Personal History Of Cardiovascular Disease Research Articles

Women’s knowledge about heart disease: Differences among ethnic and cultural groups in the Israeli Women’s Health in Midlife Study

The current investigation aimed to assess levels of knowledge about risk factors for heart disease among midlife Israeli women, and to evaluate the relationship of knowledge to personal risk factors and vulnerability to heart disease. Face-to-face interviews with women aged 45–64 years were conducted during 2004–2006 within three population groups: long-term Jewish residents (LTR), immigrants from the former Soviet Union, and Arab women. The survey instrument included six knowledge statements relating to: the risk after menopause, family history, elevated cholesterol level, diabetes, obesity, and warning signs of a heart attack. The findings showed wide disparities in knowledge by educational level and between immigrants and LTR, after taking into account personal risk factors and education. Personal risk factors were not significantly related to the knowledge items, except for personal history of cardiovascular disease, which was associated with knowledge about “warning signs of a heart attack” and “family history.” Women who perceived themselves as more vulnerable to heart disease were more likely to identify several risk factors correctly. These findings stress the need to increase knowledge about heart disease, especially among less educated and minority women, and to emphasize the risk of patients’ personal status by health providers.

Dutch Lipid Clinic Network low-density lipoprotein cholesterol criteria are associated with long-term mortality in the general population

Heterozygous familial hypercholesterolaemia (HeFH) is a severe autosomal dominant disease that is underdiagnosed, inadequately treated and has a severe long-term cardiovascular risk. Few studies have evaluated the long-term risk of high low-density lipoprotein cholesterol (LDL-C) concentrations. To evaluate long-term mortality in a large cohort of healthy subjects, according to LDL-C concentrations. Based on a sample of 6956 subjects visiting a preventive cardiology department, we selected adult subjects without a personal history of cardiovascular disease. From 1995 to 2011, 4930 healthy subjects were examined and followed up until 31 December 2011. All-cause deaths were collected exhaustively. A Cox-based multivariable analysis evaluated long-term total mortality risk according to Dutch Lipid Clinic Network (DLCN) LDL-C concentrations. After a mean follow-up of 8.6 years, 123 all-cause deaths were recorded (cumulative mortality rate, 2.5%). In the final multivariable model, major risk factors such as age, sex, tobacco use and diabetes were significantly associated with mortality. After adjustment for age, sex, tobacco use, hypertension, diabetes and statin therapy, and in comparison with subjects with LDL-C<4 mmol/L (<155 mg/dL), subjects with LDL-C between 4 and <5 mmol/L (155 to <190 mg/dL) had a hazard ratio (HR) of 1.99 (95% confidence interval [CI] 1.31-3.02; P=0.001), subjects with LDL-C between 5 and <6.5 mmol/L (190 to <250 mg/dL) had an HR of 1.81 (95% CI, 1.06-3.02; P=0.030), subjects with LDL-C between 6.5 and<8.5 mmol/L (250 to <330 mg/dL) had an HR of 2.69 (95% CI, 1.06-6.88; P=0.038) and subjects with LDL-C ≥ 8.5 mmol/L (≥330 mg/dL) had an HR of 6.27 (95% CI, 0.84-46.57; P=0.073). After excluding patients on statins at baseline, subjects with LDL-C ≥ 8.5 mmol/L (≥330 mg/dL) had an HR of 8.17 (95% CI, 1.08-62.73; P=0.042). The severity of LDL-C elevation is associated with a higher risk of death in healthy subjects. DLCN LDL-C concentrations may be used in daily practice to identify patients with HeFH who warrant aggressive treatment.

