Fabrizio Jossa

Coronary Heart Disease: Reducing the Risk: The Scientific Background to Primary and Secondary Prevention of Coronary Heart Disease A Worldwide View

Coronary heart disease (CHD) is the major cause of death in most developed countries and in many developing countries. The clinical complications of CHD lead to substantial disability and are a main source of the rising cost of health care. While CHD incidence is decreasing in western Europe, the United States, and Australia, it is steeply increasing in central and eastern Europe and, to some extent, in Asia and Africa.1 2 3 4 Worldwide, the need for more effective preventive strategies against CHD has become urgent and cannot be postponed. Much has been learned about preventive policies, both at the population and the individual level, in the past decade. The International Task Force for Prevention of CHD has developed an updated document that takes into account the results of the recent, major, lipid-lowering trials of primary and secondary prevention. Clinical and quantitative approaches are provided to assess the global risk of CHD according to classic and newly recognized risk factors and thereby to assign an appropriate level of intervention against risk factors. This targeted strategy maximizes the use of dietary methods and provides clear indications for drug treatment. The primary importance of improving health-related behavior in the population as a whole is emphasized. In the present document, the undervalued scope for preventive care at the individual clinical level is the major theme; it is based on the selection and management …

Coronary Heart Disease: Reducing The Risk A Worldwide View

Worldwide, cardiovascular diseases are now the most common cause of death and a substantial source of chronic disability and health costs. In the light of new data from clinical trials and a fuller understanding of risk factors, the International Task Force for the Prevention of Coronary Heart Disease, in cooperation with the International Atherosclerosis Society, prepared a revised and comprehensive statement regarding the scientific basis of the primary and secondary prevention of cardiovascular disease. The following is a short account of the clinical implications of this statement. It is best read in conjunction with the full document, which can be found at http://www.chd-taskforce.com Assessing a patient’s overall or global risk of cardiovascular disease is the first step in preventive care, for it enables the physician to identify and provide the appropriate level of treatment for risk factors. Much can be learned from measuring even a few risk factors. The fuller the knowledge of the patient’s risk status, the sounder the treatment decisions. Initial costs may be offset by long-term rational treatment. The goals of treatment and, hence, the extent of dietary change and the need for (and choice and dosage of) drug treatment all depend on global risk assessment. Two methods for determining global risk follow. Note and tabulate the following risk factors, including those laboratory investigations that are available. ### Age, Sex, and Menopausal Status Risk increases progressively with adult age, and coronary heart disease (CHD) is most common after the age of 60 years. In premenopausal women, CHD is rare (except in those who use oral contraceptives and smoke). After menopause, risk increases steeply, approaching that of men after the age of 70 years. ### History of Cardiovascular Disease The risk of further CHD events or stroke is much higher in persons with a history of myocardial infarction, angina, stroke, or intermittent claudication and in those who have ischemic …

Social network disturbances and psychological distress following earthquake evacuation

The relationship between social network disturbances following earthquake evacuation and self-reported psychological distress (reduced version of the SCL-90-R) 3 to 4 years later was studied among 817 Italian male factory workers. Increased distress was reported by permanently relocated men, while those who were evacuated, but returned to their original homes, reported distress levels comparable to their nonevacuated co-workers. Additionally, among evacuated men, only those whose relocation placed them at an increased distance from family and/or friends reported distress levels higher than the nonevacuated. Change in visiting frequency with family and/or friends following evacuation was not related to distress. Although these data are correlational and cross-sectional, they are consistent with the hypothesis that disaster related distress is, in part, a function of resulting social network disruption.

Serum selenium and coronary heart disease risk factors in southern Italian men

The association between serum selenium concentration and a number of coronary heart disease risk factors is studied in 364 males from southern Italy participating in the Olivetti Heart Study. Selenium correlates positively and significantly with serum cholesterol (r = 0.120; P = 0.022), and this positive association persists after adjustment for age and body mass index. Selenium levels in heavy smokers are lower than both light smokers and current non-smokers, but these differences do not reach statistical significance. Selenium is not significantly associated with any of the other CHD risk factors (e.g., triglycerides, HDL cholesterol, blood pressure, age, and body mass index). It is hypothesized that the association between selenium and serum cholesterol reported in this and previous studies could be due to dietary interrelationships between selenium intake and foods that affect serum cholesterol concentrations.

Short-term effect of natural disasters on coronary heart disease risk factors.

In this analysis of the data from a longitudinal study on coronary heart disease risk factors, it was found that participants screened a few weeks after a major disaster (earthquake) had a higher heart rate, serum cholesterol levels, and serum triglyceride levels than matched participants that were screened shortly before the catastrophic event. The two groups of participants did not differ with regard to their characteristics at the baseline examination carried out 5 years previously. The lack of difference in blood pressure between exposed and nonexposed participants could be explained by the lag-time between the earthquake and the blood pressure measurements. We conclude that the acute stress associated with major disasters can influence risk factors for coronary heart disease. Permanent elevation of these risk factors due to the disruption of the social environment of the individuals affected by major disasters might be responsible for the apparent long-term adverse effects on cardiovascular mortality discussed previously in the literature.

