Cardiac event rates after acute myocardial infarction in patients treated with verapamil and trandolapril versus trandolapril alone. Danish Verapamil Infarction Trial (DAVIT) Study Group.

Angiotensin-converting enzyme (ACE) inhibitors improve survival in patients with congestive heart failure (CHF) after an acute myocardial infarction (AMI), but mortality may be as high as 10% to 15% after 1 year. Verapamil prevents cardiac events after an AMI in patients without CHF. We hypothesized that in postinfarct patients with CHF already prescribed diuretics and an ACE inhibitor, additional treatment with verapamil may reduce cardiac event rate. In this multicenter, double-blind study, patients with CHF receiving diuretic treatment were consecutively randomized to treatment with trandolapril 1 mg/day for 1 month and 2 mg/day the following 2 months (n = 49), or to trandolapril as mentioned plus verapamil 240 mg/day for 1 month and 360 mg/day for 2 months (n = 51). Trial medication started 3 to 10 days after AMI. All patients were followed for 3 months. End points in the trandolapril/trandolapril-verapamil groups were death 1/1, reinfarction 7/1, unstable angina 9/3, and readmission for CHF 6/2. The 3-month first cardiac event rate was 35% in trandolapril-treated patients and 14% in trandolapril-verapamil-treated patients (hazard ratio 0.35, 95% confidence interval 0.15 to 0.85, p = 0.015). These data suggest that verapamil reduces cardiac event rates in post-AMI patients with CHF when added to an ACE inhibitor and a diuretic.

Effect of verapamil on the prognosis of patients with early postinfarction electrical or mechanical complications. The Danish Verapamil Infarction Trial II (DAVIT II).

The Danish Verapamil Infarction Trial II (DAVIT II) demonstrated from the second postinfarction week, that long term treatment with verapamil significantly improved reinfarction free survival after an acute myocardial infarction (AMI). The present post hoc analysis of DAVIT II was undertaken with the purpose of evaluating the effect of treatment with verapamil in patients with early electrical complications, i.e. ventricular or atrial fibrillation, ventricular tachycardia, or second or third degree atrioventricular block, with or without mechanical complication, i.e. heart failure, during the first post-AMI week. In the placebo group, the 18-month mortality rate was lowest (9.5%) in patients without electrical or mechanical complications, highest (24.6%) in patients with electrical events only, and in-between (17.5%) in patients with mechanical problems regardless of presence of electrical complications. Verapamil significantly reduced the 18-month mortality rate in patients with early electrical without mechanical complications (60% reduction, P = 0.02), and in patients without mechanical complications (35% reduction, P = 0.02). Verapamil did not change the mortality rate in patients with mechanical complications.

Prognostic implications of ventricular ectopy one week, one month, and sixteen months after an acute myocardial infarction. Danish Study Group on Verapamil in Myocardial Infarction.

BACKGROUND: Ventricular ectopy early after an acute myocardial infarction (AMI) has previously been demonstrated to predict mortality. Less information is available about the prognostic implications of ventricular ectopy occurring late after an AMI, and no information is available about the prognostic implication of the development of ventricular ectopy during the first year after an AMI. HYPOTHESIS: The purpose of the present prospectively conducted trial, a part of the Danish Verapamil Infarction Trial II (DAVIT II), was to evaluate the prognostic implication of (1) ventricular premature complexes (VPCs) recorded by 24-h Holter monitoring 1 week, 1 month, and 16 months after an AMI; and (2) development of > 10 VPCs/h or of any complex ventricular ectopy, that is, pairs, more than two types of VPCs, ventricular tachycardia, or > 10 VPCs/h during follow-up after an AMI. METHODS: Patients were monitored 1 week (n = 250), 1 month (n = 210), and 16 months (n = 201) after AMI. RESULTS: Multivariate analyses based on history, clinical findings, and ventricular ectopy showed the following results: After 1 week, > 10 VPCs/h (p = 0.0006) and heart failure (p < 0.007); after 1 month, > 10 VPCs/h (p = 0.003) and resting heart rate (p < 0.02); and after 16 months, ventricular tachycardia (p = 0.002) independently predicted long-term mortality. Mortality was significantly predicted by the development of > 10 VPCs/h from 1 week to 1 month (p = 0.003) and 16 months (p = 0.03), and from 1 to 16 months (p = 0.007) after AMI, as well as by the development of any complex ventricular ectopy from 1 week to 1 month (p = 0.02) and 16 months (p = 0.01), and from 1 to 16 months (p = 0.04) after AMI. CONCLUSION: The present study demonstrated that 1 week and 1 month after an AMI the quantity of VPCs, that is, > 10 VPCs/h, predicted mortality, whereas 16 months after an AMI the quality of VPCs, that is, ventricular tachycardia, predicted mortality.

[Early retirement among the 1914 population in Glostrup. Significance of social and health problems in choosing early retirement]. / Efterløn blandt 1914-populationen i Glostrup. Sociale og helbredsmaessige faktorers betydning for valg af efterløn.

In the population investigation in Glostrup, the 1914 population was examined at the ages of 50, 60 and 67 years. A total of 141 participants at the 67 years examination (106 men and 35 women) stated that they had chosen early retirement prior to transition to old age pensions. The social and health circumstances of these early retirees at the ages of 50 and 60 years are compared with the circumstances in the 243 persons in the cohort (154 men and 89 women) who remained occupationally active until the age for old age pensioning. In the group of early retirees, unskilled men predominated. Out of those who found the occupational environment stressful at the ages of 50 or 60 years, a majority subsequently chose early retirement. Significantly more of the men with abnormal findings in the heart and lungs at the health examinations subsequently chose early retirement. Where the remaining health variables were concerned, no connection could be found with subsequent choice of early retirement. Where the health conditions at the age of 60 years were concerned, a tendency for more frequent choice of early retirement was observed in men with a series of abnormal conditions in the lungs and intestinal tract but no distinct tendency was observed in women. Where both sexes were concerned, an increasing tendency to subsequent choice of early retirement was observed with increasing incidense of cardiovascular risk factors at the age of 60 years. Data concerning low back pain at the age of 60 years did not reveal any connection with subsequent choice of early retirement but may suggest early elimination of persons with low back pain.

[Smoking habits and risk of coronary heart disease, especially risk associated with low daily tobacco consumption]. / Rygevaner og risiko for koronar hjertesygdom, specielt risikoen ved lille dagligt tobaksforbrug.

The purpose of this study was to estimate the risk of acute myocardial infarction related to smoking habits, especially the risk among smokers with a daily tobacco consumption of five grams or less. The study is based on data from the 1914 population examined by the Glostrup Population Studies at the age of 50 and 60 in 1964 and 1974. Information concerning deaths and cases of hospitalisation has been obtained from national registers up to 1985. Blood pressure, lipids, body mass index and physical activity were used as confounders. It was not possible to make a definite conclusion for the group smoking five grams or less daily as a class, since both the size of the group and the number of myocardial infarctions within it were small. When tobacco consumption was used as a quantitative variable the risk of myocardial infarction was found to increase with increasing amount but the relation was found not to be non-linear. The best description of the tobacco-related risk of myocardial infarction was a logarithmically relation to daily tobacco consumption.

[Prognosis after primary acute myocardial infarction]. / Prognosen efter primaert akut myokardieinfarkt.

Results from many clinical trials have changed treatment strategies, but due to considerable selection caused by extensive inclusion- and exclusion criteria the results are only valid for smaller groups, while the majority of the patients still suffer from high mortality with conservative treatment. We have during eight years followed 933 patients with first myocardial infarction and found that the group who tolerated treatment with thrombolytic agents had a lower mortality than the rest. On the other hand, infarct patients are generally old, often with concomitant chronic diseases which affect mortality, and this in combination with heart-failure and cardiac arrhythmias determines outcome. Better prophylactic and treatment measures are needed to improve survival of ischaemic heart disease.

[Physical fitness of Danish men and women aged 50 to 80 years]. / Danske maend og kvinders fysiske arbejdsevne fra 50- til 80-års-alderen.

Maximal power in sustained work in originally randomly selected men and women, born in 1914, was studied five times between the ages of 50 and 80 years in a longitudinal design. Of the originally 514 men and 461 women in 1964 living in the Western suburbs of Copenhagen, 23 men and 18 women performed a bicycle test at age 50, 60, 70, 75 and 80. The mean annual decline in body mass adjusted maximal power in sustained work (W/kg) was 1.43% in the 18 men and 1.64% in the 23 women. Based on "cross-sectional" comparisons of all subjects tested at any age, the mean annual decline in men was 1.56%; in women the corresponding figure was 1.80%. When the results of the "longitudinal" and "cross-sectional" analyses were compared with each other, a rather similar picture of the age-related decline in maximal power was obtained, especially in women. In the longitudinal data only moderate (women) or zero (men) correlations were observed between the submaximal test results at the ages of 50 and 60 years and the maximal test results at higher ages. The physical work load at the age of 50 years had no significant correlation with maximal power at that age or thereafter. There were only minor changes in mean body height, body mass and BMI during the follow-up.

Treatment with verapamil and trandolapril in patients with congestive heart failure and myocardial infarction. The Danish Verapamil Infarction Trial (DAVIT Study Group).

UNLABELLED: EFFECTS OF VERAPAMIL AND TRANDOLAPRIL: Progression of heart failure, sudden death and death from re-infarction are the major cause of the increased mortality in postinfarct patients with congestive heart failure. Angiotensin converting enzyme (ACE) inhibitors such as trandolapril can prevent the progression of heart failure and thus improve survival. The calcium antagonist verapamil has been shown to prevent sudden death and re-infarction in postinfarct patients without congestive heart failure. HYPOTHESIS: The Danish Verapamil Infarction Trial (DAVIT) study group hypothesized the combined treatment with trandolapril and verapamil might prevent cardiac events in postinfarct patients with coronary heart disease. The first double-blind randomized trial included 100 patients and supported this hypothesis, as the cardiac event rate was significantly lower after 3 months in patients treated with the combination than in those treated with trandolapril alone (14 versus 35%, respectively; P = 0.01, hazard ratio 0.35, 95% confidence interval 0.15-0.85).