Pub Date : 2010-05-01DOI: 10.1177/17418267100170s215
A. Ascione, M. Borgia, A. Sciarappa, M. Aversa, S. Erbs, A. Linke, V. Adams, M. Sandri, E. Beck, R. Hambrecht, Schuler, E. Normandin, G. Billon, T. Guiraud, L. Bosquet, M. Juneau, Nigam
P244 Exercise oscillatory breathing and increased ventilation to carbon dioxide production in women with cronic heart failure and type 2 diabetes mellitus A Ascione, M Borgia, A Sciarappa, M Aversa Buon Consiglio Fatebenefratelli Hospital, Naples, Italy, Vincenzo Monaldi Hospital, Naples, Italy Topic: Exercise physiology, testing and training Background: Cardio-pulmonary exercise test with determination 02 consumption (CPET) is generally used for assessing patients with heart failure (HF). Increased slope of exercise ventilation to carbon dioxide production (VE/VCO2) is an established prognosticator in patients with heart failure. Recently, the occurrence of exercise oscillatory breathing (EOB) has emerged as an additional strong predictor even more powerful than VE/VCO2 slope. Objective: The aim of this study is to define the respective prognostic significance of these variables in female patients with type 2 diabetes mellitus. Methods:One hundred (100) womenwere recruited (mean age 54 12 years, of whom 80NYHA class II and 20 NYHA class III). As diabetics, these women were being treated with insulin and/ or oral hypoglycaemic drugs. All patients were receiving optimised therapy with beta-blockers, statins, nitro-derivatives, ACE-inhibitors and platelet anti-aggregants, and all had stable sinus rhythms. These women had been recruited in order to undergo CPETs and echocardiograms within a maximum period of 14 days. The CPETs were conducted utilising a protocol calling for testing on a cyclette with increments of 10 Watts per minute. None of them were obese. They were in stable chronic HF(average left ventricular ejection fraction, 33 þ/ 13%). We analyzed the prognostic relevance of VE/VCO2 slope, EOB, 02 pulse and peak Vo2 was evaluated bymultivariate Cox regression. Results: During a mean interval of 22 months, 22 patients died of cardiac reasons. Fifty-five percent presented with EOB. Among patients exhibiting EOB, 54% had an elevated VE/VCO2 slope and poor 02 pulse. The optimal threshold value for the VE/VCO2 slope identified by receiver operating characteristic analysis was <36.2 or >36.2 (sensitivity, 77%; specificity,64%;P<.001).Univariate predictors of death included low left ventricular ejection fraction, low peak Vo2, high VE/VCO2 slope,and EOB presence. The VE/VCO2 slope (threshold,<36.2 or>36.2) was the only other exercise test variable retained in the regression. The hazard ratio for subjects with EOB and a VE/VCO2 slope>36.2 was 14.4(95% confidence interval, 4.9-26.5; P< .001). Conclusion:These findings identify EOB as a strong survival predictor evenmore powerful than VE/VCO2 slope in diabetic women with HF.Even more in these patients EOB presence does not necessarily imply an elevated VE/VCO2 slope, but combination of either both yields to a burden of high risk.
P244运动振荡呼吸和增加通气对慢性心力衰竭和2型糖尿病妇女二氧化碳产生的影响A Ascione, M Borgia, A Sciarappa, M Aversa Buon Consiglio Fatebenefratelli医院，那不勒斯，意大利，Vincenzo Monaldi医院，那不勒斯，意大利主题:运动生理学，测试和训练背景:心肺运动试验测定02消耗(CPET)通常用于评估心力衰竭(HF)患者。运动通气对二氧化碳生成(VE/VCO2)斜率的增加是心力衰竭患者的一个确定的预后指标。最近，运动振荡呼吸(EOB)的发生已成为比VE/VCO2斜率更强大的另一个强预测因子。目的:本研究旨在明确这些变量在女性2型糖尿病患者中的预后意义。方法:招募100名女性(平均年龄54 - 12岁，其中80名NYHA II级，20名NYHA III级)，作为糖尿病患者，这些女性正在接受胰岛素和/或口服降糖药治疗。所有患者都接受了β受体阻滞剂、他汀类药物、硝基衍生物、ace抑制剂和血小板抗聚集剂的优化治疗，所有患者都有稳定的窦性心律。招募这些妇女是为了在最多14天内接受cpet和超声心动图检查。cpet是根据一项要求在每分钟10瓦增量的自行车上进行测试的协议进行的。他们都不肥胖。他们处于稳定的慢性HF(平均左室射血分数，33 þ/ 13%)。我们通过多变量Cox回归分析VE/VCO2斜率、EOB、02脉冲和峰值Vo2与预后的相关性。结果:在平均22个月的时间间隔内，22例患者死于心脏原因。55%的患者出现了EOB。在表现为EOB的患者中，54%有VE/VCO2斜率升高和02脉差。受试者工作特征分析确定的VE/VCO2斜率的最佳阈值为36.2(灵敏度为77%;特异性为64%;P36.2)是回归中唯一保留的运动试验变量。EOB和VE/VCO2斜率为36.2的受试者的风险比为14.4(95%可信区间，4.9-26.5;P <措施)。结论:这些发现表明EOB是糖尿病女性心衰患者生存的一个强有力的预测指标，甚至比VE/VCO2斜率更有效。更重要的是，在这些患者中，EOB的存在并不一定意味着VE/VCO2斜率升高，但两者的结合会产生高风险负担。
{"title":"Poster Session II: Exercise physiology","authors":"A. Ascione, M. Borgia, A. Sciarappa, M. Aversa, S. Erbs, A. Linke, V. Adams, M. Sandri, E. Beck, R. Hambrecht, Schuler, E. Normandin, G. Billon, T. Guiraud, L. Bosquet, M. Juneau, Nigam","doi":"10.1177/17418267100170s215","DOIUrl":"https://doi.org/10.1177/17418267100170s215","url":null,"abstract":"P244 Exercise oscillatory breathing and increased ventilation to carbon dioxide production in women with cronic heart failure and type 2 diabetes mellitus A Ascione, M Borgia, A Sciarappa, M Aversa Buon Consiglio Fatebenefratelli Hospital, Naples, Italy, Vincenzo Monaldi Hospital, Naples, Italy Topic: Exercise physiology, testing and training Background: Cardio-pulmonary exercise test with determination 02 consumption (CPET) is generally used for assessing patients with heart failure (HF). Increased slope of exercise ventilation to carbon dioxide production (VE/VCO2) is an established prognosticator in patients with heart failure. Recently, the occurrence of exercise oscillatory breathing (EOB) has emerged as an additional strong