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PubMed1997

Sleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: the Cardiovascular Health Study.

OBJECTIVES: To describe the prevalence of self reported sleep disturbances in older men and women and to describe their relationships with health status and cardiovascular disease (CVD). DESIGN: Cross-sectional study of sleep disturbance, CVD, general health, psychosocial factors, physical function, and use of psychotropic medications. SETTING: Participants of the Cardiovascular Health Study, 5201 adults aged 65 and older recruited from a random sample of noninstitutionalized Medicare enrollees in four US communities. MEASURES: Self-reported sleep disturbances and standardized questionnaires for cardiopulmonary symptoms and diseases, depression, social support, activities of daily living, physical activity, cognitive function, and current medications, spirometry, ECG, echocardiography, and carotid ultrasound. RESULTS: Women were twice as likely as men to report difficulty falling asleep (30% vs 14%). Daytime sleepiness, difficulty falling asleep, and frequent awakenings increased in prevalence with age. All symptoms were related strongly to depression. Symptoms of daytime sleepiness were also related strongly to poor health and limitations in activities of daily living in men and women. In multivariate analysis, men taking benzodiazepines were likely to report difficulty falling asleep and daytime sleepiness, whereas women taking benzodiazepines reported difficulty falling asleep and waking up too early. After accounting for these factors, the only cardiovascular disease independently associated with sleep disturbances was angina. Men and women with confirmed angina were 1.6 times more likely to report trouble falling asleep. Independent relationships between sleep disturbances and cardiovascular risk factors such as obesity, hypertension, smoking, and diabetes were relatively weak and inconsistent, though smokers were less likely to report frequent awakenings. CONCLUSIONS: Sleep disturbances are relatively common in older men and women and are associated with poor health, depression, angina, limitations in activities of daily living, and the use of benzodiazepines.

Aged↗
PubMed1999

Cardiovascular pathways: socioeconomic status and stress effects on hypertension and cardiovascular function.

In westernized societies there is a consistent and continuous gradient between the prevalence of cardiovascular disease (including both coronary heart disease and stroke) with SES, such that people from lower SES have more disease. Several studies have examined the roles of the major cardiovascular risk factors for explaining this gradient. There is a strong SES gradient for smoking, which parallels the gradient in disease, but the gradients for hypertension and cholesterol are weak or absent. Central obesity and physical inactivity may also be contributory factors. In the United States there is a strong association between SES and race, and it is suggested that the higher prevalence of hypertension and cardiovascular disease in blacks may be attributed to psychosocial factors, including those related to SES. The possible pathways by which SES affects cardiovascular disease include effects of chronic stress mediated by the brain, differences in lifestyles and behavior patterns, and access to health care. At the present time, the second of these is the strongest candidate; the effects of stress have been little studied.

Cardiovascular Diseases↗
PubMed1993

Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group.

BACKGROUND: Peripheral arterial disease measured noninvasively by the ankle-arm index (AAI) is common in older adults, largely asymptomatic, and associated with clinically manifest cardiovascular disease (CVD). The criteria for an abnormal AAI have varied in previous studies. To determine whether there is an inverse dose-response relation between the AAI and clinical CVD, subclinical disease, and risk factors, we examined the relation of the AAI to cardiovascular risk factors, other noninvasive measures of subclinical atherosclerosis using carotid ultrasound, echocardiography and electrocardiography, and clinical CVD. METHODS AND RESULTS: The AAI was measured in 5084 participants > or = 65 years old at the baseline examination of the Cardiovascular Health Study. All subjects had detailed assessment of prevalent CVD, measures of cardiovascular risk factors, and noninvasive measures of disease. Participants were stratified by baseline clinical CVD status and AAI (< 0.8, > or = 0.8 to < 0.9, > or = 0.9 to < 1.0, > or = 1.0 to < 1.5). Analyses tested for a dose-response relation of the AAI with clinical CVD, risk factors, and subclinical disease. The cumulative frequency of a low AAI was 7.4% of participants < 0.8, 12.4% < 0.9, and 23.6% < 1.0. participants with an AAI < 0.8 were more than twice as likely as those with an AAI of 1.0 to 1.5 to have a history of myocardial infarction, angina, congestive heart failure, stroke, or transient ischemic attack (all P < .01). In participants free of clinical CVD at baseline, the AAI was inversely related to history of hypertension, history of diabetes, and smoking, as well as systolic blood pressure, serum creatinine, fasting glucose, fasting insulin, measures of pulmonary function, and fibrinogen level (all P < .01). Risk factor associations with the AAI were similar in men and women free of CVD except for serum total and low-density lipoprotein cholesterol, which were inversely associated with AAI level only in women. Risk factors associated with an AAI of < 1.0 in multivariate analysis included smoking (odds ratio [OR], 2.55), history of diabetes (OR, 3.84), increasing age (OR, 1.54), and nonwhite race (OR, 2.36). In the 3372 participants free of clinical CVD, other noninvasive measures of subclinical CVD, including carotid stenosis by duplex scanning, segmental wall motion abnormalities by echocardiogram, and major ECG abnormalities were inversely related to the AAI (all P < .01). CONCLUSIONS: There was an inverse dose-response relation of the AAI with CVD risk factors and subclinical and clinical CVD among older adults. The lower the AAI, the greater the increase in CVD risk; however, even those with modest, asymptomatic reductions in the AAI (0.8 to 1.0) appear to be at increased risk of CVD.

