Major Coronary Heart Disease Risk Factors Research Articles

Effects of a Music-Assisted Relaxation and Imagery Compact Disc Recording on Health-Related Outcomes in Cardiac Rehabilitation

By the end of the time, you feel very, very calm and just very relaxed. Relaxes physical body. Slows down thinking too. Getting a chance to just stay in one spot and listen to something that's slower and wants you to relax, tries to help you to relax, makes a big difference.George lives with coronary heart disease (CHD) and underwent coronary artery bypass graft surgery prior to his enrollment in cardiac rehabilitation at a local hospital. He spoke these words after listening to a Music-Assisted Relaxation and Imagery (MARI1) compact disc (CD) recording as part of this research study.Literature ReviewGeorge learned to cope with heart disease, while more people have died worldwide from CHD since 1990 than from any other cause (Mackay & Mensah, 2004). CHD is the single largest killer of Americans, accounting for more than one in every five deaths in 2005 (American Heart Association, 2009a). Almost one in three American adults hypertension (National Heart Lung and Blood Institute, 2009), which is diagnosed when there is a blood pressure reading of 1 40/90 or higher, and is a major risk factor for CHD (American Heart Association, 2009b).Individual stress response may be a contributing risk factor for CHD (American Heart Association, 20090), and many of the tools of integrative medicine, mind-body medicine, and complementary and alternative medicine (CAM) assist patients in managing their stress. Principles of integrative medicine include a patient-centered, individualized health approach that combines evidence-based medicine with a holistic model to treat the whole person - body, mind, and spirit. Edelman et al. (2006) conducted a randomized, controlled trial of 154 patients to study the effect of a personalized health plan on improvement of patients' risk factors for developing cardiovascular disease. The health plan included: mindfulness meditation; relaxation training; stress management; motivational techniques; health education; and coaching. There was a statistically significant difference between conditions in the risk improvement rate (p = .04), suggesting that individuals who participated in a multi-dimensional intervention were less likely to develop CHD over a 10 year period.Benson (1975) explained that regular elicitation of the relaxation response is an inborn counterbalance to the body's stress response. Evoking the relaxation response is an effective mind-body interaction intervention for stress management (Esch, Fricchione, & Stefano, 2003; Stefano, Fricchione, Slingsby, & Benson, 2001). Relaxation response training alone has been demonstrated to be as effective as drugs in fighting hypertension under suitable circumstances (Esch et al., 2003, p. RA27).Healthcare professionals have studied the effects of music on stress. A systematic review of 12 randomized controlled trials of music listening by patients with various cardiovascular diseases (Schmidt & Ernst, 2004) indicated that all measured outcomes were favorably significant for the music listening group in three trials (Guzzetta, 1989; Lueders-Bolwerk, 1990; White, 1999); five trials demonstrated some significant and some non-significant outcomes (Barnason, Zimmerman, & Nieveen, 1995; Cadigan et al., 2001; Hamel, 2001; White, 1992; Zimmerman, Neiveen, Barnason, & Schmaderer, 1996); while three showed no difference between music and control conditions (Blankfield, Zyzanski, Flocke, Alemagno, & Scheurman, 1995; Taylor-Piliae & Molassiotis, 2001; Zimmerman, Pierson, & Marker, 1 988); and one study included no between group analysis (Elliot, 1 994). In one study that compared music listening with rest, anxiety was reduced only in the music group; there were no significant differences between groups in blood pressure (White, 1999). Another study reported that listening to music was as effective as rest in decreasing blood pressure and anxiety (Barnason et al., 1995). Chafin, Roy, Gerin, & Christenfeld (2004) found that 75 students who listened to music were able to decrease their systolic blood pressure upon recovery from stress. …

Cardiovascular Remodeling Induced by Passive Smoking

Coronary heart disease (CHD) is the most common cause of death in many developed countries. The major risk factors for CHD are smoking, high blood pressure, diabetes, high cholesterol levels, and lack of physical activity. Importantly, passive smoke also increases the risk for CHD. The mechanisms involved in the effects of passive smoke in CHD are complex and include endothelial dysfunction, lipoprotein modification, increased inflammation and platelet activation. Recently, several studies have shown that exposure to tobacco smoke can result in cardiac remodeling and compromised cardiac function. Potential mechanisms for these alterations are neurohumoral activation, oxidative stress, and MAPK activation. Although the vascular effects of cigarette smoke exposure are well known, the effects of tobacco smoking on the heart have received less attention. Therefore, this review will focus on the recent findings as to the effects of passive smoking in acute and chronic phases of vascular and cardiac remodeling.

