Conclusion

There are a number of direct and indirect biologic pathways linking dysglycemia to cardiovascular disease. Similar to dyslipidemia, in which ongoing studies are continuing to show the therapeutic value of reducing even minimally elevated lipid levels,81 dysglycemia may be a continuous modifiable cardiovascular disease risk factor therapies that reduce elevated glucose levels may reduce the risk of cardiovascular disease. A number of ongoing studies will address this issue. These include the...

DASH diets

The effects of composite dietary interventions on blood pressure levels, in normotensive and hypertensive individuals were studied in well designed clinical trials.80'100 The initial dietary intervention, used in the Dietary Approaches to Stop Hypertension (DASH) trial, involved a diet that emphasized fruit, vegetables, and low fat dairy products, and included whole grains, poultry, fish, and nuts while reducing the amounts of red meat, sweets, and sugar-containing beverages. Two variants of...

Arabs

The term Arab refers to Semitic people who originate from the Middle East. Included in this region are the countries of Egypt, Saudi Arabia, Jordan, Iran, Iraq, and the United Arab Emirates. CVD is the leading cause of death among Arabs living in the Middle East.11 This is primarily caused by the rapid socioeconomic development, urbanization, and improved survival over the past several decades. The Global Burden of Disease report estimates that the acute myocardial infarction (AMI) rate among...

Calculation of cost effectiveness

After the costs of therapy and the medical effectiveness of therapy have been assessed, cost effectiveness (CE) can be calculated as where Costj and Cost2 represent the costs of program 1 and program 2, respectively, and QALY1 and QALY2 represent the effectiveness of programs 1 and 2, respectively. There are several implications of using this formula. First, cost effectiveness ratios that are positive (that is, > 0) result if and only if one alternative has both higher cost and greater...

Alcohol

The relationship of alcohol to overall mortality and cardiovascular mortality has generally been J-shaped, when studied in Western populations in whom the rates of atherothrombotic vascular disorders are high.120-124 The protective effect of moderate ethanol consumption is primarily mediated through its effect on the risk of coronary heart disease (CHD), as supported by more than 60 prospective studies.121 A consistent coronary protective effect has been observed for consumption of one to two...

Godfrey H Fowler

Worldwide, there are about one billion current smokers and about three million die annually from their smoking, half before the age of 70 this includes about 150000 annually in the UK and half a million in the USA.1 Even in countries where the health hazards of smoking are widely acknowledged, it remains a common behavior in the USA and Canada, for example, about a quarter of all adults smoke, and, in the UK, the situation is worse with about one third of adults smoking. Cardiovascular disease,...

Issues related to diet as an independent variable

These relate to the association of dietary behaviors with other behaviors which influence cardiovascular risk and the impact of diet on several cardiovascular risk factors which may partly or wholly be in the causal pathway to CVD as intermediate variables. Unhealthy dietary behaviors often occur in association with other unhealthy behaviors such as physical inactivity and smoking. Furthermore, unhealthy dietary practices such as high consumption of saturated fats, salt and refined...

Serum cholesterol and ischemic heart disease

Evidence from genetics, animal studies, experimental pathology, epidemiologic studies and clinical trials indicates conclusively that increasing serum cholesterol is an important cause of ischemic heart disease and that lowering serum cholesterol reduces the risk,5,6 and the results of six large randomized trials of statins have ensured that this is now widely accepted.1,7-11 Three important practical questions arise the nature of the dose-response relationship, the size of the effect, and the...

Increased standard of living leading to deleterious health behaviors

A third reason to arouse concern is that, if population levels of CVD risk factors rise as a consequence of adverse lifestyle changes accompanying industrialization and urbanization, the rates of CVD mortality and morbidity could rise even higher than the rates predicted solely by demographic changes. Both the degree and the duration of exposure to CVD risk factors would increase as a result of higher risk factor levels, coupled with a longer life expectancy. The increase in body weight...

Hispanics

The term Hispanic includes Cuban Americans, Mexican Americans, and Puerto Rican Americans. There are approximately 35-3 million Mexican Americans living in the USA, and they comprise approximately 12-5 of the US population.86,87 The majority of information on CVD in Hispanics has been derived from studies in Mexican Americans. CVD is the leading cause of death among Hispanic males (28 ) and females (34 ).87 Although death certificate registries report that the age adjusted mortality rates for...

The Mediterranean diet

The traditional Mediterranean diet has been described to have eight components (i) high monounsaturated-to-saturated fat ratio (ii) moderate ethanol consumption (iii) high consumption of legumes (iv) high consumption of cereals (including bread) (v) high consumption of fruit (vi) high consumption of vegetables (vii) low consumption of meat and meat products and (viii) moderate consumption of milk and dairy products.130 Most of these are found in many diets. The characteristic component is olive...

