Nutritional modulators of lipoprotein metabolism in patients with risk factors for coronary heart disease: diet and moderate exercise trial.

To study the role of diet as a risk factor for coronary heart disease (CHD), 463 adults (25-65 years, 419 males) at risk of or with CHD were assigned to group A (n = 231) receiving a cardiovasoprotective diet or group B (n = 232) receiving a normal diet in a randomized, single-blind fashion. Age, sex, risk factors and incidence of CHD were comparable between the two groups. Group A received a significantly higher percentage of calories in relation to complex carbohydrates, vegetable proteins, polyunsaturated fatty acids, and had a higher polyunsaturated:saturated fatty acid (P:S) ratio compared to control group B, which received more saturated fat and cholesterol. Group A also received more soluble dietary fiber and magnesium (Mg) and was physically more active than group B. Exercise and dietary adherence were tested by a questionnaire. After 12 weeks, results indicated a significant decrease in mean serum total cholesterol (9.0 vs 3.1%), low-density-lipoprotein cholesterol (LDL-C) (9.8 vs 3.8%) and triglyceride (11.1 vs 5.4%), and an increase in serum Mg (8.5%) in the intervention group compared to initial levels. No significant changes in mean levels were noted in the control group. Body weight significantly decreased and physical activity was significantly higher in the intervention group compared to the control group during the 12-week followup on similar intakes of energy. There were insignificant changes in high-density-lipoprotein cholesterol (HDL-C) in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Relation between diet composition and coronary heart disease risk factors.

STUDY OBJECTIVE--The aim was to evaluate dietary intakes and their correlation to some risk factors for coronary heart disease. DESIGN--The study was a population based survey with random sample selection stratified by age and sex. PARTICIPANTS--352 adults living in a small town in Northern Italy took part in the study. Response rate was 46% among females and 48% among males. Refusal to take part was mainly due to the large number of tests involved. MEASUREMENTS AND MAIN RESULTS--Diets were high in protein (animal/vegetable ratio 1.7 in women and 1.4 in men) and in fat and low in carbohydrates. The hypercholesterolaemic and atherogenic potential of the diet, evaluated by the cholesterol/saturated fat index, was high in about 50% of the population. The thiamin and riboflavin intakes were lower than the Italian recommended allowances in more than 60% of the people tested, whereas the vitamin A intake was more than adequate in about 70%. A positive association was found in the younger groups (men and women 20-39 years old) between some nutrient components (energy, alcohol, total and saturated fats) and some blood lipids. In the older people blood lipids were correlated with body mass index. CONCLUSIONS--The overall data indicate that a correlation exists between dietary intake and some risk factors for coronary heart disease; dietary intervention, at least in young adults, is suggested.     

Nutritional risk factors for coronary heart disease in South African medical students

The African population in South Africa is undergoing relatively rapid transition in lifestyle, with increasing proneness to western diseases. At the Medical University of Southern Africa (MEDUNSA), the majority of the African students come from homes where mainly cereal‐based diets are eaten. They are now exposed to ‘western’ foods. To throw light on the subsequent changes, between 1989 and 1993, 383 third year students underwent a practical course on nutritional assessment, which included determinations of anthropometry, 3 days’ estimated dietary intake record, and serum lipid analysis. Results indicated that their dietary risk levels for western diseases were now approaching the high levels prevailing in white populations. While the likelihood of influencing African students to meaningfully conform to a ‘prudent’ diet and lifestyle is remote, every endeavour must be made to fully inform them of the benefits likely to follow.     

Cardiovascular risk factors and mortality in patients with coronary heart disease

