Prevalence of ischaemic heart disease in middle aged British men.

Shaper, A. G.; Cook, Derek G; Walker, Mary; Macfarlane, P. W.

doi:10.1136/hrt.51.6.595

Cited by 109 publications

(31 citation statements)

References 24 publications

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“…29 Among the 2055 men, 486 (24%) had some evidence of ischemia at baseline. This prevalence is slightly lower than that found by the British Regional Heart Study 30 for men of similar age. These men were not excluded from the analysis.…”

Section: Methodscontrasting

confidence: 65%

C-Reactive Protein, Fibrin D-Dimer, and Incident Ischemic Heart Disease in the Speedwell Study

Lowe

Yarnell

Rumley

et al. 2001

ATVB

205

137

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Abstract-Plasma levels of C-reactive protein (CRP, a marker of the reactant plasma protein component of the inflammatory response) and of fibrin D-dimer (a marker of cross-linked fibrin turnover) have each been associated in recent studies with the risk of future ischemic heart disease (IHD). Previous experimental studies have shown that fibrin degradation products, including D-dimer, have effects on inflammatory processes and acute-phase protein responses. In the Speedwell Prospective Study, we therefore measured CRP and D-dimer levels in stored plasma samples from 1690 men aged 49 to 67 years who were followed-up for incident IHD for an average of 75Ϯ4 months (meanϮSD) and studied their associations with each other, with baseline and incident IHD, and with IHD risk factors. CRP and D-dimer levels were each associated with age, plasma fibrinogen, smoking habit, and baseline evidence of IHD. Key Words: C-reactive protein Ⅲ fibrin D-dimer Ⅲ ischemic heart disease C -reactive protein (CRP), a marker of the reactant plasma protein component of the inflammatory response, has been associated with the risk of future ischemic heart disease (IHD), not only among patients with stable and unstable angina 1,2 and high-risk subjects 3 but also among population samples of apparently healthy middle-aged men 4,5 and elderly men and women. 6 A recent meta-analysis 7 of these prospective studies found a combined risk ratio for IHD of 1.7 (95% confidence interval [CI], 1.4 to 2.1) for subjects in the top third of the distribution of CRP compared with the bottom third. There was no evidence of heterogeneity between these studies.Fibrin D-dimer, a marker of cross-linked fibrin turnover, has also been shown in recent studies to be associated with the risk of future IHD in persons with and without baseline evidence of vascular disease. 8 -16 Local fibrin formation and lysis are part of the inflammatory response, and fibrin degradation products, including D-dimer, have been shown to have diverse effects on inflammatory processes and acutephase responses, including neutrophil and monocyte activation; secretion of cytokines, including interleukin-6 and interleukin-1; and hepatic synthesis of acute-phase proteins, including fibrinogen and CRP. [17][18][19][20] We therefore hypothesized that (1) plasma levels of CRP and D-dimer and their associations with incident IHD in the general population might be linked; (2) linkage might result from focal, vessel wall-related fibrin formation and lysis and an inflammatory response associated with unstable atherosclerotic plaque activity 21,22 ; and (3) CRP and D-dimer might be related to IHD risk factors associated with thrombogenesis and inflammation, particularly cigarette smoking. We are unaware of previously published studies of CRP and D-dimer considered jointly. We tested these hypotheses by studying the mutual relationships of CRP, D-dimer, incident IHD, and risk factors (especially smoking habit) in the middle-aged men of the Speedwell population cohort. Methods Study PopulationThe Speedwe...

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Section: Methodscontrasting

confidence: 65%

C-Reactive Protein, Fibrin D-Dimer, and Incident Ischemic Heart Disease in the Speedwell Study

Lowe

Yarnell

Rumley

et al. 2001

ATVB

205

137

View full text Add to dashboard Cite

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“…In 4% of all the men there was evidence from the electrocardiogram and the chest pain questionnaire, in 10% from the questionnaire only, and in 11% from the electrocardiogram only. 2 Only one in five of those with ischaemic heart disease (ECG or Q or both), however, recalled a diagnosis by a doctor of the condition, suggesting that there is either a failure to report chest pain to the doctor, considerable underdiagnosis of the disorder, an unwillingness to communicate the diagnosis to the patient, or a remarkable inability of men to recall the diagnosis of a major chronic disease.…”

Section: Discussionmentioning

confidence: 99%

Recall of diagnosis by men with ischaemic heart disease.