PP.41.30

Objective: An ankle brachial index (ABI) <0.90 confirms the diagnosis of peripheral arterial disease; ABI >1.40 are often associated with mediacalcosis. While values between 0.90 and 1.20 are considered as normal, the meaning of an ABI between 1.20 and 1.40 (a grey-zone) remains unknown. To approach the clinical significance of ABI values between 1.20 and 1.40 by studying their associated factors in general population. Design and method: 1001 volunteers from the STANISLAS cohort (single-center, family, longitudinal cohort of presumed healthy subjects at baseline between 1993 and 1995) were included in the fourth follow-up visit at the CIC-P INSERM in Nancy (France). The following tests were performed: examination, ABI, biology, carotid echotracking, measurement of intima-media thickness (IMT) and pulse wave velocity (PWV). Results: An 1.2<ABI <1.4 was associated with male gender (p < 0.0001), age (p < 0.002), smoking (p = 0.046), elevated blood pressure (p = 0.021), BMI >25 kg/m2 (p = 0.0006), abdominal obesity (p = 0.034), metabolic syndrome (p = 0.014), personal history of cardiovascular disease (CVD) (p = 0.0002), PWV (p = 0.040) and IMT (p = 0.011). Logistic regression found a correlation between ABI and male gender (OR = 1.88 - 95% CI (1.33–2.65), age >45 years (OR = 1.61 - 95% CI (1.05–2.45), personal history of CVD (OR = 1.83 - 95% CI (1.21–2.78). Combinations of factors male gender + age >45 years+ BMI >25 kg/m2 ± personal history of CVD were predictive of an 1.2<ABI <1,40 (OR = 1.77 - 95% CI(1.21–2.61) and OR = 3.38 - 95% CI(1.92–5.96). Cardiovascular risk equation “SCORE” was higher for ABI values >1,20 (2,72%, intermediate risk versus 1,72%, low risk, p < 0,0001). Conclusions: In a general population, ABI values between 1.20 and 1.40 are associated with a higher CV risk.

Obstetrician-gynecologists’ opinions on elective bilateral oophorectomy at the time of hysterectomy in the United States

This study aims to assess obstetrician-gynecologists' opinions on elective bilateral oophorectomy (BO) at the time of hysterectomy in the United States and to describe factors that influence their views. In April 2012, an anonymous survey was mailed twice to practicing obstetrician-gynecologists, randomly selected from a list produced by the American Medical Association, in an effort to assess their opinions regarding elective BO at the time of hysterectomy. The effects of gynecologists' various characteristics on their opinions were also evaluated. Of 1,002 mailed surveys, 443 (44%) were returned completed. Of the respondents, 59% were male and 79% were white. The largest age group was 51 to 55 years (20%), and the mean time since completion of residency was 23 years. In women with an average risk of ovarian cancer, the proportions of physicians who favored elective BO were as follows: women younger than 51 years, 32%; women aged 51 to 65 years, 62%; women older than 65 years, 6%. These recommendations were not influenced by the physicians' age, sex, training, or geographic region. If a hysterectomy candidate was younger than 51 years and had a personal history of breast or ovarian cancer and a family history of ovarian cancer, these proportions were increased to 77% and 64%, respectively. Other factors that influenced the respondents' recommendations were the women's personal history of cardiovascular disease (21%), osteoporosis (23%), and sexual dysfunction (23%). One third of obstetrician-gynecologists continue to recommend elective BO for hysterectomy candidates younger than 51 years. The majority recommend elective BO for women aged 51 to 65 years. Their demographic characteristics do not influence their opinions.

Non‐segmental vitiligo and psoriasis comorbidity – a case‐control study in Italian patients

A recent systematic evaluation of vitiligo and psoriasis comorbidity has not yet been reported in a large series of patients with vitiligo. To investigate the practical/clinical implications in subjects with both vitiligo and psoriasis compared to those with vitiligo alone. This was a case-control study on 463 vitiligo patients in our clinic from March 2008 to April 2011. Medical assessment was performed by dermatologists using the modified Vitiligo European Task Force form. In an univariate analysis, inflammation/pruritus [odds ratio (OR) 2.42, P = 0.03], use of drugs that can induce psoriasis (OR 2.74, P = 0.01), a family history (FH) of psoriasis (OR 2.87, P = 0.02), cardiovascular disease (OR 5.70, P = 0.001), hypertension (OR 4.7, P = 0.006) and type 2 diabetes mellitus (OR 3.87, P = 0.004), were significantly correlated with patients exhibiting vitiligo and psoriasis comorbidity. A trend was found in personal history of cardiovascular disease in patients with both diseases (OR 2.99, P = 0.07). FH of vitiligo was significantly associated with patients having only vitiligo (OR 0.35, P = 0.05). Multivariate analysis demonstrated that inflammation/pruritus in vitiligo macules (OR 2.56, P = 0.047) and a FH of cardiovascular disease (OR 4.07, P = 0.02) were the most significant predictors of patients having both psoriasis and vitiligo, while the presence of organ-specific autoantibodies (OR 0.24, P = 0.007) was significantly associated with patients having only vitiligo. The presence of vitiligo and even mild psoriasis is significantly correlated with a family history of cardiovascular disease, a factor that requires greater attention and follow-up with respect to that necessary for vitiligo patients.

