Aircraft noise exposure and risk for recurrent cardiovascular events after acute coronary syndrome: A prospective patient cohort study.

In several population based cohort studies associations between aircraft noise and various diagnoses of cardiovascular disease were observed. However, no study has yet addressed the risk of recurrences in relation to transportation noise in patients with acute coronary heart disease. We conducted a prospective patient cohort study of 737 individuals recruited from eleven cardiac centers in the Rhine-Main region in the vicinity of Frankfurt Airport. All patients had an angiographically confirmed acute coronary syndrome diagnosed between July 2013 and November 2018. Individual aircraft noise exposure at the place of residence was calculated using Soundplan software, and exposure to road traffic and railway noise was obtained from noise maps provided by the Hessian State Agency. Data was analyzed by means of Cox regression adjusted for relevant confounders. Recurrent event as non-fatal endpoint was defined as myocardial infarction, stroke, bypass surgery or percutaneous coronary intervention with stent implantation. In addition, all-cause mortality was evaluated. Follow-up data including socioeconomic and confounder information was obtained from 663 (90%) patients covering a mean follow-up period of 42 (range: 1-80) months. Mean Lden aircraft noise exposure was 48.1 dB. Adjusted hazard ratio (HR) for recurrence was 1.24 (95%-CI: 0.97-1.58) per 10 dB increase in Lden aircraft noise exposure. A combined analysis of recurrence and all-cause mortality yielded a HR of 1.31 (95%-CI: 1.03-1.66). Similar HRs were found for Lday and Lnight aircraft noise exposure. HRs for road traffic and railway noise were above unity but less pronounced and not significant. Observed exposure-response associations for aircraft noise were more pronounced than previously observed in population-based cohort studies suggesting that acute coronary heart disease patients are particularly vulnerable to effects from transportation noise. Measures to reduce environmental noise exposure may thus be helpful in improving clinical outcome of patients with coronary heart disease.

[Self-assessment of adolescents regarding water pipe consumption]. / Zur Selbsteinschätzung des Wasserpfeifenkonsums von Jugendlichen.

OBJECTIVE: The use of water pipes is an alternative to cigarette smoking. Current studies show that water pipe smoking is as hazardous as smoking cigarettes. However, rates of water pipe consumption are still high. The consumption behaviour of students was investigated within the evaluation of the school-based prevention program Rauchzeichen. METHODS: Data about the water pipe use of students was collected using a specially designed questionnaire. RESULTS: Water pipe user rates among students of 8th to 10th grade are still high (7.5 - 21.2 %). 13.2 % of the students, who consume water pipe regularly, state to be non smokers. DISCUSSION: It seems that many adolescents do not estimate water pipe use as smoking, which might lead to an underestimation of health risks or the use of the water pipe as an alternative addictive drug.

Detection of gender differences in incomplete revascularization after coronary artery bypass surgery varies with classification technique.

BACKGROUND: Incomplete revascularization negatively affects survival after coronary artery bypass surgery (CABG). Since gender and classification technique might impact outcome and reporting, we investigated their effect on revascularization patterns and mortality. METHODS: A cohort of bypass patients (N = 1545, 23% women) was enrolled prospectively. The degree of revascularization was determined as mathematical difference between affected vessels upon diagnosis and number of grafts or the surgeon's rating on the case file. RESULTS: Although men displayed more triple-vessel disease, they obtained complete revascularization more frequently than women (85% versus 77%, P < 0.001). The two calculation methods identified analogous percentages of incompletely revascularized patients, yet there was only a 50% overlap between the two groups. Mathematically, more women, older patients, and patients with NYHA class III/IV appeared incompletely revascularized, while the surgeons identified more patients undergoing technically challenging procedures. Regardless of the definition, incompleteness was a significant risk factor for mortality in both genders (mathematical calculation: HR 2.62, 95% CI 1.76-3.89, P < 0.001; surgeon: HR 2.04, 95% CI 1.35-3.89, P = 0.001). CONCLUSIONS: Given the differences in identification patterns, we advise that the mathematical calculation be performed after-procedure in all patients regardless of the surgeons' rating to uncover additional subjects at increased risk.

Health consequences of aircraft noise.