predictor even more powerful than VE/VCO2 slope. Objective: The aim of this study is to define the respective prognostic significance of these variables in female patients with type 2 diabetes mellitus. Methods:One hundred (100) womenwere recruited (mean age 54 12 years, of whom 80NYHA class II and 20 NYHA class III). As diabetics, these women were being treated with insulin and/ or oral hypoglycaemic drugs. All patients were receiving optimised therapy with beta-blockers, statins, nitro-derivatives, ACE-inhibitors and platelet anti-aggregants, and all had stable sinus rhythms. These women had been recruited in order to undergo CPETs and echocardiograms within a maximum period of 14 days. The CPETs were conducted utilising a protocol calling for testing on a cyclette with increments of 10 Watts per minute. None of them were obese. They were in stable chronic HF(average left ventricular ejection fraction, 33 þ/ 13%). We analyzed the prognostic relevance of VE/VCO2 slope, EOB, 02 pulse and peak Vo2 was evaluated bymultivariate Cox regression. Results: During a mean interval of 22 months, 22 patients died of cardiac reasons. Fifty-five percent presented with EOB. Among patients exhibiting EOB, 54% had an elevated VE/VCO2 slope and poor 02 pulse. The optimal threshold value for the VE/VCO2 slope identified by receiver operating characteristic analysis was <36.2 or >36.2 (sensitivity, 77%; specificity,64%;P<.001).Univariate predictors of death included low left ventricular ejection fraction, low peak Vo2, high VE/VCO2 slope,and EOB presence. The VE/VCO2 slope (threshold,<36.2 or>36.2) was the only other exercise test variable retained in the regression. The hazard ratio for subjects with EOB and a VE/VCO2 slope>36.2 was 14.4(95% confidence interval, 4.9-26.5; P< .001). Conclusion:These findings identify EOB as a strong survival predictor evenmore powerful than VE/VCO2 slope in diabetic women with HF.Even more in these patients EOB presence does not necessarily imply an elevated VE/VCO2 slope, but combination of either both yields to a burden of high risk.","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":"17 1","pages":"S53 - S54"},"PeriodicalIF":0.0,"publicationDate":"2010-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/17418267100170s215","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65491013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-01DOI: 10.1177/17418267100170s201
B. Rauch, R. Schiele, S. Schneider, H. Gohlke, H. Katus, J. Senges, L. Palmieri, R. Rielli, O. Brignoli, A. Cuffari, P. Ciccarelli, S. Giampaoli
P13 Prognostic effect of omega-3 fatty acid supplementation on top of current guideline adjusted therapy of acute myocardial infarction the OMEGA trial B Rauch, R Schiele, S Schneider, H Gohlke, H Katus, J Senges ZAR Ludwigshafen Klinikum, Center for Ambulatory Rehabilitation, Cardiology, Angiology, Neurology, Ludwigshafen am Rhein, Germany, Clinical Center of Ludwigshafen, Department of Cardiology, Ludwigshafen amRhein, Germany, Heart Attack Research Center at the University of Heidelberg, Ludwigshafen am Rhein, Germany, Heart Centre Bad Krozingen, Bad Krozingen, Germany, University Hospital Heidelberg, Internal Medicine III, Department of Cardiology, Angiology and Pneumology, Heidelberg, Germany Topic: Controlled clinical trials Background:Omega-3 fatty acids are regarded to be effective in improving prognosis after acute myocardial infarction, but there is no randomized, double blind trial testing their prognostic effect on top of current, guideline adjusted treatment. Methods: OMEGA is a randomized, placebo-controlled, double blind, multicenter trial to test the effects of omega-3-acid ethyl esters-90 (one gram per day for one year) on the rate of sudden cardiac death, total mortality, and non fatal clinical events in survivors of acute myocardial infarction with and without ST-elevation (STEMI and NSTEMI), if given on top to current guideline adjusted treatment. Patients were randomized 3 14 days after myocardial infarction from October 2003 until June 2007. Results: The trial included 3,851 patients (STEMI 59,0%; NSTEMI 41.0%; female 25.6%; mean age 64.0 years). From these patients 66.5% had a history of hypertension, 49.5% had elevated cholesterol levels, 27% had diabetes, and 36.7% were smokers. Acute coronary angiography was performed in 93.8%, acute percutaneous coronary intervention in 77.8% of all patients. Discharge medication included aspirin 95.3%, clopidogrel 88.4%, ACE-inhibitors 83.3%, beta-blockers 94.1%, and statins 94.2%. Duringthe follow-up of 365 days the event rates were as follows (placebo/verum): sudden cardiac death 1.5/1.5%, p1⁄40.84; total mortality 3.7/ 4.6%, p1⁄40.18; reinfarction in survivors 4.1/4.5%, p1⁄40.63; stroke in survivors 0.7/1.4%, p1⁄40.07. Conclusion: The OMEGA-trial demonstrates a high degree of guideline adjusted treatment of acute myocardial infarction in selected German centers. Under these conditions on top application of omega-3 fatty acids did not provide an additional prognostic benefit within one year of follow-up.
