PubMed · 5813477
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E H Lenneberg. 1969-05-09. On explaining language.. https://doi.org/10.1126/science.164.3880.635
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BACKGROUND: Outcome after coronary artery bypass grafting is usually evaluated by exercise stress testing. Increased exercise capacity and reduced angina pectoris have been equated with improved quality of life, but this represents a limited view. OBJECTIVE: To prospectively evaluate the effects of coronary artery bypass grafting on quality of life and exercise capacity and their interrelationship. METHODS: In a consecutive series of patients (N = 2365) who underwent coronary artery bypass grafting, we administered a questionnaire to assess quality of life before and 2 years after surgery. A standardized exercise test was performed during the year before surgery and 2 years after. A preoperative exercise test was performed by 726 patients. Among these patients, 462 completed a quality-of-life questionnaire preoperatively and 578 did so postoperatively. Preoperative and postoperative exercise tests were obtained from 362 patients. RESULTS: The improvement in quality of life was related to the severity of preoperative angina (P < .001) and female sex (P = .004) and was inversely related to preoperative exercise performance (P = .04). The improvement in exercise capacity was greater among men (P < .001) and was inversely related to preoperative exercise capacity (P < .001). CONCLUSIONS: The greatest improvement in quality of life after coronary artery bypass grafting appeared in those patients with the most impaired exercise capacity, those with the most severe angina pectoris, and women. Improvement in exercise capacity was greatest in patients with the poorest preoperative exercise capacity and in men. These findings indicate that exercise testing is of limited value as a measure of quality of life and that assessment by a questionnaire has a complementary place.
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The authors examine the cross-sectional and longitudinal relation of smoking habits and current alcohol intake to cognitive status and decline over a 3-year period as well as the extent to which these relations are modified by the presence of clinical conditions indicating atherosclerosis (cardiovascular disease (CVD)/diabetes). Data are from the cohort of men followed in the longitudinal Zutphen Elderly Study in 1990 (n = 489) and 1993 (n = 333). Cognitive function was measured in 1990 and 1993 with the 30-point Mini-Mental State Examination (MMSE). After adjustment for age, education, and alcohol intake, current smokers made 20% more errors on the MMSE than never smokers in the cross-sectional analyses. Cognitive decline was greatest in those with CVD/diabetes who currently smoked and never smoked (-1.9 and -1.3 points, respectively). After adjustment for age, education, and smoking status, men with CVD/diabetes and low-to-moderate alcohol intake had a significantly lower risk for poor cognitive function (MMSE < or = 25) than abstainers (odds ratios of 0.3 for less than one drink and 0.2 for one to two drinks per day). Alcohol intake was not associated with cognitive decline. These findings do not support the hypothesis of a protective effect of smoking on cognitive function; they suggest that smoking may be harmful among those with CVD/diabetes. Alcohol may result in an acute beneficial effect on cognitive function among those with CVD/diabetes. However, selection bias and unmeasured confounding should be of concern when evaluating these results.