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Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

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Natural Secrets For Healing Your Heart

This eBook is devoted to exposing the secrets that cardiologists and surgeons don't want you to know, and how to take control of your own heart and heal yourself. Eight out of every ten coronary bypasses will not actually help the patient. So why risk being in the 80% that will get no benefit from a bypass? Learn to heal your own heart and keep yourself healthy with this eBook guide. Bob Livingston has poured years of research into his findings, and is now sharing the methods that he has developed from careful, methodical research that the medical industry would never allow. It would make them go bankrupt! You will learn what supernutrient doctors don't want you to know about, and how to make an all-natural, chemical and drug-free blood thinner And even more information that doctors don't want revealed to the public. You don't have to be one of the 70% of Americans diagnosed with heart disease. You can heal your heart!

Natural Secrets For Healing Your Heart Overview

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Benefits Coronary Heart Disease

A large number of investigators have studied the relation between alcohol intake and coronary heart disease. Studies indicate that the descending leg of the curve is mainly attributable to death from coronary heart disease, as mentioned previously. The lowest risk seems to be among subjects reporting an average intake of one to four drinks daily. Several studies have found plausible mechanisms for the apparent cardioprotective effect of a light to moderate intake of alcohol. Subjects with a high alcohol intake have a higher level of high-density lipopro-tein, which has been found to be a mediator of the effect of alcohol on coronary heart disease. Thus, 40-60 of the effect of alcohol on coronary heart disease is likely to be attributable to the effect on high-density lipoprotein. Furthermore, drinkers have a lower low-density lipoprotein. Also, alcohol has a beneficial effect on platelet aggregation, and thrombin level in blood is higher among drinkers than among nondrinkers....

Cardiovascular Disease

Although clinical trials are not available, the results from several in vivo studies have suggested a potential role for andrographis in cardiovascular disease. Prevention of atherosclerotic arterial stenosis and restenosis after angioplasty According to two animal studies, andrographis significantly improved atherosclerotic iliac artery stenosis induced by both de-endothelialisation and a high-cholesterol diet, and reduced the restenosis rate after experimental angioplasty (Wang & Zhao 1993, 1994).

Tea and Heart Disease Prevention

Epidemiological studies in Europe revealed that black tea drinkers had a lower incidence of heart disease (12-14). The underlying reason rests on the fact the tea polyphenols act as effective antioxidants that inhibit the oxidation of LDL cholesterol caused by reactive oxygen species, and lead to athero-genesis (15-19). In has been shown that the mechanism can be reproduced using a copper-catalyzed oxidation of LDL cholesterol, inhibited by tea polyphenols (Table 2) (20). Other investigations confirmed a lower risk of heart disease as a function of tea intake, both green and black tea (21). A meta-analysis of stroke and coronary heart disease ''cardiovascular disease'' evaluated the results of many studies and found that heart disease decreased 11 by intake of 3 cups (about 700 mL) of tea per day (22). In Japan, it was noted that the relative risk of cardiovascular disease and cancers was significantly lower with 10 cups of tea per day (23). Different approaches suggest that tea...

DCoronary Heart Disease

Directly related to cardiovascular risk factors, including high levels of total cholesterol, LDL-cholesterol, triglycerides, blood pressure, fibrino-gen and insulin, 86 and low levels of HDL-cho-lesterol. 42 Plasminogen activator inhibitor-1 causing impaired fibrinolytic activity is elevated in persons with abdominal obesity. 763 Overweight, obesity, and abdominal fat are also associated with increased morbidity and mortality from CHD. 1142155-161 Recent studies have shown that the risks of nonfatal myocardial infarction and CHD death increase with increasing levels of BMI. Risks are lowest in men and women with BMIs of 22 or less and increase with even modest elevations of BMI. In the Nurses' Health Study, which controlled for age, smoking, parental history of CHD, menopausal status, and hormone use, rel

Reduced Mortality In Coronary Heart Disease

The most likely mechanism by which ALA may prevent coronary heart disease (CHD) mortality is by reducing cardiac arrhythmia. In Western populations, almost 50 of all deaths from cardiovascular disease can be attributed to sudden cardiac death and the majority of sudden deaths are directly caused by acute ventricular arrhythmia (Brouwer et al 2004). A review in 2001 (Lanzmann-Petithory) and a meta-analysis of three studies in 2004 (Brouwer et al) both found in favour of a protective effect from increased ALA consumption against fatal CHD (RR 0.24). The dose associated with this trend was small only 1-3 g day ALA higher than controls (Brouwer et al 2004). A study published in 2005, which derived data from the Nurses' Health Study (Albert et al), found that women consuming ALA in the highest two quintiles had a 38-40 lower risk of sudden cardiac death than women in the lowest quintile however, the protective effect did not extend to other fatal forms of CHD or non-fatal myocardial...

Cardiovascular Disease Protection Independent Of Homocysteine Status

In the absence of a causal relationship between homocysteine and cardiovascular disease, what remains most promising for folate are studies illustrating its protective 2007 Elsevier Australia Several studies show the cardiovascular protective effects of folic acid, including the predictive value of low folate status on stroke risk (Verhaar et al 2002, Bazzano et al 2002). Few interventional studies have been conducted and on the whole results have been disappointing, which may be because the trials are commonly looking at folate in secondary prevention rather than primary. One such study was an open label trial of 500 g day folate over 2 years in 593 patients, which failed to reduce cardiovascular events (Liem et al 2003).

Studies on the Role of Exercise Fitness in the Etiology of Coronary Heart Disease

Coronary heart disease (CHD) has a multifactorial etiology, and major 'biological' risk factors include elevated concentrations of blood total and low-density lipoprotein (LDL) cholesterol, reduced concentration of high-density lipoprotein (HDL) cholesterol, high blood pressure, diabetes mellitus, and obesity. In addition, 'behavioral' risk factors for CHD include cigarette smoking, a poor diet, and low levels of physical activity and physical fitness associated with the modern, predominantly sedentary way of living. Among these risk factors, a sedentary lifestyle is by far the most prevalent according to data from both the United States and England (Figure 1). Figure 1 Estimates of the prevalence ( ) of the U.S. population with selected risk factors for coronary heart disease and the population from England. In both studies, a sedentary lifestyle was taken as 'no physical activity' or irregular physical activity (i.e., fewer than three times per week and or less than 20 minutes...

Coronary Heart Disease

Most epidemiologic studies and clinical trials using n-3 fatty acids in the form of fish or fish oil have been carried out in patients with coronary heart disease. However, studies have also been carried out on the effects of ALA in normal subjects and in patients with myocardial infarction. Another important consideration is the finding that during chronic fish oil feeding postprandial triacylgly-cerol concentrations decrease. Furthermore, consumption of high amounts of fish oil blunted the expected rise in plasma cholesterol concentrations in humans. These findings are consistent with the low rate of coronary heart disease found in fish-eating populations. Studies in humans have shown that fish oils reduce the rate of hepatic secretion of very low-density lipoprotein (VLDL) triacylglycerol. In normolipidemic subjects, n-3 fatty acids prevent and rapidly reverse carbohydrate-induced hypertriglyceridemia. There is also evidence from kinetic studies that fish oil increases the...

Endothelial Function Atherosclerosis and Cardiovascular Disease

Differences in n-6 fatty acid intake have the potential to influence several chronic diseases and disorders. This article will focus on the effects of n-6 fatty acids on cardiovascular disease and atherosclerosis. Atherosclerosis is an inflammatory disease involving multiple cellular and molecular responses that lead to an alteration in vascular function and structure, and the development and progression of cardiovascular disease. Atherosclerosis is characterized by degenerative changes, deposition of cholesterol, proliferation of smooth muscle cells, involvement of a range of circulating proinflamma-tory cell types, and fibrosis. Resulting atheromatous plaques cause narrowing of arteries and increase the likelihood of thrombosis and occlusion. When this process occurs in the coronary arteries, the outcome is myocardial infarction and with possible death.

Actions on Cardiovascular Diseases

Myocardial Infarction Tablets and injections made from pharmacologically active components isolated from SM, like DA (D(+) 3,4-dihydroxyphenol lactic acid, Dan-shensu) and sodium tanshinone IIA sulfonate (STS) are currently used in China for patients with various heart ailments, especially myocardial infarction. Clinical trials indicate that SM could effectively improve and protect myocardial ischemia and angina pectoris in patients with coronary heart disease, and no side effect was observed (78,79). To explore the scientific bases for using SM to treat this disease, the protective effect of SM on myocardial infarction was studied in an experimental acute myocardial ischemia model by ligating the branch of the left coronary artery (80,81). Results showed that the degree of ST-segment elevation was decreased, and the ultimate myocardial infarction size was reduced dramatically by preadministration of SM. In addition, SM could improve ultrastructural changes of the ischemic myocardium,...

Highfat diets cause heart disease

The medical term for a heart attack is coronary thrombosis. Coronary comes from the Latin word for a crown or circle. The small blood vessels which encircle the heart, supplying the heart muscle, are called coronary arteries. A coronary thrombosis is a clot or thrombus in one of these arteries. One theory put forward to account for this epidemic of heart attacks, blames the fat we eat. According to this theory, too much dietary fat is supposed to raise the level of a waxlike chemical called cholesterol in the blood, and form deposits on the linings of arteries, narrowing their bore and encouraging the blood to clot within them. Australians, who had fewer coronaries during the war, ate no less fat. And in Great Britain, while the mortality from heart attacks has risen steeply since the war, consumption of fat has gone up only 7 . In 1955, Dr. Bronte Stewart, then at Oxford, found that the blood cholesterol level could be lowered by giving people more unsaturated fat. But a survey of...

