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

We reviewed the records of 217 children whose first episode of supraventricular tachycardia occurred before 18 years (median age 24 months). There were 112 males and 105 females. Of the 49 with congenital heart disease, SVT began before any operation in 26 and greater than 2 weeks postoperatively in 23. Wolf-Parkinson-White syndrome was present on surface ECG in 47/217 (22%). Congestive heart failure accompanied the first episode of SVT in 38% of the patients who were 4 months of age or younger, and in only 19% of those over 4 months (P less than 0.001). Treatment was successful in stopping SVT within 48 hours in 90/142 (63%). Successful short-term treatment included digoxin 57/184 (68%), cardioversion 12/20 (60%), vagal maneuvers 12/19 (63%), phenylephrine 3/9, and overdrive pacing 4/5. SVT recurred at least once in 83% of all patients. On follow-up (mean 4.6 years), episodes of SVT were still present in 56%. Three patients died--two from incessant SVT and one from a CVA after VSD repair. We conclude that long-term status was difficult to predict, but SVT was present in fewer patients whose age at onset was less than 4 months and in those with unoperated CHD. Early recurrence was not a poor prognostic sign. We recommended treatment for at least one year in all patients with SVT, whether or not the first episode terminates spontaneously.
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PMID:Supraventricular tachycardia in children: clinical features, response to treatment, and long-term follow-up in 217 patients. 722 88

The Framingham Heart Study is one of the leading longitudinal cohort studies of cardiovascular disease in both men and women. Women have been included since study inception in 1948. The Study has provided a wealth of sex-specific information concerning coronary and cardiovascular disease incidence as well as the impact of multiple risk factors on disease occurrence. Risk factor prediction charts based on Framingham data can be used by physicians to determine an individual patient's probability of developing CHD or stroke. Investigations of factors unique to women, such as menopause and estrogen replacement, and factors of interest to women, such as weight cycling and smoking cessation, have been reported.
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PMID:Women and cardiovascular disease: contributions from the Framingham Heart Study. 772 4

A prospective study of persons older than 70 years provided evidence to contest the association between blood cholesterol level and incidence of CHD or death due to CHD. Drug treatment for mild to moderate hypertension substantially reduced morbidity and mortality from stroke and from CHD.
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PMID:Geriatric medicine. 775 16

Blood pressure (BP), particularly systolic blood pressure (SBP), rises with advancing age. Isolated systolic hypertension is the most common type of hypertension (HTN) phenotype after age 70. Moreover, at similar BP levels the absolute risk for CVD is several fold higher in elderly than in young patients. End-organ damage is common, and significant renal impairment can be present even when serum creatinine levels are normal. All forms of HTN in the elderly should be treated. A recent meta-analysis of eight clinical trials involving elderly patients documented a 15/6 mm Hg treatment difference between intervention and control groups, and a lower rate of stroke, CHD and death from all causes in the intervention group. Gradual BP control into the "normal" range should be the goal in elderly patients. There is no convincing evidence that lowering BP is harmful (J-curve hypothesis). Coexisting medical conditions influence therapeutic choices. The suggested medical evaluation of elderly hypertensive patients with suspected secondary forms of HTN is covered as well as pervasive clinical myths about HTN in the elderly.
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PMID:High blood pressure in older persons: a high risk special population. 780 55

The relationship of dyslipidemia, particularly hypercholesterolemia to coronary heart disease is now well established. Although ischemic heart disease and stroke share many of the same risk factors, the relationship of cholesterol to stroke remains controversial. The 6-year and 12-year follow-up of the MRFIT study showed that elevated cholesterol significantly increased the risk for fatal nonhemorrhagic stroke. Atkins found no evidence that lowering plasma cholesterol influenced the incidence of fatal or nonfatal stroke and regression analysis showed no statistical association between the magnitude of cholesterol reduction and the risk for fatal stroke. We cannot preclude the possibility that more effective cholesterol lowering over a longer period of time might be effective. Hypertension is the most powerful risk factor for stroke. The San Antonio Heart Study reported a clustering of cardiovascular risk factors in individuals who developed hypertension during an eight-year follow-up period (higher levels of BP, fasting TC and LDLC, TG, glucose and insulin, and BMI, less favourable fat deposition, and lower HDL). Insulin resistance may be the unifying factor that results in those phenomena, the so-called syndrome X. The important factor underlying syndrome X may be central or visceral obesity, suggesting that maintenance or attainment of ideal weight would be a powerful preventive factor against both CHD and nonhemorrhagic stroke. There is evidence from the Treatment of Mild Hypertension Study that nutritional/hygienic measures can reduce the syndrome X risk factors and hence the risk of coronary heart disease and stroke.
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PMID:Dyslipidemia and metabolic factors in the genesis of heart attack and stroke. 791 92

We examined the relationship between the risk of CVD mortality and morbidity and HCT over a period of 34 years of follow-up in the 5209 men and women in the Framingham cohort. There was an increased risk of all-cause death as well as morbidity and mortality due to CVD in subjects with HCT values in the highest quintile. There was no evidence of a decrease risk of CVD in men with lower than median HCT values, and women actually showed increased risk of CVD events with lower HCT values, indicating a J- or U-shaped relationship between HCT and CVD events. The impact of HCT on CVD events appears to differ for different age groups and by sex. HCT is significantly related to the incidence of CVD, including CHD, MI, angina pectoris, stroke, and IC in younger men. In younger women, HCT is related to the incidence of CVD, CHD, MI and mortality from CVD and CHD. A negative association with CHF incidence and stroke death is noted in elderly women. These results support the hypothesis that HCT is an important risk factor for some CVD events, an association that merits further investigation.
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PMID:Hematocrit and the risk of cardiovascular disease--the Framingham study: a 34-year follow-up. 812 18