Risk factors for cardiovascular diseases: Kuwait Heart Foundation’s mobile screening

Screening through a fully equipped unit of Kuwait Heart Foundation (KHF) was initiated to promote awareness of known risk factors of cardiovascular diseases (CVD) among the population between the periods of November 2010–May 2011. There were 5027 participants (35.5% were Kuwaitis). A specially designed questionnaire was prepared to gather information about socio-demographic characteristics, behavioral factors, metabolic measurements and risk factors. Male:Female ratio was 2.4:1. Most of the subjects (51%) belonged to the age group (35–50) years. Based on BMI, males were found to be more overweight than females (35%) – BMI 25–29.99kg/m 2 and (12%) of males were obese with BMI ⩾30kg/m 2 compared to females as (13.5%) of them were overweight and (8.9%) were obese. Among the screened subjects, (21.1%) were smokers and most of them were males (19.7%), (19.5%) were diabetic, (3.7%) of participants had personal history of CVD. Overall, (21.3%) of participants had high blood pressure. Approximately, (19.5%) had high glucose (⩾7.2mmol/L) and (7.0%) had high cholesterol level (⩾6.5mmol/L). High cholesterol level were more prevalent in males than females. The results revealed that the volunteers for the mobile unit screening program had overall high levels of obesity and cholesterol, especially among the males who belonged to a relatively younger age groups. Mobile screening unit could be considered as an indicator for the level of known risk factors of CVD. Nevertheless, mobile screening unit is a good method for increasing the awareness of the public.

Telocytes form networks in normal cardiac tissues.

Telocytes (TC) are a class of interstitial cells present in heart. Their characteristic feature is the presence of extremely long and thin prolongations (called telopodes). Therefore, we were interested to see whether or not TCs form networks in normal cardiac tissues, as previously suggested. Autopsy samples of cardiac tissues were obtained from 13 young human cadavers, without identifiable cardiac pathology and with a negative personal history of cardiovascular disease. Immunohistochemistry on formalin-fixed paraffin-embedded tissues was performed using monoclonal antibodies for CD117/c-kit. Additionally, ventricular samples from 5 Sprague-Dawley rats were ultrastructurally evaluated under transmission electron microscopy. We found c-kit positive cells with TC features in subepicardium, as well in subepicardial arteries and in subepicardial fat. TCs were also present in the subendocardium. Light and electron microscopy revealed the existence of intramyocardial networks built up by bipolar TCs. Larger c-kit positive multipolar TCs were found between cardiac muscle bundles. Our results support the existence of a cardiac network of telocytes.

Associations between family history of cardiovascular disease, knowledge of cardiovascular disease risk factors and health behaviours

The objective of the study was to examine associations between family history of premature cardiovascular disease (CVD), knowledge of CVD risk and protective factors, and health behaviours. The design was via administration of a questionnaire to 307 participants from four general practice centre waiting rooms in the Sydney West area. The most recognised CVD risk factor was smoking (97.7%) and the most recognised CVD protective factor was omega-3 fatty acids (78.5%). After adjustment for age, sex, education attainment and personal history of CVD, a strong family history of premature CVD was associated with being more likely to interpret a blood pressure of 130/85 as a CVD risk factor (OR 2.77, 95% CI 1.07-7.14), but less likely to identify being an ex-smoker (compared with never having smoked before) as a risk factor (OR 0.32, 95% CI 0.12-0.90). Those with a strong family history of premature CVD, on average, had smoked 0.82 pack years more than those with an average family history of premature CVD (s.e. 4.22, P=0.04). In conclusion, there continues to be both strengths and deficits in the community's overall knowledge of CVD risk and protective factors, and a strong family history of premature CVD appears to be an independent risk factor for smoking.