Aged↗
PubMed2006

Understanding the coronary heart disease versus total cardiovascular mortality paradox: a method to enhance the comparability of cardiovascular death statistics in the United States.

BACKGROUND: Coronary heart disease (CHD) represents the largest share of cardiovascular disease in the United States, but there are conspicuous discrepancies between CHD and total cardiovascular death rates across the states, possibly due in part to variations in physician assignment of causes of death. Our aim was to identify exogenous individual- and community-level predictors of cause-of-death assignment and variability and to use these predictors to improve the comparability of CHD mortality estimates across states. METHODS AND RESULTS: We performed a multinomial logistic regression analysis to estimate the effect of individual- and community-level factors on the likelihood of a death being certified as 1 of 3 ill-defined clusters (general atherosclerosis and unspecified heart disease, heart failure, and cardiac arrest) relative to being certified as CHD. The individual-level variables were the decedent's race, sex, age, education, and place of death; the community-level variable was the number of cardiologists per capita. We used the model to estimate state-level CHD rates that are standardized with regard to the levels of individual- and community-level determinants of cause-of-death assignment. Decedents who died in hospitals and in counties with more cardiologists per capita were more likely to be assigned to CHD than to the ill-defined categories, as were white males relative to other race-sex combinations. Adjustment for these factors resulted in substantially improved correlation between death rates for CHD and all cardiovascular causes. Increases in CHD death rates across states after adjustment for external predictors of cause-of-death assignment ranged from 2% (North Dakota) to 72% (Washington, DC); New York had a decrease (1%) in CHD death rates after adjustment. Nationally, CHD death rates increased 10% for males and 15% for females. The total number of deaths in 2001 attributed to CHD in patients over 30 years of age rose from 433,625 to 489,836 after adjustment. CONCLUSIONS: Greater presence of medical knowledge at the time of death, reflected by place of death and cardiologists per capita, reduces the use of the ill-defined cardiovascular clusters. Racial and gender effects on CHD assignment may reflect disparities in access to care and quality of care. By adjusting for differentials in these parameters, a comparable and consistent set of CHD mortality estimates can be created. The role of the exogenous predictors in validity and comparability of cause-of-death statistics should be confirmed in carefully designed validation autopsy studies.

Cardiovascular Diseases↗
PubMed2001

Global burden of cardiovascular diseases: Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies.

This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiological transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.

Africa↗
PubMedDate not supplied

[Comparison of the SCORE and REGICOR models for calculating cardiovascular risk in cardiovascular disease-free individuals at a healthcare center in Barcelona, Spain].

