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At least 163 records · Page 9Linked to original sources
PubMed1984

Coronary heart disease and coronary disease risk factors in black populations in underdeveloped countries: the case for primordial prevention.

Coronary heart disease (CHD) is relatively rare in black populations in Africa and is a much less significant cause of morbidity and mortality in black populations in the Caribbean than in U.S. blacks. The incidence of CHD appears to be increasing in segments of some black populations in underdeveloped countries, concurrently with certain patterns of socioeconomic change. Hypertension, hypercholesterolemia, and cigarette smoking are not as common in most of these black populations as in white populations in industrialized countries, although certain affluent groups in African and Caribbean countries have higher levels of some of these risk factors than do the rest of the population. Moreover, the impact on CHD of these risk factors, especially hypertension, appears to be less than is observed in industrialized countries. The absence of mass hyperlipidemia probably accounts for the lower prevalence and incidence of CHD. A policy of primordial prevention of CHD, by control of risk factors and preemptive action to prevent their establishment in the population, has been recommended to Third World governments by a World Health Organization Expert Committee. The need for such a policy, and its applicability in black populations in Africa and the Caribbean, are limited by their socioeconomic situations. Thus for practical purposes, the deteriorating economic situation in the low-income countries (the majority) of sub-Saharan Africa and the Caribbean restricts the possibilities of adverse risk factor changes. In particular, the widespread assumption of the food consumption patterns typical of industrialized countries and the development of mass hyperlipidemia are effectively prevented. In contrast, attempts to foster or maintain desirable food consumption patterns are warranted in middle-income African and Caribbean countries, especially among newly affluent minorities. In all of these territories, primary prevention of hypertension, especially in urban populations, is the ideal approach to the primordial prevention of cardiovascular diseases, of which CHD is a small component.

Adolescent↗
PubMed2003

[Stunning, hibernation, and heart failure in patients with coronary disease: crucial role of impaired coronary flow reserve].

Hibernating myocardium can be defined as a chronic, but reversible left ventricular dysfunction that may contribute to congestive heart failure in patients with coronary artery disease. The dysfunction can improve after coronary revascularization and therefore its identification and treatment become central in the management of patients with heart failure secondary to coronary artery disease. Hibernating myocardium can be detected by several techniques (echocardiography performed during the infusion of dobutamine, single photon and positron emission tomography-PET, and magnetic resonance imaging), but none of these techniques can be considered unequivocally superior to the others for the identification of hibernating myocardium. As PET technology has advanced, the noninvasive quantification of absolute regional myocardial blood flow has become possible. The measurement of myocardial blood flow by PET has contributed to the demonstration that transmural blood flow in hibernating muscle is generally within the normal range while the coronary flow reserve is invariably and severely impaired. These findings have contributed to a new pathophysiological theory of hibernation where repetitive ischemia and stunning are considered as the initial mechanisms that might start the process of myocardial hibernation.

Animals↗
PubMed1995

Risk factors that attenuate the female coronary disease advantage.

OBJECTIVE: To compare the coronary disease experience of men and women in a community setting. DESIGN AND SETTING: Prospective cohort study. PATIENTS: Long-term follow-up of a population-based sample of 5209 men and women. RESULTS: Women outlive men and experience fewer cardiovascular events. By middle age, women lag 20 years behind men in the incidence of myocardial infarction, but the gap closes in the elderly, when cardiovascular disease becomes the leading cause of death in women as well as in men. Menopause promptly escalates coronary disease risk threefold and greatly erodes the advantage over men. Women and men share the same major risk factors for coronary disease, although women experience a lower absolute risk. However, high ratios of total/high-density lipoprotein cholesterol level ratios, left ventricular hypertrophy, and diabetes tend to eliminate the female advantage. CONCLUSION: Coronary disease is not a minor problem in women. Consequently, women should take vigorous preventive measures. There is a need for particular attention to glucose tolerance and blood lipid levels and a greater sense of urgency when hypertension progresses to left ventricular hypertrophy.

Adult↗
PubMed1996

[Coronary disease in women].

