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Biomedical subjects

Demosthenes B Panagiotakos

Publications and source records attributed to Demosthenes B Panagiotakos.

At least 19 recordsLinked to original sources

Association of creatinine clearance and in-hospital mortality in patients with acute coronary syndromes: the GREECS study.

BACKGROUND: The relationship between renal dysfunction and mortality in patients with myocardial infarction (MI) has been extensively investigated, but there are limited data about this relationship in patients presenting with non-ST-segment-elevation MI and unstable angina. Therefore, the aim of the present study was to investigate whether renal insufficiency is an independent predictor for in-hospital mortality among such patients. METHODS AND RESULTS: Two thousand a hundred and seventy-two patients presenting with acute coronary syndrome (ACS) in 6 Greek hospitals were enrolled. Creatinine clearance rates were estimated by the Cockcroft-Gault formula. Five percentage of patients presented with severe renal dysfunction, 27% with moderate dysfunction and the other 68% were normal. Patients with moderate or severe renal dysfunction were older, more likely to be women and more likely to have history of hypertension and diabetes mellitus compared with those with normal renal function. In comparison with patients with normal renal function, those with moderate and severe renal dysfunction were respectively 3- and 12-fold more likely to die. Moreover, moderate and severe renal insufficiency continued to be a prognostic factor for mortality, even after controlling for potential confounders. CONCLUSIONS: Creatinine clearance rate is an important independent predictor of in-hospital mortality, so patients with ACS complicated by renal dysfunction should receive more aggressive medical care.

Aged↗

Prevalence of asthma among schoolchildren in Patras, Greece: four questionnaire surveys during 1978-2003.

BACKGROUND: The prevalence of asthma and wheezing has risen during the past four decades. Recent reports suggest that the "asthma epidemic" has reached a plateau. OBJECTIVE: To examine further trends in the prevalence of childhood diagnosed asthma and wheezing in an urban environment in Greece. METHODS: A population-based cross-sectional parental questionnaire survey was repeated among third-grade and fourth-grade school children (8-10 years) of public primary schools in 2003 in the city of Patras, Greece, by using methods identical to that of surveys conducted in 1978 (completed questionnaires, n = 3003), 1991 (n = 2417) and 1998 (n = 3076). RESULTS: 2725 questionnaires were completed in the 2003 survey. The prevalence rates of current asthma and/or wheezing in 1978, 1991, 1998 and 2003 were 1.5%, 4.6%, 6% and 6.9%, respectively (p for trend <0.001). The lifetime prevalence of asthma and/or wheezing in the three more recent surveys was 8%, 9.6% and 12.4%, respectively (p for trend <0.001). The male:female ratios of current asthma and/or wheezing in the four surveys were 1.14:1, 1.15:1, 1.16:1 and 1.22:1, respectively. The proportion of those with wheezing diagnosed with asthma has increased during the study period, more so among non-current children with asthma. CONCLUSIONS: Our findings show a continuous increase in the prevalence of asthma and wheezing among preadolescent children in Patras, Greece, over 25 years, albeit at a decelerating rate. There seems to be a true increase in wheezing, despite some diagnostic transfer, particularly among younger children. The male predominance of the disease has persisted in the population of this study.

Asthma↗

Insulin action in adipose tissue and muscle in hypothyroidism.

