A cluster randomized trial to assess the impact of opinion leader endorsed evidence summaries on improving quality of prescribing for patients with chronic cardiovascular disease: rationale and design [ISRCTN26365328] Dietary determinants of ischaemic heart disease in health conscious individuals Vital exhaustion as a risk factor for ischaemic heart disease and all-cause mortality in a community sample. A prospective study of 4084 men and 5479 women in the Copenhagen City Heart Study. Weight Changes and Risk of Ischaemic Heart Disease for Middle Aged and Elderly Men. An 8-Year Follow-Up in the Copenhagen Male Study Ischemic Heart Disease and Its Related Factors in Mongolia: A Nationwide Survey Pre-existing ischaemic heart disease and ischaemic heart disease mortality in women compared with men. Cardiovascular risk assessment and treatment to target low density lipoprotein levels in hospitalized ischemic heart disease patients: results of the HOLEM study. Increased mortality among women with Rose angina who have not presented with ischaemic heart disease. The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality. A randomized non-pharmacological intervention study for prevention of ischaemic heart disease: baseline results Inter99 (1) Combined effect of resting heart rate and physical activity on ischaemic heart disease: mortality follow-up in a population study (the HUNT study, Norway) Chest pain and ischaemic heart disease in primary care. Impact of opinion leader-endorsed evidence summaries on the quality of prescribing for patients with cardiovascular disease: a randomized controlled trial. Fruit and vegetable intake and mortality from ischaemic heart disease: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study. Psychosocial distress and impaired quality of life - targets neglected in the secondary prevention in women with ischaemic heart disease Fibrin D-dimer, tissue plasminogen activator, plasminogen activator inhibitor, and the risk of major ischaemic heart disease in the Caerphilly Study. Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. Cognitive-behavioural stress management does not improve biological cardiovascular risk indicators in women with ischaemic heart disease: a randomized-controlled trial. Do patients with angina alone have a more benign prognosis than patients with a history of acute myocardial infarction, revascularisation or both? Findings from a community cohort study Skinfold thickness, body mass index and ischaemic heart disease.
Background Although much has been written about the influence of local opinion leaders on clinical practice , there have been few controlled studies of their effect , and almost none have attempted to change prescribing in the community for chronic conditions such as heart failure ( HF ) or ischemic heart disease ( IHD ) . These two conditions are common and there is very good evidence about how to best prevent morbidity and mortality – and good evidence that quality of care is , in general , suboptimal . Practice audits have demonstrated that about one-half of eligible HF patients are prescribed ACE inhibitors ( with fewer still reaching appropriate target doses ) and less than one-third of patients with established IHD are prescribed statins ( with many fewer reaching recommended cholesterol targets ) . It is apparent that interventions to improve quality of prescribing are urgently needed . We hypothesized that an intervention that consisted of patient-specific one-page evidence summaries , generated and then endorsed by local opinion leaders , would be able to change prescribing practice s of community-based primary care physicians . Methods ( study design ) A pragmatic single-centre cluster r and omized controlled trial comparing an opinion leader-based intervention to usual care for patients with HF or IHD . R and omization will be clustered at the level of the primary care physician ; as the design effect is anticipated to be negligible , the unit of analysis will be the patient . Patients with HF or IHD ( not receiving ACE inhibitors or statins , respectively ) will be recruited from community pharmacies and allocated to intervention or usual care  based on the r and omization status of their primary care physician . The primary outcome is improvement in prescription of proven efficacious therapies for HF ( ACE inhibitors ) or IHD ( statins )  within 6 months of the intervention . Conclusion If the methods used in this intervention are found to improve prescribing practice s , similar interventions could be design ed for other chronic conditions dealt with in the outpatient setting Objective To investigate dietary determinants of ischaemic heart disease ( IHD ) in health conscious individuals to