Prognosis of congestive heart failure after prior myocardial infarction in older persons with atrial fibrillation versus sinus rhythm

In a prospective study of 651 older persons with congestive heart failure after prior myocardial infarction, persons with atrial fibrillation had a significantly higher mortality than those with sinus rhythm if they had an abnormal (p = 0.005) or normal (p = 0.0001) left ventricular ejection fraction. The Cox regression model showed that significant independent risk factors for total mortality were age (risk ratio 1.03 for an increment of 1 year of age), hypertension (risk ratio 1.2), diabetes mellitus (risk ratio 1.4), abnormal left ventricular ejection fraction (risk ratio 2.1), and atrial fibrillation (risk ratio 1.5).     

The association of fasting glucose levels with congestive heart failure in diabetic adults > or =65 years: the Cardiovascular Health Study

OBJECTIVES: The purpose of this study was to determine if fasting glucose levels are an independent risk factor for congestive heart failure (CHF) in elderly individuals with diabetes mellitus (DM) with or without coronary heart disease (CHD). BACKGROUND: Diabetes mellitus and CHF frequently coexist in the elderly. It is not clear whether fasting glucose levels in the setting of DM are a risk factor for incident CHF in the elderly. METHODS: A cohort of 829 diabetic participants, age > or =65 years, without prevalent CHF, was followed for five to eight years. The Cox proportional hazards modeling was used to determine the risk of CHF by fasting glucose levels. The cohort was categorized by the presence or absence of prevalent CHD. RESULTS: For a 1 standard deviation (60.6 mg/dl) increase in fasting glucose, the adjusted hazard ratios for incident CHF among participants without CHD at baseline, with or without an incident myocardial infarction (MI) or CHD event on follow-up, was 1.41 (95% confidence interval 1.24 to 1.61; p < 0.0001). Among those with prevalent CHD at baseline, with or without another incident MI or CHD event on follow-up, the corresponding adjusted hazard ratio was 1.27 (95% confidence interval 1.02 to 1.58; p < 0.05). CONCLUSIONS: Among older adults with DM, elevated fasting glucose levels are a risk factor for incident CHF. The relationship of fasting glucose to CHF differs somewhat by the presence or absence of prevalent CHD.     

Incidence of new atherothrombotic brain infarction in older persons with prior myocardial infarction and serum low-density lipoprotein cholesterol >or=125 mg/dl treated with statins versus no lipid-lowering drug

BACKGROUND: We report the incidence of new atherothrombotic brain infarction (ABI) in older men and women with prior myocardial infarction and a serum low-density lipoprotein (LDL) cholesterol of >or=125 mg/dl treated with statins and with no lipid-lowering drug. METHODS: The incidence of new ABI was investigated in an observational prospective study of 1410 men and women, mean age 81 +/- 9 years, with prior myocardial infarction and a serum LDL cholesterol of >or=125 mg/dl treated with statins (679 persons or 48%) and with no lipid-lowering drug (731 persons or 52%). Follow-up was 36 +/- 21 months. RESULTS: At follow-up, the stepwise Cox regression model showed that significant independent predictors of new ABI were age (risk ratio = 1.04 for a 1-year increase in age), cigarette smoking (risk ratio = 3.5), hypertension (risk ratio = 3.1), diabetes mellitus (risk ratio = 2.3), initial serum LDL cholesterol (risk ratio = 1.01 for each 1 mg/dl increase), initial serum high-density lipoprotein cholesterol (risk ratio = 0.97 for each 1 mg/dl increase), prior stroke (risk ratio = 2.5), and use of statins (risk ratio = 0.40). The Cochran-Armitage test showed a trend in the reduction of new ABI in persons treated with statins as the level of serum LDL cholesterol decreased ( p <.0001). CONCLUSIONS: Use of statins caused a 60%, significant, independent reduction in new ABI in older men and women with prior myocardial infarction and a serum LDL cholesterol of >or=125 mg/dl.     

