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PubMed1983

Symptom distress, current concerns and mood disturbance after diagnosis of life-threatening disease.

This study describes the level of symptom distress, current concerns and mood disturbance in persons with a diagnosis of one of two life-threatening diseases at two occasions. The sample included 56 lung cancer patients and 65 heart attack patients who completed interviews at 1 and 2 months post diagnosis. Data were obtained using a modified version of the McCorkle and Young Symptom Distress Scale, the Weisman and Worden Inventory of Current Concerns and the Profile of Mood States. One conclusion that can be drawn from the study is that the plight of newly diagnosed lung cancer patients appears to be bleaker than that of heart attack patients. Cancer patients experienced more symptom distress of all kinds than heart attack patients. They also reported more health and existential concerns and they suffered more mood disturbances, on the average, than heart attack patients did. The most striking finding of the mean differences analysis was that, although symptom distress remained the same between occasions for both groups, both kinds of patients reported fewer concerns and better mood at the second interview. Although the plight of neither type of patient improved, patients reported being in better spirits and less worried at the second measurement occasion. This reduction in concerns and mood disturbance between interviews suggests that patients assimilate that their situation is not as immediately life-threatening as they had feared.

Adult↗
PubMed1985

The relationship between parental history of vascular disease and cardiovascular disease risk factors in children: the Bogalusa Heart Study.

The relationship between parental history of vascular disease (heart attack, stroke, diabetes mellitus, and hypertension) and risk factor variables for cardiovascular disease was assessed in 3,312 offspring aged 5-17 years during the 1981-1982 school year in the biracial community of Bogalusa, Louisiana. Risk factors studied included systolic blood pressure, diastolic blood pressure, serum total cholesterol, triglycerides, and individual lipoprotein cholesterol (beta-, low density lipoprotein (LDL) cholesterol; pre-beta, very low density lipoprotein (VLDL) cholesterol; and alpha-, high density lipoprotein (HDL) cholesterol). Risk factors were adjusted for age, race, sex, and height (blood pressure only) prior to testing parental history effects. Univariate comparisons between risk factors in children and vascular disease in parents resulted in statistically significant increases in systolic and diastolic pressures associated with the presence of maternal or paternal hypertension (p less than 0.001). Paternal heart attack was also associated with elevations in diastolic pressure (p less than 0.01) of children. Maternal diabetes mellitus was associated with an increase in serum total cholesterol (p less than 0.05). Paternal diabetes mellitus and maternal heart attack (for female progeny only) were associated with increases in mean triglyceride levels of children. VLDL cholesterol results were similar to those for triglycerides. For HDL cholesterol, paternal diabetes mellitus was associated with a small decrease in mean levels (p less than 0.05). Dramatic increases to the highest decile of risk were found in association with the following parental disease combinations: paternal heart attack-paternal diabetes for serum total cholesterol (p less than 0.0001), maternal heart attack-paternal diabetes (p less than 0.001) and paternal stroke-maternal diabetes (p less than 0.0001) for LDL cholesterol. Multivariate analysis detected no significant effects of single parental vascular disease. However, paternal heart attack in combination with either diabetes mellitus or hypertension was statistically significant in their relationship to the risk factors overall.

Adolescent↗
PubMed1992

Is a parental history of coronary arterial disease in children as discriminating as their lipoprotein profile? Niño Jesus Group.

The relationship between hyperlipidemia and a parental history of heart attack and other related disorders was studied in 2224 two- to 18-yr-old children in Madrid (Spain). Children were divided into three groups: those with a parental history of heart attack (first group), a parental history of stroke, hypertension, diabetes mellitus or hypercholesterolemia (second group), and no parental history of disease (third group). The number of children with higher than normal levels of total cholesterol (greater than 200 mg/dl), LDL-cholesterol (greater than 135 mg/dl) and/or apolipoprotein B100 (greater than 75 mg/dl) was significantly higher in the first and second group (positive parental history) than in the third (no parental history). Children and adolescents with a parental history of heart attack (first group) had significantly higher mean levels of total cholesterol and LDL-cholesterol; in the 2- to 13-yr age group a significantly higher level of apolipoprotein B was also found. Children and adolescents belonging to the second group had a significantly higher level of LDL-cholesterol, and a significantly higher level of apolipoprotein B was also found in the 2- to 13-yr age group. However, only 15% of children with hypercholesterolemia had a parental history of heart attack or other related disorders. This percentage was 41% when second-degree relatives were included in the family history. We conclude that a parental history is not enough to detect children with an abnormal lipid profile who might be at risk for early development of coronary arterial disease.

