Assessment of vital exhaustion and identification of subjects at increased risk of myocardial infarction in general practice.

Vital exhaustion, a state characterized by unusual fatigue, loss of energy, increased irritability, and feelings of demoralization, is one of the cardiovascular risk factors. The authors investigated whether vital exhaustion contributes to the identification of subjects at increased risk of myocardial infarction in general practice. In this prospective cohort study, vital exhaustion was assessed with the Maastricht Interview on Vital Exhaustion. Other cardiovascular risk factors established were age, gender, systolic and diastolic blood pressure, total cholesterol, body mass index, smoking habits, cardiovascular disease, and diabetes mellitus. A Cox regression analysis was used. The subjects were adults (41-66 years) in an average Dutch village population. Outcome measures were fatal and nonfatal myocardial infarction. At the univariate level, vital exhaustion doubled the risk of myocardial infarction. The effect of exhaustion was confounded by gender; women had higher exhaustion scores and a lower incidence of myocardial infarction. With control for gender, age, systolic blood pressure, total cholesterol, smoking habits, self-reported cardiovascular disease, and diabetes mellitus, vital exhaustion almost tripled the risk of myocardial infarction. Assessment of vital exhaustion contributes to the identification of subjects at increased risk of myocardial infarction in general practice.

Fibrinogen levels in hypercholesterolemic smokers and non-smokers in relation to age and gender.

Elevated total cholesterol and plasma fibrinogen levels and smoking are risk factors for cardiovascular disease, whose inter-relationships are influenced by both gender and age. The aim of this study was to investigate the effect of smoking on fibrinogen levels in a hypercholesterolemic population subdivided on the basis of gender and age. The study included 492 hypercholesterolemic subjects, divided into four subpopulations: men and women, aged 26-49 and 50-66 years. Mean fibrinogen levels among smokers and non-smokers in the four subpopulations of this hypercholesterolemic cohort followed mean total cholesterol levels. Three subpopulations (men <50 years, men >/=50 years and women >/=50 years) showed differences in mean total cholesterol and fibrinogen values between smokers and non-smokers (total cholesterol 7.23+/-0.54 vs. 7.40+/-0.93 mmol/l and fibrinogen 2.79+/-0.48 vs. 3.23+/-0.72 g/l in men <50 years; total cholesterol 7.17+/-0.43 vs. 7.50+/-0.60 mmol/l and fibrinogen 3.11+/-0.44 vs. 3.68+/-0.66 g/l in men >/=50 years and 7.41+/-0.59 vs. 7.65+/-0.73 mmol/l and fibrinogen 3.29+/-0.61 vs. 3.58+/-0.71 g/l in women >/=50 years). These values correspond to a percentage difference between smokers and nonsmokers in total cholesterol and fibrinogen of 2.4% and 15.8% in men <50 years, 4.6% and 18.3% in men >/=50 years and 3.2% and 8.8% in women >/=50 years. All differences were significant ( P<0.05), except for total cholesterol in the younger men (<50 years). No differences between smokers and non-smokers were observed in the younger female group (<50 years). Except in the younger female group (<50 years), significant differences between smokers and non-smokers were also observed in the number of subjects exceeding the upper reference value of fibrinogen (>4.0 g/l), the highest percentage being found for the older women smokers (>/=50 years) (29%). In Conclusion, smoking elevates fibrinogen levels in hypercholesterolemic men (<50 years; >/=50 years) and older women (>/=50 years), but not in younger women (<50 years).

Vital exhaustion as a risk indicator for first stroke.

Fatigue is a common condition after stroke. An unresolved question is whether the fatigue is a consequence of the stroke or is one of the precursors. The authors' objective was to investigate whether vital exhaustion is a precursor of first stroke while controlling for other cardiovascular risk factors. The design was a prospective cohort study. Vital exhaustion was diagnosed with the Maastricht Interview Vital Exhaustion scale. The authors controlled for age, gender, diabetes mellitus, systolic and diastolic blood pressure, total cholesterol, body mass index, and smoking habits as possible confounders. Data were analyzed with Cox regression analysis. The subjects were adults ages 41-66 in an average Dutch village population. Outcome measures included first stroke. Vital exhaustion increased the risk of stroke by 13% per vital exhaustion point on the Maastricht Interview Vital Exhaustion scale. This value remained statistically significant after control for other risk factors. Total cholesterol, diastolic blood pressure, systolic blood pressure, diabetes mellitus, and smoking also increased the risk of stroke significantly. A state of exhaustion is one of the risk indicators for stroke. This means that the fatigue so often seen after stroke was already experienced by many patients before the occurrence of the stroke.

Relationship between smoking habits and low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglycerides in a hypercholesterolemic adult cohort, in relation to gender and age.

