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Jiang X, Alnoud MAH, Ali H, Ali I, Hussain T, Khan MU, Khan SU, Khan MS, Khan SU, Ur Rehman K, Safhi AY, Alissa M. Heartfelt living: Deciphering the link between lifestyle choices and cardiovascular vitality. Curr Probl Cardiol 2024; 49:102397. [PMID: 38232921 DOI: 10.1016/j.cpcardiol.2024.102397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 01/19/2024]
Abstract
Cardiovascular diseases (CVDs) are still leading to a significant number of deaths worldwide despite the remarkable advancements in medical technology and pharmacology. Managing patients with established CVDs is a challenge for healthcare providers as it requires reducing the chances of recurring cardiovascular events. On the other hand, changing one's way of life can also significantly impact this area, reducing the likelihood of cardiovascular disease and death through their unique advantages. Consequently, it is advisable for healthcare providers to regularly advise their patients with coronary issues to participate in organized physical exercise and improve their overall physical activity. Additionally, patients should adhere to a diet that promotes heart health, cease smoking, avoid exposure to secondhand smoke, and address any psychosocial stressors that may heighten the risk of cardiovascular problems. These lifestyle therapies, whether used alongside drug therapy or on their own in patients who may have difficulty tolerating medications, face financial barriers, or experience ineffectiveness, can substantially reduce cardiovascular mortality and the likelihood of recurring cardiac events. Despite the considerable advancements in creating interventions, it is still necessary to determine the optimal intensity, duration, and delivery method for these interventions. Furthermore, it is crucial to carry out further investigations incorporating extended monitoring and assessment of clinical outcomes to get a more comprehensive comprehension of the efficacy of these therapies. Presenting the findings within the framework of "lifestyle medicine," this review seeks to offer a thorough synopsis of the most recent scientific investigations into the potential of behavioral modifications to lower cardiovascular disease risk.
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Affiliation(s)
- Xiaorui Jiang
- Ezhou Central Hospital, Hubei Province 436000, China
| | - Mohammed A H Alnoud
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Hamid Ali
- Department of Biosciences, COMSATS University Islamabad, Park Road Tarlai Kalan, Islamabad 44000, Pakistan
| | - Ijaz Ali
- Centre for Applied Mathematics and Bioinformatics, Gulf University for Science and Technology, Hawally 32093, Kuwait
| | - Talib Hussain
- Women Dental College Abbottabad, Khyber Pakhtunkhwa 22020, Pakistan
| | - Munir Ullah Khan
- Department of Polymer Science and Engineering, MOE Key Laboratory of Macromolecular Synthesis and Functionalization, International Research Center for X Polymers, Zhejiang University, Hangzhou 310027 China
| | - Safir Ullah Khan
- Hefei National Laboratory for Physical Sciences at the Microscale, School of Life Sciences, University of Science and Technology of China, Hefei 230027, China
| | - Muhammad Shehzad Khan
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Shatin City, Hong Kong Special Administrative Region of China
| | - Shahid Ullah Khan
- Integrative Science Center of Germplasm Creation in Western China (CHONGQING) Science City and Southwest University, College of Agronomy and Biotechnology, Southwest University, Chongqing 400715, China; Department of Biochemistry, Women Medical and Dental College, Khyber Medical University, Abbottabad, Khyber Pakhtunkhwa 22080, Pakistan
| | - Khalil Ur Rehman
- Institute of Chemical Sciences, Gomal University, Dera Ismail Khan 29050, Pakistan.
