Cardiovascular mortality

Gaziano, J.M. et al., A prospective study of consumption of carotenoids in fruits and vegetables and decreased cardiovascular mortality in the elderly, Ann. Epidemiol, 5, 255, 1995. 

P-blocker therapy was ineffective in preventing coronary heart disease, cardiovascular mortality, and all-cause mortality when compared to diuretics for elderly patients (60 years of age or greater) treated for primary hypertension. Clearly, the effects of P-blockers on blood pressure are complex and difficult to ascribe to one or two mechanisms. Rather, the varied effects of negative chronotropic and inotropic properties along with reduced renin levels (Fig. 2-3) appear to result in an overall reduction in cardiac output and/or reduction in peripheral resistance. 

Longer-term studies evaluating the cardiovascular risks associated with the use of COX-2 inhibitors have found a higher incidence of cardiovascular mortality with the use of these agents compared to traditional NSAIDs.29,33,34 This prompted the withdrawal of both rofecoxib and valdecoxib from the market and the inclusion of a black box warning in... 

The presence of protein in the urine is a marker of glomerular and tubular dysfunction and is recognized as an independent risk factor for the progression of CKD.8 Furthermore, the degree of proteinuria correlates with the risk for progression of CKD. An increase of 1 g of protein excretion per day is associated with a five-fold increase in the risk of progression of CKD, regardless of the cause of CKD.9 The mechanisms by which proteinuria potentiates CKD are discussed later. Microalbuminuria is also linked with vascular injury and increased cardiovascular mortality.10... 

DES was once a mainstay of prostate cancer therapy. While very effective in androgen ablation, DES-treated patients experienced increased cardiovascular mortality.41 LHRH agonists, with equivalent efficacy and decreased cardiovascular toxicity, supplanted DES as a mainstay of therapy. 

Buijsse B, Feskens EJ, Kok FJ and Kromhout D. 2006. Cocoa intake, blood pressure, and cardiovascular mortality the Zetphen Elderly Study. Arch Intern Med 166 411-417. 

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 polyunsaturated fatty acids that are most abundant in fatty fish such as sardines, salmon, and mackerel. A diet high in EPA plus DHA or supplementation with these fish oils reduces the risk of cardiovascular mortality, reinfarction, and stroke in patients who have experienced an MI. 

Type III hyperlipoproteinemia may be treated with fibrates or niacin. Although fibrates have been suggested as the drugs of choice, niacin is a reasonable alternative because of the lack of data supporting a cardiovascular mortality benefit from fibrates and because of their potentially serious adverse effects. Fish oil supplementation may be an alternative therapy. 

Shacklette, T. H., Sauer, H. I., Miesch, A. T. (1970). Geochemical Environment and Cardiovascular Mortality rates in Georgia. U.S. Geological Survey Prof. Paper No. 574-C, Washington, pp. 1-39. 

Patterson F, Schnoll R, Wileyto E, Pinto A, Epstein L, Shields P, Hawk L, Tyndale R, Benowitz N, Lerman C (2008) Toward Personalized Therapy for Smoking Cessation A Randomized Placebo-controlled Trial of Bupropion. Chn Pharmacol Ther 84(3) 320-325 Perez-Stable EJ, Herrera B, Jacob P 3rd, Benowitz NL (1998) Nicotine metabohsm and intake in black and white smokers. JAMA 280(2) 152-156 Perry RJ, Griffiths W, Dextraze P, Solomon RJ, Trebbin WM (1984) Elevated nicotine levels in patients undergoing hemodialysis. A role in cardiovascular mortality and morbidity Am J Med 76(2) 241-246... 

The publication of the 4S study in 1994 transformed the debate. The study demonstrated unequivocally that cholesterol, lowered total as well as cardiovascular mortality with no increased risk of cancer. Cardiologists, who as a group, were previously sceptical of the value of cholesterol lowering, became strong advocates of a change in public health policy. As Professor Oliver wrote in the British Medical Journal in 1995 Lower patient s cholesterol now - trial evidence shows clear benefits from secondary prevention. As noted previously, UK physicians are remarkably conservative, and largely follow the principles of evidence-based medicine. When the evidence is presented to them... 

Nurminen M, Hemberg S Effects of intervention on the cardiovascular mortality of workers exposed to carbon disulphide A 15-year follow-up. Br J Ind Med 42 32-35,... 

Stayner LT, Danneberg AL, Thun M, et al Cardiovascular mortality among munitions workers exposed to nitroglycerin and dinitrotoluene. Stand J Work Environ Health 18 34-43, 1992... 

Epidemiological studies have suggested that the effects of long-term workplace exposure to NG may not be completely reversed after exposure is terminated. Eormer workers may be at increased risk for cardiovascular mortality for months to years after exposure has ceased. 

A cohort study of 5668 NG-exposed workers found an increased standardized mortality ratio for deaths from ischemic heart disease. The increase was more pronounced for those with 10 or more years of exposure and was statistically significant for the 40- to 49-year age group, whereas a deficit of cardiovascular mortality had been anticipated because of preplacement and annual medical examinations designed to exclude persons with cardiovascular abnormalities. These results were confirmed in a retrospective cohort mortality study that found a significant excess of ischemic heart disease mortality among workers actively exposed to NG and under the age of 45. ° (Note this study failed to detect a chronic cardiovascular effect as excess risk was only associated with workers actively exposed to NG.)... 

