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PubMed1978

Diet and coronary heart disease.

Coronary heart disease (CHD) is rare in South African Blacks, even in urban dwellers, but very common in Whites. The disease is multifactorial in causation. Habitual pattern of diet undoubtedly is strongly involved. Epidemiological and other evidence suggests that for the primary and secondary dietary prevention of CHD, intake of fat (also cholesterol) should be reduced, with an increase in the polyunsaturated moiety, and obesity should be controlled. Less specific general recommendations are increased consumptions of unrefined or partially refined grain products, and fruit and vegetables. Controversies over interpretations of evidence, over dietary recommendations, and also over the changes of their adoption, are discussed.

Cholesterol, Dietary↗
PubMedDate not supplied

[Circadian variation in complex ventricular arrhythmias in patients with coronary disease].

In a group of 60 patients with coronary artery disease and complex ventricular arrhythmias which were recorded by 24-hour ambulatory electrocardiogram, circadian variation of ventricular arrhythmias was analysed. All patients had multiform ventricular premature beats: 40 (67%) patients had pairs of ventricular premature beats; 26 (43%) patients had episodes of ventricular tachycardia, and 8 (13%) patients had R on T type of ventricular premature beats. The most frequent multiform ventricular premature contraction was recorded between 7 and 10 h. a. m. and between 5 and 8 h. p. m. Similar bimodal distribution in frequency of pairs of ventricular premature beats and episodes of ventricular tachycardia, was recorded. Episodes of both symptomatic and asymptomatic types of myocardial ischaemia showed a circadian rhythm similar to that seen in complex ventricular arrhythmias. The study revealed the existence of significant circadian rhythm of ventricular arrhythmias in coronary patients which may be important for chronopharmacologic approach to antiarrhythmic therapy.

Arrhythmias, Cardiac↗
PubMed1993

The role of coronary angioplasty in the management of coronary artery disease.

Coronary angioplasty is well established as a treatment modality for coronary artery disease. Clinical experience leaves no doubt that it can be very effective in relieving symptoms in patients with unstable angina and with chronic stable angina. There are, at present, no controlled trials to demonstrate its efficacy, though several are under way. In straightforward cases the initial success rate is about 90%, but for each lesion dilated, there is about a 30% chance of significant re-stenosis. Re-stenosis (which is the main chronic complication) usually occurs early--often within a few weeks of the procedure--and it rarely develops later than six months after the procedure. Acute closure of the dilated artery (usually within an hour or two of procedure) is the most feared acute complication and is the main factor contributing to the 0.2% acute mortality rate and to the 1-5% risk of emergency coronary artery bypass grafting. The procedural risk does not increase progressively with serial interventions (in contrast to coronary artery surgery). Furthermore, angioplasty is often undertaken following surgery when stenoses have developed within the grafts, at the graft-vessel anastomosis, in the native vessels distal to the graft insertion or in native ungrafted vessels. Angioplasty is less costly than coronary surgery, although the 30% re-stenosis rate implies a requirement for additional interventions as a result of which the cost differential is not as great it initially appears.

Angioplasty, Balloon, Coronary↗
PubMed2004

[Neurohormonal prediction of post-infarction ventricular dysfunction and coronary disease].

Little information is available about the potential role of brain (type B) natriuretic peptide in patients with acute myocardial infarction. We therefore analyzed peptide levels, measured at discharge from our coronary care unit, in 56 patients admitted with a diagnosis of acute myocardial infarction. We examined peptide concentrations in the light of different features in our patients, and found a significant association between natriuretic peptide levels and the two most important prognostic factors: left ventricular ejection fraction, and the severity and extent of coronary disease. Type B natriuretic peptide was a good predictor of these features, and we conclude that concentration of type B natriuretic peptide, measured at discharge from the coronary care unit, provides important clinical and prognostic information in patients with acute myocardial infarction.

Coronary Disease↗
PubMed1990

[Clinical presentation and diagnosis of coronary heart disease].

Coronary artery disease may present as silent ischemia, chronic typical angina pectoris, unstable angina, Prinzmetal angina, acute myocardial infarction, and sudden cardiac death. These manifestations can usually be differentiated by the clinical history. Each of them has its own pathophysiology and, accordingly, therapy and prognosis are different. Myocardial ischemia is common to all of the manifestations and this can be assessed by history taking, ECG stress-testing, ambulatory monitoring, myocardial perfusion scanning, or radionuclide angiography (RNA). The diagnostic accuracy of these diagnostic procedures varies from 70% (history) to 81% (RNA).

Coronary Disease↗
PubMed2001

Women and coronary heart disease.

