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In summary, coronary heart disease is an equal opportunity killer for women and thus requires the equal application of preventive interventions. Areas to be highlighted include intensive coronary risk reduction for diabetic women of all ages, because these are women at high risk. Smoking cessation has high priority both for healthy women and for women with defined coronary disease. Emphasis should also be placed on weight reduction in overweight women as a means of lessening hypertension, glucose intolerance, hyperlipidemia, and the like. Hypertension control likely imparts greater stroke than coronary benefit for women, based on available data. There is substantial evidence that moderate-intensity leisure exercise, as a means of imparting physical fitness, has widespread and powerful survival benefits. The efficacy of lipid-lowering interventions has been less extensively documented in the literature, although the extent of cholesterol lowering and resultant decline in rates of coronary heart disease were often comparable for women and men. Finally, postmenopausal hormone therapy appears a promising approach to addressing a risk attribute unique to women; however, definitive recommendations must await the result of ongoing clinical trials, both in healthy women and in women with coronary heart disease.
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PMID:Preventive coronary interventions for women. 877 44

Obesity, a major health problem in industrialized societies, is associated with a high incidence of cardiovascular complications such as hypertension, ischemic heart disease and stroke. However, the underlying mechanism relating obesity and these cardiovascular events is not clear. In lean subjects even slight elevations in plasma insulin concentration exert marked effects on the cardiovascular system, and these effects are directly related to insulin (rather than to insulin-induced stimulation of intermediary metabolism). Moreover, insulin's vascular effects are mediated both by the sympathetic nervous system and the L-arginine nitric oxide pathway. Obesity is characterized by sustained sympathetic activation (possibly related to chronic hyperinsulinemia) and an impaired vasodilator responsiveness to insulin. Although, undoubtedly many factors contribute to the increased incidence of cardiovascular complications in overweight subjects, sympathetic activation could be one important mechanism and either trigger acute events or--possibly in conjunction with an impairment in insulin-induced vasodilation--contribute to sustained elevation of arterial pressure.
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PMID:Body fat and sympathetic nerve activity. 882 43

A sample of 861 Roman children, aged 7 to 14 years, was investigated in order to evaluate the association between some cardiovascular risk factors such as high systolic (SBP) and diastolic (DBP) blood pressure levels, body mass index (BMI), arm fat area (AFA) and a history of diabetes, stroke, angina pectoris, myocardial infarction, hypertension and overweight in their parents. The sample investigated was subdivided into three subgroups, based on whether the children had just one parent, both parents or no parent with a positive history. For all the variables considered, the highest values were found in the group of children with a positive history for both parents and the lowest ones in children with a negative history for both parents. The analysis of significance, based on the mean values for the three groups, revealed statistically significant differences for SBP, DBP, BMI and AFA between the group of children with a positive history for both parents and that of children with a negative history for both parents. Significant differences also emerged for DBP, BMI and AFA between the mean values of children positive for one parent and those negative for both parents and for BMI and AFA between the means of children positive for one parent and those positive for both parents. The odds ratio of high systolic and/or diastolic BP, BMI and AFA levels was consistently higher in children with one or two parents with a positive history compared to children with both parents with a negative history, and even higher considering only children with both parents with a positive history vs children with both parents with a negative history.
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PMID:Family history of cardiovascular diseases and risk factors in children. 887 39

Experts agree that overweight and obesity pose a significant public health problem in the United States. Obesity is considered to be a complex, multifactorial disease involving genetics, physiology, psychology, and environment, and is influenced by cultural messages. Comorbidities linked to obesity include coronary heart disease, stroke, hypertension, diabetes mellitus, gout, dyslipidemias, cholecystitis, and gallstones. Pharmacists can help patients with dietary goals by understanding sound principles of weight management.
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PMID:Nonpharmacologic treatment of obesity. 895 51

