Personality and Mortality from Ischemic Heart Disease and Stroke

Background. The role of personality in the causation of circulatory diseases has been controversial. Methods. From June through August 1990, 41,442 residents of Miyagi Prefecture in northern Japan completed the Japanese version of the short-form Eysenck Personality Questionnaire-Revised and another questionnaire on various health habits. During 11 years of follow-up until March 31, 2001, we identified 90 deaths from ischemic heart disease (IHD) and 131 deaths from stroke. We used Cox regression to estimate the relative risk of IHD and stroke according to the three levels of four personality subscales (extraversion, neuroticism, psychoticism, and lie), with adjustment for sex, age, and other potentially confounding variables. Results. Multivariate relative risks of IHD for the highest verses the lowest level of personality subscales were 0.7 for extraversion, 1.1 for neuroticism, 1.3 for psychoticism, and 0.8 for lie. Multivariate relative risks of stroke for the highest verses the lowest level of personality subscales were 1.0 for extraversion, 0.9 for neuroticism, 1.2 for psychoticism, and 1.2 for lie. Conclusions. This prospective study does not support the hypothesis that personality is a risk factor for mortality from IHD and stroke.     

Four-year Incidence of Myocardial Infarction and Sudden Coronary Death in Twelve Finnish Population Cohorts

ABSTRACT. Suhonen O, Reunanen A, Aromaa A, Knekt P, PyÖrÄlÄ K. (Research Institute for Social Security, Social Insurance Institution, Helsinki, Finland.) Four-year incidence of myocardial infarction and sudden coronary death in twelve Finnish population cohorts. The incidence of myocardial infarction (MI) and sudden coronary death in four years was studied in 6510 men and 5800 women, aged 30–59 years, derived from 12 Finnish population cohorts constituting the invited population to a prospective study. The incidence of all fatal coronary events in four years was 13.0/1000 in men and 1.8/1000 in women. The incidence of sudden coronary death was 7.8/1000 in men and 0.7/1000 in women. The incidence of non-fatal MI was 22.2/1000 in men and 7.3/1000 in women. Coronary mortality was significantly higher in non-participants in the initial survey than in participants. The incidence of MI was highest in men from eastern Finland (North Karelia), intermediate in men from central and western Finland and lowest in men from southwestern Finland. There were no significant regional differences in the incidence of MI in women. The incidence of MI in this study was in good agreement with that recorded in the myocardial community registers.     

Social Isolation and Mortality in Ischemic Heart Disease

ABSTRACT The effects of psychosocial and clinical factors on mortality in ischemic heart disease (IHD) were examined in a 10-year follow-up of 150 middle-aged men. Three groups of men were included: men with clinically manifest IHD, men with risk factors and healthy men. Psychosocial factors were assessed by means of standardized questionnaires. They comprised educational level, social class, marital status and a comprehensive assessment of the daily rounds of life of these men. Furthermore, a subjective rating of the own general health status was obtained. The clinical investigation included a standard physical examination, fasting serum lipids, glucose and urate, a frontal and sagittal chest X-ray and a 24-hour ambulatory ECG monitoring. During follow-up 37 men died, 20 of them from IHD. Non-survivors were descriminated from survivors by the following factors: older age, lower education, lower social class, higher systolic blood pressure, increased ventricular irritability and cardiac enlargement. Furthermore, a relative social isolation as indicated by a low social activity level and a poor self-rated general health status was characteristic of non-survivors. In multivariate analyses three factors emerged as the equally strong predictors of mortality, both from all causes and from IHD: social isolation, a poor self-rated health status and ventricular irritability. The psychosocial mortality predictors were independent of and of similar strength as the clinical predictors.     

心肌代谢药物治疗缺血性心脏病的研究进展

近年来通过改变心肌代谢发挥抗心绞痛作用的一类药物受到关注。这类代谢药物主要通过诱导游离脂肪酸代谢向葡萄糖代谢的转换,从而增加单位氧耗生成三磷酸腺苷供能物质的量而发挥抗心绞痛作用。适用于冠心病、肥厚型心肌病、非手术主动脉狭窄和慢性心力衰竭心肌缺血的治疗。代谢药物有可能成为缺血性心脏病患者药物治疗新的选择。现对4种心肌代谢药物进行综述。     

First Hospitalization for Heart Failure in Outpatients With Stable Coronary Artery Disease: Determinants,Role of Incident Myocardial Infarction,and Prognosis

Background

We lack recent data on the incidence, correlates, and prognosis associated with heart failure (HF) development in patients with stable coronary artery disease (CAD). Here, we analyzed HF development in a contemporary population of outpatients with stable CAD.

