Showing papers by "Diederick E. Grobbee published in 1997"
TL;DR: Evidence is provided that an increased common carotid IMT is associated with future cerebrovascular and cardiovascular events and Stroke risk increased gradually with increasing IMT.
Abstract: Background Noninvasive assessment of intima-media thickness (IMT) is widely used in observational studies and trials as an intermediate or proxy end point for cardiovascular disease. However, data showing that IMT predicts cardiovascular disease are limited. We studied whether common carotid IMT is related to future stroke and myocardial infarction. Methods and Results We used a nested case-control approach among 7983 subjects aged ≥55 years participating in the Rotterdam Study. At baseline (March 1990 through July 1993), ultrasound images of the common carotid artery were stored on videotape. Determination of incident myocardial infarction and stroke was predominantly based on hospital discharge records. Analysis (logistic regression) was based on 98 myocardial infarctions and 95 strokes that were registered before December 31, 1994. IMT was measured from videotape for all case subjects and a sample of 1373 subjects who remained free from myocardial infarction and stroke during follow-up. The mean durati...
2,355 citations
TL;DR: It is suggested that dementia and its two major subtypes Alzheimer's disease and vascular dementia are associated with atherosclerosis and that there is an interaction between apolipoprotein E and Atherosclerosis in the aetiology of Alzheimer’s disease.
1,372 citations
1,028 citations
TL;DR: Dementia and subtypes Alzheimer's disease and vascular dementia may be related to atrial fibrillation even if no clinical stokes have occurred, and the relation with dementia was more pronounced in the relatively younger elderly.
Abstract: Background and Purpose Atrial fibrillation is a frequent disorder in the elderly and a known risk factor for cerebrovascular stroke. We investigated the association of atrial fibrillation with dementia and cognitive impairment in a large cross-sectional, population-based study in the elderly. Methods Of the 6584 participants in the Rotterdam Study aged 55 to 106 years, detailed information on dementia status and ECG abnormalities was available. Dementia was diagnosed in three phases. First, participants were screened. Screen-positive subjects were tested further. Those with possible dementia underwent an extensive diagnostic workup. Dementia and dementia subtypes were diagnosed according to prevailing criteria. Cognitive impairment was defined as a Mini-Mental State Examination test score of <26 points for a nondemented subject. Results Atrial fibrillation was diagnosed in 195, dementia in 276, and cognitive impairment in 635 subjects. We found significant positive associations of atrial fibrillation with...
661 citations
TL;DR: In this article, the distribution of central corneal thickness and its association with intraocular pressure in an elderly population was studied and a linear regression analysis showed an increase of 0.19 mm Hg with each 10-μm increase in central cepstral thickness (95% CI, 0.09 to 0.28 mm hg).
378 citations
TL;DR: The findings are compatible with the view that at lower degrees of IMT, the thickening appears to reflect an equilibrium state in which the effects of pressure and flow on the arteries are in balance, given a characteristic relation between shear stress and local transmural pressure.
Abstract: Background and Purpose Carotid intima-media thickness (IMT) measurements are used widely to study atherosclerosis. Some have suggested that an increased IMT reflects a nonatherosclerotic adaptive response to changes in shear stress and tensile stress. This stems from the hypothesis that changes in shear stress and subsequently in lumen diameter are followed by changes in IMT to keep tensile stress constant. We studied the relation of common carotid IMT to common carotid end-diastolic lumen diameter and tensile stress, as approximated by mean arterial pressure · (lumen diameter/IMT)]. Methods A cross-sectional analysis was performed with data obtained from the first 1715 participants in the Rotterdam Study, a population-based cohort study among 7983 subjects aged 55 years and over who underwent ultrasonographic examination of the carotid arteries. End-diastolic lumen diameter and IMT of the common carotid arteries were evaluated and quantified. Results With increasing IMT, inner and outer lumen diameters i...
339 citations
TL;DR: It is suggested that sodium intake in infancy may be important in relation to blood pressure later in life.
