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PubMed2000

Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group.

INTRODUCTION: As part of the baseline examination in the Cardiovascular Health Study, sleep disturbance symptoms including snoring and daytime sleepiness, were assessed as potential risk factors or precipitants of cardiovascular disease (CVD). Because of the association of sleep disturbance with poorer health and the possible associations of sleep apnea with CVD, we hypothesized that those with poorer sleep or daytime sleepiness may be at increased risk of mortality or incident CVD. SETTING: Participants (n = 5888) were recruited in 1989, with an additional minority cohort recruited in 1993, in four US communities for a cohort study designed to evaluate risk factors for cardiovascular disease. METHODS: An interview-administered questionnaire regarding health and sleep habits with ongoing ascertainment of total mortality and cardiovascular disease morbidity and mortality, including total CVD morbidity and mortality, incident myocardial infarction, and congestive heart failure. RESULTS: Daytime sleepiness was the only sleep symptom that was significantly associated with mortality in both men and women. The unadjusted hazard ratio was 2.12 (1.66, 2.72) in women and 1.40 (1.12, 1.73) in men. Men who reported difficulty falling asleep also had an increased mortality rate (HR = 1.43 (1.14, 1.80)) which was not seen in women. The risks were attenuated with adjustment for age but remained significant for daytime sleepiness in women (HR = 1.82 (1.42, 2.34)) and for difficulty falling asleep in men. (HR = 1.29 (1.03, 1.63)). Frequent awakenings, early morning awakening, and snoring were not associated with a significantly increased risk of mortality in these older men and women. Crude event rates were evaluated for total incident cardiovascular morbidity and mortality, incident myocardial infarction, and incident congestive heart failure (CHF). Incident CVD rates were higher in both men and women with daytime sleepiness. The aged adjusted HR was 1.35 (95% CI = 1.03, 1.76) in men and was 1.66 (95% CI = 1.28, 2.16) in women. Incident CVD was not higher in those with any other sleep disturbance including snoring. The risk of CVD events associated with daytime sleepiness was attenuated but remained significant in women after adjustment for age. Incident myocardial infarction (MI) rates were also higher in women with daytime sleepiness but were not significantly higher in men. Incident CHF rates were increased in both men and women with daytime sleepiness. In men, the age adjusted HR was 1.49 (95% CI, 1.12- 1.98) and in women, was 2.21 (95% CI, 1.64-2.98). Women reporting both daytime sleepiness and frequent awakening had a hazard ratio of 2.34 (95% CI, 1.66-3.29) for incident CHF compared with those with daytime sleepiness but without frequent awakening. This interaction was not found in men. CONCLUSIONS: In this study, daytime sleepiness was the only sleep disturbance symptom that was associated with mortality, incident CVD morbidity and mortality, MI, and CHF. These findings were stronger in women than men, i.e., the associations persisted for mortality, CVD, and CHF in women after adjustment for age and other factors. Thus, a report of daytime sleepiness identifies older adults at increased risk for total and cardiovascular mortality, and is an independent risk factor in women.

Age Factors↗
PubMed2005

Circulating inflammatory markers and risks of cardiovascular and non-cardiovascular disease.

There is current interest in the associations of circulating inflammatory markers (C-reactive protein, fibrinogen, white cell count, albumin, erythrocyte sedimentation rate, the factor VIII:von Willebrand factor complex, the tissue plasminogen activator:plasminogen activator inhibitor type 1 complex, fibrin D-dimer) not only with prognosis in acute coronary syndromes and acute stroke, but also in prediction of cardiovascular events in the general population. Recent meta-analyses of long-term prospective studies have established their associations with coronary heart disease (CHD) events, which may be cause, consequence or coincidence. These markers are also associated in epidemiologic studies of general populations with many cardiovascular risk factors (which may confound their associations with CHD risk), and also with asymptomatic arterial disease (of which they be consequences: 'reverse causality'). The causality of their associations with cardiovascular events is questioned by their lack of specificity for risk of cardiovascular events; and by the lack of association of their functional genotypes with CHD in 'Mendelian randomized trials'. Hence, proof of causality awaits testing in randomized-controlled trials of long-term selective reduction by future agents. Markers are of little additional predictive value to current cardiovascular risk scores, and it is premature to advocate their use in screening for cardiovascular risk prior to careful evaluation of costs, risks, and benefits.

