Journal of cardiovascular risk最新文献

{"title":"Alcohol and cardiovascular disease--more than one paradox to consider. Alcohol and hypertension: does it matter? Yes.","authors":"Arthur L Klatsky","doi":"10.1097/01.hjr.0000051960.68260.79","DOIUrl":"https://doi.org/10.1097/01.hjr.0000051960.68260.79","url":null,"abstract":"<p><p>Observational studies and clinical experiments solidly establish an empiric relationship between heavy drinking (>/= 3 standard drinks/day) and higher blood pressure. A biologic mechanism for this link remains unclear. It has been difficult to study the incidence of usual hypertension sequelae in alcohol-associated hypertension because of complex interactions of alcohol, hypertension and cardiovascular conditions. Even with these limitations, a causal association is the most likely explanation and control of alcohol intake is probably important in prevention and treatment of hypertension.</p>","PeriodicalId":79345,"journal":{"name":"Journal of cardiovascular risk","volume":"10 1","pages":"21-4"},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22230601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a general practice-based intervention on diet, body mass index and blood lipids in patients at cardiovascular risk.","authors":"Janet Woollard,&nbsp;Valerie Burke,&nbsp;Lawrie J Beilin,&nbsp;Marieke Verheijden,&nbsp;Max K Bulsara","doi":"10.1097/01.hjr.0000050718.61003.30","DOIUrl":"https://doi.org/10.1097/01.hjr.0000050718.61003.30","url":null,"abstract":"<p><strong>Background: </strong>General practice-based health-promotion programmes implemented by nurse-counsellors may reduce cardiovascular risk factors, particularly in patients at increased risk.</p><p><strong>Design: </strong>In a randomized controlled trial, trained nurse-counsellors delivered cognitive behavioural programmes aiming to reduce cardiovascular risk in patients with hypertension, Type 2 diabetes mellitus or coronary heart disease. Of 591 eligible patients from seven general practices in Perth, Western Australia, 212 agreed to participate and were randomized to one of three groups. In the 'Low' intervention (n = 69), monthly telephone contacts for 1 year followed one face-to-face individual counselling session; in the 'High' intervention (n = 74) individual face-to-face counselling continued over 1 year, taking place monthly, for up to 1 h; Controls (n = 69) received usual care only. Participants were assessed at baseline with follow-up 12 and 18 months later.</p><p><strong>Results: </strong>Follow-up assessments were attended by 77, 71 and 65% of the Control, 'Low' and 'High' groups, respectively. Total fat intake fell by 9, 12 and 5% in the 'High', 'Low' and Control groups, respectively, at 12 months and by 2, 10 and 5% at 18 months. Total serum cholesterol fell by 3, 3 and 2% in the 'High', 'Low' and 'Control' groups, respectively, at 12 months and by 7, 5 and 8% at 18 months. Neither change in fat intake nor serum cholesterol differed significantly between groups. Body mass index increased in all groups with no significant changes related to the programme.</p><p><strong>Conclusions: </strong>Programmes using nurse-counsellors were not significantly more successful than usual care from general practitioners, consistent with reported benefits of lifestyle advice from primary-care physicians.</p>","PeriodicalId":79345,"journal":{"name":"Journal of cardiovascular risk","volume":"10 1","pages":"31-40"},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22230603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a general practice-based intervention on diet, body mass index and blood lipids in patients at cardiovascular risk.","authors":"J. Woollard, V. Burke, L. Beilin, M. Verheijden, M. Bulsara","doi":"10.1097/00043798-200302000-00007","DOIUrl":"https://doi.org/10.1097/00043798-200302000-00007","url":null,"abstract":"Background General practice-based health-promotion programmes implemented by nurse-counsellors may reduce cardiovascular risk factors, particularly in patients at increased risk. Neither change in fat intake nor serum cholesterol differed significantly between groups. Body mass index increased in all groups with no significant changes related to the programme. Design In a randomized controlled trial, trained nurse-counsellors delivered cognitive behavioural programmes aiming to reduce cardiovascular risk in patients with hypertension, Type 2 diabetes mellitus or coronary heart disease. Of 591 eligible patients from seven general practices in Perth, Western Australia, 212 agreed to participate and were randomized to one of three groups. In the 'Low' intervention (n = 69), monthly telephone contacts for 1 year followed one face-to-face individual counselling session; in the 'High' intervention (n = 74) individual face-to-face counselling continued over 1 year, taking place monthly, for up to 1 h; Controls (n = 69) received usual care only. Participants were assessed at baseline with follow-up 12 and 18 months later. Results Follow-up assessments were attended by 77,71 and 