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PubMed2002

Robotic inhibition assay for determination of HMG-CoA reductase inhibitors in human plasma.

The cholesterol-lowering drug simvastatin (SIMV, Zocor reduced heart attacks by 42% in patients who had high cholesterol levels and suffered from heart disease. Upon oral administration, SIMV is quickly hydrolyzed to its beta-hydroxyacid and other acid metabolites, which are potent inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase. A Tecan-based enzyme inhibition assay has been developed to improve the existing Zymark-based assay for the determination of both active and total concentrations of HMG-CoA reductase inhibitors in human plasma. A Tecan Genesis 200 robotic workstation equipped with eight probes and customized hardware was utilized to achieve higher sample throughput and improve assay reproducibility and mechanical stability. The developed enzyme inhibition assay was validated over two concentration ranges of 0.4-20 ng equivalent/mL, and 2-50 ng equivalent/mL. Intra- and interday precision data (coefficient of variation (CV)) for both concentration ranges were less than 9%, with an accuracy of 93-107%. The interday precision for the determination of quality control (QC) samples was less than 2% and 8%, respectively. The respective interday QC accuracy values were 93-103% and 97-104%. Good linearity across the two concentration ranges was observed, with acceptable reproducibility. This improved enzyme inhibition assay has been utilized to analyze human plasma samples from several clinical studies.

Humans↗
PubMed1988

Mortality among diabetics in a national sample.

The authors compare the mortality experience of a national sample of diabetic men and women with their nondiabetic counterparts. The study population consists of respondents from the First National Health and Nutrition Examination Survey (NHANES I), conducted in 1971-1975, who were traced in 1982-1984 through the NHANES I Epidemiologic Follow-up Study. Over the nine-year follow-up period, the age-adjusted death rates for diabetic men and women were twice the rates for nondiabetics. About 75% of the excess mortality among diabetic men and 57% among diabetic women was attributable to cardiovascular disease deaths. After adjustment for age, systolic blood pressure, serum cholesterol, body mass index, and smoking, the relative risk of death was 2.3 for diabetic men and 2.0 for diabetic women. The relative risk for diabetics was highest for ischemic heart disease mortality (2.8 for men and 2.5 for women) and lowest for noncardiovascular disease deaths (1.4 for men and 1.1 for women). When subjects who reported having had a heart attack prior to the baseline examination were excluded, the relative risks for ischemic heart disease mortality among diabetics remained substantial (2.4 for men and 2.6 for women). There was little evidence that the relative risk of death for diabetics compared with nondiabetics differed by age or sex, although 95% confidence intervals around these estimates were wide.

Adult↗
PubMed1987

The accuracy and reliability of commercial heart rate monitors.

In recent years increasing emphasis has been placed on the benefits of exercise to normal healthy adults as well as to those recovering from heart attacks and other illnesses. As an aid to exercise training many portable heart-rate monitors have been placed on the market but little appears to have been done to assess the performance of these machines. The authors have examined the performance of four such monitors both under bench-test and practical exercising conditions. When tested on the bench using electronic equipment, the machines rarely exhibited errors exceeding 2-3 bpm over a measurement range of 30-240 bpm. However, when tested with subjects walking or jogging at low speeds on a treadmill, typically 20-70% of the readings given by the machines had errors of greater than 20 bpm. In some cases over 50% of readings had errors exceeding 50 bpm.

Electronics↗
PubMed2001

Intelligent system and risk of different diseases in the general population.

This is a new approach to define the risk of the general population for a specific disease. We use Bayesian theory to define the risk of the population. Analyzing the major risk factors of a disease, how they affect the incidence and/or prevalence of the disease, and the statistics of each risk factor in the population, along with the power of the Bayes theorem helps us define the risk of that population for that disease. To find out what the risk of the general population for a disease is, prospective epidemiological studies in the population shown are needed. These studies usually lead to the identification of the major risk factors for a disease and their impacts which are quite costly and requires a long time to get to the results. Also a large personnel is needed to perform effectively in the study. The result of the risk of the general population for a first heart attack using our software is in agreement with the result of the Framingham heart study. Large studies like Framingham is not available for other diseases to enable us to evaluate the accuracy of our software precisely. To overcome this shortage we have sought medical experts' evaluation of the predicted risk of the general population for other disease by this software, which needs to be completed.