The Incidence and Prognosis of Cerebrovascular Disease in Hospital Patients in Helsinki,Finland, in the Decade 1970–1980

ABSTRACT Over 21000 hospital episodes due to cerbrovascular disease (CVD, ICD-8 nos. 430–438) were registered in the Helsinki hospitals in 1970–1980. Of those 17629 were identified as new cases. The age-adjusted incidence of haemorrhagic and thrombotic stroke (430–433) declined during the period 1970–1975 from 221 to 139 cases/100000 inhabitants, whereafter no further decrease was observed. The decline in incidence was significant in both sexes. Analysis by diagnosis group showed that the decrease was confined to the incidence of haemorrhagic stroke (430–432), whereas the incidence of thromboembolic stroke (433, 434) and transient ischaemic attacks (435) remained virtually unchanged. Survival was mainly determined by patient age and type of CVD. Intracerebral haemorrhage and occlusion of precerebral arteries exhibited the poorest short-term prognosis. About half of the patients hospitalised due to cerebral thrombosis and embolism survived over One year. Long-term prognosis of the major CVD groups was very poor with only 10% of the patients alive after eight years. Transient cerebral ischaemia and subarachnoid haemorrhage had a clearly better prognosis, the survival rates after eight years being 45 and 30%, respectively.     

Variation in Revascularization Practice and Outcomes in Asymptomatic Stable Ischemic Heart Disease

Objectives

The aims of this study were to assess variation in revascularization of asymptomatic patients with stable ischemic heart disease, identify the predictors of variation, and determine if it was associated with clinical outcomes.

The Effects of Antihypertensive Drug Treatment on the Incidence of Stroke and of Coronary Heart Disease

The effects of differences in usual diastolic blood pressure (DBP) on the risks of stroke and of coronary heart disease (CHD) were estimated from nine major prospective observational studies involving about 420,000 men and women, followed up over intervals of 6 to 25 years. The results indicated that a prolonged difference in usual DBP of approximately 6 mmHg was associated with about 36% (±2) fewer strokes and 22% (±1) fewer CHD deaths and non-fatal myocardial infarctions. The effects of equivalent reductions in DBP produced by antihypertensive drug treatment but maintained for just a few years, have been estimated in several overviews of randomised controlled trials, involving totals of between 30,000 and 40,000 hypertensive patients. The results of the overviews indicated that antihypertensive treatment reduced the risk of stroke by about 40%, suggesting that all of the long-term potential benefit for stroke of lower DBP was achieved within about 3 years of beginning treatment. The risk of CHD may have been reduced by about 10% among patients allocated active treatment, but the 95% confidence limits for the difference ranged from about zero to about 20%. Whatever the true effect of treatment on CHD, it would appear to be somewhat less than the difference in risk estimated from the prospective observational studies for a prolonged difference in DBP of the same size. This apparent shortfall may reflect chronic pathophysiological processes in the relationship between DBP and CHD, and/or possible cardiotoxic side-effects of the principal trial treatments.     

Medical and Revascularization Management of Stable Ischemic Heart Disease: An Overview

Stable ischemic heart disease (SIHD) affects approximately 10 million Americans with 500,000 new cases diagnosed each year. Patients with SIHD are primarily managed in the outpatient setting with aggressive cardiovascular risk factor modification via medical therapy and lifestyle changes. Currently, this approach is considered as the mainstay of treatment. The recently published ISCHEMIA trial has established the noninferiority of medical therapy in comparison to coronary revascularization in patients with moderate to severe ischemia. Percutaneous coronary intervention is currently recommended for patients with significant left main disease, large ischemic myocardial burden, and patients with severe refractory angina despite maximal medical therapy.     

The Tromsø Heart Study: Is Coffee Drinking an Indicator of a Life Style with High Risk for Ischemic Heart Disease?

