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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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 strongest predictors of cardiovascular disease in women have been shown to be diabetes, high blood pressure, cigarette smoking, and, to a lesser degree, hypertriglyceridemia. The difference in risk between men and premenopausal women has been explained by the following widely held hypothesis: androgens lower plasma concentrations of high-density lipoprotein (HDL), particularly the HDL-2 subfraction, and increase plasma concentrations of low-density lipoprotein (LDL). In contrast, estrogens have the opposite effect, raising plasma concentrations of HDL, particularly HDL-2, and lowering plasma concentrations of LDL. After the menopause, it is believed that the protective effect of estrogens in women is lost and the incidence of heart disease rises to equal that in men. This paper provides a brief review of the effect of endogenous and exogenous androgens on lipoprotein metabolism in men and women, and considers the relevance of these findings to the choice of progestogens used in oral contraceptive preparations.
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PMID:Mechanism of action/effects of androgens on lipid metabolism. 135 63

The information explosion characteristic of recent years has presented a series of findings enabling a more effective prevention of ischemic heart disease by controlling low density lipoprotein (LDL) levels of cholesterol. The detection of LDL receptors has provided new information on the mechanisms regulating the level of plasma LDL. Data on competitive inhibitors of endogenous cholesterol synthesis have afforded new possibilities of pharmacological control of LDL levels. Studies of primary prevention of ischemic heart disease have yielded evidence showing that a 1% decrease of cholesterol level reduces coronary risk by 2%. A prospective study of the relationship between cholesterol levels and coronary mortality, absolutely unique as to its extent (368,000 middle-aged men followed up over a period of 6 years) has demonstrated that there is no borderline cholesterol level below which coronary risk would be absolutely excluded. Between total cholesterol level and coronary mortality there is a close, continual and graded relationship. In light of these findings, total cholesterol levels have been reclassified: desirable levels -5.2 x 10(-3) mol.l-1, borderline risk levels under 5.2-6.2 x 10(-3) mol.l-1, and high risk levels--above 6.2 x 10(-3) mol.l-1. In subjects with several risk factors (smoking, hypertension, familial occurrence of heart, heart disease, obesity, diabetes mellitus, HDL cholesterol below 0.9 x 10(-3) mol.l-1) the level of total cholesterol should be brought down below 4 x 10(-3) mol.l-1.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Plasma cholesterol levels and ischemic heart disease: new findings and new approaches]. 139 27

Gypsies in the United States are not a healthy group. They have a high incidence of heart disease, diabetes mellitus, and hypertension. When they seek medical care, Gypsies often come into conflict with medical personnel who find their behavior confusing, demanding, and chaotic. For their part, Gypsies are often suspicious of non-Gypsy people and institutions, viewing them as a source of disease and uncleanliness. Gypsy ideas about health and illness are closely related to notions of good and bad fortune, purity and impurity, and inclusion and exclusion from the group. These basic concepts affect everyday life, including the way Gypsies deal with eating and washing, physicians and hospitals, the diagnosis of illness, shopping around for cures, and coping with birth and death.
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PMID:Gypsies and health care. 141 69

Percutaneous endoscopic gastrostomy (PEG) is used to provide nutrition for patients who are unable to eat but have a functionally intact gut. Clinical guidelines for PEG are uncertain and have been derived mainly from referral practices. We performed a population-based cohort study in 97 residents of Olmsted County, Minnesota, referred for PEG between January 1982 and December 1988 to determine complications, duration of tube feeding, and survival. Follow-up continued until death or February 1990. Inpatient and outpatient records were reviewed to determine indications, comorbid conditions, level of consciousness, and limitations in activities of daily living. Outcomes determined after referral for PEG included type and number of complications, tube removal, and survival. Statistical methods used included Kaplan-Meier and proportional hazards regression analyses. PEG placement was successful in 94% of patients. Although complications occurred in 70% of patients, they usually were minor (88%) and most occurred within 3 months. In 24 patients, tubes were removed because eating was resumed. The probability of surviving 30 days, 1.5 years, and 4 years after referral for PEG was 78%, 35%, and 27%, respectively. The major causes of death within and after 30 days were pneumonia, heart disease, and vascular disease of the central nervous system. An increased risk of death after referral for PEG placement was associated with older age, male gender, diabetes, and specific indications for PEG. If validated in other population-based studies, these predictors of survival after referral for PEG placement could be used to identify patients with a low probability of survival who may not benefit from PEG.
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PMID:Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study. 143 74

