Presence Of Cardiovascular Risk Research Articles

Long-term circadian disruption shortens lifespan and dampens blood pressure diurnal rhythms in stroke-prone spontaneously hypertensive rats.

Environmental cues such as light and timing of food intake influence molecular clocks that produce circadian rhythmicity of many biological functions. The master circadian clock is entrained by light input and synchronizes to peripheral clocks in every organ. Careers that require rotating shift work schedules predispose workers to a constant desynchronization of biological clocks and are associated with increased risk of cardiovascular disease. We utilized a stroke-prone spontaneously hypertensive rat model exposed to a known biological desynchronizer, chronic environmental circadian disruption (ECD), and hypothesized that it would accelerate time to stroke onset. We investigated whether time-restricted feeding could delay stroke onset and evaluated its usefulness as a countermeasure when combined with the disruption of the light cycle. We found that a phase advancing schedule accelerated stroke onset. Restricting food access time to 5 hours/day regardless of lighting delayed stroke onset in both standard 12:12 light:dark or ECD lighting conditions compared with ad-lib feeding, but acceleration by ECD versus control lighting conditions was still observed. Since hypertension is a precursor to stroke in this model, we assessed blood pressure in a small cohort longitudinally using telemetry. Daily systolic and diastolic blood pressure was increased in both control and ECD conditions, thus hypertension was not accelerated to cause earlier strokes. We observed intermittent dampening of rhythms after each shift of the light cycle reminiscent of a relapsing-remitting non-dipping state. Our results suggest that constant ECD rhythms may be associated with increased risk of cardiovascular complications in the presence of cardiovascular risk factors.

Associations of adipocytokine expression and cardiovascular risk factors in stable coronary artery disease

Aim. To determine the expression of adiponectin, leptin and I interleukin-6 (IL-6) in subcutaneous, epicardial and perivascular adipose tissue, depending on the presence of cardiovascular risk factors.Material and methods. The study included 90 patients with stable coronary artery disease (CAD) who underwent coronary artery bypass grafting. Samples of adipose tissue were obtained during surgery. The levels of matrix ribonucleic acid (mRNA) of the studied adipocytokines were determined in the presence/absence of the main cardiovascular risk factors.Results. Differences in the expression of genes of the studied adipocytokines in different sex and age groups of patients were revealed, depending on the tissue belonging of adipocytes. Expression of adiponectin in the epicardial and perivascular adipose tissue (EАT and PVAT, respectively), as well as of leptin in the PVAT was less pronounced in men. However, the level of IL-6 mRNA in the subcutaneous adipose tissue (SAT) of men was three times higher than in women, and in the PVAT it was lower. The maximum expression of leptin and IL-6 in the EAT and PVAT was found in persons aged 50-59 years. The presence of dyslipidemia is associated with a decrease in the expression of adiponectin in the EAT, PVAT, and IL-6 in the PVAT. In patients with hypertension (HTN), there was a low level of adiponectin mRNA in the EAT against the background of high leptin levels in the EAT and IL-6 in SAT and EAT. In hypertension with a duration of more than 20 years, there was a decrease in adiponectin expression and an increase in leptin in all types of AT. In smokers, an increase in the expression of adiponectin in the SAT, EAT, PVAT and leptin in the SAT, EAT was found.Conclusion. Associations of traditional cardiovascular risk factors with imbalance of adipocytokines of local fat depots in patients with CAD were revealed. The detected imbalance is manifested by a decrease in the expression of cardioprotective adiponectin in the EAT, PVAT, an increase in leptin and IL-6, which is an unfavorable sign. The presence of such risk factors as male sex, age of 50-59 years, dyslipidemia and hypertension in patients can enhance atherogenesis and contribute to the further progression of CAD.

Blood Pressure Increase and Microvascular Dysfunction Accelerate Arterial Stiffening in Children: Modulation by Physical Activity.