B Rauch, R Schiele, S Schneider, H Gohlke, H Katus, J Senges ZAR Ludwigshafen Klinikum，德国莱茵河畔路德维希港门诊康复中心，心脏病学，血管学，神经病学，德国莱茵河畔路德维希港临床中心，心脏病学系，德国路德维希港，海德堡大学心脏病研究中心。主题:对照临床试验背景:Omega-3脂肪酸被认为可有效改善急性心肌梗死后的预后，但目前尚无随机、双盲试验验证其在现行指南调整治疗基础上的预后效果。方法:OMEGA是一项随机、安慰剂对照、双盲、多中心试验，旨在测试OMEGA -3-酸乙酯-90(每天1克，持续一年)对伴有或不伴有st段抬高(STEMI和NSTEMI)的急性心肌梗死幸存者的心源性猝死率、总死亡率和非致命性临床事件的影响，如果在当前指南调整治疗的基础上给予。从2003年10月至2007年6月，患者在心肌梗死后14天随机分组。结果:试验纳入3851例患者(STEMI 59.0%;NSTEMI 41.0%;女性的25.6%;平均年龄64.0岁)。66.5%的患者有高血压病史，49.5%的患者胆固醇水平升高，27%的患者患有糖尿病，36.7%的患者吸烟。93.8%的患者行急性冠状动脉造影，77.8%的患者行急性经皮冠状动脉介入治疗。出院药物包括阿司匹林95.3%、氯吡格雷88.4%、ace抑制剂83.3%、受体阻滞剂94.1%和他汀类药物94.2%。在365天的随访中，事件发生率如下(安慰剂/verum):心源性猝死1.5/1.5%，p1 / 40.84;总死亡率3.7/ 4.6%，p1 / 40.18;幸存者再梗死4.1/4.5%，p1 / 40.63;卒中幸存者为0.7/1.4%，p1 / 40.07。结论:omega试验在选定的德国中心显示了高度的急性心肌梗死指南调整治疗。在这些条件下，omega-3脂肪酸的应用在一年的随访中没有提供额外的预后益处。
{"title":"Moderated Poster Session I: Prevention & health policy","authors":"B. Rauch, R. Schiele, S. Schneider, H. Gohlke, H. Katus, J. Senges, L. Palmieri, R. Rielli, O. Brignoli, A. Cuffari, P. Ciccarelli, S. Giampaoli","doi":"10.1177/17418267100170s201","DOIUrl":"https://doi.org/10.1177/17418267100170s201","url":null,"abstract":"P13 Prognostic effect of omega-3 fatty acid supplementation on top of current guideline adjusted therapy of acute myocardial infarction the OMEGA trial B Rauch, R Schiele, S Schneider, H Gohlke, H Katus, J Senges ZAR Ludwigshafen Klinikum, Center for Ambulatory Rehabilitation, Cardiology, Angiology, Neurology, Ludwigshafen am Rhein, Germany, Clinical Center of Ludwigshafen, Department of Cardiology, Ludwigshafen amRhein, Germany, Heart Attack Research Center at the University of Heidelberg, Ludwigshafen am Rhein, Germany, Heart Centre Bad Krozingen, Bad Krozingen, Germany, University Hospital Heidelberg, Internal Medicine III, Department of Cardiology, Angiology and Pneumology, Heidelberg, Germany Topic: Controlled clinical trials Background:Omega-3 fatty acids are regarded to be effective in improving prognosis after acute myocardial infarction, but there is no randomized, double blind trial testing their prognostic effect on top of current, guideline adjusted treatment. Methods: OMEGA is a randomized, placebo-controlled, double blind, multicenter trial to test the effects of omega-3-acid ethyl esters-90 (one gram per day for one year) on the rate of sudden cardiac death, total mortality, and non fatal clinical events in survivors of acute myocardial infarction with and without ST-elevation (STEMI and NSTEMI), if given on top to current guideline adjusted treatment. Patients were randomized 3 14 days after myocardial infarction from October 2003 until June 2007. Results: The trial included 3,851 patients (STEMI 59,0%; NSTEMI 41.0%; female 25.6%; mean age 64.0 years). From these patients 66.5% had a history of hypertension, 49.5% had elevated cholesterol levels, 27% had diabetes, and 36.7% were smokers. Acute coronary angiography was performed in 93.8%, acute percutaneous coronary intervention in 77.8% of all patients. Discharge medication included aspirin 95.3%, clopidogrel 88.4%, ACE-inhibitors 83.3%, beta-blockers 94.1%, and statins 94.2%. Duringthe follow-up of 365 days the event rates were as follows (placebo/verum): sudden cardiac death 1.5/1.5%, p1⁄40.84; total mortality 3.7/ 4.6%, p1⁄40.18; reinfarction in survivors 4.1/4.5%, p1⁄40.63; stroke in survivors 0.7/1.4%, p1⁄40.07. Conclusion: The OMEGA-trial demonstrates a high degree of guideline adjusted treatment of acute myocardial infarction in selected German centers. Under these conditions on top application of omega-3 fatty acids did not provide an additional prognostic benefit within one year of follow-up.","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":"17 1","pages":"S1 - S2"},"PeriodicalIF":0.0,"publicationDate":"2010-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/17418267100170s201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65491050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-01DOI: 10.1177/17418267100170s209
B. Giusti, A. Gori, F. Cesari, R. Marcucci, S. Agouri, V. Dao, O. Kocgirli, M. Oppermann, T. Suvorava, P. Pignatelli, R. Carnevale, S. Santo, V. Sanguigni, M. Proietti, A. Plebani, F. Violi
P151 Cytochrome P450 2c19 polymorphism and cardiovascular recurrences in patients under clopidogrel treatment: a meta-analysis F Sofi, B Giusti, AM Gori, F Cesari, R Marcucci, R Abbate, GF Gensini University of Florence, Florence, Italy Topic: Genetic-environmental interactions Introduction: Nonresponsiveness to clopidogrel has been reported to be an independent predictor of clinical recurrences in patients with coronary artery disease under clopidogrel treatment. Recently, several polymorphisms in gene encoding platelet components or cytochrome P450 (CYP) enzymes have been proposed as possible mechanisms for nonresponsiveness to clopidogrel. Among them, a great deal of attention has been posed on a loss-of-function CYP2C19 2 (or 681 G>A) polymorphism. To evaluate the role of such polymorphism in recurrent atherothrombotic events in patients with CAD under clopidogrel treatment, we considered all available studies in a meta-analysis. Material and Methods: Cohort prospective studies evaluating the association between CYP2C19 2 polymorphism and adverse clinical outcome were searched in MEDLINE, EMBASE, Web of Science, The Cochrane Systematic Review Database and bibliographies of retrieved articles up to January, 2009. The principal prior hypothesis was that the presence of the 2 variant allele of the polymorphism would be associated with an increased risk of clinical recurrence. Results: Data were available for a total of 7,950 patients from 6 cohort prospective studies who were followed for a time ranging from 6 months to 8.4 years. The summary risk ratios for included cohort prospective studies showed a significant association between the CYP2C19 2 polymorphism and an increased risk of major adverse cardiac events in the follow-up [RR: 1.80 (1.02-3.19); p1⁄40.04].When studies evaluating stent thrombosis (n1⁄44) for a total of 4,975 patients were considered, the presence of the variant allele was associated with an increased risk of stent thrombosis [RR: 2.82 (1.43-5.56); p1⁄40.0001]. Conclusion: The present meta-analysis performed on nearly 8,000 patients with CAD under clopidogrel treatment shows that the CYP2C19 2 polymorphism is associated with an increased risk of major adverse cardiac events and stent thrombosis. These results need to be confirmed by further studies.
