ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundWhile the age-specific rates of cardiovascular diseases (CVD) are declining in many developed countries, the epidemic is accelerating in most developing countries. Elevated serum total cholesterol (TC) is one of the major risk factors for atherosclerotic CVD. This review was carried out to describe the current situation in mean TC and in the prevalence of hypercholesterolaemia in developing countries.Design and MethodsA search for papers published in medical journals from 1990 to 2002 was performed using the MEDLINE database. A total of 37 articles were selected according to previously defined criteria containing information on mean blood total cholesterol and/or hypercholesterolaemia from 38 developing countries.ResultsHypercholesterolaemia is a public health problem in most of the developing countries reviewed. A positive association between the population mean TC and the GNP per capita was evidenced.ConclusionsDifferences in methodology between national surveys make international comparisons difficult. Nevertheless, low-cost dietary interventions and the development of primary prevention strategies are needed to reduce the already existing public health problem of elevated TC in developing countries.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe prognostic significance of left ventricular hypertrophy (LVH) identified by simple electrocardiographic (ECG) criteria in high-risk patients with established cardiovascular (CV) diseases is not clearly understood.Design and methodsThe Heart Outcomes Prevention Evaluation (HOPE) trial was a randomized trial, which evaluated the effects of ramipril and of vitamin E on major CV outcomes in 9541 men and women aged 55 years or older with a history of coronary artery disease, stroke, peripheral vascular disease or diabetes mellitus with at least one additional CV risk factor. Patients were followed for an average of 4.5 years. We evaluated the association between simple ECG criteria for LVH and the risk for major vascular events, for CV and all-cause mortality and for heart failure.ResultsElectrocardiographic LVH was present in 793 (8.3%) HOPE study participants. Of these, 19.0% sustained a major CV event (MI, stroke or CV death), 15.6% died and 6.1% developed heart failure compared with 15.6%, 10.8% and 2.9% respectively of those without ECG-LVH (P = 0.0023;P < 0.0001 andP < 0.0001). In multivariate analysis ECG-LVH was an independent predictor of CV and all-cause death and of heart failure.ConclusionsIn patients with CV disease simple, easily applicable ECG criteria for LVH identify a subset of individuals at particularly high risk for death and for heart failure.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundLifestyle measures of coronary heart disease (CHD) prevention have been overshadowed by the efficacy of drug treatments. This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering, anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials. Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects.ObjectivesThe objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years. In addition, an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study.DesignA total of 197 patients with proven coronary heart disease were included and randomised to a lifestyle intervention programme or to usual care. Follow-up was after a period of two years.MethodsIntervention comprised a low fat diet, regular exercise, smoking cessation, psychosocial support and education, delivered by nurses on the rationale for pharmacological and lifestyle measures. Usual care comprised follow-up in the routine outpatient clinic. Both groups were given the same comprehensive medication according to recent guidelines.ResultsPatients in the lifestyle intervention group reduced the intake of saturated fat, sugar and cholesterol (P<0.001), increased their exercise level (P<0.01) and stopped smoking (P<0.05) when compared with the usual care group. A sub-analysis of the influence of five-year CHD calculated risk in males resulted in a relative risk reduction of 22% (95% confidence intervals 9-35). Although significant, this result must be interpreted with caution due to poor statistical power and reproducibility of the method.ConclusionsIn the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet, exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundMany studies have analysed the relation between cardiovascular risk factors and oral contraceptive use in adult women, whereas information on the possible health effects of oral contraceptive use during adolescence is lacking.DesignThe effect of current contraceptive pill use on blood pressure and serum total cholesterol concentration was studied in a cross-sectional sample of 120 adolescent girls with a mean age of 17.4 years.MethodsAfter the girls had rested for 5 minutes in the sitting position, trained study nurses measured blood pressure three times consecutively using a mercury sphygmomanometer. The nurses also administered a questionnaire gathering information on the use of oral contraceptives, smoking and parental social class. In the morning