The psychological impact of cardiovascular screening and intervention in primary care: a problem of false reassurance? British Family Heart Study Group.

BACKGROUND: There have been many reports of the adverse psychological effects of screening. Here we discuss the results of a randomized controlled study--one of the first to address this issue. AIM: To determine the extent to which participation in a population-based intervention programme that aims to reduce the risk of cardiovascular diseases raises concerns about health, or undermines a belief in the ability to reduce that risk. METHOD: A randomized controlled trial involving 13 general practices in England, Wales and Scotland was conducted. Two thousand, nine hundred and eighty-four middle-aged men and women undergoing cardiovascular risk-screening and intervention, and a randomized comparison group of 3,576 men and women from the same practices, who were not offered the intervention, were compared on three outcomes: perception of current health, perceived risk of suffering a heart attack, and perceived ability to reduce the risk of suffering a heart attack. RESULTS: We found no evidence to suggest that participation in this one-year, population-based intervention programme, to reduce the risk of cardiovascular disease raised concerns about health or risk of a heart attack; indeed, those in the intervention group were slightly more optimistic about their health. Alterations in perceptions of current health and the risk of suffering a heart attack were associated directly with true alterations in risk factors. A more noticeable effect on participants in this intervention programme was a reduction in their perceived ability to further reduce their risks of a heart attack. This was associated with a decrease in weight and with quitting smoking. CONCLUSION: Contemporary screening and intervention programmes in primary care, aimed at reducing risk of cardiovascular disease, do not necessarily lead to raised anxiety or concern about health. A more subtle effect of screening would appear to be one of reassurance in the face of continuing, albeit reduced, risk.     

Patient expectations on lipid-lowering drugs

OBJECTIVE: The objective of this study was to assess expectations of effect when using statins in a treatment population. Further the aim was to examine factors, including history and concurrent risk of coronary heart disease, associated with a higher and lower treatment belief. METHODS: Eight hundred and twenty-nine (829) Swedish patients using statins completed postal questionnaires about their health, life style, cardiovascular risk factors and expectation of the treatment. Expected treatment benefit was used as outcome measurement. RESULTS: A medical history of coronary heart disease did not affect treatment expectations. Patients with a high risk of cardiovascular disease reported a slightly lower expectation of the treatment effect at a 10-year perspective (p<0.01) but not at shorter time perspectives. Low satisfaction with the explanation of the purpose of the treatment and a poor perceived control of own health was associated with a more negative view on treatment benefit. CONCLUSION: The rationale applied by physicians prescribing statins does not seem to relate to the patients' expectations, whereas factors relating to the patient-physician relationship, the social situation and the perceived control of health seem to affect patient belief. PRACTICE IMPLICATIONS: The association between patients' poor satisfaction of treatment explanation and a low belief in treatment benefits emphasizes the importance of the patient-physician communication. It is suggested that clinical tools are developed in order to identify patients with poor belief in treatment benefit since tailored education for this group might reduce the risk of non-compliance and subsequently reduce the risk of coronary heart disease.     

Relation of familial patterns of coronary heart disease,stroke, and diabetes to subclinical atherosclerosis: the multi-ethnic study of atherosclerosis

PurposeTo investigate the possibility that family history beyond early-onset coronary heart disease might contribute to coronary heart disease susceptibility, we studied associations between additional family history and the coronary artery calcium score.MethodsAssociations between coronary artery calcium score and self-reports of coronary heart disease, stroke, and diabetes in first-degree relatives of 5264 nondiabetic subjects were assessed using logistic and linear regression adjusting for risk factors; adjusted mean coronary artery calcium score estimates were determined by pooling results.ResultsFamily history of coronary heart disease alone and in combination with diabetes and/or stroke was significantly associated with a positive coronary artery calcium score compared with no family history with odds ratios ranging from 1.7 (95% CI: 1.3–2.3) to 1.9 (95% CI: 1.6–2.3) and adjusted mean coronary artery calcium score estimates ranging from 137 (95% CI: 101–173) to 184 (95% CI: 143–226). Associations between family history of coronary heart disease and coronary artery calcium score were significant regardless of age at onset, sex, lineage, or number of relatives with coronary heart disease. The association between family history of diabetes only and coronary artery calcium score was also significant (OR, 1.3; 95% CI: 1.1–1.7) with an adjusted mean coronary artery calcium score estimate of 122 (95% CI: 93–151). Generally, family history of stroke had nonsignificant associations with coronary artery calcium score.ConclusionsNumerous family history variables in addition to early-onset coronary heart disease are associated with subclinical atherosclerosis. Our results have implications for improving coronary heart disease risk assessment.     

