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PubMed1975

Prevalence of plasma lipoprotein abnormalities in the farming village of Tanushimaru and the fishing village of Ushibuka. From the epidemiological aspects.

A prospective survey was made on the population of two village in order to compare the frequency of plasma lipoprotein abnormalities in the two cohorts. The inhabitants of the farming village and those of the fishing village had different mode of life, especially eating habits, and different incidence rates of heart attack and brain stroke, but invariably had low serum cholesterol levels. The results of the study indicated that the nature and frequency of plasma lipoprotein abnormalities made vary with difference eating habits. However, the way in which this variance is related to the development into heart attack and brain stroke in the two populations remains to be settled by further follow-up study.

Adult↗
PubMed2004

Self-reported adherence to cholesterol-lowering medication in patients with familial hypercholesterolaemia: the role of illness perceptions.

BACKGROUND: The objectives of this study are to describe levels of adherence to cholesterol-lowering medication and to identify predictors of adherence in patients with familial hypercholesterolaemia (FH). DESIGN: Descriptive questionnaire study. METHODS: 336 adults patients with FH attending one of five outpatient lipid clinics in South East England underwent a clinical assessment by a nurse and completed a questionnaire. The questionnaire assessed self-reported adherence to cholesterol-lowering medication, anxiety, depression, and patient perceptions of heart disease. RESULTS: Overall, participants reported high levels of medication adherence, although 63% reported some level of non-adherence. Total medication adherence (never deviating from the regimen) was more likely to be reported by older participants, those with no formal educational qualifications, those with a personal history of cardiovascular disease, those with a lower total cholesterol level, and those with a greater difference between untreated cholesterol levels and current cholesterol levels. The illness perceptions associated with reported total adherence were lower perceived risk of raised cholesterol, perceiving greater control over FH, and perceiving genes and cholesterol to be important determinants of a heart attack. Emotional state was not associated with medication adherence. In logistic regression analysis, predictors of total medication adherence were having personal history of cardiovascular disease, having no formal qualifications, and perceiving genes to be important determinants of a heart attack. CONCLUSIONS: Both clinical factors and patients' illness perceptions were associated with self-reported cholesterol-lowering medication adherence. The association with illness perceptions was small and many of these associations may be a consequence, rather than a cause, of greater adherence. Given this, intervention strategies aimed at helping patients' to establish routines for medication taking may be more effective in increasing adherence than interventions designed to alter perceptions related to taking statins.

Anticholesteremic Agents↗
PubMed2000

Application of HEDIS measures within a Veterans Affairs medical center.

OBJECTIVE: To pilot test 3 HEDIS performance measures--beta-blocker treatment after a heart attack, ambulatory follow-up after hospitalization for mental illness, and cervical cancer screening--within a Veterans Affairs (VA) medical center. STUDY DESIGN: Retrospective review of administrative data. For 1 performance measure (beta-blocker treatment after a heart attack), a medical record review was performed for purposes of data validation. METHODS: The eligibility criteria differed by the performance measure. Eligible populations for the first, second, and third performance measures, respectively, were: (1) patients aged 35 years or older who were hospitalized and discharged alive with a primary diagnosis of acute myocardial infarction in calendar year 1996; (2) patients hospitalized for treatment of selected mental health disorders in fiscal year 1997; and (3) female patients aged 21 to 64 years enrolled in VA primary care clinics during fiscal years 1995-1997. We collected data in accordance with HEDIS 3.0 specifications for administrative data. RESULTS: With few or no modifications to the HEDIS specifications, we successfully adapted the HEDIS performance measures to the VA setting. We found that, in some areas, VA performance compared favorably to or exceeded that of the private sector. We also identified opportunities for quality improvement. CONCLUSIONS: HEDIS performance measures can be applied within the VA system, both as a means of quantifying performance and as a tool for improving the quality of care. Adopting HEDIS measures would provide additional value to VA medical centers by allowing them to compare their performance with that of private-sector providers.

