Previous Heart Attack Research Articles

Efficacy and Safety of Nilotinib in First Line Therapy in a Real Life Cohort of Chronic Myeloid Leukemia Patients

IntroductionConsistent data show that the real goal in CML therapy is to obtain a very rapid and deep response because the cinetic of molecular response (MR) is important for quickly reducing the tumor burden by reducing the BCR/ABL level.The second generation TKIs Nilotinib was designed to have enhanced selectivity and potency toward BCR-ABL compared with imatinib and was able to obtain very rapid and deeper response as shown by many clinical trials. Nilotinib has been approved in multiple countries for use in first line therapy in CML-CP Pts. In order to verify the efficacy and safety of Nilotinib used in first line treatment, we collected the results of a real life cohort of Pts treated in some italian hematological Institutions.Patients and Methods68 Pts affected by CML-CP were treated in 9 hematologic units with Nilotinib as first line therapy from 2010 to 2014. The median age was 47.7y with equal distribution by sex. Cytogenetic analysis at diagnosis showed in 66/68 Pts the presence of the typical Ph1 chromosome, 1 pt showed a Ph1 in a complex translocation and 1 pt showed the typical Ph1 chromosome plus der(17). The molecular analysis confirmed the presence of a BCR/ABL hybrid gene (55/68: b3a2 transcript; 12/68 b2a2 transcript; 1/68 both transcripts). The Sokal risk was: Low 24 Pts (35.3%), Intermediate 33 Pts (48.5%), High 11 Pts (16.2%); the Hasford risk was: Low 35 Pts (51.5%), Intermediate 27 Pts (39.7%), High 6 Pts (8.8%); the EUTOS risk was: Low 61 Pts (89.7%) and High 7 Pts (10.3%). All Pts have an ECOG 0/1 out of 1 with an ECOG 2. 45/68 pts received a cytoreduction by HU. All Pts received the Nilotinib standard dose of 600 mg/die except 1 pt who received 300 mg/die. At diagnosis some Pts showed comorbidities (21/68: hypertension; 6/68: diabetes; 5/68: dyslipidemia; 2/68: previous myocardial infarction; 1/68 was in treatment for HIV infection)Results66/68 Pts received at least 3 months of treatment and were considered for analysis. At 3 months, all Pts obtained hematological response; cytogenetic response was complete for 65/68 and partial in 3/68.At 6, 12 and 18 months cytogenetic response was complete in all Pts except for 1 that showed a partial response (pt not compliant); at 24 mo the cytogenetic response was complete for all 25 evaluable Pts.The molecular results at the different time points are summarized in table 1.6/68 Pts showed G1/G2 cutaneous side effects (pruritus, erithema, alopecia) , 6/68 a G1 increase of amylase and/or lipase, but only 1 developed clinical pancreatitis (at diagnosis: hypertension, hypercolesterolemia and cardiac disfunction). One pt underwent to leg amputation for PAOD (at diagnosis: hypertension and hypertriglyceridemia). He discontinued treatment in optimal response at 12mo. One pt had ischemic cerebral event (at diagnosis had hypertension and a previous heart attack). One pt discontinued treatment for pancitopenia in failure of response at 3mo and one pt died at 12mo in failure of response for IMF diagnosed during treatment.No pts developed mutations of BCR/ABL during treatment. In 24 months of observation no Pts lost the response.ConclusionThe response to Nilotinib treatment at 3 months according to ELN revealed that all evaluable Pts were in optimal response; at 6 mo 51/55 (92,7 %) Pts were in optimal response, while at 12 mo 38/45 (86,7%) Pts were in optimal response. At 18 mo 94,1% reached at least MMR with a very deep response (MR>= 4) in 55,9% of Pts. This kind of response was mantained at 24 mo (92% of Pts had at least an MR3 and 15/25 had an MR 4).Notabily starting from 12 months, at least 40 % of pts showed a very deep response (MR >= 4) and the number increased at the subsequent time points.The side effects were few and of low grade. Only 3 Pts discontinued the treatment because side effects. Only a severe side effect (PAOD) was reported in a pt who already had a vascular risk because affected from hypertension and hypertriglyceridemia. It is recommended to check at diagnosis and carefully follow during the treatment for all comorbidities to prevent toxicity.These data collected in a real life treatment with Nilotinib in first line in CML -CP patients, confirmed the results of the clinical trials. The rapid and deep response with a tolerable toxicity profile allow to consider Nilotinib as a good choice for first line treatment also in consideration of a stop therapy in a future.Table 1Time Pts MR1 MR2 MR3 MR4 MR4.5 MR5(mo) (N)3 60 10 31 13 4 2 -6 55 4 16 20 4 11 -12 45 1 6 20 4 13 118 34 0 2 13 6 12 124 25 0 2 8 6 8 1 DisclosuresNo relevant conflicts of interest to declare.

