Coronary Heart Disease - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

CORONARY HEART DISEASE A 3-IN-1 MEDICAL REFERENCE Medical Dictionary Bibliography & Annotated Research Guide TO I NTERNE...

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CORONARY HEART DISEASE A 3-IN-1 MEDICAL REFERENCE Medical Dictionary Bibliography & Annotated Research Guide TO I NTERNET

R EFERENCES

CORONARY HEART DISEASE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES

J AM ES N. P ARK ER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Coronary Heart Disease: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00303-1 1. Coronary Heart Disease-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on coronary heart disease. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON CORONARY HEART DISEASE .................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Coronary Heart Disease.............................................................. 11 E-Journals: PubMed Central ....................................................................................................... 68 The National Library of Medicine: PubMed ................................................................................ 70 CHAPTER 2. NUTRITION AND CORONARY HEART DISEASE ........................................................ 115 Overview.................................................................................................................................... 115 Finding Nutrition Studies on Coronary Heart Disease............................................................. 115 Federal Resources on Nutrition ................................................................................................. 119 Additional Web Resources ......................................................................................................... 119 CHAPTER 3. ALTERNATIVE MEDICINE AND CORONARY HEART DISEASE .................................. 123 Overview.................................................................................................................................... 123 The Combined Health Information Database............................................................................. 123 National Center for Complementary and Alternative Medicine................................................ 124 Additional Web Resources ......................................................................................................... 132 General References ..................................................................................................................... 137 CHAPTER 4. DISSERTATIONS ON CORONARY HEART DISEASE .................................................... 139 Overview.................................................................................................................................... 139 Dissertations on Coronary Heart Disease.................................................................................. 139 Keeping Current ........................................................................................................................ 141 CHAPTER 5. PATENTS ON CORONARY HEART DISEASE ............................................................... 143 Overview.................................................................................................................................... 143 Patents on Coronary Heart Disease........................................................................................... 143 Patent Applications on Coronary Heart Disease ....................................................................... 153 Keeping Current ........................................................................................................................ 163 CHAPTER 6. BOOKS ON CORONARY HEART DISEASE .................................................................. 165 Overview.................................................................................................................................... 165 Book Summaries: Federal Agencies............................................................................................ 165 Book Summaries: Online Booksellers......................................................................................... 171 Chapters on Coronary Heart Disease......................................................................................... 173 CHAPTER 7. MULTIMEDIA ON CORONARY HEART DISEASE........................................................ 177 Overview.................................................................................................................................... 177 Video Recordings ....................................................................................................................... 177 CHAPTER 8. PERIODICALS AND NEWS ON CORONARY HEART DISEASE..................................... 179 Overview.................................................................................................................................... 179 News Services and Press Releases.............................................................................................. 179 Newsletter Articles .................................................................................................................... 181 Academic Periodicals covering Coronary Heart Disease ........................................................... 182 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 185 Overview.................................................................................................................................... 185 NIH Guidelines.......................................................................................................................... 185 NIH Databases........................................................................................................................... 187 Other Commercial Databases..................................................................................................... 189 APPENDIX B. PATIENT RESOURCES ............................................................................................... 191 Overview.................................................................................................................................... 191 Patient Guideline Sources.......................................................................................................... 191 Finding Associations.................................................................................................................. 195 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 197 Overview.................................................................................................................................... 197

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Preparation................................................................................................................................. 197 Finding a Local Medical Library................................................................................................ 197 Medical Libraries in the U.S. and Canada ................................................................................. 197 ONLINE GLOSSARIES................................................................................................................ 203 Online Dictionary Directories ................................................................................................... 203 CORONARY HEART DISEASE DICTIONARY ..................................................................... 205 INDEX .............................................................................................................................................. 275

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with coronary heart disease is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about coronary heart disease, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to coronary heart disease, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on coronary heart disease. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to coronary heart disease, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on coronary heart disease. The Editors

1 From

the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON CORONARY HEART DISEASE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on coronary heart disease.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and coronary heart disease, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “coronary heart disease” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

NCEP-Defined Metabolic Syndrome, Diabetes, and Prevalence of Coronary Heart Disease Among NHANES III Participants Age 50 Years and Older Source: Diabetes. 52(5): 1210-1214. May 2003. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: Although the individual components of the metabolic syndrome are clearly associated with increased risk for coronary heart disease (CHD), the authors of this study wanted to quantify the increased prevalence of CHD among people with metabolic syndrome. The authors used the Third National Health and Nutrition Examination Survey (NHANES III) to categorize adults over 50 years of age by presence

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of metabolic syndrome, with or without diabetes. Metabolic syndrome is very common, with approximately 44 percent of the United States population over 50 years of age meeting the criteria. In contrast, diabetes without metabolic syndrome is uncommon (13 percent of those with diabetes). Older Americans over 50 years of age without metabolic syndrome, regardless of diabetes status, had the lowest CHD prevalence. The prevalence of CHD markedly increased with the presence of metabolic syndrome. Among people with diabetes, the prevalence of metabolic syndrome was very high, and those with diabetes and metabolic syndrome had the highest prevalence of CHD. 2 figures. 4 tables. 31 references. •

Does Chronic Periodontitis cause Coronary Heart Disease?: A Review of the Literature Source: JADA. Journal of the American Dental Association. 133 (Supplement 6): 31S-36S. June 2002. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2867. Website: www.ada.org. Summary: Chronic periodontitis (CP) has been associated with coronary heart disease (CHD). This article reviews the evidence to support this connection. The author found that in 9 cohort studies, CP was associated with a 15 percent greater risk of developing CHD. Conclusions from individual studies depended on the study's characteristics. Summary risk estimates for studies controlling for smoking intensity (five of nine studies) or health awareness (two of nine studies) or studies with more than 600 CHD events (three of nine studies) suggest that CP is either not at all or only weakly associated with CHD. These data suggest that the CP-CHD associations observed in smaller studies are due to insufficient control for lifestyle differences. In addition, one cohort study reported that edentulous (without teeth) people had a CHD risk similar to that of people with CP. Therefore, the plausibility of dental infection elimination affecting CHD risk appears limited. 1 table. 44 references.

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Role of Cigarette Smoking in the Association Between Periodontal Disease and Coronary Heart Disease Source: Journal of Periodontology. 73(9): 988-994. September 2002. Contact: Available from American Academy of Periodontology. Suite 800, 737 North Michigan Avenue, Chicago, IL 60611-2690. (312) 573-3220. Fax (312) 573-3225. Summary: Cigarette smoking is a significant risk factor for both coronary heart disease and periodontal disease. This article reports on a study undertaken to better understand the role of smoking in the relationship between periodontal disease and heart attack history. The study population consisted of 5,285 participants in the Third National Health and Nutrition Examination Survey (NHANES) during 1988 to 1994 and who were age 40 years or older when examined. After adjustment for potential confounders, the authors only found significant associations between periodontal loss of attachment (LOA) and heart attack history for smokers. When the analysis was stratified by smoking status and age at heart attack, the statistically significant associations were limited to smokers who had a heart attack between the ages of 25 and 50 years. These results suggest that cigarette smoking is a necessary cofactor in the relationship between periodontal disease and coronary heart disease, and the increase in risk appears to be age dependent. However, the key role played by smoking in the etiology of both periodontal and heart diseases makes it difficult to determine how much of the observed association resulted from periodontal disease. 5 tables. 45 references.

Studies

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Risk Factors for Mortality from All Causes and from Coronary Heart Disease among Persons with Diabetes. Findings from the National Health and Nutrition Examination Survey I. Epidemiologic Follow-up Study Source: American Journal of Epidemiology. 133(12): 1220-1230. 1991. Summary: Coronary heart disease is the leading cause of mortality among people with diabetes mellitus, but the factors that account for this high coronary heart disease mortality remain unclear. This article reports on an epidemiologic follow-up study conducted from 1982-1984 as part of the National Health and Nutrition Examination Survey. Ninety-two deaths from coronary heart disease were found to have occurred among 602 people with diabetes and 558 deaths from coronary heart disease were found to have occurred among 12,562 nondiabetic participants during the follow-up period (1971-1984; average follow-up, 10 years). The authors found age, male sex, severe overweight, and non-leisure-time physical inactivity to be significantly associated with coronary heart disease mortality among people with diabetes. The strength of the associations between risk factors and all-cause and coronary heart disease mortality did not differ significantly among persons with and without diabetes. These results reinforce the importance of controlling coronary heart disease risk factors among persons with diabetes. 4 tables. 23 references. (AA-M).

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Age, Dental Infections, and Coronary Heart Disease Source: Journal of Dental Research. 79(2): 756-760. February 2000. Contact: Available from International Association for Dental Research. Subscription Department, 1619 Duke Street, Alexandria, VA 22314. (703) 548-0066. Fax (703) 548-1883. Summary: Epidemiological and intervention studies have suggested that infections are risk factors for coronary heart disease (CHD). This article reports on a case control study aimed at detailed assessment of the dental pathology found in various CHD categories (including elderly patients). Altogether, 85 patients with proven coronary heart disease and 53 random controls, matched for sex, age, geographic area, and socioeconomic status, were compared with regard to dental status, and were assessed on four separate scores and the classic coronary risk factors. The dental indices were higher among CHD patients than in the controls, but, contrary to previous studies, the differences were not significant. This result could not be explained by potential confounding factors. The participants in the present study were older and had more often undergone recent dental treatment in comparison with subjects in our earlier studies. Age correlated with the severity of dental infections only in the random controls but not in the coronary patients who, although young, already had high dental scores. The authors contend that the higher age of the participants in this study is the most likely reason for the results. Other possible explanations include an age related selection bias among older CHD patients, and the fact that those participating in studies like this may have better general health and thus also less severe dental infections. The authors conclude that the role of dental infections as a coronary risk factor varies according to the characteristics of the population studied. 2 tables. 24 references.

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Long-term Intake of Dietary Fiber and Decreased Risk of Coronary Heart Disease Among Women Source: JAMA. 281(21):1998-2004; June 2, 1999. Contact: American Medical Association, (800) 621-8335.

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Summary: Epidemiological studies of men suggest that dietary fiber intake protects against coronary heart disease, but data on this association in women are sparse. Using a group of 68,782 women aged 37 to 64 without previously diagnosed angina, myocardial infarction, stroke, cancer, hypercholesterolemia, or diabetes, the study examined the association between long-term intake of total dietary fiber as well as fiber from different sources and risk of coronary heart disease in women. The findings support the hypothesis that higher fiber intake, particularly from cereal sources, reduces the risk of coronary heart disease. •

Diabetes and Coronary Heart Disease Risk in Mexican Americans Source: Annals of Epidemiology. 2(1/2): 101-106. January-March 1992. Summary: Mexican Americans have a high prevalence of diabetes relative to nonHispanic whites but paradoxically experience a lower prevalence of myocardial infarction and cardiovascular mortality (at least in men). This article reports on a study undertaken to determine whether Mexican Americans might be more resistant to the atherogenic effects of diabetes than nonHispanic whites, by examining the associations between diabetes and myocardial infarction and selected coronary heart disease (CHD) risk factors in these two ethnic groups. The study population consisted of 5,149 Mexican Americans and nonHispanic whites who were 25 to 64 years old. Data showed that in both sexes, the association between myocardial infarction and diabetes was nearly identical between the two ethnic groups. These associations were at least as strong, if not stronger, in Mexican Americans as in nonHispanic whites. The authors stress that their data provide no evidence to suggest that Mexican Americans are resistant to the lipid-altering effects of diabetes. They conclude that the protective effect against CHD conferred by Mexican American ethnicity may be obscured in part by the high prevalence of diabetes in this ethnic group. 3 tables. 17 references. (AA-M).

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Periodontal Disease and Coronary Heart Disease Risk Source: JAMA. Journal of the American Medical Association. 284(11): 1406-1410. September 20, 2000. Contact: Available from American Medical Association. P.O. Box 10946, Chicago, IL 60610-0946. (800) 262-2350 or (312) 670-7827. Fax (312) 464-5831. Website: jama.amaassn.org. Summary: Research has suggested a relationship between periodontal disease and coronary heart disease (CHD), but data on the association between these 2 common conditions are inconclusive due to the possibility of confounding. This article reports on a study undertaken to evaluated the risk of CHD in persons with periodontitis, gingivitis (inflamed gums), or no periodontal disease. The prospective cohort study used data from the First National Health and Nutrition Examination Survey Epidemiologic Follow up Study, conducted in 1982 to 1984, 1987, and 1992. The study comprised a total of 8,032 dentate adults aged 25 to 74 years with no reported history of cardiovascular disease, including 1,859 individuals with periodontitis, 2,421 with gingivitis, and 3,752 with healthy periodontal tissues. The outcome measure was first occurrence of death from CHD or hospitalization due to CHD, or revascularization procedures, obtained from death certificates and medical records, by baseline periodontal status. During follow up, 1,265 individuals had at least 1 CHD event, including CHD fatality (n = 468) or at least 1 hospitalization with a diagnosis of CHD (n = 1,022), including coronary revascularization procedures (n = 155). After adjustment for known cardiovascular risk factors, gingivitis was not associated with CHD, while

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periodontitis was associated with a nonsignificant increased risk for CHD event. The authors conclude that this study did not find convincing evidence of a causal association between periodontal disease and CHD risk. 3 tables. 34 references. •

Prevalence of Nontraditional Risk Factors for Coronary Heart Disease in Patients with Chronic Kidney Disease Source: Annals of Internal Medicine. 140(1): 9-17. January 2004. Summary: Risk for coronary heart disease is high among patients with chronic kidney disease (CKD). This article reports on a study undertaken to compare the prevalence of nontraditional risk factors for coronary heart disease in patients with CKD. The authors considered the prevalence of low apolipoprotein A1 levels and elevated apolipoprotein B, plasma fibrinogen, lipoprotein (a), homocysteine, and C-reactive protein levels by estimated glomerular filtration rate (GFR, a measure of kidney function). After standardization for age, race or ethnicity, and sex, lower estimated GFR was associated with lower average levels of apolipoprotein A1, and higher levels of apolipoprotein B, plasma fibrinogen, homocysteine, and C-reactive protein in patients with CKD. These findings imply that these risk factors may be important underlying causes of an excess risk for cardiovascular disease among patients with CKD. 1 figure. 4 tables. 48 references.

