Cerebrovascular Disease Mortality Research Articles

Association between high nocturnal blood pressure and white matter change and its interaction by obstructive sleep apnoea among normotensive adults.

A reverse dipping pattern, characterized by higher night-time blood pressure (BP) than daytime BP, is associated with the increased risk for cerebrovascular disease, cardiovascular events and all-cause mortality. However, little has known about the association between white matter change (WMC) and reverse dipping pattern, particularly in normotensive adults. We aimed to examine whether WMC is associated with BP dipping patterns as measured with a 24-h ambulatory BP monitoring and whether obstructive sleep apnoea (OSA) is involved in this relationship : A total of 703 normotensive adults were from an ongoing longitudinal study in a general population. WMC was measured with brain MRI. BP dipping patterns were defined as the ratio of the change in night-time and daytime SBP. OSA was categorized with the apnoea-hypopnea index, as measured with polysomnography. To avoid the influence of hypertensive medications, we only included normotensive adults for the final analysis. To examine the associations between WMC and dipping patterns, we built logistic models. To elucidate the role of OSA, we also conducted both modification and mediation tests. Reverse dipping pattern was significantly associated with WMC (odds ratio 1.49, 95% confidence interval 1.02-2.18). Further, OSA modified the association between dipping patterns and WMC (P = 0.0118). No mediation effect of OSA was assessed. In 703 normotensive adults, the reverse dipping pattern showed a significant association with WMC, after adjusting for covariates. Further, according to the presence of OSA, the association between reverse dipping and WMC was varied.

Monitoring of non-communicable diseases such as hypertension in South Africa: challenges for the post-2015 global development agenda.

Examining the non-communicable disease (NCD) profile for South Africa (SA) is crucial when developing health interventions that aim to reduce the burden of NCDs. To review NCD indicators in national data sources in order to describe the burden of NCDs in SA, using hypertension as an example. Age, gender, district of death and underlying cause of death data were obtained for 2008 and 2009 mortality unit records from Statistics SA and adjusted using STATA 11. Data for raised blood pressure were obtained from four national household surveys: the South African Demographic and Health Survey 1998, the Study on Global Ageing and Adult Health 2007, and the National Income Dynamics Study 2008 and 2010. The proportion of years of life lost due to NCDs was highest in the metros and least-deprived districts, with all metros (especially Mangaung) showing high age-standardised mortality rates for ischaemic heart disease, cerebrovascular disease and hypertensive disease. The prevalence of hypertension has increased since 1998. National household surveys showed a measured hypertension prevalence of over 40% in adults aged ≥25 years in 2010. Treatment coverage was 35.7%. Only 36.4% of hypertensive cases (on treatment) were controlled. Further work is needed if NCD monitoring is to be enhanced. Priority targets for NCDs must be integrated into national health planning processes. Surveillance requires integration into national health information systems. Within primary healthcare, a larger focus on integrated chronic care is essential.

Short-term changes in ambient particulate matter and risk of stroke: a systematic review and meta-analysis.

BackgroundStroke is a leading cause of death and long‐term disability in the United States. There is a well‐documented association between ambient particulate matter air pollution (PM) and cardiovascular disease morbidity and mortality. Given the pathophysiologic mechanisms of these effects, short‐term elevations in PM may also increase the risk of ischemic and/or hemorrhagic stroke morbidity and mortality, but the evidence has not been systematically reviewed.Methods and ResultsWe provide a comprehensive review of all observational human studies (January 1966 to January 2014) on the association between short‐term changes in ambient PM levels and cerebrovascular events. We also performed meta‐analyses to evaluate the evidence for an association between each PM size fraction (PM2.5, PM10, PM2.5‐10) and each outcome (total cerebrovascular disease, ischemic stroke/transient ischemic attack, hemorrhagic stroke) separately for mortality and hospital admission. We used a random‐effects model to estimate the summary percent change in relative risk of the outcome per 10‐μg/m3 increase in PM.ConclusionsWe found that PM2.5 and PM10 are associated with a 1.4% (95% CI 0.9% to 1.9%) and 0.5% (95% CI 0.3% to 0.7%) higher total cerebrovascular disease mortality, respectively, with evidence of inconsistent, nonsignificant associations for hospital admission for total cerebrovascular disease or ischemic or hemorrhagic stroke. Current limited evidence does not suggest an association between PM2.5‐10 and cerebrovascular mortality or morbidity. We discuss the potential sources of variability in results across studies, highlight some observations, and identify gaps in literature and make recommendations for future studies.

Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data

Objectives To evaluate the impact of Brazil’s recently implemented Family Health Program (FHP), the largest primary health care programme in the world, on heart and cerebrovascular disease mortality across Brazil...

Around-the-clock ambulatory blood pressure monitoring is required to properly diagnose resistant hypertension and assess associated vascular risk.

Diagnosis of resistant hypertension (RH) is currently based upon awake-time office blood pressure (BP). An increasing number of studies have documented abnormally elevated sleep-time BP in most RH patients, indicating that diagnosis of true RH cannot be determined solely by comparison of office BP with either patient awake-time BP self-measurements or awake-BP mean from ambulatory monitoring (ABPM), as is customary in the published literature. Moreover, the ABPM-determined sleep-time BP mean is an independent and stronger predictor of cardiovascular and cerebrovascular disease (CVD) risk than either daytime office/ABPM-derived awake or 24-hour means. Results of the recently completed MAPEC (Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares) prospective outcomes study, which included a large cohort of RH patients, established that time of treatment relative to circadian rhythms constituted a critically important yet often neglected variable with respect to BP control. The study found that bedtime versus morning ingestion of the full dose of ≥1 BP-lowering medications resulted in both better therapeutic normalization of sleep-time BP and reduced CVD morbidity and mortality, including in RH patients. Accordingly, ABPM is highly recommended to properly diagnose and manage true RH, with a bedtime hypertension medication regimen as the therapeutic scheme of choice.

Long-term Exposure to Air Pollution and Cardiovascular Mortality

Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE), we investigated the associations of long-term exposure to several air pollutants with all cardiovascular disease (CVD) mortality, as well as with specific cardiovascular causes of death.Data from 22 European cohort studies were used. Using a standardized protocol, study area-specific air pollution exposure at the residential address was characterized as annual average concentrations of the following: nitrogen oxides (NO2 and NOx); particles with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and 10 μm to 2.5 μm (PMcoarse); PM2.5 absorbance estimated by land-use regression models; and traffic indicators. We applied cohort-specific Cox proportional hazards models using a standardized protocol. Random-effects meta-analysis was used to obtain pooled effect estimates.The total study population consisted of 367,383 participants, with 9994 deaths from CVD (including 4,992 from ischemic heart disease, 2264 from myocardial infarction, and 2484 from cerebrovascular disease). All hazard ratios were approximately 1.0, except for particle mass and cerebrovascular disease mortality; for PM2.5, the hazard ratio was 1.21 (95% confidence interval = 0.87-1.69) per 5 μg/m and for PM10, 1.22 (0.91-1.63) per 10 μg/m.In a joint analysis of data from 22 European cohorts, most hazard ratios for the association of air pollutants with mortality from overall CVD and with specific CVDs were approximately 1.0, with the exception of particulate mass and cerebrovascular disease mortality for which there was suggestive evidence for an association.

Impact of Cerebrovascular Disease Mortality on Life Expectancy in China

ObjectiveTo evaluate the impact of cerebrovascular disease mortality on life expectancy (LE) in China in 2010 compared with 2005, and to identify the high-risk population (age, sex, and region) where cerebrovascular disease mortality has had a major impact on LE. MethodsLE and cause-eliminated LE were calculated by using standard life tables which used adjusted mortality data from the Death Surveillance Data Sets in 2005 and 2010 from the National Disease Surveillance System. Decomposition was used to quantitate the impact of cerebrovascular disease in different age groups. ResultsLE in China was 73.24 years in 2010, which was higher in women and urban residents compared with men and rural residents. The loss of LE caused by cerebrovascular disease mortality was 2.26 years, which was higher in men and rural residents compared with women and urban residents. More than 30% of the loss of LE were attributed to premature death from cerebrovascular disease in people aged <65 years. Compared with 2005, LE in 2010 increased by 0.92 years. The reduction of cerebrovascular disease mortality in urban residents contributed 0.45 years to the increase of LE, but the increase of cerebrovascular disease mortality caused a 0.12-year loss of LE in rural residents. ConclusionCerebrovascular disease mortality had a major impact on LE in China, with a significant difference between urban and rural residents. LE is likely to be further increased by reducing cerebrovascular disease mortality, and special attention should be paid to reducing premature deaths in people aged <65 years.