65% of the Control,'Low' and 'High' groups, respectively. Total fat intake fell by 9,12 and 5% in the 'High','Low' and Control groups, respectively, at 12 months and by 2, 10 and 5% at 18 months. Total serum cholesterol fell by 3, 3 and 2% in the 'High','Low' and 'Control' groups, respectively, at 12 months and by 7, 5 and 8% at 18 months. Conclusions Programmes using nurse-counsellors were not significantly more successful than usual care from general practitioners, consistent with reported benefits of lifestyle advice from primary-care physicians. J Cardiovasc Risk 10:31-40 (C) 2003 Lippincott Williams Wilkins.","PeriodicalId":79345,"journal":{"name":"Journal of cardiovascular risk","volume":"10 1","pages":"31-40"},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00043798-200302000-00007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62042928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary calcification and predicted risk of coronary heart disease in asymptomatic men with hypercholesterolaemia.","authors":"Robert S Elkeles,&nbsp;Alex Dunlop,&nbsp;Gilbert R Thompson,&nbsp;Clare Neuwirth,&nbsp;Kirstie Gibson,&nbsp;Michael B Rubens,&nbsp;S Richard Underwood","doi":"10.1097/01.hjr.0000043734.11474.ff","DOIUrl":"https://doi.org/10.1097/01.hjr.0000043734.11474.ff","url":null,"abstract":"<p><strong>Objective: </strong>To document the relationship between coronary calcification and coronary risk assessed clinically in asymptomatic patients with hypercholesterolaemia.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Health screening clinic.</p><p><strong>Patients: </strong>A total of 286 asymptomatic men aged 45-64 with plasma cholesterol >or= 6.5 mmol/l.</p><p><strong>Interventions: </strong>Electron beam computed tomography to measure coronary calcium score.</p><p><strong>Main outcome measures: </strong>The Framingham equation was used to separate subjects into groups with either low 10-year risk of coronary artery disease (<or= 10%) or high 10-year risk (>or= 20%). Coronary calcium score was assessed in each group.</p><p><strong>Results: </strong>The mean log calcium score was significantly higher in the 97 high-risk men than in the 189 low-risk men (1.58 +/- 0.84 versus 1.00 +/- 0.85, < 0.001). Arithmetic means (158 versus 55), and the proportion with a score > 400 (11% versus 2%, p < 0.01) were also greater. However, 27% of the high-risk group had a low calcium score (<or= 10), which is known to be associated with minimal coronary artery disease assessed by angiography.</p><p><strong>Conclusions: </strong>Approximately one quarter of asymptomatic hypercholesterolaemic men aged 45 to 64 who have an estimated risk of coronary heart disease of >or= 20% in 10 years have minimal coronary calcification. They may therefore represent a subset at lower risk of disease. However, uncertainties about the predictive power of coronary calcification for coronary events must be resolved before electron beam computed tomography can be used to select high-risk patients for primary prevention.</p>","PeriodicalId":79345,"journal":{"name":"Journal of cardiovascular risk","volume":"9 6","pages":"349-53"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22152977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postmenopausal hormone replacement therapy and the prevention of cardiovascular disease: a review.","authors":"Beth L Abramson","doi":"10.1097/01.hjr.00000445155.34172.04","DOIUrl":"https://doi.org/10.1097/01.hjr.00000445155.34172.04","url":null,"abstract":"<p><p>The role of hormone replacement therapy (HRT) for the prevention of cardiac disease is contentious. In this review the epidemiological evidence for the role of HRT in primary and secondary prevention of cardiac disease is assessed. Although current studies suggest very little role for HRT in women with established cardiac disease, its use in the 'healthy woman' without vascular disease until recently was not clear. HRT for the sole purpose of prevention of cardiac disease is now not indicated.</p>","PeriodicalId":79345,"journal":{"name":"Journal of cardiovascular risk","volume":"9 6","pages":"309-14"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22153038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting cardiovascular risk associated with both low density and high density lipoproteins using statin-niacin combination therapy.","authors":"W Lane Duvall,&nbsp;Michael A Blazing,&nbsp;Shilpa Saxena,&nbsp;John R Guyton","doi":"10.1097/01.hjr.0000044518.34172.72","DOIUrl":"https://doi.org/10.1097/01.hjr.0000044518.34172.72","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular risk might be reduced by targeted changes in both low density and high density lipoprotein cholesterol (LDL-C and HDL-C). This dual strategy will require a well tolerated, effective regimen, as well as a better understanding of how HDL-C may be targeted.</p><p><strong>Design: </strong>An open-label, uncontrolled, retrospective cohort study of combined statin-niacin therapy.