The Health Status and Unmet Health Needs of Old-Age Pensioners Living in Selected Urban Poor Communities in Cape Town, South Africa

Indigent elderly residing in low-income urban communities face many adversities. This study investigated the health status and health needs of the elderly collecting an old-age pension at pay points in impoverished urban communities in the City of Cape Town. The pay-out points were selected to constitute a fair representation of points serving impoverished areas of the city. Data was gathered by means of a structured interview with a formal questionnaire since a large proportion of the participating elderly could not read well. Systematic sampling with random starting points of persons in the pay-out queue was used and 703 pensioners were selected to participate from eight pension points in four urban poor communities. All agreed to do so. The health status of the participants was not good: 82.8% were on chronic medication, 32% had diarrhoea in the previous 2 weeks, 24% had TB in the past and 36% reported a previous heart attack. Their health needs were equally not great: 48% reported that their spectacles need changing while 56% have trouble hearing well and 65% needed dentures, while 66% needed a walking aid. Only 4.7% did not have problems with activities of daily living while many faced added burdens such as custodial child care.

Statins and Risk of New-Onset Diabetes Mellitus

For any prescription drug, the potential benefits to health must be balanced against potential risks. Understanding these potential risks can help physicians and patients make informed decisions on whether to use a medication. Recently, statins, a class of medications prescribed to treat high cholesterol levels, have been found to modestly increase the risk of developing diabetes mellitus. It is clear that statins can prevent future major cardiovascular events, such as heart attack, stroke, and deaths from cardiovascular causes, in patients who have had a previous heart attack or those with multiple cardiovascular risk factors. However, the associations between diabetes mellitus and statin use have raised concerns over the widespread use of statin medications in patients at lower risk for cardiovascular disease. In this Patient Page, we describe the indications for statin therapy, the most common adverse effects, and recent concerns about new-onset diabetes mellitus to help patients and providers make more informed decisions about the use of this important class of medications in at-risk individuals. Cardiovascular disease is a major cause of illness and death worldwide. Elevated blood cholesterol levels (specifically the low-density lipoprotein [LDL] cholesterol) are associated with a higher risk of heart attack, stroke, and heart failure. It has become clear that elevated LDL cholesterol levels predict future events, and modern risk scores such as the Framingham Risk Score use LDL cholesterol level as an important predictor of future cardiac events.1 In addition, as new large trials shed light on the important role of LDL in cardiac disease, the optimal LDL cholesterol level has been progressively lowered in national guidelines. Statins are a class of medications called 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. These drugs block a critical …

