Diet for preventing cardiovascular diseases: light from Ancel Keys, distinguished centenarian scientist

On the great occasion of Professor Ancel Keys' 100th birthday (26 January,2004), it is particularly appropriate--and highly relevant for today and tomorrow--to note the highlights of his professional accomplishments and contributions: the Seven Countries Study (SCS) he initiated and led demonstrated unequivocally in its cross-population analyses that dietary saturated fat intake significantly influences serum cholesterol and the risk of coronary heart disease (CHD), and in turn serum cholesterol relates to CHD risk. In SCS analyses on the several thousand individual participants, it further showed that serum cholesterol, blood pressure, and cigarette smoking all have a continuous, graded, strong, independent, predictive relation to long-term CHD. These data have been critically invaluable for the definition of the major coronary risk factors and low risk status. In scores of metabolic ward feeding trials, Keys and colleagues also demonstrated that dietary saturates and cholesterol relate positively to serum cholesterol, polyunsaturates inversely, and they derived the predictive equation bearing Keys' name. They further showed that increased dietary fiber and weight loss by obese people contribute to reduction of serum cholesterol. All these data served importantly for the development of sound public policy for CHD prevention, and Keys--along with many colleagues all over the world whom he trained and inspired--pioneered in the struggle to achieve and apply that policy in modern public health and medical care.     

The prevalence of cardiovascular risk factors among centenarians is low: risk factors in centenarians.

BACKGROUND: The presence of major cardiovascular risk factors was investigated in a group of centenarians. METHODS: The following risk factors: sex, smoking, overweight, diabetes, hypertension and hypercholesterolemia were analysed in 93 centenarians and compared with data obtained from 90 individuals age 40-60 years. RESULTS: Smoking, overweight and hypercholesterolemia were found statistically more often in a younger population, whereas hypertension was diagnosed more frequently in centenarians. No or one risk factor were found in 55.4% of centenarians and in 14.2% of younger subjects. CONCLUSIONS: Centenarians are characterized by a much better cardiovascular risk profile than middle-aged individuals. This indicates that longevity is related to low cardiovascular risk.     

Healthy centenarians do not exist, but autonomous centenarians do: a population-based study of morbidity among Danish centenarians

OBJECTIVE: To assess the prevalence of common illnesses in an unselected population of centenarians. DESIGN: A population-based survey. SETTING: Denmark. PARTICIPANTS: All Danes who celebrated their 100th anniversary between April 1, 1995 and May 31, 1996: 276 persons. MEASUREMENTS: All participants (including proxies) were visited at their domicile for an interview (sociodemographic characteristics, activities of daily living, living conditions, need of assistance from other people, former health and current diseases, current medication) and a clinical examination (dementia screening test, heart and lung auscultation, neurological assessment, height and weight, electrocardiogram, arm and ankle blood pressure, assessment of hearing and vision capacity, a short physical performance test, bio-impedance, lung function test, blood test). Further health information was retrieved from medical files and national health registers. RESULTS: Seventy-five percent (207) of eligible subjects participated in the study. Cardiovascular disease was present in 149 (72%) subjects. Osteoarthritis (major joints) was present in 54%, hypertension (> or =140/ > or =90) in 52%, dementia in 51%, and ischemic heart disease in 28%. The mean number of illness was 4.3 (standard deviation (SD) 1.86). Only one subject was identified as being free from any chronic condition or illness. Sixty percent had been treated for illness with high mortality. In 25 autonomous (nondemented, functioning well physically, living at home) and 182 nonautonomous centenarians, comorbidities were equivalent. CONCLUSION: Because they have a high prevalence of several common diseases and chronic conditions, Danish centenarians are not healthy. However, a minor proportion was identified as being cognitively intact and functioning well.     

Dementia is not inevitable: a population-based study of Danish centenarians

The authors evaluated the prevalence of dementia in centenarians. In this population-based survey, persons living in Denmark who turned 100 during the period April 1, 1995--May 31, 1996 (N = 276) were interviewed and examined at their residences. Additional health information was retrieved from medical files, including the National Discharge Registry. A participation rate was 75%, and no differences were found between participants and nonparticipants regarding sex and type of housing. The prevalence of mild to severe dementia in centenarians was 51%; 37% had no signs of dementia. Among the 105 demented centenarians, 13 (12%) had diseases (vitamin B12 and folic acid deficiencies, hypothyroidism, Parkinson's disease) that could contribute to a dementia diagnosis. Of the remaining 92 demented participants, 46 (50%) had 1 one or more cerebro- or cardiovascular diseases known to be risk factors in the development of dementia. The prevalence of these risk factors was the same in demented and nondemented participants, whereas hypertension was significantly more frequent in nondemented than demented participants. Dementia is common but not inevitable in centenarians. Cerebro- and cardiovascular diseases are equally common in demented and nondemented persons.     