Artificial Intelligence↗
PubMedDate not supplied

Emerging trends in dual energy X-ray absorptiometry.

The risk of osteoporosis and cardiovascular disease increase significantly with age. Because of the long silent latency of these diseases, there is the opportunity for primary prevention before clinical symptoms occur. The newer fan beam dual energy x-ray absorptiometry (DXA) systems can detect vertebral fractures with fast, low dose lateral scans of the vertabrae from T4 to L4 in as little as 10 s. The next generation of DXA imaging technology will image the hip in 3D and is expected to give a more accurate picture of bone density as well as the geometry and underlying strength of a bone. Visualizing abdominal aortic calcifications (AAC) as a part of a standard vertebral fracture assessment exam is a particularly valuable measurement since it is an independent measure of cardiovascular disease risk, including heart attacks and strokes.

Absorptiometry, Photon↗
PubMed1997

Autonomic reactivity and hormonal secretion in lactate-induced panic attacks.

To compare autonomic and neuroendocrine responses during lactate-induced panic attacks, heart rate variability and cortisol and atrial natriuretic hormone (ANH) levels were measured in patients with panic attacks and in healthy control subjects. In a randomized double-blind design, all subjects received either 10 ml/kg body weight of 0.5 M racemic sodium lactate or normal saline from 1100 to 1120. Spectral analysis of the R-R interval of analog electrocardiograms was performed, and total (0.001-0.45 Hz), low-frequency (0.01-0.05 Hz), midfrequency (0.05-0.15 Hz), and high-frequency power (0.15-0.45 Hz) were computed. Cortisol was measured 12 times in the period from 0900 to 1300, and ANH was measured at 1100, 1120, and 1200 by radioimmunoassay. In both panickers (n = 6) and nonpanickers (n = 8), an infusion of lactate resulted in an acceleration of heart rate, a reduction in total spectral power, and a decrease in the high- and low-frequency components of spectral power. Panickers showed a significant enhancement of the high-frequency power, whereas in nonpanickers, a shift from the mid- and high-frequency toward the low-frequency power emerged. ANH plasma concentrations during lactate infusion in panickers showed a significant increase (115 and 131% at 1120 and 1200, respectively, over concentrations at 1100) in contrast to nonpanickers (20 and 74%, respectively). No group or treatment effects on cortisol secretion emerged, which is in line with former reports. Our study supports preliminary observations that lactate-induced panic attacks enhance the release of ANH, a vasodilatator and inhibitor of sympathetic activity. Hence this hormone not only could inhibit the secretion of the stress hormone cortisol but, in parallel, could also attenuate the sympathetic stimulation to the heart. These inhibitory effects of ANH could explain the so-far-unresolved dissociation between psychopathological alterations and autonomic and endocrine responses of panic attacks.

Adult↗
PubMedDate not supplied

Generalized anxiety disorder patients seek evaluation for cardiological symptoms at the same frequency as patients with panic disorder.

Although panic disorder (PD) and generalized anxiety disorder (GAD) have similar somatic symptoms, panic attacks with chest pain and/or palpitations may seem more likely to be mistaken for heart attacks because of their acute onset. One would therefore expect that PD patients are more likely than GAD patients to seek cardiological consultations. In a survey of 146 PD and 154 GAD patients entering a multi-site drug trial, we found virtually identical rates of such consults. Approximately 50% of each patient group sought medical evaluation for cardiac symptoms. Furthermore, 40% of each group had standard treadmill evaluations and 33% reported having an echocardiogram. This study suggests that future epidemiological studies in cardiology populations should include probes for generalized anxiety disorder.

Anxiety Disorders↗
PubMed2002

Left ventricular hypertrophy in hypertension as a predictor of coronary events: relation to geometry.

