Peripheral artery disease and cardiovascular risk factors in the elderly. The Honolulu Heart Program

Peripheral vascular disease as measured by the ankle/brachial blood pressure index (ABI) is associated with increased risk of mortality and morbidity. Few sources of data on the relationship of risk factors to ABI are available for the elderly, especially those > 80 years of age, and minority populations. ABI measurements from the Honolulu Heart Program's fourth reexamination of 3450 ambulatory, elderly Japanese American men indicate that the prevalence of an abnormal ABI, defined as a ratio of < 0.9, was 13.6%, increasing from 8.0% in those 71 to 74 years of age to 27.4% in those 85 to 93 years. Associations that were U or J shaped were present for a number or risk factors (higher rates of abnormality [ABI < 0.9] in those in the lowest and highest risk factor quintiles) in a cross-sectional analysis. Risk factors measured at baseline were also predictive of an abnormal ABI 25 years later, even after adjustment for multiple risk factors. The odds ratio (OR) for an ABI < 0.9 at the 80th percentile of cholesterol compared with that at the 20th percentile was 1.4; the OR for 1-hour postload glucose was 1.3, and for alcohol intake 1.2. The OR associated with hypertension was 1.8 and that for smoking, 2.9 (P < .05 for all ORs). These findings are consistent with ABI being a marker for generalized atherosclerotic disease in old and very old Japanese American men.     

High prevalence of risk factors for cardiovascular disease in parents of IDDM patients with albuminuria

Life expectancy is shorter in the subset of insulin-dependent diabetic (IDDM) patients who are susceptible to kidney disease. Familial factors may be important. In this study the prevalence of cardiovascular disease mortality and morbidity and of risk factors for cardiovascular disease was compared in the parents of 31 IDDM patients with elevated albumin excretion rate (AER > 45 microg/min; group A) with that of parents of 31 insulin-dependent diabetic patients with normoalbuminuria (AER < 20 microg/min; group B). The two diabetic patient groups were matched for age and duration of disease. Information on deceased parents was obtained from death certificates and clinical records and morbidity for cardiovascular disease was ascertained using the World Health Organization questionnaire and Minnesota coded ECG. Hyperlipidaemia was defined as serum cholesterol higher than 6 mmol/l and/or plasma triglycerides higher than 2.3 mmol/l and/or lipid lowering therapy; arterial hypertension as systolic blood pressure higher than 140 mmHg and/or diastolic blood pressure higher than 90 mmHg and/or antihypertensive treatment. The percentage of dead parents was similar in the two groups (26 vs 20% for parents of group A vs group B, respectively), but the parents of the diabetic patients with elevated AER had died at a younger age (58 +/- 10 vs 70 +/- 14 years; p < 0.05). Parents of diabetic patients with nephropathy had a more than three times greater frequency of combined mortality and morbidity for cardiovascular disease than that of the parents of diabetic patients without nephropathy (26 vs 8%; odds ratio 3.96, 95% CI 1.3 to 12.2; p < 0.02). Living parents of group A had a higher prevalence of arterial hypertension (42 vs 14% p < 0.01) and hyperlipidaemia (49 vs 26% p < 0.05) as well as higher levels of lipoprotein (a) [median (range) 27.2 (1-107) vs 15.6 (0.2-98) mg/dl; p < 0.05]. They also had reduced insulin sensitivity [insulin tolerance test: median (range) K(itt) index: 3.7 (0.7-6.2) vs 4.8 (0.7-6.7)% per min; p < 0.05]. In the families of IDDM patients with elevated AER there was a higher frequency of risk factors for cardiovascular disease as well as a predisposition to cardiovascular disease events. This may help explain, in part, the high prevalence of cardiovascular disease mortality and morbidity in those IDDM patients who develop nephropathy.     

