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PubMed2004

Increased cardiovascular risk in long-term hemodialysis patients carrying deletion allele of ACE gene polymorphism.

BACKGROUND: Controversy continues about the relation of insertion (I)/deletion (D) polymorphism of the angiotensin-converting enzyme (ACE) gene to the genetic predisposition to develop such cardiovascular diseases as myocardial infarction, stroke, and other arteriosclerotic disorders. METHODS: To examine the relation of ACE gene polymorphism to risk for developing cardiovascular diseases in long-term hemodialysis patients, we followed up 534 patients on long-term hemodialysis therapy for 3 years after determining ACE genotype. RESULTS: Numbers of patients with the II, ID, and DD genotypes were 208, 245, and 81, and frequencies of the I and D alleles were 0.62 and 0.38, respectively. Background characteristics, such as age, sex, causative diseases of renal failure, and preexistence of cardiovascular diseases at the time of study entry, were similar among the 3 genotype groups. Serum ACE activity was significantly greater in the DD and ID groups than the II group; however, plasma angiotensin II concentrations were not significantly different among the 3 groups. During the 3 years of follow-up, 46 fatal and 167 nonfatal cardiovascular events occurred. The incidence of these cardiovascular events was significantly associated with older age (P < 0.001), diabetes (P < 0.001), preexistence of cardiovascular diseases (P < 0.001), systolic blood pressure (P = 0.009), high cardiothoracic ratio on chest roentgenogram (P < 0.001), electrocardiographic abnormalities (P < 0.001), and low serum sodium level (P < 0.001). In addition, the incidence of cardiovascular events was greater in patients carrying the D allele (II, 22.1%; ID, 31.8%; DD, 38.3%; P = 0.010). CONCLUSION: It is suggested that the D allele of ACE gene polymorphism is a risk factor for cardiovascular complications in hemodialysis patients.

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PubMed2004

Physician roles in improving cardiovascular health: counseling patients and involvement in the community.

Cardiovascular disease (CVD) is the leading cause of death in Kentucky. No previous research on Kentucky primary care physician concern for CVD--or possible roles in promoting cardiovascular health--has been published. We report here the results of an original research project addressing this information gap. The results provide an opportunity to review and discuss the evidence base relating to ways that primary care physicians can use their time, talents, and influence to have the greatest impact on the cardiovascular health of their patients and their communities, and we provide some specific guidance for how this can be done. We used a key informant survey of 241 primary care physicians in 26 Kentucky counties to gather more information regarding physician concern for CVD and roles that physicians can play in promoting cardiovascular health. We found that the majority of respondents were concerned about cardiovascular disease and its risk factors, thought that public programs were important for the reduction of cardiovascular risk in their communities, and felt that tobacco settlement money was a valid resource for funding such programs. Three fourths of the physicians were willing to participate in community efforts to improve health. With varying frequency, the physicians reported that they used office visits to counsel patients and parents on reducing the risk factors for CVD. A majority of the physicians reported that they counseled smoking cessation in at least 75% of the office visits of smokers. However, only 9% of them counseled on the benefits of fruits and vegetables in at least 75% of office visits. We conclude that Kentucky primary care physician community leaders are concerned about the consequences of cardiovascular disease in their communities. In addition to counseling patients in their offices, they can have a role in community efforts to promote cardiovascular health.

Cardiovascular Diseases↗
PubMedDate not supplied

[New strategies in cardiovascular prevention].

Cardiovascular diseases, especially coronary heart disease, are the leading cause of mortality in Spain and western countries. The prevention of complications is based on a cardiovascular risk stratification that is based on the presence of classical cardiovascular risk factors. There are many scales for cardiovascular risk stratification that classify subjects into low, intermediate or high risk. Despite the fact that the impact and treatment of risk factors are well known, their control remains poor. Obesity, diabetes, and hypertension seems also seem to be increasing trends due to the changes in lifestyles and nutritional habits of our communities. In recent decades some new, or emerging, cardiovascular risk factors have been identified that can improve the stratification of cardiovascular risk: C-reactive protein, homocysteine, and lipoprotein a. The metabolic syndrome is an association of cardiovascular risk factors that cluster in the same subject because they share a physiopathologic link: insulin resistance. Its presence is related to most cardiovascular risk factors, classical or emerging, especially obesity, hypertension, and C-reactive protein. On the other hand, detection of subclinical or incipient atherosclerosis, especially with the measurement of intima-media thickness, offers indirect information closely related to coronary atherosclerosis that improves the stratification of subjects at intermediate risk.