Abstract: In 1980, a randomized trial was conducted among 476 Dutch newborn infants to study the effect of a low or normal sodium diet on blood pressure during the first 6 months of life. At the end...
302 citations
TL;DR: The data show a positive association between plasma tHcy and risk of severe coronary atherosclerosis, of similar strength for fasting and postload tH Cy levels, and suggest that the association exists over a wide range of tHCy levels, without a clear cutoff point below which there is no increased risk.
Abstract: Epidemiological research has shown that elevated plasma total homocysteine (tHcy) is a risk factor for atherosclerotic disease. In the present case-control study, we investigated whether fasting or postmethionine-loading tHcy was a stronger predictor of risk of severe coronary atherosclerosis. Furthermore, we studied levels of B vitamins, which are involved in homocysteine metabolism. Subjects were recruited from men and women, aged 25 to 65 years, who underwent coronary angiography between June 1992 and June 1994 in a hospital in Rotterdam, The Netherlands. Cases (n=131) were defined as those with > or =90% occlusion in one and > or =40% occlusion in a second coronary artery, while control subjects (n=88) had <50% occlusion in only one coronary vessel. In addition, a population-based control group free from clinical cardiovascular disease (n=101) was studied. Coronary patients were studied at least 2.5 months after angiography or other acute illness, such as myocardial infarction. After adjusting for age and sex differences between the groups, cases had 9% (P=.01) higher geometric mean fasting and 7% (P=.04) higher geometric mean postload tHcy than the combined control groups. Despite higher levels of tHcy for cases, their geometric mean levels of red cell folate and pyridoxal 5'-phosphate were higher than for control subjects, whereas plasma vitamin B12 was only slightly lower in cases. The frequency distribution of tHcy values in cases was slightly shifted toward the right, across the entire range, compared with the distribution in the combined control group. This was somewhat more obvious for fasting than postload tHcy levels. The odds ratio (OR) for severe coronary atherosclerosis (case status) for each 1 SD increase in fasting tHcy (5 micromol/L) was 1.3 (95% confidence interval [CI], 1.0-1.6), similar to the OR for each 1 SD increase (12 micromol/L) in postmethionine-loading tHcy (1.3 [95 CI, 1.0-1.7]), after adjustment for sex, age, and other potential confounders. Furthermore, there was a significant linear trend of increasing fasting tHcy with increasing number of occluded arteries (P=.01), correcting for sex, age, and other potential confounders. Our data show a positive association between plasma tHcy and risk of severe coronary atherosclerosis, of similar strength for fasting and postload tHcy levels. The data suggest that the association exists over a wide range of tHcy levels, without a clear cutoff point below which there is no increased risk.
248 citations
TL;DR: The data suggest that a high intake of dietary vitamin E may protect against the occurrence of PD.
Abstract: Objective: To investigate whether high dietary intake of antioxidants decreases the risk of Parkinson disease (PD). Setting: The community-based Rotterdam Study, the Netherlands. Design: The cross-sectional study formed part of a large community-based study in which all participants were individually screened for parkinsonism and were administered a semiquantitative food frequency questionnaire. The study population consisted of 5342 independently living individuals without dementia between 55 and 95 years of age, including 31 participants with PD (Hoehn-Yahr stages 1-3). Results: The odds ratio for PD was 0.5 (95% confidence interval [CI], 0.2-0.9) per 10-mg daily dietary vitamin E intake, 0.6 (95% CI, 0.3-1.3) per 1-mg beta carotene intake, 0.9 (95% CI, 0.4-1.9) per 100-mg vitamin C intake, and 0.9 (95% CI, 0.7-1.2) per 10-mg flavonoids intake, all adjusted for age, sex, smoking habits, and energy intake. The association with vitamin E intake was dose dependent ( P for trend=.03). To assess whether the association was different in participants with more advanced disease, we excluded those with PD who had a Hoehn-Yahr stage of 2.5 or 3. This did not fundamentally alter the results. Conclusion: Our data suggest that a high intake of dietary vitamin E may protect against the occurrence of PD.