Comparison of risk factors for coronary heart disease among attenders and non-attenders at a screening programme.

Few objective comparative data are available from primary care on the prevalence of risk factors for coronary heart disease among those who do and do not attend screening programmes. This study set out to examine differences in risk factors between attenders and non-attenders at such a coronary heart disease screening programme. The 2402 patients in the age range 25-55 years who attended the original health check were examined by a practice nurse, and a questionnaire about health issues was completed. A one in 10 systematic sample of the 1398 patients who did not attend the original screening programme were approached and after considerable effort 98 were persuaded to attend for the same examination and questionnaire analysis. The 98 non-attenders were found to be older and to have a higher mean body mass index, mean cholesterol level, mean systolic blood pressure and mean diastolic blood pressure than the 2402 attenders. The non-attenders were more likely to be in the lower social classes, to have a personal or family history of coronary heart disease and to smoke than attenders. They were less likely to be highly educated and to have an unacceptably high level of alcohol consumption. The results of this study suggest that clinics that invite patients to attend are likely to attract those with lower risk factor profiles. For coronary heart disease prevention to be effective there is a need to cater for patients opportunistically.     

Coronary-prone behavior in the Netherlands: A cross-cultural validation study

As part of the Kaunas-Rotterdam Intervention Study (KRIS), the Jenkins Activity Survey (JAS), designed to measure the coronary-prone behavior pattern type A, was administered to 2712 males who participated in a health intervention program. A JAS score was computed by a maximum-likelihood method for item analysis and test scoring using the structured interview as the criterion. The Dutch adaptation classified 73% of the subjects correctly. Those who were treated at the moment of screening for one or more cardiovascular risk factors and those who suffered from angina pectoris had higher mean JAS scores that those without concurrent cardiovascular complaints. Those results provide some evidence that the type A coronary-prone behavior pattern, as measured by the JAS, is linked to coronary heart disease outside the United States.     

Take it to heart: a national health screening and education project in African-American communities. A joint project of the NMA and Bayer Corporation

"Take It to Heart" is a community health screening and education project jointly sponsored by the National Medical Association (NMA) and Bayer Corporation, Pharmaceutical Division. The project was designed to increase awareness of the prevalence of hypertension and the risks of coronary heart disease in the African-American community. Free health testing for hypertension and cholesterol was provided in six communities. Participants received an individualized coronary risk assessment outlining key risk areas, followed by consultation with an NMA physician. A total of 1651 individuals between the ages of 18 and 82 participated in the health screenings. Ninety-five percent of those tested were African American. In a preliminary health history, 76% reported insufficient exercise, 23% reported a history of high blood pressure, and 19% had a positive family history of early cardiovascular disease. Screening test results revealed 40% of participants had a blood pressure > 140/90 mmHg, 52% had a cholesterol level > 200 mg, and 42% had a body mass index > 27. Based on these results, more than 76% were calculated to have a moderate to high coronary risk profile. Hypertension and cardiovascular disease are major public health problems associated with an increased incidence of death in the African-American community. The Take It to Heart Project is an important mechanism of providing health information to the public and encouraging those at highest risk to take steps to improve their health status.     

