Pre-existing ischaemic heart disease and ischaemic heart disease mortality in women compared with men. A randomized non-pharmacological intervention study for prevention of ischaemic heart disease: baseline results Inter99 (1) 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] The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality. A randomized multifactorial intervention study for prevention of ischaemic heart disease (Inter99): The long-term effect on physical activity 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. Caerphilly and Speedwell collaborative heart disease studies. The Caerphilly and Speedwell Collaborative Group. Mortality and appropriate and inappropriate therapy in patients with ischaemic heart disease and implanted cardioverter-defibrillators for primary prevention: data from the Danish ICD Register. Impact of opinion leader-endorsed evidence summaries on the quality of prescribing for patients with cardiovascular disease: a randomized controlled trial. Ischemic Heart Disease and Its Related Factors in Mongolia: A Nationwide Survey Combined effect of resting heart rate and physical activity on ischaemic heart disease: mortality follow-up in a population study (the HUNT study, Norway) [Efficacy of an educational preventive technology in patients with stable angina in ambulatory conditions]. A mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial Exclusion of Elderly People from Randomized Clinical Trials of Drugs for Ischemic Heart Disease The impact of ischemic heart disease on symptoms, health status, and exacerbations in patients with COPD. Psychosocial distress and impaired quality of life - targets neglected in the secondary prevention in women with ischaemic heart disease [Prevalence of ischemic heart disease and mortality among kaunas population aged 35-64 years in the prospective study].
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 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 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 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 Aim : To examine the effect of a r and omized multiple risk factor intervention study for prevention of ischaemic heart disease ( IHD ) on the development in physical activity over a 36-month period . Methods : Two r and om sample s ( high intensity intervention , group A , n=11,708 ; low intensity intervention , group B , n=1,308 ) were invited for a health examination , an assessment of absolute risk of developing IHD , and an individualized lifestyle intervention . The participation rate was 52.5 % . High-risk persons in group A were also offered diet/physical activity and /or smoking cessation group counselling . High-risk persons in group B were referred to their GP . High-risk persons were re-counselled after 12 and 36 months . The  control group ( group C , n=5,264 , response rate=61.3 % ) answered a mailed question naire . Data were analysed using longitudinal linear regression models with r and om effects . Main outcome : Change in physical activity from baseline to 12- and 36-month follow-up . Results : In men , the high-intensity ( group A ) intervention had a beneficial effect at 12-month follow-up , whereas after 36 months both the high-intensity and the low-intensity ( group B ) intervention had a beneficial effect on the development in physical activity when compared with group C. This was regardless of baseline physical activity level . At 36-month follow-up there was no significant difference between groups A and B. There was no intervention effect among women . Conclusions : Only men seemed to benefit from the intervention 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 The Caerphilly and Speedwell studies are based on representative sample s of over 3000 subjects in South Wales and over 2000 in Bristol . They include cross sectional studies of risk factors for prevalent ischaemic heart disease ( IHD ) and of determinants of those risk factors . Prospect i ve studies based on over 2000 men aged 45 - 59 in each area have been set up . In addition to the examination of  lipid and thrombosis factors  of possible relevance to IHD , the studies also focus on possible  dietary , hormonal , and psychological risk factors  , both as possible " risk factors " for IHD and also as possible " determinants " of risk factors AIMS To evaluate the incidences of and risk factors predisposing to appropriate and inappropriate shocks and mortality in a ' real-world ' population of patients with ischaemic heart disease ( IHD ) and implantable cardioverter defibrillators ( ICD ) for primary prevention of sudden cardiac death ( SCD ) . METHODS AND RESULTS In this nationwide cohort , we prospect ively followed 1609 patients with IHD and left ventricular dysfunction from the Danish ICD Register who received an ICD for primary prevention of SCD ( 1 January 2007 to 30 November 2011 ) . Primary study outcomes were appropriate shocks , inappropriate shocks , and all-cause mortality . Secondary study outcomes included the composite endpoints : appropriate therapy and inappropriate therapy ( defined as shock or anti-tachycardia pacing ) . All-cause mortality was 12.1 % during a mean follow-up time of 1.9 ± 1.3 years . Inappropriate shocks and therapy occurred in 2.6 % and 3.7 % during follow-up , respectively . Appropriate shocks and therapy was identified in 7.8 % and 13.4 % , respectively . Time-dependent multivariable Cox regression analyses were used to identify risk factors of inappropriate/appropriate shock , therapy and mortality . Implantation of a dual-chamber ICD was associated with increased risk of both inappropriate shocks and any inappropriate therapy compared to single-chamber ICD [ hazard ratios ( HR ) = 2.45 ; confidence intervals (CI):1.16 - 5.14 and HR = 2.38 ; CI:1.28 - 4.42 , respectively ] . No excess risk of mortality was associated with any device type . CONCLUSION In this nationwide study of IHD patients with an ICD for primary prevention of SCD , the incidence of appropriate shocks as well as inappropriate shocks were significantly lower than reported in r and omized trials . Implantation of a dual-chamber ICD was associated with more inappropriate shocks compared with single chamber devices 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 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 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 Aim of the study was to assess efficacy of educational technology -- School for patients with stable angina -- in conditions of practical health care . We r and omized 100 patients with ischemic heart disease ( IHD ) and stable FC I-III angina into 2 groups one of which went through learning in a School for patients with IHD  ( 6 90 min sessions 2 times a week ) . Patients of both main and control groups were followed up for 12 months . During the whole term of the investigation in both groups observation and treatment of patients was conducted by physicians of city polyclinic in accordance with generally accepted method of care of patients with diagnosis " IHD , stable angina pectoris " . Results of the investigation evidence that study ing in the School for patients with stable angina significantly elevates level of medical information adopted by patients , ensures positive dynamics of the whole row of clinical and psychological parameters as well as integral parameters of quality of life of patients with IHD Aim To determine the effectiveness and cost-effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease ( IHD ) . Methods and results In this single-blind , parallel , two-arm , r and omized controlled trial adults ( n = 171 ) with IHD were r and omized to receive a mobile phone delivered intervention  ( HEART ; n = 85 ) plus usual care , or usual care alone ( n = 86 ) . Adult participants aged 18 years or more , with a diagnosis of IHD , were clinical ly stable as out patients , able to perform exercise , able to underst and and write English , and had access to the Internet . The HEART ( Heart Exercise And Remote Technologies ) intervention involved a personalized , automated package of text messages and a secure website with video messages aim ed at increasing exercise behaviour , delivered over 24 weeks . All participants were able to access usual community-based cardiac rehabilitation , which involves encouragement of physical activity and an offer to join a local cardiac support club . All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake ( PVO2 ; primary outcome ) , self-reported physical activity , health-related quality of life , self-efficacy and motivation ( secondary outcomes ) . Results showed no differences in PVO2 between the two groups ( difference −0.21 ml kg−1 min−1 , 95 % CI : −1.1 , 0.7 ; p = 0.65 ) at 24 weeks . However significant treatment effects were observed for selected secondary outcomes , including leisure time physical activity ( difference 110.2 min/week , 95 % CI : −0.8 , 221.3 ; p = 0.05 ) and walking ( difference 151.4 min/week , 95 % CI : 27.6 , 275.2 ; p = 0.02 ) . There were also significant improvements in self-efficacy to be active ( difference 6.2 % , 95 % CI : 0.2 , 12.2 ; p = 0.04 ) and the general health domain of the SF36 ( difference 2.1 , 95 % CI : 0.1 , 4.1 ; p = 0.03 ) at 24 weeks . The HEART programme was considered likely to be cost-effective for leisure time activity and walking . Conclusions A mobile phone intervention was not effective at increasing exercise capacity over and above usual care . The intervention was effective and probably cost-effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services OBJECTIVES To measure exclusion of elderly adults from r and omized trials study ing drug interventions for ischemic heart disease ( IHD ) and describe the characteristics of these trials . DESIGN Cross-sectional analysis . SETTING Interventional clinical trials study ing a drug intervention for IHD that started in 2006 and after were identified in Clinical Trials.gov . Data were extracted on study features , including age-based inclusion criteria . Data on participants and their age distribution were collected from trial publications , investigator inquiry , and result data in Clinical Trials.gov . PARTICIPANTS Individuals aged 65 and older . MEASUREMENTS Proportion of trials excluding individuals based on age , mean age of trial participants , and proportion of  enrolled participants aged 65 and older and 75 and older . RESULTS Of 839 identified trials , 446 ( 53 % ) explicitly excluded elderly adults . The most-frequent upper age limits were 80 ( n = 164 ) and 75 ( n = 114 ) , with a median upper age limit of 80 ( interquartile range 75 - 80 ) . Trials with upper age limit exclusions tended to be smaller ( median number of participants 100 vs 201 , P < .001 ) and were more likely to be funded primarily by nonindustry sources ( 78.3 % vs 70.0 % , P = .006 ) . The  overall mean age of trial participants was 62.7 ( mean maximum age 74 ) . The estimated proportion of participants aged 65 and older was 42.5 % and the estimated proportion aged 75 and older was 12.3 % . CONCLUSION Despite the high burden of IHD in elderly adults , the majority of drug trials do not enroll participants reflective of age-related prevalence of the disease BACKGROUND Comorbid ischemic heart disease ( IHD ) is a common and important cause of morbidity and mortality in patients with COPD . The impact of IHD on COPD in terms of a patient 's health status , exercise capacity , and symptoms is not well understood . METHODS We analyzed stable-state data of 386 patients from the London COPD cohort between 1995 and 2009 and prospect ively collected exacerbation data in those who had completed symptom diaries for ≥ 1 year . RESULTS Sixty-four patients ( 16.6 % ) with IHD had significantly worse health status as measured by the St. George Respiratory Question naire ( 56.9 ± 18.5 vs 49.1 ± 19.0 , P = .003 ) , and a larger proportion of this group reported more severe breathlessness in the stable state , with a Medical Research Council dyspnea score of ≥ 4 ( 50.9 % vs 35.1 % , P = .029 ) . In subsets of the sample , stable patients with COPD with IHD had a higher median ( interquartile range [ IQR ] ) serum N-terminal pro-brain natriuretic peptide concentration than those without IHD ( 38 [ 15 , 107 ] pg/mL vs 12 [ 6 , 21 ] pg/mL , P = .004 ) and a lower exercise capacity ( 6-min walk distance , 225 ± 89 m vs 317 ± 85 m ; P = .002 ) . COPD exacerbations were not more frequent in patients with IHD ( median , 1.95 [ IQR , 1.20 , 3.12 ] vs 1.86 ( IQR , 0.75 , 3.96 ) per year ; P = .294 ) , but the median symptom recovery time was 5 days longer ( 17.0 [ IQR , 9.8 , 24.2 ] vs 12.0 [ IQR , 8.0 , 18.0 ] ; P = .009 ) , result ing in significantly more days per year reporting exacerbation symptoms ( median , 35.4 [ IQR , 13.4 , 60.7 ] vs 22.2 [ IQR , 5.7 , 42.6 ] ; P = .028 ) . These findings were replicated in multivariate analyses allowing for age , sex , FEV(1 ) , and exacerbation frequency where applicable . CONCLUSIONS Comorbid IHD is associated with worse health status , lower exercise capacity , and more dyspnea in stable patients with COPD as well as with longer exacerbations but not with an increased exacerbation frequency 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 MONICA ( MONItoring trends and determinants of CArdiovascular diseases ) study was carried out in Kaunas in 1983 - 1993 in three r and om sample s of population aged 35 - 64 ( overall 2694 men and 2801 women ) . The prevalence of previous MI among men was higher than among women in the first and in the third surveys ( 2,2 and 1,1 % , p < 0,05 and 4,4 and 1,2 % , p < 0,001 , respectively ) . The prevalence of angina pectoris among men and among women did not reveal statistically significant difference in all three surveys . The prevalence of silent myocardial ischemia was higher among women than among men in the two surveys . The prevalence of all forms of IHD was higher among women than among men in the first and in the second surveys ( 16,2 and 10,2 % , p < 0,001 and 16,4 and 10,9 % , p < 0,001 , respectively ) . Total mortality , mortality from CVD and from IHD among men with IHD was higher than among men without IHD . Total mortality and mortality from CVD among women with silent myocardial ischemia and IHD was higher than in control group . The differences in mortality among women with different forms of IHD were not significant from those without IHD
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 .