Silent myocardial ischaemia and risk factors in a diabetic Afro-Caribbean population

Aims In Guadeloupe, an island in the French West Indies, diabetes has a prevalence recently reported to be 10%. Myocardial ischaemia is more frequently silent in diabetics, and needs to be screened for and monitored, once identified. This study aimed to evaluate the prevalence of silent myocardial ischaemia (SMI) in a diabetic population and to analyze its associated cardiovascular risk (CVR) factors. Methods This was a cross-sectional study of 147 patients with associated CVR factors, defined according to the 2004 SFC/ALFEDIAM guidelines. Exercise stress tests, myocardial performance imaging and stress echocardiography were performed. Ancova and logistic regression were used in the statistical analyses. Results The patients’ mean age was 62 years, and 53% were male. Mean duration of diabetes was 14 years. Overall, 23.1% had SMI, and these patients more frequently had a personal history of cardiovascular disease vs those without SMI. On multivariate logistic-regression analyses, the adjusted odds ratios of SMI were significantly increased in patients with a personal history of cardiovascular disease (4.36, 95% CI: 1.36–13.96; P = 0.01) and left ventricular hypertrophy (LVH) (2.46, 95% CI: 1.03–5.86; P = 0.04). Conclusion The prevalence of SMI in our Afro-Caribbean diabetic population was 23.1%. Searching for a personal history of cardiovascular disease and LVH may help to identify patients who need to be screened for SMI.

Gender Differences in Thrombogenic Profile Associated to Coronary Obstruction Angiographically Evaluated

Objective: To identify potential differences between concentrations of thrombogenic markers associated to coronary obstruction in men and women. Patients and Methods: We included 502 consecutive patients (251 men and 251 women), with a mean age of 63.94(11.26) and 66.08(10.58) years respectively. In all patients coronary arteriography was performed, either by presenting an acute coronary episode or for discard coronary heart disease (CHD). CHD was defined as a � 50% narrowing of lumen in one of the three major coronary arteries. At the hospital admission, a blood sample was withdrawn to determine lipoprotein (a), fibrinogen, C reactive protein (CRP) and D-dimer levels. Patients also answered a survey questionnaire which included family and personal history of cardiovascular disease, and personal habits. Weight, height, and abdominal perimeter were also measured. Results: 80.47% of men and 59.36% of women presented coronary heart disease. Hypertension, diabetes and dyslipidaemia were clearly associated with CHD in women whereas in men only dyslipidaemia and diabetes showed this association. D-dimer was the only marker with significantly higher values (p<0.032) in men with coronary obstruction, while in women these markers were CRP (p<0.004), Lp(a) (p<0.001) and fibrinogen (p<0.045). In the multivariate analysis, hypertension, dyslipidaemia, smoking habit and Lp(a) showed an independently association with CHD in women, whereas in men dyslipidaemia and age were the independent risk factors for CHD. Conclusions: Our results strongly suggest that major cardiovascular risk factors associated to CHD present gender differences. Lipoprotein (a) proved to be the only differential thrombogenic factor between men and women independently associated with coronary obstruction.