BackgroundAtherosclerotic remodeling starts early in life and can accelerate in the presence of cardiovascular risk (CV) factors. Regular physical activity (PA) can mitigate development of large and small artery disease during lifespan. We aimed to investigate the association of changes in body mass index (BMI), blood pressure (BP), PA behavior and retinal microvascular diameters with large artery pulse wave velocity (PWV) in prepubertal children over 4 years.MethodsThe school-based prospective cohort study included 262 children initially aged 6–8 years, assessing the above CV risk factors and retinal vessels by standardized procedures at baseline (2014) and follow-up (2018). PWV was assessed by an oscillometric device at follow-up.ResultsChildren with increased systolic BP over 4 years showed higher PWV at follow-up (β [95% CI] 0.006 [0.002 to 0.011] mmHg per unit, P = 0.002). In contrast, increased vigorous PA corresponded to a lower PWV at follow-up (β [95% CI] −0.009 [−0.018 to <0−0.001] 10 min/day per unit, P = 0.047). Progression of retinal arteriolar narrowing and venular widening were linked to a higher PWV after 4 years (β [95% CI] −0.014 [−0.023 to −0.004] 0.01 changes per unit, P = 0.003).ConclusionIncrease in systolic BP and progression of microvascular dysfunction were associated with higher PWV after 4 years. Children with increasing levels of vigorous PA were found to have lower PWV at follow-up. Habitual vigorous PA has the potential to decelerate the process of early vascular aging in children and may thus help counteract CV disease development later in life.Clinical Trial RegistrationClinicalTrials.gov, Identifier: NCT03085498.

Inflammatory cytokines in type 2 diabetes mellitus as facilitators of hypercoagulation and abnormal clot formation

BackgroundThe global burden of type 2 diabetes mellitus (T2DM), together with the presence of cardiovascular risk in this population, is reaching pandemic levels. A prominent feature of T2DM is chronic and systemic inflammation, with the accompanying presence of circulating and dysregulated inflammatory biomarkers; which in turn is associated with abnormal clot formation.MethodsHere, we investigate the correlation between abnormal blood clotting, using thromboelastography (TEG), clot ultrastructure using scanning electron microscopy (SEM) and the presence of a dysregulated inflammatory cytokine profile, by examining various circulating biomarkers.ResultsOur results show that many biomarkers, across TEG, cytokine and lipid groups, were greatly dysregulated in the T2DM sample. Furthermore, our T2DM sample’s coagulation profiles were significantly more hypercoagulable when compared to our heathy sample, and ultrastructural analysis confirmed a matted and denser clot structure in the T2DM sample.ConclusionsWe suggest that dysregulated circulating molecules may in part be responsible for a hypercoagulable state and vascular dysfunction in the T2DM sample. We propose further that a personalized approach could be of great value when planning treatment and tracking the patient health status after embarking on a treatment regimes, and that looking to novel inflammatory and vascular biomarkers might be crucial.

Effects of Preeclampsia on Maternal and Pediatric Health at 11 Years Postpartum.

To determine the association of preeclampsia (PE) with the presence of cardiovascular risk (CVR) factors at approximately 11 years postpartum and to assess the longer term effect of PE on childhood development. A mail-out survey was sent to all women who were previously recruited into the Kingston arm of the Pre-Eclampsia New Emerging Team's prospective cohort (n = 112 PE and n = 150 control). Physical and biochemical CVR markers were compared between the two groups. Physical, social, and cognitive development of the children involved in the pregnancies was evaluated using the Vineland-3 Domain-Level Parent/Caregiver Form. Thirteen PE women and 28 control women returned the study questionnaire. Based on the 2017 American Heart Association High Blood Pressure Clinical Practice Guidelines, 9/13 (69.2%) of the PE women, compared with 6/28 (21.4%) of the control women, have hypertension (p < 0.01). The median percentile rank for overall adaptive functioning was 58 (interquartile range [IQR: 21-73]) in the PE children and 81 (IQR: 61-94) in the control children (p < 0.05). The development of PE leads to longer term changes in CVR markers and in childhood development at approximately 11 years postpartum. Pregnancy and the postpartum provide an early window of opportunity for early maternal and child screening and intervention for health preservation and disease prevention.

Presence of Cardiovascular Risk as Diabetes Mellitus Progresses

As individual lives with Diabetes Mellitus, the emergence and progression cardiovascular risks are relevant in the management of patients. While some appear early and last long some appear late and cause patients condition to deteriorate rapidly.

Eating habits and presence of cardiovascular risks in children.

