Differences In Coronary Risk Factors Research Articles

What Factors Contribute to Chest Symptoms during Exercise in Patients with Vasospastic Angina?

Objective: Chest symptoms in patients with vasospastic angina (VSA) typically occur during rest. However, we have occasionally experienced patients with VSA who have had chest symptoms even during exercise. However, factors contributing to the chest symptoms during exercise in patients with VSA remain unclear. Therefore, we investigated this relationship. Methods: We investigated 101 patients with VSA (mean age: 67 years, 51 males and 50 females). We completed detailed chest symptom examinations at rest (n=85), during exercise (n=2), and both at rest and during exercise (n=14). Patients were divided into the two groups: Group I consisted of patients with VSA whose chest symptoms occurred only at rest (n=85, 84%) and Group II consisted of patients with VSA whose chest symptoms occurred during exercise (n=16, 16%). On a coronary angiography, the presence of atherosclerosis (% stenosis>25%), significant coronary stenosis (% stenosis>50%), and myocardial bridging (MB), defined as the narrowing of the coronary artery during systole, were checked. Clinical parameters, including angiographic findings, were assessed in the two groups. Results: There were no significant differences in coronary risk factors between the two groups. The presence of atherosclerosis (Group I: 58% vs. group II: 75%) and significant coronary stenosis (Group I: 10% vs. group II: 25%) did not differ between-groups. The presence of MB was significantly higher in Group II (50%) than in Group I (12%, p=0.0002). Logistic regression analysis showed that the presence of MB was associated with patients in Group II. Conclusions: MB, rather than coronary atherosclerosis or significant coronary stenosis, may contribute to chest symptoms during exercise in patients with VSA.

P6453Sex-related differences in coronary risk factors of major adverse cardiovascular events in acute coronary syndrome with contemporary dyslipidaemia management: a sub-analysis of data from the HIJ-PROPE

P6453Sex-related differences in coronary risk factors of major adverse cardiovascular events in acute coronary syndrome with contemporary dyslipidaemia management: a sub-analysis of data from the HIJ-PROPE

Differences in coronary risk factors, procedural characteristics, mortality and stent thrombosis between two all-comers percutaneous coronary intervention registries from Europe and Japan: a patient-level data analysis of the Bern-Rotterdam and j-Cypher registries.

The reported rate of stent thrombosis (ST) after drug-eluting stent (DES) implantation varies among registries. To investigate differences in baseline characteristics and clinical outcome in European and Japanese all-comers registries, we performed a pooled analysis of patient-level data. The j-Cypher registry (JC) is a multicentre observational study conducted in Japan, including 12,824 patients undergoing SES implantation. From the Bern-Rotterdam registry (BR) enrolled at two academic hospitals in Switzerland and the Netherlands, 3,823 patients with SES were included in the current analysis. Patients in BR were younger, more frequently smokers and presented more frequently with ST-elevation myocardial infarction (MI). Conversely, JC patients more frequently had diabetes and hypertension. At five years, the definite ST rate was significantly lower in JC than BR (JC 1.6% vs. BR 3.3%, p<0.001), while the unadjusted mortality tended to be lower in BR than in JC (BR 13.2% vs. JC 14.4%, log-rank p=0.052). After adjustment, the j-Cypher registry was associated with a significantly lower risk of all-cause mortality (HR 0.56, 95% CI: 0.49-0.64) as well as definite stent thrombosis (HR 0.46, 95% CI: 0.35-0.61). The baseline characteristics of the two large registries were different. After statistical adjustment, JC was associated with lower mortality and ST.

Safety and effectiveness of drug-eluting stents in Chinese patients with coronary artery disease with off- and on-label indications: results from a single-centre registry

BackgroundOff-label use of drug-eluting stents (DES) is more common than on-label use and may be associated with a persistently higher rate of adverse angiographic and clinical outcomes.ObjectiveTo evaluate the safety...

