Ischemic heart disease case study

The committee identified one study of an important and specific clinical outcome—incident ischemic heart disease—and four studies of cardiovascular mortality. Jain et al. (2007) examined the association between bone lead and incidence of ischemic heart disease (myocardial irrfarction or angina pectoris) in a prospective cohort of veterans in the Boston, Massachirsetts, area (Normative Aging Study 83 cases and 754 noncases) with 10 years of followup. The mean (SD) concentrations of baseline BLL, patella lead, arrd tibia lead were 7.0 (3.8) pg/dL, 36.8 (20.8) pg/g, and 24.2 (15.9) pg/g in cases arrd 6.2 (4.3) pg/dL, 30.6 (19.7) pg/g, and 21.4 (13.6) pg/g in noncases, respectively. SD increases in BLL and patella lead were significantly associated with a 27% (95% Cl of hazard ratio [HR] 1.01, 1.59) and a 29% (95% Cl of HR 1.02, 1.62) increased risk of ischemic heart disease. Compared with srrbjects who had BLLs under 5 pg/dL, those who had BLLs of 5 pg/dL or higher had an HR of 1.73 (95% Cl 1.05, 2.87). Weisskopf et al. (2009) conducted a strrvival analysis of mortality in the same cohort (an average of 8.9 years of followup) and found that men in the highest tertile of patella lead had HRs of 2.52 (95% Cl 1.17, 5.41) for all causes, 5.63 (95% Cl 1.73, 18.3) for cardiovascular disease, and 8.37 (95% Cl 1.29, 54.4) for ischemic heart disease. Baseline BLLs were not associated with cardiovascular mortality. 

Copenhagen Ischemic Heart Disease Study (CIHDS), a case-control study (1991-2004, = 2461, 1231 MI events). 

Juul A, Scheike T, Davidsen M, Gyllenborg J, Jorgensen T. Low serum insulinlike growth factor I is associated with increased risk of ischemic heart disease a population-based case-control study. Circulation 2002 106 939-944. 

The effects of dietary vitamin E have been examined in several studies, many of which have reported a clear association between the reduction in the relative risk of CVD and high intake or supplement of vitamin E, although some have shown no such association. The Vitamin Substudy of the WHO/MONICA Project showed that in Em-opean populations whose classical risk factors for CVD were very similar, the 7-fold differences in CVD mortality could be explained at least to approximately 60% by differences in the plasma levels of vitamin E and up to 90% by the combination of vitamins E, A, and C. The Edinburgh Case Control Study and Basel Prospective Study consistently revealed an increased risk of ischemic heart disease and stroke for low plasma levels of vitamin E. 

Coronary heart disease is associated with ischemic stroke in postmortem (Stemmermann et al. 1984), twin (Brass et al. 1996), case-control (Feigin et al. 1998) and cohort studies (Harmsen et al. 1990 Shaper et al. 1991 Wolf et al. 1991b Touze et al. 2006) as are electrocardiographic abnormalities, cardiac failure, left ventricular hypertrophy, claudication and asymptomatic peripheral vascular disease (Leys et al. 2006). 

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