OBJECTIVE: The purpose of our study was to evaluate whether repeated ventricular pacing is able to induce adaptation against ischemia in coronary artery disease patients. DESIGN: Fifteen patients with documented coronary artery disease were subjected to two successive periods of rapid ventricular pacing (150 bpm) of equal length (295+/-33 s), the first being limited by intolerable anginal pain. The second pacing period, of the same length as the first, was initiated after the disappearance of angina and ST depression, the mean resting time being 433+/-30 s. Blood samples for the determination of transcardiac differences in glucose, lactate, free fatty acids, K+, pCO2, pH, oxygen saturation and noradrenaline were taken from the femoral artery and coronary sinus before and at the end of each pacing period. The mechanical performance of the hearts was followed by continuous monitoring of intra-arterial blood pressure and pulmonary capillary wedge pressure, and the observed adaptation in the measured variables during the successive pacing tests was correlated with the duration of angina, severity of coronary artery disease and degree of collateralization. RESULTS: Changes in the transcardiac pH and K+ differences, ST segment and pulmonary capillary wedge pressure were less pronounced during the second pacing period. The subgroup with net lactate production before or after the first pacing period demonstrated metabolic adaptation manifested as improved lactate extraction during the second pacing period. Rate-pressure product and oxygen extraction, and thus presumably also overall oxygen consumption and oxygen delivery, were similar during both tests. The magnitude of adaptation did not correlate with the duration of angina, severity of coronary artery disease or overall collateral score. CONCLUSION: Rapid ventricular pacing is able to induce adaptation to myocardial ischemia, but the exact mechanisms in this process remain to be elucidated.
Dual antiplatelet therapy, with aspirin and a thienopyridine, is the accepted treatment after percutaneous coronary intervention (PCI). No clear evidence exists regarding the ideal dosage of aspirin. Recent guidelines recommend higher-dose aspirin because of the possible decrease in stent thrombosis. The purpose of this study was to test the hypothesis that high-dose aspirin of 325 mg decreases death and myocardial infarction (MI) compared to a lower dose of 81 mg in patients undergoing PCI.
An observational cohort study of 1,840 consecutive patients who underwent PCI was conducted. Patients who did not survive to discharge were excluded. The primary endpoint was a composite of all-cause mortality and MI at 1 year.
Nine-hundred and thirty patients (50.5%) were discharged on 325 mg of aspirin and 910 (49.5%) were discharged of 81 mg. The risk of all-cause mortality or MI was not significantly different between patients: low-dose 5.49% (50/910) vs. high-dose 4.19% (39/930); adjusted odds ratio [OR], 1.16; 95% confidence interval [CI], 0.73-1.85). In a multivariable analysis, the Charlson comorbidity score (OR, 1.37; 95% CI, 1.18-1.58) and urgent PCI (OR, 1.75; 95% CI, 1.03-3.00) were associated with increased death or MI. Among patients with drug-eluting stents, the use of low-dose aspirin did not predispose them to death or MI (adjusted OR, 1.12, 95% CI, 0.53-2.34).
In this large contemporary analysis of PCI patients, no differences in death or MI were observed at 1 year between patients discharged on low-dose aspirin 81 mg compared to patients on a higher dose.
OBJECTIVE: To clarify the importance of health beliefs and some socio-demographic data for accepting an invitation to take part in a health examination by comparing attenders and non-attenders with respect to health beliefs and social status. DESIGN: Multipractice study including questionnaires for men. SETTINGS: 65 GPs in two areas in the county of Aarhus, Denmark, invited 2452 40-49 year old men to a health examination for ischaemic heart disease. The examination was free in one area, whereas there was a fee in the other. All 1272 attenders and 423/1180 non-attenders completed the questionnaire. RESULTS: The attendance rate was 66% in the area with free examination and 37% in the fee-paying area. The attendance was significantly higher for cohabitants than for single men in both areas. There was a slightly higher attendance of men with an occupational training in both areas, but the difference was not significant. In general, all agreed that IHD is a serious disease, and that it can be prevented by a personal effort. There were only minor differences in the attenders' and non-attenders' health beliefs. CONCLUSION: The main conclusion is that 40-49 year old men are in general concerned about IHD. Whether they want to have a health examination for IHD depends mainly on its availability (exemplified here as fee versus free), since the differences were small with respect to health beliefs between attenders and non-attenders.