Cardiovascular Diseases↗
PubMedDate not supplied

Associations of health, dietary and job-related factors, and mental problems with cardiovascular diseases in aging.

BACKGROUND: While cardiovascular diseases are prevalent in aging population, associations between different factors and cardiovascular diseases are less studied or inconsistency still exists. AIM: To determine which factors measured at baseline predicted overall cardiovascular diseases and hypertension, and which factors were currently associated with these conditions. METHODS: Based on a sample of aging and retired food industry employees (N = 100, mean age 62 years) associations of health, dietary and job-related factors and mental problems with overall cardiovascular morbidity and hypertension were assessed with independent samples t-test, chi2 test and binary logistic regression analyses. Data were derived from health examinations and self-completed questionnaires in 1989 and 2000. RESULTS: Added medical findings, related to cardiovascular diseases, appeared as predictor of overall cardiovascular morbidity, while elevated blood pressure together with high systolic and diastolic pressure, dyslipidemia and elevated blood pressure together, added medical findings, and inability to enjoy daily activities predicted hypertension. According to our analyses most significant current associations with overall cardiovascular morbidity were feeling of weakness, dyspnoea, hopelessness about the future, cardiac arrhythmia, chronic mental stress and lower HDL cholesterol, and with hypertension metabolic syndrome, lower HDL cholesterol, hopelessness about the future and muscular fatigue on exertion. CONCLUSIONS: Health factors were most important predictors of hypertension during a long-term period, while health factors together with mental problems had significant current associations with overall cardiovascular morbidity including hypertension.

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PubMed2005

Integrated cardiovascular risk management for the future: lessons learned from the ASCOT trial.

Cardiovascular disease is the leading cause of morbidity and mortality in Western countries, and hypertension-related cardiovascular events affect about 37 million people per year worldwide. In this perspective, treatment of hypertension is a reference illustrating strategies of cardiovascular prevention. Hypertensive patients are at increased risk of undergoing a cardiovascular event throughout their lives, and treatment of high blood pressure is one of the most effective strategies to reduce global cardiovascular risk. However, due to its multifactorial pathophysiology and frequent association with other important risk factors and clinical conditions such as dyslipidemia, diabetes, left ventricular dysfunction, and renal impairment, treatment of hypertension requires an integrated approach, including life-style measures, antihypertensive drugs and other therapies (statins, ASA, etc.). Nonetheless, worldwide, general practitioners continue to focus on managing a single risk factor, e.g. blood pressure, rather than on overall cardiovascular risk profiles. Another debated issue is whether it matters how blood pressure is lowered in hypertensive patients at high risk. In other words, are the latest antihypertensive drugs more effective than older blood pressure strategies in terms of reduction of cardiovascular events? The recent results of the ASCOT Study address these controversial issues and throw new light on the management of cardiovascular risk in hypertension.

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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↗
PubMed2006

[Renal function and cardiovascular risk in patients with essential hypertension. The "FRESHA" study].