The strong and consistent relationship observed between body weight and blood pressure develops early in life, and overweight/obesity in adult life is a good predictor of hypertension. Weight reduction leads to a decrease in blood pressure and prevention of weight increase lowers the incidence of hypertension, but obesity is not necessarily the direct cause of raised blood pressure. Obesity is not established as an independent risk factor for stroke beyond its association with other risk factors. Obesity is a relatively weak risk factor for coronary heart disease (CHD) but it is closely associated with almost all other coronary risk factors. Thus, becoming obese on a Western high fat diet, with development of excess central fat, promotes atherogenesis through a wide range of biochemical and hormonal parameters, including insulin sensitivity. The obesity-CHD relationship is further confused by the weight loss associated with smoking and smoking-related disease, and is confounded by risk factors that accompany the development and maintenance of obesity. Weight loss in middle-aged populations does not apparently lower CHD incidence, possibly because of lack of specificity in methods of weight reduction. Irrespective of the mechanisms involved, early prevention of atherogenic weight gain in young adulthood is an important public health goal towards the control of hypertension and CHD.
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PMID:Obesity and cardiovascular disease. 901 76

The purpose of the present study was to delineate a health profile of professional Danish army personnel. Two-hundred twenty officers, noncommissioned officers, and gunners on active duty at Varde Barracks, housing the South Jutland Artillery Regiment and the Danish Army Artillery School, were asked about their physical and psychological health, interpersonal relations, and working conditions as well as their dietary, drinking, and smoking habits. Measurements were made of resting pulse rate, blood pressure, height, weight, waist and hip girth, and pulmonary function. The ratio of waist-to-hip girth and body mass index (BMI) were calculated. Psychological well-being was evaluated using the 12-item version of the General Health Questionnaire (GHQ). Psychosomatic symptoms were frequently reported, but very few of those surveyed appeared to have psychiatric disorders as measured by the GHQ. Also, somatic health problems were frequently reported, the most frequent being lower-back pain, mild chest pain, and sensory disorders. Differences in interpretation and reporting of "lasting health problems" may explain the relatively high score for this question. The interpersonal relations, both upward and downward in the hierarchy rank order, received high scores. Compared with the general population, alcohol consumption was very low, whereas smoking-in particular heavy smoking-was much more frequent among professional Danish army personnel. Lung function testing showed significantly poorer mean values of forced expiratory volume in 1st second of expiration and mean forced expiratory flow 25 to 75% of forced vital capacity among smokers compared with nonsmokers, although the mean values for the whole group of both smokers and nonsmokers were well above reference values for all lung function parameters. The frequency of moderately overweight individuals (25 < BMI < or = 30) was significantly higher among the male army personnel than in the general population, whereas this was not the case for obesity (BMI > 30). Abdominal obesity, regarded as an independent risk factor for the development of ischemic heart disease, stroke, diabetes, hypertension, and all-cause mortality, was present in 5%, and 3% belonged to the highest-risk group by having a low BMI as well as abdominal obesity.
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PMID:Health profile of Danish army personnel. 918 68

Cardiovascular disease (CVD), including coronary heart disease, stroke, and hypertensive disease, is the leading cause of death in Louisiana and in the United States and, in 1994, accounted for 43.7% and 45.2% of all deaths among persons aged > or = 45 years in Louisiana and in the United States, respectively. The primary risk factors for CVD are hypertension, high cholesterol, diabetes, overweight, cigarette smoking, and physical inactivity. The first four of these risk factors may cluster in some persons and have been identified as components of a syndrome known as metabolic cardiovascular syndrome (1) or the "deadly quartet" (2). This syndrome is characterized by a persistent state of insulin resistance and compensatory hyperinsulinemia that may be etiologically related to the four risk factors. Persons with one of the four risk factors are at increased risk for having any of the other three (3). To determine the prevalence of risk-factor clustering among older residents of Louisiana, CDC analyzed data from the 1991, 1992, 1993, and 1995 Louisiana Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of this analysis, which documented a prevalence of clustering of the four risk factors among 1.7% of the respondents aged > or = 45 years.
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PMID:Prevalence of cardiovascular disease risk-factor clustering among persons aged > or = 45 years--Louisiana, 1991-1995. 921 69