explain the reduced risk in vegetarians , and to examine the relation between IHD and body mass index ( BMI ) within the normal range . Design Prospect i ve observation of  vegetarians , semi-vegetarians , and meat eaters for whom baseline dietary data , reported weight and height information , social class , and smoking habits were recorded . Subjects 10 802 men and women in the UK aged between 16 and 79 , mean duration of follow up 13.3 years . Main outcome measures Death rate ratios for IHD and total mortality in relation to dietary and other characteristics recorded at recruitment ( reference category death rate = 100 ) . Results IHD mortality was less than half that expected from the experience reported for all of Engl and and Wales . An increase in mortality for IHD was observed with increasing intakes of total and saturated animal fat and dietary cholesterol  — death rate ratios in the third tertile compared with the first tertile : 329 , 95 % confidence interval ( CI ) 150 to 721 ; 277 , 95 % CI 125 to 613 ; 353 , 95 % CI 157 to 796 , respectively . No protective effects were observed for dietary fibre , fish or alcohol  . Within the study , death rate ratios were increased among those in the upper half of the normal BMI range ( 22.5 to < 25 ) and those who were overweight ( BMI ⩾ 25 ) compared with those with BMI 20 to < 22.5 . Conclusions In these relatively health conscious individuals the deleterious effects of saturated animal fat and dietary cholesterol appear to be more important in the aetiology of IHD than the protective effect of dietary fibre . Reduced intakes of saturated animal fat and cholesterol may explain the lower rates of IHD among vegetarians compared with meat eaters . Increasing BMI within the normal range is associated with increased risk of IHD . The results have important public health implication BACKGROUND Vital exhaustion , a psychological measure characterized by fatigue and depressive symptoms , has been suggested to be an independent risk factor for ischaemic heart disease ( IHD ) but the generality of the phenomenon remains in question . The aim of this study is to describe prevalence of these symptoms in a community sample and determine whether they prospect ively predict increased risk of IHD and all-cause mortality in men and women . METHODS The study base was 4084 men and 5479 women aged 20 - 98 free of IHD examined in 1991 - 1993 in the Copenhagen City Heart Study . Events were ascertained through record linkage until 1998 for IHD and September 2000 for all-cause mortality . There were 483 first hospital admissions and deaths caused by IHD and 1559 deaths from all causes during follow-up . RESULTS The 17 items on the vital exhaustion question naire were frequently endorsed with prevalence ranging from 6 to 47 per cent , higher in women . All but 4 of the 17 items were significantly associated with IHD with significant relative risks ( RR ) ranging between 1.36 ( 95 % CI : 1.08 , 1.72 ) and 2.10 ( 95 % CI : 1.63 , 2.71 ) . Associations with all-cause mortality were also observed , but were weaker . RR of both IHD and all-cause mortality increased with increasing item sum score and were similar in men and women . For IHD , RR reached a maximum of 2.57 ( 95 % CI : 1.65 , 4.00 ) for subjects endorsing > 9 items . The similar RR for all-cause mortality was 2.50 ( 95 % CI : 2.09 , 2.99 ) . Multivariate adjustment for biological , behavioural , and socioeconomic risk factors did not substantially affect the association for IHD but attenuated the association with all-cause mortality . CONCLUSIONS Measures of fatigue and depression were common symptoms in this population sample and convey increased risk of IHD and of all-cause mortality . We propose this knowledge begin to be implemented in risk assessment in clinical practice Background  Weight gain and weight loss  are determined by a complex interplay of health , lifestyle and genetic factors . There is controversy concerning whether weight changes are associated with an increased risk of ischaemic heart disease ( IHD ) . Methods The Copenhagen Male Study was initiated in 1970/1971 . This paper presents the results of a prospect i ve study using a baseline comprising survivors examined 15 years later in 1985/1986 including 2903 men ( aged 53 - 74 years ) without cardiovascular disease . They were classified according to their weight change from 1970/1971 to 1985/1986 . Results There were no differences among the incidences of IHD during the period 1985/1986 - 1993 for men who had lost weight ( gt ; 5 % weight loss ) , men whose weight had remained constant ( within ± 5 % ) and men who had gained weight ( gt ; 5 % weight gain ) ; the incidence rates were 7.8 , 8.4 and 7.6 % , respectively , NS . Adjustment for age and confounders including disease history had no influence on this result . Only for men who had already been overweight at the time of the initial study in 1970/1971 ( body mass index > 28 kg/m2 ) was there a slightly increased risk of IHD among those who gained weight . Men in this group who gained weight were characterized by a significantly ( P < 0.05 ) larger tendency to have the Lewis phenotype Le(a-b- ) , a genetic marker previously shown to be associated with an increased risk of IHD mortality . With respect to death from all causes , only those who lost weight had a significantly increased risk compared with that of the constant weight group ; the incidence rates were 25.0 and 1 2.6 % , respectively , age-adjusted P < 0.001 . The incidence rate of IHD among those who gained weight was 11.8 % , NS . Conclusion The results suggest that an increase or decrease in weight from middle age to old age is of little clinical importance in the prediction of IHD among men without cardiovascular disease Ischemic heart disease ( IHD ) remains one of the most important disorders associated with disability and mortality worldwide , and is one of the major causes of cardiovascular diseases in Mongolia . The objective of the current study was to determine the prevalence of IHD and its related factors in a general population in Mongolia . We conducted a nationwide cross-sectional survey between March and September , 2009 . General participants were recruited from urban to rural regions in a multistage r and om cluster sampling method . The diagnosis of IHD was based on the Rose question naire ( World Health Organization ) and electrocardiographic findings . A total of 369 ( 16.2 % ) subjects with IHD were diagnosed among 2,280 participants . The prevalence of subjects with IHD was significantly increased by age : from 9.9 % in individuals age 40–44 years compared to 17.7 % in those over 60 years .  Smoking habits ( former and current ) and non-frequent intake of fruits and vegetables were significantly positively associated with IHD in men , while heavy alcohol drinking habits and lower education period of time were significantly positively associated with IHD in women . IHD was found to be prevalent , especially among people aged over 40 years , in Mongolia . Statistical factors related to IHD were found to be significantly different based on sex . The current data may provide relevant information to prevent IHD in the Mongolian population BACKGROUND In all 8353 women and 7058 men aged 45 - 64 took part in the Renfrew/Paisley survey in 1972 - 1976 . They formed a prospect i ve cohort study of a general population in the West of Scotl and ; an area with high ischaemic heart disease ( IHD ) mortality rates . The objective of this study was to investigate three indicators of pre-existing IHD and determine how they predicted subsequent IHD mortality in females compared with males . METHODS Pre-existing IHD was ascertained by the Rose Angina question naire , a question on severe chest pain indicating evidence of previous IHD and an electrocardiogram at a screening examination .  Mortality information for a 15-year follow-up period was available . RESULTS Pre-existing IHD was higher at older ages and was less common in women than men . The risks of IHD mortality were doubled for those with a single cardiovascular indicator compared to those without , and were increased to fourfold for those with two or more indicators . Indicators of pre-existing IHD had high specificity and low sensitivity for subsequent IHD mortality in both women and men , and the positive predictive values for women in the oldest age group were similar to those for men in the youngest age group . CONCLUSIONS Each indicator of pre-existing IHD was a useful predictor of subsequent IHD mortality in both women and men , even though IHD mortality rates were lower in women . The indicators obtained by question naire could be implemented in the primary health care setting to identify quickly those at risk who would benefit from further investigation and intervention BACKGROUND Hypercholesterolemia control status is lacking throughout the western world . OBJECTIVES To examine whether the treatment recommendations given to ischemic heart disease patients at hospital discharge are compatible with the guidelines of the Israeli medical societies and the U.S. National Cholesterol Education Program for coronary artery disease prevention ; and to study the effects of brief educational sessions on the adherence of physicians with the guidelines . METHODS We included consecutive IHD patients admitted to four central hospitals in Israel between 1998 and 2000 . The study was conducted in two phases . In