BACKGROUND: Although insulin resistance in thyroid hormone excess is well documented, information on insulin action in hypothyroidism is limited. METHODS: To investigate this, a meal was given to 11 hypothyroid (HO; aged 45 +/- 3 yr) and 10 euthyroid subjects (EU; aged 42 +/- 4 yr). Blood was withdrawn for 360 min from veins (V) draining the anterior abdominal sc adipose tissue and the forearm and from the radial artery (A). Blood flow (BF) in adipose tissue was measured with 133Xe and in forearm with strain-gauge plethysmography. Tissue glucose uptake was calculated as (A-V)glucose(BF), lipoprotein lipase as (A-V)Triglycerides(BF), and lipolysis as [(V-A)glycerol(BF)]-lipoprotein lipase. RESULTS: The HO group had higher glucose and insulin levels than the EU group (P < 0.05). In HO vs. EU after meal ingestion (area under curve 0-360 min): 1) BF (1290 +/- 79 vs. 1579 +/- 106 ml per 100 ml tissue in forearm and 706 +/- 105 vs. 1340 +/- 144 ml per 100 ml tissue in adipose tissue) and glucose uptake (464 +/- 74 vs. 850 +/- 155 micromol per 100 ml tissue in forearm and 208 +/- 42 vs. 406 +/- 47 micromol per 100 ml tissue in adipose tissue) were decreased (P < 0.05), but fractional glucose uptake was similar (28 +/- 6 vs. 33 +/- 6% per minute in forearm and 17 +/- 4 vs. 14 +/- 3% per minute in adipose tissue); 2) suppression of lipolysis by insulin was similar; and 3) plasma triglycerides were elevated (489 +/- 91 vs. 264 +/- 36 nmol/liter.min, P < 0.05), whereas adipose tissue lipoprotein lipase (42 +/- 11 vs. 80 +/- 21 micromol per 100 ml tissue) and triglyceride clearance (45 +/- 10 vs. 109 +/- 21 ml per 100 ml tissue) were decreased in HO (P < 0.05). CONCLUSIONS: In hypothyroidism: 1) glucose uptake in muscle and adipose tissue is resistant to insulin; 2) suppression of lipolysis by insulin is not impaired; and 3) hypertriglyceridemia is due to decreased clearance by the adipose tissue.

Adipose Tissue↗

Prevalence of self-reported hypertension and its relation to dietary habits, in adults; a nutrition & health survey in Greece.

BACKGROUND: Hypertension leads to many degenerative diseases, the most common being cardiovascular in origin. This study has been designed to estimate the prevalence of self-reported hypertension in a random nationwide sample of adult Greek population, while focus was set to the assessment of participants' nutritional habits in relation to their hypertension status. METHODS: A random-digit dialed telephone survey. Based on a multistage, stratified sampling, 5003 adults (18 - 74 yr) participated (men: 48.8%, women: 51.2%). All participants were interviewed via telephone by trained personnel who used a standard questionnaire. The questionnaire included demographic and socioeconomic characteristics, medical history, lifestyle habits and nutritional assessment. RESULTS: The prevalence of self-reported hypertension was 13.3% in men and 17.7% in women (P < 0.001). Furthermore, women reported higher values of systolic blood pressure (180 +/- 27 mmHg) than men (169 +/- 24 mmHg). Positive relationships were found between hypertension status and the prevalence of the rest investigated health conditions (i.e. hypercholesterolaemia, diabetes mellitus, renal failure and obesity). Nutritional assessment showed that consumption of fish, fruits and juices, cereals, and low fat milk and yogurt was significantly higher among hypertensive subjects while the opposite was observed for food items as red meat, pork, egg, pasta and rice, full fat dairy products and desserts. CONCLUSION: Hypertension seems to be a serious public health problem in Greece. It is encouraging that hypertensives may have started adopting some more healthy nutritional behaviour compared to normotensive ones. However, they can gain significant benefits regarding to blood pressure control, if they increase the level of compliance with dietary recommendations.

Adolescent↗

The implication of obesity on total antioxidant capacity in apparently healthy men and women: the ATTICA study.

BACKGROUND AND AIM: We evaluated the association of obesity with serum total antioxidant capacity (TAC), in a population-based sample of 3042 adults. METHODS AND RESULTS: During 2001-2002 we randomly enrolled 1514 men (18-87 years old) and 1528 women (18-89 years old), from the Attica area in Greece into the study, and the sample was stratified by the age-sex distribution of the region (census 2001). Among several variables we also measured serum TAC and weight, height, waist and hip circumferences. Waist circumference greater than 102 cm for men and 88 cm for women was considered an indicator of central fat. METHODS AND RESULTS: Mean waist circumference was 98+/-13 cm in men and 84+/-22 cm in women (P<0.001), while mean hip circumference was 106+/-28 cm in men and 103+/-13 cm in women (P<0.001). Central fat prevailed in 53% of men and 45% of women (P<0.001). Male participants with central fat exhibited 5% lower TAC concentrations compared to leaner individuals (214+/-35 vs. 226+/-33 micromol/L, P=0.04) and female participants with central fat exhibited 7% lower TAC concentrations (256+/-38 vs. 239+/-27 micromol/L, P=0.03). Similarly, obese or overweight male participants had 6% lower TAC concentrations compared to normal weight (217+/-33 vs. 234+/-39 micromol/L, P=0.03) and female obese or overweight participants had 10% lower TAC concentrations (226+/-32 vs. 250+/-30 micromol/L, P=0.02) compared to the others. CONCLUSIONS: Our results suggest an inverse relationship between body fat, central adiposity and antioxidant capacity, irrespective of age and various other potential confounders, namely smoking, physical activity, dietary habits, blood pressure, glucose levels, and lipid concentrations.