The changes in the eating habits associated with physical inactivity are directly related to the increase in the prevalence of obesity and associated diseases such as diabetes mellitus (DM), metabolic syndrome and cardiovascular diseases. The aim of this study was to investigate the relationship between the frequency of consumption of some food groups (snacks, fruits, vegetables and candies), physical exercise, nutritional classification and biochemical profile in children. After the approval of the Ethics Committee, we studied 882 schoolchildren ranging between 6 and 10 years of age. Biochemical and anthropometric evaluations were performed and questionnaires were used in order to check the eating habits and physical activity. Our results showed that we may relate the consumption of snacks, fruits, vegetables or candies with modifications in the glycemia, triglycerides, total cholesterol, HDL-c, and LDL-c but we did not observe association with the nutritional classification. It is noteworthy to say that almost 50% of the studied children were overweight or obese and many presented alterations in the lipid and glucose levels. Our results also show that many children have abnormal levels of lipids and glycemia and a great number of them are classified as overweight or obese. In this context, we can say that urgent approaches are needed to be carried out by a multidisciplinary team in order to improve the diet and reduces the risk factors in this population of children and prevent secondary diseases in adolescence and adulthood.

Evaluation of statin prescriptions in type 2 diabetes: India Heart Watch-2

BackgroundContemporary treatment guidelines advise statin use in all patients with diabetes for reducing coronary risk. Use of statins in patients with type 2 diabetes has not been reported from India.MethodsWe...

SOBREPESO COMO FATOR DE RISCO PARA HIPERTENSÃO EM ESCOLARES DE CASCAVEL, PARANÁ

The main objective of the study was evaluate the nutritional status and risk factors for the development of cardiovascular disease in adolescents, aged between 14 and 19 years, enrolled in public schools in the city of Cascavel, Parana.. There were 549 participants, who were evaluated according to criteria proposed by the World Health Organization and Cole et al. For nutritional assessment and risk factors anthropometric measurements of weight and height to calculate body mass index, waist circumference and blood pressure were collected, all of which were evaluated following recommendations of the Brazilian Cardiology Society. The prevalence of overweight was 14.39% and 13.39% for the World Health Organization and Cole et al., respectively. The presence of cardiovascular risk was assessed by in 10.02% of adolescents and high arterial blood pressure was observed in 17.85% (n = 98) of adolescents, prevailing again in males. Therefore, the conclusion is that obesity and other risk factors for cardiovascular diseases are highly prevalent being necessary to intervein in the eating habits of this group, keeping them under surveillance with regular studies to promote health and prevent diseases in the adulthood.

Role of prolactin as a cardiovascular risk in type 2 diabetes mellitus patients: a case-control study in Egypt

Prolactin is a recognized platelet co-stimulator due to enhancement of ADP-induced platelet aggregation, and hence participates in the atherosclerotic process. Studies had shown that human adipose tissue produces PRL as well as expresses the PRL receptor (PRLR), which highlights a previously unappreciated action of PRL as a cytokine involved in adipose tissue function. The aim of our study was to asses whether prolactin level is associated with the presence of cardiovascular risk in patients with acute myocardial infarction (AMI) and patients with type 2 diabetes mellitus (DM). This case-control study was conducted on 89 adult males (ages 40–60 years) divided into four groups: 25 diabetics with AMI patients (group 1), 24 non-diabetics with AMI patients (group 2), 20 diabetics but not known to have AMI (group 3), and 20 healthy controls (group 4), in whom serum prolactin was determined using commercially available ELISA kits. Prolactin levels increased along with increased serum troponin; group 1 had the highest level of serum prolactin (10.6 ± 6 ng/ml) in comparison to groups 2 (8.8 ± 4 ng/ml), 3 (6.9 ± 2 ng/ml), and 4 (5 ± 2 ng/ml). According to the cutoff of the receiver operating characteristic (ROC) curve, prolactin is considered better positive than negative marker in cases of AMI. Hyperprolactinemia may be associated with increased risk of atherosclerotic process and hence occurrence of AMI, as one of the serious macrovascular complications in diabetics. Elevated prolactin levels detected in diabetics having AMI supports the recent trend of using dopamine agonists, e.g., bromocriptine in treatment of type 2 DM especially those who had a prior ischemic event. Also, increased prolactin being associated with increased troponin level in AMI patients may be considered a prognostic factor correlated with the extent of myocardial damage.

Retrospective assessment of the prevalence of cardiovascular risk factors among homeless individuals with schizophrenia in Shanghai.

