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1.
Panagiotakos DB Pitsavos C Zampelas A Chrysohoou C Griffin BA Stefanadis C Toutouzas P 《International journal of cardiology》2005,102(3):403-409
OBJECTIVE: The aim of this work was to investigate the association between fish consumption and the development of non-fatal acute coronary syndromes (ACS), in a Mediterranean population. METHODS: During 2000-2001, we randomly and stratified selected, from all Greek regions, 848 hospitalised patients (695 males, 58+/-10 years old and 153 females, 65+/-9 years old) who had a first event of ACS and 1078 paired, by region-sex-age, controls without any clinical symptoms or signs of coronary heart disease. RESULTS: On multivariate logistic regression analysis and, after controlling for several potential confounders, we found that fish consumption less than 150 g/week was associated with 38% lower odds of developing ACS as compared to no consumption (odds ratio=0.62, P-value<0.05). In contrast, moderate (150-300 g/week) and high (>300 g/week) fish consumption was not associated with the developing of the disease (odds ratios=1.10 and 1.01, respectively, P-value>0.1). The benefits from low fish consumption were also significant even amongst current smokers and diabetics. CONCLUSION: Moderate fish consumption was independently associated with a significant reduction in the odds of developing ACS. The strength and consistency of this finding has implications for public health and should be explored further. 相似文献
2.
Pitsavos C Panagiotakos DB Chrysohoou C Tzioumis K Papaioannou I Stefanadis C Toutouzas P 《Heart and vessels》2002,16(4):127-130
Although the effect of smoking on human health has been established as a major risk factor, the effect of passive smoking
is controversial. The purpose of this study was to investigate the association between passive smoking and the risk of acute
coronary syndromes (ACS) among nonsmokers. Eight hundred and forty-eight patients with the first event of ACS and 1078 cardiovascular
disease-free matched controls completed a detailed questionnaire regarding their exposure to environmental smoke. Two hundred
and ninety-seven (35%) of the patients and 259 (24%) of the controls were defined as nonsmokers and passive smokers, respectively.
After controlling for several potential confounders, the results showed that nonsmokers exposed to cigarette smoke increased
the risk of ACS by 51% (odds ratio = 1.51, 95% confidence interval 1.21–2.99) compared with nonsmokers not exposed to smoke.
It was estimated that 34 coronary events per 134 subjects would occur as a result of passive smoking during their lifetime.
Consequently, this study supports the hypothesis that passive smoking increases the risk of developing acute coronary syndromes.
Given the high prevalence of cigarette smoking in many developing societies, the public health consequences of passive smoking
with regard to coronary heart disease may be important.
Received: November 19, 2001 / Accepted: January 25, 2002 相似文献
3.
Meropi D Kontogianni Demosthenes B Panagiotakos Christina Chrysohoou Christos Pitsavos Christodoulos Stefanadis 《European journal of cardiovascular prevention and rehabilitation》2006,13(5):791-797
BACKGROUND: Dairy consumption may be associated with a small but worthwhile reduction in cardiovascular disease risk, but results from epidemiological studies are inconsistent. The aim of the present study was to evaluate the association between dairy consumption and the prevalence of a first, non-fatal event of an acute coronary syndrome, in a Greek sample. DESIGN: Seven hundred male and 148 female patients with first event of an acute coronary syndrome and 1078 population-based controls, age and sex matched, were randomly selected. METHODS: Detailed information regarding their medical records, alcohol intake, physical activity and smoking habits was recorded. Nutritional habits were evaluated with a semi-quantitative food-frequency questionnaire. Multiple logistic regression analysis estimated the odds ratio of having acute coronary syndrome by level of dairy intake, after taking into account the effect of several confounders. RESULTS: An inverse relationship was observed between dairy products consumption and odds of having acute coronary syndrome. One portion increase in weekly dairy products intake was associated with 12% lower likelihood of having acute coronary syndrome, after controlling for various potential confounders (P<0.001). Cut-off analysis showed that 7.4 portions per week are the optimal consumption that benefits people from having acute coronary syndrome. CONCLUSIONS: Dairy consumption seems to offer significant protection against coronary heart disease, irrespective of various clinical, lifestyle and other characteristics of the participants. 相似文献
4.
