Smoking, Lung Function, and Atherosclerosis in the 5,000 Elderly Participants of the Cardiovascular Health Study.
ABSTRACT The Cardiovascular Health Study (CHS) is an observational study of heart disease and stroke designed to evaluate risk factors and noninvasive measures and to describe and predict atherosclerotic events in older adults. Five thousand two hundred one individuals ages 65 or older were recruited from a stratified random sample of Medicare recipients from 4 US communities. This review of cross-sectional data from the CHS baseline examination describes the cigarette smoking habits of elderly persons and the relationships of smoking to lung function (spirometry) and atherosclerosis, as noninvasively measured by the ankle-arm index (AAI) and carotid ultrasonography. Only 10% of the men and 13% of the women were current smokers, and about half were former smokers. Forced expiratory flow (FEV1) was about 20% lower in current smokers when compared with never smokers. Current and former smoking were strongly associated with an increased risk for an abnormal AAI. Common and internal carotid artery walls were thicker and stenosis more common in current smokers and former smokers, when compared with never smokers. Analysis of long-term follow-up morbidity and mortality data from the CHS cohort should provide even stronger evidence of the effects of smoking in the elderly. Vigorous efforts should be made to persuade elderly smokers to quit.
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ABSTRACT: Pulmonary embolism (PE) is more often diagnosed post mortem by pathologists than in vivo by clinicians. The identification of practical diagnostic algorithms could reduce the rate of diagnoses first made at autopsy. The literature was reviewed for evidence-based approaches to PE diagnosis. Since the PE mortality rate greatly exceeds that of deep vein thrombosis (DVT), more emphasis was given to reports specifically dealing with PE diagnosis by objective pulmonary vascular imaging techniques than to those aimed at DVT detection. Several studies have shown that standardized clinical estimates can be effectively used to give a pretest probability to calculate, after appropriate objective testing, the post-test probability of PE. A prospective trial has shown that perfusion scanning, rather than ventilation/perfusion scanning, should be the imaging technique of first choice for the management of patients suspected of having PE. The clinical usefulness of spiral computed tomography has not as yet been firmly established. However, ongoing technological developments would probably render the technique accurate enough to replace conventional angiography. The authors propose a noninvasive diagnostic algorithm with high predictive accuracy (positive predictive value 96%; negative predictive value 98%) starting with a standardized assessment of clinical likelihood, followed by a perfusion scan and, eventually, spiral computed tomography in only a minority of patients (< 20%) with discordant clinical and scintigraphic findings.The European respiratory journal. Supplement 02/2002; 35:28s-39s.
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ABSTRACT: Patients with fixed airflow limitation are grouped under the heading of chronic obstructive pulmonary disease (COPD). The authors investigated whether COPD patients have distinct functional, radiological and sputum cells characteristics depending on the presence or absence of emphysema. Twenty-four COPD outpatients, 12 with and 12 without emphysema on high-resolution computed tomography scan of the chest, were examined. Patients underwent chest radiography, pulmonary function tests and sputum induction and analysis. Subjects with documented emphysema had lower forced expiratory volume in one second (FEV1), FEV1/forced vital capacity ratio, and lower carbon monoxide diffusion constant (K(CO)), compared with subjects without emphysema. Chest radiograph score of emphysema was higher, chest radiograph score of chronic bronchitis was lower, and the number of sputum lymphocytes was increased in patients with emphysema, who also showed a negative correlation between K(CO) and pack-yrs. Chronic obstructive pulmonary disease patients with emphysema, documented by high-resolution computed tomography scan, have a different disease phenotype compared with patients without emphysema. Identification of chronic obstructive pulmonary disease-related phenotypes may improve understanding of the natural history and treatment of the disease.European Respiratory Journal 04/2003; 21(3):450-4. · 6.36 Impact Factor
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ABSTRACT: Cigarette smoke exposure has been associated with a variety of diseases, including emphysema. The current study evaluated the interaction of cell density and cigarette smoke extract (CSE) on fibroblast contraction of collagen gels. Protein levels of transforming growth factor (TGF)-beta1, fibronectin, PGE(2), and TGF-beta1 mRNA were quantified. Although both 5 and 10% CSE inhibited contraction by low-density fibroblasts (1 x 10(5) cell/ml), only 5% CSE augmented contraction in higher-density cultures (3-5 x 10(5) cells/ml). CSE also inhibited fibronectin and TGF-beta1 production in low-density cultures but stimulated fibronectin production in high-density cultures. Active TGF-beta1 was readily detectable only in higher-density cultures and was markedly augmented by 5% CSE. In contrast, although TGF-beta1 mRNA expression was inhibited in high-density cultures by 10% CSE, expression was increased in the presence of 5% CSE. These results suggest that CSE-induced inhibition of low-density fibroblast contraction is due to inhibition of fibronectin production, whereas CSE's stimulatory effect on high-density cells is the result of increased release of TGF-beta1. These effects may help explain the varied pathologies associated with exposure to cigarette smoke.AJP Lung Cellular and Molecular Physiology 02/2003; 284(1):L205-13. · 3.52 Impact Factor