Prevalencia de factores de riesgo cardiovascular en un colectivo de mujeres adolescentes

Objective This study was designed to assess cardiovascular risk in a group of adolescent girls due to the need to take action on risk profiles at early ages. Methods A total of 135 students (18.51 ± 1.12 years) at the School of Nursing of the University of the Basque Country (Spain) completed a questionnaire that included items on family and personal history of cardiovascular disease and lifestyle habits. Height, weight and abdominal circumference were measured, as were levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), apolipoprotein A1 and apolipoprotein B100. Results A family history of cardiovascular disease was reported by 43.7%, diabetes by 33.3%, dyslipidemia by 29.6% and hypertension by 25.2%. A personal history of cardiovascular disease was reported by 3%. One-fifth (21.5%) were smokers, 88.1% engaged in regular physical activity, and 86.7% consumed alcohol on weekends. Lipid profile was as follows: 90.2% had optimal values of total cholesterol, the entire sample had HDL-c levels >40 mg/dL and 45.7% >60 mg/dL; 2.6% had LDL-c >160 mg/dL and 2.2% triglyceride levels >150 mg/dL. The prevalence of apolipoprotein A1 <120 mg/dL and B100 >120 md/dL was 2.17% and 1.08%, respectively. A total of 14.1% was overweight and 1.5% was obese. Abdominal circumference was >88 cm in 5.9%. Conclusions Cardiovascular risk factors were low in the population studied, except for alcohol consumption, indicating the importance of promoting a healthy lifestyle to help to reduce the risk of cardiovascular disease.

Prevalence, treatment and control of dyslipidaemia in Switzerland: still a long way to go

There is little information regarding the prevalence and management of dyslipidaemia in Switzerland. Cross-sectional population-based study of 3238 women and 2846 men aged 35-75. Dyslipidaemia prevalence, treatment and control were defined according to PROCAM guidelines adapted to Switzerland. About 29% of the overall sample presented with dyslipidaemia, of which 39% were treated and 58% of those treated were controlled. Among the 710 patients with personal history of cardiovascular disease (CVD) and/or diabetes, 632 (89%) presented with dyslipidaemia, of which 278 (44%) and 134 (21%) patients were treated and adequately controlled, respectively. On multivariate analysis, hypolipidaemic drug treatment was positively related with age and body mass index (P for trend <0.001), and negatively related with smoking status (P for trend <0.002), whereas personal history of CVD and/or diabetes had no effect [odds ratio (OR)=1.12, 95% confidence interval (CI): 0.90-1.38]. Adequate control of lipid levels was negatively related with female sex (OR=0.65, 95% CI: 0.45-0.94) and personal history of CVD and/or diabetes (OR=0.42, 95% CI: 0.30-0.59). When personal history of CVD and/or diabetes was replaced by PROCAM risk categories, patients in the highest risk were also less well controlled. In this population-based study, one-third of the participants was dyslipidaemic, but less than half was treated and only one-fifth was adequately controlled. The low treatment and control levels among individuals at high risk for CVD calls for a better application of recommendations regarding personal preventive measures.

Central blood pressure and pulse wave velocity: relationship to target organ damage and cardiovascular morbidity-mortality in diabetic patients or metabolic syndrome. An observational prospective study. LOD-DIABETES study protocol

BackgroundDiabetic patients show an increased prevalence of non-dipping arterial pressure pattern, target organ damage and elevated arterial stiffness. These alterations are associated with increased cardiovascular risk.The objectives of this study are the following: to evaluate the prognostic value of central arterial pressure and pulse wave velocity in relation to the incidence and outcome of target organ damage and the appearance of cardiovascular episodes (cardiovascular mortality, myocardial infarction, chest pain and stroke) in patients with type 2 diabetes mellitus or metabolic syndrome.Methods/DesignDesign: This is an observational prospective study with 5 years duration, of which the first year corresponds to patient inclusion and initial evaluation, and the remaining four years to follow-up.Setting: The study will be carried out in the urban primary care setting.Study population: Consecutive sampling will be used to include patients diagnosed with type 2 diabetes between 20-80 years of age. A total of 110 patients meeting all the inclusion criteria and none of the exclusion criteria will be included.Measurements: Patient age and sex, family and personal history of cardiovascular disease, and cardiovascular risk factors. Height, weight, heart rate and abdominal circumference. Laboratory tests: hemoglobin, lipid profile, creatinine, microalbuminuria, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood insulin, fibrinogen and high sensitivity C-reactive protein. Clinical and 24-hour ambulatory (home) blood pressure monitoring and self-measured blood pressure. Common carotid artery ultrasound for the determination of mean carotid intima-media thickness. Electrocardiogram for assessing left ventricular hypertrophy. Ankle-brachial index. Retinal vascular study based on funduscopy with non-mydriatic retinography and evaluation of pulse wave morphology and pulse wave velocity using the SphygmoCor system. The medication used for diabetes, arterial hypertension and hyperlipidemia will be registered, together with antiplatelet drugs.DiscussionThe results of this study will help to know and quantify the prognostic value of central arterial pressure and pulse wave velocity in relation to the evolution of the subclinical target organ damage markers and the possible incidence of cardiovascular events in patients with type 2 diabetes mellitus.Trial RegistrationClinicalTrials.gov Identifier: NCT01065155

Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score

BackgroundChest pain raises concern for the possibility of coronary heart disease. Scoring methods have been developed to identify coronary heart disease in emergency settings, but not in primary care.MethodsData were collected from a multicenter Swiss clinical cohort study including 672 consecutive patients with chest pain, who had visited one of 59 family practitioners' offices. Using delayed diagnosis we derived a prediction rule to rule out coronary heart disease by means of a logistic regression model. Known cardiovascular risk factors, pain characteristics, and physical signs associated with coronary heart disease were explored to develop a clinical score. Patients diagnosed with angina or acute myocardial infarction within the year following their initial visit comprised the coronary heart disease group.ResultsThe coronary heart disease score was derived from eight variables: age, gender, duration of chest pain from 1 to 60 minutes, substernal chest pain location, pain increasing with exertion, absence of tenderness point at palpation, cardiovascular risks factors, and personal history of cardiovascular disease. Area under the receiver operating characteristics curve was of 0.95 with a 95% confidence interval of 0.92; 0.97. From this score, 413 patients were considered as low risk for values of percentile 5 of the coronary heart disease patients. Internal validity was confirmed by bootstrapping. External validation using data from a German cohort (Marburg, n = 774) revealed a receiver operating characteristics curve of 0.75 (95% confidence interval, 0.72; 0.81) with a sensitivity of 85.6% and a specificity of 47.2%.ConclusionsThis score, based only on history and physical examination, is a complementary tool for ruling out coronary heart disease in primary care patients complaining of chest pain.

294 Implementation time of a lipid lowering therapy in patients with dyslipidemia: results of Prysme study

Despite the availability of specific guidelines, the management of dyslipidemia in practice is not optimal. PRYSME, a non-interventional multicentre study carried out with 1226 general practitioners, aimed to describe the implementation time of a lipid lowering treatment according to cardiovascular risk level (primary objective) and to identify its determinants. Were eligible patients treated for a dyslipidemia diagnosed less than 2 years ago. Demographic and clinical characteristics and circumstances of diagnosis and treatment initiation were collected. 3268 patients were included (mean age: 57 years old, males: 64%). 26% were obese and 45% overweight. Only 12% had no cardiovascular risk factors (CRF) at the time of dyslipidemia diagnosis. The most frequent CRF were arterial hypertension (50%), smoking (43%), family history of premature coronary heart disease (28%), HDL-c <0.4g/l (20%) whereas 15% of the patients had a personal history of cardiovascular disease. Dietary programs were initially implemented for 98% of the patients. More than 90% were treated with a statin. The implementation time of the treatment (evaluated according to the biological confirmation of dyslipidemia), according to the initial number of CRF, was as following: 0 CRF 1 CRF 2 CRF ≥ 3 CRF Secondary prevention Total [-3;0] months 34.3% 28.6% 27.1% 29.3% 49.1% 33.1% ]0;3] months 23.1% 26.2% 26.4% 24.0% 21.9% 23.9% > 3 months 42.6% 45.3% 46.5% 46.8% 29.0% 43.0% Chi-2 test : P<0.001 The main determinant of an early implementation of a lipid lowering therapy (≤ 3 months) was secondary prevention (OR=1.8). The number of CRF had no significant impact. This study underlines the lack of awareness towards cardiovascular risk factors in the management of dyslipidemia, particularly while considering the implementation time of a lipid lowering therapy.