Abdominal Fat↗

Association between plasma inflammatory markers and irrational beliefs; the ATTICA epidemiological study.

OBJECTIVE: Recent research data suggest that inflammation and/or depression are associated with the development and progression of cardiovascular disease (CVD). Considering that depression may arise as a response to irrational beliefs according to the Ellis model of psychological disturbances and therapy, we sought to evaluate whether irrational beliefs are associated with plasma inflammatory factors in cardiovascular disease-free people. METHOD: From May 2001 to December 2002 we randomly enrolled 453 men (23-69 years old) and 400 women (24-71 years old) stratified by age and gender. C-reactive protein, interleukin-6, serum amyloid-A, tumor necrosis factor-alpha and white blood cells were measured in all participants. Detailed dietary characteristics of these people were assessed through a validated food frequency questionnaire. Subjects completed also the irrational beliefs inventory (IBI), which is a brief self-report measure consistent with the Ellis model of psychological disturbance and therapy and the Zung's Depression questionnaire. RESULTS: The IBI scores were similar in men and women (53+/-11 vs. 53+/-10, p = 0.83). IBI score was positively correlated with C-reactive protein (rho = 0.14, p = 0. 02), interleukin-6 (rho = 0.11, p = 0.02), tumor necrosis factor-alpha (rho = 0.21, p = 0.014) and white blood cell counts (rho = 0.14, p = 0.02). These associations were confirmed even after adjusting for age, sex, years of school, body mass index, physical activity status, depression level and food items consumed by the participants. CONCLUSION: These findings indicate that irrational beliefs are associated with increased inflammation process, among apparently healthy individuals.

Adult↗

Cigarette smoking and myocardial infarction in young men and women: a case-control study.

BACKGROUND: The effect of cigarette smoking on the risk of myocardial infarction (MI) has long been investigated. However, its role on the likelihood of having MI at young age has not been well understood and appreciated. We investigated whether smoking habits can discriminate young individuals with MI from age- and sex-matched controls. METHODS: We enrolled 100 consecutive patients who had survived their first episode of MI before the age of 36 years and 100 age- and sex-matched controls without a history of cardiovascular disease. Smoking habits, physical activity status, body mass index and blood lipids levels were measured in all participants. RESULTS: 96% of the patients with premature MI and 55% of the controls reported current smoking habits (p<0.001). Moreover, patients had higher levels of total cholesterol, low density lipoprotein cholesterol, triglycerides and lower levels of high density lipoprotein cholesterol (p<0.05). Multivariate logistic regression analysis showed that current smoking increased 6-fold the odds of having a MI (95% CI 1.01 to 37), after controlling for age, sex, body mass index, hypertension, diabetes, physical activity, family history of coronary heart disease and total cholesterol levels. Finally, discriminant analysis showed that pack-years of smoking was the strongest discriminator for MI among all the investigated factors (lambda-Wilks=0.85). CONCLUSIONS: Our study suggests that cigarette smoking seems to play the most important role for having a MI in individuals under the age of 36 years.

Adult↗

MedDietScore: a computer program that evaluates the adherence to the Mediterranean dietary pattern and its relation to cardiovascular disease risk.

Mediterranean dietary traditions have long been associated with lower mortality rates and better health status. The Mediterranean dietary pattern has become customary to be represented in the form of a pyramid, the base of which refers to foods which are suggested to be consumed most frequently and the top of the pyramid to those foods consumed rarely. Recently, an index (diet score) that estimates the adherence level to Mediterranean diet was developed and associated with cardiovascular disease risk and biomarkers. In this work we present a computer program that can easily calculate this diet score, as well as its association with cardiovascular disease risk. The application of this software to the general public might be a useful tool for the reduction of the disease burden related with nutritional habits at population level.

Biomarkers↗

The association between pre-hypertension status and oxidative stress markers related to atherosclerotic disease: the ATTICA study.

