Lipid changes on hormone therapy and coronary heart disease events in the Heart and Estrogen/progestin Replacement Study (HERS)

Background

Despite the effect of lowering low-density lipoprotein cholesterol (LDL-C) levels and raising high-density lipoprotein cholesterol (HDL-C) levels, combination hormone therapy did not reduce the incidence of coronary heart disease (CHD) events in the Heart and Estrogen/progestin Replacement Study (HERS). To explore possible mechanisms, we examined the association between lipid changes and CHD outcomes among women assigned to hormone therapy.

Methods

HERS participants were postmenopausal women with previously diagnosed CHD who were randomly assigned to receive conjugated estrogens and medroxyprogesterone or identical placebo and then followed-up for an average of 4.1 years. Among women assigned to hormone therapy, associations between baseline-to-year-1 lipid level changes and CHD events were compared with the associations observed for baseline lipids using multivariate proportional hazards models.

Results

Among women assigned to hormone therapy, CHD events were independently predicted by baseline LDL-C levels (relative hazard [RH] 0.94 per 15.6 mg/dL decrease, 95% CI 0.88-1.01) and HDL-C levels (RH 0.89 per 5.4 mg/dL increase, 95% CI 0.81-0.99), but not by triglyceride levels (RH 1.01 per 13.2mg/dL increase, 95% CI 0.97-1.06). CHD events were marginally associated with first-year reductions in LDL-C levels (RH 0.95 per 15.6mg/dL decrease, 95% CI 0.86-1.04), and were not associated with increases in HDL-C levels ( RH 1.03 per 5.4 mg/dL increase, 95% CI 0.91-1.16) or triglyceride levels (RH 1.01 per 13.2 mg/dL increase, 95% CI 0.98-1.05).

Conclusion

Changes in lipid levels with hormone therapy are not predictive of CHD outcomes in women with heart disease in the HERS trial.     

Smoking, alcohol consumption, and Raynaud's phenomenon in middle age

Background

Data suggest Raynaud’s phenomenon shares risk factors with cardiovascular disease. Studies of smoking, alcohol consumption, and Raynaud’s have produced conflicting results and were limited by small sample size and failure to adjust for confounders. Our objective was to determine whether smoking and alcohol are independently associated with Raynaud’s in a large, community-based cohort.

Methods

By using a validated survey to classify Raynaud’s in the Framingham Heart Study Offspring Cohort, we performed sex-specific analyses of Raynaud’s status by smoking and alcohol consumption in 1840 women and 1602 men. Multivariable logistic regression analyses were used to examine the relationship of Raynaud’s to smoking and alcohol consumption.

Results

Current smoking was not associated with Raynaud’s in women but was associated with increased risk in men (adjusted odds ratio [OR] 2.59, 95% confidence interval [CI], 1.11-6.04). Heavy alcohol consumption in women was associated with increased risk of Raynaud’s (adjusted OR 1.69, 95% CI, 1.02-2.82), whereas moderate alcohol consumption in men was associated with reduced risk (adjusted OR 0.51, 95% CI, 0.29-0.89). In both genders, red wine consumption was associated with a reduced risk of Raynaud’s (adjusted OR 0.59, 95% CI, 0.36-0.96 in women and adjusted OR 0.30, 95% CI, 0.15-0.62 in men).

Conclusions

Our data suggest that middle-aged women and men may have distinct physiologic mechanisms underlying their Raynaud’s, and thus sex-specific therapeutic approaches may be appropriate. Our data also support the possibility that moderate red wine consumption may protect against Raynaud’s.     

Trends in leisure time physical activity practice in the 1995-2005 period in Girona

Introduction and objectives

The aims of the study were: to describe the distribution of physical activity practice; to determine the prevalence and trends of sedentary lifestyle in the population aged 35 to 74 years of Girona in the 1995-2005 period; and to identify the variables associated to sedentary lifestyle at the population level.

Methods

Data from three independent population-based cross-sectional studies undertaken in 1995 (n=1419), 2000 (n=2499), and 2005 (n=5628) were analyzed. Physical activity was measured using the Minnesota Leisure Time Physical Activity questionnaire. Sedentary lifestyle was defined as an energy expenditure in moderate physical activity (4-5.5 METs) <675 kcal/week or <420 kcal/week in intense PA (≥6 METs). Logistic regression was used to determine the variables associated with sedentary lifestyle.

Results

The age-standardized prevalence of sedentary lifestyle was 53.8%, 39.5%, and 32.6% in 1995, 2000, and 2005 respectively. The prevalence of sedentary lifestyle has decreased especially in women older than 50 years living in the urban areas. An increase in light and moderate physical activity practice in men older than 50 years and in light physical activity practice in women older than 50 years was observed. Female gender, age, smoking and lower educational level were associated with a higher prevalence of sedentary lifestyle.

Conclusions

Prevalence of sedentary lifestyle has decreased in the 1995-2005 period in Girona, especially in women, but is still high. Health promotion programs should include physical activity practice as a key element and should take into account gender and social inequalities.Full English text available from: www.revespcardiol.org     

Risk determination of dyslipidemia in populations characterized by low levels of high-density lipoprotein cholesterol

Background

Current guidelines for managing dyslipidemia qualify patients for treatment based on low-density lipoprotein cholesterol (LDL-C) levels and other risk factors for coronary heart disease (CHD). However, when LDL-C is the sole lipid criterion for initiating therapy, patients with levels below the treatment initiation threshold who are at high risk because of low levels (<40 mg/dL) of high-density lipoprotein cholesterol (HDL-C) might not be identified. Twenty percent of male patients with CHD in the United States fall into this category. The total cholesterol/HDL-C (TC/HDL-C) ratio predicts CHD risk regardless of the absolute LDL-C and HDL-C.

Methods

We compared guidelines based on TC/HDL-C and LDL-C with those recommended by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). Both sets of guidelines were applied to 9837 adults (>20 years of age) in the Turkish Heart Study, which has shown that 75% of men and 50% of women in Turkey have HDL-C <40 mg/dL.

Results

ATP III guidelines identified 14% of Turkish adults, 20 years or older, as candidates for lifestyle treatment only and an additional 18% for drug treatment. In conjunction with ATP III LDL-C thresholds, the TC/HDL-C ratio (>3.5, patients with CHD; ≥6.0, 2+ risk factors, ≥7.0, 0 to 1 risk factor) assigned lifestyle therapy alone to 18% and drug treatment to an additional 36%. Among primary prevention subjects at high risk because of age (men ≥45 years; women ≥55 years), both sets of guidelines prescribed lifestyle therapy for only 5%; however, drug treatment was recommended for an additional 13% by ATP III guidelines and an additional 18% by TC/HDL-C and LDL-C.

Conclusions

In populations at risk for CHD caused by low HDL-C, qualification of subjects for treatment based on either the TC/HDL-C ratio or LDL-C thresholds identifies more high-risk subjects for treatment than LDL-C threshold values alone, and use of the ratio, instead of risk tables, simplifies the approach for physicians.     

Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women

Background

Cigarette smoking has been associated with rheumatoid arthritis (RA), but the importance of smoking intensity, duration, and time since quitting, and whether the risk is primarily for rheumatoid factor (RF) seropositive versus seronegative RA are still unclear.

Methods

We conducted a prospective analysis of smoking and the risk of RA among 103,818 women in the Nurses’ Health Study. A total of 680 RA cases, diagnosed from 1976 and 2002, were confirmed using a questionnaire and medical record review. Sixty percent were RF positive. Cox proportional hazards models calculated the relative risks (RRs) of RA with smoking, adjusting for reproductive and lifestyle factors.

Results

The RR of RA was significantly elevated among current (RR 1.43 [95% confidence interval 1.16-1.75]) and past smokers (RR 1.47 [95% confidence interval 1.23-1.76]), compared with never smokers. The risk of RA was significantly elevated with 10 pack-years or more of smoking and increased linearly with increasing pack-years (P trend <.01). A greater number of daily cigarettes and longer duration of smoking were associated with increased risk. The effect of smoking was much stronger among RF-positive cases than among RF-negative cases. The risk remained elevated in past smokers until 20 years or more after cessation.

Conclusions

In this large cohort, past and current cigarette smoking were related to the development of RA, in particular seropositive RA. Both smoking intensity and duration were directly related to risk, with prolonged increased risk after cessation.     

Effect on high-density lipoprotein cholesterol of maximum dose simvastatin and atorvastatin in patients with hypercholesterolemia: results of the Comparative HDL Efficacy and Safety Study (CHESS)

Background

Previous studies have shown that effects on high-density lipoprotein cholesterol (HDL-C) may differ among statins.

Methods

A multicenter, randomized, double-blind, parallel-dose study was conducted in 917 hypercholesterolemic patients to compare the efficacy of 80 mg/d simvastatin versus 80 mg/d atorvastatin on HDL-C and apolipoprotein (apo) A-I for 24 weeks. Efficacy was assessed as the means of weeks 6 and 12 and weeks 18 and 24. Prespecified subgroups analyzed were patients with low HDL-C levels and with the metabolic syndrome.

Results

Simvastatin increased HDL-C and apo A-I values significantly more than did atorvastatin for the mean of weeks 6 and 12 (8.9% vs 3.6% and 4.9% vs −0.9%, respectively) and the mean of weeks 18 and 24 (8.3% vs 4.2% and 3.7% vs −1.4%). These differences were observed across both baseline HDL-C subgroups (<40 mg/dL, ≥40 mg/dL) and in patients with the metabolic syndrome. Low-density lipoprotein cholesterol and triglyceride reductions were greater with atorvastatin. Consecutive elevations >3× the upper limit of normal in alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) occurred in significantly fewer patients treated with simvastatin than with atorvastatin (2/453 [0.4%] vs 13/464 [2.8%]), with most elevations observed in women taking atorvastatin (11/209 [5.3%] vs 1/199 [0.5%] for simvastatin).

Conclusions

Simvastatin (80 mg) increased HDL-C and apo A-I significantly more than did atorvastatin (80 mg) in patients with hypercholesterolemia. This advantage was observed regardless of HDL-C level at baseline or the presence of the metabolic syndrome. Significantly fewer consecutive elevations >3× the upper limit of normal in ALT and/or AST occurred in patients receiving simvastatin.     

Adherence to Healthy Lifestyle Habits in US Adults, 1988-2006

Background

Lifestyle choices are associated with cardiovascular disease and mortality. The purpose of this study was to compare adherence to healthy lifestyle habits in adults between 1988 and 2006.

Methods

Analysis of adherence to 5 healthy lifestyle trends (≥5 fruits and vegetables/day, regular exercise >12 times/month, maintaining healthy weight [body mass index 18.5-29.9 kg/m²], moderate alcohol consumption [up to 1 drink/day for women, 2/day for men] and not smoking) in the National Health and Nutrition Examination Survey 1988-1994 were compared with results from the National Health and Nutrition Examination Survey 2001-2006 among adults aged 40-74 years.

Results

Over the last 18 years, the percent of adults aged 40-74 years with a body mass index ≥30 kg/m² has increased from 28% to 36% (P <.05); physical activity 12 times a month or more has decreased from 53% to 43% (P <.05); smoking rates have not changed (26.9% to 26.1%); eating 5 or more fruits and vegetables a day has decreased from 42% to 26% (P <.05), and moderate alcohol use has increased from 40% to 51% (P <.05). Adherence to all 5 healthy habits has gone from 15% to 8% (P <.05). Although adherence to a healthy lifestyle was lower among minorities, adherence decreased more among non-Hispanic Whites over the period. Individuals with a history of hypertension/diabetes/cardiovascular disease were no more likely to be adherent to a healthy lifestyle than people without these conditions.

Conclusions

Generally, adherence to a healthy lifestyle pattern has decreased during the last 18 years, with decreases documented in 3 of 5 healthy lifestyle habits. These findings have broad implications for the future risk of cardiovascular disease in adults.     

Lifetime risk for developing dyslipidemia: the Framingham Offspring Study

Background

High serum low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL) cholesterol are major vascular risk factors. National surveys indicate that 40% of individuals in the United States have borderline-high LDL cholesterol, and 13-34% have low HDL. The lifetime risk of developing dyslipidemia is unknown, however.

Methods

We estimated the 10- to 30-year long-term risks of developing “borderline-high” LDL cholesterol (≥130 mg/dL [3.4 mmol/L]), “high” LDL cholesterol (≥160 mg/dL [4.1 mmol/L]) and “low” HDL cholesterol (<40 mg/dL [1.0 mmol/L]) in 4701 Framingham Offspring Study participants (53% women) who attended at least 2 examinations between 1971 and 2000. We performed sex-specific analyses (for age groups 30-34, 40-44, 50-54 years), and estimated risks conditional on surviving without the lipid abnormality up to the baseline age. We also estimated risks accounting for baseline prevalence of dyslipidemia (elevated LDL, low HDL).

Results

Over a 30-year period, approximately 6 of 10 participants developed borderline-high LDL, 4 of 10 people developed high LDL, and 2 (women) to 4 (men) of 10 individuals developed low HDL levels; estimates were generally similar for different age groups. Adjustment for baseline prevalence of dyslipidemia increased these estimates: 30-year risks exceeded 80% for borderline-high LDL, 50% for high LDL, and 25% (women) to 65% (men) for low HDL; 20-50% had or developed a low HDL along with a high LDL level. The 30-year estimates approximate the lifetime risk in 50-year-olds.

Conclusions

The long term risks of developing dyslipidemia are substantial in both sexes, and considerably exceed prevalence estimates from cross-sectional surveys.     

Cardiovascular risk factors in Spain in the first decade of the 21st Century, a pooled analysis with individual data from 11 population-based studies: the DARIOS study

Introduction and objectives

To estimate the prevalence of cardiovascular risk factors in individuals aged 35-74 years in 10 of Spain's autonomous communities and determine the geographic variation of cardiovascular risk factors distribution.

Methods

Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. The average response rate was 73%. Lipid profile (with laboratory cross-validation), glucose level, blood pressure, waist circumference, height, and weight were measured and standard questionnaires administered. Age-standardized prevalence of smoking, diabetes, hypertension, dyslipidemia, and obesity in the European population were calculated. Furthermore, the coefficient of variation between component studies was determined for the prevalence of each risk factor.

Results

In total, 28,887 participants were included. The most prevalent cardiovascular risk factors were high blood pressure (47% in men, 39% in women), total cholesterol ≥250 mg/dL (43% and 40%, respectively), obesity (29% and 29%, respectively), tobacco use (33% and 21%, respectively), and diabetes (16% and 11%, respectively). Total cholesterol ≥190 and ≥250 mg/dL were the respective minimum and maximum coefficients of variation (7%-24% in men, 7%-26% in women). Average concordance in lipid measurements between laboratories was excellent.

Conclusions

Prevalence of high blood pressure, dyslipidemia, obesity, tobacco use and diabetes is high. Little variation was observed between autonomous communities in the population aged 35-74 years. However, presence of the most prevalent cardiovascular risk factors in the Canary Islands, Extremadura and Andalusia was greater than the mean of the 11 studies.Full English text available from: www.revespcardiol.org     

New York Heart Association Functional class influences the impact of diabetes on cardiac autonomic function

Background

Diabetes (D) and heart failure (HF) are associated with abnormal heart rate variability (HRV). It is unclear whether the HRV effect of having both is cumulative.

Methods

Pretreatment HRV (traditional, nonlinear, and heart rate [HR] turbulence) in 80 D versus 74 non-D (ND) systolic HF patients was compared by New York Heart Association II versus III among patients entered into an HF drug evaluation study.

Results

Age-adjusted HR was lower in class II D versus class III and most HRV including HR turbulence was better in class II ND versus all others, with few differences between class II D and class III ND and D patients.

Conclusion

The effect of D and HF on autonomic function may be cumulative in class II, but D may have little additional effect on most HRV in class III patients. The prognostic value of different HRV measures in D versus ND HF patients should be further investigated.     

Perceived vs Actual Knowledge and Risk of Heart Disease in Women: Findings From a Canadian Survey on Heart Health Awareness,Attitudes, and Lifestyle

Background

Heart disease is a leading cause of morbidity and mortality in men and women. Our understanding of heart disease stems chiefly from clinical trials on men, but key features of the disease differ in women. This article reports findings from the first Canadian national survey of women that focuses on knowledge, perceptions, and lifestyle related to heart health.

Methods

A cross-country survey using an adaptation of an instrument used in the United States was undertaken in spring of 2013. Based on online (208) and telephone (1446) responses from a randomly selected sample of women aged 25 or older, a total sample of 1654 weighted percentage estimates were produced. The overall response rate was 12.5%.

Results

Just under half of women were able to name smoking as a risk factor of heart disease, and less than one quarter named hypertension or high cholesterol. Fewer than half of women knew the major symptoms of heart disease. Most women prefer to receive information on heart health from their doctor, but only slightly more than half report that their doctor includes discussion of prevention and lifestyle during clinical consultations.

Conclusions

Most women lack knowledge of heart disease symptoms and risk factors, and significant proportions are unaware of their own risk status. The findings underscore the opportunity for patient education and intervention regarding risk and prevention of heart disease.     

Relationship of Ethnic Origin, Gender, and Age to Blood Creatine Kinase Levels

Background

Creatine kinase is expressed at high levels in muscle, where it plays a central role in energy metabolism. Highly elevated creatine kinase levels in blood may indicate muscle trauma or disease. However, it is known that baseline creatine kinase levels are higher in African Americans than in whites and that they are higher in men than in women. This analysis explores the relationship of ethnic origin, gender, and age to baseline blood creatine kinase levels in a large group of adults with hypercholesterolemia.

Methods

Data from the screening phases of 4 North American trials of statins, which included large numbers of specific racial/ethnic populations, were combined for analysis. The pooled population (N = 11,346) included 2760 African Americans, 3301 whites, 2930 Hispanics, and 2355 South Asians.

Results

Creatine kinase levels varied according to ethnic origin, gender, and age. African American participants had higher median creatine kinase levels than did individuals of the 3 other ethnicities. Within each ethnic group, men had higher median creatine kinase levels than women: African Americans, 135 versus 73 U/L; whites, 64 versus 42 U/L; Hispanics, 69 versus 48 U/L; and South Asians, 74 versus 50 U/L. An age-dependent decrease in creatine kinase levels was noted among men, but no such trend was seen among women. The median creatine kinase levels for younger African American men exceeded the standard upper limit of normal.

Conclusion

Physicians should use caution when interpreting creatine kinase levels that seem elevated, particularly when treating African American patients and younger men.     

Prediction of missed myocardial infarction among symptomatic outpatients without coronary heart disease

Background

Missed diagnoses of acute myocardial infarction (AMI) in the ambulatory setting can cause patient suffering and malpractice litigation. Multiple algorithms have been developed to detect the presence of coronary heart disease (CHD) or acute coronary ischemia.

Methods

We performed a case-control study of patients with no prior history of CHD presenting to outpatient practices with potential cardiac ischemia. Malpractice claims files were used to identify 18 cases of patients with missed AMIs. For each case, we identified 3 control patients who had office visits for chest pain during the same month and assessed the association of 4 different prediction tools with missed AMI.

Results

The 18 cases of missed AMI had a 39% 1-month mortality rate. Cases were more likely than controls to be men (67% vs 26%, P = .001), to be smokers (88% vs 39%, P < .001), and to have low HDL cholesterol (39 mg/dL vs 59 mg/dL, P < .001) and elevated total cholesterol (236 mg/dL vs 213 mg/dL, P = .01). A Framingham risk score predicting a 10-year risk of CHD ≥10% and a positive score using the Goldman risk predictor were associated with an increased risk of missed AMI (odds ratio 5.7, 95% CI 1.8-18.4 for Framingham risk score; odds ratio 7.2, 95% CI 1.4-36.8 for Goldman risk predictor).

Conclusions

Among ambulatory patients with possible cardiac ischemia and no prior CHD, multiple algorithms may be useful for improvement of risk stratification.     

Low triglycerides-high high-density lipoprotein cholesterol and risk of ischemic heart disease

BACKGROUND: A high triglyceride (TG)--low high-density lipoprotein cholesterol (HDL-C) level (TG > or =1.60 mmol/L [> or =142 mg/dL] and HDL-C < or =1.18 mmol/L [< or =46 mg/dL]) is associated with a high risk of ischemic heart disease (IHD), whereas a low TG--high HDL-C level (TG < or =1.09 [< or =97 mg/dL] and HDL-C > or =1.48 mmol/L [> or =57 mg/dL]) is associated with a low risk. Conventional risk factors tend to coexist with high TG--low HDL-C levels. We tested the hypothesis that subjects with conventional risk factors would still have a low risk of IHD if they had low TG--high HDL-C levels. METHODS: Observational cohort study of 2906 men aged 53 to 74 years free of IHD at baseline. RESULTS: During 8 years, 229 subjects developed IHD. Stratified by conventional risk factors-low-density lipoprotein cholesterol level (< or =4.40 mmol/L or >4.40 mmol/L [< or =170 mg/dL or >170 mg/dL] [median value]), hypertensive status (blood pressure >150/100 mm Hg or taking medication), level of physical activity (>4 h/wk or < or =4 h/wk), and smoking status (nonsmokers vs smokers)-the incidence in men with high TG--low HDL-C levels was 9.8% to 12.2% in the low-risk and 12.2% to 16.4% in the high-risk strata; the corresponding values in men with low TG--high HDL-C concentrations were 4.0% to 5.1% and 3.7% to 5.3%, respectively. Based on an estimate of attributable risk, 35% of IHD might have been prevented if all subjects had had low TG--high HDL-C levels. CONCLUSION: Men with conventional risk factors for IHD have a low risk of IHD if they have low TG--high HDL-C levels.     

Determinants of serum HDL-C level in a Tehran urban population: the Tehran Lipid and Glucose Study

BACKGROUND AND AIM: Decreased serum high-density lipoprotein cholesterol (HDL-C) is one of the most common lipid disorders in patients with coronary artery disease (CAD). Existing evidence suggests that every 1 mg/dL decrease in serum HDL-C increases the risk of CAD by 2-3%. This study was performed in the year 2000 to study HDL-C determinants in a Tehran population. METHODS AND RESULTS: We studied 9514 subjects (3942 men and 5572 women) aged 20-69 years, who participated in the Tehran Lipid and Glucose Study (TLGS), completed a personal history questionnaire (especially concerning physical activity and cigarette smoking), and underwent a clinical examination including anthropometric and blood pressure measurements. Serum total cholesterol, triglyceride and HDL-C levels were measured, and OGTT was used to define diabetic patients according to WHO criteria. The women had a significantly higher mean HDL-C level than the mean (45 +/- 11 vs 38 +/- 9 mg/dL; p < 0.001); low HDL-C levels (< 35 mg/dL) were observed in 31% of the men and 13% of the women (p < 0.001). Obese subjects (BMI > or = 30 kg/m2) had a significantly lower HDL-C level than the normal subjects (42 +/- 11 vs 44 +/- 11 mg/dL: p < 0.001), and those with truncal obesity (WHR > or = 0.95 in men and > or = 0.8 in women) lower HDL-C levels than the normal subjects (37 +/- 9 vs 39 +/- 10 mg/dL in men and 44 +/- 11 vs 42 +/- 11 mg/dL in women; p < 0.001 for both). Smokers had a significantly lower HDL-C level than non-smokers (38 +/- 10 vs 43 +/- 11 mg/dL; p < 0.001) and a low HDL-C level was twice as common (36.4 vs 18.2%). Passive smokers also had lower HDL-C levels (42 +/- 11 vs 43 +/- 11 mg/dL; p < 0.001). Mean serum HDL-C was significantly lower in hypertriglyceridemic than those with normal triglycerides levels (men: 4 +/- 8 vs 40 +/- 9 mg/dL, p < 0.001; women: 40 +/- 10 vs 47 +/- 11 mg/dL, p < 0.01). Mean HDL-C levels were similar in subjects with different degrees of physical activity, as well as between diabetics and non-diabetics and hypertensive and normotensive subjects. Multiple stepwise regression analysis showed that the determinants of serum HDL-C levels were, in order of entering the model: hypertriglyceridemia (OR 3.4, p < 0.001), male sex (OR 3.1, p < 0.001), cigarette smoking (OR 1.7, p < 0.001), obesity (OR 1.4, p < 0.01), age (OR 0.9, p < 0.05), high WHR (OR 1.2, p < 0.05), and passive smoking (OR 1.1, p < 0.05). Physical activity, hypertension, and diabetes mellitus did not enter the predictive model. CONCLUSION: Apart from age and sex which are constitutional, and unmodifiable variables, the determinants of HDL-C level (hypertriglyceridemia, obesity, truncal obesity, cigarette smoking, and passive smoking) can be used in community CAD prevention programmes.     

Estimating the benefits of patient and physician adherence to cardiovascular prevention guidelines: the MyHealthCheckup Survey

Background

The management of cardiovascular risk factors such as hypertension and dyslipidemia is poorly described in many communities, and the benefits associated with tighter control remain unknown. We used data from the 2007 MyHealthCheckup survey to document the treatment gaps and estimated the potential benefits of better adherence to recommended guidelines.

Methods

Cardiovascular risk factors, lifestyle habits, and prescribed medications were evaluated among Canadian adults recruited primarily in pharmacies. The Cardiovascular Life Expectancy Model was used to estimate the potential benefits of optimally treating hypertension or dyslipidemia (defined as not smoking, regular physical activity, an acceptable body weight, and maximal medication as needed).

Results

Among 2674 screened individuals, 1266 (47%) were receiving pharmacotherapy for either dyslipidemia or hypertension, including 772 (61%) and 656 (63%), respectively, who remained above treatment targets. Among those above lipid or blood pressure targets, 27% and 22%, respectively, were optimally treated. The average increased life expectancy or life-years gained associated with making appropriate lifestyle changes included 2.2 to 4.7 years from smoking cessation, 0.7 to 1.1 years from regular exercise, and 0.4 to 0.7 years from weight reduction. The life-years gained following better risk factor treatment included maximal pharmacotherapy for elevated blood pressure (0.6-0.8), low-density lipoprotein cholesterol (0.5-0.6), and the ratio of total cholesterol to high-density lipoprotein cholesterol (0.3-0.4). Years of life free of cardiovascular disease would be similarly increased.

Conclusions

Better treatment of cardiovascular risk factors could result in a substantial reduction in morbidity and mortality among Canadians. Given current physician prescribing and patient habits, lifestyle modification should be considered a priority before additional medications are prescribed.     

Oral contraceptive use and abnormal glucose regulation in Swedish middle aged women

Aim

To investigate the association between oral contraceptive (OC) use and abnormal glucose regulation in Swedish middle aged women.

Methods

A prospective population-based study including 4794 women, aged 36-56 at baseline. None had previously diagnosed diabetes. At both baseline and follow-up 8 years later, the women were examined by oral glucose tolerance test. Information regarding lifestyle factors and anthropometric measurements were collected.

Results

At baseline, current use of OCs was associated with pre (Odds ratio, OR 4.1, 95%CI 2.2-7.8) but not with type 2 diabetes. The association to prediabetes was entirely linked to IGT (OR 7.1, 3.3-15.8) in current users of OCs and in former users (OR 2.1, 1.1-3.9). Women who used OC at baseline had a better cardiovascular disease risk profile; lower body mass index (BMI), more physically active and less smoking. At follow-up, the increased risk did not persist.

Conclusion

Current use of OC was associated with a four times increased risk of having prediabetes and seven times of having impaired glucose tolerance. No increased risk persisted at the follow-up, suggesting that the risk due to prior use of OC is decreasing with time. The healthier lifestyle in women who used OCs may have contributed to reduced long-term risk of prediabetes.     

Diabetes Prevalence and Therapeutic Target Achievement in the United States, 1999 to 2006

Objective

Changes in the prevalence, treatment, and management of diabetes in the United States from 1999 to 2006 were studied using data from the National Health and Nutrition Examination Survey.

Methods

Data on 17,306 participants aged 20 years or more were analyzed. Glycemic, blood pressure, and cholesterol targets were glycosylated hemoglobin less than 7.0%, blood pressure less than 130/80 mm Hg, and low-density lipoprotein (LDL) cholesterol less than 100 mg/dL, respectively.

Results

The prevalence of diagnosed diabetes was 6.5% from 1999 to 2002 and 7.8% from 2003 to 2006 (P < .05) and increased significantly in women, non-Hispanic whites, and obese people. Although there were no significant changes in the pattern of antidiabetic treatment, the age-adjusted percentage of people with diagnosed diabetes achieving glycemic and LDL targets increased from 43.1% to 57.1% (P < .05) and from 36.1% to 46.5% (P < .05), respectively. Glycosylated hemoglobin decreased from 7.62% to 7.15% during this period (P < .05). The age-adjusted percentage achieving all 3 targets increased insignificantly from 7.0% to 12.2%.

Conclusions

The prevalence of diagnosed diabetes increased significantly from 1999 to 2006. The proportion of people with diagnosed diabetes achieving glycemic and LDL targets also increased. However, there is a need to achieve glycemic, blood pressure, and LDL targets simultaneously.     

Evaluation of Paraoxonase,Malondialdehyde, and Lipoprotein Levels in Patients with Asymptomatic Cholelithiasis

Background/Aim:

To compare lipoprotein and malondialdehyde levels and paraoxonase-1 activity between subjects with asymptomatic cholelithiasis and controls.

Patients and Methods:

Eighty subjects with asymptomatic cholelithiasis (55 women, 25 men, mean age: 51, SD 14 years) and 40 control subjects without cholelithiasis (25 women, 25 men, mean age: 51, SD 12 years) were enrolled to the study. Serum paraoxonase activity, lipoproteins, and malondialdehyde were measured.

Results:

In the cholelithiasis group, serum total cholesterol, low-density lipoprotein cholesterol, and malondialdehyde were significantly higher and high-density lipoprotein cholesterol (HDL-C) and paraoxonase-1 were significantly lower than the controls. In cholelithiasis patients with serum glucose level > 100 mg/dL, body mass index, serum total cholesterol, triglyceride (TG), and malondialdehyde levels were significantly higher than cholelithiasis patients with serum glucose level < 100 mg/dL. Paraoxonase-1 activity was significantly lower in patients with serum glucose level > 100 mg/dL. In cholelithiasis patients with TG > 150 mg/dL, mean age, body mass index, glucose, total cholesterol, and malondialdehyde were significantly higher than in cholelithiasis patients with TG < 150 mg/dL. In cholelithiasis subgroup with TG > 150 mg/dL, HDL-C level and paraoxonase-1 activity were lower than in the cholelithiasis subgroup with TG < 150 mg/dL. All of the above comparisons were statistically significant (P < 0.05).

Conclusions:

Patients with asymptomatic cholelithiasis have evidence of increased lipid peroxidation and decreased antioxidant capacity. Patients with asymptomatic cholelithiasis with components of the metabolic syndrome have more lipid peroxidation and less antioxidant capacity than patients with asymptomatic cholelithiasis but without the components of the metabolic syndrome.     

Lifestyle adjustments of adults with long-term implantable left ventricular assist devices: a phenomenologic inquiry

Objective

To explore and describe the lifestyle adjustments made by adult recipients of a long-term implantable left ventricular assist device (LVAD).

Methods

A phenomenologic inquiry was used to uncover the lifestyle adjustments of 7 men and 2 women, ages 31 to 70 years, who had an LVAD for more than 3 months after hospital discharge.

Results

An overarching theme, “adjustment takes time,” represents the lifestyle adjustments of the study participants. Early adjustment was highlighted by participants’ concerns with physical, psychologic, and environmental aspects, whereas late adjustment was highlighted by behaviors associated with acceptance of the LVAD as an integral component of their bodies and lives.

Conclusion

This study provides insight into the patient’s perspective regarding the challenges faced in living with an LVAD. The findings inform health care providers in the acute and critical care settings in assisting patients to positively adjust with the lifestyle imposed by an LVAD.