Coronary Artery Disease

Coronary artery disease (CAD) refers to any of the conditions that affect the coronary arteries and reduces blood flow and nutrients to the heart. It is the leading cause of death worldwide for both men and women. Atherosclerosis is the primary cause of CAD. Controlled risk factors associated with CAD include hypertension, cigarette smoking, elevated blood lipids (e.g., cholesterol, triglyceride), a high-fat diet (especially saturated fats and trans-fatty acids), physical inactivity, obesity, diabetes, and stress. Lifestyle changes can assist in prevention of CAD. Uncontrolled risk factors include a family history of CAD, gender (higher in males), and increasing age.

Diabetes Heart Disease and Stroke

Many people with diabetes are not aware that they are at particularly high risk for heart disease and stroke, which can result from the poor blood flow that is a symptom of diabetes. In addition, people with type 2 diabetes have higher rates of hypertension and obesity, which are additional risk factors. Diabetics are two to four times more likely to have a heart attack than nondiabetics, and at least 65 percent of people with diabetes die from heart attack or stroke. While deaths from heart disease have been declining overall, deaths from heart disease among women with diabetes have increased, and deaths from heart disease among men with diabetes have not declined nearly as rapidly as they have among the general male population. The National Diabetes Education Program has launched a campaign to bring the problem to public attention. Patients are advised to work with medical personnel to control their glucose level, blood pressure, and cholesterol level and, of course, to avoid...

Alcohol Abuse And Cardiovascular Disease

Although there is considerable evidence that moderate drinking protects against mortality and morbidity from coronary heart disease 21,22 , heavy consumption is shown to have deleterious cardiovascular effects. It exerts its adverse effects by increasing the risks of cardiomyopathy, hypertension, and stroke 23 , Chronic ethanol consumption has been linked to the prevalence of hypertension, which contributes to an increased incidence of stroke. Heavy drinkers have alO mmHg higher systolic blood pressure than non-drinkers even though the relationship may differ between men and women 24 , Stroke is a leading cause of death and morbidity. Alcohol may increase the risk of stroke through various mechanisms that include hypertension, hypercoagulable states, cardiac arrhythmias, and cerebral blood flow reductions 25 , Hypertension, including borderline hypertension, is probably the most important stroke risk factor based on degree of risk and prevalence. Furthermore, cardiac morbidity,...

Healthy Diets Healthy Hearts

HEART disease rates in women have dropped, and changes in diet, smoking cigarettes, and the use of estrogen explain much of the decline, say researchers at the Harvard School of Public Health. Frank Hu and colleagues compared the health and lifestyles of roughly 86,000 women in the Nurses' Health Study. Between 1980 and 1994, the incidence of heart disease dropped 31 percent. Diet explained roughly half (16 percent) of the decline, while a drop in smoking accounted for 13 percent, and the increased use of estrogen by postmenopausal women explained 9 percent. But a rise in obesity offset some of the gains. If obesity hadn't increased, the decline in heart disease would have been much greater, says Hu.32

Prevention Of Cardiovascular Disease

Strong population-based evidence comes from the large Women's Health Study (n 39,876), the European Community Multicenter Study on Antioxidants, Myocardial Infarction and Breast Cancer (EURAMIC) study and the Kuopio Ischaemic Heart Disease Risk Factor study (Kohlmeier et al 1997, Rissanen et al 2003, Sesso et al 2004). In the Women's Health Study, higher plasma lycopene concentrations were associated with a lower risk of cardiovascular disease (Sesso et al 2004). Specifically, for cardiovascular disease, exclusive of angina, women in the upper three quartiles had a significant multivariate risk reduction of 50 compared with those in the lowest quartile. For the EURAMIC study, 1379 individuals (662 patients, 717 controls) from 10 European countries were recruited (Kohlmeier et al 1997). Needle aspiration biopsy samples of adipose tissue were taken shortly after myocardial infarction, and levels of alpha- and beta-carotenes, lycopene, and alpha-tocopherol were measured. After adjusting...

Gene Therapy for Cardiovascular Disease and Vascular Grafts

The earliest, and perhaps most obvious, clinical embodiments of gene transfer technology have involved the treatment of rare genetic disorders. The development of effective methods of manipulating gene expression in vivo, however, coupled with an explosive growth in the understanding of changes in gene expression associated with the onset and progression of acquired diseases, has created a prospect for revolutionizing the clinician's approach to common disorders. As researchers learn more about the genetic blueprints of disease, they gain the potential to alter, or even reverse, pathobiology at its roots. Nowhere are these possibilities more avidly sought, nor more likely to impact a significant population of patients, than in the arena of cardiovascular disease.

Lycopene and Cardiovascular Disease

The European Multicentre Euramic Study, which reported that risk of developing myocardial infarct was inversely related to lycopene intake, after appropriate adjustment for other cardiovascular risk factors. Some Scandinavian studies have subsequently supported this claim moreover, lycopene is capable of reducing LDL-cholesterol levels, possibly by inhibiting hydroxymethylglutaryl CoA reductase (HMGCoA reductase), the rate-limiting enzyme for cholesterol synthesis.

Lipids And Cardiovascular Disease

There are a substantial number of large epidemiological studies examining the relationship between dietary ATC intake and cardiovascular disease mortality (reviewed in 116-118 ). For example, studies carried out two decades ago showed a correlation between higher than expected mortality and very low dietary ATC intakes (as well as with very high ATC intakes 119 ). The basis of its cardioprotective effects is the ability of ATC to reduce damage caused by ROS in general, and specifically to inhibit the oxidation and MDA-modification of unsaturated lipids in low-density lipoprotein (LDL) particles 116,120,121 , These oxidized products ofLDL are highly damaging and initiate the formation of atherosclerotic plaques and lesions and are related to the course of myocardial infarction 116,122 . However, atherosclerotic plaque formation and the mechanisms for the ensuing increased morbidity and mortality are complex processes, which involve, for example, the production of superoxide by...

Ivflavonoids And Cardiovascular Disease

Dietary consumption offlavonoids was shown to be inversely related to morbidity and mortality from coronary heart disease (73-75). Flavonoids compose the largest and most studied group of plant phenols. Over 4000 different flavonoids have been identified to date. They are usually found in plants as glycosides, and large compositional differences exist between different types of plants, even between different parts of the same plant.

Preventing Cardiovascular Disease

The cardioprotective properties of quercetin, demonstrated in animal and in vitro studies, provide a theoretical basis for the use of quercetin in the prevention of cardiovascular disease however, current human data is less encouraging. A double-blind, placebo-controlled study investigating the effects of a quercetin-containing supplement on plasma quercetin status, risk factors for heart disease and serum platelet fatty acid levels was conducted on 27 healthy men and women with cholesterol levels of 4.0-7.2 mmol L (Conquer et al 1998). The subjects consumed a quercetin-containing supplement (1 g quercetin day) or rice flour placebo for 28 days. Quercetin intakes were approximately 50-fold greater than dietary intakes previously associated with lower coronary heart disease mortality in epidemiologic studies. Plasma quercetin concentrations were approximately 23-fold greater in subjects consuming the quercetin capsules than in the placebo group. Quercetin supplementation did not alter...

Hypertensive heart disease coronary artery disease and heart failure

ACE inhibitors, and possibly ARBs, are the best monotherapeutic way to reduce LVH, followed by calcium antagonists, diuretics, and, distinctly less effective, beta-blockers. ACE inhibitors are also a cornerstone in the management of the patient with heart failure and the post-MI patient. ACE inhibitors, and possibly ARBs, are probably the best choice for initial therapy in the patient with hypertensive heart disease. Beta-blockers have morbidity and mortality benefits in the post-MI patient but do not have any primary cardioprotective effects in hypertension. Low-dose beta-blockade is also very useful in patients with heart failure. As shown in the Val-HeFT study, the combination of an ACE inhibitor and an ARB may benefit certain patients with heart failure 45 . Morbidity and mortality benefits of diuretics have never been documented in heart failure. However, as in any other edematous state, diuretics will bring symptomatic relief. Calcium antagonists are useful in the patient with...

Large Scale Community Coronary Heart Disease and Diabetes Prevention Trials

The results of early large-scale community CVD prevention trials, such as the Stanford Three Community and Five Community studies as well as the Minnesota Heart Health Program, had limited impact on weight status and reinforced the difficulty of preventing weight gain in the community. However, later programs, such as the Pawtucket Heart Health Program, were able to make a modest impact on weight gain in the intervention community after 10 years. These programs demonstrate the time lag that can be expected between the implementation of a truly community-wide program and the extent of behavior change likely to be required to impact upon the weight status of the community. It has been suggested that unless weight is the primary outcome of the intervention, it is unlikely that sufficient focus will be placed on achieving the level of change required to impact on energy balance and community weight status.

Cardiovascular Disease Prevention

Selenium may decrease cardiovascular disease mortality however, epidemiological studies have produced mixed results. morbidity and mortality (Salonen et al 1982). A more recent study of just over 3000 middle-aged and elderly men also established an association between low serum selenium levels and a significantly increased risk of ischaemic heart disease (Suadicani et al 1992). Alternatively, no association was identified between serum selenium levels and coronary deaths or myocardial infarctions in a study of 1110 men however, a significant association with stroke mortality was detected (Virtamo et al 1985). No significant primary preventative effect was seen for selenium supplementation (200 g day) and incidence of cardiovascular disease, myocardial infarction, stroke or all cardiovascular disease mortality in the Nutritional Prevention of Cancer study (Stranges et al 2006). Lack of association was confirmed when analyses were further stratified by tertiles of baseline plasma...