Coronary heart disease is the leading cause of death among women, with a high prevalence in the older women. Women have a less favorable outcome after myocardial infarction and after myocardial revascularization procedures. We have revised the most up to date published information about risk factors for coronary heart disease in women. The most salient features concerning lipids, hypertension, diabetes, cigarette smoking, physical activity and obesity are summarized. The differences on clinical manifestations of coronary heart disease among men and women are also presented. The salient data about estrogen replacement therapy effect on coronary heart disease on postmenopausal women is also summarized.

Adult↗
PubMed1984

Evaluation of habitual excessive alcohol consumption on myocardial infarction risk in coronary disease patients.

Overt coronary heart disease does occur at times in a setting of alcoholism. In an attempt to test the hypothesis that habitual excessive drinking may have an aggravating effect upon coexisting ischemic heart disease and may help precipitate new coronary events, we compared myocardial infarct prevalence among heavy drinkers and non-heavy drinkers with angiographically documented coronary artery disease. Infarct prevalence was found to be higher for heavy drinkers than for non-heavy drinkers under age 60 years, after controlling for differences in smoking habits and underlying atherosclerosis severity. A reversal in trend which may be due to the operation of selective factors causing premature coronary death among alcoholics was observed for individuals above age 60 years. These results, although open to differing interpretations, are consistent with the notion that heavy drinking has a destabilizing effect upon preexisting ischemic heart disease and may increase acute coronary event risk.

Adult↗
PubMed1989

Risk factors and noncontraceptive estrogen use in women with and without coronary disease.

To evaluate the risk factors for coronary disease, 345 women, aged 35 to 59 years, who had undergone coronary arteriography for suspected coronary disease completed a mail questionnaire, telephone interview, or both. Two hundred eight women with angiographically normal coronary arteries constituted the control group, and 137 with a 70% or more occlusion of one or more coronary vessels were classified as having severe coronary occlusive disease. Age-adjusted odds of severe coronary disease based on the logistic regression model for the risk factors evaluated were as follows: smoking, 5.73 (p less than 0.001); diabetes, 5.09 (p less than 0.001); cholesterol level greater than 240 mg/dl, 2.35 (p less than 0.05); a parental history of death from heart disease before age 60 years, 2.03 (p less than 0.05); and estrogen use for 6 months or longer, 0.50 (p less than 0.01). There were no differences with regard to the presence of obesity and a history of hypertension in women with and without coronary disease. These data support the hypothesis that use of noncontraceptive estrogen significantly reduces the risk of severe coronary disease, whereas smoking, an elevated cholesterol level, and a parental history of heart disease all increase the risk of ischemic heart disease in women.

Adult↗
PubMedDate not supplied

Clinical evaluation of four study protocols with 99mTc-methoxyisobutylisonitrile and SPECT for detecting diseased coronary vessels.

Different techniques have been suggested for coronary artery disease (CAD) detection with single-photon emission computed tomography (SPECT) and 99mTc-methoxyisobutylisonitrile (99mTc-MIBI). We evaluated four protocols employing myocardial SPECT with 99mTc-MIBI in separate groups of patients. The first involved stress and rest studies performed on separate days, whereas the other three involved "same day" studies. Group 1 (n = 23) was examined in separate sessions, after ergometric exercise and at rest. Group 2 (n = 24) was first injected after dipyridamole infusion, then injected again at rest after completion of the stress study. Group 3 (n = 24) was first injected at rest and imaged one hour later. Afterwards an ergometric stress was performed, with injection at peak exercise. The inverse sequence was adopted for group 4 (n = 24). All patients underwent coronary angiography. For all groups and vessels, the sensitivity and specificity for diseased coronary artery identification were not statistically different. Studies using the new myocardial perfusion tracer 99mTc-MIBI may therefore be completed on the same day or on separate days according to laboratory and patient needs. Dipyridamole iv infusion proved to be as effective as ergometric exercise for diseased coronary artery identification.

Clinical Protocols↗
PubMed1994

[Catheter therapy of coronary disease].

