Association Of Ischemic Heart Disease Research Articles

Road traffic noise pollution and prevalence of ischemic heart disease: modelling potential association and abatement strategies in noise-exposed areas.

In many developing countries with surging vehicular traffic and inadequate traffic management, excessive road traffic noise exposure poses substantial health concerns, linked to increased stress, insomnia and other metabolic disorders. This study aims to assess the linkage between sociodemographic factors, traffic noise levels in residential areas and health effects using a cross-sectional study analyzing respondents' perceptions and reports. Noise levels were measured at 57 locations in Srinagar, India, using noise level meter. Sound PLAN software was employed to generate noise contour maps, enabling the visualization of noise monitoring locations and facilitating the assessment of noise levels along routes in proximity to residential areas. Correlation analysis showed a strong linear relationship between field-measured and modelled noise (r2 = 0.88). Further, a questionnaire-based survey was carried out near the sampling points to evaluate the association of ischemic heart disease with traffic noise. Residents exposed to noise levels (Lden > 60dB(A)) were found to have a 2.24 times higher odds ratio. Compared to females, males reported a 16% higher prevalence of the disease. Multi-faceted policy strategies involving noise mapping initiatives, source noise standards, traffic flow urban mobility optimization, smart city initiatives and stringent litigatory measures could significantly reduce its detrimental impact on public health. Finally, this study envisions a region-specific strong regulatory framework for integrating noise pollution mitigation strategies into the public health action plans of developing nations.

Reclassification of CADILLAC risk score with lung ultrasound at admission in patients with STEMI in a one-year follow-up

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): JC-M received Original Research Projects Grant from the Catalan Society of Cardiology and LR-S received Scholarship for Training and Research from the Association of Ischemic Heart Disease and Cardiological Critical Care of the Spanish Society of Cardiology. Introduction Lung ultrasound (LUS) has emerged as a valuable diagnostic and prognostic tool in heart failure (HF) and shows promise in risk stratification for ST-segment elevation myocardial infarction (STEMI) during the acute phase. Current risk stratification scales for STEMI primarily rely on the Killip scale to assess the severity of heart failure (HF) upon admission. However, these scales were developed before the widespread use of LUS, and as a result, LUS findings have not been incorporated into any existing risk stratification scales for STEMI. Purpose To assess the potential improvement in prognostic predictive value achieved by incorporating LUS findings into a current risk score for STEMI. Methods In a prospective multicenter cohort study, an independent operator conducted LUS, and offline B-line counting was performed upon admission. Patients were categorized as having wet lung (at least one site with ≥3 B-lines) or dry lung based on LUS results. The CADILLAC score was calculated, and patients were classified as either low risk (≤2 points) or medium/high risk (>2 points). We evaluated the Net Reclassification Index (NRI) and conducted a Receiver Operating Characteristics (ROC) comparison based on the prediction of a composite endpoint which included death, hospitalization for HF, acute coronary syndrome, or stroke within one year following revascularization. Results The CADILLAC score was computed for 353 patients after excluding those admitted with Killip IV. Among these, 216 (61.2%) had a low-risk score (≤2), and 137 (38.8%) had a medium-high score. LUS significantly reclassified CADILLAC results, resulting in an absolute NRI of 12.4%. ROC comparison of models comprising CADILLAC and CADILLAC + LUS demonstrated that the addition of LUS significantly improved the accuracy of predicted risk (0.722 vs. 0.770, p=0.05). Conclusion The inclusion of LUS findings in the CADILLAC score enhances its prognostic capacity.Figure 1

Prognostic evaluation of ST-segment elevation acute myocardial infarction according to lung ultrasound in the acute phase