Kontogianni MD Panagiotakos DB Chrysohoou C Pitsavos C Zampelas A Stefanadis C 《Clinical cardiology》2007,30(3):125-129
BACKGROUND: According to epidemiological and metabolic studies monounsaturated fatty acids (MUFAs) seem to exert a protection against coronary heart disease (CHD) risk. The aim of the present study was to evaluate the association between the pattern of edible oils and fats consumption and the prevalence of a first, nonfatal event of an acute coronary syndrome (ACS) in a Greek sample. METHODS: Seven hundred males and 148 females patients with first event of an ACS and 1078 population-based controls, age and sex matched, were randomly selected. Detailed information regarding their medical records, alcohol intake, physical activity and smoking habits was recorded. Nutritional habits were evaluated with a semi-quantitative food-frequency questionnaire and use of oils in daily cooking or preparation of food was also recorded. Multiple logistic regression analysis estimated the odds ratio (OR) of having ACS by types of oil used, after taking into account the effect of several confounders. RESULTS: Exclusive use of olive oil was associated with 47% (95% confidence interval (CI) 0.4-0.71) lower likelihood of having ACS, compared to nonuse, after adjusting for BMI, smoking, physical activity level, educational status, the presence of family history of CHD, as well as hypertension, hypercholesterolemia and diabetes. Consumption of olive oil in combination with other oils or fats was not significantly associated with lower odds of ACS compared to no olive oil consumption (p=0.14). CONCLUSIONS: Exclusive use of olive oil during food preparation seems to offer significant protection against CHD, irrespective of various clinical, lifestyle and other characteristics of the participants. 相似文献
5.
An integrated assessment of family history on the risk of developing acute coronary syndromes (CARDIO2000 study) 总被引:2,自引:0,他引:2
Panagiotakos DB Pitsavos C Chrysohoou C Bratsas A Toutouzas P Stefanadis C 《Acta cardiologica》2004,59(4):383-390
OBJECTIVE: In this work we assessed a risk score for developing a first event of acute coronary syndrome (ACS) based on the family history of the cardiovascular risk factors. METHODS AND RESULTS: The studied population consisted of 848 randomly selected middle-aged patients with first event of ACS and 1078 sex-age-region matched controls admitted to the same hospitals for minor operations and without any clinical suspicion of cardiovascular disease in their life. A Family History Score (FHS) was developed based on the presence of coronary heart disease, hypertension, hypercholesterolaemia and diabetes mellitus, among first-degree relatives of the participants after adjusting for the family size. The evaluation of FHS was based on conditional logistic regression analysis, after controlling for demographic variables as well as for the mutual confounding effects of other risk factors. Family history of CHD, hypercholesterolaemia and diabetes was highly associated with the development of the disease. The introduced FHS was also highly associated with the development of ACS among participants who had no family history of CHD (odds ratio = 10.9, p < 0.001), whereas it was not associated with the development of the disease among participants who had a family history of CHD (odds ratio = 1.41, p = 0.543). CONCLUSIONS: The suggested FHS could be a useful tool in the primary prevention of ACS, as well as in detecting and understanding associations between genetic vulnerability and cardiovascular risk factors. 相似文献
6.
Panagiotakos DB Pitsavos C Zampelas A Chrysohoou C Stefanadis C 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2005,15(6):402-409
BACKGROUND AND AIM: We sought to investigate the relationship between fish consumption and the risk of developing non-fatal acute coronary syndromes (ACS) among current smokers. METHODS AND RESULTS: During 2000-2001, we conducted the CARDIO2000 case-control study that included patients hospitalized for a first event of ACS and matched (age, sex) individuals without clinical evidence of CHD (controls), from all the Greek regions. In the present analysis we studied data from 519 men (59+/-10 years old) and 45 women (62+/-9 years old) patients, as well as 444 men and 90 women controls, matched for age with the patients that reported current smoking. To evaluate the hypothesis tested we applied conditional logistic regression analysis after controlling for several potential confounders. Overall, 94% of controls and patients reported fish consumption at least once a week. Compared to low fish consumption (<60 g/week), moderate (60-180 g/week) intake was associated with 15% (p<0.05) lower risk of ACS, while increased (180-300 g/week, or >300 g/week) consumption was associated with 18% (p<0.05) and 19% (p = 0.53) higher risk, respectively. CONCLUSION: Moderate fish consumption seems to moderate the deleterious effect of smoking on the occurrence of ACS. However, increased intake does not seem to confer any benefit on coronary risk. 相似文献
7.
