摘要:

PreambleGuidelines aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making. A great number of guidelines have been issued in recent years by different organisations—European Society of Cardiology (ESC), American Heart Association (AHA), American College of Cardiology (ACC), and other related societies. By means of links to web sites of National Societies several hundred guidelines are available. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing guidelines. In spite of the fact that standards for issuing good quality guidelines are well defined, recent surveys of guidelines published in peer-reviewed journals between 1985 and 1998 have shown that methodological standards were not complied with in the vast majority of cases. It is therefore of great importance that guidelines and recommendations are presented in formats that are easily interpreted. Subsequently, their implementation programmes must also be well conducted. Attempts have been made to determine whether guidelines improve the quality of clinical practice and the utilisation of health resources. In addition, the legal implications of medical guidelines have been discussed and examined, resulting in position documents, which have been published by a specific task force. The ESC Committee for practice guidelines (CPG) supervises and coordinates the preparation of new guidelines and expert consensus documents produced by task forces, expert groups or consensus panels. The Committee is also responsible for the endorsement of these guidelines or statements.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundPsychological distress has been associated with the pathogenesis and progression of coronary heart disease (CHD) but little is known about the determinants of distress as a coronary risk factor. Although it has become unfashionable to focus on personality factors since research on Type A behaviour yielded inconsistent findings, personality may comprise a major explanatory factor of individual differences in stress-related CHD. This article focuses on Type D – thedistressed– personality, which describes patients who experience increased negative emotions and tend to inhibit the expression of these emotions in social interactions.MethodsThe article reviews research on Type D personality in the context of CHD.ResultsAccumulating evidence indicates that cardiac patients with the Type D personality are at increased risk for cardiovascular morbidity and mortality (odds ratios ranging from 4.1–8.9,P<0.0001) independent of standard cardiac risk factors. Type D patients are also at increased risk for psychological distress, clustering of psychosocial risk factors, impaired quality of life, and seem to benefit less from medical and invasive treatment. Preliminary evidence suggests that physiological hyper-reactivity and activation of pro-inflammatory cytokines may be responsible for the detrimental effect of Type D personality on cardiac prognosis.ConclusionsThere is an urgent need to adopt a personality approach in the identification of patients at risk for stress-related cardiac events. Type D is a stable personality construct that may be of special interest not only in CHD, but in other chronic cardiac conditions as well.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundVascular mortality is increasing in economically developing countries but reliable data about the determinants of cardiovascular disease are few. The International Collaborative Study of Cardiovascular Disease in Asia (InterASIA) was designed to obtain precise estimates of cardiovascular risk factor levels in the adult population of Thailand.DesignA complex sample survey.MethodsData from a structured questionnaire, brief physical examination and a blood sample were collected from 5305 individuals aged 35 years or older (response rate 68%). Mean risk factor levels were calculated for eight groups defined by age and sex in 18 representative urban and rural areas of Thailand. Population risk factor levels were calculated by applying sampling weights derived from the 2000 Thai Census and allowing for the complex sampling design.ResultsThe estimated mean (standard error) population blood pressure was 120/76 (0.7/0.5) mmHg, mean serum total cholesterol was 5.2 (0.06) mmol/l, mean body mass index was 24 (0.2) kg/m2, mean fasting plasma glucose was 5.6 (0.06) mmol/l, the proportion with diabetes 9.6 (1)% and the proportion of current smokers was 25 (3)%. There were estimated to be 5.1 (0.5) million individuals with high blood pressure, 4.4 (0.4) million with high total cholesterol, 8.9 (0.8) million overweight or obese, 2.4 (0.2) million with diabetes and 6.2 (0.9) million current smokers. Mean levels of all major risk factors, except smoking, were worse in urban compared with rural areas. However, except for total cholesterol, the absolute numbers of individuals with abnormal risk factor levels were highest in rural areas.ConclusionAbsolute levels of cardiovascular risk factors in Thailand are high. Effective risk factor control strategies that target both rural and urban areas of Thailand have the potential to avert much premature cardiovascular disease.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundSecondary prevention in patients with ischaemic heart disease (IHD) focusing on classical risk factors has been less successful in women than in men. Previous studies have suggested that psychosocial factors may be new targets for secondary prevention. In the present study, psychosocial factors have been compared in women with and without IHD.Methods and subjectsUsing a cross-sectional comparison, classical cardiovascular risk factors and self-rated stress behaviour, vital exhaustion, stressful life events and quality of life were assessed in 198 women (age 35–77 years) who had IHD and a population-based sample of 206 women (age 45–74 years) without IHD.ResultsControl of classical risk factors was most often adequate in women with IHD. The prevalence of smoking was 9% in women with versus 18% in women without IHD (P<0.001), blood pressure levels were similar, and a very large share of women with IHD were on treatment with anti-thrombotic, anti-hypertensive and/or lipid-lowering drugs (P<0.001 compared with women free of IHD). In contrast, women with IHD scored significantly worse than women without IHD in self-rated stress behaviour (P=0.003 after adjustment for other possible determinants), and in vital exhaustion (P=0.003). In univariate analyses, quality of life was significantly worse in women with IHD. Stressful life events did not differ between the two groups.ConclusionsIn this group of women with IHD, control of classical risk factors was good, whereas control of psychosocial risk factors was clearly inadequate. Secondary prevention by psychosocial intervention in women with IHD should be evaluated in randomized controlled trials.