BACKGROUND: We sought to evaluate the association between pre-hypertension status and oxidative stress markers (total antioxidant capacity (TAC) and oxidized low density lipoprotein (LDL)), in a random sample of cardiovascular disease-free adults. METHODS: The ATTICA study is a cross-sectional population-based survey that conducted in Attica region during 2001-2002. Based on a multistage and stratified random sampling, 1514 men and 1528 women (18-89 years old) were enrolled. The survey included a detailed interview; blood samples collected after 12h of fasting and, among other clinical measurements, status of blood pressure levels was evaluated. RESULTS: Six hundred and fifty-three men (43%) and 535 women (35%) were defined as pre-hypertensives. Both systolic and diastolic blood pressures were inversely correlated with TAC (p<0.001) and positively correlated to oxidized LDL (p<0.001). Particularly, compared to normotensive subjects, pre-hypertensives had 7% lower TAC levels (p<0.001) and 15% higher oxidized LDL levels (p<0.05), after correcting for multiple comparisons and adjusting for age, body mass index, blood lipids, glucose, food groups consumed and other potential confounders. CONCLUSIONS: Studying a large sample of cardiovascular disease-free adults, we revealed an association of pre-hypertension with oxidative stress markers linking to atherosclerotic process.

Adult↗

The relationship between adherence to the Mediterranean diet and the severity and short-term prognosis of acute coronary syndromes (ACS): The Greek Study of ACS (The GREECS).

BACKGROUND: Although adherence to the Mediterranean diet has long been associated with lower incidence of various chronic diseases among apparently healthy individuals, its relationship with the severity and short prognosis (30 d) of patients with cardiovascular disease has rarely been investigated. OBJECTIVE: We sought to evaluate the association between adherence to the Mediterranean diet and the severity and prognosis of acute coronary syndromes. METHODS: From October 2003 to September 2004, a sample of 6 hospitals located in several urban and rural Greek regions was selected, and almost all survivors after an acute coronary syndrome were enrolled into the study (2172 patients were included in the study; 76% were men and 24% women). Adherence to the Mediterranean diet was assessed by a diet score that incorporated the inherent characteristics of this diet. Higher values of the score (range 0-55) were closer to the Mediterranean diet. Biochemical indices of myocardial damage were also considered. RESULTS: Diet score was inversely correlated with entry values of cardiac troponin I (rho = -0.19, P < 0.001), creatine phosphokinase (rho = -0.09, P < 0.001), and creatine phosphokinase-MB (rho = -0.09, P < 0.001). An increment in the diet score was associated with significant decrease in troponin I and creatine phosphokinase-MB levels (P < 0.01) after adjusting for various potential confounders. Moreover, diet score was associated with lower risk of recurrent events (odds ratio = 0.81, 95% confidence interval 0.61-0.98). However, this association became insignificant when the discharge diagnosis of the patients was taken into account. CONCLUSION: Background dietary habits close to the Mediterranean diet seem to be associated with lower severity of coronary heart disease.

Acute Disease↗

Prevalence of self-reported hypercholesterolaemia and its relation to dietary habits, in Greek adults; a national nutrition & health survey.

BACKGROUND: The strong causal role of hypercholesterolaemia on the progression of atherosclerosis and subsequently on the development of cardiovascular disease is well described. Main aim of this study was to evaluate the prevalence of self-reported hypercholesterolaemia and its relation to nutritional habits, in a representative nationwide sample of adult Greek population. METHODS: Cross sectional survey. Based on a multistage sampling, 5003 adults (18-74 yr) were enrolled (men: 48.8%, women: 51.2%). All participants were interviewed by trained personnel who used a standard questionnaire. The questionnaire included demographic and socioeconomic characteristics, medical history, lifestyle habits and nutritional assessment. RESULTS: The prevalence of self-reported hypercholesterolaemia was 16.4% in men and 21.8% in women (P < 0.001). Hypercholesterolaemic status was positively associated with the prevalence of hypertension, diabetes mellitus, renal failure, obesity and physical inactivity, and inversely with the prevalence of smoking. The analysis of reported food consumption patterns showed that consumption of fish, fruits and juices, cereals, and low fat milk and yogurt was significantly higher among hypercholesterolaemic participants while the opposite was observed for food items as red meat, pork, egg, full fat dairy products and desserts. CONCLUSION: Hypercholesterolaemia seems to affect a large part of Greek population. It is hopeful that hypercholesterolaemics may have started adopting some more healthy nutritional behaviour compared to normocholesterolaemic ones.