Nonpharmacologic Treatment of Dyslipidemia

Cardiovascular disease is the number one cause of morbidity and mortality in the United States, with coronary heart disease (CHD) and myocardial infarction (MI) being the leading causes of death. The 5 major risk factors for CHD—hypertension, dyslipidemia, diabetes mellitus, smoking and obesity—account for 80% of the risk for CHD. Interventions, both pharmacologic and nonpharmacologic, can improve all of these risk factors and decrease the incidence of cardiovascular disease (CVD) and its consequences such as MI, angina, congestive heart failure, and stroke. In this article, we will review the nonpharmacologic treatment of dyslipidemia. Recent guidelines by the National Cholesterol Education Program recommend more aggressive control of serum lipids to reduce the incidence of CHD. Nutritional and dietary therapy, weight loss, exercise, and scientifically proven nutritional supplementation should be used initially in appropriately selected patients to manage dyslipidemia. Hypertriglyceridemia, frequently due to obesity, insulin resistance, metabolic syndrome, and diabetes mellitus, deserves special attention. Pharmacologic therapy should be administered in those cases that are at high or very high risk for CHD or who do not respond to nondrug therapy. Many patients prefer nondrug therapies for many reasons including adverse effects of antilipid drugs, contraindications or allergic reactions to drugs, perceptions of adverse effects of drugs, or personal

Would Achieving Healthy People 2010’s Targets Reduce Both Population Levels and Social Disparities in Heart Disease?

The US Healthy People 2010 (HP2010) agenda set targets for major risk factors for coronary heart disease (CHD). However, the potential impact of achieving those risk factor reductions on both population levels and social disparities in CHD has not been quantified. Data on 10-year risk of CHD (from the First National Health and Nutrition Examination Epidemiological Follow-Up study 1971 to 1982), prevalence of major CHD risk factors (from the National Health and Nutrition Examination Survey 2003 to 2004), and HP2010 targets for CHD risk factors (reduction of smoking rate to 12%, hypertension to 14%, high cholesterol levels to 17%, diabetes to 2.5%, and obesity to 15%) were used to estimate effects of different scenarios on population levels and social disparities in CHD. Over a 10-year period, the largest relative reductions in population levels of CHD (20.0% in men; 23.9% in women) would be achieved if all social groups met the HP2010 targets. CHD disparities would be most reduced if the less educated (absolute disparities reduced by 66.1% in men; 56.3% in women) and the low income group (absolute disparities reduced by 93.7% in men; 94.3% in women) achieved the targets before the most advantaged. These reductions are larger than those expected if targets were achieved overall for the population but relative social group differences in risk factors remained, or under leveling-up approaches in which the least advantaged achieved the current levels of risk factors of the most advantaged. Interventions to reduce CHD risk factors to HP2010 targets that focus on all social groups would produce the best overall scenario for both population levels and disparities in CHD.

Associations of arterial tissue lipids with coronary heart disease risk factors in young people

Objective To examine the associations of the coronary heart disease (CHD) risk factors with lipid composition of arterial tissue in 397 autopsied subjects 15–34 years of age from the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study. Methods and results We measured esterified cholesterol, free cholesterol, and phospholipid in the left circumflex coronary artery and two segments of the abdominal aorta, one of which is more susceptible to advanced atherosclerosis than the other, and also measured the major CHD risk factors. Non-HDL cholesterol concentration was positively associated, and HDL cholesterol concentration was negatively associated, with tissue lipids in the left circumflex coronary artery and the abdominal aorta. Hypertension was positively associated with tissue lipids in both arteries. Hyperglycemia was associated with tissue lipids in the left circumflex coronary artery and smoking with lipids in the abdominal aorta. PDAY risk scores summarize the effects of the CHD risk factors on advanced atherosclerosis. These risk scores, computed from the mutable risk factors, were associated with tissue lipids in the left circumflex coronary artery and both segments of the abdominal aorta. Conclusions The CHD risk factors are associated with lipids in arterial tissue just as they are associated with gross and microscopic lesions. These results support the proposal that early control of risk factors is likely to prevent or delay progression of atherosclerosis and prevent or delay the onset of CHD.

