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PubMed1978

The evening meal and atherosclerosis.

A trial by any means that can possibly prevent or retard the development of arteriosclerosis is to be recommended. Arteriosclerosis is the chief cause of strokes and heart attacks. The heavy evening meal now in vogue is characteristically rich in animal fats. Normal digestion is at its peak at about the seventh hour, usually during sleep, when the body economy is at its lowest ebb. A large amount of digested material with a high content of lipids is dumped into the slow-moving circulation. As this material, full of saturated fats, moves slowly through the arteries, the situation is ideal for clot formation, possibly resulting in a stroke, a heart attack, or sudden death. Such a catastrophe can occur in almost anyone, but is more apt to strike the high-powered executive or the apparently healthy man past 45 who has a voracious appetite. It seems logical to postulate that a light, rather than a heavy evening meal would result in less arteriosclerosis with complications such as heart attacks and strokes.

Arteriosclerosis↗
PubMed2000

Hospital mergers and acquisitions: does market consolidation harm patients?

Debate continues on whether consolidation in health care markets enhances efficiency or instead facilitates market power, possibly damaging quality. We compare the quality of hospital care before and after mergers and acquisitions in California between 1992 and 1995. We analyze inpatient mortality for heart attack and stroke patients, 90-day readmission for heart attack patients, and discharge within 48 h for normal newborn babies. Recent mergers and acquisitions have not had a measurable impact on inpatient mortality, although the associated standard errors are large. Readmission rates and early discharge increased in some cases. The adverse consequences of increased market power on the quality of care require further substantiation.

California↗
PubMed1989

Role of the general practitioner in managing patients with myocardial infarction: impact of thrombolytic treatment. Report of a British Heart Foundation Working Group.

Thrombolytic treatment, combined with aspirin, has been shown to reduce mortality by half in patients in hospital with suspected acute myocardial infarction if it is given early after the onset of symptoms. This fact adds to the importance of prompt and skillful intervention. At present in the United Kingdom the median time for receiving suitable management for this condition is about four to six hours. With better organisation this delay could, in most areas, be reduced to two or three hours. A major change in the care of patients with myocardial infarction is needed in which the general practitioner should have a crucial role. Health authorities, hospital physicians, general practitioners, and the ambulance services must coordinate their efforts if the potential reduction in mortality is to be realised. The district medical officer should consult colleagues and draw up guidelines for organising the care of patients who have had heart attacks. The management of patients who have had heart attacks in the community and in hospital should be continually audited. There are dangers inherent in the use of thrombolytic treatment, particularly when conditions other than myocardial infarction are treated in error. This treatment should be given only when the diagnosis is highly probable and when close observation of the patient can be ensured during the ensuing hours. Thrombolytic treatment should not, therefore, be given out of hospital except when trained, equipped personnel are in attendance. Treatment can be given in any hospital (including community hospitals) provided there are adequate diagnostic facilities and suitably experienced nursing staff.

Aspirin↗
PubMed1988

Cholesterol and lipids in the risk of coronary artery disease--the Framingham Heart Study.

The USA is about to launch a massive campaign to identify those members of the population at risk for coronary artery disease (CAD). A screening process based on the high blood pressure campaign started in the 1970s aims at identifying those people with elevated cholesterol so measures can be taken to prevent fatal or nonfatal heart attacks. Data from 35 years of the Framingham Heart Study have shown that factors other than total or low density lipoprotein (LDL) cholesterol must be considered when evaluating CAD risk. In fact low levels of high density lipoprotein (HDL) cholesterol are as much a risk factor for CAD as high LDL cholesterol. The best simple test for predicting CAD is the ratio of total:HDL cholesterol and using this criterion, approximately half the population of North America is at risk for heart attack. This highlights the necessity for a screening program of cholesterol levels, and as there are tests available which can measure cholesterol in under 10 mins, the time should soon be here that everyone knows their CAD risk.

Adult↗
PubMedDate not supplied

The effectiveness of cardiac rehabilitation.

Factors influential in the occurrence and timing of heart attacks are summarised. Patients' and partners' experiences of heart attack are reviewed. Evidence is presented for the efficacy and effectiveness of cardiac rehabilitation programmes. A three elemental model for cardiac rehabilitation is introduced. Key recommendations are made for hospitals running cardiac rehabilitation programmes. Directions for the future development of cardiac rehabilitation are suggested

Coronary Disease↗
PubMed1983

The beriberi analogy to myocardial infarction.