Low risk of coronary heart disease in female type II diabetic subjects with diabetic relatives

Possible risk factors for cardiovascular disease were studied in 52 type II diabetic subjects, 19 with and 33 without a history of coronary heart disease (CHD). None of the recognized risk factors, such as hypertension, hyperlipidaemia, smoking and blood glucose imbalance, could be related to CHD. However, all female patients with CHD were lacking a family history of diabetes, while seven of nine female diabetic subjects without a history of CHD had diabetes in the family (p less than 0.02). This was confirmed in a second study of 150 type II diabetic subjects; CHD was more common among female patients without compared to those with diabetes in the family; 9/38 and 1/28, respectively (p less than 0.03). Diabetes increases the risk of CHD, and it does so for women more than it does for men. The finding of a possible low CHD risk in female diabetic subjects with diabetes in the family supports the hypothesis of genetic factors being important for the pathogenesis of cardiovascular disease in diabetes mellitus.     

The prevention of coronary heart disease in general practice

Four hundred and eighty-one (75 per cent) of the male patients between 35 and 55 years of age in a health centre group practice were screened for risk factors for coronary heart disease. An attempt was made to alter these factors and the effectiveness of the intervention was later assessed. We consider that where there is an attached health visitor a screening programme can be carried out as part of general practice without too great an increase in work-load for the general practitioner. The continued surveillance of those at risk and the alteration of the risk factors is more arduous. We think the assistance of the other health care professionals such as the area health education officer and dietician is essential in such a programme.     

Introducing genetic testing for cardiovascular disease in primary care: a qualitative study

Background

While primary care systematically offers conventional cardiovascular risk assessment, genetic tests for coronary heart disease (CHD) are increasingly commercially available to patients. It is unclear how individuals may respond to these new sources of risk information.

Aim

To explore how patients who have had a recent conventional cardiovascular risk assessment, perceive additional information from genetic testing for CHD.

Design and setting

Qualitative interview study in 12 practices in Nottinghamshire from both urban and rural settings.

Method

Interviews were conducted with 29 adults, who consented to genetic testing after having had a conventional cardiovascular risk assessment.

Results

Individuals’ principal motivation for genetic testing was their family history of CHD and a desire to convey the results to their children. After testing, however, there was limited recall of genetic test results and scepticism about the value of informing their children. Participants dealt with conflicting findings from the genetic test, family history, and conventional assessment by either focusing on genetic risk or environmental lifestyle factors. In some participants, genetic test results appeared to reinforce healthy behaviour but others were falsely reassured, despite having an ‘above-average’ conventional cardiovascular risk score.

Conclusion

Although genetic testing was acceptable, participants were unclear how to interpret genetic risk results. To facilitate healthy behaviour, health professionals should explore patients’ understanding of genetic test results in light of their family history and conventional risk assessment.     

General practice screening clinic for Bangladeshi families.

AIM. A screening clinic for Bangladeshi families was established in order to improve the health care provided by one general practice to its Bangladeshi patients. METHOD. The clinic was run by a general practitioner, a health visitor and a Bangladeshi health worker. Patients were invited to attend household by household. The composition of each household was recorded using a genogram. Details of family illness, housing and employment were noted. A medical history was taken from each individual. Every adult was screened for diabetes and risk factors for coronary heart disease; cervical cytology was offered to women. The immunization status of all patients was recorded and adults were immunized. Children were referred to the child health clinic for immunizations. The clinic concluded with a health education session focusing on smoking, exercise and diet. RESULTS. Over a two year period, 58% of the Bangladeshi families registered with the practice attended the clinic, a total of 207 people. Meeting Bangladeshi patients household by household was an effective and apparently efficient way of providing basic screening and health education. It allowed the practice to learn about the structure of its Bangladeshi families, the social problems faced by their community, and the areas in which their health care could be improved. CONCLUSION. This clinic provides a model which could be adapted for use with other ethnic or 'hard-to-reach' groups. It may also prove an effective way of screening all families in general practice.     

Missed opportunities for coronary heart disease diagnoses: primary care experience

Aim

To investigate missed opportunities to reveal existing but not formerly diagnosed coronary heart disease cases and related risk factors in primary health care.