| | - Awaji Y Safhi
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
| | - Mohammed Alissa
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
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Purine metabolite-based machine learning models for risk prediction, prognosis, and diagnosis of coronary artery disease. Biomed Pharmacother 2021; 139:111621. [PMID: 34243599 DOI: 10.1016/j.biopha.2021.111621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/23/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023] Open
Abstract
Alterations in xanthine oxidase activity are known to be pathologically influential on coronary artery disease (CAD), but the association between purine-related blood metabolites and CAD has only been partially elucidated. We performed global metabolomics profiling and network analysis on blood samples from the Wonju and Pyeongchang (WP) cohort study (n = 2055) to elucidate the importance of purine related metabolites associated with potential CAD risk. Then, 5 selected serum metabolites were quantified from the WP cohort, Shinchon cohort (n = 259), and Shinchon case control (n = 424) groups to develop machine learning models for 10-year risk prediction, relapse within 10 years and diagnosis of the disease via 100 repeated 5-fold cross-validations of logistic models. The combination of purine metabolite levels or only xanthine levels in blood could be applied for machine learning model development for major adverse cardiac and cerebrovascular event (MACCE, cerebrovascular death, nonfatal myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass graft, and stroke) risk prediction, relapse of MACCEs among patients with myocardial infarction history and diagnosis of stable CAD. In particular, our research provided initial evidence that blood xanthine and uric acid levels play different roles in the development of machine learning models for primary/secondary prevention or diagnosis of CAD. In this research, we determined that purine-related metabolites in blood are applicable to machine learning model development for CAD risk prediction and diagnosis. Also, our work advances current CAD biomarker discovery strategies mainly relying on clinical features; emphasizes the differential biomarkers in first/secondary prevention or diagnosis studies.
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Palmiero P, Zito A, Maiello M, Cecere A, Mattioli AV, Pedrinelli R, Scicchitano P, Ciccone MM. Primary Prevention of Cardiovascular Risk in Octogenarians by Risk Factors Control. Curr Hypertens Rev 2019; 15:78-84. [PMID: 30747075 PMCID: PMC6635644 DOI: 10.2174/1573402115666190211160811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/19/2018] [Accepted: 02/01/2019] [Indexed: 01/03/2023]
Abstract
Primary prevention of cardiovascular events in older adults is a relevant problem, due to lack of evidence for safe and efficacious therapy, its costs and elderly quality of life, Italy's aging population is constantly increasing, so cardiovascular disease (CVD) primary prevention in the elderly is a prime objective. Life expectancy has dramatically increased over the last 2 decades, the proportion of individuals aged 80 years and older has grown rapidly in Europe and the United States, but cost / effective ratio of CVD prevention through risk factors control is debated. It is therefore important to implement cardiovascular risk factors estimation in the elderly to maximize the quality of life of patients and to lengthen their healthy life expectancy, choosing the better treatment for each patient sharing the choice with himself when it is possible, always remembering that elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of CVD prevention therapy. Nevertheless, CVD is not an inevitable concomitant of aging. Sometimes, autopsy in the elderly reveals atheroma-free coronary arteries, a normal-sized heart and unscarred valves. All primary prevention strategy decisions should consider estimated life expectancy and overall function and not just the cardiovascular event risks, magnitude and time to benefit or harm, potentially altered adverse effect profiles, and informed patient preferences. CVD primary prevention needs to be more implemented in the elderly, this might contribute to improve health status and quality of life in this growing population if correctly performed.
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Affiliation(s)
- Pasquale Palmiero
- Address correspondence to this author at the ASL BRINDISI, Cardiology Equipe, District of Brindisi, Via Dalmazia 3, 72100 Brindisi, Italy; E-mail:
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Stewart J, Manmathan G, Wilkinson P. Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovasc Dis 2017; 6:2048004016687211. [PMID: 28286646 PMCID: PMC5331469 DOI: 10.1177/2048004016687211] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/22/2016] [Accepted: 12/02/2016] [Indexed: 12/25/2022] Open
Abstract
Cardiovascular disease is a significant and ever-growing problem in the United Kingdom, accounting for nearly one-third of all deaths and leading to significant morbidity. It is also of particular and pressing interest as developing countries experience a change in lifestyle which introduces novel risk factors for cardiovascular disease, leading to a boom in cardiovascular disease risk throughout the developing world. The burden of cardiovascular disease can be ameliorated by careful risk reduction and, as such, primary prevention is an important priority for all developers of health policy. Strong consensus exists between international guidelines regarding the necessity of smoking cessation, weight optimisation and the importance of exercise, whilst guidelines vary slightly in their approach to hypertension and considerably regarding their approach to optimal lipid profile which remains a contentious issue. Previously fashionable ideas such as the polypill appear devoid of in-vivo efficacy, but there remain areas of future interest such as the benefit of serum urate reduction and utility of reduction of homocysteine levels.