phase 1 , we review ed discharge letters to document treatment recommendations given to each patient . In phase 2 we educated the practitioners by review ing the Israeli medical societies and the NCEP guidelines and the quality of their recommendations in phase 1 , after which we reevaluated the discharge letters . RESULTS The study included 2,994 patients : 627 in phase 1 and 2,367 in phase 2 . Of the patients who needed cholesterol-lowering according to their low density lipoprotein levels  , 37.4 % were not prescribed such drugs at discharge ( under-treatment group ) . This proportion was reduced by education to 26.6 % ( P < 0.001 ) in phase 2 . Of the treated patients , 65.6 % did not reach the target LDL goal in phase 1 ( under-dosage group ) as compared to 60.2 % in phase 2 ( P = 0.23 ) . In phase 2 there was an increase in the percent of patients reaching LDL levels < 130 mg/day ( 69.3 % vs. 63.8 % of patients prescribed medication , P = 0.01 ) , but the percent of patients reaching ' LDL levels < 100 was not different in phase 2 after adjusting for age and gender ( the odds ratio for reaching target LDL was 1.16 , with 95 % confidence interval of 0.95 - 1.43 ) . CONCLUSIONS Physician recommendations to IHD patients discharged from hospital were suboptimal . We documented a high proportion of under-treated and under-dosaged patients . Brief educational sessions have a beneficial effect on the usage of statins ; however , additional effort in guideline implementations is needed BACKGROUND Little is known about the clinical importance of disease that is not presented to healthcare services . AIM To determine the 5-year mortality among those with angina symptoms , known or not known by their general practitioner ( GP ) to have ischaemic heart disease ( IHD ) . DESIGN A prospect i ve cohort study . SETTING The study was conducted in the United Kingdom as part of the Royal College of General Practitioners ' Oral Contraception Study . METHOD In 1994 - 1995 women ( n = 11,797 ) still under GP observation were sent a question naire that inquired about their smoking habits , other lifestyle issues , general health , and selected symptoms ( including chest pain , assessed using the Rose angina question naire ) . The main outcome measure was the chances ( odds ) of dying during the next 5 years , among those with and without exertional chest pain , Rose angina or Rose myocardial infa rct ion ( MI ) , stratified by documented history of IHD . RESULTS Overall , the lifetime prevalence of any exertional chest pain was 10.1 % ( 95 % confidence interval [ CI ] = 9.5 to 10.8 ) ; grade I Rose angina was 6.1 % ( 95 % CI = 5.6 to 6.6 ) ; grade II Rose angina was 1.3 % ( 95 % CI = 1.1 to 1.6 ) ; and Rose MI was 4.4 % ( 95 % CI = 4.0 to 4.9 ) . The prevalence of each condition tended to increase with age , social class , parity , body mass index , and documented history of IHD . The proportion of women documented as having IHD was 23 % among those with any exertional chest pain , 21.7 % for grade I Rose angina , 37.7 % for grade II Rose angina , and 31.4 % for Rose MI . Compared to women without Rose angina , significantly higher odds ratios for all-cause mortality were observed among women with grade I Rose angina and no documented history of IHD ( adjusted odds ratio [ AOR ] = 1.71 , 95 % CI = 1.05 to 2.79 ) ; those with grade II Rose angina and documented IHD ( AOR = 3.94 , 95 % CI = 1.58 to 9.83 ) ; and women with grade II Rose angina and no documented history of IHD ( AOR = 3.35 , 95 % CI = 1.47 to 7.62 ) . CONCLUSIONS Women with angina symptoms that have not been documented by their GP appear to have an increased risk of future mortality . Research is needed to determine the best way of identifying and managing these individuals AIMS To determine the combined influence of leisure-time physical activity and weekly alcohol intake on the risk of subsequent fatal ischaemic heart disease ( IHD ) and all-cause mortality . METHODS AND RESULTS Prospect i ve cohort study of 11 914 Danes aged 20 years or older and without pre-existing IHD . During approximately 20 years of follow-up , 1242 cases of fatal IHD occurred and 5901 died from all causes . Within both genders , being physically active was associated with lower hazard ratios ( HR ) of both fatal IHD and all-cause mortality than being physically inactive . Further , weekly alcohol intake was inversely associated with fatal IHD and had a U-shaped association with all-cause mortality . Within level of physical activity , non-drinkers had the highest HR of fatal IHD , whereas both non-drinkers and heavy drinkers had the highest HR of all-cause mortality . Further , the physically inactive had the highest HR of both fatal IHD and all-cause mortality within each category of weekly alcohol intake . Thus , the HR of both fatal IHD and all-cause mortality were low among the physically active who had a moderate alcohol intake . Conclusion Leisure-time physical activity and a moderate weekly alcohol intake are both important to lower the risk of fatal IHD and all-cause mortality Background 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 . Methods From a population of 61,301 individuals two r and om sample s ( 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 question naire . 