Risk Factors for Cerebrovascular Disease Mortality among the Elderly in Beijing: A Competing Risk Analysis

ObjectiveTo examine the associations of combined lifestyle factors and physical conditions with cerebrovascular diseases (CBVD) mortality, after accounting for competing risk events, including death from cardiovascular diseases, cancers and other diseases.MethodsData on 2010 subjects aged over 55 years were finally analyzed using competing risk models. All the subjects were interviewed by the Beijing Longitudinal Study of Aging (BLSA), in China, between 1 January 1992 and 30 August 2009.ResultsElderly females were at a lower risk of death from CBVD than elderly males (HR = 0.639, 95% CI = 0.457–0.895). Increasing age (HR = 1.543, 95% CI = 1.013–2.349), poor self-rated health (HR = 1.652, 95% CI = 1.198–2.277), hypertension (HR = 2.201, 95% CI = 1.524–3.178) and overweight (HR = 1.473, 95% CI = 1.013–2.142) or obesity (HR = 1.711, 95% CI = 1.1754–2.490) was associated with higher CBVD mortality risk. Normal cognition function (HR = 0.650, 95% CI = 0.434–0.973) and living in urban (HR = 0.456, 95% CI = 0.286–0.727) was associated with lower CBVD mortality risk. Gray’s test also confirmed the cumulative incidence (CIF) of CBVD was lower in the ‘married’ group than those without spouse, and the mortality was lowest in the ‘nutrition sufficient’ group among the ‘frequent consumption of meat group’ and the ‘medial type group’ (P value<0.001).ConclusionsCBVD mortality was associated with gender, age, blood pressure, residence, BMI, cognitive function, nutrition and the result of self-rated health assessment in the elderly in Beijing, China.

Long-term exposure to high particulate matter pollution and cardiovascular mortality: A 12-year cohort study in four cities in northern China

Epidemiologic studies have demonstrated that long-term exposure to relatively low levels of particulate air pollution is associated with adverse cardiovascular outcomes in Europe and North America. However, few studies have assessed the association with high level air pollutants. We aimed to assess the cardiovascular effects of long-term exposure to high level concentrations of inhalable particulate and to identify the characteristics of the Chinese population that are susceptible to the health effects. A retrospective cohort, containing 39,054 subjects from four cities in northern China, was followed for mortality of all cause and specific cardiovascular diseases from 1998 to 2009. Information on concentrations of PM10 (particulate matter<10μm in aerodynamic diameter) was collected from the local Environmental Monitoring Centers. The estimated exposure for the study participants was the mean concentration of PM10 over their surviving years during the cohort period. Relative risk values were obtained using Cox proportional hazards regression models after adjusting for potential confounding factors. For each 10μg/m3 increase in PM10, the relative risk ratios (RRs) of all-cause mortality, cardiovascular disease mortality, ischemic heart disease mortality, heart failure disease mortality, and cerebrovascular disease mortality were 1.24 (95% CI, 1.22–1.27), 1.23 (95% CI, 1.19–1.26), 1.37 (95% CI, 1.28–1.47), 1.11(95% CI, 1.05–1.17), and 1.23(95% CI:1.18–1.28), respectively. Results from stratified analyses suggest that the effects of PM10 on cardiovascular mortality were more pronounced in males, smokers and people with a higher socioeconomic status. Long-term exposure to PM10 increases mortality from cardiovascular disease, especially from ischemic heart disease and this association seemed to be modified by other factors. Further research that focuses on exploring dose–response relationship and inter-population comparisons is warranted.