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Assessing the Relationship Between Dental Disease and Coronary Heart Disease in Elderly U.S. Veterans Source: JADA. Journal of American Dental Association. 129(3): 301-311. March 1998. Summary: Several recent studies have shown a link between dental disease and coronary heart disease. This article reports on a study of 320 U.S. veterans undertaken to assess the relationship between oral health and systemic diseases among older people. They present cross-sectional data confirming that a statistically significant association exists between a diagnosis of coronary heart disease and certain oral health parameters, such as the number of missing teeth, plaque benzoyl-DL-argininenaphthylamide (BANA) test scores (a test for bacteria), salivary levels of Streptococcus sanguis, and complaints of xerostomia (dry mouth). The oral parameters in these subjects were independent of and more strongly associated with coronary heart disease than were recognized risk factors, such as serum cholesterol levels, body mass index, diabetes, and smoking status. However, because of the convenience sample studied, these findings cannot be generalized to other populations. 5 tables. 40 references. (AAM).

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Risk Factors for Coronary Heart Disease Mortality Among Persons with Diabetes Source: Annals of Epidemiology. 3(1): 27-34. January 1993. Summary: This article reports on a study in which the authors used data from two large surveys to perform a case-control analysis of risk factors for coronary heart disease (CHD) mortality among persons with diabetes. They focused on three modifiable risk factors: cigarette smoking, high blood pressure, and obesity. Results showed that women younger than 55 years with diabetes and with no other risk factors for CHD had a 16-fold higher risk of dying from CHD than did women without diabetes. About onethird of younger women who died of CHD had diabetes. Men with diabetes less than 45 years old with no other risk factors for CHD had an eight-fold higher risk of CHD mortality. Among older white men and women, diabetes increased the risk of mortality from CHD about two-fold. In younger people with diabetes, current cigarette smoking

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was associated with a 50-percent increase in risk, and high blood pressure increased the risk more than three-fold. In the older age group, risk factors for CHD mortality were similar among those with and those without diabetes. The authors stress that smoking and blood pressure control represent major opportunities to reduce the risk of CHD among persons with diabetes. 4 tables. 26 references. (AA-M). •

Cardiovascular Risk Factors in Confirmed Prediabetic Individuals: Does the Clock for Coronary Heart Disease Start Ticking Before the Onset of Clinical Diabetes? Source: JAMA. Journal of the American Medical Association. 263(21): 2893-2898. June 6, 1990. Summary: This article reports on a study that documented the cardiovascular risk factor status of 614 initially nondiabetic Mexican Americans who later participated in an 8-year follow-up of the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. Individuals who were nondiabetic at the time of baseline examination, but who subsequently developed NIDDM, had higher levels of total and low-density lipoprotein cholesterol, triglyceride, fasting glucose and insulin, 2-hour glucose, body mass index, and blood pressure and lower levels of high-density lipoprotein cholesterol than subjects who remained nondiabetic. Most of these differences persisted after adjustment for obesity and/or level of glycemia, but were abolished after adjustment for fasting insulin concentration. These results indicate that prediabetic subjects have an atherogenic pattern of risk factors (possibly caused by obesity, hyperglycemia, and especially hyperinsulinemia), which may be present for many years and may contribute to the risk of macrovascular disease as much as the duration of clinical diabetes itself. 5 tables. 46 references. (AA-M).

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Prospective Study of Obesity and Risk of Coronary Heart Disease Among Diabetic Women Source: Diabetes Care. 25(7): 1142-1148. July 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on a study undertaken to examine the relationship of obesity, measured as BMI, and weight change to incidence of coronary heart disease (CHD) among women with diabetes. The authors followed 5,897 women with type 2 diabetes in the Nurses' Health Study for up to 20 years. Women were aged 40 to 74 years and had no history of cardiovascular disease or cancer at the beginning of the follow up period. During follow up, the authors document 418 incident cases of CHD (236 of nonfatal myocardial infarction and 182 of fatal CHD). After adjustment for age, smoking, and other coronary risk factors, current BMI (body mass index) was strongly associated with increased risk of CHD among women with diabetes. Increasing BMI values from age 18 years to 1976, before diagnosis of diabetes, were also positively associated with risk of CHD. Weight gain before the diagnosis of diabetes was related to increased risk of CHD. In contrast, weight change after diagnosis of diabetes was not associated with risk of CHD. The authors conclude that these findings provide strong evidence that obesity and weight gain before diagnosis of diabetes are associated with future risk of CHD among women with type 2 diabetes. 1 figure. 2 tables. 34 references.

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Risk Factors for Coronary Heart Disease in Diabetes Mellitus Source: Diabetes. 41(Supplement 2): 1-3. October 1992.

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Summary: This article reviews the putative risk factors associated with the development of coronary heart disease (CHD) in diabetes. The author emphasizes to the effect of nephropathy (persistent proteinuria) and hypertension on cardiovascular mortality in insulin-dependent diabetes (IDDM). Risk factors associated with CHD in noninsulindependent diabetes (NIDDM) are also reviewed. Finally, possible reasons to explain the increased incidence of CHD associated with proteinuria in IDDM patients, including lipoprotein abnormalities, increased fibrinogen levels, increased platelet adhesiveness, and altered hemostatic variables, are discussed. 1 table. 32 references. (AA-M). •

Periodontitis: A Risk Factor for Coronary Heart Disease? Source: Annals of Periodontology. 3(1): 127-141. July 1998. Contact: Available from American Academy of Periodontology. Suite 800, 737 North Michigan Avenue, Chicago, IL 60611. (312) 787-5518. Fax (312) 787-3983. Website: www.perio.org. Summary: This paper evaluates the current information on the relationship between oral disease (specifically, periodontitis) and atherosclerosis (coronary heart disease or CHD) to determine whether there is sufficient information to conclude that periodontitis is a risk factor for CHD. The authors first define the term risk factor and review the 3 criteria used to establish exposures as risk factors. In addition, epidemiologic criteria for defining an exposure as causal are presented. The available evidence then is evaluated according to the criteria for causality, which are extensions of the criteria for establishing a risk factor. The authors also present new findings which indicate that the extent of the periodontal infection, a measure reflecting microbial burden, also is related to onset of new CHD events. The authors conclude that the available evidence does allow an interpretation of periodontitis being a risk factor for atherosclerosis or CHD. This conclusion is made with some qualifications, however, which the authors outline. 9 figures. 4 tables. 40 references. (AA-M).

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Diagnosing Coronary Heart Disease in Patients with Diabetes: How and Why Source: Consultant. 39(2): 556-557, 561. February 1999. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: This review article presents highlights from a consensus statement developed by the American Diabetes Association and the American College of Cardiology that offers insights into the importance of diagnosing coronary heart disease in patients with diabetes. Although patients who have type 1 diabetes may not have the usual risk factors for coronary artery disease (CAD), patients who have type 2 diabetes frequently have many of the usual risk factors for CAD. The question of whether the atherosclerotic process is different in diabetes has not been definitively determined, but early diagnosis of asymptomatic CAD has many benefits. The article presents indications for cardiac testing and highlights various intervention measures. Beneficial treatment modalities include control of hypertension, aspirin therapy, lipid lowering therapy, improved glycemic control, and beta-blocker therapy. 1 figure. 6 references.

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Dyslipidemia, Morbidity, and Mortality in Non-Insulin-Dependent Diabetes Mellitus: Lipoproteins and Coronary Heart Disease in Non-Insulin-Dependent Diabetes Mellitus Source: Journal of Diabetes and Its Complications. 11(2): 137-141. March-April 1997.

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Contact: Available from Elsevier Science, Inc. Journal Fulfillment Department, 655 Avenue of the Americas, New York, NY 10010. (212) 633-3950. Fax (212) 633-3990. Summary: This review article summarizes typical characteristics of dyslipidemia in noninsulin dependent diabetes mellitus (NIDDM, or Type II) and its association with the risk of macrovascular complications. Lipid and lipoprotein abnormalities in NIDDM include particularly elevated levels of total and very-low-density lipoprotein (VLDL) triglycerides and reduced levels of high-density lipoprotein (HDL) cholesterol. Total and low-density lipoprotein (LDL) cholesterol levels are usually normal if glycemic control is adequate. The worsening of glycemic control deteriorates lipid and lipoprotein abnormalities and particularly total and LDL cholesterol levels are often elevated in patients with poor glycemic control. According to prospective population-based studies, total cholesterol is a powerful risk factor for coronary heart disease (CHD) in NIDDM patients as in nondiabetic subjects. In contrast, high total triglycerides and low HDL cholesterol may be even stronger risk factors for CHD in NIDDM patients than in nondiabetic individuals, but more prospective studies are needed to substantiate this view. Compositional changes in LDL and VLDL particles may further increase the risk for CHD but epidemiologic data are missing to support this notion. Preliminary data from the Scandinavian Simvastatin Survival Study including 202 patients with diabetes seem to indicate that patients with diabetes benefit from simvastatin treatment equally to nondiabetic subjects. 31 references. (AA-M). •

Impact of Coexistent Diabetes on the Prevalence of Coronary Heart Disease Source: Journal of Diabetes and Its Complications. 11(5): 268-273. September-October 1997. Contact: Available from Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010. Summary: This study is designed to examine the overall prevalence of coronary heart disease (CHD) and the impact of diabetes on ischemic heart disease at the time of diagnosis. The authors compared the impact of diabetes on ischemic heart disease in people hospitalized in a public hospital over a 10-year period. In comparison with the nondiabetic population, the prevalence of CHD was consistently higher among people with noninsulin-dependent diabetes mellitus (NIDDM, or Type II). The prevalence was similar in both genders, increased with age, and was independent of body-mass index, a history of smoking, metabolic control, or lipid pattern. In people with NIDDM and CHD, heart rate and blood pressure levels were significantly higher. In addition, even in subjects with impaired glucose tolerance, there was a significant association between ischemic heart disease and atherosclerotic peripheral artery disease prevalence. The authors conclude that diabetes has a harmful effect on general risk factors of atherosclerosis and increases susceptibility to cardiovascular disease by itself. Based on the epidemiological evidence of an excessive occurrence of NIDDM in people with preexisting vascular diseases, a genetically determined link between metabolic disturbances and cardiovascular disease is possible. 2 figures. 6 tables. 42 references. (AA-M).

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Examining the Link Between Coronary Heart Disease and the Elimination of Chronic Dental Infections Source: JADA. Journal of the American Dental Association. 132(7): 883-889. July 2001. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2867. Website: www.ada.org.

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Summary: While it has been suggested that periodontal disease may be associated with coronary heart disease (CHD), there are no data to suggest that the elimination of chronic dental infections actually lowers the risk of developing chronic CHD. This article reports on a study undertaken to determine whether people with a definitive elimination of all potential dental infections (i.e., edentulous people, who are at the optimum endpoint of dental infection elimination as they have no teeth) lower their CHD risk over time when compared with people who have a specific dental infection, periodontitis. The authors examined data from a prospective cohort of 4,027 people who participated in the First National Health and Nutrition Examination Survey (NHANESI) Epidemiologic Follow up Study. The primary outcome measure was the first CHD event. During a mean follow up of 17 years, there were 1,238 CHD events (538 fatal). The confirmed elimination of chronic dental infections did not lead to a decreased risk of experiencing a CHD event. The CHD risk among people with and without chronic dental infections remained constant over time with respect to each other. The authors concluded that people who had a complete, definitive and long term elimination of all potential dental infections through extraction of all teeth did not have lower CHD risk when compared with people with diagnosed periodontitis. Until evidence is found to the contrary, the authors suggest that prevention of CHD should not be used as the basis for recommending treatment to eliminate chronic dental infections. 3 tables. 35 references.

Federally Funded Research on Coronary Heart Disease The U.S. Government supports a variety of research studies relating to coronary heart disease. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to coronary heart disease. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore coronary heart disease. The following is typical of the type of information found when searching the CRISP database for coronary heart disease: •

Project Title: A RANDOMIZED, CONTROLLED TRIAL FOR HOMOCYSTEINE Principal Investigator & Institution: Bostom, Andrew G.; Associate Professor of Medicine; Rhode Island Hospital (Providence, Ri) Providence, Ri 029034923 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 31-JAN-2006 Summary: (Adapted from the application) This multicenter, randomized, double-blind controlled clinical trial has been designed to determine whether total homocysteine

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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(tHcy)-lowering treatment with a standard multivitamin augmented by a high dose combination of folic acid, vitamin B12, and vitamin B6, versus treatment with a standard multivitamin devoid of these three B-vitamins, reduces the pooled rate of recurrent and de novo cardiovascular disease outcomes (i.e., pooled occurrence of non-fatal and fatal arteriosclerotic outcomes, including coronary heart, cerebrovascular, and peripheral vascular disease events= primary outcome), among clinically stable renal transplant recipients who have mild to moderately elevated tHcy levels. The basic eligibility criteria are age 35 to 75 years old, functioning renal allograft for greater than six-months with serum creatinine based creatinine clearance greater than 30 mL/min, and a screening random tHcy level greater than12 uM/L. Patients will be stratified based on the presence/absence of clinical CVD, and randomly assigned to treatment with a standard multivitamin containing a high dose combination of folic acid, vitamin B6, and vitamin B12, or an identical multivitamin devoid of these three micronutrients. Randomized patients will also undergo a methionine loading test. All patients will receive standard clinical management for traditional CVD risk factor reduction. The study is designed to recruit 4000 patients (2000 in each group) over a two-year period for 83% power to detect a 25% treatment effect. Follow-up continues until occurrence of de novo or recurrent non-fatal CVD, or death, or a maximum of four-years. Data analysis will be performed on the basis of original randomization (intention to treat) using the log-rank test of difference in survival-without-endpoint curves. In the current era of cereal grain flour fortified with physiologic amounts of folic acid, RTRs comprise a patient population particularly well-suited to test the tenable hypothesis that tHcylowering treatment will reduce CVD outcomes, given: a) their persistent excess prevalence of mild hyperhomocysteinemia post-fortification, in contrast, for example, to coronary heart disease patients with normal renal function; b) the demonstrated capability of B-vitamin treatment regimens featuring supraphysiologic amounts of folic acid to successfully "normalize" tHcy levels in RTRs. Furthermore, overall "conditions" in the RTR population (i.e., renal impairment, mild to moderate hyperhomocysteinemia which can be normalized by supraphysiologic dose B-vitamin supplements, and high CVD event rates) are representative of the larger population of patients with chronic renal insufficiency, who are not yet dialysis-dependent. Accordingly, findings from the proposed trial are very likely to be generalizable to the much more sizable population of patients with renal insufficiency progressing to end-stage renal disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMINOSTEROL MSI-1436 AS A THERAPEUTIC FOR OBESITY Principal Investigator & Institution: Mclane, Michael; Genaera Corporation 5110 Campus Drive Plymouth Meeting, Pa 19462 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2005 Summary: (provided by applicant): Obesity is a disease that has increased at an alarming rate. Today, 64.5 percent of adult Americans (about 127 million) are categorized as being overweight (body mass index >25) or obese (body mass index >30). Obesity is strongly associated with type 2 diabetes, hypertension, coronary heart disease, respiratory conditions, increased incidence of certain forms of cancer, and many other diseases. Each year, obesity causes at least 300,000 excess deaths in the U.S. and healthcare costs of American adults with obesity amount to approximately $100 billion. Diet and exercise are stalwart anti-obesity therapies but success is variable. With the valvular heart disease associated with fenfluramine and phentermine in the late 1990's and subsequent withdrawal of fenfluramine and dexfenfluramine anti-obesity agents from the market, there has been a reduction in use of products that have similar