146. Depressive symptoms and cardiovascular risk

Background: Increased cardiovascular risk in those with depressive symptoms is well-documented, notably increased mortality, rehospitalizations, and adverse cardiac events. B-type natriuretic peptide (BNP) is used as a prognostic marker of cardiovascular disease risk for heart failure. We seek to elucidate whether BNP and other cardiac parameters are associated with depressive symptoms to determine biological factors that may prevent adverse cardiac outcomes. Methods: Patients receiving echocardiograms between May and July 2010 completed the Beck Depression Inventory (BDI) to assess depressive symptoms. Information was collected regarding past medical history, surgeries, cardiac symptoms, medications, lipids, BNP, and echocardiogram findings. Linear regression analyses identified relationships between depressive symptoms and cardiac measures. Results: Total BDI score was independently correlated with edema ( p = 0.017), arrhythmia ( p = 0.013), previous myocardial infarction (MI) ( p = 0.003), and weakness ( p = 0.007). When combining variables: including edema and fatigue ( p = 0.005); arrhythmia and previous heart attack ( p Conclusions: Patients with edema, arrhythmia, previous MI, and weakness were more likely to be depressed. The presence of multiple cardiac factors strengthened the association.Although BNP was unrelated to depressive symptoms, perhaps it has a role in more specific cardiovascular populations with depression.Clinicians must maintain awareness of depressive symptoms in cardiac patients to help minimize adverse outcomes.

Snoring Is Not Associated With All-Cause Mortality, Incident Cardiovascular Disease, or Stroke in the Busselton Health Study

To ascertain whether objectively measured snoring increases mortality, cardiovascular disease, or stroke risk over the effects of obstructive sleep apnea and other established risk factors. Community-based cohort. 400 residents of the Western Australian town of Busselton. N/A. Snoring and obstructive sleep apnea were quantified via the percentage of the night spent snoring and the respiratory disturbance index as measured by a single night recording in November-December 1990 by a home sleep apnea monitoring device (MESAM IV), along with a range of cardiovascular disease risk factors. Follow-up for deaths and cardiovascular hospitalizations was ascertained via record linkage until the end of 2007. Our analytical sample of 380 people was made up of the 397 people for whom the authors had follow-up data, minus 17 people who reported a previous stroke or heart attack at baseline (n = 380/400 = 95% of cohort). Snoring was observed for a mean/median of 32.0/27.4% of the night (standard deviation = 23.9%; range = 0-97.2%). There were 46 deaths, 68 cardiovascular events, and 24 strokes during 17 yr of follow-up. Snoring as either a categoric or continuous variable was not significantly associated with death, incident cardiovascular disease, or stroke in both unadjusted Cox regression models and in models that adjusted for obstructive sleep apnea and other risk factors. No measure of snoring was associated with all-cause mortality, or incident cardiovascular disease or stroke over 17 yr in this community-based sample.

Subjective memory impairment in older adults: aetiology, salience and help seeking

Subjective memory impairment (SMI) is one of the key symptoms with which people with early cognitive impairment may present to health services. However, little research has investigated how older people view the symptom, its salience and how often help is sought. The objectives were to investigate (a) factors associated with SMI, (b) salience of SMI in comparison with other symptoms and (c) help seeking for SMI. A cross-sectional survey was based in two Primary Care services in south London in which registered people aged 65+ were interviewed blind to the study objectives. Measurements included systematic ascertainment of SMI and other common symptoms/disorders. In each of these, concern and interference were quantified, and participants were asked to rank all reported symptoms/disorders in order of importance. Of 126 participants, any SMI was reported in 66.7%, and 31.0% reported SMI to a significant degree. SMI occupied a middling rank in terms of salience, being ranked as more concerning than angina, asthma, hypertension or a previous heart attack in around half of participants in whom these co-occurred. However, only one participant with SMI had sought help from their GP, making it the least likely symptom to be reported. Subjective memory impairment is common and appears to have functional and/or emotional significance for many older people. However, very few appear to seek medical attention for this symptom, which has implications for wider policy regarding prompt assessment and diagnosis of mild cognitive impairment or dementia.

