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At least 1,207 records · Page 67Linked to original sources
PubMed1998

Gender differences in accessing cardiac surgery across England: a cross-sectional analysis of the health survey for England.

OBJECTIVE: To examine gender differences in access to cardiac surgery in a nationally representative sample. DESIGN: Nationwide cross sectional household based survey (Health Survey for England). SETTING: Private households in England around 1993 and 1994. SUBJECTS: 1708 subjects reporting a history of either doctor diagnosed angina or heart attack from a stratified random sample of 32 378 people aged 16 and above. OUTCOME MEASURE: The proportion reporting having had cardiac surgery or on a waiting list. RESULTS: 13.5% reported previous (n = 206) or pending (n = 25) cardiac surgery. Men were more likely than women to have had or to be waiting for cardiac surgery (19.1% of men versus 6.8% of women, chi2 54.7, P<0.001). This finding was consistent regardless of age group and across three regional areas. The unadjusted odds ratio for cardiac surgery for men versus women was 3.3 (95% Cl 2.3, 4.5, P<0.001) and was only slightly attenuated to 2.8 (95% CI 1.9, 4.0. P<0.001), after adjustment for other factors. The gender difference remained even when analysis was restricted to subjects reporting a previous heart attack, and after statistical adjustment for disease severity. CONCLUSION: Women are less likely than men to receive cardiac surgery across all age groups and regional areas. These results include private operations and adjust for individual behavioural data. Neither disease severity or co-morbidity explains these discrepancies. Further studies are required to determine why this inequality occurs and how it can be addressed.

Adolescent↗
PubMed1989

Diuretic agents versus beta-blockers. Comparison of effects on mortality, stroke, and coronary events.

Three recently concluded large randomized clinical trials have compared the preventive effects of diuretic agents and beta-blockers in the treatment of approximately 22,000 subjects with hypertension. In the Medical Research Council trial, bendrofluazide (10 mg daily) was compared with a dose of propranolol (as much as 240 mg daily), a nonselective beta-blocker without intrinsic sympathomimetic activity. Two selective beta-blockers, atenolol (100 mg daily) and metoprolol (200 mg daily), were compared with bendrofluazide (5-10 mg daily) and hydrochlorothiazide (50-100 mg daily) in the Heart Attack Primary Prevention in Hypertension trial. In the International Prospective Primary Prevention Study in Hypertension, 160 mg of slow-release oxprenolol, a beta-blocker with intrinsic sympathomimetic activity, was compared with a diuretic-based regimen not containing beta-blockers. In each trial, similar reductions in mean diastolic blood pressure were achieved with diuretic and beta-blocker treatment that lasted for several years. All-cause mortality and fatal and nonfatal stroke and coronary event rates were also similar in the treatment groups. Thus, it appears that beta-blockers are as effective as diuretic agents in improving survival and in preventing major morbid events. Regarding cigarette smoking and stroke incidence, observations based on post hoc subgroup analyses of the Medical Research Council trial were not supported by subgroup findings in the Heart Attack Primary Prevention in Hypertension and the International Prospective Primary Prevention Study in Hypertension trials, and these observations should not form the basis for any treatment recommendations.

Adrenergic beta-Antagonists↗
PubMed2006

A community intervention by firefighters to increase 911 calls and aspirin use for chest pain.

OBJECTIVES: To test the effectiveness of an intervention, delivered face-to-face by local firefighters, designed to increase utilization of 911 and self-administration of aspirin for seniors experiencing chest pain. METHODS: King County, Washington was divided into 126 geographically distinct areas that were randomized to intervention and control areas. A mailing list identified households of seniors within these areas. More than 20,000 homes in the intervention areas were contacted by local firefighters. Data on all 911 calls for chest pain and self-administration of aspirin were collected from the medical incident report form (MIRF). The unit of analysis was the area. Firefighters delivered a heart attack survival kit (that included an aspirin) and counseled participants on the importance of aspirin and 911 use for chest pain. Main outcome measures were 911 calls for chest pain and aspirin ingestion for a chest pain event, obtained from the MIRFs that are collected by emergency medical services personnel for 2 years after the intervention. RESULTS: There were significantly more calls (16%) among seniors on the mailing list in the intervention than control areas in the first year after the intervention. Among the seniors who were not on the mailing list, there was little difference in the intervention and control areas. The results were somewhat sensitive to the analytical model used and to an outlier in the treatment group. CONCLUSIONS: A community-based firefighter intervention can be effective in increasing appropriate response to symptoms of a heart attack among elders.