Pitsavos C Panagiotakos DB Chrysohoou C Skoumas J Papaioannou I Stefanadis C Toutouzas PK 《Coronary artery disease》2002,13(5):295-300
BACKGROUND: Hypercholesterolemia has been identified as a major risk factor for the development of coronary artery disease. The aim of this study was to assess the effect of a Mediterranean diet on the development of non-fatal acute coronary syndromes (ACS) in hypercholesterolemic people, with or without statin treatment. METHODS: During 2000-2001, 848 randomly selected patients with a first event of coronary heart disease and 1078 cardiovascular disease-free people, matched to the patients by sex, age and region, were studied. Treatment of hypercholesterolemia with statin and the adoption of a Mediterranean diet were recorded. RESULTS: Hypercholesterolemia was present in 534 (63%) out of 848 coronary patients and 399 (37%) out of 1078 control participants. One hundred and seventy-one (32%) of the hypercholesterolemic patients and 168 (42%) of the hypercholesterolemic control participants were treated with statins and also followed a Mediterranean diet. The analysis showed that the combination of a Mediterranean diet and statin medical therapy is associated with an additional reduction of the coronary risk (odds ratio = 0.57, P < 0.01), independently from cholesterol levels and the other cardiovascular factors. CONCLUSION: The adoption of a Mediterranean diet by hypercholesterolemic people seems to reinforce the benefits from statin treatment on lipid levels and reduces the risk of developing ACS. However, it is hard to claim that our findings suggest causal evidence, and in order to explain the potential common mechanism between diet and statin treatment much remains to be learned. 相似文献
8.
C Pitsavos K Makrilakis D B Panagiotakos C Chrysohoou I Ioannidis C Dimosthenopoulos C Stefanadis N Katsilambros 《Diabetic medicine》2005,22(3):243-248
AIMS: To identify the threshold of alcohol consumption above which the balance of risk and benefit becomes adverse in diabetic subjects. METHODS: We studied demographic, lifestyle, dietary and clinical information in 216 hospitalized diabetic patients (171 men, 63 +/- 9 years old, 45 women, 67 +/- 5 years old) with a first event of an acute coronary syndrome (ACS) and 196 frequency matched (age-sex) diabetic controls, without any clinical evidence of coronary heart disease. Alcohol consumption was quantified and a measure for the comparisons was predetermined to be a wine glass (100 ml of wine, 12 g of ethanol) and its alcohol equivalents. RESULTS: Alcohol consumption was associated with an age-adjusted J-shape relationship with total cholesterol, blood pressure and smoking (all P < 0.001). A J-shape association was also found between alcohol intake and the risk of ACS (OR = 2.54-2.43 x (alcohol intake) + 0.80 x (alcohol intake)2, R2 = 0.96, P < 0.001), adjusted for several risk factors and interactions between alcohol intake and smoking status, job and familial stress, and low income. In particular, low alcohol consumption (< 12 g/day) was associated with a 47% (OR = 0.53, 95% CI 0.28-0.97) reduction of the prevalence of ACS, while a higher intake (12-24 and > 24 g/day) increased the prevalence by 2.7-fold (OR = 2.72, 95% CI 1.39-5.38) and 5.4-fold (OR = 5.44, 95% CI 1.21-24.55), respectively. CONCLUSIONS: Alcohol intake is a significant predictor of coronary events. Low-to-moderate intake seems to be associated with a reduction in the prevalence of ACS in diabetes, whereas higher consumption is associated with an increase in lipids and blood pressure levels, and also the risk of developing ACS. 相似文献
9.
During 2000 to 2002, 700 men (59 +/- 10 years) and 148 women (65 +/- 9 years) patients with first event of an ACS were randomly selected from cardiology clinics of Greek regions. Afterwards, 1078 population-based, age-matched and sex-matched controls were randomly selected from the same hospitals. The frequency ratio between men and women in the case series of patients was about 4:1, in both south and north Greek areas. Hierarchical classification analysis showed that for north Greek areas family history of coronary heart disease, hypercholesterolemia, hypertension, diabetes (explained variability 35%), and less significantly, dietary habits, smoking, body mass index, and physical activity status (explained variability 4%) were associated with the development of ACS, whereas for south Greek areas hypercholesterolemia, family history of coronary heart disease, diabetes, smoking, hypertension, dietary habits, physical activity (explained variability 34%), and less significantly body mass index (explained variability <1%), were associated with the development of the disease. 相似文献
10.
