk factor for cardiovascular disease in subjects with non-insulin-dependent diabetes mellitus than in nondiabetic subjects.

Aged↗
PubMed1993

Gender differences in obesity-related cardiovascular disease risk factors among participants in a weight loss programme.

Obesity is associated with increased cardiovascular disease risk factors in some, but not all, individuals, and blood pressure responses to weight loss are also heterogeneous. The purposes of this study are: (i) to assess associations among cardiovascular disease risk factors in obese individuals and (ii) to determine clinical predictors of a hypotensive response to weight loss. The study was undertaken in 155 consecutive patients enrolled in a weight loss programme. Individuals entering the programme were predominantly women and differences were found between men and women who joined the programme. Before weight loss, obese men exhibited higher cardiovascular disease risk factors (body mass indices, waist-to-hip ratios, systolic and diastolic blood pressures, serum glucose, and lower HDL cholesterol) than did women. However, among women, but not men, cardiovascular disease risk factors clustered in individuals with higher waist-to-hip ratios. Furthermore, in contrast to men, a higher waist-to-hip ratio in women was associated with a reduction in systolic blood pressure in response to weight loss. While it is possible that selection bias may explain gender differences among programme participants, and smaller numbers of men available for study may obscure associations in men, our data document that even at high levels of obesity, waist-to-hip ratios are associated with hypertension and a clustering of cardiovascular disease risk factors in women. We conclude that body fat distribution, as reflected in waist-to-hip ratios, may be a more robust risk factor in female than in male obese patients and that this risk factor extends to those women with high levels of obesity.

Adult↗
PubMed1995

Serum levels of vitamin E in relation to cardiovascular diseases.

Serum vitamin E levels in healthy people (n = 71) and patients with cardiovascular diseases (n = 62) were determined. The cases of cardiovascular disease comprised patients with acute myocardial infarction (AMI) (n = 31), atherosclerosis (AT) (n = 23) and myocardial ischaemia (MI) (n = 8). The mean (+/- SD) serum vitamin E levels of the control group and the group with cardiovascular disease were 1.12 +/- 0.27 mg% and 0.98 +/- 0.41 mg%, respectively. Patients with AMI, AT and MI had corresponding levels of 0.97 +/- 0.48 mg%, 1.00 +/- 0.39 mg% and 1.01 +/- 0.44 mg%, respectively. Overall serum vitamin E levels were lower in the group with cardiovascular disease than in the control group. Patients and the control group are also discussed with respect to a number of potentially confounding parameters such as age, sex, smoking status, quetelet index (kg/m2), alcohol consumption, dietary intake and serum lipids.

Adult↗
PubMed2006

Carotenoids and cardiovascular disease: what research gaps remain?

PURPOSE OF REVIEW: Dietary and blood carotenoids, including alpha-carotene, beta-carotene, lycopene, lutein/zeaxanthin, and beta-cryptoxanthin, have been examined in a number of epidemiological studies in recent years for the risk of cardiovascular disease. This review assimilated the existing and recent literature on carotenoids and cardiovascular disease and considered what research gaps may remain. RECENT FINDINGS: Numerous large cohort studies have been published in largely American men and women that have examined dietary intake or blood levels of total or individual carotenoids with the risk of various cardiovascular endpoints. Overall, early, promising results have grown increasingly inconsistent over time. More recently, studies examining lycopene and lutein/zeaxanthin have offered more promising data on a possible, but not yet established, inverse association with the risk of cardiovascular disease. Recent epidemiological data on beta-cryptoxanthin and cardiovascular disease are lacking. Primary and secondary prevention trials have extensively examined beta-carotene, but not other carotenoids, for the risk of cardiovascular disease as either the primary or secondary endpoint with largely null results. More recent studies have focused on individual carotenoids in relation to cardiovascular disease and require a more careful evaluation of potential mechanisms of effect. SUMMARY: The promise of early epidemiological studies on carotenoids and cardiovascular disease paved the way to largely disappointing results from several large prevention trials of beta-carotene. Emerging recent evidence of potential cardioprotective effects for lycopene and other carotenoids besides beta-carotene in the diet and blood suggest that there is more to be learned in the story of carotenoids and both atherosclerotic progression and clinically manifested cardiovascular disease.