Epidemiology of congestive heart failure in three ethnic groups

Congestive heart failure (CHF) is a leading cause of morbidity, disability, and mortality in old age, but little is known about the epidemiology of this condition in free-living minority populations. To determine the prevalence of CHF and associated risk factors in a multiethnic community, a population sample of 2759 elderly (i.e., 65 years of age and older) African American (AA), Hispanic-Cuban (HC), and white non-Hispanic (WNH) men and women from Miami-Dade County, Florida, were examined. There were 153 (5.6%) cases of self-reported CHF in the sample. The unadjusted prevalence rate of CHF was virtually identical among elderly AA (4.8%) and WNH (4.9%) but was significantly (p=0.04) lower than the rate among HC (6.8%). Sex- and ethnic-specific analyses showed that the highest prevalence rate of CHF was among HC women (8.2%). A multiple logistic analysis was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of CHF in relation to age, sex, ethnicity, medical history, and smoking and alcohol drinking habits. Age (65-74 vs. 75-84; OR 1.7; CI 1.2-2.4; p=0.01), HC ethnic group (OR 1.5; CI 1.0-2.4; p=0.05), history of hypertension (OR 1.5; CI 1.1-2.1; p=0.02), history of myocardial infarction (OR 2.3; CI 1.5-3.5; p=0.0001), and history of diabetes mellitus (OR 1.9; CI 1.3-2.8; p=0.001) were directly, significantly, and independently associated with the prevalence of self-reported CHF. The findings here confirm those of prior studies in elderly white US residents, which indicate that heart attack, hypertension, and diabetes mellitus are major risk factors for CHF. The results also show that elderly AA and WNH have similar CHF prevalence rates. The higher CHF prevalence in elderly HC women found in this study requires further investigation. (c)2001 by CHF, Inc.     

Incidence, predictive factors, and prognostic significance of supraventricular tachyarrhythmias in congestive heart failure

BACKGROUND: The incidence, predictive factors, morbidity, and mortality associated with the development of supraventricular tachyarrhythmias (SVTs) in patients with congestive heart failure (CHF) are poorly defined. METHODS: In the Digitalis Investigation Group trial, patients with CHF who were in sinus rhythm were randomly assigned to digoxin (n = 3,889) or placebo (n = 3,899) and followed up for a mean of 37 months. Baseline factors that predicted the occurrence of SVT and the effects of SVT on total mortality, stroke, and hospitalization for worsening CHF were determined. RESULTS: Eight hundred sixty-six patients (11.1%) had SVT during the study period. Older age (odds ratio [OR], 1.029 for each year increase in age; p = 0.0001), male sex (OR, 1.270; p = 0.0075), increasing duration of CHF (OR, 1.003 for each month increase in duration of CHF; p = 0.0021), and a cardiothoracic ratio of > 0.50 (OR, 1.403; p = 0.0001) predicted an increased risk of experiencing SVT. Left ventricular ejection fraction, New York Heart Association functional class, and treatment with digoxin vs placebo were not related to the occurrence of SVT. After adjustment for other risk factors, development of SVT predicted a greater risk of subsequent total mortality (risk ratio [RR] = 2.451; p = 0.0001), stroke (RR = 2.352; p = 0.0001), and hospitalization for worsening CHF (RR = 3. 004; p = 0.0001). CONCLUSION: In CHF patients in sinus rhythm, older age, male sex, longer duration of CHF, and increased cardiothoracic ratio predict an increased risk for experiencing SVT. Development of SVT is a strong independent predictor of mortality, stroke, and hospitalization for CHF in this population. Prevention of SVT may prolong survival and reduce morbidity in CHF patients.     