F Sofi, B Giusti, AM Gori, F Cesari, R Marcucci, R Abbate, GF Gensini意大利佛罗伦萨大学主题:遗传-环境相互作用介绍:据报道，氯吡格雷无反应性是氯吡格雷治疗下冠状动脉疾病患者临床复发的独立预测因子。最近，一些编码血小板成分或细胞色素P450 (CYP)酶的基因多态性被认为是对氯吡格雷无反应的可能机制。其中，功能缺失的CYP2C19 2(或681 G> a)多态性引起了大量关注。为了评估这种多态性在接受氯吡格雷治疗的冠心病患者复发性动脉粥样硬化血栓事件中的作用，我们在荟萃分析中考虑了所有可用的研究。材料和方法:在MEDLINE、EMBASE、Web of Science、Cochrane系统评价数据库和检索文献的参考文献中检索到2009年1月之前评价CYP2C19多态性与不良临床结局之间关系的队列前瞻性研究。主要的先验假设是多态性的2个变异等位基因的存在与临床复发的风险增加有关。结果:从6项队列前瞻性研究中获得了7950例患者的数据，随访时间从6个月到8.4年不等。纳入的队列前瞻性研究的总风险比显示，CYP2C19多态性与随访中主要心脏不良事件风险增加之间存在显著关联[RR: 1.80 (1.02-3.19);p1⁄40.04]。当评估总共4,975例患者的支架血栓形成(n1 / 44)时，变异等位基因的存在与支架血栓形成风险增加相关[RR: 2.82 (1.43-5.56);p1⁄40.0001]。结论:目前对近8000名接受氯吡格雷治疗的冠心病患者进行的荟萃分析显示，CYP2C19多态性与主要心脏不良事件和支架血栓形成的风险增加有关。这些结果需要进一步的研究来证实。
{"title":"Moderated Poster Session III: Basic science","authors":"B. Giusti, A. Gori, F. Cesari, R. Marcucci, S. Agouri, V. Dao, O. Kocgirli, M. Oppermann, T. Suvorava, P. Pignatelli, R. Carnevale, S. Santo, V. Sanguigni, M. Proietti, A. Plebani, F. Violi","doi":"10.1177/17418267100170s209","DOIUrl":"https://doi.org/10.1177/17418267100170s209","url":null,"abstract":"P151 Cytochrome P450 2c19 polymorphism and cardiovascular recurrences in patients under clopidogrel treatment: a meta-analysis F Sofi, B Giusti, AM Gori, F Cesari, R Marcucci, R Abbate, GF Gensini University of Florence, Florence, Italy Topic: Genetic-environmental interactions Introduction: Nonresponsiveness to clopidogrel has been reported to be an independent predictor of clinical recurrences in patients with coronary artery disease under clopidogrel treatment. Recently, several polymorphisms in gene encoding platelet components or cytochrome P450 (CYP) enzymes have been proposed as possible mechanisms for nonresponsiveness to clopidogrel. Among them, a great deal of attention has been posed on a loss-of-function CYP2C19 2 (or 681 G>A) polymorphism. To evaluate the role of such polymorphism in recurrent atherothrombotic events in patients with CAD under clopidogrel treatment, we considered all available studies in a meta-analysis. Material and Methods: Cohort prospective studies evaluating the association between CYP2C19 2 polymorphism and adverse clinical outcome were searched in MEDLINE, EMBASE, Web of Science, The Cochrane Systematic Review Database and bibliographies of retrieved articles up to January, 2009. The principal prior hypothesis was that the presence of the 2 variant allele of the polymorphism would be associated with an increased risk of clinical recurrence. Results: Data were available for a total of 7,950 patients from 6 cohort prospective studies who were followed for a time ranging from 6 months to 8.4 years. The summary risk ratios for included cohort prospective studies showed a significant association between the CYP2C19 2 polymorphism and an increased risk of major adverse cardiac events in the follow-up [RR: 1.80 (1.02-3.19); p1⁄40.04].When studies evaluating stent thrombosis (n1⁄44) for a total of 4,975 patients were considered, the presence of the variant allele was associated with an increased risk of stent thrombosis [RR: 2.82 (1.43-5.56); p1⁄40.0001]. Conclusion: The present meta-analysis performed on nearly 8,000 patients with CAD under clopidogrel treatment shows that the CYP2C19 2 polymorphism is associated with an increased risk of major adverse cardiac events and stent thrombosis. These results need to be confirmed by further studies.","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":"17 1","pages":"S29 - S30"},"PeriodicalIF":0.0,"publicationDate":"2010-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/17418267100170s209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65491254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-12-01DOI: 10.1097/HJR.0b013e3283299542
Roland von Känel, Hugo Saner, Sonja Kohls, Jürgen Barth, Hansjörg Znoj, Gaby Saner, Jean-Paul Schmid
Background: Psychological distress, poor disease-specific quality of life (QoL), and reduction in vagally mediated early heart rate recovery (HRR) after exercise, all previously predicted morbidity and mortality in patients with chronic heart failure (CHF). We hypothesized lower HRR with greater psychological distress and poorer QoL in CHF.
Design: All assessments were made at the beginning of a comprehensive cardiac outpatient rehabilitation intervention program.
Methods: Fifty-six CHF patients (mean 58+/-12 years, 84% men) completed the Hospital Anxiety and Depression Scale and the Minnesota Living With Heart Failure Questionnaire. HRR was determined as the difference between HR at the end of exercise and 1 min after exercise termination (HRR-1).
Results: Elevated levels of anxiety symptoms (P=0.005) as well as decreased levels of the Minnesota Living With Heart Failure Questionnaire total (P = 0.025), physical (P=0.026), and emotional (P=0.017) QoL were independently associated with blunted HRR-1. Anxiety, total, physical, and emotional QoL explained 11.4, 8, 7.8, and 9.0%, respectively, of the variance after controlling for covariates. Depressed mood was not associated with HRR-1 (P=0.20).
Conclusion: Increased psychological distress with regard to elevated anxiety symptoms and impaired QoL were independent correlates of reduced HRR-1 in patients with CHF. Reduced vagal tone might explain part of the adverse clinical outcome previously observed in CHF patients in relation to psychological distress and poor disease-specific QoL.