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): JC-M received an Original Research Projects Grant from the Catalan Society of Cardiology and LR-S received Scholarship for Training and Research from the Association of Ischemic Heart Disease and Cardiological Critical Care of the Spanish Society of Cardiology. Introduction Lung ultrasound (LUS) has emerged as a useful diagnostic and prognostic tool in heart failure (HF) and has shown promise in risk stratification for ST-segment elevation myocardial infarction (STEMI) in the acute phase. These studies consistently indicate that the degree of pulmonary congestion, assessed by the number of B-lines on LUS, is significantly associated with a worse prgnosis during hospitalization and short-term follow-up in STEMI patients. However, this prognostic value has mainly been evaluated during hospital admission or a few days after discharge without a long-term follow-up. Purpose To assess the prognostic value of LUS at one year in patients admitted for STEMI. Methods In a prospective multicenter cohort study involving STEMI patients, an independent operator performed LUS during the first 24 hours after revascularization and offline B-line counting was conducted. LUS results were assessed both as a categorical [wet (at least one site with ³3 B-lines)/dry lung] and continuous variable (total number of B-lines). The primary endpoint was a composite of death or hospitalization for HF, acute coronary syndrome, or stroke within one year. Results A total of 173 patients were included. The composite endpoint occurred in 13.7% of the patients over a median follow-up of 368 days. LUS was able to predict the composite outcome with hazard ratios (HR) of adjusted hazard ratios of 4.85 (95% CI 2.79-8.43) for having a wet lung and 1.13 (95% CI 1.09-1.18) for each B-line. After and adjustment for sex, age, chronic kidney disease, previous atrial fibrillation, Killip class and left ventricular ejection fraction HR was 1.72 (95% CI 0.91-3.28) for having a wet lung and 1.06 (95% CI 1.00-1.11) for each B-line. Conclusion Detecting B-lines on LUS predicts adverse events at one year in STEMI patients.Kaplan-Meier curves

Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability.

Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability Association of ischemic heart disease (adjusted for traditional risk factors and socioeconomics variables) and income level (A), and walkability z-score (B), and association of walkability z-score and income level (C). Socioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability). Data from the association between income and IHD is lacking in middle-income countries. It is also uncertain whether walkability mediates this association. To investigate whether income is associated with IHD in a middle-income country and whether neighborhood walkability mediates the income-IHD association. This cross-sectional study evaluated 44,589 patients referred for myocardial perfusion imaging (SPECT-MPI). Income and walkability were derived from participants' residential census tract. Walkability quantitative score combined 4 variables: street connectivity, residential density, commercial density, and mixed land use. IHD was defined by abnormal myocardial perfusion during a SPECT-MPI study. We used adjusted mixed effects models to evaluate the association between income level and IHD, and we performed a mediation analysis to measure the percentage of the income-IHD association mediated by walkability. We considered p values below 0.01 as statistically significant. From 26,415 participants, those living in the lowest-income tertile census tract were more physically inactive (79.1% versus 75.8% versus 72.7%) when compared to higher-income tertile census tracts (p < 0.001). Income was associated with IHD (odds ratio: 0.91 [95% confidence interval: 0.87 to 0.96] for each 1,000.00 international dollars increase in income) for both men and women equally (p for interaction = 0.47). Census tracts with a higher income were associated with better walkability (p < 0.001); however, walkability did not mediate the income-IHD association (percent mediated = -0.3%). Income was independently associated with higher prevalence of IHD in a middle-income country irrespective of gender. Although walkability was associated with census tract income, it did not mediate the income-IHD association.

Association of ischemic heart disease with long-term risk of cognitive decline and dementia: A cohort study.

The independent and joint effect of ischemic heart disease (IHD) and coexisting atrial fibrillation (AF) and heart failure (HF) on dementia risk is largely unknown. This population-based cohort study included 2568 dementia-free participants (age ≥60 years) in SNAC-K, who were regularly examined from 2001-2004 through 2013-2016. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Global cognitive function was assessed using a global cognitive composite z-score derived from five cognitive domains. Data were analyzed using Cox, Fine-Gray, and linear mixed-effects models. Overall, IHD at baseline was associated with multivariable-adjusted hazard ratio (HR) of 1.39 (95% confidence interval=1.06-1.82) for dementia and multivariable-adjusted β-coefficient of -0.02 (-0.03 to -0.01) for annual changes in global cognitive z-score, independent of AF, HF, and cerebrovascular disease. Coexisting AF or HF did not add further risk to dementia and cognitive decline. IHD is independently associated with dementia and cognitive decline in older adults, whereas coexisting AF/HF is not associated with an increased risk. Is a history of ischemic heart disease (IHD) associated with a risk for dementia? How do coexisting heart diseases affect this association? IHD was an independent risk factor for dementia in older adults. This association was independent of coexisting heart and cerebrovascular diseases. The coexistence of heart diseases did not confer additional risk for dementia.