Atherosclerosis↗
PubMed2006

[Hormonal replacement therapy and selective estrogen receptor modulators in prevention of cardiovascular disease].

Postmenopausal women are at higher risk of cardiovascular disease because of increased prevalence of major coronary artery disease risk factors. The protective activity on cardiovascular system of estrogen was postulated. The data from many studies indicate favourable effect of estrogen replacement therapy. However prospective, randomized clinical trials have not proved protective influence of hormonal replacement therapy (HRT) on cardiovascular system. Moreover it was found to increased the risk of cardiovascular disease events. This article presents mechanism of estrogens activity and results of major clinical trials concerning hormonal replacement therapy. Activity of selective estrogen receptor modulators (SERMs) was also described.

Cardiovascular Diseases↗
PubMed2001

[Trend of changes in mortality of cardiovascular diseases in some areas of Beijing during 1984 to 1998].

OBJECTIVE: To understand the main causes of deaths affecting population health and the trend of mortality of cardiovascular disease (CVD) in Beijing area during 1984 to 1998. METHODS: Monitoring data for cardiovascular diseases in some areas of Beijing during 1984 to 1998 were collected from MONICA project and used to analyze the distribution of disease, mortality caused by cardiovascular diseases and its age-adjusted mortality. Yearly average change in cardiovascular disease-specific mortality was calculated with regression analysis. RESULTS: Cardiovascular disease-specific mortality ranked the first place of the causes of deaths in Beijing population during 1984 to 1998, accounting for 46.0% of the total deaths. Cancer ranked the second, accounting for 26.5% of the total. Overall mortality, cardiovascular-specific mortality and cerebro-specific mortality all lowered significantly during the past 15 years, with yearly average reductions of 2.9%, 2.7% and 3.5%, respectively. Mortality of coronary heart disease significantly rose. CONCLUSIONS: Cardiovascular disease was the top cause of death in Beijing population during 1984 to 1998. Mortality of coronary heart disease significantly rose in the past 15 years. It is a pressing matter of the moment to prevent cardiovascular diseases in the population.

Adult↗
PubMed2002

Assessment of periodontal conditions and systemic disease in older subjects. II. Focus on cardiovascular diseases.

BACKGROUND: Panoramic radiographs (PMX)s may provide information about systemic health conditions. AIMS: i). To study clinical periodontal conditions and collect self-reported health status in a cohort of 1084 older subjects; ii). to study signs of alveolar bone loss and carotid calcification from panoramic radiographs obtained from these subjects; and iii). to study associations between study parameters. MATERIAL AND METHODS: PMXs from 1064 adults aged 60-75 (mean age 67.6, SD +/- 4.7) were studied. Signs of alveolar bone loss, vertical defects, and molar furcation radiolucencies defined periodontal status. Medical health histories were obtained via self-reports. Signs of carotid calcification were identified from panoramic radiographs. RESULTS: The PMX allowed assessment of 53% of the films (Seattle 64.5% and Vancouver 48.4%). A self-reported history of a stroke was reported by 8.1% of men in Seattle and 2.9% of men in Vancouver (P < 0.01). Heart attacks were reported by 12% of men in Seattle and 7.2% in Vancouver (N.S.). PMX evidence of periodontitis was found in 48.5% of the subjects, with carotid calcification in 18.6%. The intraclass correlation score for PMX findings of carotid calcification and stroke was 0.24 (95% CI: 0.10-0.35, P < 0.001). The odds ratio for PMX carotid calcification and periodontitis was 2.1 (95% CI: 1.3-3.2, P < 0.001), and for PMX carotid calcification and stroke 4.2 (95% CI: 1.9-9.1, P < 0.001). The associations disappeared when smoking was accounted for. A history of a heart attack was associated with stroke, gender, age, and PMX scores of alveolar bone loss. CONCLUSIONS: PMXs may provide valuable information about both oral conditions and signs of carotid calcification, data that are consistent with self-reported health conditions. Alveolar bone loss as assessed from PMXs is associated with cardiovascular diseases.