235 citations
TL;DR: The results of a recently published study which suggested that hypertension should not be lowered too far by treatment and the subsequent debate provide an example of problems that may arise in validating the conclusions of such studies.
Abstract: In research on the effectiveness of treatments, the randomised controlled trial is considered the best study design because it enables several sources of bias to be removed from the observation. The most important advantage of such a trial is that the baseline prognoses of patient groups are comparable so that unbiased estimates of the effects of a particular intervention can be obtained. In non-experimental (observational) studies allocation to drug treatment is, by definition, not random. This usually means that the prognoses of the patient groups are not comparable and any inferences drawn about the relative effects of treatment are therefore invalid.1 2 In studies of patients who are not randomly allocated to a treatment arm but receive treatment when their doctor decides to prescribe it, the onus is on the investigator to achieve comparability. We discuss the pitfalls of non-randomised comparisons of treatment effects. The results of a recently published study which suggested that hypertension should not be lowered too far by treatment and the subsequent debate provide an example of problems that may arise in validating the conclusions of such studies.
A sensible doctor prescribes drugs only to patients who need them—those who have indications that this treatment is required. Moreover, he or she will give priority to treating the most needy patients. When two patients seem to have indications but only one is being treated, the treated patient probably has more compelling indications than the second. The prognosis in any given group of treated patients will be different from that in untreated subjects because the latter will not generally have any indications for treatment. Furthermore, although many drugs can affect the course of a disease positively, the outcome in people with that disease compared with those who do not have it or have a less severe form …
134 citations
TL;DR: Five of the six heart failure scores studied are broadly similar in the detection of heart failure, although the men born in 1913 score relies heavily on the assessment of dyspnea, resulting in a relatively large number of false positives.
Abstract: Several scores based on symptoms and signs have been developed to assess the presence of heart failure. The goal of this study was to compare six heart failure scores in non-hospitalised subjects and to determine their usefulness in population based research. The scores were applied to 54 participants of a population based study. All underwent a complete medical examination, including chest X-ray, electrocardiography and Doppler echocardiography. Using all information available, a cardiologist, unaware of the results of the scores, clinically classified participants as having no, possible or definite heart failure. Sensitivity, specificity, predictive values and receiver operating characteristics were calculated, using the cardiologist's assessment as a gold standard. The cardiologist judged definite or possible heart failure to be present in 17 persons. All scores had a high sensitivity for the detection of definite heart failure, whereas the study of men born in 1913 and Walma's score had the highest sensitivity for the combination of possible and definite heart failure. Gheorgiade's and the Boston score had the highest positive predictive values. In conclusion, five of the six scores we studied are broadly similar in the detection of heart failure. The men born in 1913 score relies heavily on the assessment of dyspnea, resulting in a relatively large number of false positives. Although the scores are useful in detecting manifest heart failure, objective measurements of cardiac function appear necessary to reduce the false positive rate and accurately detect early stages of heart failure.
TL;DR: It is shown that birth weight is consistently inversely associated with systolic blood pressure level from childhood to young adulthood and with diastolicBlood pressure in young adulthood, and is not related to change of blood pressure with increasing age.
