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PubMed1997

Functional recovery after myocardial infarction in men: the independent effects of social class.

BACKGROUND: Social class has been repeatedly associated with cardiovascular-related illness and death, but no studies have examined the effect of social class on recovery from myocardial infarction. Moreover, few studies have simultaneously evaluated a broad array of f1p4graphic, clinical, and psychosocial factors that may influence health outcomes after myocardial infarction. OBJECTIVE: To determine whether social class remains independently associated with functional recovery after myocardial infarction, even after controlling for clinical, demographic, and psychosocial factors known to influence outcomes after infarction. DESIGN: Analysis of prospective data from a multicenter, randomized, double-blind clinical trial. SETTING: 25 hospitals or clinical settings in the United States and Canada that participated in the Beta Blocker Heart Attack Trial, including the Health Insurance Plan substudy. PATIENTS: 2145 men 29 to 69 years of age who were hospitalized with acute myocardial infarction and were recruited into the Beta Blocker Heart Attack Trial. MEASUREMENTS: The primary outcome was change in New York Heart Association functional class between baseline assessment and 12 months after infarction, dichotomized as improved or not improved (that is, no change, decline in at least one category, or death). RESULTS: Social class maintained its independent effect on improved functional status, even after controlling for pertinent prognostic factors. Persons of high social class were significantly more likely than persons of low or middle social class to have improved functional status 1 year after infarction. Certain clinical, demographic, and psychosocial features were related to recovery, but the effect of social class could not be explained by these additional features. CONCLUSIONS: Social class has a substantial influence on recovery from myocardial infarction and may explain differences in clinical outcomes.

Activities of Daily Living↗
PubMed2004

Pathophysiology and biochemistry of cardiovascular disease.

Atherosclerosis is the major cause of cardiovascular disease. Hypercholesterolaemia, hypertension and cigarette smoking are the common risk factors for atherosclerosis. These risk factors unite behind a convergence of mechanism, involving oxidation and inflammation in the artery wall that, with time, gives rise to characteristic fatty-fibrous lesions. Physical trauma and inflammation produce lesion rupture, which can lead to clinical events such as heart attack and stroke, or resolve with plaque growth. Disease progression is marked by the inflammatory indicator CRP (C-reactive protein). Early indicators of heart attack are the inflammatory marker CD40, and the cardiac myofilament protein troponin. Coronary atherosclerosis is the common cause of heart failure (HF). Disordered calcium signalling to the myofilaments occurs in HF and in cardiomyopathy. Enhanced calcium signalling suppresses HF. Neuro-humoral and biomechanical processes, as seen in hypertension, produce cardiac hypertrophy, which predisposes to HF through apoptosis. Although in humans cardiac damage produces permanent loss of cells, because the heart cannot regenerate, developments in stem cell technology suggest that help is at hand.

Arteriosclerosis↗
PubMed2006

Comorbidity and disability in elderly Mexican and Mexican American adults: findings from Mexico and the southwestern United States.

This article aims to compare the effects of morbid and comorbid medical conditions on disability in elderly Mexican and Mexican American adults. Data from the 2001 Mexican Health and Aging Study (N = 4,872) and 1993 to 1994 Hispanic Established Population for Epidemiologic Studies of the Elderly (N = 3,050) were analyzed. Prevalence of medical conditions and disability in activities of daily living were calculated and logistic models were used to test associations. Prevalence of disability in older Mexicans was 16.3% while it was slightly lower in Mexican Americans (13.1%). Prevalence of arthritis, cancer, diabetes, heart attack, and stroke were substantially higher in Mexican Americans than in older adults living in Mexico. Diabetes, stroke, and heart attack were comorbid conditions that raised the likelihood of disability in both populations among subjects with other medical conditions. Despite differences in prevalence, the associations of morbidity and comorbidity with disability had similar magnitudes in both populations.

Activities of Daily Living↗
PubMed1991

[Myocardial infarct, functional heart symptoms and panic syndrome].

