A questionnaire was sent to all 475 members of the Norwegian Gynaecological Society. It was based on a similar study previously performed in Denmark and Sweden. 85% of the members returned the questionnaire. 382 (80%) had answered the questions; 153 (40%) women, 228 (60%) men, and one case where the sex was not stated. The mean age was 48 years (SD 10). The male gynaecologists had a more liberal attitude towards hormone replacement therapy than their female counterparts, 43% of them recommending oestrogen for all women, compared to 31% of the female gynaecologists. The younger doctors were more restrictive in their recommendations but attitudes became more liberal the older the doctors were. Among gynaecologists over 55 years, 49% of males and 50% of females recommended oestrogen for all women. The final decision as to whether or not to take hormone replacement therapy was most often made by the patient herself (61%). The majority of both female (86%) and male (75%) gynaecologists considered risk factors for heart disease to be an indication for oestrogen. In perimenopausal women, 356 (93%) preferred oral cyclical oestrogen combined with progestagen, whereas in postmenopausal women 333 (87%) preferred to take oral oestrogen combined with progestagen continuously.
INTRODUCTION: General practitioners have an important role in the prevention of cardiovascular disorders, and it is a precondition for motivating patients to preventive issues that doctors are aware of the prevalent risk factors. The aim of the study was to analyse agreement between patients' and general practitioners' (GPs) perception of risk factors and overall risk of ischemic heart diseases (IHD). MATERIAL AND METHODS: The data consisted of records from an audit in May 1999. The GPs (n = 26) registered all enquiries from patients with IHD (n = 252) and a sample of healthy individuals (n = 1239). Both doctors and patients were asked to register the occurrence of cardiovascular risk factors (smoking, weight, stress, family history) and they were asked to evaluate the state of health and to estimate the overall risk of IHD. The agreement was evaluated by Kappa statistics. RESULTS: The level of agreement between GPs and patients varied from 70 to 97 per cent. Disagreement was observed most often for patients with IHD and patients listed with elderly GPs. (> 50 years). Disagreement was predominantly caused by a lower detection rate of the risk factors by the GPs. The patients' perception of overall risk of IHD was badly correlated to doctors' perception. Generally, patients perceived the overall risk of IHD lower than their doctors, and in more than half of the patients with a perception of low risk the GP estimated the risk as high. DISCUSSION: Patients and GPs have different perceptions of the risk of IHD. This may be due to the fact that GPs do not have all the information about their patients' lifestyle. It may also be due to different perception of the importance of specific risk factors and different reference frames for risk perception. GPs have an important role in communicating cardio-preventive issues and the meaning of risk factors. Interventions should be considered to improve risk communication in general practice.
Effects of a global health and risk assessment tool for prevention of ischemic heart disease in an individual health dialogue compared with a community health strategy only results from the Live for Life health promotion programme.
OBJECTIVE: To evaluate the effect of an individual health dialogue on health and risk factors for ischemic heart disease in addition to that of a community based strategy. METHOD: Inhabitants in four communities in the area of Skaraborg, Sweden were invited to a health examination including a health dialogue both at the age of 30 and 35 (target communities). In another four communities inhabitants were invited only at the age of 35 (reference communities). Health and risk factors in 35-year old inhabitants in the target communities who participated in the health dialogue in 1989-1991 and 1994-1996 were analysed and compared with 35-year olds in the reference communities participating during the same periods of time. RESULTS: Inhabitants in communities where there had been a previous individualised health intervention programme had, on the community level, a more favourable development concerning dietary habits, mental stress, body mass index, waist circumference, cholesterol, blood pressure and metabolic risk profile compared to inhabitants in communities with only a community based health intervention programme. CONCLUSIONS: An individual lifestyle oriented health dialogue supported by a global health and risk assessment pedagogic tool seems to be more effective than a community health strategy only.