Abstract: Associations between birth weight and blood pressure have been found in children and adults. In this longitudinal study, the objective was to assess the relation between birth weight and blood pressure level and the change in blood pressure from childhood and young adolescence into adulthood. A cohort of 483 children from a middle-class community in the town of Zoetermeer in the Netherlands had annual measurements of blood pressure during an average follow-up period of 14 years. For 330 of these participants, initially aged 5 through 21 years, birth weight data were collected, which were related to blood pressure level and blood pressure change. An inverse association between birth weight and systolic blood pressure was found, with adjustment for current body height and weight, sex, and use of alcohol, cigarettes, and oral contraceptives. This inverse association was found for the total follow-up in 5- to 37- year-olds (regression coefficient: -2.4 mm Hg/kg; 95% confidence interval: -3.9 to -1.0, as well as in most individual age groups: 5 through 9 years (-0.6 mm Hg/kg, -3.2 to 2.0); 10 through 14 years (-2.5 mm Hg/kg, -4.7 to -0.4); 15 through 19 years (-3.1 mm Hg/kg, -4.9 to -1.2); 20 through 24 years (-2.7 mm Hg/kg, -4.6 to -0.9); 25 through 29 years (-2.0 mm Hg/kg, -3.9 to -0.01); and 30 through 37 years (-1.9 mm Hg/kg, -4.6 to 0.7). For diastolic blood pressure, there appeared to be an inverse association with birth weight in the age group of 30 through 37 years, both unadjusted (-2.0 mm Hg/kg, -4.6 to 0.5) and adjusted for risk factors other than sex (-2.3 mm Hg/kg, -4.7 to 0.1), although these findings were of borderline statistical significance. The results were independent of gestational age and were similar in the group of subjects with low birth weight but normal gestational age (-2.7 mm Hg/kg, -4.3 to -1.0). In relation to systolic blood pressure, birth weight showed a significant interaction with body mass index (regression coefficient, 0.02; SE=0.01; P=.05). There was no relation between birth weight and change in systolic or diastolic blood pressure with age. Our longitudinal study shows that birth weight is consistently inversely associated with systolic blood pressure level from childhood to young adulthood and with diastolic blood pressure in young adulthood. Birth weight is not related to change of blood pressure with increasing age. Low birth weight in combination with high current body mass index seems to be of particular importance in the development of high blood pressure.
TL;DR: It is concluded that near wall common carotid intima-media thickness measurement provides at least as good an indicator of atherosclerosis elsewhere and of cardiovascular risk as the far wall Intima- media thickness measurement.
TL;DR: Differences in associations with risk factors between typical TIA and nonspecific TNA point toward different underlying mechanisms of symptoms and may lead to different ancillary investigations and possibly treatment.
Abstract: BACKGROUND AND PURPOSE: Patients with typical transient ischemic attacks (TIAs) have a higher risk of stroke but a lower risk of cardiac events than patients with nonspecific transient neurological symptoms. We assessed the prevalences of typical TIAs and nonspecific transient neurological attacks (TNAs) and their determinants in the general population because such data are virtually absent.
METHODS: The Rotterdam Study is a population-based cohort study of 7983 subjects, aged 55 years and over, conducted in a district of Rotterdam, the Netherlands. At baseline examination, a history of episodes of disturbances in sensibility, strength, speech, and vision that lasted less than 24 hours and occurred within the preceding 3 years was determined by a trained physician. When such a history was present, information on time of onset, duration, and disappearance of symptoms and a detailed description of the symptoms (in ordinary language) were obtained. Subjects were classified by a neurologist as typical TIA or nonspecific TNA.
RESULTS: Prevalence of TNAs was 1.9% in subjects aged 55 to 64 years, 3.5% in subjects aged 65 to 74 years, 4.3% in subjects aged 75 to 84 years, and 5.1% in subjects aged 85 years or over. Prevalence figures for typical TIA were 0.9%, 1.7%, 2.3%, and 2.2% and for nonspecific TNA 1.0%, 1.8%, 2.0%, and 2.9%, respectively. Clinical parameters such as number of attacks, onset, duration, and disappearance of symptoms were similar for typical TIA and nonspecific TNA. Increased age, male sex, diabetes mellitus, low HDL cholesterol, Q-wave myocardial infarction on electrocardiogram, and carotid atherosclerosis were related to typical TIA, whereas increased age, hypertension, low HDL cholesterol, smoking, and angina pectoris were associated with nonspecific TNA.
CONCLUSIONS: About half of the subjects with a TNA had symptoms that were not entirely typical for a TIA. Differences in associations with risk factors between typical TIA and nonspecific TNA point toward different underlying mechanisms of symptoms and may lead to different ancillary investigations and possibly treatment.
TL;DR: Diagnostic electrocardiogram interpretation by computer can be very helpful in population-based research, being at least as good as ECG interpretation by a trained research physician, but much more efficient and therefore less expensive.