Calcium antagonists and p blockers in effort angina

Regarding trials with outcome end points, the major studies are two relatively small RCTs comparing calcium antagonists with ( blockers in effort angina, neither trial having a placebo arm. In the APSIS22 study, slow release verapamil was compared with metoprolol, the main prognostic end points being a combination of morbidity and mortality (total and cardiovascular), and non-fatal cardiovascular complications including MI, revascularization, stroke, and peripheral vascular events, as well as...

Definition and epidemiology of diabetes and impaired glucose tolerance

The diagnosis of DM applies to a heterogeneous group of disorders that are all characterized by high levels of glucose in the blood.8 This hyperglycemia is due either to absent or minimal insulin secretion from insulin-producing (3 cells of the pancreas, or to insufficient insulin secretion to overcome a variable degree of insulin resistance that is present in a large proportion of the general population. As insulin is the primary hormone that prevents hyperglycemia, both by inhibiting hepatic...

Insufficient insulin production

Glucose is the major stimulus for insulin secretion, which in turn prevents rises in glucose levels. Therefore an elevated glucose level implies a lack of sufficient insulin to maintain normoglycemia. Such a lack of sufficient insulin may occur in the presence of both low and high absolute levels of insulin, depending on the degree of insulin resistance. A number of observations support the possibility that insufficient insulin secretion may be related to cardiovascular disease. Patients with...

African Americans

African Americans comprise the largest non-white population in the USA and represent approximately 13 of the population. CVD is the leading cause of death among African Americans, and the incidence of both CHD and CBVD is higher in African Americans compared to white Americans. The CHD mortality rate in African American males is 2-4 higher than in white males (138-1 v 134-8 per 100 000), and 33 higher in African American women compared to white American women (85 v64 per 100000).18 Moreover,...

Flavonoids and other phytochemicals

Flavonoids are polyphenolic antioxidants which occur in a variety of foods of vegetable origin, such as tea, onions and apples. Data from several prospective studies indicate an inverse association of dietary flavonoids with coronary heart disease.68 A benefit on stroke risk has also been reported.69 However, confounding may be a major problem and may explain conflicting results of observational studies on flavonoids and coronary heart disease. Fruit and vegetables also contain other...

Costs and cost effectiveness of lipid alterations for CHD prevention

True benefits for individuals and the public health have only been demonstrated for alteration of plasma LDL-C. One method for comparing the costs of cholesterol lowering is shown in Table 13.5 where the cost of the various statins is given in terms of the number of dollars per per cent of LDL-C lowering per year. Table 13.5 Comparative cost, dose and LDL-C lowering of statins Table 13.5 Comparative cost, dose and LDL-C lowering of statins

Info

The diagnostic value of the pedal pulse examination, as an aid to establishing the diagnosis of peripheral arterial disease, has also been studied.45 In this review the absence of both the dorsalis pedis and posterior tibial pulses was a powerful predictor for the presence of vascular disease (defined as an ankle-to-arm systolic pressure index of < 0-9), with likelihood ratios ranging from 9-0 to 44-6. The presence of a femoral arterial bruit was also a strong indicator of disease, with...

Dietary fats

The relationship between dietary fats and cardiovascular disease (CVD), especially coronary heart disease (CHD), has been extensively investigated, with strong and consistent associations emerging from a wide body of evidence accrued from animal experiments, as well as observational studies, clinical trials, and metabolic studies conducted in diverse human populations. The relationship of dietary fat to CVD was initially considered to be mediated mainly through the atherogenic effects of plasma...

References

Task Force on Research in Epidemiology and Prevention of Cardiovascular Diseases (news). Circulation 1994 90 2609-17. 2.Anand SS. Using ethnicity as a classification variable in health research perpetuating the myth of biological determinism, serving socio-political agendas, or making valuable contributions to medical sciences Ethnicity Health 1999 4 241-4. 3.Littlefield A, Lieberman L, Reynolds L. Redefining race the potential demise of a concept in physical anthropology. Curr...

Fibric acid derivatives Table 132

The fibrates currently marketed in the US are clofibrate, gemfibrozil, and fenofibrate. Fibrates available in other countries include bezafibrate, fenofibrate, ciprofibrate, becla-fibrate, etiofibrate and clinofibrate. In a WHO study clofibrate was shown to reduce modestly (P < 0-05) all cardiovascular events. However, increases in non-cardiovascular morbidity and mortality and total mortality occurred.58 In the Helsinki Heart Study, gemfibrozil was associated with a 35 reduction in MIs,...

Bile acid sequestering agents resins

This class of agents was first developed for the treatment of cholestasis-related pruritus by Carey and Williams in 1960. Hashim and Van Itallie subsequently demonstrated that cholestyramine lowered plasma cholesterol and it has been in clinical use for 30 years. Other agents in this class are colestipol and the recently approved colesevelam. The enterohepatic circulation of bile acids allows for only 6 or 7 of them to be excreted each day. These polymers with a molecular weight of over 106 are...