A priority in preventive cardiology is to reduce the number of recurrent events and to prolong survival in patients with established coronary heart disease (CHD). Aim of the present study was to examine risk factors for long-term mortality in CHD patients who entered routine secondary prevention after a coronary event or intervention. Such patients, from the EUROASPIRE (EUROpean Action on Secondary Prevention through Intervention to Reduce Events) I and II studies in the region of Münster, Germany, were followed over a mean period of 8.0 years up to the end of 2005. Patients were up to 70 years of age at baseline when they were interviewed and examined using standardised methods. Baseline examination was carried out at least 6 months and at a mean of 19.5 months after the coronary event or procedure. In 367 patients from EUROASPIRE I and 380 patients from EUROASPIRE II, a total of 125 deaths (16.7%) occurred during follow-up. Multivariate analyses, using Cox proportional hazards models, established diabetes mellitus and smoking as predictors for all-cause mortality with estimated hazard rate ratios (HRRs) of 2.24 (95% confidence interval (CI): 1.43-3.49) and 1.95 (95% CI: 1.23-3.10), respectively. Significant associations were found between diabetes mellitus and cardiovascular (HRR 2.36; 95% CI: 1.31-4.24) as well as CHD mortality (HRR 2.40; 95% CI: 1.25-4.59). Systolic blood pressure was significantly associated with increased cerebrovascular disease mortality (HRR 1.04; 95% CI: 1.01 and 1.08 for 1 mmHg increase). In conclusion, long-term mortality in coronary patients from routine secondary prevention is substantial. Diabetes mellitus and smoking represent key issues in patients with established CHD.     

Effects of exercise intensity on physical fitness and risk factors for coronary heart disease

OBJECTIVE: To determine whether "low-intensity" exercise (walking) and "high-intensity" exercise (aerobic dance), when added to a weight loss diet, have different effects on coronary heart disease (CHD) risk factors and physical fitness. RESEARCH METHODS AND PROCEDURES: Ninety obese women were divided into diet only (DO), diet plus walking (DW), and diet plus aerobic dance (DA) groups. DXA was used to evaluate segmental body composition. Leg-extension strength and maximal oxygen uptake (VO2max) were the indicators of physical fitness. Blood pressure, lipoproteins, and fasting glucose were used as indices for CHD risk factors. These items were measured before and after a 14-week intervention period. RESULTS: Whole-body plus all segmental fat masses were significantly reduced (p < 0.001). Reductions in whole-body and lower-limb fat- and bone-free masses were significantly less (p < 0.01) in the DA group (-1.5 and -0.1 kg, respectively) compared with the DO (-2.1 and -0.4 kg, respectively) and DW (-2.5 and -0.5 kg, respectively) groups. Improvements in leg-extension strength and VO2max were significantly greater (p < 0.05) in the DA group compared with the DO group. The CHD risk factors clearly improved (p < 0.05) within each group. Reductions in low density lipoprotein-cholesterol and fasting glucose were significantly greater (p < 0.05) in the DA group compared with the DO and DW groups. DISCUSSION: Adding higher intensity aerobic dance to a weight-loss diet program may help maintain fat- and bone-free mass and may be more effective in improving CHD risk factors compared with low-intensity walking.     

Effect on hematologic risk factors for coronary heart disease of a cholesterol reducing diet

BACKGROUND: A dietary portfolio of cholesterol-lowering ingredients has proved effective in reducing serum cholesterol. However, it is not known whether this dietary combination will also affect hematologic risk factors for coronary heart disease (CHD). Reductions in hematocrit and polymorphonuclear leukocytes have been reported to improve cardiovascular risk. We, therefore, report changes in hematological indices, which have been linked to cardiovascular health, in a 1-year assessment of subjects taking an effective dietary combination (portfolio) of cholesterol-lowering foods. METHODS: For 12 months, 66 hyperlipidemic subjects were prescribed diets high in plant sterols (1.0 g/1000 kcal), soy protein (22.5 g/1000 kcal), viscous fibers (10 g/1000 kcal) and almonds (23 g/1000 kcal). Fifty-five subjects completed the study. RESULTS: Over the 1 year, data on completers indicated small but significant reductions in hemoglobin (-1.5+/-0.6 g/l, P=0.013), hematocrit (-0.007+/-0.002 l/l, P<0.001), red cell number (-0.07+/-0.02 10(9)/l, P<0.001) and neutrophils (-0.34+/-0.13 10(9)/l, P=0.014). Mean platelet volume was also increased (0.16+/-0.07 fl, P=0.033). The increase in red cell osmotic fragility (0.05+/-0.03 g/l, P=0.107) did not reach significance. CONCLUSIONS: These small changes in hematological indices after a cholesterol-lowering diet are in the direction, which would be predicted to reduce CHD risk. Further research is needed to clarify whether the changes observed will contribute directly or indirectly to cardiovascular benefits beyond those expected from reductions previously seen in serum lipids and blood pressure.     

