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Long-term prognosis after partial gastrectomy for gastroduodenal ulcer

WORLD JOURNAL OF SURGERY 2000年第3期24卷 307-314页

作者： von Holstein, CS Univ Lund Hosp Dept Surg S-22185 Lund Sweden

The decline in duodenal ulcer disease and the established relation of peptic ulcer to Helicobacter pylori have virtually abolished the need for elective ulcer surgery, However, a substantial proportion of the population around retirement age has previously been subjected to partial gastric resection due to peptic ulcer, and the long-term outcome of these patients is of continuing relevance, Patients subjected to elective surgery could represent a selected group of healthy subjects with a lower overall morbidity, but reports indicate that patients operated on for peptic ulcer have more advanced disease associated with excess smoking and a different pattern of social behavior, The surgical procedure induces enterogastric reflux, leading to profound changes in the remnant mucosa and the formation of carcinogens in the gastric juice, In addition, metabolic abnormalities are common, especially fat malabsorption. Evaluation of the impact of these factors on morbidity and mortality is difficult. Increased mortality in gastrointestinal tumors (especially gastric stump carcinoma), respiratory diseases and other smoking-related malignancies, and suicide are found in the long-term follow-up after partial gastric resection due to peptic ulcer. However, these hazards to life are offset by a decreased mortality in cardiovascular disease. Preventive measures against suicide and especially tobacco smoking are recommended to improve the outcome for this cohort.

关键词：胆汁返流/并发症心血管疾病/死亡率胃切除术/副作用胃泌素类/缺乏螺杆菌感染/并发症幽门螺杆菌营养障碍/病因学消化性溃疡/并发症消化性溃疡/代谢消化性溃疡/死亡率消化性溃疡/外科学预后危险因素性别因素吸烟/副作用胃肿瘤/病因学胃肿瘤/死亡率自杀/统计学和数值数据时间因素女(雌)性人类男(雄)性

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Proteinuria as a risk factor for cardiovascular disease and mortality in older people: A prospective study

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AMERICAN JOURNAL OF MEDICINE 2000年第1期109卷 1-8页

作者： Culleton, BF Larson, MG Parfrey, PS Kannel, WB Levy, D NHLBI Framingham Heart Study Framingham MA 01702 USA Boston Univ Sch Med Dept Prevent Med & Epidemiol Boston MA 02118 USA Mem Univ Newfoundland Div Nephrol St John NF Canada

BACKGROUND: The prognostic significance of proteinuria in older people is not well defined. We examined the associations between proteinuria and incident coronary heart disease, cardiovascular mortality, and all-cause mortality in older people. SUBJECTS AND METHODS: Casual dipstick proteinuria was determined in 1,045 men (mean [+/- SD] age 68 +/- 7 years) and 1,541 women (mean age 69 +/- 7 years) attending the 15th biennial examination of the Framingham Heart Study. Participants were divided by grade of proteinuria: none (85.3%), trace (10.2%), and greater-than-trace (4.5%). Cox proportional hazards analyses were used to determine the relations of baseline proteinuria to the specified outcomes, adjusting for other risk factors, including serum creatinine level. RESULTS: During 17 years of follow-up, there were 455 coronary heart disease events, 412 cardiovascular disease deaths, and 1,214 deaths. In men, baseline proteinuria was associated with all-cause mortality (hazards ratio [HR] = 1.3, 95% confidence interval [CI] 1.0 to 1.7 for trace proteinuria;HR = 1.3, 95% CI 1.0 to 1.8 for greater-than-trace proteinuria;P for trend = 0.02). In women, trace proteinuria was associated with cardiovascular disease death (HR = 1.6, 95% CI 1.1 to 2.4), and all-cause mortality (HR = 1.4, 95% CI 1.1 to 1.7). CONCLUSION: Proteinuria is a significant, although relatively weak, risk factor for all-cause mortality in men and women, and for cardiovascular disease mortality in women. Am J Med. 2000;109:1-8. (C) 2000 by Excerpta Medica, Inc.

关键词：年龄因素生物学标记/血液生物学标记/尿心血管疾病/病因学心血管疾病/代谢心血管疾病/死亡率死亡原因肌酸酐/血液疾病恶化马萨诸塞/流行病学比例危险度模型前瞻性研究蛋白尿/血液蛋白尿/并发症蛋白尿/尿危险因素性别分布存活率老年人女(雌)性人类男(雄)性

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Measurement of heart rate variability:: A clinical tool or a research toy?

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第7期34卷 1878-1883页

作者： Huikuri, HV Mäkikallio, T Airaksinen, KEJ Mitrani, R Castellanos, A Myerburg, RJ Univ Oulu Dept Med Div Cardiol SF-90220 Oulu Finland Univ Miami Sch Med Miami FL USA

OBJECTIVES The objectives of this review are to discuss the diversity of mechanisms that may explain the association between heart rate (HR) variability and mortality, to appraise the clinical applicability of traditional and new measures of HR variability and to propose future directions in this field of research. There is a large body of data demonstrating that abnormal HR variability measured over a 24-h period provides information on the risk of subsequent death in subjects with and without structural heart disease. However, the mechanisms responsible for this association are not completely established. Therefore, no specific therapy is currently available to improve the prognosis for patients with abnormal HR variability. Reduced HR variability has been most commonly associated with a risk of arrhythmic death, but recent data suggest that abnormal variability also predicts vascular causes of death, progression of coronary atherosclerosis and death due to heart failure. A consensus is also lacking on the best HR variability measure for clinical purposes. Time and frequency domain measures of HR variability have been most commonly used, but recent studies show that new analysis methods based on nonlinear dynamics may be more powerful in terms of risk stratification. Before the measurement of HR variability can be applied to clinical practice and used to direct therapy, more precise insight into the pathophysiological link between HR variability and mortality are needed. Further studies should also address the issue of which of the HR variability indexes, including the new nonlinear measures, is best for clinical purposes in various patient populations. (C) 1999 by the American College of Cardiology.

关键词：心血管疾病/死亡率心血管疾病/病理生理学昼夜节律/生理学猝死心脏/流行病学猝死心脏/预防和控制心电描记术便携式/方法心率/生理学发病率预后存活率动物人类

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Management of patients with hypertension and diabetes mellitus: Advances in the evidence for intensive treatment

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AMERICAN JOURNAL OF MEDICINE 2000年第3期108卷 238-245页

作者： White, WB Prisant, LM Wright, JT Univ Connecticut Sch Med Sect Hypertens & Clin Pharmacol Farmington CT 06032 USA Med Coll Georgia Div Cardiol Augusta GA 30912 USA Case Western Reserve Univ Sch Med Div Hypertens Cleveland OH USA

Diabetes mellitus is common in patients with hypertension, and greatly increases the risk of cardiovascular disease, including myocardial infarction, stroke, and peripheral vascular disease. The pharmacologic therapy of patients with hypertension and diabetes has been surrounded by controversy because of concerns about the metabolic effects of several antihypertensive agents, as well as concerns about the safety of calcium antagonists. The objective of this review is to re-evaluate the management of diabetic patients with hypertension in light of the latest clinical trials. We also review the importance of intensive blood pressure control in these patients. (C) 2000 by Excerpta Medica, Inc.

关键词：血管紧张素转换酶抑制药/治疗应用抗高血压药/治疗应用血压/药物作用心血管疾病/病因学心血管疾病/死亡率糖尿病并发症糖尿病/治疗糖尿病肾病/预防和控制疾病管理疾病恶化高血压/并发症高血压/药物疗法结果评价(卫生保健) 危险人类

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Angiotensin I-converting enzyme and plasminogen activator inhibitor-1 gene variants: Risk of mortality and fatal cardiovascular disease in an elderly population-based cohort

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第4期34卷 1176-1183页

作者： Heijmans, BT Westendorp, RGJ Knook, DL Kluft, C Slagboom, PE TNO Prevent & Hlth Gaubius Lab NL-2301 CE Leiden Netherlands Leiden Univ Med Ctr Dept Gen Internal Med Sect Gerontol & Geriatr Leiden Netherlands Leiden Univ Med Ctr Dept Clin Epidemiol Leiden Netherlands

OBJECTIVES We studied the contribution of putative risk genotypes at the angiotensin I-converting enzyme inhibitor (ACE D/D) and plasminogen activator inhibitor-1 (PAI-1 4G/4G) loci to all-cause and cardiovascular mortality in a population-based cohort. BACKGROUND The ACE D/D and PAI-1 4G/4G genotypes have been consistently associated with elevated plasma activities of the gene products. Their role in cardiovascular disease, although explored intensively, is still equivocal. METHODS The ACE and PAI-1 genotypes were determined in 648 subjects greater than or equal to 85 years old. In a cross-sectional analysis, the genotype distributions in a subset of 356 elderly subjects who were born in Leiden, The Netherlands, were compared with those in 250 young subjects whose families originated from the same geographic region. In addition, the complete cohort of elderly subjects was followed over 10 years for all-cause and cardiovascular mortality and was stratified according to genotype. RESULTS In the cross-sectional analysis, the ACE and PAI-1 genotype distributions were similar in elderly and young subjects. In the prospective follow-up study, however, the age-adjusted risk of fatal ischemic heart disease was increased threefold (95% confidence interval [CI] 1.2 to 7.6) in elderly men carrying the PAI-1 4G/4G genotype. The risk of all-cause mortality was not increased among elderly subjects carrying the PAI-1 4G/4G (relative risk [RR] 0.9, 95% CI 0.7 to 1.1) or the ACE D/D genotype (RR 0.9, 95% CI 0.7 to 1.1), nor did we observe elevated risks of death from all cardiovascular diseases combined. There was no interaction between the genotypes. CONCLUSIONS The PAI 4G/4G genotype may be a risk factor for fatal ischemic heart disease in elderly men. The impact of moderately increased ACE and PAI-1 activities associated with the ACE D/D and PAI-1 4G/4G genotypes is too small to affect mortality in the general population. (J Am Coll Cardiol 1999;34:1176-83) (C) 1999 by the Ameri

关键词：心血管疾病/遗传学心血管疾病/死亡率死亡原因队列研究疾病遗传易感性/遗传学遗传变异基因型荷兰肽基二肽酶A/遗传学纤溶酶原激活物抑制物1/遗传学危险存活率分析老年人老年人 80以上女(雌)性人类男(雄)性

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Relation of fibrinogen to cardiovascular events is independent of preclinical cardiovascular disease: The Strong Heart Study

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AMERICAN HEART JOURNAL 2003年第3期145卷 467-474页

作者： Palmieri, V Celentano, A Roman, MJ de Simone, G Best, L Lewis, MR Robbins, DC Fabsitz, RR Howard, BV Devereux, RB Cornell Univ Weill Med Coll New York NY USA Univ Naples Federico II Naples Italy Missouri Breaks Ind Res Timber Lake SD USA Univ Vermont Coll Med Burlington VT USA Medstar Res Inst Washington DC USA Natl Heart Long Blood Inst Bethesda MD USA

Background It is unclear whether fibrinogen predicts cardiovascular events independently of echocardiographic cardiovascular abnormalities and traditional risk factors., Methods We studied 2671 American Indians who participated in the second Strong Heart Study examination (19931995) and were observed for an average of 50 - 6 months. Participants with baseline overt coronary artery disease or. a plasma creatinine level greater than or equal ***/dL were excluded. Left ventricular hypertrophy, elevated arterial stiffness, and subnormal myocardial contractility were assessed by echocardiography. Results Prevalences of echocardiographic abnormalities and cardiovascular event rates were higher with higher fibrinogen levels. Incident cardiovascular events (n = 158) and deaths (n = 64) were more frequent in participants with elevated fibrinogen levels (>400 mg/dL) than in participants with lower fibrinogen levels, as was the prevalence of echocardiographic abnormalities (both P < .01). Incident cardiovascular fatal and nonfatal events and cardiovascular deaths were 4 and 8 times higher, respectively, in participants with both elevated fibrinogen levels and echocardiographic abnormalities than in participants with neither echocardiographic abnormalities nor elevated fibrinogen levels. However, participants with fibrinogen levels >400 mg/dL had a 2 times greater relative risk of cardiovascular events or mortality, independent of both risk factors and echocardiographic abnormalities. Conclusions in a population-based sample of adults without clinical evidence of coronary artery disease at, baseline, fibrinogen levels predicted cardiovascular events independent of traditional risk factors, left ventricular hypertrophy, elevated arterial stiffness, and subnormal myocardial. systolic function.

关键词：心血管疾病/血液心血管疾病/流行病学心血管疾病/死亡率超声心动描记术/统计学和数值数据纤维蛋白原/分析心脏病/血液心脏病/流行病学心脏病/死亡率肥大左心室/血液肥大左心室/流行病学肥大左心室/死亡率印第安人北美洲纵向研究危险因素心室功能障碍左/血液心室功能障碍左/流行病学心室功能障碍左/死亡率人类

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A decrease in diastolic blood pressure combined with an increase in systolic blood pressure is associated with a higher cardiovascular mortality in men

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第3期35卷 673-680页

作者： Benetos, A Zureik, M Morcet, J Thomas, F Bean, K Safar, M Ducimetière, P Guize, L Ctr Invest Prevent & Clin IPC 6-14 Rue Perouse F-75116 Paris France INSERM U337 Paris France INSERM U258 Villejuif France

OBJECTIVES The study evaluated the risk of cardiovascular mortality according to combined spontaneous (non-treatment-related) changes in both systolic and diastolic blood pressure (BP). BACKGROUND Long-term longitudinal changes in blood pressure may be a more accurate determinant of cardiovascular risk since changes in systolic Or-diastolic blood pressure over a period of time reflect the evolution of arterial and arteriolar alterations. METHODS Two independent French male cohorts were;studied: the IPC cohort (Investigations Preventives et Cliniques) composed of 15,561 men aged 20 to 82 years who had had two visits spaced four to 10 years apart, and the Paris Prospective Study composed of 6,246 men aged 42 to 53 years, examined annually for a period of-four years. None of the subjects were taking antihypertensive medication. Annual changes-in BP were estimated, and subjects were divided into groups according to the increase, lack of change, or decrease of systolic or diastolic BP. Nine groups were formed by-combining the changes of systolic and diastolic BP. Cardiovascular mortality was assessed for a mean period of 13.5 years for the IPC Study and 17 years for the Paris Prospective Study. RESULTS In both cohorts, after adjustment for age and major-risk factors, the group with an increase in systolic and a decrease in diastolic BP presented the highest relative risk of cardiovascular mortality compared to the group with no changes in either systolic or diastolic BP (relative risk: 2.07 [1.05 to 4.06] in the IPC Study and 2.16 [1.16 to 4.01] in the Paris Prospective Study). CONCLUSION Assessment of spontaneous changes of BP over a: long period of time can contribute to the evaluation of cardiovascular risk. Subjects whose systolic BP increased while their diastolic BP decreased had the highest cardiovascular risk independently of absolute values of BP or other risk factors. (C) 2000 by the American College of Cardiology.

关键词：血压/生理学心血管疾病/死亡率心血管疾病/病理生理学心舒期法国/流行病学预后前瞻性研究存活率心缩期成年人老年人老年人 80以上人类男(雄)性中年人

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Prolongation of life with angiotensin converting enzyme inhibitor therapy

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EUROPEAN HEART JOURNAL 2000年第8期21卷 597-598页

作者： Torp-Pedersen, C Kober, L Univ Copenhagen Gentofte Hosp Copenhagen Denmark

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CAUSES OF DEATH IN AUTOPSIED RA PATIENTS

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SCANDINAVIAN JOURNAL OF RHEUMATOLOGY 1976年第4期5卷 239-240页

作者： MUTRU, O KOOTA, K ISOMAKI, H CENT HOSP KUOPIO DEPT PATHOL KUOPIO FINLAND RHEUMATISM FDN HOSP HEINOLA FINLAND

Among 3115 autopsied patients, rheumatoid arthritis [RA] was registered in 41 patients (1.3%). The causes of death of these were correlated with the causes of death of 310 non-rheumatoid autopsied patients. Of the RA patients, 32% died from cardiovascular disease, 24% from infection, 27% from renal failure and 7% from malignant disease. Of the control patients, 42% died from cardiovascular disease, 9% from infection, 3% from renal failure and 23% from malignant disease. The low frequency of malignant disease as a cause of death in RA patients may be due to a continuous immunological stimulation or due to a missed diagnosis of RA in patients who died from malignant disease.

关键词：关节炎类风湿/死亡率心血管疾病/死亡率芬兰感染/死亡率肾功能衰竭慢性/死亡率肿瘤/死亡率青少年成年人老年人女(雌)性人类男(雄)性中年人

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Hyperglycemia as a risk factor for cardiovascular disease in type 2 diabetes

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PRIMARY CARE 1999年第4期26卷 829-+页

作者： Laakso, M Univ Kuopio Dept Med SF-70210 Kuopio Finland

According to several prospective population-based studies, glycemic control influences the risk for cardiovascular disease, including coronary heart disease, independently of conventional risk factors in patients with type 2 diabetes. Recent clinical trials, particularly the United Kingdom Prospective Diabetes Study, have shown that microvascular complications and macrovascular complications, although to a lesser extent, can be prevented in patients with type 2 diabetes with correction of glycemic control. However, in the treatment and prevention of cardiovascular disease in type 2 diabetes, all known cardiovascular risk factors should be attacked simultaneously.

关键词：血糖/代谢心血管疾病/病因学心血管疾病/死亡率糖尿病 2型/血液糖尿病 2型/并发症高血糖症/并发症高血糖症/治疗危险因素人类

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