Two pandemics of heart attack deaths have plagued the world's population during the past 130 years. The first pandemic, induced by beriberi, was caused by the industrial revolution altering the nutritional composition of rice. By 1892 a simple working knowledge, then at hand, could have terminated the beriberi plague; however, orthodox medicine being then enchanted with the false concept that all disease was caused by germs, permitted millions of Asians to die needlessly of beriberi by refusing to tell them to eat rice bran or to drink rice bran tea. A second pandemic of heart attack deaths, called myocardial infarction (MI), struck the developed nations of the Western World in full force after 1930. As a hypothesis, it is suggested that this MI pandemic, still raging today, was caused by a change in food processing that occurred after 1920, when the new oil seed industry introduced into our food three greatly harmful lipid substances. The unnatural trans-trans isomer of linoleic acid, which had never been in human food prior to 1920 and which entered our food in margarines and refined oils, blocked the conversion of natural cis-cis linoleic acid to prostaglandin E1, which tends to prevent MI, both by acting as a vasodilator and by minimizing platelet aggregation. Harmful lactones were also introduced into our food, increasing the risk of MI by decreasing the fibrinolytic activity of our blood. The oil seed industry also introduced into our diet free radical lipid peroxides that make the myocardium more vulnerable to infarction. It is suggested that except for the one in 500 of us who is afflicted by familial hypercholesterolemia, the cholesterol concept of MI is as false today as was the concept in 1900 that germs caused beriberi. It is further suggested that a working knowledge is at hand today that can make death from MI just as rare as death is now from a beriberi-induced heart attack.

Animals↗
PubMed1982

The epidemiology of high density lipoprotein cholesterol levels in post-menopausal women.

High density lipoprotein cholesterol (HDLc) appears to be the most important risk factor of heart attack where increased HDLc levels are associated with reduced heart attack risk. Little is known regarding the determinants of HDLc in older women. The current research investigated possible HDLc correlates in 75 post-menopausal women. Obesity was negatively related and was the strongest determinant. Alcohol consumption and physical activity were also highly related. Of importance was that physical activity was related but only at the highest levels (greater than or equal to 2,000 Kilo-Calories per week). The increased levels of HDLc as a function of physical activity was very interesting because the activities were of relatively low intensity suggesting that the amount of activity rather than intensity was the primary physical activity determinant of HDLc.

Aged↗
PubMed1993

Beliefs about the world and recovery from myocardial infarction.

Seventy male, Hindu Myocardial Infarction (MI) patients were interviewed twice--4 to 5 days after their first heart attack (Time 1) and a month after their first heart attack (Time 2). The patients' beliefs about the world (world beliefs), about the causes of the disease (causal beliefs), and about the factors contributing to their recovery (recovery beliefs) were measured. Each category of beliefs was concerned with three domains: karma, God, and just world (or self). The patients' physical and psychological recovery was evaluated. World and recovery beliefs were intercorrelated, but these beliefs were only weakly correlated with causal beliefs. Furthermore, world beliefs and recovery beliefs were positively associated with recovery from MI at both Time 1 and Time 2. Attribution of causality to God was negatively correlated with medical recovery, perceived recovery, and mood state at Time 2. This trend was in the reverse direction for attribution of causality to self.

Adaptation, Psychological↗
PubMed1995

Myocardial infarction and cardiovascular risk factors in Mexico City and San Antonio, Texas.

Because the epidemiology of cardiovascular disease in Mexico is largely unknown, we examined the prevalence of cardiovascular risk factors and myocardial infarction (MI) in adults from low-income colonias in Mexico City. Data were collected as part of the Mexico City Diabetes Study, a population-based survey of diabetes and cardiovascular disease conducted between 1987 and 1992. Results were compared with those obtained from a comparable survey conducted previously among low-income Mexican Americans in San Antonio, Tex. A total of 2271 individuals between the ages of 35 and 64 years from Mexico City and 1143 adults of the same age range from San Antonio were studied. Despite being leaner and having lower levels of total cholesterol, Mexicans in Mexico City had markedly higher levels of triglycerides (P < .001) and lower levels of HDL cholesterol (P < .001) than Mexican Americans in San Antonio. MI was assessed by Minnesota-coded electrocardiograms and by a self-reported history of physician-diagnosed heart attack. In men, the prevalence of self-reported heart attack was significantly higher in San Antonio than in Mexico City (odds ratio, 5.85; P < .001), and in women, the prevalence of electrocardiogram-documented MI was significantly higher in San Antonio than Mexico City (odds ratio, 2.51; P < .001). The apparent excess of MI in San Antonio relative to Mexico City could be due to higher case-fatality in Mexico City or to a higher incidence in San Antonio.

Adult↗
PubMed1989

Cardiovascular disease in Canada.