Stroke mortality rates in Spain are one of the highest in all of Europe. At the same time, the Murcia region (south-east Spain) shows, for both genders, the highest age-adjusted stroke mortality rates in all of Spain. The earliest available hypertension figure estimations for this area go back to 1981, when a high prevalence combined with an almost nonexistent control was detected. One decade later, updated prevalence estimations of hypertension are presented jointly with their degree of control and their association with other risk factors based on the results of a prevalence survey in a random population sample (n = 3,091). Arterial blood pressure was measured following the MONICA protocol, maintaining a tight quality control on between and within-observer variability. As hypertensive was considered any person with systolic blood pressure (SBP) > or = 140 mmHg or with diastolic blood pressure (DBP) > or = 90 mmHg or with antihypertensive pharmacological treatment. Detected prevalence rises to 32.3% (CI 95%: 29.1%-35.5%) among males and to 23.7% (CI 95%: 21.4%-26%) among females, maintaining its level regarding figures observed back in 1981. However, its control has been increased, especially among hypertensive women [from less than 5% in 1981 to 35% (95% CI: 32%-37.8%) at present]. Hypertension is strongly associated to hipercholesterolemia, overweight, obesity and diabetes (p < 0.01). On the contrary, it shows an opposite association with current smoking, higher educational level and leisure time physical activity (p < 0.01). The highest educational level was associated with better hypertension treatment and control. In summary, while hypertension prevalence is stabilized in our population, its control has improved in a measurable but still insufficient way. These results are in accordance with a decreasing trend in stroke mortality registered in the Murcia Region along the last decade.
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PMID:Prevalence and control of arterial hypertension in the south-east of Spain: a radical but still insufficient improvement. 925 29

High blood pressure is associated with increased risk of developing coronary heart disease, stroke, peripheral vascular disease and congestive heart failure. The risk of cardiovascular disease mortality increases progressively with incremental increases in blood pressure from the optimal level od less than 120/80 mm Hg to highest levels. Many observations nad clinical trials have demonstrated that a reduction of just a few mm Hg for everyone could produce cardiovascular benefit. Several non-pharmacological interventions are recommended in primary prevention of hypertension. Reduction of weight in overweight patients, reduction of sodium chloride intake to no more than 5 g a day, reduction of alcohol consumption to no more than 30 g ethanol a day and regular mild exercise in sedentary subjects are effective in lowering blood pressure and can also reduce other risk factors for premature coronary heart disease.
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PMID:[Nonpharmacologic treatment of hypertension]. 948 Jan 86

Cardiovascular disease (CVD), the leading cause of death in the United States, caused 960,592 deaths in 1995 (41.5% of all deaths). Approximately 58 million persons in the United States (20% of the total population) have one or more types of CVD, which include high blood pressure, coronary heart disease, stroke, rheumatic fever or rheumatic heart disease, and other forms of heart disease. Behavioral risk factors for CVD and other chronic diseases include physical inactivity, a diet high in fat, overweight, and smoking. The U.S. Preventive Services Task Force and the American Heart Association recommend that all primary-care providers offer their patients counseling to promote physical activity, a healthy diet, and smoking cessation as part of the preventive health examination. To characterize the provision of counseling by physicians about preventive health behaviors during office visits in 1995, data were analyzed from CDC's National Ambulatory Medical Care Survey (NAMCS). This report summarizes the results of that analysis, which indicates that a high proportion of office visits in 1995 did not include counseling for the prevention of CVD.
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PMID:Missed opportunities in preventive counseling for cardiovascular disease--United States, 1995. 948 Apr 10


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