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pharmacological activities. Currently approved anti-obesity therapies (see Table 1) work by stimulating noradrenergic receptors, inhibiting serotonin and norepinephrine reuptake, or inhibiting absorption of fats via inhibition of Iipase but results are variable and there are some associated side effects. Major advances in understanding the homeostatic system and neural pathways that regulate body weight have led to potential therapeutic agents with novel activities, such as leptin, ghrelin antagonists, and ciliary neurotrophic factor (CNTF). We have discovered a natural occurring (in dogfish sharks), novel aminosterol, MS1-1436, that causes body weight reduction in genetically obese or diet-induced obese rodents when administered via various routes and in dogs. This compound, also re-established normoglycemia in diabetic obese animals and lowered serum cholesterol levels. Two steps are necessary to elevate this compound to clinical development and will be the aims of this grant: 1) the mechanism(s) of action(s) or neural pathways used by this compound need to be elucidated and 2) a minimal dose/frequency and formulation that allows subcutaneous implantable, intranasal or oral bio-availability needs to be developed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANXIETY & VAGAL CONTROL OF THE HEART IN CORONARY DISEASE Principal Investigator & Institution: Watkins, Lana L.; Psychiatry; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 01-JUN-1999; Project End 31-MAY-2004 Summary: Coronary heart disease continues to be the leading cause of death in the United States, despite risk factor reduction and technological advances in treatment options. Prospective studies implicate chronic anxiety as an independent risk factor for fatal coronary heart disease. In particular, anxiety increases the risk of sudden cardiac death substantially. The primary objective of the proposed research is to examine the role of reduced vagal control of heart rate in the increased risk of cardiac mortality associated with anxiety in a population with established coronary artery disease (CAD). A second objective is to determine whether the effects of anxiety are independent of the effects of depression. Nine hundred and fifty CAD patients will be recruited for this study from patients hospitalized for elective cardiac catheterization. Anxiety will be measured by the Hospital Anxiety Scale, the Spielberger Trait Anxiety Inventory, and the Crown-Crisp Phobic Anxiety Scale. Symptoms of depression will be measured by the Montgomery-Asberg Depression Rating Scale, the Hospital Depression Scale, and the Beck Depression Inventory. Vagal control of heart rate will be determined using power spectral analysis to measure two indices of vagal control: baroreceptor-mediated vagal reflex cardiac control, and respiratory sinus arrhythmia. Patients will be followed at 6 months, l year, 2 years, and 3 years postcatheterization, and cardiac mortality data will be obtained, including non-sudden and sudden cardiac death. The data generated by this study will be used to examine the involvement of impaired vagal cardiac control in the risk of fatal coronary heart disease and sudden cardiac death associated with anxiety. Specifically, the proposed study will examine: (1) the relationship between anxiety and cardiac mortality; (2) the relationship between anxiety and vagal control; (3) the role played by reduced vagal control in mediating anxiety-related risk; and (4) the relationship between depression, vagal control and cardiac risk. Findings of a relationship between anxiety, reduced vagal control and sudden cardiac death would suggest the potential importance of early intervention in cardiac patients with anxiety disorders and would underscore the benefit of aggressive monitoring of arrhythmias in this population, which may ultimately translate to reduced mortality rates.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOLOGY OF PHAGE INFECTION IN CHLAMYDIA Principal Investigator & Institution: Bavoil, Patrik M.; Oral & Craniofacial Biol Scis; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-MAY-2006 Summary: (provided by applicant): Chlamydial disease of humans includes predominant ocular, genital and respiratory tract infections, with sequelae ranging from blindness, to female infertility, arthritis and asthma. Chronic infection with the respiratory pathogen, Chlamydia pneumoniae is also associated with coronary heart disease, the number one killer disease of humans. In spite of their public health magnitude, chlamydiae are reputed for their elusiveness as infectious microorganisms to clinicians and molecular biologists alike. This owes to several factors, prominent among which are a unique obligate intracellular developmental lifestyle and the fact that chlamydiae have resisted genetic manipulation to this day. We have isolated a bacteriophage, phiCPG1 from the model Chlamydia psittaci strain ?Guinea Pig Inclusion Conjunctivitis?. A member of the single-stranded DNA microviridae family, phiCPG1 is nearly identical to a ?virtual? phage of C. pneumoniae that was revealed by genome sequence analysis. The infection of an intracellular pathogen by its own parasitic bacteriophage is a unique biological phenomenon, with potentially important implications in infection and disease. Moreover, phages offer unique opportunities for the development of molecular and genetic tools for research. The objectives of this application are therefore to gain a broad understanding of Chlamydia phage biology in the context of chlamydial infection. We will determine the molecular basis of the interaction of the phage with its host and comparatively evaluate gene expression in phage-free and phage-infected bacteria. The availability of well-established models of infection and disease in the guinea pig will allow for the first time to study the impact of phage infection on the natural infection of a vertebrate animal by an obligate intracellular pathogen. Finally, the information gained in these studies will be exploited toward the development of genetic methodologies in Chlamydia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BLACK POOLING PROJECT Principal Investigator & Institution: Lackland, Daniel T.; Professor and Director of Graduate Train; Biometry & Epidemiology; Medical University of South Carolina P O Box 250854 Charleston, Sc 29425 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2006 Summary: (provided by applicant): Over the last three decades a sustained and marked decline in death rates from coronary heart disease (CHD) has occurred for all major demographic groups of the US population. Recently, however, the decline has proceeded less rapidly in blacks than in whites, and in women than men. These trends have focused further attention on possible heterogeneity in the risk factor patterns among the demographic sub-groups. As is well recognized, the knowledge on CHD risk factors and statistical models used to predict personal risk of CHD have been based on studies among white populations. In some epidemiological studies with samples from black populations, large variation in the effect of specific factors has been noted. Given the small sample of blacks under investigation, however, low statistical power exists for many of the black-white comparisons. The fundamental obstacle to progress in this area remains the absence of the cohorts of sufficient size that is representative of all four

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major groups. Hence, a strong rationale exists to undertake a "pooling project" to clarify a set of important unanswered questions in cardiovascular disease epidemiology. We propose to conduct a person-level meta-analysis by pooling 9 US studies with both black and white samples: the First National Health and Nutrition Examination Survey (NHANES I) Epidemiological Follow-up Study, the NHANES II Mortality Follow-up Study, the Charleston Heart Study, the Evans County Heart Study, the Chicago Heart Association Detection Project in Industry, the Atherosclerosis Risk in Communities Study (ARIC), the Follow-up Study of the screenees for the Multiple Risk Factors Intervention Trial (MRFIT), the Follow-up Study of the participants from the MRFIT, and the Follow-up Study of the participants from the Hypertension Detection and Follow-up Program (HDFP). We will perform black-white comparison on the CHD incidence and mortality, exposure-outcome relationship, patterns of co-morbidity (or coexistence of risk factors) and population attributable risk. We will also examine the multivariate risk functions in blacks and whites in the three contexts: ordering risk, magnitude of relative risks, and estimation of absolute risk. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BORDER EPIDEMIOLOGY STUDY ON AGING (BESA) Principal Investigator & Institution: Bastida, Elena M.; Professor; Univ of Texas-Pan American Edinburg, Tx Timing: Fiscal Year 2002; Project Start 01-JUN-1977; Project End 31-JUL-2006 Summary: (provided by applicant): The Border Epidemiologic Study of Aging (BESA) offers the unique opportunity to investigate intra-group health disparities in a longitudinal study of 1133 middle aged and older Mexicans Americans. The proposed study builds and extends on three earlier waves of data and expands previous research to include two new emphases: the investigation of diabetes and health disparities. In exploring health disparities two additional dimensions of social stratification have been added, social trust and work productivity and conditions. Five Specific Aims are proposed: 1)To examine and compare the dynamic association between socioeconomic status (SES) and disease, mainly diabetes and coronary heart disease which disproportionately affect the Mexican American population along the border; 2)To identify predictors of risk factors for diabetes and to explore the economic, social and psychological consequences of diabetes for this population over time; 3)To identify predictors and patterns of change, particularly, incidence rates for major diseases, changes in risk factors for major diseases; changes in productivity and earnings, family dynamics, acculturative status, and changes in social support and other ways of coping over time; 4)To identify predictors of mortality for each wave; 5)To identify predictors of survival for the 80+ in Waves 3 & 4. The proposed research strategies include: (1) Conducting extensive longitudinal analyses on the three waves of available data; (2) Building on the current three waves by collecting a fourth wave; (3) Increasing the current sub-sample of the 39-44 years old to 250 participants; and, (4) Gathering qualitative data through a series of focus groups and in-depth interviews with selected participants in the established BESA sample and in the younger sub-sample. A Social stratification theoretical model of Health is proposed. This model is used in drawing a set of hypotheses for each of the listed aims above. Various statistical methods are proposed in discussing hypotheses testing and evaluation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CARDIAC AND RENAL DISEASE STUDY (CARDS) Principal Investigator & Institution: Iribarren, Carlos; Physician / Scientist; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 946123433 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Mild-to-moderate chronic renal insufficiency (CRI) is reaching epidemic proportions in the US. Studies relating mild-to-moderate CRI and cardiovascular risk are limited and inconsistent. Although we have learned much about the natural history and adverse outcomes associated with end-stage renal disease (ESRD), we have little specific information regarding risk factors for the development or progression of renal disease. Using a population-based, ethnically diverse large cohort of male and female health plan enrollees with extended follow-up, we propose: Aim 1: To evaluate: a) whether baseline and decline in renal function overtime are independent predictors of coronary heart disease (CHID), stroke, heart failure and peripheral vascular disease; b) effect modifiers of these relationships, including baseline hypertension and diabetes status. Aim 2: To determine whether baseline and increase over time in blood pressure level (as well as prevalent and incident hypertension) are predictive of the subsequent risk of ESRD after adjusting for diabetes and for baseline serum creatinine, proteinuria and hematuria. Aim 3: To examine other potential predictors of ESRD including demographic factors (race/ethnicity, level of education) total cholesterol level, family history of renal disease, body mass index, sagittal abdominal diameter, cigarette (as well as cigar and pipe) smoking, coffee intake, alcohol consumption, family history of renal disease and self-reported occupational exposures. We will take advantage of existing longitudinal data resources at the Northern California Kaiser Permanente Division of Research and available patient-level crosslinkage with the US Renal Data System end-stage renal disease registry to obtain comprehensive renal and cardiovascular outcomes. A de novo prospective study of this magnitude and duration will be prohibitively expensive and time-consuming. This proposal will leverage unique resources and methodological expertise to provide novel insights into the epidemiology of renal disease and its association with cardiovascular events. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CARDIAC MR OF SUBCLIN CVD: IMPACT OF AGE Principal Investigator & Institution: Manning, Warren J.; Assistant Professor; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2005 Summary: (Verbatim from the Applicant's Abstract): Coronary heart disease and stroke are leading causes of mortality for men and women in the United States. Our current understanding of the pathogenesis of and the risk factors for cardiovascular disease (CVD) is derived largely from prospective studies of clinically overt disease. Unfortunately, clinical risk factors for CVD defined by these methods fail to predict a large proportion of CVD events, and some subjects at high clinical risk fail to develop overt disease. Subclinical disease precedes clinical events by years/decades but is difficult to quantify. For example, left ventricular hypertrophy (LVH) and aortic atherosclerosis are strong predictors of CVD events, but are difficult to accurately noninvasively quantify, especially among the elderly and overweight subjects (both growing populations in the U.S.). MRI perrnits accurate assessment of cardiac anatomy/function and subclinical aortic atherosclerosis. The underlying hypothesis of this proposal is that subclinical CVD is a precursor to overt CVD, and that MRI

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measures of subclinical aortic and cardiac anatomic disease are superior for the characterization of risk as compared with current measures of risk factors as well as more conventional imaging (e.g., carotid ultrasound, echo). Longitudinal/timeaveraged indexes of all established risk factors for CVD have been collected in the Framingham Heart Study (FHS). These time-averaged indexes are stronger predictors of clinical CVD than single measures. In a Pilot study of 312 FHS Offspring subjects, MRI measures of LV mass were successfully acquired in a larger proportion of subjects than echo, and MR evidence of LVH and subclinical aortic disease correlated more strongly (than echo and carotid ultrasound measures) with these time-averaged indexes. Application of MRI methods in the FHS offers an opportunity to identify subclinical atherosclerosis and LVH in this well-characterized cohort and to relate these data with conventional imaging measures already acquired in this cohort. Importantly, the nearconcurrent acquisition of brain MRI/neuropsychologic examination in the same FHS cohort offer the unique contemporaneous opportunity to examine subclinical cerebrovascular disease with MRI indexes of subclinical atherosclerosis. We propose to expand our Pilot study to perform heart and thoracic/abdominal aorta MRI studies in 2400 FHS participants to allow for identification of individual CVD risk factors for subclinical atherosclerosis. These population-based data will extend our knowledge of the distribution and severity of atherosclerosis in adult men and women and their relations to existing echo, carotid ultrasound and brain MRI measures. This study provides the rare opportunity to examine associations of quantitative MRI measures of aortic atherosclerosis and LVH with both cross-sectional and time-averaged measures of individual atherosclerotic risk factors (e.g., blood pressure, cigarette smoking, and cholesterol) and with novel inflammatory markers (e.g., C-reactive protein, MCP-1). Further, because the FHS consists of hundreds of sibships for which a DNA repository has been established, we propose to determine the heritability of MRI indexes of atherosclerosis and LVH, laying the groundwork for future genetic studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CARDIOVASCULAR DISEASE IN THE PIMA INDIANS Principal Investigator & Institution: Howard, Barbara V.; President; Medstar Research Institute Hyattsville, Md 20783 Timing: Fiscal Year 2002; Project Start 30-SEP-1988; Project End 31-MAY-2005 Summary: MedStar (formerly Medlantic) Research Institute proposes to continue its participation in the Strong Heart Study to manage the Arizona field center and the core laboratory. For the field center, this proposal describes methodology for 1) morbidity and mortality surveillance of the original Strong Heart Study cohort (1099 surviving out of 1500 original men and women ages 45-74 years in Phase I); 2) recruitment and examination of 30 families of at least 30 members, each 15 years and older; and 3) reexamination of the 900 family members from the Phase Ill pilot study. The Arizona field center comprises three American Indian communities: Gila River, Salt River, and Ak Chin. The Arizona center had a 71% recruitment rate in Phase I and 90%+ completion rates in Phases II and III. Morbidity and mortality surveillance obtained data on 99% of the participants. The core laboratory will provide accurate, reliable, stable, and comparable phenotypic measures of coronary heart disease risk factors in blood and urine samples. Measurements to be made for the family cohort include lipoprotein profile, glucose, HbA1c, insulin, LDL size, fibrinogen, PAI-1, apoE phenotype, apoB, apoA1, chemistry profile, and urinary albumin and creatinine. In addition, some exciting new markers of evolving importance in the etiology of atherosclerosis will be evaluated on stored baseline samples using a case-cohort design. sVCAM and