Since the first national mortality statistics were published in 1921, cardiovascular disease (CVD) has been the leading cause of death in Canada, accounting for almost half of all deaths each year. In 1987, more than 77,000 Canadians died from CVD, almost 60% more than cancer, the second leading cause of death. The costs of CVD are high in economic as well as human terms. CVD accounts for 21% of all hospital days and is responsible for 25% of all disability pensions paid by the Canadian Pension Plan before age 65. CVD hospital costs alone, excluding doctors' fees and costs of surgery, exceed $3 billion annually. Not all the news about CVD is bad, however. Overall CVD incidence has been steadily declining since the early 1950s, and since 1979 the total number of CVD deaths has actually been decreasing, despite a growing and aging population. Improved survival rates are probably the result from more widespread use of advanced surgical technology during the acute phases of heart attacks, and better medical care for people who survive heart attacks. As this paper shows, CVD incidence varies by sex, age, region, and socio-economic status, as does the prevalence of controllable factors that increase the risk of CVD. These risk factors include smoking, high blood pressure, overweight, lack of physical activity, high levels of dietary fat, and elevated cholesterol levels. Lowering CVD rates to those of nations such as Japan and France, both with less than half the Canadian rate, requires increased public awareness of the dangers of the 'typical' Canadian lifestyle. At the same time, lower-income Canadians, the group with the highest CVD rates, must be given increased opportunities to make healthy lifestyle choices.

Adolescent↗
PubMed2005

Learning through connections with others: women's cardiac symptoms.

Conducting group sessions in which women can share experiences, develop connections, and learn from each other may potentially be a powerful health educational tool. In a focus group conducted for evaluative feedback, the authors found that women began spontaneously sharing their experiences and feelings, receiving validation, and learning from each other almost from the start of the group session. The participants who were dissimilar in age, ethnicity/race, and socioeconomic status developed a strong connection based on the common experience of having had a heart attack. Although the participants had received patient education after their heart attack, they learned new information about cardiac symptoms and how to respond to them in the group session. This case example is a compelling reminder that women learn through connections. Therefore, a group approach to health education that acknowledges the salience of personal experiences, the experiences of others, the development of connections, and the exchange of information may provide a meaningful learning environment. Further research needs to be conducted to determine if conducting group appointments for women that fosters the development of connections and the exchange of information enriches the learning environment and enhances patient education.

Adaptation, Psychological↗
PubMed2005

Real-time plaque characterization and visualization with spectral analysis of intravascular ultrasound data.

Coronary artery disease is the number one cause of death in the United States and the Western world, and approximately 250,000 affected people die per year without ever being admitted to a hospital. One of the main reasons of such a high death-rate without any diagnosis is that more than 50 or heart-attacks) occur in patients with no prior history of known heart disease or symptoms. Coronary artery disease leads to the occlusion of arteries that are vital in providing nutrients to the heart muscles. The disease develops by progressive accumulation or formation of "plaque" within an artery. Certain types of plaques could occlude blood flow and yet might be "stable". These plaques usually have a high fibrous content, and are known as hard plaques. On the other hand, "unstable" or "soft" plaques might not cause much occlusion but could be vulnerable to rupture. Rupture of such plaques could lead to total or partial occlusion in arteries resulting in sudden cardiac death or heart-attack. In fact, 68 coronary arteries are less than 50.Intravascular ultrasound (IVUS) is a minimally invasive imaging modality that provides cross-section images of arteries in real-time, allowing visualization of atherosclerotic plaques in vivo. In standard IVUS gray-scale images, calcified regions of plaque and dense fibrous components generally reflect ultrasound energy well and thus appear bright and homogeneous on IVUS images. Conversely, regions of low echo reflectance in IVUS images are usually labeled "soft" or "mixed" plaque. However, this visual interpretation has been demonstrated to be very inconsistent in accurately determining plaque composition and does not allow real-time assessment of quantitative plaque constituents.Spectral analysis of the backscattered radiofrequency (RF) ultrasound signals allows detailed assessment of plaque composition. Advanced mathematical techniques can be employed to extract spectral information from these RF data to determine composition. The spectral content or signature of RF data reflected from tissue depends on density, compressibility, concentration, size, etc. A combination of spectral parameters were used to develop statistical classification schemes for analysis of in vivo IVUS data in real-time. The clinical data acquisition system is ECG gated and the analysis software developed by our group reconstructs IVUS gray-scale images from the acquired RF data. A combination of spectral parameters and active contour models is used for real-time 3D plaque segmentation followed by computation of color-coded tissue maps for each image cross-section and longitudinal views of the entire vessel. The "fly-through" mode allows one to visualize the complete length of the artery internally with the histology components at the lumen surface. In addition, vessel and plaque metrics such as areas and volumes of individual plaque components (collagen, fibro-lipid, calcium, lipid-core) are also available.

