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Showing papers in "European Journal of Preventive Cardiology in 2011"


Journal ArticleDOI
TL;DR: The ability of these methods to detect endothelial dysfunction before overt cardiovascular disease manifests make them attractive clinical tools for prevention and rehabilitation.
Abstract: The endothelium holds a pivotal role in cardiovascular health and disease. Assessment of its function was until recently limited to experimental designs due to its location. The advent of novel techniques has facilitated testing on a more detailed basis, with focus on distinct pathways. This review presents available in-vivo and ex-vivo methods for evaluating endothelial function with special focus on more recent ones. The diagnostic modalities covered include assessment of epicardial and microvascular coronary endothelial function, local vasodilation by venous occlusion plethysmography and flow-mediated dilatation, arterial pulse wave analysis and pulse amplitude tonometry, microvascular blood flow by laser Doppler flowmetry, biochemical markers and bioassays, measurement of endothelial-derived microparticles and progenitor cells, and glycocalyx measurements. Insights and practical information on the theoretical basis, methodological aspects, and clinical application in various disease states are discussed. The ability of these methods to detect endothelial dysfunction before overt cardiovascular disease manifests make them attractive clinical tools for prevention and rehabilitation.

289 citations


Journal ArticleDOI
TL;DR: Despite interventions being mostly successful in retarding progression to overt diabetes, this did not result in reductions in all-cause or cardiovascular mortality, or myocardial infarction, with the possible exception of stroke.
Abstract: Background: Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are pre-diabetic states, treatment of which may prevent or delay the onset of overt diabetes and thus potentially red...

146 citations


Journal ArticleDOI
TL;DR: Major cardiovascular events in contemporary populations with type 2 diabetes can be predicted on the basis of routinely measured clinical and biological variables and can be used to quantify risk and guide the intensity of treatment in people with diabetes.
Abstract: Background: Existing cardiovascular risk prediction equations perform non-optimally in different populations with diabetes. Thus, there is a continuing need to develop new equations that will reliably estimate cardiovascular disease (CVD) risk and offer flexibility for adaptation in various settings. This report presents a contemporary model for predicting cardiovascular risk in people with type 2 diabetes mellitus.Design and methods: A 4.5-year follow-up of the Action in Diabetes and Vascular disease: preterax and diamicron-MR controlled evaluation (ADVANCE) cohort was used to estimate coefficients for significant predictors of CVD using Cox models. Similar Cox models were used to fit the 4-year risk of CVD in 7168 participants without previous CVD. The model’s applicability was tested on the same sample and another dataset.Results: A total of 473 major cardiovascular events were recorded during follow-up. Age at diagnosis, known duration of diabetes, sex, pulse pressure, treated hypertension, atrial fib...

138 citations


Journal ArticleDOI
TL;DR: Strengths of associations and discrimination statistics suggested that WHR was the best predictor of cardiovascular events and mortality in patients with type-2 diabetes and BMI the worst.
Abstract: AIMS: The aim of this study was to compare the strength of associations and discrimination capability of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with cardiovascular disease risk in individuals with type-2 diabetes. METHODS AND RESULTS: Eleven thousand, one hundred and forty men and women were followed for a mean of 4.8 years. The Cox proportional hazard models were used to compute the hazard ratios and 95% confidence intervals (95% CI) for one standard deviation (SD) increase in baseline BMI (SD: 5 kg/m2), WC (SD: 13 cm) and WHR (SD: 0.08) with cardiovascular disease risk. After adjustment, hazard ratio (95% CI) for WC were 1.10 (1.03-1.18) for cardiovascular events, 1.13 (1.03-1.24) for coronary events, and 1.08 (0.98-1.19) for cardiovascular deaths. Estimates for WHR were 1.12 (1.05-1.19), 1.17 (1.08-1.28) and 1.19 (1.09-1.31). BMI was not related to any of these outcomes. Although the receiver operating characteristic curve could not differentiate between anthropometric variables (P values 0.24), the relative integrated discrimination improvement statistic showed an enhancement in the discrimination capabilities of models using WHR for cardiovascular outcomes, except for cerebrovascular events. CONCLUSION: Strengths of associations and discrimination statistics suggested that WHR was the best predictor of cardiovascular events and mortality in patients with type-2 diabetes and BMI the worst.