The metabolic syndrome: similar deleterious impact on all-cause mortality in hypertensive and normotensive subjects

Few data are available on the impact of the metabolic syndrome on all-cause mortality risk according to the presence of hypertension. Our aim was to evaluate the 5-year impact of the metabolic syndrome, according to blood pressure status, on all-cause mortality risk in a large French population. The study population included 39 998 men and 20 756 women with no personal history of cardiovascular disease, who had a health check-up at the IPC Center (Paris, France) between 1999 and 2002, and who were followed up for 4.7 +/- 1.2 years. The metabolic syndrome was defined according to the National Cholesterol Educational Program classification (2001). Cox regression models were used to evaluate risk of all-cause mortality after adjustment for age, sex, classical risk factors and socioeconomic categories. Subjects were classified according to blood pressure status: hypertensive subject (systolic blood pressure > or =140 mmHg and/or diastolic blood pressure > or =90 mmHg or treatment) and normotensive subject. The risk of all-cause mortality associated with the metabolic syndrome was 1.50 (1.24-1.82) [hazard ratio (HR) (95% confidence interval)]. The risk of all-cause mortality associated with the presence of hypertension was 1.60 (1.38-1.85). During the 4.7 years of follow-up, the impact of the metabolic syndrome was similar among normotensive and hypertensive subjects [HR: 1.09 (0.68-1.75) and 1.40 (1.13-1.74), respectively, P for interaction = 0.35]. The findings from this study show that, in a large middle-aged French population, the metabolic syndrome has the same deleterious impact on all-cause mortality in hypertensive subjects and normotensive subjects.

Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction.

Because of the known relationship between exposure to combination antiretroviral therapy and cardiovascular disease (CVD), it has become increasingly important to intervene against risk of CVD in human immunodeficiency virus (HIV)-infected patients. We evaluated changes in risk factors for CVD and the use of lipid-lowering therapy in HIV-infected individuals and assessed the impact of any changes on the incidence of myocardial infarction. The Data Collection on Adverse Events of Anti-HIV Drugs Study is a collaboration of 11 cohorts of HIV-infected patients that included follow-up for 33,389 HIV-infected patients from December 1999 through February 2006. The proportion of patients at high risk of CVD increased from 35.3% during 1999-2000 to 41.3% during 2005-2006. Of 28,985 patients, 2801 (9.7%) initiated lipid-lowering therapy; initiation of lipid-lowering therapy was more common for those with abnormal lipid values and those with traditional risk factors for CVD (male sex, older age, higher body mass index [calculated as the weight in kilograms divided by the square of the height in meters], family and personal history of CVD, and diabetes mellitus). After controlling for these, use of lipid-lowering drugs became relatively less common over time. The incidence of myocardial infarction (0.32 cases per 100 person-years [PY]; 95% confidence interval [CI], 0.29-0.35 cases per 100 PY) appeared to remain stable. However, after controlling for changes in risk factors for CVD, the rate decreased over time (relative rate in 2003 [compared with 1999-2000], 0.73 cases per 100 PY [95% CI, 0.50-1.05 cases per 100 PY]; in 2004, 0.64 cases per 100 PY [95% CI, 0.44-0.94 cases per 100 PY]; in 2005-2006, 0.36 cases per 100 PY [95% CI, 0.24-0.56 cases per 100 PY]). Further adjustment for lipid levels attenuated the relative rates towards unity (relative rate in 2003 [compared with 1999-2000], 1.06 cases per 100 PY [95% CI, 0.63-1.77 cases per 100 PY]; in 2004, 1.02 cases per 100 PY [95% CI, 0.61-1.71 cases per 100 PY]; in 2005-2006, 0.63 cases per 100 PY [95% CI, 0.36-1.09 cases per 100 PY]). Although the CVD risk profile among patients in the Data Collection on Adverse Events of Anti-HIV Drugs Study has decreased since 1999, rates have remained relatively stable, possibly as a result of a more aggressive approach towards managing the risk of CVD.

