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

CHD is the number one killer of men and women. Men and women need to be educated about the warning symptoms of CHD and MI to assist in earlier diagnosis and treatment. Women need to be taught about the variety of factors that may affect their risk for CHD. All women should be counseled about the importance of primary and secondary prevention, as those with low probability of disease may some day have some form of cardiovascular illness, and those with high probability of disease may prevent or lessen the effects from an infarction. The Women's Health Initiative (WHI) is a study that may answer many of the unresolved questions about women and MI. The WHI was established by the National Institutes of Health (NIH) in 1993 to address negligence of women's health by the major federal research agencies. It is the largest study ever funded by NIH. Forty centers throughout the United States will follow 163,000 women for a 10-year-period to determine how to prevent heart disease, breast and colon cancer, and osteoporosis in postmenopausal women. The age range of women is from 50 to 79 years old. This study will have a major impact upon care of women for these varied conditions. While waiting for the answers to questions about treatment and prevention, we must use what information is available to us now. Women report for care later than men and often do not receive the same therapies and treatments, thus we need to become advocates for the female patient. We need to also assess the social support and caregiver availability that women have at home. If the situation is inadequate then community resources need to be accessed. In addition, follow-up care is essential. Because many women have complications of CHF and shock with their infarcts, we need to assure adequate follow-up. Transportation for the follow-up may also need to be provided or arranged since women's caregivers may be unable to drive their spouses to the doctor's office. Also, single, older women may be unable to use public transportation with ease. We can address the needs of the female population with CHD if we make a thorough assessment and individualize their plan of care. In today's world of health care, meeting an individual's needs is an ongoing challenge because the length of stay is shortened and resources are tighter. Creativity is often needed to adequately meet the assessed needs. In the future, MI may not be the number one killer of women. Preventing the onset of the disease or decreasing the risk of a reinfarction by empowering women may have an impact. It is hoped that the information given in this article could help the health care worker educate and empower women about this disease.
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PMID:Myocardial infarction. The number one killer of women. 944 72

This study presents findings from an updated retrospective cohort mortality study of male police officers from January 1, 1950 to December 31, 1990 (n = 2,593; 58,474 person-years; 98% follow-up). Significantly higher than expected mortality rates were found for all cause mortality (Standardized mortality ratio [SMR] = 110; 95% confidence interval [95% CI] = 1.04-1.17), all malignant neoplasms (SMR = 125; 95% CI = 1.10-1.41), cancer of the esophagus (SMR = 213; 95% CI = 1.01-3.91), cancer of the colon (SMR = 187; 95% CI = 1.29-2.59), cancer of the kidney (SMR = 2.08, 95% CI = 100-3.82), Hodgkin's disease (SMR = 313; 95% CI = 1.01-7.29), cirrhosis of the liver (SMR = 150; 95% CI = 1.00-2.16), and suicide (SMR = 153; 95% CI = 1.00-2.24). All accidents were significantly lower (SMR = 53; 95% CI = 0.34-0.79). Mortality by years of police service showed higher than expected rates for (1) all malignant neoplasms in the 1- to 9-years-of-service group; (2) all causes, bladder cancer, leukemia, and arteriosclerotic heart disease in the 10 to 19-year group; and (3) colon cancer and cirrhosis of the liver in the over 30 years of service group. Hypotheses for findings are discussed.
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PMID:Mortality of a police cohort: 1950-1990. 951 43

Health objectives, developed by the United States Department of Health and Human Services, were published recently in the document entitled Healthy People 2000: National Health Promotion and Disease Prevention Objectives. They were developed to guide national and local health policy toward actions to increase the health of the nation. To effectively apply these objectives locally, epidemiologists and health planners must work together. Through collaboration, the Healthy People 2000 objectives can be prioritized to guide health policy and planning on a regional basis. The purpose of this study was to assess certain health status indicators in southwestern Pennsylvania to determine whether it was likely that the year 2000 targets would be met if trends from the past 20 years were to continue. The following mortality rates were analyzed: heart disease, homicide, breast cancer, colon cancer, lung cancer, suicide, motor vehicle accidents, work-related injury, and infant mortality. In addition, incidence of the following diseases was evaluated against the year 2000 targets: gonorrhea, primary and secondary syphilis, measles, tuberculosis, and AIDS. By employing epidemiological principles and considering strategic planning needs, it is possible to prioritize some of the health care needs in local areas for the next decade.
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PMID:Epidemiologic indicators of health status to guide health care management decision making. 1013 Feb 41