Prognostic value of subclinical congestion assessed by lung ultrasound in STEMI patients in a short-term follow-up

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This project received a Scholarship for Training and Research from the Association of Ischemic Heart Disease and Cardiological Critical Care of the Spanish Society of Cardiology and an Original Research Projects Grant from the Catalan Society of Cardiology. Background Heart failure (HF) is an important prognostic factor in ST-segment elevation myocardial infarction (STEMI). Although most STEMI patients are Killip-Kimball class I (KK-I) at admission, there is a risk of developing HF during hospitalization and follow-up. Lung ultrasound (LUS) is an easy, fast, and accurate technique that allows pulmonary congestion to be diagnosed even in pre-clinical stages. Several risk scores have been developed to identify low-risk STEMI patients, nonetheless any of these scores include LUS assessment. Purpose We evaluated the prognostic value of subclinical congestion assessed by LUS at hospital admission in patients with KK-I STEMI. Primary endpoint was a composite of readmission for HF or new acute coronary syndrome or death during 30-day follow-up. Methods This was a multicenter study prospectively enrolling 300 patients admitted for KK-I STEMI. LUS was performed during the first 24 hours after revascularization by and independent operator and B-lines were counted off-line differentiating between patients with wet lung (≥ 3 B-lines in at least one lung field) or dry lung. To assess whether LUS could improve the predictive capacity of current risk scales, a model with categorical result of LUS (dry/wet lung) and categorical result of Zwolle score (low/higher risk) was compared to the isolated result of Zwolle score and net reclassification index (NRI) was calculated. Results Wet lung patients had a higher risk of developing the follow-up composite endpoint (hazard ratio [HR] 10.8, 95% CI 2.6-45.2, p=0.001). After adjusting by a propensity score including age, sex, hypertension, chronic kidney disease (glomerular filtration rate &amp;lt;60ml/min/1,73m2), previous atrial fibrillation/flutter, anterior STEMI, and LVEF, a LUS finding of wet lung remained an independent risk factor for the composite endpoint (adjusted HR 5.4, 95% CI 1.0-28.7, p=0.049). LUS was able to predict de composite endpoint with 62.5% sensitivity, 86.8% specificity, 11.1% positive predictive value and 98.9% negative predictive value. LUS improved the predictive capacity of the Zwolle score (net reclassification improvement = 0.99, 95% CI 0.29-1.69, p=0.006) to predict the composite endpoint. CONCLUSIONS Early subclinical pulmonary congestion identified by LUS in KK-I STEMI patients at hospital admission is a strong predictor of adverse outcomes at 30-day follow-up. Patients without subclinical congestion have a very low risk of adverse outcomes and can potentially benefit from an early discharge. LUS improves the predictive ability of the Zwolle risk score, allowing a more accurate identification of low-risk patients.

Lung ultrasound can predict heart failure developing and mortality during hospitalization in ST-segment elevation myocardial infarction

Abstract Introduction About 10% of patients admitted for ST-segment elevation myocardial infarction (STEMI) present with signs of heart failure at admission. Heart failure developed during hospitalization and mortality are uncommon complications in patients admitted for STEMI with no signs of heart failure at admission (Killip-Kimball class I, KKI). Most of these patients have a good prognosis during hospitalization. B-lines in lung ultrasound (LUS) provide useful diagnostic and prognostic information in heart failure patients with the potential to stratify the risk of complications in patients presenting with STEMI KKI. Purpose To evaluate the predictive value of the LUS to develop heart failure and death during hospitalization in patients admitted with STEMI KKI. Methods This is a prospective observational multicenter study. Consecutive patients admitted for STEMI KKI in two tertiary hospitals were included. Exclusion criteria were patients with cardiac arrest at presentation, severe lung disease or hemodialysis. The LUS was carried out by an independent operator blinded to clinical data in the first 24 hours after admission. We counted B-lines using 8-scan site LUS protocol and divided patients in two groups: wet lung group (3 or more B-lines in at least one zone) and dry lung (no positive zone). The primary endpoint was a composite of clinical congestive heart failure, cardiogenic shock or mortality during the index hospitalization. Results From June 2020 to February 2021, 135 patients STEMI KKI patients were included. Twenty-nine patients (21,5%) had a wet lung according to the LUS. Ten patients (7,4%) presented the primary outcome (all of them developed heart failure, 1 of them cardiogenic shock and 2 of them died during hospitalization). Eight in 29 wet-lung patients (27,6%) presented the primary outcome whereas only 2 in 106 (1,9%) of the dry-lung patients [relative risk of 14,6 (IC 95% 3,3–65,1)]. Patients who develop the primary outcome had no differences in NTproBNP at admission but had higher NTproBNP peak, higher troponin T peak, lower left ventricular ejection fraction and longer length of stay (Figure 1). Conclusions In patients admitted with STEMI KKI, presenting 3 or more B-lines at least at one lung zone in the LUS at first 24 hours after admission was strongly associated with worse prognosis during hospitalization. LUS allows a better risk classification of patients and may potentially discriminate those with potential risk of complications during hospitalization from those with an excellent prognosis who can benefit from early discharge. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 2020 grant for training and research of the Association of Ischemic Heart Disease and Critical Cardiological Care, Spanish Society of Cardiology Figure 1. Baseline data in event/no event groupsFigure 2. Wet lung/dry lung groups events graphic