Adolescent↗
PubMed1982

Assessment of cardiac risk 10 days after uncomplicated myocardial infarction.

A total of 188 patients with uncomplicated acute myocardial infarction (long-term Norris prognostic index 3.2) were rapidly mobilised, underwent a symptom-limited exercise test around the day of discharge from hospital (day 10), and returned to work at a median of six weeks after the acute event. The incidence of cardiac death six months, one year, and three years after infarction was 2.7%, 4.5%, and 7.3% respectively, and the corresponding figures for recurrent heart attacks were 3.4%, 8.2%, and 18.5% respectively. The risk of recurrence of heart attack was predicted by three variables assessed at discharge--namely, a history of classical effort angina (p less than 0.01), radiological heart failure (p less than 0.05), and angina induced by the exercise test (p less than 0.05). The presence of any of these risk factors defined a group of patients with a sevenfold risk of recurrent heart attacks within six months of the initial acute infarct. It is concluded that these risk factors identify a group of patients with a high risk of recurrence early after infarction, in whom vigorous secondary prophylaxis is desirable.

Exercise Test↗
PubMed1983

Attack and case fatality rates for acute myocardial infarction in the Hunter Region of New South Wales, Australia, in 1979.

The Hunter Valley Heart Attack Study was conducted throughout 1979 to investigate all cases of suspected heart attack among permanent residents 20 to 69 years of age in a well-defined area in New South Wales, Australia. The study design followed that for the Myocardial Infarction Community Registers coordinated by the World Health Organization (WHO) in Europe and elsewhere around 1971. The attack rates obtained confirm that in Australia myocardial infarction incidence, like mortality, is high by international standards. Case fatality rates were somewhat lower than those reported elsewhere. To discover whether heart attack rates are changing with the decrease in heart disease mortality, it is proposed to carry out longitudinal surveillance in the study population. Experience with this baseline survey indicates that there may be difficulties in reliably interpreting the WHO diagnostic criteria and that changes in medical management of heart disease may affect the numbers of cases diagnosed. This highlights an epidemiologic need for clear definitions of myocardial infarction.

Adult↗
PubMed2002

The role of cigarette smoking in the association between periodontal disease and coronary heart disease.

BACKGROUND: Cigarette smoking is a significant risk factor for both coronary heart disease and periodontal disease. The goal of this study was to better understand the role of smoking in the relationship between periodontal disease and heart attack history. METHODS: The study population consisted of 5,285 participants in the Third National Health and Nutrition Examination Survey (NHANES) during 1988-1994 and who were age 40 years or older when examined. The data analysis employed logistic regression models and accounted for the complex sampling design used in NHANES. RESULTS: After adjustment for potential confounders, we only found significant associations between periodontal loss of attachment (LOA) and heart attack history for smokers, with odds ratios and 95% confidence interval (CI) of 2.64 (1.48 to 4.71), 3.84 (1.22 to 12.10) and 5.87 (1.91 to 18.00) for those with 2.0 to 2.99, 3.0 to 3.99, and 4 mm or more mean LOA, respectively. When the analysis was stratified by smoking status and tertile of age at heart attack, the statistically significant associations were limited to smokers who had a heart attack between the ages of 25 and 50 years, with odds ratios and 95% Cl associated with increasing mean LOA for this group of 3.29 (1.35 to 8.04), 7.32 (1.60 to 33.51), and 8.04 (1.91 to 18.00), respectively. CONCLUSIONS: These results suggest that cigarette smoking is a necessary cofactor in the relationship between periodontal disease and coronary heart disease, and the increase in risk appears to be age dependent. However, the key role played by smoking in the etiology of both periodontal and heart diseases makes it difficult to determine how much of the observed association resulted from periodontal disease.

Adult↗
PubMed2005

Social class and all-cause mortality in an urban population of North India.