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIncreased ventilatory drive, reflected by the slope of increase of ventilation relative to carbon dioxide production (VE/VCO2slope), has been shown to have a high prognostic value in patients with chronic heart failure (CHF). However, there is no consensus on how to calculate it, as the relation between VE and VCO2becomes nonlinear near the end of exercise, when ventilation is driven both by CO2output and by decrease in plasma pH. This may influence the results.MethodsNinety-seven CHF patients with ejection fraction <45% (mean 27±9%), in NYHA class II-IV underwent a cardiopulmonary exercise test. VE/VCO2slope was assessed by linear regression using all the data points (Sl), using only points before (Sli), or after (Slf) the non-linear part of the curve, and using only the first 3-min data (Sl3 min). Peak oxygen uptake (VO2), and circulatory power (VO2×systolic arterial pressure) were also assessed. Death and transplantation were the end-points considered (mean follow-up 22 months).ResultsMean value of VE/VCO2overall slope was 39.3±11.6 (22–78). In 64% of the patients, two distinct slopes could be found: an initial, linear slope (31.8±7.5, 18–62) and a final, steeper slope (48.6±15.7, 24–101). Patients in whom no rupture of slope was observed were sicker. There was a relation between initial and overall VE/VCO2slopes (r=0.915,P<10−4) and between overall and 3-min VE/VCO2slopes (r=0.808,P<10−4). VE/VCO2slope correlated with peak VO2(r=−0.55,P<10−4) and peak circulatory power (r=−0.49,P<10−4). Univariate analysis showed that the prognostic value of overall VE/VCO2slope (χ225.4,P<10−4) was greater than initial (χ222.8,P<10−4), 3-min (χ214.6,P<10−4) or final VE/VCO2slopes (χ26.7,P=0.09). By multivariate analysis, the prognostic value of the peak circulatory power was similar to that of the VE/VCO2overall slope.ConclusionsThe VE/VCO2slope should be computed from all the data points to have its highest prognostic value. Peak circulatory power also has similar prognostic value.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIn the advanced stages of chronic heart failure (CHF) the expression of inducible nitric oxide synthase (iNOS) in skeletal muscle (SM) may contribute to exercise intolerance and early fatigue. Cell culture studies and promoter analysis demonstrated that the transcription factor nuclear factor kappa B (NF-κB) is essential for iNOS-expression. The aim of this study was to assess whether NF-κB is activated in skeletal muscle of patients with CHF and linked to the expression of iNOS.MethodsSkeletal muscle biopsies were obtained from seven CHF patients and seven healthy controls (HC). Nuclear proteins were isolated and the content of activated NF-κB was analysed by electrophoretic mobility shift assay (EMSA). Inducible nitric oxide synthase expression in SM was determined by real time polymerase chain reaction (PCR).ResultsThe expression of iNOS (1.4±0.2 versus 0.5±0.08 arbitrary units,P=0.001) and the activation of NF-κB in the SM (0.5±0.1 versus 0.1±0.04 arbitrary units,P=0.009) was significantly increased in CHF patients as compared to healthy controls. Furthermore, a linear correlation was observed between NF-κB activation and iNOS expression (r=0.78,P<0.001).ConclusionsThe results of this study indicate for the first time that in the skeletal muscle of patients with chronic heart failure the activation of the transcription factor NF-κB is increased and may represent one important regulatory factor for the expression of iNOS in patients. Nevertheless, due to the small sample size this observation has to be confirmed in subsequent studies with more patients.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundInfectious agents might play a role in the aetiology of cardiovascular diseases. The aim was to determine the association of antibodies to implicated infectious agents with coronary heart disease (CHD) and stroke in a population-based prospective study.DesignThis study was based on a cohort of 1612 cardiovascular disease-free adults in the 1981 Busselton Health Survey. Primary risk factors were measured from stored serum and case-cohort sampling was used to reduce costs and preserve serum. The outcomes of interest were time to first CHD or stroke event. Serum antibody tests were carried out for all 218 CHD cases, all 119 stroke cases and a random subset of 451 subjects.MethodsSera were tested for antibodies toChlamydia pneumoniae(IgG and IgA), and for IgG antibodies toHelicobacter pyloriand cytomegalovirus (CMV). The association between serum antibody and risk of cardiovascular diseases was analysed using Cox proportional hazards regression.ResultsThe estimated population prevalence was 24% forC. pneumoniaeIgG, 7% forC. pneumoniaeIgA, 58% forH. pyloriand 85% had CMV antibody levels greater than 15 AU/mL. The estimated relative risk of CHD was around 1.2 for all antibodies examined, except forC. pneumoniaeIgA for which it was less than one, and the estimated relative risk of stroke was around 0.85, however in all cases the 95% confidence interval included one.ConclusionsThis study of an Australian population does not support an association between serum antibody levels toC. pneumoniae,H. pyloriand CMV with development of cardiovascular diseases.

ISSN:1741-8267    

出版商:OVID    

年代:2003

数据来源: OVID