Jaroslav Šimon

educational level and risk profile of cardiac patients in the EUROASPIRE II substudy

Study objective: To ascertain, whether, conventional risk factors and readiness of coronary patients to modify their behaviour and to comply with recommended medication were associated with education in patients with established coronary heart disease. Design and methods: EUROASPIRE II was a cross sectional survey undertaken in 1999–2000 in 15 European countries to ascertain how effectively recommendations on coronary preventions are being followed in clinical practice. Consecutive patients, men and women ⩽71 years who had been hospitalised for acute coronary syndrome or revascularisation procedures, were identified retrospectively. Data were collected through a review of medical records, interview, and examination at least six months after hospitalisation. The education reached was ascertained at the interview. Main results: A total of 5556 patients (1319 women) were evaluated. Significantly more patients with ischaemia had only primary education, in contrast with the remaining diagnostic groups. Body mass index and glucose were negatively associated with educational level, while HDL-cholesterol was positively associated. Men with highest education had significantly lower systolic blood pressure and total cholesterol. The prevalence of current smoking decreased significantly from primary to secondary and high education only in men. Both men and women with primary educational level were more often treated with antidiabetics, and antihypertensives, but less often with lipid lowering drugs. The effectiveness of treatment was virtually the same in all education groups. Conclusions: Patients with higher education had lower global coronary risk, than those with lower education. This should be considered in clinical practice. Particular strategies for risk communication and counselling are needed for those with lower education status.

Predictive value of classical risk factors and their control in coronary patients: a follow-up of the EUROASPIRE I cohort.

Background Both EUROASPIRE studies revealed the suboptimal management of coronary patients regarding lifestyle changes and prophylactic use of cardiovascular drugs. We report here on the mortality follow-up of the EUROASPIRE I cohort over a median period of 4.4 years. Design and methods The EUROASPIRE I cohort consisted of a consecutive sample of patients aged ≤ 70 years from nine European countries, hospitalized because of coronary artery bypass graft, percutaneous transluminal coronary angioplasty, acute myocardial infarction or myocardial ischaemia. Baseline data, gathered in 1995–96 through standardized methods, were linked to cause-specific mortality as registered up to 1 April 2000 in 3343 patients. Results After adjustment for age, gender and diagnostic category according to Cox modelling, smoking, previous coronary heart disease and diabetes proved significant predictors of total, cardiovascular (CVD) and coronary heart disease (CHD) mortality. Obesity, low education, raised blood pressure, elevated total cholesterol and low HDL cholesterol, however, were not significantly associated with higher mortality rates. In multivariate analysis, smoking and diabetes emerged as the strongest predictors of CVD [risk ratios (RR) 2.2 and 2.5 respectively] and CHD mortality (RR 2.4 and 2.4 respectively). Conclusions The results of the mortality follow-up of the EUROASPIRE I patients underline the importance of smoking and diabetes in the secondary prevention of CHD. Failure to find statistically significant associations between other classical risk factors, such as blood pressure and plasma lipid levels, and mortality may be related to the extensive use of antihypertensive and lipid-lowering drugs in this cohort.

Short to long term mortality of patients hospitalised with heart failure in the Czech Republic—a report from the EuroHeart Failure Survey

The European Society of Cardiology initiated the EuroHeart Failure Survey to obtain more data about the quality of care in patients hospitalised with suspected heart failure (HF). The Czech Republic was 1 of the 24 European Society countries included in the survey. The aim of this report is to extend the original follow‐up period of 12 weeks out to 4 years to assess mortality.

Changes of blood pressure and lipid pattern during a physical training course in hypertensive subjects

Among 77 hypertensive subjects with a previous predominantly sedentary way of life we followed the changes of several cardiovascular and biochemical parameters during a 5-week physical training course. A highly significant drop in both systolic and diastolic blood pressure (BP) was observed in 58 subjects (75%, p less than 0.001). There was a strong negative correlation between initial uricaemia and the diastolic BP decrease (r = -0.382; p less than 0.001). The decrease of systolic as well as diastolic BP correlated positively with the increase of maximum oxygen uptake per kilogram (VO2max/kg) during the intervention (for systolic BP: r = 0.282, p less than 0.05; for diastolic BP: r = 0.286, p less than 0.05). Serum total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), uricaemia levels and body mass index (BMI) decreased (p less than 0.01 for uricaemia; p less than 0.001 for the rest), whereas the HDL-C/TC ratio increased significantly (p less than 0.001). These positive changes disappeared already 3-7 months after the intervention except for BMI, TG and uricemia, where the lower levels persisted. Thus, the 5-week intensive physical training had a favourable but short-time effect on BP and lipid pattern in the majority of hypertensives.