Long-term use of oral nicorandil stabilizes coronary plaque in patients with stable angina pectoris

ObjectiveThe Impact of Nicorandil in Angina (IONA) trial demonstrated that the use of nicorandil, an anti-anginal drug, reduced future cardiovascular events in patients with stable angina. We hypothesized that nicorandil has beneficial effects on coronary arterial plaque characteristics and atherosclerogenesis. Methods and ResultsPreintervention intravascular ultrasound-virtual histology was performed prospectively in 65 consecutive patients with stable angina pectoris. There were no differences in coronary risk factors between the nicorandil (n=16) and non-nicorandil (n=49) groups. However, the nicorandil group demonstrated a larger %fibrous tissue (68±10 vs. 62±11%, P=0.049) and a smaller %necrotic core tissue (11±7 vs. 16±10%, P=0.049) compared with the non-nicorandil group. Multiple regression analysis showed that %necrotic core tissue (P=0.045) was negatively and %fibrous tissue (P=0.026) was positively associated with the use of nicorandil independent of statin use. We also analyzed the effect of nicorandil on atherosclerotic lesion formation in a mouse model of atherosclerosis. Lipid profiles were unaffected, but the area of atherosclerotic lesion and plaque necrosis were significantly reduced following 8-week nicorandil treatment in ApoE-deficient mice fed an atherogenic diet. Nicorandil significantly reduced the expression levels of endoplasmic reticulum stress markers, C/EBP homologous protein (CHOP) and glucose regulated protein/BiP (GRP78) in atherosclerotic lesions. Nicorandil significantly attenuated tunicamycin-induced CHOP upregulation in cultured THP-1 macrophages. ConclusionsNicorandil exerts its anti-atherogenic effect by mechanisms different from those of statins. Long-term nicorandil treatment is a potentially suitable second-line prevention therapy for patients with coronary artery disease.

035 Have socio-economic differences in coronary risk factors changed over 20 years? Results from a population-based study of men between 1978–1980 and 1998–2000

BackgroundAlthough CHD mortality has declined in the UK since the late 1970s, the decline has been particularly marked among more affluent subjects. While the decline substantially reflects improvements in established...

Gender differences in coronary plaque characteristics in patients with stable angina: a virtual histology intravascular ultrasound study

The purpose of this study was to compare culprit coronary plaque characteristics between female and male patients with stable angina using virtual histology intravascular ultrasound (VH-IVUS). The target population consisted of three hundred and sixty-four consecutive patients with stable angina who underwent percutaneous coronary intervention (PCI) after VH-IVUS. The baseline characteristics and VH-IVUS results were compared between 72 female and 292 male patients. Culprit coronary plaque histological composition ratios, which were classified as fibrous (FI)%, fibro-fatty (FF)%, dense-calcium (DC)% and necrotic core (NC)%, were evaluated by VH-IVUS. The HbA1c (6.4±1.2% vs. 5.9±1.0%, p<0.0001), total cholesterol (202±33mg/dL vs. 189±34mg/dL, p=0.004), and LDL-cholesterol (118±32mg/dL vs. 110±27mg/dL, p=0.03) were higher in female patients compared to male patients. The FI ratio (55±15% vs. 60±15%, p=0.02) and FF ratio (9±8% vs. 12±10%, p=0.02) were lower, but the DC ratio (12±13% vs. 9±11%, p=0.01) and NC ratio (23±11% vs. 19±12%, p=0.02) were higher in female patients than in male patients. The differences in coronary risk factors between females and males may be associated with coronary plaque characteristics. Differences in culprit coronary plaque composition were observed between female and male patients with stable angina.

Evaluation of a workplace health program to reduce coronary risk factors

PurposeThe purpose of this paper is to docoment a randomized controlled trial, with follow‐up at three and six months, to determine the impact of a coronary risk factor modification program for employees.Design/methodology/approachIntervention participants received a 12‐week health promotion program involving exercise, education seminars, nutritional analysis and smoking cessation counselling. Outcome measures included differences in coronary risk factors of control and intervention participants between baseline and three and six‐month follow‐up visits.FindingsThe participants included 566 individuals employed in the Halifax area, Nova Scotia, Canada. They were between 19 and 66 years old with at least two modifiable coronary risk factors. There were statistically significant differences at three months in coronary risk score improvement, smoking cessation, physical activity level increases, body mass index reductions and serum cholesterol. At six months, improvements remained significant except for cholesterol. Reduction in blood pressure was not significantly different. Intervention participants compared to control participants showed significant differences in both cardiac and stroke risk at three and six‐month visits.Practical implicationsThis study demonstrates that employees had a significant coronary disease risk reduction as a result of a relatively short health promotion intervention. Benefits three months post‐intervention were not sustained to the same extent as during the intervention. This underscores the need for long‐term commitment with lifestyle changes and raises the issue of the need for a comprehensive approach that also addresses environmental factors.Originality/valueThis paper contributes to the current research base on this topic as there are few well‐designed studies to reduce coronary risk factors for employees.

