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At least 1,099 records · Page 61Linked to original sources
PubMed2006

Prevalence of diabetes and cardiovascular comorbidity in the Canadian Community Health Survey 2002-2003.

Diabetes mellitus is a major risk factor for heart disease (heart attack, angina, and heart failure), stroke, and hypertension, which shorten the average life expectancy. The main objective of this study was to describe the prevalence of heart disease, hypertension, and stroke among Canadians with diabetes compared to those without diabetes in the Canadian general population aged 12 years and over. It also estimated the strength of association between diabetes, heart disease, hypertension, and other factors such as age, gender, cigarette smoking, alcohol drinking, education status, body mass index (BMI), and other socioeconomic factors. Descriptive statistics were used initially to estimate the prevalence of related comorbidities by age and gender. Logistic regression was then employed to determine the potential strength of association between various effects. Data included 127,610 individuals who participated in the 2.1 cycles of the Canadian Community Health Survey (CCHS) in 2002-2003. The prevalence of self-reported hypertension, heart disease, and stroke among individuals with diabetes were 51.9, 21.7, and 4.8%, respectively. By comparison, prevalence among those without diabetes was 12.7, 4.2, and 0.9%. Adjusted Odds Ratios (OR) were 4.15, 5.04, and 6.75 for males', and 4.10, 5.29, and 4.56 for females' hypertension, heart disease, and stroke, respectively. Lower income (OR from 1.27-1.94) and lower education (OR from 1.23-1.86) were independently associated with a high prevalence of hypertension, heart disease, and stroke among diabetics. Alcohol consumption (OR from 1.06-1.38), high BMI (OR from 1.17-1.40), physical inactivity (OR from 1.21-2.45), ethnicity, and immigration status were also strongly associated with hypertension, heart disease, and stroke. The adjusted prevalence of hypertension, heart disease, and stroke in the CCHS-2003 health survey in Canada was significantly higher among those with diabetes compared to those without. Other factors such as age, gender, BMI, lifestyle, family incomes, physical activity levels, and socioeconomic status also affected the strength of association between diabetes and resulting comorbidities.

Adolescent↗
PubMedDate not supplied

Advances in the prevention and treatment of cardiovascular disease.

Over the past thirty-five years, U.S. age-adjusted mortality from cardiovascular disease declined 50 percent. This marked reduction reflects advances in the prevention, diagnosis, and treatment of common cardiovascular conditions. Pharmaceutical agents play a major role in prevention of atherosclerosis and its consequences: heart attack, stroke, and heart failure. Additionally, novel device-based therapies contribute to the decline in cardiac morbidity and mortality. Whereas innovative strategies based on accurate imaging of the heart and blood vessels are implemented widely now, hope exists that lifestyle changes, early risk-factor screening, and more efficacious drugs will strikingly reduce cardiovascular disease in the future.

Arteriosclerosis↗
PubMed1999

CPCs (chest pain center) serve to streamline chest pain evaluation.

Key points Heart attacks kill nearly 600,000 Americans annually. The early signs of a heart attack are often ignored--with potentially disastrous results. A chest pain center (CPC) provides readily accessible facilities for the immediate medical evaluation of chest pain. The hallmark of a CPC is its emphasis on streamlined procedures that triage patients into one of five clinical pathways, or tracks. CPCs are increasingly being recognized as cost- and mission-effective.

Baltimore↗
PubMed1977

[General medical concepts for the dental treatment of aging patients].

Patients, particularly older ones, with internal medical diseases, may be hazards for the dental treatment. Therefore, anamnestic data seem to be most important in order to uncover the hazard patient (diabetes, survived heart attacks, anticoagulation, rheumatic heart affections, hypertonics, allergies). Local anesthesia can be another problem, because it may lead to collapse (psychogenous or from anaphylactic shock). Focal infection, although in general overrated in its importance for the general organism, may pose some problems before heart surgery and antibiotic therapy previously may seem necessary. Finally, therapeutic consequences from emergencies in the dental office are reviewed.