老年冠心病患者医院感染的危险因素分析

目的探讨老年冠心病患者医院感染的危险因素及防治对策,为预防老年冠心病患者医院感染提供科学依据。方法回顾性分析2011年2月-2013年2月464例60⁸5岁的老年冠心病患者临床资料,统计其医院感染率,采用SPSS19.0软件对所有数据进行统计分析。结果 464例老年冠心病患者中有64例发生医院感染,感染率为13.8%;发生呼吸系统感染42例、泌尿系统感染11例、胃肠道感染5例、口腔感染3例、其他部位3例,分别占65.6%、17.2%、7.8%、4.7%、4.7%;感染病原菌以革兰阴性菌为主占55.3%;老年冠心病患者医院感染的发生与患者年龄、住院天数、合并基础疾病、心功能低下、抗菌药物使用以及侵入性操作有关,差异有统计学意义(P<0.05)。结论年龄、住院天数、合并基础疾病、心功能低下、抗菌药物的使用以及侵入性操作是老年冠心病患者医院感染的危险因素,针对以上环节采取相应的措施,对于预防医院感染具有重要意义。     

冠心病危险因子在女性冠心病心力衰竭中的研究

目的 探讨冠心病危险因子在女性冠心病患者发生心力衰竭中的影响。方法 选取328例冠心病患者,其中男196例（男性冠心病组）,女132例（女性冠心病组）,对两组患者各种冠心病危险因子包括年龄、高血压、糖尿病、血脂、血浆纤维蛋白原及血尿酸水平等进行比较;对所有患者随访1～3年,观察两组患者心力衰竭发生率,并对女性冠心病组发生心力衰竭者与未发生心力衰竭者的血尿酸水平进行比较。结果 女性冠心病组三酰甘油、血浆纤维蛋白原及血尿酸水平显著高于男性冠心病组(P＜0.05)。随访l～3年,女性冠心病组心力衰竭发生率显著高于男性冠心病组[27.27％(36/132)比16.84％( 33/196)],女性冠心病组发生心力衰竭者血尿酸水平为(368.85±78.60)μmol/L,未发生心力衰竭者血尿酸水平为(336.63±69.65)μmol/L,两者比较差异有统计学意义(P＜0.05)。结论 冠心病危险因子是女性冠心病患者心力衰竭的重要推动因素,而血尿酸是其发生心力衰竭的独立危险因素,可通过对血尿酸等进行早期监测并采取干预措施,减缓疾病的发展。     

Earthquake and coronary heart disease risk factors: a longitudinal study.

The longitudinal association between a number of coronary heart disease risk factors and the experience of a natural disaster (earthquake) was analyzed in a group of workers participating in a longitudinal epidemiologic investigation. The 5-year follow-up examination was interrupted by a major earthquake, and examinations were resumed 2 weeks after the quake. Participants screened after the quake had, on average, higher heart rates, serum cholesterol, and triglycerides than participants examined before the quake; these differences were independent from the coronary heart disease risk factor values measured 5 years previously during the baseline examination. The data collected during the 12-year examination indicated that the observed short-term increase in serum lipids and heart rate was not present long-term (7 years after the quake). These longitudinal data indicate that exposure to a natural disaster can be associated with short-term increases in heart rate, serum cholesterol, and triglycerides but that there is no apparent long-term effect on these coronary heart disease risk factors.     

冠心病危险因素的临床评价

目的 探讨冠心病危险因素与冠状动脉病变的关系。方法 对341例冠状动脉造影患者可能伴有的危险因素进行询问和检测。结果 (1)冠状动脉造影显示有病变者214例,冠状动脉造影显示无病变者127例。两组的年龄、糖尿病病史、高脂血症史、冠心病家族史、吸烟史、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇／高密度脂蛋白胆固醇比率(TC／HDL-C)、脂蛋白(a)[Lp(a)]、纤维蛋白原(Fbg)、高敏C反应蛋白(hs-CRP)比较,差异均有显著性。(2)冠状动脉造影显示有病变者其病变积分与危险因素的相关性依次排列为hs-CRP、Lp(a)、TC／HDL-C、Fbg、高脂血症史、TC、LDL-C和甘油三酯(r=0．338、0．250、0．241、0．207、0．167、0．147、0．140和0．139)。(3)对冠状动脉造影患者与危险因素应用ROC曲线分析结果依次为hs-CRP、TC／HDL-C、Lp(a)、Fbg、LDL-C、高脂血症史,其ROC曲线下面积比分别是0．810、0．669、0．626、0．625、0．619和0．618。结论 高脂血症史是冠心病发生的预告信号,脂质检查项目中对冠心病的预测作用以TC／HDL-C和Lp(a)为优;提示当前冠状动脉炎性损伤以hs-CRP为优。     