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 . Results The r and omization 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 . Conclusion This large r and omized 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 Background The combined effect of resting heart rate ( RHR ) and physical activity ( PA ) on  ischaemic heart disease ( IHD )  has never been assessed . The objective of this study was to assess the association of RHR with IHD mortality , and to evaluate the potentially modifying effect of PA on this association . Methods In a prospect i ve cohort study of 24 999 men and 25 089 women free from cardiovascular disease at baseline , Cox proportional hazard models were used to estimate adjusted hazard ratios of death from IHD related to RHR measured at baseline . The combined effect of RHR and self-reported PA on the risk of death from IHD was also assessed . Results During a mean of 18.2 ( SD 4 ) years of follow-up , 2566 men and 1814 women died  from cardiovascular causes . For each increment of 10 heart beats per minute , risk of death from IHD was 18 % higher in women < 70 years of age ( p<0.001 ) ; no such association was observed among women ≥70 years . Among men , there was a corresponding 10 % higher risk in the younger ( p = 0.004 ) , and 11 % higher risk in the older age group ( p = 0.01 ) . Among women , the risk associated with high RHR was substantially attenuated in those who reported a high level of PA , whereas in men , there was no clear indication that PA could modify the positive effect of RHR . Conclusion RHR is positively associated with the risk of death from IHD , and among women , the results suggest that by engaging in PA , the risk associated with a high RHR may be substantially reduced BACKGROUND Chest pain is the main symptom of first presentation with ischaemic heart disease ( IHD ) . Little is known about the incidence of IHD among patients consulting the general practitioner ( GP ) for chest pain . AIMS To estimate the occurrence of IHD among patients consulting for chest pain , to study the results of the bicycle exercise test  , and to estimate the incidence of IHD in the population . DESIGN OF STUDY Prospect i ve descriptive study . SETTING Three primary health centres in south-eastern Sweden . METHOD All patients without a current IHD diagnosis , aged 20 to 79 years , and consulting for a new episode of chest pain , were included consecutively . The outcome was classified as IHD , possible IHD or not IHD , according to the results of a postal question naire , an exercise test or hospital care . Data from the hospital registry on patients with a diagnosis of IHD were analysed retrospectively . RESULTS Out of 38,075 GP consultations , 577 ( 1.5 % ) were for chest pain . IHD was diagnosed in 41 ( 8 % ) of the chest pain patients , in 441 ( 83 % ) the diagnosis was excluded , and in 50 ( 9 % ) the diagnosis was judged as being uncertain . Even though the diagnostic criteria were strict , the exercise tests led to a diagnostic conclusion in 77 % of the cases , most frequently a normal test result . Combining data from primary and hospital care , the yearly incidence of IHD was 6.5 diagnosed per 1000 inhabitants ( aged 20 to 79 years old ) . CONCLUSION The incidence of a new episode of chest pain bringing the patients to the GP was low . Eight per cent of the patients received an IHD diagnosis , and in 9 % further investigation or clinical assessment is needed BACKGROUND Local opinion leaders are educationally and socially influential physicians . Although they can accelerate the adoption of new evidence in hospitals , their impact on the quality of prescribing for out patients has only been examined by a few studies . We hypothesized that an intervention consisting of patient-specific one-page evidence summaries , generated and endorsed by local opinion leaders , would improve prescribing of angiotensin-converting enzyme ( ACE ) inhibitors or angiotensin receptor blockers ( ARBs ) in heart failure ( HF ) and that of statins in ischemic heart disease ( IHD ) . METHODS We conducted a community-based r and omized controlled trial in patients with HF ( not receiving ACE inhibitors or ARBs ) and those with IHD ( not receiving statins ) who were recruited from 40 pharmacies and allocated either to the opinion leader intervention or to usual care based on r and omization of their primary care physician . The primary outcome was an increase in the use of efficacious therapies ( ACE inhibitors or ARBs in HF and statins in IHD ) within 6 months ; the secondary outcomes were prescribing changes for HF or IHD . RESULTS A total of 171 patients participated in the study ; 87 were allocated to the intervention , whereas 84 were assigned to the  control group .  