Cardiovascular Disease Categories Research Articles

Lifestyle factors associated concurrently and prospectively with co-morbid cardiovascular disease in a population-based cohort of colorectal cancer survivors

Aims To assess self-reported lifetime prevalence of cardiovascular disease (CVD) among colorectal cancer survivors, and examine the cross-sectional and prospective associations of lifestyle factors with co-morbid CVD. Methods Colorectal cancer survivors were recruited ( n = 1966). Data were collected at approximately 5, 12, 24 and 36 months post-diagnosis. Cross-sectional findings included six CVD categories (hypercholesterolaemia, hypertension, diabetes, heart failure, kidney disease and ischaemic heart disease (IHD)) at 5 months post-diagnosis. Longitudinal outcomes included the probability of developing ( de novo) co-morbid CVD by 36 months post-diagnosis. Lifestyle factors included body mass index, physical activity, television (TV) viewing, alcohol consumption and smoking. Results Co-morbid CVD prevalence at 5 months post-diagnosis was 59%, and 16% of participants with no known CVD at the baseline reported de novo CVD by 36 months. Obesity at the baseline predicted de novo hypertension (odds ratio [OR] = 2.20, 95% confidence intervals [CI] = 1.09, 4.45) and de novo diabetes (OR = 6.55, 95% CI = 2.19, 19.53). Participants watching >4 h of TV/d at the baseline (compared with <2 h/d) were more likely to develop ischaemic heart disease by 36 months (OR = 5.51, 95% CI = 1.86, 16.34). Conclusion Overweight colorectal cancer survivors were more likely to suffer from co-morbid CVD. Interventions focusing on weight management and other modifiable lifestyle factors may reduce functional decline and improve survival.

Association of Very Highly Elevated C-Reactive Protein Concentration with Cardiovascular Events and All-Cause Mortality

The clinical relevance of very highly increased high-sensitivity C-reactive protein (hsCRP) concentrations (>10 mg/L) is incompletely understood. We examined the association between very highly increased hsCRP and risk of incident cardiovascular disease (CVD) events and all-cause mortality. We recruited 5248 participants free from overt CVD and acute infection [mean age 53.5 (SD 12.4) years, 55.5% women] from the Scottish Health Survey, a representative sample of community-dwelling adults. hsCRP and other conventional risk factors were measured at baseline. Over an average of 7 years' follow-up, there were a total of 259 incident CVD events (including myocardial infarction, coronary artery bypass, percutaneous coronary angioplasty, stroke, heart failure) and 357 all-cause deaths. Very highly increased hsCRP was associated with CVD events after adjustment for Framingham risk score (FRS), body mass index (BMI), central obesity, and hormone replacement therapy (HRT) (hazard ratio 2.40, 95% CI 1.51-3.81) and also with all-cause death (hazard ratio 3.64, 95% CI 2.57-5.15). With the addition of CRP scores to the conventional Framingham model, 7.4% of participants were reclassified into a high-risk (>20% FRS) CVD category. Very highly increased hsCRP was also associated with several modifiable risk factors, including smoking, HDL cholesterol, and central obesity. hsCRP >10 mg/L was a stronger predictor of clinical events than a conventional cut point of 3 mg/L. Very highly increased hsCRP may provide clinically meaningful prognostic information.

Cardiovascular Disease in African American Women: A Health Care Disparities Issue

ObjectivesTo review the current status of cardiovascular disease (CVD) in African American women compared to Caucasian women in regards to 4 categories of CVD: coronary artery disease (CAD), hypertension, stroke, and congestive heart failure (CHF), and to call attention to the need to place more emphasis on the need to increase awareness of CVD as the greatest killer of African American females in the United States. MethodsA review of the recent literature on the subject of CVD in women over the past several years was conducted with a focus on CVD in African American women. Statistical data on incidence, prevalence, morbidity and mortality of CAD, hypertension, stroke, and CHF in black and white women were compared. ResultsStatistical data gathered over the past several years indicate that African American women have greater mortality than Caucasian women from CAD, hypertension, stroke, and CHF. The mortality rate from CAD is 69% higher in black women than in white women. Mortality for black females from hypertension is 352% higher than for white females. Age-adjusted stroke death rates are 54% higher in African American than in Caucasian women, and the age-adjusted mortality rate per 100 000 is 113.4 vs 97.5 for black and white women, respectively. Incidence, prevalence, and morbidity figures for CAD, hypertension, stroke, and CHF are all higher for African American females than for Caucasian females. ConclusionsAfrican American women are at exceptional risk for CVD, and more recognition of this fact as well as greater awareness of the problem should be promulgated and distributed by means of public education programs. Physicians who treat black patients also need to be encouraged to be more aggressive in their efforts to detect patients at risk and to initiate therapy early on in the course of CVD in this sub-population.