133 citations


Journal ArticleDOI
TL;DR: There was a strong, graded but J-shaped univariable relationship between BMI and CVD mortality in both genders and this increases the public health importance of BMI as both a simple indicator and mediator of CVD risk.
Abstract: Background: Although cardiovascular disease (CVD) is the biggest global cause of death, CVD mortality is falling in developed countries. There is concern that this trend may be offset by increasing levels of obesity.Design: We used the Systematic Coronary Risk Evaluation (SCORE) data set to examine relationships between body mass index (BMI), conventional risk factors and CVD mortality.Methods: The SCORE data set comprises data from 12 European cohort studies. The relationship between BMI and CVD mortality was examined in each BMI category using univariable and multivariable (Cox) analyses. The SCORE population was also divided into gender and age strata: under 40, 40–49, 50–59, and over 60. The rate of CVD mortality in each BMI category was calculated within each gender and age stratum. Relationships between BMI and other CVD risk factors were also examined.Results: There was a strong, graded but J-shaped univariable relationship between BMI and CVD mortality in both genders. Each 5-unit increase in BMI ...

122 citations


Journal ArticleDOI
TL;DR: The current study supports a role for statin therapy in patients with endothelial dysfunction and shows treatment withstatin therapy is associated with significant improvement in both peripheral and coronary endothelial function.
Abstract: Objective: The purpose of this study was to quantify the effect of statins on peripheral and coronary endothelial function in patients with and without established cardiovascular disease.Background: Early atherosclerosis is characterized by endothelial dysfunction, a known prognostic factor for cardiovascular disease.Methods and results: The search included MEDLINE, Cochrane Library, Scopus, and EMBASE to identify studies up to 1 December 2009. Eligible studies were randomized controlled trials on the effects of statins compared with placebo on endothelial function. Two reviewers extracted data on study characteristics, methods, and outcomes. Forty-six eligible trials enrolled a total of 2706 patients: 866 (32%) were women and 432 (16%) had established cardiovascular disease. Meta-analysis using random-effects models showed treatment with statins significantly improved endothelial function [standardized mean difference (SMD) 0.66, 95% CI 0.46–0.85, p < 0.001]. Subgroup analyses demonstrated statistically ...

107 citations


Journal ArticleDOI
TL;DR: The findings indicate that exercise training may improve the functional status of VAD recipients even at a later period after implantation and thus, may have additional importance in cases of destination therapy.
Abstract: Background: Capacity to exercise may not be fully restored in patients with heart failure even in the long term after ventricular assist device (VAD) implantation. The benefits of exercise training in patients with VAD are unknown.Design and methods: Fifteen patients, aged 38.3 ± 15.9 years, bridged to heart transplantation with left ventricular assist device or biventricular assist device were randomized at a ratio of 2 : 1 to a training group (TG, n = 10) or a control group (n = 5), 6.3 ± 4 months after implantation. Both the groups were advised to walk 30–45 min/day. TG also underwent moderate-intensity aerobic exercise using a bike or treadmill for 45 min, three to five times a week, combined with high-intensity inspiratory muscle training using a computer-designed software to respiratory exhaustion, two to three times a week for 10 weeks. The patients were tested using cardiopulmonary exercise testing, 6-min walk test, spirometry and electronic pressure manometer for inspiratory muscle strength (Pima...

99 citations


Journal ArticleDOI
TL;DR: Findings showed that interventions can increase PA; however, there were notable differences across CR contexts in their purpose, the participant demographics, and some of the behaviour change techniques used.
Abstract: To examine the behaviour change techniques that have been used in physical activity (PA) interventions to increase PA during and after completing cardiac rehabilitation (CR) and for patients who do not attend CR (non-CR). PubMed, PsychINFO, SPORTdiscus, Web of Science, Prowler and Cochrane databases were searched to identify studies that described an intervention delivered to adults in the CR and non-CR contexts that focused solely on promoting PA. Twenty-three studies (14 post-CR and nine non-CR) were included in this review. Findings showed that interventions can increase PA; however, there were notable differences across CR contexts in their purpose, the participant demographics, and some of the behaviour change techniques used. Techniques shown to be most effective in the post-CR context were self-monitoring, setting specific goals, identifying barriers and developing plans for relapse prevention. In the non-CR context, unsupervised home-based interventions were shown to be effective at increasing PA, particularly when accompanied by follow-up prompts, general encouragement, specific goals set by the researcher and self-monitoring. Post-CR and non-CR interventions can result in improved PA outcomes; however, the research in this area is limited. More interventions are needed that target PA-only, particularly in the non-CR context.

