Coffee intake and risk of incident diabetes in Puerto Rican men: results from the Puerto Rico Heart Health Program.

OBJECTIVE: To study prospectively the association of coffee intake with incident diabetes in the Puerto Rico Heart Health Program cohort, comprising 9824 middle-aged men (aged 35-79 years). METHODS: Of 9824 men, 3869 did not provide a fasting blood sample at baseline, 1095 had prevalent diabetes and 131 were not given fasting glucose tests at any subsequent study visit. Thus, the present analysis includes 4685 participants. Diabetes was ascertained at baseline and at two study visits between 1968 and 1975 using fasting glucose tests and self-reports of physician-diagnosed diabetes or use of insulin or hypoglycaemic medication. Logistic regression analysis was used to assess the association of coffee intake with risk of incident diabetes while adjusting for covariates (age, BMI, physical activity, smoking, education, alcohol intake, family history of diabetes, intakes of milk and sugar). RESULTS: Five hundred and nineteen participants met the criteria for incident diabetes. Compared with those reporting intake of 1-2 servings of coffee/d, coffee abstainers were at reduced risk (OR = 0.64; 95 % CI 0.43, 0.94). Among coffee drinkers, there was a significant trend of decreasing risk by intake (P = 0.02); intake of >/=4 servings/d was associated with an odds ratio of 0.75 (95 % CI 0.58, 0.97). CONCLUSIONS: Study findings support a protective effect of coffee intake on diabetes risk, while also suggesting that abstainers may be at reduced risk.

Cardiovascular disease in HIV infection

Cardiovascular disease has been well documented in patients with Human Immunodeficiency Virus infection, especially after the introduction of highly active antiretroviral therapy. At present, HIV infection is one of the leading causes of acquired cardiovascular disease including heart failure. Some of the changes observed in these patients include left ventricular systolic dysfunction, dilated cardiomyopathy, congestive heart failure, myocarditis, lipodystrophy, dyslipidemia, insulin resistance, accelerated atherosclerosis including myocardial infarction, prothrombotic state, pericardial effusion, pulmonary hypertension, autonomic dysfunction, and malignancy. This article summarizes the main findings in the principal HIV-associated cardiovascular manifestations in order to stimulate its early recognition so helping in early intervention and therapy.

Evidence based secondary prevention of coronary artery disease in the elderly-2006

Eighty percent of coronary deaths occur in people above 65 years of age. Fifty percent of deaths in persons above 85 years of age is due to coronary artery disease. The overall aging of the population and the improvement in survival of patients with coronary artery disease has been creating a growing large population of elderly adults who are elegible for secondary prevention. Multiple clinical trials and research trials have revealed evidence based information confirming the usefulness and effectiveness of secondary prevention of coronary artery disease in the elderly patient. The secondary prevention beneficial results have been obtained by addressing and controlling the predisposing items recognized a coronary risk factors. Secondary preventive measures, including lifestyle modifications and pharmacotherapy, modifying risk factors in elderly patients, have been shown to reduce morbidity and mortality from coronary artery disease. Evidence based data on prevention in elderly patients with coronary artery disease concerning smoking cessation, treatment of hypertension, control of hyperlipidemia, improved dietary patterns, physical activity, moderation in alcohol intake, management of diabetes, weight management, use of antiplatelet agents, beta blockers and renin-angiotensin-andosterone blockers is summarized. Emphasis has been given to AHA/ACC consensus statements on the prevention of coronary artery disease.

Prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001

OBJECTIVE To study the prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001. METHODS All medical claims for coronary heart disease (ICD-9 410-414), hypertension (ICD-9 401-405), congestive heart failure (ICD-9 428) and cerebrovascular accidents and transient ischemia (ICD-9:430-438.9) submitted for reimbursement purposes to an insurance company (private and public sector) in Puerto Rico in 2001 were identified. Prevalence and medical care utilization concerning cardiovascular conditions was estimated with 95% confidence. RESULTS Overall prevalence of cardiovascular conditions was 13.5% (95% CI: 11.68%-15.44%), being larger in the private sector (16.0%; 95% CI: 15.98%-16.08% vs. 11.7%; 95% CI: 11.62%-11.77%). Although in both sectors prevalence increased with age, at same age groups was two times higher in the private sector. Hypertension was the most prevalent condition (9.7; 95% CI: 8.14%-11.41%) being higher in females (10.4; 95% CI: 10.37%-10.51%) than in males (8.9; 95% CI: 8.81%-8.96%). The health service utilization (physician's office visits, emergency room visits, and hospital admissions) was higher in males. However, it varies by sectors. CONCLUSIONS Significant difference exists in the prevalence of cardiovascular conditions and health services utilization among private and public sectors in Puerto Rico. The observed differences among the private and public populations imply that there are factors such as socioeconomic status, education, lifestyles, environmental hazards in neighborhoods, and health habits that could be involved in the differences

La Troponina Cardiaca, Marcador Biológico para el Diagnóstico de Necrosis Miocáirdica / Cardiac Troponin, a biological marker for the diagnosis of myocardial necrosis

Cardiovascular diseases are the main cause of death in Puerto Rico and all over the World. Among these, the most frequent one is ischemic heart disease. The diagnosis is primarily based upon clinical findings, electrocardiography, and the use of biological markers for cardiac injury and necrosis. In the last years, cardiac troponins have been available as the most useful biological markers due to its high sensitivity and specificity for myocardial necrosis. Information concerning the fundamental studies and trials that confirm thejustification for the use of cardiac troponins as biological markers for myocardial necrosis is presented.

Status of cardiovascular disease in Puerto Rico

For the last 40 years diseases of the heart has ranked as the primary cause of death in Puerto Rico, being cancer the second. In the National Vital Statistics of the Department of Health of Puerto Rico for the year 2002, cancer is listed as the main cause of death and diseases of the heart ranks as the second most frequent. This unexpected change is mainly due a new classification by ICD-10, that now substitutes ICD-9, in association to a change introduced by using the 2000 population census rather than the 1990 census used until 1999. Additional relevant information concerning life expectancy at birth, death by specific causes in the last 5 years and statistics about invasive surgical and medical services rendered to cardiovascular patients in the year 2003 are included. A summary of the situation concerning postgraduate training programs in Puerto Rico in different cardiovascular subspecialties is also included.

Control of blood lipids in the elderly

In individuals 65 years of age and older cardiovascular disease is the leading cause of death around the world. Hypercholesterolemia is among the major risk factors for the development of cardiovascular disorders. Most of the scientifically based studies on preventive measures for cardiovascular conditions have been conducted in subjects younger then 65 years of age. In the last 10 years some clinical trials have included a considerable number of individuals older than 65 years of age providing a scientific basis for therapeutic and preventive intervention in the aged. In this article we summarize the main studies concerning lipids as risk factors for cardiovascular disease in the elderly and we present the indicated primary and secondary preventive measures for reducing cholesterol levels in the elderly leading to a reduction in total and cardiac mortality, and to lesser development of myocardial infarction and coronary artery disease

Clinical trials in isolated systolic hypertension in the elderly

The presence of isolated systolic hypertension in elderly subjects predisposes to the development of coronary artery disease, myocardial infarction, heart failure, cardiovascular events, stroke and cardiovascular mortality. Whether pharmacologic management of isolated systolic hypertension in the elderly is justified or not has not received attention until the recent years. In this era of the practice of evidence based medicine it is important to review the results of clinical trials about the management of isolated systolic hypertension involving thousands of elderly patients. The main trials and their results will be presented. These demonstrate a 17 per cent reduction in total mortality, 25 per cent reduction in cardiovascular mortality, 37 per cent reduction in stroke and a 25 per cent reduction in myocardial infarction for those patients under pharmacologic treatment.

Primary and secondary prevention of cardiovascular disease in the elderly.

Cardiovascular disease is the commonest cause of death and hospitalization in patients 65 years of age or older. The main offenders among the cardiovascular disorders in this age are CHD and hypertension. Many non-pharmacologic and pharmacologic measures in the middle-aged persons have confirmed for many years the effectiveness of primary and secondary prevention. Multiple intervention trials in the recent years have also demonstrated the effectiveness of these measures in patients 65 years of age and older. A summary of the main primary and secondary non-pharmacologic and pharmacologic measures that have been proven to be effective and useful in elderly patients has been presented with particular attention to hypertension and CHD. It also has been demonstrated that elderly patients have the capacity to follow the instructions of their physicians and that, as younger patients, they respond to these measures.

Primary and secondary prevention of cardiovascular disease in the elderly

Cardiovascular disease is the commonest cause of death and hospitalization in patients 65 years of age or older. The main offenders among the cardiovascular disorders in this age are CHD and hypertension. Many non-pharmacologic and pharmacologic measures in the middle-aged persons have confirmed for many years the effectiveness of primary and secondary prevention. Multiple intervention trials in the recent years have also demonstrated the effectiveness of these measures in patients 65 years of age and older. A summary of the main primary and secondary non-pharmacologic and pharmacologic measures that have been proven to be effective and useful in elderly patients has been presented with particular attention to hypertension and CHD. It also has been demonstrated that elderly patients have the capacity to follow the instructions of their physicians and that, as younger patients, they respond to these measures

The endothelium in health and in cardiovascular disease.

Significant new findings in the last decade have demonstrated that the vascular endothelium is an important regulatory organ in maintaining cardiovascular homeostasis and that endothelial dysfunction is present in several cardiovascular diseases. With the production of multiple vasoactive substances the normal endothelium modulates the tone of the underlying vascular smooth muscle. These include endothelium-derived relaxing factors such as prostacyclin (PG1(2)), nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF) and vasoconstrictors such as endothelin-1 and angiotensin II. The antiplatelet, antithrombotic and antifibrinolytic properties of the normal endothelium contribute to the maintenance of the fluidity of the blood. Activation or injury to the endothelial cells disrupts the function of the endothelial cells leading to the development of endothelial dysfunction. Endothelial dysfunction is accompanied by vasospasm, thrombosis, and atherosclerosis. It is present in cardiovascular diseases such as hypertension, atherosclerotic heart diseases, congestive heart failure and many others. It has been shown that some therapeutic effects of drugs such as angiotensin-enzyme inhibitors is in part due to the overcoming of endothelial dysfunction.

[Coronary disease in women]. / Enfermedad coronaria en la mujer.

Coronary heart disease is the leading cause of death among women, with a high prevalence in the older women. Women have a less favorable outcome after myocardial infarction and after myocardial revascularization procedures. We have revised the most up to date published information about risk factors for coronary heart disease in women. The most salient features concerning lipids, hypertension, diabetes, cigarette smoking, physical activity and obesity are summarized. The differences on clinical manifestations of coronary heart disease among men and women are also presented. The salient data about estrogen replacement therapy effect on coronary heart disease on postmenopausal women is also summarized.