Impact of Cardiovascular Risk Factors on Morbidity and Mortality in Czech Middle-Aged Men: Pilsen Longitudinal Study

The impact of biological and life-style characteristics measured during baseline examination on 12-year morbidity and mortality of coronary heart disease (CHD), stroke (STR), and malignancies was investigated in an urban population of 3,540 middle-aged men initially free of clinical disease. The following factors enhanced significantly (at the 5% level) the adjusted relative risk ratios: for total mortality age, smoking, and elevated systolic blood pressure; for CHD age, smoking, elevated systolic blood pressure, serum cholesterol levels, and body mass index, and family history (father or mother). Myocardial infarction was positively associated with age, smoking and elevated serum cholesterol levels. For STR age and elevation of both systolic and diastolic blood pressure were risk factors. The relative risk for all malignancies was enhanced by age and smoking. Regular alcohol consumption was associated with a significantly lower risk for all CHD; however, with only marginal significance for myocardial infarction. Higher education was associated with a significantly lower risk of total mortality, all CHD, and myocardial infarction and a marginally lower risk of STR. A high leisure physical activity was negatively (but not significantly) associated with the risk of all end points.

Fibrate treatment and prevalence risk of mild hyperhomocysteinaemia in clinical coronary heart disease patients

Background Several prospective studies reported that fibrates might increase blood total homocysteine (tHcy). In this study we aimed to establish whether the reported fibrate treatment was associated with an increased risk of mild hyperhomocysteinaemia in patients with clinical coronary heart disease, and to establish whether confounding variables may influence this effect. Design A retrospective, case-control analysis. Methods A total of 410 patients, 301 males and 109 females, mean age 59.2 were examined in a Czech sample from the EUROASPIRE II survey. In addition to examinations and measurements, defined by the protocol, we estimated serum total homocysteine (tHcy), folate, B12 vitamin and methylenetetrahydrofolate reductase (MTHFR) genotypes. Results We found significantly higher tHcy concentrations in patients with reported treatment with fibrate (16.6 ± 0.66 μmol/l) compared with no lipid-lowering treatment (13.5 ± 0.64 μmol/l, P< 0.001) or to statin (12.4 ± 0.39 μmol/l, P< 0.001). Concentrations of tHcy ≤15mmol/l (i.e. mild hyperhomocysteinaemia) as a dependent variable were positively associated with age (OR 1.18, P< 0.0003), serum vitamin B12 (OR 0.87, P< 0.003), serum creatinine (OR 1.35, P< 0.0001 and treatment with fibrates (OR 1.30, P< 0.0001), using multiple regression. Using unifactorial or multifactorial analyses, association between fibrate and tHcy is independent from conventional confounders such as age, gender, smoking, folate or B12 concentration, serum creatinine and MTHFR genotypes, however interference of low folate or B12 and fibrate treatment resulted in concentrations of tHcy more than 20 μmol/l. Conclusions Fibrate treatment was associated with a significant increase in prevalence of the risk of mild hyperhomocysteinaemia in coronary patients, independently from conventional confounders.

The New Editorial Board: 1991-1996

The New Editorial Board: 1991-1996 Cardiology was first published in 1937; the original editors were Drs. Bruno Kirsch of Cologne and W. Löffler of Zurich. The journal was originally named Cardiologia International Archives of Cardiology. In 1970, the name of the journal was changed to Cardiology. The Editorial Board at the time the journal was founded consisted of 24 distinguished cardiologists from Europe, North and South America, and Asia. The United States had 5 members including Paul D. White and Frank N. Wilson; Switzerland had 3 members, the UK and Czechoslovakia 2. The remaining 14 members came from the Netherlands, Portugal, Rumania, France, Germany, Sweden, Denmark, Austria, Mexico, and Japan. The 3 eastern European members are of even greater interest given current political changes in that region. More than half the articles in the first two volumes were in German, a quarter were in French, 15% were in Italian, and only 5% were in English. By 1960, the majority of the articles were in English, although French and German manuscripts were still being published. In 1970, when the journal took its present name, English became the sole language of the publication. Contributions in those first two volumes (1937-1938) came from the Netherlands, Italy, Germany, Denmark, France, Switzerland, and the USA. Each article ended with summaries in French, German, English, and Italian. There were no editorials and only occasional book reviews. Slightly more than one-third of the articles dealt with laboratory investigations in animals. Most studies were observational rather than experimental. It is interesting to review the topics covered in the first two volumes of Cardiologia. A number of animal studies were published including one of particular merit on the circulatory effects of intravenous epinephrine and adrenal cortical hormones. Clinical studies of note included work dealing with ventricular premature beats recorded by electrocardiography, congenital heart block, pathological observations on the etiology of atherosclerosis, and the application of cardiac output determinations to clinical problems. Thus, many of the topics which interest us today were already being considered in 1937 and 1938. Modern cardiology was already prefigured at that time. The new Editor and Editorial Board are honored to be part of a scholarly enterprise that is more than 50 years old. On behalf of the publisher and the members of the new Board, I would like to take a few minutes of 2 The New Editorial Board: 1991-1996