Relación entre cardiopatía isquémica y la proteína C reactiva.

Las enfermedades cardiovasculares están relacionadas con procesos inflamatorios prolongados o persistentes que causan el aumento de los niveles de reactantes de fase aguda como la proteína C reactiva (PCR), el fibrinógeno y las interleucinas IL-1 e IL-6. Desde este punto es importante saber si existen en los ecuatorianos polimorfismos genéticos ya establecidos para otras poblaciones, en especial en las citosinas IL-1 e IL-6. El objetivo del estudio fue relacionar la proteína C reactiva ultrasensible (PCR-us) en pacientes con cardiopatía isquémica. Se analizaron un total de 91 personas: 50 pacientes con criterios de inclusión para el diagnóstico de cardiopatía isquémica y 41 pacientes sin criterios de inclusión o síntomas de cardiopatía isquémica, escogidos en el área de consulta externa y hospitalización de los Servicios de Cardiología del hospital de Especialidades de las FF.AA. N° 1- Quito y del hospital Carlos Andrade Marín (hospital IESS - Quito).&#x0D; Entre los hábitos, en el grupo de casos prevaleció el tabaquismo 11 pacientes (22 %) seguidos por el alcoholismo y tabaquismo juntos 9 (18 %). 25 individuos (50 %) de este grupo manifestó no tener hábito alguno, debemos mencionar que muchos de estos pacientes acudían a consulta externa de cardiología donde recibían educación médica.&#x0D; El nivel de glicemia en ayunas mayor a 100 mg/dl encontró asociación de padecer cardiopatía isquémica (OR = 4.13, IC 95 %: 1.54 – 11.0), (p = 0.03).&#x0D; Los niveles de LDL, colesterol, triglicéridos y de glicemia en el grupo de los casos fueron superiores en relación con el grupo control.&#x0D; La lectura inmediata de la PCR-us no tuvo una diferencia significativa: p = 0.20 IC del 95 % entre los dos grupos de estudio. Igualmente la lectura de la PCR-us a los 30 minutos: p = 0.21 IC del 95 %.&#x0D; Existe gran interés clínico y fisiopatológico en el desarrollo de nuevos marcadores que nos permitan un diagnóstico rápido y preciso en personas con mayor riesgo de desarrollar futuros eventos cardiovasculares.

ANALYSIS OF THE TRADITIONAL RISK FACTORS INFLUENCE ON DEVELOPMENT OF ISCHEMIC HEART DISEASE IN FAMILIAL HYPERCHOLESTEROLEMIA

Familial hypercholesterolemia (FH) is inherited pathology with increased level of cholesterol, and predisposes for early development of atherosclerosis, but prevalence of cardiovascular pathology in FH patients varies, and demands for more precise definition of additional factors of risk of ischemic heart disease (IHD). Aim . To evaluate in FH patients an association of IHD and classical risk factors (sex, age, arterial hypertension (AH), smoking, obesity, cholesterol of low density lipoproteides (LDL-C) and high density (HDL-C), complicated heredity for cardiovascular disorders), mutation of LDL receptors. Material and methods . Totally, 253 patients studied, age 18 and older, with heterozygous FCHE, diagnoses according to Dutch Lipid Clinic Network, (mean age — 51±3,4 y. o.). 109 patients (43%) underwent genetic test. IHD was diagnosed in 106 (41,8%), anamnesis of acute myocardial infarction (MI) had 63 (24,9%) patients. Results. In FH, IHD was associated with the following risk factors: AH, age older 40 y., complicated inheritance for cardiovascular pathology. An increase of LDL-C level by every1 mM increased the prevalence of CHD in heterozygous FCHE patients by 4,5% up to LDL-C 8,5 mM/L. In higher LDL-C values IHD prevalence increases by 1-2%. In patients with mutation of LDL receptor, IHD develops 5 years earlier. There was no association revealed for the type of mutation and IHD. Conclusion . The main risk factors associated with CHD in heterozygous FH are AH, age more than 40 y. o., complicated inheritance for cardiovascular diseases. The relation of LDL-C and IHD prevalence in FH patients is not linear.

