Showing papers by "Kalevi Pyörälä published in 2004"

Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women.

Abstract: Background: Few studies have evaluated the associations between the metabolic syndrome (by any definition) and mortality. This study examined the age- and sex-specific prevalence of the metabolic syndrome and its association with all-cause and cardiovascular mortality in nondiabetic European men and women. Methods: The study was based on 11 prospective European cohort studies comprising 6156 men and 5356 women without diabetes and aged from 30 to 89 years, and had a median follow-up of 8.8 years. A modification of the World Health Organization definition of the metabolic syndrome was used. The subjects were considered to have the metabolic syndrome if they had hyperinsulinemia and 2 or more of the following: obesity, hypertension, dyslipidemia, or impaired glucose regulation; however, other definitions were also studied. Hazard ratios for all-cause and cardiovascular mortality were estimated with Cox models in each cohort. Meta-analyses were performed to assess the overall association of the metabolic syndrome with mortality risk. Results: The age-standardized prevalence of the metabolic syndrome was slightly higher in men (15.7%) than in women (14.2%). Of the 1119 deaths recorded during follow-up, 432 were caused by cardiovascular disease. The overall hazard ratios for all-cause and cardiovascular mortality in persons with the metabolic syndrome compared with persons without it were 1.44 (95% confidence interval [CI], 1.17-1.84) and 2.26 (95% CI, 1.61-3.17) in men and 1.38 (95% CI, 1.02-1.87) and 2.78 (95% CI, 1.574.94) in women after adjustment for age, blood cholesterol levels, and smoking. Conclusions: The overall prevalence of the metabolic syndrome in nondiabetic adult Europeans is 15%. Nondiabetic persons with the metabolic syndrome have an increased risk of death from all causes as well as cardiovascular disease. Arch Intern Med. 2004;164:1066-1076

The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)

Abstract: The metabolic syndrome, which is a set of lipid and nonlipid risk factors of metabolic origin linked with insulin resistance, is believed to be associated with an elevated risk for cardiovascular disease, but few have studied this association in prospective long-term cardiovascular outcomes trials. Placebo data from the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) were used post hoc to estimate the long-term relative risk of major coronary events (MCEs) associated with the metabolic syndrome, after excluding diabetes mellitus. In 4S and AFCAPS/TexCAPS, respectively, placebo-treated patients with the metabolic syndrome were 1.5 (95% confidence interval 1.2 to 1.8) and 1.4 (95% confidence interval 1.04 to 1.9) times more likely to have MCEs than those without it. Of the components of the metabolic syndrome, low high-density lipoprotein levels were associated with elevated risk of MCEs in both studies, whereas high triglycerides in 4S and elevated blood pressure and obesity in AFCAPS/TexCAPS were associated with significantly increased relative risk. Patients with the metabolic syndrome showed increased risk of MCEs irrespective of their Framingham-calculated 10-year risk score category (>20% vs

European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force Of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts).

Abstract: Guidelines aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making. A great number of guidelines have been issued in recent years by different organisations--European Society of Cardiology (ESC), American Heart Association (AHA), American College of Cardiology (ACC), and other related societies. By means of links to web sites of National Societies several hundred guidelines are available. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing guidelines. In spite of the fact that standards for issuing good quality guidelines are well defined, recent surveys of guidelines published in peer-reviewed journals between 1985 and 1998 have shown that methodological standards were not complied with in the vast majority of cases. It is therefore of great importance that guidelines and recommendations are presented in formats that are easily interpreted. Subsequently, their implementation programmes must also be well conducted. Attempts have been made to determine whether guidelines improve the quality of clinical practice and the utilisation of health resources. In addition, the legal implications of medical guidelines have been discussed and examined, resulting in position documents, which have been published by a specific task force. The ESC Committee for practice guidelines (CPG) supervises and coordinates the preparation of new guidelines and expert consensus documents produced by task forces, expert groups or consensus panels. The Committee is also responsible for the endorsement of these guidelines or statements.

Gender Difference in the Impact of Type 2 Diabetes on Coronary Heart Disease Risk