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endothelin-1 will be measured in approximately 400 definite cardiovascular disease cases and suitable controls. TSH also will be measured in these samples to allow evaluation of its role in cardiovascular disease in American Indians. The core laboratory will store blood, urine, and DNA in a safe and organized manner for effective inventory so that the resources will be retrievable for other scientists and the American Indian communities. Laboratory performance during the previous exams has been excellent, with high completion rates and precision and accuracy exceeding those of most core laboratories. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CASE CONTROL STUDY OF STATIN USE AND LARGE BOWEL CANCER Principal Investigator & Institution: Coogan, Patrica F.; Epidemiology; Boston University Medical Campus 715 Albany St, 560 Boston, Ma 02118 Timing: Fiscal Year 2002; Project Start 18-SEP-2000; Project End 31-AUG-2005 Summary: (Adapted from applicant's abstract): Cancer of the large bowel is a leading cause of cancer morbidity and mortality in the United States. Our previous epidemiologic studies played a key role in documenting an inverse association between the use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) and the incidence of large bowel cancer. Those studies were inspired by laboratory data suggesting that NSAIDs may reduce colon carcinogenesis. Now a growing body of laboratory data indicates that the commonly used, relatively new class of cholesterollowering drugs, the "statins" may have a similar chemopreventive potential: statins inhibit the growth of colon cancer cells in vitro and in vivo. There is also some evidence that statins may enhance the chemopreventive effect of NSAIDS. The statins (e.g., lovastatin, simvastatin) were first marketed in 1987, and are now among the most commonly prescribed drugs in the United States. At this time there is little epidemiologic data concerning their potential protective effect against large bowel cancer. Two randomized trials of statin use as preventives of coronary heart disease had nonsignificant deficits of large bowel cancer in the treated groups. We propose to conduct a population-based case-control study in Massachusetts of the relation of statin use to the risk of large bowel cancer. We will identify 2050 incident cases aged 50-74 through participating hospitals and 2050 age, sex, and precinct matched community controls from Massachusetts town lists. Cases and controls will be interviewed to obtain information on demographic factors, risk factors for large bowel cancer, detailed histories of statin and NSAID use, and data useful for addressing potential biases. The study is large enough to assess the influence of characteristics of statin use (timing, duration, dose) on the risk of large bowel cancer and to assess consistency of findings across subgroups of age, sex, and cancer site. The joint effect of statins and NSAIDs will also be assessed. The proposed study will provide informative epidemiologic data on a potential chemopreventive of large bowel cancer. Because the incidence of the disease and prevalence of statin use by U.S. men and women are high, an inverse association would be of considerable public health importance. Moreover, it would shed light on a mechanism of colon carcinogenesis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CELLULAR DISORDERS IN FAMILIAL HDL DEFICIENCIES Principal Investigator & Institution: Oram, John F.; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105

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Timing: Fiscal Year 2002; Project Start 15-APR-1996; Project End 31-MAR-2004 Summary: Population studies have shown an inverse correlation between plasma HDL levels and risk for coronary heart disease, suggesting that HDL protects against atherosclerosis. This protection may be related to the ability of HDL to stimulate clearance of cholesterol from peripheral cells, particularly those of the artery wall. Lipidpoor HDL apolipoproteins such as apoAI remove excess cholesterol and phospholipids from cells by an active process that may account for the cardioprotective effects of HDL. This pathway is virtually absent in fibroblasts from subjects with Tangier disease (TD), a genetic disorder characterized by extremely low plasma levels of HDL, deposition of cholesteryl esters in tissue macrophages, and a high prevalence of cardiovascular disease. Other forms of familial HDL deficiency (FHD) have a less severe impairment of the same pathway. Thus a failure of apoAI to acquire cellular lipids may account for the rapid catabolism of nascent HDL particles, low HDL levels, and increased atherosclerosis in TD and other FHDs. Using microarray gene expression technology, we identified the probable TD gene product, called ABC1 , that appears to play a critical role in the apolipoprotein-mediated lipid removal pathway. We have prepared the necessary cell lines, cDNAs, antibodies, and assays for studying this protein and its gene. With these tools, we will characterize the biologic properties of ABC1 and other newly-discovered proteins using cultured cells, and we will establish the role of ABC1 in whole-body lipoprotein metabolism and atherogenesis using genetically-manipulated mouse models. Characterization of ABC1 and related proteins will advance significantly our understanding of cellular processes involved in clearing excess cholesterol from tissues by HDL apolipoproteins. These studies will help design therapeutic approaches for correcting cellular disorders associated with low plasma HDL and increased risk for heart disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CENTER FOR AFRICAN AMERICAN URBAN HEALTH Principal Investigator & Institution: Flack, John M.; Professor; Internal Medicine; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2003; Project Start 18-SEP-2003; Project End 31-MAY-2008 Summary: The Wayne State University (WSU) Center for African American Urban Health is a 5-year proposal that consists of five Cores and four Projects with participation of 34 investigators from various Departments, Centers, and Programs across the WSU campus. The Center has invested heavily in coalescing and expanding a shared research infrastructure that is widely accessible to investigators. The four Cores represent specialized areas of expertise and services required to undertake testing of multi-level hypotheses related to research in racial health disparities. These Cores form the foundation of our application. The Cores are: 1) Psychosocial and Community Measures; 2) Recruitment and Clinical Assessment; 3) Biostatistics and Research Database; and 4) Genomics Core. These Cores allow the investigators to test a broader range of Project-specific study hypotheses in a more cost-efficient manner than would be possible with stand-alone Projects. African Americans were selected as the exclusive study population for the Center because of their high burden of obesity-related disease such as breast cancer and cardiovascular diseases (hypertension, heart failure, diabetes mellitus, and coronary heart disease). Also, while Detroit has the third largest population of African Americans, it has the highest percentage (81.6%) of African Americans of any major city in the USA. The four Projects are: 1) Project 1: Obesity, Nitric Oxide, Oxidative Stress and Salt Sensitivity, 2) Project 2: Weight Loss in Breast Cancer Survivors, 3) Project 3: A Dyadic Intervention for Cardiac Rehabilitation

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Patients, and 4) Project 4: Promotion of Healthy Behavior in African American Women. These Projects are thematically linked through obesity, diet and other lifestyle factors including physical activity, and obesity-related cardiovascular disease and cancer. Our research efforts are focused on understanding the mechanisms operating at multiple levels (environment, lifestyle, physiology, genetics) mediating known disparate chronic conditions and their precursors. We also seek to identify preventive strategies and therapeutic approaches that might alleviate the disproportionate burden of disease. Primary as well as interactive effects of environmental exposures (household and community-level) and psychobehavioral characteristics with physiological measures (e.g., 24-hour BP burden and oxidative stress), genes, and body composition will be explored in relation to their impact on study outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHLAMYDIA ATHEROSCLEROSIS

PNEUMONIAE

AND

MACROPHAGES

IN

Principal Investigator & Institution: Byrne, Gerald I.; Professor & Chairman; Medical Microbiol & Immunology; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2002; Project Start 15-FEB-1999; Project End 30-SEP-2002 Summary: (Adapted from the Applicant's Abstract): Chlamydia pneumoniae, a causative agent in human community acquired pneumonia, also has been implicated in a variety of sequelae associated with chronic disease and re-exposure to the organism. One important sequel associated with C. pneumoniae infection is the development of atherosclerotic lesions that define the pathology of cardiovascular disease in people. Cardiovascular disease due to atherogenic processes is a major health problem in most of the world, accounting for about 50% of all deaths. It is clear that vascular injury is crucial in the development and progression of atherosclerosis and that this injury can result from a variety of causes, including infection. Several lines of evidence support the hypothesis that C. pneumoniae infection is linked to the development of atherosclerosis. Initially, seroepidemiological evidence was generated to establish a relationship between C. pneumoniae and cardiovascular disease. Subsequently, evidence for the presence of the organism in atherosclerotic lesions was obtained using either direct antigen detection methods or probes specific for C. pneumoniae nucleic acids. In addition, the organism has been isolated from an aortic lesion and grown in cell culture. Finally, two pilot secondary prevention antibiotic treatment trials have provided evidence to suggest that treatment of C. pneumoniae in individuals with coronary heart disease significantly reduces cardiac events in treated versus placebo administered populations. Thus, although the association of C. pneumoniae and atherosclerosis is well-established, existing data do not prove an etiology or pathogenic role for the organism in disease, although both rabbit and murine animal models have been developed to determine if C. pneumoniae is causally associated with development or progression of atherosclerotic lesions in vivo. Activation and modification of mononuclear phagocyte function is associated with atherosclerotic lesion development. Characteristic changes include development of cholesteryl ester-laden monocytes (foam cells) and oxidation of lipids to form tissue-damaging derivatives. The hypothesis to be tested here is that infection of human monocytes, monocyte-derived macrophages or murine monocyte cell lines with C. pneumoniae results in changes in macrophage morphology and function that are consistent with a role for C. pneumoniae in the pathogenesis of atherosclerosis. This hypothesis will be tested by determining if C. pneumoniae causes mononuclear phagocytes to form foam cells in the presence of low

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density lipoprotein (LDL) or other cholesterol-containing serum lipoprotein complexes. Studies also will be conducted to determine if C. pneumoniae contributes to the oxidative modification of LDL and molecular characterization of C. pneumoniae antigens involved in these processes will be identified. Finally, a murine model will be developed to provide in vivo correlates to cell culture observations. Results will help establish links between C. pneumoniae infection and the atherosclerotic disease process. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHLAMYDIA SIGNIFICANCE

PNEUMONIAE

ANTIGENS

OF

BIOLOGICAL

Principal Investigator & Institution: Campbell, Lee Ann.; Professor; Pathobiology; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-APR-1998; Project End 31-MAR-2007 Summary: (provided by the applicant): Chlamydia pneumoniae is a human respiratory pathogen that causes 5 percent to 10 percent of pneumonia, bronchitis, and sinusitis. Virtually everyone is infected in his or her lifetime and reinfection is common. Infection is difficult to treat even with sensitive antibiotics. Chronic infection is common and has been associated with asthma, reactive airway disease, Reiter's syndrome, erythema nodosum, and sarcoidosis. The potential public health impact of infection with this pathogen is underscored by the association of C. pneumoniae with atherosclerosis and related clinical manifestations such as coronary heart disease, carotid artery stenosis, aortic aneurysm, claudication, and stroke. If C. pneumoniae infection plays a role in atherogenesis, there will be an urgent need to facilitate diagnosis and develop strategies for intervention and prevention. The overall goal of this proposal is two fold. First, C. pneumoniae specific antigens that are recognized during human infection will be exploited to facilitate serodiagnosis and identify putative vaccine candidates. The second goal is to define chlamydial/host cell interactions that lead to entry and survival of C. pneumoniae in host cells relevant to atherosclerosis. The specific focus will be on the interaction of the chlamydial glycan moiety with carbohydrate binding receptors on the host cell. Importantly, infection of epithelial cells can be inhibited with N-linked high mannose type oligosaccharide, the major component of the glycan. The novel hypothesis to be tested is that C. pneumoniae enters through the mannose-6 phosphate receptor by binding to the site involved in transport of phosphomannosylated residues to the lysosome and this differs from C. trachomatis, which utilizes the mannose receptor. The ultimate goals of these studies are to identify C. pneumoniae specific antigens to facilitate laboratory diagnosis and virulence factors playing a role in pathogenesis to guide vaccine development or develop anti-adhesive strategies for prevention of infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHLAMYDIA PNEUMONIAE VACCINE CANDIDATES Principal Investigator & Institution: Kaltenboeck, Bernhard; Assistant Professor; Vet Pathobiology; Auburn University at Auburn Auburn University, Al 36849 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 31-MAY-2005 Summary: (Provided by Applicant): Chlamydia (C.) pneumoniae is a major agent of community-acquired upper and lower respiratory infection and pneumonia. Increasing evidence suggests that C. pneumoniae infection plays an integral role in atherosclerotic coronary heart disease in developed countries, making C. pneumoniae a major public health concern. This clearly merits an effort to develop a vaccine against C. pneumoniae