ABSTRACT Associations between coffee drinking, use of table fat with low contents of polyunsaturated fatty acids, preference for low-fat milk, use of fruits and vegetables, smoking and lack of physical activity in leisure time have been described in a cross-sectional study of 14582 men and women. Coffee drinking was negatively related to the use of low-fat milk, use of table fat high in polyunsaturated fatty acids, use of fruits and vegetables, and positively associated with bread consumption. Three persons out of four with high coffee consumption (>8 cups/day) were daily smokers, in contrast to about a quarter of those with low coffee consumption (<1 cup/day). In women and young men, high coffee consumption was associated with low physical activity at leisure. The results suggest that high coffee consumption may be an indicator of a life style with high risk for coronary heart disease.     

高血压冠心病患者清晨血压回升与缺血性ST段改变的相关性

目的通过动态血压监测（ＡＢＰＭ）清晨血压变化参数与动态心电图（Ｈｏｌｔｅｒ）对应时域的缺血性ＳＴ段演变的相关性研究，观察高血压合并冠心病患者血压改变是否与Ｈｏｌｔｅｒ所示心肌缺血改变存在相关性。方法对７９例高血压合并冠心病患者，行同步ＡＢＰＭ与Ｈｏｌｔｅｒ检查２４ｈ，获得的血压变化和ＳＴ段压低数据由计算机进行统计分析。结果清晨血压（收缩压、平均脉压、舒张压）与对应时域的ＳＴ段压低呈正相关关系（Ｐ＜０．０５，ｒ＝０．３９，０．１８，０．３３）；尤以血压（收缩压、平均脉压、舒张压）回升值、心肌耗氧量与夜间均值之差跟对应ＳＴ段压低的相关性更为显著（Ｐ＜０．０１，ｒ＝０．３８，０．１３，０．２９，０．２３）。昼夜节律消失组较昼夜节律存在组发生ＳＴ段缺血性改变的构成比具有显著性差异（Ｐ＜０．０５）。结论清晨清醒前后血压升高与心肌缺血的发生呈直线正相关，且多为无痛性心肌缺血，尤以昼夜节律消失者为著。     

Disability-Adjusted Life Years (DALYs) Due to Ischemic Heart Disease (IHD) Associated with Natural Disasters: A Worldwide Population-Based Ecological Study

Background:Recent studies have reported an association between natural disasters of various kinds and ischemic heart disease (IHD). We investigated the association between Disability-adjusted life years (DALYs) due to IHD and natural disasters and aimed to assess DALYs as a quantification of the burden of IHD related to natural disasters at the global level.Methods:Country-specific data of natural disaster impacts DALYs due to IHD and socioeconomic variables were obtained from open sources over the period of 1990–2013 and 2014–2017. A population-based trend ecological design was conducted to estimate the association between trends in DALYs and natural disasters (occurrence, casualties and total damage), adjusting for socioeconomic variables.Results:Most countries have experienced increases in natural disaster occurrences and decreases in DALYs during this study period. The unadjusted correlation analysis demonstrated a positive and significant correlation between DALYs and natural disasters for females and for both sexes (R = 0.163 and 0.146, p = 0.024 and 0.043), and a marginally significant correlation for males (R = 0.128, p = 0.076). After adjusting for socioeconomic variables, multiple linear regression demonstrated independent associations between the occurrence and DALYs due to IHD for males, females and both sexes (standardized coefficients = 0.192, 0.23 and 0.187, p = 0.016, 0.004 and 0.022).Conclusions:A weak but significantly positive association between natural disaster and IHD was confirmed and quantified at the global level by this DALY metric analysis. Adaptation strategies for natural disaster responses and IHD disease burden reduction need to be developed.     

Use of Implantable Cardioverter-Defibrillators in Congenital Heart Disease and Pediatric Patients: Results from the German National Registry for Congenital Heart Defects