In the past few decades, increasing concern about the role of diet in the aetiology of diseases such as heart disease and certain cancers, including colon cancer and the hormone-related cancers, has led to a number of studies assessing the role of various food components. Many of these studies, particularly those in the 1970s and 1980s looked at individual foods or nutrients without assessing their role in relation to other dietary components. Thus the role of red meat was often examined in isolation from energy, fat or fibre intake or from consumption of other food groups such as vegetables or fruit. Epidemiological studies of the dietary aetiology of colon cancer have been undertaken in a number of communities with varying meat and dietary intake profiles and with varying results. To provide background information for an assessment of the potential role of red meat consumption in the aetiology of colon cancer in the Australian context, an analysis of current consumption patterns of red meat in the population was undertaken. The results show that red meat consumption, which had been falling since the 1970s, continued to decline in Australia at a time when colon cancer rates were rising. Red meat intake in 1995/6 averaged 88 g a day for men and 45 g a day for women and was contributing less than one-fifth of the dietary fat and saturated fat in the Australian diet. Those with the highest intakes of red meat on the day of the survey had intakes of vegetables and fruits closer to those of non-red meat eaters, with the low-to-moderate red meat consumers having the lower intakes of fruits and vegetables.
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PMID:Red meat consumption in Australia: intakes, contributions to nutrient intake and associated dietary patterns. 1044 46

HRT provides both prevention and treatment of osteoporosis. HRT is most likely beneficial in primary prevention of heart disease, and may have a role in preventing Alzheimer's disease and colon cancer. Prospective trials, such as the Women's Health Initiative, are needed to substantiate both benefits and risks. Decisions regarding HRT, as well as nonhormonal regimens, should be individualized.
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PMID:Benefits and challenges of hormone replacement therapy. 1102 58

Though the first choice of treatment for liver metastasis in colon cancer is surgical resection of liver, 30-60% of such patients experience a recurrence of liver metastasis. Even if reoperation is done optimally, the surgical resection of liver metastasis may not be a definitely curative treatment. For cases of liver metastasis from colon cancer that are non-resectable due to multiple liver metastases, other organ metastases (lung, bone, brain etc.), the advanced age of the patient, or other complications (cerebrovascular disease, diabetes mellitus, heart disease etc.), hepatic arterial infusion or systemic combination chemotherapies are selected. In the present paper, we report 3 cases of effective systemic chemotherapy utilizing CPT-11 for liver metastases from colon cancers. The method was UFT + irinotecan (CPT-11), cisplatin (CDDP) + tegafur + CPT-11, UFT + CPT-11 + etoposide (ETP) + pirarubicin (THP). The result obtained was a partial response (PR) in each case. As there were few adverse effects, we could provide treatment during a short-term admission or an outpatient basis. We thus obtained good post-chemotherapeutic QOL, and these regimens may be effective forms of chemotherapies in the future.
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PMID:[Three cases of liver metastasis of colon cancer responding to systemic combination chemotherapy utilizing CPT-11]. 1114 72

We tested the effects of feeding a diet very high in fiber from fruit and vegetables. The levels fed were those, which had originally inspired the dietary fiber hypothesis related to colon cancer and heart disease prevention and also may have been eaten early in human evolution. Ten healthy volunteers each took 3 metabolic diets of 2 weeks duration. The diets were: high-vegetable, fruit, and nut (very-high-fiber, 55 g/1,000 kcal); starch-based containing cereals and legumes (early agricultural diet); or low-fat (contemporary therapeutic diet). All diets were intended to be weight-maintaining (mean intake, 2,577 kcal/d). Compared with the starch-based and low-fat diets, the high-fiber vegetable diet resulted in the largest reduction in low-density lipoprotein (LDL) cholesterol (33% +/- 4%, P <.001) and the greatest fecal bile acid output (1.13 +/- 0.30 g/d, P =.002), fecal bulk (906 +/- 130 g/d, P <.001), and fecal short-chain fatty acid outputs (78 +/- 13 mmol/d, P <.001). Nevertheless, due to the increase in fecal bulk, the actual concentrations of fecal bile acids were lowest on the vegetable diet (1.2 mg/g wet weight, P =.002). Maximum lipid reductions occurred within 1 week. Urinary mevalonic acid excretion increased (P =.036) on the high-vegetable diet reflecting large fecal steroid losses. We conclude that very high-vegetable fiber intakes reduce risk factors for cardiovascular disease and possibly colon cancer. Vegetable and fruit fibers therefore warrant further detailed investigation.
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PMID:Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. 1128 49

High-fat diet has been associated with conditions such as heart disease and colon cancer. Is there a link between high-fat diet and prostate cancer? The summation of an abbreviated literature search strives to answer this question.
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PMID:High-fat diet and prostate cancer: the controversial connection. 1199 40