The present review examines epidemiological evidence for a relation of left ventricular hypertrophy with coronary heart disease, and mechanisms that may represent pathophysiological links between left ventricular hypertrophy and coronary events. Left ventricular hypertrophy has been demonstrated to be a powerful predictor of coronary heart disease, and when geometry is concentric the relation is even stronger. In addition to its association with risk factors for atherosclerosis and mechanisms that precipitate acute heart attacks, left ventricular hypertrophy also directly predisposes to and aggravates clinical presentation of coronary heart disease through a number of biological mechanisms. These include the following: increase in oxygen requirement related to left ventricular geometry; coronary hypertension, with endothelial dysfunction and reduced coronary reserve; diastolic dysfunction; and structural remodelling of myocardium and vascular bed. Some of these alterations are also worsened by underlying coronary heart disease, and can potentially be maintained by loop mechanisms. A recognizable stage of abnormal coronary haemodynamics in the context of left ventricular hypertrophy is probably that at which coronary reserve is impaired in the absence of any other sign of heart disease; in many circumstances, this may occur early in the disease process.

Coronary Disease↗
PubMed2004

Controlling the cellular organization of tissue-engineered cardiac constructs.

There are currently no effective treatments to restore the cardiac muscle lost because of ischemia for the millions of people who suffer heart attacks annually. Cell therapy procedures have emerged as novel therapeutic strategies for treatment of heart failure after myocardial infarction but have been hampered by the lack of adequate cell sources of cardiomyocytes and by the inability to integrate cell grafts into cardiac muscle. A cardiac patch composed of organized and functional cardiomyocytes could drastically enhance the efficacy of this important clinical approach. Here, we report our ongoing efforts to develop a bioartificial cardiac muscle capable of synchronized multidirectional contraction within a three-dimensional hydrogel scaffold. Neonatal rat cardiomyocytes, smooth muscle cells, and reconstituted polymeric collagen enriched with growth factors and hormones are used. A bioreactor system is used to impart precise strains onto the developing tissue constructs in vitro. The results demonstrate that cell-mediated collagen compaction is significantly enhanced by strain preconditioning, resulting in a more favorable cellular organization. Furthermore, the results demonstrate that strain stimulation guides cellular orientation in the direction of applied strain (i.e., in the circumferential direction). Hence, we demonstrate the importance of mechanical preconditioning as a means of promoting the in vitro development of engineered cardiac muscle for use with myocardial regeneration therapies.

Animals↗
PubMed1990

Health and other characteristics of employed women and homemakers in Tecumseh, 1959-1978. II. Prevalence of respiratory and cardiovascular symptoms and illnesses, mortality rates and physical and physiological measurements.

Using data collected in 1959-60 and 1978-79 in the Tecumseh Community Health Study, characteristics of 866 women aged 20-44 years at baseline were analyzed according to employment status, at baseline and follow-up (employed/employed, homemaker/employed, employed/homemaker, and homemaker/homemaker). To avoid the bias of including unhealthy women with homemakers, disabled and retired women were excluded. There were few significant differences in health among the groups. Prevalence rates of respiratory conditions were slightly higher at follow-up for women employed at both exams, while prevalence rates of cardiovascular conditions were slightly higher for homemakers at follow-up. The rate of reporting heart attacks was significantly higher for homemakers at both exams, although rates of diagnosed coronary heart disease were similar among employment groups.

Adult↗
PubMed1996

Aerobic capacity of coronary heart disease (CHD) patients and its use in accommodating them in the workplace.

According to the American Heart Association, more than 1.5 million new Americans suffer from heart attacks and angina each year. Approximately one million of these victims survive, making coronary heart disease (CHD) the most pressing health problem in America. Worldwide, survivors of CHD number in millions. The sufferers of CHD create a very significant economic burden on the society (hospital services, medications, diagnostic tests, physician fees, lost work days and productivity, providing disability income to the victims, etc.). Besides the economic burden, pain and suffering, actual and perceived loss of physical capabilities, and grief to the family are other significant losses the victims suffer. The restoration of CHD patients to an active and productive role in society, therefore, has become a major goal of rehabilitation experts. This work provides aerobic capacity data on 111 male and 32 female CHD patients (myocardial infarction, angioplasty, and coronary artery bypass). The Bruce treadmill protocol was used for measuring aerobic capacity. The post-phase II cardiac rehab aerobic capacity for males range from 0.83 l/min to 5.41 l/min. For females the corresponding range was from 0.67 l/min to 4.04 l/min. These capacity data can be used by designers to design jobs that can be performed by CHD patients who have undergone phase II cardiac rehabilitation; successful accommodation of CHD patients, besides restoring their psychological outlook, could result in the savings of billions of dollars. In addition, a listing of jobs that can be performed by CHD patients is provided. The literature-based metabolic energy requirements for these jobs are also provided.