Biomarkers↗
PubMed1996

Cardiovascular risk factors in British children from towns with widely differing adult cardiovascular mortality.

OBJECTIVE: To examine whether cardiovascular risk factors differ in children from towns in England and Wales with widely differing adult cardiovascular death rates. DESIGN: School based survey conducted during 1994 in 10 towns, five with exceptionally high adult cardiovascular mortality (standardised mortality ratio 131-143) and five with exceptionally low adult cardiovascular mortality (64-75). Towns were surveyed in high-low pairs. SUBJECTS: 3415 white children aged 8-11 years with physical measurements (response rate 75%), including 1287 with blood samples (response rate 64%), of whom 515 had blood samples taken 30 minutes after a glucose load. RESULTS: Children in towns with high cardiovascular mortality were on average shorter than those in towns with low mortality (mean difference 1.2 cm; 95% confidence interval 0.3 to 2.1 cm; P = 0.02) and had a higher ponderal index (0.34 kg/m3; 0.16 to 0.52 kg/m3; P = 0.006). Mean systolic pressure was higher in high mortality towns, particularly after adjustment for height (2.0 mm Hg; 0.8 to 3.2 mm Hg; P = 0.009). Mean waist:hip ratio, total cholesterol concentration, and 30 minute post-load glucose measurements were similar in high and low mortality towns. The differences in height and blood pressure between high and low mortality towns were unaffected by standardisation for birth weight. CONCLUSIONS: The differences in height, ponderal index, and blood pressure between towns with high and low cardiovascular mortality, if persistent, may have important future public health implications. Their independence of birth weight suggests that the childhood environment rather than the intrauterine environment is involved in their development.

Adult↗
PubMed2006

Effect of age on the relationship of occupational social class with prevalence of modifiable cardiovascular risk factors and cardiovascular diseases. A population-based cross-sectional study from European Prospective Investigation into Cancer - Norfolk (EPIC-Norfolk).

BACKGROUND: Previous studies on cardiovascular risk profile in different socioeconomic status were focused on younger populations and many of them have not been able to take into account age and sex differences. OBJECTIVES: To investigate the relationship of occupational social class with the prevalence of cardiovascular disease risk factors and cardiovascular diseases in younger (<65 years) and older (>or=65 years) men and women. METHODS: A population-based-cross sectional study was conducted in a general community in Norfolk, United Kingdom. Participants were 23,085 men and women aged 40-79 years, recruited from general practice age-sex registers as part of European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk). The prevalence of cardiovascular risk factors and cardiovascular diseases were examined. RESULTS: The prevalence of smoking was significantly higher in those in manual social classes particularly in the younger (<65) age group. Younger women in manual social classes were more likely to be smokers compared to older women in the same social class. Being in manual social classes was associated with higher cholesterol levels in women but lower cholesterol levels in men. Manual social class was associated with higher physical activity in those younger than 65 years but this association was reversed in those 65 years or older. CONCLUSION: Occupational social class is differently related to cardiovascular risk factors in individuals depending on their age and sex. This may reflect differences in behavior at work and leisure, which vary by sex and pre- and postretirement. Interventions to promote health and reduce social inequalities need to take age and gender into account.

Age Factors↗
PubMed2006

Asymmetrical dimethylarginine independently predicts total and cardiovascular mortality in individuals with angiographic coronary artery disease (the Ludwigshafen Risk and Cardiovascular Health study).