Aged↗
PubMed1996

Temporal expression of extracellular matrix metalloproteinases and tissue plasminogen activator in the development of collateral vessels in the canine model of coronary occlusion.

Although heart attack is caused by occlusion of a major coronary artery, some patients have occlusion without heart attack because these patients have sufficient collateral circulation to provide an alternate pathway for blood supply to the myocardium at ischemic risk. The growth of new capillary vessels (angiogenesis) and enlargement of preexisting vessels play an important role in the collateral development. We evaluated the hypothesis that extracellular matrix metalloproteinase (MMP) expression is altered in coronary collateral arteries (0.5-1 mm o.d.) isolated from canine hearts 2-4 months after surgical placement of an ameroid occluder around the proximal left circumflex artery (n = 4), during the development of collateral vessels and restructuring new vessels. Histologic studies (hematoxylin and eosin, trichrome, and van Gieson stains) indicated cellular proliferation and increased collagen and elastin content in collateral vessels compared with comparable-sized unoccluded arterial segments of the left anterior descending (LAD) artery. In situ MMP activity of collateral vessels, measured using denatured collagen in the gel matrix, indicated an increase in total MMP activity in the intima of collateral vessels compared with normal LAD vessels. To further identify the type of MMP, tissue homogenates were prepared from collateral and LAD vessels and analyzed by SDS-PAGE zymography. The results suggest induction of gelatinase A and gelatinase B expression in collateral vessels compared with normal LAD tissue, when identical amounts of total protein were loaded onto each lane in the gel. Based on plasminogen-casein zymography, we observed the tissue plasminogen activator level to be increased in collateral vessels. On the basis of immunoblot and mRNA (Northern blot) analyses, we determined that the MMP-1 level was induced in collateral vessels 2 and 4 months after ameroid occlusion. In contrast with MMP-1, the level of TIMP-1 (tissue inhibitor of metelloproteinases) was decreased significantly (p < 0.001) in collateral compared with LAD vessels, suggesting a role for arterial TIMP in anti-angiogenic activity. Collectively, these results suggest that chronic occlusion of a major coronary artery induces upregulation of vascular remodeling mechanisms subserving collateral development. Increased MMP-2 activity in collaterals may be associated with decreased levels of tissue inhibitor of metalloproteinases and fibrous tissue remodeling following angiogenic and (or) adaptive responses of the myocardium to chronic ischemia.

Animals↗
PubMed1977

Patients' knowledge of heart disease in general practice.

Interviews with 400 consecutive patients attending a general practice sought their knowledge of the signs and symptoms of an acute heart attack, what action they would take for such an event, and their understanding of the predisposing factors contributing to heart disease. The survey revealed poor recognition of the relevant signs and symptoms of an acute heart attack and lack of knowledge of some of the main predisposing factors associated with heart disease.

Adolescent↗
PubMed2002

State-specific mortality from sudden cardiac death--United States, 1999.

Each year in the United States, 400,000-460,000 persons die of unexpected sudden cardiac death (SCD) in an emergency department (ED) or before reaching a hospital (1). Based on the latest U.S. mortality data, this report summarizes and analyzes 1999 national and state-specific SCD data. Reducing the proportion of out-of-hospital* SCDs would decrease the overall incidence of premature death in the United States. Heart attacks are the major cause of SCD; approximately 70% of SCDs are caused by coronary heart disease. National efforts are needed to increase public awareness of heart attack symptoms and signs and to reduce delay time to treatment.

Adolescent↗
PubMed1995

Benefit/risk of estrogen therapy in cardiovascular disease: current knowledge and future challenges.