Adult↗
PubMed2002

[Misleading advertising claims about the indication of doxazosin (Cardura) for type 2 diabetes mellitus and hypertension].

A number of Dutch medical journals have carried an advertisement promoting doxazosin in the treatment of hypertension in patients with type 2 diabetes mellitus. No long-term randomised clinical trials have examined the cardiovascular outcomes of the alpha-adrenergic blockers to which doxazosin belongs. The drug was removed from the largest study into blood pressure and cholesterol reduction ever performed until now (the antihypertensive and lipid-lowering treatment to prevent heart attack trial), due to an increased incidence of cardiovascular events and in particular congestive heart failure. The clinical significance of its insulin-sensitivity improving and lipid-neutralising effects in small-scale, short-term, small patient-group studies are ambiguous. Accordingly, national and international guidelines omitted the drug in their treatment recommendations. The advertisement claims are therefore misleading.

Adrenergic alpha-Antagonists↗
PubMed1984

Chest pain in adolescents--functional consequences.

In prospectively evaluating 100 cases of adolescents with chest pain (along with two control groups), 91 were found to have recurrent chest pain; fewer than 5 had a serious organic cause. Significantly higher school absenteeism occurred in patients with either chest or abdominal pain than in patients without pain. Adolescents with chest and abdominal pain were more likely to be high users of medical services than those with no pain. Most adolescents believed that persons their age could have attacks; 44 of those with chest pain thought their symptom was due to a heart attack. The occurrence of chest pain was not influenced by an adolescent's age, sex, race, smoking status or family structure, nor was it consistently associated with depression. Chest pain is thus a common problem of adolescence that produces considerable functional impairment not attributable to serious underlying disease.

Abdomen↗
PubMedDate not supplied

Severe heart failure: a focus on the quality of care.

Heart failure usually originates from conditions such as coronary heart disease, valvular disease, hypertension or cardiomyopathy. Heart failure may develop after several heart attacks as a result of extensive myocardial damage. Despite many advances in treatment for heart disease, chronic heart failure is a terminal condition with a death rate as high as that for many malignant tumours.

Chronic Disease↗
PubMed1976

Electrical ventricular defibrillation.

Ventricular fibrillation is the condition in which all of the muscle fibers in the ventricles of the heart contract and relax randomly and do not propel blood from the heart. This condition, which is the major cause of sudden death from a heart attack, can be reversed by passage of a single pulse of current through the heart using electrodes applied to the chest wall; this technique is known as ventricular defibrillation. World-wide clinical experience has shown that with existing defibrillators, successful defibrillation of subjects weighing over 100 kg is infrequent. It should not be concluded, however, that defibrillation cannot be achieved in such subjects. To illustrate this point, data will be presented to show that it is possible to establish a dose concept in which the output required from a defibrillator can be specified in terms of the weight of the subject. This dose concept evolved slowly from studies reported by investigators in various countries. For example, the present-day techniques of ventricular defibrillation are due to the investigations of researchers all over the world. Prevost and Battelli (1898) in Switzerland first showed that electric current can both induce ventricular fibrillation and achieve defibrillation. The studies of Kouwenhoven in the 1930's in the USA showed that 60 Hz alternating current can be used for defibrillation. The first human defibrillations in 1947 and 1952 used this type of current; these studies were reported by Beck and Zoll in the USA. The present-day technique for defibrillation derives from the animal studies reported by Gurvich and Yuniev 1946 in Russia. Finally, Lown et al. in the early 1960's applied the technique to man. Exciting new developments are underway in ventricular defibrillation. Not only are higher output defibrillators beginning to appear, but automatic and fully implantable defibrillators are being involved. In this paper, the present state of the art of defibrillation will be reported and future trends will be described.

Animals↗
PubMed2000

Secondary prevention in a cardiology group practice and hospital setting after a heart-care initiative.

