Rates Of Heart Attack Research Articles

Organizational downsizing and stress-related illness

Epidemiological evidence of physical correlates of stress for midlevel workers threatened by organizational restructuring, reorganization, and downsizing was obtained for seamen in the U. S. merchant fleet, an industry which has lost 75% of its jobs in a working lifetime. Illness reports of 22,763 seamen were analyzed to ascertain the relationship between job-related and situational stress factors and the occurrence of eight stress-related diseases (cardiovascular disease, hypertension, heart attack, psychoneurosis, suicide, peptic ulcer-gastritis, arthritis, and asthma). Rank difference was revealed as the primary determinant of disease occurrence rate. The licensed group, midlevel managers in both deck and engine departments, showed a significantly higher percentage of stress related illness than did the unlicensed group. Licensed deck personnel showed higher rates of cardiovascular disease, heart attack, psychoneurosis, suicide, and asthma. Licensed engine personnel showed higher rates of heart attack and asthma. Explanations for high stress levels among licensed personnel center around declining job opportunity due to downsizing and end-of-career anxiety. Other factors include the burdens of supervisory responsibility in an era of eroding management authority, accommodation to technological and situational change, and general aging of the merchant marine workforce.

Benefit/risk of estrogen therapy in cardiovascular disease: current knowledge and future challenges.

In the United States, cardiovascular disease represents the leading cause of death among women. A majority of the deaths are due to coronary disease. In addition, the incidence of heart attacks increases with age. Among those who are 65 years of age or older, the estimated heart attack rate is 374,000 per year for women, compared with 440,000 per year for men. In the past three decades, a number of observational studies have suggested that estrogen therapy can reduce the risk of coronary disease in postmenopausal women. This protective effect appears to be much greater in women who have existing coronary disease. These observational data point to the potential usefulness of estrogen therapy in preventing cardiovascular death among women. Although large, well-controlled, clinical trials are needed to confirm the benefit of estrogen therapy, several important findings strongly support the cardioprotective effect of estrogen therapy. For example, in monkeys estrogen prevents the accumulation of low-density lipoprotein (LDL) cholesterol (a known risk factor for heart disease) in coronary arteries, and estrogen has also been shown to increase high-density lipoprotein (HDL) cholesterol (a known cardioprotective factor). Estrogen also possesses a vasodilating property, which can improve cardiac performance in ischemic heart disease. In addition, recent studies have demonstrated that estrogens (especially equilin) exhibit a high antioxidant effect, which may also be related to cardioprotectivity. Although estrogen therapy has been observed to decrease the risk of coronary disease, long-term estrogen therapy has also been found to increase the risk of uterine carcinoma; the addition of progesterone to estrogen therapy may lessen this undesirable risk, however. On the other hand the addition of progesterone to estrogen therapy may decrease estrogen's beneficial effect on HDL cholesterol. What should be the present position on estrogen therapy in postmenopausal women? What is the best dosage regimen? Should it be used alone or in combination with a progesterone? These important issues are discussed, as are several current clinical trials addressing the issue of estrogen therapy in postmenopausal women.

The Calcium Channel Blocker Scare

The recent panic over use of calcium channel blockers to treat hypertension illustrates the crucial role played by the communication (or miscommunication) of research results to the public. As most readers are aware, the situation was triggered by presentation of a case-control study at the American Heart Association (AHA) 35th Annual Conference on Cardiovascular Disease Epidemiology and Prevention. The study, which was funded by the National Heart, Lung, and Blood Institute (NHLBI), observed that rates of heart attack were higher among hypertensive patients taking a calcium channel blocker than among patients taking a diuretic or a β-blocker. The press release issued by the investigator’s institution noted that the increased heart attack risk associated with calcium channel blockers might be as high as 60%. Although the investigator was interviewed by the press and some of the reporting reflected a balanced perspective, many alarming stories were printed and broadcast. Headlines such as “Drug for Blood Pressure Linked to Heart Attacks: Researchers Fear 6 Million Are Imperiled” generated considerable public concern. At the heart of the problem …

Weight change and risk of heart attack in middle-aged British men.