BACKGROUND: No studies have been published to date comparing SCORE, REGICOR and Framingham models. This study is aimed at analyzing how the REGICOR and SCORE functions classify cardiovascular risk, their correlation and concordance with Framingham (1998) and whether any differences exist among them with regard to the cardiovascular risk factors in high-risk groups. METHODS: Descriptive cross-sectional study conducted in primary care. A total of 851 individuals within the 35-74 age range, free of cardiovascular diseases and selected by simple random sampling were included. A study was made of the percentage of high-risk patients with Framingham (> or = 20% ten-year risk), SCORE (> or = 5% ten-year risk) and REGICOR with cutoff points > or = 20%, > or = 15%, > or = 10% and > or = 5% at 10 years, given that with REGICOR > or = 20% there are hardly any high-risk cases. A comparison was drawn between the correlation (Pearson's r) and concordance (Kappa index) of the REGICOR and SCORE high-risk individuals as compared to Framingham. RESULTS: The high-risk percentages respectively found were: 23.3% with Framingham; 15.2%; with SCORE; and 1.4%, 5.8%, 17.6% and 57.0% with REGICOR with the cutoff points described. REGICOR has a 0.99 correlation, SCORE a 0.78 correlation. REGICOR > or = 10% showed a better concordance (Kappa 0.83) than SCORE (Kappa 0.61). On comparing the cardiovascular risk factors of the high-risk cases (> or = 20% Framingham, > or = 5% SCORE and > or = 10% REGICOR), SCORE showed higher prevalence of diabetes and a lower prevalence of hypercholesterolemia (p<0.05). CONCLUSIONS: REGICOR showed a good correlation with Framingham. With the > or = 10% cutoff point, it classifies a number of individuals as high-risk similar to SCORE and fewer than Framingham. The SCORE model would treat a number of patients similar to the REGICOR > or =10% model with hypolipemiant drugs, however showing lesser evidence of effectiveness of the treatment.

Adult↗
PubMed2006

Low ankle-brachial pressure index predicts increased risk of cardiovascular disease independent of the metabolic syndrome and conventional cardiovascular risk factors in the Edinburgh Artery Study.

OBJECTIVE: To investigate whether a low ankle-brachial pressure index (ABI) predicts increased risk of cardiovascular disease (CVD) independent of the metabolic syndrome and conventional cardiovascular risk factors. RESEARCH DESIGN AND METHODS: The Edinburgh Artery Study is a population-based cohort study in which subjects were followed up until their death or for approximately 15 years. Low ABI at baseline was defined as <0.9; subjects with ABI >1.4 (n = 13) were excluded from the analyses. We used a modified version of the definition of the metabolic syndrome published in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, replacing waist circumference criteria with BMI criteria. Data on relevant parameters were available for 1,467 men and women ages 55-74 years at baseline. Cox proportional hazards models were used to study cardiovascular morbidity and mortality before and after adjusting for potential confounding factors. RESULTS: We determined that 25% of the study population had the metabolic syndrome and that a low ABI was more prevalent among people with than without the metabolic syndrome (24 vs. 15%; P < 0.001). During the follow-up period, there were 226 deaths from CVD and 462 nonfatal cardiovascular events. The hazard ratio (95% CI) for low ABI after adjusting for age, sex, baseline CVD, diabetes, smoking status, LDL cholesterol, and metabolic syndrome was 1.5 (1.1-2.1) for CVD mortality and 1.5 (1.2-1.8) for all CVD outcomes. CONCLUSIONS: Low ABI is associated with increased risk of CVD independent of the metabolic syndrome and other major CVD risk factors.

Aged↗
PubMed1996

Asthma and its association with cardiovascular disease in the elderly. The Cardiovascular Health Study Research Group.

Cardiovascular disease (CVD) is more prevalent in elderly than in middle-aged patients. Symptoms such as intermittent wheezing with dyspnea may then be due to either CVD or asthma. The objective of this study was to determine the prevalence and correlates of asthma in the elderly and their associations with CVD and CVD risk factors. A community sample of 5201 elderly persons from the Cardiovascular Health Study was asked if they had a physician diagnosis of asthma, and multiple cardiovascular risk and disease variables were measured. Six percent of the participants (309) recalled a history of asthma, and half of these were never smokers. Thirty percent of those with asthma were currently taking a bronchodilator, 14% inhaled steroids, and 10% oral prednisone. Men and women with asthma who were cigarette smokers were more likely to report a concurrent diagnosis of congestive heart failure than smokers without asthma (p = .04). However, when we determined the independent CVD correlates of asthma in this cohort, controlling for smoking status, age, gender, and diagnoses of chronic bronchitis and emphysema, only higher levels of high-density lipoprotein cholesterol (HDL-C) and higher plasma fibrinogen levels were significantly associated with asthma. It was concluded that asthma is as prevalent in the elderly as in middle-aged persons and is associated with higher HDL-C and higher fibrinogen levels, but not with prevalent cardiovascular disease.

Aged↗
PubMed2000

Cardiovascular risk factors of young adults in relation to parental socioeconomic status: the Cardiovascular Risk in Young Finns Study.

