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Coronary artery disease in women is associated with higher morbidity and mortality than in men. The purpose of this article is to summarize recent literature concerning gender-based differences. Specific differences in pathophysiology, traditional and psychosocial risk factors, symptom presentation, treatments, and outcomes between women and men will be reviewed.
Since thyroid hormones in a particular degree increase the need of oxygen of the heart, in a present coronary heart disease must be differentiated between the advantages of a treatment with thyroid hormones and the disadvantages of a deterioration of the angina pectoris and the dangers of a myocardial infarction, respectively, which are to be expected by this. In general one will be reserved with a thyroxine therapy in patients with a bland struma and coronary heart disease. In hypothyreotic patients one has to find out the individual optimum dosis, in which cases all the cardiological measures for the treatment of the coronary heart disease must be used. This optimum dose is a compromise between the inconveniences of the hypothyreosis and the danger of the coronary heart disease. Often a slightly hypothyreotic metabolic condition must be kept, in order not to endanger the patient.
BACKGROUND: The objective of this study was to investigate in patients with unstable angina and significant coronary stenosis (> 70%) whether or not the morning peak of myocardial ischemia is associated with a reduction in the ischemic threshold. The morning increased incidence of ischemic episodes in stable angina appears to be attributable to a coincidence of several factors. Patients with unstable angina who remain at bed rest, however, also present a similar morning increased incidence of ischemia, but its mechanisms are not completely understood. METHODS AND RESULTS: The ischemic threshold was assessed by atrial pacing at 7 to 8 AM and at 12 to 1 PM in 46 patients. In the 34 with a positive pacing response (ST segment shift > 1.0 mm), ischemic threshold was lower at 7 to 8 AM than at 12 to 1 PM (131 +/- 16 versus 139 +/- 15 beats per minute, P < .001), whereas in the remaining 12 patients, the pacing response was negative. Moreover, 4 patients presented ST segment elevation during pacing in the morning but only 1 at noon and at a higher threshold. Baseline heart rate and diastolic blood pressure were higher at noon than in the morning (81 +/- 16 versus 76 +/- 13 beats per minute, P < .01, and 87 +/- 11 versus 82 +/- 10 mm Hg, P < .05). CONCLUSIONS: The morning lowering of ischemic threshold in the absence of increases in baseline blood pressure or heart rate suggests that a reduced coronary vasodilator capacity or an increased coronary tone may favor the increased incidence of ischemic events during this interval.
Bloodfilling of myocardial capillaries was determined morphometrically on the material of 12 autopsy observations of sudden coronary death (patients of 42-60 years) and 6 control observations of sudden death (subjects of 40-51 years), and these data were compared with the degree of stenosis of coronary arteries of the heart. Almost two-fold decrease of bloodfilling in sudden death was found alongside with marked increase of uneven pattern of bloodfilling. Bloodfilling was particularly decreased in the basal parts of the left ventricle and in the interventricular septum. Blood supply in much better in the apical parts of the left ventricle and the right ventricle. A trend for reverse correlation between the blood supply of the capillaries and the degree of stenosis of coronary arteries was observed.
Coronary artery disease (CAD) and peripheral arterial disease (PAD) are significant medical problems worldwide. Although substantial progress has been made in prevention as well as in the treatment, particularly of CAD, there are a large number of patients, who despite maximal medical treatment have substantial symptomatology and who are not candidates for mechanical revascularization. Therapeutic angiogenesis represents a novel, conceptually appealing treatment option. Ad(GV)VEGF121.10 (BIOBYPASS) is an adenovector, carrying the transgene encoding for human vascular endothelial growth factor 121 (VEGF(121)). A number of preclinical studies have demonstrated angiogenic activity of BIOBYPASS, not only anatomically but also functionally. Phase I clinical studies have demonstrated that intramyocardial infection of BIOBYPASS in patients with severe CAD as well as intramuscular injections of BIOBYPASS in patients with severe peripheral vascular disease (PVD) was well tolerated; furthermore, these studies provided some intriguing indications of activity, which led to initiation of major randomized Phase II "proof-of-concept" studies. This paper provides a review of the rationale behind BIOBYPASS as well as a summary of pertinent preclinical and early clinical data.
To study the effect of small amounts of ethanol 1 ml whisky (43 vol. %) per kg body weight was given to normal subjects (n = 11) and patients with coronary heart disease (n = 11) and the systolic time intervals (STI) PEP (preejection period), LVET (left ventricular ejection time), QS2 (total electromechanical systole) and PEP/LVET were measured. A control group consisted of five patients with coronary heart disease. The following results were obtained: Already at rest PEP/LVET was significantly higher in patients with coronary heart disease. After the ingestion of alcohol, significant changes of the STI were observed; mainly an increase of PEP and PEP-LVET was found. In patients with coronary heart disease the effect began earlier, was significantly higher and lasted significantly longer than in normal subjects. According to invasive correlation-studies of different authors, these results indicate an impairment of left ventricular function, especially of ejection fraction and contractility. These alterations seem to be more pronounced in patients with coronary heart disease. The results of this study should be considered in advising patients with coronary heart disease.