PAI-1, obesity, insulin resistance and risk of cardiovascular events

Circulating (PAI-1) levels are elevated in patients with coronary heart disease and may play an important role in the development of atherothrombosis. Many clinical studies have indicated that the insulin resistance syndrome, which is a situation predisposing to diabetes and ischemic heart disease, may be a major regulator of PAI-1 expression, especially in determining plasma PAI-1 levels. Central obesity is a characteristic of insulin resistance and is a well recognized risk factor for coronary heart disease. Recently the production of PAI-1 by adipose tissue, in particular by tissue from omentum, has been demonstrated and could be an important contributor to the elevated plasma PAI-1 levels observed in insulin resistant patients. Besides the effect of the metabolic status on plasma PAI-1 levels, the role of a genetic control has been emphasized, but according to recent results obtained in a family segregation study, its participation seems limited. Prospective cohort studies of patients with previous myocardial infarction or angina pectoris have underlined the association between increased plasma PAI-1 levels and the risk of coronary events, but the predictive capacity of PAI-1 disappears after insulin resistance marker adjustments. Taken together these results support the notion that PAI-1 can be a link between obesity, insulin resistance and cardiovascular disease.     

Dietary risk factors and their modification in cardiovascular disease.

This article provides an overview of dietary risk factors for cardiovascular disease and intervention strategies for their modification.The most prominent dietary risk factors for cardiovascular disease are hypertension, hypercholesterolemia, and obesity. Dietary fat and cholesterol contribute to hypercholesterolemia; diet sodium intake is linked to hypertension; and both conditions are exacerbated by obesity. Clinical strategies for modifying diet have relied heavily on education, skills training, and problem-solving procedures. Short-term changes in dietary behavior are often achieved, but maintenance remains an unresolved problem. Clinical approaches have been criticized as too limited in scope and too costly to deal with diet as a public health issue. A new generation of studies now underway is attempting to modify dietary behavior in entire populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nightmare prevalence in the healthy elderly.

51 healthy elderly Ss (median age 65 yrs) gave retrospective estimates of nightmare frequency in questionnaires and recorded the occurrence of nightmares in daily logs over a 2-wk period. Mean annual nightmare frequency as estimated from logs was only 65% as high among college student controls. Elderly Ss were about –1/? as likely as college students to report a problem with nightmares. Frequency estimates on the basis of logs were over 10 times higher than retrospective estimates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of coronary heart disease and major cardiovascular risk factors in Thailand

BACKGROUND: Coronary heart disease (CHD) is expected to become one of the major health problems in developing countries such as Thailand where prevalence data are scarce. This study reports the prevalence of CHD, as indicated by electrocardiogram (ECG) Minnesota coding, and its risk factors in Thailand. METHODS: In 1991 we conducted a cross-sectional ECG survey in a multistage random sample of the Thai population, aged > or =30. All major cardiovascular risk factors were measured. Standard supine 12-lead ECG data were collected; amplitudes and intervals were measured manually and entered into a computer. Abnormal tracings were verified by five cardiologists, and agreement among at least three of them was accepted as final. RESULTS: The total sample included 3822 men and 4967 women aged > or =30 years. The age-standardized prevalence rate of CHD was 9.9/1000 (men 9.2/1000, women 10.7/ 1000). The age-standardized level of major cardiovascular risk factors among men and women respectively were: total cholesterol 4.8 mmol/l (187.3 mg/dl), 5.1 mmol/l (197.7 mg/dl); hypercholesterolaemia (> or =6.2 mmol/l) 12.2%, 16.9%; systolic blood pressure (mmHg) 117.8, 117.7; diastolic blood pressure (mmHg) 76.9, 75.8; body mass index (kg/m2) 21.7, 22.8; fasting blood sugar 4.8 mmol/l (87.9 mg/dl), 5.0 mmol/l (90.3 mg/dl); hypertension (> or =160/95 +/- on antihypertensive drugs) 6.3%, 8.1%; smoking 65.1%, 8.5%; diabetes mellitus (> or =7.8 mmol/l) 2.4%, 3.7%; obesity (>25 kg/m2) 15.2%, 27.2%. CONCLUSIONS: Most of the age-adjusted mean values and proportion of major cardiovascular disease risk factors as well as the prevalence of total CHD in the Thai population were much lower than the median of those values found in developing countries.     

Heart protection: controlling risk factors for cardiovascular disease

Cardiovascular disease is the leading cause of illness and death in the United States. Clinical data continue to support primary prevention through the aggressive treatment of well-defined cardiovascular risk factors. Three risk factors that can be modified to lower the risk of cardiovascular disease and death are hypercholesterolemia, hypertension, and cigarette smoking. Even patients with asymptomatic cardiovascular disease have been shown to benefit from aggressive cholesterol-lowering therapy. New JNC-VI guidelines for managing hypertensive disease recommend that treatment decisions be based on level of blood pressure plus presence or absence of target organ damage or other risk factors. The risk of myocardial infarction in former smokers approaches that of nonsmokers after 3 years.     