94 citations


Journal ArticleDOI
TL;DR: A reference set of data of normal values of newly developed cardiopulmonary parameters of exercise testing in an 8-18-year-old population is lacking.
Abstract: Background: A reference set of data of normal values of newly developed cardiopulmonary parameters of exercise testing in an 8-18-year-old population is lacking.Patients and methods: Cardiopulmonar...

86 citations


Journal ArticleDOI
TL;DR: CIMT progression meets the criteria of a surrogate for cardiovascular disease endpoints and may be considered as a valid alternative for cardiovascular events as outcome.
Abstract: Background: Surrogate markers for cardiovascular disease might be of great value in observational research, clinical trials, and clinical practice. Carotid intima–media thickness (CIMT) is probably the most commonly used marker for atherosclerotic disease as an alternative for cardiovascular morbidity and mortality. A suitable marker for atherosclerosis, however, should meet several criteria before it can be validly used.Methods and results: We reviewed the literature following a set of criteria for a surrogate marker. These include a comparison with a ‘gold standard’; adequate reproducibility; cross-sectional relations with established risk factors and prevalent disease; relations with severity of atherosclerosis elsewhere in the arterial system; relations with the occurrence with future events; ability for a biomarker to change over time; ability to be affected by interventions over time; and relations between change over time in biomarker level and change in risk. A large number of studies from a varie...

82 citations


Journal ArticleDOI
TL;DR: It is shown for the first time that concomitantly elevated NT-proBNP concentration, at least, partially explains the apparently positive relationship between adiponectin concentration and risk of CVD and mortality in asymptomatic elderly men.
Abstract: Background: Raised adiponectin is associated with increased rather than decreased risk of cardiovascular disease (CVD) and mortality at older age. We examined whether N-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of cardiac dysfunction, may help explain this relationship.Methods and results: A prospective study of 2879 men aged 60–79 years with no history of CVD at baseline followed-up for a mean of 9 years during which there were 196 major coronary heart disease events (fatal and non-fatal myocardial infarction) and 667 deaths (including 225 CVD deaths), whereas adiponectin concentration was inversely associated with several conventional CVD risk factors; it was significantly and positively associated with NT-proBNP concentration. After adjustment for several vascular risk factors, including renal function and muscle mass, relative risks associated with a top third versus bottom third comparison of adiponectin concentration were 1.51 (1.02–2.23) for coronary heart disease, 1.67 (1.15–2.4...

