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.
BACKGROUND: In the mid 1980s European governments committed themselves to the WHO goal 'reduced inequality in health by year 2000' according to which inequality in health should be reduced by 25% by the year 2000. The study aim is to estimate the time trend in relative risk due to ischaemic heart disease (IHD) morbidity in employment status groups in Denmark in the period from 1981 to 1993 and to recommend a strategy to reduce inequality in health. MATERIAL AND METHODS: The study dealt with change in relative risk of IHD in main employment status AND groups as measured in three successive cohorts. The cohorts were defined as all METHODS: gainfully employed men in Denmark as of 1 January 1981, 1986 and 1991, respectively. Information on employment was retrieved for the three previous years. The cohorts were followed for first admissions with IHD as the principal cause during 5, 5, and 3 years respectively. RESULTS: Managers and white collar workers had an average or low and decreasing relative risk while male blue collar workers had a high and increasing relative risk. Thus the social inequality in IHD is rapidly increasing. Some occupational groups are known to be at high risk. Some of these high-risk groups, such as bus drivers, even have an increasing relative risk. CONCLUSIONS: The general health education has been successful in the prevention of IHD in the high-status groups but has failed to reduce the risk among blue collar workers. Preventive measures against IHD should focus on occupational groups at high, increasing risk and the measures should tailor to their 'subculture.'
AIMS: To describe prevalence, metabolic control, and complications of diabetes mellitus in a county in Northern Sweden, in order to improve diabetes care and guide decision makers. METHODS: A population-based, cross-sectional, retrospective study of medical records of all registered persons with diabetes mellitus (n = 5251) in the area. Assessments and examinations concerning metabolic control and complications were studied over a period of 15 months. RESULTS: Of the 5143 patients included, 13% had Type 1, 86% Type 2, and 1% other types of diabetes. An annual check-up was performed in 84% of patients. Glycosylated haemoglobin (HbA1c) was assessed in 88%, and had a mean value of 7.3% (sd 1.3%). Metabolic control was good in 33% and acceptable in another 26%. Risk factors for complications were found in 64%; in 35% body mass index was > 30; 50% had hypertension; 22% were smokers; 51% had macro- and/or microvascular complications; ischaemic heart disease 26%; a cerebrovascular lesion 13%; amputation 1.8%; proteinuria 7.9%; microalbuminuria 2.6%; peripheral neuropathy 30%; impaired peripheral circulation 29%; and retinopathy 37%. CONCLUSIONS: The majority of patients with diabetes in the study area attended an annual check-up, had acceptable metabolic control and severe complications were uncommon. Nevertheless, the number of undocumented examinations was high, 40% of the patients had unacceptable metabolic control and more than 50% had macrovascular risk factors. These findings emphasize the importance in diabetes care of smoking cessation and intensive treatment of high blood pressure.
Comment In: Int J Qual Health Care. 2003 Aug;15(4):283-512930043
AIM: To study correlations between personal anxiety (PA) as one of the leading psychosocial factors and ischemic heart disease (IHD). MATERIAL AND METHODS: The third screening (1994) of the program MONICA and subprogram MOPSY-MONICA-psychosocial covered a random representative sample of males at the age of 25-64 years living in Novosibirsk. The response was 82% (657 responders, mean age 44.3 +/- 0.4 years). Statistical analysis was based on the SPSS-10 software package. RESULTS: Prevalence of PA as an indication of social stress in a male population of 25-64-year-olds is very high especially in young age groups. PA is maximal among persons with elementary education and workers. Persons with PA experience strong stress in job and in family settings. An IHD rate is higher among PA patients. High PA is often associated with depression, high hostility, cachexia, sleep problems, low social support. PA patients have a negative opinion of their health but their attempts to improve it are insufficient. The proportion of those who quit smoking, reduce the number of cigarettes, keep diet, restrict physical activity grow in PA persons. CONCLUSION: PA is prevalent among male population especially in young persons. A PA level correlates with social status. IHD occurs more frequently in PA persons. High PA often associates with other psychosocial factors.