Congenital Heart Disease

Congenital cardiac anomaly (CAA), also known as congenital heart disease (CHD), refers to any structural defect of the heart or major vessels that exists from birth. It is the most common cause of infant death, other than problems of prematurity, and death is likely to occur in the first year of life. CAA may result either from genetic causes or from external causes such as maternal infection or exposure to other factors that affect embryonic development. The general problems associated with CAA include increased cardiac workload, hypertension, poor oxygenation of blood, and respiratory infections. There are many types of CAA, including aortic stenosis, atrial septal defect, valvular stenosis, and pulmonary stenosis.

Rheumatic Heart Disease

Rheumatic heart disease (RHD) involves damage to the heart and heart vessels caused by rheumatic fever. A susceptible person acquires a streptococ-cal infection, which may trigger an autoimmune reaction in the heart tissue. Rheumatic fever can cause swelling (inflammation) in the heart, joints, brain, and spinal cord. Rheumatic fever produces fatigue (tiredness) and the infection can damage or weaken heart valves. Problems with the heart may be evident early, or it may occur long after the infection. RHD is characterized by heart murmurs, abnormal pulse rate and rhythm, and congestive heart failure. Acute RHD requires aggressive treatment to prevent heart failure. Chronic RHD requires continuous observation. If poor cardiac function develops, it may be treated with a low-sodium diet and diuretics. Patients with deformed heart valves should be given prophylactic antibiotics before dental and surgical procedures.

Vitamin C in Cardiovascular Disease

Vitamin C deficiency is associated with an increased risk of atherosclerosis, but there is little evidence of protective effects at intakes greater than needed to meet requirements (Jacob, 1998). A systematic review (Ness et al., 1996) found limited evidence of benefits of high intakes of vitamin C in reducing the incidence of stroke, but inconsistent evidence with respect to coronary heart disease.

Type A Personality and Cardiovascular Disease

Cardiovascular disease is one of the most frequent causes of death and disability in the United States. Health professionals have been searching for the factors that put people at risk for this disease. Known risk factors for developing cardiovascular disease include high blood pressure, obesity, smoking, family history of heart disease, inactive lifestyle, and high cholesterol. In the 1970s, physicians began to consider a new risk factor , a specific personality trait. As mentioned in Chapter 13, this grew out of the observation by some physicians that the patients who had had heart attacks often behaved dif fer-ently, and they seemed to have different personalities, compared with other patients. The heart attack patients were often more competitive and aggressive, more active and energetic in their actions and speaking, and more ambitious and driven (Friedman & Rosenman, 1974). They called this collection of behaviors the Type A personality. Early studies of the Type A...

Curcumin Inhibits Myocardial Infarction

The effect of curcumin on myocardial infarction (MI) in the cat and the rat has been investigated (94-97). Dikshit et al. examined the prevention of ischemia-induced biochemical changes by curcumin in the cat heart (94). Myocardial ischemia was induced by ligation of the left descending coronary artery. Curcumin (100 mg kg, i.p.) was given 30 min before ligation. Hearts were removed 4 hr after coronary artery ligation. Levels of glutathione (GSH), malonaldelhyde (MDA), myeloperoxidase (MPO), superoxide dismutase (SOD), catalase, and lactate dehydrogenase (LDH) were estimated in the ischemic and nonischemic zones. Curcumin protected the animals against decrease in the heart rate and blood pressure following ischemia. In the ischemic zone, after 4 h of ligation, an increase in the level of MDA and activities of MPO and SOD (cytosolic fraction) were observed. Curcumin pretreatment prevented the ischemia-induced elevation in MDA contents and LDH release but did not affect the increase in...

Syndromic congenital heart disease

Cardiac malformations are among the most prevalent malformations in congenital syndromes. A large list of syndromes with congenital heart disease as a common manifestation has known genetic defects. CHD syndromes can be either due chromosome dosage disorders, large chromosomal deletions, small micro-deletions, or single gene defects. Table 2 shows a list of CHD syndromes within each of these categories with the corresponding genetic defect. This section will discuss the most common syndromes that include congenital heart disease as a primary manifestation. Within each syndrome, the phenotypic diversity as well as the spectrum of mutations and chromosomal defects that have been reported will be discussed. Down Syndrome is the most common disorder of chromosome dosage with an incidence of 1 in 700 to 1 in 800 live births. The incidence is known to increase tremendously with increased maternal age, particularly above the age of 35. The main clinical manifestations of Down Syndrome are...

Tocopherols and Cardiovascular Disease Epidemiological Evidence

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 European 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. However, other European population studies have not found an association between blood levels of vitamin E and end points of CVD. In the EURA-MIC study, the adipose levels of vitamin E did not correlate with the relative risk of...

Cardiovascular Disease Population Studies

The incidence of cardiovascular disease within populations with either very high or very low intakes of n-6 fatty acids may provide some indication for optimal intakes of n-6 fatty acids. Within populations with low n-6 fatty acid intakes (< 3 ) there would appear to be a benefit of having a higher n-6 fatty acid intake on cardiovascular disease risk reduction. These observations suggest that very low n-6 fatty acid intakes increase the risk for cardiovascular disease. The presence of EFA deficiency in a significant proportion of such populations may explain the increased risk. Several populations, including the Israelis, Taiwanese, and Kung bushmen in the African Kalahari desert, have high to very high intakes of n-6 fatty acids. The contribution of n-6 fatty acids to total energy intake is about 10 in the Israelis and Taiwanese and about 30 in the Kung bushmen. Rates of cardiovascular disease are low in the Taiwanese, where dietary n-6 fatty acids are obtained mainly from soybean...

Cardiovascular Diseases

In 1972 Folkers and Littaru from Italy documented a deficiency of coenzyme Q10 in human heart disease (Ernster & Dallner 1995). Since those early reports, a steady stream of research articles have been published and clinical experience in its use as an adjunct to conventional treatment in various forms of heart disease has accumulated. Data from laboratory studies have also accumulated and generally provide a supportive basis for its use. A review by Langsjoen and Langsjoen of over 34 controlled studies and additional open studies concluded that CoQ10 supplementation goes beyond the correction of a simple deficiency state with strong evidence to show it has the potential to reduce the risk of cardiovascular disease by the maintenance of optimal cellular and mitochondrial function in cardiomyocytes. Although investigation into specific cardiovascular diseases has been undertaken, the results of an open study of 424 patients suggested that CoQ10 may have widespread benefits. The...

Myocardial Infarction MI

Myocardial infarction (MI) is the clinical term for a heart attack. It is caused by occlusion (blockage) of the coronary artery (atherosclerosis) or a blood clot (coronary thrombosis), resulting in the partial or total blockage of one of the coronary arteries. When this occurs, the heart muscle (myocardium) does not receive enough oxygen. If the MI is mild, the heart muscle may partially repair itself. Permanent damage may occur when a portion of the heart muscle dies (called an infarction). MI is characterized by crushing chest pains that may radiate to the left arm, neck, or upper abdomen (which may feel like acute indigestion or a gallbladder attack). The affected person usually has shortness of breath, ashen color, clammy hands, and faints. Treatment within one hour of the heart attack is important and usually includes chewing aspirin and administering CPR. Many individuals die each year of their first MI.

Coronary Artery Disease CAD

Coronary artery disease (CAD) refers to any one of the conditions that affect the coronary arteries and reduces blood flow and nutrients to the heart. According to the American Heart Association, heart disease is the most common cause of cardiac arrest, and 95 percent of cardiac arrest patients die before they reach the hospital. That high mortality rate has prompted the placement of portable defibrillators in places such as schools, airplanes, police cars, and in this service plaza along the Pennsylvania Turnpike. Photograph by Keith Srakocic. AP Wide World Photos. Reproduced by permission. trans-fatty acids type of fat thought to increase the risk of heart disease Chronic stress is a risk factor for heart disease, and acute stress can trigger heart attacks. Regular yoga or other exercise may help prevent both conditions by releasing stress and strengthening the heart muscle. AP Wide World Photos. Reproduced by permission. Chronic stress is a risk factor for heart disease, and acute...

Alcohol and nonfatal myocardial infarction or incidence of CHD

Data on the incidence of myocardial infarction or CHD were available for about 40 of the cited cohorts. It is no longer disputed that drinkers as a group have a lower incidence of Table 1.1 Large population studies examining alcohol intake and cardiovascular disease 10 Puerto Rico Heart Health Program 11 Yugoslavia Cardiovascular Disease Study *Length of follow-up (years) +Number of incidence cases unless otherwise indicated CHD coronary heart disease CVD cardiovascular disease NHANES I the First National Health and Nutrition Examination Survey. *Length of follow-up (years) +Number of incidence cases unless otherwise indicated CHD coronary heart disease CVD cardiovascular disease NHANES I the First National Health and Nutrition Examination Survey. acute myocardial infarction or CHD than do non-drinkers. However, it is unresolved as to whether there is a dose-response relation between increasing alcohol intake and decreasing incidence and whether there is an increase in risk at the...