The American Heart Association (AHA) Consensus Panel Statement for Preventing Heart Attack and Death in Patients with Coronary Disease provides recommendations for the secondary prevention of heart disease in at-risk patients. Blackstone Cardiology Associates of Pawtucket, Rhode Island, undertook an initiative in their practice implementing secondary-prevention guidelines in patients with coronary artery disease. This retrospective study evaluates practice patterns for the management of hyperlipidemia for a cardiology group in an ambulatory and hospital setting after the institution of a physician-supervised, nurse-based disease management program. Practice patterns in patients with established coronary heart disease treated in a lipid center compared with non-lipid-center settings were evaluated. Parameters evaluated included documenting low-density lipoprotein (LDL) cholesterol, presence of lipid-lowering therapy, and achieving the National Cholesterol Education Program II (NCEP II) goal of LDL-cholesterol levels < or =100 mg/dL in patients with preexisting coronary artery disease. A total of 352 patients met inclusion criteria in the lipid-center setting and were compared with 289 non-lipid-center consecutively chosen patients. Age and gender differences were also evaluated. Inpatient medical records from a 254-bed Brown University-affiliated teaching hospital were also evaluated for lipid profile, achievement of NCEP II goal, and use of lipid-lowering medication on admission and discharge. The most recent LDL-cholesterol values of patients followed in the lipid-center and in the non-lipid-center setting of the Blackstone Cardiology Associates were compared. Blackstone Cardiology Associates consists of 4 cardiologists and 4 advanced-practice nurses. Achievement of LDL-cholesterol goal was higher in both the lipid-center and non-lipid-center settings compared with baseline. A smaller percentage of patients at goal in the lipid setting is likely due to referral bias resulting in patients with more difficult-to-manage mixed dyslipidemias and behavior-management issues ending up in the lipid center. There were no apparent sex differences at goal, and more elderly (age > or =65 years) achieved goal in the lipid clinic center. In the non-lipid-center setting, more males were at goal and had a lower mean LDL-cholesterol level.

Aged↗
PubMedDate not supplied

Lessons from SADHART, ENRICHD, and other trials.

Depression is highly prevalent in patients with cardiovascular disease and is independently associated with a poor prognosis when present. A very important aspect of continued therapeutic advances in this field will be the ability to show a convincing connection between the treatment of depression in patients with heart disease and a reduction in morbidity and mortality associated with the co-occurrence of these conditions. The recent SADHART (Sertraline AntiDepressant Heart Attack Trial) investigation demonstrated that sertraline is safe and efficacious in depressed patients with ischemic heart disease but was underpowered to detect a mortality difference between sertraline and placebo. The ENRICHD (ENhancing Recovery in Coronary Heart Disease) trial showed that cognitive-behavioral therapy is effective for treating depression but had no impact on cardiovascular morbidity or mortality. There are a number of methodologic complexities associated with research regarding depression and cardiovascular disease, including difficulties in the definition and measurement of depression, complexities in the conduction of large-scale trials, ethical considerations surrounding the use of placebo, and interpretation of trial results. In addition, the lack of certainty regarding the pathophysiologic link between depression and cardiovascular disease means that there is a lack of pharmacotherapy targeted specifically at the dysregulated physiology that might explain the increased morbidity and mortality seen when these two conditions occur together.

Angina, Unstable↗
PubMed2003

ACE inhibitors versus diuretics: ALLHAT versus ANBP2.

The ALLHAT (The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial) trial enrolled hypertensive patients with at least one additional risk factor for coronary heart disease (CHD) to a comparison of the diuretic chlorthalidone, the calcium channel blocker, amlodipine, and the angiotensin-converting enzyme (ACE) inhibitor, lisinopril. Throughout the study, chlorthalidone decreased the systolic blood pressure to a slightly, but significantly greater extent (0.8-3.1 mmHg) than amlodipine or lisinopril. No significance differences were reported for amlodipine versus chlorthalidone or lisinopril versus chlorthalidone on the primary outcome of combined incidence of fatal CHD and nonfatal myocardial infarction. The findings of ALLHAT support the use of thiazide-type diuretics as first choice pharmacological therapy in at risk patients with hypertension. ANBP2 (The Second Australian National Blood Pressure Study) was also a comparison between diuretics (hydrochlorothiazide) and ACE inhibitors (enalapril) but was performed in older hypertensives that had few previous cardiovascular events. Diastolic blood pressure reduction was similar in both groups at all times. The risk of the primary outcome of all cardiovascular events or death from any cause was 11% lower in the ACE group than the diuretic group and the benefit was predominantly in men. Thus, ANBP2 suggests that in relatively healthy elderly hypertensive patients, ACE inhibitors should be preferred to diuretics.

Comment↗