A randomized controlled trial of an information booklet for hypertensive patients in general practice

A randomized controlled trial of an information and medical record booklet designed to improve patient understanding and participation in the management of hypertension was conducted in six inner London general practices. After one year there were no significant differences between the group who had received the booklets and the control group in mean systolic or diastolic blood pressure, but the study group scored significantly higher on knowledge about hypertension and its management. However, the difference between the two groups was small, possibly because both groups started with a high level of understanding about hypertension and its management. In addition, the mean diastolic blood pressure in the control group showed that the treatment provided was already satisfactory, and that there was little need for improvement. Nevertheless, the information booklet evaluated in this study provides health professionals with a highly acceptable method of informing the patient about hypertension and its management and could be used both in hospital and general practice.     

Social and lifestyle characteristics and burden of ill-health associated with self-reported hearing and vision impairments in older men in the British community: a cross-sectional study

BackgroundSensory impairment is common in older adults and we need to understand more about its association with other health conditions. We explored sensory impairment in relation to demographic, lifestyle factors, and health conditions in older men.MethodsIn a cross-sectional study, 3981 men aged 63–85 years (82% of participants recruited to the British Regional Heart Study cohort in 1978–80 and still alive in 2003) were selected from general practices in 24 British towns. Data on hearing aid use and ability to follow television at a volume others find acceptable allowed for four categories of hearing: can hear (n=2851), can hear with an aid (n=482), cannot hear and no aid (n=424), and cannot hear despite an aid (n=168). Vision impairment was defined as not being able to recognise a friend across a road (n=124). Logistic regression was used to investigate associations of hearing impairment and vision impairment with self-reported doctor-diagnosed coronary heart disease, disability (difficulty taking the stairs, difficulty keeping balance), social interaction (attending few social activities), and quality of life (experiencing pain, feeling anxious or depressed).Findings1074 men (27%) reported hearing impairment and 124 (3%) reported vision impairment. Compared with those reporting no hearing problem, hearing impairment was associated with disability, poor social interaction, and poor quality of life. Poor quality of life remained significant after having adjusted for social class, smoking, obesity, and physical activity. Only men who could not hear despite having a hearing aid were more likely to report coronary heart disease (age-adjusted odds ratio 1·89, 95% CI 1·36–2·63) and falls (1·62, 1·05–2·48). Vision impairment was associated with symptoms of coronary heart disease including chest pain (1·58, 1·07–2·40) and breathlessness (2·06, 1·38–3·06), but not with diagnosed coronary heart disease (1·39, 0·93–2·07). Vision impairment was also significantly associated with falls, poor quality of life, poor social interaction, and disability, which remained significant after adjusting for social class, smoking, obesity, and physical activity. Men with a sensory impairment were more likely to be physically inactive, obese (hearing impairment only), and in a manual social class.InterpretationOlder men with hearing impairment and vision impairment have a high risk of disability, poor health, and poor social interaction. Policy efforts for early detection and treatment of sensory impairment could be crucial for independent living in old age.FundingThe British Regional Heart Study is funded by the British Heart Foundation. AEML is funded by the National Institute for Health Research School for Public Health Research. SER is funded by a UK Medical Research Council Fellowship.     

Femoral atherosclerosis in an older British population: prevalence and risk factors

Most estimates of the prevalence of peripheral atherosclerosis have been based on intermittent claudication or lower limb blood flow. The aim of this study was therefore to determine the prevalence of underlying femoral plaque, and to determine its association with other cardiovascular disease and risk factors. Presence of plaque was identified using ultrasound in a random sample of men (n=417) and women (n=367) aged 56-77 years. Coexistent cardiovascular disease, exercise and smoking were determined by questionnaire, blood pressure was recorded, and serum cholesterol and plasma fibrinogen were determined. Of the 784 subjects that were scanned, 502 (64%) demonstrated atherosclerotic plaque. Disease prevalence increased significantly with age (P<0.0001), and was more common in men (67.1 vs. 59.4%, P<0.05). Subjects with femoral plaque had a significantly greater odds of previous ischaemic heart disease (OR 2. 2, 95% CI 1.3, 3.7) and angina (OR 1.7, 95% CI 1.03, 2.7), but not of stroke or leg pain on exercise. Current and ex-smoking, raised serum total cholesterol and plasma fibrinogen levels, but not blood pressure, were associated with an increased risk of femoral plaque, independent of age and sex. Frequent exercise and a high HDL cholesterol were significantly associated with lower risk. In conclusion, therefore, atherosclerotic disease of the femoral artery affects almost two-thirds of the population in late middle age. It is associated with an increased prevalence of ischaemic heart disease and angina, but whether detecting at risk individuals using ultrasound offers advantages over simpler and less expensive risk factor scoring requires evaluation in trials.     

Do women exhibit greater differences in established and novel risk factors between diabetes and non-diabetes than men? The British Regional Heart Study and British Women’s Heart Health Study

Aims/hypothesis  

Type 2 diabetes is associated with greater relative risk of CHD in women than in men, which is not fully explained by conventional cardiovascular risk factors. We assessed whether cardiovascular risk factors including more novel factors such as markers of insulin resistance, inflammation, activated coagulation and endothelial dysfunction differ more between diabetic and non-diabetic women than between diabetic and non-diabetic men, and the role of insulin resistance.     

The obesity paradox in men with coronary heart disease and heart failure: The role of muscle mass and leptin

Aims

We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox.

Background

The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF).

Methods

Prospective study of 4046 men aged 60–79 years followed up for a mean period of 11 years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF.

Results

Overweight (BMI 25–9.9 kg/m²) and obesity (BMI ≥ 30 kg/m²) were associated with lower mortality risk compared to men with normal weight (BMI 18.5–24.9 kg/m²) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p = 0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p = 0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p = 0.60 for trend) but made minor differences to those with HF [p = 0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p = 0.98 for trend].

Conclusion

The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association.     

Social inequalities and disability in older men: prospective findings from the British regional heart study

The independent association of socio-economic position with self-reported disability was assessed. The effect of home and car ownership as additional indices of socio-economic position within occupational social classes was explored. Data from a prospective study of a cohort of 7735 men aged 40-59 years at recruitment and representative of the occupational social class distribution of middle-aged men in Great Britain were used. Men were selected from one general practice in each of 24 towns in England, Wales and Scotland in 1978-1980. The present study concerns 5773 (88.4% of those able to take part) men aged 52-73 years at follow up in 1992 who completed the disability section of a postal questionnaire. A quarter (1453) of men reported disability. Socio-economic position measured as both occupational class (social class I vs. V: age-adjusted OR 5.0, 95% CI 3.4-7.5) and ownership of home and car (both vs. neither: age-adjusted OR 2.8, 95% CI 2.3-3.4) showed a graded relationship with likelihood of reporting disability in 1992. Within all social class groups, those owning both home and car had a lower risk of disability than those who owned neither, even after adjustment for a wide range of risk factors. Men from manual occupations were more likely than those in non-manual occupations to report disability on developing chronic diseases. The relationship between socio-economic position and severe, but not milder, disability appeared to be independent of disease status. Socio-economic position is a strong predictor of disability in later life independent of a wide range of lifestyle factors and presence of diagnosed disease. The likelihood of reporting disability between and within social class groups is influenced by material wealth.