The socioeconomic status (SES) of the family influences the cardiovascular risk status of children and adolescents; however, it is not as well known whether parental SES has any effect on the risk factor profile of young adults. The aim of the present study was to investigate the relations of different aspects of parental SES, namely occupation, education, income and living area, to the common cardiovascular risk factors of their offspring (n = 919) aged 18, 21 and 24 years as a part of the Cardiovascular Risk in Young Finns Study in 1986. Subjects from farming families and rural areas had the highest serum total and low-density lipoprotein cholesterol values, and the lowest diastolic blood pressure compared with subjects from other occupational groups and subjects from urban regions. The diet of young adults from farming families and from rural areas contained more saturated fatty acids and less monounsaturated and polyunsaturated fatty acids. In addition, the body mass index was lower in subjects from urban regions compared with rural regions, and physical inactivity was less common in the urban group. Subjects with the highest parental occupational status smoked less compared with those with the lowest status. Parental education related inversely to physical inactivity and directly to dietary polyunsaturated fatty acids. The income level of the family associated positively with frequent inebriation by alcoholic beverages and inversely with the percentage of dietary energy from fat. In conclusion, there were modest inverse associations between different indicators of the SES of parents and some of the traditional risk factors of their offspring in young adulthood, which may contribute to the future risk of cardiovascular diseases.

Adolescent↗
PubMed2001

[Socioeconomic aspects and cardiovascular risk factors: experience at the Cardiovascular Epidemiologic Observatory].

BACKGROUND: Cardiovascular diseases are more frequent among the poorer social classes of the population. Studies including social and economic factors offer useful information when planning the strategy required in primary prevention. The aim of this investigation was to evaluate the association between socio-economic levels and cardiovascular risk factors in 3198 women and 3218 men aged 35-74 years enrolled for a cross sectional study within the Cardiovascular Epidemiologic Observatory, carried out in 1998 to evaluate the distribution of risk factors and the prevalence of cardiovascular risk conditions. METHODS: The level of education was used to determine the socio-economic status; the distribution of the risk factors and the prevalence of risk conditions were analyzed for the different levels of education. Models of logistic regression were used to evaluate the relation between the socio-economic status and obesity, cigarette smoking, hypertension, and hypercholesterolemia. RESULTS: A higher level of education is significantly protective against both obesity and cigarette smoking. With regard to obesity among males compared to those with a university degree the odds ratio increased to 1.6 for those with an upper secondary education diploma (95% confidence interval--CI 1.09-2.51) and to 3.5 for those without any qualification (95% CI 1.97-6.21). Among women the odds ratio increased to 3.2 (95% CI 1.81-5.81) and to 4.8 (95% CI 2.55-8.98) for the same levels of education. With regard to smoking among males compared to those with a university degree the odds ratio increased to 1.4 for those holding an upper secondary education diploma (95% CI 1.07-1.94) and to 2.3 for those without any qualification (95% CI 1.40-3.68). For men living in central or southern Italy, the odds ratio for cigarette smoking increased to 1.3 (95% CI 1.06-1.57) and to 1.5 (95% CI 1.24-1.82) and the odds ratio for hypercholesterolemia decreased to 0.8 (95% CI 0.62-0.95) and to 0.7 (95% CI 0.58-0.89); with regard to women, living in the same geographic areas the odds ratio for obesity increased to 1.3 (95% CI 1.03-1.65) and to 2.3 (95% CI 1.81-2.83). CONCLUSIONS: In primary prevention it is important to focus the attention on obesity and on smoking habits among the poorer social classes.

Adult↗
PubMed2004

Classical and "non-classical" cardiovascular risk factors in Tunisian patients with end stage renal disease: prevalence and association with cardiovascular events.

This study was aimed to determine the prevalence of several classical and non-classical cardiovascular risk factors, and to test their association with cardiovascular events in Tunisian patients with end-stage renal disease. A total of 35 chronic renal failure, 50 hemodialysed and 30 renal transplant recipient patients and 31 healthy subjects were included. Hypertension, elevated plasma concentrations of total homocysteine, fibrinogen, C-reactive protein, and lipoprotein(a) were highly prevalent in patients, whereas, smoking, hypertriglyceridemia, hypercholesterolemia, hypoHDLemia, and hypoalbuminemia were less common. In univariate analysis, cardiovascular events were associated with age, hypertension, and the top quartile of the total homocysteine and C-reactive protein values. When controlling for several potential confounding factors, cardiovascular events remained associated with age, hypertension (OR, 7.07; 95% CI, 1.76-28.34; P=0.01), and the top quartile of total homocysteine (OR, 10.41; 95% CI, 2.61-41.55; P=0.001) and C-reactive protein (OR, 3.99; 95% CI, 1.06-14.99; P=0.04).

