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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 1980 we examined 707 67-year-old men, 656 of whom had no previous myocardial infarction. During 8 years of follow-up, 70 (10.7%) of the 656 men developed a first myocardial infarction or died from coronary heart disease (CHD). The incidence of CHD increased 1.6-fold from the lowest to the highest quintile of cholesterol levels, 2.7-fold from the lowest to the highest quintile of triglyceride levels, and 2.2-fold among those with diabetes. Blood pressure, smoking habits, and two measurements of obesity (body mass index and waist circumference) were not significantly related to the incidence of CHD. In multivariate analysis, serum triglyceride levels and blood glucose concentration remained as significant risk factors for CHD. This may reflect that disturbances in glucose and triglyceride metabolism (as part of a metabolic syndrome?) are more important CHD risk factors in older than in younger men.
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PMID:Triglycerides and blood glucose are the major coronary risk factors in elderly Swedish men. The study of men born in 1913. 134 52

Cardiovascular disease constitutes an expanding problem in the elderly because of the increasing size of the aged population. Atherosclerosis, hypertension, and diabetes are responsible for the predonderance of cardiovascular disease, which causes 70% of all deaths beyond age 75. Coronary heart disease (CHD) is the most common and most lethal cardiovascular event in both sexes, exacting a large toll in disability and deteriorated quality of life in old age. Unrecognized myocardial infarctions are especially common and are as serious as symptomatic infarctions. beyond age 65, women are as vulnerable to cardiovascular death as men. The predisposing modifiable risk factors for coronary disease, stroke, peripheral arterial disease, and cardiac failure are similar in young and old and in men and women. These include hypertension, dyslipidemia, impaired glucose tolerance, physical indolence, and cigarette smoking. An attenuated risk ratio for some risk factors is offset by a greater incidence of cardiovascular events in advanced age so that the attributable risk and the potential benefit of treatment rise with age. Because the major risk factors predict CHD as efficiently in the elderly as in the young, and the decline in cardiovascular mortality has included the elderly, preventive efforts in the elderly may have substantial potential benefit. At advanced age, total cholesterol levels are considerably higher in women than in men. Some 10 million elderly, two-thirds of whom are women, may require investigation and treatment for elevated lipid levels, as determined by National Heart, Lung, and Blood Institute (NHLBI) guidelines. Because of the preponderance of women in the elderly population, trials of the efficacy of correcting risk factors in general, and lipids in particular, should include women.
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PMID:Demographics of the prevalence, incidence, and management of coronary heart disease in the elderly and in women. 134 64

Serum total cholesterol (> or = 6.7 mmol/L) measured in 1960 in the Charleston Heart Study cohort was found to be a risk for mortality from coronary heart disease during the period of 1960 to 1988 in white men (relative risk [RR] 1.5; 95% confidence interval [CI]: 1.1, 2.2), white women (RR 1.7; 95% CI: 1.1, 2.7), and black women (RR 1.6; 95% CI: .9, 2.9) after age, systolic blood pressure, smoking status, education level, obesity, and diabetes were considered. For black men, the relative risk was .96 (95% CI, .39, 2.39). Only among white women was the relative risk (RR 2.4; 95% CI, 1.2, 4.5) increased among those in the older ages (55 to 74) in 1960. The evidence for cholesterol as a risk factor for coronary disease mortality in black men is inconclusive and requires further study.
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PMID:Serum cholesterol--risk factor for coronary disease mortality in younger and older blacks and whites. The Charleston Heart Study, 1960-1988. 134 70

Risk factors for the 12-year incidence of definite coronary heart disease (CHD) among 3440 men who were middle-aged (51 to 59 years old) and 1419 men who were elderly (65 to 74 years old) at baseline examination were examined for differences in predictive values in terms of both relative risk and attributable (excess) risk of the highest versus the lowest quartile or appropriate categories. In multivariate models using Cox life-table regression procedures, serum cholesterol level, cigarette smoking, systolic blood pressure, and history of treatment for diabetes were significant predictors of incident CHD for both age groups. Alcohol consumption when modeled as drinker versus nondrinker showed a protective effect in both younger and older men. There was no dose relationship, however, among elderly drinkers. While the relative risks for the variables studied were similar between the two age groups, the excess risk was typically between 1.5 to 2.0 times higher for the older than the middle-aged men. In contrast, the detrimental effect of adiposity as measured by body mass index appeared to decline after age 65 for both measures of risk. This may partly be attributed to diminished adiposity overall in the older age group. The implications of these results are that serum cholesterol level, smoking, hypertension, diabetes, and possibly alcohol consumption continue to be important predictors for CHD when measured after age 65, and that the public health impact of these risk factors, in terms of excess risk, may be more important in the elderly.
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PMID:Do coronary heart disease risk factors measured in the elderly have the same predictive roles as in the middle aged. Comparisons of relative and attributable risks. 134 78