BACKGROUND: In the past few years there has been a growing amount of information about renal dysfunction and cardiovascular risk. The objectives of this study were to assess the prevalence of renal dysfunction and evaluate the relation between renal function and cardiovascular risk in patients with essential hypertension. METHODS: A multicenter, cross-sectional survey of unselected patients with essential hypertension attending primary care settings in Spain was performed between june and november 2004. Renal function was evaluated with the abbreviated equation of the Modification of Diet in Renal Disease study. Renal insufficiency was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2. RESULTS: Eighty-eight investigators from 50 centers recruited 2130 patients being mean age 65.6 +/- 11 years and female 53%. Prevalence of diabetes, lipid abnormalities, and previous cardiovascular disease were 30.3%, 45.9%, and 42.1% respectively. Prevalence of renal insufficiency was 32.4% (95% CI 30.4-34.4). Patients suffering from renal insufficiency showed a higher prevalence of cardiovascular disease when comparing with those with an estimated glomerular filtration rate = or >60 ml/min/1.73 m2 (56.2% vs. 35.3%, OR 2.35, 95% CI 1.95-2.82, p < 0.001). A logistic regression analysis showed that the relation of renal dysfunction with cardiovascular disease was independent of other variables or classical cardiovascular risk factors as age, female sex, diabetes, smoking, hypercholesterolemia, and systolic blood pressure. CONCLUSIONS: Renal insufficiency was present in 32.4% of patients with essential hypertension attending primary care settings. Cases with renal dysfunction showed a higher cardiovascular risk. Hypertensive patients with renal insufficiency should be considered as candidates for an aggressive approach of cardiovascular risk management.

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PubMed2006

[What is the most effective approach to the reduction of cardiovascular risk in type-2 diabetes mellitus?].

UNLABELLED: It is well known that the target blood glucose values are not fulfilled in treatment of patients with type 2 diabetes mellitus. (UKPDS) The high mortality rate in type 2 diabetes mellitus is associated with the augmented cardiovascular risk. It is well documented, that the beneficial influence of high blood pressure, dyslipidaemia, and hypercoagulation compared to hyperglycaemia, is a more powerful approach in reduction of cardiovascular risk in type 2 diabetes mellitus. The effect of medical interventions on alteration of cardiovascular risk and glucose homeostasis is not always concordant: beta-blockers automatically reduce cardiovascular risk, but may result in deterioration of blood glucose values, sulfanylurea drugs effectively reduce hyperglycaemia, but could paradoxically increase the cardiovascular risk. The acarbose, metformin, thiazolidindione, fibric acid treatment improves the profile of vascular risk factors, additionally could have a beneficial metabolic effect resulting in reducing cardiovascular risk in patients with type 2 diabetes mellitus. IN CONCLUSION: the cardiovascular risk in type 2 diabetes mellitus can be most effectively influenced by reduction of high blood pressure, dyslipidaemia, and dysfunction of haemostasis. The improvement of glucose homeostasis is, novel medical interventions seem to be important tools in reducing cardiovascular risk in patients with type 2 diabetes mellitus.

Cardiovascular Diseases↗
PubMed2006

[What is the impact of cardiovascular and renal complications on the benefit/risk ratio of the NSAIDs?].

Long-term studies of NSAIDs have demonstrated cardiovascular toxicity which poses a general problem of the benefit risk between the relief of the patient's symptoms and the risk of digestive and cardiovascular toxicity. The digestive complications and the risk factors associated with the ingestion of NSAIDs have been defined by numerous studies but the prevention of this digestive toxicity can be attempted. The benefit-risk ratio caused by the digestive and cardiovascular toxicities of the NSAIDs and COX-2 inhibitors must be evaluated for each individual before starting a treatment. For a treatment of short duration in patients with a low risk of digestive and cardiovascular complications, the risk of digestive toxicity must be taken into consideration first and the COX-2 inhibitors are favoured. For a treatment of long duration the risk must be evaluated with the greatest care. In the case of cardiovascular risk factors, the cardiovascular risk must be evaluated and the treatment must be prescribed at the lowest dose for the shortest duration. In patients with very high risk of digestive and cardiovascular complications, since the digestive and cardiovascular extra-mortality associated with the ingestion of NSAIDs or COX-2 inhibitors is high, it is advised to abandon this type of long-term treatment.

Age Factors↗
PubMed2006

The Bold Promise Project: a system change in primary care to support cardiovascular risk screening.