The study of healthy life-style risk factors and health status for cardiovascular diseases for employees in Kaohsiung area

To understand the healthy life style, health status and risk factors of employees, institutional employees in Kaohsiung area were studied by using questionnaire investigation and blood specimen examination. One-thousand-four hundred-fifty subjects were used, but 1147 questionnaires were completed. The complete rate was 79.1%. The reliability and validity of the healthy life style scale achieved an acceptable level. The results are as follows: 1. The mean total score of healthy life-style scale was 63.9. Four healthy behavior scored lowest: "consulted health professional about health information", "monitored self of blood pressure and blood sugar", did moderate exercise at least three times per week", "took leisure activities". 2. The severity of risk factor was as follows: (1) 32.2% of employees had abnormal value for blood cholesterol (> or = 200 mg/dl); (2) 22.9% of employees had abnormal blood pressure value; (3) 22.6% of employees were overweight or obese; (4) 16.7% of employees often smoked; (5) 13.6% of employees had abnormal values for blood triglyceride. (6) 2.1% of employees had abnormal blood sugar values. 3. 10.8% of subjects were perceieved to have a worsing health status; 14.5% of the subjects had chronic disease with physicians diagnosis and most of their (71%) were hypertersion. 4. The findings of demographic data showed that people who were male, aged over forty, had education below junior high school and those of blue collar class should be screened and monitored, for the risk factors at regular intervals. Similarly, People who are male, age below forty and blue-collar class should be encouraged to develop the healthy life-styles.     

Influence of the perimenopause on cardiovascular risk factors and symptoms of middle-aged healthy women

OBJECTIVE: To determine the changes in cardiovascular risk factors and psychological and physical symptoms that occur during the perimenopause. DESIGN: Cohort study of 541 healthy middle-aged premenopausal women followed up through the menopause. SETTING: General community. PARTICIPANTS: After a baseline evaluation taken at study entry, 152 women ceased menstruating for 3 months (not due to surgery) and were not using hormone replacement therapy, and were reevaluated in a similar protocol (perimenopausal examination); 105 of the 152 were evaluated a third time when they had ceased menstruating for 12 months and were not using hormone replacement therapy (postmenopausal examination). One hundred nine premenopausal women who were repeatedly tested constituted a comparison group. MAIN OUTCOME MEASURES: Levels of lipids and lipoproteins, triglycerides, fasting glucose and insulin, blood pressure, weight, height, and standardized measures of psychological symptoms. RESULTS: Women who became perimenopausal showed increased levels of cardiovascular risk factors, which were similar in magnitude to those experienced by the comparison group of premenopausal women. Perimenopausal women reported a greater number of symptoms, especially hot flashes, cold sweats, joint pain, aches in the skull and/or neck, and being forgetful; reports of hot flashes at the perimenopausal examination were associated with low concentrations of serum estrogens. Menopausal status was not associated with depressive symptoms. Perimenopausal women who became postmenopausal showed a decline in the level of high-density lipoprotein-2-cholesterol (means, 0.53 to 0.43 mmol/L [20.6 to 16.7 mg/dL]) and a gradual increase in the level of low-density lipoprotein cholesterol (means, 3.14 to 3.33 mmol/L [121.3 to 128.8 mg/dL]), whereas symptom reporting declined. CONCLUSIONS: During mid-life, women experience adverse changes in cardiovascular risk factors and a temporary increase in total number of reported symptoms, with no change in depression. Preventive efforts to reduce the menopause-induced increase in cardiovascular risk factors should begin early in the menopausal transition.     

Serum alpha 1-antichimotrypsin levels and cardiovascular risk factors in the Japanese elderly population

Four materials used in lining prosthetic sockets were compared for their potential usefulness in below-knee applications. Tests carried out included determinations of resistance to compression, resistance to flexural abrasion and coefficients (static and dynamic) of friction. These tests were designed, respectively, to assess changes occurring during end-use brought about by extensive application of compressive or shear force, and to predict the ability to retain contact with the body and socket. Of the four materials in the study (Bock-Lite, Pedilin, polyurethane and silicone), Bock-Lite and silicone had high compression resistance, Bock-Lite had good resistance to flexural abrasion, and polyurethane and silicone had high coefficients of frictional resistance. Thus, Bock-Lite will be the most durable of the four materials but, since it had the lowest frictional coefficient, it may slip in use. Conversely, silicone and polyurethane, which will be retained in position more easily, are easily torn or compressed, so are likely to need replacement more frequently.     