Basing on results of first screening of the Pol-MONICA Project in 1984 in two centres that is the Tarnobrzeg province and two districts of Polish capital Warsaw (Praga South and Praga North) the level of 11 main coronary disease risk factors was compared in 2469 men and 2729 women. The following 5 risk factors were statistically significant for both men and women: the Durnin index of body fat content, the total cholesterol concentration in the plasma, triglyceride level, numbers of daily meals. The mean level of two factors that is the HDL-cholesterol concentration and the HDL-cholesterol/total cholesterol ratio was lower in the Warsaw sample what speaks in favor of concept that the ischemic heart disease threat is greater in that population. Among men the Warsaw population exhibited moreover the significantly higher value of diastolic blood pressure as well as of Quetelet body mass index; age and numbers of cigarettes smoked daily has also been higher in that population. In women from the Tarnobrzeg province ++ the diastolic blood pressure was higher than that in the Warsaw population. The two populations studied showed also highly significant differences so far as the complex of all 11 features is concerned what enabled the qualification of 72.3% of men, and 68.4% of women as belonging to the big city population or to the agricultural-industrial population using the discriminant Fisher function.
Myocardial perfusion imaging and stress echocardiography play a major role in the non-invasive evaluation of patients with known or suspected coronary artery disease. Data of the literature indicate that the two techniques are practically equivalent for the diagnosis of coronary artery disease. However, tomoscintigraphic imaging is more sensitive than exercise echocardiography for localizing lesions, correctly identifying the presence of multivessel coronary disease and distinguishing viable from nonviable myocardium in a ventricular territory with abnormal contraction. Both techniques require specialized equipment and technical expertise and thus, in a given institution, one technique could be more accurately performed and provides better results. Therefore, it is preferable to underline the complementary aspects of the two techniques rather than opposing them to each other.
OBJECTIVES: Evaluate the prevalence, incidence and impact on prognosis of existing and new onset atrial fibrillation (AF) in patients with stable, symptomatic coronary artery disease. DESIGN: Data from the 7 665 participants included in the ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine GITS) trial was used. RESULTS: Over a mean follow-up of 4.9 years, the incidence of recurrent AF in patients with AF at baseline (4.1%) was 13.5/100 patient-years and 1.64/100 patient-years for patients without baseline AF. Patients with AF at baseline had increased mortality and new overt heart failure. New onset AF was associated with increased morbidity and mortality and in particular soon after onset. [adjusted 30-day relative risk for mortality 23, 95% CI 14-36; for debilitating stroke 37, 95% CI 18-77; and for heart failure 54, 95% CI 32-93]. The incidence of AF was not affected by treatment with nifedipine GITS. CONCLUSION: The presence of AF in patients with stable symptomatic CAD is an independent risk factor and in particular in the first 30 days for subsequent mortality and morbidity.
Nitrates still play an important role in the treatment of coronary heart disease after more than hundred years of use in this indication. Following oral administration, they undergo intense gastric hydrolysis, and are largery destroyed by the first-pass effect. The development of an attenuation phenomenon of the therapeutic effect has been frequently reported during continuous treatments at fixed doses. Percutaneous administration of nitroglycerin due to the development of transdermal devices palliates these various obstacles. Trinipatch is a small, transparent, matricial, monolayer patch with an absorption promoter, marketed in two dose-strengths (5 mg/24 h and 10 mg/24 h) by Laboratoires Synthelabo. Its systemic and local safety and clinical efficacy were studied by 383 private cardiologists and 2,294 general practitioners in 5,079 coronary patients, between the ages of 19 and 91 years, in two open, multicentre trials lasting 3 months. The systemic safety, assessed by adverse event reporting, was good. 2.7% of patients experienced adverse events, but only 0.3% of patients presented a serious adverse event. The effects most frequently encountered were vasodilator effects. A very good stability of cardiovascular parameters was observed, with no reflex tachycardia. The local safety, evaluated by the Draize scale, was also satisfactory; after 1 month and 3 months of treatment, 6.6% and 5.7% of patients presented erythema, usually isolated and moderate. The clinical efficacy was evaluated by subjective criteria in the 740 patients included by cardiologists. A significant reduction of the number of angina attacks and the numbers of doses of nitroglycerin was observed. The percentage of pain-free patients increased from 18.2% at the start of the study to 76% at the end of the trial. These two trials confirmed the good systemic and local safety and clinical efficacy of Trinipatch.
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