Combined Coronary Heart Disease Research Articles

Abdominal obesity with hypertriglyceridaemia, lipoprotein(a) and apolipoprotein A‐I determine marked cardiometabolic risk

Risks for coronary heart disease (CHD) and diabetes (T2DM) of the 'hypertriglyceridemic waist' phenotype (HtgW) warrant further investigation. We studied this issue and whether partial proinflammatory conversion of apolipoprotein (apo) A-I by lipoprotein(a) [Lp(a)] is a codeterminant. In a population-based prospective study, 1328 Turkish adults were analysed in four groups by the presence of abdominal obesity and elevated triglycerides (Htg). LDL-cholesterol levels, significantly elevated in isolated Htg, were lower in HtgW, yet significantly higher apoB and complement C3 values existed in women with HtgW in whom also the lowest Lp(a) values prevailed. Lp(a) was linearly associated, more strongly in HtgW than in the remaining groups, with apoB and, in women inversely, with gamma-glutamyltransferase. Incident HtgW was predicted, not in men, but in women inversely by Lp(a) (OR 0.80 [95%CI 0.65; 0.97]), regardless of adjustment for relevant confounders. After adjustment for conventional risk factors, HtgW (OR 2.84) and high apoA-I/HDL-C ratio (OR 1.50) were significantly and additively associated with combined prevalent and incident CHD risk. High apoA-I and low HDL-cholesterol levels interacted therein in women. Type-2 diabetes was strongly predicted by HtgW, mediated in men by high apoA-I/HDL-C ratio. HtgW is associated with excess inflammatory markers, is predicted in women paradoxically by lower circulating Lp(a) and is associated in both sexes with marked excess cardiometabolic risk to which high apoA-I/HDL-C ratio contributes additively. These findings are consistent in women with apoA-I being oxidized via aggregation to Lp(a).

THE RATIO OF SYSTEMIC INFLAMMATION, OXIDATIVE STRESS AND GLUTATHIONE REDOX STATUS INDICATORS IN PATIENTS WITH CORONARY HEART DISEASE AND TYPE 2 DIABETES MELLITUS

Objective. To study and compare indicators of systemic inlammation and red blood cells glutathione redox potential by chronic oxidative stress (OS) in patients with coronary heart disease (CHD), type 2 diabetes mellitus (T2DM) and the combination of both diseases.Design and methods. The study included 35 patients with CHD and newly diagnosed T2DM, 109 patients with CHD, 19 patients with T2DM, and 89 healthy individuals. Systemic inlammation indicators were measured including concentration of interleukin (IL) 6 and 8, myeloperoxidase (MPO) and OS in plasma, oxidized (GSSG) and reduced (GSH) glutathione, as well as their ratio and redox potential (E), the activity of glutathione reductase (GR) and glutathione peroxidase (GP) in red blood cells.Results. Signiicant growth of systemic inlammation (IL-6, IL-8, MPO) indicators on the weakening antioxidant defense enzyme has been registered in patients with a combination of CHD and T2DM, a 3,4-fold reduction of GSH level, 5,8-fold of 2GSH/GSSH in red blood cells and E values towards the oxidized state at 36,3 mV were noted. These changes were less pronounced in CHD group and were absent in T2DM group. All subjects showed a decreased activity of GP and increased level of glycosylated hemoglobin. The correlation of E and activity GR have been found in patients with carbohydrate metabolism disorder. High positive relationship between IL concentration and red blood cells GR, E indicators has been identiied in patients with CHD and T2DM. There is a need to control and correct cellular redox potential in patients with CHD and T2DM.Conclusion. The combination of CHD and T2DM contributes to the decrease of red blood cells redox status glutathione secondary to the increased systemic inlammatory response and chronic OS indicators.