Percutaneous transluminal coronary angioplasty (PTCA) with balloon catheters is a well established invasive treatment for coronary artery disease. The high frequency of restenosis has promoted the development of new catheters, with different techniques for removing the plaques from the coronary arteries. Until now the rate of restenosis using balloon angioplasty and new atherectomy catheters has not declined. Our experience of these techniques is discussed and compared with the experiences described in the literature. The use of stents seems to be a major step forward, leading to fewer restenoses and emergency bypass operations.

Adult↗
PubMed2005

Multiple stressors and coronary disease in women. The Stockholm Female Coronary Risk Study.

We proposed that double exposure to stressors at work and from family are associated with increased coronary risk in women and that the same exposures are accompanied by depressive feelings. The study group comprised 292 women coronary patients (30-65 years) and 292 age-matched healthy controls. Work-stress, marital-stress, and depressive symptoms were assessed by standardized questionnaires and evaluated in both case-control and 5-year follow-up analyses. We found that double exposure to stress from work and family was accompanied by the highest risk and the worst prognosis in women's coronary disease. In women patients depressive feelings were frequent, and they were more closely related to family than to work stress. In healthy women, both stressors, but in particular their combination, lead to depressive symptoms.

Adult↗
PubMed1983

Provocative ergonovine testing in patients without obstructive coronary disease.

Ergonovine administration during coronary angiography is frequently used to rule out coronary spasm as a cause of chest pain. We performed this study to determine which electrocardiographic variables (other than ST segment elevation with pain) and which chest pain characteristics might be predictive of ergonovine test outcome in patients without obstructive coronary disease. Thirty-one patients had an electrocardiogram recorded during chest pain. Three of four patients (75%) who had an ischemic electrocardiogram with pain had a positive ergonovine test while only 1 of 27 (4%) patients who had a nonischemic electrocardiogram during chest pain had a positive ergonovine test (p less than 0.001) Pain that occurred predominantly at rest was present in five of five patients with positive ergonovine tests but pain occurring predominantly at rest was also present in 76% of patients with negative ergonovine tests (85%). Prompt relief of pain with nitroglycerine was also present in all patients with a positive ergonovine test but was also seen in 58% of patients with a negative test (NS). Association of chest pain with nausea, vomiting, diaphoresis, or radiation to left arm, jaw or neck were similarly poor predictors of ergonovine test outcome. We conclude that ergonovine testing in patients without obstructive coronary disease is of low yield if an electrocardiogram recorded during pain does not show evidence of ischemia. Historical features of the chest pain are not good predictors of test outcome.

Coronary Vasospasm↗
PubMed2000

Age and sex differences in presentation of symptoms among patients with acute coronary disease: the REACT Trial. Rapid Early Action for Coronary Treatment.

BACKGROUND: There are few data on possible age and sex differences in presentation of symptoms for patients with acute coronary disease. OBJECTIVE: To investigate demographic differences in presentation of symptoms at the time of hospital presentation for acute myocardial infarction (AMI) and unstable angina. METHODS: The medical records of patients who presented with chest pain and who also had diagnoses of AMI (n = 889) or unstable angina (n = 893) on discharge from 43 hospitals were reviewed as part of data collection activities of the Rapid Early Action for Coronary Treatment trial based in 10 pair-matched communities throughout the USA. RESULTS: Dyspnea (49%), arm pain (46%), sweating (35%), and nausea (33%) were commonly reported by men and women of all ages in addition to the presenting complaint of chest pain. After we had controlled for various characteristics through regression modeling, older persons with AMI were significantly less likely than were younger persons to complain of arm pain and sweating, and men were significantly less likely to report vomiting than were women. Among persons with unstable angina, arm pain and sweating were reported significantly less often by elderly patients. Nausea and back, neck, and jaw pain were more common complaints of women. CONCLUSIONS: Results of this study suggest that there are differences between symptoms at presentation of men and women, and those in various age groups, hospitalized with acute coronary disease. Clinicians should be aware of these differences when diagnosing and managing patients suspected to have coronary heart disease.

Adult↗