Cardiovascular manifestations of anxiety have long been known. A particularly intriguing problem even today is the differentiation between real and false "heart attacks". We compared 20 patients with functional cardiac complaints and 20 patients with myocardial infarction with respect to their "heart attacks" and psychological disorders. In spite of methodological problems our results indicate much more dramatic symptoms in the functional group. Their localization of "cardiac" pain resembled the generally accepted picture for myocardial infarction much more than that of the patients with an actual infarction. Functional patients showed more help seeking behavior and were less able to describe triggers for their attacks than patients with myocardial infarction. Functional patients largely met DSM-III-R diagnostic criteria for panic disorder and had a higher prevalence of other psychological disorders.

Anxiety Disorders↗
PubMed1995

Quantifying cardiovascular risk in hypertension.

The facts are that blood pressure is a risk factor for cardiovascular disease and that its reduction saves lives. This has been convincingly demonstrated. The question now is how best to translate that knowledge into practice. Clearly, displacement of the whole community's pressure distribution downward would be of tremendous benefit. A change of only a few mm Hg, if feasible and without cost in health-care terms, would produce more disease prevention than any conceivable clinical strategy. Regrettably, the means to achieve this goal are not available. New tools to improve dietary and behavioral approaches to attaining these goals are desperately needed. For physicians, the immediate issue is how to apply the powerful and varied tools that dramatically lower blood pressure in individual patients. In this clinical setting, blood pressure must be seen for what it is--a reflection of relative risk, a risk factor, and only one of the multiple factors that together determine absolute risk. Blood pressure reduction is not curative (because high blood pressure is not a disease) but rather is a technique to reduce the odds of heart attack, stroke, and renal failure. Hypotensive therapy should therefore be applied when the absolute likelihood for a stroke or heart attack, is great enough to suggest a real chance for benefit by virtue of the reduction of any particular blood pressure level. Therapeutic decisions should weigh the potential for benefit as well as the burden of intervention. The worthy clinician must define those parameters, assist the patient to assess their implications, and finally implement the therapeutic choice that follows, to provide the best possible care.

Cardiovascular Diseases↗
PubMed1997

Walking to health.

Walking is a rhythmic, dynamic, aerobic activity of large skeletal muscles that confers the multifarious benefits of this with minimal adverse effects. Walking, faster than customary, and regularly in sufficient quantity into the 'training zone' of over 70% of maximal heart rate, develops and sustains physical fitness: the cardiovascular capacity and endurance (stamina) for bodily work and movement in everyday life that also provides reserves for meeting exceptional demands. Muscles of the legs, limb girdle and lower trunk are strengthened and the flexibility of their cardinal joints preserved; posture and carriage may improve. Any amount of walking, and at any pace, expends energy. Hence the potential, long term, of walking for weight control. Dynamic aerobic exercise, as in walking, enhances a multitude of bodily processes that are inherent in skeletal muscle activity, including the metabolism of high density lipoproteins and insulin/glucose dynamics. Walking is also the most common weight-bearing activity, and there are indications at all ages of an increase in related bone strength. The pleasurable and therapeutic, psychological and social dimensions of walking, whilst evident, have been surprisingly little studied. Nor has an economic assessment of the benefits and costs of walking been attempted. Walking is beneficial through engendering improved fitness and/or greater physiological activity and energy turnover. Two main modes of such action are distinguished as: (i) acute, short term effects of the exercise; and (ii) chronic, cumulative adaptations depending on habitual activity over weeks and months. Walking is often included in studies of exercise in relation to disease but it has seldom been specifically tested. There is, nevertheless, growing evidence of gains in the prevention of heart attack and reduction of total death rates, in the treatment of hypertension, intermittent claudication and musculoskeletal disorders, and in rehabilitation after heart attack and in chronic respiratory disease. Walking is the most natural activity and the only sustained dynamic aerobic exercise that is common to everyone except for the seriously disabled or very frail. No special skills or equipment are required. Walking is convenient and may be accommodated in occupational and domestic routines. It is self-regulated in intensity, duration and frequency, and, having a low ground impact, is inherently safe. Unlike so much physical activity, there is little, if any, decline in middle age. It is a year-round, readily repeatable, self-reinforcing, habit-forming activity and the main option for increasing physical activity in sedentary populations. Present levels of walking are often low. Familiar social inequalities may be evident. There are indications of a serious decline of walking in children, though further surveys of their activity, fitness and health are required. The downside relates to the incidence of fatal and non-fatal road casualties, especially among children and old people, and the deteriorating air quality due to traffic fumes which mounting evidence implicates in the several stages of respiratory disease. Walking is ideal as a gentle start-up for the sedentary, including the inactive, immobile elderly, bringing a bonus of independence and social well-being. As general policy, a gradual progression is indicated from slow, to regular pace and on to 30 minutes or more of brisk (i.e. 6.4 km/h) walking on most days. These levels should achieve the major gains of activity and health-related fitness without adverse effects. Alternatively, such targets as this can be suggested for personal motivation, clinical practice, and public health. The average middle-aged person should be able to walk 1.6 km comfortably on the level at 6.4 km/h and on a slope of 1 in 20 at 4.8 km/h, however, many cannot do so because of inactivity-induced unfitness. The physiological threshold of 'comfort' represents 70% of maximum heart rate. (ABSTRACT TRUNCATED)