Shaper¹,

Cook²,

Walker³

et al. 1984

Heart

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SUMMARY In a study of the prevalence of ischaemic heart disease in middle aged men in 24 British towns, the subjects were asked whether a doctor had ever told them that they had any form of cardiovascular disease. Their recall of various diagnoses was related to evidence of ischaemic heart disease obtained by an administered questionnaire on chest pain and electrocardiography. Twenty one per cent of men recalled a diagnosis of cardiovascular disease, in one quarter of whom it was ischaemic heart disease. There was a sixfold increase in the prevalence of recall of a diagnosis of ischaemic heart disease over the age range studied. Only one third of the men with possible myocardial infarction on questionnaire recalled such a diagnosis having been made by a doctor. Only half of those with a definite myocardial infarction on an electrocardiogram could recall a diagnosis of ischaemic heart disease. Even in severe (grade 2) angina 40% could not recall being told that they had heart disease. Overall, only one in five of those regarded as having ischaemic heart disease was able to recall such a diagnosis having been made by a doctor, and these were likely to be those most severely affected. Ischaemic heart disease is common in middle aged British men, but most of those affected are apparently not aware of their condition. This low level of awareness among patients and doctors may contribute to a lack of public concern regarding the need for action to reduce the incidence of ischaemic heart disease in Great Britain.Ischaemic heart disease is extremely common in middle aged men in Great Britain and is a major cause of death.' In a recent study of 7735 men aged 40-59 years, drawn from general practices in 24 towns in England, Wales, and Scotland, one quarter had some evidence of ischaemic heart disease on a questionnaire on chest pain or on electrocardiography.2 In this study we examined the awareness of these men concerning the disease by which they are affected and indirectly assessed how much of this burden of illness in the population is apparently recognised by medical practitioners. Subjects and methodsThe British Regional Heart Study includes 7735 men aged 40-59 years randomly selected from the age-sex registers of group general practices in 24 towns in

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“…The World Health Organization (WHO) (Rose) chest pain questionnaire was administered at the initial examination, and electrocardiography (three orthogonal leads) was performed at rest. Men with evidence of CHD were defined as those with a diagnosis of angina or heart attack made by a doctor, a response on WHO (Rose) chest pain questionnaire indicating angina or possible myocardial infarction (17), or electrocardiographic evidence of definite or possible myocardial ischemia or myocardial infarction (18). Men with evidence of CHD but no recollection of a physician's diagnosis of CHD are referred to as "CHD (undiagnosed).…”

Section: Research Design and Methods -The British Regionalmentioning

confidence: 99%

Smoking as a Modifiable Risk Factor for Type 2 Diabetes in Middle-Aged Men

2001

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OBJECTIVE -To examine the effects of cigarette smoking, giving up smoking, and primary or secondary pipe or cigar smoking on the risk of type 2 diabetes.RESEARCH DESIGN AND METHODS -A prospective study followed 7,735 men aged 40 -59 years from general practices in 24 British towns for an average of 16.8 years. Incident cases of physician-diagnosed diabetes were ascertained by repeated postal questionnaires and systematic reviews of primary care records.RESULTS -A total of 290 incident cases of diabetes were found in 7,124 men with no history of diabetes, coronary heart disease, or stroke. Cigarette smoking was associated with a significant increase in risk of diabetes, even after adjustment for age, BMI, and other potential confounders. The benefit of giving up smoking was only apparent after 5 years of smoking cessation, and risk reverted to that of never-smokers only after 20 years. The risk of diabetes in those who switched from smoking cigarettes to pipe or cigars remained equal to the risk in continuing cigarette smokers. Men who gave up smoking during the first 5 years of follow-up showed significant weight gain and subsequently higher risk of diabetes than continuing smokers.CONCLUSIONS -Cigarette smoking is an independent and modifiable risk factor for type 2 diabetes. Smoking cessation is associated with weight gain and a subsequent increase in risk of diabetes, but in the long term, the benefits of giving up smoking outweigh the adverse effects of early weight gain.

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Prevalence of ischaemic heart disease in middle aged British men.

Cited by 109 publications

References 24 publications

C-Reactive Protein, Fibrin D-Dimer, and Incident Ischemic Heart Disease in the Speedwell Study

C-Reactive Protein, Fibrin D-Dimer, and Incident Ischemic Heart Disease in the Speedwell Study

Recall of diagnosis by men with ischaemic heart disease.

Smoking as a Modifiable Risk Factor for Type 2 Diabetes in Middle-Aged Men

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