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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The relationship between cardiovascular event rate (stroke + coronary events), entry blood pressure (BP), change in BP over 6 months, and other variables was examined in the 8,654 placebo-treated patients in the Medical Research Council (MRC) trial. Entry BP was greater than screening pressures and fell significantly after randomization to placebo. The entry pressure was significantly greater but the fall after entry was less in those who had a cardiovascular event during 5.5 years of follow-up. Thus, patients with high entry pressure that remained elevated during follow-up had the highest event rates. This pattern was marked for stroke but was also found for coronary events. Other variables strongly related to event occurrence were sex, age, and smoking habit. Discriminant analysis based on these variables correctly identified 67% of those who had an event but incorrectly classified 40% of the much larger group who did not. These results suggest that failure of BP to fall after screening examinations is a cardiovascular risk factor. Thus, high-risk patients may be identified by repeated measurements of BP before treatment is started.
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PMID:Blood pressure, change in blood pressure, and cardiovascular event rates in placebo-treated patients in the Medical Research Council Trial. 170 37

Cardiovascular risk factors can be substantially modified by changes in life-style such as diet, exercise, smoking cessation, and moderation of alcohol consumption. In turn, these can reduce blood pressure, heart rate at rest, and blood lipid concentrations. Epidemiologic evidence shows that for every 1% change in serum cholesterol levels, there is a 3% change in the likelihood of developing coronary heart disease. In addition, a long-term (5-year) change of 5 to 6 mm Hg in diastolic blood pressure can reduce the chances of stroke by 35 to 40% and of coronary heart disease by 20 to 25%. The full impact of this broad range of interventions on population health has still to be fully realized in many countries, including the United Kingdom, however it is likely to be considerable. Some of the recent evidence in support of such cardiovascular risk factor modification is selectively reviewed.
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PMID:Cardiovascular risk factors and the effects of intervention. 199 32

This paper examines the level of cardiovascular risk knowledge in the general population and the relationship between such knowledge and behavior. The following questions are addressed: (1) How informed is the general population about what persons can do to reduce their risk of cardiovascular disease? (2) How do sociodemographic factors, self-perceptions of health, and cardiovascular risk factors relate to knowledge? (3) Is there a relationship between knowledge and behavior? (4) What might explain apparent inconsistencies between knowledge and behavior? The data used in this paper derive from a random sample of 732 men and women form the greater Boston area. We assessed cardiovascular risk factor knowledge by asking respondents what specific steps a person could take to make a heart attack or stroke less likely. Risk factors (including physiological measures), sociodemographic factors, and self-perceptions of health also were measured. Results showed that respondents were most knowledgeable about the relationships of exercise and cholesterol to heart disease. Knowledge was related positively to education, being female, and exercising. When we compared knowledge with behavior, results showed that for smokers and those who were overweight, risk was related to awareness, thus suggesting that knowledge does not lead necessarily to risk-reducing behavior. Implications of these results in terms of education and prevention are discussed.
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PMID:Is cardiovascular risk factor knowledge sufficient to influence behavior? 239 37

The incidence of hypertension increases with ageing, and one-third of the elderly population is affected. The role of hypertension as a cardiovascular risk factor has been confirmed in the elderly by the incidence of stroke and myocardial infarction. Effective treatment of hypertension significantly reduces the risk of associated complications: cardiovascular death, congestive heart failure and stroke. There are numerous secondary effects of antihypertensive treatment and the prescription and monitoring of treatment should take into account potential effects specific to elderly patients.
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PMID:Guidelines for treating hypertension in the elderly. 268 95

The incidence of definite hypertension increases with advancement of age, and one third of the elderly population is affected. Isolated systolic hypertension is frequent in this population (10 to 12 percent in subjects between 65 and 74 years of age). The role of hypertension as a cardiovascular risk factor has been confirmed in the elderly population by the increase in cerebrovascular accidents, and by the incidence of myocardial infarction with the rise in blood pressure. The relationship between elevated diastolic and systolic blood pressure and mortality rates in the elderly is also well documented (Framingham). Effective treatment of hypertension significantly reduces the risk of associated complications: cardiovascular death, congestive heart failure, and stroke. However, the goal of antihypertensive therapy in the elderly should be not only to reduce morbidity and mortality rates, but also to do so without adverse effects on the functional well-being of patients.
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PMID:Hypertension in the elderly. 327 24

In the longitudinal Schwabing study, unselected insulin-treated diabetic patients were followed for major vascular complication (MVC) (stroke, myocardial infarction, gangrene) and asymptomatic, early detectable peripheral vascular disease (PVD). In the group of insulin-treated NIDDM multiple logistic regression analysis revealed the number of daily injected insulin units as a significant predictor for MVC and PVD (t = 1.98; p less than 0.04; x +/- S.D.: PVD yes 57.6 +/- 21.4 U/d; PVD no 44.3 +/- 17.7; age-adjusted univariate p less than 0.001). Daily insulin dose correlated highly significantly with serum triglycerides (r = 0.40, p less than 0.001) as well as with blood glucose (r = 0.33, p less than 0.001). These data suggest that insulin resistance is characteristic for atherosclerotic disease in NIDDM and the hyperinsulinemia-hypertriglyceridemia-syndrome might be a powerful cardiovascular risk factor in diabetes mellitus.
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PMID:Daily insulin dose as a predictor of macrovascular disease in insulin treated non-insulin-dependent diabetics. 330 65