Cardiovascular Diseases↗
PubMed1983

Ethnic differences in health knowledge and behaviors related to the prevention and treatment of coronary heart disease. The San Antonio Heart Study.

From a public health perspective, Mexican Americans are widely recognized as an understudied population. Available evidence suggests that Mexican Americans shared equally with non-Hispanic Caucasians (Anglo Americans or "Anglos") in the national decline in coronary heart disease (CHD) mortality during 1970-1976. This finding is somewhat unexpected in view of Mexican Americans' relatively lower socioeconomic status, and it suggests that studying this ethnic group may be strategic in understanding which factors have operated to produce the decline in general. Data obtained from a random sample of Mexican Americans and Anglos residing in three socioeconomically and culturally distinct neighborhoods in San Antonio, Texas, indicated that Anglos were significantly more informed than Mexican Americans about CHD prevention and generally reported engaging in more behaviors specifically aimed toward prevention than did Mexican Americans. Levels of knowledge were not particularly high in either ethnic group; moreover, reported behavior lagged considerably behind knowledge. While Mexican Americans were significantly less likely than Anglos to volunteer knowledge about major heart attack symptoms, there were negligible ethnic differences in awareness of the need for prompt utilization of medical treatment resources when a heart attack actually occurs. Awareness of the need for prompt action was notably high among both ethnic groups. Although limitations in the nature and scope of the data dictate that these findings should be interpreted with caution, the results tend to argue in the direction that prompt access to medical treatment when coronary emergencies occur may have made a relatively greater contribution to the CHD mortality decline in both Mexican Americans and Anglos than did changes in life-style. Much additional data are needed, however, before a definitive explanation of the decline will be possible.

Coronary Disease↗
PubMed1995

Alcohol, hypertension, coronary disease and stroke.

1. The association between alcohol and hypertension has been recognized for several years. 2. However, it remains a paradox that if alcohol does cause hypertension there is little convincing evidence that alcohol is related to the cardiovascular complications of hypertension such as strokes and heart attacks. The relationship between alcohol and strokes remains inconclusive and there is evidence that moderate alcohol consumption may be protective against heart attacks. 3. It is possible, therefore, that alcohol does not so much cause hypertension, but rather a rapidly reversible rise in blood pressure which does not cause cardiovascular damage. When managing hypertensive patients, however, relevant counselling can bring about a useful fall in blood pressure.

Alcohol Drinking↗
PubMed1991

Occupational demand and human rights. Public safety officers and cardiorespiratory fitness.