</p><p><strong>Methods: </strong>We reviewed all patients ( n= 132) started on this combination in a referral lipid clinic over a 6.5-year period for tolerability, safety and effectiveness.</p><p><strong>Results: </strong>Combined therapy was tolerated by 77% of patients. No serious adverse events attributable to medication were encountered. In drug-naive patients (n = 37), moderate doses of statin and niacin (mean 1180 mg/day) reduced LDL-C 31% and increased HDL-C 29% ( P< 0.002, both comparisons). At niacin doses >or= 1000 mg/day (mean 1480) added to a constant statin regimen (n=29), HDL-C increased 20% ( P< 0.001). Even at niacin doses < 1000 mg/day (mean 580, n= 23), HDL-C increased 13% ( P< 0.05). Although mean HDL-C increased, the initial and final HDL-C distributions were broad and largely overlapping. Any chosen cutpoint for HDL-C goal would apply to only a minority of patients. The total/HDL cholesterol ratio had narrower distributions, as the percentage of patients with ratio < 5.0 increased from 17% to 67%.</p><p><strong>Conclusion: </strong>Combined statin-niacin therapy lowers LDL-C and raises HDL-C with acceptable tolerance and safety. If treating LDL-C is the primary goal, consistent with current guidelines, then a strategy of targeting the total/HDL cholesterol ratio as a secondary goal is applicable to more patients than targeting HDL-C itself.</p>","PeriodicalId":79345,"journal":{"name":"Journal of cardiovascular risk","volume":"9 6","pages":"339-47"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22152976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presenting symptoms and diagnosis of coronary heart disease in women.","authors":"Pamela Charney","doi":"10.1097/01.hjr.0000044516.34172.df","DOIUrl":"https://doi.org/10.1097/01.hjr.0000044516.34172.df","url":null,"abstract":"<p><p>Coronary artery disease generally presents later in women than men and more frequently with atypical symptoms. From the Framingham data, angina is the commonest initial clinical presenting symptom of coronary artery disease in women, compared with myocardial infarction for men. Obtaining a careful history is essential in evaluating a woman for possible coronary artery disease. Research is beginning to elucidate some barriers to the diagnosis of coronary artery disease in women.</p>","PeriodicalId":79345,"journal":{"name":"Journal of cardiovascular risk","volume":"9 6","pages":"303-7"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22153037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diurnal heart rate reactivity: a predictor of severity of experimental coronary and carotid atherosclerosis.","authors":"Hisham S Bassiouny,&nbsp;Christopher K Zarins,&nbsp;Daniel C Lee,&nbsp;Christopher L Skelly,&nbsp;John E Fortunato,&nbsp;Seymour Glagov","doi":"10.1097/01.hjr.0000049240.55385.1e","DOIUrl":"https://doi.org/10.1097/01.hjr.0000049240.55385.1e","url":null,"abstract":"<p><strong>Background: </strong>Elevated awake resting heart rate (HR) has been shown to be a major risk factor for cardiovascular disease. Since coronary ischaemic events appear to peak during transition from sleep to awake HR, we sought to determine whether the degree of diurnal HR fluctuation (dHRV) is an independent predictor of coronary and peripheral atherogenesis. In this study, we varied both baseline HR and dHRV using sino-atrial node ablation (SNA) in a primate model of diet-induced atherogenesis and determined the degree of plaque formation relative to both HR parameters.</p><p><strong>Methods: </strong>HR was recorded continuously for 6 months by an implantable intraaortic sensor/transmitter in 17 active unrestricted male cynomolgus monkeys. In nine monkeys, SNA was employed to create a wide spectrum of dHRV, and the power amplitude of dHRV was determined for the daily HRV cycle with power spectral analysis. After a 6-month diet induction period, percent coronary and carotid stenosis, intimal thickness and area were quantitated in each animal.</p><p><strong>Results: </strong>Total serum cholesterol and mean HR were no different between high ( n= 10) and low ( n= 7) dHRV groups (866 mg% vs. 740 mg%, P> 0.2 and 130 +/- 22 and 115 +/- 13, P> 0.1, respectively). Percent carotid stenosis was markedly greater in both high HR and dHRV animals ([HR], 54 +/- 19 vs. 35 +/- 10, P< 0.04) and ([dHRV], 54 +/- 17 vs. 32 +/- 10, P< 0.01). Significant increases in all measures of coronary atherogenesis were found in high dHRV animals when compared with those with low dHRV (percent stenosis: 48% +/- 22 vs. 23% +/- 16, P< 0.02), (lesion area: 1.2 +/- 0.8 vs. 0.3 +/- 0.3, P< 0.02), and (intimal thickness: 0.3 +/- 0.1 vs. 0.1 +/- 0.1, P< 0.01), respectively. While there was a trend towards greater coronary atherogenesis in animals with high HR, this did not reach statistical significance.