1,721,059 research outputs found
Coronary heart disease differences across Europe: a contribution from the Seven Countries Study.
No full textIn the Seven Countries Study of Cardiovascular Diseases, 16 cohorts of middle-aged men were enrolled in eight nations of seven countries in three continents in the late 1950s and early 1960s for a total of 12 763 individuals. Thirteen cohorts were located in Europe, two in Finland, one in the Netherlands, three in Italy, two in Croatia - former Yugoslavia, three in Serbia - former Yugoslavia, and two in Greece. Another cohort was enrolled in the USA and two cohorts in Japan. Baseline prevalence of coronary heart disease (CHD) was largely different across areas, as well as 10-year incidence of major CHD events and CHD mortality for periods ranging from 25 to 40 years of follow-up. Higher rates were found in Northern Europe, lower rates in Southern Europe and intermediate rates in Eastern Europe, represented by Serbia. Differences across countries were partly explained by different entry mean levels of serum cholesterol, blood pressure, consumption of saturated fatty acids and adherence to traditional dietary patterns. Forty-year trends of CHD mortality were largely explained by early changes in serum cholesterol and blood pressure levels, with large risk increases in Serbia and Greece, and the tendency to declines in Finland and the Netherlands. These trends in Seven Countries' experience are in line with those manifests in official mortality data. An attempt of interpretation is presented pointing to socio-economic evolution in the involved countries, which heavily modifies health and dietary habits and contributes to explaining these differences at population level
[Dynamics of post-infarction blood lipids].
No full textDuring 1993-1994, 3590 patients who recovered from acute myocardial (undergone 1 to 6 years earlier) were examined by 139 ambulatory cardiologists. Aim of the study was to investigate blood lipid changes in 2435 (67.82%) patients in whom total-HDL-and LDL-cholesterol and triglycerides were obtained. These lipids were not abnormally elevated and actually very similar to (or slightly lower than) those of the general population examined in Italy in the context of the RIsk Factors and Life Expectancy Pooling Project (including 70,000 individuals). However, blood lipids were, in general, higher in women than in men and declined as age increased (unless HDL-cholesterol which tended to increase). Among postinfarction patients lipid-lowering drugs were taken by 19% of men and 14% of women, which contrasts with proportions observed in the general population (5 and 4%, respectively). Mean blood lipid values were higher among those who were treated with lipid-lowering drugs, either from the postinfarction series or the general population (unless HDL-cholesterol which had an opposite trend). These data may indicate why treatment was undertaken, although no conclusion may be drawn about drug-efficacy. Postinfarction patients examined after 1-2 years from illness showed lower values of mean blood lipids than those examined 3-6 years after the acute episode (however, the opposite was true for HDL-cholesterol). There are several possible explanations for these observations: high lethality in infarction-patients with high blood lipids, efficacy of lipid-lowering drugs, diet or metabolic changes following acute myocardial infarction. Nevertheless, the proportion of postinfarction patients treated with lipid-lowering drugs was lower than anticipated from (and/or recommended based on) results of recent secondary preventive trials. It seems necessary to repeat (possibly periodically) this investigation in large samples of postinfarction patients to assess whether and how, in clinical practice, indications are applied from recent large trials on secondary prevention of ischemic heart disease
[Notes to the regulatory Appendix 13 of the Italian Committee for Drugs].
No full textThe Italian Committee for Drugs has recently modified "Appendix 13" to a recent Italian regulation related to reimbursement of hypolipidemic agents for primary or secondary prevention of heart diseases. There is some confusion in concepts, terminology and phrasing, also dealing with disease definition, which need comment. Moreover, "Appendix 13" suggests to estimate risk based on charts derived from the Framingham experience, which are inappropriate when applied to Italy. Finally, "Appendix 13" is not clear as to how categorize high risk individuals. There has been a growing interest in estimating coronary risk since 1994, probably as the result of primary and, secondary intervention trials with statins used to lower blood cholesterol levels. On the other hand, European guidelines have been published, accompanied by risk charts (derived from the Framingham study) helping to index individuals who may benefit from treatment of coronary risk factors. At least thirteen such or similar instruments have been produced worldwide (and three of these in Italy) to estimate coronary risk. In Italy, there are other instruments in preparation. Data are reviewed wherefrom it is possible to conclude that it is inadequate, since substantially erroneous, to use risk functions to estimate absolute coronary risk when these are derived from largely different populations as to those in which practical applications are looked for
Antihypertensive treatment: a source of confusion when considered as a cardiovascular risk factor.
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The estimate of cardiovascular risk. Theory, tools and problems.
No full textThe present article reviews the epidemiological and statistical bases of the multivariate prediction of cardiovascular events and its transformation into practical tools for primary prediction. The problems with the use of tools derived from studies conducted in populations that are different from those in which the estimate is being made are documented. A description is made of a number of predictive tools produced in the past and recently included in risk manuals, charts and computer programs and their main characteristics are outlined. The problems in the origin, structure and use of the chart suggested by the Task Force of three European Scientific Societies, including the marked overestimate of the risk when this tool is applied to Italian data, are reviewed in detail. The need to use predictive tools derived from Italian population studies is stressed. Comments are made on the difficult choice between the use of the absolute and relative risks for the identification of high-risk subjects to be treated on an individual basis for primary prevention of major cardiovascular diseases
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Normotensive middle-aged men after 5-10 years: normal blood pressure or hypertension?
No full textWe evaluated the incidence of hypertension over 5-10 years of follow-up in middle-aged men, 40-59 years at entry, selected from the Italian section of the Seven Countries Study. Out of the 2480 subjects, 852 were normotensive at entry [systolic blood pressure (SBP) less than 140 mmHg and diastolic blood pressure (DBP) less than 90 mmHg)], alive after 10 years and had been evaluated repeatedly after 5 and 10 years. After 5 years, 31.3\% had developed borderline hypertension (140 less than or equal to SBP less than 160 and 90 less than or equal to DBP less than or equal to 95 mmHg) and 14.6\% had developed definite hypertension (SBP greater than or equal to 160 mmHg or DBP greater than or equal to 95 mmHg). During the next 5 years, out of the 267 borderline hypertensives, 28.5\% became definite hypertensives, while 29.6\% reverted to normal blood pressure. Out of the 124 definite hypertensives, 46\% remained in this category, while 34.7\% became borderline hypertensives and 19.4\% became normotensive. In men aged 60-69 years, less than 2\% of hypertensives were being effectively treated and changes in body weight were closely related to blood pressure. In addition, out of 461 normotensive subjects who remained normotensive at the 5-year examination, 63.6\% remained normotensive in the next 5 years also, while 28\% developed borderline hypertension and only 8.4\% moved into the definite hypertensive class. These data suggest that a normotensive subject aged 40-59 years has a 34.4\% probability of remaining normotensive in the next 10 years.(ABSTRACT TRUNCATED AT 250 WORDS
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