Adrenergic beta-Antagonists↗
PubMed1991

Abnormal hormonal and renal responses to saline load in hypertensive patients with parental history of cardiovascular accidents.

BACKGROUND: Acute cardiac and cerebrovascular accidents are more frequent in hypertensive subjects with a family history of acute vascular accidents. The mechanisms underlying the susceptibility to vascular disease in these subjects are unknown. We investigated whether a parental history of premature heart attack or stroke in hypertensive subjects is associated with abnormalities of sodium handling. METHODS AND RESULTS: Patients with mild, uncomplicated essential hypertension were divided into two subgroups according to family history: a subgroup with a parental history of premature heart attack or stroke (FV+, n = 18) and a subgroup with a family history completely negative for vascular accidents (FV-, n = 14). The two subgroups were comparable with respect to age, weight, sex distribution, blood pressure, duration of hypertension, cardiovascular risk factors, renal function, and organ damage. Baseline plasma renin activity (PRA), concentrations of aldosterone (PA), atrial natriuretic factor (ANF), and norepinephrine, and urinary electrolyte excretion were also comparable in the two subgroups. Despite these similarities, the responses to an acute saline load, measured under controlled metabolic and experimental conditions, were different in the two subgroups. In the FV+ subgroup at 60 minutes of saline load, PRA fell by 1.0 +/- 0.2 ng/ml/hr and PA concentration by 89.4 +/- 26 pg/ml and ANF concentration increased by 38 +/- 9 pg/ml, whereas in the FV- subgroup the corresponding responses were -2.3 +/- 0.3 ng/ml/hr (p less than 0.005), -190 +/- 43 pg/ml (p less than 0.05), and 80 +/- 13 pg/ml (p less than 0.005), respectively. Urinary sodium excretion was delayed in the FV+ subgroup (270 +/- 67 mu eq/min at 60 minutes) compared with the FV- subgroup (555 +/- 157 mu eq/min at 60 minutes, p less than 0.05). At 120 minutes of saline load, significant (p less than 0.005) differences in PRA and ANF concentration were still observed. In a control group of eight normal subjects the responses to a saline load were comparable to those in the FV- subgroup but greater than those in the FV+ subgroup at 60 minutes. CONCLUSIONS: These results provide evidence that the hormonal and renal adjustments to an acute salt load are impaired in hypertensive patients with a parental history of vascular accidents. We speculate that abnormalities of sodium handling may represent markers of a more rapid development of vascular injury in human hypertension.

Adult↗
PubMed1990

Exercise and arthritis. The hematology of inactivity.

Arthritis tends to promote inactivity, and inactivity tends to promote an unhealthful constellation of blood abnormalities that increases the risk of heart attack and stroke. The hematology of inactivity comprises the following: low plasma volume, high hematocrit, high plasma fibrinogen, elevated blood viscosity, increased platelet aggregability, and diminished fibrinolysis. Regular exercise reverses all these adverse blood changes and, thereby, helps prevent heart attack and stroke. Simply put, exercise "improves" the blood, making it flow more easily and clot less readily. This "healthy hematology of exercisers" is one more reason why prudent exercise is as vital for patients with arthritis as it is for the rest of us.

Arthritis↗
PubMed1991

[Anatomical and coronary angiography data on coronary anastomosis].

Beyond two series of heart studies (anatomical with 150 hearts treated by injection-corosion method, and angiographic with 211 coronarography 3 days after a heart attack) the authors have noticed 92 coronary anastomosis with: 28 right homolateral 22 left homolateral 42 contralateral The existence of these anastomosis has been confirmed by coronarography of 30 out of 173 patients having a significant lesion of the artery responsible for the heart attack. The authors noticed also that these anastomosis are effective when the coronary system is deficient and the supplies are ensured by the other artery. The study permits to distinguish two groups of functional collateral: the functional collateral spontaneously observed during coronarography recruitable collaterals which are ready to be functional in case of main coronary artery obstruction.