The issue of discrimination in physically demanding employment, such as police, firefighters, prison guards and military personnel, is contentious. In terms of oxygen transport, the 'action limit' (calling for personnel selection or task redesign) is a steady oxygen consumption of 0.7 L/min, while the maximum permissible limit is 2.1 L/min. Note is taken of the commonly expressed belief that public safety duties are physically demanding, calling for personnel with an aerobic power of at least 3 L/min, or 42 to 45 ml/kg/min. The actual demands of such work can be assessed on small samples by physiological measurements (using heart rate or oxygen consumption meters), but the periods sampled may not be typical of a normal day. A Gestalt can also be formed as to the heaviness of a given job, or a detailed task analysis can be performed; most such analyses of public safety work list distance running and other aerobic activities infrequently. An arbitrary requirement of 'above average fitness' is no longer accepted by courts, but a further approach is to examine the characteristics of those currently meeting the demands of public safety jobs satisfactorily. Young men commonly satisfy the 3 L/min standard, but this is not usually the case for women or older men; in the case of female employees, it also seems unreasonable that they should be expected to satisfy the same standards as men, since a lower body mass reduces the energy cost of most of the tasks that they must perform. A second criterion sometimes applied to physically demanding work (a low vulnerability to heart attacks) is examined critically. It is concluded that the chances that a symptom-free public safety officer will develop a heart attack during a critical solo mission are so low that cardiac risk should not be a condition of employment. Arbitrary age- and sex-related employment criteria are plainly discriminatory, since some women and 65-year-old men have higher levels of physical fitness than the average young man of 25 years. Neither laboratory nor field tests offer a satisfactory means of distinguishing such individuals, and the only equitable basis of selecting personnel for physically demanding work seems a probationary period of employment.

Cardiovascular Diseases↗
PubMed1979

[Studies in medical meteorology at the "Zentralanstalt für Meteorologie und Geodynamik" at Vienna (author's transl)].

Weather situations connected with small pressure gradients show a statistically significant correlation with the liability to heart-attacks. Changes from cyclonic to anticyclonic situations with descending air-motion lead to a rise of the number of heart-attacks in summer. In winter the change from anticyclonic to cyclonic pressure distributions seems to be critical.

Air Movements↗
PubMed1998

Variations in angioplasty and bypass surgery.

OBJECTIVES: This article describes rates of and times to revascularization procedures for heart attack patients. DATA SOURCE: The data are from Statistics Canada's Person-Oriented Information Data Base. Hospital discharge records for heart attack patients were linked for fiscal years 1992/93 and 1993/94. ANALYTICAL TECHNIQUES: Hospital patients admitted between April 1 and September 30, 1993 with a primary diagnosis of acute myocardial infarction (AMI) were followed for six months to determine what percentage underwent percutaneous transluminal coronary angioplasty and/or coronary artery bypass graft surgery. Analyses of time-to-procedure were performed for those patients who had not been hospitalized for AMI in the previous 12 months. MAIN RESULTS: Approximately 24,000 Canadians were discharged from hospital during the first half of fiscal year 1993/94 with a diagnosis of AMI. Within six months, 8.7% had an angioplasty and 6.7% had a bypass; overall, 14.9% were revascularized. Women were less likely than men to have a bypass, but angioplasty rates did not differ significantly. The rate of revascularization declined with age. After adjusting for age and sex, rates were higher in the western provinces.

Adult↗
PubMed1999

Reducing coronary heart disease in the Australian Coalfields: evaluation of a 10-year community intervention.

Coronary heart disease is a leading cause of death in Australia with the Coalfields district of New South Wales having one of the country's highest rates. Identification of the Coalfields epidemic in the 1970's led to the formation of a community awareness program in the late 1980's (the healthy heart support group) followed by a more intense community action program in 1990, the Coalfields Healthy Heartbeat (CHHB). CHHB is a coalition of community members, local government officers, health workers and University researchers. We evaluate the CHHB program, examining both the nature and sustainability of heart health activities undertaken, as well as trends in risk factor levels and rates of coronary events in the Coalfields in comparison with nearby local government areas. Process data reveal difficulties mobilising the community as a whole; activities had to be selected for interested subgroups such as families of heart disease patients, school children, retired people and women concerned with family nutrition and body maintenance. Outcome data show a significantly larger reduction in case fatality for Coalfields men (although nonfatal heart attacks did not decline) while changes in risk factors levels were comparable with surrounding areas. We explain positive responses to the CHHB by schools, heart attack survivors and women interested in body maintenance in terms of the meaning these subgroups find in health promotion discourses based on their embodied experiences. When faced with a threat to one's identity, health discourse suddenly becomes meaningful along with the regimens for health improvement. General public disinterest in heart health promotion is examined in the context of historical patterns of outsiders criticising the lifestyle of miners, an orientation toward communal rather than individual responsibility for health (i.e. community 'owned' emergency services and hospitals) and anger about risks from environmental hazards imposed by industrialists.

