European Journal of Preventive Cardiology

A cut-off value for waist circumference (WC) of 94 cm associated with cardiovascular risk factors (CVRF) has been recommended in Caucasian populations. However, it is unclear if recommendations derived from Western studies should be extrapolated to populations from developing countries. The present study evaluated a group of Colombian subjects to determine and evaluate the level of WC capable of identifying subjects with CVRF.

(Study 1) A cross-sectional study in 145 healthy men, to determine the level of WC associated with the following lipid profile (triglycerides 2.25mmol/L and total-cholesterol/HDL-cholesterol ratio >5) was performed. (Study 2) Two hundred and thirty-eight unrelated male adults were recruited to test whether the new WC cut-off point would identify subjects with CVRF.

(Study 1) A WC cut-off point of 88 cm identified subjects with the pre-established lipid profile with a sensitivity of 80.6% and specificity of 80.1%, while the WC of 94 cm had a low sensitivity (48.3%) and a high specificity (93.3%). Additionally, the values of C-reactive protein, fasting glucose and insulin levels in subjects with a WC 88cm were significantly higher compared to subjects with WC <88cm. (Study 2) The diagnostic accuracy of the new WC cut-off point (88 cm) to identify subjects with two or more CVRF remained acceptable in the new sample studied (sensitivity: 83.7% and specificity: 84.8%); while the WC value of 94 cm suggested in Caucasians showed a very low sensitivity (43.2%) and a high specificity (93.9%).

This study demonstrates a higher prevalence of CVRF in our population at lower levels of WC than those suggested previously in Caucasians, suggesting that ethnic background should be taken into account when using WC as a screener for CVRF. Eur J Cardiovasc Prevention Rehab 10:328-335 © 2003 Lippincott Williams & Wilkins.

Exercise training (ET) has been shown to improve functional work capacity in patients with stable chronic heart failure (CHF) having moderate symptoms (NYHA class II). This analysis was conducted, to evaluate the effects of ET on left ventricular function and haemodynamics in patients with advanced CHF (NYHA class III) fulfilling the inclusion criteria of the COPERNICUS trial.

Seventy-three patients with moderate and advanced CHF were prospectively randomised to a training (n = 36), or to a control group (n = 37). At baseline and after six months, patients underwent echocardiography and symptom-limited ergospirometry with measurement of central haemodynamics by thermodilution.

Nine out of 37 patients in the control group (C) and 10 out of 36 patients in the training group (T) had symptoms of advanced CHF. Exercise training over a period of six months resulted in an improvement of functional status on average by one NYHA class in patients with advanced CHF. Moreover, oxygen uptake at the ventilatory threshold increased by 49% (from 7.7 ± 1.0 to 11.4 ± 0.4 mL/min/kg, P<0.01 versus baseline) and at peak exercise by 32% (from 16.3 ± 1.6 to 21.5 ± 1.2 mL/min/kg, P<0.01 versus baseline) in training patients. The small, but significant reduction in left ventricular end-diastolic diameter by 7% (from 70 ± 2 to 66 ± 2 mm; P<0.05 versus baseline) was accompanied by an augmentation in stroke volume at rest by 32% (from 45 ± 3 to 60 ± 6 mL, P<0.05 versus baseline) and at peak exercise by 27% (63 ± 9 to 81 ±9 mL, P<0.05 versus baseline) as a result of ET in patients with advanced CHF.

In patients with advanced CHF (NYHA class III), long-term exercise training is associated with an enhanced physical work capacity, an improvement in stroke volume and a reduction in cardiomegaly.

To examine the relationships of job strain and iso-strain psychosocial work environment exposures to ‘total coronary risk’ (TCR) in a cohort of male and female workers in Belgium.

The sample consists of 15 079 men and 4639 women aged 35-59 years employed in a wide range of occupations and free of any self-reported personal history of CHD. Karasek's job strain model was used to define high strain (high demands and low control), low strain, active and passive jobs. Iso-strain was defined as the combination of a high strain job with low worksite social support, and is compared to the other combinations. Total coronary risk is a composite measure based on a Framingham function assessing the risk of developing coronary heart disease (CHD) within the next 10 years; high and low levels of TCR were defined. Logistic regressions in each gender were applied to explore relationships, adjusting for age, level of education, occupational class and sector of employment.