Sleepdisordered breathing SDB in patients with ischemic stroke

2.1 Sleep-disordered breathing (SDB) as a risk factor for ischemic stroke The first controlled study of sleep related breathing disorders in cerebrovascular diseases were carried out in the 80s. They concerned the snoring as a risk factor for ischemic stroke. The first studies were published by a group of Palomaki (Partinen et al, 1985). They compared the incidence of snoring in 50 men with ischemic stroke with a control group. The study was retrospective with use of a standardized questionnaire. Patients were divided into groups of regularly snoring (every night), often and seldom. Polysomnographic studies were not performed. It was shown that the relative risk of ischemic stroke is 10.8 times higher in regular snorers as compared with not snoring patients. Further results of these investigators have shown that snoring is independent of other risk factor for ischemic stroke (Palomaki 1989, 1991). Results of other studies on snoring as a risk factor of ischemic stroke, show an...

Hypertension as a gateway to cardiovascular risk modification

Measurement of BP is a simple, straightforward procedure that allows us to identify the risk of cardiovascular disease. However, treatment of raised BP is clearly inefficient to reduce the overall associated cardiovascular disease risk. Antihypertensive therapy should, therefore, serve as a gateway to overall cardiovascular risk management and give rise to normal risk estimation. This can be done by using the Framingham risk score 1 or the systems put forward by the European Society of Cardiology 24 and others. We have learned recently that the use of more elaborate risk assessment by a series of biomarkers does not really add much to additional methods of assessing the cardiovascular disease risk. However, one ofthe most important criticisms of cardiovascular risk estimation is that it is based on limited time projections, most often on 10-year absolute risk estimation. This approach strongly favors treatment of the elderly population because age is a more powerful determinant of the...

Cigarette Smoking And Cardiovascular Disease

Cigarette smoking-related cardiovascular diseases have been described widely. However, the mechanisms of their effects on cardiovascular system were not totally clear. The effects of nicotine and carbon monoxide on blood vessel walls, unfavorable lipid profiles, increased myocardial work and the decreased oxygen carrying capacity of the blood of smokers contribute to the overall effect of cigarette smoking on cardiovascular disease 3J. Of the increased cardiovascular risk caused by smoking, it is estimated that approximately one-tenth of this is due to smoking-induced changes in serum lipid 4 , The majority of studies indicate elevations in serum cholesterol, phospholipids, triglycerides, low-density lipoprotein (LDL) and increased hepatic lipase activity in smokers, with decreased serum high-density lipoprotein (HDL) cholesterol 5 , In addition, cigarette smoking is associated with unhealthy eating patterns, including increased intakes of alcohol, total fat, cholesterol, saturated...

Cardiovascular Disease and CHD

An association of dietary cholesterol with cardiovascular disease is based on several lines of evidence, including studies in animal models, epidemiological data in humans, and the effects of dietary cholesterol on plasma lipoproteins (Table 9-4). There is compelling evidence that dietary cholesterol can induce atherosclerosis in several animal species, including rabbits, pigs, nonhuman primates, and transgenic mice (Bocan, 1998 McNamara, 2000 Rudel, 1997). However, given the existence of marked inter- and intraspecies differences in cholesterol metabolism and athero-genic mechanisms, it is not possible to extrapolate these data directly to humans. A number of prospective epidemiological studies have investigated the relationship of dietary cholesterol and other nutrients to the development of coronary heart disease (CHD) (reviewed in Kritchevsky and Kritchevsky, 2000 McNamara, 2000). Significant univariate relationships of cholesterol intake to risk for CHD have been observed in the...

Prevention Of Morbidity And Mortality Of Cardiovascular Disease

For over 25 years, fish and fish oils have been linked to cardiovascular health. This association was first recognised when significantly lower death rates from acute myocardial infarction (Ml) were found among Greenland's Inuit population, despite only moderate differences between the Inuits' blood cholesterol levels and those of other populations (Holub 2002). A high dietary omega-3 fatty acid intake in the form of marine mammals (seal, whale) and various fish were thought responsible for the protective effect (Bang et al 1980). In 1989, results from the first large, randomised, clinical trial investigating the effects of fatty fish consumption on survival and risk of secondary Ml confirmed a link to cardiovascular health (Burr et al 1989). The DART (Diet and Reinfarction study) found a modest intake of 2-3 portions weekly of fatty fish reduced mortality in men who had previously experienced a Ml and produced a relative reduction in total mortality of 29 during the 2-year follow-up,...

Heart Disease

The known risk factors for coronary heart disease (CHD) include high serum low density lipoprotein (LDL) cholesterol concentration, low serum high density lipoprotein (HDL) cholesterol concentration, a family history of CHD, hypertension, diabetes mellitus, cigarette smoking, advancing age, and obesity (Castelli, 1996 Hennekens, 1998 Parmley, 1997). There is a positive linear relationship between serum total cholesterol and LDL cholesterol concentrations and risk of CHD or mortality from CHD (Jousilahti et al., 1998 Neaton and Wentworth, 1992 Sorkin et al., 1992 Stamler et al., 1986). A low concentration of HDL cholesterol is positively correlated with risk of CHD, independent of other risk factors (Austin et al., 2000). The role of diet in the promotion or prevention of heart disease is the subject of considerable research. New studies investigating dietary energy sources and physical activity for their potential to alter some of the risk factors for heart disease are underway (i.e.,...

Heart Attack

A common predictor of heart attack is angina, a pain in the chest usually experienced upon exertion or after eating. The pain occurs because there is not sufficient blood reaching the heart due to atherosclerosis or a narrowing of the arteries. The actual cause of most heart attacks is the formation of a blood clot in a coronary artery that has been narrowed by atherosclerosis. The clot blocks the supply of blood carried by the artery and that portion of the heart subsequently dies. What happens mechanically at the time of death from a heart attack is ventricular fibrillation, an erratic heartbeat that interrupts delivery of oxygenated blood to the brain. The determining factor of whether the death of a portion of the heart muscle actually results in the whole heart expiring may depend on the condition of the autonomic nervous system that governs involuntary actions like breathing, digestion, and heartbeat. If the autonomic nervous system is in sympathetic mode, which has a...

Alcohol and CHD mortality

Many studies have found an L-shaped pattern of alcohol-CHD relationship with mortality decreasing with increasing consumption up to a point and then leveling off. This pattern implies that there was no significant up-turn in the trends of CHD mortality among heavy drinkers. These studies include the Framingham Heart Study 6 , the Nurses' Health Study 13 , Cancer Prevention Study II 21 , the Eastern France Study 34 , a study among the Japanese male physicians 35 , the Physicians Health Study enrollment cohort (death from cardiovascular disease as the endpoint) 18 , males from the Kaiser Permanente Study 22 , males from the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study 23 , and beer drinkers in the Copenhagen City Heart Study 32 , A U-shaped curve signifies an initial decrease in the CHD death rate followed by an increase at higher levels of alcohol consumption. This relationship was reported in the American Cancer Society Prospective Study 20 ,...

Alcohol and sudden cardiac death

Evidence for a strong association between alcohol and sudden death has been reported among problem drinkers 37,38 , Findings among population studies published in the 1980s were, however, inconsistent. A positive association between alcohol consumption and the incidence of sudden coronary death was detected in the cohort of 4,532 Finnish men with or without prior CHD 30 , No association was found in the Puerto Rico Heart Health Program 10 , the Yugoslavia Cardiovascular Disease Study 11 , and the Framingham Heart Study 39 , The numbers of sudden deaths were small in these reports, however. In the Physicians Health Study, men who consumed light-to-moderate amounts of alcohol (2-6 drinks per week) had a significantly reduced risk of sudden cardiac death compared with those who rarely or never consumed alcohol 16 . Only 3 of the physicians drank 2 or more drinks per day. Men in this open-end category had neither an increase nor a reduction in risk. About 11 of men in the British Regional...

Inherent weakness in observational studies

Consistency is often cited as one of the criteria making an observed association more likely to be causal. However, results from studies with the same design can be wrong or artefactual and remain consistent. Most population studies rely on volunteers. This may bias the study samples toward cooperative persons, who are, perhaps, more health conscious than nonparticipants. The heaviest drinkers are not likely to be included in the large cohort studies and this may diminish the role ofheavier drinking in the overall results. Studies on the highly educated and health conscious groups 12-19,29,35 are more likely to miss the up-turn of a J-shaped relationship between alcohol and outcome. The most fundamental weakness in the observational studies is that the preference and quantity of alcohol intake are entirely self-determined by the participants. Hence, all reports on the benefit of small-to-moderate alcohol consumption to cardiovascular disease reduction are referenced to those who are...

Measurements ofalcohol intake

Risk estimates for any given level of alcohol use would be mislabeled but would have rank-order validity. The hypothesized association between alcohol intake and cardiovascular disease would be found, but safe levels of drinking could not be established since true drinking habits were not known. Alternatively, if response error is not proportional, this will not only affect the existence and the shape of the association between alcohol and health, but also the relative risk could be underestimated, overestimated, or completely spurious. The ultimate effects of response error are unknown, but this issue clearly represents an important potential limitation for all epidemiologic research on alcohol.