Comparison of Clinical Characteristics and Arterial Remodeling by Intravascular Ultrasonic Imaging in Three Age Groups (≤55, 56 to 69 and ≥70 Years) of Japanese Patients With Acute Myocardial Infarction

Recent epidemiologic, pathologic, and intravascular ultrasound (IVUS) studies have shown that there are differences in coronary risk factors or plaque morphology between younger and older patients with acute myocardial infarctions (AMIs). This study examined clinical background and plaque morphology using IVUS in younger and older adults with AMIs in Japan. The study population consisted of 96 patients with AMIs, for whom preinterventional IVUS images were obtained. Patients were classified into 3 groups: a young group (aged < or =55 years), a middle-aged group (aged 56 to 69 years), and an old group (aged > or =70 years). The remodeling index was defined as the ratio of the external elastic membrane area at the culprit lesion to the external elastic membrane area at the proximal reference site. Expansive remodeling was defined as a remodeling index >1.05 and constrictive remodeling as a remodeling index <0.95. The frequency of hypercholesterolemia was significantly different among the 3 age groups. Total cholesterol (p <0.001), low-density lipoprotein cholesterol (p <0.005), and triglyceride (p <0.05) levels and body mass index (p <0.001) in the young group were significantly higher than in the old group. On IVUS images, constrictive remodeling was most common in the young group, whereas expansive remodeling occurred most commonly in the middle-aged and old groups. In conclusion, this study demonstrated that patients with AMIs in the young group had higher levels of hypercholesterolemia, obesity, and constrictive remodeling compared with those in the old group. The differences in arterial remodeling of the culprit lesions between younger and older patients with AMIs may reflect different biologic mechanisms of plaque activation and destabilization.

Trends and Regional Differences in Coronary Risk Factors in Two Areas in Belgium: Final Results from the MONICA Ghent–Charleroi Study

To study regional differences and trends in coronary risk factors and in predicted coronary risk calculated on the basis of multiple logistic function equations for the general population aged 25-64 years in two areas in Belgium during the period 1985-1992. A comparison of cross-sectional data on coronary risk factors between two cities and different survey periods. In the cities of Ghent (in Flanders) and Charleroi (in Walloonia) in Belgium, three consecutive cross-sectional age-stratified and sex-stratified random samples of 2000 subjects each were selected from the general population. We studied their coronary risk factors between 1985 and 1992. The field work was carried out according to the protocol of the international WHO-MONICA project. We observed a significant decrease in the prevalence of smoking among men in the two cities over the three surveys, while a gradual increase in diastolic blood pressure for all subgroups in Ghent was seen (this was statistically significant for men aged 45-64 years and women aged 25-44 years). The overall coronary risk predicted on the basis of multiple-logistic-function equations did not however, exhibit significant trends over time in either city. Comparisons between the two centres revealed significantly higher mean serum levels of total cholesterol in Charleroi than in Ghent (for all subgroups except women aged 45-64 years) and significantly higher mean systolic blood pressures in Charleroi for all subgroups defined in terms of age and sex. Prevalences of hypertension in Ghent were significantly lower than those in Charleroi for individuals aged 25-44 years, while the prevalence of obesity in all subgroups in Ghent was also significantly lower. The overall predicted coronary risk in Charleroi was also significantly higher, except for men aged 45-64 years. The differences in mean predicted risk ranged from 5.0% for men aged 45-64 years to 21.2% for women aged 45-64 years. From the data in this article it seems that the trends in overall coronary risk profiles in Ghent and Charleroi are not in accordance with the observed trends in incidence of coronary heart disease (CHD) in these two cities. On the other hand, the differences in predicted coronary risk between the two cities are in the same direction as the observed differences in incidence of CHD between the two cities, but are however too small to explain fully the observed difference in incidence of CHD between the two centres.