Coronary Artery Disease↗
PubMed1992

Analysis of prehospital delay among inner-city patients with symptoms of myocardial infarction: implications for therapeutic intervention.

In this study, we analyzed the duration and determinants of prehospital delay in a group of inner-city patients hospitalized with suspected myocardial infarction. The average prehospital delay was 11.9 +/- 25.1 hours. Mean and median delays were similar for males (mean: 10.9 +/- 24.2 hours; median: 2.8 hours) and females (mean: 12.7 +/- 25.7 hours; median: 3.5 hours), but were longer for blacks (mean: 13.1 +/- 27.5 hours, P < .001; median: 3 hours, P = .06) and Hispanics (mean: 12.4 +/- 19.3 hours, P < .01; median: 4 hours, P = .07) than for whites (mean: 3.3 +/- 2.9 hours; median: 2 hours). Most of the observed delay was due to the time it took for patients to decide to seek medical care following onset of symptoms. Patients were more likely to arrive at the hospital within 4 hours if they thought their symptoms might be a heart attack (79% versus 41%, P < .01), if they believed that coronary heart disease was preventable (68% versus 42%, P < .01), and if they took an ambulance to the hospital (68% versus 47%, P < .01). The factor most strongly associated with early hospital arrival was the patient's belief that the symptoms might represent a heart attack; these patients were five times more likely to get to the hospital within 4 hours than others, independent of other factors. Interventions designed to decrease prehospital delay must focus not only on improving knowledge of symptoms, but also on identifying high-risk patients and increasing patient awareness of the benefits of early response and treatment.

Black or African American↗
PubMed1997

Coronary heart disease attack rate, incidence and mortality 1975-1994 in Göteborg, Sweden.

MATERIAL AND METHODS: Data from the Göteborg myocardial infarction register were used to investigate trends in attack rate, incidence of non-fatal myocardial infarction and mortality from coronary heart disease in persons aged 64 and below during the period 1975-1994. RESULTS: Myocardial infarction was defined according to strict criteria which remained the same throughout the study period. Attack rate and incidence were 3-5 times higher among men than women. The ratio of recurrent infarcts out of all attacks increased with increasing age and was 14%, 20% and 24% for men aged 35-44, 45-54, and 55-64, respectively. Corresponding rates for women were 8%, 14%, and 22%, respectively. Both attack rate and incidence decreased significantly by 2.1-3.9% per year during the study period for most age groups. The 28-day fatality rate (hospitalized as well as non-hospitalized cases) tended to decline, but significantly so only in the oldest men. The same was true for 28-day fatality among hospitalized patients. The majority of all coronary heart disease deaths occurred outside hospital in people unaware they had coronary heart disease. Mortality from coronary heart disease decreased by 2.0-6.8% per year during the study period. In-hospital treatment of myocardial infarction with intravenous beta-blockers followed by oral treatment, nitroglycerin and thrombolytics increased during the study period. Coronary surgery and angioplasty were used in less than 5% of patients during the study period, but increased substantially in 1994. CONCLUSION: Coronary heart disease and mortality in ages below 65 years are now decreasing in Sweden. Decreasing short-term mortality is almost certainly due to more efficient treatment in hospital, but as the majority of coronary heart disease deaths occur outside hospital and in people unaware they have coronary heart disease, primary prevention is still very important.

Adult↗
PubMed1996

Bioenergetics, ischemic contracture and reperfusion injury.

The mammalian heart is normally well oxygenated and anaerobic glycolysis is extremely rare except for the production of extra ATP during extreme exercise like a marathon race. Anaerobic glycolysis plays a role when there is a serious impairment in coronary blood flow such as during heart attack and open heart surgery. The control of glycolysis in ischemic myocardial tissue appears to be extremely complex. During aerobic glycolysis, phosphofructokinase is the most important regulatory enzyme that controls the energy requirements of the cell. Under anaerobic conditions, however, glyceraldehyde-3-phosphate dehydrogenase becomes the key enzyme because it responds promptly to any changes in the essential supply of co-factors for oxidation. The conversion of pyruvate to acetyl CoA (aerobic metabolism) involves a series of chain reactions primarily catalyzed by pyruvate dehydrogenase complex which is situated at the cross roads between both aerobic and anaerobic glycolysis. It is important to remember that substrate utilization is carefully controlled by substrate availability. During aerobic metabolism, control mechanisms using fatty acids, lactate and glucose as energy substrates regulate the rate of ATP production according to energy demand. This precise mechanism is upset during ischemia and post-ischemic reperfusion for reasons discussed in this review. The demand for ATP can no longer be met by its supply because of severely reduced anaerobic glycolysis and significantly inhibited beta-oxidation of fatty acids. The impairment of bioenergetics is discussed in the context of several diseases such as cardiomyopathy, heart failure, diabetes, arrhythmias, cardiac surgery, heart-lung transplantation, and also in aging and oxidative stress. The regulation of energy metabolism in preconditioned heart is also discussed. Finally, methods used to preserve energy in ischemic myocardium are summarized and quantitation of the high-energy phosphates is discussed. This review challenges scientists to discover drugs which will stimulate energy supply during myocardial ischemia.

