Multiple Cardiac Risk Factors Research Articles

Smoking, Smoking Cessation, and Understanding of the Role of Multiple Cardiac Risk Factors among the Urban Poor

Objective.To determine in a population of low socioeconomic status (SES) patients: (a) rates of current smoking and smoking cessation, (b) persons' understanding of the adverse health impact of multiple cardiovascular disease (CVD) risk factors, and (c) if the diagnosis of other CVD risk factors, specifically hypertension or hypercholesterolemia, was related to smoking cessation.Design.Cross-sectional interview survey.Setting.Community clinics and eligibility centers of the Harris County Hospital District (HD), which provides primary care to over 166,000 indigent persons in Houston, Texas.Subjects.Randomly selected adults attending an HD setting for eligibility screening or primary care.Results.Over 93% of subjects approached participated (n= 547). Their mean age was 40.7 years, 55% were female, and 39% had >9 years of education. The ethnic distribution was 54% Hispanic, 28% black, and 14% non-Hispanic white. Current smoking ranged from 10% among Hispanic females to 56% among black males. The percentage of ever smokers who quit was 24% among black males, 44% among black females, 43% among Hispanic males, and 70% among Hispanic females. The majority recognized the increase in danger from smoking in the presence of hypertension or hypercholesterolemia. Among patients who were smokers when they found out they had hypertension (n= 70), 65% reported it increased their desire to quit. After adjustment for other variables including age and known CVD, predictors of being an ex-smoker were being female (OR 2.1, 95% CI 1.3–3.5), being Hispanic (OR 2.8 95% CI 1.5–5.7), and having hypertension (OR 2.3, 95% CI 1.3–4.2).Conclusion.In this low SES population, there was substantial smoking cessation, widespread acknowledgment of the cumulative effect of smoking and other CVD risk factors, and some evidence that smoking cessation increased after the diagnosis of hypertension.

Cholesterol screening in asymptomatic adults, revisited. Part 2.

To assess the role of serum lipid levels as screening tests in adults. Pooled analysis of clinical trials, supplemented by analysis of data from the Framingham Heart Study, to estimate the effect of cholesterol reduction in patient groups stratified by cardiac risk. Published randomized controlled trials of cholesterol reduction, meta-analyses of such trials, prospective cohort studies of the association between cholesterol levels and morbidity and death related to coronary heart disease, and cost-effectiveness analyses of cholesterol reduction. Two-stage logistic regression on cardiac risk factors and outcomes in the Framingham Heart Study. The first stage predicted the risk for death from coronary heart disease using standard risk factors but not cholesterol; the second stage predicted the risk for death from coronary heart disease and all causes as functions of age and cholesterol level, stratified by the risk predicted from the first stage. Randomized clinical trials show that cholesterol reduction confers survival benefits in patients with symptomatic coronary disease. In asymptomatic middle-aged men, who are at lower risk for death from coronary disease, cholesterol reduction prevents coronary disease but has not been shown to prolong life. The risk model based on analysis of the data from the Framingham Heart Study is consistent with the randomized trial data and shows that in the demographic groups excluded from trials, the hypothetical benefits of cholesterol reduction are greatest when the underlying risk for coronary disease is greatest. Screening with total cholesterol levels is most likely to be useful when done in populations at high short-term risk for dying of coronary heart disease, such as survivors of myocardial infarction and middle-aged men with multiple cardiac risk factors. In these populations, cholesterol reduction appears to be both effective and cost-effective. In other populations, the benefits of reduction are much smaller or are uncertain.

Penetrating atherosclerotic ulcers of the aorta

The term penetrating atherosclerotic aortic ulcer describes a condition in which an atherosclerotic plaque ulcerates and burrows through the internal elastic lamina into the media, leading to a variable amount of intramural hematoma formation. The typical patient is elderly with multiple cardiac risk factors and presents with acute chest or back pain. Diagnosis of penetrating aortic ulcer may be confirmed by computed tomography, magnetic resonance imaging or aortography. Penetrating aortic ulcers usually occur in the mid- and distal descending thoracic aorta and may be complicated by transmural aortic rupture, embolization, pseudoaneurysm formation, or progressive aneurysmal dilatation. The patient with a penetrating ulcer requires close follow-up to detect the development of complications, and may require surgical therapy.

Obstructive Sleep Apnea Manifesting as Suspected Angina: Report of Three Cases

To describe three cases of obstructive sleep apnea that resembled coronary artery disease and to suggest features that might distinguish these two syndromes. We present three detailed case reports of patients with severe obstructive sleep apnea and discuss similar cases from the literature. Two obese women and one obese man with previously undiagnosed obstructive sleep apnea had chest discomfort, episodic dyspnea, and palpitations, most prominent at night. All three patients had multiple cardiac risk factors and had previously undergone cardiac evaluations, including at least two prior cardiac catheterizations each. Repeated cardiac catheterization revealed less coronary occlusive disease than expected on the basis of the symptoms in all three patients and a small atrial septal defect in one patient. When reassessed, the medical histories suggested obstructive sleep apnea. Overnight polysomnography documented the presence of severe sleep apnea; the three patients had mean values of 56 disordered breathing events per hour and 44% minimal oxygen saturation. Although bi-level or continuous positive airway pressure yielded initial improvement, all patients had difficulty with routine use of this therapy after 1 1/2 years of follow-up. The initial manifestations of severe obstructive sleep apnea may simulate angina, suggest arrhythmia, or mimic heart failure. Failure to inquire about snoring and daytime somnolence in patients with chest pain may prevent the identification of clinically significant disordered breathing during sleep.

Approaches to the management of hypercholesterolaemia.

Patients with hypercholesterolaemia need to be carefully evaluated for underlying secondary or genetic causes. All such subjects require dietary advice. Those with total cholesterol levels persistently in excess of 6.5 mmol/l despite diet, and in the presence of multiple cardiac risk factors may need drug therapy. Drug therapy is likely to be life-long and the potential benefits need to be carefully assessed against the long-term safety of the agents employed.