In male workers, the age-adjusted prevalence of high TCR is highest in (1) in the lowest quartile group of job control and (2) in the ‘high strain’ group. The multivariate logistic regressions comparing high strain, active and passive work exposures to low strain work did not indicate a significant association with high TCR. Likewise, iso-strain jobs were neither found to be associated with high TCR.

Our cross-sectional analysis provides no support for the hypothesis that the psychosocial work environment is strongly associated with the TCR estimate in healthy workers. Eur J Cardiovasc Prevention Rehab 10:345-354 © 2003 Lippincott Williams & Wilkins.

Epidemiological studies suggest an unclear effect of alcohol consumption on cardiovascular risk. This ambiguity is likely related to the quantity of alcohol consumed in populations studied. The aim of this work was to evaluate the association between chronic alcohol consumption and several clinical and biochemical parameters related to coronary risk, in cardiovascular disease free men and women.

The ‘ATTICA’ study is a population-based cohort, which randomly enrolled 750 men and 883 women (18-88 years old) from area around Athens, during 2001-2002. We investigated the association between alcohol consumption and arterial blood pressure, fibrinogen levels, glucose concentration, total cholesterol, HDL and LDL, apolipoprotein A1 and B, Lp(a), uric acid, leucocyte count, triglycerides, C-reactive protein and homocysteine levels.

Multivariate analysis, after controlling for several potential confounders, revealed a J-shaped association between alcohol intake (none, 1-2, 3-4, 5+ wine glasses/day) and uric acid, C-reactive protein, homocysteine, fibrinogen, triglycerides, apolipoproteins A1 and B, HDL and total cholesterols, blood glucose levels, leucocyte count and arterial blood pressure levels (only in males). The most beneficial values of all these biochemical and clinical parameters were found in alcohol intake of 100-200 ml (12% alcohol), even after adjustment for various potential confounders.

The controversial association between alcohol intake and cardiovascular disease seems to be partially explained by the J-shaped relation of several biochemical parameters related to atherosclerosis and the amount of alcoholic beverages consumed.

Elevated plasma (Lp(a)) levels may represent an independent risk factor for atherothrombotic complications but the relation between Lp(a) levels and the extent of coronary artery disease (CHD) has been discussed controversially. Little is known about potential atherothrombogenic mechanisms of Lp(a).

Case—control study.

We assessed the relationship between plasma Lp(a) and angiographically defined CHD, evaluating the severity of coronary atherosclerosis by three different scores. A total of 312 patients with stable angina aged 40-68 years with at least one coronary stenosis > 50% were studied. A group of 479 voluntary blood donors matched for age and sex served as controls. A complete lipid profile and a large number of markers of coagulation, fibrinolysis and inflammation were measured.

Plasma levels of Lp(a) were significantly higher in patients (14.8 mg/dl; 5.4-47.1 mg/dl; median/interquartile range) than in controls (9.7 mg/dl; 3.5-25.3) (P>0.0001). In a logistic regression model, the fully adjusted Odds Ratio for CHD was 3.3 (95% confidence interval (CI) 1.8-5.6, P >0.0001) for patients in the upper quartile of the Lp(a) distribution compared to the bottom quartile. There was no appreciable association between Lp(a) and apolipoproteins, markers of haemostasis, fibrinolysis and inflammation and the severity of CHD.

These results indicate that elevated plasma Lp(a) levels may be an independent risk factor for CHD but unrelated to the severity and extension of CHD. Furthermore, there is no good evidence that the presumed link between Lp(a) and CHD is mediated by increased levels of markers of inflammation, or interference with markers of fibrinolysis or coagulation.

Handbiking and wheelchair racing have gained increased popularity in Germany. This is important because of the inability of wheelchair-dependent people to maintain cardiovascular health and fitness through daily activities. The purpose of this study was to evaluate the energy expenditure (EE; kcal/h) of wheelchair-dependent individuals.