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Affiliation(s)
- Jack Stewart
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, London, UK; Institute of Cardiovascular Research, Biological Sciences, University of London, Surrey, UK
| | | | - Peter Wilkinson
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, London, UK
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Hamm VP, Bazargan M, Barbre AR. Life-Style and Cardiovascular Health Among Urban Black Elderly. J Appl Gerontol 2016. [DOI: 10.1177/073346489301200203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study assessed life-style behaviors in a cross-sectional random sample of urban Black elderly with and without cardiovascular disease. Those with cardiac disease reported behavior modifications for salt mtake, fat intake, and smoking but more often reported being overweight and performing less exercise than did those elderly without cardiac disease. There remains substantial room for improvement in health maintenance and health promotion behaviors in this population, suggesting the need of intensive educational interventions. Additionally, Black elderly with cardiac disease had worse scores on a depression scale and a health locus-of-control question, suggesting the need for psychological assessment and intervention in this population.
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Vokonas PS, Kannel WB. Epidemiology of Coronary Heart Disease in the Elderly. FUNDAMENTAL AND CLINICAL CARDIOLOGY SERIES 2008. [DOI: 10.3109/9781420061710.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bermejo García J, López de Sá E, López-Sendón JL, Pabón Osuna P, García-Morán E, Bethencourt A, Bosch Genover X, Roldán Rabadán I, Calviño Santos R, Valle Tudela V. [Unstable angina in the elderly: clinical, profile, management and mortality at three months. The PEPA Registry Data]. Rev Esp Cardiol 2000; 53:1564-72. [PMID: 11171478 DOI: 10.1016/s0300-8932(00)75281-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND OBJECTIVES Few reports in the literature have studied the characteristics and management of unstable angina in the elderly in Spain. The aim of this study was to analyze the clinical characteristics and the use of diagnostic and therapeutic resources in patients > or = 70 years of age. PATIENTS AND METHODS A total of 1,551 patients > or = 70 years of age were included out of 4,115 included in the PEPA registry with a follow up of 90 days. These patients were compared with 2,564 < 70 years. RESULTS In comparison, the elderly (76 +/- 5 years) versus the younger group (58 +/- 8.5 years) included a higher proportion of women (43 vs 27%), diabetics (30 vs 23%)and hypertensive patients (60 vs 49%) with a lower proportion (p < 0.001) of hypercholesterolemia (33 vs 43%), smoking (40 vs 60%) or family history (9 vs 17%). A previous history of angina (49 vs 35%) or infarction (38 vs31%) and comorbidity was found to be significantly more frequent in the elderly, with a worse previous functional class (NYHA > 2 out of 34 vs 15%). The elderly were treated with fewer invasive procedures (25 vs 44%) or catheterization (26 vs 36%) and they were more frequently controlled with medical treatment (86 vs 83%) although with a lower use of beta blockers (45 vs 53%). The mortality at 3 months was greater in the elderly (7.4 vs 3.0%;p < 0.005) with age being an independent predictor of bad prognosis. Cox multivariate analysis showed the age, ST segment depression, diabetes and heart failure on admission to be predictors of bad prognosis in the elderly. CONCLUSIONS A different pattern is observed in cardiovascular risk factors with a more unfavorable clinical profile in elderly patients with unstable angina. The management of these patients is less aggressive and the mortality is greater. Diabetes, heart failure and ST segment depression on admission are independent predictors of bad prognosis in elderly patients.
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Kaski JC, Smith DA. The Management of Chronic Ischemic Heart Disease in the Elderly. THE AMERICAN JOURNAL OF GERIATRIC CARDIOLOGY 2000; 9:145-150. [PMID: 11416553 DOI: 10.1111/j.1076-7460.2000.80024.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite advances in medical and surgical therapy, ischemic heart disease remains the most important cause of death and disability in an ever growing population. The management of elderly patients with ischemic heart disease is made more difficult by the presence of comorbid medical conditions, which can both further aggravate ischemic heart disease and interfere with pharmacological and interventional therapy. Despite the difficulties in the management of ischemic heart disease in the elderly, there is substantial evidence that older patients can benefit greatly from aggressive, rational treatment of this condition and, therefore, such treatment should not be denied solely on the grounds of age. (c) 2000 by CVRR, Inc.
