Non insulin dependent diabetes mellitus (NIDDM) and essential hypertension (EH) are two of several manifestations of the insulin resistance syndrome. Although subjects with NIDDM and subjects with EH share a common defect in carbohydrate metabolism, only diabetics are advised to avoid sugar. We tested the theory that an adverse effect of diuretics treatment in men with EH with respect to risk of ischaemic heart disease (IHD) would depend on the intake of dietary sugar using sugar in hot beverages as a marker. The cohort consisted of 2,899 men from the Copenhagen Male Study aged 53-74 years (mean 63) who were without overt cardiovascular disease. Potential confounders were: age, alcohol,smoking, physical activity, body mass index, blood pressure, fasting lipids, cotinine, NIDDM,and social class. A total of 340 men took antihypertensives; 211 took diuretics (95% thiazides and related agents), and 129 used other antihypertensives. During 6 years, 179 men (6.2%) had a first IHD event. Among the 340 men taking antihypertensives, the incidence rate was 11%. Diuretics use was associated with a high risk of IHD in hypertensive men with a relatively high intake of dietary sugar; the cumulative incidence rate was 22%; in diuretics treated men with a low intake of sugar, the rate was 7%. After controlling for potential confounders, relative risk (95% ci.) was 3.1(1.3-7.6), p = 001. Among the 129 men who took other forms of antihypertensive drugs, the IHD incidence rate was 8%, and independent of the intake of sugar. The results indicate that the risk of IHD in hypertensives using diuretics is associated with intake of dietary sugar, which may explain at least some of the discouraging effects of antihypertensive agents on the reduction of risk of IHD.
We examined the associations between emergency department (ED) visits for ischemic heart disease (IHD) and short-term elevations in ambient air pollutants (CO and NO(2)).
A hierarchical clusters design was used to study ED visits (n = 4979) for ischemic heart disease (ICD-9: 410-414) that occurred at a Montreal hospital between 1997 and 2002. The generalized linear mixed models technique was applied to create Poisson models for the clustered counts of ED visits for IHD. The analysis was done by gender for two age categories, all patients and patients aged over 64 years.
The results are presented as an excess risk increase associated with the interquartile range (IQR) of daily average of the pollutant concentration. The results for NO(2) (IQR = 9.5 ppb) were 5.9% (95% CI: 2.1-9.9) for all patients and 6.2% (95% CI: 1.2-11.4) for males; for patients aged over 64: 7.1% (95% CI: 2.5-11.9) for all patients, 9.1% (95% CI: 2.8-15.7) for males, and 6.5% (95% CI: 0.7-12.7) for females (for exposure lagged by 1-day). The results for CO (IQR = 0.2 ppm): 5.4% (95% CI: 2.3-8.5) for all patients, and 7.5% (95% CI: 3.6-11.6) for males. For patients aged over 64 years, 4.9% (95% CI: 1.3-8.7) for all patients, and 7.5% (95% CI: 2.6-12.6) for males. The results show the associations for the same day exposures.
The short-term effects of nitrogen dioxide and carbon monoxide are associated significantly with daily ED visits for ischemic heart disease. For NO(2) the associations are stronger for patients aged over 64 years. As indicated by our results, it is likely that vehicular traffic, a producer of NO(2) and CO, contributes to an increased number of ED visits for IHD.
It is unknown whether the increased risk of heart failure (HF) in rheumatoid arthritis (RA) is independent of ischemic heart disease (IHD).
This study sought to investigate the relative risk of HF overall and by subtype (ischemic and nonischemic HF) in patients with RA and to assess the impact of RA disease factors.
Two contemporary cohorts of RA subjects were identified from Swedish patient and rheumatology registries and matched 1:10 to general population comparator subjects. A first-ever HF diagnosis (classified as ischemic HF or nonischemic HF based on the presence of IHD) was assessed through registry linkages. Relative risks for a history of HF before RA onset were calculated through odds ratios. Relative risks of incident HF in RA were calculated as hazard ratios (HRs).
By the time of RA onset, a history of HF was not more common in RA. In the new-onset RA cohort, the overall HRs for subsequent HF (any type), ischemic HF, and nonischemic HF were between 1.22 and 1.27. The risk of nonischemic HF increased rapidly after RA onset, in contrast to the risk of ischemic HF. High disease activity was associated with all HF types but was most pronounced for nonischemic HF. In the cohort of patients with RA of any duration, the HRs were between 1.71 and 1.88 for the different HF subtypes.
Patients with RA are at increased risk of HF that cannot be explained by their increased risk of IHD. The increased risk of nonischemic HF occurred early and was associated with RA severity.