Aged↗
PubMed2001

Prevalence of clinical and isolated subclinical cardiovascular disease in older adults with glucose disorders: the Cardiovascular Health Study.

OBJECTIVE: Clinical cardiovascular disease (CVD) is highly prevalent among people with diabetes. However, there is little information regarding the prevalence of subclinical CVD and its relation to clinical CVD in diabetes and in the glucose disorders that precede diabetes. RESEARCH DESIGN AND METHODS: Participants in the Cardiovascular Health Study, aged > or = 65 years (n = 5,888), underwent vascular and metabolic testing. Individuals with known disease in the coronary, cerebral, or peripheral circulations were considered to have clinical disease. Those without any clinical disease in whom CVD was detected by ultrasonography, electrocardiography, or ankle arm index in any of the three vascular beds were considered to have isolated subclinical disease. RESULTS: Approximately 30% of the cohort had clinical disease, and approximately 60% of the remainder had isolated subclinical disease. In those with normal glucose status, isolated subclinical disease made up most of the total CVD. With increasing glucose severity, the proportion of total CVD that was clinical disease increased; 75% of men and 66% of women with normal fasting glucose status had either clinical or subclinical CVD. Among those with known diabetes, the prevalence was approximately 88% (odds ratio [OR] 2.46 for men and 4.22 for women, P < 0.0001). There were intermediate prevalences and ORs for those with impaired fasting glucose status and newly diagnosed diabetes. CONCLUSIONS: Isolated subclinical CVD is common among older adults. Glucose disorders are associated with an increased prevalence of total CVD and an increased proportion of clinical disease relative to subclinical disease.

Aged↗
PubMedDate not supplied

Community demonstration programs for cardiovascular disease prevention: the Asia-Pacific experience.

Cardiovascular diseases are an important and increasing cause of death in many countries in the Asia-Pacific Region. Formal demonstration programs for the prevention of cardiovascular disease are few in number and not likely to be widely used in the future. Prevention programs focused on key risk factors are widely used in the Region and have been successful. Smoking prevention remains a high priority for all countries in the Region.

Cardiovascular Diseases↗
PubMed2003

Pulse pressure is associated with age and cardiovascular disease in type 1 diabetes: the Eurodiab Prospective Complications Study.

OBJECTIVE: Type 1 diabetic individuals are thought to have increased arterial stiffness, and are at high risk for cardiovascular disease. However, it is not known whether increased arterial stiffness in type 1 diabetes causes cardiovascular disease. To explore this issue, the present study investigated the association, in type 1 diabetes, of age and pulse pressure, an estimate of arterial stiffness, and the influence of the presence of microvascular complications on this association. In addition, we determined the association of mean arterial pressure and pulse pressure with incident cardiovascular disease. METHODS: We studied a cohort of 3250 type 1 diabetic individuals of the EURODIAB Prospective Complications Study. Mean age and median follow-up were 33 and 7.4 years. One hundred and sixty-three individuals developed a first manifestation of cardiovascular disease during follow-up. Linear regression analysis was used to determine the association of age with pulse pressure. Relative risks of cardiovascular disease were estimated by Cox regression analyses adjusted for age, sex and mean arterial pressure or pulse pressure.RESULTS In cross-sectional analyses, age was associated with pulse pressure (P < 0.001) and this association was stronger in the presence of micro- or macroalbuminuria or retinopathy than in their absence (interaction for albuminuria, P < 0.001; interaction for retinopathy, P < 0.001). In prospective analyses, both mean arterial pressure and pulse pressure were associated with cardiovascular disease [adjusted relative risks and (95% confidence interval) per 10 mmHg increase were 1.08 (0.94-1.24) and 1.09 (0.98-1.21)]. CONCLUSIONS: This study shows an association of age with pulse pressure in young type 1 diabetic individuals, which is stronger in the presence of microvascular complications. In addition, both mean arterial pressure and pulse pressure are associated with incident cardiovascular disease. These findings support the concept of early vascular ageing in type 1 diabetes, especially in the presence of microvascular complications.