Methods

The study comprised 850 people aged over 30 years with no known history of coronary heart disease, receiving health services from a primary care center located in a suburban area of Antalya, Turkey. Data on their age, gender, education level, health insurance status, income, smoking behavior, and physical activities were collected. Undiagnosed coronary heart disease patients were determined by the Rose questionnaire, physical examination, and electrocardiogram. Height and weight, blood pressure, serum glucose and cholesterol levels were measured, and body-mass index and waist-hip ratio calculated. Each patient was given a risk score regarding age, smoking behavior, systolic blood pressure, and cholesterol levels. Estimated risk ratio of each person for developing coronary heart disease in the next decade was determined.

Results

The number of formerly undiagnosed coronary heart disease cases was 126 (14.8%). Overall mean (±standard deviation) risk score for developing coronary heart disease in the next decade in study group was 6.1 ± 6.8. Diseases facilitating development of coronary heart disease: hypertension, diabetes, and hypercholesterolemia were present in 255 (30.4%), 70 (8.2%), and 364 (43.4%) participants, respectively. Obesity was detected in 315 (37.1%) subjects and there were 222 (26.1%) current smokers. For patients who attended primary health care, the estimated percentage risk for developing coronary heart disease in the next ten years was 7 to 45% in men and 2 to 45% in women.

Conclusion

Opportunities to reveal coronary heart disease and its risk factors are being missed in primary care. Measures should be taken to ensure timely diagnosis of coronary heart disease and related risk factors.Although the etiology and pathophysiology of cardiovascular diseases are well known today, and more effective tools are available to prevent these diseases, they are still the cause of one third of deaths (1,2). About 32 million people develop heart attacks and strokes every year (3). Opportunistic screening is a term which is used to describe the alertness of health care providers to seek for the symptoms and signs of some major disorders such as coronary heart disease, hypertension, hypercholesterolemia, cervical carcinoma, and breast cancer in all patients, regardless of what the main problem is (4). Any health risk can be isolated easily and cost-effectively by this approach in individuals applying for health services for any reason (5). Such an approach provides primary and secondary prevention in patients with pre-existing coronary heart disease (5,6). Neglected opportunistic approach is called “missed opportunity” (7).Primary Health Care Services in Turkey are organized on the basis of the Law of “Socialization of Health Services,” legislated in 1961. Primary care services are free and provided by the state. The core institution of primary health care is health center in which the staff from different occupation groups such as the physician, dentist, nurse, midwife, health technician, and administrator works as a team. These centers deliver health care services to 10 000 to 40 000 people, depending on location in urban or rural areas. These services include preventing and treating communicable diseases and control of chronic diseases in addition to preventive measures such as immunization, family planning, mother and child care, public health education, environmental health, and health improvement (7).Turkish people use primary health care institutions at least 2.6 times a year, and the majority of them can find a solution for their health problems in primary care settings without the need to apply for secondary health services (8). This means that the possibility of identifying coronary heart disease and its risk factors is high in primary care if an opportunistic approach is adopted. However, management of coronary heart disease in Turkey is mainly under the responsibility of cardiologists and internists who work in hospitals. There is no reference to coronary heart disease in “Diagnosis and Treatment Guidelines for Primary Health Care” published by Turkish Ministry of Health in 2002 (9) and in “Non-communicable Disease Control Program” initiated in 2002 (10). People with coronary heart disease-related complaints are generally admitted to hospitals or specialists directly, without any barrier in primary care. This causes a lack of interest in coronary heart disease among primary health care providers. We hypothesized that a considerable amount of opportunities to reveal undiagnosed coronary heart disease cases and related risk factors in primary care could be missed. The purpose of this study was to investigate missed opportunities to determine undiagnosed coronary heart disease cases and related risk factors in primary health care.     

Family history and perceptions about risk and prevention for chronic diseases in primary care: A report from the Family Healthware™ Impact Trial

