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PubMed2000

Plasma homocysteine and its association with carotid intimal-medial wall thickness and prevalent coronary heart disease: NHLBI Family Heart Study.

Mildly elevated plasma total homocysteine (tHcy) levels have been associated with increased risk of coronary heart disease (CHD). Carotid artery intimal-medial wall thickening is a predictor of cardiovascular disease and has been previously shown to be positively associated with plasma tHcy in studies of asymptomatic subjects. In the current study we examined 1467 subjects with regard to their fasting plasma tHcy levels and intimal-medial wall thickness as measured by B-mode ultrasound and early onset CHD. The results showed that there is a significant positive association between plasma tHcy levels and carotid-artery wall thickness in participants 55 years or older even after the tHcy levels are adjusted for age, smoking and anti-hypertensive medication. The direction and magnitude of the relationship is similar although the result was not statistically significant in younger participants ( < 55 years). Early onset CHD at any age was not significantly different across the tHcy quintiles. The lack of an association of tHcy and CHD in the presence of a positive association with intimal-medial wall thickening may be a reflection of increased statistical power of quantitative versus qualitative traits. We conclude that the present finding of a positive association between tHcy and intimal-medial wall thickness strengthens the in vitro finding of the stimulating effect of homocysteine on vascular smooth muscle cell growth. Vascular smooth muscle cell proliferation may be an important mechanism through which mildly elevated plasma tHcy promotes atherosclerosis.

Aged↗
PubMed2001

Trends of lipoprotein variables from childhood to adulthood in offspring of parents with coronary heart disease: the Bogalusa Heart Study.

Although dyslipidemia among offspring of parents with coronary heart disease (CHD) has been known, the development of this adverse relationship with respect to specific lipoprotein variables from childhood to young adulthood has not been elucidated. This aspect was examined in a young adult cohort with (n = 271) and without (n = 805) a parental history of CHD followed longitudinally since childhood by repeated surveys from 1973 to 1991. Trends in fasting lipoprotein variables by parental CHD status were assessed by Lowess smoothing curve and Generalized Estimating Equations (GEE). In multivariate analyses adjusted for race and sex, parental CHD associated positively with low-density lipoprotein cholesterol (LDL-C, P <.01) and triglycerides (P <.05) mainly at the young adulthood age, whereas a positive association was noted with very-low-density lipoprotein cholesterol (VLDL-C) during both childhood and young adulthood (P <.05). The positive association between parental CHD and LDL-C in young adulthood persisted independently of body mass index (BMI) and fasting insulin, but disappeared when fasting glucose was added to the model. With respect to triglycerides and VLDL-C, inclusion of BMI, insulin, and/or glucose eliminated the adverse association with parental CHD. These observations suggest that parental CHD is just one more explanatory variable that loses its partial contribution to lipoprotein profiles in their offspring when other strongly interrelated contributory variables such as age, body fatness, and measures of glucose homeostasis are taken into account. Information on these risk variables in conjunction with parental or family history of CHD may enhance the potential of CHD risk assessment in youth.

Adolescent↗
PubMed2003

Carotid intima-media thickness is associated with premature parental coronary heart disease: the Framingham Heart Study.

BACKGROUND: A family history of coronary heart disease (CHD) is an independent risk factor for cardiovascular events. However, the mechanisms underlying this susceptibility have not been fully elucidated. We hypothesized that an important mediator of the familial predisposition to CHD is subclinical atherosclerosis, which is detectable by noninvasive imaging. METHODS AND RESULTS: We studied 1662 subjects (mean age 57, 51% women) in the Framingham Offspring Study who underwent carotid ultrasonography and had both biological parents in the original (parental) cohort. Parental CHD events were validated prospectively by a physician endpoint committee. The associations of carotid intima-media thickness (IMT) with premature parental CHD (occurring before age 60) and any parental CHD (no age restriction) were examined in age- and multivariable-adjusted analyses. Age-adjusted mean internal carotid IMT was higher in subjects who had at least one parent with premature CHD than in those without a validated parental history of premature CHD (men 1.13 versus 1.04 mm, P<0.01; women 0.92 versus 0.85 mm, P=0.03). In both sexes, these differences remained significant after adjustment for cardiovascular risk factors. In analyses without a restriction on parental age of CHD onset, the association between carotid IMT and parental CHD was not statistically significant. There was also no significant association of common carotid IMT with premature or any parental CHD. CONCLUSIONS: These findings suggest that subclinical atherosclerosis, assessed in the carotid arteries, is more prevalent in individuals with a family history of CHD. Early-onset parental CHD, in particular, identifies offspring with a strong familial predisposition to atherosclerosis.