背景:心理困扰、疾病特异性生活质量(QoL)差、运动后迷走神经介导的早期心率恢复(HRR)降低，都是慢性心力衰竭(CHF)患者发病率和死亡率的预测因素。我们假设CHF患者HRR越低，心理困扰越大，生活质量越差。设计:所有的评估都是在全面的心脏门诊康复干预计划开始时进行的。方法:56例CHF患者(平均58+/-12岁，84%男性)完成了医院焦虑和抑郁量表和明尼苏达州心力衰竭患者问卷。HRR为运动结束时与运动结束后1 min HR的差值(HRR-1)。结果:焦虑症状水平升高(P=0.005)以及明尼苏达州心力衰竭患者生活问卷总分(P= 0.025)、身体(P=0.026)和情绪(P=0.017)生活质量水平下降与HRR-1钝化独立相关。控制协变量后，焦虑、总体生活质量、身体生活质量和情绪生活质量分别解释了11.4%、8.8%、7.8和9.0%的方差。抑郁情绪与HRR-1无相关性(P=0.20)。结论:与焦虑症状升高相关的心理困扰增加和生活质量受损是CHF患者HRR-1降低的独立相关因素。迷走神经张力降低可能部分解释了先前在CHF患者中观察到的与心理困扰和疾病特异性生活质量差相关的不良临床结果。
{"title":"Relation of heart rate recovery to psychological distress and quality of life in patients with chronic heart failure.","authors":"Roland von Känel, Hugo Saner, Sonja Kohls, Jürgen Barth, Hansjörg Znoj, Gaby Saner, Jean-Paul Schmid","doi":"10.1097/HJR.0b013e3283299542","DOIUrl":"https://doi.org/10.1097/HJR.0b013e3283299542","url":null,"abstract":"<p><strong>Background: </strong>Psychological distress, poor disease-specific quality of life (QoL), and reduction in vagally mediated early heart rate recovery (HRR) after exercise, all previously predicted morbidity and mortality in patients with chronic heart failure (CHF). We hypothesized lower HRR with greater psychological distress and poorer QoL in CHF.</p><p><strong>Design: </strong>All assessments were made at the beginning of a comprehensive cardiac outpatient rehabilitation intervention program.</p><p><strong>Methods: </strong>Fifty-six CHF patients (mean 58+/-12 years, 84% men) completed the Hospital Anxiety and Depression Scale and the Minnesota Living With Heart Failure Questionnaire. HRR was determined as the difference between HR at the end of exercise and 1 min after exercise termination (HRR-1).</p><p><strong>Results: </strong>Elevated levels of anxiety symptoms (P=0.005) as well as decreased levels of the Minnesota Living With Heart Failure Questionnaire total (P = 0.025), physical (P=0.026), and emotional (P=0.017) QoL were independently associated with blunted HRR-1. Anxiety, total, physical, and emotional QoL explained 11.4, 8, 7.8, and 9.0%, respectively, of the variance after controlling for covariates. Depressed mood was not associated with HRR-1 (P=0.20).</p><p><strong>Conclusion: </strong>Increased psychological distress with regard to elevated anxiety symptoms and impaired QoL were independent correlates of reduced HRR-1 in patients with CHF. Reduced vagal tone might explain part of the adverse clinical outcome previously observed in CHF patients in relation to psychological distress and poor disease-specific QoL.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":" ","pages":"645-50"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/HJR.0b013e3283299542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40054818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-10-01DOI: 10.1097/HJR.0b013e32832b38a1
Marie-Therese Cooney, Alexandra Dudina, Peter Whincup, Simon Capewell, Alessandro Menotti, Pekka Jousilahti, Inger Njølstad, Raphel Oganov, Troels Thomsen, Aage Tverdal, Hans Wedel, Lars Wilhelmsen, Ian Graham
Background: Options for the prevention of cardiovascular disease, the greatest global cause of death, include population preventive measures (the Rose approach), or specifically seeking out and managing high-risk cases. However, the likely benefit of a population approach has been recently questioned.
Objective: To compare the estimated effects of population strategies at varying levels of population-wide risk factor reduction and high-risk strategies at varying rates of screening uptake on cardiovascular disease mortality.
Methods: Data (of 109 954 participants) were pooled from six European general population cohort studies [the high-risk cohorts from the SCORE (Systematic COronary Risk Evaluation) dataset]. The effects of various population and high-risk strategies for the reduction of risk factors were estimated by calculating the change in 10-year risk of cardiovascular disease mortality (SCORE risk) before and after the particular intervention. Risk factors studied were: total cholesterol, blood pressure and smoking.
Results: At population level, if a 10-year reduction of blood cholesterol level of 10%, a BP reduction of 10% and a 10% reduction in the prevalence of smoking is considered possible, then 9125 lives per million of the population would be saved over 10 years. In contrast, an approach that treats all high-risk individuals with a polypill containing statin, three half-dose antihypertensives and aspirin, with a 20-80% uptake, would save 1861-7452 lives per million. However, the high-risk estimates are very optimistic, as their achievement would require complete compliance.
Conclusion: High-risk and population strategies are complementary. These estimates of the benefits of each may be useful to health planners, when combined with their local knowledge. Recently, benefits of population strategies have been underestimated.
{"title":"Re-evaluating the Rose approach: comparative benefits of the population and high-risk preventive strategies.","authors":"Marie-Therese Cooney, Alexandra Dudina, Peter Whincup, Simon Capewell, Alessandro Menotti, Pekka Jousilahti, Inger Njølstad, Raphel Oganov, Troels Thomsen, Aage Tverdal, Hans Wedel, Lars Wilhelmsen, Ian Graham","doi":"10.1097/HJR.0b013e32832b38a1","DOIUrl":"https://doi.org/10.1097/HJR.0b013e32832b38a1","url":null,"abstract":"<p><strong>Background: </strong>Options for the prevention of cardiovascular disease, the greatest global cause of death, include population preventive measures (the Rose approach), or specifically seeking out and managing high-risk cases. However, the likely benefit of a population approach has been recently questioned.</p><p><strong>Objective: </strong>To compare the estimated effects of population strategies at varying levels of population-wide risk factor reduction and high-risk strategies at varying rates of screening uptake on cardiovascular disease mortality.</p><p><strong>Methods: </strong>Data (of 109 954 participants) were pooled from six European general population cohort studies [the high-risk cohorts from the SCORE (Systematic COronary Risk Evaluation) dataset]. The effects of various population and high-risk strategies for the reduction of risk factors were estimated by calculating the change in 10-year risk of cardiovascular disease mortality (SCORE risk) before and after the particular intervention. Risk factors studied were: total cholesterol, blood pressure and smoking.</p><p><strong>Results: </strong>At population level, if a 10-year reduction of blood cholesterol level of 10%, a BP reduction of 10% and a 10% reduction in the prevalence of smoking is considered possible, then 9125 lives per million of the population would be saved over 10 years. In contrast, an approach that treats all high-risk individuals with a polypill containing statin, three half-dose antihypertensives and aspirin, with a 20-80% uptake, would save 1861-7452 lives per million. However, the high-risk estimates are very optimistic, as their achievement would require complete compliance.</p><p><strong>Conclusion: </strong>High-risk and population strategies are complementary. These estimates of the benefits of each may be useful to health planners, when combined with their local knowledge. Recently, benefits of population strategies have been underestimated.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":" ","pages":"541-9"},"PeriodicalIF":0.0,"publicationDate":"2009-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/HJR.0b013e32832b38a1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40029766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-05-01DOI: 10.1177/17418267090160s113