Collateral Circulation↗
PubMedDate not supplied

Symptoms of acute myocardial infarction: expectations of a community sample.

OBJECTIVE: To identify the lay public's expectations of the symptoms of acute myocardial infarction (AMI). DESIGN: Street-intercept survey method. SETTING: Four neighborhoods in a large metropolitan area. SAMPLE: One hundred ninety-seven women and 217 men. INSTRUMENT: The Representation of Heart Attack Symptoms questionnaire (RHAS), a 48-item instrument that identifies subjects' expectations concerning the associated symptoms of AMI and the location, quality, and intensity of the discomfort of AMI. RESULTS: The symptoms most individuals expected during AMI included: chest pain, irregular heart beats, inability to move, and shortness of breath. The locations selected as most likely included: middle, left, and right side of the chest, upper and lower back. The most common descriptors of the expected discomfort were "tight," "pressure," and "heaviness." More than 88% of subjects expected the intensity of a heart attack to be at least a 9 on a scale of 0 (No discomfort) to 10 (The most discomfort imagined). CONCLUSIONS: The lay public have both accurate and inaccurate expectations about the symptoms of AMI.

Adult↗
PubMedDate not supplied

Use and outcomes of a cholesterol-lowering intervention for rural elderly subjects.

Few studies have evaluated the efficacy of cholesterol-lowering interventions in a community setting and have included a control or comparison group. As part of a preventive health demonstration project in rural Pennsylvania, Medicare beneficiaries underwent cholesterol screening to identify high-risk individuals with serum cholesterol levels > or = 240 mg/dL. These high-risk individuals were randomized to a cholesterol-lowering intervention through either local hospitals or physicians' offices or to a control group. Baseline and follow-up serum cholesterol levels collected two to three years later were compared according to service location (hospital versus physician's office), intervention attendance, degree of participation, baseline heart disease history, and cholesterol-lowering medication use at follow-up. Serum cholesterol levels decreased between 5.7% and 6.6% in the hospital-based and physician-based groups, as well as in a control group not offered the intervention. Participation rates did not differ between treatment groups, nor did participation affect serum cholesterol levels. Attendance level and heart disease history were not associated with a greater decrease in serum cholesterol levels. Individuals reporting cholesterol-lowering drug use at follow-up had significantly higher baseline serum cholesterol levels and a significantly greater decrease in total serum cholesterol (P < .0001) than those not on medication. Both nonpharmacological (diet) and pharmacological (drug) interventions will reduce serum cholesterol levels and heart attack risk. The study results suggest that, at least for older individuals, the impact of nonpharmacological interventions on the community is minimal. We conclude that only very aggressive treatment will significantly loser serum cholesterol levels in older individuals at risk for heart attack.

Aged↗
PubMed2006

Missing data methods for the assessment of surrogate outcomes and treatment mechanisms in clinical trial substudies.

Hypotheses about the mechanisms of action by which a treatment affects a clinical outcome may prompt consideration of an alternative outcome as a potential surrogate. In many cases, due to costs or other factors, the candidate for surrogacy will only be measured for patients randomized to a substudy within the main trial. In this situation, the substudy patients provide information about links between the true and surrogate outcomes and the treatment, and these links can be exploited, using methods for handling missing covariates, to allow available information for patients not in the substudy to be incorporated into the analysis. The increased precision with which the treatment effect can be estimated using these methods, compared with using substudy data alone, in turn allows more precise estimates of measures of surrogacy. This paper reviews and compares some methods for handling missing covariate data and applies the methodology to a large heart attack trial, in order to investigate the properties of four measures for assessing the extent to which early response to thrombolytic therapy, as measured by an improvement in coronary blood flow, can be regarded as a surrogate for 30-day survival following heart attack. Design issues for substudies intended to assess treatment mechanisms are also considered. In particular, we consider how the precision of surrogate measures varies with the size of the substudy relative to the main trial. The results suggest that for reasonable surrogates, substudies substantially smaller than the main study can extract most of the available information regarding surrogacy.