Adult↗
PubMed1999

Hormones and heart disease in women: Heart and Estrogen/Progestin Replacement Study in perspective.

Despite the nearly universal finding from observational studies that postmenopausal estrogen therapy reduces the risk of CHD and the multiple plausible mechanisms by which estrogen might reduce the risk of CHD, hormone therapy had no benefit in the only large randomized clinical trial to date. Although it is possible that estrogen taken over the long term actually reduces CHD risk, it is not reasonable to begin the regimen used in HERS to prevent new or recurrent heart disease, given the observed excess early risk. Given the possible long term benefit, women who are already taking hormone replacement therapy may elect to remain on it. Women who are undecided should be asked to consider participation in clinical trials. The HERS has dramatically illustrated the need for them.

Aged↗
PubMed1996

Rheumatic heart disease.

Rheumatic heart disease seems in many ways emblematic of an older era in medicine, without any prospects of new development or change in the current era. Many new findings have come to light in the past few years regarding this illness, which has a relatively low prevalence in the United States. Not only have the diagnostic Jones criteria for acute rheumatic fever changed, but substantial advances have been made in the use of penicillin prophylaxis for recurrent rheumatic attacks, the use of mitral valve repair or reconstruction for rheumatic mitral regurgitation, the management of rheumatic, aortic, and mitral valve disease, and the application of balloon commissurotomy for mitral stenosis. This review details some of these advances.

Adolescent↗
PubMed1999

Valve replacement for appetite suppressant-induced valvular heart disease.

Valvular heart disease associated with the use of appetite-suppressant medication is a recently described clinical entity. Although the mechanism of valvular injury remains elusive pathologically, the valvular abnormalities resemble those observed in carcinoid syndrome. The incidence of clinically evident valvular heart disease is low with short-term (less than 3 months) exposure to appetite-suppressant drugs. Prolonged exposure to higher doses in addition to combination drug therapy confers an excess risk for valvular pathologic changes. We report the case of a patient with severe mitral regurgitation who had short-term exposure (3 weeks) to the combination of fenfluramine (20 mg) and phenteramine (15 mg).

Adult↗
PubMed2002

The neonate with suspected congenital heart disease.

Congenital heart disease (CHD) occurs in 8 per 1000 live births, with approximately one third of these neonates requiring intervention in the first month of life. Neonates with respiratory distress, cyanosis, feeding difficulties, low cardiac output, or dysmorphic syndromes commonly have CHD. Clinical suspicion increases in a symptomatic infant with a heart murmur, but the presence or absence of a murmur does not assure either the presence or absence of significant congenital heart disease. Infants suspected to have CHD may be divided into premature and term infants, as well as infants with duct-dependent pulmonary blood flow, infants with duct-dependent systemic blood flow, and infants with unrestricted pulmonary blood flow. This article will also address the specialized clinical situations of total anomalous pulmonary venous return, transposition of the great arteries, and hypoplastic left heart syndrome with intact atrial septum.

Cardiac Output, Low↗
PubMed1985

Sarcoid heart disease.

Sarcoid heart disease has had slow recognition but it is now being increasingly diagnosed in life and at necropsy. Recognition is important as energetic treatment may greatly improve the prognosis. Although patients with 'classical' sarcoidosis may be found to have cardiac involvement, most of the clinically important cases present with cardiac problems--sudden death, heart block, tachyarrhythmias and 'cardiomyopathy'--are the most frequent presentations. Sarcoidosis should be thought of in any case of difficult heart disease for which there is no obvious aetiology. Histological confirmation of sarcoidosis in some organ should be sought. Energetic treatment and follow up show that the prognosis is not necessarily bad.

Adolescent↗
PubMed1976

Genetics of ischaemic heart disease.

Coronary heart disease, especially when it affects younger individuals, tends to cluster in families. Known risk factors occur in 50-75% of patients with myocardial infarction. Yet commonly occurring risk factors are not strongly inherited, and the familial aggregation of coronary heart diseas may not be attributable to familial resemblance in serum cholesterol and blood pressure levels. Alternatively, such aggregation may be due to unknown familial risk factors. Nevertheless, screening of relatives of individuals with evident risk factors is of importance, and environmental manipulation is likely to be of value in prevention of coronary heart disease.