Combination of coronary heart disease, chronic heart failure, and anaemic syndrome: clinical features and prognostic impact of anaemia treatment

Practitioners are often faced with a combination of coronary heart disease (CHD), chronic heart failure (CHF), and anaemic syndrome. These patients are typically characterised by a worse prognosis of acute and chronic CHD, as well as by a rapid progression of CHF and chronic renal failure (CKF). This review is focussed on the epidemiology of anaemia in CHD and CHF patients; the aetiology and pathogenesis of anaemia in CHD and CHF; and the changes of cardiovascular parameters in patients with anaemic syndrome. Despite the abundance of studies on CHD and CHF clinical course and prognosis in anaemic syndrome, very little is known about the effects of anaemia treatment on the clinical course and prognosis of CHD. The review presents the external evidence and original results on the prognosis of acute and chronic CHD in anaemic patients. A modern view on anaemia treatment in various CHD forms is also presented.

LUNG DIFFUSION CAPACITY AND NON-SPECIFIC INFLAMMATION MARKERS IN PATIENTS WITH CORONARY HEART DISEASE AND DIABETES MELLITUS

Aim. To assess the differences in the lung diffusion capacity and non-specific inflammation markers among patients with coronary heart disease (CHD) and the combination of CHD and Type 2 diabetes mellitus (DM-2). Material and methods. The study included 70 CHD patients: with DM-2 (n=40; 57,1%) and without DM-2 (n=30; 42,9%). Lung diffusion capacity (DIco) was assessed with the single-breath method and subsequent correction by haemoglobin levels (DIco cor). The levels of the following non-specific inflammation markers were also assessed: IL-1

Lipid management in 13,000 high risk cardiovascular patients treated under daily practice conditions: LIMA Registry.

AimsWe aimed to document the drug management of patients at high cardiovascular risk in daily practice, with the special focus on lipid-lowering treatment.Methods and resultsIn this prospective noninterventional study in 2387 outpatient centers throughout Germany, a total of 13,942 high-risk patients (mean age 65.7 years, 61.6% males) were treated with simvastatin 40 mg/day at entry as monotherapy. All patients were followed up for 12 months in terms of drug utilization, laboratory values, target attainment, and clinical events (including death, hospitalization, vascular events, and dialysis). Patients had coronary heart disease in 35.0%, diabetes mellitus in 24.4%, and the combination of coronary heart disease plus diabetes mellitus in 25.7%. In 21% of patients, a cholesterol absorption inhibitor was added to statin therapy at the entry visit, and in 23%, this was added at the follow up visit 6 months later. The target values for low-density lipoprotein-cholesterol (<2.6 mmol/L) were reached by 31.8% of patients at entry and by 50.0% at the end of this registry after 12 months. Mean blood pressure decreased (from 135.9/80.5 mmHg at baseline) by 3.1/1.9 mmHg after 12 months. In patients with documented diabetes, the targeted glycated hemoglobin (HbA1c <6.5%) was reached by 33.5% at baseline and by 40.0% after 12 months. Clinical events occurred in 11.7% of patients between baseline and month 6, and in 12.0% between months 6 and 12.ConclusionIn patients at high risk for cardiovascular events, comprehensive management under daily practice conditions leads to improvement of lipid, glucose, and blood pressure parameters. There is a need to improve secondary prevention among high-risk patients.

Coronary Disease Risk Curve of Serum Creatinine Is Linear in Turkish Men, U-Shaped in Women

ObjectivesThe highest levels of glomerular filtration rate are associated with increased coronary heart disease (CHD) risk, an issue we investigated in separate sexes in a population prone to metabolic syndrome.Research...