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for prevention or treatment of respiratory disease, and possibly coronary heart disease and atherosclerosis. Using our new genetic immunization technologies, we are able to deconvolute the genomes of pathogens into the best vaccine candidates, and have recently validated this in a mouse model of C. psittaci infection in which we found 10 protective genes that also protect the original host animal. Perusing the complete genome sequence of C. pneumoniae, we propose as first step towards a C. pneumoniae vaccine to i) examine the C. pneumoniae homologs of the protective C. psittaci genes for protective efficacy in a mouse model of C. pneumoniae respiratory infection; ii) conduct a C. pneumoniae genome-wide search for the best antigens mediating prophylactic immunity against respiratory infection; and iii) perform experiments to understand the mechanisms for the success of such immunological intervention. We propose the following specific aims: 1) Test the C. pneumoniae homologs of the 10 protective C. psittaci genes in a mouse prophylactic respiratory model of C. pneumoniae infection. 2) Screen all approximately 1,000 C. pneumoniae genes for their protective efficacy in the mouse prophylactic model. 3) To understand the spectrum of possible responses in an outbred human population, dissect the immunological mechanisms of disease protection mediated by the C. pneumoniae vaccine candidate proteins in respiratory disease models using several inbred mouse strains. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONIC DENTAL DISEASE AND CARDIOVASCULAR DISEASE Principal Investigator & Institution: Joshipura, Kaumudi J.; Assistant Professor; Oral Health Policy & Epidem; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-JUL-2004 Summary: Several recent reports have found significant associations between periodontal disease, tooth loss and increased coronary heart disease (CHD). Possible associations between dental caries and CHD and between dental disease and stroke have also been reported. Recent literature also supports the possible role of other chronic bacterial and viral infection, fibrinogen and other inflammatory mediators in increasing CHD risk. We propose to study the relation between periodontal disease, caries and tooth loss, and risk of incidence of coronary heart disease and stroke and to assess if these associations are independent of common risk factors including behavioral factors. Additionally, we propose to evaluate two possible explanations for these associations: (1) tooth loss leads to reduced masticatory efficiency, which could lead to reduced intake of dietary antioxidant and fiber, which in turn has been associated with increased risk for cardiovascular disease; and (2) chronic dental disease could lead to hyperfibrinogenemia which is strongly and probably causally associated with increased risk of CHD. We will also evaluate C-reactive protein, von Willebrand factor, tissue plasminogen activator, and Factor VII as additional mediators. Participants include 51,529 men enrolled in the Health Professionals Follow-Up Study since 1986 and 90,000 females enrolled in the Nurses Health Study since 1976 who reported their dental status in 1992. The follow-up in these cohorts is excellent and has been consistently over 90 percent. The outcome measures will include incident cases of CHD and stroke in 15 years of follow-up among men and 9 years of follow-up among women free of cardiovascular disease and cancer at baseline. Over 4500 incident cases of CHD and stroke are anticipated. Biomarker assays will be performed for a sub-population consisting of new CHD cases incident after the time of initial blood collection, and one matched control per case. Blood samples were provided by 32,000 nurses in 1989-90 and by 18,100 male health professionals in 1993-94, allowing for sufficient follow-up to

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include an estimated 600 incident cases among males and 600 cases among females for the biomarker analyses. The high prevalence of dental infection makes its potential association with inflammatory and dietary mediators, and ultimately increased risk of CHD and stroke very important with implications for millions of Americans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHRONIC ISCHEMIC MR-MECHANISMS & NOVEL SURGICAL THERAPY Principal Investigator & Institution: Miller, D Craig.; Professor; Cardiothoracic Surgery; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 01-JUN-2001; Project End 31-MAY-2005 Summary: (Verbatim from Applicant's Abstract):.Ischemic mitral regurgitation (IMR), or "functional" MR as a consequence of coronary heart disease, continues to defy surgical attempts to repair the mitral valve in a predictable fashion because we still do not understand the mechanisms responsible for IMR. Postoperative survival is only about 55 percent after 5 years, and debate continues as to whether repair is preferable to replacement. While ring annuloplastyworks in most patients with annular dilation and normal leaflet motion, such an approach can be unreliable in those who have "complex" MR jets and/or apical leaflet tethering, which results in restricted systolic leaflet motion. Our ignorance of the mechanisms responsible for IMR has been reduced by work in experimental models of acute IMR, but the real clinical problem and surgical challenge is patients with chronic I1\IR. Chronic animal experiments are rare due to high cost and the inescapable animal attrition that these preparations entail. Clinical progress, however, will continue to be tentative and empirical until controlled studies of chronic IMR are performed which tell us how and why these morphologically normal valves leak. We propose to apply our myocardial marker technology (which can measure submillimeter instantaneous changes in leaflet, annular, papillary muscle, and left ventricular 3-D geometry and dynamic motion throughout the cardiac cycle on a beatto-beat basis) to determine the mechanisms responsible for chronic IMR in an ovine myocardial infarction model and to define how the therapeutic effects of ring annuloplasty differ from those of a novel trans-annular suture reparative technique (Septal-Lateral Annular Cinching, or "SLAC"), which we have shown can eliminate acute IMR. To address these issues, we set forth the following Specific Aims: #1) To elucidate the basic pathophysiology o chronic ischemic mitral regurgitation, with particular emphasis on the 3-D geometry of the mitral leaflets in relation t about one another and to the other components of the mitral valvular-ventricular complex. This work will define for the frst time the causal basis of chronic IMR as a function of the evolving interrelationships between leaflet, annular, and ventricular pathologic abnormalities. #2) To investigate in a randomized, controlled fashion a new surgical treatment, "SLAC," for chronic IMR and to determine the mechanistic basis for the beneficial effects conferred by either the conventional surgical approach (undersized ring annuloplasty) or this new SLAC technique based on differences in LV remodeling, interactions between leaflet, annular, and ventricular 3-D dynamics, and valvular competency. Comparison of the effects of ring annuloplasty and SLAC on LV geometry as well as leaflet and annular 3-D motion and dynamics will reveal why patients might benefit from one approach versus the other, beyond simply eliminating the MR. These experiments promise to add fundamental knowledge which will lead to more intelligent design of new, more effective, and more predictable surgical approaches for patients with CAD and chronic ischemic mitral regurgitation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CLINICAL UTILITY OF ENDOTHELIAL FUNCTION IN PAD Principal Investigator & Institution: Vita, Joseph A.; Professor; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2003; Project Start 22-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Peripheral arterial disease (PAD) produces considerable morbidity and mortality, and the precise factors that determine disease progression and the responses to therapy remain largely unknown, In addition to their risk for critical limb ischemia or graft failure, PAD patients also have markedly increased risk for coronary heart disease, particularly during the stress of vascular surgery, It is clear that new approaches are needed for optimal risk assessment and therapy. Targeting endothelial function represents a major new departure from traditional methods for assessing cardiovascular disease risk. The central hypothesis of this proposal is that endothelial dysfunction is a critical mediator of both PAD and coronary heart disease events and measuring endothelial function will enhance both the risk assessment and therapy in PAD patients. Recent studies by the applicants strongly support this contention and establish the prognostic value of endothelial dysfunction in PAD patients undergoing vascular surgery. A key unresolved question is whether reversing endothelial dysfunction will directly reduce risk. This finding would more firmly establish endothelial dysfunction as a mediator of both PAD and coronary heart disease risk and further validate its clinical utility. We propose the following specific aims: 1. To determine whether reversing endothelial dysfunction ameliorates perioperative risk in PAD patients. Patients referred for elective vascular surgery will be treated with high dose atorvastatin (80 mg/day), ascorbic acid (500 mg/day), or placebo in a randomized, double blind, fashion beginning a month prior to surgery and continuing for a month after surgery. Non-invasive assessment of vascular function will be performed at baseline and immediately prior to surgery. Patients will be monitored for cardiovascular events (cardiac death, myocardial infarction, unstable angina, and stroke) in the 30-day postoperative period. The goal is to determine whether improvement in vascular function independently predicts outcome (irrespective of which treatment produces the improvement). 2. To determine whether endothelial dysfunction predicts long-term (2-year) PAD and coronary heart disease risk in PAD patients. 3. To determine whether systemic markers of oxidative stress and inflammation relate to endothelial dysfunction and long-term PAD and coronary heart disease risk. This work will provide novel information about the pathogenesis and management of PAD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COMMUNITY SURVEILLANCE OF CHD AND SUDDEN DEATH (MHS) Principal Investigator & Institution: Luepker, Russell V.; Mayo Professor and Head; Epidemiology; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 01-AUG-2000; Project End 30-JUN-2005 Summary: The Minnesota Heart Survey (MHS) is among the few population- based longitudinal studies to monitor and explain trends in coronary heart disease (CHD) mortality and morbidity; the leading cause of death and disability in the United States. It encompasses a large and well defined community, the Minneapolis/St. Paul (Twin Cities) metropolitan area of Minnesota, comprising a population of 2.3 million (1990 census). For almost two decades, MHS has made contributions to: 1) understanding the

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components of the decline of coronary heart disease mortality including incidence rate, hospitalized attack rate, case fatality, and population levels of CHD risk factors; and 2) the methodology of disease surveillance in a time when classification and diagnostic technologies are constantly changing. In the last grant period, MHS morbidity and mortality surveillance has found: 1) a continued decline in age-adjusted CHD death rates through 1995 for both men and women; 2) continued improved survival of hospitalized AMI patients in the first half of the 1990's; 3) more modest declines of outof-hospital sudden cardiac death during the 1990's resulting in an increasing preponderance of out-of-hospital compared to in-hospital CHD mortality; 4) declining rates of hospitalized AMI including incident and recurrent events for both men and women in the 1990's; 5) a modest change in event severity for AMI; 6) dramatic improvements in two year case fatality after validated hospitalized AMI; and 7) significant increases in the use of appropriate medications, diagnostic procedures and therapeutic procedures during AMI in the setting of dramatic declines in length of hospital stay. In this application, we propose to continue efficient MHS data collection in the following domains: 1) continue surveillance of coronary heart disease mortality through the year 2002; 2) monitoring trends in AMI occurrence and survival by surveillance of hospitalized AMI in the year 2000; 3) evaluation of the effect on AMI diagnosis of the widespread use of new, highly sensitive and specific biomarkers (troponins); and 4) evaluation of out-of- hospital sudden cardiac death (SCD) through an autopsy in a population sample of victims utilizing modern anatomical, histological, toxicologic and interview-based data to better characterize this fatal condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONVECTIVE FLOW TISSUE ASSEMBLY OF VASCULAR GRAFTS Principal Investigator & Institution: Frangos, John A.; Principal Scientist; Applied Tissue and Materials, Inc. 505 Coast Blvd S, Ste 402 La Jolla, Ca 920374614 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2005 Summary: Coronary heart disease accounts for the largest fraction of heart disease (the leading cause of death in the United States, affecting 12 million Americans) and has an annual cost to society that exceeds 110 billion dollars. There is a great clinical need for small diameter vascular artery grafts, as patients requiring multiple or repeat bypass procedures frequently lack adequate autogenous vessels to serve as bypass conduit. Tissue engineering clearly has the potential to provide relief in this area, however, present attempts have had limited clinical potential, due to practicality and feasibility issues or involvement of foreign materials. As such, a novel tissue assembly methodology that avoids these pitfalls is proposed. The new methodology relies upon drag-induced convective flow to assemble tissue on an inert porous mandrel, which is later removed, yielding completely biological constructs. The flow will be generated by a transmural pressure gradient, which in turn will generate shear stresses that will mimic the mechanical environment of native arteries. The tissue assembly methodology will allow for multiple seedings, such that the culture of layered tissues is possible, and will be readily scaled up and automated, allowing for wide-scale commercial and clinical application. The present Phase I proposal seeks to test the ability of the novel bioreactor design to assemble human smooth muscle cells into thick, healthy threedimensional tissue constructs. These constructs will be evaluated in terms of physical and morphological properties. The ultimate goal is to develop a tissue assembly method that produces autologous and completely biological vascular grafts, which are produced with consistent biological and mechanical properties, by a manufacturing process that can be readily scaled-up in an economic manner.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE-CONTRIBUTION OF NEIGHBORHOOD TO HEALTH DISPARITIES IN CARDIOVASCULAR DISEASE Principal Investigator & Institution: Diez Roux, Ana V.; Assistant Professor; Columbia University Health Sciences Po Box 49 New York, Ny 10032 Timing: Fiscal Year 2003; Project Start 10-FEB-2003; Project End 31-JAN-2008 Summary: Recent epidemiologic studies have found that living in socioeconomically disadvantaged neighborhoods is associated with increased prevalence and incidence of coronary heart disease, even after controlling for measures of personal income, education, and occupation. There is also abundant evidence of important differences in neighborhood environments by race and ethnicity. For example, African Americans are significantly more likely to live in disadvantaged neighborhoods than whites, even when persons of similar personal income and education are compared. Predominantly African-American neighborhoods (and disadvantaged neighborhoods generally) have been shown to have greater density of tobacco advertising and greater availability of tobacco products. The availability and quality of recreational spaces and the availability and quality of healthy foods may also differ across neighborhoods. These data suggest that neighborhood characteristics, and access to health community environments generally, may contribute to race and ethnic differences in cardiovascular risk. Neighborhood differences may also be relevant in understanding differences in cardiovascular health among other race/ethnic groups. The proposed project will build on existing research in both cardiovascular disease epidemiology and neighborhood effects at Columbia, allowing increased focus on the examination of neighborhood effects on cardiovascular disease in minority populations and on the contributions of neighborhood differences to disparities in cardiovascular health. This increased focus will include (1) enhanced analyses of neighborhood effects on cardiovascular health in minority groups using existing cohort data and data from the US Census, (2) support for the development of operational measures of neighborhood characteristics including both survey-based and geographic information-based (GIS) approaches, and (3) support for methodological approaches which will enhance our ability to more rigorously examine neighborhood effects as well as the contribution of neighborhood differences to health disparities in cardiovascular diseae. Confirming that neighborhood characteristics are relevant to disease risk (through health damaging or health enhancing features of neighborhoods) could have important implications for the prevention of cardiovascular disease and for the reduction of persistent (and often increasing) social and race/ethnic disparities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORONARY RELATIONSHIP

HEART

DISEASE

ANXIETY:

PREVALENCE,

Principal Investigator & Institution: Carmin, Cheryl N.; Psychiatry; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2004; Project Start 01-DEC-2003; Project End 30-NOV-2008 Summary: (provided by applicant): The goals of this career development award are designed enable the candidate to develop a program of independent research examining the relationship between anxiety disorders and coronary heart disease (CHD). This study would contribute to the investigator's long-term career goal of examining the relationship between anxiety disorders and medical illness, such as CHD. There is a