INTRODUCTION: The ever-increasing level of air traffic means that any medical evaluation of its effects must be based on recent data. METHODS: Selective literature review of epidemiological studies from 2000 to 2007 regarding the illnesses, annoyance, and learning disorders resulting from aircraft noise. RESULTS: In residential areas, outdoor aircraft noise-induced equivalent noise levels of 60 dB(A) in the daytime and 45 dB(A) at night are associated with an increased incidence of hypertension. There is a dose-response relationship between aircraft noise and the occurrence of arterial hypertension. The prescription frequency of blood pressure-lowering medications is associated dose-dependently with aircraft noise from a level of about 45 dB(A). Around 25% of the population are greatly annoyed by exposure to noise of 55 dB(A) during the daytime. Exposure to 50 dB(A) in the daytime (outside) is associated with relevant learning difficulties in schoolchildren. DISCUSSION: Based on recent epidemiological studies, outdoor noise limits of 60 dB(A) in the daytime and 50 dB(A) at night can be recommended on grounds of health protection. Hence, maximum values of 55 dB(A) for the day and 45 dB(A) for the night should be aimed for in order to protect the more sensitive segments of the population such as children, the elderly, and the chronically ill. These values are 5 to 10 dB(A) lower than those specified by the German federal law on aircraft noise and in the report "synopsis" commissioned by the company that runs Frankfurt airport (Fraport).

Influence of doxycycline on clinical and angiographic outcome following percutaneous coronary intervention.

BACKGROUND: Infection with Chlamydia pneumoniae may be involved in atherosclerosis. Neointima proliferation after percutaneous coronary intervention (PCI) could be aggravated by proinflammatory action of chronic vascular chlamydial infection. We investigated the influence of doxycycline therapy on restenosis rate and adverse clinical event rates after PCI. METHODS: We followed 1,019 consecutive patients in a single center nonrandomized observational study. During a 3-month period, all patients having PCI (n = 541; treatment group) received oral doxycycline 100 mg/day for 50 days starting from the day of the procedure. A control group (n = 478) consisted of consecutive post-PCI patients recruited from immediately preceding (n = 250) and ensuing periods. Event rates were gained by questionnaires after 259 +/- 57 days. Restenosis rate was derived from the routine angiographic restudies after 172 +/- 15 days. RESULTS: No significant differences between treatment and control group were found in adverse clinical event rates (myocardial infarction: 0.7% vs 1.3%; repeat-PCI: 24.0% vs 20.9%; coronary bypass grafting: 5% vs 3.9%; overall death after 6 months: 3.5% vs 2.1%) and overall restenosis rate (21.6% vs 23.4%). A subgroup analysis of nondiabetic male smokers revealed a lower restenosis rate in the treatment group (10.9% vs 30.9%; P = 0.0195). CONCLUSION: Doxycycline therapy for 50 days following PCI does not appear to have a substantial influence on the clinical and angiographic outcome in unselected patients. The observed reduction in restenosis rate among nondiabetic male smokers defines a new hypothesis that should stimulate further investigations.

[4th report of German Association of Cardiologists in private practice (BNK) on quality assurance in cardiac catheterization and coronary intervention 1999-2002]. / 4. Bericht des Bundesverbandes Niederglassener Kardiologen zur Qualitätssicherung in der diagnostischen und therapeutischen Invasivkardiologie 1999-2002.

The Society of German Cardiologists in private practice (BNK) reports about its project on quality assurance in invasive cardiology (QuIK). Results of a computerized data collection and analysis of cardiac catheterizations and interventions in the years 1999-2002 are presented. These results are compared with other registries. The QuIK-project is done voluntarily by 70% of the society's cardiologists who perform invasive methods. A total of 225,562 diagnostic and 64,895 interventional procedures are documented over the 4 years. Patient characteristics and procedural data kept unchanged. Complication rates were low (< 2%), MACE < 0.5%. There was a rising number of patients referred with acute myocardial infarction. Less time was used to complete procedures from 1 year to another. Two out of three of the centers underwent a monitoring/auditing process in 2002. The desirable post-interventional follow-up after discharge in all cases appears to be impossible to fulfill under the given economical circumstances.