BACKGROUND: Asymmetrical dimethylarginine (ADMA) is increased in conditions associated with increased risk of atherosclerosis. We investigated the use of ADMA to predict total and cardiovascular mortality in patients scheduled for coronary angiography. METHODS: In 2543 persons with and 695 without coronary artery disease (CAD) identified by angiography we measured ADMA and recorded total and cardiovascular mortality during a median follow-up of 5.45 years. RESULTS: ADMA was correlated positively to age, female sex, diabetes mellitus, former and current smoking, and C-reactive protein and inversely to HDL cholesterol and triglycerides. ADMA was not associated with body mass index, hypertension, LDL cholesterol, or the presence or absence of angiographic CAD. Glomerular filtration rate and homocysteine were the strongest predictors of ADMA. At the 2nd, 3rd and 4th quartile of ADMA, hazard ratios for all-cause mortality adjusted for age, sex, and cardiovascular risk factors were 1.12 [95% confidence interval (CI) 0.83-1.52], 1.35 (95% CI 1.01-1.81), and 1.87 (95% CI 1.43-2.44), respectively, compared with the 1st quartile. Hazard ratios for cardiovascular death were 1.13 (95% CI 0.78-1.63), 1.42 (95% CI 1.00-2.02), and 1.81 (95% CI 1.31-2.51). ADMA in the highest quartile remained predictive of mortality after accounting for medication at baseline. The predictive value of ADMA was similar to that in the entire cohort in persons with CAD, stable or unstable, but was not statistically significant in persons without angiographic CAD. CONCLUSIONS: ADMA concentration predicts all-cause and cardiovascular mortality in individuals with CAD independently of established and emerging cardiovascular risk factors.

Analysis of Variance↗
PubMed2005

Raloxifene and cardiovascular health: its relationship to lipid and glucose metabolism, hemostatic and inflammation factors and cardiovascular function in postmenopausal women.

CHD is one of the most common serious chronic conditions in postmenopausal women and leads to extremely high risk for recurrent myocardial infarction and death. On the basis of the currently available randomized clinical-trial results the role of conventional HRT for treatment and prevention of CHD is rapidly evolving from presumed benefit to proven harm, at least in some categories of women yet to define. For this reason there has been a particular interest in potential clinical uses of selective estrogen receptor modulators (SERMs). SERMs are a class of compounds that can act as estrogen receptor (ER) agonists in some domains (bone and lipids) and acting as ER antagonists in others (breast and uterus). Raloxifene hydrochloride is an antiestrogen that is currently approved only to treat osteoporosis in postmenopausal women. Because of its effects on lipids and other biomarkers of cardiovascular risk, there is great interest in determining whether it may benefit the cardiovascular system. The great majority of data on cardiovascular effects of raloxifene concern effects on lipids and markers of thrombosis and inflammation. The purpose of this review is to summarize the best available evidence concerning raloxifene and cardiovascular disease focusing some areas known to be important risk factors for cardiovascular diseases: lipids and lipoproteins, glucose metabolism, hemostatic factors, markers of inflammation and cardiovascular function.

Aged↗
PubMed2006

Peripheral arterial disease and cardiovascular risk in Italy. Results of the Peripheral Arteriopathy and Cardiovascular Events (PACE) study.

OBJECTIVE: Our knowledge about the natural history of peripheral arterial disease (PAD) is derived from studies carried out almost exclusively in northern European and northern American populations. This study was aimed at defining mortality and cardiovascular morbidity of PAD patients in Italy. METHODS: From the lists of seven general practitioners, we identified all subjects aged 40-80 years (n = 4352). Of those reporting leg symptoms while walking at the Rose Questionnaire (n = 760), 60 (1.6% of the general population) had PAD, as evidenced by an ankle-brachial index of < 0.90 or reduced Doppler flow velocity. For each PAD patient, three sex and age-matched controls negative to the Rose Questionnaire were randomly selected from the general practice lists. RESULTS: After 24 months of follow-up, 15% of PAD patients died, 8% from cardiovascular disease, and 25% developed a non-fatal cardiovascular event. At Cox analysis, the presence of PAD was associated with an increased risk of all-cause mortality (relative risk 4.03; 95% confidence interval 1.50-10.84; P = 0.006), cardiovascular mortality (relative risk 7.77; 95% confidence interval 1.51-40.16; P = 0.014), and non-fatal cardiovascular events (relative risk 3.11; 95% confidence interval 1.41-6.80; P = 0.005). CONCLUSIONS: This Italian study shows that, in general practice, symptomatic PAD is associated with a four-fold increased risk of mortality and a nearly eight-fold increased risk of cardiovascular mortality. These figures are quite similar to those reported in northern European and northern American populations. General practitioners, who are the clinicians primarily and largely responsible for the care of these patients, should be alerted to the consequences of PAD.