AIMS: To develop a series of system changes in primary care to facilitate cardiovascular risk screening of all eligible patients identified according to the current New Zealand Cardiovascular Guidelines (NZGG), and to provide the ability to measure and track clinical management of high risk patients. METHODS: Several system changes were developed within primary care practice management software to identify the patient cohort eligible for cardiovascular risk screening, to calculate cardiovascular disease risk (CVR), and to extract the data for reporting on screening outcomes and clinical management indicators in high risk patients. Following a baseline audit, the system changes were piloted over 12 months in three general practices with a combined enrolled patient population of 30,963. RESULTS: A total of 6570 NZGG eligible patients were identified; 20.1% of these were Maori and 19.7% were Pacific people (mostly of Samoan, Tongan, Niuean, or Cook Islands origin). Over 12 months, screening rates for cardiovascular risk assessment increased from 4.7% to 53.5% for the cohort. Of the 3516 patients screened, 482 (13.7%) had established cardiovascular disease. A further 230 (6.5%) had diabetes without CVD and 646 (18.4%) had a 5-year CVD risk of > or = to 15% Management data was available in 232 (48.1%) of those with CVD, 74%, 65%, and 79% were on aspirin, statins, and blood pressure-lowering medication, respectively. Fifty-five percent exceeded the low density lipoprotein (LDL) target of 2.5 mmol/L, 62% had a systolic blood pressure (BP) above the target of 130 mmHg, 18% were still smoking, and only 9% met all clinical targets recommended in the guideline. Of 646 with a 5-year CVD risk > or = to 15%, management data was available in 347 (53.7%). Only 34% were prescribed aspirin, 40% were prescribed statins, and 57% were on blood pressure lowering medication. Forty percent of this group had a systolic BP >140 mmHg, 36% an LDL >3.5 mmol/L, with only 7% of patients meeting all the guideline clinical targets. CONCLUSIONS: The system changes comprising this intervention have dramatically increased cardiovascular risk assessment rates in a primary care setting, and will facilitate appropriate targeting of intensive cardiovascular prevention measures to close the treatment gap observed.

Female↗
PubMed1986

Comparison of resuscitation of sheep and dogs after bupivacaine-induced cardiovascular collapse.

This study evaluated interspecies sensitivity and ability to resuscitate pentobarbital anesthetized sheep and dogs after cardiovascular toxic doses of bupivacaine. Every minute, 3 mg/kg of bupivacaine was injected into the right atrium over the course of 10 sec until cardiovascular collapse occurred. While the bupivacaine was given, the animals were made apneic for 90 sec and then ventilated with 100% oxygen. After the bupivacaine administration, cardiovascular collapse occurred in the form of electromechanical dissociation progressing to asystole in dogs, whereas in sheep the predominant rhythm was ventricular fibrillation leading to asystole. Resuscitation was performed using open chest heart massage, bretylium for treatment of ventricular tachycardia and fibrillation, and epinephrine with atropine for treatment of electromechanical dissociation or asystole. The initial dose of bupivacaine used to cause cardiovascular collapse was 3.5 +/- 1.2 mg/kg in sheep and 24.6 +/- 8.5 mg/kg in dogs (P less than 0.01). All sheep and dogs were resuscitated from the first cardiovascular collapse. The resuscitation time was 2.1 +/- 1.0 min in dogs and 36.9 +/- 15.4 min in sheep (P less than 0.01). All dogs could be resuscitated after two additional cardiovascular collapses induced by bupivacaine, but no sheep could be resuscitated after a second cardiovascular collapse. Concentrations of bupivacaine in cardiac tissue and serum levels of bupivacaine after the last resuscitation attempt were significantly greater in the dogs than in the sheep. We conclude that sheep are more sensitive to bupivacaine than dogs, but that even sheep can be resuscitated after cardiovascular collapse produced by bupivacaine.

Animals↗
PubMed1993

Hormone replacement therapy and cardiovascular disease.

