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The aim of the review was to assess the effect of patient education in ischaemic heart disease. Thirteen randomised controlled trials of moderate to good quality including 68,556 patients were selected. The effect on mortality, cardiac morbidity, hospitalisation and health-related quality of life was assessed and only non-significant tendencies of effect were found. The authors of the review nevertheless conclude that the review supports current rehabilitation programmes that include patient education. Further research in patient education, especially concerning the most effective methods of education delivery, is needed.

Introduction: The purpose of this analysis is to evaluate the cost effectiveness of ezetemibe coadministration compared to a shift to higher doses of simvastatin or to a more potent statin., Materials and Methods: The calculations are based on a Markov model in which a patient who does not attain the desired cholesterol outcome with simvastatin treatment is treated either with ezetemibe coadministration, or with increased simvastatin doses, or with a more potent statin. Calculations are conducted for a total of 72 different patient types followed over the remainder of their lives., Results: Ezetemibe coadministration evaluated over the entire lifetime will be somewhat more expensive than simvastatin titration but must, however, be seen in relation to improved survival and increased quality of life. For the typical patient, treatment will be associated with costs of between DKK 50,000 and 100,000 per gained year of life, which cannot be deemed too expensive in relation to other interventions provided by the Health Authorities. For some patient types who receive treatment with a potent statin (atorvastatin), savings will also be possible here as well as an increase in life expectancy and quality of life., Conclusion: The results of the study indicate that ezetemibe coadministration is cost effective. The results are sustainable even with quite significant changes of the estimates used and taking into account uncertainties in the material and methods.

Lipid lowering treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statins) may reduce morbidity and mortality in patients with stable ischaemic heart disease. In trials where a statin was used as secondary prevention after an acute coronary syndrome (ACS), the treatment was initiated 3-6 months after the event. A high rate of serious complications occurs in the unstable clinical state after an ACS, including myocardial infarction and death. The incidence rate of serious complications declines after 1 month and then gradually diminishes. It has not been determined whether initiation of treatment with a statin soon after an ACS reduces the occurrence of early coronary events. Statins have effects on the vessel wall other than the lipid lowering effect, and these may partly account for the benefit of statin therapy. Whether these mechanisms are associated with a prognostic effect soon after an ACS has not been clarified.

Patients with critical peripheral ischaemia have a significant mortality rate of up to 50% within 4-5 years of surgical vascular reconstruction. This poor survival rate is due to concomitant coronary and cerebrovascular atherosclerotic disease. Large randomised trials have shown that dyslipidaemia is easily modifiable in patients both with and without established coronary artery disease, with significant reductions in cardiovascular morbidity and mortality. Although none of these trials directly measured peripheral vascular status, there is every indication that conclusions submitted for patients with ischaemic heart disease can be translated to patients with peripheral arterial disease (PAD). The object of this review was therefore to divulge the current evidence available, which supports active treatment of dyslipidaemia in patients with PAD.

Introduction: The aim of the present population-based cohort study was to examine the association between alcohol intake and mortality from all causes, coronary heart disease, and cancer., Methods: A prospective population study with baseline assessment of beer, wine and spirit consumption, smoking habits, educational level, physical activity, and body mass index in a total of 257,859 person-years follow-up on mortality., Results: A total of 4833 participants died, 1075 of these from coronary heart disease and 1552 of cancer. Compared with non-drinkers, light drinkers, who avoided wine, had a relative risk of death from all causes of 0.90 (0.82-0.99) and those who drank wine had a relative risk of 0.66 (0.55-0.77). Heavy drinkers, who avoided wine, were at higher risk of death from all causes than were heavy drinkers, who included wine in their alcohol consumption. Wine drinkers had a significantly lower mortality from both coronary heart disease and cancer than had non-wine drinkers (p = 0.007 and p = 0.004, respectively)., Conclusion: A moderate consumption of wine may have a beneficial effect on all causes of mortality, which is additive to that of alcohol. This effect may be attributable to a reduction in death from both coronary heart disease and cancer.

Introduction: Jogging is one of the most popular forms of vigorous exercise, but its effect on longevity has not been documented., Method: This analysis comprise a random sample of 4658 men aged 20-79 years with no prior myocardial infarction, who participated in the first (1976-1978) and second (1981-1983) examination of the Copenhagen City Heart Study. They were entered in the mortality analysis at the second examination and were followed up until 30 November 1998. The influence of jogging on time to death was analysed by Cox regression, with age as the time axis. In addition to jogging, the model included diabetes, smoking, household income, education, and alcohol consumption as potential confounding variables, and systolic blood pressure, total cholesterol, HDL cholesterol, and BMI as intermediate variables., Results: At the first examination, 217 men (4.7%) reported active jogging. Of these, 96 (2.1%) were still joggers five years later. Overall, 4335 men were non-joggers at both examinations. A significant effect of jogging was found only for the group that were joggers at both examinations, relative risk 0.37 (95% confidence interval, 0.19 to 0.71; p = 0.003)., Discussion: We have found that regular joggers have a significantly lower mortality than have non-joggers. This could also be due to other lifestyle factors, but numerous studies have pointed towards a beneficial effect of physical activity on health. The optimal intensity, frequency, and duration of physical activity has yet to be established.