Preventing Heart Disease in the 21st Century

We could prevent 90% of heart attacks. Such a claim would have seemed outrageous in the 1960s, as the coronary heart disease (CHD) epidemic reached new heights and accounted for one third of all deaths in the United States and most other developed countries.1 The identification of conditions that predicted the probability of CHD (known as “risk factors”) stimulated hope that modification of these risk factors would reduce the frequency of CHD. Long before this idea was validated in clinical trials, individual physicians2,3 and voluntary health agencies4 began in the 1960s to promote the concept to the public. Many individuals accepted the idea, and many physicians adopted the recommendations in their practices. The US CHD mortality rate declined to approximately half its former level by 1990.5 The associated favorable changes in risk factors accounted for about half of this decline, whereas improved treatment of CHD accounted for the other half.6 The extent and severity of atherosclerosis also declined during this period.7,8 CHD mortality continued to decline after 1990 but at a slower rate, and CHD remained the leading cause of death in the United States.9 A convergence of evidence from diverse sources in the last 2 decades now indicates that the claim that we can prevent 90% of CHD should no longer be thought of as outrageous but as achievable. For example, the absence of the major established CHD risk factors at 50 years of age has been shown to indicate a 90% lower lifetime risk (to age 95 years) for men and a 79% lower risk for women.10,* Subjects in several large cohorts without any of the major risk factors who were followed up for 16 to 22 years had 77% to 92% lower (men) or 79% lower (women) …

Plasminogen Activator Inhibitor-1 Activity in Type 2 Diabetes

Plasminogen activator inhibitor (PAI)-1, a key regulator of fibrinolysis, is associated with increased risk of coronary heart disease (CHD) and is a potential therapeutic target for CHD. However, the relationship between PAI-1 and the most common diabetic microvascular complication, retinopathy, is unclear. The purpose of this study was to assess the relationship between PAI-1 activity and both retinopathy and CHD in type 2 diabetes. We determined PAI-1 activity and both retinopathy (assessed by masked grading of 3-field retinal photographs) and CHD status (assessed by ECG and standard questionnaires) in 147 men and women with type 2 diabetes, mean age (SD) 64 (7) years, in a cross-sectional setting. Plasma PAI-1 activity was inversely associated with prevalent retinopathy (P=0.006) and severity of retinopathy (P=0.022), and was associated with lower risk of diabetic retinopathy, independent of major retinopathy risk factors (duration of diabetes and HbA1c) and determinants of PAI-1 (obesity and triglyceride level) (OR 0.74 [0.60 to 0.92], P=0.006). Conversely, higher plasma PAI-1 activity was independently associated with greater risk of CHD, after adjusting for the major CHD risk factors and determinants of PAI-1 (OR 1.31 [1.06 to 1.62], P=0.001). These data support mounting evidence that a higher PAI-1 plasma level is independently associated with a lower risk of retinopathy but a higher risk of CHD in type 2 diabetes.

Implementing Cardiac Risk-Factor Case Management

Case-management (CM) can positively influence chronic disease care by facilitating guideline-concordant interventions that improve outcomes through intensive, individualized, longitudinal care. Implementation of CM, however, is difficult. We have identified lessons learned from a cardiovascular risk reduction CM program that may aid future CM implementation. Heart to Heart is both a clinical trial and program dissemination project implementing CM for persons at elevated risk of coronary heart disease (CHD) events in a multiethnic, low-income population in a county health system. Patients were randomized to CM plus usual primary care (N = 212) or primary care alone (N = 207). CM patients received face-to-face nurse and dietitian visits (mean of 14 hours) over 17 months. Visits emphasized behavior change, risk-factor monitoring, and guideline-based pharmacotherapy. A total of 341 patients (81%) were available for follow-up. This CM model is currently transitioning to a County-run program. Findings demonstrated statistically significant reductions in mean Framingham Risk for CM versus usual primary care (1.56% absolute decrease in 10-year CHD risk, P = 0.007). Favorable changes were noted across most major CHD risk factors. Lessons learned are the need for the following: (1) Strategies for implementing CM in low-income, ethnically-diverse populations, (2) Methods for developing clinically more effective CM, and (3) Approaches to increase the efficiency of cardiovascular CM. CM for cardiac risk factors faces notable implementation barriers, particularly in County health systems. Specific implementation solutions recommended may help confront these barriers and improve diffusion of this evidence-based and patient centered model of care.