Aged↗
PubMed1989

Using the WHO (Rose) angina questionnaire in cardiovascular epidemiology.

During 1978-80, 7735 men aged 40-59 took part in a screening examination which included an administered version of the WHO (Rose) questionnaire on chest pain. Those men who had 'possible' angina were as likely to have an ischaemic electrocardiogram at rest as those with 'definite' angina. Furthermore, the heart attack rate over 7.5 years was similar in men with 'definite' and 'possible' angina and did not diminish with length of follow-up. Five years after the initial screening 98% of the surviving men replied to a postal questionnaire which included a self-administered version of the chest pain questionnaire. Age-specific prevalence rates of angina based on the administered questionnaire at screening and on the self-administered postal version five years later, were similar. Men who had angina ('definite' or 'possible') on both occasions had the highest prevalence rate of ischaemic electrocardiograms, men who were positive on only one occasion had intermediate rates and those who were negative on both occasions had the lowest rates. We conclude that in cardiovascular studies of middle-aged men which use the WHO (Rose) questionnaire for the purposes of determining prevalence or assessing risk of a heart attack, angina should include both 'possible' and 'definite' angina.

Adult↗
PubMed2004

The impact of the preventive medical message on intention to change behavior.

Clinicians counsel patients to adopt behaviors to reduce health risks. We studied, in the case of coronary artery disease, the impact of those parts of the preventive medical message clinicians can vary. We asked 150 French people (86 aged 20-30, 64 aged 60-80) to rate their intention to adopt a specific behavior-take medication, change their diet, or start exercising-in 64 scenarios, composed of two severities of disease manifestations (angina pectoris or heart attack); four levels of its probability of occurrence (5, 10, 15, or 20%) and the associated time horizon (20, 15, 10, or 5 years, respectively); and two levels of controllability of the risk (entirely under your control or not much you can do to reduce it). We found that all four parts of the message had significant main effects and did not interact with each other. Older participants had greater intention to adopt preventive behavior when the time horizon was short and younger ones when it was long. The only gender effect was that older women were more sensitive to time horizon. The message's parts were combined additively. Participants intended to change behavior even when told this would be of little use. We concluded that clinicians should, when possible, discuss all key parts of the preventive medical message; that they can, however, focus on one without reducing the others' impact; and that, at least for outcomes such as angina and heart attack, they should speak of risk with young patients using a long time horizon, with old patients using a short time horizon.

Adult↗
PubMed2006

Pathogenesis of atherosclerosis.

Atherosclerosis is a multifocal, smoldering, immunoinflammatory disease of medium-sized and large arteries fuelled by lipids. Endothelial cells, leukocytes, and intimal smooth muscle cells are the major players in the development of this disease. The most devastating consequences of atherosclerosis, such as heart attack and stroke, are caused by superimposed thrombosis. Therefore, the vital question is not why atherosclerosis develops but rather why atherosclerosis, after years of indolent growth, suddenly becomes complicated with luminal thrombosis. If thrombosis-prone plaques could be detected and thrombosis averted, atherosclerosis would be a much more benign disease. Approximately 76% of all fatal coronary thrombi are precipitated by plaque rupture. Plaque rupture is a more frequent cause of coronary thrombosis in men (approximately 80%) than in women (approximately 60%). Ruptured plaques are characterized by a large lipid-rich core, a thin fibrous cap that contains few smooth muscle cells and many macrophages, angiogenesis, adventitial inflammation, and outward remodeling. Plaque rupture is the most common cause of coronary thrombosis. Ruptured plaques and, by inference, rupture-prone plaques have characteristic pathoanatomical features that might be useful for their detection in vivo by imaging. This article describes the pathogenesis of atherosclerosis, how it begets thrombosis, and the possibility to detect thrombosis-prone plaques and prevent heart attack.

Atherosclerosis↗
PubMed1988

Are 24 hours of ambulatory ECG monitoring necessary for a patient after infarction?