Myocardial Performance Index Combined with Framingham CHD Risk Score in Determining Angiographic Severity of CAD by Gensini Scoring

OBJECTIVE: The aim of this study was to investigate whether myocardial performance index (MPI) and Framingham Coronary Heart Disease (CHD) score correlated with severity of coronary artery disease (CAD) as assessed by angiography (Gensini scoring), and whether combining the two parameters improved correlation with Gensini scoring. STUDY DESIGN: Prospective, cross-sectional association study SETTING: Perpetual Succour Hospital-Cebu Heart Institute POPULATION: The study included patients suspected to have CAD from June 2011 to February 2012, and had undergone two-dimensional echocardiography and coronary angiography. METHODS: After recording pertinent baseline characteristics, each patient’s Framingham CHD Risk Score was calculated. MPI was determined by echocardiography. Coronary angiography was performed by interventional cardiologists blinded to the patient’s Framingham Risk Score and MPI. Severity of the angiographic lesions was determined using Gensini scoring determined by a single angiographer. RESULTS: Male sex and alcohol consumption showed correlation with obstructive CAD (p=0.048 and 0.00, respectively). Framingham CHD Risk Score did not show significant correlation with severity of CAD assessed by Gensini score (r=0.118; p=0.332). MPI was moderately correlated with Gensini score (r=0.444; p-value=0.000), indicating a good predictive value in determining severity of CAD. The fitted model plot revealed that combined Framingham CHD Risk Score and MPI added incremental value in predicting severity of significant CAD (squared-multiple R=0.199) CONCLUSION: This study shows that Framingham CHD Risk Score alone did not show a correlation with significant CAD. The MPI and combined Framingham CHD risk score showed correlation in determining severity of CAD assessed by Gensini score.

Antihypertensive Therapy-Associated Hypokalemia and Hyperkalemia

See related article, pp 926–933 Hydrochlorothiazide was introduced into clinical practice in 1957 and chlorthalidone shortly thereafter. Diuretics continue to be a mainstay of antihypertensive therapy. They effectively reduce blood pressure and decrease hypertension-related morbidity and mortality. In addition, they are relatively inexpensive. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends diuretics as first-line therapy for the treatment of hypertension. The Antihypertensive and Lipid-Lowering Treatment to Preventing Heart Attach Trial (ALLHAT) was a prospective, randomized trial designed to compare the effects of diuretics with other antihypertensive agents on the incidence of coronary heart disease (CHD) and other cardiovascular disease (CVD) events. Beginning in 1994, 42000 participants aged ≥55 years with hypertension and ≥1 other CHD risk factor were randomized to receive initial therapy with chlorthalidone, lisinopril, amlodipine, or doxazosin.1 The doxazosin arm was terminated early because of a higher incidence of cardiovascular events, particularly congestive heart failure. During a mean follow-up of 4.9 years, there was no difference among the other 3 drug regimens in the primary outcome of combined fatal CHD or nonfatal myocardial infarction. Secondary outcomes were similar, except for higher rates of heart failure with amlodipine and higher rates of combined CVD, stroke, and heart failure with lisinopril compared with chlorthalidone. A decade ago, the ALLHAT investigators concluded that, “thiazide-type diuretics are superior in preventing 1 or more major forms of CVD and are less expensive. They should be preferred for first-step antihypertensive therapy.” In response to concerns that low and high serum …

Pharmacogenetic Associations of MMP9 and MMP12 Variants with Cardiovascular Disease in Patients with Hypertension