Both weight gain and weight loss have been associated with increased risk of cardiovascular disease mortality in recent studies from the US. This finding has led to concern and uncertainty about appropriate advice for overweight and obese subjects. In a prospective study of cardiovascular disease, the relationship between weight change over a 5-year period and subsequent risk of a heart attack during a further 6.5 year follow-up was examined in 7100 middle-aged British men. Over half of the men remained stable (< 4% change in bodyweight) and served as the reference group; 31% gained weight and 13% lost weight. The 6445 men free from a history of coronary heart disease experienced 318 heart attacks, fatal and non-fatal, during the 6.5 years. Men who gained 4-10% bodyweight had the lowest rate of heart attack, although this was not significantly different from the stable group. The men who lost weight had an increased risk of heart attack, which after adjustment (for age, recall of doctor-diagnosed hypertension and diabetes and other coronary risk factors i.e. serum total cholesterol, blood pressure, social class, initial body mass index (BMI) and lung function (FEV1), and smoking status at screening and 5 years later), was of a similar level of risk to the stable group. The men who gained > 10% bodyweight had a significantly increased risk of a heart attack after the above adjustment (P < 0.05). When the effect of weight change was examined according to initial BMI, those men with a BMI < 25 kg/m2 who lost weight had a marginally increased relative risk of heart attack after full adjustment (P = 0.06), while men who were overweight (BMI 25-27.9 kg/m2) or obese (BMI > or = 28 kg/m2) showed no benefit from weight loss. A small amount of weight gain (4-10%) in the overweight or obese men was associated with decreased risk, whereas considerable weight gain (> 10%) was associated with increased risk, both findings reaching statistical significance in the overweight men (P < 0.05 and P < 0.001 respectively). Considerable weight gain (> 10%) in middle-aged men is associated with increased risk of a heart attack, but weight loss does not appear to reduce risk even in the overweight or obese.

Prevention of Stroke in Older Persons With Isolated Systolic Hypertension

To the Editor. —The study, Prevention of Stroke by Antihypertensive Drug Treatment in Older Persons With Isolated Systolic Hypertension,1concluded that treatment of isolated systolic hypertension in patients older than 60 years has considerable potential to decrease morbidity and disability. Despite this, I believe it would be a mistake to recommend treating all patients with isolated systolic hypertension rather than to seek to identify and treat only the subgroup at highest risk. Although the benefit was evident regardless of the initial systolic blood pressure, the authors conspicuously failed to mention whether a relationship was seen between the baseline DBP and the observed benefit. A related question is this: among patients with isolated systolic hypertension, did a treatment benefit patients with an elevated mean arterial pressure more than patients with a normal mean arterial pressure? The reduction in heart attack rate was greater than that seen in many other hypertension

Physical activity and ischaemic heart disease in middle-aged British men.

To assess the relation between reported physical activity and the risk of heart attacks in middle aged British men. Prospective study of middle-aged men followed for a period of eight years (The British Regional Heart Study). One general practice in each of 24 British towns. 7735 men aged 40-59 years at initial examination. Heart attacks (non-fatal and fatal). During the follow up period of eight years 488 men suffered at least one major heart attack. A physical activity score used was developed and validated against heart rate and lung function (FEV1) in men without evidence of ischaemic heart disease. Risk of heart attack decreased significantly with increasing physical activity; the groups reporting moderate and moderately vigorous activity experienced less than half the rate seen in inactive men. The benefits of physical activity were seen most consistently in men without preexisting ischaemic heart disease and up to levels of moderately vigorous activity. Vigorously active men had higher rates of heart attack than men with moderate or moderately vigorous activity. The relation between physical activity and the risk of heart attack seemed to be independent of other cardiovascular risk factors. Men with symptomatic ischaemic heart disease showed a reduction in the rate of heart attack at light or moderate levels of physical activity, beyond which the risk of heart attack increased. Men with asymptomatic ischaemic heart disease showed an increasing risk of heart attack with increasing levels of physical activity, but with a progressive decrease in case fatality. Overall, men who engaged in vigorous (sporting) activity of any frequency had significantly lower rates of heart attack than men who reported no sporting activity. However, when all men reporting regular sporting activity at least once a month were excluded from analysis, there remained a strong inverse relation between physical activity and the risk of heart attack in men without pre-existing ischaemic heart disease. This study suggests that the overall level of physical activity is an important independent protective factor in ischaemic heart disease and that vigorous (sporting) exercise, although beneficial in its own right, is not essential in order to obtain such an effect.