Consumption of red or processed meat does not predict risk factors for coronary heart disease; results from a cohort of British adults in 1989 and 1999

To investigate whether a high consumption of red or processed meat is associated with increased risk of coronary heart disease (CHD). The subjects were 517 men and 635 women, who were members of the Medical Research Council National Survey of Health and Development, 1946 birth cohort. Assessment of diet was carried out at two time points 1989 and 1999 with outcome measures collected in 1999. Food intake data were recorded in 5-day diaries. Meat consumption was estimated by adding individual meat portions to the meat fractions of composite dishes. There was no significant association between red or processed meat consumption in 1989 and 1999 and serum cholesterol concentrations and blood pressure measured in 1999. The combined intake of red and processed meat in 1999 had a significant positive association with blood pressure in men only. Red and processed meat intakes in 1989, separately and combined, had a significant positive association with waist circumference in 1999: a 10 g increase in red meat consumption accounted for a 0.3 cm increase in waist circumference; P=0.04 (men), 0.05 (women). Consumption of red or processed meat assessed separately was not related to the major risk factors for CHD but contributed to increased waist circumference that has also been identified as a risk factor.

The ‘Forgotten’ Bile Acid Sequestrants: Is Now a Good Time to Remember?

Over 30 years ago, bile acid sequestrants (BAS) were among the first drugs approved to lower cholesterol levels. For over 10 years, BAS have been known to reduce glucose levels. Most importantly, BAS have been shown in outcomes studies to reduce cardiovascular events. Because they are true nonsystemic agents, BAS are generally safe and not associated with serious systemic adverse experiences. Despite their proven atherosclerotic coronary heart disease (CHD) benefits, and irrespective of their favorable effects on major CHD risk factors (hypercholesterolemia and hyperglycemia), BAS are not among the more frequently used drug treatments for hypercholesterolemia, even in patients with type 2 diabetes mellitus. Recent "high-profile" findings of investigational and approved lipid-altering and antidiabetes drug therapies illustrate that drug-induced improvements in lipid and glucose levels do not always reduce CHD risk. It may therefore be time to reconsider the clinical use of BAS. This review focuses on the recent lessons learned, and the potential mechanisms involved in efficacy and safety issues raised with torcetrapib and rosiglitazone with analogies related to the use of BAS therapy. Known and proposed mechanisms of how BAS may improve lipid and glucose levels are discussed, which are effects that may help explain how BAS reduce CHD risk. Improved tolerability of newer BAS (eg, colesevelam hydrochloride) and a "new" appreciation of the historic benefits of these "old" therapeutic agents may lead to an increased treatment role for these drugs, particularly in hypercholesterolemic patients with type 2 diabetes mellitus.

Educational status and cardiovascular risk profile in Indians

The inverse graded relationship of education and risk factors of coronary heart disease (CHD) has been reported from Western populations. To examine whether risk factors of CHD are predicted by level of education and influenced by the level of urbanization in Indian industrial populations, a cross-sectional survey (n = 19,973; response rate, 87.6%) was carried out among employees and their family members in 10 medium-to-large industries in highly urban, urban, and periurban regions of India. Information on behavioral, clinical, and biochemical risk factors of CHD was obtained through standardized instruments, and educational status was assessed in terms of the highest educational level attained. Data from 19,969 individuals were used for analysis. Tobacco use and hypertension were significantly more prevalent in the low- (56.6% and 33.8%, respectively) compared with the high-education group (12.5% and 22.7%, respectively; P < 0.001). However, dyslipidemia prevalence was significantly higher in the high-education group (27.1% as compared with 16.9% in the lowest-education group; P < 0.01). When stratified by the level of urbanization, industrial populations located in highly urbanized centers were observed to have an inverse graded relationship (i.e., higher-education groups had lower prevalence) for tobacco use, hypertension, diabetes, and overweight, whereas in less-urbanized locations, we found such a relationship only for tobacco use and hypertension. This study indicates the growing vulnerability of lower socioeconomic groups to CHD. Preventive strategies to reduce major CHD risk factors should focus on effectively addressing these social disparities.