Accuracy of the screening physical examination to identify subclinical atherosclerosis and peripheral arterial disease in asymptomatic subjects

This study assessed the accuracy of the screening vascular physical examination for predicting asymptomatic peripheral arterial disease (PAD) or subclinical atherosclerosis in asymptomatic and apparently healthy subjects. A standardized physical examination and a carotid and femoral ultrasonography were administered to 2736 men and women aged 20 to 90 years old, with no personal history of cardiovascular disease (CVD) and no complaint of neurologic, coronary, or lower limb symptom. We assessed the accuracy of auscultation for bruits and pulse palpation for identifying the presence of significant carotid stenosis, carotid plaque, femoral plaque, and ankle-brachial index (ABI) <0.9 at ultrasonography. The presence of a femoral bruit provided information on the presence of both an ABI <0.9 (positive likelihood ratio [+LR], 2.90; 95% confidence interval [CI], 1.63 to 5.16) and a femoral plaque (+LR, 3.23; 95% CI, 2.22 to 4.71), and this information was independent from the cardiovascular risk factors. The absence of both pedal pulses also provided additional information, beyond risk factors, on the presence of an ABI <0.9 (+LR, 3.57; 95% CI, 1.93 to 6.60). The presence of a carotid bruit did not affect the likelihood of carotid stenosis, plaque, or intima-media thickness above the median. Unlike carotid auscultation, pulse palpation and auscultation for femoral bruits provided valuable information on the presence of asymptomatic PAD and underlying atherosclerosis in apparently healthy subjects.

Familial risk assessment for early-onset coronary heart disease

PurposeWe examined the performance of a familial risk assessment method that stratifies risk for early-onset coronary heart disease by considering the number of relatives with coronary disease, degree of relationship, lineage, and age at diagnosis. MethodsBy using data from the HealthStyles 2003 survey, we assessed the associations between familial risk and early-onset coronary heart disease, diabetes, hypercholesterolemia, hypertension, and obesity. By using area under the curve statistics, we evaluated the discriminatory ability of various risk assessment models. ResultsOf 4035 respondents, 60% were female and 72% were white, with a mean age of 48.8 years. After adjustment for demographics, strong and moderate risk were significantly associated with approximately a five- and twofold risk of early-onset coronary disease, respectively. After adjustment for demographics and personal history of cardiovascular disease, strong familial risk was also significantly associated with diabetes, hypercholesterolemia, hypertension, and obesity. A risk assessment model that included familial risk, demographics, and personal history of diabetes, hypercholesterolemia, hypertension, and obesity was most optimal with an area under the curve statistic of 87.2% ConclusionsFamilial risk assessment can stratify risk for early-onset coronary heart disease. Several conditions associated with increased familial risk can be prevented. These results have important implications for risk assessment and risk-reducing interventions.

Correlation between the Framingham risk score and intima media thickness: The Paroi Artérielle et Risque Cardio-vasculaire (PARC) study

Aims Carotid intima media thickness (IMT) is associated with an increased risk of cardio-vascular events, but its correlation with the absolute cardio-vascular risk is not well known in large populations. The Paroi Artérielle et Risque Cardio-vasculaire (PARC) study was designed to evaluate the relationship between conventional assessment of the global cardio-vascular risk by means of the Framimgham score and measurement of IMT of the common carotid artery (CCAIMT). Methods and results About 246 French cardiologists selected 6416 subjects. CCAIMT measurements were performed using a specific methodology designed to harmonize the acquisition and processing of B-mode ultrasound images. The Framingham cardio-vascular score was determined for each individual. The relationship between CCAIMT and Framingham scores was evaluated using linear or polynomial models of regression. We found a significant correlation between CCAIMT and all components of the Framingham score ( p < 0.005 for all parameters). The Framingham score and CCAIMT values were non-linearly related (coefficients of determination R 2 were 19% and 20% in men, 28% and 29% in women, for subjects with and without personal history of cardio-vascular disease, respectively). The younger the subjects, the steeper the relationship, when the analysis was performed according to decades. Conclusions The Framingham score and CCAIMT values were significantly correlated. However variations in CCAIMT only explained a modest part of the Framingham score and vice versa.