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Affiliation(s)
- Juan C. Kaski
- Coronary Artery Disease Research Group, St. George's Hospital Medical School, London, UK
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Abstract
A major societal challenge is to improve quality of life and prevent or reduce disability and dependency in an ageing population. Increasing age is associated with increasing risk of disability and loss of independence, due to functional impairments such as loss of mobility, hearing and vision; a major issue must be how far disability can be prevented. Ageing is associated with loss of bone tissue, reduction in muscle mass, reduced respiratory function, decline in cognitive function, rise in blood pressure and macular degeneration which predispose to disabling conditions such as osteoporosis, heart disease, dementia and blindness. However, there are considerable variations in different communities in terms of the rate of age-related decline. Large geographic and secular variations in the age-adjusted incidence of major chronic diseases such as stroke, hip fracture, coronary heart disease, cancer, visual loss from cataract, glaucoma and macular degeneration suggest strong environmental determinants in diet, physical activity and smoking habit. The evidence suggests that a substantial proportion of chronic disabling conditions associated with ageing are preventable, or at least postponable and not an inevitable accompaniment of growing old. Postponement or prevention of these conditions may not only increase longevity, but, more importantly, reduce the period of illnesses such that the majority of older persons may live high-quality lives, free of disability, until very shortly before death. We need to understand better the factors influencing the onset of age-related disability in the population, so that we have appropriate strategies to maintain optimal health in an ageing population.
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Affiliation(s)
- K T Khaw
- Clinical Gerontology Unit, University of Cambridge, Addenbrooke's Hospital, UK
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Corti MC, Salive ME, Guralnik JM. Serum albumin and physical function as predictors of coronary heart disease mortality and incidence in older persons. J Clin Epidemiol 1996; 49:519-26. [PMID: 8636725 DOI: 10.1016/0895-4356(95)00562-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The role of traditional risk factors in predicting coronary heart disease (CHD) among men and women aged 65 years and over has been extensively debated, but the search for risk factors that are distinctive in the elderly is still ongoing. The relation of serum albumin levels and physical disability to risk of CHD morality and incidence was prospectively assessed in a cohort of 4116 men and women, aged 71 years and over, who were evaluated in 1987-1989 and followed for a mean of 4.0 years. Outcome events were based on death certificates and Medicare hospitalization records. Analyses were adjusted for major CHD risk factors. There were 275 CHD deaths (16.8/1000 person-years) among all participants and 503 incident (fatal and nonfatal) CHD events (39.4 per 1000 person-years) among participants free of prevalent CHD during the observation period. The relative risk (RR) of CHD morality for women with an albumin concentration < 38 g/liter was 2.5 times higher than for women with albumin > 43 g/liter (RR 2.5; 95% confidence interval [CI], 1.4-4.6). There was a significant and graded increase in CHD incidence with decreasing albumin concentration in women but not in men. The presence of physical disability doubled the risk of CHD mortality among both men and women, an increase in risk that was comparable to that imposed by a previous myocardial infarction and was independent of other coronary risk factors. Disability had a lesser impact on CHD incidence, which was significant only in women. Low albumin concentration (< 38 g/liter) identifies a group of women at higher risk of CHD mortality and incidence. Physical disability is an independent predictor of CHD mortality in both men and women and for CHD incidence only in women.