ObjectivesMMP-9 and -12 function in tissue remodeling and may play roles in cardiovascular disease (CVD). We assessed associations of four MMP polymorphisms and three antihypertensive drugs with cardiovascular outcomes.MethodsHypertensives (n = 42,418) from a double-blind, randomized, clinical trial were randomized to chlorthalidone, amlodipine, lisinopril, or doxazosin treatment (mean follow up, 4.9 years). The primary outcome was coronary heart disease (CHD). Secondary outcomes included combined CHD, all CVD outcomes combined, stroke, heart failure (HF), and mortality. Genotype-treatment interactions were tested.ResultsThere were 38,698 participants genotyped for at least one of the polymorphisms included here. For MMP9 R668Q (rs2274756), lower hazard ratios (HRs) were found for AA subjects for most outcomes when treated with chlorthalidone versus amlodipine (eg., CCHD: GG = 1.00, GA = 1.01, AA = 0.64; P = 0.038). For MMP9 R279Q (rs17576), modest pharmacogenetic findings were observed for combined CHD and the composite CVD outcome. For MMP12 N122S (rs652438), lower HRs were observed for CHD in subjects carrying at least one G allele and being treated with chlorthalidone versus lisinopril (CHD: AA = 1.07, AG = 0.80, GG = 0.49; P = 0.005). In the lisinopril-amlodipine comparison, higher HRs were observed for participants having at least one G allele at the MMP12 N122S locus (CHD: AA = 0.94, AG = 1.19, GG = 1.93; P = 0.041). For MMP12 −82A>G (rs2276109), no pharmacogenetic effect was found for the primary outcome, although lower HRs were observed for AA homozygotes in the chlorthalidone-amlodipine comparison for HF (P = 0.015).ConclusionsWe observed interactions between antihypertensive drugs and MMP9 and MMP12 for CHD and composite CVD. The data suggest that these genes may provide useful clinical information with respect to treatment decisions.

Healthy Psychological Functioning and Incident Coronary Heart Disease

Studies have documented effects of positive and negative emotion on the risk of developing coronary heart disease (CHD), leading investigators to speculate about the importance of effective self-regulation for good health. Little work has directly assessed the role of self-regulation in risk of incident CHD. To examine whether self-regulation is associated with reduced risk of coronary heart disease (CHD). Secondary aims were to consider whether the effects are independent of other measures of psychological functioning and how they may occur. A prospective population-based cohort study. The Normative Aging Study, an ongoing cohort study of community-dwelling men in the Boston area. One thousand one hundred twenty-two men aged 40 to 90 years without CHD or diabetes mellitus at baseline, followed up for an average of 12.7 years. Measures of incident CHD obtained from hospital records, medical history, physical examination, and death certificates. During follow-up, 168 cases of incident CHD occurred, including 56 cases of incident nonfatal myocardial infarction (MI), 44 cases of fatal CHD, and 68 cases of angina pectoris. In 1986, 1122 men completed the revised Minnesota Multiphasic Personality Inventory, from which we derived a measure of self-regulation. Compared with men with lower levels, those reporting higher levels of self-regulation had an age-adjusted hazard ratio of 0.38 (95% confidence interval, 0.22-0.64) for combined nonfatal MI and CHD death. Moreover, a dose-response relation was evident, as each 1-SD increase in self-regulation level was associated with a 20% decreased risk of combined angina, nonfatal MI, and CHD death. Significant associations were also found after adjusting for anxiety, anger, or depression and after controlling for positive affect. The association could not be explained by known demographic factors, health behaviors, or biological factors. Findings suggest that self-regulation may protect against risk of CHD in older men.

Usefulness of Cardiorespiratory Fitness to Predict Coronary Heart Disease Risk Independent of Physical Activity

Cardiorespiratory fitness has often been interpreted as a surrogate measurement of physical activity rather than an independent coronary heart disease (CHD) risk factor per se. Fitness is also known to be highly heritable, however, and rats bred selectively for treadmill endurance have low CHD risk phenotypes even in the absence of physical activity. Therefore, I assessed whether cardiorespiratory fitness predicted CHD independent of physical activity in 29,721 men followed prospectively for 7.7 years as part of the National Runners' Health Study. Specifically, CHD deaths and incident participant-reported physician-diagnosed myocardial infarction, revascularization procedures (coronary artery bypass grafting and percutaneous coronary intervention), and angina pectoris during follow-up were compared to baseline cardiorespiratory fitness (10-km footrace performance, meters/second). Nonfatal end points for the 80% of these men who provided follow-up questionnaires included 121 nonfatal myocardial infarctions, 317 revascularization procedures, and 81 angina pectora. The National Death Index identified 44 CHD deaths. Per meter/second increment in baseline fitness, men's risks decreased 54% for nonfatal myocardial infarction (p <0.0001), 44% for combined CHD deaths and nonfatal myocardial infarction (p = 0.0003), 53% for angina pectoris (p = 0.001), and 32% for revascularizations (p = 0.002). Adjustment for physical activity (kilometer/day run) had little effect on the per meter/second risk decreases for nonfatal myocardial infarction (from 64% to 63%), combined CHD deaths and nonfatal myocardial infarction (from 34% to 33%), angina pectoris (from 53% to 47%) or revascularizations (from 32% to 26%). In conclusion, the results suggest that cardiorespiratory fitness is a CHD risk factor, largely independent of physical activity, which warrants clinical screening.