M. Polovina, M. Ostojic, V. Giga, T. Potpara, N. Mujović, M. Grujić, S. Mutikainen, M. Alen, T. Leskinen, J. Karjalainen, T. Rantanen, J. Kaprio, U. Kujala, M. Angevaren, L. Vanhees, A. Nooyens, W. Wendel-Vos, W. Verschuren, G. Slavich, D. Tuniz, R. Fregolent, P. Mapelli, M. Slavich
M428 Relationship of self-reported habitual physical activity and brachial artery flowmediated dilation in healthy adults M Polovina, M Ostojic, V Giga, T Potpara, N Mujovic, M Grujic Institute for Cardiovascular Diseases, Belgrade, Serbia Topic: Physical activity Background: Exercise training improves endothelial function in adults with increased cardiovascular risk. The influence of leisure-time physical activity on endothelial function in healthy grown-up individuals is less well established. Methods: We analysed association of self-reported daily habitual physical activity with brachial artery flow-mediated dilation (FMD) in 115 healthy individuals (age: 21 to 67 yrs, 55 male). Based on self-reported habitual physical activity, participants were divided in 2 subgroups ’ Subgroup 1 (n=59): 30 min of daily brisk walking recreational sports (jogging, bicycling, swimming’Î) and Subgroup 2 (n=56): sedentary individuals (<30 min of daily physical activity). Maximal FMD value (FMD%) and FMD time-course (time to the maximal endotheliumdependent dilation) were determined using high-resolution vascular ultrasound, with offline measurements of brachial artery diameter every 10 seconds, 0 to 240 seconds after cuff release. Results: Physically active individuals achieved maximal endothelium dependent dilation faster than sedentary individuals (Subgroup 1: 59.5 11.2 seconds versus Subgroup 2: 82.7 16.7 seconds, p<0.001), and their maximal FMD% was higher (Subgroup 1: 7.3 2.9% versus Subgroup 2: 5.7 2.3%, p=0.001). In the multivariate analysis of the whole group, after adjustments for age, sex, brachial artery diameter, body mass index, total serum cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, serum creatinine, glucose, high-sensitivity C-reactive protein, systolic and diastolic blood pressure, heart rate, and smoking, physical activity emerged as a multivariate determinant of both FMD time-course (b=-12.03, p<0.001), and FMD% (b=0.96, p=0.023). Conclusions: Habitual physical activity is associated with faster endothelium-dependent dilation, and augmented FMD response, independent of other factors. Regular leisure-time physical activity has beneficial effects on endothelial function in healthy adults.
健康成人自我报告的习惯性体育活动与肱动脉血流介导的扩张的关系[M Polovina, M Ostojic, V Giga, T Potpara, N Mujovic, M Grujic心血管疾病研究所，贝尔格莱德，塞尔维亚主题:体育活动背景:运动训练可改善心血管风险增加的成年人的内皮功能。休闲时间体育活动对健康成年人内皮功能的影响尚不明确。方法:我们分析了115名健康个体(年龄:21 - 67岁，男性55名)自我报告的日常习惯性体力活动与肱动脉血流介导扩张(FMD)的关系。根据自我报告的习惯性体育活动，参与者被分为两个亚组:第1组(n=59):每天快走30分钟的休闲运动(慢跑、骑自行车、游泳Î);第2组(n=56):久坐不动的个体(每天体育活动<30分钟)。使用高分辨率血管超声测定最大FMD值(FMD%)和FMD时间过程(到达最大内皮依赖性扩张的时间)，在袖带释放后0至240秒，每10秒离线测量肱动脉直径。结果:运动个体比久坐个体更快达到最大内皮依赖性扩张(亚组1:59.5 11.2秒比亚组2:82.7 16.7秒，p<0.001)，最大FMD%更高(亚组1:7.3 2.9%比亚组2:5.7 2.3%，p=0.001)。在全组的多因素分析中，在调整了年龄、性别、肱动脉直径、体重指数、血清总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、血清肌酐、葡萄糖、高敏c反应蛋白、收缩压和舒张压、心率和吸烟等因素后，体力活动成为FMD时间过程(b=-12.03, p<0.001)和FMD% (b=0.96, p=0.023)的多因素决定因素。结论:习惯性体育活动与内皮依赖性舒张加快和FMD反应增强相关，与其他因素无关。有规律的闲暇时间体育活动对健康成人的内皮功能有有益的影响。
{"title":"Moderated Poster Session VI. Exercise Physiology","authors":"M. Polovina, M. Ostojic, V. Giga, T. Potpara, N. Mujović, M. Grujić, S. Mutikainen, M. Alen, T. Leskinen, J. Karjalainen, T. Rantanen, J. Kaprio, U. Kujala, M. Angevaren, L. Vanhees, A. Nooyens, W. Wendel-Vos, W. Verschuren, G. Slavich, D. Tuniz, R. Fregolent, P. Mapelli, M. Slavich","doi":"10.1177/17418267090160s113","DOIUrl":"https://doi.org/10.1177/17418267090160s113","url":null,"abstract":"M428 Relationship of self-reported habitual physical activity and brachial artery flowmediated dilation in healthy adults M Polovina, M Ostojic, V Giga, T Potpara, N Mujovic, M Grujic Institute for Cardiovascular Diseases, Belgrade, Serbia Topic: Physical activity Background: Exercise training improves endothelial function in adults with increased cardiovascular risk. The influence of leisure-time physical activity on endothelial function in healthy grown-up individuals is less well established. Methods: We analysed association of self-reported daily habitual physical activity with brachial artery flow-mediated dilation (FMD) in 115 healthy individuals (age: 21 to 67 yrs, 55 male). Based on self-reported habitual physical activity, participants were divided in 2 subgroups ’ Subgroup 1 (n=59): 30 min of daily brisk walking recreational sports (jogging, bicycling, swimming’Î) and Subgroup 2 (n=56): sedentary individuals (<30 min of daily physical activity). Maximal FMD value (FMD%) and FMD time-course (time to the maximal endotheliumdependent dilation) were determined using high-resolution vascular ultrasound, with offline measurements of brachial artery diameter every 10 seconds, 0 to 240 seconds after cuff release. Results: Physically active individuals achieved maximal endothelium dependent dilation faster than sedentary individuals (Subgroup 1: 59.5 11.2 seconds versus Subgroup 2: 82.7 16.7 seconds, p<0.001), and their maximal FMD% was higher (Subgroup 1: 7.3 2.9% versus Subgroup 2: 5.7 2.3%, p=0.001). In the multivariate analysis of the whole group, after adjustments for age, sex, brachial artery diameter, body mass index, total serum cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, serum creatinine, glucose, high-sensitivity C-reactive protein, systolic and diastolic blood pressure, heart rate, and smoking, physical activity emerged as a multivariate determinant of both FMD time-course (b=-12.03, p<0.001), and FMD% (b=0.96, p=0.023). Conclusions: Habitual physical activity is associated with faster endothelium-dependent dilation, and augmented FMD response, independent of other factors. Regular leisure-time physical activity has beneficial effects on endothelial function in healthy adults.","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":"16 1","pages":"S91 - S93"},"PeriodicalIF":0.0,"publicationDate":"2009-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/17418267090160s113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65490860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-05-01DOI: 10.1177/17418267090160s117
Zy Yin, L. Wei, H-C Wang, M. Sandri, S. Gielen, N. Mangner, R. Hoellriegel, S. Erbs, A. Linke, -. SMoebius, Winkler, G. Schuler, J. Rawlins, F. Carré, M. Papadakis, C. Edwards, N. Chandra, S. Sharma, A. Egger, J. Niebauer