Asian dust and daily mortality in Korea and Japan

Background: Asian dust spreads to wide areas of Asian countries. The chemical components of the dust are not fully understood, and may be complex, including pollutants from urban emissions. Desert dust is considered to have a potential toxicity and such toxicity can change during long-range transportation. The independent effects of desert dust in different location, however, have still been less clear in Asian countries. Aims: We evaluated adverse-health effects of Asian dust event on cause-specific mortality independent of particulate matter in Korea and Japan. Methods: We obtained daily mean concentrations of Asian dust as well as particulate matter between 2005 and 2010. Asian dust was obtained from Light Detection And Ranging (LIDAR) by National Institute for Environmental Studies, Japan. We then evaluated city-specific [Seoul (Korea), Matsue, Osaka, and Tokyo (Japan)] associations of Asian dust with daily mortality for all age groups using a time-series analysis. Study periods were different between each city due to data availability. Results: The mean (and maximum) concentration of Asian dust in Seoul, Matsue, Osaka, and Tokyo were 15.4 ?g/m3 (max 444.4 ?g/m3), 26.6 (458.7), 7.7 (121.6), and 9.5 (123.8), respectively. The positive associations of Asian dust with all-cause or cause-specific mortality were observed even after we adjusted for particulate matter in the same model. The excess risk following 10 ?g/m3 increase of Asian dust was 0.5% (95% CI 0.1–0.1) for all-cause mortality in Seoul (mean of lag 0–4). In addition, the excess risks for cerebrovascular disease mortality (lag 1) following 10 ?/m3 increase of Asian dust were 0.6% (95% CI -0.1–1.4) in Seoul, 4.0% (95% CI 0.1–8.0) in Matsue, 3.8% (95% CI 0.3–7.4) in Osaka, and -1.3% (95% CI -3.6–1.1) in Tokyo, respectively. Conclusions: Adverse health effects on all-cause and cerebrovascular disease mortality were observed in Seoul and Western part of Japan.

The impact of ambient particulate matter (PM10) on the population mortality for cerebrovascular diseases

The impact of ambient particulate matter (PM10) on the population mortality for cerebrovascular diseases Xuying Wang1, Fengming Dong1, Minghao Jin2, Xiaochuan Pan1 1 Department of Occupational and Environmental Health, School of Public Health, Peking University?Beijing, China 2 School of Public Health, PYONG YANG Medical University, KIMILSUNG University, Democratic People’s Republic of Korea Background: Epidemiological studies have reported the associations between increased ambient air pollution and cardiovascular mortality, morbidity and emergency department visits. But the studies of the impact of PM10 on the cerebrovascular mortality are few and the conclusions are not consistent. Aims: To examine the impact of ambient inhalable particulate matter (PM10) on cerebrovascular mortality in Beijing, during 2004-2008. Methods: Both symmetric bidirectional case-crossover design and conditional logistic regression model were used to analyze the associations between ambient PM10 and cerebrovascular mortality. Results: After adjusting the meteorological factors as daily average temperature and relative humidity, the single pollutant model showed that there was no significant lag effect. In the multi-pollutant model, the effect of the every interquartile increase of ambient PM10 had a larger impact on the daily death of the cerebrovascular diseases with statistically significant difference (P?0.05). The effect of ambient PM10 pollution on daily death of cerebrovascular diseases was significant for females, elderly who were 65 or older and winter season. Conclusion: Our data showed that elevated levels of ambient PM10 was positively associated with the increase of cerebrovascular disease mortality. The elevated levels of ambient PM10 could lead to the increase of the daily mortality on cerebrovascular diseases for females, elderly who were 65 or older and in winter season.

Modelo basado en SIG para el estudio de la mortalidad por enfermedad cerebro-vascular

En los últimos 15 años el estudio para una de las tres primeras causas de muerte a nivel mundial –enfermedad cerebrovascular (ECV)– se caracteriza por utilizar el enfoque epidemiológico tradicional y sus técnicas de análisis estadístico bivariado y multivariado orientadas a identificar su composición según variables de persona y explorar relaciones con sus determinantes pero sin impactar significativamente su ocurrencia, sin embargo, en el presente artículo se identifica como alternativa de análisis la modelación espacio-temporal con SIG a niveles de desagregación detallados; en este sentido el análisis comparativo de los modelos utilizados en los estudios conocidos, desvela el uso de datos y técnicas de análisis espacial básicas para identificar patrones como los evidenciados en los cinturones de diabetes y ECV en USA o el clúster colombiano de enfermedades del aparato circulatorio identificado en la región andina que sugiere un comportamiento similar para la ECV. El panorama anterior demanda la combinación de enfoques con énfasis en sus técnicas de análisis avanzadas –análisis multi-criterio, kriging, interpolación, correlación y regresión espacial– soportadas con SIG y por lo tanto, como contribución final se propone un modelo integrado dirigido a impactar positivamente la mortalidad por ECV.

The impact of ambient particulate matter (PM10) on the population mortality for cerebrovascular diseases-a case-crossover study

To analyze the association between the concentration of ambient inhalable particulate matter (PM10) and population mortality for cerebrovascular diseases and to explore the impact of PM10 on cerebrovascular diseases. Data including meteorological factors, air pollutants (NO2, SO2 and PM10) and cerebrovascular disease mortality in one district of Beijing from 2004 to 2008 were collected and both symmetric bidirectional case-crossover design and conditional logistic regression model were used to analyze the associations among them. After adjusting the influence of meteorological factors as daily average temperature and relative humidity, the single pollutant model showed that there was no significant lag effect. In the multi-pollutant model, the effect of the every 105.43 µg/m(3) increase of ambient PM10 had a larger impact on the daily death of the cerebrovascular diseases with statistically significant difference (P < 0.05). The effect of ambient PM10 pollution on daily death of cerebrovascular diseases was significant for females, 65 year-olds and in winter season. Our data showed that elevated levels of ambient PM10 was positively associated with the increase of cerebrovascular disease mortality. The elevated levels of ambient PM10 could lead to the increase of the daily mortality on cerebrovascular diseases for females, elderly who were 65 or older and in winter seasons.

The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease

The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease).All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events.

The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease

The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease). All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events.

Astrogliosis in the brain of obese Zucker rat: A model of metabolic syndrome

Metabolic syndrome (MetS) is a disorder characterized primarily by the development of insulin resistance. Insulin resistance and subsequent hyperinsulinemia, originating from abdominal obesity, increases the risk of cerebrovascular and cardiovascular disease and all-cause mortality. Obesity is probably a risk factor for Alzheimer's disease and vascular dementia and is associated with impaired cognitive function. The obese Zucker rat (OZR) represents a model of type 2 diabetes exhibiting a moderate degree of arterial hypertension and of increased oxidative stress. To clarify the possible relationships between MetS and brain damage, the present study has investigated brain microanatomy in OZRs compared with their littermate controls lean Zucker rats (LZRs). Male OZRs and LZRs of 12 weeks of age were used. Their brain was processed for immunochemical and immunohistochemical analysis of glial fibrillary acidic protein (GFAP). In frontal and parietal cortex of OZRs a significant increase in the number of GFAP immunoreactive astrocytes was observed. Similar findings were found in the hippocampus, where an increased number of GFAP immunoreactive astrocytes were detected in the CA1 and CA3 subfields and dentate gyrus of OZRs compared to the LZRs. These findings indicating the occurrence of brain injury accompanied by astrogliosis in OZRs suggest that these rats, developed as an animal model of type 2 diabetes, may also represent a model for assessing the influence of MetS on brain. The identification of neurodegenerative changes in OZRs may represent the first step for better characterizing neuronal involvement in this model of MetS and possible treatment for countering it.

Sizable variations in circulatory disease mortality by region and country of birth in six European countries

Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. We examine inequalities in circulatory mortality by geographical region/COB for six EU countries. We obtained national death and population data from Denmark, England and Wales, France, the Netherlands, Scotland and Sweden. Mortality rate ratios (MRRs) were constructed to examine differences in circulatory, ischaemic heart disease (IHD) and cerebrovascular disease mortality by geographical region/COB in 35-74 years old men and women. South Asians in Denmark, England and Wales and France experienced excess circulatory disease mortality (MRRs 1.37-1.91). Similar results were seen for Eastern Europeans in these countries as well as in Sweden (MRRs 1.05-1.51), for those of Middle Eastern origin in Denmark (MRR = 1.49) and France (MRR = 1.15), and for East and West sub-Saharan Africans in England and Wales (MRRs 1.28 and 1.39) and France (MRRs 1.24 and 1.22). Low ratios were observed for East Asians in France, Scotland and Sweden (MRRs 0.64-0.50). Sex-specific analyses showed results of similar direction but different effect sizes. The pattern for IHD mortality was similar to that for circulatory disease mortality. Two- to three-fold excess cerebrovascular disease mortality was found for several foreign-born groups compared with the local-born populations in some countries. Circulatory disease mortality varies by geographical region/COB within six EU countries. Excess mortality was observed for some migrant populations, less for others. Reliable pan-European data are needed for monitoring and understanding mortality inequalities in Europe's multiethnic populations.

Circulatory disease mortality rates in the elderly and exposure to PM2.5 generated by biomass burning in the Brazilian Amazon in 2005

The aim of this study was to analyze the association between the exposure to fine particulate matter and circulatory disease mortality rates in the elderly living in the Brazilian Amazon. An ecological study of circulatory disease, acute myocardial infarction and cerebrovascular disease mortality rates in micro areas of the Brazilian Amazon was carried out. The environmental exposure indicator used was percentage hours of PM2.5 concentrations &gt; 25µg/m³ divided by the total number of estimated hours of PM2.5 in 2005. The association between exposure and circulatory disease mortality rates was strongest in the oldest age group. No significant statistical association was found between cerebrovascular disease mortality rates and exposure. Circulatory disease mortality rates in the elderly living in the Amazon have been influenced by atmospheric pollution from emissions caused by forest fires.

Prognostic Value of Chronotropic Incompetence in Elderly Patients Undergoing Exercise Echocardiography

Chronotropic incompetence (CI), defined as failure to achieve less than 80% of age-expected heart rate, is a predictor of mortality and adverse cardiovascular events and may confer a worse prognosis in elderly diabetic individuals. To evaluate the prognostic value of chronotropic incompetence (CI) in elderly diabetic patients considering endpoints with acute myocardial infarction (AMI), cerebrovascular disease (CVD) and overall mortality and compare clinical and echocardiographic characteristics between patients with and without CI. A total of 298 elderly diabetic patients undergoing exercise echocardiography (EE) were studied from January 2001 to December 2010. Of these, 109 were chronotropic incompetent (group 1) and were compared with the chronotropic competent ones (group 2) regarding the occurrence of cardiovascular events, clinical and echocardiographic characteristics. Chronotropic incompetents patients showed a higher frequency of cerebrovascular disease (9.2% vs. 3.2, p = 0.027) and higher mortality was observed in those who had cerebrovascular disease or acute myocardial infarction. The presence of typical angina and dyspnea prior to the performance of EE and male gender were more frequent in group 1. Rest and exercise left ventricular wall motion score index, rate of left ventricle mass and left atrium diameter were higher in chronotropic incompetent individuals. Chronotropic incompetence was independently associated with the occurrence of cerebrovascular disease in elderly diabetic individuals.

Regional Cardiocerebrovascular Center Project in the Treatment of Acute Myocardial Infarction

The mortality of cardiac and cerebro-vascular disease has been increased in Korea rapidly. Regional cardiocerebrovascular center project was begun to decrease of the mortality of these disease on 2008. Acute myocardial infarction (AMI) and stroke are the targets of this project. The time delay from the onset to visiting hospital is one of the interrupting steps from the early reperfusion therapy in the patients with acute ST-segment elevation myocardial infarction (STEMI). Regional Cardiac Center project showed shortened door to balloon time in patient with STEMI undergoing primary PCI. Regional Cardiac Center project supports the media campaign about STEMI symptoms, early visit to emergency department, use of ambulance, and patient education. Good cooperation between regional emergency centers and regional cardiovascular center will improves survival of sudden cardiac collapse. These all activity will shorten time delay in treatment of AMI, reduce mortality rate and medical cost in the future. (Korean J Med 2013;85:272-274) Keywords: Myocardial infarction; Health impact assessment; Time delay