Journal ArticleDOI
TL;DR: Low total testosterone concentrations are prospectively associated with an adverse lipid profile and increased risk of incident dyslipidemia, which may contribute to an explanation for the higher cardiovascular disease risk in men with lower totalosterone concentrations.
Abstract: Background Earlier studies have suggested that total testosterone concentrations influence the lipid metabolism. Whether these concentrations are prospectively associated with an adverse lipid profile and an increased risk of incident dyslipidemia has not yet been investigated. Methods and results Our study population consisted of 1468 men, aged 20–79 years, who were repeatedly examined as part of the population-based Study of Health in Pomerania. Serum total testosterone concentrations measured by the chemiluminescent enzyme immunoassays were categorized into age-specific quartiles. We used generalized estimating equations models to assess the prospective association between total testosterone concentrations and lipid profile components including total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (TG) concentrations, as well as incident dyslipidemia after 5 years of follow-up. Multivariate models revealed that total testosterone concentrations in the lowest quartile were associated with higher TC and TG concentrations in both cross-sectional [TC: 0.23mmol/l (95% confidence interval, CI, 0.02–0.42); TG: 0.73mmol/l (95% CI, 0.53–0.94)] and longitudinal analyses [TC: 0.20mmol/l (95% CI, 0.03–0.27); TG: 0.62mmol/l (95% CI, 0.43–0.80)], but not with high-density lipoprotein cholesterol or low-density lipoprotein cholesterol concentrations. Baseline prevalence of dyslipidemia was 57.1% with a crude incidence rate of 46.6 per 1000 person-years. Total testosterone concentrations in the lowest quartile predicted dyslipidemia; age-adjusted relative risks (RR) for men in quartiles 1, 2, and 3 as compared to quartile 4 (highest, reference) were 1.28 (95% CI, 1.06–1.54), 1.10 (95% CI, 0.91–1.33), and 1.05 (95% CI, 0.86–1.29), respectively. This effect was particularly strong among men aged 20–39 years (relative risk, 1.51; 95% CI, 1.08–2.10). Conclusion Low total testosterone concentrations are prospectively associated with an adverse lipid profile and increased risk of incident dyslipidemia. These findings are particularly interesting and may contribute to an explanation for the higher cardiovascular disease risk in men with lower total testosterone concentrations. Eur J Cardiovasc Prev Rehabil 00:000–000 � c 2010 The European Society of Cardiology

Journal ArticleDOI
TL;DR: The purpose of this review is to provide an update of the methods for the exercise intensity assessment and continuous aerobic training intensity prescription in the CHF population, furnishing indications useful for implementation of physical rehabilitation programs in these patients.
Abstract: Chronic heart failure (CHF) is a significant cause of worldwide mortality and morbidity, whose clinical picture is characterized by exercise intolerance and impaired quality of life. Aerobic exercise training is a well-established nonpharmacological tool improving the CHF’s pathophysiological, clinical, and prognostic picture, and prescription of an adequate training intensity is crucial to obtain both exercise-induced benefits and a reasonable control of exercise-related risk. However, clarity is still lacking regarding the definition of exercise intensity domains and the lower and upper intensity limits of prescriptible aerobic exercise in CHF patients. The purpose of this review is to provide an update of the methods for the exercise intensity assessment and continuous aerobic training intensity prescription in the CHF population, furnishing indications useful for implementation of physical rehabilitation programs in these patients.

Journal ArticleDOI
TL;DR: The best strategy is to combine synergistically primary prevention of sudden cardiac death by preparticipation identification of athletes affected by at-risk cardiomyopathies and secondary prevention with back-up defibrillation of unpredictable sudden cardiac arrest on the athletic field.
Abstract: Sudden cardiac death of a young athlete is the most tragic event in sports and devastates the family, the sports medicine team, and the local community. Such a fatality represents the first manifestation of cardiac disease in up to 80% of young athletes who remain asymptomatic before sudden cardiac arrest occurs; this explains the limited power of screening modalities based solely on history and physical examination. The long-running Italian experience showed that electrocardiogram (ECG) screening definitively improves the sensitivity of pre-participation evaluation for heart diseases and substantially reduces the risk of death in the athletic field (primary prevention). However, some cardiac conditions, such as coronary artery diseases, present no abnormalities on 12-lead ECG. Moreover, cardiac arrest due to non-penetrating chest injury (commotio cordis) cannot be prevented by screening. This justifies the efforts for implementing programmes of early external defibrillation of unpredictable arrhythmic cardiac arrest. This article reviews the epidemiology of sudden cardiac arrest in the athlete in terms of incidence, sport-related risk, underlying causes, and the currently available prevention programmes such as pre-participation screening and early external defibrillation by using automated external defibrillators. The best strategy is to combine synergistically primary prevention of sudden cardiac death by pre-participation identification of athletes affected by at-risk cardiomyopathies and secondary prevention with back-up defibrillation of unpredictable sudden cardiac arrest on the athletic field.

Journal ArticleDOI
TL;DR: Findings suggest that hospitalized smokers in a large German university hospital might not be treated according to international guidelines as well as severe misperceptions regarding the effectiveness of cessation methods were noted.
Abstract: Background: Hospitalization is an opportune time for smoking cessation support; cessation interventions delivered by hospital physicians are effective. While general practitioners’ and outpatients’...

