Regional variation in ischemic heart disease incidence.

This study examines the relationship between cardiovascular risk factors and regional variation in IHD incidence among white males 55-74 years of age from the NHANES I Epidemiologic Followup Study. The age-adjusted IHD incidence rate was lowest in the west (31.3 per 1000 persons years of followup). The rates in the northeast, midwest, and south were similar and so they were combined into one region, the non-west, with a rate of 42.4. Differences in risk factors (smoking, educational level, hypertension, serum cholesterol, diabetes mellitus, and body mass index) did not explain the regional differences in IHD incidence. After adjusting for baseline risk factors using proportional hazards model, the risk of IHD incidence was still 38% higher in the non-west compared to the west. However, the effect of hypertension, diabetes, and body mass index on IHD incidence varied by region.     

Epidemiology of chronic rheumatic disease of heart among teenagers in the Republic of Dagestan

The morbidity of rheumatic heart diseases (RHD) was studied, for the purpose of designing a set of measures to prevent them, among the teenagers in the Republic of Dagestan. The studies were based on the medical aid appealability, hospitalization data and clinical-and-epidemiological research made, with respect to climatic-and-geographic zones, in 3 rural areas and in the city of Makhachkala. A total of 1142 teenagers were questioned; laboratory-instrumental examinations were made for 234 teenagers. According to the data analysis, RHD and acute rheumatic fever (ARF) have been recently on the rise in the Republic, where the average morbidity figures are 4.5-fold higher versus those registered in whole Russia. The morbidity rate of RHD went up 1.8-fold, and that of ARF--1.5-fold, in Dagestan during 2000-2002. According to clinical-and-epidemiological examinations, RHD prevail among rural youth residing primarily in plains and, to a less extent, in highlands. Finally, measures are suggested, on the basis of research, for the prevention of RHD among youth.     

Gender and ischemic heart disease

Physiological and pathological processes differ in men and women, depending on factors such as sex and sociological and anthropological characteristics. However, many diseases are still approached from a masculine point of view. In this respect, ischemic heart disease is one of the diseases that most clearly reflects biological differences and social inequalities. In women, the disease presents at a more advanced age, and presentation is frequently atypical with a higher prevalence of comorbidities and greater severity. Consequently, treatment and outcome differ from those in men. Additionally, women differ in their knowledge, and beliefs regarding ischemic heart disease, as well as in their attitudes at symptom onset. Therefore, clinical practice should place significant emphasis on all these aspects in order to avoid inequalities between men and women in the correct diagnosis, treatment, prevention, and rehabilitation of ischemic heart disease.     

Welding and ischemic heart disease

Metal welding and cutting are associated with inhalation of gases and respirable particles. The purpose of this study was to compare the mortality of male welders with that of all gainfully employed men in Sweden regarding ischemic heart disease (IHD). Male welders and gas cutters were identified in the Swedish National Censuses of 1970 and 1990. Two cohorts were established and followed until the end of 1995. The IHD mortality among the welders was compared with that of all gainfully employed men. An increased mortality due to IHD was observed among welders identified in the 1990 Census, SMR = 1.35, 95% confidence limits 1.1-1.6. The observed increased mortality due to IHD was unlikely to be explained by different smoking habits. A general hypothesis linking inhalation of particles to the occurrence of IHD via an inflammatory process is discussed.     

Application of the Minnesota Code in evaluating electrocardiographic features of ischemic heart disease in patients exposed to carbon disulphide

Summary We examined 81 men exposed for a long time to carbon disulphide (CS₂) and tested the possible electrocardiographic (ECG) changes of ischemic heart disease (I.H.D.). The subjects were examined twice in two years. In order to make the ECG evaluation more objective, the Minnesota Code was applied. Two obligatory ECG examinations and only one submaximal effort test were carried out. For comparative evaluation, the control group was examined once. We proved that, in spite of the accepted opinion concerning the atheromatous action of CS₂, this compound does not cause ECG symptoms of I.H.D. in a higher percentage of exposed persons. It also does not cause any significant increase in I.H.D. symptoms in dynamic ECG observations.     