Treatment program for erectile dysfunction in patients with cardiovascular diseases

The present study assesses the effectiveness of our progressive treatment program for erectile dysfunction in patients with cardiovascular diseases. The study sample included 453 patients aged 36 to 91 years. Therapy in all patients was begun with sildenafil citrate 25 to 100 mg. Those with contraindications, drug adverse effects, or a negative response (erection insufficient for vaginal penetration) were given intracavernous injections of a cocktail of vasoactive drugs (dimix, trimix, or quadmix), followed by the addition of sildenafil citrate to the trimix in case of failure, and then a penile prosthesis. Patients were followed for 2 years; in cases of treatment ineffectiveness during follow-up, drug dosages were increased or a penile prosthesis was suggested. Sildenafil citrate was offered to 417 patients of whom 205 (49.2%) responded positively. The remaining 248 patients received intracavernous injections: 135 (54.4%) had a positive response to the dimix, 85 (75.2%) to the trimix, and 16 (57.1%) to the quadmix. Four of the other 12 patients (0.9%) responded to sildanefil citrate + trimix, and 2 (0.4%) agreed to a penile prosthesis. At the 2-year follow-up of 447 patients, 131 (29.3%) were successfully treated with sildanefil citrate, 92 (20.6%) with dimix, 122 (27.3%) with trimix, 12 (2.7%) with quadmix, and 2 (0.4%) with sildanefil citrate + trimix; 5 patients (1.1%) had a penile implant. Forty-eight patients (10.7%) achieved spontaneous erection, of whom 46 were taking aspirin. Twenty-six patients (5.8%) stopped treatment because of health and family reasons and 9 (2%) had a negative response. Our progressive treatment program for erectile dysfunction has a high success rate in patients with cardiovascular disease: Overall, 98.7% achieved an erection sufficient for vaginal penetration immediately after the trial and 92.2% on follow-up; 10.7% achieved spontaneous erections.     

First autopsy study of an Okinawan centenarian: absence of many age-related diseases

Consistent with the compression-of-morbidity hypothesis, several studies have reported that a significant proportion of centenarians delay or escape age-related diseases. Of those who live with such diseases for a long time, many appear to do so with better functional status than do younger persons who do not achieve extreme old age. The authors describe the first autopsy in an Okinawan-Japanese centenarian who escaped many age-related illnesses and delayed frailty toward the end of her very long life. Her late-life morbidity pattern is contrasted with that of white centenarians.     

海南省百岁老人膳食维生素摄入与慢性疾病相关性

目的了解海南省百岁老人膳食维生素摄入情况,探讨多种维生素水平与长寿人群的肥胖、高血压、血脂紊乱和高血糖的关系,提出改善百岁老人营养和健康的建议。方法2014年6月至2016年12月,课题组逐户走访了海南省各市、县百岁老人,把年龄超过99岁纳入研究人群,研究对象为参加医学体检并采集膳食调查问卷者,共有992人(男177人,女815人,年龄100~115岁),参加抽血检测的有967人。采取本人或家属连续7 d食物频率和24 h膳食回顾法记录研究对象的食物摄入量,按《中国食物成分表》计算食物中维生素(V)A、VE、VB1、VB2、烟酸(PP)和VC的摄入量。结果百岁老人膳食维生素VA、VE、VB1、VB2、PP及VC的缺乏率分别为80.13%、87.55%、45.81%、67.63%、30.26%及23.59%。海南省百岁老人代谢综合征(MS)患病率为53.67%(519/967)。非MS组较MS组VA、VE及PP的摄入量高,差异具有统计学意义(P<0.05)。VA的Q4、VE的Q3和VB2的Q4均可使高血压危险性降低,变化趋势有统计学意义(P<0.05);VB2使低HDL-C危险性升高,变化趋势均有统计学意义(P<0.05)。结论海南省百岁老人膳食维生素摄入普遍较低,MS患病率与多种维生素摄入水平相关,百岁老人应适量增加富含VA、VE及VB2的食物,同时以改善其生命质量为重。     

北京房山社区人群心血管病综合防治研究

目的探索我国农村人群心血管病综合防治经验，初步总结一套有推广价值的综合防治方案。方法采用全人群与高危人群结合的防治策略，研究社区范围包括５个乡，１０万以上人口。干预方式和主要措施：（１）在卫生保健服务和社区组织体系基础上建立健全三级防治网。（２）健康教育和健康促进。（３）基层心血管病防治人员的培训。（４）高血压检出、随访和管理。结果基线调查和复查分别于１９９１～１９９２年度和１９９５年完成，通过３年干预，干预区人群知识、态度和行为得分明显高于对照区，干预区人群态度和行为向有利于心血管病防治方向改变。干预区高血压患者血压测量率和管理率分别明显高于对照区（Ｐ＜０．０１）。与对照区相比，干预区人群收缩压净下降１．２ｍｍＨｇ（Ｐ＜０．０５），但体重和体重指数略有升高。干预区脑卒中发病率下降１３．５％（Ｐ＜０．０１）；脑卒中死亡率下降了１２．９％（Ｐ＜０．０１）。对照区正相反，脑卒中发病率和死亡率均有所上升。结论心血管病综合防治方法与措施可行，初步取得预防和降低脑卒中发病和死亡的效果。     

Health and function assessments in two adjacent Danish birth cohorts of centenarians: Impact of design and methodology