Abstract: OBJECTIVE—To explain the stronger effect of type 2 diabetes on the risk of coronary heart disease (CHD) in women compared with men. RESEARCH DESIGN AND METHODS—The study population consisted of 1,296 nondiabetic subjects and 835 type 2 diabetic subjects aged 45–64 years without cardiovascular disease. The end points were CHD death and a major CHD event (CHD death or nonfatal myocardial infarction). The follow-up time was 13 years. RESULTS—Major CHD event rate per 1,000 person-years was 11.6 in nondiabetic men, 1.8 in nondiabetic women, 36.3 in diabetic men, and 31.6 in diabetic women. The diabetes-related hazard ratio for a major CHD event from the Cox model, adjusted for age and area of residence, was 2.9 (95% CI 2.2–3.9) in men and 14.4 (8.4–24.5) in women, and after further adjustment for cardiovascular risk factors, 2.8 (2.0–3.7) and 9.5 (5.5–16.9), respectively. The burden of conventional risk factors in the presence of diabetes was greater in women than in men at baseline. Prospectively, elevated blood pressure, low HDL cholesterol, and high triglycerides contributed to diabetes-related CHD risk more in women than in men. However, after adjusting for conventional risk factors, a substantial proportion of diabetes-related CHD risk remained unexplained in both genders. CONCLUSIONS—The stronger effect of type 2 diabetes on the risk of CHD in women compared with men was in part explained by a heavier risk factor burden and a greater effect of blood pressure and atherogenic dyslipidemia in diabetic women.

Prediction of the risk of cardiovascular mortality using a score that includes glucose as a risk factor. The DECODE Study.

Abstract: AIMS/HYPOTHESIS: Risk scores have been developed to predict cardiovascular or coronary risk, and while most have included diabetes as a risk factor, none have included lower glucose concentrations, either at fasting or following a 2-h oral glucose tolerance test. This article develops 5- and 10-year risk scores for cardiovascular mortality that include glucose concentrations as well as known diabetes status. METHODS: Data is from the DECODE cohort: 16,506 men and 8,907 women from 14 European studies. The risk factors studied were as follows: age, fasting and 2-h glucose (including cases of known diabetes), fasting glucose alone (including cases of known diabetes), cholesterol, smoking status, systolic blood pressure and BMI. For an absolute risk score the 1995 country- and sex-specific cardiovascular death rates were used. RESULTS: In men, for both 5- and 10-year cardiovascular mortality, after adjusting for age and study centre, all studied risk factors, except BMI, were significantly associated with cardiovascular mortality (p<0.05). These results were unchanged in multivariate models with all factors included. In women, after adjusting for age and centre, glucose categories, systolic blood pressure and BMI were predictive of 5-year cardiovascular mortality. With all factors in the model, only age and glucose categories were predictive. In terms of 10-year cardiovascular mortality, smoking status and blood pressures were also predictive in the women. For men and women, the same scores were used for the risk factors, except for age and glucose categories where the hazard ratios differed significantly. CONCLUSIONS/INTERPRETATION: Including glucose concentrations as well as diabetic status provides quantitative information on cardiovascular risk prediction.

Reduction of Cardiovascular Events by Simvastatin in Nondiabetic Coronary Heart Disease Patients With and Without the Metabolic Syndrome Subgroup analyses of the Scandinavian Simvastatin Survival Study (4S)

Abstract: OBJECTIVE —To assess the effect of simvastatin treatment on the risk of cardiovascular events in nondiabetic patients with coronary heart disease (CHD) with and without the metabolic syndrome, as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP-III). RESEARCH DESIGN AND METHODS —Subgroup analyses were performed on data from 3,933 nondiabetic patients with clinically established CHD, serum total cholesterol level 5.5–8.0 mmol/l, and serum triglyceride level ≤2.5 mmol/l who were participating in the Scandinavian Simvastatin Survival Study (4S), a randomized, placebo-controlled trial. End points were total mortality, coronary mortality, major CHD event, myocardial revascularization, any CHD event, stroke, and any atherosclerotic event. RESULTS —Over the 5.4-year median follow-up period, simvastatin produced similar changes in serum lipid levels in 893 patients with the metabolic syndrome and in 3,040 patients without the metabolic syndrome. The relative risks of main end points in simvastatin-treated patients compared with placebo-treated patients with the metabolic syndrome were as follows: total mortality 0.54 (95% CI 0.36–0.82), coronary mortality 0.39 (0.23–0.65), major CHD event 0.59 (0.45–0.77), and any atherosclerotic event 0.69 (0.56–0.84). The corresponding RRs in patients without the metabolic syndrome were 0.72 (0.56–0.91), 0.62 (0.45–0.84), 0.71 (0.61–0.82), and 0.76 (0.68–0.85). CONCLUSIONS —Nondiabetic CHD patients with or without the metabolic syndrome realize from simvastatin treatment a similar, substantial relative reduction in the risk of cardiovascular events. The absolute benefit may be greater in patients with the metabolic syndrome because they are at a higher absolute risk.

Plasma insulin and cardiovascular mortality in non-diabetic European men and women: a meta-analysis of data from eleven prospective studies.

Abstract: Plasma insulin and cardiovascular mortality in non-diabetic European men and women : a meta-analysis of data from eleven prospective studies.

Risk factor management in diabetic and non-diabetic patients with coronary heart disease. Findings from the EUROASPIRE I AND II surveys.

Abstract: Aims/hypothesis We examined risk factor management in diabetic and non-diabetic patients with CHD based on data from EUROASPIRE surveys.

