Familial History Of Cardiovascular Disease Research Articles

Prevalence of obesity, high blood pressure, dyslipidemia and their associated factors in children and adolescents in a municipality in the Brazilian Amazon region

The prevalence of CND are rocketting over the world, including in young adults. The WHO estimates that more than half of the deaths in the world are caused by CND.
 The authors carried out a cross-sectional study of 1,431 school children in the Brazilian Western Amazon, with children and young people aged 6 to 16 years. A random sampling of 496 individuals was carried out. The OpenEpi platform was used to calculate the sample size, considering p<0.05 and a presumed prevalence of CND of 50%. The authors applyied a clinical-epidemiological questionnaire, made anthropometric measurements and laboratory tests. The authors used the diagnostic parameters recommended by the most recent guidelines of the Ministry of Health in Brazil
 The study aimed to estimate the prevalence of obesity, high blood pressure (HBP) and dyslipidemia and its risk factors.
 Prevalence of CND was: Obesity 11.8%, HBP of 6.7% and Dyslipidemia of 25.4%. After multivariate log-binomial analysis of the dependent variables, the statistically significant risk factors were: overweight 18.4%, sedentarism 32.2%, familial history of cardiovascular disease 23.4%, familial history of HBP 84.2%, familila dyslipidemia 55.8%, familial obesity 38.7% and familial chronic renal disease 40.6%.
 The findings point to a picture with a relatively high prevalence of CNDs, as well as their risk factors. Intervention measures such as health education, food education, stimulation of physical exercise, and better school feeding are needed to mitigate the occurence of CND. It also points for the weakness of the local public health system, wehre specific health programmes already exist.

Cumulative Exposure to Long Working Hours and Occurrence of Ischemic Heart Disease: Evidence From the CONSTANCES Cohort at Inception.

BackgroundLong‐working hours (LWH) are a probable risk factor for ischemic heart diseases (IHD); however, no previous study has considered duration of exposure to LWH when addressing this topic. We aimed to determine the association between cumulative exposure to LWH and IHD while accounting for relevant confounders.Methods and ResultsIn this retrospective study, we included all baseline participants from the French population‐based cohort CONSTANCES. Part‐time employees and those who reported a cardiac event in the 5 years before LWH exposure were excluded. From self‐administered questionnaires and clinical examinations, we obtained participants’ age, sex, body mass index, occupational status, smoking habits, high blood pressure, diabetes mellitus, familial history of cardiovascular disease, dyslipidemia, exposure to LWH, and its duration. We defined LWH as working for >10 hours daily for at least 50 days per year. The main outcome was reported history of IHD, ie, myocardial infarction or angina pectoris, during a clinical examination. Of 137 854 included participants, 69 774 were men. There were 1875 cases (1.36%) of IHD, and exposure to LWH was reported by 42 462 subjects (30.8%) among whom 14 474 (10.50%) reported exposure for at least 10 years. Overall, exposure to LWH for ≥10 years was associated with an increased risk of IHD, adjusted odds ratio (aOR) 1.24 (1.08–1.43), P=0.0021. In stratified analyses, this effect was not observed in women, but was significant amongst men, aOR 1.28 (1.11–1.48), P=0.0008.ConclusionsThis large population‐based study supports an association between cumulative exposure to LWH and IHD in men. Future research should consider relevant strategies for reducing LWH exposure and duration.

Association of renin-angiotensin system genes polymorphisms and risk of premature ST elevation myocardial infarction in young Mexican population.