The Beta-Blocker Heart Attack Trial was a randomized clinical trial of propranolol versus placebo in 3837 patients after myocardial infarction. A 24 hour ambulatory ECG was obtained before therapy in 3290 patients 2 to 21 days after myocardial infarction. Sensitivity, specificity, positive and negative predictive values, and prevalence were calculated for four definitions of ventricular arrhythmia with either total or sudden death (death in less than 1 hour of observed symptoms) as an endpoint. These indexes were obtained using the first 1, 2, 4, 6, 12, and 24 hours plus a random hour, a random daytime hour, and a random nighttime hour of the 24-hour ECG of 1336 placebo patients. For both total death and sudden death, as the duration of monitoring increased, (1) prevalence increased, (2) sensitivity increased, (3) specificity decreased, (4) positive predictive value either changed very little or decreased, and (5) negative predictive value was high (greater than 90%) and increased slightly. None of the 3 random hours offered anything beyond the first hour. The Beta-Blocker Heart Attack Trial data, which were based on an average follow-up of 25 months, show that as the number of hours of ambulatory monitoring increase, the percentages of patients identified at risk or not at risk (the positive and negative predictive values) do not change much. Twenty-four hours of monitoring does not appear to be the optimal time duration for deciding whether to treat arrhythmias in patients after infarction.

Adult↗
PubMed1990

Death from myocardial infarction: what are the benefits of early arrival at hospital and thrombolysis?

The potential benefits of early hospital care in the event of myocardial infarction were investigated in a community-based study of all suspected cases of heart attack among people aged under 70 years in the Hunter Region of New South Wales. Between August 1984 and December 1985 acute care data were collected for 1029 cardiovascular events classified as definite myocardial infarction or sudden coronary death; 516 (50%) resulted in death within 28 days from the onset of symptoms and 325 of these deaths (63%) occurred outside hospital. Of 703 people who are known to have reached hospital alive 205 (29%) did so more than four hours after the onset of symptoms. At the time of the study fewer than 1% of patients received streptokinase. To estimate the potential benefits of increased medical care an optimistic scenario was considered in which patients who arrived at hospital more than four hours after the onset of symptoms received medical attention earlier and all eligible patients received thrombolysis. Based on the results of the Second International Study of Infarct Survival (ISIS-2), if streptokinase and aspirin had been used 14% of deaths would have been averted. If, in addition, patients had arrived at hospital earlier and received optimal benefit from thrombolysis another 13% of deaths could have been avoided. These results provide a broader perspective of the potential benefits of improved medical care than can be obtained from hospital-based studies that deal only with those heart attack victims who survive long enough to reach hospital alive.

Adult↗
PubMed2006

Cardiovascular disease and risk factors among 345 adults in rural India--the Andhra Pradesh Rural Health Initiative.

BACKGROUND: Heart attack and stroke are problems already faced by some urban populations of India, but less is known about cardiovascular disease and risk factors in rural areas. The aim of the study was to investigate the levels and management of major cardiovascular risk factors and the prevalence of cardiovascular disease in two villages in rural Andhra Pradesh, India. METHODS: A cross-sectional survey was done by selecting a random sample stratified by age and gender from each village using census lists compiled in 2002. For each individual, trained study staff administered a Telugu-translation of a structured questionnaire, performed a brief physical examination and collected a fasting venous blood sample. Weighted estimates of mean (or percentages with) risk factor levels in the population were calculated and are reported with confidence intervals unless otherwise specified. RESULTS: Data was collected from 345 adults aged 20 to 90. The average household size was 4.2 and the mean combined household income was about Indian Rupees 25,454 (580 US dollars) per year. The mean systolic blood pressure was 116 (114-117) mm Hg, diastolic blood pressure 73 (114-120) mm Hg, total cholesterol 4.6 (4.5-4.7) mmol/L, HDL-cholesterol 0.8 (0.8-0.9) mmol/L, LDL-cholesterol 3.2 (3.1-3.3) mmol/L and triglyceride 1.3 (1.2-1.4) mmol/L. The prevalence of current smoking was 19.9% (15.4-24.4%), hypertension 20.3% (16.2-24.4%), diabetes 3.7% (1.8-5.5%), overweight 16.9% (12.3-21.5%) and obesity 4.4% (1.9-6.8%). A medical diagnosis of cardiovascular disease (previous heart attack, stroke or angina) was reported by 2.5% (1.1-3.9%) and a further 1.1% (0.1-2.1%) had angina by the 'Rose' classification. CONCLUSIONS: The possibility of increasing cardiovascular risk factors and prevalence of vascular disease in areas of rural India represent a public health concern. Larger and repeated epidemiological studies focusing on chronic diseases are required to inform treatment and prevention strategies suitable for use in these areas and other resource poor settings.

Adult↗
PubMed1999

Prothrombotic factors, endothelial function and left ventricular hypertrophy in isolated systolic hypertension compared with systolic-diastolic hypertension.