Adenosine Triphosphate↗
PubMed1986

Osler's maneuver, pseudohypertension, and true hypertension in the elderly.

Up to half of the geriatric population has been reported to have arterial hypertension and, therefore, an augmented risk of heart attack, stroke, congestive heart failure, and sudden death. Recent studies indicate that mechanisms serving to elevate arterial pressure in the elderly diametrically differ from those in younger patients with similar elevation of arterial pressure. Elderly hypertensive patients have a low cardiac output, elevated vascular resistance, impaired tissue flow, and increased arterial stiffness. Arterial stiffness, if marked, can give rise to pseudohypertension--an entity often responsible for inappropriate diagnosis and inappropriate therapy in the geriatric population. Pseudohypertension can be suspected from a simple bedside maneuver that was hinted at by Sir William Osler almost a century ago. Arterial hypertension seems to accelerate the physiologic process of aging in the cardiovascular system and threatens, therefore, to set the biologic clock at a faster pace. Hopefully, antihypertensive agents more closely tailored to underlying mechanisms of pressure elevation will reverse hypertensive damage to target organs and thereby reset the aging process of the cardiovascular system at a slower pace.

Adult↗
PubMed2006

Bone marrow mesenchymal stem cells differentiate into functional cardiac phenotypes by cardiac microenvironment.

Heart attacks and congestive heart failure remain among the world's most prominent health challenges despite the many breakthroughs. Bone marrow mesenchymal stem cells (BMSCs) have the potential to transdifferentiate into myocytes if an appropriate cardiac environment is provided. This study is meant to investigate the ability of BMSCs to differentiate into cardiomyocytes in a conditioned medium. BMSCs were isolated from rat femurs and tibias using Percoll gradient centrifugation method. Cells were expanded as undifferentiated cells in culture for more than 3 passages and their phenotypes were identified with flow cytometer. BMSCs were cocultured with neonatal rat ventricular myocytes in a rate of 1:10 separated by semipermeable membrane. BMSCs marker of CD29 were highly expressed (98.89+/-1.2%); however, CD34 could hardly be identified (5.61+/-0.1%). After coculturing with myocytes, some of BMSCs showed contraction which became more regular and more vigorous. As assessed by RT-PCR, SERCA2 and RyR(2) were expressed by newly formed cells from 1 to 3 weeks. Immunostaining of newly differentiated BMSCs revealed positivity for cTnT. Some of these cells were positive for sarcomeric alpha-actinin, desmin, cTnT, and cTnI. Western blotting showed that cTnI protein expression was upregulated in these cells from 1 to 3 weeks. Newly formed BMSCs exhibited ultrastructural features of sarcomere formation and inward rectifier potassium current (I(K1)). It is concluded that BMSCs possess the potential to differentiate into cardiomyocytes in the cardiac environment. BMSCs provide an excellent model for development of stem cell therapeutics, and their potential in the cardiac repair under various pathological conditions.

Animals↗
PubMedDate not supplied

Pharmacological treatment of acute ischemic stroke.

Ischemic stroke is devastating. It is the third leading cause of death in the United States. Each year, 480,000 people fall victim to ischemic stroke, which is estimated to cost 71.8 billion dollars (Hinkle JL, Bowman L. J Neurol Nurs. 2003;35:1-8. New treatment is available. Acute ischemic stroke is no longer considered an accident resulting in damage that must simply be dealt with. Now termed a brain attack, like a heart attack it must be treated immediately. Education is key to improving outcomes. Health care professionals must be trained to recognize early signs and symptoms of stroke. The public must be educated to understand the urgency of early evaluation once symptoms of stroke occur Brown M. Clin Med. 2001; 1:60-65). Television commercials, billboards, and public health lectures can be advantageous in a campaign to educate about stroke and the need to seek help immediately when experiencing symptoms, to halt the ischemic damage Brown M. Clin Med. 2001; 1:60-65.

Brain Ischemia↗