Alcohol, wine and cardiovascular disease, two sides of the same coin

Excessive alcohol consumption is associated with increased morbidity and mortality, as well as with severe labour and traffic accidents. In fact, the dangers of alcohol intake have been with us throughout human history. The book of Genesis reported one of the first episodes demonstrating the dangers of alcohol. Upon leaving the Ark after the great flood Noah ‘‘drank wine and became drunk’’ and his sons had to protect him from embarrassment. Since then, the medical consequences of excessive alcohol consumption are well known and include acute intoxication, alcohol dependence, cirrhosis of the liver, pancreatitis, hypertension, stroke, dilated cardiomyopathy, cardiac arrhythmias and sudden death [1, 2]. On the other hand, human beings have drunk alcoholic beverages, especially wine, since ancient times and many believe in the beneficial effects of moderate wine intake. As an example, remains of a unique wine, shedeh, was found in the tomb of the pharaoh Tutankhamon to accompany him on his long trip to the ‘‘other life’’ [3]. However, the first modern evidence that there is a scientific link between alcohol consumption and cardiovascular disease was made in the early part of the last century, when it was observed that individuals that died from alcoholic cirrhosis had cleaner arteries than they ought to according to their age and lifestyle habits, suggesting that alcohol could exert a protective effect against atherosclerosis. Since then, several epidemiological studies have suggested that light to moderate alcohol consumers have an increased survival and decreased risk for cardiovascular events than abstainers. A recent meta-analysis of 34 prospective cohort studies with more than 1 million subjects and almost 100,000 deaths by any cause showed a J-shaped association between self-reported alcohol consumption and mortality [4]. Current evidence suggests beneficial effects of moderate drinking on atherothrombotic events including coronary heart disease [5], ischemic stroke [6], peripheral arterial disease and, more recently, congestive heart failure [7]. Positive effects of moderate drinking on the quality of life, cognitive function, dementia and longevity have also been reported. These effects have been reported in a variety of patients, including diabetics, hypertensive subjects and patients with previous heart attack. As explained in the paper published by Di Castelnuovo et al. in this issue [8], the underlying mechanisms to explain the protective effects of moderate alcohol against coronary heart disease include an increase in high-density lipoprotein cholesterol (HDL-C), a decrease in platelet aggregation and coagulation effects, a reduction in the levels of fibrinogen and an increase in insulin sensitivity. This latter effect explains the reduced risk of diabetes in moderate drinkers. Additional beneficial effects of the intake of alcoholic fermented beverages against atherosclerosis have been attributed to their antioxidative and anti-inflammatory effects [9, 10] as well as their actions on vascular function. However, although there are few doubts as to the beneficial effects of moderate drinking on cardiovascular system, a number of reports concerning alcohol and cancer have been published recently. According to the data of the Million Women study [11], even light to moderate levels of alcohol consumption were predictive of an increased risk of several common cancers, mainly those of the breast. Previous R. Estruch (&) Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain e-mail: RESTRUCH@clinic.ub.es

The rural-urban divide: health services utilization among older Mexicans in Mexico.

Mexico. Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's "model of health services" of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). Results showed that older Mexicans living in the most rural areas (populations of 2,500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health.

The Association Between Perceived Social Support and Health Among Patients at a Free Urban Clinic

This study examines the association between perceived social support and the prevalence of physical and mental health conditions among adult patients of an urban free medical clinic. Patients (n = 289) completed a health risk assessment (HRA) questionnaire that addressed a number of medical and social issues, including perceived social support and whether patients had been told they had certain health conditions. Among these questions were 2 validated instruments: the PRIME-MD for mental health disorder assessment and CAGE for alcohol risk assessment. A deidentified database of responses was analyzed for statistical associations between perceived social support and these health conditions. Among those with insufficient perceived social support there were higher rates of having physician-measured overweight/obesity, a heart condition, a previous heart attack, anxiety, and depression. The association between perceived social support and cardiovascular health existed among women but not among men. Higher income, not smoking, and consumption of high-fiber foods were associated with sufficient social support. Perceiving sufficient social support was associated with lower rates of several mental and physical health disorders. Social support may act as a barrier or buffer to poor health caused by the stressful living conditions often experienced by low-income underinsured people. Males and females may experience this social support buffering differently.

Risk for Increased Utilization and Adverse Health Outcomes among Men Served by the Veterans Health Administration

Using data from a nationally representative survey, we evaluated the prevalence of multiple risk factors known to predict increased health care utilization and adverse health outcomes, comparing U.S. men who rely solely on the Veterans Affairs Health Administration (VA) for health care to men in the general population. Adjusting for age and race, men who only use the VA were significantly more likely to have multiple socioeconomic and lifestyle risk factors including current smoking. Their self-reported health status was more often fair or poor and they were more likely to report the presence of multiple chronic diseases ranging from arthritis to previous heart attack to poor mental health. Although the finding that VA-only users are at elevated health risk was anticipated, our study now provides nationally representative estimates of the magnitude of these differences and reinforces the importance of accounting for them when making VA to non-VA comparisons.