Differences in the overall mortality for acute infarction in women vs men have been appreciated for some time. Some of these differences are based on the age at the time of presentation of women compared with men. Excess mortality in women is most clear at the younger end of the age spectrum. More careful examination of the data has shown differences based on factors such as greater delays in presentation in women, real biases in the types of healthcare provider, and selection of diagnostic and therapeutic interventions for women compared with men. Recently, the mode of presentation has emerged as a major defining point. Women present more frequently with unstable angina or non-Q-wave infarction and have lesser mortality with these syndromes compared with men. Thus, the overall outcomes of acute coronary syndromes vary substantially from the differences in outcome for acute Q-wave infarction alone. New data have emerged regarding differences in treatment outcome for acute infarction. Women have derived lesser benefit from thrombolytic therapy and still respond to percutaneous transluminal coronary angioplasty more favorably than thrombolytic therapy for acute infarction. Women seem to have less benefit from stent use compared with angioplasty alone for acute infarction. Although increasing scrutiny has shed a great deal of light on some of these gender differences in outcomes from acute coronary syndromes, a real difference in mortality for younger women remains unexplained. The basis for real differences in outcome with the use of various therapies for acute infarction, such as thrombolysis and stent use, are also not well elucidated. 相似文献
11.
Panagiotakos DB Pitsavos C Matalas AL Chrysohoou C Stefanadis C 《International journal of cardiology》2005,100(1):135-142
OBJECTIVE: We evaluated the interaction between adherence to the Mediterranean diet and region of Greece on the likelihood of having acute coronary syndromes (ACS). METHODS: During 2000-2001, a random sample of 848 patients (61+/-10 years) with their first coronary heart disease event, and 1078 frequency matched (by age-sex) controls with no cardiovascular disease in their medical history, from all the country, entered into the study. Among several factors, adherence to the Mediterranean diet was assessed by a diet-score that incorporated the inherent characteristics of this diet. RESULTS: The multi-adjusted analysis showed that a 10-unit increase in the diet score was associated with a 27% (95% CI 0.66 to 0.89) decrease of the odds of having ACS. Moreover, a highly significant interaction was observed between region and diet score (p<0.001). The odds ratios varied from roughly 0.5 in Southern to 1.2 or more in Northern Greek regions (p for heterogeneity<0.05). Differences in food patterns consumed did not explain the previous findings. In addition, when we stratified our analysis by rural and urban areas we found significant differences in the estimated odds ratios (p for interaction between diet score and area=0.01), since a 10-unit increase in the diet score was associated with 22% (95% CI 0.63 to 0.96) lower odds n urban areas and 31% (95% CI 0.48 to 0.98) lower odds in rural areas. CONCLUSION: Our findings underline the significance of the Mediterranean diet on the primary prevention of ACS. Moreover, we revealed a geographical variation in the importance of this dietary pattern on coronary risk, independent from the composition of food patterns followed and the prevalence of the common cardiovascular risk factors. 相似文献
12.
Barbara E. Sthli Manfred B. Wischnewsky Philipp Jakob Roland Klingenberg Slayman Obeid Dik Heg Lorenz Rber Stephan Windecker Franois Mach Baris Gencer David Nanchen Peter Jüni Ulf Landmesser Christian M. Matter Thomas F. Lüscher Willibald Maier 《Catheterization and cardiovascular interventions》2019,93(1):16-24
13.
Gender differences in the presentation and management of acute coronary syndromes: a national sample of 1365 admissions. 总被引:1,自引:0,他引:1
Frank Doyle Davida De La Harpe Hannah McGee Emer Shelley Ronán Conroy 《European journal of cardiovascular prevention and rehabilitation》2005,12(4):376-379
BACKGROUND: Gender differences in presentation and management of acute coronary syndromes (ACS) are well established internationally. This study investigated differences in a national Irish sample. DESIGN: Cross-sectional survey. METHODS: All centres (n=39) admitting cardiac patients to intensive/coronary care provided information on 25 consecutive acute myocardial infarction patients and other ACS patients admitted concurrently (n=1365 episodes). Patient data was analyzed in terms of those with prior ACS/revascularization, and those without. RESULTS: Men with prior established ACS/revascularization were twice as likely to have received revascularization procedures (coronary artery bypass graft or percutaneous coronary intervention) prior to admission when controlling for age, total cholesterol and insurance status [odds ratio (OR) 1.97, 95% confidence interval (CI) 1.18-3.29, P=0.011]. No gender differences were seen in acute-phase reperfusion (OR 0.96, 95% CI 0.76-1.24, P>0.05) or antiplatelet therapy (OR 0.99, 95% CI 0.69-1.41, P>0.05). For patients with prior ACS/revascularization, men were twice as likely to receive statins on discharge after adjustment for age and total cholesterol (OR 1.94, 95% CI 1.02-3.71, P=0.045). CONCLUSIONS: Women were treated differently to men. Fewer women with a positive history of ACS received revascularization prior to current admission and fewer women were prescribed lipid-lowering medications on discharge. Acute phase hospital treatment was not gender determined. These findings have implications for secondary prevention in Ireland. 相似文献
14.