Biomarkers↗
PubMed1992

Monitoring the incidence of myocardial infarctions: applications of capture-mark-recapture technology.

It is critical to monitor the incidence of myocardial infarction. Typically, death certificates have been used as a proxy for incidence, however, these have been found to be crude as they lag behind changes in incidence. In the last decade several myocardial infarction registries have been established, however, these registries are still too limited in geographical spread to assess either national or global trends of heart attack. Here we suggest that employing an alternate approach, that of capture-mark-recapture, would be helpful to provide accurate monitoring both within and between countries. This method would complement existing registries by providing a simple and inexpensive means to provide accurate heart attack data across broad geographical areas and time.

Cohort Studies↗
PubMed2006

Thrombolysis: past, present, and future.

Management of myocardial infarction evolved because of understanding of underlying disease processes and clinical trials of "chemical" and "mechanical" clot dissolution that reduced in-hospital mortality. Meta-analysis comparing these treatment strategies marginally favours angioplasty. Current European Society of Cardiology guidelines propose primary angioplasty as the preferred therapeutic option but few units in the UK can offer angioplasty on demand as a designated "heart attack centre". Thrombolysis will continue as it is widely available and training needs and costs less than angioplasty. Community thrombolysis should be made available for those patients who do not wish for such aggressive intervention or as a prelude to transfer time to a heart attack centre distant from a triage hospital.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Consumers' perceptions about risk of and access to nonprescription medications.

OBJECTIVES: To examine how consumers balance the principles of safety with regulatory access to pharmaceuticals and to identify respondent characteristics, including prior misuse of nonprescription medications, that are associated with a preference for nonprescription status. DESIGN: Cross-sectional survey within-subject attitudinal analysis. SETTING: Large midwestern metropolitan region of the United States. PARTICIPANTS: Convenience sample of 553 members of the general public. INTERVENTIONS: Anonymous self-administered surveys with hypothetical vignettes in which a heartburn or antihypertensive drug could be available without a prescription but in doing so would entail an increased risk (1/100,000, 1/10,000, or 1/1,000 chance of heart attack) to the user that would not be present with the medical care afforded by prescription drug status. MAIN OUTCOME MEASURE: Proportion of respondents preferring nonprescription availability. RESULTS: Overall, 33%, 19%, and 11% of respondents preferred nonprescription availability when the additional risks of a heart attack with nonprescription availability were 1/100,000, 1/10,000, and 1/1,000, respectively. Risk tolerance did not differ between the heartburn and antihypertensive vignettes. Although preference for nonprescription status was significantly greater among respondents who were men (42% versus 28%) and white (42% versus 32%), and a statistical trend was evident among respondents with higher self-reported health (37% versus 27%) and a college education (36% versus 28%), most of these differences did not persist on multivariate analysis. CONCLUSION: A substantial minority of the public appears willing to accept considerable risk to gain greater access to pharmaceuticals. Heterogeneity among the general public with regard to how safety and access to nonprescription medications should be balanced challenges policy makers working to design responsive yet appropriate regulatory policies.

Adult↗
PubMed2003

Patients' views of high blood pressure, its treatment and risks.

OBJECTIVE: To examine the understanding and beliefs of a sample of Australian patients about high blood pressure and its therapy, and to examine the accuracy of their assessment of their own risk. METHOD: A cross sectional study in two general practices in Perth, Western Australia. Interviews were conducted with 55 consecutive patients aged 40-80 years of age with uncomplicated hypertension. Qualitative and quantitative data were collected on patients' beliefs about the nature, symptoms, causes and treatment of high blood pressure as well as their adherence to antihypertensive medications during the preceding month. Patients also estimated their own risk of stroke or myocardial infarction. RESULTS: Two-thirds of the patients (65%) described high blood pressure within an appropriate biomedical definition. Forty-five percent attributed a variety of symptoms to their high blood pressure while 55% believed that stress was a cause of their high blood pressure. Three-quarters (73%) were fully adherent to their medications in the preceding month. Seventy-one percent and 62% of patients were aware that stroke and heart attack respectively are possible consequences of high blood pressure. They significantly overestimated their risk of stroke and myocardial infarction. CONCLUSION: One-third of treated hypertensive patients are poorly informed about the causes and effects of hypertension, and overestimate their risk of both stroke and heart attack, as well as the benefit derived from treatment.