Plasma phospholipid fatty acid composition as a biomarker of habitual dietary fat intake in an ethnically diverse cohort

Background and aim As an evaluation of fatty acid intake measurement, our aim was to examine associations between diet and plasma phospholipid (PL) fatty acids, and whether these were modified by age, sex, country of birth, fasting status, use of cholesterol-lowering medication, body size, chronic disease and other lifestyle factors. Methods and results Cross-sectional analysis of plasma PL fatty acid composition and dietary fatty acid intake over 12 months from a 121-item food frequency questionnaire (FFQ) in 4439 men and women aged 40–69 years, born in Australia, Greece or Italy. Crude correlation coefficients ranged from 0.18 to 0.40; and corrected correlation coefficients from 0.38 to 0.78 for total monounsaturated, polyunsaturated, n-6, n-3 fatty acids, oleic acid, linoleic acid, EPA and DHA. Weaker associations were observed for other fatty acids. The associations did not vary significantly by fasting status, use of lipid lowering medication or alcohol intake, but for some fatty acids did vary by sex, age, body mass index, country of birth, smoking and previous heart attack or diabetes. Conclusions The FFQ provides useful information on intakes of mono- and polyunsaturated fatty acids. Correlations did not differ by fasting status, or use of lipid-lowering medication.

Cardiovascular disease and risk factors among 345 adults in rural India—the Andhra Pradesh Rural Health Initiative

Background Heart attack and stroke are problems already faced by some urban populations of India, but less is known about cardiovascular disease and risk factors in rural areas. The aim of the study was to investigate the levels and management of major cardiovascular risk factors and the prevalence of cardiovascular disease in two villages in rural Andhra Pradesh, India. Methods A cross-sectional survey was done by selecting a random sample stratified by age and gender from each village using census lists compiled in 2002. For each individual, trained study staff administered a Telugu-translation of a structured questionnaire, performed a brief physical examination and collected a fasting venous blood sample. Weighted estimates of mean (or percentages with) risk factor levels in the population were calculated and are reported with confidence intervals unless otherwise specified. Results Data was collected from 345 adults aged 20 to 90. The average household size was 4.2 and the mean combined household income was about Indian Rupees 25,454 (US$580) per year. The mean systolic blood pressure was 116 (114–117) mm Hg, diastolic blood pressure 73 (114–120) mm Hg, total cholesterol 4.6 (4.5–4.7) mmol/L, HDL-cholesterol 0.8 (0.8–0.9) mmol/L, LDL-cholesterol 3.2 (3.1–3.3) mmol/L and triglyceride 1.3 (1.2–1.4) mmol/L. The prevalence of current smoking was 19.9% (15.4–24.4%), hypertension 20.3% (16.2–24.4%), diabetes 3.7% (1.8–5.5%), overweight 16.9% (12.3–21.5%) and obesity 4.4% (1.9–6.8%). A medical diagnosis of cardiovascular disease (previous heart attack, stroke or angina) was reported by 2.5% (1.1–3.9%) and a further 1.1% (0.1–2.1%) had angina by the ‘Rose’ classification. Conclusions The possibility of increasing cardiovascular risk factors and prevalence of vascular disease in areas of rural India represent a public health concern. Larger and repeated epidemiological studies focusing on chronic diseases are required to inform treatment and prevention strategies suitable for use in these areas and other resource poor settings.