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Affiliation(s)
- M C Corti
- Epidemiology, Demography, and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892-9205, USA
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Ritchie DE. Cardiac Rehabilitation for Elderly People. Phys Med Rehabil Clin N Am 1995. [DOI: 10.1016/s1047-9651(18)30469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Feskens EJ, Bowles CH, Kromhout D. Glucose tolerance and mortality from ischemic heart disease in an elderly population. Impact of repeated glucose measurements. Ann Epidemiol 1993; 3:336-42. [PMID: 8275208 DOI: 10.1016/1047-2797(93)90059-d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The impact of glucose tolerance, measured repeatedly, on the mortality from ischemic heart disease (IHD) was assessed in a cohort of 202 elderly patients, aged 64 to 84 years in 1971, from a general practice. During the period from 1971 to 1975 the participants were examined annually. The area under the glucose tolerance curve (AUC) was used as a summary index, and for every subject the mean AUC over the 5-year period was calculated. This index was most strongly correlated with the mean 60-minute glucose level (r = 0.96). Between 1975 and 1987, 125 participants died, 28.8% of whom died from IHD. No association between a single measurement of glucose tolerance and IHD mortality was observed. However, using the mean AUC over the 5-year period, a positive association was observed, independent of age, sex, and other potential confounders (P = 0.04). These results indicate that glucose tolerance independently predicts mortality from coronary heart disease in an elderly cohort, provided that information on repeated measurements is taken into account. A continuous risk gradient is suggested.
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Affiliation(s)
- E J Feskens
- Department of Epidemiology, National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands
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Cardiovascular disease risk factors and attitudes towards prevention among Korean-American elders. J Cross Cult Gerontol 1993; 8:17-33. [DOI: 10.1007/bf00973797] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
This investigation evaluated the effect of a peer-education program on preventing cardiovascular disease in older persons. Peer leaders at two urban senior housing residences were provided with training on cardiovascular disease and its risk factors, strategies to reduce the risk factors, and communication skills. Baseline and follow-up data were collected on residents at the two intervention and two control sites. The dependent variables were knowledge of cardiovascular disease risk factors; perceived self-efficacy to reduce calories, dietary fat and salt intake, to lose weight, to stop smoking, and to exercise regularly; and self-reported cardiovascular risk behaviors. Analysis of individual change scores between baseline and follow-up surveys showed a statistically significant increase in overall knowledge of heart disease, dietary self-efficacy, and exercise self-efficacy for the intervention group compared with the control group. This program appeared to benefit the individuals who lived in housing residences where the peer educators also resided.
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Affiliation(s)
- M A Rose
- University of South Florida, College of Nursing, Tampa 33612
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Katzel LI, Coon PJ, Busby MJ, Gottlieb SO, Krauss RM, Goldberg AP. Reduced HDL2 cholesterol subspecies and elevated postheparin hepatic lipase activity in older men with abdominal obesity and asymptomatic myocardial ischemia. ARTERIOSCLEROSIS AND THROMBOSIS : A JOURNAL OF VASCULAR BIOLOGY 1992; 12:814-23. [PMID: 1616906 DOI: 10.1161/01.atv.12.7.814] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Silent myocardial ischemia (SI), an asymptomatic manifestation of coronary artery disease (CAD), was identified in 10% of apparently healthy nonsmoking, nondiabetic older (60 +/- 7 years, mean +/- SD) men with normal plasma cholesterol levels. We hypothesized that in the absence of other major risk factors for CAD, the men with SI would have reduced plasma levels of high density lipoprotein (HDL) and HDL2 subspecies due to an upper-body fat distribution (waist-to-hip ratio [WHR]), hyperinsulinemia, and abnormal postheparin plasma lipoprotein lipase (LPL) and hepatic lipase (HL) activities. Compared with 47 normal control subjects of similar age, obesity, and maximal aerobic capacity, the 18 men with SI had higher plasma triglyceride (TG) (162 +/- 71 versus 102 +/- 39 mg/dl, p less than 0.001) and lower HDL-C (33 +/- 6 versus 37 +/- 7 mg/dl, p less than 0.02) levels with no difference in low density lipoprotein cholesterol level. The HDL2b and HDL2a subspecies measured by gradient gel electrophoresis were also lower in the men with SI (p less than 0.01). The plasma glucose and insulin responses during an oral glucose tolerance test were the same in both groups. Postheparin plasma HL activity was significantly higher in 12 men with SI than in 41 control subjects (34 +/- 8 versus 27 +/- 10 mumol/ml.hr-1, p less than 0.03) and was correlated with log insulin area (r = 0.36, p less than 0.05) and WHR (r = 0.32, p less than 0.05) in the control subjects but not in the men with SI. In the control group, the percent HDL2b subspecies was correlated inversely with postheparin plasma HL activity (r = -0.46, p less than 0.01, n = 41) as well as WHR (r = -0.49, p less than 0.001, n = 47) and log insulin area (r = -0.37, p less than 0.05, n = 47) but not in the men with SI. Postheparin LPL activity was the same in both groups of men and did not correlate with HDL, WHR, insulin, or plasma TG levels. As the control subjects and men with SI had comparable degrees of abdominal obesity and hyperinsulinemia, these results suggest that the reduced HDL-C levels in men with SI may be related to elevations in HL activity. Thus, abdominal obesity, hyperinsulinemia, elevated TG levels, and low HDL-C and HDL2 subspecies levels may predispose these older men to atherosclerosis.