: The renin-angiotensin system plays an important role in the regulation of blood pressure and the development of coronary artery disease. The aim was to examine the association of the insertion deletion in the angiotensin-converting enzyme gene, M235T and T174M polymorphisms in the angiotensinogen gene with ST elevation acute myocardial infarction (STEAMI) in young Mexican population. We analyzed 242 unrelated patients with STEAMI 45 or less years of age, admitted to a cardiovascular intense care unit, and 242 individuals without STEAMI matched by age and sex, recruited from January 2006 and June 2013. The polymorphisms insertion deletion, M235T and T174M were determined in all participants by a polymerase chain-reaction-restriction fragment length polymorphism assay. There was a significant difference in the insertion deletion genotype distribution between two groups (P = 0.03) and a higher percentage of the T allele M235T polymorphism in the group of STEAMI patients (P = 0.02). The T174M polymorphism was not associated (P = 0.08). The insertion deletion and M235T polymorphisms, smoking, hypertension, familial history of cardiovascular disease and dyslipidemia were independent risk factors for STEAMI. Our results identified that the D allele from the insertion deletion and M235T but not T174M polymorphisms represent an independent risk factor for STEAMI in young Mexican population.

Risk factors for QTc-prolongation: systematic review of the evidence.

Background QTc-interval prolongation has been associated with serious adverse events, such as Torsade de Pointes and sudden cardiac death. In the prevention of QTc-prolongation, special attention should go to high-risk patients. Aim of the review The aim of this review is to summarize and assess the evidence for different risk factors for QTc-prolongation (demographic factors, comorbidities, electrolytes, QTc-prolonging medication). Methods Potential studies were retrieved based on a systematic search of articles published until June 2015 in the databases Medline and Embase. Both terms about QTc-prolongation/Torsade de Pointes and risk factors were added in the search strategy. The following inclusion criteria were applied: randomized controlled trials and observational studies; inclusion of ≥500 patients from a general population (not limited to specific disease states); assessment of association between QTc-interval and risk factors. For the articles that met the inclusion criteria, the following data were extracted: study design, setting and study population, number of patients and cases of QTc-prolongation, method of electrocardiogram-monitoring, QTc-correction formula, definition of QTc-prolongation, statistical methods and results. Quality assessment was performed using the GRADE approach (for randomized controlled trials) and the STROBE-recommendations (for observational studies). Based on the number of significant results and the level of significance, a quotation of the evidence was allocated. Results Ten observational studies could be included, with a total of 89,532 patients [prospective cohort design: N=6; multiple regression analyses: N=5; median STROBE score=17/22 (range 15-18)]. Very strong evidence was found for hypokalemia, use of diuretics, antiarrhythmic drugs and QTc-prolonging drugs of list 1 of CredibleMeds. Little or no evidence was found for hyperlipidemia, the use of digoxin or statins, neurological disorders, diabetes, renal failure, depression, alcohol abuse, heart rate, pulmonary disorders, hormone replacement therapy, hypomagnesemia, history of a prolonged QTc-interval/Torsade de Pointes, familial history of cardiovascular disease, and the use of only QTc-prolonging drugs of list 2 or 3 of CredibleMeds. Conclusion This systematic review gives a clear overview of the available evidence for a broad range of risk factors for QTc-prolongation.

The Association of Family History of Premature Cardiovascular Disease or Diabetes Mellitus on the Occurrence of Gestational Hypertensive Disease and Diabetes.

BackgroundGestational hypertensive diseases (GHD) and gestational diabetes mellitus (GDM) increase the risk of cardiovascular disease (CVD) later in life. However, the association between gestational medical diseases and familial history of CVD has not been investigated to date. In the present study, we examined the association between familial history of CVD and GHD or GDM via reliable questionnaires in a large cohort of registered nurses.MethodsThe Korean Nurses’ Survey was conducted through a web-based computer-assisted self-interview, which was developed through consultation with cardiologists, gynecologists, and statisticians. We enrolled a total of 9,989 female registered nurses who reliably answered the questionnaires including family history of premature CVD (FHpCVD), hypertension (FHH), and diabetes mellitus (FHDM) based on their medical knowledge. Either multivariable logistic regression analysis or generalized estimation equation was used to clarify the effect of positive family histories on GHD and GDM in subjects or at each repeated pregnancy in an individual.ResultsIn this survey, 3,695 subjects had at least 1 pregnancy and 8,783 cumulative pregnancies. Among them, 247 interviewees (6.3%) experienced GHD and 120 (3.1%) experienced GDM. In a multivariable analysis adjusted for age, obstetric, and gynecologic variables, age at the first pregnancy over 35 years (adjusted OR 1.61, 95% CI 1.02–2.43) and FHpCVD (adjusted OR 1.60, 95% CI 1.16–2.22) were risk factors for GHD in individuals, whereas FHH was not. FHDM and history of infertility therapy were risk factors for GDM in individuals (adjusted OR 2.68, 95% CI 1.86–3.86; 1.84, 95% CI 1.05–3.23, respectively). In any repeated pregnancies in an individual, age at the current pregnancy and at the first pregnancy, and FHpCVD were risk factors for GHD, while age at the current pregnancy, history of infertility therapy, and FHDM were risk factors for GDM.ConclusionsThe FHpCVD and FHDM are significantly associated with GHD and GDM, respectively. Meticulous family histories should be obtained, and women with family histories of these conditions should be carefully monitored during pregnancy.