Using the results from measures of functional ability, cognitive and physical performance from two adjacent birth cohorts of 100-year-old adults, we aimed to elucidate the possible impact of difference in participation rates, design, and interviewer mode. Participants were birth cohort members born in 1910 (DK-1910) and 1911-12 (DK-1911). Both surveys used the same assessment instruments, but the design was different, and data collection was carried out by trained survey agency interviewers in DK-1910 and trained nurses in DK-1911. Participation rate in DK-1911 (49.8 % (251/504)) was lower than in DK-1910 (66.9 % (273/408)) (p < 0.001). The proportion of interviews with the participant answering alone or mainly alone was significantly higher in DK-1911 (77 %) than in DK-1910 (56 %), and the proportion living in nursing home was significantly lower (44 vs. 54 %, respectively). Higher proportions of DK-1911 independently performed all activities of daily living (ADL) compared to DK-1910, but only significantly for toileting, bathing, and feeding (all p < 0.01). Mini-mental state examination (MMSE) score was higher in DK-1911 than in DK-1910 (23.5 vs. 21.0; p < 0.001). Handgrip strength, gait speed, and chair stand were almost similar. DK-1911 participants had significantly better one-year survival than DK-1911 non-participants and DK-1910 participants and non-participants (p = 0.001). These results suggest that lower participation rate entails selection towards healthier participants in terms of ADL and cognitive functioning. Caution is warranted when comparing studies of centenarians with different participation rates, design, and interviewer mode, and further studies of these methodological issues are required.     

Statins: maid-of-all-work in cardiovascular diseases!

Inhibitors of HMG-CoA reductase (statins) lower the level of circulating LDL-C by blocking the activity of HMG-CoA reductase. Their efficiency to prevent cardiovascular events was demonstrated in several clinical trials for primary and secondary prevention. However, subgroups analysis of trials together with experimental studies have increasingly documented that the beneficial effects of statins extend beyond the sole reduction in LDL-C. These effects include improvements of vasoreactivity, haemostasis and plaque stability, reduction of pro-inflammatory events such as a decrease in monocyte adhesion and infiltration, oxidation level and pericellular proteolysis. Possible repair of ischemic tissues through enhancement of mobilization of endothelial progenitor cells are also described, although more investigation are needed to clearly identify the role and safety of statins in angiogenesis. These pleiotropic effects are generally explained by the fact that statins inhibit the intracellular production of metabolites located downstream of mevalonate in the cholesterol pathway, such as isoprenoids (farnesyl pyrophosphate and geranylgeranylpyrophosphate). These hydrophobic metabolites allow the membrane anchorage of small G proteins (Ras and Rho) as well as the Gy subunit of heterotrimeric G proteins, a post-translational step that is critical in the regulation of G protein signaling activity. These drugs are therefore a valuable tool not only for the clinician but also for the biologist, allowing to investigate the regulation of gene expression that is controlled by the intracellular activity of membrane-anchored prenylated signaling proteins.     

The cardiovascular manifestations of rheumatic diseases

PURPOSE OF REVIEW: To review the cardiovascular manifestations of several more common rheumatic conditions in the light of the recent reported literature. RECENT FINDINGS: Evidence that chronic inflammation is associated with the occurrence of cardiac events in people both with and without chronic inflammatory joint disease is emerging. Both atherosclerosis and rheumatic diseases, however, have a complicated cause, and it is likely that inflammation contributes to other environmental and host risk factors in these patients. Treatments used to suppress inflammation in many rheumatic conditions have the potential to reduce cardiovascular disease morbidity as well as improve musculoskeletal function. SUMMARY: Cardiovascular morbidity and mortality have been found to be increased in association with many of the rheumatic diseases. In particular, coronary heart disease seems to be associated with inflammatory rheumatic conditions. Whilst it is likely that chronic systemic inflammation promotes accelerated atherosclerosis in these patients, the mechanisms by which this occurs are complex and the effects of treatment and other cardiovascular risk factors need to be considered.     

促红细胞生成素在心血管疾病中的应用

促红细胞生成素原用于贫血的治疗,但近年研究发现除促造血作用以外,还有细胞保护及促血管生成等作用,可用于缺血性心脏病、心力衰竭等心血管疾病的治疗.本文就其在心血管疾病中的应用进展情况作一综述.     

Microparticles in cardiovascular diseases

Microparticles are membrane vesicles released from many different cell types. There are two mechanisms that can result in their formation, cell activation and apoptosis. In these two mechanisms, different pathways are involved in microparticle generation. Microparticle generation seems to be a well regulated process. Microparticles vary in size, phospholipid and protein composition. They have a potent pro-inflammatory effect, promote coagulation and affect vascular function. Since these processes are all involved in the pathogenesis of cardiovascular disease and circulating microparticle numbers are altered in many cardiovascular diseases, a role for microparticles in the pathogenesis of cardiovascular diseases is likely. Although hard evidence for a role of microparticles in cardiovascular diseases at present is still only limited, new evidence is accumulating rapidly to support this theory. Elucidation of the microparticle composition and the mechanisms involved in exertion of their effects will supply this evidence and enable us to develop additional intervention strategies for prevention and treatment of cardiovascular diseases.