</p><p><strong>Conclusion: </strong>Elevated HR and dHRV are both associated with enhanced experimental atherosclerotic plaque formation. However, a greater degree of carotid and coronary atherogenesis is observed in animals with high dHRV. These findings suggest that elevated dHRV is a stronger predictor for susceptibility to atherogenesis than elevated HR alone. Such a relationship may be attributed to the potential role of dHRV in modulating the frequency of adverse near wall haemodynamic forces, which have been shown to induce atherosclerotic plaques. Lowering of dHRV in humans by exercise or pharmacological agents may have a beneficial role in retarding atherosclerotic plaque induction, progression and complication.</p>","PeriodicalId":79345,"journal":{"name":"Journal of cardiovascular risk","volume":"9 6","pages":"331-8"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22152975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity, diabetes, and coronary risk in women.","authors":"Aruna D Pradhan,&nbsp;Patrick J Skerrett,&nbsp;JoAnn E Manson","doi":"10.1097/01.hjr.0000044513.34172.83","DOIUrl":"https://doi.org/10.1097/01.hjr.0000044513.34172.83","url":null,"abstract":"<p><p>The latter half of the twentieth century has witnessed rapid advances in cardiovascular epidemiology and medicine. Concurrently, secular trends in lifestyle practices and general improvements in standards of living have resulted in several alarming trends for cardiovascular disease prevention and health promotion. The adoption of unhealthy dietary patterns, growing socio-economic and racial disparities in chronic disease prevalence, low levels of physical activity, and other as yet unidentified genetic and environmental determinants have led to burgeoning rates of both pediatric and adult obesity and diabetes mellitus. Women appear to be at particular risk as the gender advantage for coronary heart disease (CHD) is counterbalanced by an increased incidence of obesity and diabetes. In order to further examine these complex associations, we review the available epidemiological data regarding the impact of obesity and diabetes on cardiovascular health in women.</p>","PeriodicalId":79345,"journal":{"name":"Journal of cardiovascular risk","volume":"9 6","pages":"323-30"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22153040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a cardiac prevention and rehabilitation programme for all patients at first presentation with coronary artery disease.","authors":"Kevin F Fox,&nbsp;David A Wood,&nbsp;Melissa Wright,&nbsp;Sharon Bond,&nbsp;Michaela Nuttall,&nbsp;Barbara Arora,&nbsp;Ellen Dawson,&nbsp;Patricia Devane,&nbsp;Steven J Sutcliffe,&nbsp;Ken Brown","doi":"10.1097/01.hjr.0000049245.21319.69","DOIUrl":"https://doi.org/10.1097/01.hjr.0000049245.21319.69","url":null,"abstract":"<p><strong>Background: </strong>A cardiac prevention and rehabilitation (CP&R) programme was established for patients following their first clinical episode of coronary heart disease and 1-year outcomes were evaluated against British targets for coronary prevention.</p><p><strong>Methods: </strong>Patients were evaluated 1 year after participation and outcomes compared with patients in the same health district registered with a random half of general practitioners not eligible for the programme (internal reference group) and patients identified in other English centres which participated in the EUROASPIRE II survey (external reference group).</p><p><strong>Results: </strong>Three hundred and eighteen patients (76% of 417 incident cases) attended for 1-year screening. Of those who participated in the programme 96/113 (85%) attended (Group 1); 152/194 (78%) attended from all those eligible for the programme (Group 2); 166/223 (74%) attended from those receiving usual care in the same health district (Group 3 - internal reference group). In the EUROASPIRE II survey (Group 4 - external reference group) 362/744 (58%) patients were screened. Current smoking at follow-up was Group 1, 8%, Group 2, 11%, Group 3, 13% and Group 4, 18%. Proportions with a BMI < 25 kg/m were 29%, 25%, 32%, 18%; BP < 140/90 mmHg 58%, 56%, 49%, 48%; total cholesterol < 5.0 mmol/l 60%, 54%, 43%, 46%; antiplatelet therapy 88%, 87%, 86%, 81%; beta-blocker therapy 48%, 46%, 46%, 44%; and lipid lowering therapy 56%, 51%, 36%, 69% respectively.</p><p><strong>Conclusions: </strong>A CP&R programme was associated with a majority of coronary patients, whether attending the programme or not, achieving the Joint British Society's recommended prevention targets within the same health district. Specifically, a higher proportion of programme patients reached the cholesterol target of <5.0 mmol/l compared with both usual care and other centres elsewhere. This was achieved by using more lipid lowering therapy compared with usual care in the same health district, but less than other centres outside the health district. The overall results for the whole health district show a higher standard of preventive care compared with contemporary EUROASPIRE II results from other health districts in England.</p>","PeriodicalId":79345,"journal":{"name":"Journal of cardiovascular risk","volume":"9 6","pages":"355-9"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22152978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}