Searching for a common mechanism for placenta-mediated pregnancy complications and cardiovascular disease: role of lipoprotein(a)

To investigate lipoprotein(a) [Lp(a)], a well known cardiovascular risk factor, in women with history of placenta-mediated pregnancy complications (PMPC) compared with healthy uneventful-pregnancy women (HW), and the role of LPA gene functional polymorphisms in modulating both Lp(a) levels and PMPC risk. Retrospective observational study. University hospital. A total of 360 women with history of PMPC (154 preeclampsia [PE], 121 stillbirth [SB], and 85 small for gestational age [SGA]) and 270 HW. Not applicable. Lp(a) levels measurement and LPA +93C >T and +121G>A polymorphisms genotyping. In PMPCs we observed higher Lp(a) levels than those found in HW and an association with PMPC risk, also after adjustment for age, familial history of cardiovascular disease, and traditional risk factors. By analyzing Lp(a) concentrations according to each pregnancy complication, we observed significantly higher Lp(a) levels in women with history of SB and PE, conferring 2.5-fold and 2-fold increased risks, respectively; no association with SGA was observed. Lp(a) concentrations progressively and significantly increased as LPA unfavorable allelic burden increased; unfavorable allelic burden influenced SB and PE risk. We evidenced, for the first time, an association between high Lp(a) concentrations and history of SB, and we confirmed the role of Lp(a) in PE risk; this well known atherothrombotic marker might represent one of the possible mechanisms shared by PMPC and cardiovascular disease.

Physical and Sexual Abuse in Childhood as Predictors of Early-Onset Cardiovascular Events in Women

Although child abuse is widespread and has been associated with cardiovascular disease (CVD) risk factors, its association with CVD events is not established. We examined associations of child abuse with CVD events among 66 798 women in the Nurses' Health Study 2. Proportional hazards models estimated hazard ratios and 95% confidence intervals (CIs) for myocardial infarction (n=262), stroke (n=251), and total CVD (n=513). Severe physical abuse was reported by 9% and forced sex by 11% of participants. After adjustment for age, race, childhood body type, parental education, and family CVD history, the hazard ratios for CVD events were 0.91 (95% CI, 0.70-1.17) for mild physical abuse, 1.02 (95% CI, 0.82-1.26) for moderate physical abuse, and 1.46 (95% CI, 1.11-1.92) for severe physical abuse compared with no abuse. Compared with women without childhood sexual abuse, the hazard ratio was 1.10 (95% CI, 0.88-1.35) for unwanted sexual touching and 1.56 (95% CI, 1.23-1.99) for forced sex. After adjustment for adult lifestyle and medical risk factors, the hazard ratio for severe physical abuse was 1.13 (95% CI, 0.85-1.51) and that for forced sex was 1.25 (95% CI, 0.98-1.60); these intermediates accounted for much of the association of severe child abuse with CVD. Associations were similar for retrospectively and prospectively reported events. Women with abuse were less likely to release medical records. The associations were stronger for unconfirmed self-reported events than end points that were corroborated with additional information or medical record review. Severe child abuse is a prevalent risk for early adult CVD that is partially mediated by preventable risk factors.