Adolescent↗

Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk.

BACKGROUND AND AIM: It has been suggested that overall dietary patterns and not single nutrients should be studied, since food items might have a synergistic and antagonistic effect on health. The Mediterranean diet has long been associated with lower incidence of cardiovascular disease and cancer. Therefore, we developed a diet score that incorporates the inherent characteristics of this dietary pattern. METHODS AND RESULTS: We used 11 main components of the Mediterranean diet (non-refined cereals, fruits, vegetables, potatoes, legumes, olive oil, fish, red meat, poultry, full fat dairy products and alcohol). For the consumption of items presumed to be close to this pattern we assigned scores 0, 1, 2, 3, 4 and 5 when a participant reported no consumption, rare, frequent, very frequent, weekly and daily, respectively. For the consumption of foods presumed to be away from this pattern we assigned the scores on a reverse scale. Especially for alcohol, we assigned score 5 for consumption of less than 300 ml/day, score 0 for consumption of more than 700 ml/day or none and scores 1-4 for consumption of 300-400, 400-500, 500-600, and 600-700 ml/day (100 ml = 12 g ethanol), respectively. Then a total score ranging from 0 to 55 was calculated. After having applied this diet score in the participants of the ATTICA study we observed a significant positive association with monounsaturated fat and monounsaturated-to-saturated fat intake. We also observed, an inverse association with serum lipids, blood pressures, inflammation and coagulation markers related to cardiovascular disease. The application of that score in a case-control study (CARDIO2000) suggested that the score was inversely associated with the odds of having acute coronary syndromes. CONCLUSION: The Mediterranean diet score proposed above may be useful in assessing the nutritional status of an individual and investigating the relationship of the Mediterranean diet with various health outcomes.

Biomarkers↗

Association between the prevalence of obesity and adherence to the Mediterranean diet: the ATTICA study.

OBJECTIVE: We evaluated the prevalence of obesity in relation to adherence to a Mediterranean diet. METHODS: We conducted a cross-sectional survey that randomly enrolled 1514 men (18 to 87 y old) and 1528 women (18 to 89 y old) with no history of cardiovascular disease. Anthropometric indices were measured and frequency of various foods consumed during a usual week was recorded. Adherence to a Mediterranean diet was assessed by a diet score that incorporated the inherent characteristics of this diet. RESULTS: Prevalences of overweight and obesity were 53% and 20% in men and 31% and 15% in women. An inverse relation was observed between diet score, waist-to-hip ratio (r = -0.31, P < 0.001), and body mass index (r = -0.4, P < 0.001) after adjusting for sex and age. Greater adherence to the Mediterranean diet (i.e., highest tertile) was associated with a 51% lower odds of being obese (odds ratio 0.49, 95% confidence interval 0.42 to 0.56) and a 59% lower odds of having central obesity (odds ratio 0.41, 95% confidence 0.35 to 0.47) compared with a non-Mediterranean diet (i.e., lowest tertile) after controlling for age, sex, physical activity status, metabolism, and other variables. CONCLUSION: We observed an inverse relation between adherence to a Mediterranean dietary pattern and prevalence of obesity in a free-eating, population-based sample of men and women, irrespective of various potential confounders.

Adolescent↗

Inflammatory markers and in-hospital mortality in acute ischaemic stroke.

BACKGROUND: There is substantial evidence that cerebral ischaemia triggers an inflammatory response. We examined the short-term prognostic value on mortality of C-reactive protein (CRP), interleukin-6 (IL-6) and serum amyloid A (SAA) in patients with ischaemic stroke. METHODS: We recruited 203 consecutive patients, under the age of 66 years (mean age=54.2+/-8.1 years, men=132) who admitted to the Neurology Department with the diagnosis of non-haemorrhagic stroke. Patients in atrial fibrillation or with evidence of inflammatory or malignant disease were excluded. The diagnosis was confirmed with a computed tomography or magnetic resonance imaging of the brain within 24h of admission. CRP, IL-6 and SAA levels were determined within 12h from admission. RESULTS: Fourteen (6.9%) patients died during hospitalization. Serum concentrations of CRP, IL-6 and SAA were significantly higher in patients who died compared with those who survived and were independently associated with early death, after adjusting for various confounding factors. For one unit increase in IL-6, CRP and SAA there was an 18%, 14% and 9% higher risk of dying during hospitalization, respectively. Comparisons of the areas under the ROC curve showed that IL-6 had the best predictive ability. Age-adjusted cut-off point analysis showed that IL-6 levels >13 pg/ml were the optimal point that discriminated those who died from the rest of the patients (sensitivity=85% and specificity=93%). CONCLUSIONS: We demonstrated that in-hospital mortality in ischaemic stroke is associated with an exacerbation of inflammatory response as it is reflected by the higher serum levels of IL-6, CRP and SAA. From the inflammatory markers high IL-6 levels had the strongest independent predictive value for in-hospital mortality.