BACKGROUND: Individuals with systolic-diastolic hypertension (SDH, systolic blood pressure (SBP) >160 mm Hg and diastolic blood pressure (DBP) >90 mm Hg) are at increased risk of thrombotic complications, such as stroke and heart attacks, which may be related to a hypercoagulable state. Individuals with only isolated systolic hypertension (ISH; i.e. SBP >160 mm Hg but DBP <90 mm Hg) are also at significant cardiovascular risk. We hypothesized that patients with ISH would exhibit a prothrombotic state similar to that seen in SDH. A secondary hypothesis was that individuals with ISH had similar echocardiographic parameters to those seen in SDH. METHODS: We measured indices of haemorheology, endothelial dysfunction, thrombogenesis and platelet activation in 23 individuals with ISH (mean blood pressure 193/82 mm Hg), who were compared with 51 matched patients with SDH (mean blood pressure 198/112 mm Hg) and 34 age- and sex- matched normotensive healthy control individuals (mean blood pressure 130/78 mm Hg). Echocardiographic parameters in patients with ISH were compared to those from patients with SDH. RESULTS: Mean plasma viscosity (an index of blood rheology, ANOVA, P = 0.001), von Willebrand factor (an index of endothelial damage, P = 0.013), plasminogen activator inhibitor-1 and lipoprotein (a) (both markers of thrombogenesis; Kruskal-Wallis test, both P<0.001) were all significantly raised in ISH and SDH relative to controls. Individuals with SDH also had high mean plasma fibrinogen (P = 0.018) and haematocrit (P = 0.010) levels compared with control individuals. There were no significant differences in levels of fibrin D-dimer or the platelet activation marker soluble P-selectin in the hypertensive patients (i.e. ISH and SDH) compared with control individuals. Patients with ISH had similar M-mode and Doppler echocardiographic parameters compared to patients with SDH. CONCLUSIONS: We conclude that individuals with ISH have abnormalities in plasma prothrombotic factors and markers of endothelial dysfunction, and echocardiographic parameters, broadly similar to that seen in SDH. This is consistent with the increased risk of thrombotic events (strokes and heart attacks) in patients with ISH.

Aged↗
PubMed1996

Prognostic features of menopausal and postmenopausal applicants for life insurance.

The increasing proportion of the aged in the population is posing significant new challenges to politics, society and medicine as well. Gerontology and geriatrics are playing a role in all areas of preventive and curative medicine. Since the life expectancy of women is approximately eight years longer than that of men, gynecology draws special significance from the fact that the greater part of an aging society will primarily be comprise of women. The medical treatment and care of women in climacteric and postmenopause in the past is seriously inadequate by today's standards. The attitude in earlier years of not making any great investment of cost or personnel in patients over 75 can, in view of the vitality of modern-day senior citizens, no longer be justified or maintained. The necessity of establishing old-age gynecology becomes more and more clear and urgent. The decrease of ovarian function in menopause is without doubt an important turning point in the life of a woman. The first signs of aging are inescapable. Following these years a woman still has more than one third of life expectancy ahead of her which she would like to and should spend in good mental, spiritual and physical health. The principle of postmenopausal hormone replacement has shown itself to be amazingly successful in treating climacteric disorders and their effects on the entire organism. Treatment over many years with as board a spectrum as possible of preventive hormones to combat the long-term consequences of hormone deficiency, like osteoporosis-related fractures, heart attacks, or strokes, is one of the great medical advances of our time. Furthermore, the significance of preventing a number of genital concern manifestations through hormone replacement therapy cannot be overestimated. Gynecology has taken a remarkable step toward its goal of enabling aging women to spend the third part of their lives free of unnecessary diseases and suffering. In 1994, after consultation with representatives of European countries during the World Congress of the International Menopause Society, a statement was published by the menopause society of German-speaking countries. In this consensus paper, a stand was taken on hormone replacement therapy in postmenopause. The purpose of this paper was to serve as an aid in formulating and interpreting the text in the package inserts that are enclosed with hormone preparations. The most important passages were to once again summarize the present status of knowledge on hormone replacement therapy and its risks and benefits: (Estradiol is the estrogen normally produced by a woman's ovaries that exercises all functions of the natural follicle hormone. It is used to treat all symptoms of estrogen deficiency). Estrogen eliminates, or mitigates, all typical symptoms of estrogen deficiency in menopause, including hot flashes, night sweats and other complaints frequently observed like nervousness, sleep disturbance and depression, with great reliability. Estrogen stimulates the cell division of an aging organism, of mucous membranes, of supportive and connective tissue. It improves the blood circulation and the salt and water content. Furthermore, estrogen prevents or eliminates deterioration in the urogenital area and the disorders that result from such deterioration. Estrogen prevents or retards bone deterioration, osteoporosis and spinal, lower arm and femur fractures. By positively influencing HDL- and LDL-cholesterol, blood vessels and circulation, long-term estrogen replacement inhibits the development of arteriosclerosis and nearly halves the frequency of heart attacks and strokes. The mortality rate of women over 50 is therefore decreased significantly and life expectancy increased. (Benefits to the blood vessels of such preventive treatment can already be seen after five years of estrogen therapy and their benefits continue for several years after treatment is stopped.