Journal ArticleDOI
TL;DR: In this relatively active population, types of activities of at least moderate intensity, such as cycling and sports were associated with lower CVD incidence, whereas activities of lower intensity,such as walking and gardening, were not.
Abstract: Background: Physical activity is inversely related to cardiovascular diseases. However, the type of activities that contribute most to these beneficial effects remain unclear. For this reason, we i...

Journal ArticleDOI
TL;DR: Regular exercise training in stable angina patients following PCI may attenuate some, but not all, inflammatory pathways, potentially contributing to the beneficial effects of exercise training on restenosis.
Abstract: Background: Increased plasma levels of inflammatory markers and markers of endothelial cell activation have been associated with increased risk for cardiovascular events Exercise training may lower the risk for coronary heart disease by attenuating inflammation and improving endothelial function The objective of this study was to evaluate effects of regular high-intensity exercise training on a wide range of markers of inflammation and endothelial cell activationMaterials and methods: Consecutively, 40 patients were prospectively randomized to a 6 months supervised high-intensity interval training programme or to a control group following successful percutaneous coronary intervention (PCI) Blood samples of 36 patients with stable angina, drawn at baseline (before PCI) and at 6 months, were analysed Late luminal loss was measured at 6 months using quantitative coronary angiographyResults: At 6 months, levels of the inflammatory markers interleukin (IL)-6 and IL-8 were reduced and levels of the anti-i

Journal ArticleDOI
TL;DR: Differences in lifestyle provide insufficient explanation for the observed mortality gap in these two groups of EU countries, and higher expenditures on health, better access to invasive and acute cardiac care, and better pharmacological control of hypertension and hypercholesterolemia in the West are well documented.
Abstract: Aims: There are large differences in all-cause and cardiovascular disease (CVD) mortality between eastern and western countries in Europe. We reviewed the development of these mortality trends in countries of the European Union (EU) over the past 40 years and evaluated available data regarding possible determinants of these differences.Methods and results: We summarized all-cause mortality and specific cardiovascular mortality for two country groups – 10 countries that joined the European Union (EU) after 2004 (East), and 15 countries that joined before 2004 (West). Standardized mortality rates were retrieved from the World Health Organization “European Health for All” database for each country between 1970 and 2007. Currently (in the 2000s), mortality due to circulatory system disease, ischemic heart disease (IHD), cerebrovascular disease (CBVD), and all-causes in the ‘new’ EU countries (East) is approximately twice that in the ‘old’ EU countries (West). These differences were much smaller in the 1970s. ...

Journal ArticleDOI
TL;DR: Exercise intensity was an important factor in improving HR recovery and CRF of FH+women and may have important implications for designing exercise-training programmes for the prevention of an inherited hypertensive disorder.
Abstract: Exercise training is an effective intervention for treating and preventing hypertension, but its effects on heart rate (HR) response to exercise and cardiorespiratory fitness (CRF) of non-hypertensive offspring of hypertensive parents (FH+) has not been studied. We compared the effects of three times per week equal-volume high-intensity aerobic interval (AIT) and continuous moderate-intensity exercise (CME) on HR response to exercise and CRF of FH+. Forty-four young FH+ women (25.0 ± 4.4 years) randomized to control (CON; n = 12), AIT (80-90% of VO(2MAX); n = 16), or CME (50-60% of VO(2MAX); n = 16) performed a graded exercise test (GXT) before and after 16 weeks of follow-up to evaluate HR response to exercise and several parameters of CRF. Resting, maximal, and reserve HR did not change after the follow-up in all groups. HR recovery (difference between HR(MAX) and HR at 1 minute of GXT recovery phase) improved only after AIT (11.8 ± 4.9 vs. 20.6 ± 5.8 bpm, p < 0.01). Both exercise programmes were effective for improving CRF parameters, but AIT was more effective than CME for improving oxygen consumption at the respiratory compensation point (VO(2RCP); 22.1% vs. 8.8%, p = 0.008) and maximal effort (VO(2MAX); 15.8% vs. 8.0%, p = 0.036), as well as tolerance time (TT) to reach anaerobic threshold (TT(AT); 62.0 vs. 37.7, p = 0.048), TT(RCP) (49.3 vs. 32.9, p = 0.032), and TT(MAX) (38.9 vs. 29.2, p = 0.042). Exercise intensity was an important factor in improving HR recovery and CRF of FH+women. These findings may have important implications for designing exercise-training programmes for the prevention of an inherited hypertensive disorder.