AIM: To study a 5-year prevalence of and changes in anxiety, behavior of the coronary type, social support, health self-estimation, attitude to smoking, sleep disorders in male population. MATERIALS AND METHODS: In the context of the program "MONICA-psychosocial", a random representative sample of males aged 25-64 living in Novosibirsk has been examined (screening in 1988-1989--739 males, and in 1994-1995--657 males). RESULTS: Personal anxiety in the study population has increased for 5 years from 49.5 to 51%. The number of males with coronary behavior has reduced from 25.9 to 16.9% (p
Previous exposures to Chlamydia pneumoniae (CP), Helicobacter pylori (HP) or cytomegalovirus (CMV) have been associated with atherosclerotic heart disease. These associations were studied in Canadian patients, and the exposure to five infections measured.
In the coronary care units (Hamilton General site, Henderson General site, McMaster University Medical Centre site of the Hamilton Health Sciences Corporation and St Joseph's Hospital) and from the regional angiography suite (Hamilton General site), Hamilton, Ontario.
One hundred seven consecutive patients presenting with myocardial infarction or unstable angina (coronary care unit patients), or with previous angina or myocardial infarction (angiography suite patients), were compared with 107 family practice or outpatient clinic control subjects.
Cardiovascular risk factors were measured, as was serology for CP, HP, CMV, adenovirus and hepatitis A virus. Statistical analysis was by logistic regression, adjusted for age and sex.
Exposure to CP was more frequent in patients than in control subjects (85.4% versus 70.3%, adjusted odds ratio [OR] 2.3, 95% CI 1.1 to 5.1, P=0.03). Dividing CP immunoglobulin G absorbance into quarters, with the lowest quarter as the reference group, the adjusted ORs were 2.8, 3.0 and 4.3, respectively, for the second, third and fourth quarters (P=0.001 for trend). The seroprevalences of HP (61.7%), CMV (64.0%), adenovirus (75.6%) and hepatitis A virus (59.2%) were high, with no association with disease.
An association was found between heart disease and previous exposure to CP, with a stepwise increase in ORs at higher antibody levels, whereas no association was found with HP, CMV or other infections. A prospective validation of this association is needed.
To investigate a relative risk of cardiovascular complications in uncomplicated hypertensive crises (UHC) in hypertensive patients.
A questionnaire retrospective case-control study covered one-third of patients registered in the data base of a hospital or outpatient clinic. The patients were matched by basic characteristics. By frequency of UHC the patients were divided into two groups. Group 1 (n = 305) comprised patients with frequent (weekly or more often) UHC, group 2 (n = 558) consisted of patients with rare UHC (monthly or less frequent).
Patients of group 1 had a longer history of arterial hypertension (13 +/- 9 years vs 9 +/- 7.8 years, p 0.05).
Frequent UHC raise the risk of non-fatal acute disorder of cerebral circulation, chronic cardiac failure, ischemia and left ventricular hypertrophy. Frequency of UHC is not related to the risk of myocardial infarction.
OBJECTIVES: To calculate the burden of ischaemic heart disease (IHD) and coronary risk factors in a defined population using data from all public providers of health care, i.e. inpatient and outpatient care in all settings. STUDY DESIGN: Cross-sectional, 1-year retrospective study. METHODS: The main outcome measures were the number of individuals by diagnosis and by care setting, and gender- and age-specific event rates by diagnosis. RESULTS: Less than half of the individuals who visited any care provider for IHD or coronary risk factors were identified in the hospital discharge register. Calculation of the actual burden of disease in the population showed that when hospital discharge data were combined with outpatient data, there were no or slight differences in the age-specific rates of acute myocardial infarction (AMI), while the rates of angina were between two-fold and four-fold higher, and unspecified IHD was between three-fold and ten-fold higher in individuals aged > or =50 years compared with using hospital discharge data alone. The rates of hypertension, diabetes and lipid disorders increased in all age groups when outpatient data were added to hospital discharge data. The differences in the rates were more pronounced in women aged 50-79 years. However, the age-specific rates were higher in men except for hypertension which was higher in older women. CONCLUSION: Data for epidemiological analyses of diseases are often based on hospital discharge data. This study found that hospital discharge data provide limited information on patients treated for IHD and coronary risk factors, except for AMI. These findings suggest that hospital discharge data should be combined with outpatient care data to provide a more comprehensive estimate of the burden of IHD and its risk factors.