Baldness and coronary heart disease risk factors

The present report focuses on the association between baldness pattern and coronary heart disease risk factors in 872 male factory workers from southern Italy participating in an epidemiological study. Participants were divided according to presence or absence of baldness and baldness pattern. Participants with fronto-occipital baldness (male-type baldness) (n = 280) characterized by hair loss centered over the vertex with an m-shaped frontal-temporal recession had, on the average, higher serum cholesterol and blood pressure compared to participants with no baldness (n = 321) and/or participants with just frontal baldness (n = 273). For serum cholesterol, a significant interaction was detected between age and fronto-occipital baldness (i.e. the association between fronto-occipital baldness and elevated levels of serum cholesterol became weaker with age). No interaction was detectable between age and fronto-occipital baldness for blood pressure. The results of this cross-sectional study indicate that male-type pattern of baldness is associated with elevated CHD risk profile, and that this relation between age and serum cholesterol differs in younger compared to older men.

Small dense low-density lipoprotein in familial combined hyperlipidemia: Independent of metabolic syndrome and related to history of cardiovascular events

INTRODUCTION It is unclear whether small dense low-density lipoprotein (sdLDL) are associated with familial combined hyperlipidemia (FCHL), independently of the metabolic syndrome (MS). It is also unclear whether sdLDL are related to history of cardiovascular (CVD) events in FCHL patients, independently of MS. PATIENTS AND METHODS Serum levels of sdLDL, expressed as percentage of total LDL cholesterol (LDL score), were determined in 137 probands with FCHL and in 133 normolipidemic, normotensive, normoglycemic healthy subjects. RESULTS In binary logistic regression age- and gender-adjusted LDL score values above the 90th and 95th percentiles of the values in the control group (10.23 and 13.11%, respectively) were found to be significant predictors of FCHL status, independently of MS diagnosis (p=0.007 and p<0.0001, respectively). Values of the LDL score above the 90th and the 95th percentile of the control group resulted to be significantly related to FCHL status, even after adjustment for the components of MS (p=0.006 and p=0.001, respectively). Among FCHL patients, values of the LDL score above 95th percentile of the values in the control group were found to be significantly related to personal and/or family history of CVD events, independently of age, gender, total cholesterol, apolipoprotein (apo) B, and MS status (p=0.016). The same significant relationship was found adjusting for all components of MS (p=0.034). CONCLUSIONS High concentrations of sdLDL are highly specific markers of FCHL, independently of concomitant MS. In FCHL patients high levels of sdLDL are related to history of CVD events, independently of MS, total cholesterol and apo B.

Coffee and serum lipids: Findings from the Olivetti heart study

The relationship between coffee consumption and blood lipids was analyzed in a sample of 900 male workers of southern Italy participating in the Olivetti Heart Study. In the univariate analysis, coffee drinkers (n = 856) had higher values for body mass index (P < or = 0.05) and number of cigarettes smoked per day (P < or = 0.001) and lower levels of serum high-density-lipoprotein cholesterol (P < or = 0.05), compared to noncoffee drinkers (n = 44). In addition, coffee consumption (cups/d) was positively related to serum triglyceride levels (r = 0.105, P < or = 0.01) and cigarette smoking (r = 0.491, P < or = 0.01), and was inversely related to age (r = -0.122, P < or = 0.01). After multivariate adjustment, coffee consumption remained significantly related to age, cigarette smoking, and body mass index (data not shown). After stratification for smoking status, a significant positive linear trend between coffee consumption and serum total cholesterol was observed only in smokers. No significant trend was observed for serum triglycerides and high-density-lipoprotein cholesterol with coffee intake according to smoking status. This finding suggests that the relationship between coffee consumption and serum total cholesterol may change with the smoking status.

Short- and long-term association between uric acid and a natural disaster.

Objective This paper analyzes the longitudinal relationship between serum uric acid level and a natural disaster. Methods The sample consists of factory workers who were participating in a longitudinal epidemiological study of coronary heart disease risk factors. Participants were seen in 1975 (baseline), 1980 (5 year follow-up), and 1987 (12 year follow-up). The 5 year (1980) follow-up examination was interrupted by a major earthquake and resumed 2 weeks after the quake. At this examination, participants seen after the quake had, on the average, significantly lower serum uric acid than those seen before the earthquake. In 1987 (7 years after the quake), participants were questioned whether or not (in their own perception) they were still suffering from damages due to the 1980 earthquake. Results At the examination in 1987, participants who reported suffering from damage due to the 1980 quake showed on the average significantly increased serum uric acid compared with participants who reported not suffering from damages due to the 1980 quake. The analyses of the data of 578 individuals who participated in all three examinations confirmed these findings and showed that they were independent from levels of uric acid measured prior to the disaster. Conclusions The reason for this apparent different association with uric acid and acute and long-term exposure to the quake remains to be clarified but these findings are consistent with the existence of diverse patterns of physiologic response to different stressors.

Physical activity and its relationship to blood pressure in school children

The present report analyzes the relationship between physical activity and blood pressure in 1341 school children aged 7-14 years (girls = 598, boys = 743) participating in a screening for cardiovascular risk factors that took place in the suburban area of Naples. During the baseline examination, systolic (SBP) and diastolic (DBP) blood pressure, height, weight, and resting pulse rate (PR) were measured. The Harvard-Modified Step Test was also performed in order to score both a crude recovery index (RI) and an index corrected for the initial resting pulse rate (RI-PR) used as measures of the level of habitual physical activity. Significant differences have been found between the quartiles of distribution of both the crude recovery index and the corrected index in girls and boys with regard to systolic blood pressure but not diastolic. In both sexes, better responders to the Harvard-Modified Step Test showed on the average lower systolic blood pressure than poorer responders. In boys, the inverse association between systolic blood pressure and the recovery index was independent of the effect of age, body mass index, height, and resting pulse rate, while in girls the same association did not reach statistical significance. Our results support the hypothesis that systolic blood pressure is independently related to the level of habitual physical activity in children.