Conservative management of left ventricle cardiac fibroma in an adult asymptomatic patient

Primary cardiac tumours are rare with an autopsy frequency of 0.001–0.03% and approximately 90% of them are benign. Among these, cardiac fibromas represent a minority and, together with rhabdomyomas, are themost common benign cardiac tumours in paediatric patients. However, their occurrence in the adult patient is uncommon. Most originate from the left ventricle (LV) or interventricular septum. Patients with cardiac fibroma usually present with chest discomfort or pain, syncope, heart failure, cyanosis, arrhythmias or even sudden death but approximately one third of patients diagnosed with cardiac fibroma are asymptomatic and the tumour is discovered incidentally [1]. There is a general agreement that surgical treatment should be performed whenever the cardiac fibroma is causing symptoms. In these patients, surgical options include complete surgical excision, partial resection or orthotopic heart transplantation. Indication for surgical treatment remains controversial in patients who are strictly asymptomatic. We report the case of an asymptomatic adult patient presenting with a giant LV cardiac fibroma and for whom we have opted for a conservative management. A 39-year-oldwomanwas referred to our institution for a LV cardiac mass discovered incidentally during transthoracic echocardiography performed for an unrelated reason. The patient had no personal or familial history of cardiovascular disease and presented no risk factors.

Gender-Based Differences in the Management and Prognosis of Acute Coronary Syndrome in Korea

PurposeGender-based differences exist in the characteristics, management, and prognosis of acute coronary syndrome (ACS). However, their impact on prognosis remains unclear. We aimed to identify factors causing these differences in Koreans.Materials and MethodsWe examined 6,636 ACS patients (66.2% males) visiting 72 Korean hospitals between April-2007 and December-2008. Gender-based differences in clinical demographics, therapy, and outcomes were analyzed over 6 months.ResultsWomen were older than men [mean (standard deviation, SD) age, 67.6 (9.8) vs. 60.6 (11.2) years; p<0.001]; had higher rates of hypertension, diabetes mellitus, and lack of exercise (p<0.001 for all); and lower rates of obesity, familial history of cardiovascular disease (CVD), and smoking (p<0.05 for all). Atypical symptoms were more common in women (20.5% vs. 15.1% in men, p<0.001), whereas myocardial infarction with ST-segment elevation was less common (17.1% vs. 27.8%, p<0.001). Mean (SD) time lapse from symptom onset to arrival at hospital was longer in women [11.44 (18.19) vs. 8.26 (14.89) hours in men, p<0.001], as was the duration of hospitalization [7.58 (7.61) vs. 7.04 (7.72) days, p=0.007]. Fewer women underwent revascularization procedures, including thrombolytic therapy, balloon angioplasty, stent implantation, and coronary artery bypass grafting (79.4% vs. 83.3% men, p<0.001). No significant differences were observed in CVD-related death, recurrent ACS, stroke, refractory angina, or rehospitalization for angina.ConclusionFemale ACS patients were older than male subjects and had more atypical presentation. They arrived at the hospital later than men and had longer hospital stays, but less often required revascularization therapy. However, no gender-based differences were noted in ACS-related mortality and morbidity.

POSSIBILITY OF BLOOD PRESSURE CONTROL BY UKRAINIAN GENERIC DRUGS IN DIABETIC HYPERTENSIVE PATIENTS IN PRIMARY CARE SETTING: RESULTS OF MULTICENTRE OPEN TRIAL: PP.17.128