Cigarette smoking remains the primary cause of preventable death and morbidity in the United States. Smoking causes lung cancer, COPD, and CHD and contributes significantly to mortality from other conditions such as stroke. Maternal smoking during pregnancy causes low birthweight and perinatal mortality, and it may have lasting impact on the child's physical and cognitive growth. Passive exposure to ETS causes lung cancer and poses particular danger to the respiratory health of young children. Smoking cessation strategies are important, but the should be supplemented by community and policy-level interventions. Workplace or community smoking bans, statewide taxes on tobacco, and antismoking media campaigns may be effective adjuncts to individual cessation strategies. These strategies may be an even more important disincentive to smoking initiation. The expanding horizon of health consequences of smoking and its costs to American society should again challenge public health agencies to develop and implement effective strategies to prevent smoking acquisition by young people. These health effects should also motivate health professionals in other countries where smoking prevalence is increasing, rather than decreasing, to initiate more effective efforts to reverse this trend and minimize the excess morbidity and death that accompany this dangerous habit.
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PMID:Cigarette smoking and health. American Thoracic Society. 856 46

An overview of the 17 completed randomised trials of antihypertensive treatment demonstrates that a 5-6 mm Hg reduction in DBP reduced stroke risk by 38% (SD 4) and CHD risk by 16% (SD 4). These results indicate that a few years' treatment with diuretic- or beta-blocker-based therapy produces most or all of the long-term stroke avoidance and much of the long-term CHD avoidance that would be predicted from observational epidemiological studies, given the blood pressure reductions that were achieved in the trials. The relative risk reductions were similar in trials of older and younger patients, although the absolute reduction in events was more than twice as great in the trials in older patients. From these results it can be estimated that in fully compliant patients at similar risk of vascular disease to those included in the trials, antihypertensive treatment for 5 years would prevent one major vascular event among every 20 older patients and one major vascular event among every 60 younger patients. Obviously the benefits of treatment will be greater among those at higher risk than the patients included in the previous trials. The greatest benefits are likely to be achieved in those with a history of vascular disease since their risk of future events is particularly high. Among such patients it is possible that blood pressure reduction will confer worthwhile benefits in those without hypertension, as well as those with hypertension. It is also possible that the benefits of treatment will be determined by the size of the blood pressure reduction and by the choice of the anti-hypertensive agent. However, each of these possibilities requires confirmation in large scale randomised controlled trials.
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PMID:Blood pressure lowering for the primary and secondary prevention of coronary and cerebrovascular disease. 857 Oct 98

Overwhelming evidence indicates that the Western diet plays a major role in atherogenesis. Clinicians are only now beginning to tease out the precise components of the diet that are harmful or beneficial. With respect to fat intake, it remains unclear whether it is the amount or type of fat that promotes atherosclerotic disease. There appears to be a consistent positive association of cholesterol, saturated fat, and possibly trans-fatty acid intake and atherosclerotic disease. Although there is general agreement that reducing intake of these dietary components would be beneficial, controversy remains on what should replace these harmful fats. Some researchers advocate massive reductions in total fat consumption with replacement with carbohydrates for everyone, whereas others recommend a Mediterranean-style diet, which replaces saturated animal fats with vegetable fats. Very low-fat diets have been shown to lower the chance of a heart attack among those with severe coronary artery disease, but for the majority of Americans who do not have obvious artery disease, there is no convincing evidence that a very low-fat diet is optimal. There may be other adverse health effects of this Asian diet, such as increased rates of hemorrhagic stroke. Further research is required to refine thinking on the optimal composition of fats in diet. The effects of alcohol consumption on chronic diseases are complex. The strength and consistency of the observational and experimental evidence strongly suggests a causal link between light to moderate alcoholic beverage consumption and reduced risks of CHD. These reductions in risk of CHD appear to be mediated largely by raising HDL cholesterol levels, although additional mechanisms remain possible and do not appear to be beverage specific. Maximal benefit in terms of CHD appears to be at the level of one drink per day. From a public policy standpoint, whether the benefits for CHD persist at heavy drinking levels or are attenuated is moot because clear harm of heavy drinking in terms of overall mortality outweighs any benefits in the reduction of heart disease. Although the association of alcohol and CHD is likely to be causal, any individual or public health recommendations must consider the complexity of alcohol's metabolic, physiologic, and psychological effects. With alcohol, the differences between daily intake of small to moderate and large quantities may be the difference between preventing and causing disease. A discussion of alcohol intake should be a part of routine preventive counseling. Given the complex nature of alcohol disease relationships, alcohol consumption should not be viewed as a primary preventive strategy; also, it should not necessarily be viewed as an unhealthy behavior. Based on the totality of available evidence, antioxidants represent a possible but as yet unproven means to reduce risks of cardiovascular disease. Although it remains unclear whether supplementation of diet with antioxidant vitamins will reduce risks of atherosclerotic disease, most researchers agree that consumption of fruits and vegetables is an important part of a healthy diet. The U.S. Department of Agriculture recommends two to four servings of fruit and three to five servings of vegetables per day.
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PMID:Diet and heart disease. The role of fat, alcohol, and antioxidants. 907 92

In 1960, stroke mortality in Japan was the highest among industrialized countries, while CHD mortality was the lowest. Stroke mortality for men and women aged 30-69 years, however, declined by 80% during the 1965-90 years and CHD mortality also declined during the same period. Among risk factors, trends in blood pressure level and the prevalence of hypertension were very compatible with those in stroke mortality. Serum total cholesterol level has increased remarkably, however, CHD mortality has not increased. This may be explained by the decline in population blood pressure level and the prevalence of hypertension, and decreased smoking rate.
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PMID:[Current epidemiology of hypertension in Japan]. 928 19


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