The median age of the participants was 75 years ; 103 ( 60 % ) were female , 54 ( 32 % ) had HF , and 117 ( 68 % ) had IHD . Overall , 21 ( 24 % ) intervention patients started receiving an efficacious medication within 6 months , as compared with 15 ( 18 % ) control subjects ( relative risk of improvement 1.32 , 95 % CI 0.73 - 2.40 , P = .31 ) . In the HF subgroup , 38 % of the intervention patients started receiving an ACE inhibitor or ARB therapy , as compared with 20 % of control subjects ( relative risk of improvement 1.90 , 95 % CI 0.76 - 4.72 , P = .15 ) . In the IHD subgroup , 17 % of the intervention patients and 17 % of the control subjects started receiving  statin therapy  ( P = .97 ) . CONCLUSIONS The influence of local opinion leaders may be useful for improving the quality of cardiovascular prescribing in the community , but the benefits are likely modest and may be disease specific . Further studies on this method are warranted AIMS A higher intake of fruits and vegetables has been associated with a lower risk of ischaemic heart disease ( IHD )  , but there is some uncertainty about the interpretation of this association . The objective was to assess the relation between  fruit and vegetable intake  and risk of mortality from IHD in the European Prospect i ve Investigation into Cancer and Nutrition (EPIC)-Heart study . METHODS AND RESULTS After an average of 8.4 years of follow-up , there were 1636 deaths from IHD among 313 074 men and women without previous myocardial infa rct ion or stroke from eight European countries . Participants consuming at least eight portions ( 80 g each ) of fruits and vegetables a day had a 22 % lower risk of fatal IHD [ relative risk ( RR ) = 0.78 , 95 % confidence interval ( CI ) : 0.65 - 0.95 ] compared with those consuming fewer than three portions a day . After calibration of fruit and vegetable intake to account for differences in dietary assessment between the participating centres , a one portion ( 80 g ) increment in fruit and vegetable intake was associated with a 4 % lower risk of fatal IHD ( RR = 0.96 , 95 % CI : 0.92 - 1.00 , P for trend = 0.033 ) . CONCLUSION Results from this large observational study suggest that a higher intake of fruits and vegetables is associated with a reduced risk of IHD mortality . Whether this association is causal and , if so , the biological mechanism(s ) by which fruits and vegetables operate to lower IHD risks remains unclear Background Secondary prevention in patients with ischaemic heart disease ( IHD ) focusing on classical risk factors has been less successful in women than in men . Previous studies have suggested that psychosocial factors may be new targets for secondary prevention . In the present study , psychosocial factors have been compared in women with and without IHD . Methods and subjects Using a cross-sectional comparison , classical cardiovascular risk factors and self-rated stress behaviour , vital exhaustion , stressful life events and quality of life  were assessed in 198 women ( age 35–77 years ) who had IHD and a population -based sample of 206 women ( age 45–74 years ) without IHD . Results Control of classical risk factors was most often adequate in women with IHD . The prevalence of smoking was 9 % in women with versus 18 % in women without IHD ( P < 0.001 ) , blood pressure levels were similar , and a very large share of women with IHD were on treatment with anti-thrombotic , anti-hypertensive and /or lipid-lowering drugs ( P < 0.001 compared with women free of IHD ) . In contrast , women with IHD scored significantly worse than women without IHD in self-rated stress behaviour ( P = 0.003 after adjustment for other possible determinants ) , and in vital exhaustion ( P = 0.003 ) . In univariate analyses , quality of life was significantly worse in women with IHD . Stressful life events did not differ between the two groups . Conclusions In this group of women with IHD , control of classical risk factors was good , whereas control of psychosocial risk factors was clearly inadequate . Secondary prevention by psychosocial intervention in women with IHD should be evaluated in r and omized controlled trials . Eur J Cardiovasc Prevention Rehab 10:258–266 © 2003 Lippincott Williams & Wilkins Plasma levels of fibrin D-dimer , tissue plasminogen activator ( tPA ) and  plasminogen activator inhibitor ( PAI ) have been associated with ischaemic heart disease ( IHD ) . However their associations with incident IHD in sample s of the general population are not established .  