Diabetes mellitus is a disease with major long-term implications, not only for the health and well-being of affected individuals, but also for costs to the National Health Service. Treatment of the disease and its complications takes up 4-5% of total health care expenditure in the U.K. These costs are dominated by in-patient care for the complications arising from diabetes. This paper presents a review of studies which have been carried out on the costs of diabetes and its complications. For such a chronic and potentially disabling disease with numerous complications it is surprising that costs have not been more extensively researched. A large amount of data are available about the implications of diabetes in terms of incidence and prevalence, but few costs have been collected, particularly indirect and marginal costs. Both insulin dependent (IDDM) and non-insulin dependent (NIDDM) diabetic patients exhibit similar complications so that the cost of treatment may be comparable, but further studies are needed to establish this. In addition, few studies have included diabetes as a secondary diagnosis. The studies which are available have tended to focus on direct costs, for example, the costs of hospital care, consultations and drugs, because they are the easiest to measure. Fewer studies have included indirect costs, such as the effect of time lost from work, early retirement and premature death, because of the difficulties in assigning monetary values to these factors. The most important contributors to the costs of diabetes are those of treating complications such as eye and limb disease, heart disease, neuropathy and nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The costs of diabetes and its complications. 143 13

A longitudinal study of patients with chronic medical diseases (hypertension, diabetes, heart disease) was conducted to identify antecedents of adherence to medical recommendations. Data are from 1198 patients in three health-care provision systems in Los Angeles, Chicago, and Boston. Nonadherence at the beginning of the study was the strongest predictor of nonadherence 2 years later. Other significant predictors varied by type of adherence outcome. Patients who were younger and who relied upon avoidant coping strategies tended to be less likely to follow their doctor's specific recommendations. Patients who were distressed about their health, used avoidant coping strategies, or who reported worse physical and role functioning were less likely to adhere in general. Patient satisfaction with two features of care (interpersonal quality and financial aspects) was positively related to adherence in some models, but satisfaction with the technical quality of care was negatively associated with adherence to specific recommendations among heart disease patients. Social support contributed to specific adherence among diabetic patients. Implications of the study for medical care providers are discussed.
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PMID:Antecedents of adherence to medical recommendations: results from the Medical Outcomes Study. 144 57

A 62-year-old woman, long suspected of having heart disease, was admitted to our hospital for thorough examination. Her hemoglobin level was 17.7 g/dl and her 2.3-DPG level was 8.90 microM/ml RBC. The patient proved to have polycythemia, hemoglobin Kansas, and diabetes mellitus. To our knowledge, this is the third case of hemoglobin Kansas in the world.
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PMID:Hemoglobin Kansas found in a patient with polycythemia. 145 81

The extent to which hemodialysis patients rely on nephrologists for primary medical care is unknown. The authors surveyed 74 in-center hemodialysis patients to obtain demographic data and information about primary medical care and subspecialty referrals and follow-up. Health care maintenance was also assessed. All patients were dialyzed in a free-standing university affiliated dialysis unit. The mean age of the patients was 55 +/- 17 years; most were women (43/74) and on hemodialysis more than 3 years (48/74). Most of the patients did not have a family physician and relied on the nephrologist for health maintenance care (80%) and the treatment of minor acute illnesses (91%). The most common non-renal chronic illnesses were gastrointestinal disease (32%), heart disease (26%), and diabetes (26%). Although referrals to subspecialists occurred in 55% of patients during the preceding year, nephrologists usually provided ongoing management care (gastrointestinal disease 21/24, heart disease 10/19, diabetes 12/19). Over half the women had a Papanicolaou's test within 3 years and 72% had a routine mammogram that, in most cases, had been ordered by the nurse practitioner or nephrologist. Because nephrologists provide primary medical care to the majority of dialysis patients, preventive health care protocols, such as mammography and cancer screening, should be incorporated into the nephrology practice in chronic dialysis units.
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PMID:Patients on hemodialysis rely on nephrologists and dialysis units for maintenance health care. 145 65


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