Cardiovascular disease is the chief cause of death among women in industrialized countries. Even breast cancer deaths, at 100/100,000 annually, are only 20% those from cardiovascular disease. However, the research effort in the area of cardiovascular disease among postmenopausal women is far smaller than those for osteoporosis or cancer. In postmenopausal women, the risk of cardiovascular disease rises dramatically, and among the elderly exceeds that of males. Although there is overwhelming evidence that HRT reduces the incidence, many physicians assume that it may cause hypertension and thrombosis, perhaps under the mistaken impression that HRT has the same side effects as the first generation of steroid contraceptives. A number of studies have demonstrated that cardiovascular mortality of postmenopausal women on HRT decreases by approximately one-half. The main epidemiologic evidence for this is a series of case-control and prospective (cohort) studies. Some 20 studies over the last 15 years could be briefly summarized by saying that approximately one third found cardiovascular risk among HRT users to be reduced by > 50% compared with non-users; one third found risk reductions < 50%; and one third found increased risks. HRT appears to affect a large number of risk factors associated with cardiovascular disease; but many formerly thought to be of significance have little clinical relevance, whereas some factors, such as peripheral vascular resistance and certain prostanoids, are apparently much benefited. The benefits of HRT for lipid factors (HDL-cholesterol, LDL-cholesterol, etc.) are well known, but recent evidence indicates that changes in these lipids account for only 20-25% of the cardiovascular benefits of HRT.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular Diseases↗
PubMed1996

Molecular genetic analysis in mild hyperhomocysteinemia: a common mutation in the methylenetetrahydrofolate reductase gene is a genetic risk factor for cardiovascular disease.

Mild hyperhomocysteinemia is an established risk factor for cardiovascular disease. Genetic aberrations in the cystathionine beta-synthase (CBS) and methylenetetrahydrofolate reductase (MTHFR) genes may account for reduced enzyme activities and elevated plasma homocysteine levels. In 15 unrelated Dutch patients with homozygous CBS deficiency, we observed the 833T-->C (I278T) mutation in 50% of the alleles. Very recently, we identified a common mutation (677C-->T; A-->V) in the MTHFR gene, which, in homozygous state, is responsible for the thermolabile phenotype and which is associated with decreased specific MTHRF activity and elevated homocysteine levels. We screened 60 cardiovascular patients and 111 controls for these two mutations, to determine whether these mutations are risk factors for premature cardiovascular disease. Heterozygosity for the 833T-->C mutation in the CBS gene was observed in one individual of the control group but was absent in patients with premature cardiovascular disease. Homozygosity for the 677C-->T mutation in the MTHFR gene was found in (15%) of 60 cardiovascular patients and in only 6 (approximately 5%) of 111 control individuals (odds ratio 3.1 [95% confidence interval 1.0-9.2]). Because of both the high prevalence of the 833T-->C mutation among homozygotes for CBS deficiency and its absence in 60 cardiovascular patients, we may conclude that heterozygosity for CBS deficiency does not appear to be involved in premature cardiovascular disease. However, a frequent homozygous mutation in the MTHFR gene is associated with a threefold increase in risk for premature cardiovascular disease.

Alleles↗
PubMedDate not supplied

[Chronic noise exposure and the cardiovascular system in aircraft pilots].

The aim of this study was to assess whether pilots are exposed to any risk of effects on the cardiovascular apparatus, whether chronic exposure to noise can be a risk factor for this occupation, the importance of intensity, length and type of exposure to noise, and if any relationship exists between audiometric deficits and cardiovascular effects. The study comprised 416 pilots subdivided into two groups according to the different levels of chronic exposure to noise, and a group of 150 control subjects not exposed to noise. The results showed: a) a higher prevalence of hypertension, nearly always diastolic, and of ECG abnormalities in the group of pilots of turboprop aircraft compared to jet plane pilots and to controls (p < 0.005 and p < 0.01 respectively); b) a higher prevalence of orthostatic hypotension in the two groups of pilots than in the controls (p < 0.05); c) a higher prevalence of hypertension with audiometric deficit compared to hypertension without audiometric deficit both in the more heavily and in the less heavily exposed to noise (p < 0.05), and a higher prevalence of hypertension with audiometric deficit in subjects exposed to higher levels of noise compared to hypertension with deficit but in subjects with lower levels of exposure (p < 0.05); d) a higher prevalence of abnormalities of basal, maximum effort and recovery ECG in pilots exposed to higher noise intensity (p < 0.05); e) improved hypertensive response to ergometric test in pilots with basal hypertension; f) subjects with a maximal load up to 120 W belonged prevalently to the group exposed to more intense noise (p < 0.001), while those with maximal load up to 210 W (p < 0.001) belonged to the group exposed to less intense noise. Considering that pilots are comparable for traditional cardiovascular risk factors, including age, both within the group and with the controls, the results confirm 1) that pilots could be exposed to the risk of effects on the cardiovascular apparatus, 2) that noise could be one of the risk factors and that cardiovascular effects could be related to intensity, type and length of exposure, age being the same, 3) that vascular damage is often accompanied by hearing loss even if the response of the auditory apparatus is different from the response of the cardiovascular apparatus, 4) that the postural diminution of arterial blood pressure might be a sign of a cardiovascular effect of noise. Lastly, a higher hypertensive response in hypertensive pilots suggests that basal hypertension is not reversible. Also a longer exposure to noise seems to influence the cardiovascular apparatus, causing a decrease in the response to work loads due to a lower sympathetic adaptability. The altered response of sympathetic activity to the postural modifications in the more exposed subjects and the response to lower work loads in pilots exposed to more intense noise, suggests a hypothesis of catecholamine depletion and alteration of baroceptor sensitivity as a consequence of chronic sympathetic activation due to chronic exposure to noise.