Adult↗
PubMed1992

[Cardiovascular risk factors--extent and self-assessed risk in relation to prevention of cardiovascular diseases. A questionnaire among 3,956 men and women aged 24-65 years in Vejle County, Slangerup and Helsinge municipalities].

In autumn 1989, a material of 1,330 men and 1,561 women aged 20-65 years and resident in the County of Vejle replied to a standardized questionnaire about their knowledge and behaviour in relation to prophylaxis of cardiovascular disease. During the same period, 501 men 565 women in the Municipalities of Helsinge and Slangerup participated in a similar investigation. It was investigated whether the behaviours of the participants as regards tobacco, physical activity, diet, experience of stress and overweight were unsuitable in relation to prevention of cardiovascular disease. 22% of the men and 11% of the women had unfavourable behaviour in more than two of these factors. The percentage proportion with many unfavourable factors was greatest among persons with the lowest school education. The majority of the participants were aware of the factors which are of significance for the development of cardiovascular disease. The general level of knowledge was high. A majority of the participants with many unfavourable factors assessed their own risk of development of cardiovascular disease as great. The proportion of the participants who were aware that a personal effort was of significance to retain health was greatest in the group where the behaviour was most suitable both where men an women were concerned.

Adult↗
PubMed2005

[Distribution of the global cardiovascular risk in the Italian population: results from the cardiovascular epidemiologic observatory].

BACKGROUND: The aim of this study was to assess the 10-year cardiovascular risk categories using risk chart, recently set up by the National Institute of Health in the population examined by the Cardiovascular Epidemiologic Observatory. METHODS: 3745 men and 3664 women aged 40-69 years were classified into five risk categories (< 5 %; 5-10%; 10-15%; 15-20%; > or = 20%) taking into account age, smoking habit, history of diabetes, systolic blood pressure, serum cholesterol and excluding those already under treatment for hypertension and hypercholesterolaemia or experienced a previous major cardiovascular event (1937 persons: 955 men, 982 women). RESULTS: Proportion of people estimated at risk in 10 years > or = 20% is minimal in the youngest age range, increases in adulthood, duplicates in smokers and is higher in diabetics. In non-diabetic men that proportion varies between 3.4% in non-smokers and 5.6% in smokers. All women at risk are already under specific treatment. CONCLUSIONS: Cardiovascular Epidemiologic Observatory data allowed to assess the expected proportion of individuals at risk in 10 years > or = 20%. Besides attention to high-risk individuals, preventive measures supporting a healthier lifestyle in the general population must be adopted, considering that it will produce the greatest number of events.

Adult↗
PubMed1987

Cardiovascular changes during mental stress: correlations with presence of coronary risk factors and cardiovascular disease in physicians and dentists.

Stress may play a role in the etiology of cardiovascular disease. Research showing that mental stress administered in laboratory settings causes great change in cardiovascular and hemodynamic functioning supports this hypothesis. In a small sample of physicians and dentists, those who showed greater cardiovascular reactivity (hot reactors) to stress were more likely to be hyperlipidemic or to have had a myocardial infarction or coronary bypass surgery. In addition, some of the nonreactive group were hypertensives taking medication, which may have blunted their response to stress. Persons with higher cholesterol, higher triglyceride levels, and lower HDL levels all showed greater increases in blood pressure (BP) in response to stress. Also, the reactive group reported less emotional support and experienced greater numbers of family-related stressful events in the previous year. The degree of aerobic fitness influenced resting hemodynamics and percentage of body fat but not reactivity to stress. Likewise, smoking did not affect reactivity, but former smokers did have a significantly elevated total systemic resistance at rest. While it is impossible to say whether reactivity causes disease, is the result of the presence of risk factors and disease, or is caused by some other factor which also contributes to disease, these results suggest that the presence of cardiovascular reactivity to mental stress is a sign of potential illness and indicates the need for further medical and risk factor study of the patient.

Adult↗
PubMed1994

Comparison of risk factors for coronary heart disease in Dresden and Münster. Results of the DRECAN (Dresden Cardiovascular Risk and Nutrition) study and the PROCAM (Prospective Cardiovascular Münster) Study.