The aim of this study was to compare diabetic and non diabetic hypertensive patient characteristics and to evaluate the possibility of BP control by Ukrainian generic drugs in dependency from diabetes presence. 10158 patients (12,7% with new diagnosed hypertension) with BP > 140/90 mmHg were included in 3 mth multicentre (62 towns and 531 primary care physicians) open trial. All patients were divided in 2 groups: 1st – 1208 with DM type 2; 2nd – 8950 without DM. Patients were treated by primary care physician, who prescribed mostly the Ukrainian generic drugs for achieving target BP. Baseline patients with DM had higher systolic and diastolic BP, more percentages of complications, CAD, risk factors and were less educated. Drug compliance was lower in DM patients baseline and at the end of study. Patients with obesity (P < 0.001) and low physical activity (P < 0.005) had significant higher percentage of DM, than patients without obesity and higher physical activity – 19.9, 12.7% and 9.1, 10.7% respectively. BP decreased significantly (P < 0.001) in both groups from 171.3 ± 0.73/98.6 ± 0.3 and 165.5 ± 0.27/96.4+/0.14 mmHg to 137.5 ± 0.39/82.9 ± 0.24 and 134.3 ± 0.19/81.3 ± 0.15mmHg respectively in 1st and 2nd groups. But the level of BP in DM patients was higher than in non DM. The BP<140/90mmHg was achieved in 54.7% of DM patients and in 71.8% without DM (P < 0.001). The level <130/80mmHg was achieved only in 16.4% DM patients. Predictors of poor BP in DM hypertensives were older age, higher BMI, complications (stroke, heart failure, retinopathy), CAD, family cardiovascular disease history, baseline high BP level, low drug compliance, low physical activity, low consumption of fresh vegetables or fruits. Higher BP was in patients with lower doses of antihypertensive drugs and with rare using of combinative therapy. DM hypertensive patients were more severe group, than patients without DM. It was harder to achieve target BP in them. For better BP control there were necessary to provide more intensive therapy and life style modification, improve of drug compliance.

Relationship between PON1L55M and Q192R gene polymorphisms and high APO B/APO A-I ratios

Elevated Apolipoprotein B Apolipoprotein A-I ratio is a risk factor for predicting coronary artery disease (CAD). Paraoxonase 1 (PON1) is a high density lipoprotein (HDL) associated serum enzyme. PON1 protects lowdensity lipoproteins (LDLs) from oxidative modifications and thus has a protective effect against CAD progression. There are two common polymorphisms, Q192R and L55M, in PON1 gene. There may be a relationship between these polymorphisms and elevated ApoB/ApoA-I ratios. Therefore, we decided to evaluate effect of these polymorphisms on individuals with high and normal ApoB/ApoA-I ratios. To evaluate Q192R and L55M polymorphisms in Iranian case group (n=75) with high ApoB/ApoA-I ratio, and control group (n=75) with normal ApoB/ApoA-I ratio, we carried out PCR using specific primers. Then, we digested PCR products by RFLP. ApoB and ApoA-I levels were determined by immunoturbidimetry method. Genotype frequencies for Q192R were determined: 49.3%QQ, 44%QR, 6.7%RR in case group, and 53.3%QQ, 33.3%QR, 13.4%RR in controls (P= 0.236). Genotype frequencies for L55M were determined: 21.3%LL, 68%LM, 10.7%MM in case group and 42.7%LL, 52%LM, 5.3%MM in controls (P= 0.016). A significant relationship between L55M polymorphism and familial history of cardiovascular disease was found (P= 0.011). In our study PON1L55M polymorphism was associated with high ApoB/ApoA-I ratios in case group. Thus, L55M polymorphism may be an independent risk factor for cardiovascular disease. Since L55M polymorphism was associated with familial history of cardiovascular disease, it is better to evaluate L55M polymorphism in younger ages even in the absence of high ApoB/ApoA-I ratios.

Parental precocious influences on offspring cardiovascular risk markers: an exploratory study in the STANISLAS Cohort

Familial history of cardiovascular disease is acknowledged as a risk indicator in offspring. The aim of this study was to assess whether the cardiovascular risk factors in parents predicted the risk of their children developing cardiovascular disease in a French population: the STANISLAS Cohort, in which Caucasian biparental families with at least two siblings were followed for 5 years. Silent risk factors (blood pressure, lipid traits, glycemia, BMI and waist circumference) of children were compared according to their parents' risk status in a subsample of 693 families. All of these traits, with the exception of glucose, were significantly higher in children who had parents at a high risk than in children with parents at a low risk at the first health examination, and these results were confirmed again 5 years later at the second health examination. Thus, silent cardio-metabolic risk factors can be screened in children according to the risk status of their parents for early prevention. The influence of parents' variants on their offspring underlined the need to initiate familial prevention strategies, with a particular follow-up of young individuals between childhood and adolescence.