BackgroundCardiovascular diseases are increasingly important in China, but the prevalence of risk factors for cardiovascular diseases in the indigent mentally ill are unknown.AimAssess the prevalence of four key risk factors for cardiovascular disease -- hypertension, hyperglycemia, hyperlipidemia and smoking – among homeless patients with schizophrenia and identify factors associated with the presence of these risk factors.MethodsWe reviewed medical charts of 181 homeless and 181 non-homeless patients with schizophrenia or schizophreniform disorder admitted to the Shanghai Jiading Mental Health Center between May 2007 and April 2013. Demographic characteristics and risk factors of cardiovascular events were compared between the two groups. Logistic regression models identified the factors that were associated with the presence of one or more of the four risk factors.ResultsThe prevalence of hypertension and hyperlipidemia were 19 to 20% in both males and females in the two groups; these rates are similar to those reported in the general population. The prevalence of hyperglycemia ranged from 11 to 15% among males and females in the two groups. Smoking was highly prevalent in male patients (82% in homeless males and 78% in non-homeless males) but, like in China generally, much less prevalent in female patients (7% in homeless females and 5% in non-homeless females). The logistic regression analysis found that male gender, older age, and urban (vs. rural) residence were independently associated with the presence of one or more of the four cardiovascular risk factors. Homelessness was not associated with the presence of cardiovascular risk factors.ConclusionThis study is the first known report on cardiovascular risk factors among homeless mentally ill in China. The study did not assess several important factors (such as the type, dose and duration of use of antipsychotic medication) but it was, nevertheless, able to show that, unlike in high-income countries, homelessness is not related to elevated risk of cardiovascular disease in Chinese individuals with mental illnesses. Prospective studies with the growing number of homeless individuals in China will be needed to get a clearer picture of the best ways to provide them with the health care services they need.

AB0233 Cardiovascular risk factors and awareness in rheumatoid outpatients

BackgroundIt is becoming increasingly accepted that cardiovascular events are an important comorbidity in rheumatoid arthritis. Myocardial infarction, heart failure and cardiac death are significantly increased in rheumatoid patients compared to...

Frequency and extent of coronary atherosclerotic plaques in patients with zero coronary artery calcium score: assessment with computed tomographic angiography

We aimed to evaluate the frequency and extent of coronary atherosclerotic plaques in patients with a coronary artery calcium (CAC) score of zero and establish the demographic characteristics and the cardiovascular risk factors that affect the formation of atheromatous plaques. Coronary computed tomography (CT) angiography was performed in 288 cases with a CAC score of zero. The plaques that were detected using coronary CT angiography were categorized into two groups: nonsignificant (<50%) and significant (≥50%). Based on the coronary CT angiography results, the patients who had plaque and those who did not have plaque were compared in terms of the demographic characteristics and the presence of cardiovascular risk factors. Noncalcified plaques were detected in 50 cases (17.4%) on CT angiography, of which six cases (2.1%) had significant stenosis. The plaques were localized most frequently (38.2%) in the proximal left anterior descending artery. When all the plaques considered 50% of the plaques were localized in the proximal segments, 42.7% were in the mid-segments, and 7.3% were in the distal segments. Hypertension was a significant risk factor for coronary artery disease in both genders, and smoking was a significant risk factor in females. Additionally, diabetes mellitus was a borderline significant risk factor in both genders. In patients with a CAC score of zero, the frequency of noncalcified plaques is too high to be ignored. The distribution of these plaques in the coronary artery is similar to calcified plaque localizations. Patients who have a CAC score of zero and cardiovascular risk factors need to be evaluated with additional tests for the detection of noncalcified plaques.

The impact of obesity on cardiac troponin levels after prolonged exercise in humans.

Elevated cardiac troponin I (cTnI), a marker for cardiac damage, has been reported after high-intensity exercise in healthy subjects. Currently, little is known about the impact of prolonged moderate-intensity exercise on cTnI release, but also the impact of obesity on this response. 97 volunteers (55 men and 42 women), stratified for BMI, performed a single bout of walking exercise (30–50 km). We examined cTnI-levels before and immediately after the exercise bout in lean (BMI < 25 kg/m2, n = 30, 57 ± 19 years), overweight (25 ≤ BMI < 30 kg/m2, n = 29, 56 ± 11 years), and obese subjects (BMI ≥ 30 kg/m2, n = 28, 53 ± 9 years). Walking was performed at a self-selected pace. cTnI was assessed using a high-sensitive cTnI-assay (Centaur; clinical cut-off value ≥0.04 μg/L). We recorded subject characteristics (body weight, blood pressure, presence of cardiovascular risk) and examined exercise intensity by recording heart rate. Mean cTnI-levels increased significantly from 0.010 ± 0.006 to 0.024 ± 0.046 μg/L (P < 0.001). The exercise-induced increase in cTnI was not different between lean, overweight and obese subjects (two-way ANOVA interaction; P = 0.27). In 11 participants, cTnI was elevated above the clinical cut-off value for myocardial infarction. Logistic regression analysis identified exercise intensity (P < 0.001), but not BMI, body fat percentage or waist circumference to significantly relate to positive troponin tests. In conclusion, prolonged, moderate-intensity exercise results in a comparable increase in cTnI-levels in lean, overweight and obese subjects. Therefore, measures of obesity unlikely relate to the magnitude of the post-exercise elevation in cTnI.