O576 Cardiac microvascular dysfunction in diabetes and insulin treatment: Role of glucoseinduced PKC-BII activity ZY Yin, LP Wei, HC Wang Xijing Hospital, Xi’an, China, People’s Republic of Topic: Heart disease Purpose: Diabetes mellitus is an independent risk factor for cardiovascular disease and little attention is addressed on PKC-bII in cardiac microvascular dysfunction. Methods: In animal experiment, normal Sprague-Dawley rat, streptozotocin-induced diabetic rat, insulin-treated and physiological saline-treated diabetic rat were administrated with a serial of evaluations including pressure measurements, angiogenesis and permeability observations under electron microscope, histopathologic analysis for cardiac microvascular endothelium cell (CMECs), TUNEL, and Western blotting for PKC-bII. In cell research part, CMECs in four different mediums (normal medium, high-glucose concentration medium, insulin-stimulated and physiological saline-stimulated high-glucose medium) were investigated with MTT, apoptosis, quantitative permeability assessment and Western blotting. Results: 1. Accompanied with more active expression of PKC-bII and higher apoptosis rate in diabetic model, either increased microvascular permeability or pathological angiogenesis is observed, and which is attenuated in certain extent while receiving insulin treatment. 2. Accordant results from cell research were obtained. Compared with normal group, CMECs in high-glucose medium are demonstrated with poor proliferation, more notable apoptosis, increased permeability of cell monolayer, and augmented PKC-bII expression. Insulin-stimulated group poses a midst performance between normal and high-glucose group. Conclusions: Increased PKC-bII activity has been implicated responsible for the pathogenesis of cardiac microvascular dysfunction in diabetes and elevated glucose is sufficient to induce these effects. PKC-bII is indicated to occupy an important position in the whole process of insulin treatment.
{"title":"Young Investigators' Award Session","authors":"Zy Yin, L. Wei, H-C Wang, M. Sandri, S. Gielen, N. Mangner, R. Hoellriegel, S. Erbs, A. Linke, -. SMoebius, Winkler, G. Schuler, J. Rawlins, F. Carré, M. Papadakis, C. Edwards, N. Chandra, S. Sharma, A. Egger, J. Niebauer","doi":"10.1177/17418267090160s117","DOIUrl":"https://doi.org/10.1177/17418267090160s117","url":null,"abstract":"O576 Cardiac microvascular dysfunction in diabetes and insulin treatment: Role of glucoseinduced PKC-BII activity ZY Yin, LP Wei, HC Wang Xijing Hospital, Xi’an, China, People’s Republic of Topic: Heart disease Purpose: Diabetes mellitus is an independent risk factor for cardiovascular disease and little attention is addressed on PKC-bII in cardiac microvascular dysfunction. Methods: In animal experiment, normal Sprague-Dawley rat, streptozotocin-induced diabetic rat, insulin-treated and physiological saline-treated diabetic rat were administrated with a serial of evaluations including pressure measurements, angiogenesis and permeability observations under electron microscope, histopathologic analysis for cardiac microvascular endothelium cell (CMECs), TUNEL, and Western blotting for PKC-bII. In cell research part, CMECs in four different mediums (normal medium, high-glucose concentration medium, insulin-stimulated and physiological saline-stimulated high-glucose medium) were investigated with MTT, apoptosis, quantitative permeability assessment and Western blotting. Results: 1. Accompanied with more active expression of PKC-bII and higher apoptosis rate in diabetic model, either increased microvascular permeability or pathological angiogenesis is observed, and which is attenuated in certain extent while receiving insulin treatment. 2. Accordant results from cell research were obtained. Compared with normal group, CMECs in high-glucose medium are demonstrated with poor proliferation, more notable apoptosis, increased permeability of cell monolayer, and augmented PKC-bII expression. Insulin-stimulated group poses a midst performance between normal and high-glucose group. Conclusions: Increased PKC-bII activity has been implicated responsible for the pathogenesis of cardiac microvascular dysfunction in diabetes and elevated glucose is sufficient to induce these effects. PKC-bII is indicated to occupy an important position in the whole process of insulin treatment.","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":"16 1","pages":"S121 - S122"},"PeriodicalIF":0.0,"publicationDate":"2009-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/17418267090160s117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65491007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-05-01DOI: 10.1177/17418267090160s108
T. Aspelund, V. Gudnason, B. Magnúsdóttir, K. Andersen, G. Sigurdsson, -. JCritch, Ley, M. O’Flaherty, S. Capewell, B. Jefferis, DALawlor, S. Ebrahim, SGWannamethee, D. Cook, P. Whincup, U. Toft, C. Pisinger, M. Aadahl, T. Jørgensen, L. Yan, L. Thijs, J. Boggia, C. T. Pedersen, J. Jeppesen, H. Ibsen, Ja, Staessen
O379 Explaining the massive declines in coronary heart disease mortality rates in Iceland, 1981 2006 T Aspelund, V Gudnason, B Magnusdottir, K Andersen, G Sigurdsson, J Critchley, M O’Flaherty, S Capewell Icelandic Heart Association, Kopavogur, Iceland, Unversity of Iceland, Reykjavik, Iceland, University Hospital, Reykjavik, Iceland, University of Newcastle, Newcasle, United Kingdom, University of Liverpool, Liverpool, United Kingdom Topic: Cardiovascular epidemiology Background: coronary heart disease mortality rates have been decreasing in Iceland since the 1980s. We used the validated IMPACT model to examine how much of the decrease in Iceland between 1981 and 2006 could be attributed to medical and surgical treatments and how much to changes in cardiovascular risk factors. Methods: the previously validated IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of cardiological treatments and risk factor trends in the entire Iceland population. The main data sources were official statistics, national quality registers, published trials and meta-analyses, clinical audits and a series of national population surveys. Sensitivity analyses were then conducted. Results: between 1981 and 2006, coronary heart disease mortality rates in Iceland decreased by 80% in men and women aged 25 to 74 years. This fall resulted in 295 fewer deaths in 2006. Approximately one quarter of this decrease was attributable to treatments in individuals (including some 7% to secondary prevention, 6% to heart failure treatments, 5% to initial treatments of acute coronary syndrome, and 1% to hypertension treatments). Approximately three quarters of the mortality decrease was attributable to population risk factor reductions (principally cholesterol, 36%; smoking, 20%; systolic bloodpressure, 25% and physical activity, 5%). Adverse trends were seen for diabetes (-5%), and obesity (-4%). Conclusions: approximately three quarters of the large coronary heart disease mortality decrease in Iceland between 1981 and 2006 was attributable to reductions in major cardiovascular risk factors in population, (mainly decreases in total serum cholesterol, smoking and bloodpressure levels). These findings emphasise the value of a comprehensive strategy that promotes tobacco control and a healthier diet. It also highlights the potential importance of effective, evidence based medical treatments.