老年冠心病患者医院感染的危险因素分析

目的探讨老年冠心病患者医院感染的危险因素,提出干预措施,为临床治疗提供依据。方法回顾性分析医院2011年5月-2013年3月收治的289例老年冠心病患者临床资料,调查分析入选患者医院感染发生情况,根据患者感染情况将其分为感染组17例,非感染组272例;并针对感染相关因素进行比较分析,数据采用SPSS13.0软件进行分析。结果共17例发生医院感染,感染率为5.88%;其中男8例感染率为4.91%;女9例感染率为7.14%;感染部位分别为上呼吸道4例、下呼吸道6例、泌尿系统4例、胃肠道2例和皮肤软组织1例;老年冠心病患者医院感染与其性别、疾病类别、抗菌药物使用情况和合并高血压等不相关,与患者的年龄、住院时间、侵入性操作和合并糖尿病等相关。结论老年冠心病患者发生医院感染与患者的年龄、住院时间、侵入性操作和合并糖尿病有关,采取适宜的干预措施,可有效降低医院感染的发生率。     

老年冠心病患者医院感染的危险因素分析及护理干预措施

目的 探讨老年冠心病患者医院感染的危险因素及护理干预措施.方法 对635例老年冠心病患者医院感染情况进行回顾性调查.结果 635例老年冠心病患者中有84例发生医院感染,医院感染率为13.2％,以下呼吸道感染为主;老年冠心病患者的医院感染发生与患者住院天数、侵入性操作、合并心力衰竭、使用抗菌药物密切相关,差异有统计学意义(P＜0.01).结论 住院天数、侵入性操作、合并心力衰竭、使用抗菌药物是老年冠心病患者医院感染发生的危险因素,医护人员应给予患者针对性的预防保护措施,控制相关危险因素,以有效地降低医院感染的发生.     

Effect of diet and physical exercise intervention programmes on coronary heart disease risk in smoking and non-smoking men in Sweden.

STUDY OBJECTIVE: To investigate differences between smokers and non-smokers in health behaviour, cardiovascular risk factors, coronary heart disease (CHD) risks, health knowledge, health attitudes, and compliance with a CHD prevention programme. DESIGN: Differences between smokers and non-smokers were studied via medical examinations, questionnaires, physical exercise activity logs, and food record sheets. Data were analysed using univariate and multivariate analyses. The five and 10 year CHD risks were assessed using the Framingham CHD risk estimate. SETTING: The Karolinska Hospital, Stockholm, and Sollentuna Primary Health Centre, Sollentuna, Sweden. PARTICIPANTS: The analyses were based on 158 healthy smoking and non-smoking men aged 35-60 years with raised cardiovascular risk factors who enrolled in controlled, randomised six month diet and exercise programmes. MAIN RESULTS: Discriminant analysis suggested that smokers, compared with non-smokers, were characterised by a higher alcohol energy percent, lower HDL cholesterol concentration, lower systolic blood pressure, and a higher plasminogen activator inhibitor-1 (PAI-1) value. Knowledge of the risk factors for CHD was not a discriminating factor. Both smokers and non-smokers increased the exercise taken, improved their diet, and lowered their CHD risk. Before, as well as after the intervention, smokers had a higher CHD risk than non-smokers. CONCLUSIONS: The best CHD prevention action that could be taken by smokers would of course be to quit smoking. Those who cannot stop should be encouraged to improve their diet and increase the amount of physical exercise they take in order to reduce the health hazards of their smoking behaviour.     

Characteristics of individuals with multiple behavioral risk factors for coronary heart disease: the Netherlands.