Domenico Corrado MD PhDa Pierantonio Michieli MD PhDb Cristina Basso MD PhDc Maurizio Schiavon MDb Gaetano Thiene Md

The majority of athletes who die suddenly have previously unsuspected structural heart diseases 1-10 . The causes of sudden cardiac death (SCD) reflect the age of participants. In older athletes (adults over 35 years), atherosclerotic coronary artery disease is the most common cause of fatalities. In young athletes, there is a broad spectrum of cardiovascular substrates, including congenital and inherited heart disorders (Box 1). Cardiomyopathies have been consistently implicated as the leading cause of sports-related cardiac arrest in the young, with hypertrophic cardiomyopathy (HCM) accounting for more than one third of fatal cases in the United States 1,3,7,9 and arrhythmogenic right ventricular cardiomyopathy (ARVC) for approximately one fourth in Italy 2,4-6,10 . The most common mechanism of SCD in young competitive athletes is abrupt ventricular fibrillation as a consequence of these underlying cardiovascular diseases. The culprit diseases are often clinically silent and...

Some statistical issues

The non-continuous feature of the measures of drinking habit has limited studies on the alcohol-health relationship to categorical analyses. The categories selected, the number of categories, and the distance between the categories were determined by the available data, the sample sizes and number of outcome events. The clear demonstration of a U- or J-shaped relationship requires a much larger amount of data than is generally appreciated. Some studies have combined all cardiovascular diseases or all types of stroke as the endpoint. This is often necessary because of the small numbers of cases for some of the diagnostic endpoints, but might result in partial cancellation of positive and negative associations. Furthermore, as the result of a loss of power in the categorical analysis, many reports drew conclusions based on visual observation on the trends in relative risks by drinking categories and ignored the results of formal statistical tests. Another drawback of the categorical...

Genuine Alcoholic Cardiomyopathy Asymptomatic Type

Chronic alcoholics without cardiac symptoms have been shown to have slightly depressed myocardial function as shown especially well by systolic time intervals and by the rise in pulmonary artery pressure and end-diastolic pressure with exercise 10-12 , Acute or chronic alcohol ingestion is frequently associated with conduction abnormalities and abnormal T waves, e.g., notched T waves, as well as arrhythmias, especially atrial fibrillation 13-15 , This asymptomatic alcoholic type of cardiomyopathy with slightly decreased myocardial function is not what is generally meant by an alcoholic cardiomyopathy even though in fact it is so. When nutritional deficiencies together with heavy intake of alcohol combine to produce overt congestive heart failure, this produces a genuine type of alcoholic cardiomyopathy known as beriberi heart disease, which may be further divided into two types, an acute hyperkinetic and an acute hypokinetic type. Both types respond to stopping alcohol and taking...

Other Prospective Studies

Is most effective in reducing risk of CHD comes largely from ecological studies which have considerable limitations as they are based on population drinking habits and not on individuals 5,6 , In many of the cohort studies reviewed, drinks are limited to one or two alcohol-types and few prospective studies have compared the CHD and mortality risk ofbeer, spirits and wine drinkers -within the same study population. Of those that have, some have found little or no difference between the effects ofbeer, spirits or wine on CHD 13,15 , while others (The Framingham and Copenhagen Studies) have suggested wine to be most protective 14,17 , The Kaiser Permanente Study observed no difference in relationship betweeen beverage choice (beer, spirits and wine) and risk of coronary artery disease hospitalisation 15 but observed a lower risk of CHD mortality and cardiovascular mortality in wine drinkers compared to spirit drinkers 16 , These findings are very similar to those in the British Regional...

Largeartery Atherosclerosis

A strong positive relation between alcohol consumption and the risk of mortality from stroke is apparent 26 , In the Scandinavian countries, binge drinking has been observed to associate with both an increased risk for ischemic stroke mortality 27 and the progression of atherosclerosis 28 , It is therefore not surprising that a weak association has been observed even between large-artery atherosclerotic stroke and recent heavy drinking 13 . An artery-to-artery embolism (tandem embolism) may easily be detached from an existing thrombus attached to an atherosclerotic vessel wall because of the abrupt increase in

Cervical Arterial Dissection

Cervical arterial dissection is probably one of the most common causes of ischemic stroke in young subjects. It is diagnosed by imaging with conventional or MR angiography and typically occurs after major trauma, but may also occur spontaneously or after trivial injury. Needless to say, alcoholic intoxication is a major risk factor for all types of trauma. Therefore, it is not surprising that cervical arterial dissections have also been described to have occurred in connection with alcohol abuse 22,37 , Some reports have emphasized that extracranial vessel compression due to unusual posturing during alcoholic stupor or coma could also result in a brain infarct 38-40 , but it has remained unclear whether cervical arterial dissection is the underlying mechanism or not. In at least one of the reported cases dissection was excluded 40 , Surprisingly, case-control studies have not yet been able to prove alcohol as a risk factor for ischemic stroke caused by cervical arterial dissection 13...

Effects Of Light Drinking

Several studies have shown regular light (10-20 g of ethanol daily) or moderate (less than 300 g of ethanol per week) drinking to associate with a decreased risk for ischemic stroke of atherothrombotic origin 43-45 , but the observations on the effects of light and moderate alcohol consumption on stroke mortality have been conflicting 27,46,47 , For example, one study showed light-to-moderate drinking to be associated with a 36 reduction in deaths from ischemic heart disease, but had no effect on death from stroke 47 , A recent study 48 reported that light-to-moderate alcohol consumption reduces the overall risk of stroke and the risk of ischemic stroke in men. The benefit was apparent with as little as one drink per week. More abundant consumption, up to one drink per day, did not increase the observed benefit. In fact, some investigators have pointed out that there is no convincing evidence to show that light or moderate drinking is protective against stroke 50 , Nor does...

Box 1 Cardiovascular causes of sudden death associated with sports

Age greater than or equal to 35 years Atherosclerotic coronary artery disease Age less than 35 years conduction diseases Ion channel diseases Congenital heart disease, operated or unoperated cardiovascular disease, which is usually clinically silent. This explains why a screening protocol based solely on the athlete's history and physical examination is of limited value for identification of athletes at risk for SCD. Preparticipation cardiovascular screening has traditionally been performed in the United States by means of history (personal and family) and physical examination, without 12-lead ECG or other testing, which are requested largely at the discretion of the examining physician 1,7 . This screening method has been recommended by the American Heart Association Council on Nutrition, Physical Activity, and Metabolism on the assumption that 12-lead ECG is not cost-effective for screening large populations of young athletes because of its low specificity 7 . The United States...

Ethanol And Other Aspects Of Hemostasis

Because a variety ofhemostatic factors beyond those associated with platelets also contribute to the complications associated with coronary heart disease, it is important to consider the above information on platelets in the context of some of these other observations. One of the strongest risk factors for myocardial infarction is elevated plasma fibrinogen level 41 . The association of fibrinogen and alcohol consumption was evaluated by Mennen and colleagues 42 , Alcohol consumption was associated with plasma fibrinogen levels in a U-shaped fashion for men only, with fibrinogen being the lowest in those subjects who drank 20-59 grams of alcohol per day. Fibrinogen levels were greater for nondrinkers and those who consumed over 60 grams of alcohol per day. The type of alcohol consumed also apparently played a role, with a lower level of fibrinogen in those who drank wine and spirits as opposed to those who drank beer and cider (in which no association was found).

Concommitant Cocaine And Ethanol Consumption

It has proved a difficult task to determine the long-term cardiovascular consequences of cocaine use. One such study that attempted to ascertain this information was The Coronary Artery Risk Development in Young Adults(CARDIA)study 79 , The purpose of this study was to identify the distribution of coronary heart disease risk factors (including illicit drug use) among a randomly sampled, biethnic cohort of men and women (3,848 persons, 20-32 years of age) of varied socioeconomic status in 1987, and then to evaluate the relationship between lifetime cocaine use in 1987 and cardiovascular disease risk factors 5 years later. The longitudinal design, the cardiovascular focus of CARDIA, and the inclusion of essentially healthy individuals at baseline, provided a unique opportunity to assess the cardiotoxicity of chronic cocaine use. Results of the CARDIA study indicate that lifetime cocaine use experience in 1987, after adjustment for age, ethnicity, daily alcohol intake, cigarettes smoked...

Mechanisms of cocaine cardiotoxicity

Cocaine abuse induces coronary vasospasm 1-5 , myocardial infarction 6-8 , hypertension 9,10 , stroke 7,H , and fatal cardiac rhythm disorders, including ventricular fibrillation 12-15 , Chronic cocaine abuse has also been shown to cause dilated cardiomyopathy 16,17 , and left ventricular hypertrophy in normotensive cocaine users 18-20 , It is only since modern electrocardiographic techniques have come into widespread use that the effect of cocaine on cardiac rhythm has been effectively studied. These techniques were the first to demonstrate that cocaine produced severe intractable ventricular arrhythmias that resulted in death during routine nasal surgery 21 . The previously mentioned cocaine-induced accumulation of catecholamines can hyperactivate a- and fi-adrenergic receptors, thus provoking coronary vasospasm (myocardial infarction and ischemia), increased contractile force resulting in increased metabolic demand and cardiac arrhythmias 1 , -Adrenergic receptor antagonists have...

In the cardiovascular system

The role of fatty acids in cardiovascular disease Much evidence has accumulated from various lines of inquiry that indicates that the dietary fatty acid intake and lipid acyl composition of tissues is a determinant of many of the chronic diseases prominent in the Western World, notably cardiovascular disease. It has been appreciated since the 1950s that when dietary polyunsaturated fat intake is increased, a decrease in the total serum and lipoprotein cholesterol levels results 1 . Bang and Dyerberg, in their study of the Greenland Eskimos, a group in which CVD had an extremely low incidence, made the ground breaking inference that the high dietary intake of the long chain polyunsaturated fatty acids, eicosapentanoate and docosahexaenoate was responsible for this protection from disease 2 , More recently, several epidemiological studies have reported a relationship between dietary n-3 polyunsaturates and the risk of CVD 3-8 , For example, Dolechek et al. found an inverse relationship...