Journal ArticleDOI
TL;DR: Hospital-based training enabled participants to walk for longer periods and it is clinically important that both training groups maintained physical activity level in the long term, given the potential for heart failure to worsen over this time period.
Abstract: Background: In heart failure, reduced physical activity level can adversely affect physical and psychosocial functioning. No previous heart failure research has compared effects of home and hospita...

Journal ArticleDOI
TL;DR: Middle–aged men and women with MS have an increased risk for future CHD and this CHD risk associated with MS is substantially lower among those who are physically active, compared to people without MS who were physically inactive.
Abstract: Objective: We investigated the association between physical activity, metabolic syndrome (MS), and the risk of future coronary heart disease (CHD) and mortality due to CHD in middle–aged men and wo...

Journal ArticleDOI
TL;DR: Support is given to the hypothesis of obesity shifting to the poor and extended to the related concepts of abdominal obesity and metabolic syndrome to be considered as a socially-generated disease and an indicator of socioeconomic disadvantage.
Abstract: Aims: Earlier reviews have found that the proportion of inverse associations between socioeconomic status and obesity increased according to the level of development of the studied country. Based o...

Journal ArticleDOI
TL;DR: Both patients with symptomatic PAOD and healthy volunteers respond to a single episode of limb ischemia with a time-dependent increase in circulating EPCs, underlining the reduced vasculogenic potential of patients with PAOD.
Abstract: Objectives: The concept of neovascularization in response to tissue ischemia was recently extended by the finding of postnatal vasculogenesis through circulating endothelial progenitor cells (EPCs). The aim of this study was to assess the role of acute ischemia for EPC mobilization in patients with peripheral arterial occlusive disease (PAOD) and in healthy volunteers.Methods: The number of circulating EPCs was analyzed by flow cytometry in PAOD patients (n = 23) with exercise-induced limb ischemia for up to 72 h after a maximal treadmill test and in healthy volunteers (n = 17) who underwent a 15-min suprasystolic occlusion of one lower extremity to induce limb ischemia. Plasma concentrations of vascular endothelial growth factor, basic fibroblast growth factor, tumor necrosis factor-α, and granulocyte macrophage-colony stimulating factor were determined by ELISA.Results: EPCs (CD 34 pos/KDRpos) increased significantly in both PAOD patients from 82 ± 20 to 256 ± 52 (P < 0.05) and healthy volunteers from 1...

Journal ArticleDOI
TL;DR: Overweight/obese children have an initial endothelial dysfunction and vascular damage, i.e., the first stage in the development of atherosclerosis.
Abstract: Background: To investigate endothelial dysfunction and morphological vascular changes in childhood obesity.Methods: 93 overweight/obese children (body mass index 26 ± 5 kg/m2; median 26 kg/m2; interquartile range 22–28 kg/m2), mean age 10.9 ± 2.7 years, underwent a check-up of total, high-density lipoprotein- and low-density lipoprotein-cholesterol, triglycerides, C-reactive protein, erythrocyte sedimentation rate, and white blood cell count, together with ultrasound measures of flow-mediated dilatation, carotid intima-media thickness, and anterior-posterior diameter of the abdominal aorta.Results: The body mass index of overweight/obese children had a statistically significant linear relationship (p < 0.05) with triglycerides, erythrocyte sedimentation rate, carotid intima-media thickness, anterior-posterior diameter of the abdominal aorta, and flow-mediated dilatation values.Conclusions: Overweight/obese children have an initial endothelial dysfunction and vascular damage, i.e., the first stage in the d...

Journal ArticleDOI
TL;DR: Determinants of smoking cessation after MI are multifactorial and include demographic, socioeconomic, smoking behaviour, clinical and psychosocial measures and patients with low sense of coherence and high depression should be provided with targeted help to quit.
Abstract: Background: Smoking has been causally linked to cardiovascular disease, and smoking cessation after myocardial infarction (MI) has been associated with a 50% reduction in mortality. Post-MI smokers are a vulnerable population for which efforts to encourage cessation should be maximized. We examined the determinants of smoking cessation after MI.Methods: A population-based cohort of 768 Israeli smokers was followed-up longitudinally after first MI. Data were collected at study entry on demographic, socioeconomic, smoking behaviour, and clinical variables. Psychosocial measures were obtained in a subsample (n = 330). Self-reported smoking status was assessed at 3–6 months, 1–2 years, 5 years, and 10–13 years after MI. Generalized estimating equation analyses determined which factors were significant predictors of smoking status.Results: Point abstinence rates throughout follow-up ranged from 55% to 70%, while continuous abstinence rates were 59% after 1–2 years, 44% after 5 years, and 35% after 10–13 years,...

Journal ArticleDOI
TL;DR: After a nationwide educational campaign, shorter pre-hospital delays were observed, and more patients were able to be treated promptly, which may be useful in planning future health strategies to improve management and outcome of patients with ACS.
Abstract: Background: To improve the outcome in patients with acute coronary syndrome (ACS), public campaigns have been launched aimed at shortening presentation delays and allowing more efficient treatment. Their impact is uncertain.Methods: Pre-hospital delays and outcome in patients with ACS included in the Swiss National AMIS Plus registry were assessed prospectively before and after a nationwide multimedia campaign (‘HELP’) by the Swiss Heart Foundation in 2007. The campaign aimed at better awareness of symptoms, increasing knowledge in laymen of resuscitation and more rapid access to medical services. The primary study endpoint was the time between onset of symptoms and hospital admission. Secondary endpoints were successful out-of-hospital resuscitation, symptoms upon admission, and outcome.Results: Between January 2005 and December 2008, 8906 ACS patients (61% ST-segment elevation myocardial infarction (STEMI), 39% non-ST-segment elevation myocardial infarction/unstable angina pectoris (NSTEMI/UAP), mean ag...

Journal ArticleDOI
TL;DR: CHD and CVD mortality steadily declined in Europe, except in Russia, whose rates were 10 to 15-fold higher than those of France, Italy or Sweden, and also Scotland, where CHD trends were less favourable than in other western European countries.
Abstract: Background: Over the last two decades, mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) declined by about 30% in the European Union (EU).Design: We analyzed trends in CHD (X ICD codes: I20–I25) and CVD (X ICD codes: I60–I69) mortality in young adults (age 35–44 years) in the EU as a whole and in 12 selected European countries, over the period 1980–2007.Methods: Data were derived from the World Health Organization mortality database. With joinpoint regression analysis, we identified significant changes in trends and estimated average annual percent changes (AAPC).Results: CHD mortality rates at ages 35–44 years have decreased in both sexes since the 1980s for most countries, except for Russia (130/100,000 men and 24/100,000 women, in 2005–7). The lowest rates (around 9/100,000 men, 2/100,000 women) were in France, Italy and Sweden. In men, the steepest declines in mortality were in the Czech Republic (AAPC = −6.1%), the Netherlands (−5.2%), Poland (−4.5%), and England and Wales...