OBJECTIVES: Obesity and dyslipidemia are risk factors for ischemic heart disease, and prevention and treatment in primary care can reduce these risks. The objective of this cost-effectiveness analysis was to compare the costs and effects (in terms of life years gained) of providing nutritional counseling by a general practitioner (GP) or a dietician. METHODS: A total of 60 GPs, who accepted to participate, were randomized either to give nutritional counseling or to refer patients to a dietician for counseling. The life years gained was estimated using a Cox regression model. Costs were estimated on the basis of registered use of time (dieticians) or agreed salaries (GPs). RESULTS: The effect of nutritional counseling comparing GPs and dieticians is greatest when counseling is performed by a GP--0.0919 years versus 0.0274 years. These effects appear to be moderate, but they are significant. It is also proven that the GP group was the most cost-effective-the cost of gaining 1 extra life year was estimated to be 8213 DKK compared with the dietician group, for which the incremental cost-effectiveness ratio was estimated to be 59,987 DKK. CONCLUSIONS: The effects were moderate, but other studies of other patient groups and interventions report effects within the same magnitude. The GP group was the most cost-effective, but it must be concluded that both counseling strategies were relatively cost-effective. Even though the cost of gaining an extra life year was estimated to be 59,987 DKK in the dietician group, this might be an acceptable price.
To examine the effects on consumption and risk of ischemic heart disease (IHD) of the Danish fat tax, effective from October 2011 to January 2013.
We used comprehensive retail outlet data on the sale of twelve foodstuff categories targeted by the fat tax. Data covered January 2010 to July 2013. IHD risk was assessed by modelling first the effect of changes in intake of monounsaturated, polyunsaturated and saturated fat and dietary cholesterol on serum cholesterol and subsequently modelling the resulting changes in risk of IHD using two different methods.
The total sale of the included foodstuffs decreased by 0.9%. The fat tax was associated with marginal changes in population risk of IHD. One estimate suggests an increased population risk of IHD by 0.2% and the other estimate suggests that the risk of IHD decreased by 0.3%.
The Danish fat tax had a marginal effect on population consumption of fat and risk of IHD. Fat taxes have to be carefully designed to prevent possible adverse effects from outweighing its beneficial effects on health outcomes. Policymakers must therefore be more ambitious in relation to food taxes, e.g. by implementing more comprehensive tax-subsidy schemes.
Drop-out rates are high in many lifestyle programmes. To promote adherence, the aim of this study was to identify mediators of participation in a diet and exercise (DE) intervention in a general population.
Data were baseline data from a randomized non-pharmacological clinical trial in Copenhagen during 1999-2001. The participation rate was 53.3%. Participants at high risk of ischaemic heart disease (IHD) and who were offered participation in a DE counselling group intervention were included (N = 2022). Clinical characteristics, and demographic, psychosocial and lifestyle factors were measured.
Mediators of acceptance of participation were awareness of an unhealthy lifestyle or a bad health, low self-rated care of own health, perceived susceptibility of cardiovascular disease (CVD; overall and associated with lifestyle), high degree of motivation towards dietary changes and low self-efficacy about increasing physical activity. Overweight and impaired glucose tolerance (IGT)/screen-detected diabetes predicted acceptance whereas an absolute risk score for IHD was inverse associated with acceptance. Mediators of high adherence were low self-efficacy about changing dietary habits and perceived susceptibility of CVD and furthermore screen-detected diabetes and overweight predicted high adherence.
Awareness of unhealthy lifestyle, perceived susceptibility of disease and motivation towards lifestyle changes were important mediators of participation. Screen-detected diabetes/IGT predicted participation and adherence whereas overweight individuals were more likely to accept but also to drop out of the course. The use of an absolute risk score in health promotion should be further evaluated.
OBJECTIVE--To describe the proportion of patients who were discharged from hospital after witnessed cardiac arrest outside hospital in relation to whether a bystander initiated cardiopulmonary resuscitation. PATIENTS--All patients with witnessed cardiac arrest outside hospital before arrival of the ambulance and in whom cardiopulmonary resuscitation was attempted by the emergency medical service in Gothenburg during 1980-92. RESULTS--Cardiopulmonary resuscitation was initiated by a bystander in 18% (303) of 1,660 cases. In this group 69% had ventricular fibrillation at first recording compared with 51% in the remaining patients (P
The recent literature on the role of fatty acids and antioxidants as protective factors in ischemic heart disease (IHD) has been reviewed. Serum cholesterol, especially LDL-cholesterol, is regarded as an index of risk for IHD. Epidemiological studies have connected a high dietary intake of n-3 fatty acids with a low occurrence of IHD. It is believed that this effect is brought about by a modification of the eicosanoid synthesis and a lowering of the cholesterol level. Intervention studies have not demonstrated that n-3 acids can lower the level whereas monounsaturated fatty acids (MUFAs) have been shown to have such an effect although they were previously believed to be neutral. The epidemiological observations probably reflect the combined effect of both n-3 polyunsaturated fatty acids (PUFAs) and MUFAs. Recently, oxidized LDL has been suggested to be involved in the earliest lesion of atherogenesis. This hypothesis suggest that the antioxidant balance is an important factor for IHD. As the traditional Greenlandic diet is rich in n-3 PUFAs, MUFAs and antioxidants (selenium), epidemiological studies in Greenland could shed important light on the role of individual dietary components and their interactions.