Mounting data support a causal connection between high-normal fibrinogen levels and atherosclerotic cardiovascular disease. There is clearly a thrombogenic component to atherosclerosis and the onset of clinical manifestations. This offers the possibility to better identify high-risk candidates and also to protect them by reducing blood fibrinogen concentration or blocking its action. The relationship of antecedent fibrinogen to the subsequent development of cardiovascular disease is examined, based on 18 years of surveillance of a cohort of 1274 men and women aged 47 to 79 years who participated in the Framingham Study. The association with the development of peripheral arterial disease and cardiac failure is now examined in addition to previously studied relationships to coronary heart disease and stroke. In men and women, there is a significant age-adjusted relationship of fibrinogen level to coronary heart disease and to cardiovascular disease in general. In women, a significant relationship to cardiac failure and peripheral arterial disease, but not to stroke, was also found. These data on women are unique as they are not available elsewhere. Age-adjusted cardiovascular, all-cause, and coronary heart disease mortality were all related to fibrinogen in both sexes. In men, fibrinogen impact was the greatest for stroke and the least for peripheral arterial disease. For women, the impact on coronary heart disease was greatest. The absolute risk for an elevated fibrinogen level was greatest for coronary heart disease in both sexes. Average fibrinogen values are higher in women and in persons with other risk factors, including hypertension, cigarette smoking, diabetes, obesity, and elevated hematocrit. However, there is an independent contribution of fibrinogen to cardiovascular disease in general and coronary disease in particular, on adjustment for coexistent risk factors. Fibrinogen enhances the risk of cardiovascular disease in hypertensives, diabetics, and cigarette smokers. About half the cardiovascular risk of cigarette smoking appears due to the higher fibrinogen values. Now, five prospective studies document the excess incidence of cardiovascular events in persons with elevated fibrinogen levels within the "normal range." Each standard deviation increase in fibrinogen is associated with a 30% increment of coronary heart disease in men and a 40% increase in women. Fibrinogen should be added to the list of major cardiovascular risk factors. Trials of intervention to lower fibrinogen in high-risk coronary candidates are needed.
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PMID:Update on fibrinogen as a cardiovascular risk factor. 134 96

Cardiovascular risk factors were examined in 453 subjects participating in the Wadena City Health Study, a population-based study to assess the relationship between diabetes and glucose intolerance with age. Each subject was classified as either having non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), or normoglycemia, using WHO criteria. Age- and body-mass-adjusted levels of systolic and diastolic blood pressure were lowest for those with normoglycemia, intermediate for those with IGT, and highest for those with NIDDM. Age- and body-mass-adjusted levels of high-density lipoprotein cholesterol were lowest for those with NIDDM, intermediate for those with IGT, and highest for those with normoglycemia, while triglyceride levels were highest for those with NIDDM, intermediate for those with IGT, and lowest for those with normoglycemia in women but not in men. Low-density lipoprotein cholesterol levels were lowest for those with NIDDM, intermediate for those with IGT, and highest for those with normoglycemia. With the exception of men with IGT, no differences by glycemic strata were observed for plasma total cholesterol. The prevalence of smoking showed no consistent pattern by glycemic status. These findings suggest that individuals with IGT have an atherogenic risk factor pattern that may put them at greater risk for coronary heart disease than those with normoglycemia. Intervention strategies such as diet, exercise, and/or drug therapy should be tested to evaluate whether these are effective in preventing conversion to overt diabetes and normalizing cardiovascular disease risk factors.
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PMID:Cardiovascular disease risk factors and glucose tolerance. The Wadena City Health Study. 134 16