Genetics of coronary heart disease and its risk factors.

Lipoprotein parameters related to coronary heart disease (CHD) exhibit impressive heritability, and several traditional genetic marker systems are associated with lipid levels or CHD. Recent studies indicate a population-attributable risk of 28% for myocardial infarction for men below age 60 in the top quartile of Lp(a) lipoprotein levels. Thus, a high level of Lp(a) lipoprotein emerges as a major genetic risk factor for premature CHD. Studies of DNA polymorphisms at apolipoprotein loci have uncovered associations with lipid levels and genetic linkage between DNA polymorphisms at the apolipoprotein B (apoB) locus and the Ag(x) antigenic polymorphism of low density lipoprotein. This finding proves that the Ag(x) antigenic variation resides in apoB and co-assigns its locus to chromosome 2. Lipid associations of the Ag(x) polymorphism and of DNA polymorphisms at the apoB locus are internally consistent and consistent with association between Ag(x) and DNA variants. A new approach to the study of gene-environment interactions, using monozygotic twin pairs makes it possible to uncover genes that contribute to the frame within which lifestyle factors can cause changes in a clinically relevant quantitative parameter such as serum cholesterol concentration. A new concept of interaction between 'level genes' and 'variability genes' in the aetiology of atherosclerosis emerges from these studies.

Calorie restriction or exercise: effects on coronary heart disease risk factors. A randomized, controlled trial

Coronary heart disease (CHD) risk factors and the risk of CHD increase with increased adiposity. Fat loss induced by negative energy balance improves all metabolic CHD risk factors. To determine whether fat loss induced by long-term calorie restriction (CR) or increased energy expenditure induced by exercise (EX) has different effects on CHD risk factors in nonobese subjects, we conducted a 1-yr controlled trial involving 48 nonobese subjects who were randomly assigned to one of three groups: CR, 20% CR diet (n = 18); EX, 20% increase in energy expenditure through daily exercise with no increase in energy intake (n = 18); or HL, healthy lifestyle guidelines (n = 10). Subjects were 29 women and 17 men aged 57 +/- 3 yr, with BMI 27.3 +/- 2.0 kg/m(2). Assessments included total body fat by DEXA, lipoproteins, blood pressure, HOMA-IR, C-reactive protein (CRP), and estimated 10-yr CHD risk score. Body fat decreased by 6.3 +/- 3.8 kg in CR, 5.6 +/- 4.4 kg in EX, and 0.4 +/- 1.7 kg in HL, which corresponded to reductions of 24.9, 22.3, and 1.2% of baseline body fat mass, respectively. These CR- and EX-induced energy deficits were accompanied by reductions in most of the major CHD risk factors, including plasma LDL-cholesterol, total cholesterol/HDL ratio, HOMA-IR index, and CRP concentrations that were similar in the two intervention groups. Data from the present study provide evidence that CR- and EX-induced negative energy balance result in substantial and similar improvements in the major risk factors for CHD in normal-weight and overweight middle-aged adults.