O379解释冰岛冠心病死亡率大幅下降的原因，1981年2006年T Aspelund, V Gudnason, B Magnusdottir, K Andersen, G Sigurdsson, J Critchley, M O 'Flaherty, S Capewell冰岛心脏协会，冰岛Kopavogur，冰岛，冰岛雷克雅未克，冰岛大学，冰岛雷克雅未克，大学医院，冰岛，纽卡斯尔大学，英国，利物浦大学，英国主题:心血管流行病学自1980年代以来，冰岛的冠心病死亡率一直在下降。我们使用经过验证的IMPACT模型来检验1981年至2006年间冰岛的死亡率下降有多少归因于医疗和手术治疗，有多少归因于心血管危险因素的变化。方法:使用先前验证的IMPACT死亡率模型来结合和分析整个冰岛人口中心脏病治疗的吸收和有效性以及风险因素趋势的数据。主要数据来源是官方统计数据、国家质量登记册、已发表的试验和荟萃分析、临床审计和一系列国家人口调查。然后进行敏感性分析。结果:1981年至2006年期间，冰岛25岁至74岁的男性和女性冠心病死亡率下降了80%。这一下降导致2006年死亡人数减少了295人。大约四分之一的减少可归因于个体治疗(包括约7%的二级预防，6%的心力衰竭治疗，5%的急性冠状动脉综合征初始治疗，1%的高血压治疗)。大约四分之三的死亡率下降可归因于人口危险因素的减少(主要是胆固醇，36%;吸烟,20%;收缩压，25%，体力活动，5%)。糖尿病(-5%)和肥胖(-4%)出现了不良趋势。结论:1981年至2006年期间冰岛冠心病死亡率大幅下降的原因中，约有四分之三可归因于人口中主要心血管危险因素的减少(主要是血清总胆固醇、吸烟和血压水平的降低)。这些发现强调了促进烟草控制和健康饮食的综合战略的价值。它还强调了有效的、基于证据的医学治疗的潜在重要性。
{"title":"Oral Session I Risk factors: from population to PCI","authors":"T. Aspelund, V. Gudnason, B. Magnúsdóttir, K. Andersen, G. Sigurdsson, -. JCritch, Ley, M. O’Flaherty, S. Capewell, B. Jefferis, DALawlor, S. Ebrahim, SGWannamethee, D. Cook, P. Whincup, U. Toft, C. Pisinger, M. Aadahl, T. Jørgensen, L. Yan, L. Thijs, J. Boggia, C. T. Pedersen, J. Jeppesen, H. Ibsen, Ja, Staessen","doi":"10.1177/17418267090160s108","DOIUrl":"https://doi.org/10.1177/17418267090160s108","url":null,"abstract":"O379 Explaining the massive declines in coronary heart disease mortality rates in Iceland, 1981 2006 T Aspelund, V Gudnason, B Magnusdottir, K Andersen, G Sigurdsson, J Critchley, M O’Flaherty, S Capewell Icelandic Heart Association, Kopavogur, Iceland, Unversity of Iceland, Reykjavik, Iceland, University Hospital, Reykjavik, Iceland, University of Newcastle, Newcasle, United Kingdom, University of Liverpool, Liverpool, United Kingdom Topic: Cardiovascular epidemiology Background: coronary heart disease mortality rates have been decreasing in Iceland since the 1980s. We used the validated IMPACT model to examine how much of the decrease in Iceland between 1981 and 2006 could be attributed to medical and surgical treatments and how much to changes in cardiovascular risk factors. Methods: the previously validated IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of cardiological treatments and risk factor trends in the entire Iceland population. The main data sources were official statistics, national quality registers, published trials and meta-analyses, clinical audits and a series of national population surveys. Sensitivity analyses were then conducted. Results: between 1981 and 2006, coronary heart disease mortality rates in Iceland decreased by 80% in men and women aged 25 to 74 years. This fall resulted in 295 fewer deaths in 2006. Approximately one quarter of this decrease was attributable to treatments in individuals (including some 7% to secondary prevention, 6% to heart failure treatments, 5% to initial treatments of acute coronary syndrome, and 1% to hypertension treatments). Approximately three quarters of the mortality decrease was attributable to population risk factor reductions (principally cholesterol, 36%; smoking, 20%; systolic bloodpressure, 25% and physical activity, 5%). Adverse trends were seen for diabetes (-5%), and obesity (-4%). Conclusions: approximately three quarters of the large coronary heart disease mortality decrease in Iceland between 1981 and 2006 was attributable to reductions in major cardiovascular risk factors in population, (mainly decreases in total serum cholesterol, smoking and bloodpressure levels). These findings emphasise the value of a comprehensive strategy that promotes tobacco control and a healthier diet. It also highlights the potential importance of effective, evidence based medical treatments.","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":"16 1","pages":"S80 - S81"},"PeriodicalIF":0.0,"publicationDate":"2009-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/17418267090160s108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65491152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：