Multimorbidity and survival in older persons with colorectal cancer

OBJECTIVES: To ascertain the effect of common chronic conditions on mortality in older persons with colorectal cancer. DESIGN: Retrospective cohort study. SETTING: Population-based cancer registry. PARTICIPANTS: Patients in the Surveillance Epidemiology and End Results-Medicare linked database who were aged 67 and older and had a primary diagnosis of Stage 1 to 3 colorectal cancer during 1993 through 1999. MEASUREMENTS: Chronic conditions were identified using claims data, and vital status was determined from the Medicare enrollment files. After estimating the adjusted hazard ratios for mortality associated with each condition using a Cox model, the population attributable risk (PAR) was calculated for the full sample and by age subgroup. RESULTS: The study sample consisted of 29,733 patients, 88% of whom were white and 55% were female. Approximately 9% of deaths were attributable to congestive heart failure (CHF; PAR = 9.4%, 95% confidence interval (CI) = 8.4-10.5%), more than 5% were attributable to chronic obstructive pulmonary disease (COPD; PAR = 5.3%, 95% CI = 4.7-6.6%), and nearly 4% were attributable to diabetes mellitus (PAR = 3.9%, 95% CI = 3.1-4.8%). The PAR associated with CHF increased with age, from 6.3% (95% CI = 4.4-8.8%) in patients aged 67 to 70 to 14.5% (95% CI = 12.0-17.5%) in patients aged 81 to 85. Multiple conditions were common. More than half of the patients who had CHF also had diabetes mellitus or COPD. The PAR associated with CHF alone (4.29%, 95% CI = 3.68-4.94%) was similar to the PAR for CHF in combination with diabetes mellitus (3.08, 95% CI = 2.60-3.61%) or COPD (3.93, 95% CI = 3.41-4.54%). CONCLUSION: A substantial proportion of deaths in older persons with colorectal cancer can be attributed to CHF, diabetes mellitus, and COPD. Multimorbidity is common and exerts a substantial effect on colorectal cancer survival.     

Incidence of new stroke or new myocardial infarction or death at 39-month follow-up in patients with diabetes mellitus, hypertension or both with and without microalbuminuria

We investigated in 306 patients, mean age 57 +/- 10 years, with diabetes mellitus (202 patients) or hypertension (179 patients) whether microalbuminuria was a significant independent risk factor for the development of new stroke or new myocardial infarction (MI) or death. At 39-month follow-up, new stroke or new MI or death developed in 44 of 111 patients (40%) with microalbuminuria and in 38 of 195 patients (19%) without microalbuminuria (p = 0.0001). Stepwise Cox regression analysis showed that significant independent predictors of the time to development of new stroke or new MI or death were (1) diabetes (risk ratio = 1.76), (2) left ventricular (LV) mass index (risk ratio = 1.020 for each 1 g/m(2) increase), (3) prior stroke (risk ratio = 5.39), and (4) prior MI (risk ratio = 3.29). Microalbuminuria was not a significant independent predictor of new stroke or new MI or death, but LV mass index, diabetes mellitus, prior stroke, and prior MI were significant independent predictors.     

Risk factors for new atherothrombotic brain infarction in older Hispanic men and women.

BACKGROUND: We report the prevalence and incidence of atherothrombotic brain infarction (ABI) in older Hispanic men and women in a long-term health care facility. METHODS: The prevalence and incidence of ABI and the association of risk factors with new ABI were investigated in 201 Hispanic men, mean age 79 +/- 8 years, and in 302 Hispanic women, mean age 80 +/- 9 years, in a long-term health care facility. Mean follow-up was 42 +/- 20 months in men and 47 +/- 26 months in women. RESULTS: The prevalence of prior ABI was 33% in Hispanic men and 30% in Hispanic women. The incidence of new ABI was 24% in Hispanic men and 23% in Hispanic women. Significant independent risk factors for new ABI were age (risk ratio = 1.09 in men and 1.08 in women for each increase of 1 year of age), current cigarette smoking (risk ratio = 2.8 in men and 2.7 in women), hypertension (risk ratio = 2.8 in men), diabetes mellitus (risk ratio = 3.5 in men and 5.0 in women), prior ABI (risk ratio = 5.6 in men and 5.5 in women), serum total cholesterol (risk ratio = 1.03 in men and 1.01 in women for each 1 mg/dl increase), and serum high-density lipoprotein (HDL) cholesterol (risk ratio = 1.06 in men and 1.06 in women for each 1 mg/dl decrease). CONCLUSIONS: Significant independent risk factors for new ABI were age, current cigarette smoking, diabetes mellitus, prior ABI, serum total cholesterol, and serum HDL cholesterol (inverse association) in older Hispanic men and women and hypertension in older Hispanic men.     

Prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease and of associated risk factors in older men and women with and without diabetes mellitus

The authors performed a retrospective analysis of the prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease and of associated risk factors in 99 men (mean age 79±8 years) with diabetes mellitus vs. 368 men (mean age 81±8 years) without diabetes mellitus, and in 260 women (mean age 80±8 years) with diabetes mellitus vs. 1184 women (mean age 81±8 years) without diabetes mellitus. All patients were seen in an academic outpatient geriatrics practice. Diabetic men had a higher prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease (p<0.0001); a higher prevalence of smoking (p=0.023), hypertension (p<0.0001), and obesity (p=0.0007); higher levels of serum total and low density lipoprotein cholesterol (p<0.0001) and triglycerides (p=0.003); and lower levels of serum high density lipoprotein cholesterol (p=0.0001) than men without diabetes mellitus. Diabetic women had a higher prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease (p<0.0001); a higher prevalence of hypertension and obesity (p<0.0001); higher levels of serum total and low density lipoprotein cholesterol (p=0.0001) and triglycerides (p=0.005); and lower levels of serum high density lipoprotein cholesterol (p=0.0001) than women without diabetes mellitus.     

Effect of beta blockers on incidence of new coronary events in older persons with prior myocardial infarction and diabetes mellitus

Of 613 persons, mean age 79 +/- 9 years, with prior myocardial infarction and diabetes mellitus, 68 (11%) had contraindications to beta blockers; 289 of 545 persons (53%) without contraindications to beta blockers were treated with beta blockers. The Cox regression model showed that significant independent predictors of new coronary events were age (risk ratio 1.02 for an increment of 1 year of age), systemic hypertension (risk ratio 2.0), serum low-density lipoprotein cholesterol > or =125 mg/dl (risk ratio 1.4), serum high-density lipoprotein cholesterol < or =35 mg/dl (risk ratio 1.6), and use of beta blockers (risk ratio 0.73).     

Association of extracranial carotid arterial disease and chronic atrial fibrillation with the incidence of new thromboembolic stroke in 1,846 older persons

In a prospective study of 1,846 persons, mean age 81 +/- 8 years, 281 persons (15%) had 40% to 100% extracranial carotid arterial disease and 253 persons (14%) had chronic atrial fibrillation. The Cox regression model showed that significant independent risk factors for new thromboembolic stroke were atrial fibrillation (p = 0.0001, risk ratio 3.3), 40% to 100% extracranial carotid arterial disease (p = 0.0001, risk ratio 2.5), prior stroke (p = 0.0001, risk ratio 2.1), and male gender (p = 0.045, risk ratio 1.2).     

Risk factors for symptomatic peripheral arterial disease in older persons in an academic hospital-based geriatrics practice

