Age and CVD and DM in men and women

ScienceDirect - The Lancet : Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study: "

Adults with diabetes are thought to have a high risk of cardiovascular disease (CVD), irrespective of their age. The main aim of this study was to find out the age at which people with diabetes develop a high risk of CVD, as defined by: an event rate equivalent to a 10-year risk of 20% or more; or an event rate equivalent to that associated with previous myocardial infarction.

Methods

We did a population-based retrospective cohort study using provincial health claims to identify all adults with (n=379 003) and (n=9 018 082) without diabetes mellitus living in Ontario, Canada, on April 1, 1994. Individuals were followed up to record CVD events until March 31, 2000.

Findings

The transition to a high-risk category occurred at a younger age for men and women with diabetes than for those without diabetes (mean difference 14·6 years). For the outcome of acute myocardial infarction (AMI), stroke, or death from any cause, diabetic men and women entered the high-risk category at ages 47·9 and 54·3 years respectively. When we used a broader definition of CVD that also included coronary or carotid revascularisation, the ages were 41·3 and 47·7 years for men and women with diabetes respectively.

Interpretation

Diabetes confers an equivalent risk to ageing 15 years. However, in general, younger people with diabetes (age 40 or younger) do not seem to be at high risk of CVD. Age should be taken into account in targeting of risk reduction in people with diabetes. "

Fluimucil Reduces Kidney Failure in Primary Angioplasty

Fluimucil Reduces Kidney Failure in Primary Angioplasty - CME Teaching Brief - MedPage Today: "MILAN, June 28 � The potent antioxidant Fluimucil (N-acetylcysteine) may prevent contrast-medium-induced nephropathy and preserve kidney function in patients who undergo primary angioplasty after a heart attack.
Moreover, the benefit of Fluimucil appears to be dose dependent, with the rate of death, acute renal failure requiring temporary dialysis or mechanical ventilation only 5% in patients randomized to high-dose Fluimucil, versus 7% in those who received a standard dose and 18% in controls (P=0.002), according to a report in the June 29 issue of New England Journal of Medicine. /.../"

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke.

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke. A Scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council -- Moser et al., 10.1161/CIRCULATIONAHA.106.176040:
"Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research."

Preventing Cardiovascular Disease and Diabetes

Preventing Cardiovascular Disease and Diabetes: A Call to Action From the American Diabetes Association and the American Heart Association -- Eckel et al. 113 (25): 2943 -- Circulation: "Excess body weight has become a major public health problem in the U.S., with nearly two-thirds of adults either overweight or obese. The steady gain in the prevalence of obesity over the last 25 years has affected our entire population—no racial or ethnic group, no region of the country, and no socioeconomic group has been spared. Perhaps most worrisome is the observation that the rise in the rate of obesity has been greatest in children and minorities, which suggests that future generations of Americans, and our fastest growing populations, may bear the ultimate burden of this condition. /.../"

Working Conditions and Angina Pectoris Symptoms

Associations Between Working Conditions and Angina Pectoris Symptoms Among Employed Women -- Lallukka et al. 68 (2): 348 -- Psychosomatic Medicine:
Reccommended byMarcelo Gustavo Colominas [mgcolominas@hotmail.com]
"Objective: This study aimed to examine whether psychosocial working conditions are associated with angina pectoris (AP) symptoms in women.
Methods: Data were derived from postal questionnaires filled in by 40- to 60-year-old women employed by the City of Helsinki, Finland, in 2000 to 2002 (n = 7093, response rate 67%). AP symptoms were measured by the Rose Questionnaire. Logistic regression analyses were carried out to examine AP symptoms as outcome. Independent variables consisted of Karasek’s job demands and job control, work fatigue, working overtime, work-related mental and physical strain, the work–home interface, and social support, adjusted for age. Confounding effects of socioeconomic status, health behaviors (smoking, binge drinking, body mass index), and menopause were also examined. Pregnant women were excluded.
Results: AP symptoms were reported by 6% of participants. Work fatigue was strongly associated with AP. In addition, working overtime, low job control, and high physical strain at work were associated with AP. The associations between psychosocial working conditions and AP symptoms were unaffected by health behaviors, socioeconomic status, or menopause.
Conclusions: Working conditions were associated with the AP symptoms identified by the Rose Questionnaire. Longitudinal studies are needed to disentangle the causal relationships, i.e., whether psychosocial stress is a true risk factor/cause of angina symptoms and cardiovascular disease among women. "

Very elderly may not benefit from low BP

Very elderly may not benefit from low BP:

Very elderly may not benefit from low BP

Low systolic blood pressure (BP) increases the risk of death among the very elderly, an epidemiological study suggests.