Adolescent↗
PubMed1989

Preliminary report of cardiac study: cross-sectional multicenter study on dietary factors of cardiovascular diseases. CARDIAC Study Group.

The International cooperative 'Cardiovascular Diseases and Alimentary Comparison Study' (CARDIAC Study) was designed to study the relationship of dietary factors to blood pressure (BP) and other major cardiovascular diseases (CVD) in widely different populations of both industrialized and developing countries. The primary aim of the research was to test specific hypotheses linking the intake of certain dietary constituents, e.g., sodium (Na), potassium (K), calcium (Ca) and protein, to BP ('Core' Study); in some centers the relationship between dietary factors and mortality from CVD was also examined ('Complete' Study). The final aim of this multicenter research was to contribute to the scientific information base required to guide the formulation of dietary goals for the primary prevention of major CVD. Forty centers in 20 countries are now participating in the CARDIAC Study. From each population 100 males and 100 females aged 50-54 years were selected randomly for BP measurement by an automated system, 24-hour urine collection by aliquot cups, blood sampling etc. according to CARDIAC protocol; and all samples were analyzed by the WHO Collaborating Center (Izumo) by standardized methods. Although studies are now in progress, surveys in China, Tanzania, USSR and Japan suggest the importance of Na and protein intakes, and all data so far obtained of systolic and diastolic BP, urinary Na and K excretions, serum cholesterol levels, etc. show wide distribution in different populations, so that dietary factors of CVD will be analyzed in more detail when the analyses of total samples are completed.

Blood Pressure↗
PubMed2004

Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years.

OBJECTIVE: Mild thyroid failure is associated with an increased risk for development of atherosclerosis, but whether subclinical hypothyroidism is related to risk for cardiovascular disease is controversial. The purpose of the present study was to examine a possible association between subclinical hypothyroidism and cardiovascular disease. DESIGN: Cross-sectional study of a general population. PATIENTS: Twelve hundred and twelve subjects, men and women, between 20 and 69 years old without thyroid disease not treated with drugs interfering with thyroid function or analysis of TSH were included. MEASUREMENTS: Clinical signs of cardiovascular disease based on a questionnaire and medical records and laboratory analysis of lipids, atherothrombotic risk markers, C-reactive protein and TSH. RESULTS: The main findings were a high incidence of subclinical hypothyroidism (19.7%) in a general population. Subclinical hypothyroidism was associated with higher concentrations of triglycerides and C-reactive protein. Below 50 years of age cardiovascular disease was more frequent in males with subclinical hypothyroidism compared to euthyroid males. Subclinical hypothyroidism was a predictor of cardiovascular disease in males below 50 years with an odds ratio of 3.4 (95% confidence interval 1.6-6.8) for developing cardiovascular disease compared to euthyroid age-matched males. CONCLUSION: Our study demonstrates that patients with subclinical hypothyroidism have increased levels of triglycerides and signs of low-grade inflammation (raised C-reactive protein levels) and that subclinical hypothyroidism might be a risk factor for development of cardiovascular disease in younger males.

Adult↗
PubMed2001

Implications from and for food cultures for cardiovascular disease: longevity.