OBJECTIVE: To investigate risk factors for symptomatic peripheral arterial disease (PAD) in older persons. DESIGN: A retrospective analysis of charts from all older persons seen from January 1, 1998, through June 15, 1999, at an academic, hospital-based geriatrics practice. SETTING: An academic, hospital-based geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians. PATIENTS: A total of 467 men, mean age 80 +/- 8 years, and 1444 women, mean age 81 +/- 8 years, were included in the study. MEASUREMENTS AND MAIN RESULTS: Symptomatic PAD was present in 93 of 467 men (20%) and in 191 of 1444 women (13%) (P = .001). Significant risk factors for symptomatic PAD by univariate analysis were: age (P = .021 in women); cigarette smoking, hypertension, diabetes mellitus, serum total cholesterol, serum high-density lipoprotein (HDL) cholesterol (inverse association), and serum low-density lipoprotein (LDL) cholesterol (P < .001 in men and women); obesity (P = .013 in men and .002 in women); and serum triglycerides (P = .027 in women). Significant independent risk factors for symptomatic PAD by stepwise logistic regression analysis were: age (odds ratio = 1.052 in men and 1.025 in women); cigarette smoking (odds ratio = 2.552 in men and 4.634 in women); hypertension (odds ratio = 2.196 in men and 2.777 in women); diabetes mellitus (odds ratio = 6.054 in men and 3.594 in women); serum HDL cholesterol (odds ratio = .948 in men and .965 in women); and serum LDL cholesterol (odds ratio = 1.019 in men and women). CONCLUSIONS: Significant independent risk factors for symptomatic PAD in older men and women were age, cigarette smoking, hypertension, diabetes mellitus, serum HDL cholesterol (inverse association), and serum LDL cholesterol.     

Metabolic syndrome and risk of cardiovascular events after myocardial infarction

OBJECTIVES: We aimed to assess the prevalence and prognostic role of metabolic syndrome (METS) and diabetes in post-myocardial infarction (MI) patients. BACKGROUND: Diabetes is a well known risk factor for patients with previous MI, but glycemic dysmetabolism develops over a protracted period of time. Scanty data are available on the role of METS in patients with previous MI. METHODS: Adjusted Cox's regression models, having diabetes, death, major cardiovascular events (CVE), and hospitalization for congestive heart failure (CHF) during follow-up as outcome events, were fitted on 11,323 patients with prior MI enrolled in the GISSI-Prevenzione Trial. RESULTS: At baseline, 21% and 29% of patients had diabetes mellitus and METS, respectively. The METS patients had a significant (93%) increased risk of diabetes during follow-up. As compared with control subjects, the probability of death and CVE were higher in both METS (+29%, p = 0.002; +23%, p = 0.005) and diabetic patients (+68%, p <0.0001; +47%, p <0.0001), although diabetic but not METS patients were more likely to be hospitalized for CHF (+89%, p <0.0003 and +24%, p = 0.241). Moderate (-6% to -10%) and substantial (>-10%) weight reduction were associated with a significant (18% and 41%, respectively) decreased risk of diabetes. Weight gain was significantly associated with increased risk of diabetes. The risk conferred by METS and diabetes tended to be higher among women. CONCLUSIONS: In patients with MI, METS and diabetes were highly prevalent and are associated with increased risk of death and CVE. Diabetes is also associated with increased risk of hospitalization for CHF. Weight reduction significantly decreased the risk of becoming diabetic in patients with METS.     

Risk factors for coronary artery disease in old persons in an academic hospital-based geriatrics practice

BACKGROUND: Risk factors for coronary artery disease (CAD) in old men and women include age, cigarette smoking, hypertension, diabetes mellitus, dyslipidemia, and obesity. OBJECTIVE: To investigate the association of risk factors with prevalence of CAD. METHODS: We performed a retrospective analysis of charts for all old persons seen during the period from 1 January 1998 through 15 June 1999 at an academic hospital-based geriatric practice to investigate associations of risk factors with prevalence of CAD among old persons. We studied 467 men, mean age 80 +/- 8 years, and 1444 women, mean age 81 +/- 8 years. RESULTS: CAD was present in 201 of 467 men (43%) and in 473 of 1444 women (33%; P < 0.0001). Risk factors for CAD according to univariate analysis were age (P < 0.0001 for women), cigarette smoking (P < 0.0001 for men and women), hypertension (P < 0.0001 for men and women), diabetes mellitus (P < 0.0001 for men and women), obesity (P < 0.0001 for men and women), and serum levels of total cholesterol (P < 0.0001 for men and P = 0.0001 for women), low-density lipoprotein (LDL) cholesterol (P < 0.0001 for men and P = 0.001 for women), and high-density lipoprotein (HDL) cholesterol (inverse association; P = 0.0001 for men and women). Stepwise logistic regression analysis showed that significant independent risk factors for CAD were cigarette smoking (odds ratio 6.7 for men), hypertension (odds ratios 3.3 for men and 2.7 for women), and serum levels of HDL cholesterol (odds ratio 0.83 for men and women) and LDL cholesterol (odds ratios 1.10 for men and 1.09 for women). CONCLUSIONS: Significant independent risk associations with prevalence of CAD among old persons were found for cigarette smoking by men, hypertension in men and women, and serum levels of HDL cholesterol (inverse association) in men and women, and of LDL cholesterol in men and women.     