BACKGROUND: There is a rapid emergence of cardiovascular disease in India with economic development, leading to an increase in mortality due to these diseases. The exact causes of death in India, however, are not known. SUBJECTS AND METHODS: We studied randomly selected death records from 2222 (1385 men and 837 women) victims, aged 25-64 years, out of 3034 death records during 1999-2001 at the Municipal Corporation, Moradabad. All the families of these victims could be contacted individually to find out the causes of death, by scientists/doctors-administered pre-tested verbal autopsy questionnaires, completed with the help of spouses and local treating doctors practising in the concerned lane. Social classes were assessed by a questionnaire based on attributes of per capita income, occupation, education, housing and ownership of consumer luxury items in the household. RESULTS: Causes of mortality included infectious diseases (41.1%, n = 915) such as tuberculosis, pneumonia, chronic obstructive pulmonary disease, diarrhea/dysentery, hepatitis B, and inflammatory brain infections as the commonest causes of death in the urban population of North India. The second most common causes of death were circulatory diseases (29.1%, n = 646), including heart attacks (10.0%), strokes (7.8%), valvular heart disease (7.2%, n = 160), sudden cardiac death, and inflammatory cardiac disease (each 2.0%, n = 44). Malignant neoplasm (5.8%, n = 131), injury (14.0%, n = 313), including accidents, fire and falls, and poisonings were also quite common causes of death. Miscellaneous causes of death were noted in 9.1% (n = 202) death records, including diabetes mellitus (2.2%, n = 49), suicides (1.8%, n = 41), congenital anomalies (1.0, n = 37), dental caries infections (1.9, n = 42), and burns (1.3%, n = 33). Pregnancy and perinatal causes (0.72%, n = 15) were not commonly recorded in our study. Circulatory diseases as the cause of mortality were statistically significantly more common among higher social classes (1-3) than in lower social classes (4 and 5) whose members died more often due to infections. Heart attacks, strokes, hypertension, diabetes and obesity were statistically significantly more common among higher social classes (1-3) as compared to classes 3 and 4, but tobacco intake showed only minor differences among various classes. CONCLUSIONS: This study indicates that circulatory diseases, injury and malignant diseases have become the major causes of death in India, after infections. Members of social classes 1-3 died more often due to circulatory diseases and members in lower social classes died more often due to infections. Urbanization with rapid changes in diet and lifestyle in various social classes, and possibly aging of the population seem to be responsible for the double burden of diseases, related to under- and over-nutrition, causing death in a developing economy. Monitoring of blood pressure and heart rate around the clock for 7 days, with data analysed chronobiologically can detect abnormal circadian patterns associated with a large increase in cardiovascular disease risk, greater than hypertension itself, allowing the institution of prophylactic treatment. Such prehabilitation may be particularly useful to curb the increasing burden of cardiovascular diseases in both developed and developing countries.

Adult↗
PubMed2002

Seniors' preferences for cancer screening and medication use based on absolute risk reduction.

BACKGROUND: This study was conducted to determine the influence of patient perceptions of absolute risk on choices for cancer screening and use of medications to prevent heart attack, stroke, and hip fracture. METHODS: At the end of routine office visits, we surveyed all eligible consecutive patients who visited four geriatricians in a Denver practice between November 8, 1993, and February 9, 1994. RESULTS: We saw a total of 675 outpatients during the study period and completed the interview with 409 patients (75% female, mean age 81, 78% Caucasian). We found a strong correlation between (i) increased probability of detecting cancer and greater preference for cancer screening tests (p <.001) and (ii) increased probability of preventing disease (heart attack, stroke, or hip fracture) and greater preference for preventive medication (p <.0001). There was notable variability in seniors' preferences for a given therapy at each absolute risk threshold. For example, 15% of seniors did not think that highly effective, inexpensive medications to prevent heart attacks were worthwhile for them. At the other end of the spectrum, 22% of seniors felt that low-yield, costly medications to prevent heart attacks were worthwhile. CONCLUSIONS: Seniors readily understand the probability of benefit expressed in terms of absolute risk reduction. Furthermore, probability of benefit strongly influences seniors' preferences for cancer screening and preventive medication use. Finally, there is variety in the thresholds of prevention at which individuals are willing to accept preventive treatment. The probability of benefit is an essential and useful element for seniors to make informed decisions about routine health services.

Age Factors↗
PubMed1975

Sudden death and sport.