Adult↗
PubMed2003

beta-Blockers in hypertension-the emperor has no clothes: an open letter to present and prospective drafters of new guidelines for the treatment of hypertension.

Over the past decade, national and international guidelines have proposed beta-blockers to be used on an equal footing with diuretics for initial therapy of hypertension. This preferred status was supposedly based on evidence documenting a reduction in morbidity and mortality with beta-blocker therapy in hypertension. We systematically analyzed all available outcome studies and found no evidence that beta-blocker based therapy, despite lowering blood pressure, reduced the risk of heart attacks or strokes. Despite the inefficacy of beta-blockers, the incidence of adverse effects is substantial. In the MRC study, for every heart attack or stroke prevented, three patients withdrew from atenolol because of impotence, and another seven withdrew because of fatigue. Thus the risk/benefit ratio of beta-blockers is characterized by lack of efficacy and multiple adverse effects. Given that many thorough, prospective, randomized trials attest to efficacy and safety of diuretics, calcium antagonists, ACE inhibitors, and angiotensin receptor inhibitors, the time has come to admit that beta-blockers should no longer be considered appropriate for first-line therapy in uncomplicated hypertension.

Adrenergic beta-Antagonists↗
PubMed2001

Aspirin use among adults with diabetes: estimates from the Third National Health and Nutrition Examination Survey.

OBJECTIVE: Since 1997, the American Diabetes Association has recommended that aspirin therapy be considered for adults with diabetes who have cardiovascular disease (CVD) or CVD risk factors. We examined the prevalence of regular aspirin use among adults in the U.S. with diagnosed diabetes. RESEARCH DESIGN AND METHODS: The Third National Health and Nutrition Examination Survey (1988-1994) used a probability sample of the U.S. population and included an interview, physical examination, and laboratory studies. Among the survey participants were 1,503 adults (age > or =21 years) with self-reported diabetes. We defined regular aspirin use as reported having taken aspirin > or = 15 times in the previous month. CVD conditions were self-reported heart attack and stroke and symptoms of angina and claudication. CVD risk factors included smoking, hypertension, obesity, albuminuria, lipid abnormalities, and family history of heart attack. RESULTS: An estimated 27% of adults with diabetes had CVD, and an additional 71% had one or more CVD risk factors. Aspirin was used regularly by 37% of those with CVD and by 13% of those with risk factors only Adjusted odds of regular aspirin use were significantly greater for individuals with CVD than for those with one CVD risk factor (odds ratio [OR] = 4.3); for non-Hispanic whites than for blacks, Mexican-Americans, and others (OR = 2.5); and for individuals age 40-59 years than for those <40 years (OR = 33.3). CONCLUSIONS: Nearly every adult in the U.S. with diabetes has at least one risk factor for CVD and thus may be considered a potential candidate for aspirin therapy. During 1988-1994, only 20% (95% CI 16-23) took aspirin regularly Major efforts are needed to increase aspirin use.

Adult↗
PubMed2005

[Rupture of interventricular septum as consequence of diaphragmatic heart infarct].

Patient, with massive heart attack of the hart's lower wall which happened six months ago, and consequent rupture of the ventricular septum, 1.2 cm of size, next to the left to right shunt, and development of aneurisms at the place of heart attack (4.2 cm x 2.9 cm), is admitted in our Clinic. Weakening signs of the right heart are present with retention of the liquid, edemas and ascites. After a long preoperative preparation graft on CX is being performed, reconstruction of aneurisms of the left verticle, and VSD being reconstructed with Dacron's patch. Postoperative flow is extended with occurrence of profusely diarrhea and existence of a smaller pericardial effusion, but status of the patient is improving, and he is being dismissed home in a satisfactory general condition.

Heart Rupture, Post-Infarction↗
PubMed2001

Family history as a risk factor for early onset myocardial infarction in young women.