Research into the links between BP, death, and cardiovascular disease in old people have provided conflicting information, say the Finnish researchers.

In an attempt to clarify the matter, they conducted a population-based prospective study among 521 people (79% women) aged 85 years and above living in Vantaa, an industrial city in Southern Finland.

Mean systolic BP in the group was 149 mmHg and mean diastolic pressure was 82 mmHg. Just over half of patients (n=263) were taking BP-lowering medications, of whom 40.3% were taking a diuretic, 10.6% a calcium channel blocker, 9.4% a beta blocker, and 2.5% an ACE inhibitor.

Women were more likely to have previously diagnosed hypertension than men (27.7% vs 18.2%) and also more likely to use antihypertensive drugs (52.6% vs 42.7%).

During follow-up of up to 9 years (mean=3.5 years), 479 participants - 86.6% of the group - died. Multivariate analysis showed that death was linked to smoking (hazard ratio [HR]=1.97), functional status (HR=0.56), cancer (HR=1.42), dementia (HR=1.47), stroke (HR=1.80), and systolic BP of less than 140 mmHg (HR=1.35).

Interestingly, there was a tendency towards lower mortality among individuals with a systolic BP of 160 mmHg or greater. Other factors such as diastolic BP, a history of hypertension, and use of BP-lowering medication were not related to mortality, however.

Sari Rastas (Lohja Hospital) and colleagues report that the effect of lower systolic BP on mortality was particularly evident in patients without cancer, dementia, or a history of stroke.

Writing in the Journal of the American Geriatric Society, they conclude: "It is possible that the very old represent a select group of individuals, and the results from clinical trials including younger participants should be applied cautiously and individually in the very old."

Diet and Lifestyle Recommendations Revision 2006. AHA.

Abstract--Improving diet and lifestyle is a critical component of the American Heart Association’s strategy for cardiovascular disease risk reduction in the general population. This document presents recommendations designed to meet this objective. Specific goals are to consume an overall healthy diet; aim for a healthy body weight; aim for recommended levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides; aim for normal blood pressure; aim for a normal blood glucose level; be physically active; and avoid use of and exposure to tobacco products. The recommendations are to balance caloric intake and physical activity to achieve and maintain a healthy body weight; consume a diet rich in vegetables and fruits; choose whole-grain, high-fiber foods; consume fish, especially oily fish, at least twice a week; limit intake of saturated fat to <7%>trans fat to <1%> to <300> fat-free (skim) or low-fat (1% fat) dairy products and minimize intake of partially hydrogenated fats; minimize intake of beverages and foods with added sugars; choose and prepare foods with little or no salt; if you consume alcohol, do so in moderation; and when you eat food prepared outside of the home, follow these Diet and Lifestyle Recommendations. By adhering to these diet and lifestyle recommendations, Americans can substantially reduce their risk of developing cardiovascular disease, which remains the leading cause of morbidity and mortality in the United States.

Primary Prevention of Ischemic Stroke

This guideline provides an overview of the evidence on various established and potential stroke risk factors and provides recommendations for the reduction of stroke risk.

Methods— Writing group members were nominated by the committee chair on the basis of each writer’s previous work in relevant topic areas and were approved by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee. The writers used systematic literature reviews (covering the time period since the last review published in 2001 up to January 2005), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate recommendations based on standard American Heart Association criteria. All members of the writing group had numerous opportunities to comment in writing on the recommendations and approved the final version of this document. The guideline underwent extensive peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee.