Association of Ischemic Heart Disease Assessed by Radionuclide Myocardial Perfusion Imaging with Bone Mineral Density Measurements by Dual-Energy X-Ray Absorptiometry and Serum Vitamin D Deficiency

Background: Because of the increasing prevalence of both ischemic heart diseases and vitamin D deficiency and also due to recent evidences on association between these two phenomena, it is vital to clarify the association of ischemic heart disease with vitamin D deficiency and low bone mass. Objectives: The aim of the present study was to assess the relationship between low serum vitamin D and low bone mass measured by dual-energy X-ray absorptiometry (DEXA) with ischemic heart disease assessed by the functional radionuclide myocardial perfusion imaging (MPI). Patients and Methods: In this cross-sectional study, 204 consecutive patients aged older than 50 years who were candidates for MPI were included. Blood sample was extracted to measure the level of serum 25-OH vitamin D using a special kit (IDS kit). Then, the patients were assessed by MPI. Within a month of myocardial perfusion scanning, subjects underwent bone mineral density (BMD) measurements by DEXA method. Results: There was no significant difference in serum level of vitamin D between patients with normal and those with abnormal MPI results. In addition, no significant correlation was detected between BMD and myocardial ischemia. Conclusion: Coronary atherosclerosis may not be associated with the severity of low bone mass or level of vitamin D adequacy.

Association Analysis Identifies Risk of Ischemic Heart Disease When Temperature Increases

The increase of mortality from ischemic heart disease has been considered to accompany falling temperature. The effects of temperature rise have been mostly neglected. The aim of this paper is to provide new insights into risk of ischemic heart disease when temperature increases. Many researchers used Poisson regression model to assess this sort of problems. Then, the cases of temperature rise were ignored as a random term in regression equations. In this article, we adopted association analysis, which highlighted the patterns of occurrence of ischemic heart disease when temperature increased. Association rule mining was performed using both daily data of emergency medical transport usage at Nagoya City in Japan and the data of weather information. The use of association analysis identified typical patterns among risky incidence of ischemic heart disease even when the weather became warmer in both winter and summer. The association rule method discovered also the importance of the weather pattern of the preceding day. These findings will suggest the existence of a mechanism, underlying the association of ischemic heart disease with a temperature rise and will contribute to better understanding for incidence of ischemic heart disease during both winter and summer.

Association of ischemic heart disease to global and regional longitudinal strain in asymptomatic aortic stenosis.

Longitudinal deformation has been shown to deteriorate with progressive aortic stenosis as well as ischemic heart disease. Despite that both conditions share risk factors and are often coexisting, studies have not assessed the influence on longitudinal deformation for both conditions simultaneously. Thus the purpose of this study was to evaluate the association between subclinical ischemic heart disease and global and regional longitudinal strain in asymptomatic patients with significant aortic stenosis. Prevalent patients with a diagnosis of aortic stenosis at six hospitals in the Greater Copenhagen area were screened for inclusion. A total of 104 asymptomatic patients with moderate-severe aortic stenosis (aortic valve area ≤1.5 cm(2)) fulfilled study criteria and underwent advanced echocardiographic analysis and coronary angiography by multi-detector computed tomography. Angiography revealed coronary stenosis >50% in 31% (n = 32). All regional longitudinal strain measures (apical, mid and basal longitudinal strain) were significant predictors of significant coronary stenosis (>70% stenosis), but only apical and mid longitudinal strain were significant predictors in multivariable analyses independent of aortic valve area, stroke volume index, pro-BNP, valvulo-arterial impedance, body mass index and heart rate. In linear regression models with both aortic valve area and significant coronary stenosis, apical (p < 0.001) and mid (p < 0.01) longitudinal strain were associated to significant coronary stenosis but not aortic valve area. Conversely, basal longitudinal strain was significantly associated to aortic valve area (p = 0.001), but not to significant coronary stenosis. Subclinical coronary artery disease is frequent in moderate and severe aortic stenosis, and should be suspected when regional longitudinal dysfunction is predominant in the apical and mid ventricular segments.

Lack of association of ischemic heart disease with COPD when taking into account classical cardiovascular risk factors

The aim of our study is to determine whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for ischemic heart disease and whether this association is related with a greater prevalence of classical cardiovascular risk factors. Ours is a case-control cross-sectional study design. Cases were hospital patients with ischemic heart disease in stable phase, compared with control hospital patients. All patients underwent post-bronchodilator (PBD) spirometry, a standardized questionnaire, and blood analysis. COPD was defined as per GOLD PBD forced expiratory volume in the first second (FEV(1))/forced vital capacity (FVC) < 0.70. In our series of patient cases (n = 204) and controls (n = 100), there were 169 men in the case group (83%) and 84 in the control group (84%). Ages were 67 and 64 years, respectively (P < 0.05). There were no significant differences by weight, body mass index (BMI), pack-years, leukocytes, or homocysteine. The abdominal perimeter was significantly greater in cases (mean 101 cm ± standard deviation [SD] 10 versus 96 cm ± 11; P < 0.000). Both groups also had significant differences by C-reactive protein (CRP), fibrinogen, and hemoglobin values. In univariate analysis, increased risks for cases to show with individual classical cardiovascular risk factors were seen, with odds ratio (OR) 1.86 and 95% confidence interval (CI) (1.04-3.33) for diabetes mellitus, dyslipidemia (OR 2.10, 95% CI: 1.29-3.42), arterial hypertension (OR 2.47, 95% CI: 1.51-4.05), and increased abdominal perimeter (OR 1.71, 95% CI: 1.06-2.78). Percent predicted PBD FEV(1) was 97.6% ± 23% in the patient group and 104% ± 19% in the control group (P = 0.01), but the prevalence of COPD was 24.1% in cases and 21% in controls. Therefore, COPD was not associated with ischemic heart disease: at the crude level (OR 1.19, 95% CI: 0.67-2.13) or after adjustment (OR 1.14, 95% CI:0.57-2.29). In conclusion, COPD was not associated with ischemic heart disease. The greater prevalence of classical cardiovascular risk factors in COPD patients could explain the higher occurrence of ischemic heart disease in these patients.

Developmental Programming Through Epigenetic Changes

See related article, pages 520–526 The last decade has seen an exponential number of scientific articles addressing the concept of fetal programming of adult onset diseases. Though it has long been known (as it is probably part of common knowledge in human history) that the environment and life events during the fetal period impact on the child’s development, the notion that intrauterine life can also impact on adult health and on the incidence of late onset diseases such as hypertension and type II diabetes is relatively more recent. In 1964, Rose reported the association of ischemic heart disease and infant mortality within the same families (reviewed by1). Then Forsdahl in 1977 showed that incidence of arteriosclerotic heart disease in a certain age group could be correlated with the infant mortality rate of that same population.1 Interest in these types of association rose dramatically following Professor Barker and collaborators’ extensive observations of a well documented population in England and Wales. The meticulous work of home health visitors in the early 20th century, which noted every child weight and length at birth and throughout the first year of life as well as other observations of the mother health and living milieu, generated data which clearly demonstrated an inverse relationship between birthweight and adult incidence of cardiovascular related mortality and morbidities as well as type II diabetes.1 We will focus here on hypertension and related complications. The association between birthweight and adult blood pressure was demonstrated in many parts of the world, in industrialized as well as in more developing countries, in both men and women.1 The association is first noted in early childhood (but not at birth) and seems to increase with age. Despite the significant number of studies published, which have examined to date tens …