Coronary heart disease (CHD) is the leading cause of death in men and women in the United States. The incidence of CHD during midlife is lower in women than men, but the gap narrows with each decade. Because women have a longer life span than men, the absolute numbers of CHD deaths are roughly equal. Effective diagnosis of CHD in women requires the recognition of gender differences in presentation and pathogenesis. Women present with atypical symptoms and are less likely to have adequate primary prevention. This article discusses the differences between men and women in CHD and examines the assessment, diagnosis, and clinical management of CHD in women.

Clinical Trials as Topic↗
PubMed1998

Estrogen replacement therapy and coronary artery disease.

Coronary artery disease (CAD) is the number one cause of death and disability in women and men in the United States. In women, CAD typically develops after menopause, and, therefore, it has been hypothesized that estrogen replacement therapy (ERT) may have a role in preventing and treating CAD. Indeed, a body of epidemiologic data suggests that estrogen does protect against CAD. Much information is also available on the mechanisms by which estrogen may confer protection versus CAD. For example, ERT has been shown to have an overall beneficial effect on cardiac risk factors such as hyperlipidemia in postmenopausal women, but the degree to which ERT affects the lipid profile and other risk factors is relatively modest and does not seem to account for all of the benefits of estrogen. Thus, this review focuses not only on the effects of ERT on cardiac risk factors but also on other aspects of CAD, such as atherogenesis, lipid oxidation, vasomotor tone, and thrombosis and thrombolysis. The recent literature on the effect of ERT on secondary prevention of cardiovascular events after percutaneous coronary interventions or coronary artery bypass surgery is also reviewed.

Animals↗
PubMedDate not supplied

Review of serum lipids and apolipoproteins in risk-assessment of coronary heart disease.

Coronary heart disease (CHD), the leading cause of death in the western world, is multifactorial in nature. Abnormal lipoprotein levels are among the risk factors that cause atherosclerosis and, therefore, have been used as biochemical markers in assessing risk of developing CHD. The measurement of serum cholesterol, lipoprotein cholesterol, and apolipoproteins accurately and reliably has been hampered with technical difficulties. In addition, the interpretation of these tests and the determination of their clinical values have been challenging for both physicians and laboratory scientists. This article addresses and reviews the major current analytical and clinical concerns in the testing of lipids as well as the prevention and treatment of CHD.

Adult↗
PubMed1986

Predicting outcome in coronary disease. Statistical models versus expert clinicians.

To study the accuracy with which long-term prognosis can be predicted in patients with coronary artery disease, prognostic predictions from a data-based multivariable statistical model were compared with predictions from senior clinical cardiologists. Test samples of 100 patients each were selected from a large series of medically treated patients with significant coronary disease. Using detailed case summaries, five senior cardiologists each predicted one- and three-year survival and infarct-free survival probabilities for 100 patients. Fifty patients appeared in multiple samples for assessing interphysician variability. Cox regression models, developed using patients not in the test samples, predicted corresponding outcome probabilities for each test patient. Overall, model predictions correlated better with actual patient outcomes than did the doctors' predictions. For three-year survival, rank correlations were 0.61 (model) and 0.49 (doctors). For three-year infarct-free survival predictions, correlations with outcome were 0.48 (model) and 0.29 (doctors). Comparisons by individual doctor revealed Cox model three-year survival predictions were better than those of four of five doctors (model predictions added significant [p less than 0.05] prognostic information to the doctor's predictions, whereas the converse was not true). For infarct-free survival, the Cox model was superior to all five doctors. Where predictions were made by multiple doctors, the interphysician variability was substantial. In coronary artery disease, statistical models developed from carefully collected data can provide prognostic predictions that are more accurate than predictions of experienced clinicians made from detailed case summaries.

Coronary Disease↗
PubMed2001

Long-term outcome of angioplasty for multivessel coronary disease: importance and price of complete revascularization.

BACKGROUND: Complete revascularization of multivessel coronary artery disease (MVD) by coronary artery bypass surgery has been shown to improve outcome, but there is a lack of similar data for patients treated by angioplasty. METHODS: Therefore, a consecutive series of 250 patients with MVD was separated into two groups, those with complete revascularization (n=101) and those with incomplete revascularization (n=149). Six-month 'clinical restenosis' rate assessed by stress myocardial perfusion scintigraphy or symptom-driven angiography and long-term 32 months outcome were compared with an equally sized group of single vessel disease (SVD) patients. RESULTS: MVD patients with complete revascularization had a higher 'clinical restenosis' rate than patients with SVD (35 vs. 22%, P<0.02), although restenosis rate per treated vessel was similar (23%, 18%, P NS). If this higher early restenosis rate were accepted as 'price' for complete MVD angioplasty, long-term event-free survival was no longer different from that of SVD patients (86 vs. 93%, P NS). In contrast, patients with incomplete multivessel angioplasty had a significantly worse long-term outcome (22% events), especially if initially untreated, non-occluded vessels remained untreated (25% events). CONCLUSION: MVD angioplasty with complete revascularization has a long-term event-free survival similar to that of SVD angioplasty but at the price of a higher rate of 6-month restenosis and repeat interventions.