Predictors of Symptom Severity in Patients With Chronic Prostatitis and Interstitial Cystitis

Numerous studies have been performed to identify potential risk factors for CP/CPPS and IC. However, few studies have been done to identify predictors of disease severity. A total of 174 men with CP/CPPS and 111 women with IC completed questionnaires to quantify symptom severity and identify demographic, medical and psychosocial characteristics. Symptom severity was assessed with the National Institutes of Health CPSI in men, and the O'Leary-Sant ICSI and problem index in women. Univariate and multivariate analyses were performed to identify characteristics predictive of worse symptoms. The mean National Institutes of Health CPSI score in men was 15.32, and the mean O'Leary-Sant ICSI and problem index in women was 19.17. The most commonly reported comorbidities were allergies, sinusitis, erectile dysfunction and irritable bowel syndrome in men, and allergies, urinary incontinence, sinusitis and irritable bowel syndrome in women. In the 2 sexes self-reported urinary frequency and urgency, worse depression scores and lower education level were independent predictors of worse symptom severity. In men additional independent predictors were self-reported pelvic pain, fibromyalgia and previous heart attack, and in women an additional independent predictor was postmenopausal status. There are several common medical conditions associated with urological pelvic pain syndromes in men and women. Few of them were predictive of symptoms severity in this analysis. Self-reported pelvic pain symptoms, education and depression severity were the factors most strongly predictive of symptom severity in patients with CP/CPPS and IC.

Basilar Dolichoectasia with Clot Formation and Subarachnoid Haemorrhage

PATIENT 1 See Fig. 1. A 71-year-old hypertensive man on clopidogrel for a previous heart attack experienced a mild brainstem ischaemic stroke, followed by progressive hearing loss. 17 months later,...

Ohio State University College of Medicine and Public Health.

Ohio State University College of Medicine and Public Health.

Diabetes mellitus as a risk factor for stroke incidence and mortality in Mexican American older adults.

Little is known regarding diabetes mellitus as a risk factor for stroke incidence and death in older Mexican Americans. The authors studied diabetes and other potential risk factors for stroke in a sample of community-dwelling older Mexican Americans. A prospective cohort design was used that involved the Hispanic Established Population for the Epidemiologic Study of the Elderly, a longitudinal study using a weighted probability sample of Mexican Americans (aged older than 65 years) living in the southwestern United States. 3050 older Mexican American persons were originally interviewed and tested at baseline and then followed with reassessment at 2, 5, and 7 years. The incidence of stroke and stroke death were studied for the participants during a 7-year follow-up period. 690 participants were identified at baseline with diabetes. 238 participants experienced a first-time stroke during the follow-up period. 66 died as a result of a stroke. Cox proportional hazard regression analysis revealed an increased hazard ratio (HR) for stroke in persons with diabetes (HR, 1.80; 95% confidence interval [CI], 1.32 to 2.44; p <.0002) when adjusted for age, sex, body mass index, smoking, systolic blood pressure, previous heart attack, and lower extremity function. The stroke mortality rate was also higher (HR, 2.02; 95% CI, 1.04 to 3.93) for persons with diabetes when adjusted for covariates. Diabetes was associated with an increased incidence of stroke and death in older Mexican Americans, particularly those taking insulin.

Cigarette Smoking-Attributable Morbidity

Cigarette Smoking-Attributable Morbidity

Cost-Effectiveness of Lowering Cholesterol in Older Patients after Heart Attack

Summaries for Patients16 May 2000Cost-Effectiveness of Lowering Cholesterol in Older Patients after Heart AttackSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-132-10-200005160-00037 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail What is the problem and what is known about it so far?Statins are drugs used to lower cholesterol levels. Use of statin therapy to lower cholesterol levels in patients younger than 75 years of age who have had a previous heart attack (secondary prevention) is well accepted in the medical community. However, the use of statins in patients older than 75 years of age has not been well studied. Thus, little is known about the costs and benefits of secondary prevention with statins for patients in this age group.Why did the researchers do this particular study?To find ... Author, Article, and Disclosure InformationAffiliations: The summary below is from the full report titled “ Cost-Effectiveness of 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitor Therapy in Older Patients with Myocardial Infarction.” It is in the 16 May 2000 issue of Annals of Internal Medicine (volume 132, pages 780-787). The authors are D.A. Ganz, K.M. Kuntz, G.A. Jacobson, and J. Avorn.Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness of 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitor Therapy in Older Patients with Myocardial Infarction David A. Ganz , Karen M. Kuntz , Gretchen A. Jacobson , and Jerry Avorn Metrics 16 May 2000Volume 132, Issue 10Page: 780KeywordsAge groupsCholesterolDrugsLongitudinal studiesMedical risk factorsMyocardial infarctionQuality adjusted life yearsSimulation and modelingStatinsStroke ePublished: 15 August 2000 Issue Published: 16 May 2000 Copyright & PermissionsCopyright © 2000 by American College of Physicians. All Rights Reserved.Loading ...