blood samples were taken for the measurement of serum total cholesterol.ResultsMean age (±SD) was 17.4±0.8 years. Blood pressure averaged (±SD) 108.7±9.9 systolic and 68.0±8.2 mmHg diastolic. Serum total cholesterol was 4.5±0.7 mmol/l. Forty-nine girls (41%) were taking the contraceptive pill. Of these, 44 (90%) were on a combination of ethinyloestradiol (20–35 μg) and a progestogen, four (8%) on anti-androgens (35 μg) and one (2%) only on a progestogen. After adjustment for age, body mass index, smoking and alcohol status systolic blood pressure was 4.6 mmHg higher (95% CI 1.2–8.1;P<0.001) in current pill users than in girls not currently on the pill (111.4 versus 106.8 mmHg). Adjusted for the aforementioned covariates, diastolic blood pressure was not related to pill use (68.2 versus 67.8 mmHg;P=0.7). Serum total cholesterol was 0.43 mmol/l (95% CI 0.18–0.60;P=0.001) higher among girls using oral contraceptives (4.7 versus 4.3 mmol/l), irrespective of whether or not the model was adjusted for age, body mass index, smoking and alcohol status.ConclusionsIn 17-year-old girls, the use of oral contraceptives was associated with a nearly 5 mmHg higher systolic blood pressure and a 0.4 mmol/l higher level of serum total cholesterol. The long-term prognostic implications of our findings remain to be elucidated.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundAlthough obesity is an important determinant of an unfavourable risk factor pattern reported associations between cardiovascular disease and obesity in women have been remarkably inconsistent.DesignLongitudinal observational population study.Methods1408 Göteborg women without prior cardiovascular disease aged 39 to 65 years at baseline were examined with respect to cardiovascular risk factors, including body mass index (BMI), in 1979 to 1981. Quartiles of BMI were formed of <22 (reference), 22 to 24, 24 to 27, and >27 kg/m−2. Follow-up was conducted by use of the Swedish patient and cause-specific death registers.ResultsAll trends with respect to incident coronary heart disease (CHD – myocardial infarction or revascularization), stroke and all cardiovascular disease were positive and significant (P<0.05). No significant increase in risk was noted in women with BMI 22–24, compared with women below 22. After adjustment for smoking, women with BMI 24 to 27 had a doubled risk of CHD [hazard ratio(HR) 2.41 (1.06–5.50)] and of any cardiovascular disease [HR 1.89 (1.05–3.37)] whereas the increase in stroke risk was non-significant [HR 1.80 (0.81–4.01)]. Hazard ratios in the heaviest women, with BMI >27, were 3.75 (1.68–8.37) for CHD, 2.84 (1.32–6.12) for stroke, and 2.98 (1.70–5.21) for any cardiovascular disease, after adjustment for smoking. After further adjustment for other cardiovascular risk factors, all trends became non-significant. However, women with BMI >27 still displayed a statistically independent association with respect to coronary disease [adjusted HR 2.67 (1.10–6.47)] and all cardiovascular disease [HR 2.23 (1.23–4.04)], but not stroke [HR 2.08 (0.94–4.61)].ConclusionThe influence of BMI on cardiovascular disease in women may be greater than previously thought and, although to a great extent explained by the influence of obesity on other risk factors, associated with adverse outcomes already at moderately increased body weight.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundMeasurement of intima-media thickness (IMT) is a well established surrogate marker for cardiovascular endpoints. We studied the long-term effects of statins on femoral IMT and plaque scoring in the Atorvastatin versus Simvastatin on Atherosclerosis Progression (ASAP) study.Methods and ResultsThree hundred and twenty-five patients with familial hypercholesterolaemia were randomized to either atorvastatin 80 mg/day or simvastatin 40 mg/day. IMT was measured at baseline and at 2 years. At baseline, femoral IMT was 1.69 mm in the atorvastatin group and 1.61 mm in the simvastatin group; at 2 years, IMT increased by 0.06 mm (P=0.24) and 0.15 mm (P=0.012), respectively. No significant differences were obvious between these two treatment arms (P=0.26). Femoral plaques were present in 64.7% in the atorvastatin group and 56.1% in the simvastatin group at baseline; after 2 years, these proportions rose to 66.0% (P=0.47) and 67.3% (P=0.02), respectively (P=0.87 between treatment arms). Carotid plaques were present in 6.3% versus 4.9%; after 2 years, these percentages were 5.0% (P=0.48) versus 5.5% (P=0.71), respectively (P=0.90 between treatment arms).ConclusionOur study indicates increased efficacy of atorvastatin 80 mg in retarding progression of atherosclerosis in the femoral artery compared with simvastatin 40 mg. Interestingly, in the carotid arteries these statins influenced IMT to a greater extent, whereas in the femoral artery the effects were more pronounced on plaque frequency. These findings underscore the generalized effects of lipid lowering on atherosclerosis.