Introduction: Cigarette smoking is a serious threat against public health and the most important preventable cause of death. The purpose of this study is to predict the effect on smoking-attributable mortality in Denmark by reducing the number of cigarette smokers., Materials and Methods: The simulation model "Prevent" is used. This model operates with the population size and death rates in 1993, data on cigarette smoking from 1973 to 1992 and relative risks for the association between cigarette smoking and lung cancer, chronic bronchitis and emphysema, ischaemic heart disease and stroke. The influence of reduced cigarette smoking on mortality due to these diseases is studied. The expected effect on a smoke-free year group is estimated and so is the effect of the implementation of targets in the Danish Government's Public Health Programme 1999-2008., Results: For the smoke-free year group death rates of ischaemic heart disease are reduced by one third for men and one half for women compared to unchanged cigarette smoking. Death rates of lung cancer, chronic bronchitis and emphysema would be approx. five times lower. If the proportion of Danish cigarette smokers could be reduced by one third over a period of ten years the reduced mortality due to lung cancer, chronic bronchitis and emphysema, ischaemic heart disease and stroke would increase the population (five mio. individuals) by 25,000 after 20 years., Discussion: Intervention against cigarette smoking, especially among young people, would massively reduce mortality from several diseases in the long term. Also in the short term mortality would be reduced substantially by reducing the number of cigarette smokers.

Introduction: The aim of the present study was to quantify the impact of different dietary factors on the mortality from ischaemic heart disease in Denmark., Methods: Relative risks and knowledge on the distribution of different dietary factors were used to estimate etiological fractions., Results: It is estimated that an intake of fruit and vegetables and saturated fat as recommended would prevent 12 and 22%, respectively, of deaths from ischaemic heart disease in Denmark. An intake of fish among those at high risk for ischaemic heart disease, would lead to a 26% lower mortality, while alcohol intake among abstainers would have no significant quantitative effect., Discussion: These results suggest that changes in dietary habits according to current recommendations would have an impact on public health in Denmark.

Shift work has been reported as a risk factor for ischaemic heart disease. Most studies have only partly controlled for social class differences, a recognized risk factor for ischaemic heart disease (IHD), and the relative risk of 1.4 could be a result of confounding. The Copenhagen Male Study was established in 1971 as a prospective cohort study of 5,249 men, and included questions on working time, social class and other potential confounders. The cohort was followed through registers for 22 years. Risk of IHD and all cause mortality did not differ between shift and day workers, the adjusted relative risk for IHD being 0.9 (0.7-1.1). Restriction to social class III led to lower risk estimates, with an adjusted relative risk of 0.7 (0.5-1.0). The study gave no support to the hypothesis that shift work is an independent risk factor for IHD. The role of shift work as an independent risk factor for IHD is still controversial.

It was the aim to reduce deaths among future patients queuing for heart catheterization or surgery. All the patients who died, after they were referred for heart catheterization or surgery because of coronary heart and heart valve disease, were registered over a three year period (July 1, 1990 to June 30, 1993). The total number of deaths was 98. Ninety-two (94%) died of cardiac disease. Seventyfour (80%) only had symptoms of cardiac disease; ten (11%) had competitive disease and eight (9%) had received revascularizing treatment previously. The number of catheterizations increased from 968 to 1312 per year, while the number of operations remained constant at about 600 per year. The death-rate for patients referred to heart catheterization was 2.5% for patients with aortic valve disease and 1.7% for patients with coronary heart disease. For patients referred for coronary artery bypass grafting the death-rate was 2.6% and for heart valve surgery 3.9%. The survival-time for patients waiting for catheterization was 4.2 months (0.3-16) and 4 months (1-16) for patients waiting for surgery. Half of the deaths in patients queuing for cardiac catheterization occurred within one month of waiting while half of the deaths in patients waiting for heart surgery appeared within 1.3 months. In the early deaths among patients queuing for cardiac catheterization there was a tendency towards prolonged doctor's delay and a surplus of patients with aortic valve disease. Deaths among patients awaiting heart catheterization or surgery can hardly be avoided. However, in the present study the death-rates for patients referred to surgery was 1.8 to 7.7 times higher compared to the conditions in other Western countries. The waiting-time was long and cardiac deaths frequent, reflecting the low capacity for invasive procedures as well as operations during this period.

From 1974 to 1984, decreases in the mortality of ischaemic heart disease of 11% for men 30 to 69 years of age and 16% for women in the same age-group were observed. From the Copenhagen City Heart Study, a population study of 20,000 men and women, a significant decrease in per cent of smokers, a significant decrease in P-cholesterol, a significant increase in per cent of joggers, but no change in systolic blood pressure were demonstrated, between 1976-1978 and 1981-1983. The decrease in mortality of ischaemic heart disease, may be due to reduction in risk-factor levels, and to advanced medical and surgical treatment.