Results— Schemes for assessing a person’s risk of a first stroke were evaluated. Risk factors or risk markers for a first stroke were classified according to their potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Nonmodifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic factors. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Less well-documented or potentially modifiable risk factors include the metabolic syndrome, alcohol abuse, drug abuse, oral contraceptive use, sleep-disordered breathing, migraine headache, hyperhomocysteinemia, elevated lipoprotein(a), elevated lipoprotein-associated phospholipase, hypercoagulability, inflammation, and infection. Data on the use of aspirin for primary stroke prevention are reviewed.

Conclusion— Extensive evidence is available identifying a variety of specific factors that increase the risk of a first stroke and providing strategies for reducing that risk.

AHA/ACC Guidelines Update for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease

Since the 2001 update of the American Heart Association (AHA)/American College of Cardiology (ACC) consensus statement on secondary prevention (1), important evidence from clinical trials has emerged that further supports and broadens the merits of aggressive risk-reduction therapies for patients with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease, and carotid artery disease. This growing body of evidence confirms that aggressive comprehensive risk factor management improves survival, reduces recurrent events and the need for interventional procedures, and improves quality of life for these patients./.../

ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease

During the past 2 decades, major advances have occurred in diagnostic techniques, the understanding of natural history, and interventional cardiology and surgical procedures for patients with valvular heart disease. These advances have resulted in enhanced diagnosis, more scientific selection of patients for surgery or catheter-based intervention versus medical management, and increased survival of patients with these disorders. The information base from which to make clinical management decisions has greatly expanded in recent years, yet in many situations, management issues remain controversial or uncertain. Unlike many other forms of cardiovascular disease, there is a scarcity of large-scale multicenter trials addressing the diagnosis and treatment of patients with valvular disease from which to derive definitive conclusions, and the information available in the literature represents primarily the experiences reported by single institutions in relatively small numbers of patients./.../

Predition of CHD: Diabetes & Albuminuria

Participants of the Strong Heart Study were examined initially in 1989-1991 and were monitored with additional examinations and mortality and morbidity surveillance. CHD outcome data through December 2001 showed that age, gender, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, smoking, diabetes, hypertension, and albuminuria were significant CHD risk factors. Hazard ratios for ages 65 to 75 years, hypertension, LDL cholesterol ≥160 mg/dL, diabetes, and macroalbuminuria were 2.58, 2.01, 2.44, 1.66, and 2.11 in men and 2.03, 1.69, 2.17, 2.26, and 2.69 in women, compared with ages 45 to 54 years, normal blood pressure, LDL cholesterol <100 mg/dL, no diabetes, and no albuminuria. Prediction equations for CHD and a risk calculator were derived by gender with the use of Cox proportional hazards model and the significant risk factors. The equations provided good discrimination ability, as indicated by a c statistic of 0.70 for men and 0.73 for women. Results from bootstrapping methods indicated good internal validation and calibration.

Conclusions--A "risk calculator" has been developed and placed on the Strong Heart Study Web site, which provides predicted risk of CHD in 10 years with input of these risk factors. This may be valuable for diverse populations with high rates of diabetes and albuminuria.

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack

The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations. (Stroke. 2006;37:577-617.)/.../

Personality, lifestyle and risk

People's belief that the onset and progress of disease is caused by their behaviour may be linked to a reduced risk of myocardial infarction but not of stroke and cancer. High "time urgency" may be associated with a reduced risk of cancer but not of cardiovascular disease. Stürmer and colleagues (p 1359) analysed the presence of chronic diseases in more than 5000 adults 7-10 years after those people had completed a questionnaire on psychological traits, lifestyle, and comorbidity. Most personality traits that were assessed did not have a major impact on incidence and mortality from cardiovascular disease or cancer.

Related Article

Personality, lifestyle, and risk of cardiovascular disease and cancer: follow-up of population based cohort
Til Stürmer, Petra Hasselbach, and Manfred Amelang
BMJ 2006 332: 1359. [Abstract] [Full Text]

Third Heart Sound

http://www.cardiosource.com/media/HS08_Third_Heart_Sound.mp3

Rimonabant

Rimonabant is a selective cannabinoid type 1 (CB1) receptor blocker that is part of the newly discovered endocannabinoid (EC) system. The EC plays an important role in the central and peripheral regulation of energy balance and body composition, offering a new target to induce weight loss and improve carbohydrate and lipid metabolism./.../