Associations of apolipoprotein E polymorphism with low-density lipoprotein size and subfraction profiles in Arab patients with coronary heart disease

The APOE gene locus has 3 major alleles, E3, E4 and E2, which variably influence coronary heart disease (CHD) risk. Plasma low-density lipoprotein (LDL) profile, another major CHD risk factor, is characterized on the basis of size and density into 2 main patterns: large buoyant LDL and small dense LDL. The latter has also been linked with increased CHD risk. This study investigates associations of specific APOE allelic patterns with LDL size and subfraction profiles in patients with CHD and healthy control subjects. We recruited 2 groups of male subjects: (A) 65 apparently healthy control subjects, median age, 39.0 years (range, 25.0-60.0 years); (B) 50 patients with CHD, median age, 54.0 years (range, 40.0-76.0 years). APOE genotypes were determined by validated polymerase chain reaction-restriction fragment length polymorphism methods, and LDL size and subfractions were assessed by a high-resolution, nongradient polyacrylamide gel electrophoresis technique (LIPOPRINT, Quantimetrix, Redondo Beach, CA). Lipid and other biochemical analyses were done by autoanalyzer techniques. The associations of specific APOE alleles and genotypes with LDL size and subfraction patterns were then assessed. As expected, patients with CHD had a worse atherogenic lipoprotein profile (waist-hip ratio, LDL, uric acid, and apolipoprotein B) than the controls. APOE genotype and allele frequencies were similar for both groups. In either group, median percent large buoyant LDL (pattern A) was greater in controls (51.0% vs 46.5%, P < .001) and percent small dense LDL (pattern B) was greater with CHD (9.0% vs 3.0%, P < .001). The latter also had smaller median particle size (26.5 vs 26.9 nm, P < .001). In controls, percent LDL pattern B was significantly lower with APOE2 than with APO non-E2 (4.0% vs 0.0%, P < .05); in patients with CHD, E2 patients had smaller particle size, and pattern B was significantly lower with non-E2 than with E2 (15.0 vs 8.0, P < .05). With respect to E4, control non-E4 had a smaller median percent LDL pattern B than E4; otherwise, there were no significant findings in relation to APOE type and LDL size and subfractions in both subject groups. These results confirm observations in other populations of increased levels of small dense LDL in patients with CHD. Although the APOE allelic pattern, especially APOE2, could be related to LDL subfraction profiles in control subjects, such associations could not be demonstrated in those with CHD.

Associations of adiponectin with metabolic and vascular risk parameters in the British Regional Heart Study reveal stronger links to insulin resistance-related than to coronory heart disease risk-related parameters

Adiponectin is considered by many to be part of the 'common soil' linking type 2 diabetes and coronary heart disease (CHD). We examined the relationship between adiponectin and insulin resistance, metabolic, inflammatory and haemostatic risk factors and hepatic function. The study was carried out in 3640 non-diabetic men aged 60-79 years drawn from general practices in 24 British towns and who were not on warfarin. Adiponectin was associated with waist circumference (inversely), alcohol intake (positively) and physical activity (nonlinearly); no association was seen with cigarette smoking, prevalent CHD or stroke. After adjustment for these factors, adiponectin was significantly inversely associated with insulin resistance, triglyceride, C-reactive protein (but not interleukin 6), tissue plasminogen activator and alanine aminotransferase and positively associated with high-density lipoprotein cholesterol (HDL-cholesterol) and Factor VIII, factors associated with diabetes. No association was seen with cholesterol, smoking, systolic blood pressure or coagulation factors. Risk of the metabolic syndrome decreased significantly with increasing adiponectin. Adiponectin is inversely associated with factors strongly associated with the development of diabetes. Limited associations with the established major risk factors for CHD suggest adiponectin may be a stronger marker of risk for diabetes than for CHD.

Hormone Therapy and Coronary Heart Disease: The Role of Time Since Menopause and Age at Hormone Initiation