Adult↗
PubMed2006

Predictors of healthcare utilization among older Mexican Americans.

OBJECTIVE: To examine the effects of predisposing, enabling, and need factors on physician and hospital use among older Mexican Americans. DESIGN: A two-year prospective cohort study. SETTING: Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: A population-based sample of 1987 non-institutionalized Mexican American men and women age > or =65 years. MAIN OUTCOMES MEASURES: Physician and hospital utilization. Predictor variables included predisposing, enabling, and need factors. Ordinary least square and logistic regression analysis were used to model the effects of predictor factors specified in the Andersen model of health service use on physician and hospital use. RESULTS: After two years of follow-up, predisposing and enabling factors accounted for <5% of the variance in physician and hospital use. Need factors explained 21% of the variance in physician use and 7% of the variance in hospital use. Older age; being female; insurance coverage; having arthritis, diabetes, heart attack, hypertension, stroke, or cancer; and number of medications were factors associated with higher physician utilization. Subjects with arthritis, diabetes, hip fracture, high depressive symptoms, activities of daily living (ADL) disability, or high number of medications increased the odds of having any hospitalization. Subjects with diabetes, heart attack, hip fracture, ADL disabled, and high number of medications had a greater number of hospital nights than their counterparts. CONCLUSIONS: Older age, female sex, insurance coverage, and prevalent medical conditions are determinants of healthcare use among older Mexican Americans.

Aged↗
PubMed2003

Do health control beliefs predict behaviour in Russians?

BACKGROUND: Unhealthy lifestyles contribute substantially to Russia's high mortality. Health control beliefs influence lifestyles to some extent in the West but this relationship is not well studied in Russia. METHOD: Data from a 1996 cross-sectional interview study in a multistage random Russian population sample (n=1599, response rate 66%) were analysed. These were belief in the ability to influence general health, risk of heart attack, or cancer; the prevalence of smoking, drinking alcohol several times weekly, binge drinking (>80 g alcohol per occasion), and obesity (self-reported body mass index >30); and several social characteristics. RESULTS: Believing one could influence one's health (prevalence 63%) and reduce the risk of a heart attack (42%) and cancer (30%) was associated with younger age, male sex, and higher income after controlling for other socioeconomic factors. Associations between health control beliefs and behaviours were generally weak and inconsistent. Men believing they could influence their general health were somewhat less likely to smoke or drink regularly. Fewer women who believed that they could reduce their risk of cancer were obese. CONCLUSIONS: Health control beliefs, commoner in younger and better off Russians, were weakly related to behaviours. This has implications for designing interventions to change health behaviours in Russia.

Adolescent↗
PubMed1987

Family history of diabetes and cardiovascular disease risk factors and mortality among euglycemic, borderline hyperglycemic, and diabetic adults.

In a prospective population-based study begun in 1972 in Rancho Bernardo, California, the association of cardiovascular disease risk factors, at baseline, with a family history of diabetes and subsequent death from cardiovascular disease was investigated among 3,081 euglycemic, 1,290 borderline hyperglycemic, and 347 diabetic adults between 20 and 79 years of age. The main difference in risk factor distribution was in diabetic men and women 20-49 years of age, of whom those with a family history of diabetes were older and had higher levels of fasting plasma cholesterol and triglyceride. In addition, in all age-sex-diabetes status groups, those with a family history of diabetes included a greater proportion with a family history of heart attack. In five out of 12 groups, the association was statistically significant. Significant independent predictors of cardiovascular disease mortality in euglycemic and borderline hyperglycemic adults were age, sex, cholesterol, and systolic blood pressure, while fasting plasma glucose was a significant predictor in euglycemic adults only. Family history of heart attack was significantly associated with cardiovascular disease mortality in euglycemic and borderline hyperglycemic adults. Family history of diabetes was not significantly associated with mortality risk in any of the three groups, but the risk followed an increasing trend from euglycemic (0.89) to borderline hyperglycemic (1.17) to diabetic (1.31) adults.

Adult↗
PubMed2004

Serum lipid profiles and homocysteine levels in adults with stroke or myocardial infarction in the town of Gombe in northern Nigeria.

While the incidence of infectious diseases has been on the decline in developing countries, the toll of cardiovascular diseases, including stroke and myocardial infarction, has been increasing. The impression of physicians in certain regions of the western Sahel, including the state of Gombe in northeastern Nigeria, is that macrovascular disease in the indigenous population is on the rise. This study was, therefore, undertaken to compare well-established risk factors for cardiovascular disease in a group of 53 men (n=34) and women (n=19) in the town of Gombe who had suffered a stroke or heart attack with the corresponding parameters in 48 age- and gender-matched healthy adults living in the same environment. The parameters of cardiovascular diseases considered were: overweight and obesity, blood pressure, lipid profiles, and homocysteine. While the male and female patients who had suffered stroke (n=48) or heart attack (n=5) were borderline hypertensive, their mean body mass index values were not different from the corresponding values of their control groups. Although the serum homocysteine levels of the patients and controls were not significantly different, 85% of the stroke patients had serum homocysteine levels greater than 10 microM. These high homocysteine levels could not be accounted for by sub-optimal folate or vitamin B 12 status. The serum levels of HDL-cholesterol and triglyceride were not significantly different between the male and female patients and their respective controls. However, the males, but not the females, with macrovascular disease had significantly higher levels of total cholesterol (161 vs 137 mg/dL, p=0.04) and LDL-cholesterol (91 vs 70 mg/dL, p=0.02). In addition, both female and male stroke/myocardial infarction patients exhibited an elevated LDL-cholesterol/HDL-cholesterol ratio. These results indicate that blood pressure and the LDL-cholesterol/HDL-cholesterol ratio are associated with stroke and myocardial infarction in adults in northern Nigeria, thereby creating potential opportunities for possible public-health interventions.

Case-Control Studies↗
PubMedDate not supplied

Effects of a 12-week cardiac rehabilitation exercise program on motivation and health-promoting lifestyle.

OBJECTIVE: The purpose of this study was to determine the effects of a 12-week cardiac rehabilitation exercise program on the motivation and lifestyle of persons recovering from a recent heart attack or cardiac-related procedures. DESIGN: The study design was a pretest and posttest quasi-experimental, nonrandom assignment. SETTING: The study was conducted at 4 cardiac rehabilitation centers in Northeast Ohio. SUBJECTS: The study included 57 participants in a cardiac rehabilitation exercise program (mean age = 64 years) and 57 comparisons (mean age = 64.6 years) who recently had a heart attack or underwent cardiac-related procedures. OUTCOME MEASURE: Motivation and health-promoting lifestyle were measured. INTERVENTION: A 12-week cardiac rehabilitation exercise program for small groups of participants (fewer than 12 persons) was conducted. The program provided arm and leg exercises 3 times a week for 30 to 60 minutes per session at an intensity of 60% to 90% of the maximum heart rate. RESULTS: Analysis of covariance was used to analyze the data. After controlling for education, income, and pretest scores, the exercise group scored significantly higher than the comparison group in most motivation-related variables. Regarding lifestyle, after adjusting for the control variables both groups showed positive changes during the 12-week period, but no significant difference was found between the 2 groups in overall lifestyle. CONCLUSION: The findings of the study confirmed that motivational variables were modifiable. Thus, when developing health promotion programs for initiating and maintaining a healthy lifestyle, the relative importance of different motivational variables should be considered.

Adult↗