Gender differences in accessing cardiac surgery across England: a cross-sectional analysis of the Health Survey for England

Objective: to examine gender differences in access to cardiac surgery in a nationally representative sample. Design: nationwide cross sectional household based survey (Health Survey for England). Setting: private households in England around 1993 and 1994. Subjects: 1708 subjects reporting a history of either doctor diagnosed angina or heart attack from a stratified random sample of 32 378 people aged 16 and above. Outcome measure: the proportion reporting having had cardiac surgery or on a waiting list. Results: 13.5% reported previous ( n=206) or pending ( n=25) cardiac surgery. Men were more likely than women to have had or to be waiting for cardiac surgery (19.1% of men versus 6.8% of women, χ 2 54.7, P<0.001). This finding was consistent regardless of age group and across three regional areas. The unadjusted odds ratio for cardiac surgery for men versus women was 3.3 (95% CI 2.3, 4.5, P<0.001) and was only slightly attenuated to 2.8 (95% CI 1.9, 4.0, P<0.001), after adjustment for other factors. The gender difference remained even when analysis was restricted to subjects reporting a previous heart attack, and after statistical adjustment for disease severity. Conclusion: women are less likely than men to receive cardiac surgery across all age groups and regional areas. These results include private operations and adjust for individual behavioural data. Neither disease severity or co-morbidity explains these discrepancies. Further studies are required to determine why this inequality occurs and how it can be addressed.

Mortality differences between black and white men in the USA: contribution of income and other risk factors among men screened for the MRFIT

Summary Background Studies of underlying differences in adult mortality between black and white individuals in the USA have been constrained by limitations of data or small study size. We investigated the extent to which differences in socioeconomic position between black and white men contribute to differences in all-cause and cause-specific mortality. Methods 361 662 men were screened for the Multiple Risk Factor Intervention Trial between 1973 and 1975, in 22 sites. Median family income of households by zipcode (postal) area of residence was available for 20 224 black and 300 685 white men as well as data on age, cigarette smoking, blood pressure, serum cholesterol, previous heart attack, and treatment for diabetes. We classified deaths during 16 years of follow-up into specific causes and compared differences in death rates between black men and white men, before and after adjustment for differences in income and other risk factors. Findings Age-adjusted relative risk of death (black vs white) was 1·47 (95% CI 1·42–1·53). Adjustment for diastolic blood pressure, serum cholesterol, cigarette smoking, medication for diabetes, and previous admission to hospital for heart attack decreased the relative risk to 1·40 (1·35–1·46). Adjustment for income but not the other risk factors decreased the risk to 1·19 (1·14–1·24) and adjustment for other risk factors did not alter this estimate. For cardiovascular death, relative risk on adjustment for income was decreased from 1·36 to 1·09; for cancer from 1·47 to 1·25; and for non-cardiovascular and non-cancer deaths from 1·71 to 1·26. For some specific causes of death, including prostate cancer, myeloma, and hypertensive heart disease, the higher death rates among black men did not seem to reflect differences in income. Rates of death for suicide and melanoma were lower among black than white men, as were those for coronary heart disease after adjustment for income. Interpretation Socioeconomic position is the major contributor to differences in death rates between black and white men. Differentials in mortality from some specific causes do not simply relect differences in income, however, and more detailed investigations are needed of how differences are influenced by environmental exposures, lifetime socioeconomic conditions, lifestyle, racism, and other sociocultural and biological factors.