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Biomedical subjects

Zvonko Rumboldt

Publications and source records attributed to Zvonko Rumboldt.

14 recordsLinked to original sources
PubMed2005

Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study.

BACKGROUND: Obesity is a major risk factor for cardiovascular disease, but the most predictive measure for different ethnic populations is not clear. We aimed to assess whether markers of obesity, especially waist-to-hip ratio, would be stronger indicators of myocardial infarction than body-mass index (BMI), the conventional measure. METHODS: We did a standardised case-control study of acute myocardial infarction with 27 098 participants in 52 countries (12,461 cases and 14,637 controls) representing several major ethnic groups. We assessed the relation between BMI, waist and hip circumferences, and waist-to-hip ratio to myocardial infarction overall and for each group. FINDINGS: BMI showed a modest and graded association with myocardial infarction (OR 1.44, 95% CI 1.32-1.57 top quintile vs bottom quintile before adjustment), which was substantially reduced after adjustment for waist-to-hip ratio (1.12, 1.03-1.22), and non-significant after adjustment for other risk factors (0.98, 0.88-1.09). For waist-to-hip ratio, the odds ratios for every successive quintile were significantly greater than that of the previous one (2nd quintile: 1.15, 1.05-1.26; 3rd quintile: 1.39; 1.28-1.52; 4th quintile: 1.90, 1.74-2.07; and 5th quintiles: 2.52, 2.31-2.74 [adjusted for age, sex, region, and smoking]). Waist (adjusted OR 1.77; 1.59-1.97) and hip (0.73; 0.66-0.80) circumferences were both highly significant after adjustment for BMI (p<0.0001 top vs bottom quintiles). Waist-to-hip ratio and waist and hip circumferences were closely (p<0.0001) associated with risk of myocardial infarction even after adjustment for other risk factors (ORs for top quintile vs lowest quintiles were 1.75, 1.33, and 0.76, respectively). The population-attributable risks of myocardial infarction for increased waist-to-hip ratio in the top two quintiles was 24.3% (95% CI 22.5-26.2) compared with only 7.7% (6.0-10.0) for the top two quintiles of BMI. INTERPRETATION: Waist-to-hip ratio shows a graded and highly significant association with myocardial infarction risk worldwide. Redefinition of obesity based on waist-to-hip ratio instead of BMI increases the estimate of myocardial infarction attributable to obesity in most ethnic groups.

Adult↗
PubMed2005

Effects of atenolol and propranolol on platelet aggregation in moderate essential hypertension: randomized crossover trial.

AIM: To compare the effects of a selective beta-blocker atenolol and a nonselective beta-blocker propranolol on platelet aggregation. METHODS: Twenty successive outpatients with moderate essential hypertension (6 women and 14 men, mean age-/+standard deviation 42.6-/+8.5 years) were randomized to either propranolol (40 mg three times a day) or atenolol (100 mg once a day) for the first two weeks, followed by a one-day washout period, and then a two-week administration of the alternative drug. Along with standard examinations and tests, circulating platelet aggregates were measured. RESULTS: There were no significant differences in creatinine, blood glucose, potassium, total cholesterol, hemoglobin, red blood cells (RBC), or platelets in three periods: baseline, atenolol, and propranolol period. Significant and comparable reductions in systolic and diastolic arterial pressure, body weight, heart rate, and HDL-cholesterol were recorded in both patient groups. The LDL-cholesterol concentration increased significantly in propranolol compared with both baseline and atenolol period. Serum triglycerides increased significantly with both medications. The number of circulating platelet aggregates decreased significantly with propranolol (0.99-/+0.19) in comparison with both atenolol (1.41-/+0.70; P=0.004, Wilcoxon matched pairs test) and baseline (1.59-/+0.94; P=0.002, Wilcoxon matched pairs test). CONCLUSION: Propranolol inhibits platelet aggregation more than atenolol and may have a favorable effect on the management of hypertension especially in patients with increased cardiovascular risk.