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIn Belgium, regulations restrict the reimbursement of statins to patients with total serum cholesterol above 250 mg/dl (6.41 mmol/l) after a three-month lipid-lowering diet. We investigated the possible impact of these regulations on characteristics of Belgian patients receiving a lipid-lowering drug.DesignFrom 1998 to 2000, standard questionnaires on coronary risk factors and treatments with lipid-lowering drugs were completed by 301 GPs sampled at random in the 11 Belgian Provinces. Questionnaires had to be completed for 18 consecutive patients 35 years old or more attending GPs' practices, irrespective of the underlying motive for attendance.ResultsOf the 5511 patients included in the study, 1519 (28%) had established coronary disease or diabetes mellitus, or ≥ 2 non-cholesterol coronary risk factors. Most (70%) of these patients were not treated with a lipid-lowering drug. Only 22% of patients with established coronary disease, 10% of patients with diabetes mellitus and 9% of patients with ≥ 2 coronary risk factors were treated with a statin. Fifty-nine percent of fibrate users and 50% of statin users had a pre-treatment cholesterol level above 250 mg/dl, but had no or only one non-cholesterol coronary risk factor.ConclusionsIn Belgium, the majority of patients at higher risk of coronary event do not benefit from lipid-lowering drugs, particularly the statins. In contrast, one of two statin users and three of five fibrate users should probably not receive the drug prescribed. Regulation based on blood cholesterol level encourages the overlooking of other risk factors relevant for selecting patients having the greatest chance to benefit from statin treatment.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe minute ventilation-carbon dioxide production (VE/VCO2) slope, obtained during exercise testing, possesses prognostic value in heart failure (HF). The VE–VCO2relationship is generally linear thereby hypothetically producing similar slope values regardless of the exercise-test time interval used for calculation.DesignThis study assesses the ability of the VE/VCO2slope, calculated at different time intervals throughout a progressive exercise test, to predict 1-year cardiac-related hospitalization and mortality in subjects with HF.MethodsSeventy-two subjects underwent symptom-limited exercise testing with ventilatory expired gas analysis. Mean age and left ventricular ejection fraction for 44 male and 28 female subjects were 51.2 years (±13.0) and 27.0% (±12.3) respectively. The VE/VCO2slope was calculated from time 0 to 25, 50, 75 and 100% of exercise time and subsequently used to create five randomly selected VE/VCO2slope categories.Results(The intraclass correlation coefficient found calculation of the VE/VCO2slope, when divided into quartiles, to be a reliable measure (alpha=0.94,P<0.0001). Univariate Cox regression analysis revealed all VE/VCO2slope categories (25–100% and random selections) were significant predictors of cardiac-related hospitalization and mortality over a 1-year period. Multivariate Cox regression analysis revealed all VE/VCO2slope categories outperformed peak oxygen consumption (VO2) in predicting hospitalization and mortality at 1 year.ConclusionsAlthough the different classification schemes were not identical, these results suggest VE/VCO2slope maintains prognostic significance regardless of exercise-test time interval. Calculation of VE/VCO2slope may therefore still be valuable in subjects putting forth a sub-maximal effort while effort-dependent measures, such as peak VO2, are not.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

PurposeThe aim of this study was to evaluate the predictive factors of return to work after coronary bypass graft surgery, for the subgroup of professionally active patients aged less than 60 years included in the PERISCOP study.MethodsIn the principal, prospective, multicentre study, 2065 patients were evaluated 20±10 days after surgery by exercise testing, echocardiogram and 24-h ambulatory ECG monitoring. A questionnaire was completed one year after surgery. We studied a subgroup of this population, consisting of 530 patients previously defined (94.5% men; mean age: 50.5±5.8 years).ResultsOne year after surgery, five of these patients had died and 21 were lost to follow-up. Among the remaining patients, 340 patients (67.5%) had returned to work. Forty patients (7.9%) had retired, 45 (8.9%) were on sick leave, 22 (4.4%) were unemployed, 49 (9.7%) returned to work after the deadline of 12 months, eight (1.6%) had given insufficient information on return to work. In multivariate analysis, the independent predictors of a failure to return to work were age >51 years [OR: 0.39 (95% CI: 0.25–0.59)], being a manual worker [OR: 0.49 (95% CI: 0.31–0.79)], being from South East France [(OR: 0.42 (95% CI: 0.23–0.74)], presence of angina [OR: 0.40 (95% CI: 0.20–0.82)], dyspnoea [(OR: 0.46 (95% CI: 0.28–0.77)] and a duration of exercise <420 s [(OR: 0.50 (95% CI: 0.33–0.76)].ConclusionsReturn to work after coronary bypass graft surgery is observed in 67.5% of cases and depends essentially on socio-professional factors and residual symptoms. A regional effect was also observed, which requires further study.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID