Favorable cardiovascular risk profile in middle age and health-related quality of life in older age

BACKGROUND: Life expectancy is greater for people with favorable midlife cardiovascular risk profiles (ie, low risk). However, some speculate that increased longevity may lead to large numbers of ill, disabled, older persons with lower quality of life. Few data exist on this important issue. This study evaluates the relationship of midlife low-risk status to quality of life and illness in older age. METHODS: Cohort of middle-aged adults from the Chicago Heart Association Detection Project in Industry (2692 women and 3650 men; baseline ages, 36-64 years [average age, 73.2 years in 1996]) without baseline (1967-1973) major electrocardiographic abnormalities or history of diabetes or myocardial infarction. Quality of life (12-item Health Status Questionnaire [HSQ-12] on physical, mental, and social well-being) and self-reported diseases were assessed after 26 years of follow-up. Baseline risk strata included low risk (favorable blood pressure and serum cholesterol levels, no smoking, and no minor electrocardiographic abnormalities); 0 risk factors (ie, no high risk factors but >or=1 risk factors not at favorable levels); or any 1, any 2, or 3 or more of the following 4 risk factors: high blood pressure, high serum cholesterol level, smoking, and minor electrocardiographic abnormalities. The HSQ-12 scores and disease outcomes for low risk were compared with other strata. RESULTS: Adjusted scores for physical, mental, social functioning, and disease-free outcomes were highest for low-risk individuals and decreased significantly with number of risk factors (eg, 58% of low-risk women had excellent/very good health compared with 28% of women with >or=3 risk factors). CONCLUSIONS: Favorable cardiovascular risk profile in middle age is associated with better quality of life and lower risk of diseases in older age. Moreover, the fewer the risk factors, the higher the quality of life.     

Lipid profile and lipoprotein (a) as a risk factor for cardiovascular disease in women with subclinical hypothyroidism

This study evaluated changes of lipids and lipoprotein (a) [Lp (a)] as atherosclerotic risk factors and the effects of levothyroxine (LT4) treatment on these parameters in patient with subclinical hypothyroidism (SH), defined by increased concentrations of thyrotropin (TSH) and normal thyroid hormone concentrations. We prospectively included 35 female patients with SH and 30 healthy controls. Serum lipid measurements and clinical score as well as fT3, fT4, and TSH levels were assessed at baseline. Body mass index (BMI) was also calculated. Women with proven SH received LT4 treatment that continued for 6 months. Twenty-six of 35 patients completed the study. At the end of treatment period, the same parameters were determined. Total cholesterol was significantly increased in patients with SH when compared with those of controls (p < 0.01), but increase of LDL-cholesterol (LDL-C) and Lp (a) were not significant (p > 0.05). In the levothyroxine-treated group, total cholesterol and LDL-C were significantly reduced when compared with the baseline values of women with SH (p < 0.05). Zulewski clinical score assessing symptoms and signs of hypothyroidism improved significantly with treatment (p < 0.001). In conclusion, serum lipids as important atherosclerotic risk factors increased before treatment and decreased with treatment. Levothyroxine therapy is effective in SH and improvements in serum lipids suggests that LT4 treatment also decreases the risk of atherosclerotic diseases.     

Hemostatic system as a risk factor for cardiovascular disease in women with subclinical hypothyroidism.

Hypothyroidism has been associated with atherosclerosis. The mechanisms of atherosclerosis in patients with thyroid failure remain controversial. Hypofibrinolysis might be a risk factor for thromboembolic disease in subclinical hypothyroidism (SH). We measured fibrinolytic activity in patients with SH before and after levothyroxine (LT(4)) treatment and compared it to those of controls. We prospectively included 35 patients with SH and 30 healthy controls. We treated patients with LT(4) until almost 6 months after the euthyroid state has been achieved. We measured fibrinogen, D-dimer, antithrombin III (ATIII), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA) activity, and factor VII. Clinical and anthropometric variables were recorded for both groups. We found increased levels of fibrinogen, PAI-1, and factor VII and decreased levels of ATIII activity in patients compared to control (p < 0.001 and p < 0.05). Decrease of tPA was not significant (p > 0.05). At the end of the LT(4) treatment, significant decreases were determined in PAI-1 and factor VII (p < 0.05). In conclusion, our data suggest an important role of hypofibrinolytic and hypercoagulable state on the development of atherosclerosis in patients with SH and beneficial effects of LT(4 )treatment for decreasing the risk of atherosclerosis.     