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Affiliation(s)
- L I Katzel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
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Affiliation(s)
- G F Fletcher
- Department of Rehabilitation Medicine (Division of Cardiac Rehabilitation), Emory University School of Medicine, Atlanta, Georgia
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Abstract
Changes in lipid metabolism with age result in lower total serum cholesterol and low-density lipoprotein concentrations. There is no evidence that longevity and lipid profiles are influenced by genetic make-up. It is difficult to establish an optimum total serum cholesterol in the elderly but values established in younger subjects give a guide. High-density lipoprotein may be even more protective in the elderly and could turn out to be a better predictor of coronary disease. Screening for the treatment of hypercholesterolaemia should be carried out in the elderly. Although death is an inevitable fact, intervention in, for example, recently retired, apparently disease-free subjects is important. The first approach should be the introduction of changes in life style (increased exercise, stopping smoking, improved diet). Drugs may also be introduced if these interventions fail. Although drug therapy in the elderly may pose immediate problems due to poor renal and hepatic function, the adverse effects of long-term use have less relevance in the elderly.
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Affiliation(s)
- B Kirby
- Postgraduate Medical School, University of Exeter, UK
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Carleton RA, Dwyer J, Finberg L, Flora J, Goodman DS, Grundy SM, Havas S, Hunter GT, Kritchevsky D, Lauer RM. Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction. A statement from the National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health. Circulation 1991; 83:2154-232. [PMID: 2040066 DOI: 10.1161/01.cir.83.6.2154] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
In all but a few remote and unacculturated tribes, blood pressure rises with advancing age. By the time Western adult males or females reach their 70s their probability of being hypertensive (BP greater than 140/90 mmHg) exceeds 50%. Unlike various other risk factors for vascular disease, hypertension retains its predictive power as age increases, but since the baseline risk is higher, the number of cases of disease attributable to hypertension is much higher in the elderly than in the young. The reason for the rise in blood pressure with aging is not well established, although a high lifetime intake of sodium may be a contributing factor. It now appears that the major hemodynamic abnormality is an increased peripheral resistance. It is possible that an accentuation of changes that take place with normal aging might be responsible for this phenomenon. They include a reduction in renal function, decreased baroreceptor sensitivity, or increased sympathetic activity. Up until the present time studies have been unable to isolate the mechanisms involved.
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Affiliation(s)
- J J McNeil
- Department of Social and Preventive Medicine, Monash University Medical School, Alfred Hospital, Victoria, Australia
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Abstract
This study investigated the physician's role in proffering appropriate medical advice to aged patients and the patient's role in complying with that advice. Heart disease, which takes a major health toll among the aged but is amenable to risk reduction practices, exemplifies a condition that offers physicians the opportunity to play an important health promotion role. The advice given by physicians to 246 heart patients and their compliance with the advice is the subject of this article. Data were obtained from a longitudinal study of recovering myocardial infarction patients aged 60 and over (n = 204), and a comparison group of patients aged 45-59 (n = 42). The patient cohorts were similar in health and demographic factors. Findings from interviews conducted six weeks after hospital discharge indicated major age differences in cardiac risk reduction advice given by physicians, but no age effects of patient compliance with the medical advice. Neither preinfarction nor postinfarction cardiac health were factors in compliance. Findings suggest that older patients are systematically denied the opportunity for lessening risk of future heart problems by adopting behavioral changes, despite a lack of evidence that aged heart patients will not adhere to medical advice to engage in these changes. Suggestions are given for interventive efforts directed at both physicians and patients.
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