Adult↗
PubMedDate not supplied

[Premonitory psychiatric signs of cardiovascular complaints].

The present study attempts to find out whether 19 behaviors, identified in 1952 and considered as revealing of a psychoneurotic state, appear more often among subjects who complain, 16 years later (in 1968), of a cardiovascular problem than among the subjects who remain free of any cardiovascular complaint during this period. The sample analysed comes from an epidemiological survey, realized by Leighton and known by the name Stirling County Study. That study includes 654 subjects free of any cardiovascular complaint in 1952. These subjects were divided into five independent categories in terms of the presence or absence of certain cardiovascular complaints expressed in 1968. The five categories of cardiovascular complaints were compared as to the frequency and nature of the psychiatric characteristics which differentiate them. Three conclusions appear from this study. 1. The psychiatric characteristics (identified in 1952) are more numerous among the subjects who manifest, 16 years later, a cardiovascular complaint (identified in 1968), when one compares them to the psychiatric characteristics of those who do not develop any cardiovascular complaint during this period. 2. The patterns of psychiatric characteristics which differentiate the subjects who develop a cardiovascular complaint vary with sex. These patterns are much more broad, coherent, and differentiating among women. 3. The accumulation of psychiatric characteristics possesses, among women, a differentiating value greater than any characteristic taken alone.

Adult↗
PubMed1998

A single risk factor measurement predicts 35-year mortality from cardiovascular disease.

Two Italian rural cohorts of men aged 40-59 years, were examined in 1960 within the Seven Countries Study of Cardiovascular Diseases and a total of 1712 men were enrolled (participation rate 98.8%). Cardiovascular risk factors were measured and 35-year follow-up made for vital status, mortality and cause of death. Cardiovascular diseases represented the first cause of death (46.2%), cancer the second (29.9%). The association between risk factors measured at baseline and the occurrence of cardiovascular deaths was tested by the use of multivariate functions (proportional hazards model in particular) which predict an event as a function of many possible factors. The predicted fatal events were, among men initially free of cardiovascular disease, coronary heart disease-restricted criteria (CHD-RC), coronary heart disease-broad criteria (CHD-BC), strokes (STR), and all cardiovascular diseases (CVD). The predicting variables were 21 risk factors of different nature. All models were highly discriminant between cases and non-cases. The predictivity of risk factors was assessed by testing the statistical significance of their multivariate coefficients, and by computing relative risks (expressed as hazards ratios) for standard differences in their levels. Age and systolic blood pressure produced significant coefficients and large hazards ratios in solutions for all end-points; cholesterol and cigarette smoking in three (not for STR); vital capacity (inverse relationship) and gerontoxon in two; physical activity (inverse relationship), forced expiratory volume (inverse relationship), urine glucose, family history of heart attack, and xanthelasma in one each. Marital status, family history of hypertension or diabetes, body mass index, skinfold thickness, arm circumference, shoulder-pelvis shape, laterality-linearity index, trunk-height ratio, and heart rate never provided a significant contribution to prediction. As an example, a difference of 20 mmHg in systolic blood pressure corresponds to a relative risk (excess risk) of 1.50 for CHD-RC, 1.46 for CHD-BC, 1.42 for STR and 1.43 for CVD; a difference of 40 mg/dl of serum cholesterol corresponds to relative risks of 1.38, 1.33, 1.13 and 1.25 respectively for the four end-points; a difference of 10 cigarettes smoked per day corresponds to relative risks of 1.19, 1.21, 1.06 and 1.17 respectively for the four end-points. The findings indicate that some cardiovascular risk factors measured once in middle age retain a long term association with prediction of future cardiovascular events, up to 35 years follow-up.