Chest pain, the second most frequent presenting complaint in the emergency department (ED), often poses a challenge to the physicians dealing with these patients owing to the wide spectrum of presentation of acute coronary syndromes (ACS). A majority of the patients presenting with chest pain are usually admitted to the hospital for further evaluation and management. Despite the availability of modern-day tools for diagnosis of acute myocardial infarction (AMI), about 5% of patients with AMI are missed in the ED with subsequent associated morbidity and mortality and legal consequences. Several centers have adapted critical pathways derived from American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients presenting with ACS. We now have some evidence suggesting adherence to the critical pathways derived from ACC/AHA guidelines will optimize the quality of patient care and probably result in better patient outcomes. This article reviews initial evaluation and the importance of risk stratification of the patients presenting with chest pain using the currently available clinical and diagnostic tools. Critical pathways derived from the ACC/AHA guidelines for various presentations of ACS are also reviewed. 相似文献
15.
D B Panagiotakos C Pitsavos C Chrysohoou A D Moraiti C I Stefanadis P K Toutouzas 《Acta cardiologica》2001,56(6):357-365
OBJECTIVE: The aim of this study is to evaluate the effect of recent depressive episodes on coronary risk, taking into account the presence of several cardiovascular risk factors and various lifestyles, and social conditions that aggregate in the Greek population. METHODS AND RESULTS: CARDIO2000 is a matched case-control study consisting of 750 patients with a first event of acute coronary syndrome and 778 cardiovascular disease-free hospitalized subjects, randomly and stratified selected from several Greek regions. Assessment of depressive symptoms, during the past month, was based on the CES-D Scale (Radloff S, 1977). 158 (21%) coronary patients and 74 (9%) controls had short-term depressive symptoms (P<0.001). A recent depressive episode increases coronary risk by 12%, after adjusting for several confounders, while the previous outcome seems to differ significantly between sexes (OR-men = 1.09 vs. OR-women = 1.19, P<0.01). The effect of the interaction between depression and various components of social class (education, occupation, income) increases the coronary risk from 55% to 132%, while the interaction with marital status increases the previous risk by 167%, in divorced/widowed men, and by 123%, in women. Also, significant additive effects were observed between depression and smoking (25% increased coronary risk per pack-year), alcohol consumption (+97%), physical inactivity (+137%) and obesity (+127%). CONCLUSION: This study showed the moderate effect of recent depression on the risk of developing non-fatal acute coronary syndromes in the investigated population. Also, sex differences and the additional effect of the interactions between short-term depressive episodes and several emerging or established cardiovascular risk factors occurred. 相似文献
16.
Bodí V Fácila L Sanchís J Llàcer A Ferrero JA Chorro FJ 《Revista espa?ola de cardiología》2003,56(4):412-416
Sex differences have been observed in the clinical profile, prognosis, and treatment of patients with unstable ischemic heart disease. Men tend to receive more invasive management. We assessed these differences in 823 consecutive patients (543 men) with possible acute coronary syndrome without ST-segment elevation who were seen since our chest pain unit opened. A protocol for the management of unstable ischemic heart disease was followed. Women had a worse baseline clinical profile but men more frequently had a positive exercise stress test. Univariate analysis showed that angiography and revascularization procedures were performed more often in men. However, multivariate analysis did not confirm male sex as an independent predictor of the need for a more invasive strategy. The inauguration of a chest pain unit and application of a protocol for the management of unstable ischemic heart disease has helped to correct case stratification and optimize the application of invasive treatments. 相似文献
17.
Chandra KS 《Indian heart journal》2012,64(3):270-272
There have been considerable advances in the management of acute coronary syndromes in the recent past. There are three risk scoring systems used for prognosticating these patients. An attempt is made in this article to discuss the pros and cons of the different risk scoring systems and their clinical utility. 相似文献
18.
19.
Radovanovic D Erne P Urban P Bertel O Rickli H Gaspoz JM;AMIS Plus Investigators 《Heart (British Cardiac Society)》2007,93(11):1369-1375