Of 21 sudden deaths in sportsmen, 18 were thought to be caused by heart attacks either during or after sport. There was firm evidence of ischaemic heart-disease in 9, strongly suggestive evidence in 7, but in 2 there was only suggestive clinical evidence. As a group, these subjects were characterised by (1) a mean age above thirty (above twenty-five for rugby players); (2) a family history of early heart-attacks; and (3) antecedent symptoms of chest pain or pressure in 9, fatigue or blackout in 4, and minor complaints in 2. Most were known to their medical practitioners. Psychological factors were thought to be important in 8. Doctors, players and referees should be aware that severe sporting exertion as in rugby football involves a risk which for most players is relatively minor, but in the minority predisposed to heart-attacks by family history, smoking, or age (as in referees) the risk is more serious. To reduce hazard of sudden death in exercise, players and referees should be warned against smoking and informed of the serious implications of the development of chest pain, pressure, or undue tiredness before, during, or after sport.

Cholesterol↗
PubMed1978

Energy expenditure, cigarette smoking, and blood pressure level as related to death from specific diseases.

In a 22-year followup of 3686 San Francisco longshoremen, the roles of physical activity, cigarette smoking habit, and systolic blood pressure level were evaluated independently in relation to risk of death from a broad range of diseases. Smoking pattern and blood pressure status were established in 1951 and job activity was assessed annually during the followup period. Lower levels of energy expenditure predicted increased risk of fatal heart attack and perhaps of stroke. Heavy cigarette smoking predicted increased risk of death from heart attack, cancer, chronic obstructive respiratory disease, and pneumonia. Higher levels of systolic blood pressure were associated with death from all cardiovascular diseases, diabetes mellitus, and cirrhosis. Tacit to these findings: sedentary living takes its toll largely through heart disease and stroke; the toxicity of cigarette smoking is associated with a broader range of diseases, including heart attack, cancer, and respiratory disease; and higher level of blood pressure related to an even broader range of cardiovascular disease than either of the other characteristics studied.

Adult↗
PubMed1999

Risk factors for coronary heart disease in African American women.

There have been few studies of risk factors for coronary heart disease in African American women. The authors investigated factors associated with prevalent coronary heart disease in data provided by participants in the Black Women's Health Study. In 1995, 64,530 US Black women aged 21-69 years completed postal health questionnaires. The 352 women who reported having had a heart attack (cases) were frequency matched 5:1 on age with 1,760 women who had not (controls); medical record review for 35 cases indicated that two-thirds had had a heart attack and the remainder had other coronary heart disease. Odds ratios, obtained from multiple logistic regression analyses, were significantly elevated for cigarette smoking, drug-treated hypertension, drug-treated diabetes mellitus, elevated cholesterol level, and history of heart attack in a parent. High body mass index (kg/m2) was associated with coronary heart disease in the absence of control for hypertension, diabetes mellitus, and elevated cholesterol but not when they were controlled, suggesting that obesity may influence risk as a result of its effects on blood pressure, glucose tolerance, and cholesterol levels. Odds ratios increased with increasing parity and with decreasing age at first birth. These data suggest that important risk factors for coronary heart disease are similar in Black women and White women.

Adult↗
PubMed2006

Cardiovascular disease knowledge among culturally Deaf patients in Chicago.

BACKGROUND: Deaf persons experience communication barriers that may impact on their knowledge of cardiovascular disease (CVD); however, data measuring this deficit are limited. A comprehensive health survey of Deaf adults included questions on CVD knowledge. METHODS: Between November 2002 and March 2003, 203 Deaf adults participated in the survey, which was conducted via face-to-face interviews in American Sign Language. Questions assessed knowledge of heart attack and stroke symptoms, risk factors, and emergency response. RESULTS: Forty percent of respondents could not list any symptoms of a heart attack, while over 60% could not list any symptoms of a stroke. Less than half of respondents identified chest pain/pressure as a symptom of a heart attack. Only 61% reported that they would call 911 in response to cardiovascular disease symptoms. The median number of risk factors correctly identified by respondents was 3 of 6. CONCLUSIONS: Knowledge of cardiovascular disease among Deaf respondents is low, and considerably lower than that of the general hearing population. The need to develop health education materials and programs for Deaf individuals is evident. Health care providers should be educated on Deaf culture and barriers in communication. Finally, efforts need to be made to assure that 911 is deaf-accessible.