Trend analyses based on WHO statistics for average life expectancy, age-standardized cardiovascular (CVD) morbidity and mortality show significant differences between the former German Democratic Republic (GDR) and the former Federal Republic of Germany (FRG). To investigate whether this is due to a different prevalence of cardiovascular risk factors, the Dresden Cardiovascular Risk and Nutrition (DRECAN) study was conducted using the complete methodology of the Prospective Cardiovascular Münster (PROCAM) study, i.e., the same methods and strict quality controls, with an exchange of specimens between both laboratories. The results were compared with those of an adjusted subpopulation of the PROCAM study. Even before unification there were only small differences in lipoprotein profiles between West and East Germany, 10 months after unification these differences were minimal. The survey does not sufficiently explain the differences in CHD morbidity and mortality between Western and Eastern Germany. Further analyses of the nutritional aspects will show whether the change, in available foodstuffs after unification has led to substantially changed nutritional habits, and whether this might explain some of the results.

Adolescent↗
PubMed1997

Relationships between children's cardiovascular stress responses and resting cardiovascular functioning 1 year later.

Resting cardiovascular parameters were predicted from anthropometric data, resting baseline cardiovascular data, and cardiovascular responses to three laboratory stressors completed 1 year earlier. Subjects were 106 male and female children (72 Whites, 34 Blacks) aged 6-7 years at the initial evaluation. During initial testing, blood pressure, heart rate, cardiac output, and total peripheral resistance were assessed at rest and also during a forehead cold pressor task, postural change, and treadmill exercise. The same cardiovascular parameters were then assessed at rest 1 year later. After controlling for significant anthropometric measures and the pertinent previous year's resting data, systolic and diastolic responses to the cold pressor were predictive of respective follow-up resting levels. Postural change heart rate responses were predictive of follow-up resting heart rate after controlling for initial resting levels. Exercise cardiac index reactivity predicted follow-up cardiac index after controlling for earlier resting levels and adiposity. Follow-up total peripheral resistance index was predicted by earlier resting levels.

Blood Pressure↗
PubMed2006

Peri-infarct ischemia determined by cardiovascular magnetic resonance evaluation of myocardial viability and stress perfusion predicts future cardiovascular events in patients with severe ischemic cardiomyopathy.

BACKGROUND: We assessed whether cardiovascular magnetic resonance imaging (CMR) of peri-infarct ischemia provides prognostic information in severe ischemic cardiomyopathy (ICM) patients referred for revascularization. METHODS: Twenty-one patients with severe ICM were recruited prospectively for combined stress adenosine perfusion, late gadolinium enhancement, and rest perfusion studies. The patients were followed for in-hospital and post-discharge cardiovascular events. RESULTS: During 12+/- 9.8 months follow-up, 67% of the patients with peri-infarct ischemia and 13% of the patients without peri-infarct ischemia had cardiovascular events (p = 0.03). CONCLUSION. In severe ICM patients, the presence of peri-infarct ischemia was associated with a higher incidence of cardiovascular events.

Adenosine↗
PubMed1991

Neuroendocrine and cardiovascular stress reactivity in middle-aged normotensive adults with parental history of cardiovascular disease.

Neuroendocrine and cardiovascular stress reactivity was studied in healthy middle-aged individuals whose parental history included essential hypertension and/or myocardial infarction and a control group without parental history of cardiovascular disease. All subjects completed a rest session (1 hour) and a stress session (1 hour). The stress session included behavioral (mirror image tracing, mental arithmetic, and the Stroop color word conflict test) and physical stressors (the cold pressor test and isometric exercise). Systolic and diastolic blood pressures and heart rate were recorded at baseline before and during all stressors. Specimens for determination of urinary catecholamines and cortisol were sampled after the rest and stress sessions respectively. Generally, a parental history of hypertension but not of myocardial infarction influenced neuroendocrine and cardiovascular stress reactivity. A family history of hypertension was associated with exaggerated epinephrine, norepinephrine, and cortisol excretion during stress and with enhanced heart-rate reactivity to behavioral (mental arithmetic and mirror image tracing) but not to physical stressors (isometric exercise or the cold pressor test). We conclude that individuals with a family history of hypertension tend to display exaggerated cardiovascular and neuroendocrine reactivity to stress.

Arousal↗