Observational studies of hormone therapy (HT) in postmenopausal women have found considerably lower rates of coronary heart disease (CHD) in those taking either estrogen alone or a combination of estrogen and progestin. Nevertheless, data from the Women's Health Initiative suggest a possible increase in risk of CHD for women taking estrogen plus progestin compared with those receiving placebo. Estrogen alone reportedly had no effect. The present investigators prospectively studied CHD in relation to HT in postmenopausal women participating in the Nurses' Health Study and followed from 1976 to 2000. Information was obtained on 121,700 female nurses ranging in age from 30 to 55 years. Proportional hazards models were used to determine the multivariable adjusted relative risk (RR). The age-adjusted RR of major CHD (coronary death and nonfatal myocardial infarction) in women taking estrogen alone was 0.57 for current users compared with women who never had HT. The RR for combined HT was 0.49. After adjusting for a wide range of possible confounding factors, the respective RR values were 0.71 and 0.68. In both instances, the higher RR figures resulted from controlling for major CHD risk factors. HT correlated strongly and inversely with CHD when women began therapy near the time of menopause. The risk of CHD was somewhat higher when treatment-either estrogen alone or combined HT-began 10 years or longer after menopause. Estrogen alone was not related to the risk of CHD in women starting HT at age 60 years or older. There was some indication of a reduced risk for women taking combined HT. No substantial differences in the relation of HT to CHD risk were apparent across strata of either major CHD risk factors or the use of cholesterol-lowering drugs. Sensitivity analyses failed to show that a reduced risk of CHD for current users of HT was a result of incomplete capture of coronary events occurring shortly after the start of HT. Postmenopausal women in this large study exhibited an approximately 30% lower risk of CHD when taking estrogen alone or combined with progestin. Coronary risk may depend in part on when HT begins in relation to the onset of menopause or age. Current data do not permit a general recommendation for long-term HT with the goal of preventing chronic disease.

Assessing risk factors of coronary heart disease and its risk prediction among Korean adults: The 2001 Korea National Health and Nutrition Examination Survey

Background An in-depth assessment of coronary heart disease (CHD) risk factors in Koreans was conducted to develop effective risk reduction strategies for this population. Method Based on 2001 Korea National Health and Examination Survey, a cross-sectional survey, this paper presents the prevalence of major CHD risk factors and estimates future risk by applying the Framingham model and CHD risk factor guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP) to 4639 Koreans aged 20 to 79 years. Result Our findings indicate that CHD is a major health threat to Koreans. Among these factors, low high-density lipoprotein cholesterol (HDL-C) was seen in 35.1% of men and 17.8% of women; both had a low rate of controlled high blood pressure (men 13.7%, women 23.6%), and age-adjusted current smoking was especially high (61.6%) in men. The 10-year CHD risk averaged 11.1% in men and 5.5% in women based on Framingham model, and 7.4% and 1.4% based on NCEP guidelines. About 9.1% of men and 2.6% of women were “high-risk,” (> 20%) based on the Framingham model, and 4.7% and 0.7%, respectively, on the NCEP guideline. Diabetes was the most prevalent risk factor among high-risk individuals and total cholesterol in men and low HDL-C in women was fairly high regardless of prediction method. Conclusion These findings suggest that current coronary heart health of Koreans is nearly comparable to that of western developed countries. Developing and implementing effective population-based intervention strategies focusing on diabetes is warranted to lower the CHD risk for Koreans.

Association between nitrogen dioxide and heart rate variability in a susceptible population

Panel studies have shown a consistent association between changes in the cardiac autonomic nervous system with particulate matters (PM) but less with gaseous pollutants. This study examined the linkage between nitrogen dioxide (NO2) and heart rate variability (HRV) in a susceptible population. We recruited a panel of 83 patients from the National Taiwan University Hospital Cardiology Clinic to measure their 24-h HRV by ambulatory electrocardiography. Thirty-nine patients had coronary heart disease (CHD) and another 44 patients had more than one major CHD risk factor. Ambient concentrations of NO2, sulphur dioxide (SO2), carbon monoxide (CO), ozone, and PM less than 10 microm in diameter (PM10) at each participant's close-by monitoring station were used to represent study participants' exposures. We used linear mixed-effects models to analyse the association between individual air pollutants and log10-transformed HRV, with key personal and environmental attributes and co-pollutants being adjusted. We found that an increase in 10 ppb NO2 at 4-h to 8-h moving averages was associated with 1.5-2.4% decreases in the standard deviation of all normal-to-normal intervals (SDNN) in our participants. For every 10 ppb NO2 at 5 and 7-h moving averages, our participants' low frequency was decreased by 2.2 and 2.5%, respectively. In contrast, HRV was not associated with PM10, CO, SO2, or O3. Increasing NO2 exposure was found to be associated with decreasing SDNN and low frequency in susceptible populations.