TL;DR: It is concluded that β-blockade after MI leads to a substantial reduction in mortality, and the so-called ‘class-effect' of β-blocks, however, can be questioned, because ancillary properties appear to play an important role in the efficacy of these drugs.
TL;DR: It is concluded that myocardial infarction occurs frequently in the elderly without typical symptoms or electrocardiographic changes, and these manifestations convey an increased risk of symptomatic heart disease or death.
Abstract: We evaluated the prevalence, determinants, and misclassification of different types of myocardial infarction in 3,272 men and women age 55 years or older. We defined self-reported myocardial infarction with electro-cardiographic evidence as "typical myocardial infarction." We defined self-reported myocardial infarction without electrocardiographic evidence, but verified with additional clinical information, as "non-Q-wave myocardial infarction." Finally, we defined myocardial infarction detected by electrocardiogram that was not self-reported as "silent myocardial infarction," after verification of absence of symptoms. Overall, the prevalence of typical myocardial infarction was 4.1% [95% confidence interval (CI) = 3.5-4.9], of non-Q-wave myocardial infarction 2.8% (95% CI = 2.2-3.4), and of silent myocardial infarction 3.9% (95% CI = 3.2-4.5). Silent myocardial infarction was more prevalent in women, hypertensives, cigarette smokers, and those with higher post-load blood glucose. Self-reported myocardial infarction without electrocardiographic characteristics could be verified as myocardial infarction by means of additional clinical information in 56% of the cases. We conclude that myocardial infarction occurs frequently in the elderly without typical symptoms or electrocardiographic changes. As all these manifestations of myocardial infarction convey an increased risk of symptomatic heart disease or death, they require further attention. Misclassification due to limited sources of information can be considerable and should be taken into account in the design and interpretation of epidemiologic studies.
TL;DR: If investigators wish to measure physical activity in women over age 50 years with the aim of identifying high- and low-risk groups for cardiovascular disease, they should consider not only housework activity, but also leisure-time activities such as cycling, sports, and do-it-yourself activities.
Abstract: In a population of 4,576 Dutch women aged 49-70 years who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) in 1993-1995, the relation between physical activity and the presence of cardiovascular disease risk indicators was assessed cross-sectionally. Physical activity was determined from a self-administered questionnaire, while blood pressure, heart rate, body mass index, waist/hip ratio, and waist circumference were measured at the study center. Mean risk indicator levels were calculated for different activity categories. Blood pressure was most clearly associated with time spent in sports (mean systolic blood pressure, adjusted for age, level of education, and smoking, 128.9 mmHg in the highest sports tertile, and 132.1 mmHg in the lowest sports tertile; mean diastolic blood pressure, 77.8 mmHg and 79.0 mmHg, respectively). Body mass index, waist/hip ratio, and waist circumference showed an inverse relation with cycling, gardening, do-it-yourself-activities, and sports. In this population, leisure-time activity was inversely related to cardiovascular disease risk indicators, but work activity and housework were not. The authors conclude that if investigators wish to measure physical activity in women over age 50 years with the aim to identify high- and low-risk groups for cardiovascular disease, they should consider not only housework activity, but also leisure-time activities such as cycling, sports, and do-it-yourself activities.
TL;DR: This review summarizes the scientific evidence for a possible role of antioxidants in the prevention of coronary heart disease and concludes that general preventive measures based on antioxidant supplementation are not yet justifiable.
Abstract: This review summarizes the scientific evidence for a possible role of antioxidants in the prevention of coronary heart disease (CHD). Dietary antioxidants include vitamin E, vitamin C and beta-carotene, whereas selenium is an integral part of the antioxidant enzyme glutathione peroxidase. Experimental studies suggest that the oxidation of low-density lipoproteins (LDL) in the vessel wall plays an important role in the development of atherosclerotic lesions. The resistance of LDL to oxidation is increased by antioxidant supplementation, at least in vitro. Epidemiological studies have not demonstrated unequivocally that a high intake of antioxidants leads to a decreased risk of CHD. Studies on dietary intake and serum levels of antioxidants do point in the direction of a preventive effect of antioxidants, whereas the results of intervention studies are less conclusive. Beta-carotene supplementation is not associated with any decrease in CHD; high doses of vitamin E may be beneficial, but results from large trials are to be awaited. General preventive measures based on antioxidant supplementation are not yet justifiable.