Estudo comparativo do perfil pró-aterosclerótico de estudantes de Medicina e de Educação Física

Recent studies have demonstrated a strong association between physical activity, low level of cardiorespiratory fitness and the presence of cardiovascular risk factors.Compare the level of physical activity, level of cardiorespiratory fitness and cardiovascular risk in students of medicine and physical education.At the first phase, the International Physical Activity Questionnaire (IPAQ) was used to quantify the physical activity level of 126 students from the 7th and 8th semesters of the physical education and medicine courses. At the second phase, 40 students were randomly selected (20 from each course) to undergo cardiovascular risk assessment and cardiorespiratory fitness. The following data were assessed 1) arterial pressure; 2) body mass index (BMI); 3) percentage of fat (electrical bioimpedance); 4) abdominal circumference (AC); 5) laboratory biochemical assessment; and 6) cardiorespiratory fitness (Kline's Test).The comparison of students of medicine and physical education, respectively, showed a higher frequency of individuals presenting: low level of physical activity (55% vs 15.0%; p = 0.008); pre-hypertension measured by SAP (80% vs 25.0%; p = 0.000) and by DAP (45% vs 5.0%; p = 0.003); overweight (50% vs 10.0%; p = 0.006); increased abdominal circumference (25% vs 0.0%; p = 0.017); increased total cholesterol (165 +/- 28 vs 142 +/- 28 mg/dl; p = 0.015); increased LDL-c (99 +/- 27 vs 81 +/- 23 mg/dl; p = 0.026); increased glycemia (81 +/- 8.0 vs 75 +/- 7.0 mg/dl; p = 0.013); lower cardiorespiratory fitness (48 +/- 8.0 vs 56 +/- 7.0 ml/kg/min; p = 0.001).Students of medicine presented lower levels of physical activity practice, lower level of cardiorespiratory fitness and higher frequency of cardiovascular risk factors, when compared to Physical Education students.

Abstract 3638: Abnormalities of Left Ventricular Geometry in Youth with Type 2 Diabetes: A greater effect of obesity than fasting glucose

Background: Type 2 diabetes (T2), previously a disease of adult onset, is increasing in prevalence amongst children and young adults. Yet the presence of cardiovascular risks, such as left ventricular hypertrophy (LVH) are largely unknown in this population. Purpose: To determine the frequencies of abnormal left ventricular (LV) mass and geometry in young people with T2. Methods: LV mass (LVM) was assessed by echo, indexed to height in meters 2.7, and compared to healthy Obese (O) and Lean (L) controls of similar age, gender matched, non-diabetics. Statistical analysis was performed with non-parametric tests. Data are presented as mean and standard deviations. Results: A total of 98 T2 (ages 11–23 yrs, 19 ± 4 yrs; 64% female, 36% male; BMI 35 ± 8) were evaluated and compared to O &amp; L controls (BMI 36 ± 7 and 21 ± 3, respectively). Although indexed LVM was higher for T2 compared to L (36 ± 11 vs. 27 ± 6 gm/m2.7, p = &lt;0.0001) it was not different compared to O controls. LV geometry was similarly abnormal in the T2 &amp; O groups, with increased frequency of concentric and eccentric LVH compared to lean controls (Table 1 ). Systolic (SBP) and diastolic (DBP) blood pressure were higher in the T2 vs. O &amp; L (p&lt;0.05). In univariate analysis for T2, indexed LVM correlated with BMI (p&lt;0.0001, R=0.65) but not: BP, gender, race, or fasting plasma glucose. In multiple regression for T2, log index LVM was predicted by BMI (p&lt;0.0001) &amp; gender (p=0.02) (R2=0.46) but not BP, race or fasting plasma glucose. Conclusions: Young people with T2 have higher indexed LVM and abnormal LV geometry compared to lean controls. Obesity, not fasting plasma glucose seems to be a primary factor associated with LVM. These data suggest that obesity is a primary factor in the early cardiac changes in youth with T2. Early weight loss may have a greater beneficial effect on cardiac geometry than glycemic control. Table I: Prevalence of Left Ventricular Geometries

