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PubMed2004

Heart disease: the greatest 'risk' factor of them all.

By the turn of the last century, flying in the face of over a hundred years of research and clinical observation to the contrary, medicine abandoned the link between infection and atherogenesis; not because it was ever proven wrong, but because it did not fit in with the trends of a medical establishment convinced that chronic disease such as heart disease must be multifactorial, degenerative and non-infectious. Yet it was the very inability of 'established' risk factors such as hypercholesterolemia, hypertension and smoking to completely explain the incidence and trends in cardiovascular disease that resulted in historically repeated calls to search out an infectious cause, a search that began more than a century ago. Today, half of US heart attack victims have acceptable cholesterol levels and 25% or more have none of the "risk factors" associated with heart disease, including smoking, high blood pressure or obesity, most of which are not inconsistent with being caused by infection. Even the case of the traditionalist's latest 2003 JAMA assault to 'debunk' what they call the "50% risk factor myth" falls woefully short under scrutiny. In one group 30% died of heart disease with a cholesterol of at least 240 mg/dl, a condition which also existed in 21% who did not die during the same period. And the overlap was obvious throughout the so-called risk categories. Under such scrutiny, lead author Greenland conceded that if obesity, inactivity and elevated cholesteriol in the elderly are included, just about everyone has a risk factor and he likened the dilemma of people who do or do not wind up with heart disease akin to the susceptibility of people who are exposed to tuberculosis but do not get the disease. In Infections and Atherosclerosis: New Clues from an old Hypothesis? Nieto stressed the need to extend the possible role of infectious agents beyond the three infections which have in recent years been the focus of research: Cytomegalovirus (CMV) Chlamydia pneumoniae and Helicobactor pylori. Mycobacterial disease shares interesting connections to heart disease. Not only is tuberculosis the only microorganism to depend on cholesterol for its pathogenesis but CDC maps for cardiovascular disease bear a striking similarity to those of State and regional TB case rates. Ellis, Hektoen, Osler, McCallum, Swartz, Livingston and Alexander-Jackson all saw clinical and laboratory evidence of a causative relationship between the mycobacteria and heart disease. And Xu showed that proteins of mycobacterial origin actually led to experimental atherosclerosis in laboratory animals Furthermore present day markers suggested as indicators for heart disease susceptibility such as C-Reactive Protein (CRP), interleukin-6 and homocysteine are all similarly elevated in tuberculosis. It therefore behooves us to explore the link between heart disease and typical and atypical tuberculosis.

Comorbidity↗
PubMed1966

Beri-Beri heart disease.

Beri-beri heart disease is a distinctive clinical entity which must be distinguished from alcoholic cardiomyopathy and other forms of heart disease in chronic alcoholics. A 27-year-old man is described who for six months before the onset of symptoms of right heart failure-admitted to hospital with dyspnea and pitting edema in the lower limbs and over the sacrum-had lived over a tavern and consumed 24 pints of beer daily.The pathophysiology of beri-beri heart disease includes right heart failure, edema and peripheral vasodilatation in the muscular bed. These features were described by Wenckebach and others as early as 1928. Within the main entity, beri-beri heart disease, a number of sub-groups with special features and prognosis such as acute pernicious beri-beri have been described. Beri-beri heart disease is due to vitamin B(1) deficiency and is curable if this deficiency is corrected in time.

Adult↗
PubMed1985

Diet and 20-year mortality from coronary heart disease. The Ireland-Boston Diet-Heart Study.