TL;DR: In a population-based study, the routine 12-lead electrocardiogram was found to have a high negative predictive value for detecting left ventricular (LV) systolic dysfunction.
Abstract: In a population-based study, the routine 12-lead electrocardiogram was found to have a high negative predictive value for detecting left ventricular (LV) systolic dysfunction. Withholding echocardiography in persons without major electrocardiographic abnormalities, however, would result in a considerable underestimation of LV systolic dysfunction (sensitivity only 54%); thus, echocardiography remains an essential tool for detecting LV systolic dysfunction in population-based studies.
TL;DR: Further pharmacoepidemiological research is needed to quantify the risk for CHF attributable to the use of NSAIDs and to identify patients who are particularly susceptible to the adverse cardiovascular effects of these agents.
Abstract: Congestive heart failure (CHF) is a complex clinical syndrome, especially in the elderly, which results from cardiac dysfunction. Epidemiological studies have shown a gradual increase in age-adjusted hospitalisation rates for CHF and overall population prevalence of CHF during the last 2 decades in Western countries. The healthcare costs associated with CHF are considerable and are likely to increase in the near future. Hence, identification of risk factors which could induce or exacerbate CHF is of major importance. NSAIDs are frequently prescribed in elderly patients for several rheumatological and nonrheumatological indications. Numerous adverse reactions, mainly related to the gastrointestinal tract and kidney function, have been described for NSAIDs. In addition, some case reports have suggested a causal relation between the use of NSAIDs and the onset of CHF The pathophysiology of CHF and the pharmacological properties of NSAIDs support this hypothesis. In particular, the inhibition of prostaglandin synthesis may adversely affect cardiovascular homeostasis in patients with a propensity to develop CHF. Notwithstanding the adverse effects, however, the prescription of NSAIDs in elderly patients is often desirable and justifiable. Therefore, further pharmacoepidemiological research is needed to quantify the risk for CHF attributable to the use of NSAIDs and to identify patients who are particularly susceptible to the adverse cardiovascular effects of these agents. In these patients, it may be advisable to avoid the use of NSAIDs.
TL;DR: Young age, hypertension, general complaints of abdominal pain, and a family history of myocardial infarction are associated with an increased risk of chest pain attributed to sumatriptan, and sex is an effective modifier of risk factors of sum atriptan-induced chest pain.
Abstract: Background: Serious cardiac adverse reactions, including myocardial infarction, have been attributed to the antimigraine drug sumatriptan succinate. Chest pain is considered to be a relatively common adverse reaction to sumatriptan. Design: Postmarketing study. Patients and Methods: The study was a part of a national cohort study on adverse reactions to sumatriptan, which was performed with the assistance of drug-dispensing general practitioners in the Netherlands. After data were collected on observed adverse reactions, the patients received a second questionnaire, with specific questions regarding the adverse event, and questions regarding medical history, other health complaints, and smoking habits. Furthermore, they had a physical examination and a blood cholesterol measurement. Results: A total of 137 patients with chest pain associated with intake of sumatriptan were identified and compared with 229 consumers of sumatriptan without this adverse reaction. After multivariate analysis, young age, hypertension, general complaints of abdominal pain, and a family history of myocardial infarction were associated with an increased risk of chest pain attributed to sumatriptan. Hypertension in particular was a risk factor for sumatriptan-induced chest pain in men (relative risk, 8.0; 95% confidence interval, 1.8-40) compared with hypertension as a risk factor in women (relative risk, 1.63; 95% confidence interval, 0.9-3.1). Conclusions: Young age, hypertension, general complaints of abdominal pain, and a family history of myocardial infarction are associated with an increased risk of chest pain attributed to sumatriptan. Sex is an effective modifier of risk factors of sumatriptan-induced chest pain. In particular, hypertension is a strong risk factor in men.