Adrenergic beta-Antagonists↗
PubMed2005

In-hospital cardiac arrest and resuscitation outcomes: rationale for sudden cardiac death approach.

AIM: To assess the frequency of cardiac arrest and outcomes and predictors of survival after cardiopulmonary resuscitation in hospitalized patients. METHODS: We prospectively analyzed the data on all patients who experienced cardiac arrest while hospitalized at the Split University Hospital between January and December 2003. Data were collected on patients' demographic characteristics, etiology and presentation of cardiac arrest, time, site, methods, and outcomes of cardiopulmonary resuscitation. RESULTS: Out of 120 cases of cardiac arrest among 32,861 hospitalized patients, 76.7% were witnessed. Ninety-six (80.0%) patients with cardiac arrest underwent resuscitation, and 22.5% of them were discharged alive. The survival rate was 20.0% at the Department of Internal Medicine, 29.2% in the Coronary Care Unit, and only 7.1% in other departments (P=0.058, chi2 test). Out of 92 patients with witnessed cardiac arrest, 28.3% survived to discharge, whereas only one of 28 patient with unwitnessed cardiac arrest survived to discharge (P=0.004, Fisher's exact test). More patients with cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia survived than patients with asystole and pulseless electrical activity (47.6% vs 10.7%, respectively, P<0.001, Fisher's exact test). None of the patients with unclassified cardiac arrest survived until discharge. Cardiac arrest survivors were significantly younger (60.8+/-12.9 vs 71.1+/-11.7 years, P<0.001, Student t-test). Sex had no influence on survival. There were no significant circadian or hospital shift differences in the frequency rate of cardiac arrest, but the rate of successful resuscitation was lower during the night shift. CONCLUSION: The rate of successful resuscitation was higher in the coronary care unit, during the day and in younger witnessed cardiac arrest patients with ventricular fibrillation or pulseless ventricular tachycardia.

Aged↗
PubMed2003

Smoking cessation with nicotine replacement therapy among health care workers: randomized double-blind study.

AIM: To assess the smoking prevalence and efficacy of nicotine replacement therapy on the quitting rate after 3 weeks of therapy and after 1- and 5-year follow-up among health care workers with a smoking habit in Split, Croatia. METHODS: Among 311 hospital health professionals included in the study, there were 112 (36%) smokers; 44 (39%) of them were physicians and 68 (61%) nurses. In a randomized double-blind study, 112 smokers were divided in 2 groups, applying daily either a transdermal nicotine system (TNS) or placebo patch over 3 weeks. Abstinence was evaluated via questionnaire and on the basis of carbon monoxide concentration measured in the exhaled breath. RESULTS: The abstinence rates after the 3-week intervention period were 39% in the TNS group and almost 20% in the control group (chi-square test, p=0.038). After one year, these rates declined to 23% and 16%, respectively (p=0.476), and converged to 18% and 14% (p=0.797), respectively, at 5-year follow-up. CONCLUSIONS: Short-term TNS treatment is effective in smoking cessation, although the effects steadily wane over time and the relapse rate is high. Continuous, structured, and composite efforts are needed for the maintenance of the non-smoking behavior.

Administration, Cutaneous↗
PubMed2003

Premature parental heart attack is heralding elevated risk in their offspring.