National trends of cardiovascular mortality are incompatible with these risk estimates excess deaths may not be attributable entirely to smoking the clinical diagnosis of thromboembolism is often unreliable. 

The administration of oral hypoglycemic drugs The administration of oral hypoglycemic drugs has been associated with increased cardiovascular mortality as compared with treatment with diet alone or diet plus insulin. 

Patients treated for 5 to 8 years with diet plus tolbutamide (1.5 g/day) had a rate of cardiovascular mortality approximately 2.5 times that of patients treated with diet alone. A significant increase in total mortality was not observed. 

Left ventricular dysfunction (LVD) following Ml To reduce cardiovascular mortality in clinically stable patients who have survived the acute phase of a Ml and have a left ventricular ejection fraction of 40% or less (with or without symptomatic heart failure). 

Fig. 1.10 Influence of diabetes and metabolic syndrome on cardiovascular mortality. Adapted from reference [19]...

Possible increased risk of cardiovascular mortality with this class of drugs. 

Reduction of cardiovascular mortality and reinfarction in patients with previous MI PO... 

Reduction of cardiovascular mortality in definite or suspected acute MI PO lOmgtwice a day, beginning 1-4 wk after infarction. 

Cardiovascular mortality has been reported higher in patients treated with tolbutamide. 

Epidemiologic, experimental, and in vitro mechanistic data indicate that lead exposure elevates blood pressure in susceptible individuals. In populations with environmental or occupational lead exposure, blood lead concentration is linked with increases in systolic and diastolic blood pressure. Studies of middle-aged and elderly men and women have identified relatively low levels of lead exposure sustained by the general population to be an independent risk factor for hypertension. In addition, epidemiologic studies suggest that low to moderate levels of lead exposure are risk factors for increased cardiovascular mortality. Lead can also elevate blood pressure in experimental animals. The pressor effect of lead may be mediated by an interaction with calcium mediated contraction of vascular smooth muscle, as well as generation of oxidative stress and an associated interference in nitric oxide signaling pathways. 

Oral antidiabetic agents have been associated with an increased risk of cardiovascular mortality as compared to treatment with diet alone or diet and insulin... 

Consumption of fats containing n-6 polyunsaturated fatty acids lowers plasma LDLs, but HDLs, which protect against coronary heart disease, are also lowered. Dietary n-3 polyunsaturated fats have little effect on plasma HDL or LDL levels, but they suppress cardiac arrhythmias and reduce serum triacylglycerols, decrease the tendency to thrombosis, and substantially reduce the risk of cardiovascular mortality. 

Goldberg, D. M., Hahn, S. E., and Parkes, J. G., 1995, Beyond alcohol Beverage consumption and cardiovascular mortality, Clin. Chim. Acta 237 155. 

Schwingl PJ, Ory HW, King TDN. Modeled estimates of cardiovascular mortality risks in the US associated with low dose oral contraceptives. 1995 Unpublished draft. 

Reconsideration of contraindications has also been proposed in a prospective study in patients with serum creatinine concentrations of 130-220 pmol/1 and coronary heart disease (n — 226), congestive heart failure (n = 94) and chronic obstructive pulmonary disease (n = 91). Half of the patients continued to take metformin and the other half stopped (39). Bodyweight and HbAic increased over 4 years in those who stopped taking metformin. Lactic acid concentrations were similar in the two groups. Deaths were similar in the two groups (62 and 64 respectively). The incidences of myocardial infarction, all cardiovascular events, and cardiovascular mortality were the same. Changes in additional therapy were only significant for insulin (30% versus 45% respectively) and diet (25% versus 0% respectively). 

Wascher TC. Sulfonylureas and cardiovascular mortality in diabetes a class effect Circulation 1998 97(14) 1427-8. 

Sundstrom, J., Riserus, U., Byberg, L., Zethelius, B., Lithell, H., and Lind, L. (2006). Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality Prospective, population based cohort study. BMJ 332,878-882. 

Antithrombotic therapy for acute peripheral occlusive disease is largely empirical. Thrombolytic therapy typically is reserved for patients in whom the occlusion is not amenable to surgery and for those in whom a possible delay between the initiation of therapy and thrombolysis would not jeopardize the viability of the limb. Evidence that antithrombotic therapy changes the natural course of the peripheral disease is sparse, but these patients are at an increased risk of cardiovascular mortality and should receive long-term aspirin therapy. Initial trials suggest that ticlopidine may improve the symptoms of chronic arteriosclerotic arterial insufficiency and also reduce fatal and nonfatal cardiovascular events, but further studies are needed. 

In a recent meta-analysis study on European men and women (25), high plasma concentrations of a- and /3-carotene were associated both with lower mortality from all causes and cancer, For cardiovascular mortality the inverse association was confined to the elderly with body mass index <25. 

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