Prevention of Heart Failure With Chlorthalidone in ALLHAT: Placing the Results Into Perspective

Prevention of Heart Failure With Chlorthalidone in ALLHAT: Placing the Results Into Perspective

The effect of nine common polymorphisms in coagulation factor genes (F2, F5, F7, F12 and F13) on the effectiveness of statins: the GenHAT study

Pharmacogenetic research has shown that genetic variation may influence statin responsiveness. Statins exert a variety of beneficial effects beyond lipid lowering, including antithrombotic effects, which contribute to the risk reduction of cardiovascular disease. Statins have been shown to influence the expression of coagulation factors II, V, VII, XII and XIII. Data from a large randomized clinical trial of pravastatin, designed to show efficacy relative to usual care, were used to investigate whether a pharmacogenetic effect of polymorphisms in genes coding for coagulation factors II, V, VII, XII and XIII is associated with reduced fatal coronary heart disease (CHD) and nonfatal myocardial infarction, combined CHD and all-cause mortality. The Genetics of Hypertension Associated Treatment is an ancillary study of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. The genotyped population in the lipid-lowering trial of Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial included 9624 participants randomly assigned to pravastatin or to usual care. The efficacy of pravastatin in reducing risk of all-cause mortality, CHD and nonfatal myocardial infarction and combined CHD, was compared among genotype strata by examining an interaction term in a proportional hazards model. None of the polymorphisms were associated with the clinical outcomes. For the F7 (-323) ins/del polymorphism there was no interaction with pravastatin for either outcome. For both the F5 Arg506Gln G>A (rs6025) polymorphism and F7 Arg353Gln G>A (rs6046) polymorphism there were no interactions with pravastatin in relation to all-cause mortality, but there were significant interactions with combined CHD [interaction hazard ratio = 1.33, 95% confidence interval (1.01-1.76) and interaction hazard ratio = 1.92, 95% confidence interval (1.00-3.65), respectively]. There were no interactions between the polymorphisms in the other coagulation genes and pravastatin in relation to any outcome. Polymorphisms in anticoagulation genes (F5 and F7) seem to modify the efficacy of pravastatin in reducing risk of cardiovascular events.

Combined Effects Of Cardiorespiratory Fitness, Not Smoking, And Normal Waist Girth On Morbidity And Mortality