Angioplasty, Balloon, Coronary↗
PubMed2006

Triglycerides and remnant particles as risk factors for coronary artery disease.

Coronary artery disease (CAD) is the largest cause of morbidity and mortality in the world. A relationship between CAD and elevated levels of low-density lipoprotein cholesterol has been established. However, risk assessment limited to low-density lipoprotein fails to identify a significant portion of patients at risk for CAD. Remnant lipoproteins, derived from very low-density lipoprotein and chylomicrons, have been considered atherogenic. Recently, a simple and reliable immunoaffinity separation method for the isolation of remnant-like particles (RLP) has been developed. It has been shown that RLP cholesterol levels are significantly correlated with CAD, and thus cellular mechanisms have been determined by which RLP cholesterol causes progression of atherosclerosis. Measurement of RLP cholesterol is useful for the assessment of risk and the evaluation of therapy in patients at risk for CAD.

Biomarkers↗
PubMed1995

A variant of human paraoxonase/arylesterase (HUMPONA) gene is a risk factor for coronary artery disease.

Coronary artery disease (CAD) is a complex trait caused by a number of genetic and environmental factors. Recently, paraoxonase/arylesterase (PONA) enzyme has been implicated in the pathogenesis of atherosclerosis. There is a 10-40-fold variability in the activity of this enzyme among individuals. This variability is due to the presence of an A/G polymorphism in the coding region of the gene (HUMPONA). The A and G alleles code for glutamine (A genotype) and arginine (B genotype), respectively. Individuals with A genotype have a lower enzymatic activity than those with B genotype. We determined the HUMPONA genotypes and alleles in 223 patients with angiographically documented CAD and in 247 individuals in the general population. The distribution of genotypes were in Hardy-Weinberg equilibrium in patients and in controls. Genotypes A and B were present in 120 (49%) and 28 (11%) individuals in controls and in 68 (30%) and 40 (18%) patients with CAD, respectively (chi squared= 16.5, P= 0.0003). The frequency of the A allele was 0.69 in controls and 0.56 in patients (OR= 1.7, P= 0.0001). There were no differences in the distribution of HUMPONA genotypes in the subgroups of patients with restenosis, myocardial infarction, or any of the conventional risk factors for CAD as compared with corresponding subgroups. In summary, variants of the HUMPONA gene are involved in predisposition to coronary atherosclerosis.

Adult↗
PubMed2002

Noninvasive evaluation of women with coronary artery disease.

Coronary artery disease (CAD) is the leading cause of death in women. More women than men die of CAD each year, and unlike men, the death rate has not declined for women but has remained stable over the last 20 years. Despite these statistics, much less is known about the prevention, diagnosis, or treatment of CAD in women. The noninvasive diagnosis of CAD in women is difficult secondary to differences in physiology, etiology, presenting symptoms, risk factor prevalence, comorbid conditions, hormonal status, and body habitus between women and men. Echocardiography and Tc-99m sestamibi single photon emission computed tomography imaging are two noninvasive imaging techniques commonly combined with exercise or pharmacologic agents (dobutamine, adenosine, dipyridamole) that have recently evolved to address these differences. These evolutions and the role of both techniques in the diagnosis and prognosis of women with CAD will be reviewed in this article.

Coronary Disease↗
PubMed1997

Setting the agenda for research and education on coronary heart disease.

Coronary heart disease (CHD) disproportionately affects the African American population with death and disability. The disparity in mortality continues to exist between the general population and African Americans despite decreases in death rates in both groups since the 1970s. The National Heart, Lung, and Blood Institute (NHLBI) is committed to developing and supporting research and activities that improve the health of African Americans through community partnership initiative. One such initiative is the CHD in Blacks Project, developed to increase awareness of the adverse effects of CHD, encourage healthy lifestyle behaviors, and, among health professionals, ensure that the latest treatment guidelines from the NHLBI in high blood pressure, high blood cholesterol, and obesity are used. The NHLBI has also established a network of health professionals from across the country to assist in developing medical education programs and community education outreach activities in conjunction with the National Medical Association, the Association of Black Cardiologists, and the National Black Nurses Association.

Black or African American↗
PubMed2006

Alcohol intake and incidence of coronary disease in Australian aborigines.