During the tenth biennial examination of the Framingham Study, 1315 participants who were free of cardiovascular disease had fibrinogen levels measured. During the ensuing 12 years, cardiovascular disease developed in 165 men and 147 women. For both sexes, the risk of cardiovascular disease was correlated positively to antecedent fibrinogen values higher than the 1.3 to 7.0 g/L (126 to 696 mg/dL) range. The magnitude of the risk diminished with advancing age in women but not in men. Risk for coronary heart disease also was significantly related to fibrinogen level. Here, the magnitude of risk displayed diminishing impact with age, again only in women. Risk of stroke increased progressively with fibrinogen level in men but not in women. The impact of fibrinogen value, considered as a separate variable, on cardiovascular disease was comparable with the major risk factors, such as blood pressure, hematocrit, adiposity, cigarette smoking, and diabetes. Fibrinogen values were also significantly related to these risk factors. Taking all these into account in a multivariate analysis, fibrinogen level was still significantly related to the incidence of cardiovascular disease in men and marginally significant in women. For coronary heart disease, the fibrinogen level was significant for both men and women. Elevated fibrinogen level is a predictor of cardiovascular disease that should be added to the cardiovascular risk factor profile.
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PMID:Fibrinogen and risk of cardiovascular disease. The Framingham Study. 362 1

In the Whitehall study of 18 403 male civil servants aged 40-64 years the 10 year mortality rates from coronary heart disease and stroke showed a non-linear relation to two hour blood glucose values, with a significantly increased risk for glucose intolerant subjects with concentrations above the 95th centile point (5.4-11.0 mmol/l; 96-199 mg/100 ml) and for diabetics (blood glucose greater than or equal to 11.1 mmol/l; greater than or equal to 200 mg/100 ml). Multiple logistic analysis showed that between one half and three quarters of the relative risks for deaths from coronary heart disease and stroke were "unexplained" by between group differences in risk factors such as age, blood pressure, obesity, smoking, cholesterol concentration, and electrocardiographic abnormalities. Within the glucose intolerant and diabetic groups the risk factors most strongly related to subsequent death from coronary heart disease were age and blood pressure, with less consistent relations for smoking, cholesterol concentration, and obesity. This study confirms the importance of hypertension as a cardiovascular risk factor in groups with glucose intolerance and diabetes, and this may have important preventive implications.
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PMID:Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall study. 641 62

Marital status and indices of social support are associated with mortality due to coronary heart disease and stroke. This association seems not entirely due to differences in recognised cardiovascular disease risk factors. The Western Sydney Stroke risk in the Elderly Study examined the relationship between marital status, living arrangements, widowhood and extent of social support, and risk factors for cardiovascular disease in men and women aged over 65 years. Unmarried men had the lowest mean HDL-C levels. Men living alone had the highest mean systolic blood pressures. The lower mean HDL-C levels and higher DBP levels seen among widows were not statistically significant after adjustment for differences in past medical history and education levels. The extent of social support was not associated with any significant differences in cardiovascular risk factor levels among men or women. We conclude that some of the increased risk of cardiovascular disease associated with socio-demographic factors among men in this age-group may be due to differences in primary cardiovascular disease risk factors. However, some of the mechanisms underlying risk of cardiovascular disease in this age-group remains obscure.
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PMID:Social support, marital status and living arrangement correlates of cardiovascular disease risk factors in the elderly. 774 15

Seven prospective, epidemiological studies indicate plasma fibrinogen levels (over 300-350 mg/dl) as an important, independent cardiovascular risk factor for subsequent myocardial infarction and stroke. Furthermore, several clinical studies revealed an association between fibrinogen and both the angiographic and clinical degree of coronary heart disease. In addition, a significant relation of fibrinogen with the number of occluded coronary vessels was found. The following pathophysiologic mechanism are of particular importance: Fibrinogen is a main determinant of plasma viscosity and red cell aggregation. Both phenomena deteriorate blood fluidity especially in the microcirculation. Fibrinogen plays a central role in platelet aggregation and performs an essential substrate in the coagulation cascade. Thus, high fibrinogen levels may favor a hypercoagulable state resulting in final thrombotic events of cardiovascular disease. Fibrinogen is also involved in atherogenesis by stimulating proliferation and migration of smooth muscle cells. Several determinants of fibrinogen levels are known. Smoking is the strongest one in healthy persons. This clinically important effect is dose related. Consequently, cessation of smoking is a major step to lower fibrinogen and subsequently the individual cardiovascular risk. Reduction of overweight and maintenance of regular physical activity are further nonpharmacologic means. Fibrates decrease fibrinogen about 10-30% on an average. Finally, intermittent low-dose Urokinase for end-stages of coronary artery disease and LDL-apheresis (HELP) represent additional approaches to reduce fibrinogen.
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PMID:[Clinical significance of the cardiovascular risk factor fibrinogen in secondary prevention]. 776 17


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