The impact of diabetes mellitus at the time of heart transplantation on long-term survival

AIMS/HYPOTHESIS: To analyse the impact of diabetes mellitus (DM) at the time of heart transplantation on long-term survival and incidence of transplant coronary artery disease (TxCAD). METHODS: We analysed 773 consecutive adult heart transplant recipients who underwent primary heart transplantation from May 1986 until December 2000. The cohort consisted of 140 patients with diabetes mellitus (with DM, men 82%) and 633 patients without (wo DM, men 84%) diabetes mellitus at the time of transplantation. The patients were documented as to survival and incidence of TxCAD. RESULTS: Patients with diabetes mellitus were older compared to those without diabetes mellitus (with DM 54.9+/-6.8a vs wo DM 49.7+/-10.8a; p=0.0001), they had a higher incidence of ischaemic cardiomyopathy prior to transplantation (with DM 52% vs wo DM 30%; p=0.0001), but reduced long-term survival (10 year survival: with DM 40% vs wo DM 58%; log-rank=0.025). Surprisingly, the incidence of transplant coronary artery disease (TxCAD) was comparable at 10 years (with DM 28% vs wo DM 22%; log-rank=0.625). In multivariate Cox proportional hazard analysis, diabetes mellitus present at the time of heart transplantation (HR 1.594; 95%CI 1.009-2.518; p=0.045), but not age (HR 0.990; 95%CI 0.965-1.014; p=0.404) was an independent predictor affecting long-term survival. CONCLUSION/INTERPRETATION: The presence of diabetes mellitus at the time of heart transplantation adversely affects long-term patient survival, but does not predict the occurrence of transplant coronary artery disease. The definite mechanisms of adverse survival primarily seem to relate to generally impaired global organ function. Despite a less favourable long-term outcome, our data still justify heart transplantation in end-stage heart failure patients with diabetes mellitus.     

The incidence of congestive heart failure associated with antidiabetic therapies

BACKGROUND: Increased risk for CHF in persons with type 2 diabetes is well established. Our objectives were to estimate the CHF risk associated with specific therapies for diabetes and to determine the differences in incidence rates of CHF associated with adding various antidiabetic agents. METHODS: Subjects were members of the Kaiser Permanente Northwest (KPNW) diabetes registry as of 1 January 1998, with no prior history of CHF (n = 8063). We identified their therapy as of that date and then defined the start of the subject study period as the date when their drug regimen changed, either by switching to or by adding another antidiabetic drug. We defined the new therapy as the index therapy and the date of initiating the new therapy as the index date. Follow-up on the patients was done until the index therapy was discontinued or changed, or until 31 December 2002, whichever came earlier. We calculated the incidence rate of CHF in patients on various therapeutic regimens adjusting for age, gender, diabetes duration, existing ischemic heart disease, hypertension, renal insufficiency and glycemic control (HbA(1c)). RESULTS: CHF incidence rates were highest in index therapy categories that included insulin and lowest in regimens that included metformin. When insulin was added to an initial therapy, CHF incidence was increased 2.33 times (p < 0.0001) and 2.66 times (p < 0.0001) compared to the addition of sulphonylurea or metformin respectively. CONCLUSIONS: Our findings support the theory that elevated serum insulin levels promote the development of cardiac disease. Consistent with the UKPDS, metformin may offer some protection from incident CHF relative to sulphonylurea or insulin.     