Effect of square aerobic exercise on cardiovascular risk factors and health-related quality of life in Chinese women with type 2 diabetes

The study aimed to determine whether square aerobic exercise (SAE), the most popular group-based activity in China, is effective in improving cardiovascular risk factors and quality of life in Chinese women with type 2 diabetes (T2D). In total, 60 women with T2D (50–65 years) were randomly and equally divided into an SAE group and a control group treated with usual care. The body weight, glucose metabolism, and lipid metabolism at both 3 and 6 months were compared between groups. The Short-Form Health Survey Questionnaire (SF-36) was completed at the start and end of the study. No participant in the two groups was shed. During the 6-month follow-up, the body mass index, glucose metabolic indexes (except 2-h postprandial insulin), low-density lipoprotein cholesterol, and scores of SF-36 domains (except pain and vitality) in the SAE group were significantly improved from baseline. The body weight, SF-36 scores, or glucose and lipid metabolism were not significantly improved in the control group. SAE is associated with improved cardiovascular risk factors and quality of life in Chinese T2D women. The participants also adhered well to exercise. Therefore, SAE can be recommended as a daily fitness program for T2D patients.     

Parity and the risk of autoimmune thyroid disease: a community-based study

CONTEXT: Recent studies have suggested that fetal microchimerism (transplacental passage of fetal cells followed by engraftment into maternal tissues) may play a role in the pathogenesis of autoimmune thyroid disease. If that is true, then parity should be a risk factor for autoimmune thyroid disease. OBJECTIVE: The objective of this study was to examine parity as a risk factor for autoimmune thyroid disease. Design, SETTING, AND PARTICIPANTS: TSH, thyroid peroxidase antibody, and thyroglobulin antibody concentrations were measured on archived sera from 1045 female participants in a 1981 community health survey in Busselton, Western Australia. OUTCOME MEASURES: Odds ratios (ORs) for positive thyroid antibodies (increased concentration of either antibody) or thyroid dysfunction (abnormal serum TSH) were used. RESULTS: After adjustment for age, women who had previously been pregnant did not have a significantly increased risk of positive thyroid antibodies [OR, 1.20; 95% confidence interval (CI), 0.74-1.97; P = 0.46], raised TSH (OR, 0.93; 95% CI, 0.46-1.87; P = 0.84), or reduced TSH (OR, 0.87; 95% CI, 0.33-2.30; P = 0.79) compared with women who had never been pregnant. For each additional pregnancy, the OR was 1.02 (95% CI, 0.94-1.11; P = 0.57) for positive antibodies, 1.02 (95% CI, 0.91-1.14; P = 0.67) for raised TSH, and 1.03 (95% CI, 0.87-1.22; P = 0.73) for reduced TSH. Analysis using number of live births gave similar results. The results were similar in younger and older women. CONCLUSIONS: Parity is not a risk factor for thyroid autoimmunity or thyroid dysfunction. These data do not support a key pathogenic role for fetal microchimerism in chronic autoimmune thyroid disease.     

Impaired quality of life as a risk factor in cardiovascular disease

Traditionally, quality of life has been considered a major outcome variable in the study of patients with chronic disease or handicap. In this paper, impaired quality of life is analyzed as a risk, that is, a condition influencing early manifestation of cardiovascular disease. Specific social contexts as well as a psychological coping style (need for control) that generates sustained emotional distress are defined, and data from two socio-epidemiological studies are presented. The first is a retrospective case-control study of 380 men with a first myocardial infarction. The second is a prospective study of 416 middle-aged blue-collar workers followed over 3 years. Findings show that indicators of impaired quality of life are related to high levels of cardiovascular risk factors and high prevalence of overt cardiovascular disease. Practical implications point to the importance of a socio-behavioral approach in cardiovascular prevention.     

Plasma viscosity, an early cardiovascular risk factor in women with subclinical hypothyroidism

OBJECTIVE: It is controversial, if subclinical hypothyroidism increases cardiovascular risk. Plasma viscosity is a hemorheological parameter, which is accepted as an early cardiovascular risk factor. We investigated the alterations in plasma viscosity in women with subclinical hypothyroidism. DESIGN: 40 female patients with subclinical hypothyroidism and 31 age- and weight-matched healthy women were included. Free thyroxine (FT4), thyroid stimulating hormone (TSH), lipid parameters, fibrinogen, C-reactive protein (CRP) levels, hematocrit and plasma viscosity were measured in all subjects. MAIN OUTCOME: Plasma viscosity, total cholesterol and low density lipoprotein were significantly increased and high density lipoprotein was significantly decreased in patients with subclinical hypothyroidism. No significant correlation was found among the parameters. CONCLUSION: Increased plasma viscosity in patients' group suggests that cardiovascular risk might be increased in patients with subclinical hypothyroidism. As far as we could reach, this is the first study concerning plasma viscosity in subclinical hypothyroidism.     