The results of the Women's Health Initiative's (WHI) large prospective randomized controlled study on the benefits and risks of combined hormone replacement therapy (HRT) have been reported earlier than expected, due to the findings of a small excess in cases of breast cancer, myocardial infarction, cerebrovascular accident, and venous thrombosis, in conjunction with a slight diminution of the number of cases of bone fracture and colon cancer. These results were obtained in a population of women with a mean age of 63 +/- 7 years, many of whom were already presenting relative risks of diseases at randomization. The results provide the best evidence available at present on HRT for prevention of heart disease, and indicate that combined HRT is not indicated for this purpose in the studied population, thus contradicting the reported beneficial effects of HRT on coronary heart disease (CHD) in previous observational studies. Some comments need to be made, particularly with regard to the relevance of the WHI study results to the traditional use of HRT at the beginning of menopause. The results, obtained from a population having a wide age range (50 to 79 years), with only 33% being between the ages of 50 and 59, taking 0.625 mg/day conjugated equine estrogens combined with 2.5 mg/day medroxyprogesterone acetate or placebo, are presented without stratification according to the various decades. Further, 73.9% of the women never took HRT before entering the study; rather, they began HRT several years after menopause. Thus, the age distribution and late start of HRT in the women in the WHI study do not correspond to the traditional use of HRT. The studied population presented numerous risks of diseases related to aging, in particular cardiovascular disease. Except for venous thrombosis, the confidence intervals for outcomes are near the limit of statistical significance, which disappears after adjustment. The accrual of breast cancer cases appearing during the fourth year of observation is similar to that found in previous studies, and remains inferior to the increases related to lifestyle factors reported in other studies. The overall results are being applied to women aged 50 to 60 without specific data for this age group, who are usually considered to be at no or low risk for the traditional use of HRT. There are no data to compare the various formulations actually approved as class labelling (estrogens or estradiol associated or not with a progestin or natural progesterone by the oral or transdermal route) in the various outcomes of the WHI study. Results of the ongoing WHI study on estrogen alone will have to be considered when they become available. The results of the WHI study do not put into question the validity of prescribing combined HRT in early menopause. They are likely to modify somewhat the recommendations of published consensus cautioning the use of HRT. HRT remains an effective and safe intervention when it is prescribed to palliate the signs and symptoms related to estrogen deficiency, mainly in women soon after menopause, but also in women presenting risk factors for osteoporosis but without actual risk factors of cardiovascular disease and without a family history of breast cancer. New mid-term and long-term randomized studies need to be conducted on women starting various formulations of HRT before the age of 60, to evaluate their impact on risk factors and events of cardiovascular disease.
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PMID:The relevance of the Women's Health Initiative results on combined hormone replacement therapy in clinical practice. 1236 Mar 60

The Women's Health Initiative (WHI) is sponsored by the NIH. The study focuses on risk and benefits of strategies that could potentially reduce the incidence of heart disease, breast and colon cancer, and fractures in postmenopausal women. One arm of the study, a double-blind, placebo-controlled trial, looking at the effects of continuous combined estrogen-progestin regimen was stopped prematurely based on health risks which exceeded health benefits. The main reason for this decision was the increase in risk of invasive breast cancer, as well as a slight increase in the rate of myocardial infarction and stroke. In this paper, we inform our colleagues of the detailed results of the study. We comment on its limitation and discuss the new original observations. Finally, we integrate the others to previous world literature data that are confirmed by the WHI study. It is important for the individual prescribing practitioner to issue practical conclusions and therapeutic recommendations. The department of Obstetrics and Gynaecologic of the University of Liege, in agreement with the European Menopause Society and the International Menopause Society, is convinced that there is no alternative to the hormone replacement therapy for menopausal symptoms. We should stick to the traditional indications for hormones, namely vasomotor symptoms and osteoporosis. We should continue to recommend hormones for symptomatic women. One should realize that the risk for breast cancer appears only after several years of use, and the risk for cardiovascular events below age 60 is very small (the age of the patients was 63 at inclusion in the WHI study). We should encourage women to take the necessary measures for routine, periodic breast examinations (both manual, echographic and radiographic). Women who use HRT for more than 5 years should discuss the latest data of the WHI study with their physician, in order to consider their individual benefit-risk equation. Those who feel good on hormones and are fully satisfied with this treatment should learn of possible harm after long-term use. It is important to take into account the importance of quality of life. We should leave to the patient the final decision whether or not to continue the treatment. It is presently impossible to decide whether other estroprogestin associations, other administration routes and other molecules such as estradiol, natural progesterone or other progestins, SERMS and Tibolone could have an impact very different from that of the estroprogestin combination used in the WHI study. It is the duty of every physician to decide, from the complex epidemiological data obtained in the aged women (63-68 years) with a high cardiovascular risk in the WHI study, if it is possible or not in each individual case to recommend the initiation or pursue of an hormone replacement therapy.
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PMID:[Clinical study of the month. Benefit/risk balance of postmenopausal estrogen-progestin treatment in peril in the Women's Health Initiative study: practical attitude of the clinician]. 1240 30


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