A healthy cardiovascular system, with minimal arteriosclerosis, good endothelial function and well-compensated ventricular function has been observed at advanced ages, and linked to a healthy lifestyle. This has consisted of a plant-based diet, low in salt and fat, with monounsaturates as the principal fat. Other healthy lifestyle factors include regular physical activity (farming and traditional dance) and minimal tobacco use. The associated negative risk factors are low homocysteine, healthy cholesterol profile (Total:HDL ratio less than 3.5) and reasonable blood pressures throughout the life cycle. Hormone-dependent cancers including breast, ovary, prostate and colon and osteoporotic complications, such as hip fracture rates, are also less frequent compared to the west. Protective factors may include high anti-oxidant consumption, mainly flavonoids and carotenoids, through a high vegetable (e.g., onions) and soy intake. Related biological observations include low lipid peroxide, high superoxide dismutase activity and high serum hydroxyproline, a marker of bone formation. Dehydroepiandrosterone (DHEA) and its hormonal byproducts testosterone and oestrogen appear to be high in Okinawan serum compared with age-matched Americans, possibly reflecting a slower age-associated decline in the sex hormone axis in Okinawans. This may be linked to better cardiovascular and overall health. Further study is needed to delineate the reasons behind the impressive cardiovascular and overall health of the Okinawans.

Aged↗
PubMed1993

[The potentials of angiographic studies in the diagnosis of cardiovascular diseases].

Studies of the cardiovascular system in 1150 patients were performed by means of angiographic complex of the firm "Thompson" (USA) equipped with a computer "DG-300" (USA). The morphofunctional characteristics of circulation--capacity of vascular bed, elasticity of a vessel, degree of its stenosis, time of circulation and perfusion were studied. Four (0.3%) patients developed complications: 2--bleeding from the femoral artery, 2--cardiac arrest during coronarography.

Angiography, Digital Subtraction↗
PubMed2000

Cardiovascular disease: a historic perspective.

Cardiovascular disease (CVD) is the leading cause of death and disability in the United States and in most industrialized nations. Major breakthroughs to modern day cardiovascular/lipid research have been attributed to the findings of the Framingham Heart Study and Gofman and colleagues who made associations between lipoprotein levels (LDL, VLDL and HDL) and CVD. Unfortunately, half of all CVD patients have none of the established coronary risk factors (hypertension, hypercholesterolemia, cigarette smoking, diabetes mellitus, obesity) and new strategies for identifying patients need be considered. Although there remains little disagreement regarding the necessity to lower elevated plasma cholesterol levels, there remains much controversy regarding appropriate dietary means of accomplish this goal. The National Cholesterol Education Program (1993) proposed a dietary reduction (Step I and Step II diets) to the percent saturated fat and cholesterol consumed by at-risk patients. Many currently question about the effectiveness of these diets and an alternative diet, replacing saturated fats by monounsaturated fats (olive oil), has attracted recent attention. While diet modification is considered the foundation of primary treatment, other interventions are frequently required. Although early drug trials demonstrated that agents such as nicotinic acid, clofibrate, gemfibrozil, bile acid-binding resins generally slowed progression of atherosclerotic lesions, lowered plasma cholesterol levels and decreased mortality from CVD, the greatest advance to current drug therapy involved the discovery of the "statins" (HMG-CoA reductase inhibitors). In the current work, mechanisms for vascular dysfunction resulting in myocardial ischemia were explored and potential nutritional (dietary) and pharmacologic interventions were reviewed.

Arteriosclerosis↗
PubMed1992

Cardiovocal (Ortner's) syndrome left recurrent laryngeal nerve palsy associated with cardiovascular disease.

Five patients with cardiovascular disease presented with hoarseness due to left recurrent laryngeal nerve palsy. One had secundum atrial septal defect, one had ventricular septal defect, two had mitral stenosis and the other had aortic aneurysm. All except the patient with aortic aneurysm had pulmonary artery dilatation and moderate to severe pulmonary hypertension. Four patients' hoarseness resolved after successful interventional therapy. As for the patient with the aortic aneurysm, hoarseness persisted; the patient died before surgery. We postulate that the dilated pulmonary artery or aortic arch was responsible for the compression of the left recurrent laryngeal nerve.

Adult↗