In a prospective epidemiologic study of 1001 middle-aged men, we examined the relation between dietary information collected approximately 20 years ago and subsequent mortality from coronary heart disease. The men were initially enrolled in three cohorts: one of men born and living in Ireland, another of those born in Ireland who had emigrated to Boston, and the third of those born in the Boston area of Irish immigrants. There were no differences in mortality from coronary heart disease among the three cohorts. In within-population analyses, those who died of coronary heart disease had higher Keys (P = 0.06) and modified Hegsted (P = 0.02) dietary scores than did those who did not (a high score indicates a high intake of saturated fatty acids and cholesterol and a relatively low intake of polyunsaturated fatty acids). These associations were significant (P = 0.03 for the Keys and P = 0.04 for the modified Hegsted scores) after adjustment for other risk factors for coronary heart disease. Fiber intake (P = 0.04) and a vegetable-foods score, which rose with increased intake of fiber, vegetable protein, and starch (P = 0.02), were lower among those who died from coronary heart disease, though not significantly so after adjustment for other risk factors. A higher Keys score carried an increased risk of coronary heart disease (relative risk, 1.60), and a higher fiber intake carried a decreased risk (relative risk, 0.57). Overall, these results tend to support the hypothesis that diet is related, albeit weakly, to the development of coronary heart disease.

Adult↗
PubMed1982

Type A behavior and the ten year incidence of coronary heart disease in the Framingham Heart Study.

This study explored the association between Type A behavior, as measured by a short questionnaire on time urgency and competitiveness, and the development of coronary heart disease (CHD). An assessment of Type A behavior in 750 women and 580 men, aged 45-64 years, participating in the Framingham Heart Study, took place between 1965 and 1969. Type A behavior was associated with a two-fold risk of developing CHD over the ensuing 10 years. Among all women, the relative risk (RR) was 2.0 with confidence limits = 1.2 to 3.3. Among housewives, CHD incidence rates were 2.5 times greater among Type A's compared to Type B's (p = 0.02). Type A working women were more than 1.5 times as likely to develop CHD as Type B's, although this was not significant at the 10 year follow-up. Among men employed in white-collar jobs, the RR was 2.4 with confidence limits = 1.1 to 5.7. Type A behavior was most strongly related to coronary diagnoses in which angina pectoris symptoms were present. Synergism between Type A behavior and other CHD risk factors is demonstrated. The findings suggest that assessment of Type A behavior can improve the prediction of incident coronary cases, independent of the standard coronary risk factors.

Age Factors↗
PubMed1985

Prognosis in valvular heart disease. I. Description of purpose, organization, data collection techniques, estimates of statistical power, and criteria for termination of patient entry. VA Cooperative Study Group on Valvular Heart Disease.

This report describes the design of a multicenter study with two major goals: the identification of valvular heart disease patients at risk for death or a serious complication, and the comparison of hemodynamic function and late outcome of a mechanical prosthetic valve (Björk-Shiley) with a bioprosthesis (Hancock porcine heterograft valve). Strengths of the study design are quantitative assessment of valvular and left ventricular function before and 6 months after valve replacement, measurement in a central laboratory of critical data items such as valve orifice area and left ventricular volumes, and assignment of cause of death and valve-related complications by a committee blinded to valve type. Statistical power calculated by a simulation technique shows only modest loss of power with frequent examination of outcome compared to infrequent examination. Guidelines for premature termination of the study because of superiority of one valve type are described; this includes a critical region with a sloping boundary, which allows for greater chance variation early in the study when the number of patients and events is small, gives the greatest statistical power, and yet appears to provide adequate protection for the subjects in the study.

Bioprosthesis↗
PubMedDate not supplied

Brain and atrial natriuretic peptides in patients with ischemic heart disease with and without heart failure.

The objective of the study was the evaluation of natriuretic peptides in ischemic heart disease. Atrial and brain peptides (ANP, BNP) were elevated in patients with ischemic heart failure, as compared with patients with angina without over failure, and controls (p < 0.01). BNP/ANP ratio was higher in NYHA class IV than in class III patients (2.67 +/- 0.87 vs. 1.52 +/- 0.59, respectively). Patients in the angina group, in whom elevated BNP or ANP was found, had subclinical systolic or diastolic dysfunction. There was inverse correlation between BNP, ANP and the left-ventricular ejection fraction (each r = 0.78, p < 0.001). We conclude that BNP is elevated as a result of myocardial dysfunction, but not of ischemia and seems to be a better index of disease stage and prognosis than ANP.

Adult↗
PubMed1977

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California. Incidence of myocardial infarction and death from coronary heart disease.