Prevalence of cardiovascular disease and risk factors in a type 2 diabetic population of the North Catalonia diabetes study

The purpose of the study was to evaluate the prevalence of cardiovascular disease (CVD), cardiovascular risk factors (CVRFs), and their control in patients with type 2 diabetes mellitus (T2DM) at primary care settings from the North Catalonia Diabetes Study (NCDS). In this multicentre cross-sectional descriptive study, data were collected from a random sample of 307 patients with T2DM. The prevalence of CVD, CVRF, metabolic syndrome (MS), coronary heart disease (CHD) risk at 10 years (Framingham Point Scores), and CVRF control was evaluated. MS and lipid profiles were established according to Adult Treatment Panel III criteria. CVD prevalence was 22.0% (CHD: 18.9% and peripheral ischemia: 4.5%) and more frequent in men. The prevalence of selected CVRF was: hypertension: 74.5%; dyslipidemia: 77.7%; smoking: 14.9%; obesity 44.9%, and familial CVD: 38.4%. Three or more CVRFs, including T2DM, were observed in 91.3%. MS prevalence was 68.7%. Framingham score was 10.0%, higher in men than in women. CVD prevalence was related to: age, number of CVRFs, duration of diabetes, familial history of CVD, waist circumference, hypertension, lipid profile, kidney disease, and Framingham score, but not to MS by itself. Correct lipid profiles and blood pressure were only observed in 18.9% and 24.0%, respectively, whereas platelet aggregation inhibitors were only recorded in 16.1% of the patient cohort. MS presence was not an independent risk factor of CVD in our study. The high prevalence of CVD and an inadequate control of CVRF, which were apparent in the NCDS population, would suggest that advanced practice nurses should consider incorporating specific cardiovascular assessment in their routine care of persons with T2DM.

Homocyst(e)ine, Folate, and Vitamin B12 Status in a Cohort of Welsh Young People Aged 12–13 Years Old

The aim of this unique study was to consider the relationship between folate and vitamin B12 on homocyst(e)ine (Hcy) concentration in an apparently healthy cohort of Welsh young people. A cohort of 179, 12–13 year olds (88 boys and 91 girls) were measured for Hcy, folate, vitamin B12, adiposity, and dietary habits. Boys had significantly higher waist circumference and folate concentration than girls. Folate was negatively associated with Hcy in both sexes, whereas vitamin B12 was negatively associated with Hcy in boys only. Adiposity was not associated with Hcy. Folate was an independent predictor of Hcy in both sexes, whilst vitamin B12 was an independent determinant of Hcy in boys only. Familial history of cardiovascular disease (CVD) risk factors was identified in 69% of the children with elevated Hcy (≥ 8.5 μmol·L−1). Young people might be encouraged to increase their folate intake through diet, particularly by increasing their consumption of leafy vegetables and fruit. Further research is necessary to determine the exact contribution of genetics and diet on Hcy levels in young people, and whether Hcy levels during childhood and adolescence might influence future CVD risk.

Cardiac magnetic resonance imaging findings in a patient with noncompaction of ventricular myocardium

Noncompaction of ventricular myocardium (NCVM) is a rare cardiomyopathy characterized by numerous prominent trabeculations in the ventricular wall and deep intertrabecular recesses communicating with the ventricular cavity. This article reports a 33-year-old female with a familial history of cardiovascular disease, who presented with shortness of breath and palpitations. Transesophageal echocardiography and cardiac magnetic resonance imaging (MRI) were consistent with the diagnosis of NCVM. The advantages of MRI in depicting both the morphological features and pathological characteristics of NCVM were presented.