Acute Disease↗

Correlates of BMI misreporting among apparently healthy individuals: the ATTICA study.

OBJECTIVE: The aim of this study was to investigate correlates of misreporting in BMI, based on self-reported weight and height, in a randomly selected population sample of Greek adults and to evaluate the effect of obesity status misclassification on the associations between obesity and disease. RESEARCH METHODS AND PROCEDURES: During 2001 to 2002, we randomly enrolled 1514 men (18 to 87 years old) and 1528 women (18 to 89 years old) from the Attica area, Greece; the sampling was stratified by the age-sex distribution of the region. Various sociodemographic, clinical, and psychological characteristics were self-reported, and weight and height were measured and recorded in all participants. RESULTS: The proportions of true positives and true negatives for correct obesity status identification were 62% and 97%, respectively. Women were 9 times more likely to be under-reporters than men, whereas men were 7.5 times more likely to be over-reporters. A 10-year increase in age was associated with a 48% higher likelihood of being an under-reporter and 26% lower likelihood of being an over-reporter, irrespective of sex and other characteristics of the participants. Clinical status, such as the presence of hypertension and diabetes, was associated with under-reporting of body weight. Furthermore, the use of self-reported data may substantially exaggerate associations between obesity and obesity-related diseases, such as diabetes, hypercholesterolemia, and hypertension. DISCUSSION: The study indicates that, apart from age and sex, disease status may be another factor that influences misreporting of obesity status, with diabetic and hypertensive people to be more likely to under-report their overweight. Use of self-reported data may bias obesity-disease associations.

Adolescent↗

Modelling dairy intake on the development of acute coronary syndromes: the CARDIO2000 study.

BACKGROUND: Dairy consumption may be associated with a small but worthwhile reduction in cardiovascular disease risk, but results from epidemiological studies are inconsistent. The aim of the present study was to evaluate the association between dairy consumption and the prevalence of a first, non-fatal event of an acute coronary syndrome, in a Greek sample. DESIGN: Seven hundred male and 148 female patients with first event of an acute coronary syndrome and 1078 population-based controls, age and sex matched, were randomly selected. METHODS: Detailed information regarding their medical records, alcohol intake, physical activity and smoking habits was recorded. Nutritional habits were evaluated with a semi-quantitative food-frequency questionnaire. Multiple logistic regression analysis estimated the odds ratio of having acute coronary syndrome by level of dairy intake, after taking into account the effect of several confounders. RESULTS: An inverse relationship was observed between dairy products consumption and odds of having acute coronary syndrome. One portion increase in weekly dairy products intake was associated with 12% lower likelihood of having acute coronary syndrome, after controlling for various potential confounders (P<0.001). Cut-off analysis showed that 7.4 portions per week are the optimal consumption that benefits people from having acute coronary syndrome. CONCLUSIONS: Dairy consumption seems to offer significant protection against coronary heart disease, irrespective of various clinical, lifestyle and other characteristics of the participants.

Case-Control Studies↗

Short-term effects of atmospheric temperature and humidity on morbidity from acute coronary syndromes in free of air pollution rural Greece.

STUDY OBJECTIVE: An evaluation of the effect of ambient temperature on morbidity from acute coronary syndromes (ACS) while avoiding confounding by air pollution. DESIGN: An ecological study in rural Greece. METHODS: Daily admissions to hospital because of ACS were recorded for 1 year and analysed versus daily temperature and humidity. RESULTS: For a 1 degrees C decrease in temperature there was a 1.6% (95% confidence interval 0.9-2.2%) increase in admissions. This effect was more prominent in the elderly. No difference was detected according to sex or type of ACS. CONCLUSION: It is important to implement measures against cold in coronary heart disease prevention, irrespective of air pollution.

Air Pollution↗