To test the hypothesis that risk factors are interrelated, the simultaneous occurrence of smoking, inadequate nutrition, obesity, and physical inactivity was studied in a random sample (n = 1,951) of the Dutch adult population. Although the results did not suggest systematic clustering, the assumption of independence of these risk factors could not be maintained. Sociodemographic and health-related characteristics of the group with three or four risk factors were assessed (n = 246). Comparison with a prudent life-style group (zero risk factors, n = 387) by means by discriminant analysis indicated that the target group included proportionally more men (odds ratio: OR = 3.3), of all ages, with low education and occupation (OR = 3.5 and 1.7). The two groups did not differ in awareness of cardiovascular risk factors, preventive orientation regarding cardiovascular risk, or disease in general, and the effectiveness of health education in modifying life-style. The target group exhibited a distorted perception of the healthfulness of its own life-style and unfavorable attitudes toward modifying existing smoking, eating habits, and physical activity.     

介入治疗缺血性卒中的冠心病患者危险因素研究

目的:研究经皮冠状动脉介入治疗合并缺血性卒中史的冠心病患者发生不良事件的危险因素.方法:选择收治的合并缺血性卒中史的冠心病患者40例作为研究组,另选择同期收治的40例不合并缺血性卒中史的冠心病患者作为对照组.对比发生不良事件的危险因素进行Logistic分析.结果:左室射血分数降低、吸烟是合并缺血性卒中史冠心病患者发生不良事件的主要危险因素,差异具有统计学意义(P<0.05).结论:经皮冠状动脉介入治疗合并缺血性卒中史的冠心病患者发生不良事件的主要危险因素是左心室射血分数降低、吸烟,所以临床应结合具体情况,予以针对性的预防措施.     

Clustering of risk factors for coronary heart disease. the longitudinal relationship with lifestyle

PURPOSE: The purpose of this study was to investigate whether or not clustering of biological coronary heart disease (CHD) risk factors exists and to investigate the longitudinal relationship between lifestyle parameters (dietary intake, daily physical activity, smoking behaviour, alcohol consumption) and a biological CHD risk factor clustering score. This was defined as belonging to one or more gender specific 'high risk' quartiles for the following CHD risk factors: ratio between total serum cholesterol and high density lipoprotein cholesterol (TC:HDL), mean arterial blood pressure (MABP), body fatness [sum of skinfolds (SSF)], and cardiopulmonary fitness (VO2-max). METHODS: The data were derived from the Amsterdam Growth and Health Study, an observational longitudinal study in which six repeated measurements were carried out over a period of 15 years covering adolescence and young adulthood. The longitudinal relationships were analysed with generalized estimating equations. RESULTS: The results showed significant clustering for the TC:HDL ratio, SSF, and VO(2)-max. MABP was not significantly associated with the other CHD risk factors. Daily physical activity and alcohol consumption (only for males) were both inversely related to the clustering score. None of the other lifestyle parameters showed significant relationships with the clustering score. CONCLUSIONS: Based on this small longitudinal study, it can be stated that during adolescence and young adulthood both daily physical activity and alcohol consumption were related to a healthy CHD risk profile.     

Roma coronary heart disease patients have more medical risk factors and greater severity of coronary heart disease than non-Roma

Objectives

Coronary heart disease (CHD) is the most common cause of mortality and morbidity world-wide. Evidence on ethnic differences between the Roma and non-Roma regarding medical risk factors is scarce. The aim of this study was to assess differences in medical risk factors and the severity of CHD in Roma compared with non-Roma CHD patients, adjusted for gender, age and education.

Methods

Six hundred seventy four patients were included in this cross-sectional study (132 Roma, 542 non-Roma). Data on medical risk factors, symptoms, medication and severity of CHD were obtained from medical records. After matching Roma and non-Roma according to education, linear and logistic regression analyses with adjustments for gender and age were used.

Results

Compared with non-Roma, Roma patients had significantly more risk factors and more severe types of CHD. They were treated less frequently with statins and beta-blockers, were more frequently left on pharmacotherapy and surgically revascularised. These differences remained after controlling for education, gender and age.

Conclusions

Roma CHD patients have a worse risk profile at entry of care and seem to be undertreated compared with non-Roma CHD patients.