Showing papers by "Jaap W. Deckers published in 2010"

Unrecognised myocardial infarction and long-term risk of heart failure in the elderly: the Rotterdam Study

Abstract: Objective To examine the association between unrecognised myocardial infarction (MI) as detected by electrocardiography and the long-term risk of heart failure. Design The Rotterdam Study is a prospective population-based cohort study of the general population of a suburb of the city of Rotterdam, The Netherlands. Participants At baseline 2581 men and 3724 women aged ≥55 years were classified on the basis of electrocardiography, interview and clinical data into those with recognised MI, those with ECG-based unrecognised MI and those without MI. The participants were followed-up for incident heart failure, death or end of the study period on 12 October 2006. Results During a median follow-up time of 13.2 years, 823 cases of heart failure occurred, of which 403 in men. Independently of cardiovascular risk factors, recognised and unrecognised MIs yielded HRs of developing heart failure in men of 2.6 (95% CI 2.0 to 3.3) and 2.1 (95% CI 1.5 to 2.9), respectively. In women, recognised MI was associated with heart failure (HR=2.8; 95% CI 1.9 to 4.1), whereas unrecognised MI was not significantly related to the risk of heart failure (HR=1.1; 95% CI 0.7 to 1.7). Conclusion Unrecognised MI detected by electrocardiography yields a long-term risk of heart failure equivalent to recognised MI in men, but is not significantly related to heart failure in women. In the light of the high incidence of both unrecognised MI and heart failure in the elderly, it may be worthwhile for both doctors and patients to improve responsiveness to typical and atypical symptoms of MI.

Effect of Genetic Variations in Syntaxin-Binding Protein-5 and Syntaxin-2 on von Willebrand Factor Concentration and Cardiovascular Risk

Abstract: Background—Elevated von Willebrand factor (VWF) plasma levels are associated with an increased risk of cardiovascular disease. A meta-analysis of genomewide association studies on VWF identified no...

Statin prescription in men and women at cardiovascular risk: to whom and when?

Abstract: Purpose of reviewTo review the recent evidence of the effectiviness of statin therapy in the primary prevention of cardiovascular disease in men and women without established cardiovascular disease (CVD).Recent findingsThe use of statins in patients without established CVD has important public healt

Distribution of echocardiographic parameters and their associations with cardiovascular risk factors in the Rotterdam Study

Abstract: Insight into echocardiographic parameters in the general population may facilitate early recognition of ventricular dysfunction, reducing the population morbidity and mortality of heart failure. We examined the distribution of structural, systolic and diastolic echocardiographic parameters and their associations with cardiovascular risk factors in the Rotterdam Study, a population-based cohort study in men and women aged ≥55 years. Participants with prevalent heart failure, myocardial infarction and atrial fibrillation and flutter were excluded. Echocardiographic parameters were assessed using two-dimensional, M-mode and Doppler echocardiography. Echocardiograms were available in 4,425 participants. Structural parameters were generally larger in men, and most consistently associated with age, body mass index and blood pressure in both sexes. Prevalence of moderate or poor left ventricular systolic function was 3.9% in men and 2.1% in women. Age, body mass index and blood pressure were most consistently associated with systolic function. E/A ratio was lower in women than in men. Age and diastolic blood pressure were most consistently associated with E/A ratio in both sexes. In conclusion, ventricular systolic and diastolic dysfunction is present in asymptomatic individuals. Selected established cardiovascular risk factors are associated with structural, systolic and diastolic parameters.

[Trends in prevalence of cardiovascular risk factors and their treatment in coronary heart disease: the Euroaspire-project].

Abstract: OBJECTIVE: To determine the prevalence of cardiovascular risk factors and their treatment in Dutch patients with coronary heart disease (the 'Euroaspire'-project) and to compare these data with those from 4 and 10 years previously. DESIGN: Retrospective. METHOD: The study included consecutive patients under 71 years of age, who had already been admitted for coronary revascularization or with myocardial infarction. Data were collected > 6 months after discharge. The prevalence of risk factors and their treatment were compared during the period May 1995-February 2006. RESULTS: In this third part of the study almost 80% of the patients were overweight (BMI >or= 25 kg/m2). 21% had diabetes mellitus. The average cholesterol level was 4.3 mmol/l. The percentage of smokers decreased significantly, from approximately 30% to 15%. More than 60% of subjects were hypertensive. More than 95% of the patients were on antiplatelet therapy or oral anticoagulants, 92% on cholesterol-reducing medication and 94% on antihypertensive medication. A sharp increase in medication was noted in comparison with earlier studies. CONCLUSION: Treatment of the most important cardiovascular risk factors has intensified over the past few years. Almost all patients were treated with antiplatelets, statins and antihypertensive medication. Overweight, hypertension and diabetes have become more important in the past decade. Care of cardiac patients will continue to be characterized by long-term and intensive care.

Statins and All-Cause Mortality in High-Risk Primary Prevention of Patients With Cardiovascular Risk Factors

Abstract: tice of dilatating and stenting renal arteries has spread like an epidemic since the 1980s (eg, 45 000 per year in the United States). In 2009, ASTRAL showed no benefit from these vascular procedures vs drug treatment but only serious complications (23 per 400 patients, including 2 deaths and 3 amputations). In the 1980s, FDA standards for medical devices were deficient. By contrast, the French drug agency (Agence FrançaisedeSécurité SanitairedesProduitsdeSanté [AFSSAPS]) has recently developed an opposite concept. The chief executiveofficerofAFSSAPShas justprefacedabookonmedical devices, which is freely offered by Medtronic. One of the authors is Medtronic’s director of regulatory affairs, and the other one is the director in charge of medical devices evaluation at AFSSAPS. The chapter on evaluation is a pledge to avoid evaluation: “rapid obsolescene of the products . . . is hardly compatible with the delay necessary for clinical trials, particularly morbidity-mortality data.” The alternative solution recommended is “predictive equivalence”! No one seems to know what can be considered“predictiveequivalence”but theauthors.A twodozen–lined chapter titled “Predicitive Appearance of Preclinical Evaluation” indicated that clinical evaluation can be limited to the check of the results of the specific test bench. There is no concern for clinical end points such as mortality and morbidity, effectiveness, and the collection of postapproval data.