Adult↗
PubMed1999

High heart rate: a risk factor for cardiovascular death in elderly men.

OBJECTIVE: To examine the association between heart rate and 12-year incidence rates of total and cardiovascular death in a cohort of elderly subjects stratified by sex. SUBJECTS AND METHODS: The study was carried out in 763 white men and 1175 women aged 65 years or older who were participating in the Cardiovascular Study in the Elderly. Subjects were divided into quintiles of heart rate; the top quintile comprised those with a heart rate of greater than 80/min and the bottom quintile, those with a heart rate of less than 64/min. RESULTS: In the men, the number of deaths from cardiovascular causes was significantly increased in those in the top quintile of heart rate (crude relative risk, 1.55) but decreased in those in the bottom quintile (crude relative risk, 0.65). Similar relationships were found in the women, but the associations did not reach statistical significance (all-cause, P = .11; cardiovascular, P = .15). After adjustment for baseline age, body mass index, hypertension, diabetes mellitus, angina or previous myocardial infarction (coronary heart disease), regular medication, lipid levels, smoking, alcohol intake, forced expiratory volume in 1 second, and other confounders, the relative risk for cardiovascular death in the men was 1.38 (95% confidence interval, 0.94-2.03) for the subjects in the top quintile of heart rate and 0.82 (95% confidence interval, 0.52-1.28) for those in the bottom quintile. In the Cox analysis, predictors of time to cardiovascular death were heart rate (P < .001), age (P < .001), coronary heart disease (P < .001), clinical heart failure (P = .001), diabetes mellitus (P = .001), hypertension (P = .02), and triglyceride levels (P = .04), whereas total (P = .20) and high-density lipoprotein-cholesterol (P = .21) levels and smoking (P = .74) were found to be nonsignificant by the model. The heart rate-cardiovascular death association held true when subjects who died in 2 years after enrollment were excluded (P = .008). CONCLUSIONS: An elevated heart rate may be a strong predictor of cardiovascular death in elderly men. Conversely, a low heart rate is related to a better outcome in these subjects.

Aged↗
PubMed1976

Habituation and conditioning of the defense reactions and their cardiovascular components in cats and dogs.

Cardiovascular and behavioural responses elicited by novel, noxious or aversive stimuli have been studied in dogs and cats. Hindlimb blood flow, heart rate and arterial blood pressure increased in dogs when an orienting response was elicited by a novel stimulus (a sound). Similar cardiovascular responses occurred in dogs to mild noxious stimulus and in cats displaying a threatening posture when confronted by a dog. The cardiovascular components of the orienting response to a sound habituated with repetition of the sound. In two dogs however sensitization (increase) of the response occurred with reped by repetition of the confrontations: the vasodilation in the muscles waned and eventually was replaced by vasoconstriction while the cardiac acceleration and pressor response persisted. The threatening response was the most persistent. The modification of the behavioural and cardiovascular aspect of the response was not developing in parallel. The cardiovascular pattern was altered before any apparent changes of the behavioural pattern occurred. The cardiovascular responses of the noxious stimulus in dogs and cardiovascular components of the defence reaction in cats were readily conditioned to a sound. The possible role of the modification of the cardiovascular pattern in defence reactions in pathogenesis of hypertension is discussed.

Animals↗