Trends and Cardiovascular Co-morbidities of COPD Patients in the Veterans Administration Medical System, 1991–1999

Persons with Chronic Obstructive Pulmonary Disease (COPD) are at risk for developing other smoking-related complications, including cardiac and vascular diseases. Information about the prevalence and incidence of these conditions is needed to anticipate their occurrence in clinical research. We conducted a cohort study using longitudinal administrative data to describe the prevalence and incidence of cardiovascular (CV) diseases among COPD patients treated by the Veterans Administration Medical System. The COPD cohort included all persons with a diagnosis of COPD admitted to a Veterans Administration Medical System hospital (N = 70,679) or seen in a outpatient clinic (N = 314,209) in fiscal year 1998. Each COPD patient was matched to a Veteran of the same age and gender who did not have a COPD diagnosis, creating a non-COPD cohort for comparison. Among all hospitalized Veterans, the prevalence of COPD steadily increased from 1991 to 1999, although the total number of Veterans hospitalized during this time period decreased by more than one-third. Among COPD patients hospitalized in 1998, the prevalence of coronary artery disease, congestive heart failure, and atrial fibrillation were very high (33.6%, 24.4%, and 14.3%, respectively) and significantly higher than those seen among the matched non-COPD cohort (27.1%, 13.5%, and 10.4%; p < 0.001). Among COPD outpatients, increased complications were found in every CV disease category with rate ratios that were greater than observed among inpatients. We conclude that CV diseases are remarkably prevalent among Veterans with COPD, and their incidence is likely to increase as the Veteran population ages.

I. Introduction

The number of patients with chronic kidney disease (CKD) is increasing. Unfortunately, the survival of CKD patients remains poor.5 This is, in large part, due to premature cardiovascular disease (CVD) that manifests itself as coronary heart disease (CHD), cerebrovascular disease, and/or peripheral vascular disease (Table 1). There are 2 major overlapping categories of CVD: (1) disorders of cardiovascular perfusion, which include atherosclerotic CVD (ACVD); and (2) disorders of cardiac function, such as heart failure and left ventricular hypertrophy. Some risk factors are unique to each category of CVD, and some risk factors are shared by both categories of CVD.

Drug disorders and cardiovascular disease: the impact on annual hospital length of stay for the Medicare population.

We studied 3,942,868 Medicare patients (comprised of elderly and disabled) discharged with cardiovascular disease (CVD) during 1987, of which 41,095 (1%) had a drug disorder. Among this small subgroup, the percent of those overlapping with an alcohol and/or mental disorder is 33% for the elderly and 47% for the disabled. The presence of a drug disorder discharge diagnosis is associated with an excess of 329,650 days of hospital care and +174,498,071 in hospital charges as illustrated by a 51% increase in average annual days in the hospital for the elderly, and a similar 61% increase for the disabled. The concomitant increase in average annual discharges offers an explanation. Clinical progression in drug disorder severity (six categories were defined) is associated with increasing lengths of stay; for example, drug dependence comorbidities present longer lengths of stay than drug abuse comorbidities. Among the 12 categories of CVD defined, patients with rheumatic heart disease, hypertensive heart disease, hypertension, and other venous disorders were those whose length of stay experienced the largest percent increase when a drug disorder was present. When drug disorders compete with alcohol and/or mental disorders in a general linear model predicting average annual length of stay, they remain significant at the p < .001 level.

Trends in the geographic inequality of cardiovascular disease mortality in the United States, 1962–1982

Substantial geographic variation of cardiovascular disease (CVD) mortality within the U.S. has been recognized for decades. Analyses reported here address the question of whether relative geographic inequality has increased or decreased during the period of rapidly declining CVD mortality 1962–1982. Trends in geographic inequality, as measured by the weighted coefficient of variation of State Economic Area rates, are analyzed for whites and blacks by sex for 10-year age groups 35–44 to 85 and over. The average annual percent change in the coefficient of variation for each demographic group is presented for all cause mortality, all CVD, stroke and ischemic heart disease. In general, geographic inequalities declined in total mortality for all except the youngest age group. This is consistent with reports of a strong convergence of age-adjusted cancer mortality in U.S. counties. By contrast, increasing geographic inequality dominates in the CVD categories, especially for whites in heart disease and stroke. At younger ages, increases in the coefficient of variation for all race-sex groups exceeded 1% per year in stroke and 2% per year in heart disease. These results suggest that factors influencing the percent decline of CVD mortality are not reaching communities of the U.S. equally. Since increases in relative inequality are strongest in the younger age groups, the pattern of inequality may be accentuated as these cohorts move into ages of higher mortality.