European Journal of Preventive Cardiology

Renal transplant candidates are at high risk of fatal and nonfatal cardiac events.

This study evaluated five clinical risk factors – age at least 50 years, insulin-requiring diabetes mellitus, angina, congestive heart failure and an abnormal electrocardiogram (ECG) (excluding left ventricular hypertrophy) – that had been used in the first tier of a two-tiered prospectively applied risk stratification algorithm.

Using multiple logistic regression analysis, age at least 50 years, abnormal ECG, and diabetes mellitus were independently predictive of cardiac death. Of the two remaining clinical risk factors, the presence of angina had independent predictive value for nonfatal cardiac events (myocardial infarction, coronary angioplasty, bypass surgery, and unstable angina). The independent predictive value of congestive heart failure approached statistical significance.

Clinical risk-factor analysis is helpful in identifying renal transplant candidates at high risk for fatal or nonfatal cardiac events.

Previous studies have shown that people who rate their health as poor have reduced life expectancy. The purpose of the present study was to determine to what extent self-rated perception of health modifies the survival rates in men at risk from tobacco smoking or hypertension.

A prospective population-based study.

The baseline examination took place in 1969 and study participants were followed until 1993. The study cohort comprised 632 men born in 1914 and residing in Malmö, Sweden. Self-rated health (good, average or poor) was assessed in a structured interview in 1969. Mortality data were obtained from the Swedish National Bureau of Statistics. Subjects were stratified for smoking and hypertension.

After adjustments for a number of medical risk factors and physical activity, health self-rated as good was significantly associated with reduced mortality in smoking (adjusted relative risk 0.63, confidence interval (CI) 0.47 to 0.84), hypertensive (adjusted relative risk 0.56, CI 0.34 to 0.91) and normotensive (adjusted relative risk 0.66, CI 0.49 to 0.91) men.

We conclude that subjective well-being modifies the survival rates in hypertensive or smoking men.

It is well established that, in patients with increased cholesterol concentrations and vascular disease, decreasing the cholesterol concentration significantly reduces the risk of coronary events. After coronary artery bypass graft surgery (CABG), the risk of further coronary events is likely to be reduced if there is effective control of cholesterol concentrations. The aim of the survey was to review awareness among general practitioners and patients of the need for maintenance of serum cholesterol values, frequency of serum cholesterol checks, dietary advice and lipid-decreasing medication in patients after CABG.

Hospital notes of 200 patients who underwent primary, coronary artery bypass surgery from January 1994 to 1996 were examined and postal questionnaires sent to patients and their general practitioners inquiring whether they had had their serum cholesterol tested in the past 3 years; whether dietary advice had been given if cholesterol concentrations were increased to more than 5.2 mmol/l; whether a repeat serum cholesterol test was performed 3 months later if values were greater than 5.2 mmol/l; and (for those with serum cholesterol values greater than 5.2 mmol/l), whether they were on lipid-decreasing medication.

We considered 146 (76%) replies to be complete. Hospital and general practitioner records of these patients showed, that in the previous 3 years, after CABG, only 63% (n = 92) had their serum lipid profile checked and, of these, 74% (n = 68) had increased serum cholesterol concentrations of more than 5.2 mmol/l. Only 46% (n = 31) received dietary advice alone. After dietary advice had been given, serum cholesterol was rechecked in 26% (n = 8) of patients and only 3% (n = 1) had a decrease in serum cholesterol to less than 5.2 mmol/l. Among the patients with increased serum cholesterol, 50% (n = 34) received lipid-decreasing medication, but serum cholesterol was rechecked in only 52% (n = 17) of patients. In 9% (n = 3) of these, serum cholesterol concentrations had decreased to less than 5.2 mmol/l. Among the 146 complete replies from patients, 95% (n = 139) indicated that control of serum cholesterol was important, 82% (n = 120) had received dietary advice and 39% (n = 57) were on lipid-decreasing medication.

General practitioners and patients were generally aware of cholesterol control after CABG. However, a relatively low proportion of patients underwent serum cholesterol checks and received documented dietary advice, lipid-decreasing medication, or both. Dietary advice alone may be inadequate in controlling lipid concentrations and, in many cases, needed to be supplemented with adequate lipid-decreasing therapy.

In contrast to those for coronary restenosis, the data regarding the risk factors for renal restenosis are limited.

To evaluate potential humoral risk factors for restenosis after percutaneous transluminal renal angioplasty (PTRA).

We studied 27 patients aged 54 ± 10 years with atherosclerotic renal artery stenosis in a 1-year prospective follow-up. Restenosis (confirmed by angiography) occurred in eight patients 1–6 months after PTRA. We detected no Doppler ultrasound evidence of restenosis in 19 patients throughout 1 year. Blood studies were done before PTRA for all patients, at the time of diagnosis of restenosis and, for those without restenosis, after 1 year, including determinations of fibrinogen, lipids, platelets and leukocytes.

The mean level of fibrinogen in patients who experienced restenosis was higher than that in those who did not (450 ± 150 mg% versus 337 ± 57 mg%, P < 0.01) and remained unchanged for both groups during follow-up. The other parameters did not differ between the groups before PTRA and did not change over time, with the exception of platelet count in patients who did not experience restenosis, which had decreased from 253 ± 93 G/l to 200 ± 63G/l (P < 0.01) 1 year after PTRA. The logistic multiple regression analysis disclosed that an increment of fibrinogen level by 100 mg% was linked with an odds ratio for restenosis of 3.2 (95% confidence interval 1.1–9.8).

Restenosis was associated with higher than normal levels of fibrinogen before PTRA. A high plasma fibrinogen level might play a role in the development of restenosis after PTRA.

In epidemiological studies, the electrocardiogram has often been interpreted by means of a categorical classification. Computerized recording offers the possibility of analysing electrocardiographic measurements as continuous variables.

To test the hypothesis that duration of QRS complex and T-wave inversion would be independent predictors of myocardial infarction.

In a population-based study, we prospectively investigated the risk of developing myocardial infarction according to duration of QRS complex and peak-to-peak T-wave amplitude measured from lead I of the 12-lead electrocardiogram by computerized electrocardiography. In total 6628 men aged 25–61 years who had not previously suffered a myocardial infarction were followed up for 3.9 years.

Eighty-two first myocardial infarctions (55 non-fatal and 24 fatal myocardial infarctions and three sudden deaths) were identified. The risk of myocardial infarction increased with duration of QRS complex and with decreasing T-wave amplitude. A proportional hazards model with adjustment for possible confounders yielded a relative risk of myocardial infarction of 3.74 (P for linear trend 0.015) for duration of QRS complex ≥ 120 ms compared with duration of QRS complex < 80 ms. The multivariate relative risk for T-wave amplitude ≥ 0.35 mV compared with T-wave amplitude < 0.20 mV was 0.55 (P for linear trend 0.036). When both duration of QRS complex and T-wave amplitude were included in the multivariate model, T-wave amplitude retained its predictive power, whereas duration of QRS complex became marginally no longer significant (P = 0.067).

Peak-to-peak T-wave amplitude from lead I is an independent predictor of myocardial infarction in men who have not previously suffered a myocardial infarction. Greater duration of QRS complex clearly indicates a higher risk of myocardial infarction. However, when T-wave amplitude is included as a covariate, the predictive power of duration of QRS complex does not remain significant Single-lead electrocardiography is a feasible method for improving the assessment of the relative risk of myocardial infarction.