Overweight and obesity in patients with established coronary heart disease: Are we meeting the challenge?

Abstract: Aims Several epidemiological studies have reported increasing obesity rates in the general population during last decades. We studied the prevalence of overweight and obesity in the high priority group of patients with established coronary heart disease (CHD) and the therapeutic control of manageable coronary risk factors in relation to body mass index. Methods Data from a representative sample of patients having experienced a recent cardiac event before the age of 71 years from 15 European centres participating in the EUROASPIRE II study, were gathered in the period 1999–2000 through standardized methods. In total, 5535 coronary patients with valid height and weight measurements were included. Results About one in three patients (31%) was diagnosed as obese with additionally half of the patient population being overweight (48%). Obesity was 10% more prevalent among women and significantly less smokers were observed among overweight and obese subjects, twice as many diabetics and more people with low education. Overweight and obese patients had more frequently raised blood pressure and elevated cholesterol after adjustment for age, gender, education, diabetes and centre. In patients using blood pressure lowering agents, 56% of obese and 51% of overweight patients were still having raised blood pressure compared to 42% in normal weight patients. A similar result was observed for the therapeutic control of total cholesterol. Since their hospital discharge, obese and overweight patients did not alter lifestyles regarding fat intake and physical activity. In the period between coronary event and interview, body weight had increased with at least five kilograms in a quarter of all patients.

Low-risk patients with chest pain and without evidence of myocardial infarction may be safely discharged from emergency department.

Abstract: Aims This study is an audit of the risk stratification of patients admitted to a university hospital emergency department with a suspected acute coronary syndrome (ACS). The main aim of the study was to investigate the prognosis of those patients who were discharged to home from the emergency room (ER) or adjacent chest pain observation unit (CPU). Methods and results Three thousand one hundred and seven consecutive patients admitted to the ER with a suspected ACS were retrospectively identified. Seven hundred and sixty-four (25%) patients were discharged from the ER and 417 (13%) from the CPU after observation and ruling out myocardial infarction (MI) and high-risk ACS. One thousand seven hundred and two patients were hospitalized. Follow-up end-points were cardiovascular mortality, hospitalization for ACS and incidence of any cardiovascular disease event during 6 months. During 4 weeks after the discharge from the ER and CPU cardiovascular mortality was 0.1% and 0.5% and during 6 months 0.8% and 1.7%, respectively. Within 6 months 4.2% and 8.4% of the patients were hospitalized for ACS and 9.3% and 11.5% had a cardiovascular disease event. Conclusions Patients admitted with chest pain may be safely discharged from the emergency department, if there is no evidence of MI or high-risk ACS. However, further examination and appropriate treatment must be arranged.

Resumen Ejecutivo: Guía Europea de Prevención Cardiovascular en la práctica clínica

Abstract: clerosis, que se desarrolla silenciosamente a lo largo de muchos años y suele estar avanzada cuando aparecen los síntomas. – La muerte, el infarto de miocardio y el ictus ocurren frecuentemente de manera súbita y antes de acceder a los servicios sanitarios, por lo que muchas intervenciones terapéuticas son inaplicables o paliativas. – La presentación epidémica de las ECV está estrechamente asociada con hábitos de vida y factores de riesgo modificables. – Se ha demostrado de forma inequívoca que la modificación de los factores de riesgo reduce la mortalidad y la morbilidad, especialmente en personas con ECV diagnosticada o no.

Guía Europea de Prevención Cardiovascular en la Práctica Clínica (y II)

Abstract: de alto riesgo y, en ambos casos, el cambio de conductas de riesgo (dieta inadecuada, consumo de tabaco, sedentarismo), arraigadas durante muchos años, requiere un abordaje profesional. Para muchas personas puede resultar difícil cambiar la conducta de acuerdo con los consejos del médico, especialmente para los desfavorecidos social y económicamente, los que tienen un trabajo monótono dependiente y no estimulante, los que se encuentran en situaciones familiares estresantes o los que viven solos y carecen de apoyo social. Además, las emociones negativas, como la depresión, la cólera y la agresividad, pueden constituir barreras a los esfuerzos preventivos, tanto en pacientes como en individuos de alto riesgo. El médico puede reconocer estas barreras mediante un conjunto sencillo de preguntas y, aunque ello puede ayudar y ser suficiente en algunos casos, la persistencia de emociones negativas graves puede requerir la consulta con el especialista, así como el inicio de una terapia conductual o tratamiento farmacológico. Puesto que los factores de riesgo psicosociales son independientes del resto, siempre que sea posible se insistirá en los esfuerzos para aliviar el estrés y contrarrestar el aislamiento social. Los pasos estratégicos que pueden ser utilizados para mejorar la efectividad de los consejos sobre el cambio de conducta incluyen los siguientes: