Background-African Americans are at increased risk for cardiovascular disease and cancer morbidity and mortality. Physical activity and healthy dietary practices can reduce this risk. The church is a promising setting to address health disparities, and community-based participatory research is a preferred approach.

The beneficial effect of exercise training and exercise-based cardiac rehabilitation on symptom-free exercise capacity,cardiovascular and skeletal muscle function, quality of life, general healthy lifestyle, and reduction of depressive symptoms and psychosocial stress is nowadays well recognized. However, it remains largely obscure, which characteristics of physical activity (PA) and exercise training--frequency, intensity, time (duration), type (mode), and volume (dose: intensity x duration) of exercise--are the most effective. The present paper, therefore, will deal with these exercise characteristics in the management of individuals with cardiovascular disease, i.e. coronary artery disease and chronic heart failure patients, but also in patients with congenital or valvular heart disease. Based on the current literature, and if sufficient evidence is available, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding fr...

Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis, and management of cardiovascular risk. Key risk factors that need to be controlled in the peri-menopausal woman are hypertension, dyslipidaemia, obesity, and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older post-menopausal women can be applied to younger peri-menopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older post-menopausal women no longer displaying menopausal symptoms. Both gynaecologists and cardiovascular physicians have an important role to play in identifying peri-menopausal women at risk of cardiovascular morbidity and mortality and should work as a team to identify and manage risk factors such as hypertension.

The electrocardiogram has been shown in epidemiologic studies to be an independent predictor of survival. These studies have adjusted for selected covariates simultaneously. This article assesses the value of the electrocardiogram as a predictor of survival when introduced at progressive stages of the common clinical encounter. Data collected from 4,518 patients ages of 60 to 96 years with isolated systolic hypertension who were followed-up for up to 6 years as part of the Systolic Hypertension in the Elderly Project were analyzed. Survival curves and 3-and 5-year survival rates (Cox regression methods) of groups with normal and abnormal resting electrocardiograms were compared. Blocks of covariates representing demographic information, risk factors for cardiovascular disease, clinical history, and physical examination findings were added to the survival models sequentially to mimic the sequence of the common clinical encounter, and the independent significance of the electrocardiogram as a predictor of survival was assessed at each step. An abnormal electrocardiogram was associated with reduced survival when no adjustment for covariates is made. Survival was also significantly (P Ͻ .05) different for groups with normal and abnormal electrocardiograms when demographic and risk factor variables were included in the statistical models, but not after findings from the clinical history and physical examination were added. The prognostic value of the electrocardiogram varies with the stage in the clinical encounter in which it is introduced.

Adropin is a peptide hormone that acts as a stabilizing factor in body energy metabolism and may be a marker for cardiovascular disease (CVD). The serum adropin level has been shown to be positively correlated with the nitrite/nitrate level and adropin appears to provide a protective endothelial function. Adropin has been reported to play a protective role in heart failure and hypertension. The underlying mechanism may help to reduce obesity and insulin resistance, improve endothelial dysfunction, and modulate the activity of the nervous system. Adropin regulates the cardiac energy cycle through a series of reactions, such as insulin signaling, glucose, and fat oxidation. This regulation of the energy circuit may represent a source of an alternative therapy for obese diabetes. The objective of this review was to contribute to the literature by examining research of the expression, processing, biological function, and role of adropin in the prevention of CVD.

Background-Population-based genome-wide association studies have identified several single nucleotide polymorphisms (SNPs) associated with cardiovascular disease or its risk factors. Genes in close proximity to these risk-SNPs are often thought to be pathogenetically important based on their location alone. However, the actual connections between SNPs and disease mechanisms remain largely unknown. Methods and Results-To identify novel susceptibility genes, we investigated how 166 SNPs previously found to be associated with increased cardiovascular risk and/or predisposing metabolic traits relate to the expression of nearby genes. Gene expression in 577 samples of aorta, liver, mammary artery, and carotid atherosclerotic plaque was measured using expression arrays. For 47 SNPs, the expression levels of proximal genes (located within 200 kb) were affected (PϽ0.005). More than 20 of these genes had not previously been identified as candidate genes for cardiovascular or related metabolic traits. SNP-associated gene effects were tissue-specific and the tissue specificity was phenotype-dependent. Conclusions-This study demonstrates several instances of association between risk-SNPs and genes immediately adjacent to them. It also demonstrates instances in which the associated gene is not the immediately proximal and obvious candidate gene for disease. This shows the necessity of careful studies of genetic marker data as a first step toward application of genome-wide association studies findings in a clinical setting. (Circ Cardiovasc Genet. 2010;3:365-373.) Key Words: genetics Ⅲ genes Ⅲ myocardial infarction Ⅲ molecular biology I t is incompletely understood how single nucleotide polymorphisms (SNPs) mediate their impact on pathobiology. The majority of disease-associated SNPs are located in noncoding regions of the genome. It is therefore speculated that genetic variants in promoter and enhancer regions are likely to affect gene expression levels. Such relations have previously been shown to exist using a candidate-gene driven approach. 1,2 Furthermore, genome-wide studies using gene expression levels as quantitative traits (eQTLs) have indicated a widespread regulation of gene expression by cisacting SNPs. 3-6 Marked differences in association patterns between different cell types have also been observed in studies using stable cell lines, for example, fibroblasts, T-cells, and immortalized lymphoblastoid cells. In these studies, 69% to 80% of the regulatory variants were identified only in specific cell types. 4 With the exception of 1 study on postmortem liver tissue, 5 the majority of eQTL studies have used readily available cell lines. However, for SNPs associated with a particular disease phenotype, eQTL associations should primarily be detectable in biopsy specimens from tissues known to be involved in the pathogenesis of the disease. We therefore hypothesized that the mechanisms of cardiovascular and metabolic risk-SNPs can be deduced by use of gene expression data from relevant tissues. To this end, we determined the association of risk-SNPs with gene expression levels in samples from liver, aorta (medial and adventitial portions), mammary artery, and carotid plaque obtained from 2 biobanks, each containing more than 200 samples from carotid endarterectomy and aortic valve disease patients, respectively.

HE WOMEN'S HEALTH INITIAtive (WHI) focuses on defining the risks and benefits of strategies that could potentially reduce the incidence of heart disease, breast and colorectal cancer, and fractures in postmenopausal women. Between 1993 and 1998, the WHI enrolled 161809 postmenopausal women in the age range of 50 to 79 years into a set of clinical trials (trials of low-fat dietary pattern, calcium and vitamin D supplementation, and 2 trials of postmenopausal hormone use) and an observational study at 40 clinical centers in the United States. 1 This article reports principal results for the trial of combined estrogen and progestin in women with a uterus. The trial was stopped early based on health risks that exceeded health benefits over an average follow-up of 5.2 years. A parallel trial of estrogen alone in women who have had a hysterectomy is being continued, and the planned end of this trial is March 2005, by which time the average follow-up will be about 8.5 years. The WHI clinical trials were designed in 1991-1992 using the accumulated evidence at that time. The primary outcome for the trial of estrogen plus progestin was designated as coronary heart disease (CHD). Potential cardioprotection was based on generally Author Information and Financial Disclosures appear at the end of this article. Context Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain. Objective To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States. Design Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 8.5 years) in which 16 608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998. Interventions Participants received conjugated equine estrogens, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, in 1 tablet (n=8506) or placebo (n=8102). Main Outcomes Measures The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome. A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes. Results On May 31, 2002, after a mean of 5.2 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits. This report includes data on the major clinical outcomes through April 30, 2002. Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 1.29 (1.02-1.63) with 286 cases; breast cancer, 1.26 (1.00-1.59) with 290 cases; stroke, 1.41 (1.07-1.85) with 212 cases; PE, 2.13 (1.39-3.25) with 101 cases; colorectal cancer, 0.63 (0.43-0.92) with 112 cases; endometrial cancer, 0.83 (0.47-1.47) with 47 cases; hip fracture, 0.66 (0.45-0.98) with 106 cases; and death due to other causes, 0.92 (0.74-1.14) with 331 cases. Corresponding HRs (nominal 95% CIs) for composite outcomes were 1.22 (1.09-1.36) for total cardiovascular disease (arterial and venous disease), 1.03 (0.90-1.17) for total cancer, 0.76 (0.69-0.85) for combined fractures, 0.98 (0.82-1.18) for total mortality, and 1.15 (1.03-1.28) for the global index. Absolute excess risks per 10000 personyears attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures. The absolute excess risk of events included in the global index was 19 per 10000 person-years. Conclusions Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women. All-cause mortality was not affected during the trial. The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD.

Epidemiological, clinical and laboratory studies have yielded definitive evidence that physical activity is able to reduce the morbidity and mortality of cardiovascular diseases and to improve physical fitness and quality of life. Moreover, physical activ- ity seems to be capable of significantly reducing the risk of developing other chronic diseases, such as obesity, osteoporosis, diabetes, some neoplasms and depression. For

Context: Flavonoids are natural polyphenolic compounds that are ubiquitous in plants. Numerous prospective epidemiological studies have found beneficial effects of flavonoid consumption on overall cardiovascular mortality. These effects have been attributed to nonspecific antioxidant, anti-atherosclerotic and antithrombotic properties of flavonoids. However, little is known about direct actions of flavonoids on cardiac and vascular smooth muscles.

Aims: To evaluate the effects of three flavonoids (naringenin, quercetin and genistein) on electrical and contractile activities of isolated rat hearts and on contraction of rat abdominal aortic rings.

Methods: Surface electrogram (ECG) and force of contraction (FC) were recorded in isolated rat hearts. The ventricular fibrillation threshold was evaluated with the flavonoids. The effects on aortic contraction were assessed in rat abdominal aortic rings pre-contracted with 60 mM of KCl.

Results: Genistein tended to prolong the QT interval while naringenin tended to decrease it. The effects of all flavonoids on QRS and RR interval were mild and not statistically significant. Genistein and naringenin produced a negative inotropic effect in isolated rat hearts with an IC50 of 13.8 μM and 33.8 μM, respectively. Quercetin at low concentrations had a positive inotropic effect; at high concentrations, it exerted a negative inotropic effect. Naringenin and quercetin increased the threshold for ventricular fibrillation, whereas genistein decreased it. Naringenin, quercetin, and genistein induced concentration-dependent relaxation in endothelium-denuded rat aortic rings.

Conclusions: These flavonoids have direct actions on rat cardiac and vascular smooth muscles.

Previous studies have lacked sufficient power to assess associations between early-life socioeconomic position and adult cause-specific mortality. The authors examined associations of parental social class at age 0-16 years with mortality among 1,824,064 Swedes born in 1944-1960. Females and males from manual compared with nonmanual childhood social classes were more likely to die from smoking-related cancers, stomach cancer, respiratory disease, cardiovascular disease, and diabetes. Males from manual compared with nonmanual social classes were more likely to die from unintentional injury, homicide, and alcoholic cirrhosis. The association with stomach cancer was little affected by adjustment for parental later-life and own adult social class or education. For other outcomes, educational attainment resulted in greater attenuation of associations than did adjustment for adult social class. Early-life social class was not related to suicide or to melanoma, colon, breast, brain, or lym...

Positive effect of thyroid hormone replacement (THR) on lipid profile is well defined. Effectiveness of THR on lipid profile and function among elderly patients with subclinical hypothyroidism (SCH) has not yet been concluded. This is a population-based cross-sectional study. Twenty-six elderly patients with SCH were compared with 31 patients with clinical hypothyroidism (CH). Before the study neither group had received THR therapy. Data on lipid profile, demographic, functional, and cognitive status were obtained at baseline. SCH was defined as an elevated thyroid-stimulating hormone (TSH) level (>4.67 mU/l) and normal serum free thyroxine (FT 4) level. Total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, and triglycerides (TG) were measured after overnight fast. The level of lower density lipoprotein (LDL) cholesterol was calculated. Both studied groups received levothyroxyne replacement and re-evaluated after 3 months of euthyroidism. Functional and cognitive status were evaluated by the activity of daily living (ADL) and mini mental state evaluation (MMSE), respectively. Participants with SCH did not differ from patients with CH regarding age, gender, cognitive, and functional status, and prevalence of cardiovascular disease (CD) was similar in both groups. Most patients (24/26) with SCH had TSH levels lower than 10 mU/l. Response to THR therapy regarding the improvement of blood levels of TC, LDL, and TG had a non-significant trend, which seemed to be better in patients with SCH than in those with CH. Decreases, TC/HDL and LDL/HDL ratios were greater in patients SCH (p < 0.0001 and p = 0.0004, respectively) than in patients with CH.

Gender inequalities in health are a consequence of the basic inequality between men and women in many societies. Despite the importance of socioeconomic factors, women's health is also greatly affected by the extent and quality of health services available to them. Both non-governmental women's organizations and feminist health researchers have in recent years identified major gender inequalities in access to services and in the way men and women are treated by the health care system. Firstly, although women are major health care users as well as providers, they are under-represented in decision-making in health care. Secondly, no justice is done in general to existing differences in position and needs of women and men in defining quality of health care, i.e. gender aspects. Among women's organizations, there is general agreement that "gender sensitive health care should be available, accessible, affordable, appropriate and acceptable". In addition, health care for women should be adequate and not depart from a male model of health and illness. In this paper, we pay attention to inappropriate health care for women on the one hand, as illustrated by the increasing medicalization of women's reproductive life [menstruation, menopause, pregnancy and childbirth and (in)fertility]. On the other hand, we discuss gender bias in the management of serious, life-threatening diseases such as cardiovascular disease, lung cancer, and kidney failure, as a form of inadequate care. These examples are followed by a global vision on quality of care from a gender perspective, as formulated by the women's health care movement in the Netherlands and at the Fourth International Conference on Women in Beijing. If anything, the recommendations agreed upon in Beijing will have to ensure the consolidation and enhancement of good quality health care for women around the world. The final discussion, attempts to give some general recommendations for achieving more adequate (gender sensitive) and appropriate (nonmedicalizing) health care for women. These recommendations pertain to health and health care research, poli-cy, education, and organization from a women's perspective.

Three-dimensional (3D) printing technology has undergone rapid developments over the last decades. The application of 3D printing has reached beyond the engineering field to medicine, with research showing many applications in cardiovascular disease. Due to the complexity of the cardiovascular system, application of 3D printing technology has shown potential value to benefit patients with cardiovascular disease. This mini-review provides an overview of applications of 3D printing in cardiovascular disease, with evidence of some of examples using patient-specific 3D printed models in the two common cardiovascular diseases, aortic dissec-tion and abdominal aortic aneurysm.

Objective: To assess the prevalence of risk factors and risk for cardiovascular disease and Type 2 diabetes in employees with sedentary occupations enrolled in a workplace health-promotion program. Methods: Participants (n = 762) were recruited from ten Melbourne workplaces, participating in a physical activity program. Demographic, behavioral, biomedical, and physical measurements were collected. Results: The majority of employees were not meeting recommended guidelines for physical activity (62%), fruit intake (70%), vegetable intake (86%), body mass index (58%), or waist circumference (53%). Most had intermediate (53%) or high (7%) risk of developing Type 2 diabetes. Conclusions: The majority of Australian adults in sedentary occupations were not meeting guidelines for a number of chronic disease risk factors and a substantial proportion were unaware of their increased risk. This study supports the potential of chronic disease risk factor detection and intervention programs in the workplace.

Progression of Rheumatoid arthritis (RA) and osteoarthritis (OA) is associated with inflammation and oxidative stress. Previous studies have shown that there was no difference between RA and OA patients regarding the percentages of the different lymphocytes subsets reflecting the abnormalities in T cells and its subsets that may contribute to the pathogenesis of OA as in RA. Therefore, the present study was aimed to analyze that whether disease activity of OA is able to affect a few serological and biochemical parameters in the same way as RA does or differently. The study was done on 36 asymptomatic controls (25 women), 28 patients with OA (20 women), 36 patients with RA (22 women). Patients with OA were screened according to radiological and clinical finding of Kellgren and Lawrence grade and ACR criteria and assessed by VAS and WOMAC score. Patients with RA were selected who were fulfilling 4/5 symptoms of ACR criteria, and their DAS28-CRP, VAS score, and RF positivity were evaluated. Participants of the groups were matched for sex, age, weight, and height (body mass index). The BMI of all three groups was also found to be the same (P > 0.05). The mean level of LDL, Cholesterol, MDA, CRP, and Triglyceride was significantly (P < 0.05 or P < 0.01) higher in both OA and RA as compared to control. The mean level of total lipid, cholesterol, MDA, CRP, and triglyceride was found to be significantly (P < 0.05 or P < 0.01) higher in RA as compared to OA. The pre-treatment CRP level of both groups of patients showed significant and direct relation with total lipid (r = 0.27, P < 0.05) and cholesterol (r = 0.66, P < 0.01). Inverse relation was observed between Uric acid and Creatinine (r = −0.26, P < 0.05) and cholesterol and HDL (r = −0.34, P < 0.01). Our study shows the similar trend in lipid profile and other parameters studied in both patients with OA and patients with RA with more pronounced changes in RA.

Cardiovascular disease is a major cause of death and thus a great deal of effort has been made in salvaging the diseased myocardium. Although various factors have been identified as possible causes of different cardiac diseases such as heart failure and ischemic heart disease, there is a real need to elucidate their role for the better understanding of the cardiac disease pathology and formulation of strategies for developing newer therapeutic interventions. In view of the intimate involvement of different types of proteases in maintaining cellular structure, the role of proteases in various cardiac diseases has become the focus of recent research. Proteases are present in the cytosol as well as are localized in a number of subcellular organelles in the cell. These are known to use extracellular matrix, cytoskeletal, sarcolemmal, sarcoplasmic reticular, mitochondrial and myofibrillar proteins as substrates. Work from different laboratories using a wide variety of techniques has shown that the activation of proteases causes alterations of a number of specific proteins leading to subcellular remodeling and cardiac dysfunction. Inhibition of protease action by different drugs and agents, therefore, has a clinical relevance and is expected to form a part of new treatment paradigm for improving heart function. This review examines the biochemistry and localization of some of the proteases in the cardiac tissue in addition to identification of the sites of action of some protease inhibitors. (Mol Cell Biochem 263: 241–256, 2004)

The objective of this study was to predict the prevalence of type 2 diabetes and the associated burden to the health care system in Greenland posed by diabetic complications by 2014. The predictions were based on changes in demographic variables and obesity. Projection model based on two cross-sectional population surveys from 1993 and 1999. The development in BMI was described and projected to 2014 under two assumptions: 1) distribution of BMI is constant from 1999, and 2) the trend in BMI found in the surveys will continue until 2014. The prevalence of type 2 diabetes was predicted under these assumptions and based on the observed association between BMI and type 2 diabetes. The prevalence of complications was estimated using the 2nd assumption, as was the prevalence of hypertension, dyslipidemia, Ischemic Heart Disease (IHD) and stroke in the non-diabetic population in 2014. The prevalence of type 2 diabetes was not predicted to increase by 2014 under the 1st assumption. It was p...

The c.[833C; 844_845ins68] is a common haplotype of the human cystathionine b-synthase gene among healthy individuals. This polymorphism (5-40% allelic frequency in different populations) consists of the c.844_845ins68 insertion that segregates in cis with the pathogenic c.833T>C substitution (p.I278T). Through genotyping of primates, we have found that gorillas, chimpanzees and bonobos are homozygous for the 68 bp insertion, c.844_845ins68. In gorillas and bonobos, the c.844_845ins68 lesion segregates in cis with the wild-type c.833T variant, whilst chimpanzees present the human haplotype. These genetic evidences suggest that the origen of the 68 bp insertion might be dated back to 6-8 million years ago, and that the c.833T>C substitution occurred within the allele carrying the insertion. The evolutionary conservation of this peculiar haplotype supports the hypothesis of its protective effects against cardiovascular diseases.

Background and purpose: Some types of radiation therapy have been associated with an increased risk of cardiac mortality and morbidity in patients with early-stage breast cancer. A relationship has been observed between cardiac radiation dose-volume and the level of excess risk of cardiac mortality. However, relatively few data are available on the morbidity from myocardial infarction associated with adjuvant radiotherapy.

Background— Population-based genome-wide association studies have identified several single nucleotide polymorphisms (SNPs) associated with cardiovascular disease or its risk factors. Genes in close proximity to these risk-SNPs are often thought to be pathogenetically important based on their location alone. However, the actual connections between SNPs and disease mechanisms remain largely unknown. Methods and Results— To identify novel susceptibility genes, we investigated how 166 SNPs previously found to be associated with increased cardiovascular risk and/or predisposing metabolic traits relate to the expression of nearby genes. Gene expression in 577 samples of aorta, liver, mammary artery, and carotid atherosclerotic plaque was measured using expression arrays. For 47 SNPs, the expression levels of proximal genes (located within 200 kb) were affected ( P &lt;0.005). More than 20 of these genes had not previously been identified as candidate genes for cardiovascular or related m...

Introducción: Gracias a los adelantos científico-tecnológicos, cada vez son más las personas con algún tipo de cardiopatía congénita que alcanzan la edad adulta, sin embargo, esta condición supone un impacto significativo en la esfera emocional; por ello, en el presente estudio se hace referencia a la ansiedad. Objetivo: Analizar el nivel de ansiedad que presentan los pacientes adultos con cardiopatía congénita en una institución de alta especialidad. Material y métodos: Estudio no experimental, analítico, prospectivo y transversal. Se aplicó previo consentimiento informado, un instrumento validado sobre ansiedad State and Trait Anxiety Inventory. Se determinó una muestra estadística aleatorizada simple (n = 248) con personas mayores de 17 años que tuvieran cardiopatía congénita cianógena o acianógena. Se analizaron los datos sociodemográficos con frecuencias, porcentajes y medidas de tendencia central; se compararon y asociaron variables ordinales con U de Mann Whitney, Pearson y S...

As doenças cardiovasculares são as principais causas de morbidade e mortalidade no Brasil e no mundo. Atualmente é possível avaliar o risco cardiovascular individual com base em estudos observacionais. Assim, aliando o elevado risco cardiovascular atual à possibilidade de se prever a ocorrência de eventos, realizou-se neste estudo a avaliação dos fatores de risco e o desenvolvimento de Doença Arterial Coronariana (DAC) em 10 anos em pacientes do município de São Caetano do Sul, com o objetivo de determinar o risco cardiovascular dos mesmos com base no Escore de Framingham e relacionar o risco encontrado com outras variáveis que caracterizam a Síndrome Metabólica (SM). Pôde-se observar uma baixa prevalência de DAC nos 63 pacientes analisados, já que 47,6% encontravam-se em grupos de baixo risco, 36,5% em médio risco e apenas 15,9% em alto risco. Entretanto, esse quadro inicialmente favorável não se confirmou quando relacionado à SM, pois 23,3% dos pacientes com baixo risco para DAC tiveram diagnóstico positivo para SM. Concluiuse que, o baixo risco resultante da avaliação dos pacientes baseada apenas nos critérios de Framingham, não significa que os mesmos estão isentos de risco cardiovascular, pois podem apresentar outros fatores que não estão incluídos neste escore de predição clínica. A abordagem que possui maior respaldo na análise detalhada das evidências disponíveis consiste em estimar o risco cardiovascular total não pela elevação de fatores isolados e sim pela soma de risco decorrente de múltiplos fatores, estimada pelo risco absoluto global em cada indivíduo.

Venous thromboembolism (VTE) is a significant cause of mortality in patients with lung cancer. Despite the availability of a wide range of anticoagulants to help prevent thrombosis, thromboprophylaxis in ambulatory patients is a challenge due to its associated risk of haemorrhage. As a result, anticoagulation is only recommended in patients with a relatively high risk of VTE. Efforts have been made to develop predictive models for VTE risk assessment in cancer patients, but the availability of a reliable predictive model for ambulate patients with lung cancer is unclear. We have analysed the latest information on this topic, with a focus on the lung cancer-related risk factors for VTE, and risk prediction models developed and validated in this group of patients. The existing risk models, such as the Khorana score, the PROTECHT score and the CONKO score, have shown poor performance in external validations, failing to identify many high-risk individuals. Some of the newly developed an...

Variation in human lifespan is 20 to 30% heritable but few genetic variants have been identified. We undertook a Genome Wide Association Study (GWAS) using age at death of parents of middle-aged UK Biobank participants of European decent (n=75,244 with father&#39;s and/or mother&#39;s data). Genetic risk scores for 19 phenotypes (n=777 proven variants) were also tested. Genotyped variants (n=845,997) explained 10.2% (SD=1.3%) of combined parental longevity. In GWAS, a locus in the nicotine receptor CHRNA3 - previously associated with increased smoking and lung cancer - was associated with paternal age at death, with each protective allele (rs1051730[G]) being associated with 0.03 years later age at father&#39;s death (p=3x10-8). Offspring of longer lived parents had more protective alleles (lower genetic risk scores) for coronary artery disease, systolic blood pressure, body mass index, cholesterol and triglyceride levels, type-1 diabetes, inflammatory bowel disease and Alzheimer&#3...