BACKGROUND: The relation between a family history of heart attack and the occurrence of early myocardial infarction (MI) has not been studied extensively in women. In addition, whether recognized and newly-identified coronary heart disease (CHD) risk factors account for the familial aggregation of these events remains unknown. We therefore examined these questions in a population-based case-control study among female 18- to 44-year-old residents of western Washington State. METHODS AND RESULTS: The patients consisted of 107 women with first acute MI, and the control subjects comprised 526 women similar in age identified from the community and without a history of recognized clinical coronary heart disease or stroke. Trained interviewers used a structured questionnaire to elicit a detailed history of heart attack in first-degree relatives. Information about other known MI risk factors was collected and biochemical measurements performed, and common polymorphisms in various candidate genes were determined. The rate of MI among first-degree relatives of MI cases was twice as high as among first-degree relatives of controls (relative risk, 1.96; 95% confidence interval (CI), 1.46-2.48); this association was present for each familial relationship. Sibling history of MI but not parental history was associated with MI, after controlling for established CHD risk factors. In a subsample of subjects with blood measurements, further adjustment for lipids, lipoproteins and specific genetic risk factors slightly reduced the association with sibling MI history (from odds ratio (OR), 5.17; 95% CI, 1.93-13.85 to OR, 3.97; 95% CI, 0.92-17.17). CONCLUSION: Family history of MI is positively associated with the risk of early MI in women. While the association with parental history of MI is mediated through the clustering of other common risk factors, the association of sibling history of MI with early-onset MI in young women is only partially explained by the clustering of established and newly-identified risk factors.

Adult↗
PubMed2000

Self-reported prevalence and health correlates of functional limitation among Massachusetts elderly Puerto Ricans, Dominicans, and non-Hispanic white neighborhood comparison group.

BACKGROUND: Limited data suggest that Puerto Ricans experience greater disability than other ethnic groups, but few studies have examined the factors associated with this apparent difference. METHODS: We describe the prevalence of functional limitation and disability in a representative sample of Puerto Rican and Dominican elders in Massachusetts, and in a neighborhood comparison group of non-Hispanic whites (NHWs). We then relate disability scores, based on both prevalence and severity of ADL or IADL limitation, with self-reported history of diagnosed health conditions--adjusting for age, sex, body mass index (BMI; weight kg/height m(2)), income, education, living alone, smoking, and alcohol use. RESULTS: Seventy-five percent of Dominican women and 73% of Puerto Rican women reported difficulty with at least one ADL, compared with 64% of NHW women. Puerto Rican men reported significantly more limitation than did NHW or Dominican men. Conditions significantly associated with at least two disability measures among the NHW included smoking, former heavy alcohol use, arthritis, cataract, respiratory disease, and high BMI, but not stroke, diabetes, history of heart attack, or depression. The patterns for Puerto Ricans differed, with the strongest associations between disability and stroke, arthritis, diabetes, and depression, followed by history of heart attack, high BMI, cataract, poverty status, and respiratory disease. Only arthritis and depression were consistently significantly associated with disability among this smaller sample of Dominican elders. CONCLUSIONS: Functional limitation and disability are more prevalent among Puerto Ricans and among Dominican women than among neighborhood NHWs in Massachusetts. Greater disability is associated with the presence of chronic health conditions, which differ by ethnic group. Additional research is needed to further define the social and health factors that contribute to these ethnic differences.

Activities of Daily Living↗
PubMed2003

Familial associations in women with polycystic ovary syndrome.

OBJECTIVE: To confirm whether there was a familial association between polycystic ovary syndrome (PCOS) and thromboembolic disease, ovarian or breast cancer, diabetes, and heart disease. DESIGN: Cross-sectional study. SETTING: A university hospital in the United Kingdom. PATIENT(S): Two hundred and seventeen women with and without PCOS under the care of the same consultant gynecologist at a teaching hospital. INTERVENTION(S): Questionnaire survey. MAIN OUTCOME MEASURE(S): Prevalence of a personal or positive family history of thromboembolism, ovarian cancer, breast cancer, diabetes, and heart attacks. RESULT(S): In an analysis of the replies from 41 women with PCOS and 66 controls, we found a statistically significant positive family history of breast cancer and heart attacks among women with PCOS. There was no statistically significant difference in the mean age, ethnic origin, or prevalence of a family history of other diseases. CONCLUSION(S): Our results show a positive association between polycystic ovary syndrome and a family history of breast cancer and heart disease. These associations may be genetic in origin, or secondary to a complex interplay of genetic, intrauterine, and environmental factors. More studies are required to confirm these findings and determine the factors that explain these associations.

Adult↗