Background: Sudden cardiac death is a leading cause of death in patients with congenital heart disease (CHD). Risk stratification for implantable cardioverter defibrillators (ICD) remains difficult due to limited data about use and outcome of device therapy in CHD patients in larger community-based cohorts. Methods and results: Out of a dataset with more than 50,000 patients registered at the German National Register for Congenital Heart Defects, 109 patients (median age 35.5; IQR 23.75–46.00), 68 (62%) male) with an ICD were identified and were retrospectively analyzed. Although the number of implantations increased steadily throughout the investigated time interval from 2001 to 2015, only 0.2% of the CHD patients in the national register received an ICD. Indication for ICD implantation was secondary prevention in 84 patients (78%) and primary prevention in 24 patients (22%). 23 patients (21%) of the ICD patients received appropriate ICD therapy. 7 patients (6%) received an inappropriate ICD therapy. In 23 patients (21%) device complications were documented with a high number of lead fractures and insulation defects (n = 14,13%). Conclusion: The current study investigates the clinical uptake and use of ICD therapy based on a large national registry for CHD patients. Despite a steady increase in the number of implanted devices, ICD uptake remains relatively low, particularly for primary prevention. The data suggests a potential reluctance in utilization of device therapy in this patient cohort for primary prevention. Selecting patients in whom benefits outweigh the risks associated with lifelong ICD therapy remains challenging.     

The Impact of Socioeconomic Factors,Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis

Background:No other disease has killed more than ischemic heart disease (IHD) for the past few years globally. Despite the advances in cardiology, the response time for starting treatment still leads patients to death because of the lack of healthcare coverage and access to referral centers.Objectives:To analyze the spatial disparities related to IHD mortality in the Parana state, Brazil.Methods:An ecological study using secondary data from Brazilian Health Informatics Department between 2013–2017 was performed to verify the IHD mortality. An spatial analysis was performed using the Global Moran and Local Indicators of Spatial Association (LISA) to verify the spatial dependency of IHD mortality. Lastly, multivariate spatial regression models were also developed using Ordinary Least Squares and Geographically Weighted Regression (GWR) to identify socioeconomic indicators (aging, income, and illiteracy rates), exam coverage (catheterization, angioplasty, and revascularization rates), and access to health (access index to cardiologists and chemical reperfusion centers) significantly correlated with IHD mortality. The chosen model was based on p < 0.05, highest adjusted R² and lowest Akaike Information Criterion.Results:A total of 22,920 individuals died from IHD between 2013–2017. The spatial analysis confirmed a positive spatial autocorrelation global between IDH mortality rates (Moran’s I: 0.633, p < 0.01). The LISA analysis identified six high-high pattern clusters composed by 66 municipalities (16.5%). GWR presented the best model (Adjusted R²: 0.72) showing that accessibility to cardiologists and chemical reperfusion centers, and revascularization and angioplasty rates differentially affect the IHD mortality rates geographically. Aging and illiteracy rate presented positive correlation with IHD mortality rate, while income ratio presented negative correlation (p < 0.05).Conclusion:Regions of vulnerability were unveiled by the spatial analysis where sociodemographic, exam coverage and accessibility to health variables impacted differently the IHD mortality rates in Paraná state, Brazil.Highlights

• The increase in ischemic heart disease mortality rates is related to geographical disparities.
• The IHD mortality is differentially associated to socioeconomic factors, exam coverage, and access to health.
• Higher accessibility to chemical reperfusion centers did not necessarily improve patient outcomes in some regions of the state.
• Clusters of high mortality rate are placed in regions with low amount of cardiologists, income and schooling.

     

Association Between Quality of Primary Care and Hospitalization for Coronary Heart Disease in England: National Cross-sectional Study

BACKGROUND A new pay-for-performance scheme for primary care physicians was introduced in England in 2004 as part of an initiative to link the quality of primary care with physician pay. OBJECTIVE To investigate the association between the quality of primary care and rates of hospital admissions for coronary heart disease. DESIGN Ecological cross-sectional study using data from the Quality and Outcomes Framework for family practice, hospital admissions, and census data. PARTICIPANTS All 303 primary care trusts in England, covering approximately 50 million people. MEASUREMENTS Rates of elective and unplanned hospital admissions for coronary heart disease and rates of coronary angioplasty and coronary artery bypass grafting were regressed against quality-of-care measures from the Quality and Outcomes Framework, area socioeconomic scores, and disease prevalence. RESULTS Correlations between prevalence, area socioeconomic scores, and admission rates were generally weak. The strongest relations were seen between area socioeconomic scores and elective and unplanned hospital admissions and revascularization procedures among the age group 45–74 years. Among those aged 75 years and over, the only positive association observed was between area socioeconomic scores and unplanned hospital admissions. CONCLUSIONS The lack of an association between quality scores and admission rates suggests that improving the quality of primary care may not reduce demands on the hospital sector and that other factors are much better predictors of hospitalization for coronary heart disease.