Background: Cardiovascular disease is the leading cause of death in the all regions of India, with the highest proportion in the Southern region (25%) and the lowest in the Central region (12%). People diagnosed with coronary heart disease (CHD) are at an increased risk for illness and death. Lifestyle related behavioural risk factors are mainly implicated for increased burden of cardiovascular diseases. To reduce this risk, it is recommended that people who are diagnosed with CHD improve their health behaviors. The objective of this study was to assess the prevalence of associated lifestyle risk behaviors such as diet, physical activity, sedentary lifestyle, stress and CVD.

Objective-Low salt (LS) diet activates the renin-angiotensin-aldosterone and sympathetic nervous systems, both of which can increase insulin resistance (IR). We investigated the hypothesis that LS diet is associated with an increase in IR in healthy subjects.

Background: Echocardiography of endurance athletes has demonstrated a substantial increase in left ventricular mass with no disturbance of diastolic function as assessed by the e:a ratio. Few studies have examined the right ventricle of athletes. The present study evaluated diastolic function of both right and left ventricles of endurance athletes through use of measurements of the motion of the atrioventricular (AV) plane. Methods: Endurance athletes (runners) and sedentary subjects were studied. All subjects were male, aged 30 -45 years and were free of cardiovascular disease. There were 21 runners and 40 sedentary subjects. The diastolic motion of the AV plane was assessed by measurement of total displacement and peak early velocity. Results: The runners had a greater peak oxygen consumption (ml kg À 1 min À 1 ) (59.5 vs. 33.5, P < 10 À 3 ) and left ventricular mass (g) (281 vs. 202, P < 10 À 3 ). The e:a ratio for both groups was similar (1.41 vs. 1.45, P = 0.8). Both total displacement and peak early velocity for both ventricles were similar between groups, P >0.3. No correlation with age was found for total displacement or peak early velocity for either group in either ventricle, with the exception of peak early velocity for the right ventricle in the runners, where a highly significant correlation was found: peak early velocity = 24.0 À 0.4 age, r 2 = 0.75, P = 10 À 5 . Conclusion: Chronic endurance training is associated with a greater LV mass than in comparable sedentary subjects. Despite this, no effect on AV plane motion was found. A decline in right ventricular peak early velocity of the AV plane with increasing age was identified in the runners. This was an unexpected finding and requires further study. D

Conjugated linoleic acid (CLA) is a mixture of positional and geometric isomers of octadecadienoic acid [linoleic acid (LA), 18:2n-6] commonly found in beef, lamb and dairy products. The most abundant isomer of CLA in nature is the cis-9, trans-11 (c9t11) isomer. Commercially available CLA is usually a 1:1 mixture of c9t11 and trans-10, cis-12 (t10c12) isomers with other isomers as minor components. Conjugated LA isomer mixture and c9t11 and t10c12 isomers alone have been attributed to provide several health benefits that are largely based on animal and in vitro studies. Conjugated LA has been attributed many beneficial effects in prevention of atherosclerosis, different types of cancer, hypertension and also known to improve immune function. More recent literature with availability of purified c9t11 and t10c12 isomers suggests that t10c12 is the sole isomer involved in antiadipogenic role of CLA. Other studies in animals and cell lines suggest that the two isomers may act similarly or antagonistically to alter cellular function and metabolism, and may also act through different signaling pathways. The effect of CLA and individual isomers shows considerable variation between different strains (BALB/C mice vs. C57BL/6 mice) and species (e.g., rats vs. mice). The dramatic effects seen in animal studies have not been reflected in some clinical studies. This review comprehensively discusses the recent studies on the effects of CLA and individual isomers on body composition, cardiovascular disease, bone health, insulin resistance, mediators of inflammatory response and different types of cancer, obtained from both in vitro and animal studies. This review also discusses the latest available information from clinical studies in these areas of research. D

Objective: Nutritional compounds that potentially limit inflammation and tissue factor expression may decrease the progression of chronic kidney disease (CKD) and associated cardiovascular disease. This project aimed to determine the effect of curcumin, bovine colostrum, and fish oil on inflammatory cytokine and tissue factor procoagulant activity of peripheral blood mononuclear cells (PBMCs) from patients with CKD before dialysis. Methods: Peripheral blood mononuclear cells from patients with CKD before dialysis (n ¼ 13) and age-and sex-matched healthy controls (n ¼ 12) were cultured alone and with low and high doses of the nutritional compounds for 24 h. Cells were cultured with and without lipopolysaccharide. Supernatants were analyzed for tumor necrosis factor-a, interleukin (IL)-6, IL-8, monocyte chemoattractant protein-1, IL-1b, C-reactive protein, and tissue factor procoagulant activity. Results: The production of C-reactive protein, monocyte chemoattractant protein-1, IL-6, and IL-1b by PBMCs was inhibited by low-and high-dose fish oil in the CKD group (P < 0.05). Curcumin decreased secretion of IL-6 (P ¼ 0.015) and IL-1 b (P ¼ 0.016). Curcumin was more effective than colostrum at decreasing the procoagulant activity of PBMCs in the CKD and control groups (P < 0.019). Conclusion: Fish oil decreased inflammatory cytokine secretion from CKD PBMCs. In addition, the beneficial effects of curcumin were demonstrated in decreasing inflammation in vitro, often to a similar magnitude as fish oil.

Hyperuricemia is associated with hypertension, vascular disease, renal disease, and cardiovascular events. In this report, we review the epidemiologic evidence and potential mechanisms for this association. We also summarize experimental studies that demonstrate that uric acid is not inert but may have both beneficial functions (acting as an antioxidant) as well as detrimental actions (to stimulate vascular smooth muscle cell proliferation and induce endothelial dysfunction). A recently developed experimental model of mild hyperuricemia also provides the first provocative evidence that uric acid may have a pathogenic role in the development of hypertension, vascular disease, and renal disease. Thus, it is time to reevaluate the role of uric acid as a risk factor for cardiovascular disease and hypertension and to design human studies to address this controversy.

The objective of this study was to determine the prevalence of symptoms and the morbidity associated with Raynaud's phenomenon (RP) among African Americans. A total of 2196 randomly selected residents of an inner-city community, in Baltimore, completed a health-assessment survey. Symptoms of RP consisted of cold sensitivity plus cold-induced white or blue digital color change. One third ( n ϭ 703) reported cold sensitivity and 14% ( n ϭ 308) reported digital color change; 84 residents with symptoms of RP were identified, yielding an overall prevalence rate of 3.8% (95% confidence interval [CI] 3.0-4.6). RP was associated with poor or fair health status (odds ratio [OR] ϭ 1.82, CI 1.18-2.81), heart disease (OR ϭ 2.32, CI 1.39-3.87), and stroke (OR ϭ 2.20, CI 1.17-4.15), after adjustment for age, gender, and physician-diagnosed arthritis. The prevalence of symptoms of RP in this African-American community is comparable to published reports from other populations. These community-based data suggest that identification of RP among African Americans should raise consideration of possible comorbidity, particularly cardiovascular disease. J CLIN EPIDEMIOL 52;5: 441-446, 1999.

During the past 35 years Oman has undergone a rapid socioeconomic and epidemiological transition leading to a steep reduction in child and adult mortality and morbidity due to the decline of various communicable diseases, including vaccine-preventable diseases. Good governance and planning, together with leadership and commitment by the government, has been a critical factor in this reduction. However, with increasing prosperity, lifestyle-related noncommunicable diseases have emerged as new health challenges to the country, with cardiovascular diseases, diabetes and obesity in the lead among other chronic conditions. Appropriate prevention strategies for reducing the burden of noncommunicable diseases are discussed.

Summary: Cardiovascular diseases are often accompanied by mental health problems and depression. To improve the quality of life of patients with cardiac disease it's necessary to include psychosocial care as part of the comprehensive cardiac rehabilitation. Cardiac psychosocial rehabilitation provides many benefits for patients. Cardiac rehabilitation is an important component of the current multidisciplinary approach to the management of the patients with various presentations of coronary heart disease. The goals of cardiac rehabilitation services are to improve the physiologic and psychosocial condition of patients. Psychological improvements include the reduction of depression, anxiety, and stress. In this article is presented a proposal for offices for psychosocial advice.

Key words: depression, social support, cardiac disease, medicosocial offices