Women, like men, are susceptible to coronary atherosclerosis. Like men, more women die of heart disease than all forms of cancer combined. Coronary atherosclerosis is the result of the interplay of a number of factors, the most important of which are abnormal levels of circulating lipoproteins. As more has become known about the mechanisms by which abnormal levels of circulating lipoproteins promote atherosclerosis, certain risk factors have emerged as concerns for women, including: (1) diabetes mellitus as a risk factor, perhaps through its more profound effects on circulating lipoproteins; (2) serum triglyceride levels, and (3) changes in high-density lipoprotein cholesterol. The widespread use of exogenous hormones in women as both oral contraceptives and postmenopausal hormone replacement may also play a role in developing atherosclerosis. In general, estrogen affects circulating lipoprotein levels favorably, whereas progestins have the opposite effect. The effects of estrogen/progestin combinations in either oral contraceptives or postmenopausal hormone replacement will depend on the relative dose and potency of each of these constituents. Epidemiologic studies indicate that the use of oral contraceptives has no profound effect on the long-term risk of heart disease, whereas unopposed estrogen (without progestin) in postmenopausal hormone replacement therapy may lower that risk considerably. Recent U.S. and European guidelines for the detection, evaluation, and treatment of hypercholesterolemia in adults make it imperative that obstetrician-gynecologists, in their dual role as primary-care physicians and prescribers of exogenous hormones, be aware of and informed about the relationship between circulating lipids and lipoproteins and coronary heart disease in women.
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PMID:Women, lipoproteins, and cardiovascular disease risk. 135 61

Coronary heart disease is the most common cause of death in men and women in developed countries. Three primary risk factors--high serum cholesterol concentration, hypertension, and cigarette smoking--are known to increase the risk in both men and women more or less equally, although the latter two risk factors are a somewhat greater risk to men. This paper reviews two additional risk factors whose impact may be greater in women: diabetes and hypertriglyceridemia. Understanding how diabetes and hypertriglyceridemia act differently in women may explain some of the sex differences in the risk of heart disease.
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PMID:Diabetes mellitus, hypertriglyceridemia, and heart disease risk in women. 135 62

The purpose of this study was to examine the change in apolipoprotein and lipoprotein levels in patients with normolipidemic untreated non-insulin-dependent diabetes mellitus (NIDDM). Fifteen untreated, non-obese male NIDDM patients without hyperlipidemia were chosen, and 15 healthy subjects, matched for age, sex, body weight, alcohol consumption and cigarette smoking served as the control group. We observed that the concentrations of plasma total cholesterol (TC), triacylglycerol (TG) and very low density lipoprotein cholesterol (VLDL-C) were identical in both NIDDM and control groups. The levels of low-density lipoprotein cholesterol (LDL-C) were slightly increased in the diabetic group, but the difference did not reach statistical significance in our study. High-density lipoprotein cholesterol (HDL-C) was lower in the NIDDM group than in the controls. Significantly increased TC/HDL-C and LDL-C/HDL-C ratios were found in NIDDM patients compared with controls. The apolipoprotein A-I (apo A-I) and apolipoprotein A-II (apo A-II) levels were decreased in NIDDM patients, while the apolipoprotein B (apo B) level remained similar to that of the control subjects. The ratio of apo A-I/apo B was decreased significantly in the NIDDM group. Our results suggest that NIDDM patients are at higher risk of coronary heart disease, even if they remain normolipidemic.
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PMID:Apolipoprotein levels in normolipidemic non-insulin-dependent diabetes mellitus. 135 44

Hypertension is a known risk factor in the genesis of coronary artery disease. However, the effect of pre-existing hypertension on the long-term mortality in patients with established coronary heart disease is not clear. The present cohort study analysed the influence of baseline mild to moderate treated hypertension in cases of known coronary heart disease with cardiac mortality as end point. Data from a cohort of 511 patients including 266 normotensives and 245 controlled hypertensives was analysed over a follow-up period of 9 to 11 years. The baseline data were identical regarding other major risk factors like age, gender, smoking, diabetes, cholesterol levels and congestive heart failure on univariate analysis. There were more cases of myocardial infarction in the normotensive group. The number of patients receiving beta-blockers or aspirin were similar in both groups. However, more patients in the hypertensive group received nifedipine. Actuarial analysis of survival showed that mortality was the same in both groups with an overall cardiac mortality of 65 (26.5%) in the hypertensive group and 86 (32.3%) in the normotensive group (P greater than 0.1). The survival curves also showed no significant difference in mortality at any point in time (logrank test = 2.37, P greater than 0.1). Analysis of mortality after adjusting for myocardial infarction at first presentation also showed no significant difference. These data indicate that in patients with coronary heart disease the presence of mild to moderate hypertension does not add to the risk of cardiac mortality.
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PMID:Influence of mild to moderate treated hypertension on 9-11 year mortality in patients with pre-existing coronary heart disease. 135 40


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