Comparison of dietary risk factors for cardiovascular disease in African-American and white women

OBJECTIVE: To compare African-American and white women's knowledge, attitudes, and energy and nutrient intakes related to cardiovascular disease risk. DESIGN: The 1989 through 1991 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey (DHKS). SUBJECTS: A nationally representative sample of 2,684 white and 449 African-American women who completed the DHKS and provided 3 days of dietary information. STATISTICAL ANALYSES PERFORMED: Comparisons between groups were made using t tests and chi 2 analyses. Analysis of covariance was used to adjust for age, percentage of poverty, and education. RESULTS: Significant differences in dietary risk for cardiovascular disease were identified. White women consumed significantly less cholesterol and more potassium than African-American women. African-American women had significantly lower knowledge scores, but they were more likely than white women to indicate that their diets should be lower in fat and salt and to consider nutrition very important when shopping. White women had more positive attitudes toward the impact of diet on health than African-American women. Accounting for differences between the groups in age, education, and income explained few differences between the groups. APPLICATIONS: This study identified differences in nutrient intake, knowledge, and attitudes about diet and health that can influence the willingness and ability of women to choose foods for a more healthful diet. Dietitians can use these findings to target strategies for changing behavior. For example, many African-American women acknowledge the need to change their current diets, so dietitians can help them design implementation plans or specific action plans to accomplish needed changes.     

Effect of insulin versus sulfonylurea therapy on cardiovascular risk factors and fibrinolysis in type II diabetes

1. The synthesis and release of nitric oxide may play a role in the pathogenesis of peripheral vasodilatation and hyperdynamic circulation observed in liver cirrhosis. In this work, we analysed the synthesis of nitric oxide by the lympho-mononuclear cells of peripheral blood from patients with chronic alcoholic and non-alcoholic liver disease and we identified the isoform of nitric oxide synthase involved in the increased nitric oxide synthesis. 2. Patients were classified following clinical and histological criteria in non-alcoholic cirrhotic, alcoholic cirrhotic and non-cirrhotic chronic liver disease. We studied clinical and analytical characteristics, haemodynamic parameters and endotoxin levels in these patients. 3. Cirrhotic patients showed an increase of cardiac output and a decrease of peripheral vascular resistance. These patients had higher levels of plasma endotoxin than those observed in the control group. N omega-Nitro-L-arginine methyl ester (L-NAME)-inhibitable nitrite production from mononuclear lymphocyte cells was higher in patients than in the control group, the highest levels being in non-alcoholic cirrhotic patients, and the lowest levels in patients with non-cirrhotic alcoholic liver disease. 4. Immunocytochemistry studies revealed a positive immunoreactivity for the inducible isoform of nitric oxide synthase in lympho-mononuclear cells that was more evident in non-alcoholic than in alcoholic cirrhotic patients. By Northern blot, inducible nitric oxide synthase mRNA expression was observed only in lymphomononuclear cells from non-alcoholic cirrhotic patients. 5. Our patients show a correlation between nitric oxide synthesis, endotoxin levels and haemodynamic parameters. 6. These findings indicate that lympho-mononuclear cell stimulation may play a role in elevated nitric oxide production in hepatic cirrhosis. Thus, this increased nitric oxide synthesis could be implicated in the pathogenesis of the haemodynamic disturbances frequently found in cirrhotic patients. This increase seems to be induced, at least in part, by activation of an inducible isoform of nitric oxide synthase.     

The prevalence of the main risk factors in hypertension patients

Incidence was studied of risk factors (RF) in 669 patients with stage I and II hypertensive disease (as per WHO classification). There has been developed a risk-factor HD module. The prevailing RFs among HD patients include meteorolability, hereditary predisposition, hyperlipidemia, blood hypercoagulation, surplus body mass, hypodynamia, mental/nervous overstrain, consumption of salt going up, smoking, hyperglycemia, alcoholic liquor abuse, with n = 485 (72.5%), 417 (62.3%), 360 (53.8%), 335 (50.1%), 324 (48.4%0), 218 (32.6%), 166 (24.8%), 144 (21.5%), 84 (12.6%), 39 (5.8%), 8 (1.2%) respectively. A pathogenetic relation was found between RFs and HD clinical pattern determined by the RFs number and aggressiveness. The "mutual aggravation" phenomenon has been disclosed, its main point being to the effect that if a HD patient has several RFs, these would create certain conditions for development of each of them through affecting each other in a negative way.     