PurposeTo determine whether family medical history as a risk factor for six common diseases is related to patients' perceptions of risk, worry, and control over getting these diseases.MethodsWe used data from the cluster-randomized, controlled Family Healthware™ Impact Trial (FHITr). At baseline, healthy primary care patients reported their perceptions about coronary heart disease, stroke, diabetes, and breast, ovarian, and colon cancers. Immediately afterward, intervention group participants used Family Healthware™ to record family medical history; this web-based tool stratified familial disease risks. Multivariate and multilevel regression analyses measured the association between familial risk and patient perceptions for each disease, controlling for personal health and demographics.ResultsFor the 2330 participants who used Family Healthware™ immediately after providing baseline data, perceived risk and worry for each disease were strongly associated with family history risk, adjusting for personal risk factors. The magnitude of the effect of family history on perceived risk ranged from 0.35 standard deviation for ovarian cancer to 1.12 standard deviations for colon cancer. Family history was not related to perceived control over developing diseases. Risk perceptions seemed optimistically biased, with 48–79% of participants with increased familial risk for diseases reporting that they were at average risk or below.ConclusionsParticipants' ratings of their risk for developing common diseases, before feedback on familial risk, parallels but is often lower than their calculated risk based on family history. Having a family history of a disease increases its salience and does not change one's perceived ability to prevent the disease.     

A randomized trial to evaluate the effectiveness of dietary advice by practice nurses in lowering diet-related coronary heart disease risk.

BACKGROUND: Dietary factors are an important contribution to the high rates of coronary heart disease in the UK. One approach to achieving change is health-promoting advice in primary care. AIM: To compare the effectiveness of structured dietary advice by practice nurses with standard health education in changing serum cholesterol, weight and diet. METHOD: Randomized, controlled trial within eight general practices in England and Wales allocated within matched geographical pairs to 'dietary advice' or 'usual care'. Men and women aged 35-59 years, recruited opportunistically by their GPs, underwent health checks. In 'dietary advice' practices, subjects received dietary advice from specially trained nurses based on negotiated change principles, reinforced at follow up. In 'usual care' practices, subjects were only given standard health education materials. RESULTS: A total of 956 patients were recruited: 473 in 'dietary advice' practices and 483 in 'usual care' practices. Compliance with annual follow up was 80%. Compared with 'usual care' practices, there was a mean 0.20 mmol/l lower serum cholesterol (95% CI -0.38 to -0.03 at 1 year) in 'dietary advice' practices. There was a small fall in weight of 0.56 kg (95% CI -1.04 to -0.07) and reductions in total and saturated fat. Factor VII coagulant activity fell by a mean of 6.7% of the standard (95% CI -15.4 to +2.0). CONCLUSION: Provision of standard health education material alone as part of a health check had no effect on coronary heart disease risk factors. There were modest changes in diet and associated risk factors when a more intensive and individual approach to dietary advice was given by practice nurses. This is, however, probably an ineffective use of resources, except in those at high risk of coronary heart disease. Whole-population strategies to achieve dietary change are required.     

Randomized controlled trial on the long-term efficacy of a multifaceted, interdisciplinary lifestyle intervention in reducing cardiovascular risk and improving lifestyle in patients at risk of cardiovascular disease

The objective of the study was to evaluate the efficacy of an interdisciplinary intervention known as Educoeur in reducing cardiovascular risk and improving health behaviors in people without evidence of cardiovascular disease and to compare the Educoeur program to interventions in a specialized clinic and in usual care family practice. In a parallel, randomized, controlled trial of 185 adults with at least two modifiable cardiovascular risk factors, patients were randomly assigned to either Educoeur, specialized clinic or usual care. Cardiovascular risk, biological and lifestyle measures were assessed at baseline and at 2 years. In Educoeur, measurements were also taken before and after the lifestyle group treatment program. In 12 weeks, patients in Educoeur significantly lowered their cardiovascular risk, weight, body mass index, waist circumference, systolic blood pressure, kilocalories intake and improved their VO₂ Max and mental health. Changes remained significant at 2 years. Between group comparisons at 2 years demonstrated that Educoeur was significantly better in reducing cardiovascular risk than interventions in usual care. Together, these results highlight the importance of providing interdisciplinary programs that optimize cardiovascular risk reduction and promote active lifestyles in patients at risk of cardiovascular disease.     

Anger and coronary calcification in individuals with and without risk factors of coronary artery disease

The authors investigated the relationship between anger and the calcification of the coronary artery in individuals with and without risk factors for coronary artery disease in Korea. Sixty-one subjects with risk factors of coronary artery disease and 31 subjects without risk factors were enrolled in this study. Electron Beam Computed Tomography was used to measure the calcium level of coronary artery. The anger expression scale was used to measure the anger levels. The anxiety, depression, hostility, and somatization subscales of the symptom checklist-90-revised (SCL-90-R) and the global assessment of recent stress (GARS) scale were used to assess the psychopathology and perceived stress. The logistic regression analysis results showed that only the anger-total score was significantly associated with the coronary calcification regardless of the risk factors. These results suggest that anger plays an important role in the calcification of the coronary artery.     

Why does genetic causal information alter perceived treatment effectiveness? An analogue study

Objectives. When a health problem is perceived as having a genetic cause, this appears to increase the perceived effectiveness of pharmacological treatments and reduce perceived effectiveness of non‐pharmacological treatments. Potential mediators of this effect include causal attributions, perceived severity, and perceived control over the health problem. This study aimed to use experimental methods to establish which beliefs mediate the effect of genetic causal information on perceived effectiveness of treatments. Design. A 4(cause: environmental, family history, genetic test, family history & genetic test)×2(severity: higher or low) between‐subjects design using vignettes about heart disease risk, obesity or depression. Methods. A total of 647 adults, randomly assigned to read one of the experimental vignettes, were interviewed. Key outcomes were perceived effectiveness of medication and of non‐pharmacological treatments. Potential mediators of perceived severity, perceived controllability, and causal attributions were also assessed. Results. For heart disease risk, genetic causes reduced perceived effectiveness of non‐pharmacological treatments (an effect mediated by causal attributions and perceived control) but did not influence perceived medication effectiveness. For obesity, neither severity nor cause influenced the perceived effectiveness of either treatment. For depression, genetic causes only increased perceived effectiveness of medication for more severe depression, an effect mediated by perceived control. Conclusions. The impact of genetic causal information on perceived effectiveness of treatments varies with type of health problem. When genetic causal information influences perceived treatment effectiveness, it does so by altering causal attributions and perceived controllability. However, these effects are small and unlikely to translate into clinically meaningful differences in health‐enhancing behaviours.     

Mortality over a period of 10 years in patients with peripheral arterial disease.

BACKGROUND. Previous investigators have observed a doubling of the mortality rate among patients with intermittent claudication, and we have reported a fourfold increase in the overall mortality rate among subjects with large-vessel peripheral arterial disease, as diagnosed by noninvasive testing. In this study, we investigated the association of large-vessel peripheral arterial disease with rates of mortality from all cardiovascular diseases and from coronary heart disease. METHODS. We examined 565 men and women (average age, 66 years) for the presence of large-vessel peripheral arterial disease by means of two noninvasive techniques--measurement of segmental blood pressure and determination of flow velocity by Doppler ultrasound. We identified 67 subjects with the disease (11.9 percent), whom we followed prospectively for 10 years. RESULTS. Twenty-one of the 34 men (61.8 percent) and 11 of the 33 women (33.3 percent) with large-vessel peripheral arterial disease died during follow-up, as compared with 31 of the 183 men (16.9 percent) and 26 of the 225 women (11.6 percent) without evidence of peripheral arterial disease. After multivariate adjustment for age, sex, and other risk factors for cardiovascular disease, the relative risk of dying among subjects with large-vessel peripheral arterial disease as compared with those with no evidence of such disease was 3.1 (95 percent confidence interval, 1.9 to 4.9) for deaths from all causes, 5.9 (95 percent confidence interval, 3.0 to 11.4) for all deaths from cardiovascular disease, and 6.6 (95 percent confidence interval, 2.9 to 14.9) for deaths from coronary heart disease. The relative risk of death from causes other than cardiovascular disease was not significantly increased among the subjects with large-vessel peripheral arterial disease. After the exclusion of subjects who had a history of cardiovascular disease at base line, the relative risks among those with large-vessel peripheral arterial disease remained significantly elevated. Additional analyses revealed a 15-fold increase in rates of mortality due to cardiovascular disease and coronary heart disease among subjects with large-vessel peripheral arterial disease that was both severe and symptomatic. CONCLUSIONS. Patients with large-vessel peripheral arterial disease have a high risk of death from cardiovascular causes.     