Unhealthy abstainers question

A large proportion of abstainers (non-drinkers) are ex-drinkers 46 , Men who were heavier drinkers are more likely to reduce their alcohol consumption as they grow older 46-48 , This is at least in part associated with the accumulating burden of ill-health and medication as people grow older 49 , The British Regional Health Study suggested a strong downward drift from heavy or moderate drinking to occasional drinking or abstinence under the influence of accumulating ill-health not necessarily related to alcohol intake 47 , Ex- and never-drinkers were more frequently unmarried and had the highest prevalence rates of angina, ECG abnormalities, elevated blood pressure, and several other chronic conditions 50,51 , Thus, abstainers may constitute a misleading reference category for the analysis of the relation between alcohol and disease, and for the interpretation of alcohol-related dose-risk relations, leading to underestimates of alcohol-related effects or overestimates of...

Alcohol And The Heart

Ethanol has important effects on the cardiovascular system and particularly on anti-oxidant systems (reviewed in 75,158 ). Although the relative incidence of alcohol consumption reduces the overall risk of cardiovascular disease by a number of mechanisms (for example, increasing HDL LDL ratio, reducing platelet function and aggregation 140,159 ) excessive alcohol is damaging and can lead to the development of alcoholic cardiomyopathy 160-163 , Paradoxically, moderate alcohol consumption has been advocated to reduce the incidence of coronary artery disease, albeit within the confines of a multifactorial approach 147 , For example, an interaction between alcohol consumption and vitamin C has been proposed to account for the reduced incidence of angina in alcohol consumers 164 ,

Appropriate interpretation of an athletes ECG saves lives as well as money

Misinterpretation of ECG by nonexperienced physicians may lead to serious consequences 15 . Athletes may undergo an expensive diagnostic work-up or may be unnecessarily disqualified from competition for abnormalities, such as isolated voltage criteria for left ventricular hypertrophy (LVH), that fall within the normal range for athletes. Conversely, signs of potentially lethal organic heart disease, such as T-wave inversion, may be misinterpreted as normal variants of an athlete's ECG. The experience of screening athletes for HCM and ARVC D is noteworthy in this regard. Compared with patients with HCM, trained athletes significantly more often had isolated voltage criteria for LVH (403, or 40 ), but significantly less often negative T waves (27, or 2.7 ), pathologic Q waves (17, or 1.7 ), and nonvoltage criteria of LVH (13, or 1.3 ). No athletes with isolated voltage criteria had echo-cardiographic evidence of HCM. This study shows that ECG of HCM overlaps marginally with ECG findings...

Cocaine Cardiotoxicity

As cocaine abuse has become widespread, the number of cocaine related cardiovascular events, such as angina pectoris, myocardial ischemia and infarction, cardiac myopathy, left ventricular hypertrophy, and sudden death has increased substantially 1-15 , These occur in young subjects, a significant percentage of whom had no evidence of atherosclerotic coronary artery disease on subsequent angiography 10,11,18-21 . Twice as many men as women experience cocaine related cardiac ischemic events, at least partly caused by a greater frequency of cocaine use in men. The concomitant use of cigarettes and or ethanol is pervasive, with up to 75 of cocaine users admitting to each. Although myocardial ischemia, infarction, and sudden death are most likely to occur in chronic cocaine users, they have been reported in first time users as well. These events can occur from any route of administration and with a large or small amount of the drug 3,4,8,9,20-29 , It is thought that the pathophysiology of...

Epidemiological Studies

Recently, the South Bay Heart Watch (Torrance, CA) reported a study ofl,196 asymptomatic subjects with coronary risk factors who were assessed for alcohol consumption history and for the presence of calcium deposits in coronary atherosclerotic lesions as measured by electron beam computed tomography (EBCT). Participants were followed prospectively for 41 months for coronary events, defined as the occurrence of myocardial infarction or CHD death 6 , Subjects who drank alcohol had a relative risk of 0.3 ofhaving a coronary event compared with abstainers. The diminished risk of myocardial infarction or CHD death associated with moderate alcohol consumption was independent of serum HDL cholesterol levels, EBCT coronary calcium scores, and all other coronary risk factors. Abstention from alcohol in this study was as strong a predictor of coronary events as diabetes, smoking, hypertension, and coronary calcification 6 , Also reported recently was an analysis of the relationship between...

The Effect Modification Of Alcohol By Smoking

The effects of both alcohol and tobacco are manifold, which makes them complicated to examine and understand. The effects may be additive or synergistic, or counteract each other either directly via the same mechanisms or indirectly influencing the same phenomena but through different mechanisms. Both alcohol intake and cigarette smoking increase blood pressure 17-20,42,51-55 , even though the relationship between smoking and hypertension is controversial 18,52,55,57-62 , Alcohol consumption increases serum HDL cholesterol 17,18,20-26 whereas cigarette smoking has been consistently associated with reduced levels of HDL cholesterol 18,20,51,57,58,60,65,66 , Alcohol decreases platelet activity and fibrinogen levels and increases fibrinolysis 27,30 , whereas smoking increases platelet aggregability and fibrinogen levels 27,51,53,57,68,69 , It is very plausible that smoking substantially modifies the effects of drinking on stroke risk, but it remains to be studied what the actual net...

Cigarette Smoking And The Risk Of Stroke

Heavy smoking (> 20 cigarettes day) increases both the incidence 37-41 and mortality from stroke 40,41 , Cigarette smoking is a major modifiable risk factor for subarachnoid hemorrhage 42-48 , In contrast, evidence concerning the role of tobacco in the risk of intracerebral hemorrhage is still controversial, yet it appears that heavy, but not light-to-moderate cigarette smoking, increases the risk 9,38,49,50 , Smoking is dose-dependantly associated with the risk of ischemic stroke 38,46 , Cessation of smoking reduces stroke risk 37,39 , with major reduction within 2-5 years after cessation 37,39,46 , indicating that part of the effects of smoking is reversible. The risk of stroke seems to return to the level of never-smokers in light smokers, but heavy smokers seem to retain an increased risk even though also they benefit from cessation 37 , There are several mechanisms by which smoking may cause stroke. Cigarette smoking causes an immediate, yet reversible increases in blood...

Cardiogenic Brain Embolism

Stroke admission rates have been observed to be high among heavy drinkers 10 , Some studies also suggest that alcohol abuse may associate with ischemic stroke recurrence 11,12 . A study on recent alcohol intake showed that heavy drinking is an independent risk factor for most subtypes of ischemic stroke and particularly a risk factor for cardiogenic brain embolism 13 . Atrial fibrillation is certainly the commonest cause of cardiogenic brain embolism, and about 0.4 of the population have atrial fibrillation. The relative risk of ischemic stroke in subjects with atrial fibrillation is 5- to 7-fold compared to subjects without this condition. Alcohol abuse has been estimated to account for a substantial portion (30 ) of the new-onset cases 16 and to precipitate atrial fibrillation even in healthy nonalcoholic subjects 17 . Alcohol-induced atrial fibrillation 18 and atrial flutter 19 have been reported as causes of cardiogenic brain embolism in nonalcoholic young adults. These cases were...

The Editors

Watson attended the University of Idaho but graduated from Brigham Young University in Provo, Utah with a degree in chemistry in 1966. He completed his Ph.D. degree inl971 in biochemistry at Michigan State University. His postdoctoral schooling in nutrition and microbiology was completed at the Harvard School of Public Health and included a 2-year postdoctoral research experience in immunology. He was an assistant professor of immunology and did research at the University ofMississippi Medical Center in Jackson from 1973 to 1974. He was an assistant professor of microbiology and immunology at the Indiana University Medical School from 1974 to 1978 and an associate professor at Purdue University in the Department ofFood and Nutrition from 1978 to 1982. In 1982, Dr. Watsonjoined the faculty at the University of Arizona in the Department ofFamily and Community Medicine. He is also a research professor in the University of Arizona's newly formed College ofPublic Health. He is a member...

Alcohol and stroke

Alcohol was recognized as a possible risk factor for stroke as early as the 17th century 41 . Results gathered from large prospective studies were not available until the late 1970s to early 1980s and the epidemiological evidence has been highly inconsistent. Variations in the reported alcohol-stroke relationship are much greater than for the alcohol-CHD relationship. Increasing alcohol consumption was related to an increased incidence of all strokes (fatal and non-fatal) in men from the Honolulu Heart Program 8 , in the Swedish conscripted men 33 , and in the male smokers in the Finnish Cancer Prevention Study 31 . Alcohol intake was also associated with an increased total stroke mortality in men from the Yugoslavia Cardiovascular Disease Study 42 and the Japanese male physicians 35 , On the other hand, some studies 17,21 have reported an L-shaped alcohol-stroke relationship. The Cancer Prevention Study II 21 found that men who consumed alcohol less than daily through 4 or more...