Adult↗
PubMed1994

Modern strategies to prevent coronary sequelae and stroke in hypertensive patients differ from the JNC V Consensus Guidelines.

In recent years, government agencies of many countries have established consensus guidelines for the evaluation and treatment of hypertension. Once published, guidelines tend to be perceived as directives by a variety of health care providers. Unfortunately, these guidelines often do not reflect the practices of most hypertension experts. This report summarizes the opinions of seven hypertension experts concerning the impact of "official" guidelines on clinical practice. In addition, the individual therapeutic recommendations of these panel members are summarized. Their different treatment strategies reflect the diversity of first rate treatment plans that aim to reduce the cardiovascular sequelae in individual patients with essential hypertension. Most importantly, not one of these seven treatment strategies followed the "preferred" treatment of the U.S. guidelines, which recommend diuretics and beta-blockers as first-line therapy. The present authors approach the treatment of hypertension as a means to reduce cardiovascular events. Thus, reduction of blood pressure is not the most important therapeutic endpoint. The panel believes that whereas many different drugs can produce effective blood pressure reduction, the modern primary goal of antihypertensive drug therapy is to select a regimen most likely to prolong the quality and duration of life. In real terms, this means that the primary goal of treatment is the prevention of the major vascular sequelae of hypertension (heart attack, ventricular remodeling, hypertrophy, heart failure, and stroke) that shorten useful life. There are a number of effective hypertensive treatments, which can be selected based on individual patient requirements. However, many consensus guidelines do not allow the flexibility required to optimize individual patient treatment. As a result, health care providers should not feel compelled to regard the preferences of "official" guidelines as the best, modern, state-of-the-art therapy for an individual patient. All seven experts who are deeply involved in the daily care of patients preferred drugs other than beta-blockers and diuretics (the Joint National Committee [JNC] choices) for first-line therapy of hypertension.

Cardiovascular Diseases↗
PubMed2005

Self-awakening prevents acute rise in blood pressure and heart rate at the time of awakening in elderly people.

Self-awakening, waking up at a designated time decided before sleeping, could prevent failure in the blood circulation vessel system such as heart attack, acute increases in heart rate or blood pressure upon waking. Previous research showed that anticipatory changes occurred in heart rate prior to awakening from a short nap by means of self-awakening for young participants. However, the effects of self-awakening remained unclear for elderly people. The present study examined the effects of self-awakening on heart rate and blood pressure in a short afternoon nap (20 min) among the elderly. Nine participants [74.1 (SD = 5.01) years old] underwent both self-awakening and forced-awakening conditions. In the self-awakening condition, it was revealed that blood pressure gradually increased before the scheduled time of awakening, and that heart rate did not show a rapid increase at arousal. In contrast, forced-awakening induced acute increases in both heart rate and blood pressure. These results suggest that self-awakening facilitates a more smooth transition from sleep to wakefulness via autonomic activation before the time of self-awakening.

Acute Disease↗
PubMedDate not supplied

Implications of childhood hypercholesterolemia.

Several studies have documented that hypercholesterolemia is common in American children. Other studies have shown that elevated cholesterol levels in childhood remain elevated well into adult life. Autopsy studies of adolescents have also found a strong positive correlation between antemortem cholesterol levels and early atherosclerotic changes in their aortas and coronary arteries. Collectively, these studies provide strong and consistent evidence that atherosclerosis begins in childhood. The evidence is also overwhelming that lowering elevated low density lipoprotein cholesterol levels reduces the risk of heart attacks caused by coronary heart disease, at least among middle-aged men. As a result, routine cholesterol and coronary heart disease risk factor surveillance in childhood is both productive and appropriate. Premature coronary heart disease may be largely preventable and atherosclerosis, if not preventable, can be significantly delayed.

Adult↗