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relatively well-established link between emotional and behavioral variables and the risk for CHD. Despite the comorbidity of anxiety and depressive disorders, the lines of research investigating these conditions and CHD have remained largely independent of one another. Further, despite it being more prevalent than and often pre-dating the onset of depression, less attention has been paid to the relationship between anxiety and CHD. The existing research focusing on anxiety disorders in those at risk for or who have CHD is limited by the use of descriptive, rather than state-of-the-art diagnostic measures of psychopathology. It remains unclear to what extent clinically significant anxiety disorders serve as independent risk factors and may be influential in the development of CHD. In order to address the risk that anxiety disorders pose in CHD prone individuals, the initial phase of this award will allow the investigator to develop background in areas related to the interface between cardiology and psychology including psychosocial epidemiology, biostatistics, psychophysiological assessment, and scanning technology related to CHD. Existing epidemiological databases that assess CHD will be utilized to determine whether anxiety disorders are independently related to the development of CHD. The 2 nd phase of the award will be used to apply the skills acquired in coursework and in analyzing existing data to execute a study comparing a sample of anxiety disordered subjects to a matched control group based on anxiety symptoms (severity, frequency, duration), cardiac calcium as assessed by electron beam tomography, lipid levels, and heart rate variability. The investigator is in the unique position of having access to individuals who are being screened for CHD using EBT as well as having access mentors and collaborators involved in multicenter cardiovascular research (Drs. Lynda Powell, Peter Buttrick, Kiang Liu, George Kondos), psychophysiological research (Dr. Stephen Porges) and who are experienced in the psychopathology and treatment of anxiety disorders (Dr. Richard Heimberg). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORONARY HEART DISEASE: WOMEN'S VALUES, BELIEFS AND COGNITIVE PROCESSES Principal Investigator & Institution: Arslanian-Engoren, Cynthia; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 30-JUN-2007 Summary: Coronary heart disease, which includes acute and old myocardial infarction, angina pectoris, and other acute, subacute, and chronic forms of ischemic heart disease, is the single largest killer of American women. In 1999, 262,391 United States women, of all ethnic and racial groups, lost their lives to coronary heart disease. However, Black women have the highest overall death rates from coronary heart disease, followed by White and Hispanic women. Despite these findings and the fact that women are more likely than men to die after a myocardial infarction, women are less likely than men to seek medical attention after the onset of initial symptoms. Explanations for these delays have been linked to low perceptions of susceptibility to heart disease, the lack of association of initial symptoms as significant indicators of an acute cardiac event, low socioeconomic status, and patient race. While not negating the importance of these variables, they do not speak to the values attitudes or beliefs that underlie women's decision to seek emergency care. Guided by The Health Belief Model, this triangulated, descriptive study will examine the values, beliefs, and cognitive process of a total of 78 women (26 Hispanic, and 26 white) relative to the manifestation and presentation of an acute myocardial infarction, while the quantitative phase will focus on the symptoms women believe most likely indicate an acute myocardial infarction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORTISOL, CENTRAL OBESITY, AND INSULIN RESISTANCE Principal Investigator & Institution: Purnell, Jonathan Q.; Associate Professor; Medicine; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 15-AUG-2000; Project End 31-JUL-2004 Summary: (adapted from the application) Central (visceral) obesity contributes to an excess risk of diabetes, dyslipidemia, hypertension, and premature death from coronary heart disease. A feed-back loop model of weight regulation has emerged from recent studies of animals and humans: afferent hormones signal amount of fat mass to the central nervous system; weight regulation centers in the hypothalamus interpret these signals and control efferent systems including appetite, energy expenditure, and enzymes in the fat cell, such as lipoprotein lipase, that facilitate partitioning of energy into lipid storage. It is proposed in this grant that the hypothalamic-pituitary-adrenal axis is an effector system of hypothalamic weight regulatory centers and that increased cortisol production rates in the obese state directly regulate enzyme transcription in the fat cell to promote lipid uptake and central fat distribution. Cross sectional data from lean and obese humans using stable isotope enrichment determined by mass spectroscopy demonstrate that increases in cortisol production rates across the physiological range are associated with increased adipocyte lipoprotein lipase activity, accumulation of fat mass independent of non-fat mass, increased visceral fat, and increased insulin resistance. These findings, however, do not establish whether increased cortisol production causes, or is simply associated with these variables. To directly test whether cortisol enhances lipid uptake, fat mass accumulation, increased visceral fat mass, and insulin resistance, it is proposed to study the effect of administration of increasing doses of hydrocortisone (including doses within the physiological replacement range) in subjects with complete adrenal failure on these parameters. Finally, leading cellular candidates for the regulation of adipocyte lipoprotein lipase gene expression and fat cell differentiation, including PPAR-gamma and C/EBP, will be measured in adipose samples from the subjects in these studies to provide a mechanistic link between peripheral signaling systems such as cortisol and the adipocyte enzymes involved with fat partitioning. These studies will not only provide insight into the mechanisms of central obesity and its metabolic consequences, they also have great importance to clinicians who care for subjects with adrenal insufficiency as to the consequences of recommended replacement doses of cortisol on risk factors for heart disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DETECTING CHANGES IN MYOCARDIAL PERFUSION AND FUNCTION Principal Investigator & Institution: Faber, Tracy L.; Associate Professor; Radiology; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 30-JUN-2006 Summary: Coronary heart disease caused 476,124 deaths in 1996 and continues to be the leading cause of death in America today. Over 12 million people alive today have a history of myocardial infarction, angina pectoris, or both. Every year in the US about 5 million perfusion studies are performed to evaluate extent and severity of CAD, thereby enabling clinical decisions regarding diagnosis, prognosis, and therapy for patients with heart disease. Of these, 1 million undergo angioplasty and about 500,000 have bypass surgery, and millions of others undergo drug therapy and or lifestyle changes to prevent progression of cardiac disease. It is widely recognized that computer quantification of

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myocardial perfusion images improves diagnostic accuracy and enhances confidence and reproducibility of interpretation. Theses quantitative approaches are wellestablished for assessing abnormalities in myocardial perfusion and function. However, they have not been developed or optimized for detecting changes in serial studies of the same patient such as is needed for assessing the effect of interventions, medical therapy, or disease progression. In this project, we will develop and validate computer-based methods to automatically quantify and visualize serial changes in myocardial perfusion and function from perfusion SPECT. The work can be separated into 4 projects: 1) To assess changes in myocardial perfusion, 2) to assess changes in myocardial function, 3) to design a virtual heart suitable for creating simulation data for optimizing and analyzing our algorithms, and 4) to validate the methods using both simulations and animal studies. Important subprojects include: a) development of 3-d and 4-d surface detection methods for defining LV endocardial and epicardial surfaces, b) development of algorithms for non-rigid alignment of static and/or dynamic serial SPECT images so that they may be more directly compared, c) development of motion analysis methods using similar non-linear alignment techniques to measure regional myocardial function and also to correct ungated SPECT scans for motion blur, and d) creation of new statistical approaches to determine significant changes in both global and regional perfusion and functional variables. The ultimate goal of this project is to create a clinically useful tool for detecting changes in serial SPECT studies. Most importantly, the tools will be extremely well characterized as to their sensitivity in detecting small changes as well as for overall accuracy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIETARY ETIOLOGIES OF HEART DISEASE AND CANCER Principal Investigator & Institution: Rimm, Eric B.; Associate Professor; Nutrition; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 01-DEC-1985; Project End 31-MAY-2007 Summary: (provided by applicant): We propose to continue the biennial follow-up of cardiovascular disease among 51,529 male health professionals, age 40 to 75 years in 1986, to address a series of new dietary hypotheses related to risk of a coronary heart disease and stroke. We project over 4,000 incident MI, fatal CHD, and stroke cases through the end of the follow-up period. Nested within this cohort, over 18,000 participants provided blood samples in 1994 from which we propose to investigate several biological (plasma and genetic) determinants of disease. We will concentrate on several hypotheses related to nutritional and genetic determinants of cardiovascular disease (CVD). With this exceptional resource of repeated assessments of diet and lifestyle characteristics tied to potential genetic markers of disease, we will prospectively evaluate in relation to coronary heart disease 1) n-6 fatty acids across a wide range of n3 fatty acid intake from fish and vegetable sources, 2) foods with a high glycemic load, specifically among men with a BMI > 25kg/m^2, 3) protein intake as a replacement for carbohydrate, and 4) putative functional variants and haplotypes in candidate genes thought to be insulin targets. Within this metabolic domain we seek to determine if lifestyle practices such as physical activity or a low glycemic load diet can modify underlying genetic risk. To investigate further the effect of diet on mediators of CHD we will investigate a) the interaction between n- 3 and n-6 fatty acids on inflammatory risk factors for CVD and b) glycemic load on adiponectin and the associated risk of this adipocyte-derived cytokine on risk of MI and fatal CHD. Also, we propose further to examine aims 1-3 with respect to stroke. Finally, within a small exploratory aim, we propose to document basic risk factors for congestive heart failure by utilizing the

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innovative methods we designed to study coronary heart disease. The ongoing Health Professionals Follow-up Study will provide follow-up of non-CVD endpoints (CA55075) in addition to information on important covariates for the proposed study. Overall, the large size of the prospective cohort, the high follow-up rate, the repeated assessment of dietary and lifestyle information, and the availability of archived bloods provide a unique cost-effective opportunity to test hypotheses related to CVD risk. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIETARY PATTERN INDEXES: RELATION WITH CVD RISK FACTORS Principal Investigator & Institution: Kant, Ashima K.; Professor; Family, Nutrition & Exercise Scis; Queens College Flushing, Ny 113671597 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Although many studies have examined the role of single nutrients, foods, or food groups in the etiology of disease, relatively little research has addressed the health effects of dietary patterns comprising multiple interdependent dietary factors. Research on dietary patterns is warranted on several grounds. First, complex diets consumed by free-living individuals do not consist of single nutrients or foods but rather a combination of foods containing multiple nutrients and nonnutrients. Second, intercorrelation of dietary variables makes it difficult to isolate effects of single nutrients or foods. Third, biological activities of nutrients in vivo are interdependent. Finally, recommendations for disease prevention implicitly reflect the dietary pattern approach by emphasizing the simultaneous change of several dietary behaviors such as increasing fruit, vegetable, and grain intake, and decreasing fat intake. However, the exact mechanisms through which healthy diet patterns modify the risk of heart disease are not known. Intuitively, such patterns may be effective at several levels, but little is known about it. This proposal will test the hypothesis that two diet indexes intended to represent healthy eating patterns may be associated with several major, lifehabit, and emerging risk factors of coronary heart disease (CHD) risk identified by the ATP III in a representative sample of adult Americans. We will use dietary, anthropometric, biochemical, and health data from the third National Health and Nutrition Examination Survey, 1988-1994 (>15,000), to address these issues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DISLIPIDEMIA DETECTION IN WV FAMILIES Principal Investigator & Institution: Harris, Carole V.; Behavioral Med and Psychiatry; West Virginia University P. O. Box 6845 Morgantown, Wv 265066845 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): West Virginians are at high-risk for developing coronary heart disease due to high rates of biomedical risk factors, low socio economic status, and a rural geography with limited access to health care. West Virginian's health beliefs influence participation in health care programs and must be considered in the development of interventions to improve health. The long-range goal of this research program is to prevent the development and progression of coronary heart disease in atrisk children and their parents. The objective for this application is to identify and reduce the health belief barriers to an existing cholesterol screening program in this high-risk, rural, poor population. The existing program, Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) has a four year history of providing no cost dyslipidemia testing to fifth grade children and their parents. The specific aims for this

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proposal are: (1) To identify health beliefs that act as barriers to participation in the dyslipidemia screening program and to develop belief-based strategies to reduce those barriers, and (2) To improve the identification of children and families who are at-risk for the development of CHD. Research Design and Methods: The Theory of Planned Behavior will provide the theoretical framework for identifying beliefs barriers and developing interventions to address them. Belief barriers to participation in the dyslipidemia detection program will be initially identified through interviews with children, parents, and community leaders in rural West Virginia. The reliability and validity of interview responses will be assessed through administration of general and study-specific health beliefs questionnaires to a larger, random sample of children and adults. A Health Beliefs (HB) approach will be developed for the screening and diagnosis phases of the dyslipidemia detection program. The new HB approach will be compared to the standard CARDIAC (SC) approach in a randomized controlled trial. Three thousand fifth grade students in fourteen counties will be randomly assigned to receive either the HB or SC approach. Participants will be followed through screening and diagnosis. The HB and SC approaches will be compared on participation rates for children and parents. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EDUCATION AND AWARENESS FOR LIFE THAT'S HEALTHY Principal Investigator & Institution: Addison, Clifton; Jackson State University Jackson, Ms 39217 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: Purpose and Specific Aims of the PROJECT. Mississippi has not developed any comprehensive programs to address CVD disparities even though many researchers have reported that overall mortality and cardiovascular disease mortality are higher in African Americans than whites. One important challenge for preventing the onset of cardiovascular disease is to decrease the number of people who are engaged in unhealthy lifestyle behaviors, such as sedentary lifestyle practices, inappropriate dietary practices, and the incidence of overweight among young people. Project HEALTH will provide intervention programs that are designed to increase intrinsic motivation for youth to participate in fitness activity, in achieving this goal the intervention also hopes to increase participant self-esteem, establish more harmonious relationships with peers and educate youth on the necessity of fitness to promote health and prevent debilitating diseases, which afflict minority populations at higher rates than the general population. Project HEALTH will design intervention programs to change the trends that currently exist relating to cardiovascular disease among African Americans in Mississippi. This study hopes to reduce overweight in children because it is well known that being overweight during childhood and adolescence has been associated with increased adult mortality 1. Weight in adolescence is considered to be a good measure of future adult weight status and is a good predictor of the occurrence of later adverse health reports, hence the importance of preventing obesity in children. Researchers conclude that school intervention, especially the case of classroom-based intervention, is effective for preventing future cardiovascular disease. It is predicted that there would be a reduction of 5% to 25% in the rate of coronary heart disease if all sedentary individuals could become physically active 2. One primary benefit of regular physical activity is protection against cardiovascular disease. A well designed exercise program can increase stamina and endurance, lower blood pressure, improve blood cholesterol levels, help with weight control, help lower abnormal blood sugar levels, reduce stress, improve sleep, and help prevent osteoporosis 3 Harshfield et al. (1990) found that less fit African