Impact of duration in a cardiac rehabilitation program on coronary risk profile and health-related quality of life outcomes

BACKGROUND: Optimal cardiac rehabilitation (CR) program length and the time course of changes in relevant outcomes are unknown. The purpose of this study was to assess changes in coronary risk factors and health-related quality of life (HRQoL) after 3 months and 6 months of cardiac rehabilitation. METHODS: This is an observational study of a cohort of 126 consecutive cardiac rehabilitation patients who completed baseline, 3-month, and 6-month evaluations of coronary risk factors and HRQoL. The coronary risk factors included lipid profile, blood pressure, body mass index (BMI), and physical activity level. HRQoL was assessed using the Short Form-36 questionnaire (SF-36) comprising eight health concepts and two component scales (physical [PCS] and mental [MCS]). RESULTS: There was significant improvement in all coronary risk factors and HRQoL measures, except BMI, over the 6-month period (P < 0.001). Significant changes in blood pressure, physical activity, PCS, and high-density lipoprotein cholesterol (HDL-C) were apparent at 3 months, and no additional significant changes in these variables occurred between 3 and 6 months. For total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and MCS, significant change was achieved between 3 and 6 months but not between baseline and 3 months. CONCLUSIONS: Secondary prevention and HRQoL outcomes improved at variable rates. Physical activity and physical function peaked at 3 months and were maintained at program completion. Significant improvements occurred in mental health recovery beyond the traditional 12-week CR program length. Outcomes furthest from normative values showed the most rapid improvement. Optimal duration of participation may vary according to the outcome of interest.     

Factors that impact health-related quality of life in adults with celiac disease： A multicenter study

AIM： TO evaluate the factors involved in the impairment of health-related quality of life （HRQOL） in patients with celiac disease. METHODS： A multicenter, cross-sectional prospective study was performed in patients with celiac disease who completed two HRQOL questionnaires： the gastrointestinal quality of life index （GIQLI） and the EuroQol-5D （EQ）. RESULTS： Three hundred and forty patients （163 controlled with a gluten-free diet, and 177 newly diagnosed with a normal diet） were included. The GIQLI score was significantly better in patients on a gluten- free diet （GFD） than in non-treated patients on their usual diet, both in terms of the overall score （3.3 vs 2.7, respectively; P 〈 0.001）, as well as on the individual questionnaire dimensions. Both the preference value of the EQ as the visual analogue scale were significantly better in treated than in non-treated patients （0.93 vs 0.72 P 〈 0.001 and 80 vs 70 P 〈 0.001, respectively）. Variables significantly associated with a worse HRQOL score were female gender, failure to adhere to a GFD, and symptomatic status. CONCLUSION： In untreated celiac disease, the most important factors that influence patient perception ofhealth are the presence of symptoms and a normal diet. HRQOL improves to levels similar to those described in the general population in celiac disease patients well controlled with a GFD.     

Risk factors for cardiovascular disease in women with subclinical hypothyroidism.

Overt hypothyroidism may result in accelerated atherosclerosis and coronary heart disease (CHD) presumably because of the associated hypertension, hypercholesterolemia, and hyperhomocysteinemia. As many as 10%-15% of older women have subclinical hypothyroidism (SH) and thyroid autoimmunity. Whether SH is associated with risk for CHD is controversial. We examined 57 women with SH and 34 healthy controls. SH was defined as an elevated thyrotropin (TSH) (>4.5 mU/L) and normal free thyroxine (FT(4)) level (8.7-22.6 nmol/L). None of the patients had been previously treated with thyroxine. In all participants we determined blood pressure, body mass index (BMI), and fasting TSH, FT(4), antibodies to thyroid peroxidase and thyroglobulin, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, folic acid, vitamin B(12), creatinine, and total plasma homocysteine levels. The SH and control groups did not differ in their total homocysteine values. Mean diastolic blood pressure was increased in SH patients versus controls (82 vs. 75 mm Hg; p < 0.01). Mean values of TC, HDL-C, LDL-C, triglycerides, TC/HDL-C, and LDL-C/HDL-C were not different in patients with SH compared with controls. Individual analysis revealed that the percentage of patients with SH having hypertension (20%), hypertriglyceridemia (26.9%), elevated TC/HDL-C (11.5%), and LDL-C/HDL-C (4%) ratios were higher than the percentages in controls. Hyperhomocysteinemia (> or = 10.98 micromol/L) was observed in 29.4% of SH and was not significantly different from the percentage in controls (21.4%). No significant correlation between TSH and biochemical parameters was detected. We conclude that subclinical hypothyroidism in middle-aged women is associated with hypertension, hypertriglyceridemia, and elevated TC/HDL-C ratio. This may increase the risk of accelerated atherosclerosis and premature coronary artery disease in some patients.     