Predictors and importance of congestive heart failure in patients with acute inferior myocardial infarction

Inferior myocardial infarction (MI) is considered to have a more favorable prognosis than anterior wall MI but includes high risk groups with increased mortality and morbidity. It is well known that congestive heart failure (CHF) complicating acute MI has poor prognosis. In this study we assessed the clinical and prognostic significance of CHF and the predictive value of the baseline demographic and clinical variables for CHF in patients with acute inferior MI. A total of 350 patients with acute inferior MI were included. In group A there were 26 patients (7.4%) with CHF, and in group B there were 324 patients (92.6%) without this complication. Baseline clinical and demographic characteristics and in-hospital complications of the groups were assessed. In group A patients were older (67.6±9.5 vs 53.7±10.9 years, p<0.0001) and there were more female patients (50% vs 15%, p<0.00001) compared to group B. The prevalence of diabetes mellitus (58% vs 16%) and precordial ST segment depression on admission ECG (81% vs 50%) were significantly higher in group A compared to group B (p<0.00001 and p=0.002 consecutively). In group A there was a higher rate of righ ventricular (25% vs 23%), posterior (26% vs 24%) and posterolateral myocardial infarction (19% vs 14%), but the differences were not statistically different. In group A patients had significantly higher rate of second- or third-degree AV block (46% vs 8%, p<0.00001), cardiogenic shock (35% vs 1%, p<0.00001) and mortality (46% vs 3%, p<0.00001) compared to group B. In a multivariate regression analysis diabetes mellitus (p=0.0003) and precordial ST segment depression on admission ECG (p=0.002) were found as the independent predictors of in-hospital CHF in patients with acute inferior MI. CHF and ST segment depression on admission ECG were found as the independent predictors of in-hospital mortality (p<0.00001, p=0.04 consecutively). Patients with CHF complicating acute inferior MI have more unfavorable demographic and clinical characteristics on admission, higher rate of in-hospital complications and mortality. History of diabetes mellitus and precordial ST segment depression on admission ECG have an independent predictive value for CHF in this particular group of patients.     

Incidence of new stroke or new myocardial infarction or death in patients with severe carotid arterial disease treated with and without statins

We investigated in 449 patients with severe carotid arterial disease, who did not undergo revascularization, the incidence of new stroke or new myocardial infarction (MI) or death in patients treated with statins (66%) and in patients not treated with lipid-lowering therapy (34%). Hypercholesterolemia was present in all of the 298 patients (100%) treated with statins and in 145 of 151 patients (96%) not treated with statins (p = 0.001). Follow-up was 26 +/- 18 months in patients treated with statins and 21 +/- 17 months in patients not treated with statins (p <0.0001). New stroke or new MI or death occurred in 45 of 298 patients (15%) treated with statins and in 102 of 151 patients (68%) not treated with statins (p <0.0001). Stepwise Cox regression analysis showed that significant independent prognostic factors for time to development of new stroke or new MI or death were use of statins (risk ratio 0.13, p <0.0001), smoking (risk ratio 1.45, p = 0.0329), systemic hypertension (risk ratio 1.81, p = 0.0011), diabetes mellitus (risk ratio 2.87, p <0.0001), previous stroke (risk ratio 3.18, p <0.0001), and previous MI (risk ratio 2.15, p <0.0001). In conclusion, statins decrease the incidence of new stroke or MI or death in patients with severe carotid arterial disease who do not undergo revascularization.     