Elevated total cholesterol, the related low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, and smoking habits are risk factors for cardiovascular disease. The objective of this study was to investigate the influence of habitual smoking on these parameters in 492 hypercholesterolemic men and women, aged between 26 and 66 years. Relative differences between smokers and non-smokers in the mean values of total cholesterol, low-density and hig-density lipoprotein-cholesterol, and triglycerides were 2.2%, 5.5%, -8.1%, and 13.7%, respectively. These differences were statistically significant (P<0.04). Over the entire cohort, including men and women, age did not affect the mean values significantly, except for total cholesterol and triglyceride values in smoking women, which were significantly higher in women over 50 years than in the younger women (P=0.011 and P=0.004). In both men and women, regardless of smoking habits, 43%-59% of subjects exceeded the upper reference range value for low-density lipoprotein-cholesterol (4.9 mmol/l), while 38%-59% exceeded the upper reference range value for triglycerides (2.0 mmol/l) and 82%-91% had values below the lower reference range value for high-density lipoprotein-cholesterol (0.9 mmol/l for men, 1.2 mmol/l for women). Smoking habits hardly influenced the extent to which reference values were exceeded, except for low-density lipoprotein-cholesterol in all subjects (higher percentage for smokers, P=0.041). Similar results were obtained for age, except for triglycerides in smoking women, wich showed high values in 26% of women <50 years versus 50% of women > or = 50 years (P=0.026). In conclusion, smoking has an adverse effect on low-density and high-density lipoprotein-cholesterol, and triglycerides in a hypercholesterolemic population of men and women, regardless of age.

A placebo-controlled, double-blind, randomised trial of magnesium-pyridoxal-5'-phosphate-glutamate for hypercholesterolaemia and other clinical-chemical risk factors of cardiovascular disease in a primary care setting.

BACKGROUND: Lipid-lowering drugs are extensively used in primary care to reduce the risk of cardiovascular disease (CVD). Apart from high total cholesterol (TC), several other clinical-chemical variables are associated with the risk of CVD. Magnesium-pyridoxal-5'-phosphate-glutamate (MPPG) has been found to have a positive influence on TC levels and other clinical-chemical values in some selected populations. OBJECTIVE: To assess, in a general practice (GP) setting, the efficacy and clinical effectiveness of MPPG in the treatment of clinical-chemical risk factors for CVD. DESIGN: Randomised double-blind, placebo-controlled, clinical trial, lasting 12 months. PATIENTS: Adults (25-66 years) in an average Dutch village population with serum cholesterol levels between 7.0 mmol/l and 9.9 mmol/l. INTERVENTION: Subjects were assigned at random to treatment with MPPG (3 x 150 mg daily) or placebo. Clinical-chemical parameters were assessed at 1, 3, 6, 9 and 12 months (t1, t2, t3, t4, t5). Efficacy was measured at t2. Long-term effect (clinical effectiveness) was measured by combining the results at t2, t3, t4 and t5 (t2-5). OUTCOME MEASURES: TC (primary), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), triglycerides, apolipoprotein-A1 (Apo-A1), apolipoprotein-B100 (Apo-B), fibrinogen and lipoprotein a [Lp(a), secondary]. RESULTS: No statistically significant differences in the efficacy and effectiveness of TC were found between the MPPG group and the placebo group. The same was demonstrated for the other clinical-chemical values, except for LDL-C (effectiveness, P = 0.04). CONCLUSIONS: Efficacy and effectiveness of MPPG are too poor to be of relevance for application as a lipid-lowering drug in GP.

Low dosages of felodipine ER once daily as monotherapy in elderly hypertensive patients: effect on ambulatory blood pressure and quality of life.

OBJECTIVE: To establish the efficacy of 24-h ambulatory and casual blood pressure (BP) reduction, and the tolerability of once daily felodipine extended release (ER) 2.5 mg and felodipine ER 5 mg as monotherapy. DESIGN: Randomised, double-blind placebo controlled 6 weeks parallel study. SETTING: From 15 general practices centres (with 19 GPs) in the region of the University of Maastricht, The Netherlands. SUBJECTS: A total of 129 subjects aged 50-80 years with primary hypertension were screened; 27 men and 61 women with a casual diastolic BP of 100-115 mm Hg and/or a systolic BP of less than 200 mm Hg entered the study. MAIN OUTCOME MEASURES: Casual and 24-h ambulatory BP and a subjective symptom assessment (SSA) questionnaire after 6 weeks of therapy. RESULTS: After correlation for placebo response the mean casual systolic/diastolic BP (SBP/DBP) reduction was 10/5 mm Hg (NS) and 12/10 mm Hg (P < 0.05) for felodipine ER 2.5 and 5 mg, respectively. By using 24-h ambulatory BP measurements these reduction were 6/4 mm Hg (NS) and 13/8 mm Hg (P < 0.05), respectively. No significant difference for SBP and DBP was found during the night time between felodipine 2.5 and placebo (-1/0). Felodipine ER 5 mg lowered the BP load significantly during both daytime and night time but felodipine ER 2.5 mg only for DBP during the daytime. There was a significant difference for the number of responders between placebo (28%) vs felodipine ER 2.5 mg (55%) and ER 5.0 mg (59%). Both felodipine dosages and placebo were comparable in (a low) number of adverse events and results of the SSA. CONCLUSIONS: During daytime felodipine ER 2.5 mg and 5 mg are effective in BP lowering in elderly hypertensive patients. However, only felodipine ER mg is effective in reducing BP during night time (22.00-7.00). Only felodipine ER 5 mg has a significant reducing effect on BP load during day and night time. Both felodipine ER 2.5 and ER 5.0 have a significant effect on the responder rate. It appeared from this study that compared to placebo, and in contrast with felodipine ER 5 mg, the ER form of felodipine 2.5 mg has no BP lowering effect during night time in elderly patients. To assess the effectivity during night time of felodipine ER 2.5 mg in an individual patient it is recommendable to measure the BP at the end of the dose interval.