Functional disability in France and its relationship with health-related quality of life - a population-based prevalence study

OBJECTIVE: To estimate the prevalence of functional disability in France and assess its association with the health-related quality of life (HRQoL). METHODS: Each member in 8,000 households randomly selected in the Lorraine population were mailed a questionnaire asking about their sociodemographic characteristics; the presence of chronic locomotor or non-rheumatic diseases; functional disability on the Health Assessment Questionnaire (HAQ); and HRQoL on the Duke Health Profile. The prevalence of functional disability was described, and its relationship with HRQoL was assessed by logistic regression analysis. RESULTS: Among the 6,148 subjects who responded (mean age 46 years +/- 18.3, 48% men), the prevalence of moderate (HAQ >or= 1) and severe (HAQ >or= 2) functional disability, adjusted for age and sex, was 6.5% and 1.6% respectively. HRQoL was significantly low in all dimensions for subjects with severe functional disability. Functional disability of locomotor origin significantly affected the physical (OR = 10.6 [5.1-22.1]), mental (OR = 4.4 [2.5-7.8]), and social (OR = 2.4 [1.4-4.3]) dimensions, with a threshold effect according to the disability level and perceived health (OR= 10.6 [5.8-19.4]), with a cause-effect relationship. CONCLUSION: The prevalence of reported (i.e., not observed) functional disability in terms of its impact on HRQoL helps physicians to better understand its differential consequences, which should ease patient dependence, facilitate the analysis of health care needs and the development of prevention measures, and improve the HRQoL of patients and their families.     

江苏社区人群亚临床甲状腺功能异常和血压关系的研究

通过对6044名江苏社区人群横断面流行病学调查发现,亚临床甲状腺功能异常(亚临床甲状腺功能亢进症/亚临床甲状腺功能减退症)与血压的升高无明显相关性.     

江苏社区人群亚临床甲状腺功能异常和血压关系的研究

通过对6044名江苏社区人群横断面流行病学调查发现,亚临床甲状腺功能异常(亚临床甲状腺功能亢进症/亚临床甲状腺功能减退症)与血压的升高无明显相关性.     

江苏社区人群亚临床甲状腺功能异常和血压关系的研究

通过对6044名江苏社区人群横断面流行病学调查发现,亚临床甲状腺功能异常(亚临床甲状腺功能亢进症/亚临床甲状腺功能减退症)与血压的升高无明显相关性.     

江苏社区人群亚临床甲状腺功能异常和血压关系的研究

通过对6044名江苏社区人群横断面流行病学调查发现,亚临床甲状腺功能异常(亚临床甲状腺功能亢进症/亚临床甲状腺功能减退症)与血压的升高无明显相关性.     

江苏社区人群亚临床甲状腺功能异常和血压关系的研究

通过对6044名江苏社区人群横断面流行病学调查发现,亚临床甲状腺功能异常(亚临床甲状腺功能亢进症/亚临床甲状腺功能减退症)与血压的升高无明显相关性.     

江苏社区人群亚临床甲状腺功能异常和血压关系的研究

通过对6044名江苏社区人群横断面流行病学调查发现,亚临床甲状腺功能异常(亚临床甲状腺功能亢进症/亚临床甲状腺功能减退症)与血压的升高无明显相关性.     

江苏社区人群亚临床甲状腺功能异常和血压关系的研究

通过对6044名江苏社区人群横断面流行病学调查发现,亚临床甲状腺功能异常(亚临床甲状腺功能亢进症/亚临床甲状腺功能减退症)与血压的升高无明显相关性.     

江苏社区人群亚临床甲状腺功能异常和血压关系的研究

通过对6044名江苏社区人群横断面流行病学调查发现,亚临床甲状腺功能异常(亚临床甲状腺功能亢进症/亚临床甲状腺功能减退症)与血压的升高无明显相关性.