A small subgroup of children, whose parents have suffered a heart attack in their late thirties and early forties, may be at particularly high cardiovascular risk. University Hospital "Split" gives tertiary health care to some 700,000 people in southern Croatia and treats about 300 acute myocardial infarctions per year, with a 3-5% share in the age under 45 years. This cross-sectional, clinical and laboratory study included all the patients below the age limit of 45 years, treated for acute myocardial infarction between 1990 and 1995, complexively 55 of them, and their natural children, 97 all in all. The results were compared to those of a stratified children's sample taken from the population of the same region. The relative weight, blood pressure, and plasma cholesterol were significantly higher in these children than in the control group (p < 0.05). In 50 of these offspring (51.5%), in addition to the obviously positive family history, detected were further cardiovascular risk factors, defined as values above the 95th distribution percentile for age and gender. The average blood pressure, relative weight and cholesterol levels were even higher in these, "risky" children than in the studied sample (p < 0.05), and much more elevated than in the matching control pupils (p < 0.001). The most often detected risk factors were elevated cholesterol (in 44%), arterial hypertension (in 40%), obesity (in 32%), and smoking (in 24%). Most of the children (64%) had only one additional risk factor, while in the remaining 36% the most prevalent risk factors were overweight (in 14 out of 18) and arterial hypertension (in 11 out of 18). It is concluded that cardiovascular risk factor screening among children with a positive family history of premature atherosclerotic complications is appropriate and cost-effective.

Adolescent↗
PubMed2002

Prospective controlled trial of two nifedipine extended release formulations in the treatment of essential hypertension.

The aim of this study was to assess the pharmacodynamic equivalence of two different slow-release formulations of nifedipine (CAS-21829-25-4). In a prospective, controlled, double-blind clinical trial, 42 patients with essential hypertension (sitting diastolic blood pressure (DBP) 95-114 mmHg) underwent an initial washout, drug free period of 2 weeks, after which they were randomized to receive either 30 mg of nifedipine in the test preparation "XL" (Nifecard) or 30 mg of nifedipine in a reference formulation, "LA", during six weeks. The response to treatment was assessed by measuring the blood pressure (BP) every two weeks (standard office mercury sphygmomanometry) and by 24-h ambulatory blood pressure monitoring (ABPM). Of the 42 included patients 36 (85.5%) completed the trial: 19 on "XL" and 17 on "LA". After 2 weeks of therapy the DBP decreased by about 11% (-13.4 mmHg) and 10% (-9.5%), respectively, after 4 weeks the mean decrease versus the end of the placebo period reached about 14% (-15.5 mmHg) and 11% (-13 mmHg), and at the end of the trial the DBPs were lower by about 13% (-14.5 mmHg) in both groups. In all these measurements the within group differences were significant (p < 0.001), while the between groups differences were not (p > 0.05). Quite comparable results were obtained with ABPM, e.g. in the "XL" group the systolic blood pressure at the end of the study was lower by 12.3% (-4.6 mm Hg) and in the "LA" group, by 10.6% (-9.0 mm Hg); p = 0.358. The adverse effects were similar in both groups and they required neither particular interventions nor withdrawal from the study. The drugs under study were comparably effective and well tolerated antihypertensives.

Adolescent↗
PubMed2002

Comparison of ondansetron with metoclopramide in the symptomatic relief of uremia-induced nausea and vomiting.

BACKGROUND: Nausea and vomiting are well-known gastrointestinal complications in chronic renal failure and are frequent indications for the commencement of dialysis. Although the administration of antiemetic drugs (metoclopramide and, recently, ondansetron) is usually mentioned, there are scanty data on their effects. METHODS: A double-blind crossover study was done in 10 uremic patients. All the patients were uremic and suffered from nausea and vomiting. The drugs were randomly administered intravenously (either metoclopramide 10 mg or ondansetron 8 mg) 2 h after blood drawing for laboratory tests either on the 1st or on the 3rd study day at the same time. The outcomes were scored after 24 h of follow-up by (1) one of us (D.P.; 1-3 points: 1 = no effect; 2 = moderate effect - decreased frequency of vomiting, and 3 = good effect - no vomiting), and (2) by the patients (1-5 points). RESULTS: The results obtained showed that ondansetron was more effective in controlling nausea and vomiting than metoclopramide, either objectively (2.80 +/- 0.422 vs. 1.40 +/- 0.699, p < 0.005) or subjectively (4.10 +/- 0.738 vs. 2.10 +/- 0.994, p < 0.005). CONCLUSIONS: We conclude that at the dosage level studied ondansetron is about twice as effective as metoclopramide in the symptomatic relief of uremia-induced nausea and vomiting.