Body Fat Distribution and Self-Reported Prevalence of Hypertension, Heart Attack, and Other Heart Disease in Older Women

The associations of self-reported body mass and fat distribution with self-reported prevalence rates of hypertension, heart attack, and other heart disease were examined in a sample of 40,000 women, aged 55-69 years. Fat distribution was measured by the waist-to-hip circumference ratio (WHR), which had a mean +/- SD of 0.838 +/- 0.085. Prevalence of hypertension was significantly and positively associated with both body mass index (BMI) and waist-to-hip ratio. The prevalence rate ratio for hypertension in the highest versus the lowest tertile of body mass index and waist-to-hip ratio (considered jointly) was 2.7. Prevalence rates of heart attack and other heart disease were significantly and positively associated with waist-to-hip ratio but not with body mass index. The prevalence rate ratios were 2.2 for heart attack and 1.4 for other heart disease in the highest versus the lowest tertile of body mass index and waist-to-hip ratio. Findings were substantiated using multiple logistic regression. These results support the hypothesis that a significant relationship exists between body fat distribution and the occurrence of cardiovascular disease in older women.

Occupational hazards and heart attacks

There has been limited research on occupation health hazards and heart disease. With the exception of the effects of noise, even less research has been conducted on occupational safety hazards, however. This study takes an initial look at interrelationships between safety hazards and heart disease. Fatal injury rates within industries are taken as proxies for safety hazards; fatal heart attack rates are taken as proxies for heart disease. Holding age, race, and gender constant evidence is found which is consistent with the hypothesis that safety hazards, through their effects on stress, either cause or exascerbate heart disease.

Risk of a coronary heart attack in the normal population and how it might be modified in flyers

Fatal accident rates in passenger aircraft can be compared directly with coronary heart attack rates in pilots. Although heart attacks are unpredictable in the short term and about 50% of them might cause immediate total incapacitation, rates are such that only a very small percentage of fatal accidents could come from this cause. Risk of attack is highly age- and sex-dependent but pilots should be at lower risk than the general population as half of the events in the latter are recurrences in those with manifest disease which would usually lead to permanent loss of licence . Identification of other markers for coronary heart disease and of coronary risk factors in pilots could lead to a further potential reduction in risk but the effect is small and could be brought about only by grounding a large proportion of existing pilots. Below the age of 50, risk in men is small but above this age special scrutiny may be justified for those involved in single-pilot operations. Better data on the actual risk of developing coronary heart disease in pilots should be provided by setting up a central recording system covering both active aircrew and those who retire for whatever reason.

Interim Policy to Prevent Coronary Heart Disease

While neither Williams and Wynder in this issue (p 2196) nor we are in a position to set national policy to prevent coronary heart disease, it is useful to discuss, with the goal of defining, what could reasonably be included in such a policy at the present stage of our knowledge. Williams and Wynder begin with the currently popular assumption, not yet proved, that the frequency rate of heart attacks in adults may be decreased by instituting preventive programs in childhood. This assumption arose in part from the realization that preventive measures started in middle-adult life did little to decrease heart attacks.¹It is also known that atherosclerotic lesions begin in childhood and can be fairly advanced by the age of 20 years. Therefore, a way to prevent heart attacks is to begin a "moderate intervention program" in childhood. The questions we raise are (1) is the intervention suggested

Prevalence of plasma lipoprotein abnormalities in the farming village of Tanushimaru and the fishing village of Ushibuka. From the epidemiological aspects.

A prospective survey was made on the population of two village in order to compare the frequency of plasma lipoprotein abnormalities in the two cohorts. The inhabitants of the farming village and those of the fishing village had different mode of life, especially eating habits, and different incidence rates of heart attack and brain stroke, but invariably had low serum cholesterol levels. The results of the study indicated that the nature and frequency of plasma lipoprotein abnormalities made vary with difference eating habits. However, the way in which this variance is related to the development into heart attack and brain stroke in the two populations remains to be settled by further follow-up study.