AIMS: To examine risk for coronary heart disease (CHD) and cardiovascular disease (CVD) in relation to alcohol in a cohort of Australian Aborigines. METHODS: In 1988-1989, alcohol intake, drinking pattern, and beverage preference were elicited by interviewer-administered questionnaire in Western Australian Aborigines (258 men and 256 women) and cardiovascular outcomes ascertained through linkage to mortality and hospital admission records to 2002. RESULTS: In proportional hazards models, risk for CHD, relative to lifetime abstainers, was significantly increased in ex-drinkers [Hazard ratio (HR), 2.29; 95% confidence intervals (CI), 1.23-4.27], those drinking 41-60 g/day in men or 21-40 g/day in women (HR 2.80; 95% CI, 1.04-7.53) and those drinking >150 g/day for men or >100 g/day for women (HR, 2.25; 95% CI, 1.03-4.90) with a J-shaped relationship. Low-to-moderate drinkers had lower waist girth, exercised more and had a lower prevalence of overweight and smoking than at-risk drinkers. A preference for wine was associated with lower HR (0.28; 95% CI, 0.10-0.95). With CVD, only ex-drinkers showed significantly increased risk (HR, 1.87; 95% CI, 1.20-2.91). CONCLUSIONS: More favourable health-related behaviours in low-to-moderate drinkers suggest that lower risk could be mediated by lifestyle, as proposed in other populations.

Adolescent↗
PubMed2006

Alcohol intake and incidence of coronary disease in Australian aborigines.

AIMS: To examine risk for coronary heart disease (CHD) and cardiovascular disease (CVD) in relation to alcohol in a cohort of Australian Aborigines. METHODS: In 1988-1989, alcohol intake, drinking pattern, and beverage preference were elicited by interviewer-administered questionnaire in Western Australian Aborigines (258 men, 256 women) and cardiovascular outcomes ascertained through linkage to mortality and hospital admission records to 2002. RESULTS: In proportional hazards models, risk for CHD, relative to lifetime abstainers, was significantly increased in ex-drinkers [Hazard ratio (HR) 2.29, 95% CL 1.23, 4.27], those drinking 41-60 g/day in men or 21-40 g/day in women (HR 2.80, 95% CL 1.04, 7.53), and those drinking >150 g/day for men or >100 g/day for women (HR 2.25, 95% CL 1.03, 4.90) with a J-shaped relationship. Low-to-moderate drinkers had lower waist girth, exercised more, and had a lower prevalence of overweight and smoking than at-risk drinkers. A preference for wine was associated with lower HR (0.28, 95% CL 0.10, 0.95). With CVD, only ex-drinkers showed significantly increased risk (HR 1.87, 95% CL 1.20, 2.91). CONCLUSIONS: More favourable health-related behaviours in low-to-moderate drinkers suggest that lower risk could be mediated by lifestyle, as proposed in other populations.

Adolescent↗
PubMed1994

Genetic markers in coronary heart disease.

Coronary heart disease (CHD) was found to aggregate in families. So the present study aimed at studying certain genetic markers (lipoproteins, ABO blood groups and dermatoglyphics), in a group of 60 patients with CHD and a control group to detect any significant association between such genetics markers in this disorder. This can throw light on its genetics. The study revealed significant and marked association of CHD with low alpha-lipoprotein, high pre-beta and beta-lipoproteins. No significant association wa detected with ABO phenotypes. Definite significant association was also detected between CHD and certain dermatoglyphics phenotypes including FTP, T-D count and palm patterns. These significant associations of CHD and these genetic markers "which are genetically determined" denoted strongly genetic etiology or at least genetic predisposition of CHD. Detection of such genetic markers may help in determination of risky individuals in population and families of CHD patients. This can help in prevention by proper genetic counseling.

Adult↗
PubMed2001

With increasing ageing in Western populations, what are the prospects for lowering the incidence of coronary heart disease?

Coronary heart disease (CHD), rare in the early 1900s, in the 1970s was responsible for almost a third of deaths in Western populations. Although its mortality rate has fallen in the last 20 years, considerably in certain populations, it remains the leading cause of death, and there is little evidence of any fall in its incidence rate. The primary risk factors, which include pattern of diet, smoking practice, and level of physical activity, are well known, but explain only approximately 50% of variation in its occurrence. Despite the numerous health improvement recommendations made, alterations in diet have been relatively slight. Although smoking practice has halved in some populations, its prevalence is now rising in the young. The extent of physical activity is low, compared with that in the past, and may even be decreasing in the young. With the general ageing of populations, the near absence of strong encouragement from the state, and individuals' general failure to reduce risk factors significantly, the chances of decreases in the incidence of CHD appear remote.

Coronary Disease↗