The treatment of coronary heart disease: an update. Part 2: Mortality trends and main causes of death in the Greek population.

The Seven Countries Study, carried out in the 1960s, showed a low cardiovascular disease (CVD) mortality in the Greek population. Since then, although the age-adjusted all-cause mortality has gradually and steadily decreased, CVD mortality has increased, mainly due to a rise in ischaemic heart disease (IHD) mortality, and, more specifically, myocardial infarction (MI). The number of MIs per 100,000 men aged 30-69 years increased from 195 in 1981 to 297 in 1988 and from 35 to 52 in women, respectively. Age-adjusted IHD mortality in men aged 45-74 years almost doubled from 1956 to 1978. The rate of increase slowed down for a decade and since 1990 it has declined slightly. In women, the age-adjusted IHD mortality increased, but to a lesser degree until 1990, and then it started to decline. Cerebrovascular mortality was higher than IHD mortality in women and equal to IHD mortality in men in the late 1950s and early 1960s, but it started to decrease in 1972 in men, and in 1973 in women. Cancer mortality is the second commonest cause of death in both genders. Age-adjusted cancer mortality (in those aged 45-74 years) increased slightly in men until 1979 and then remained stable. In women, it remained stable until 1991 and then started to decline. The eradication of malaria and rheumatic fever, the decrease in infectious diseases, the improvement of the medical care system and the rise of the population's socio-economic level achieved during the last five decades in Greece have reduced all-cause mortality. On the other hand, the changes in lifestyle (lack of physical exercise, new dietary habits) have resulted in a higher IHD mortality. However, this increase is less than would be expected, taking into account the rise in blood cholesterol levels and the high prevalence of smoking. The recent small decline in IHD mortality is probably attributable to better treatment of IHD rather than to preventive measures.

In-hospital mortality of habitual cigarette smokers after acute myocardial infarction; the "smoker's paradox" in a countrywide study.

AIMS: Habitual cigarette smokers, paradoxically, present improved short-term prognosis after acute myocardial infarction, a phenomenon often termed "smoker's paradox". We sought to examine cigarette smokers' post-infarction survival advantage in a countrywide survey of unselected, consecutive patients presenting with acute myocardial infarction. METHODS AND RESULTS: The study population was derived from the registry of the Hellenic study of acute myocardial infarction, which recruited 7433 consecutive patients with acute myocardial infarction from 76, out of a total of 86, hospitals countrywide. Cigarette smokers presented with lower unadjusted mortality rates (7.4% vs 14.5%, P<0.001), were younger, predominantly of male gender and were less likely to suffer from diabetes mellitus and arterial hypertension. When all univariate predictors of poor outcome were included as covariates in multivariate analysis, smoking status was not significantly associated with inhospital mortality (relative risk=1.12, 95% CI=0.86-1.44, P=0.399). The beneficial effect of thrombolytic therapy was independent of the smoking status in both univariate and multivariate analysis. CONCLUSION: Unadjusted mortality rates are significantly lower in smokers, but age accounted for much of their seemingly improved outcome. When a number of additional clinical variables were taken into consideration, no significant influence of habitual smoking on early outcome following acute myocardial infarction was observed.

Lipoprotein(a) is related to the extent of lesions in the coronary vasculature and to unstable coronary syndromes.

BACKGROUND: Lp(a) is a highly atherogenic particle with a prothrombotic effect. Until now its relation to the extent and severity of the atheromatic lesions had not been established by standard procedures. HYPOTHESIS: This study examined the correlation of Lp(a) to the extent and severity of coronary artery disease (CAD) and its relation to unstable clinical events (not including sudden death). METHODS: In 202 patients undergoing coronary angiography, plasma lipids were measured with the usual procedures and Lp(a) with the enzyme-linked immunosorbent assay. The extent of CAD was expressed in the number of diseased vessels and its severity in terms of the severity coefficient and the obstruction coefficient. RESULTS: A very strong relationship between LP(a) and the number of diseased vessels (p = 0.0007) signifying diffuse atherosclerosis, but no relation with the severity of the lesions. was found. However, it was the only lipid that correlated significantly with the number of totally occluded vessels (p = 0.0003). The thrombogenic ability of Lp(a) was manifested by increased incidence of myocardial infarction and unstable angina episodes in patients with elevated Lp(a) (p = 0.0157). CONCLUSION: Elevated Lp(a) predisposes to the extent of CAD and total occlusions but not to the severity of lesions. Patients with increased Lp(a) levels and unstable angina are at increased danger of suffering myocardial infarction. Thus, Lp(a) may predispose to plaque destabilization and thrombosis of noncritical lesions.