D-dimer antigen , tPA antigen and PAI activity  were measured in stored , fasting plasma sample s from 1,998 men aged 45 - 65 examined between 1984 and 1988 , during the first re-examination of the Caerphilly Study cohort . These variables were related to major IHD events ( myocardial infa rct ion or IHD death ) which occurred in 129 men during a follow-up period which averaged 61 months . Mean fibrin D-dimer was higher in men who developed IHD events ( 90 vs. 71 ng/ml ; age-adjusted logarithmic mean difference 0.21 ; 95 % CI 0.11 , 0.30 ; p < 0.0001 ) . This association remained after adjusting for baseline IHD and for other risk factors including fibrinogen : the adjusted relative odds of IHD in the highest fifth of D-dimer were 3.5 ( 95 % CI 1.8 , 6.9 ; p = 0.0003 ) . Mean tPA antigen was also higher in men who developed IHD ( 12.6 vs. 11.6 ng/ml ; mean difference 0.9 ; 95 % CI 0.2 , 1.7 ; p = 0.02 ) ; however this difference largely disappeared after adjusting for other risk factors . PAI activity was not associated with risk of IHD Consecutive survivors of a myocardial infa rct ion from the Southern Hospital , below 70 years of age , were r and omized into a  Control group ( n = 276 ) and a Treatment group ( n = 279 ) . The latter was openly prescribed the combination of clofibrate and nicotinic acid for serum lipid lowering . Each patient should remain in the study for 5 years and be seen regularly every 4 months at a special IHD outpatient clinic within the hospital . The concentration of serum cholesterol and triglyceride was lowered by 13 % and 19 % , respectively , in the Treatment group compared to the Control group . Total mortality was 82 cases in the Control group and 61 in the Treatment group , a 26 % reduction ( p less than 0.05 ) . For patients above 60 years of age in the Treatment group the reduction in mortality was 28 % ( p less than 0.05 ) . IHD mortality was reduced by 36 % ( p less than 0.01 ) in the Treatment group compared to the Control group . The beneficial effect of the serum lipid lowering treatment was related to the serum triglyceride concentration in two ways . First , it only occurred in patients with a triglyceride level greater than 1.5 mmol/l ( n = 216 ) . Secondly , it was most pronounced in the 44 % of the treated patients who had a lowering of the serum triglyceride by 30 % or more , and in this subgroup the reduction of IHD mortality was 60 % ( p less than 0.01 ) . For serum cholesterol there were no such relations . The difference between serum triglycerides and cholesterol concerning these relations to the treatment outcome may be due to the fact that hypertriglyceridaemia was the most common hyperlipidaemia among our patients , occurring in 50 % , while hypercholesterolaemia only occurred in 13 % . Caution should be exercised in the interpretation of the results as the trial was not blind . However , the fact that the decrease in IHD deaths was directly related to the degree of serum triglyceride lowering indicates that it was the drug effect on serum lipids that was responsible for the beneficial effect of the treatment OBJECTIVES Psychosocial factors , such as stress and vital exhaustion , are associated with an increased risk of cardiovascular events , and women report more psychosocial ill-being after an acute myocardial infa rct ion than men . We have earlier shown that a cognitive-behavioural intervention in women with ischaemic heart disease ( IHD ) improved psychosocial well-being . In the present study , we tested the hypothesis that the improvement in psychosocial well-being is associated with an improvement in biochemical indicators of cardiovascular risk . DESIGN R and omized-controlled trial in northern Sweden . SETTING Outpatient care . SUBJECTS Women with IHD were r and omized to either a 1-year cognitive-behavioural stress management programme or usual care . Of the 159 women who completed the study , 77 were in the intervention group , and 82 in the control group . INTERVENTIONS A 1-year cognitive-behavioural stress management programme versus conventional care . RESULTS Group assignment was not found to be a determinant of waist circumference , high sensitive C-reactive protein ( hs-CRP ) , fibrinogen , von Willebr and factor ( vWF ) , plasminogen activator inhibitor type 1 ( PAI-1 ) activity , tissue plasminogen activator ( tPA ) activity , tPA antigen , tPA-PAI-1 complex , leptin , or HOMA2 insulin resistance index ( HOMA2-IR ) at follow up . Changes in psychosocial variables were not associated with changes in any of the biological risk indicators . CONCLUSIONS Even if our cognitive-behavioural stress management programme had effects on proximal targets , such as stress behaviour and vital exhaustion , we found no improvement in intermediate biochemical targets related to the metabolic syndrome and IHD . Our results challenge the proposition that the relationship between psychological well-being and biological cardiovascular risk indicators is a direct cause-effect phenomenon Aim : To compare prognosis for patients with a diagnosis of angina alone to patients postacute myocardial infa rct ion ( AMI ) and /or revascularisation and /or angina . Design : Community-based retrospective cohort study . Setting : A r and om selection of 37 Irish general practice s. Participants : 1,609 adults with ischaemic heart disease ( IHD ) identified in 2000/1 . Intervention : Medical records search es and postal question naires in 2000/1 and 2005/6 . Outcome measures : Primary : all-cause and IHD-related mortality . Secondary :  acute myocardial infa rct ion ( AMI ) , cardiac artery bypass grafting ( CABG ) and percutaneous transluminal coronary angioplasty ( PTCA ) ; physical and mental health status as measured by SF36 and SF12 ; process of care measurements and behavioural risk factor outcomes . Results : Compared with patients with previous AMI and /or revascularisation , patients with angina alone had slightly lower risks of all-cause and IHD-related death : however , although hazard ratios of 0.73 ( 95 % CI 0.55 to 0.98 ) and 0.65 ( 95 % CI 0.44 to 0.98 ) , respectively , were significant at the p<0.05 level , they were not significant at the p<0.01 level currently suggested as appropriate in observational research . Proportional hazards models identified no statistically significant differences in adjusted risks of subsequent AMI , CABG or PTCA between patients with angina-alone and those with other IHD . Over the 4.5-year follow-up , physical functioning was consistently lower among those with angina alone , and the extent to which physical functioning was increasingly impaired was slightly greater . Conclusions : Prognosis to death or cardiac outcomes for patients with angina alone was similar to those with previous AMI and /or revascularisation , while health status was poorer . The clinical importance of angina should not be underestimated in primary care . Further descriptive research is needed among representative community cohorts of people with angina STUDY OBJECTIVE : To determine the relationship between obesity and subsequent incidence of ischaemic heart disease ( IHD ) .  DESIGN : Prospect i ve cohort survey . SETTING : Study of three occupational groups , with follow up examinations . SUBJECTS : 3500 people recruited between 1972 and 1978 ( 80 % response rate ) , and followed up between 1978 and 1984 . This report is based on subgroup of 1511 white men aged 40 - 64 at entry . MEASUREMENTS AND MAIN RESULTS : Information was obtained on smoking and family history of IHD . Blood pressure , weight , height , skinfold thickness at four sites , fibrinogen , factor VII activity and cholesterol were measured during follow up . Body mass index ( BMI ) was used as an index of obesity . BMI was found to be more strongly correlated with IHD than any of the skinfold measurements , none of which was significantly associated with IHD when BMI was allowed for . Increase in BMI by 1 SD ( approximately 8 kg ) was associated with a 44 % increase in the risk of IHD . Of the four skinfolds , subscapular was the most closely associated with risk , confirming the relevance of central obesity . The association between obesity and IHD remained when possible mechanisms for its effects were taken into account , and its strength may increase with time : for 1 SD increase in BMI , risk of events within 5 years was increased by 28 % , while risk of events after longer than 5 years was increased by 65 % . CONCLUSIONS : Preventive strategies for IHD should include avoidance of obesity
Conclusions Organisational and professional interventions improved prescribing of statins/lipid-lowering agents and target blood pressure in patients with IHDs but there was little evidence of change in other outcomes .
Objectives Ischaemic heart diseases ( IHDs ) are a leading cause of death worldwide .
Although prescribing according to guidelines improves health outcomes , it remains suboptimal .
We determined whether interventions targeted at healthcare professionals are effective to enhance prescribing and health outcomes in patients with IHDs .