TL;DR: The methods and baseline findings of a large study aimed at identifying potentially modifiable vascular, thrombogenic, and metabolic determinants of dementia are described, and the role of vascular factors in dementia, irrespective of its cause is investigated.
Abstract: Dementia is a rapidly increasing health problem in the industrialized countries. With the ageing of the population the number of demented persons increases both in relative and absolute terms. Obviously, there is a need for prevention and intervention strategies. We describe the methods and baseline findings of a large study aimed at identifying potentially modifiable vascular, thrombogenic, and metabolic determinants of dementia. The study population consists of subjects 55 years of age or older. Since the vascular wall of the cerebral vessels is different from that of the coronary or peripheral vessels, we formed three subgroups in which vascular risk factors for dementia are studied. Subjects with stroke were distinguished from subjects with coronary or peripheral artery disease, and from subjects without stroke or coronary or peripheral artery disease. To obtain a large enough number of subjects with stroke, cases and controls from a stroke registry were combined with cases and controls of a population-based study from the same region. For the diagnosis of dementia the DSM-III-R criteria were used. Extensive information on cardiovascular risk factors was collected, including indicators of atherosclerosis. Blood and urine were sampled to study platelet function and thrombogenic and metabolic factors. The study population consists of 7,466 subjects, of whom 300 were recruited from a hospital-based stroke registry. Coronary or peripheral artery disease was present in 956 subjects and stroke in 617. Dementia was present in 434 (5.8%) of all subjects. The prevalence of dementia was 3.0, 24.0, and 4.4% in subjects with a history of coronary or peripheral artery disease, a history of stroke, and subjects without a history of coronary or peripheral artery disease or stroke, respectively. The study will allow us to investigate the role of vascular factors in dementia, irrespective of its cause.
TL;DR: The impact of routine screening for congenital heart disease appeared relatively small and further data may be required to fully assess the utility of prenatal screening.
Abstract: OBJECTIVES: This study assessed the potential impact of fetal ultrasound screening on the number of newborns affected by cardiac anomalies. METHODS: A decision model was developed that included the prevalence and history of congenital heart disease, characteristics of ultrasound, risk of abortion, and attitude toward pregnancy termination. Probabilities were obtained with a literature survey; sensitivity analysis showed their influence on expected outcomes. RESULTS: Presently, screening programs may prevent the birth of approximately 1300 severely affected newborns per million second-trimester pregnancies. However, over 2000 terminations of pregnancy would be required, 750 of which would have ended in intrauterine death or spontaneous abortion. Further, 9900 false-positive screening results would occur, requiring referral. Only the sensitivity of routine screening and attitude toward termination of pregnancy appeared to influence the yield substantially. CONCLUSIONS: The impact of routine screening for co...
TL;DR: Future research is needed to relate QT interval to prognosis, to obtain measurement technique specific reference values of heart-rate adjusted QT measurements, and to obtain age- and sex-specific threshold values for prolonged QT.
Abstract: Prolonged heart-rate adjusted QT intervals on the electrocardiogram (ECG) are associated with an increased risk for coronary heart disease and sudden death. However, the diagnosis of the prolonged QT interval is hampered by lack of standards. We studied variations in the prevalence of prolonged QT, based on different common definitions, in a large nonhospitalized population, and compared our results with other studies applying the same definitions. The study population consisted of 2,200 men and 3,366 women participants of the Rotterdam Study, ≥55 years old. The QT interval was computed by our Modular ECG Analysis System (MEANS). Three different formulas to adjust QT for heart rate were used: Bazett’s formula (QT c ), a linear regression equation (QT lr ), and the QT index (QTI). Prolonged QT occurred frequently in both men and women, and its prevalence increased with age. Women had longer heart-rate adjusted QT intervals than men (mean QT c 433 ms vs 422 ms), and mean values for QT lr were lower than for QT c (mean QT lr 422 ms in women and 412 ms in men). Prevalence was highest for prolonged QT lr (31% in men and 26% in women) and lowest for prolonged QTI (6% in men and 9% in women). Comparison with other studies applying the same correction formulas showed large discrepancies in prevalence estimates of prolonged QT c and QT lr , and to a lesser degree of prolonged QTI, possibly due to differences in measurement techniques. Future research is needed to relate QT interval to prognosis, to obtain measurement technique specific reference values of heart-rate adjusted QT measurements, and to obtain age- and sex-specific threshold values for prolonged QT. Such data are needed to use the QT interval with confidence.