Adult↗
PubMed2002

Effects of four antihypertensive monotherapies on cardiac mass and function in hypertensive patients with left ventricular hypertrophy: randomized prospective study.

AIM: To compare the effects of four antihypertensive drugs, which have reportedly different effectiveness in reducing myocardial mass. METHODS: A randomized, double-blind, prospective study included 80 hypertensive patients with left ventricular (LV) hypertrophy confirmed both electrocardiographically and echocardiographically. We investigated the effects of indapamide, nicardipine, propranolol, and chlorthalidone on arterial blood pressure and LV mass and function. RESULTS: Sixty-four patients (34 men and 30 women) completed the 6-month study. No significant differences in antihypertensive effects of the four medications were found. The average decrease in systolic and diastolic blood pressure was 12.8% and 10.4%, respectively. All four antihypertensive medications caused pronounced reduction in LV mass, between 7.9% in the propranolol group and 10.1% in the nicardipine group, with no significant difference between the groups. In patients receiving diuretics, predominant decrease was observed in LV mass and LV mass index. In patients treated with propranolol, the thickness of both the LV wall and interventricular septum was reduced, whereas the reduction in LV mass, LV wall and interventricular septum thickness was found in patients treated with nicardipine. There was no significant correlation between the changes in LV mass and other variables (blood pressure, and systolic and diastolic function). Systolic function did not improve with the reversion of LV hypertrophy in any group of patients, but improvement was observed in some indices of diastolic function. The early and late LV filling velocity and their ratio did not improve significantly, either. Clinically relevant side effects were not observed. CONCLUSION: All four antihypertensive monotherapies achieved a comparable control of hypertension and reduction in LV hypertrophy.

Adult↗
PubMedDate not supplied

[Smoking cessation using the transdermal nicotine system].

There are a lot of methods for smoking cessation but transdermal nicotine system (TNS) is one of the most popular. On a sample of more than 300 smokers we have formerly shown that TNS achieves higher abstinence rate than placebo (38%:21%). In the present study we have tested the optimal administration of TNS. 160 smokers were subdivided in 4 groups of 40, receiving either TNS or placebo, for 3 or 6 weeks. The abstinence rate was evaluated by appropriate questionnaires and measuring CO in the exhaled air. After 3 weeks of TNS 60% of the examinees were abstaining compared to 50% after 6 weeks; the abstinence rates in the placebo groups were 17.5% and 20%, respectively (p < 0.05). Short TNS treatment (3 weeks) is at least as effective as a longer one (6 weeks), which is relevant both medically and economically.

Administration, Cutaneous↗
PubMedDate not supplied

[Untoward interactions between antihypertensives and nonsteroidal anti-inflammatory drugs].

Interactions between antihypertensive agents and nonsteroidal anti-inflammatory drugs (NSAIDs) are often seen in clinical practice. Inhibiting the renal synthesis of vasodilatory prostaglandins and enhancing salt and water retention, NSAIDs increase blood pressure, particularly in hypertensive subjects. Not all NSAIDs are equal in this respect: the highest elevations in mean arterial pressure are reported with indomethacin, naproxen, piroxicam and rofecoxib, while low-dosed aspirin, celecoxib and ibuprofen, are less unwelcome in this respect. The same is true for the antihypertensive drugs: the most prone to the interaction (worsening of blood pressure control) are diuretics and ACE inhibitors, and the most resistant seem to be the calcium channel blockers. Although these claims must be corroborated by further clinical investigations, one of which is under way in Croatia, coprescription of antihypertensives and NSAIDs, particularly to the elderly, in addition to vigilance and care, requires operative knowledge of the therapeutic options.

Anti-Inflammatory Agents, Non-Steroidal↗