The object of this investigation was to examine general practitioners' attitudes to prophylaxis, assessment of the significance of a series of risk factors for the development of heart disease and how much emphasis they employed in attempting to alter the risk factors. In addition, the general practitioners' own health habits were investigated and it was assessed whether there was any connection between health habits and assessment of risk factors and the priorities given to these efforts. The general practitioners' advice and current behaviour as regards risk factors were investigated. The investigation was carried out as a questionnaire investigation in the County of Aarhus where all doctors received a questionnaire. A total of 313 general practitioners replied to the questionnaire which corresponds to a percentage participation of 84. The investigation revealed that general practitioners are interested in prophylaxis but find it difficult. By and large, general practitioners regarded the usual risk factors as being of great significance for the development of ischaemic heart disease and considered that it was important to alter these. A connection was present between their own health habits, assessment of risk factors and the priority awarded to these. Practitioners who had had their own serum cholesterol measured, considered that hypercholesterolaemia was important and awarded efforts to correct this greater priority than practitioners who had not had their serum cholesterol measured. The general practitioners abilities in taking case histories and giving dietary advice in cases of hypercholesterolaemia showed that they had only few deficiencies, but that there was a great scatter in their intervention limits for hypercholesterolaemia.
In Denmark it is recommended to eat 600 g of fruit and vegetables daily. This recommendation has to a large extent been derived from the demonstrated inverse association with the risk of certain major cancer diseases, while the focus with respect to prevention of ischemic heart disease (IHD) has been directed primarily towards a reduced intake of ''hard'' fats. This systematic review includes prospective studies which have examined the association between the intake of fruit and vegetables, as well as specific fruits and vegetables (e.g., nuts and pulses, which are considered to be fruits and vegetables in the Danish recommendations), and the risk of developing IHD. Only one controlled intervention study has been performed. This study came out with a negative result because the advice to increase intake was unsuccessful. In the eight published cohort studies, the overall finding was that the risk of developing IHD was reduced, in the scientifically well-conducted studies, by about 20%. Studies have generally found a dose-response effect, from low intakes to high intakes, up to about 800 g daily. Large cohort studies have shown convincing evidence that increased intake of nuts reduces the risk of IHD. With respect to other groups of fruits and vegetables, there is good but not sufficient scientific evidence that particularly pulses, but also the group of carotenoid-rich fruit and vegetables (such as tomatoes, leafy green vegetables, carrots, broccoli, Brussels sprouts and many berries and fruits), reduces risk. In contrast, it is not possible to single out specific substances in fruit and vegetables as being beneficial. Based on the studies, it seems reasonable to recommend an increased intake of a mix of fruits and vegetables to reduce the risk of IHD. The maximum beneficial amount seems to be about 800 g per day.
The cardioselective KATP channel activator BMS 180448 (3 mg/kg) administered intravenously 15 min before the coronary artery occlusion (10 min) decreased the incidence of ischemic and reperfusion arrhythmias in rats. A similar antiarrhythmic effect was observed when BMS 180448 was infused 2 min before reperfusion. Pretreatment with BMS 180448 also prevented the occurrence of CsCl induced arrhythmias, but but did not affect the incidence of epinephrine induced arrhythmias. On the contrary, BMS 180448 potentiated the arrhythmogenic action of CaCl2. The mechanism of the antiarrhythmic activity of BMS 180448 is discussed.
Possible risk indicators of ischemic heart disease relevant to the occupation of professional driving were identified in a cohort of 440 professional drivers and 1000 referents from the Swedish countries of Västerbotten and Norrbotten. The subjects were randomly selected. Data on cardiovascular risk indicators were collected from questionnaires, blood pressure measurements, serum lipid levels, height, and weight. The results showed that significantly more drivers than referents were overweight, smokers, and shift workers; were sedentary in their leisure time; and had a work situation characterized by high demands, low decision latitude, and low social support. There were no significant differences concerning blood pressure and serum lipid levels. The odds ratio for having a high score on a cardiovascular risk index was 3.18 (95% confidence interval 2.41-4.20) for the drivers when they were compared with the referents. When adjusted for age, heredity, shift work, educational level, marital status, and working class, the odds ratio was 2.34 (95% confidence interval 1.70-3.21).
Variation in diet associated with drinking patterns may partly explain why wine seems to reduce ischaemic heart disease mortality. In a cross-sectional study conducted in Copenhagen and Aarhus from 1995 to 1997 including 23,284 men and 25,479 women aged 50-64 years, the relation between intake of different alcoholic beverages and selected indicators of a healthy diet was investigated. In multivariate analyses, wine, as compared with other alcoholic drinks, was associated with a higher intake of fruit, fish, cooked vegetables, salad, the use of olive oil for cooking and not using fat spread on rye bread. In conclusion, the association between wine drinking and an intake of a healthy diet may have implications for the interpretation of previous reports of the relation between type of alcoholic beverage and ischaemic heart disease mortality.