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American males and females had higher systolic and diastolic pressures than more fit adolescents 4 Danforth et al. (1990) found that in low socio-economic African American youth, a 12-week aerobic exercise program could decrease blood pressure readings significantly. Furthermore, exercise seemed to lower cholesterol and helped to maintain recommended weight, particularly when combined with good nutrition. Given the problem of health disparities in minority populations and its prevalence and acute nature in Mississippi, ways and means of successfully motivating youth to a fit, active lifestyle becomes a desired goal. The study also seeks to decrease the development of cardiovascular disease by decreasing the number of students who are engaged in unhealthy lifestyle behaviors, such as inappropriate dietary practices, and to increase students' self-esteem. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF MEDITATION ON MECHANISMS OF CHD Principal Investigator & Institution: Bairey Merz, C. Noel.; Associate Professor and Medical Director; Cedars-Sinai Medical Center Box 48750, 8700 Beverly Blvd Los Angeles, Ca 900481804 Timing: Fiscal Year 2000; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: Coronary heart disease (CHD) is the leading cause of death, disability, and health care costs in the US. The majority of CHD patients continue to have acute cardiac events, many sudden and unexpected, despite identification and treatment of their disease and attention to the traditional risk factors. The pathophysiologic bases of these cardiac events are not fully established, but substantial evidence indicates that psychosocial stress and resulting sympathetic nervous system imbalance are major contributors. Evidence indicates that psychosocial stress and a hyperresponsive sympathetic nervous system have adverse effects on both vasomotor function and longterm autonomic balance. Recent advances in our understanding of the pathophysiology of acute cardiac events-specifically, identification of the roles that arterial vasomotor dysfunction and autonomic nervous system imbalances play in the interplay of psychosomatic stress and CHD. Preliminary evidence further suggests that Complementary and Alternative Medicine (CAM) practices, such as the Transcendental Meditation (TM) technique, can not only reduce stress but also reduce acute cardiac events in patients with CHD. Based on these and related data, we propose a randomized, blinded, controlled study of the effects of one CAM practice, the TM technique, compared to a control group, on the primary outcomes of (1) arterial vasomotor dysfunction (brachial artery reactivity); (2) autonomic nervous system imbalances (heart rate variability); (3) transient ambulatory myocardial ischemia (ST segment depression); and (4) the secondary outcomes of psychological stress and quality of life (anger, hostility, anxiety, depression, perceived health, disease-specific symptoms, and life stress/social resources). We hypothesize that significance effects on these physiological and psychological mechanisms associated with practice of the TM program will elucidate the known effectiveness of certain CAM techniques as additive/alternative approaches to prevention of acute cardiac events in CHD patients. Results of this randomized controlled trial will: (a) yield new data regarding the reversal of pathophysiological mechanisms underlying CHD, (b) provide mechanism data to complement our ongoing NIH- sponsored trial of this CAM practices on CVD-related mortality, and (c) provide pilot data for an expanded study of the effect of the TM technique on the pathophysiological mechanisms underlying acute cardiac events. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OUTCOMES

ENDODONTIC

INFLAMMATION

AND

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Principal Investigator & Institution: Caplan, Daniel J.; Assistant Professor; Dental Ecology; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 10-JUL-2001; Project End 30-JUN-2004 Summary: Several large-scale epidemiologic investigations have uncovered relationships between chronic periodontal disease and adverse cardiovascular outcomes such as coronary heart disease and stroke. To date, endodontic inflammation has not received the same attention despite its being a commonly found sequel to bacterial infection of the Dental pulp space and its having several important characteristics in common with inflammation of periodontal origin. These similarities form the basis of the proposed epidemiologic study, which seeks to test the hypothesis that a greater history of endodontic inflammation is associated with 1) increased risk of coronary heart disease and stroke; and 2) increased carotid artery intimal-medial thickness and prevalence of coronary heart disease. These hypotheses will be addressed by linking data from three large, well-established, ongoing epidemiologic studies of aging populations with newly collected variables involving endodontic disease and treatment. Two of the three sub-studies (from populations of adult men in Boston and adult women in Sweden) will employ a review of existing intra- and extra-oral radiographs to assess variables related to apical periodontitis and frequency and quality of root canal therapy, and will relate these exposures to subsequent incidence of coronary heart disease and stroke. The third sub-study (from adult populations in four U.S. communities) will compare self-reports of endodontic treatment with prevalence of coronary heart disease and thickened carotid arterial walls in a cross-sectional fashion. Given the relatively high frequency of endodontic inflammation among adult populations, the proposed study describes a straightforward, fast, and inexpensive way to gain preliminary insight into the relationship between endodontic and cardiovascular disease. It also will serve as the epidemiologic foundation for future investigations into endodontic disease and other systemic outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ENDOTHELIN-1-CARDIOMYOPATHY

A

NEW

PLAYER

IN

DIABETIC

Principal Investigator & Institution: Schwartz, Dean D.; Vet Microbiology and Pathology; Auburn University at Auburn Auburn University, Al 36849 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG-2003 Summary: Applicant's Abstract Diabetes mellitus is a metabolic disorder recently identified as a strong independent risk factor for cardiovascular disease. Both Type 1 and 2 diabetes mellitus have been linked to a marked increase in the incidence of heart failure and mortality associated with coronary heart disease. Diabetic cardiomyopathy, an independent clinical syndrome, is characterized by diastolic dysfunction, abnormalities in systolic function and histological changes that occur with or without coronary artery disease. The specific etiological mechanism(s) responsible for the cardiormyopathy observed in diabetic patients and experimental models of diabetes has not been clearly defined. However, the direct effects of abnormal carbohydrate metabolism and excessive fatty acid oxidation have been implicated as important proximate causes in diabetic cardiomyopathy. We propose that another factor contributing to altered cardiac energy metabolism and function associated with diabetic

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cardiomyopathy is the bioactive peptide, endothelin-1 (ET-1). In this application, we present preliminary data demonstrating that diabetic rats have elevated plasma and tissue levels of ET-1, decreased cardiac mechanical function and decreased tissue fructose-2,6-bisphosphate (F26P2) levels compared to vehicle-treated rats eight weeks after induction with streptozotocin. Furthermore, in isolated ventricular myocytes. ET-1 inhibits glucose uptake, glycolysis and F26P2 production, possibly by a protein kinase C (PKC)-dependent mechanism. We therefore hypothesize that the progressive decline in cardiac metabolism and function observed in the diabetic patient is due in part to the metabolic effects of ET-1, which augment the already altered cardiac metabolism produced by insulin deficiency/resistance and subsequent elevations in free fatty acid levels. To test this hypothesis, the following specific aims will be examined in streptozotocin (STZ)- and vehicle-treated rats: 1) Determine the cellular effects of ET-1 on cardiac glucose uptake and utilization in isolated ventricular myocytes; 2) Examine endothelin-insulin myocardial receptor signaling crosstalk in isolated ventricular myocytes and the effect of protein kinase C activation on this crosstalk; and 3) Determine the time course for the pathological effects of ET-1 on cardiac metabolism, PKC activation and function in vivo in diabetic rats using the endothelin receptor antagonist bosentan. In summary, this application will delineate the connections between altered intracellular signaling between ET-1 and insulin as they relate to glucose utilization, protein kinase C activation and myocyte function, and examine the relation between altered energy metabolism and myocardial function in diabetes mellitus. (End of Abstract) Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ENHANCING SUPPORT FOR WOMEN AT RISK FOR HEART DISEASE Principal Investigator & Institution: Toobert, Deborah J.; Research Scientist; Oregon Research Institute Eugene, or 97403 Timing: Fiscal Year 2002; Project Start 12-APR-1999; Project End 31-MAR-2005 Summary: ABSTRACT=The overall goal of this project is to test a practical, theorybased intervention to achieve long-term behavior change for women with Type 2 diabetes at high risk for developing coronary heart disease (CHD). Epidemiological and clinical studies suggest that diabetes is associated with increased risk for CHD that is greater in women than in men. CHD is a major cause of death and functional limitations in women, but the vast majority of CHD studies have primarily involved middle-aged men. There is convincing research evidence that healthy lifestyle behaviors, including low-fat diet, physical activity, stress management, smoking cessation, and social support, can reduce CHD risk. We will conduct a randomized trial to compare shortterm (6-month) outcomes in women receiving usual care compared to a modified Ornish-type comprehensive lifestyle management (CLM) intervention. After 6 months, women in the CLM condition will be randomized to one of two approaches for providing support either lay-led group support or personalized computer-based support - to evaluate these strategies in enhancing longer-term maintenance of effects. Outcomes will include multiple CHD lifestyle behaviors (e.g., dietary intake, exercise levels, stress management, smoking cessation), physiological risk factors associated with CHD (e.g., serum lipids, hypertension, weight, vascular reactivity), HbA1c and quality of life (e.g., depression, functioning). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EPIDEMIOLOGY OF CAROTID ARTERY ATHEROSCLEROSIS IN YOUTH Principal Investigator & Institution: Davis, Patricia H.; Neurology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 30-SEP-1995; Project End 31-MAR-2004 Summary: (Adapted from Investigator's Abstract) The atherosclerotic process begins in childhood and progresses through adult life resulting in coronary heart disease (CHD), stroke, and peripheral vascular disease. There is a need to identify young people at risk for premature atherosclerosis so that preventive measures can be instituted before occlusive vascular disease occurs. The ultrasonic measurement of carotid intimal-medial thickness (IMT) allows detection of early atherosclerosis and is related to incident CHD and stroke in older adults. In 1970, a population of school age children and adolescents was first examined in Muscatine, Iowa. A sample of 776 members of this longitudinal cohort, who are representative of the initial childhood population, is now aged 37 to 45 years. Their risk factors were measured in childhood, young adulthood and twice in later adult life, and they have undergone measurement of carotid IMT as well as electron beam computed tomography to identify coronary artery calcification (CAC). In this cohort, carotid IMT is significantly associated with CAC as well as current LDL cholesterol and systolic blood pressure, but only 14 percent of carotid IMT variability can be explained by these risk factors. Parents of the cohort have been assessed for cardiovascular morbidity and mortality. In this application the investigators propose to do the following: (1) examine the third generation to determine whether the offspring of cohort members with premature atherosclerosis and/or a familial history of cardiovascular disease have increased carotid IMT or elevated risk factors; (2) identify risk factors for progression of carotid IMT over four years in this cohort; and (3) measure putative risk factors for increased IMT (serologic evidence of Clamydia pneumoniae or cytomegalovirus infection, high sensitivity C-reactive protein, fibrinogen, plasminogen activator inhibitor-1 and glycosylated hemoglobin). The investigators state that the study has the potential of providing information which would allow identification of subjects at risk for atherosclerosis at an early age and may lead the way to interventions to halt or slow progression of atherosclerosis prior to the development of clinical disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EPIDEMIOLOGY OF CHD OF MEN AGED 40+ IN US, HAWAII, JAPAN Principal Investigator & Institution: Curb, J David.; Pacific Health Research Institute 846 S Hotel St, Ste 303 Honolulu, Hi 96813 Timing: Fiscal Year 2003; Project Start 05-SEP-2003; Project End 31-JUL-2007 Summary: (provided by applicant): Substantial change toward a more Westernized lifestyle has taken place among younger individuals who were born after World War II (WWII) in non-Western countries including Japan. Data from national sample surveys in Japan clearly demonstrate that risk factor profiles for coronary heart disease (CHD) are very similar to those in the United States (US) in this post WWII cohort. Men in Japan do have a considerably higher prevalence of cigarette smoking and men in the US have a higher prevalence of obesity. CHD mortality among men in Japan is, however, still less than a half of that in the US. Careful review of mortality statistics confirms this. This difference remains unique among industrialized countries. The investigators propose to test the null hypothesis that there are no differences in the extent of atherosclerosis

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among Japanese men in Japan, Japanese American men in Hawaii, and US white and black men in this post WWII birth cohort. This project will be based on recent and ongoing successful Japan/US collaborations in the INTERMAP, INTERLIPID and Honolulu Heart Program studies including development of the first standardized US/Japan diet tables. We will examine 300 white men and 100 black men aged 40-49, randomly selected from Allegheny County, PA, 300 Japanese American men aged 40-49 from the population-based sample recruited from the offspring of the members of the Honolulu Heart Program cohort, and 300 Japanese men aged 40-49, randomly selected from Kusatsu City, Japan. The Japanese recruitment and examination has already been supported in Japan. The extent of atherosclerosis and risk factor profiles for CHD will be evaluated and compared, as well as the relationship of specific risk factors to the measures of atherosclerosis. The measures of subclinical disease proposed include calcium scores of coronary artery and aorta measured by electron beam computed tomography (EBCT) and carotid intima thickness measured by ultrasound. Other proposed measures include dietary intake by food frequency questionnaire, total cholesterol, LDLc, HDLc, lipids by NMR spectroscopy, blood pressure, cigarette smoking, thiocyanate, omega-3 fatty acid, alcohol consumption, body mass index (BMI), intra-abdominal fat, and others. Better understanding the reasons for the low Japanese rates may help us find new methods for prevention of CHD in all populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF CORONARY CALCIFICATION IN THE ELDERLY Principal Investigator & Institution: Newman, Anne B.; Associate Professor of Medicine and Epid; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 15-AUG-1999; Project End 31-JUL-2006 Summary: Recent studies indicate that coronary artery calcium is a strong predictor of coronary heart disease events in middle- aged men and women. We examined the extent and predictors of coronary artery calcium and its relationship to other noninvasive measures of atherosclerosis in 614 (89 percent) of the surviving cohort from the Pittsburgh center of the Cardiovascular Health Study (CHS). These individuals were ages 67-99 (mean 80). Key findings have been reported and include: 1) Coronary artery calcium scores were strongly age related, yet the range of scores was quite broad. Ten percent had scores of zero. 2) Other non- invasive vascular tests missed many of those with high coronary calcium scores. 3) Other than age, gender and race, traditional risk factors were relatively weak predictors of calcification. We now propose to follow these individuals to determine whether coronary artery calcification predicts cardiovascular disease and mortality in old age, and whether this is independent of other non-invasive measures of disease and traditional risk factors. The alternative hypothesis is that the risk is attenuated in old age, as it may represent stable plaque that is less prone to occlusion or rupture. The CHS is ending the ascertainment of outcomes at the end of 2001, necessitating additional funding for local follow-up of this cohort. In addition to monitoring cardiovascular events, we will evaluate the functional significance of the extent of calcification by an exercise test and will assess progression after 4 years by repeating the EBT scan, and determine the rate of new calcification in those with scores of zero at baseline. Such individuals with no calcium might be regarded as "immune from coronary artery disease." The specific aims are: 1) To determine whether the extent of coronary artery calcium is an independent predictor of total and incident myocardial infarction and total CVD morbidity and mortality in older adults. 2) To determine the