Fetal Origins of Cardiovascular Disease

Human epidemiological studies have shown a clear association of adverse intrauterine environment and an increased risk of ischemic heart disease in later adult life. Although adult lifestyle adds to the effects developed during intrauterine life, compelling evidence indicates that the association of ischemic heart disease with adverse intrauterine environment does not reflect confounding variables linked to adult lifestyle. It is suggested that epigenetic programming in the gene expression pattern caused by adverse intrauterine environments at a critical period of development in early life plays an important role in the heart development, and its lifelong pathophysiological consequences in the adult heart. Potential fetal programming of adult disease has been shown in maternal undernutrition and fetal exposure to glucocorticoids, hypoxia, alcohol, tobacco smoking, and cocaine. Although early epidemiological studies suggest that small body size at birth is associated with an increased risk of death from ischemic heart disease in the adult, it is becoming clear that fetal growth restriction is not a prerequisite of adult disease. Recent animal studies suggest that adverse intrauterine environments suppress fetal cardiac function, alter cardiac gene expression pattern, increase apoptosis of cardiomyocytes, cause a premature exit of the cell cycle of cardiomyocytes and myocyte hypertrophy, and result in an increase in susceptibility of the adult heart to ischemia-reperfusion injury. This review discusses recent epidemiological evidence in humans, as well as evidence from studies in experimental animals, of an association of adverse intrauterine environments and an increased risk of ischemic heart disease in the adult, and the possible molecular mechanisms of epigenetic programming involved in fetal gene expression pattern, which is essential in explaining many fundamental biological processes by which a variety of cardiovascular dysfunctions and disease emerge and evolve.

Virulent strains of Helicobacter pylori and vascular diseases: A meta-analysis

Cytotoxin-associated gene A (CagA)-positive strains of Helicobacter pylori are an etiological factor for peptic ulcer and gastric cancer. Studies on the role of these virulent strains in vascular diseases yield conflicting results. We searched the MEDLINE database for relevant studies. Meta-analysis was performed using the random effects method. We found 10 retrospective case-control studies (with 1527 case patients and 1661 control subjects) and 3 prospective cohort studies (with 701 case patients and 1439 control subjects) on CagA status and ischemic heart disease and 4 retrospective case-control studies (with 513 case patients and 590 control subjects) on CagA status and cerebral ischemia. In the case-control studies, an association of ischemic heart disease with CagA-positive strains (OR 1.87, 95% CI 1.46-2.40) but no significant association with CagA-negative strains (OR 1.15, 95% CI 0.83-1.60) has been found; in the 3 prospective studies, association with ischemic heart disease was weaker but still significant (OR 1.26, 95% CI 1.05-1.51). In the 4 case-control studies, CagA-positive strains were significantly associated with cerebral ischemia (OR 2.43, 95% CI 1.89-3.13), again with no association for CagA-negative strains. We found a small but significant association between vascular diseases and virulent CagA-positive strains of H. pylori. The lack of association with CagA-negative strains further supports the hypothesis of an independent relationship between virulent strains of H. pylori and vascular diseases. The magnitude of the association with cerebral ischemia needs to be confirmed by prospective studies.

Renal dysfunction and ischemic heart disease mortality in a hypertensive population

While recent studies indicate that renal dysfunction may be predictive of all-cause mortality and cardiovascular disease (CVD) outcomes in hypertensive individuals, there has been little attention to the specific association of ischemic heart disease (IHD) mortality and renal function. This study examines the relationship between IHD mortality and baseline glomerular filtration rate (GFR) (estimated by the Cockcroft and Gault formula) among treated hypertensive subjects. A prospective cohort study of participants in a worksite-based antihypertensive treatment program in New York City (1981-1999). We studied 9929 subjects who had at least 6 months follow-up (mean 9.6 years) with a baseline serum creatinine. IHD death outcomes (n=343) ascertained from the National Death Index. Multivariate Cox proportional hazard models were constructed adjusting for known cardiovascular risk factors. Mean GFR of the cohort was 91.6 ml/min per 1.73 m. Those with lower GFR were more likely to be older, female, White, report a history of cardiovascular disease, have higher cholesterol and blood urea nitrogen values, and lower hemoglobin and body mass index than those with highest GFR. After adjustment for known cardiovascular risk factors, the risk of IHD death increased progressively as the GFR decreased. Hazard ratio for IHD mortality for each 10-unit reduction of estimated GFR below the normal threshold of >or=90 ml/min per 1.73 m was 1.33 (95% confidence interval 1.17, 1.50; P<0.001). The results of this study suggest an independent inverse association between estimated GFR and IHD mortality among treated hypertensive individuals.