Risk of cardiovascular events in patients at optimal values for combined lipid parameters

ABSTRACTBackground: Current prevention guidelines support efforts to achieve optimal high-density lipoprotein (HDL‑C) and triglyceride (TG) values, in addition to low-density lipoprotein (LDL‑C) in order to reduce cardiovascular (CV) events. The study objective was to evaluate the risk of CV events in patients attaining versus not attaining combined (LDL‑C, HDL‑C, and TG) optimal lipid values.Methods/results: This retrospective cohort analysis was conducted using a 1.1 million member managed care database. Eligible patients had a full lipid panel between 10/1/99 and 9/30/00, were naive to lipid therapy, and had health plan eligibility 12 months pre- and post-index (baseline) lipid laboratory value. Optimal lipid values (LDL‑C, HDL‑C, and TG) were established using the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) guidelines, and patients were placed into one of four groups: none, one, two, or three lipid components non-optimal at baseline. The presence of cardiovascular risk, disease, and events were determined by selected International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) and Current Procedural Terminology (CPT codes). The definition of a CV event included: diagnosis of ischemic heart disease, peripheral arterial disease, stroke/TIA, or revascularization procedure. Odds ratios (OR) for a CV event associated with attainment of each optimal lipid fraction were determined by multivariate logistic regression. The study cohort included 30 348 patients, with a mean follow-up of 27 ± 8 months. Mean age was 66 ± 12 years; 16 549 (54%) were male; and 17 289 (57%) patients had coronary heart disease (CHD) or CHD risk equivalent. There were 5955 CV events that occurred in 4059 (13%) study patients. The presence of a single non-optimal lipid value slightly increased CV event risk [OR: 1.06; 95% CI: 0.95–1.18], whereas two or all three non-optimal lipid values significantly increased the risk of a CV event [OR: 1.22; 95% CI: 1.08–1.37; and 1.45; 95% CI: 1.24–1.68, respectively].Limitations: As with all large observational databases there are potential limitations including: patient selection bias (e.g., more interventions in patients with greater illness, lack of mortality data, and frequency of lipid monitoring), unknown confounding variables, and potential coding errors.Conclusion: Not attaining optimal combined lipid values, independently and significantly, increased the risk of CV events in this large at-risk population with approximately 68 283 patient-years of follow-up. The combination of non-attainment of optimal LDL‑C with non-attainment of optimal HDL‑C or TG values, or both, increased the adjusted risk of CV events by 22–45%. Thus, therapeutic strategies should focus on assessment and management of multiple lipid abnormalities, and not on single lipid risk factor modification.

Bronchoplastic procedures in malignant and nonmalignant disease: Multivariable analysis of 144 cases

Objectives: We sought to analyze the experience with bronchoplastic procedures over a 7-year period and to determine putative prognostic factors for survival. Methods: From 1991 to 1997, 144 bronchoplastic procedures were performed for non–small cell lung cancer (n = 123), small cell lung cancer (n = 5), carcinoid tumor (n = 10), and metastases of extrathoracic malignant tumors (n = 6). There were 111 sleeve lobectomies, 17 bilobectomies, 4 lobectomies with carinal resection, 8 sleeve pneumonectomies, and 4 bronchotomies without parenchymal resection. Multivariable analysis included risk factors, such as age, sex, type of bronchoplastic procedure (bronchotomy, lobectomy, bilobectomy, or pneumonectomy), additional angioplasty, TNM staging, histology, radicality of resection, respiratory risk (forced expiratory volume in 1 second, percent predicted < 60), cardiovascular risk, and adjuvant therapy. Results: Overall 1- and 3-year survival was 72% and 52%, respectively. The overall 30-day mortality was 8.3% (5.4% for single sleeve lobectomies). Multivariable analysis demonstrated 4 risk factors for survival. High tumor stage, type of bronchoplastic procedure, impaired lung function, and presence of cardiovascular risk were associated with a poor outcome. Univariate analysis showed reduced survival in patients with sleeve pneumonectomies (1-year survival, 25%). Conclusions: Bronchoplastic procedures for central tumors and sleeve pneumonectomies are associated with poor survival. Careful selection of these patients, as well as of patients with impaired lung function and cardiovascular risk factors, is mandatory. (J Thorac Cardiovasc Surg 2000;120:119-27)