Adult↗
PubMed2002

European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.5.1. Cardiovascular risks. Cardiovascular disease after renal transplantation.

GUIDELINES: A. Post-transplant cardiovascular disease is very common, an important cause of morbidity and the first cause of mortality in renal transplant recipients. Therefore, detection and early treatment of post-transplant cardiovascular disease are mandatory. B. Specific risk factors for developing post-transplant cardiovascular disease include pre-transplant cardiovascular disease, arterial hypertension, uraemia (graft dysfunction), hyperlipidaemia, diabetes mellitus, smoking and immunosuppressive treatment. These factors should be targeted for intervention. C. Pre-transplant cardiovascular disease is a major risk factor for post-transplant cardiovascular disease. Therefore, prior to transplantation, it is mandatory to detect and treat symptomatic coronary artery disease, heart failure due to valvular failure or cardiomyopathy, and pericardial constriction. This policy should also be followed in asymptomatic diabetic patients.

Cardiovascular Diseases↗
PubMed2003

Is the decrease of cardiovascular mortality in Poland associated with the reduction of global cardiovascular risk related to changes in life style?

BACKGROUND: After an ascending trend of cardiovascular mortality, which was observed up to the sixties, there was a declining tendency in western countries thereafter. The decrease in mortality rates in Poland has been noticed since 1991. There is an uncertainty whether this improvement in prognosis was only due to the improvement in health care level or was accomplished, to some extent, by population life style changes. AIM: To assess whether the decrease in cardiovascular mortality in Poland was accompanied by a simultaneous reduction in global cardiovascular risk profile. METHODS: The study was based on screened random samples from the Warsaw population aged 35-64 years, who were examined in the years 1984 (2646 subjects), 1988 (1433 subjects), 1993 (1539 subjects) and 2001 (853 subjects). The group evaluated in 1984 was followed up for 10 years with all fatal events recorded (364 deaths were registered including 166 cardiovascular deaths). The model of 10 years probability of total and cardiovascular death was developed, which was based on 11 risk factors (age, smoking cigarettes, systolic blood pressure, pulse pressure, ratio of total cholesterol/HDL-cholesterol, triglyceride, symptoms of coronary heart disease or heart failure, death of mother before 65 or death of father before 55 years due to myocardial infarction or stroke, energy in daily food intake and percentage of energy derived from saturated fatty acids). This model was applied to assess the probability of deaths between years 1984 and 2001, utilising data from screenings. RESULTS: The probability of death (in %) decreased from 1984 to 2001 by 11% in men. However, it remained stable for women. On the other hand the probability of cardiovascular death decreased by 25% and 33%, respectively. The main role in global risk decrease was played by beneficial trends in mean systolic blood pressure (in both genders) and percentage of smokers in men. CONCLUSIONS: Modification of life style influencing risk factors profile decreased the probability of death in the Warsaw population, correlating with changes in mortality rates.

Adult↗
PubMedDate not supplied

Familial occurrence in cardiovascular diseases. Cardiovascular involvement in genetic disorders (2).

Current knowledge and assumptions about inheritance of cardiovascular diseases are reported in this review. They are examined from two different points of view. In the first section (familial cardiovascular diseases) discussion centered on main cardiovascular diseases with a definite clinical and pathophysiological feature in which familial occurrence has been extensively demonstrated. The genetic aspects of the primary cardiomyopathies, mitral valve prolapse, arrhythmias and conduction disturbances, long QT syndromes and abnormalities of ventricular repolarization, cardiovascular malformations, coronary artery disease, essential hypertension and rheumatic fever were examined. In this section discussion will be confined to the inherited multisystem disorders involving the cardiovascular system that most frequently occur in clinical practice. Currently known cardiovascular findings in relationship to chromosomal aberrations, connective tissue disorders, metabolic and enzymatic disorders, neuromuscular disorders and other rarer syndromes will be reported.