Aim of the study was elucidation of association between prevalence of ischemic heart disease (IHD) with high levels of psychosocial risk factors in open male population aged 25-64 years. We examined a representative sample of men aged 25-64 years formed from electoral lists in one of administrative districts in Tyumen. In a framework of cardiological screening we studied prevalence of IHD and levels of psychosocial risk factors - personality anxiety and depression - using standard WHO questionnaire MONICA-psychosocial. IHD prevalence among men aged 25-64 years in Tyumen was 12.4%. Among men of this age high levels of psychosocial risk factors were more frequent - in men with IHD than in men without IHD. In men with high levels of psychosocial risk factors we observed increase of risk of development of acute (A)IHD. Increases of risk of AIHD and IHD in the presence of personal anxiety or depression were characteristic for age categories 55-64 and 45-64 years, respectively.
Environmental pollution in the Arctic is due to long range transport from lower latitudes or to local industrial activities. Since the latter are not different from point source exposure in the rest of the world the paper focuses on the former aspect which is the main type of environmental pollution in the western Arctic. The environmental pollutants of major significance are heavy metals (mercury, cadmium, lead) and persistent organic pollutants (PCB's, pesticides) and the main exposure is through the traditional diet of sea mammals (mercury, cadmium, persistent organic pollutants) and through smoking (cadmium). There is rather strong evidence that lead is a (weak) risk factor for high blood pressure even at low levels of exposure. Apart from lead there is little evidence that the above mentioned pollutants are significantly related to cardiovascular diseases. Since the pollutants, however, are found in the traditional diet together with n-3 polyunsaturated fatty acids, monounsaturated fatty acids, and selenium which are believed to promote cardiovascular health there is an indirect link between the pollutants and cardiovascular disease. This becomes relevant when dietary guidelines are developed for arctic populations. Epidemiological evidence from Greenland relevant for this discussion is presented, i.e. i) findings from a countrywide interview survey on dietary habits which show that sea mammals are widely consumed and appreciated for health and other reasons and that there is virtually no fear of pollution, and ii) mortality results which do not support the hypothesis that the low rate of ischemic heart disease in Inuit is due to their traditional diet.
Cardiovascular diseases estimate to be the leading cause of death and loss of disability-adjusted life years globally. Conventional risk factors for cardiovascular diseases only partly account for the social gradient. The purpose of this study was to compare the occurrence of the most frequent cardiovascular diseases and cardiovascular mortality in two close cities, the Twin cities.
We focused on the total population in two neighbour and equally sized cities with a population of around 135 000 inhabitants each. These twin cities represent two different social environments in the same Swedish county. According to their social history they could be labelled a "blue-collar" and a "white-collar" city. Morbidity data for the two cities was derived from an administrative health care register based on medical records assigned by the physicians at both hospitals and primary care. The morbidity data presented are cumulative incidence rates and the data on mortality for ischemic heart diseases is based on official Swedish statistics.
The cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women revealed significantly differences for studied cardiovascular diagnoses. The occurrence rates were in all aspects highest in the population of the "blue-collar" twin city for both sexes.
This study revealed that there are significant differences in risk for cardiovascular morbidity and mortality between the populations in the studied different social environments. These differences seem to be profound and stable over time and thereby give implication for public health policy to initiate a community intervention program in the "blue-collar" twin city.
BACKGROUND: Patients' health beliefs influence their willingness to comply with medical advice. In an earlier study, it was found that men with a previous history of information on risk factors for ischaemic heart disease expressed more feelings of threat to their health than did men without this experience. As anxiety may have adverse effects, such as making patients avoid the desired action, this could complicate adequate patient treatment. AIMS: To investigate the impact on health beliefs caused by participation in a screening programme for risk factors for ischaemic heart disease, including individualized information to patients with hypercholesterolaemia. METHODS: A random sample of middle-aged, urban men participating in a health screening completed a questionnaire on socioeconomic factors, medical history, lifestyle, and health beliefs. Blood pressures and plasma cholesterol values were measured. Four months after the initial screening, hypercholesterolaemic men and controls completed the questionnaire again. RESULTS: In a univariate analysis, no differences in health belief indices were found between cases and controls at the baseline screening. Controls achieved lower values of the indices "perceived control over illness" and "medical motivation" at follow-up. In a matched case-control design, the differences in "medical motivation" increased between cases and controls because controls reported lower values. "Perceived threat to health" did not change, and it is suggested that this is due to the supportive information to the patients. CONCLUSION: Individualized and supportive patient information on risk factors for cardiovascular disease does not increase patients' perceptions of threat.
Studies have shown an increased risk of ischaemic heart disease (IHD) in patients with coeliac disease (CD), despite the patients' lack of traditional IHD risk factors.
To characterise IHD according to CD status.
Data on duodenal or jejunal biopsies were collected in 2006-2008 from all 28 pathology departments in Sweden and were used to define CD (equal to villous atrophy; Marsh stage 3). We used the Swedish cardiac care register SWEDEHEART to identify IHD and to obtain data on clinical status and risk factors at time of first myocardial infarction for this case-only comparison. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). CD patients were compared with general population reference individuals.
We identified 1075 CD patients and 4142 reference individuals with subsequent IHD. CD patients with myocardial infarction had lower body mass index (P