In the United States, cardiovascular disease represents the leading cause of death among women. A majority of the deaths are due to coronary disease. In addition, the incidence of heart attacks increases with age. Among those who are 65 years of age or older, the estimated heart attack rate is 374,000 per year for women, compared with 440,000 per year for men. In the past three decades, a number of observational studies have suggested that estrogen therapy can reduce the risk of coronary disease in postmenopausal women. This protective effect appears to be much greater in women who have existing coronary disease. These observational data point to the potential usefulness of estrogen therapy in preventing cardiovascular death among women. Although large, well-controlled, clinical trials are needed to confirm the benefit of estrogen therapy, several important findings strongly support the cardioprotective effect of estrogen therapy. For example, in monkeys estrogen prevents the accumulation of low-density lipoprotein (LDL) cholesterol (a known risk factor for heart disease) in coronary arteries, and estrogen has also been shown to increase high-density lipoprotein (HDL) cholesterol (a known cardioprotective factor). Estrogen also possesses a vasodilating property, which can improve cardiac performance in ischemic heart disease. In addition, recent studies have demonstrated that estrogens (especially equilin) exhibit a high antioxidant effect, which may also be related to cardioprotectivity. Although estrogen therapy has been observed to decrease the risk of coronary disease, long-term estrogen therapy has also been found to increase the risk of uterine carcinoma; the addition of progesterone to estrogen therapy may lessen this undesirable risk, however. On the other hand the addition of progesterone to estrogen therapy may decrease estrogen's beneficial effect on HDL cholesterol. What should be the present position on estrogen therapy in postmenopausal women? What is the best dosage regimen? Should it be used alone or in combination with a progesterone? These important issues are discussed, as are several current clinical trials addressing the issue of estrogen therapy in postmenopausal women.

Aged↗
PubMed1988

The epidemiology of atherosclerosis in 1987: unraveling a common-source epidemic.

Epidemiologists studying the risk factors of coronary heart disease, as indicated by a heart attack, often presume that these risk factors combine in a susceptible host to increase the risk of the heart attack. The "biological" basis for the interaction of the key risk factors is often not considered in the analysis. A more rational model for the study of clinical heart disease, stroke, and peripheral vascular disease would be to separate the epidemiology of atherosclerosis from that of the clinical event. In the past, this has been extremely difficult because of the absence of techniques for the measurement of atherosclerosis in vivo, especially in well-defined populations. However, in recent years, greater emphasis on the quantification of atherosclerosis and its relationship to specific risk factors has improved our ability to study the underlying pathology that is atherosclerosis. Atherosclerosis is an example of a common-source epidemic. The environmental agent is the intake of cholesterol and saturated fat. The interaction of specific dietary factors and genetic determinants is the key to the evolution of atherosclerosis. There are marked variations in the evolution of the disease in different vascular beds as well as among individuals exposed to similar environmental factors. In the future, we will probably be able to study atherosclerosis as a continuous variable in populations and to relate the rate of progression, the extent of disease at any point in time, and topical distribution of atherosclerosis within individual vascular beds to specific genetic and environmental determinants.

Adult↗
PubMed1977

[Group therapy. Rehabilitation of heart and hemiplegic patients].

In this paper, ideas and methods for working in group psychoterapy with hemiplegics and post-heart-attack patients in a general hospital in Mexico City are outlined. With hemiplegics support therapy is used and with heart-attack-patients, learning therapy. Both groups meet once a week.

Heart Diseases↗
PubMed2003

Information needs of myocardial infarction patients.