Cell therapy for ischemic heart disease

Despite advances in pharmacological therapies, cardiovascular surgery, use of mechanical assist devices, and organ transplantation, more than 50% of the patients with clinically evident heart failure die within 5 years of the initial diagnosis. The use of cellular therapy offers a promising approach for both the prevention and treatment of heart failure. This review will discuss the current state of this emerging field and the prospects to introduce the method into clinical practice. Since functional restoration of the damaged heart presents a formidable challenge, developing strategies for the prevention of postinfarct heart failure remains of utmost priority. Recent research has provided evidence that several cell lines including adult or embryonic stem cells, skeletal myoblasts, fetal cardiomyocytes or fibroblasts may be useful in strategies that aim to both prevent and treat heart failure through establishment of new blood vessels supplying surviving heart muscle cells and replacement of damaged heart muscle cells themselves. It is therefore reasonable to anticipate that new strategies will be developed to optimize cell delivery, homing and survival in the failing myocardium improving myocardial recovery after acute or chronic deterioration.     

Helicobacter pylori and ischemic heart disease

In the last years, a considerable number of studies have been performed on the relationship between infection from Helicobacter Pylori and atherosclerotic diseases, like stroke and ischemic heart disease. In particular, some infections could have a role on the genesis and development of damage to the vascular wall and of atheromatous plaque. It has been suggested that HP could influence the development of IHD through different pathways, such as endothelial cells colonization, changes in the lipid profiles, increased coagulation and platelet aggregation levels, induction of molecular mimicry mechanisms and the promotion of a low-grade systemic inflammation. Based on this hypothesis, it has been performed a considerable number of studies in order to investigate the role of HP in the development and pathogenesis of CAD. Most of this trials gave conflicting results, some denying the presence of a possible relationship between HP infection and increased risk of CAD. Despite of that, results from these studies have raised new interesting perspectives on coronary heart disease, especially regarding the possibility of modifying the clinical history of the disease through eradication of these microorganisms. The results are contradictory and require further investigation.     

Applying the acute ischemic heart disease predictive instrument

A predictive instrument (or index) previously reported to be of value in reducing unnecessary coronary care unit admissions was tested in a randomized study. Acceptability to the physician was then measured by monitoring utilization in a subsequent nonrandomized phase and by debriefing. The predictive instrument retained predictive accuracy in the new setting with good correlation between predicted and actual risk of acute cardiac ischemia (r = 0.925). False-positive diagnosis rate decreased from 71 percent to 0.0 percent (P = .0096) in a subgroup admitted to the intermediate care unit, consistent with previously reported usefulness in low-risk patients. Acceptability was poor, however, with utilization rate of only 2.8 percent of eligible patients. Debriefing revealed low perceived usefulness. This problem will need to be addressed if widespread utilization is to occur. The criteria of predictive accuracy, usefulness, and acceptability are suggested as a standard panel for testing new predictive instruments.     

Family history of ischemic heart disease with respect to mean twin-pair cholesterol and subsequent ischemic heart disease in the NHLBI twin study

This study examines the independent and interactive effects of family history scores (FHxS) for the prevalence of ischemic heart disease with plasma lipids and subsequent morbidity and mortality from ischemic heart disease. FHxS were calculated for 514 sets of middle aged male twins who participated in the entry examination of the NHLBI Veteran twin study in 1969-1973. Comparison of the FHxS with the level of plasma total cholesterol and HDL cholesterol (HDLc) paralleled earlier reported findings in young adults; individuals with high total cholesterol in two exams 8-12 years apart had significantly (P less than .01) higher FHxS. The same relationship was noted when using the mean twin-pair cholesterol level at the initial exam when the twins were in their 40s. Using the pair means over two exams as the cotwins aged into their 50s, the association of FHxS with total cholesterol declined and pairs with HDLc persistently in the highest quintile at both exams had significantly (P less than .01) lower FHxS. The changes in the pattern of association of lipid fractions with FHxS with age parallel the reported age decline of total cholesterol as a risk factor for heart disease. Assessment of ischemic heart disease events up to January 1988 revealed a highly significant association (P less than .0001) of later ischemic heart disease events with FHxS. At each level of lipid categorization pairs who later had events had higher FHxS than those without any subsequent heart disease; these differences were significant in all but the low risk lipid groups (low total cholesterol, high HDLc, and low total cholesterol/HDLc ratio). We conclude that FHxS is related to total cholesterol and HDLc but also is an independent predictor of subsequent ischemic heart disease after 14-18 years of follow-up.     

Regional differences in mortality from ischemic heart disease

The geographical distribution of mortality from ischaemic heart disease in the Netherlands has changed dramatically since 1950. In 1950-1954 mortality was highest in high-income, urbanized areas, in 1980-1984 the reverse was true. This development resembles the one observed in the United States of America. The changes in geographical distribution cannot be attributed to differences in cause-of-death certification. The change in the association with income and the association between mortality and a number of ischaemic heart disease risk factors found in 1970-1974, suggest that at least part of the explanation is a change in the geographical distribution of risk factors.