Cardiovascular Diseases↗
PubMed2006

Cardiovascular endothelins: essential regulators of cardiovascular homeostasis.

The endothelin (ET) system consists of 3 ET isopeptides, several isoforms of activating peptidases, and 2 G-protein-coupled receptors, ETA and ETB, that are linked to multiple signaling pathways. In the cardiovascular system, the components of the ET family are expressed in several tissues, notably the vascular endothelium, smooth muscle cells, and cardiomyocytes. There is general agreement that ETs play important physiological roles in the regulation of normal cardiovascular function, and excessive generation of ET isopeptides has been linked to major cardiovascular pathologies, including hypertension and heart failure. However, several recent clinical trials with ET receptor antagonists were disappointing. In the present review, the authors take the stance that ETs are mainly and foremost essential regulators of cardiovascular function, hence that antagonizing normal ET actions, even in patients, will potentially do more harm than good. To support this notion, we describe the predominant roles of ETs in blood vessels, which are (indirect) vasodilatation and ET clearance from plasma and interstitial spaces, against the background of the subcellular mechanisms mediating these effects. Furthermore, important roles of ETs in regulating and adapting heart functions to different needs are addressed, including recent progress in understanding the effects of ETs on diastolic function, adaptations to changes in preload, and the interactions between endocardial-derived ET-1 and myocardial pump function. Finally, the potential dangers (and gains) resulting from the suppression of excessive generation or activity of ETs occurring in some cardiovascular pathological states, such as hypertension, myocardial ischemia, and heart failure, are discussed.

Animals↗
PubMed2002

Therapy with hydroxymethylglutaryl coenzyme a reductase inhibitors (statins) and associated risk of incident cardiovascular events in older adults: evidence from the Cardiovascular Health Study.

BACKGROUND: Recommendations to treat older adults with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) for the primary prevention of coronary heart disease events are supported by a single clinical trial restricted to adults 73 years or younger with low levels of high-density lipoprotein cholesterol. METHODS: We investigated the association of statin use with incident cardiovascular disease and all-cause mortality during up to 7.3 years' follow-up of 1250 women and 664 men from the Cardiovascular Health Study. Study participants were 65 years and older and free of cardiovascular disease at baseline. They received drug therapy to lower cholesterol levels at baseline or no treatment with a recommendation for therapy according to the National Cholesterol Education Program guidelines. Use of these drugs was assessed annually. We used proportional-hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for confounding variables. RESULTS: We found 382 incident cardiovascular events (159 myocardial infarctions, 159 strokes, and 64 deaths due to coronary heart disease) and 362 total deaths from June 1, 1989, to May 31, 1997. Compared with no use of drugs to lower cholesterol levels, statin use was associated with decreased risk of cardiovascular events (multivariate HR, 0.44; 95% CI, 0.27-0.71) and all-cause mortality (HR, 0.56; 95% CI, 0.36-0.88). Similar associations were observed among participants 74 years or older at baseline. CONCLUSIONS: Use of statins was associated with decreased risk of incident cardiovascular events among elderly adults. These findings lend support to the National Cholesterol Education Program guidelines, which recommend therapy for the lowering of cholesterol levels for older adults with hypercholesterolemia.

Aged↗
PubMed2003

Microalbuminuria and cardiovascular events in elderly hypertensive patients without previous cardiovascular complications.