TL;DR: Although it was suggested in the 2 recent case-control studies that recipients of β-blockers are also at an increased risk of sudden death, further studies are required to confirm this finding, particularly since these drugs have several well-documented cardioprotective effects.
Abstract: The cornerstones of current antihypertensive treatment are diuretics and β-blockers and the efficacy of these drugs in preventing cardiovascular disease is undisputed. This article focuses on the effect of these 2 drug classes on the incidence of sudden death.
TL;DR: It is concluded that the use of data obtained early in a selection period can predict subsequent exclusions, and therefore could increase the efficiency of such a period.
TL;DR: NYHA classification and serum-creatinine levels were independent risk factors for death in patients with heart failure on ibopamine, and these did not reach statistical significance.
Abstract: Background: A recent interim analysis of the PRIME II placebo-controlled study showed a significantly higher mortality in the group treated with ibopamine than in the control group. The objective was to study mortality in patients on ibopamine, and to assess risk factors for death.
Methods: All 2147 drug-dispensing outlets (DDO) in the Netherlands were asked to provide a printout of the complete medication history of users of ibopamine. A reaction was received from 92% of the DDO. From the 14 024 identifed former or current users of ibopamine, a sample of 3148 patients (22%) was enrolled in the follow-up study. All general practitioners (GP) of these patients received an enquiry pertaining to the vital status of their patient, cause of death, primary cause and NYHA classification of heart failure, echo- and electrocardiographic data, serum creatinine, admissions and the effects of ibopamine. Cases were defined as patients who died during the follow-up period which ended on the day of return of the questionnaire or the day of decease (index date). Two random controls were obtained for each case from the non-deceased patients at the index date. The design was a follow-up study with risk factor assessment in a nested case—control design.
Results: Questionnaires were returned regarding almost 70% of the sample. Mortality in this group was 25%. A case—control analysis was performed with the first 104 cases and 208 random controls. Patients with NYHA class IV had a 3-times increased risk of dying. In patients with a serum-creatinine level in the highest quartile the risk of dying was increased threefold. Higher doses of ibopamine seemed to have a protective effect. Significantly more cases than controls used amiodarone. Also, opioids were used more often, which may be related to their use in terminal cardiac failure.
Conclusion: NYHA classification and serum-creatinine levels were independent risk factors for death in patients with heart failure on ibopamine. Although there were increased risk estimates for current use of ibopamine and amiodarone, these did not reach statistical significance. This may be related, however, to the fact that this analysis was restricted to the first 20% of cases.
Journal Article•
TL;DR: A prospective, randomized, open-label, multicentre study being conducted in which 60-70 Dutch hospitals will participate to compare the efficacy and safety of three regimens of long-term antithrombotic treatment in patients with acute ischaemic syndromes.
Abstract: In order to compare the efficacy and safety of three regimens of long-term antithrombotic treatment in patients with acute ischaemic syndromes, a prospective, randomized, open-label, multicentre study is being conducted in which 60-70 Dutch hospitals will participate. Eligible patients discharged following hospitalization for acute myocardial infarction or unstable angina pectoris are randomly assigned to receive either (a) adjusted full intensity oral anticoagulation (target range: 3.0-4.0 International Normalised Ratio (INR), (b) low dose aspirin or (c) combined therapy of low dose aspirin and adjusted low intensity oral anticoagulation (target range INR: 2.0-2.5). It is planned to enroll 8,700 patients within three years. During an estimated mean follow-up of 2.5 years the evolutions of total mortality, non-fatal myocardial infarction, non-fatal stroke and major bleeding complication will be assessed.