Physical inactivity, cigarette smoking, and obesity are key modifiable risk factors for coronary heart disease (CHD). Little is known about the relations between these combined risk factors and incident CHD and mortality. PURPOSE: We investigated the combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on incident CHD and mortalities from cardiovascular disease (CVD), cancer, and all causes in men. METHODS: We followed 40,397 men, ages 20-79 yr, who completed a medical evaluation including a maximal treadmill exercise test and self-reported health habits at baseline examination. We defined a low-risk profile as not smoking, moderate- or high-fitness, and normal waist girth (<94 cm), respectively. The combined low-risk group was defined as satisfying all three above factors. There were 1,147 incident CHD (fatal and nonfatal CHD events) and 2,682 deaths (862 CVD, 985 cancers, and 835 others) during an average of 17.8 yr of follow-up (717,404 man-yr). RESULTS: After adjustment for age, examination year, alcohol intake, and family history of CHD, men who were at low-risk for these 3 factors had 70% lower risk of incident CHD (95% CI: 57%, 79%), 84% lower risk of CVD mortality (95% CI: 77%, 89%), 72% lower risk of cancer mortality (95% CI: 58%, 81%), and 75% lower risk of all-cause mortality (95% CI: 69%, 80%), respectively, as compared with men who had none of these low-risk factors (all p for trend <0.001). Associations persisted after additional adjustment for hypertension, diabetes, and high cholesterol (all p for trend <0.001). The CHD events in this population might have been reduced by 20% (95% CI: 11%, 29%) if they had been physically fit, not smoking, and had normal waist girth. Men with all three exposures had 2.2 times the risk of CHD (95% CI: 1.52, 3.09 p<0.001) compared with men with none of theses risk factors. This was equivalent to being 10.4 years older in chronological age. CONCLUSIONS: Moderate and high levels of cardiorespiratory fitness, not smoking, and normal waist girth are associated with a reduced risk of incident CHD and much lower mortality from CVD, cancer, and all causes in men.

Short course of iodine-bromine bath therapy and physical exercises for patients with coronary heart disease with disturbed cardiac rhythms

The objective of this sanatorium-based study was to evaluate effect of short courses of iodine-bromine bath therapy and veloergometer exercises during 14 days on the working capacity, ventricular and supraventicular extrasystoles, painful and silent myocardial ischemia in patients with a combination of coronary heart disease (CHD), stable angina of functional class II, and grade II hypertensive disease (according to the WHO classification). The patients' conditions were monitored by means of spiroveloergometry and Holter ECG recordings. The study included a total of 108 patients. It was shown that short courses of iodine-bromine bath therapy and veloergometer exercises had training and anti-arrhythmic effect on the patients with concurrent coronary heart disease, stable angina, and hypertensive disease. The treatment improved their working capacity, enhanced coronary heart reserve, reduced the frequency of ventricular and supraventicular extrasystoles, decreased manifestations of painful and silent myocardial ischemia.

Physical Activity and Cardiovascular Disease: How Much Is Enough?

Physical inactivity is an established risk factor for cardiovascular diseases. However, while physical activity is recommended as a component of healthy lifestyle, the amount (intensity, duration and frequency) of physical activity required to protect against coronary heart disease (CHD) and cerebrovascular disease (i.e., stroke) is unclear. In general, there is a graded inverse association of physical activity with CHD and total cardiovascular disease (the combination of CHD and stroke). The patterns of association between physical activity dose and stroke are less clear; individual studies suggest a threshold effect for benefits, while meta-analytic studies report a graded inverse association. Despite known differences in physical activity behaviors between men and women, the patterns of association between dose of activity and cardiovascular diseases are similar by gender. Observational studies of walking behaviors and one recent clinical trial suggest that lower "doses" of physical activity are associated with a lower risk of cardiovascular disease. Thus, with very few specific cautions, there is enough evidence to recommend to healthy adults that any activity is beneficial and that more activity is even better.

Relationship between thiazolidinedione use and cardiovascular outcomes and all‐cause mortality among patients with diabetes: a time‐updated propensity analysis

To investigate the association of the thiazolidinediones (TZDs), rosiglitazone, and pioglitazone, together and individually on the risk of cardiovascular outcomes and all-cause mortality, using time-updated propensity score adjusted analysis. We conducted a retrospective cohort study in a large vertically integrated health system in southeast Michigan. Cohort inclusion criteria included adult patients with diabetes treated with oral medications and followed longitudinally within the health system between 1 January 2000 and 1 December 2006. The primary outcome was fatal and non-fatal acute myocardial infarction (AMI). Secondary outcomes included hospitalizations for congestive heart failure (CHF), fatal, and non-fatal cerebrovascular accidents (CVA) and transient ischemic attacks (TIA), combined coronary heart disease (CHD) events, and all-cause mortality. 19,171 patients were included in this study. Use of TZDs (adjusted hazard ratio (aHR) with propensity adjustment (PA), 0.92; 95% confidence interval (CI) 0.73-1.17), rosiglitazone (aHR with PA, 1.06; 95%CI 0.66-1.70), and pioglitazone (aHR with PA, 0.91; 95%CI 0.69-1.21) was not associated with a higher risk of AMI. However, pioglitazone use was associated with a reduction in all-cause mortality (aHR with PA, 0.60; 95%CI 0.42-0.96). Compared with rosiglitazone, pioglitazone use was associated with a lower risk of all outcomes assessed, particularly CHF (p = 0.013) and combined CHD events (p = 0.048). Our findings suggest that pioglitazone may have a more favorable risk profile when compared to rosiglitazone, arguing against a singular effect for TZDs on cardiovascular outcomes.