Journal ArticleDOI
TL;DR: The distribution of blood lipids in this large sample of unselected type 2 diabetic patients challenges the previous conception of diabetic dyslipidemia, and calls for new studies to explain the roles of LDL-C and HDL-C as strong cardiovascular risk factors in type 2 diabetes.
Abstract: Background: Type 2 diabetes and diabetic dyslipidemia are high-risk conditions for cardiovascular disease. However, the description of the distribution of blood lipids in diabetic patients has not been based on population-based surveys. The aim of this study was to describe diabetic dyslipidemia in a large unselected sample of patients from the Swedish National Diabetes Register. Methods: Blood lipid profiles and clinical characteristics in 75,048 type 2 diabetic patients (57% men) were studied. Results: Pronounced hypertriglyceridemia (triglycerides >4.0mmol/l) was seen in 3.4% of the patients. Total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C) and non-HDL-C were generally higher, and LDL-C/HDL-C and Non-HDL-C/HDL-C ratios were lower in women. Mean TC, LDL-C as well as HDL-C values were lower in patients treated with lipid-lowering agents, whereas triglycerides was higher than in the untreated patients. In patients not treated with lipid-lowering agents all blood lipids increased in women and decreased in men (except HDL-C) at higher ages. Patients with LDL-C/HDL-C ratio >= 3 were slightly younger, less frequently used lipid-lowering drugs and had not so often a history of coronary heart disease or stroke. Conclusion: The distribution of blood lipids in this large sample of unselected type 2 diabetic patients challenges the previous conception of diabetic dyslipidemia, and calls for new studies to explain the roles of LDL-C and HDL-C as strong cardiovascular risk factors in type 2 diabetes.

Journal ArticleDOI
TL;DR: RHR is an independent risk marker of mortality but not of incident CHD events in community-dwelling elderly and its routine measurement may help identify those who are at increased risk of mortality in the short term.
Abstract: Objectives: To investigate the association between resting heart rate (RHR) and mortality and incident coronary heart disease (CHD) in the elderly.Methods: Data derived from the Three-City Study, a French multicentre prospective study including 9294 community-dwelling elderly subjects aged ≥65 years at baseline examination between 1999 and 2001. The study population comprised 7147 participants (61% women) who were free of a pacemaker or any cardiac arrhythmias at baseline. RHR was measured twice at baseline in a seated position using an electronic tensiometer. Participants were then followed up bi-annually for vascular morbidity and mortality over 6 years. CHD events and cardiovascular death were adjudicated by an independent expert committee.Results: After 6 years of follow-up, 615 subjects died including 17.9% from cardiovascular causes. Subjects from the top quintile of RHR (>79 bpm) had respectively a 74% (95% CI, 1.3–2.3), a 87% (95% CI: 0.98–3.6, p = 0.06) and a 72% (95% CI, 1.3–2.3) increased risk ...

Journal ArticleDOI
TL;DR: Moderate exercise training increases nitric oxide production of early endothelial progenitor cells and reduces their superoxide production and is associated with a marked beneficial effect on the in vivo endothelial repair capacity of early EPCs in subjects with metabolic syndrome.
Abstract: BACKGROUND: Endothelial dysfunction and injury are considered to contribute considerably to the development and progression of atherosclerosis. It has been suggested that intense exercise training can increase the number and angiogenic properties of early endothelial progenitor cells (EPCs). However, whether exercise training stimulates the capacity of early EPCs to promote repair of endothelial damage and potential underlying mechanisms remain to be determined. The present study was designed to evaluate the effects of moderate exercise training on in vivo endothelial repair capacity of early EPCs, and their nitric oxide and superoxide production as characterized by electron spin resonance spectroscopy analysis in subjects with metabolic syndrome. METHODS AND RESULTS: Twenty-four subjects with metabolic syndrome were randomized to an 8 weeks exercise training or a control group. Superoxide production and nitric oxide (NO) availability of early EPCs were characterized by using electron spin resonance (ESR) spectroscopy analysis. In vivo endothelial repair capacity of EPCs was examined by transplantation into nude mice with defined carotid endothelial injury. Endothelium-dependent, flow-mediated vasodilation was analysed using high-resolution ultrasound. Importantly, exercise training resulted in a substantially improved in vivo endothelial repair capacity of early EPCs (24.0 vs 12.7%; p < 0.05) and improved endothelium-dependent vasodilation. Nitric oxide production of EPCs was substantially increased after exercise training, but not in the control group. Moreover, exercise training reduced superoxide production of EPCs, which was not observed in the control group. CONCLUSIONS: The present study suggests for the first time that moderate exercise training increases nitric oxide production of early endothelial progenitor cells and reduces their superoxide production. Importantly, this is associated with a marked beneficial effect on the in vivo endothelial repair capacity of early EPCs in subjects with metabolic syndrome.