Other confounders

The difficulty of controlling completely for correlates of alcohol use and of cardiovascular disease is obvious. For example, alcohol use is related to age, sex, race ethnic background, geographical location, smoking, coffee use, educational attainment socioeconomic status, marital status, adiposity, salt use and other dietary habits, religious affiliation, social network, stress, psychological well-being, and physical activity. People who drink (excluding heavy drinkers) had a better self-perceived health status than did non-drinkers 52 , The differences in self-perceived health status accounted for one-fourth to one-third of the lower risk of

Conclusions

Two thirds of Americans report using alcohol and since social drinking is a potentially modifiable behavior, the relation between alcohol consumption and cardiovascular disease is a subject of considerable importance. Although the literature is not unanimous, evidence from large epidemiologic studies leads to the conclusion that moderate alcohol intake decreases risk of non-fatal and fatal CHD and ischemic stroke. The observed differences in the shape of the relationship between various studies might be partly explained by varying distributions of other risk factors and partly by the variation of alcohol intake in the study populations. If heavy drinking was infrequent in a study sample, an L-shaped relationship would be observed instead of a J-shape. If only abstainers and light drinkers were studied, an inverse linear association should appear. If the study sample did not include abstainers, a positive linear trend could emerge. A randomized, controlled clinical trial is the gold...

Case

In April 1994, a 60-year-old nonsmoking man who had diabetes and untreated hypertension, but who did not use any medication, suddenly developed right hemiparesis and a visual field defect several hours after getting out ofbed in the morning. He was an episodic heavy drinker and had ingested a large amount of alcohol on the preceding evening (150 g ethanol). His usual weekly alcohol intake averaged 300 g of ethanol. On admission, he had atrial fibrillation. During the preceding month, he had both an upper respiratory infection and a bacterial dental infection, and two weeks before the index stroke he experienced symptoms suggestive of a transient ischemic attack. A computed tomography head scan showed a new left temporo-occipital brain infarct and an older left deep capsular infarct. Duplex imaging of the carotid and vertebral arteries did not suggest any significant stenoses, but TEE showed an enlarged left atrium with a moving appendicular thrombus.

Exposure To Ethanol

Because no clinical trials actually test prospectively the relationship between alcohol consumption and coronary heart disease, efforts to identify the mediators of ethanol-induced cardiac protection in humans focus on statistical modeling of observational data. These analyses have identified increased HDL cholesterol levels 8,9 , decreased platelet aggregation 10 , and increased expression of tissue-type plasminogen activator 11 as potential mechanisms underlying ethanol-induced cardiac protection. Moderate ethanol exposure may also protect against CHD through direct effects on heart muscle. For example, Auffermann et al. reported that ethanol significantly reduces the functional and structural damage caused by one component of ischemia-reperfusion injury, the pathological influx of Ca2+ into myocardial cells termed the calcium paradox injury 12 . Using isolated Langendorff-perfused rat hearts, these investigators found that addition of 2.5 (vol vol) ethanol to the perfusate...

Summary

In conclusion, the abstinence of cigarette smoking should always be appropriated for prevention of heart disease. Moderate alcohol drinking may be helpful for protection of the heart. However, individuals must astain under special circumstances such as pregnancy or severe liver disorders. Cigarette smoking along with heavy alcohol drinking must be

Stroke

Some clinical studies have suggested that dietary ATC does not reduce the risk of stroke 157 , In the aforementioned study in the USA, 43,738 male subjects, (without cardiovascular disease or diabetes) aged from 40-75 years were examined, and after 8 years, 210 ischaemic strokes had occurred. However, the relative risk for ischaemic stroke in the group with the top quintile with highest ATC intake (median 411 IU d) was 1.18 compared to the group with the lowest intake of ATC (5.4 IU d), and there was no relation between the dose or duration of ATC and the risk for total or ischaemic stroke 157 ,

Function

As discussed elsewhere in this volume, quite a few epidemiological studies have examined the association between morbidity and mortality from CHD and moderate alcoholic beverage consumption, and an inverse association has been established in studies involving nearly a million subjects 29 , One example of such reports is a study of American Cancer Society volunteers, which showed that the rate of death from all cardiovascular diseases was 30-40 lower among men and women who consumed at least one alcoholic drink daily than among nondrinkers. While it should be emphasized that alcohol consumption is associated with higher death rates from injuries, violence, suicide, cirrhosis, certain cancers and hemorrhagic stroke 30 , the incidence of death from heart disease is much greater compared to these other causes, making any role of platelets potentially important. Cross-cultural studies have shed light onto the French paradox involving the Mediterranean diet. A Mediterranean diet typically...

Introduction Normal Adolescent Growth and Diets

Adolescence is a unique time of rapid growth, with half of eventual adult weight and 45 of peak bone mass accumulated during adolescence. Adolescence is a time when peak physical muscular development and exercise performance is reached. However, adolescent diets are often notorious for their reliance on snacks and 'junk foods' that are high in calories, sugar, salt, and saturated fat, which could provide extra energy for high-activity demands of teenagers, but often risk becoming part of bad habits leading to obesity and increased risk of atherosclerotic heart disease in later life. Although most studies have been on older subjects, it is now clear that many Western diseases, especially heart disease, stroke, diabetes, hypertension, and many cancers, are diet related, and that diets high in saturated fat and low in fruits, vegetables, and fiber may increase risks of heart disease. Indeed, autopsy reports of atherosclerotic plaques already present in adolescents who died accidentally...

The Genetics of Pancreatic Cancer

Palladin RNA is over-expressed in tissues from both precancerous dysplasia and pancreatic adenocarcinoma in familial and sporadic pancreatic disease. The mutated gene is assumingly, best detected in very early precancerous dysplastic tissue, heralding neoplastic transformation before the overarching of genetic instability, underlying cancer, has occurred. Palladin is a component of actin-containing microfilaments that control cell shape, adhesion and contraction and is associated with myocardial infarction and pancreatic cancer. Palladin is most probably a proto-oncogene (Pogue-Geile et al., 2006).

Effects of Alcohol on the Cardiovascular System

The beneficial, cardioprotective effects of alcohol consumption have been broadcast widely. This observation is based on population studies of mortality due to ischemic heart disease, case-control studies, and animal experiments. However, there is no evidence from randomised controlled trials. The apparent protective effect of alcohol may therefore result from a confounding factor. Furthermore, on the population level, the burden of alcohol-induced morbidity and mortality far outweighs any possible cardiovascular benefit.

Alcoholism Versus Unwise Drinking

Although the word medicine derives from a Latin word meaning ''of a physician,'' throughout much of recorded history and even today, folk medicine and ''home remedies'' are widely practiced. Early medicines were taken exclusively from nature, and PLANTS are still an important source of medicinal products (e.g., foxglove for heart problems, bread mold for penicillin).

Alcohol and Mortality Amount of Alcohol

Some have explained the J shape as an artefact due to misclassification or confounding. Prevailing beliefs among these researchers is that abstainers comprise a mix of former heavy drinkers, underreporting drinkers, ill people who have stopped drinking, and people with an especially unhealthy lifestyle apart from abstaining. However, most researchers attribute the 'J' to a combination of beneficial and harmful effects of ethanol. This is based on findings from population studies of alcohol-related morbidity and cause-specific mortality that show a decreased relative risk of coronary heart disease, and an increased risk of certain cancers and cirrhosis, with increased alcohol intake. Further evidence derives from studies in which people who were ill at baseline were excluded, and these confirmed the previously mentioned findings.

The unique efficacy of dryneedling acupuncture in sports medicine

Some athletes resort to drugs to achieve better performance, and they risk paying a high price for this in the future. Anabolic steroids greatly increase the risk of cardiovascular damage, heart attack, and stroke, because they cause hypertension, a decrease in high-density blood lipoproteins, and an increase in low-density lipoproteins. The consumption of male sex hormones by male athletes can decrease testicular function, causing both lowered sperm formation and a reduction in the natural secretion of testosterone. The use of amphetamines and cocaine

Nutrient Functions And The Indicators Used To Estimate Requirements

Intake level shown to provide the greatest protection against coronary heart disease (14 g 1,000 kcal) X median energy intake level (kcal 1,000 kcal d) Intake level shown to provide the greatest protection against coronary heart disease (14 g 1,000 kcal) X median energy intake level (kcal 1,000 kcal d) Intake level shown to provide the greatest protection against coronary heart disease (14 g 1,000 kcal) X median energy intake level (kcal 1,000 kcal d) Intake level shown to provide the greatest protection against coronary heart disease (14 g 1,000 kcal) X median energy intake level (kcal 1,000 kcal d) Intake level shown to provide the greatest protection against coronary heart disease (14 g 1,000 kcal) X median energy intake level (kcal 1,000 kcal d) Intake level shown to provide the greatest protection against coronary heart disease (14 g 1,000 kcal) X median energy intake level (kcal 1,000 kcal d) Intake level shown to provide the greatest protection against coronary heart disease...

Criteria And Proposed Values For Tolerable Upper Intake Levels

There were insufficient data to use the model of risk assessment to set a UL for total fat, monounsaturated fatty acids, n-6 and n-3 polyunsaturated fatty acids, protein, or amino acids. While increased serum low density lipoprotein cholesterol concentrations, and therefore risk of coronary heart disease, may increase at high intakes of saturated fatty acids, trans fatty acids, or cholesterol, a UL is not set for these fats because the level at which risk begins to increase is very low and cannot be achieved by usual

Nonprotein Amino Acids

Homocysteine is an intermediate in the transul-phuration pathway for the conversion of methio-nine to cysteine. Homocystinuria is an inborn error of metabolism that is characterized by the accumulation of high concentrations of homocys-teine, and this leads to severe cardiovascular disease at an early age. However, there is a much more common mutation in the enzyme 5,10-methylenetetrahydrofolate reductase that causes a moderate increase in plasma homocysteine concentration in more than 10 of the population. A high plasma homocysteine concentration appears to be an independent risk factor for cardiovascular disease in the population as a whole, although the mechanism is not known. Supplementing the diet with folic acid is often effective in reducing plasma homocysteine concentration because methyltetra-hydrofolate is a substrate for the remethylation of homocysteine by the vitamin B12-dependent enzyme methionine synthase. An inverse relationship has been observed between plasma...