Adult↗
PubMedDate not supplied

Communicating the benefits of chronic preventive therapy: does the format of efficacy data determine patients' acceptance of treatment?

Patients' informed acceptance of chronic medical therapy hinges on communicating the potential benefits of drugs in quantitative terms. In a hypothetical scenario of treatment initiation, the authors assessed how three different formats of the same data affected the willingness of 100 outpatients to take what were implied to be three different lipid-lowering drugs. Side-effects were declared negligible and costs insured. Subjects make a "yes-no" decision about taking such a medication, and graded the decision on a certainty scale. Advised of a relative risk reduction--"34% reduction in heart attacks"--88% of the patients assented to therapy. All other formats elicited significantly more refusals (p < 0.0001): for absolute risk difference--"1.4% fewer patients had heart attacks"--42% assented; for inverted absolute risk--"treat 71 persons for 5 years to prevent one heart attack"--only 31% accepted treatment. When the data were extrapolated to disease-free survival--"average gain of 15 weeks"--40% consented. Similar responses were obtained for descriptions of an antihypertensive drug: 89% assented to therapy when given relative risk reduction but only 46% when given absolute risk reduction. The subjects were confident in both acceptance and refusal: 93% of the decisions were rated "somewhat certain" to "completely certain." The authors conclude that patients' views of medical therapy are shaped by the formats in which potential benefits are presented. Multiple complementary formats may be most appropriate. The results imply that many patients may decline treatment if briefed on the likelihood or extent of benefit.

Adult↗
PubMed1993

Blood pressure management: individualized treatment based on absolute risk and the potential for benefit.

Clinical practice often conflicts with epidemiologic evidence in the management of blood pressure. Antihypertensive therapy is generally prescribed if blood pressure exceeds some arbitrary level, thus committing many persons with minimal cardiovascular risk to long-term drug therapy. By contrast, below that level, regardless of cardiovascular risk, blood pressure reduction is rarely sought. Epidemiologic data, however, consistently show a continuous, positive, linear relationship of the height of both systolic and diastolic blood pressure with the incidence of stroke and heart attack. No threshold level distinguishes those who will have a cardiovascular event from those who will not. In fact, most heart attacks and many strokes occur among persons with "normal" blood pressures. Observational experience suggests that benefit could be obtained from universal blood pressure reduction of even a few millimeters of mercury. This public health strategy can be augmented by identifying those individuals, at every level of blood pressure, whose risk for cardiovascular disease justifies the cost of pharmacologic intervention. Antihypertensive drug therapy will be most efficient and effective if directed at those who, by virtue of their constellation of risk factors or evidence of preclinical vascular disease, are likely to have a heart attack or stroke. The resulting redirection of clinical resources will spare many hypertensive persons whose absolute risk for a cardiovascular event is small, from life-long treatment. At the same time, other persons, currently classified as normotensive, will become candidates for blood pressure reduction because their cardiovascular risk is high.

Antihypertensive Agents↗
PubMed2001

A group size effect on personal risk judgments: implications for unrealistic optimism.

In Experiments 1 and 2, college students (N = 32 and N = 18, respectively) read heart attack risk profiles (i.e., lists of risk factors) for each of several employees at a series of fictional companies and judged the heart attack risk of the typical employee at each company. In both experiments, subjects' risk judgments increased as a function of the number of employees at the companies. In Experiments 3A and 3B, college students (N = 56 and N = 33, respectively) judged the heart attack risk of the typical employee at a company and also judged the risk of each individual employee. In these experiments, the typical employee was generally judged to be at higher risk than the individual employees. This group size effect might help to explain unrealistic optimism--people's tendency to judge themselves to be at lower risk than their peers for negative life events. Furthermore, it can be modeled successfully within Fiedler's (1996) BIAS framework.

Adult↗
PubMed1993

[Myocardial infarct and cerebral vascular disorders associated with high temperature and carbon monoxide in a metropolitan area of southeastern Brazil].