Kidney Transplantation Candidates and Cardiovascular Risk Factors

Objective We sought to determine the prevalence of cardiovascular disease and risk factors among chronic renal failure (CRF) patients on the transplantation waiting list. Methods Fifty CRF patients on chronic hemodialysis who underwent evaluation for transplantation were compared with 60 hypertensive patients matched for age. We used Framingham scoring to calculate the absolute risk; relative risk was calculated based on the low-risk Framingham cohort. Results According to traditional risk factors, a significant difference was observed in systolic blood pressure and total cholesterol (greater in the hypertensive group), and in the prevalence of the male gender, smoking, and diabetes, which were greater in the CRF group. The latter had a greater degree of left ventricular hypertrophy, lower diastolic blood pressure, and a lower prevalence of familial history of cardiovascular disease and obesity. Patients with CRF had a greater relative risk compared with the Framingham control population, but it did not differ from that observed in the group of hypertensive individuals. Conclusion The prevalence of cardiovascular disease and traditional risk factors is high among renal transplantation candidates. The Framingham equations do not adequately quantify the real cardiovascular risk; other risk factors specific for that population probably contribute to their greater cardiovascular risk.

Patterns of persistence with antihypertensive medications in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care

To describe patterns of persistence and related primary care costs associated with first antihypertensive treatment. Retrospective cohort study during 2000-2001, using information from 320 Italian general practitioners. We studied 13 303 patients with newly diagnosed hypertension, who received a first single antihypertensive prescription within 3 months after diagnosis. Persistence with first-line single treatment, categorized as follows: continuers: patients continuing the first-line medication for at least 1 year; combiners: patients receiving an additional antihypertensive drug and continuing the initial medication; switchers: patients changing from the first-line to another class of antihypertensive drug and discontinuing the initial treatment; discontinuers: patients stopping the first-line treatment without having another prescription until the end of the follow-up. Primary care costs were expressed as the cost of hypertension management per person-year of follow-up. In the study cohort, 19.8% were continuers, 22.1% were combiners, 15.4% were switchers, and 42.6% were discontinuers. Continuation was greatest with angiotensin II type 1 receptor blocking agents (25.2%), calcium channel blockers (23.9%) and angiotensin-converting enzyme inhibitors (23.3%). Severe hypertension [hazards ratio 1.30; 95% confidence interval (CI) 1.18 to 1.43] and severe health status (hazards ratio 1.22; 95% CI 1.15 to 1.30) increased the risk of discontinuation. The likelihood of needing an additional antihypertensive drug was associated with mild-to-severe baseline blood pressure, diabetes (hazards ratio 1.20; 95% CI 1.06 to 1.36), and familial history of cardiovascular disease (hazards ratio 1.24; 95% CI 1.10 to 1.39). Discontinuers accounted for 22.4% of the total primary care cost. Initial treatment with angiotensin II type 1 receptor blocking agents and beta-blockers resulted in incremental primary care costs of 145.2 and 144.2, respectively, compared with diuretics. Combiners and switchers increased the primary care cost by 140.1 and 11.7, compared with continuers. Persistence with first-line single antihypertensive drugs is extremely low during the first year of treatment. Potential cost saving should be possible by reducing the high frequency of discontinuation. Diuretics represent the least expensive therapeutic option, although further investigations in the long-term are needed to analyse the effects of persistence on therapeutic effectiveness and related costs.

Blood pressure and carotid-femoral pulse wave velocity in twins. Effect of birth weight