冠心病患者血清中hs-CRP、APN和BNP的表达及意义研究

目的 研究超敏C反应蛋白(hs-CRP)、脂联素(APN)和脑尿钠肽(BNP)在冠心病患者中的表达水平及临床价值.方法 选择我院2014年1月至2016年9月心血管内科收治的154例冠心病患者(观察组)及105例同期健康体检人群(对照组)作为研究对象.检测观察组和对照组受试对象血清中hs-CRP、APN和BNP的表达水平,通过Logistic回归分析冠心病发病的危险因素并运用ROC曲线分析hs-CRP、APN、BNP及联合检测在冠心病中的诊断效能.结果 ①观察组患者血清中hs-CRP、BNP表达高于对照组,血清APN表达低于对照组,差异均具有统计学意义(P＜0.05).②冠心病患者GRACE评分与hs-CRP、BNP呈正相关,与APN呈负相关.③Logistic回归分析得出,hs-CRP、BNP和APN均与冠心病发病有关.④联合检测在冠心病中的诊断效能明显高于hs-CRP、APN和BNP.结论 冠心病患者血清hs-CRP、BNP高表达,APN低表达,其与冠心病严重程度相关,可辅助诊断冠心病.     

Family history of cardiovascular disease is associated with cardiovascular responses to stress in healthy young men and women.

Heightened cardiovascular stress responsivity is associated with cardiovascular disease, but the origins of heightened responsivity are unclear. The present study investigated whether disturbances in cardiovascular responsivity were evident in individuals with a family history of cardiovascular disease risk. Data were collected from 60 women and 31 men with an average age of 21.4 years. Family history of cardiovascular disease risk was defined by the presence of coronary heart disease, hypertension, diabetes or high cholesterol in participants' parents and grandparents; 75 participants had positive, and 16 had negative family histories. Systolic and diastolic blood pressure (BP), heart rate and heart rate variability were measured continuously for 5 min periods at baseline, during two mental stress tasks (Stroop and speech task) and at 10-15 min, 25-30 min and 40-45 min post-stress. Individuals with a positive family history exhibited significantly greater diastolic BP reactivity and poorer systolic and diastolic BP recovery from the stressors in comparison with family history negative individuals. In addition, female participants with a positive family history had heightened heart rate and heart rate variability reactivity to stressors. These effects were independent of baseline cardiovascular activity, body mass index, waist to hip ratio and smoking status. Family history of hypertension alone was not associated with stress responsivity. The findings indicate that a family history of cardiovascular disease risk influences stress responsivity which may in turn contribute to risk of future cardiovascular disorders.     

Family history and perceived vulnerability to some common diseases: a study of young people and their parents.

During the last two decades, health promotion has concentrated on lifestyle factors. However, recent research in genetics has shown that inherited susceptibility may be important in many common conditions. This raises questions about how these two different messages are integrated into people's beliefs about their own susceptibility. We report a study based on interviews with 58 young people, who had all recently completed the National Curriculum science course including basic human genetics, and 54 of their parents. We aimed to examine the extent to which people take account of family history when considering their susceptibility to health risks, with comparisons being made between generations, gender, and between different diseases. Family health histories were compared between generations and the relationship between reported family history and perceived vulnerability was examined. Family health history was seen as more relevant for a perceived vulnerability to heart disease and diabetes than cancer, while actions and behaviour were seen as important in determining the chance of developing heart disease and cancer but less so for diabetes. Chance was seen as an important factor in the risk of cancer and diabetes, but was barely mentioned in connection with heart disease. Nearly half of those who reported affected family members with heart disease or cancer did not perceive this to have any effect on their own susceptibility. Notably, women were much more likely than men to see the presence or absence of affected relatives as being relevant to the chances of developing cancer. Differences were found between generations in the reporting of the family tree and in knowledge of health of family members. Although words such as genes, chromosomes, and DNA were used by both generations there was no evidence of any understanding of the process of inheritance in scientific terms.