Probability Of Coronary Heart Disease Research Articles

Cardiovascular Risks in Firefighters

Limited cardiovascular risk data are available for firefighters. This cross sectional study of data collected during annual physical examinations described the prevalence of cardiovascular risk factors among firefighters (N = 200) and examined relationships between body mass index (BMI) and other cardiovascular risk factors. Evidence based guidelines were used to determine prevalence of cardiovascular risk factors and Framingham risk scoring was used to estimate probability of coronary heart disease (CHD). Firefighters ranged in age from 22 to 64 with a mean of 41. The prevalence of obesity, elevated total cholesterol, and elevated blood pressure in firefighters exceeded Healthy People 2010 targets. In addition, their prevalence of obesity, low high density lipoprotein (HDL), high low density lipoprotein (LDL), and high total cholesterol levels was higher relative to the general population. Elevated body mass index (BMI) values had positive significant (p < or = .01) associations with elevated blood pressures, triglycerides, and glucose levels, and a negative significant (p < .05) association with lower HDL cholesterol levels. Fire department worksite health and fitness policies and programs should proactively target firefighters' cardiovascular risks. Future firefighter related intervention research will benefit from considering not only the individual determinants of cardiovascular disease, but also the ecological framework that includes the influences of workplace and external environmental factors.

Prediction of coronary heart disease in middle-aged adults with diabetes.

To determine the 10-year probability of coronary heart disease (CHD) in diabetic adults and how well basic and novel risk factors predict CHD risk. We measured risk factors in 14054 participants (1500 with diabetes) initially free of CHD in the Atherosclerosis Risk in Communities study from 1987 to 1989 and followed them prospectively for CHD incidence through 1998. We used proportional hazards regression models and receiver operating characteristic (ROC) curves for CHD risk prediction. Based on our model using basic risk factors (age, race, total and HDL cholesterol, systolic blood pressure, antihypertensives, and smoking status), approximately 61% of diabetic women and 86% of diabetic men had a predicted 10-year CHD probability >or=10%. This CHD risk-prediction model had an area under the ROC curve of 0.72 in diabetic women and 0.67 in diabetic men. Novel risk factors or subclinical disease markers individually added only modest predictivity, but the addition of multiple markers (BMI, waist-to-hip ratio, Keys dietary score, serum albumin and creatinine, factor VIII, white blood cell count, left ventricular hypertrophy determined by electrocardiogram, and carotid intima-media thickness) increased the area under the curve by approximately 10%. Although all diabetic adults are at high risk for CHD, their variation in CHD risk can be predicted moderately well by basic risk factors. No single novel risk marker greatly enhanced absolute CHD risk assessment, but a battery of novel markers did. Our model can provide estimates of CHD risk for the primary prevention of this disease in people with type 2 diabetes.

STRESS ECHOCARDIOGRAPHY IN WOMEN

The diagnosis of coronary heart disease in women has been thought to be more difficult than in men, owing to the overall lower prevalence and severity of disease in women, as well as more subtle clinical presentations. Exercise electrocardiography is associated with a high rate of false-positive results. In contrast, exercise and pharmacologic stress echocardiography have been shown to have high sensitivity, specificity, and prognostic value in women, comparable to that obtained in a male population. Although exercise thallium provides high f disease accuracy, due to its cost, availability, and radiation exposure, it may not be the ideal initial test in women. Thus, compared with other modalities, the advantages of stress echocardiography include its lower cost, availability, and high diagnostic accuracy. In the evaluation of women with chest pain, the initial step should involve clinical stratification into low, moderate, or high-probability groups based on symptoms, age, and cardiovascular risk factors. In women with atypical chest pain and a low probability of coronary heart disease, further testing should be avoided because any positive result is likely to be falsely positive. In those women with a moderate likelihood of disease, the most efficient and cost-effective strategy includes stress echocardiography as the initial test. This approach avoids the high rate of false-positive results with subsequent unnecessary angiography generated by exercise electrocardiography, as well as minimalizing false-negative results, which would lead to delays and potential increase in morbidity and mortality from untreated coronary heart disease. The optimal strategy for women at high clinical risk may be either exercise echocardiography or cardiac catheterization as the initial test. Although the diagnosis of CAD in women is different than in men, it is not necessarily more difficult. Astute clinical evaluation, in conjunction with judicious use of diagnostic testing, yields excellent results.

The influence of non-beta-blocking drugs on the lipid profile: Are diuretics outclassed as initial therapy for hypertension?