Role of known risk factors in explaining the difference in the risk of coronary heart disease between eastern and southwestern Finland

BACKGROUND: Estradiol (E2) has a potent antioxidant effect on low density lipoproteins (LDL) in vitro and in vivo, which could be important in explaining the cardioprotective effect of hormone replacement therapy (HRT) in post menopausal women. Estriol (E3), on the other hand, is a weak estrogen with low metabolic effects on different tissues, and at present no cardioprotective effect has been attributed to this steroid. AIM: To study the antioxidant effect of E3 on LDL and to compare it with the potent antioxidant action exhibited by E2. SUBJECTS AND METHODS: After LDL was isolated by ultra centrifugation from plasma of 12 healthy untreated post menopausal women, it was divided into aliquots containing 0.5 mg of LDL protein. Estriol and E2 in doses of 0, 1, 5, 15 and 50 microM were incubated with different aliquots of LDL. CuSO4 15 microM was added to each aliquot to induce an oxidative stress. The aliquots were then incubated during 4 hours at 37 degrees C. Malonaldehyde (MDA) was measured as a marker of LDL oxidation, and expressed as nM/mg protein. RESULTS: (mean +/- SD): Estriol induced a dose-dependent decrease in MDA concentration (baseline 62.8 +/- 21.7; 1 microM: 61.5 +/- 23.0; 5 microM: 52.9 +/- 20.3; 15 microM 43.5 +/- 20.1 and 50 microM: 31.0 +/- 17.6 nM/mg protein; F = 92.4; p < 0.0001), reaching a mean decrease of 50.7% at the highest dose tested. Estradiol has a similar dose-dependent decrease in MDA concentration (F = 60.2; p < 0.0001), revealing a more potent effect than E3 (p < 0.05), with a mean decrease of 67.4% at the highest dose tested. CONCLUSIONS: Our results demonstrate that estriol shows an important antioxidant action of LDL in vitro, although its effect is less potent than estradiol. These results raise the possibility that estriol could have a cardioprotective effect in post menopausal women, possibility that has not been yet demonstrated.     

Declining prevalence of cervicovaginal human papillomavirus infection with age is independent of other risk factors

The purpose of this study was to determine whether the addition of small quantities of minor lecithin components (phosphatidylinositol, phosphatidic acid, lysophosphatidylethanolamine, and cholesterol) and Pluronic F68 to lecithin could improve the stability of lecithin-stabilized perfluorocarbon emulsions. Attempts were made to correlate emulsion stability with interfacial properties (tension and charge). Dynamic interfacial tension was determined using a Teflon Wilhelmy plate method [reported previously (1)]. Emulsions were prepared by microfluidization. Microelectrophoresis was used to measure emulsion droplet charge, and photon correlation spectroscopy and Coulter analysis were used to determine emulsion stability as a function of droplet size. Thermal kinetic accelerated stability testing was conducted. Various droplet size parameters were used to compare emulsion stabilities, and an overall stability ranking, based on these parameters, was obtained for each emulsion. Small quantities of additives altered emulsion stability and these data were correlated with interfacial properties and initial droplet diameters. The addition of cholesterol to lecithin resulted in the most stable perfluorocarbon emulsion.     

Cardiovascular risk factors in the elderly

Although a number of risk factors for cardiovascular morbidity and mortality have been identified in young and middle-aged adults, their prevalence and importance are less known in the elderly. Elderly people have a risk profile different from that of younger subjects, but representative data on risk factors for cardiovascular disease in the elderly are difficult to find in the literature. Some typical 'major' risk factors, like blood pressure (BP), total cholesterol or left ventricular hypertrophy, do not have a clear predictive role for cardiovascular mortality in the elderly, especially in the extreme ages, while risk indicators usually labelled as 'minor' (serum uric acid, ventilatory function or proteinuria), do have a strong predictive value in these individuals. This must be taken into account when evaluating the cumulative risk of the elderly, in order to avoid overtreatment of subjects with mildly elevated BP or cholesterol.