Many studies have been published about the relationship between life style and genetic risk factors and stroke and heart attack, but there have been few about the relationship between atmospheric pollution, specifically with carbon monoxide, and temperature and stroke and heart attack. With a view to filling this gap the relationship between values of carbon monoxide concentration in the air, maximum and average by day, and maximum temperature by day and the number of new cases of CVA and IM admitted as emergencies at the biggest hospital complex of S. Paulo city was analysed. If was concluded, by the use of multivariable regression analysis, that 2.1% and 4.9% of heart attack admissions were due to carbon monoxide air pollution and high temperature, respectively. 2.8% of stroke admissions were due high temperature. Stroke and carbon monoxide were not associated in this population.

Brazil↗
PubMed2001

Lifestyle behaviors affect cardiovascular risk status in men 1 year after kidney transplantation.

Persons with end-stage renal disease have an accelerated risk for cardiovascular (CV) morbidity and mortality. Unfortunately, their accelerated CV risk persists even after kidney transplantation associated with pretransplant and post-transplant vascular disease. number of rejections treated with high-dose steroids, prolonged use of immunosuppressive therapy post-transplant, effects of comorbid chronic conditions and male gender. Unhealthy, modifiable lifestyle practices often augment their CV risk. The purpose of this study was to examine health-related lifestyle behaviors and estimate CV risks of men 1 year following kidney transplantation. Using the Healthier People Network Health Risk Appraisal (HPN-HRA), we examined CV risk characteristics of 34 men (M age=47.3 years) enrolled in an urban, mid-southern transplant center. Participants were assessed via self-administered paper-and-pencil questionnaires and medical record review provided biological data for analyses. HPN-HRA software was used to analyze biological and behavioral characteristics to compute CV risk estimates. Data were analyzed using descriptive, inferential and correlational analyses. The majority of participants reported smoke cessation (n= 19) or never having smoked (n = 8), and consumption of one or less alcoholic drinks per week (n=28). On the other hand, increased risk for heart attack and stroke were associated with advancing age (P<0.0001), white race (P<0.05) and higher systolic blood pressure (P<0.01). While risk for heart attack was associated with current cigarette smoking (P<0.01), risk for stroke was not. Conversely, risk for stroke was associated with higher BMI (P<0.05), risk for heart attack was not. Thus, the study provides evidence that male kidney transplant survivors exhibit a significant number of non-modifiable and modifiable characteristics that contribute to their posttransplant CV risk.

Cardiovascular Diseases↗
PubMed1996

[Incidence and course of acute coronary events in the population of Ghent from 1983 to 1990].

In the framework of the W.H.O.- MONICA project, a register for acute coronary events was established in the adult population aged 25-69 years of the city of Ghent. One of the objectives is to collect on an annual basis precise and valid information on the frequency of the disease. Fatal and non-fatal coronary events were monitored through the population-based register, using a standardized protocol and rigid diagnostic criteria. These criteria were evaluated by the research group on the basis of available information that was collected in collaboration with family doctors, hospital physicians, the city hall services and the district medical structure. Lethality was defined as deaths occurring within 28 days after initial symptoms. From 1993 to 1990, 2.626 events were registered. The age standardized annual event rates in men varied from 32.2 to 41.7/10.000; in women the corresponding values were 9.2 and 16.6/10.000. The attack rate declined over time at a rate of -13% over 5 years in men and -23% over 5 years in women. Attack rates of fatal coronary events declined even stronger. The incidence was calculated only in hospitalized cases in whom the antecedents of heart attacks were known in 93%. The age standardized annual incidence rates in hospitalized men varied from 15.5 to 22.4/10.000 and from 4.0 to 6.8/10.000 in hospitalized women. Over time no significant changes in incidence rates were observed. In both sexes there was a trend towards a decline in the incidence of fatal cases and towards an increase in the incidence of non-fatal cases. Lethality was dependent on age, sex and declined over time; the maximal case fatality rate was 57.9% and the minimal 42.3%. The lethality in hospitalized cases was 23.8% on average and declined significantly over time. In hospitalized cases with a first heart attack the lethality was 18.5%. All patients who entered the register from 1983 to 1985 for a non-fatal event (n = 465) were followed as to vital status until the end of 1991. The five years survival was 80.4 and 77.0% in respectively men and women. The long term prognosis was not different between sexes, strongly dependent on age and slightly different in the presence of antecedents of heart attacks. These results illustrate how precise and valid information on the frequency of acute coronary events can be collected through a population-based register. The results indicate high attack and incidence rates, a high case-fatality but favorable time trends from 1983 to 1990.

Acute Disease↗