The incidence of myocardial infarction and death from coronary heart disease was studied in defined samples of 45 to 68 year old Japanese men in Japan, Hawaii and California. The incidence rate was lowest in Japan where it was half that observed in Hawaii (P less than 0.01). The youngest men in the sample in Japan were at particularly low risk. The incidence among Japanese men in California was nearly 50 percent greater than that of Japanese in Hawaii (P less than 0.05). A striking increase in the incidence of myocardial infarction appears to have occurred in the Japanese who migrated to the United States; this increase is more pronounced in California than in Hawaii.

Age Factors↗
PubMed2005

Building bridges: a partnership between professional nursing and the Centers for Disease Control and Prevention to reduce the burden of heart disease and stroke.

The escalating burden of heart disease and stroke in the United States, coupled with the complexity of public health goals to prevent and control chronic diseases, warrant new strategies and partners. The 2.7 million nurses in the United States represent the nation's largest healthcare profession and, through their professional organizations, constitute a strategic partner for the Centers for Disease Control and Prevention (CDC) Heart Disease and Stroke Programs. In addition, because heart disease and stroke rank first and third among leading causes of death in women in the United States, and 95% of nurses are women, nurses represent an important population to target with preventive cardiovascular health approaches. The authors describe a proposed CDC strategic partnership with professional nursing organizations, including goals aimed at improving the capacity of nurses as change agents in the area of heart disease and stroke, as well as promoting change among the change agents to reduce nurses' risk for cardiovascular disease. The primary goals of the partnership between key professional nursing organizations and the CDC Cardiovascular Health (CVH) Programs follow: (1) share information and develop effective communication; (2) link with key professional and community organizations; (3) assess capabilities and expertise that nursing organizations can add to CDC's internal and external partnerships, including the Public Health Action Plan; (4) explore possible linkages with the CDC-funded state-level heart disease and stroke prevention programs and emerging CDC stroke networks; (5) develop, disseminate, and apply evidence-based guidelines to improve outcomes of care; and (6) develop policy and environment strategies in work-site settings to prevent heart disease and stroke in women and among the membership of professional nursing organizations. The development and implementation of a CDC CVH Program Professional Nurse Partnership have strong potential for enhancing collaborative public health efforts to prevent heart disease and stroke, and to improve cardiovascular outcomes for hypertension, high cholesterol, myocardial infarction, stroke, and heart failure.

Centers for Disease Control and Prevention, U.S.↗
PubMed2004

[Use of meloxicam (movalis) in patients with rheumatic diseases with concomitant coronary heart disease].

The purpose of the study was to examine the clinical features of the course of coronary heart disease (CHD) in patients with rheumatoid arthritis (RA) and to evaluate the effects of the selective cyclooxygenase-2 (COG-2) inhibitor movalis (meloxicam) in two dosage forms (as injections and tablets) on the course of CHD in this group of patients. The developed questionnaire was used to make a comparative screening survey of 304 patients with RA and 152 patients with osteoarthrosis (OA), who were aged above 40 years. A comprehensive examination of the cardiovascular system was performed in 52 patients with RA concurrent with CHD and 25 patients with OA concurrent with CHD. Angina pectoris on exertion was detected in 37% of the patients with PA and in 35% of the patients with OA. Most (52%) patients with RA and CHD reported rare anginal attacks (once a month) whereas 24-day ECG monitoring revealed myocardial ischemia in 71% of the patients with RA concurrent with CHD; only silent ischemic episodes were recorded in 70% of them. The incidence of silent myocardial ischemia was higher in patients with RA concurrent with CHD than that in those with OA concurrent with CHD (p < 0.03). Examination of the incidence of anginal attacks showed that there was a tendency of the incidence of pains to decrease in patients with RA concurrent with CHD who took selective COG-2 inhibitors. Patients with RA concurrent with CHD who received movalis had atendency of arrhythmia to occur more rarely and of the duration of myocardial ischemia to reduce as compared with those who took nonselective COG-2 inhibitors.

Administration, Oral↗