Premenopausal Black Women Are Uniquely at Risk for Coronary Heart Disease Compared to White Women

Premenopausal black women have a two to threefold greater rate of coronary heart disease than premenopausal white women. This study was designed to provide greater insight into the reasons for this difference which is currently unclear. Coronary heart disease risk factors were compared in 100 black and 100 white, healthy premenopausal women, ages 18-45 years, and of relatively advantaged socioeconomic status. Compared to white women, black women had a higher body mass index (32.0±9.2 vs. 29.0±9.4 kg/m2, p=0.021), and higher systolic (124±17 vs. 115±14 mm Hg, p<0.0001) and diastolic (79±14 vs. 75±11 mm Hg, p=0.048) blood pressures. The mean plasma lipoprotein(a) concentration was markedly higher in the black women (40.2±31.3 mg/dL) than in the white women (19.2±23.7 mg/dL, p<0.0001). The plasma total homocysteine level was also higher in the black women (8.80±3.38 vs. 7.81±2.58 mmol/L, p=0.013). The black women, however, had lower plasma triglyceride levels (0.91±0.46 vs. 1.22±0.60 mmol/L, p<0.0001) and a trend toward higher high-density lipoprotein cholesterol levels (1.37±0.34 vs. 1.29±0.31 mmol/L, p=0.064) than the white women. Plasma total and low-density lipoprotein cholesterol levels were similar. Black women consumed more saturated fat and cholesterol. Rates of cigarette smoking and alcohol intake were low and similar between the races. In summary, compared to white women, black women had a higher mean body mass index, higher blood pressures, higher lipoprotein(a) and plasma total homocysteine levels, and greater consumption of saturated fat and cholesterol. The differences in coronary risk factors between these two premenopausal groups may explain the higher incidence of coronary heart disease in black women. (c) 2000 by CHF, Inc.

Premenopausal black women have more risk factors for coronary heart disease than white women

Premenopausal black women have a 2- to 3-fold greater rate of coronary heart disease (CHD) than premenopausal white women. The purpose of this study was to provide greater insight into the reasons for this difference, which are currently unclear. We compared CHD risk factors in 99 black and 100 white, healthy premenopausal women, aged 18 to 45 years, and of relatively advantaged socioeconomic status. Compared with white women, black women had a higher body mass index (32.0 ± 9.2 vs 29.0 ± 9.4 kg/m 2, p = 0.021), and higher systolic (124 ± 17 vs 115 ± 14 mm Hg, p <0.0001) and diastolic (79 ± 14 vs 75 ±11 mm Hg, p = 0.048) blood pressures. The mean plasma lipoprotein(a) concentration was markedly higher in the black women (40.2 ± 31.3 mg/dl) than in the white women (19.2 ± 23.7 mg/dl, p <0.0001). The plasma total homocysteine level was also higher in the black women (8.80 ± 3.38 vs 7.81 ± 2.58 μmol/L, p = 0.013). The black women, however, had lower plasma triglyceride levels (0.91 ± 0.46 vs 1.22 ± 0.60 mmol/L, p <0.0001), and a trend toward higher high-density lipoprotein (HDL) cholesterol levels (1.37 ± 0.34 vs 1.29 ± 0.31 mmol/L, p = 0.064) than the white women. Plasma total and low-density lipoprotein (LDL) cholesterol levels were similar, despite a greater consumption of saturated fat and cholesterol by the black women. Rates of cigarette smoking and alcohol intake were low and similar between the races. In summary, premenopausal black women had a higher mean body mass index, blood pressure, lipoprotein(a), and plasma total homocysteine level, and a greater consumption of saturated fat and cholesterol than white women. These differences in coronary risk factors may place the black women in our study at increased risk for CHD compared with the white women.

Long-term effect of nutritional counseling: a study in family medicine

This paper reports research using data in the Nijmegen Family Practice Monitoring Project. One part of the research is follow-up, after 17 y, of a 1977 trial of dietary advice for patients with hypertension or a family history of premature cardiovascular disease. In the intervention group, 840 patients were given health education every 2 mo by trained practice nurses for 1 y. There were 497 patients with similar coronary risk factors in the control group, who received usual care. One year after the intervention a significant decrease was found (and published) in serum cholesterol concentrations and blood pressure in the intervention group. By the time of the 1995 reexaminations, however, there were no differences in coronary risk factors between the two groups. Blood pressures had come down, more so in the control group, and the percentage of smokers had decreased equally in both groups. There were no significant differences in intake of dietary fat or in type of fat. The lack of difference was still found when the groups were divided into those with serum cholesterol concentrations > and < 6.5 mmol/L. A second part of the research was to investigate in 1995 the relation between patients' stage of change of fat intake and their dietary intake. It was found that those in stage 5 (sustaining desired changes in behavior) had the lowest saturated fat intake. Since 1977 both groups have been treated equally if hypertension was diagnosed. The two groups were not managed differently with regard to dietary advice after 1977.