Ten wheelchair racers (WR) and 17 handbikers (HB) completed a basal metabolism evaluation, an incremental exercise test until exhaustion and an endurance test. Oxygen uptake and carbon dioxide production ( V . O 2 , V . CO 2 ; ml/min), arterialized capillary blood lactate concentration (LA; mmol/l) and heart rate (HR; bpm) were recorded during each test. EE was calculated by indirect calorimetry.

In the endurance test V . O 2 , V . CO 2 , LA, HR and EE at an intensity corresponding to 2 mmol/l lactate were: HB: 1332 ± 368 ml/min, 1178 ± 303 ml/min, 2.23 ± 0.85 mmol/l, 116.8 ± 19.1 bpm, 389.6 ± 105.4 kcal/h; WR: 1175 ± 285 ml/min, 1145 ± 258 ml/min, 2.65 ± 0.36 mmol/l, 142.5 ± 28.0 bpm, 341.7 ± 84.0 kcal/h. At an intensity corresponding to 4 mmol/l lactate the values were: HB: 1792 ± 408 ml/min, 1666 ± 326 ml/min, 4.27 ± 1.40 mmol/l 146.1 ± 22.8 bpm, 530.1 ± 115.4 kcal/h; WR: 1505 ± 210 ml/min, 1427 ± 188 ml/min, 3.31 ± 1.0 mmol/l, 165.3 ± 22.7 bpm, 445.5 ± 70.8 kcal/h.

The results show that EE of HB and WR is high enough to maintain fitness and probably to help to prevent cardiovascular diseases even at a moderate intensity.

Various strategies have been used to induce lifestyle changes to reduce ischaemic heart disease (IHD) with various successes. The aim of Inter99 is to assess the effect on IHD incidence of individually tailored non-pharmacological intervention on lifestyle using a newly developed computer-based health educational tool. The article describes the study and baseline results.

From a population of 61,301 individuals two random samples (high intensity intervention group (A), n = 11,708; low intensity intervention group (B), n = 1308) are screened to assess their absolute risk of IHD. Those at high risk receive individual lifestyle counselling. Individuals in group A are furthermore offered lifestyle counselling in groups on smoking cessation or physical activity/diet over a 6-month period. Individuals in group B are referred to their GP. High-risk persons are re-counselled after 1 and 3 years and the whole group is re-invited after 5 years. The remaining 48,285 (group C) are followed by questionnaire. The total population is followed through central registers. Intermediate end-points are changes in lifestyle, cholesterol, blood pressure and body mass index. Final end-point is reduction in incidence of IHD.

The randomization leads to comparable groups. Participation rate was 52.5%. A total of 60% fulfilled the predetermined criteria for being at high risk for developing IHD. After an individual lifestyle counselling 41% accepted group-based counselling.

This large randomized population based trial discloses a noticeable need for and acceptance of lifestyle intervention in the general population. Eur J Cardiovasc Prevention Rehab 10:377-386 © 2003 Lippincott Williams & Wilkins.

A combined community and high-risk intervention study of three years duration started in one district in Oslo after a baseline health survey in two multi-ethnic and low socio-economic status (SES) districts, using a pseudo-experimental design with an age-matched sample from the other district as controls. The intervention focused on promoting physical activity to reduce the burden of type 2 diabetes and cardiovascular disease (CVD).

A total of 6140 subjects were invited to participate (age group: 31-67). Data on health status and health-related behaviours, collected via standardized questionnaires, physical examinations and blood sample analyses, were available for 2950 persons (attendance rate 48%), whereas official statistics were available for the invited population.

The prevalence of self-reported diabetes was 5.1% in men and 3.5% in women, but the total diabetes prevalence was 9% for men and 5.1% for women. One-third of the population were sedentary in their leisure time, men more than women (38% versus 29%). The prevalence of obesity did not differ between the genders (21% had BMI 30 kg/m²). The relatively high mean scores on most psychosocial variables related to physical activity, especially among women, indicate a high motivational readiness for increase in physical activity behaviour. The baseline data, for example on the prevalence of chronic diseases were similar in the two districts.

The prevalence of self-reported diabetes is remarkably higher than reported from other studies in Norway. The proportion of undiagnosed diabetes was higher than anticipated, and constituted 39% of all those categorized as diabetics.