The main objectives of this study were to assess the perceptions of patients immediately after their first myocardial infarction of their needs in a cardiac education programme and to compare these with their perceptions 6 weeks after the event and also with their nurse educators. The data were collected by a questionnaire, the cardiac patients' learning needs inventory which was administered to both patients and nurses. It comprised 37 "needs" items grouped into seven categories, each item to be scored into one of five levels of importance. There were 27 patients interviewed on the first occasion, of whom 18 responded to a postal questionnaire on the second occasion. A census of three groups of nurses was taken in the study, namely all nurses employed in one coronary care unit and in a cardiac ward at a large Dublin Hospital and all nurses employed as cardiac rehabilitation nurses/officers in Ireland at the time of commencement of the study. Sixty-eight nurses responded, a response rate of 80%. A key finding was that the responses were highly skewed, with two-thirds in the top grade ("very important") and less than 1% in the two lowest grades ("not important" and "somewhat important"). The overall response score distribution of the patients differed somewhat from that of the nurses, but this difference was accounted for by mainly three items, all in the "physical activity" category, namely "when to resume driving", "when to resume sexual activity", and "when to resume work", which the nurses scored high and the patients low. Both patients and nurses gave the highest mean scores to four items, namely "what to do when in chest pain", "what are the symptoms of a heart attack", "when to call a doctor", and "what to do to reduce the chance of another heart attack". The first three of these are in the "symptom management" category. These findings support previous studies on the topic. The findings also support the need for individualised nurse/patient negotiated cardiac teaching programmes that can be tailored to suit each patient's needs.

Activities of Daily Living↗
PubMed1997

Management of acute myocardial infarction. Synopsis of ACC and AHA practice guidelines. American College of Cardiology and American Heart Association.

The average time that elapses from a patient's first awareness of heart attack symptoms to start-up of specific reperfusion therapy is currently 4 hours. The National Heart Attack Alert Program wants to see this time reduced to 2 hours. Such dispatch would surely benefit patients, because when it comes to thrombolytic therapy, the sooner the better. Dr Ryan summarizes the new recommendations for handling patients with acute myocardial infarction rapidly and efficiently, from the 911 call and transport to the emergency department, through the important first 24 hours of hospitalization, to hospital discharge and long-term management.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Specialist unit improves outcome after acute stroke.

Stroke rehabilitation units are associated with reduced mortality, morbidity and length of stay, in much the same way that coronary care units are known to improve the acute care of patients who have had a heart attack. Such units have facilitated the development of drugs that may improve the outcomes following a heart attack. The acute stroke unit at King's Healthcare, London, was set up to improve the early management of stroke and facilitate the development of new treatments. The unit has just celebrated its first anniversary and this paper evaluates its work one year on, plus the implications for nursing practice.

Acute Disease↗
PubMed1993

The relationship of treatment adherence to the risk of death after myocardial infarction in women.

OBJECTIVE: To examine the relationship between adherence to a medical regimen and mortality following a myocardial infarction in women. DESIGN: Analysis of the female cohort entered into a randomized double-blind multicenter trial. SETTING: National Heart, Lung, and Blood Institute beta-Blocker Heart Attack Trial. PARTICIPANTS: The 602 women, aged 30 to 69 years, enrolled in the beta-Blocker Heart Attack Trial. INTERVENTION: Random assignment to propranolol hydrochloride or placebo 5 to 21 days following a myocardial infarction. MEASUREMENTS: Adherence for each patient was calculated as the mean of all quarterly adherence estimates during the course of the trial (median follow-up, 26 months). Adherence was classified as good (taking > or = 75% of medication) or poor (taking < 75% of medication). The end point was death from all causes occurring at any time during the trial, adjusted for treatment category and other clinical and sociodemographic features. RESULTS: Adherence data were available on 505 women, of whom 32 (6.3%) died. Death occurred in 13.6% of poor adherers compared with 5.6% of good adherers (relative risk, 2.4; 95% confidence interval, 1.1 to 5.6). The effect of adherence on mortality remained undiminished after adjustment for treatment category (propranolol or placebo), age, severity of myocardial infarction, congestive heart failure, smoking history, marital status, educational level, and race (adjusted relative risk of death for poor adherers, 2.5 to 3.0; P < or = .02). CONCLUSIONS: The independent effect of adherence on mortality following a myocardial infarction in women is clinically substantial, statistically significant, and similar in magnitude to that reported earlier for men.

Adult↗
PubMed1995

Coronary artery disease and colorectal neoplasia.