高電位型およびストレイン型左室肥大に関する臨床的検討

健診時に心電図上, 左室肥大所見を示した受診者について, 心電図所見と冠危険因子との関連性を検討した。左室肥大型心電図を, 高電位のみの場合とストレイン型ST-T変化を伴った左室肥大の2群に分類し, 両群間の冠危険因子の差を検討した結果, ストレイン型ST-T変化を伴った左室肥大群では, ST-T変化を伴わない群に比して, より高い血圧, より大きいLV massを示した。さらに, Body mass index, 空腹時血糖は高値を示し, HDLコレステロールは低値を示すなど冠危険因子との関連がみられた。以上の結果から, ストレイン型ST-T変化を伴う左室肥大型心電図所見は, 冠危険因子の存在を示唆することから, 予防医学的に重要な所見であると考えられた。

第23回日本総合健診医学会学術大会講演抄録集 高電位型およびストレイン型左室肥大心電図に関する臨床的検討

第23回日本総合健診医学会学術大会講演抄録集 高電位型およびストレイン型左室肥大心電図に関する臨床的検討

Are regional variations in ischaemic heart disease related to differences in coronary risk factors?

In a previous report, a large regional variation was reported in total mortality and mortality rate from ischaemic heart disease (IHD) in mid-Sweden. In this report, IHD prevalence and risk factor data are presented. A postal questionnaire was sent out to a random sample of men aged 45-64 years in each of 40 communities. 14,675 men (88%) responded. Based on a validity study, IHD cases were defined as those with a history of myocardial infarction and/or angina pectoris. Age, smoking habits, antihypertensive treatment, body mass index, food habits, stress and physical activity during leisure time were used as risk factors. IHD prevalence showed the same geographical variation as IHD mortality, with a low prevalence in the east and a high prevalence in the west. There was a moderate variation in risk factor levels over the 40 communities. When this variation was taken into account the geographical IHD variation was somewhat smaller but still substantial. Other factors may involve socio-economics, drinking water qualities, mineral soil content or other environmental factors. Which of these cause the largest IHD variation is at present unknown, but is subject to systematic examination in this project.

Clinical significance of plasminogen activator inhibitor activity in patients with exercise-induced ischemia

To assess the fibrinolytic system in patients with exercise-induced ischemia and its relation to ischemia and severity of coronary artery disease (CAD), 47 patients with CAD confirmed by results of coronary angiography underwent symptom-limited multistage exercise thallium-201 emission computed tomography. All patients with CAD had exercise-induced ischemia as assessed from thallium-201 images. Pre- and peak exercise blood samples from each patient and preexercise blood samples from control subjects were assayed for several fibrinolytic components and were also assayed for plasma adrenaline. The extent of ischemia was defined as Δ visual uptake score (total visual uptake score in delayed images minus total visual uptake score in initial images) and the severity of CAD as the number of diseased vessels. In the basal condition, plasminogen activator inhibitor (PAI) activity was significantly higher in patients with exercise-induced ischemia as compared to control subjects ( p < 0.01), although there were no significant differences in other fibrinolytic variables between the two groups. Moreover, PAI activity in the basal condition displayed a significantly positive correlation with the extent of ischemia ( r = 0.47, p < 0.01). Patients with exercise-induced ischemia were divided into two groups (24 with single-vessel disease and 23 with multivessel disease). There were no significant differences in coronary risk factors, hemodynamics, or plasma adrenaline levels during exercise between single-vessel and multivessel disease except that Δ visual uptake score was significantly higher in multivessel disease ( p < 0.01). Multivessel disease had significantly high PAI activity both in the basal condition ( p < 0.05) and at peak exercise ( p < 0.05) because of significantly high free PAI-1 ( p < 0.05, respectively) in addition to a significant reduction in tissue plasminogen activator release ( p < 0.01) compared to single-vessel disease. These results suggest that PAI activity may be an important index for assessing the severity of CAD and the extent of ischemia, and they also suggest that impaired fibrinolysis in CAD may be caused by the vascular endothelial damage resulting from ischemia and atherosclerosis.