Cholesterol↗
PubMed2006

Predictors of poor coronary heart disease knowledge level in women without prior coronary heart disease.

PURPOSE: The purpose of this study was to measure coronary heart disease (CHD) knowledge levels in women without a history of CHD and to determine predictors of poor CHD knowledge in these women. DATA SOURCES: The sample included 120 women between the ages of 35 and 60, who had no CHD history. Women were asked to complete self-administered surveys including demographic data, personal CHD risk factors, and a CHD Knowledge Test. CONCLUSIONS: Women lack CHD knowledge. Low educational level, normal serum lipids, high body mass index (BMI), and lack of access to a nurse practitioner (NP) were predictors of poor CHD knowledge levels in women without CHD history. IMPLICATIONS FOR PRACTICE: Women who had access to an NP were more likely to have higher CHD knowledge. In an attempt to decrease the morbidity and mortality associated with CHD, NPs may be able to improve CHD knowledge in women, particularly in those with lower educational level, normal serum lipids and higher BMI.

Adult↗
PubMed1981

Overdistention of the neural tube causes congenital heart disease.

Congenital heart disease consists of cardiac anomalies that originated before or during the truncus arteriosus stage. The central nervous system, serving all organs, is the first to develop. It is the only organ possessing a third circulation. Immediately after the neural tube closes at the fourth week, its lining of immature ependymal cells secretes a proteinaceous neural tube fluid (NTF) at a pressure higher than the amniotic pressure. The resulting distention helps to shape not only the embryonic brain and spinal cord but also the bordering mesodermal cells that later will form vertebrae. The choroid plexus does not begin to secrete true cerebrospinal fluid until two weeks later. Should hypersecretion occur during this critical two week interval, the neural tube will overdistend and allow NTF to infiltrate into mesoderm (Fig. 1). Here, this fluid with its extraneous protein, may damage cells that are destined to form the anlagen of mesodermal organs such as the heart. It may also damage the primitive gut resulting in pulmonary, gastrointestinal and genitourinary anomalies. The most convincing evidence that the neural tube had been overdistended is the combination of anterior and posterior spina bifida that constitutes bilateral hemivertebrae. Vertebral anomalies are present in congenital heart disease though scarcely recognizable on the chest film of the newborn.

Animals↗
PubMedDate not supplied

Asymptomatic ischemic heart disease and diabetic nephropathy: relationship between prevalence of asymptomatic ischemic heart disease and urinary albumin excretion rate.

To examine whether prevalences of asymptomatic ischemic heart diseases in type II diabetic patients are correlated with the degree of diabetic nephropathy, 201TI scintigraphies with dipyridamole loading were performed in 28 type II diabetic patients without any chest discomforts. Positive findings of ischemic changes were found in 5 (28%) of 18 patients with normoalbuminuria (urinary albumin excretion rate, AER less than 20 micrograms/min) and 5 (50%) of 10 patients with micro- or macroalbuminuria (AER greater than 20 micrograms/min). Coronary angiography (CAG) was performed in 6 of 10 patients with positive findings of 201TI scintigraphy. No stenotic findings were found in any patients, but wall motion was decreased in some patients and pulmonary artery pressure was increased in one patient. As stenosis of arteries with diameter of more than 0.3 mm can be detected by CAG, it seems likely that microangiopathy may play some role in the pathogenesis of asymptomatic ischemic heart disease detected with 201TI scintigraphy.

Adult↗
PubMed1996

Hyperlipoproteinemic states and ischemic heart disease.

Ischemic heart disease and contributing risk factors such as the hyperlipoproteinemic states affect a great percentage of the general population. Because these disease processes can effectively place patients at risk for a life-threatening event, every health care provider must be knowledgeable, disciplined to take a thorough medical history, and prepared for emergency situations that may arise in the clinical practice of dentistry. A proactive approach to identification of risk factors and to primary prevention of ischemic heart disease not only helps to lengthen and improve the quality of patient's lives, but also ensures that necessary modifications of treatment reflect each patient's medical and pharmacologic status.

Cardiovascular Agents↗