PURPOSE: This study was designed to determine whether patients with coronary artery disease are at elevated risk for colorectal neoplasia. METHODS: A case-control study was conducted among consecutive patients in three colonoscopy practices in New York City from 1986 to 1988. All study participants completed an interview questionnaire covering demographics, diet, environmental and behavioral exposures, family and personal medical history, and other variables. For the present study, 298 newly diagnosed colorectal adenoma cases and 107 incident cancer cases were compared with 507 colonoscoped controls without colorectal neoplasia or other significant findings on colonoscopy. Data on history of coronary artery disease (angina and/or heart attack) were obtained solely from the study participants' questionnaire responses. RESULTS: No association was observed between angina, heart attack, or either and colorectal adenomas in males. However, prior coronary artery disease was found to be associated with colorectal cancer in males more than 60 years of age and with colorectal adenomas in females aged 50 years or younger. CONCLUSION: Men with coronary artery disease may be at elevated risk for subsequent colorectal cancer. Young women with coronary artery disease also may be at elevated risk for colorectal neoplasia.

Adenomatous Polyps↗
PubMed2002

Apolipoprotein E epsilon4 and risk of mortality in African American and white older community residents.

PURPOSE: The goal of this study was to determine whether the epsilon4 allele of apolipoprotein E is predictive of mortality in a community-based sample. DESIGN AND METHODS: Of the stratified random household sample of 4,162 participants age 65 years and older enrolled in the Duke site of the Established Populations for Epidemiologic Studies of the Elderly, those included in the present study were the 1,998 who were genotyped for apolipoprotein E (alleles epsilon2, epsilon3, and epsilon4) six years after baseline, and for whom survival status eight years later was known by search of the National Death Index. Information on demographic characteristics, physical and mental health status, functional status, and health services use was determined by structured questionnaires administered in person in the home. RESULTS: The epsilon4 allele did not predict mortality for the group as a whole, or for those who were cognitively impaired. It did predict mortality for those who reported having had a heart attack or stroke. IMPLICATIONS: The apolipoprotein epsilon4 allele-although a risk factor for Alzheimer's disease, heart disease, and stroke-was only found to be a risk factor for mortality for those community residents who had had a heart attack or stroke. Otherwise, for this community-based sample, 71 years of age and older, it did not predict time to death and was not a risk factor for mortality.

Black or African American↗
PubMed1990

Coronary artery disease in women.

The past three decades have seen coronary artery disease investigated almost exclusively in men. Data about this disease in women come from the longitudinal Framingham study and mortality statistics. According to the Framingham study, angina is more often the first symptom of coronary disease in women, while for men it is more often myocardial infarction. Post menopausal women are two to three times more likely to have a heart attack than premenopausal. Forty per cent of female cardiac patients versus 13% of men suffered a second heart attack. Sudden death, a frequent manifestation of coronary disease in men, occurs rarely in women until old age. Women aged 35 to 64 years were more vulnerable to risk factors of systolic blood pressure, blood glucose and excess weight than men. Cigarette smoking, highly correlated in men, was not a significant risk factor in women. The greater the number of risk factors, the greater the risk of developing coronary artery disease. Central or truncal obesity is associated with higher blood pressure and hyperinsulinemia which is thought to result in increases in atherogenic lipoproteins and decreases in high density lipoprotein cholesterol.

Adult↗
PubMed2006

Explanatory models of illness: a study of within-culture variation.

The current studies explore causal models of heart attack and depression generated from American healers whom use distinct explanatory frameworks. Causal chains leading to two illnesses, heart attack and depression, were elicited from participant groups: registered nurses (RNs), energy healers, RN energy healers, and undergraduates. The domain-specificity hypothesis predicted that psycho-social and physical causes would not interact in illness models. Across illnesses, RNs and undergraduates rarely cited interactions between mental and physical causes, consistent with the domain specificity hypothesis. In contrast, energy healers frequently mentioned interactions. Study 2 showed that these differences were not due to salience. These results suggest that domain-specificity theory is supported for groups with extensive exposure to western medicine but does not explain energy models of illness. Implications for other cultural models of illness are discussed.

Culture↗