Abdominal obesity is an independent risk factor for chronic heart failure in older people

OBJECTIVES: To examine whether total and abdominal adiposity are risk factors for the development of chronic heart failure (CHF) in older men and women. DESIGN: Prospective, longitudinal cohort: The Health, Aging and Body Composition study. SETTING: Memphis, Tennessee, and Pittsburgh, Pennsylvania, metropolitan areas. PARTICIPANTS: Three thousand seventy-five well-functioning community-dwelling older adults aged 70 to 79. MEASUREMENTS: Body composition using dual energy X-ray absorptiometry, visceral adipose tissue area using computed tomography, adjudicated CHF. RESULTS: Of the remaining (640 participants excluded from original group of 3,075) 2,435 participants (1,081 men, 1,354 women) without coronary heart disease or CHF at baseline, there were 166 confirmed diagnoses of CHF during the median+/-standard deviation (SD) follow-up of 6.1+/-1.4 years. After adjustment for age, race, sex, site, education, smoking, and chronic obstructive pulmonary disorder, all adiposity variables (body mass index (BMI), adipose tissue mass, percentage body fat, waist-to-thigh ratio, waist circumference, and visceral and subcutaneous abdominal adipose tissue) were significant predictors of the development of CHF. In a model that included waist circumference and BMI, waist circumference was associated with incident CHF (hazard ratio (HR)=1.27, 95% confidence interval (CI)=1.04-1.54 per SD increase, P=.02), but BMI was not (HR=1.08, 95% CI=0.86-1.35). When waist circumference and percentage fat were included together, both variables were significant predictors of CHF (waist: HR=1.17, 95% CI=1.00-1.36 per SD increase, P=.05; percentage fat: HR=1.47, 95% CI=1.16-1.87 per SD increase, P=.002). Stepwise adjustment for inflammation, hypertension, insulin resistance, and diabetes mellitus did not decrease the relative risk of a greater waist circumference for the development of CHF (all HR=1.27-1.32, 95% CI=1.02-1.61 per SD increase). CONCLUSION: Abdominal body fat distribution may be a stronger risk factor for CHF than overall obesity.     

A study of cardiovascular risk factors in Delhi, India

Acute myocardial infarction (AMI) is a leading cause of mortality and disability of adults in urban and rural India, and occurs at younger age than in western populations. In this paper an attempt has been made to determine the risk factors for non- fatal AMI among Indian men and women and to study the difference in proportion of risk factors by taking non- AMI group along with healthy group as controls. Mantel Haenzel test showed that while comparing AMI with non-AMI group, diabetes mellitus (p < 0.05), family history of MI (p < 0.0001) and smoking (p < 0.0001) are significantly associated with AMI after adjusting the effects of hypertension. The same test was carried out in comparing AMI with healthy group which showed that diabetes mellitus (p < 0.05), family history of MI (p < 0.0001) and smoking (p < 0.0001) are significantly associated with AMI after adjusting the effects of hypertension. Similarly, while comparing CVD group with healthy group, family history of MI (p < 0.0001) and smoking (p < 0.0001) are significantly associated with CVD after adjusting the effects of hypertension. Stepwise logistic regression showed that while comparing AMI cases with non- AMI controls, arrhythmias (odds ratio (OR) = 5.196, p < 0.0001), angina (OR = 3.599, p < 0.0001), CHF (OR = 3.121, p < 0.0001), hypertension (OR = 2.717, p < 0.0001), smoking (OR = 1.993, p < 0.0001) and family history of MI (OR = 1.819, p < 0.01) were important risk factors for a first myocardial infarction. Moreover, while comparing AMI cases with healthy controls, family history of AMI (OR = 15.925, p < 0.0001), smoking (OR = 2.806, p < 0.001), hypertension (OR = 2.718, p < 0.0001), gender (OR = 2.410, p < 0.01) and age (OR = 2.410, p < 0.05) were important predictors of AMI; and while comparing CVD cases (AMI and non-AMI) with healthy group, family history of MI (OR = 10.377, p < 0.01), hypertension (OR = 8.237, p < 0.01) and smoking (OR = 4.454, p < 0.01), were important predictors of cardiovascular disease.