Needs to Change the Direction of Cholesterol-related Medication—A Problem of Great Urgency

The cholesterol hypothesis implies that reducing the intake of saturated fatty acids and cholesterol and increasing that of polyunsaturated fatty acid are effective in lowering serum total cholesterol (TC), and thereby reducing the incidence of coronary heart disease (CHD). However, these dietary recommendations are essentially ineffective in reducing TC in the long run, but rather increase mortality rates from CHD and all causes. The reported "apparent relative risk of high TC in CHD mortality" (the ratio of mortality at the highest/lowest TC levels) varied several-fold among populations studied. The incidence of familial hypercholesterolemia (FH) in a population was proposed to be a critical factor in the observed variability, which could be accounted for by assuming that 1) the high CHD mortality rate in high-TC groups is mainly a reflection of the incidence and severity of FH, and 2) high TC is not a causative factor of CHD in non-FH cases. This interpretation is supported by recent observations that high TC is not positively associated with high CHD mortality rates among general populations more than 40-50 years of age. More importantly, higher TC values are associated with lower cancer and all-cause mortality rates among these populations, in which relative proportions of FH are likely to be low (circa 0.2%). Although the effectiveness of statins in preventing CHD has been accepted in Western countries, little benefit seems to result from efforts to limit dietary cholesterol intake or to TC values to less than approximately 260 mg/dl among the general population and the elderly. Instead, an unbalanced intake of omega6 over omega3 polyunsaturated fats favors the production of eicosanoids, the actions of which lead to the production of inflammatory and thrombotic lipid mediators and altered cellular signaling and gene expression, which are major risk factors for CHD, cancers, and shorter longevity. Based on the data reviewed here, it is urgent to change the direction of current cholesterol-related medication for the prevention of CHD, cancer, and all-cause mortality.

High frequency of Fredrickson's phenotypes IV and IIb in Brazilians infected by human immunodeficiency virus

BackgroundHuman immunodeficiency virus (HIV) infection is very prevalent in Brazil. HIV therapy has been recently associated with coronary heart disease (CHD). Dyslipidemia is a major risk factor for CHD that is frequently described in HIV positive patients, but very few studies have been conducted in Brazilian patients evaluating their lipid profiles.MethodsIn the present work, we evaluated the frequency and severity of dyslipidemia in 257 Brazilian HIV positive patients. Two hundred and thirty-eight (93%) were submitted to antiretroviral therapy (224 treated with protease inhibitors plus nucleoside reverse transcriptase inhibitors, 14 treated only with the latter, 12 naive and 7 had no records of treatment).The average time on drug treatment with antiretroviral therapy was 20 months. None of the patients was under lipid lowering drugs. Cholesterol, triglyceride, phospholipid and free fatty acids were determined by enzymatic colorimetric methods. Lipoprotein profile was estimated by the Friedewald formula and Fredrickson's phenotyping was obtained by serum electrophoresis on agarose. Apolipoprotein B and AI and lipoprotein "a" were measured by nephelometry.ResultsThe Fredrickson phenotypes were: type IIb (51%), IV (41%), IIa (7%). In addition one patient was type III and another type V. Thirty-three percent of all HIV+ patients presented serum cholesterol levels ≥ 200 mg/dL, 61% LDL-cholesterol ≥ 100 mg/dL, 65% HDL-cholesterol below 40 mg/dL, 46% triglycerides ≥ 150 mg/dL and 10% have all these parameters above the limits. Eighty-six percent of patients had cholesterol/HDL-cholesterol ratio ≥ 3.5, 22% increased lipoprotein "a", 79% increased free fatty acids and 9% increased phospholipids. The treatment with protease inhibitors plus nucleoside reverse transcriptase inhibitors increased the levels of cholesterol and triglycerides in these patients when compared with naïve patients. The HDL-cholesterol (p = 0.01) and apolipoprotein A1 (p = 0.02) levels were inversely correlated with the time of protease inhibitor therapy while total cholesterol levels had a trend to correlate with antiretroviral therapy (p = 0.09).ConclusionThe highly varied and prevalent types of dyslipidemia found in Brazilian HIV positive patients on antiretroviral therapies indicate the urgent need for their early diagnosis, the identification of the risk factors for CHD and, when needed, the prompt intervention on their lifestyle and/or with drug treatment.