Amlodipine

Amlodipine

Thiazide-type diuretics and beta-adrenergic blockers as first-line drug treatments for hypertension.

Systemic arterial hypertension affects 72 million US adults and an additional hundreds of millions of persons worldwide.1,2 Most of these are candidates for pharmacological treatment to reduce risk of cardiovascular disease (CVD) events, based primarily on a very large body of epidemiological and intervention research in humans. Because of this high prevalence and the cardiovascular consequences of untreated or inadequately treated hypertension, the selection of drugs for initial and continuing, long-term treatment has large public health and economic implications. Fortunately, such decisions and the expert recommendations that seek to guide them can call on evidence from 4 decades of randomized multicenter clinical trials evaluating effects of treatment on clinical CVD. We summarize that evidence in this article, in approximate chronological order, and we comment on the related treatment guidelines. We close with some of the major clinical questions yet to be resolved. Response by Messerli et al p 2705 Before the current era beginning in the early 1990s of emphasis on positive-control trials, which directly compare different drug regimens, there were 3 decades of trials that compared an active regimen with placebo or, in a few cases, “usual care.” For most of this period, the mainstay of treatment was generally a thiazide-type diuretic (hereinafter called thiazides) or, to a lesser extent, a β-adrenergic blocker (termed β-blockers). With few exceptions, these trials, especially those with high statistical power and thiazide-based regimens, showed benefit for CVD outcomes.3–8 This evidence, which provided a basis for recommending thiazides or β-blockers as first-step drugs in most editions of US guidelines through 1997,9 needs to continue to be given due weight in practice and practice guidelines. The largest and most consistent benefits from the earlier trials were for stroke and (where reported) heart failure. Benefits for coronary heart disease (CHD) were less clear, …

Familial predisposition to cardiovascular risk and disease contributes to cardiovascular risk and disease interacting with other cardiovascular risk factors in diabetes—Implication for common soil (JDDM 14)

In diabetic population cardiovascular morbidity is high and the effects of genetic predisposition remain elucidated. In a large-scale multicenter-based diabetic population, clinical parameters including conventional cardiovascular risk factors and first-degree family history (FH) of diabetes, hypertension, coronary heart disease (CHD) and stroke were investigated in association with presence of CHD and stroke. Among 3611 diabetic patients, 181 (5.0%) had CHD and 118 (3.3%) had stroke. After adjustment for conventional risk factors, FH of CHD (OR 2.32, p < 0.0001) and of diabetes (OR 1.44, p < 0.05) were associated with CHD, and FH of stroke (OR 1.86, p < 0.01) was associated with stroke. FH of hypertension was significantly associated with presence of hypertension and obesity. Synergistic effect of FH of CHD in combination with hypertension or aging on increasing CHD, and that of FH of stroke in combination with microalbuminuria on increasing stroke were found. FH of diabetes, of hypertension, of CHD and of stroke were significantly associated with FH of each disease, indicating clustering of FH. In diabetic population, FH of CHD and FH of stroke doubled the risk of CHD and stroke, respectively, and had synergistic effect in combination with other risk factors. Clustering of FH may indicate interrelation of genetic predisposition.