Validation of an instrument to measure the impact of coronary disease on patient's daily life.

AIM: To evaluate the psychometric Instrument to Measure the Impact of Coronary Disease on Patient's Everyday Life (IDCV) when applied on patients with coronary disease being followed at an outpatient clinic. METHODS: One hundred and fifty-three patients with coronary disease were registered. Patients were analysed in terms of acceptability, ceiling and floor effect, reliability (using Cronbach's alpha coefficient) and convergent construct validity (by means of Spearman correlation) between the domains of IDCV and of 'Medical Outcomes Trust Short-form Health Survey (SF-36)' and 'MacNew Heart Disease Health-related Quality of Life Questionnaire'. RESULTS: Evidence was found for high acceptability of IDCV. No evidence was found for ceiling and floor effects regarding the total score of IDCV; however, ceiling and floor effects were found from the adjustment to the disease domain. Evidence was found for reliability of the instrument as a whole and for its domains (Cronbach's α ranged between 0·70-0·85). Similar domains on the IDCV, MacNew and SF-36 were correlated: Physical impact - symptoms on the IDCV with the physical function domain on MacNew (r = -0·64) and with most domains on the SF-36 related to the physical dimension; Social impact and emotional impact on the IDCV with emotional function (r = -0·53) and social function (r = -0·55) on the MacNew and mental health on SF-36 (r = -0·55). However, smaller correlations of moderate/high magnitude were found between different constructs entre: Social and emotional impact on the IDCV with physical function on the MacNew (r = -0·56) and with the following domains: Functional capacity (r = -0·50), general health (r = -0·52) and vitality (r = -0·50) on SF-36. CONCLUSION: The IDCV is an instrument with evidence regarding reliability and convergent validity also for the population of patients with coronary disease. Further studies to validate its factor structure could offer contributions for understanding the psychometric performance of the IDCV among patients with coronary disease.

Sodium intake is associated with carotid artery structure alterations and plasma matrix metalloproteinase-9 upregulation in hypertensive adults.

The mechanisms by which dietary sodium modulates cardiovascular risk are not fully understood. This study investigated whether sodium intake is related to carotid structure and hemodynamics and to plasma matrix metalloproteinase (MMP) activity in hypertensive adults. One hundred thirty-four participants were cross-sectionally evaluated by clinical history, anthropometry, carotid ultrasound, and analysis of hemodynamic, inflammatory, and metabolic variables. Daily sodium intake (DSI) was estimated by 24-h recall, discretionary sodium, and a FFQ. In 42 patients, plasma MMP-2 and MMP-9 activities were also analyzed. The mean DSI was 5.52 ± 0.29 g/d. Univariate analysis showed that DSI correlated with common carotid artery systolic and diastolic diameter (r = 0.36 and 0.34; both P < 0.001), peak and mean circumferential tension (r = 0.44 and 0.39; both P < 0.001), Young's Elastic Modulus (r = 0.40; P < 0.001), intima-media thickness (r = 0.19; P < 0.05), and internal carotid artery resistive index (r = 0.20; P < 0.05). Multivariate analyses revealed that only artery diameter, circumferential wall tension, and Young's Elastic Modulus were independently associated with DSI. Conversely, plasma MMP-9 activity was associated with DSI (r = 0.53; P < 0.001) as well as with common carotid systolic diameter (r = 0.33; P < 0.05) and Young's Elastic Modulus (r = 0.38; P < 0.01). In conclusion, sodium intake is associated with carotid alterations in hypertensive adults independently of systemic hemodynamic variables. The present findings also suggest that increased MMP-9 activity might play a role in sodium-induced vascular remodeling.

Upper arm circumference is an independent predictor of left ventricular concentric hypertrophy in hypertensive women.

Upper arm circumference (UAC) measurement is necessary for the proper sizing of cuffs and is recommended for accurate blood pressure (BP) assessment. The aim of this report is to identify and quantify the relationships between UAC and the usual anthropometric measurements of body fat distribution and cardiac structure in hypertensive subjects. We evaluated 339 patients (202 women and 137 men) by medical history, physical examination, anthropometry, metabolic and inflammatory parameters, and echocardiography. Partial correlation analyses adjusted for age and body mass index revealed that anthropometric variables were significantly associated with echocardiographic parameters exclusively in women. In this regard, UAC correlated with interventricular septum thickness, posterior wall thickness, and relative wall thickness >or=0.45, while waist circumference was related to left cardiac chamber diameter. Multivariate analyses including age, body mass index, systolic BP, homeostasis model assessment index, and use of antihypertensive medications demonstrated that UAC was an independent predictor of left ventricular wall thickness and concentric hypertrophy in women. Further linear regression analyses revealed that waist circumference was an independent predictor of left ventricular end-diastolic and left atrial diameters in this gender. Overall, these findings suggest that UAC determination might serve not only as a routine approach preceding BP evaluation but also as a simple and feasible predictor of adverse LV remodeling in hypertensive women.