Definition of hypertension

A survey of the literature of the past few decades shows that the definition of hypertension has changed drastically, and it seems to continue to change. It is presently recommended that antihypertensive therapy is started in patients who have confirmed hypertension, defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment ofHigh Blood Pressure (JNC 7) as a blood pressure (BP) level exceeding 140 90 mmHg. However, data from the Framingham Heart Study 1 make it exceedingly clear that BP is directly related to cardiovascular events, even at levels below that defined as hypertensive by the JNC 7 2 . High normal BP was associated with a several-fold increase of cardiovascular disease in the Framingham population (Figure 1). A number of recent studies have shown that lowering BP in the so-called normotensive population reduces morbidity and mortality. These recent data indicate that any arbitrary definition of hypertension, such as...

Atkins Robert MD 19302003

Atkins' death in 2003, attributed to a heart attack, was used by many critics of his diet as evidence of the danger of high-fat, high-protein diets. While there has been much controversy over the true cause of his death, as well as the report that Atkins weighed 258 pounds at his death, no consensus has been reached about the effects of his diet on his own health.

Determination Of Adequacy Adequacy

In the derivation of Estimated Average Requirements (EARs) or Adequate Intakes (AIs), close attention has been paid to the determination of the most appropriate indicators of adequacy. A key question is, Adequate for what In many cases, a continuum of benefits may be ascribed to various levels of intake of the same nutrient. One criterion may be deemed the most appropriate to determine the risk that an individual will become deficient in the nutrient, whereas another may relate to reducing the risk of a chronic degenerative disease, such as certain neurodegenerative diseases, cardiovascular disease, cancer, diabetes mellitus, or age-related macular degeneration.

Searching for the Right Weight Loss Plan

My journey to disease prevention through diet actually began when my education as a cardiologist did, 30 years ago. During my training in the late 1970s, I looked forward to treating patients with heart disease despite the fact that we didn't have many preventive weapons in our arsenal. I asked the most respected cardiologist I knew this question What is the best way to prevent heart disease His answer Pick the right parents. If you inherited the gene for cardiac longevity, you were likely to live to a ripe old age. If heart disease struck early in your family, there was not much you could do to change your destiny. Then, in 1984, I attended a course at the Heart House in Bethesda, Maryland, the national headquarters of the American College of Cardiology. There, I heard a lecture by a brilliant researcher and charismatic teacher, Bill Castelli, who headed the world-famous Framingham Heart Study. Dr. Castelli told us about the results of the recently completed National Institutes of...

Potential Nutrition Related Problems

Obesity, Diabetes, and Heart Disease. All over the world, adolescent obesity is on the rise. This has led to an increase in obesity-related diseases like diabetes and heart disease. Experts believe this rise in obesity is due to lack of physical activity and an increase in the amount of fast food and junk food available to adolescents. Staying active and eating foods that are low in fat and sugar promote a healthy weight for teens.

What does Oxidant Stress Cause

Oxidant stress, through its effects on key biological sites and structures, is implicated in chronic noncommunicable diseases such as coronary heart disease, cancer, cataract, dementia, and stroke (Figure 4). Oxidant stress is also thought to be a key player in the aging process itself. A cause-and-effect relationship between oxidant stress and aging and disease has not been confirmed, however, and it is very unlikely that oxidant stress is the sole cause of aging and chronic degenerative disease. Nonetheless, there is evidence that oxidant stress contributes substantially to age-related physiological decline and pathological changes. Consequently, if it is accepted that oxidant stress is associated with aging and degenerative disease, then opposing oxidant stress by increasing antiox-idant defense offers a potentially effective means of delaying the deleterious effects of aging, decreasing the risk of chronic disease, and achieving functional longevity. For this reason, there has...

Scott E Lukas Revised by Andrew J Homburg

Complications Through their ethanol (alcohol) content, alcoholic beverages significantly affect the body's cellular function as well as its cognitive actions. Many of these effects are the consequence of a complex set of biochemical reactions, long-term exposure to ethanol with an accumulation of damage that is manifested in diverse ways, or the result of increased incidence or severity of major disease states, including AIDS, CANCER, or heart disease. However, some effects of ethanol are immediate and do not require prolonged exposure, nor are they induced as the end product of many physiological changes. For example, ethanol induces changes in cell membranes' fluidity by mixing with the lipids there. The membrane changes inhibit neurological functions and thus can cause car ACCIDENTS. All of these can occur with a single exposure and thus could be considered a direct effect of the ethanol in alcoholic beverages.

Answers To Patients Frequently Asked Questions

Beta-carotene supplementation will ensure you maintain adequate vitamin A levels, as well as possibly assist in preventing cancer and cardiovascular disease, help maintain a healthy immune system, prevent sunburn and photoageing of the skin, assist with asthma, and deal with oxidative stress. When will it start to work

Effects of Socioeconomic Status Poverty and Health

Heart disease any disorder of the heart or its blood supply, including heart attack, atherosclerosis, and coronary artery disease potassium. In 1989, 9.3 million of the black population (30.1 ) had incomes below the poverty level. Individuals who are economically disadvantaged may have no choice but to eat what is available at the lowest cost. In comparison to other races, African Americans experience high rates of obesity, hypertension, type II diabetes, and heart disease, which are all associated with an unhealthful diet. Obesity and hypertension are major causes of heart disease, diabetes, kidney disease, and certain cancers. African Americans experience disproportionately high rates of obesity and hypertension, compared to whites. High blood pressure and obesity have known links to poor diet and a lack of physical activity. In the United States, the prevalence of high blood pressure in African Americans is among the highest in the world. The alarming rates of increase of obesity...

Establish the emotional reasons why you want to achieve your goals

When you think about the reasons you want your goal, you are feeling with emotion. What are your reasons Sometimes people have something to prove. Getting in shape for a wedding or vacation is often an important reason for many people to get in shape. So is being attractive to the opposite sex. For others, their reason is fear of health consequences (their doctor tells them if they don't lose 50 pounds in the next six months, they will die of a heart attack )

Drug therapy or lifestyle modification

Many patients are unwilling, or unable, to live up to the high expectations of lifestyle modification. Also, there seems little reason to expose the vascular tree of a patient, and its target organs, to an elevated pressure for months before antihypertensive therapy is started. Importantly, there is no justification to deny antihypertensive therapy to patients who are unable to modify their alcohol intake to the desired two drinks a day, to overweight patients who are unable to shed the necessary pounds, or to smokers who are unable, or unwilling, to give up cigarettes. To the contrary, BP needs to be aggressively treated in such patients because they have comorbid factors that greatly accelerate the long-term repercussions of hypertensive cardiovascular disease.

The Human Genome Project

Diseases result from genetic factors and from the deleterious effects of things in the environment, from microbes, trauma, violence, or deficient diets. They often involve abnormalities in molecular processes affected by both genetic and environmental factors. Diseases, including heart disease, diabetes, cancer, mental illnesses, and age-related disorders, are complex, influenced by many different genes, that affect many processes. 1. TNFS -4 myocardial infarction 2. NOS3 myocardial infarction 3. MMP3 myocardial infarction 4. KL stroke, coronary artery disease

Comparative analysis of mutations in the LDLR gene

To facilitate the mutational analysis of the LDLR gene and promote the analysis of the relationship between genotype and phenotype, in 1997 we created a software package along with a computerised database UMD-LDLR. For each mutation, information is provided at several levels at the gene level (exon and codon number, wild type and mutant codon, mutational event, mutation name), at the mRNA level (size, processing), at the protein level (wild type and mutant amino acid, affected domain, activity, mutation class), and at the personal level (ethnic background, age, sex, body mass index and familial history of coronary heart disease). The software package contains routines for the analysis of the LDLR database that were developed with the 4th dimensionR (4D) package from ACI. The use of the 4D SGDB gives access to optimised multi-criteria research and sorting tools to select records from any field. Moreover, 13 routines were specifically developed (Varret et al. 1997, 1998, Villeger et al....

Ephedra Ephedra SiNiCA

Reported side effects have included hypertension, nephrolithiasis, hepatitis, insomnia, arrythmias, myocardial infarction, and stroke. Cases of death and permanent disability have also been reported (46). Concomitant use of ephedra and other stimulant medications should be avoided to protect from potentiation of toxicity.

Fatigue is associated with disability

Although fatigue is sometimes thought of as a trivial symptom, it is associated with considerable disability. Studies that have assessed the levels of disability in CFS sufferers suggest profound deficits. Two prevalence surveys (Buchwald et al. 1995 Wessely et al. 1997) used quality of life questionnaires and found a stepwise increase in disability from healthy subjects to those with chronic fatigue and those with CFS. Role performance (the ability to fulfil occupational or household functioning) was especially impaired. Patients with CFS have disabilities comparable to, or worse than, patients with many common medical illnesses such as heart disease, diabetes, or arthritis (Wells et al. 1989). This applies both to cases seen in clinical settings and those who do not consult. Patients with CFS who also suffer from psychological distress or depression have particularly severe impairments. Wessely et al. (1997) demonstrated a striking gradient of decreasing function in subjects with...