To assist in the development of better treatments for elderly hypertensive patients, we studied the degree to which the baseline values of urinary albumin excretion (UAE) and other cardiovascular risk factors were predictive of cardiovascular complications in a cohort of elderly hypertensive patients. In 1994, we adopted 144 elderly hypertensive patients, who had been treated for more than 6 years at various clinics and more than 1 year at the National Cardiovascular Center, Osaka, Japan. They were divided into 2 groups: a NA group (n=111) with normoalbuminuria (UAE<30mg/day) and an MA group (n=33) with microalbuminuria (UAE 30-300 mg/day). At baseline, the two groups were similar with respect to systolic and diastolic blood pressure (SBP/DBP), pulse pressure (PP), age, ratio of males to females, serum creatinine, uric acid, total cholesterol, fasting plasma glucose (FPG), and creatinine clearance (CCr). PP was calculated as SBP minus DBP. The efficacy of blood pressure (BP) control was similar in both groups during the 8-year follow up period; however, a total of 14 cardiovascular events occurred in the MA (6/33) and NA (8/111) groups, with the MA group showing the higher incidence rate by multiple logistic regression analysis (p<0.05). At 8 years of follow-up, PP and age were correlated with UAE (p<0.05, p<0.001). At the same time point, CCr was correlated with UAE at baseline (p<0.05). The results indicated that, in elderly hypertensive patients without previous cardiovascular complications, microalbuminuria can be a predictor of cardiovascular events irrespective of conventional BP control.

Aged↗
PubMed1991

[Cardiovascular surgery in Spain in 1989. The Registry of Operations of the Spanish Society of Cardiovascular Surgery].

The Spanish Society of Cardiovascular Surgery has sent a questionnaire to all 36 cardiovascular surgical groups to know the number and type of cardiovascular operations carried out in our country during 1989. The questionnaire was answered by 36 out of 36. In the year 1989, 20,912 cardiovascular patients have been operated upon and 9,582 interventions with extracorporeal circulation have been carried out: 45% in valvular disease, 34% in coronary and 13% in congenital. The number of operations was 5,771 for vascular disease, 4,272 for valvular, 3,296 for coronary, 1,973 for congenital and 3,031 for pacemaker implantation. Comparing with other countries, and specially with the Federal Republic of Germany, few points in our country deserve a remarkable mention: 1) Valvular pathology causes more operations than coronary one; 2) There is a low number of cardiovascular operations per million of inhabitants; 3) The cardiovascular surgical groups have a low yield.

Cardiac Surgical Procedures↗
PubMed1996

Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction?

Much remains to be understood about how low socioeconomic status (SES) increases cardiovascular disease and mortality risk. Data from the Kuopio Ischemic Heart Disease Risk Factor Study (1984-1993) were used to estimate the associations between acute myocardial infarction and income, all-cause mortality, and cardiovascular mortality in a population-based sample of 2,272 Finnish men, with adjustment for 23 biologic, behavioral, psychologic, and social risk factors. Compared with the highest income quintile, those in the bottom quintile had age-adjusted relative hazards of 3.14 (95% confidence interval (CI) 1.77-5.56), 2.66 (95% CI 1.25-5.66), and 4.34 (95% CI 1.95-9.66) for all-cause mortality, cardiovascular mortality, and AMI, respectively. After adjustment for risk factors, the relative hazards for the same comparisons were 1.32 (95% CI 0.70-2.49), 0.70 (95% CI 0.29-1.69), and 2.83 (95% CI 1.14-7.00). In the lowest income quintile, adjustment for risk factors reduced the excess relative risk of all-cause mortality by 85%, that of cardiovascular mortality by 118%, and that of acute myocardial infarction by 45%. These data show how the association between SES and cardiovascular mortality and all-cause mortality is mediated by known risk factor pathways, but full "explanations" for these associations will need to encompass why these biologic, behavioral, psychologic, and social risk factors are differentially distributed by SES.

Adult↗
PubMed2006

Achieving quality in cardiovascular imaging: proceedings from the American College of Cardiology-Duke University Medical Center Think Tank on Quality in Cardiovascular Imaging.

Cardiovascular imaging has enjoyed both rapid technological advances and sustained growth, yet less attention has been focused on quality than in other areas of cardiovascular medicine. To address this deficit, representatives from cardiovascular imaging societies, private payers, government agencies, the medical imaging industry, and experts in quality measurement met, and this report provides an overview of the discussions. A consensus definition of quality in imaging and a convergence of opinion on quality measures across imaging modalities was achieved and are intended to be the start of a process culminating in the development, dissemination, and adoption of quality measures for all cardiovascular imaging modalities.

Academic Medical Centers↗