Disorders in the oxygen or nutrients supply during the so called critical periods of intrauterine growth (IUG) may cause permanent organ damage and result in higher blood pressure and cardiovascular risk. Viscoelastic properties of arteries depend on their amount of elastin and collagen fibres. Elastin synthesis only occurs during the critical period of blood vessel development, so that any disturb in this period can cause a lesser arterial compliance. Monozygotic twins with different birth weight (BW) are an ideal model to study the relation between arterial compliance and BW because differences cannot be from genetic load or maternal nutrition. We have studied whether low BW as an index of IUG affects blood pressure and arterial compliance in twins with different BW. 19 twin pairs (11 monozygotic) in which one of them had intrauterine growth retardation (IUGR; BW < percentile 5 for gestational age) were studied. Weigth, height and blood pressure were measured. Carotid-femoral pulse-wave velocity (PWV) was assessed with a Complior (Colson) ® device. Obstetric history and familial history of cardiovascular disease were registered. An uni- and multivariant analysis with PWV as dependent variable was performed. Values of ph0.05 were considered significant. Mean (SD) age, BW, birth lenght and gestational age were 5.63 (0.59) years, 2.21 (0.42) Kg, 46.75 (3.84) cm, 35.36 (3.38) weeks, respectively. Values of systolic (SBP) and diastolic blood pressure (DBP) were 86.68 (15.2) and 55.18 (12.2) mm Hg, and PWV was 6.16 (2.83) m/seg. Univariant analysis showed a negative relation between BW and PWV in monozygotics (r = -0.45 p=0.034). No significant relation was found in dizygotics (r = -0.2 p=0.45). In Multivariant Model (monozygotics and dizygotics) (R2 0.32 p=0,009) predicting variables of PWV were gestational age (= 0.43 p=0.014), SBP (= 7 p=0.016) and BW (= -4.21 p=..007). In monozygotics (R2 0.49) only BW was a predicting variable with a stronger negative relation (= -6.33 p=0.014). Our data support the hypothesis that a IUGR favours from early ages higher arterial stiffness and SBP. This relation is more evident when monozygotic twins are compared, although studies with a greater number of subjects as well as follow up to adult life are needed to confirm this hypothesis.

Doença cardiovascular e fatores de risco cardiovascular em candidatos a transplante renal

To determine the prevalence of cardiovascular disease (CVD) and traditional risk factors in patients with chronic renal failure undergoing evaluation for inclusion on the renal transplantation list. One hundred ninety-five patients with dialytic chronic renal failure underwent clinical evaluation and complementary tests and were compared with a group of 334 hypertensive patients paired for age. The Framingham equations were used for calculating the absolute risk (AR). The relative risk (RR) was calculated based on the absolute risk of the low-risk Framingham cohort. Thirty-seven percent of the patients had some sort of cardiovascular disease on the initial evaluation, peripheral vascular disease (23%) being the most prevalent. Patients with cardiovascular disease were excluded. Regarding traditional risk factors, a significant difference was observed in systolic blood pressure and total cholesterol (greater in the hypertensive group), and in the prevalence of men, diabetes, and smoking, which were greater in the chronic renal failure group. The latter had a greater degree of left ventricular hypertrophy, lower diastolic blood pressure, and a lower prevalence of familial history of cardiovascular disease and obesity. The relative risk for cardiovascular disease in patients with chronic renal failure was greater compared with that in the Framingham control population, but it did not differ from that observed in the group of hypertensive individuals. The prevalence of cardiovascular disease and traditional risk factors is high among candidates for renal transplantation; the Framingham equations do not adequately quantify the real cardiovascular risk, and other risk factors specific for that population should contribute for their greater cardiovascular risk.

Perceptions of cardiovascular risk among patients with hypertension or diabetes

We aimed to examine risk perceptions among patients at moderate to high cardiovascular risk. A questionnaire about perceived absolute risk of myocardial infarction and stroke was sent to 2424 patients with hypertension or diabetes. Response rate was 86.3% and 1557 patients without atherosclerotic disease were included. Actual cardiovascular risk was calculated by using Framingham risk functions. A total of 363 (23.3%) of the 1557 patients did not provide any risk estimates and these were particularly older patients, patients with a lower educational level, and patients reporting no alcohol consumption. The remaining 1194 patients tended to overestimate their risk. In 42.3% (497/1174) and 46.8% (541/1155) of the cases, patients overestimated their actual 10-year risk for myocardial infarction and stroke, respectively, by more than 20%. Older age, smoking, familial history of cardiovascular disease (CVD), and actual absolute risk predicted higher levels of perceived absolute risk. Male sex, higher scores for an internal health locus of control, lower scores for a physician locus of control, and self-rated excellent or (very) good health were positively related to higher accuracy. In conclusion, patients showed inadequate perceptions of their absolute risk of cardiovascular events and physicians should thus provide greater information about absolute risk when offering preventive therapy.