Diuretic drugs, when used in the treatment of hypertension, raise the blood concentrations of total cholesterol and low-density or very low-density lipoprotein cholesterol. Triglycerides often increase as well. Thiazide, phthalimidine, loop, potassium-sparing, and methylindoline drugs produce a similar effect. Only indapamide, a methylindoline agent with vasodilator activity, has been free of adverse lipid effects. It remains unclear whether it is the low dose of indapamide or some other quality that frees it of this effect. In long-term diuretic therapy, total cholesterol returns to, or below, baseline values, suggesting that the lipid elevations are transitory. However, in studies with adequate control groups, total cholesterol declines below baseline valves in control subjects such that an adverse differential in lipid values persists in long-term treatment. Selective alpha-1-adrenoceptor-blocking drugs cause no change or favorable alterations in lipid concentrations in short-term and long-term (1 year) treatment. Among all antihypertensive drugs, this class of agents, and especially prazosin, has produced the most consistently salutary lipid and metabolic effects. Although less well examined, guanabenz, clonidine, guanfacine, and diltiazem have been associated with favorable lipid changes. Captropril and nifedipine have caused no change in lipid-lipoprotein values in limited investigations. These agents are preferable to diuretics and certain beta blockers with respect to short-term effects on lipids and lipoproteins. Their ultimate superiority as monotherapy depends on whether they lower blood pressure equally well. Lowering of the probability of coronary heart disease in hypertensive patients depends as much on blood pressure control as on lipid effects. Eventually, the drugs with the best antihypertensive and lipid characteristics will need to be compared to diuretics in a clinical trial. Only in this way can it be ascertained whether these theoretical considerations, based on coronary heart disease probability estimates, translate into fewer real-life coronary heart disease events.

Socio-economic conditions in childhood and mortality and morbidity caused by coronary heart disease in adulthood in rural Finland

In this study, the hypothesis that bad socio-economic conditions in childhood may increase the probability of coronary heart disease in adulthood is examined. The study is based partly on the data of the East-West Study in Finland, which is part of the Seven Countries Study. The study began with 823 men in Eastern Finland and 888 men in Western Finland in 1959. The mortality and morbidity of the cohorts were followed from 1959 to 1974. Risk factors were measured in medical examinations in 1959, 1964, 1969 and 1974. Parents of those included in the sample were traced by using parish registers from 1900 to 1919. Over 90% of those in the East-West Study were found. The parents' socio-economic position (socio-economic conditions in childhood) was determined. According to our findings, the relative risks of coronary death, myocardial infarction and ischemic heart disease are systematically increased for those born landless in East Finland. Variables partly explaining the increased risk were body height and smoking. The effect of cholesterol was negligible.

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: Coronary heart disease risk factors in Japan and Hawaii

Various risk factors were evaluated to explain a significantly greater incidence of coronary heart disease in men of Japanese ancestry resident in Hawaii compared with men resident in Japan. The independent predictors of incidence of coronary heart disease in both Japan and Hawaii were systolic blood pressure, serum cholesterol, relative weight and age. These factors appeared to influence incidence similarly in both areas because in each case the correlation coefficients for Japan and Hawaii did not differ significantly. The hypothesis that the greater incidence in Hawaii could be attributed to differences in levels of these risk factors was tested with the Walker-Duncan method. The four variable multiple logistic function describing the probability of coronary heart disease in Japan was applied to the cohort characteristics observed in Hawaii. The estimated incidence thus obtained was not significantly different from that actually observed in the men resident in Hawaii. Therefore the increased coronary risk profile in Hawaii compared with Japan can account for the greater incidence of coronary heart disease in the former. Current cigarette smoking was significantly related to the risk of coronary heart disease in Hawaii but not in Japan. This difference requires further investigation.

Cardiovascular Endurance Training for Blind Persons

Cardiovascular endurance training (CVET), or continuous, whole-body activity involving a major portion of the total muscle mass, is suggested as a positive and feasible activity for blind persons. Evidence is presented that supports CVET as an agent capable of 1) producing adequate levels of physical fitness, 2) reducing to some degree the probability of coronary heart disease, and 3) reducing the effects of the state of anxiety accompanying unguided blind mobility. A program of chair stepping, which may be implemented as a progressive and productive CVET regimen, is described.

Wide band recording of the electrocardiogram and coronary heart disease

Wide band, high frequency electrocardiography employing an expanded time scale and both greater amplitude and a greater frequency response than conventional electrocardiographs reveals small notches in the QRS complex which are obscured in the conventional electrocardiogram. A total of more than three high frequency notches in Leads V 4, V 5, and V 6 plus the notches in the three largest limb leads suggests a high probability of coronary heart disease. This criterion is a modification of one we previously reported in that now fewer leads need be examined and slurs are not counted. In a control group of 100 normal subjects and 76 subjects with coronary artery disease used to develop this new criterion, there were 8 false positives (8 per cent) and 5 false negatives (7 percent). The Health Evaluation Center group provided 966 new subjects who were studied using the high frequency technique; 875 were classified as normal; 11 per cent had an abnormal number of notches. Of 24 patients with histories of myocardial infarction, 79 per cent showed excess notching. Of 12 subjects with angina pectoris, 7 showed excess notching. Notching in the 35 patients with uncomplicated hypertension and in 20 subjects with hypercholesterolemia was within the normal range. Twenty-four additional Provident Mutual Life Insurance Company employees were added to our long term study. Of these, two developed coronary artery disease. Both exhibited serial changes in the high frequency electrocardiogram. Wide band electrocardiography using the sum of the notches in the three largest limb leads and the notches in V 4, V 5, and V 6 is a useful adjunct for the detection of coronary heart disease especially when the conventional electrocardiogram is normal.