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functional significance of coronary artery calcification in about 312 of these older adults without clinical cardiovascular disease. 3) To determine the rate of progression over 4 years in coronary artery calcium score in an estimated 424 survivors and to determine if those with zero (n=47) develop any calcification. This study can determine the risk of cardiovascular disease events in relationship to coronary artery calcium in older adults in a time-efficient and cost- effective manner that capitalizes on the rich CHS database. This is the largest population study of coronary artery calcium in this older age group, and can rapidly produce definitive data to determine the potential for benefit of screening older adults for coronary artery calcium. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF CORONARY HEART DISEASE OF MEN AGED 40+ Principal Investigator & Institution: Sekikawa, Akira; Epidemiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 05-SEP-2003; Project End 31-JUL-2007 Summary: (provided by applicant): Substantial change toward a more Westernized lifestyle has taken place among younger individuals who were born after World War II (WWII) in non-Western countries including Japan. Data from national sample surveys in Japan clearly demonstrate that risk factor profiles for coronary heart disease (CHD) are very similar to those in the United States (US) in this post WWII cohort. Men in Japan do have a considerably higher prevalence of cigarette smoking and men in the US have a higher prevalence of obesity. CHD mortality among men in Japan is, however, still less than a half of that in the US. Careful review of mortality statistics confirms this. This difference remains unique among industrialized countries. The investigators propose to test the null hypothesis that there are no differences in the extent of atherosclerosis among Japanese men in Japan, Japanese American men in Hawaii, and US white and black men in this post WWII birth cohort. This project will be based on recent and ongoing successful Japan/US collaborations in the INTERMAP, INTERLIPID and Honolulu Heart Program studies including development of the first standardized US/Japan diet tables. We will examine 300 white men and 100 black men aged 40-49, randomly selected from Allegheny County, PA, 300 Japanese American men aged 40-49 from the population-based sample recruited from the offspring of the members of the Honolulu Heart Program cohort, and 300 Japanese men aged 40-49, randomly selected from Kusatsu City, Japan. The Japanese recruitment and examination has already been supported in Japan. The extent of atherosclerosis and risk factor profiles for CHD will be evaluated and compared, as well as the relationship of specific risk factors to the measures of atherosclerosis. The measures of subclinical disease proposed include calcium scores of coronary artery and aorta measured by electron beam computed tomography (EBCT) and carotid intima thickness measured by ultrasound. Other proposed measures include dietary intake by food frequency questionnaire, total cholesterol, LDLc, HDLc, lipids by NMR spectroscopy, blood pressure, cigarette smoking, thiocyanate, omega-3 fatty acid, alcohol consumption, body mass index (BMI), intra-abdominal fat, and others. Better understanding the reasons for the low Japanese rates may help us find new methods for prevention of CHD in all populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ESTROGEN AND EXERCISE--VASCULAR BENEFITS AFTER MENOPAUSE Principal Investigator & Institution: Brownley, Kimberly A.; Psychiatry; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 15-SEP-2000; Project End 31-AUG-2005 Summary: (Adapted from the applicant's abstract) This application describes a 5-year career development training program for Dr. Kim Brownley. The program includes extensive research and pedagogical training designed to facilitate her growth as an independent researcher investigating combination modality therapies in high-risk cardiac patient populations. The plan is structured around a randomized placebocontrolled study of raloxifene and aerobic exercise training in hypertensive postmenopausal women. Dr. Kathleen Light, whose expertise is in cardiovascular stress responses, hypertension, and hormone (estrogen) replacement therapy (HRT), will serve as mentor. A collaborative support team is also in place, including: 1) Dr. James Blumenthal, who specializes in exercise training interventions in coronary heart disease (CHD); and 2) Alan Hinderliter, M.D. (Cardiology consultant), who will provide training in ultrasound measurement of cardiovascular function, and oversee data interpretation from a clinical perspective. The proposed study will investigate cardiovascular, neuroendocrine, and metabolic functioning in borderline and stage I hypertensive postmenopausal women. This patient group is at increased CHD risk due to elevations in blood pressure (BP), insulin resistance, and low-density lipoproteins. HRT and exercise training can offset these harmful effects by enhancing vasodilatory processes, and their effects may be additive when combined. HRT improves cardiovascular and neuroendocrine function; yet despite these benefits, HRT use and compliance are low because of added cancer risks in some women. Raloxifene, a secondgeneration nonsteroidal selective anti-estrogen, has beneficial lipid and osteogenic effects but does not confer added cancer risks. However, the cardiovascular effects of raloxifene are unspecified. Also, HRT has only modest BP-reducing effects and is thus insufficient antihypertensive therapy for hypertensive postmenopausal women. In contrast, exercise training has robust BP-reducing potential, especially in hypertensive individuals. Therefore, after all subjects complete a 3-month intervention with raloxifene alone, they will be randomized to either an additional 3-month treatment with raloxifene alone or treatment with raloxifene plus exercise training. Pre- and posttreatment assessments will include: 1) impedance cardiography measures of hemodynamic responses to laboratory challenge, 2) 24-hour ambulatory BP and impedance cardiography monitoring, 3) echocardiography assessment of left-ventricular geometry and function, 4) B-mode ultrasound assessment of flow-mediated brachial artery dilatation, 5) assay of neuroendocrine and lipid levels at rest and in response to laboratory stress, and 6) euglycemic insulin clamp to assess insulin sensitivity. Implementation of this training will provide a unique and highly advantageous opportunity for Dr. Brownley to work with this team of senior scientist- practitioners within the collaborative environments of the University of North Carolina and Duke University. This investigation, coupled with the didactic experiences outlined in this plan, will lay the foundation for her future endeavors as a scientific advocate for the systematic investigation of underlying mechanisms of hypertensive heart disease, and for the delivery of effective combination behavioral and pharmacological interventions for stress- related cardiovascular disorders in patients at increased risk for CHD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ESTROGEN, INFLAMMATION AND CARDIOVASCULAR RISK Principal Investigator & Institution: Reuben, David B.; Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2004 Summary: (provided by applicant): The effects of exogenous estrogen on coronary heart disease are controversial. Substantial observational data support a protective effect and several randomized clinical trials have demonstrated that estrogen produces a more favorable lipid profile. Yet, when administered for secondary prevention in the Heart and Estrogen/Progestin Replacement Study (HERS) and Estrogen Replacement and Atherosclerosis (ERA) trials, estrogen had no overall benefit. In HERS, estrogen use was associated with an increase in early events but a late reduction in risk. These conflicting data suggest the need for additional exploration of the effect of estrogen on the risk factors and precipitants of coronary heart disease. Peripheral blood markers of inflammation, specifically C-reactive protein (CRP) and interleukins, have been increasingly recognized as predictors of cardiovascular events and suggest new pathophysiologic mechanisms. However, the effects of estrogen upon inflammatory markers and their subsequent impact upon endothelial function are still unclear. This study will use data from the NHLBI-funded Postmenopausal Estrogen Progestin Intervention (PEPI) randomized clinical trial to assess the effect of conjugated equine estrogens (CEE) with or without progestins upon two peripheral blood inflammatory markers, CRP and IL-6, and their subsequent effects on other cardiovascular risk factors. We will also examine the relation of exogenous CEE on sex hormone-binding globulin (SHBG), a hepatic protein whose production is independent of inflammation but is stimulated by CEE. Assays for IL-6, CRP, and SHBG will be performed on longitudinal stored serum samples and these results will be linked to extensive socio-demographic, lifestyle, and clinical information already collected in the PEPI clinical trial. We hypothesize that CEE will create unfavorable risk profiles of inflammatory markers (higher IL-6 and higher CRP) during the first year of therapy but these patterns will change toward more favorable profiles (lower IL-6 despite continued higher CRP) with continued treatment. We also hypothesize that the continued stimulation of CRP beyond the first year will be through a non- inflammatory effect on liver protein production (similar to estrogen's stimulation of sex hormone-binding globulin SHBG) rather than IL-6 mediated. These findings may provide substantial insight into why CEE appears to promote early but protect against late cardiovascular effects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ETHANOL, NITRIC OXIDE AND CORONARY HEART DISEASE Principal Investigator & Institution: Demaster, Eugene G.; Pharmacology; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 01-JUN-2001; Project End 30-SEP-2003 Summary: Epidemiological studies conducted over the last several decades consistently show that light to moderate alcohol consumption protects the heart against coronary artery disease. The major protective properties of alcoholic beverages reside with ethanol itself rather than with bioflavinoids/ antioxidants present in some of these beverages, although the latter may possess certain beneficial biological properties distinct from ethanol. Historically, this protection has been attributed to an ethanolinduced increase in one of the subfractions of HDL in plasma; however, this increase in HDL is now regarded to account for only a minor part of the observed protection by ethanol. The antithrombotic properties of alcohol also continue to it beneficial effect, but

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a specific molecular mechanism connecting these properties to alcohol has not been forthcoming. We are proposing that nitric oxide (NO) mediates the protective effects of ethanol on the cardiovasculature, including the antithrombotic properties of ethanol, through the NO-cyclic GMP (cGMP) signal transduction pathway. According to our mechanism, protection by ethanol occurs via an enhancement of the NO activation of guanylate cyclase by products of ethanol metabolism. The key specific objectives of this proposal are to show that (a) ethanol metabolism promotes the catalase-catalyzed oxidation of NO to NO2 and (b) NO2 is a more potent activator of guanylate cyclase than NO itself. We propose that ethanol drives the catalase-mediated NO oxidation reaction via a cascade of well established metabolic conversions that result in increased production of hydrogen peroxide. The two-electron oxidation of NO to NO2 by catalase and the subsequent activation of guanylate cyclase by NO2 are two biochemical steps that we have undertaken to establish as fact. These two steps are critical to our understanding of the overall mechanism for the protection of the cardiovasculature provided by ethanol. Moreover, because ethanol and its metabolites as well as NO alter or regulate cellular processes in almost every tissue and body organ, we anticipate that the biochemical mechanisms described here for the interaction between ethanol and the NO-cGMP signaling pathway likely have relevance beyond the cell types located within the cardiovascular system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EVALUATION OF CHD IN MEN AND WOMEN PRIOR TO FIRST AMI Principal Investigator & Institution: Yawn, Barbara P.; Director of Research; Olmsted Medical Group Box 4300, 210 9Th St Se Rochester, Mn 55904 Timing: Fiscal Year 2002; Project Start 29-SEP-2000; Project End 31-AUG-2004 Summary: Coronary heart disease (CHD) is the leading cause of death in women in the United States. The recent proliferation of studies of woman and heart disease suggest that women may receive less aggressive treatment and thereby missing the important pre- and peri-CHD diagnostic phase. A recent vignette study confirmed a gender bis in proposed evaluation rather than actual practice information. No studies have addressed the possible the possible existence of gender differences in the critical pre- CHD diagnostic phase nor incorporated observed practice data across the total spectrum of primary to tertiary care. This study will focus on the important pre-diagnostic or differential diagnosis (hypothesis activation) phase. We will describe and compare the recorded CHD-related symptoms and their evaluation as well as timing of the CHD diagnosis in women and men during the ten years prior to their first acute myocardial infarction (AMI). In addition, we will describe and compare the evaluation and treatment of CHD risk factors in the ten years prior to the first AMI. These data will allow us to identify gender differences in timing of CHD diagnoses prior to AMI and differences in physician response to men and women's symptoms. Our extensive data collection will allow exploration of the association of other factors such as risk status, comorbidity and age with gender differences in CHD-related testing or treatment. Control subjects (both men and women) who do not have known CHD will provide information on the role of prior probabilities on non-cardiac disease in gender differences in the evaluation of possible cardiac symptoms. The retrospective of look-back design starting at the time of the subject's first AMI, assures that subjects have CHD and will achieve greater efficiency in design than would be possible using a prospective cohort study. It also avoids the Hawthorne effect that might be observed in a clinical trial. Using a unique community population-based dataset maintained for > 70 years on all residents

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of Olmsted County avoids referral bias and will allow access to data from the entire spectrum of care, from primary ambulatory to tertiary hospital care. The information obtained will help fill important gaps in existing knowledge regarding gender differences in the recognition and evaluation of CHD. In addition, we will provide specific information on current gender-related practice patterns. This information can be used to inform future practice recommendations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FHS--CENTRAL LABORATORY Principal Investigator & Institution: Eckfeldt, John H.; Lab Medicine and Pathology; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 1999; Project Start 15-AUG-1996; Project End 31-JUL-2004 Summary: (Adapted from the applicants' abstract) FHS: Molecular Genetics and Genetic Epidemiology is submitted collaboratively by seven research groups including four clinical sites (University of North Carolina; Boston University; University of Minnesota; and University of Utah), a molecular biology laboratory (University of Utah), a coordinating center (Washington University, St. Louis, MO), a chemistry laboratory (University of Minnesota). The proposed study will perform state-of-the-art molecular genetic and genetic epidemiology studies using the extensive data on family and medical histories, risk factors, life style, blood specimens and banked DNA, previously collected by the Family Heart Study (FHS). The purpose is to identify and characterize genes of coronary heart disease (CHD) and atherosclerosis, familial environmental factors and behavioral characteristics, and to advance our understanding of how they interact with one another in the development of clinical outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FOLIC ACID & HOMOCYSTEINE-- DOSE RESPONSE STUDY Principal Investigator & Institution: Beresford, Shirley A.; Professor; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: We will examine chronically stressed individuals (spouse caregivers of persons with Alzheimer's disease (AD). Spouse caregivers lose the companionship and support of their AD spouses. These losses, coupled with chronic physical, emotional and financial demands (1, 2) as well as biobehavioral vulnerabilities, put spouse caregivers at increased risk for psychophysiological distress and physical health problems (3). In previous work with caregivers and matched controls, we studied a variety of psychobehavioral (e.g., hassles, anger/hostility, exercise, diet) and physiological measures. Of the metabolic, cardiovascular (CV), and immune measures examined, metabolic variables (Body Mass Index/obesity, insulin, and glucose) showed the strongest relationships with caregiving, whereas CV measures showed some relationships. These results lead us to focus now on metabolic/neuroendocrine measures. Such measures qualify as mediators of the relationship between caregiving and coronary heart disease (CHD) because they are related to both stress and CHD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Coronary Heart Disease

Project Title: FRAMINGHAM OFFSPRING STUDY: PSYCHOSOCIAL RISK FACTORS Principal Investigator & Institution: Eaker, Elaine D.; Eaker Epidemiology Enterprises, Llc 8975 County Rd, V Chili, Wi 544209506 Timing: Fiscal Year 2002; Project Start 01-MAY-2001; Project End 31-OCT-2003 Summary: (Provided by Applicant) The outstanding design and methods of the Framingham Offspring Study offers the next major step in understanding how behavioral, psychological, and social factors not only contribute to health and illness, but also interact with biological factors to influence health outcomes. A unique data set of social, psychological, and behavioral measures were collected at the third examination of the Offspring Study from 1984 through 1987 (which results in 14 to 17 years of follow-up). Hypotheses for this research are focused toward understanding the sex and age differences in the effects these variables have on health endpoints. The research questions involve the prediction of three separate endpoints: incidence of coronary heart disease; the incidence and prognosis of atrial fibrillation; and total mortality. The analyses of psychosocial predictors for these outcomes are divided into four conceptual areas: 1) occupational status and strain, income, and employment status; 2) type A behavior, expressions of anger, hostility, and rate; 3) symptoms of depression, tension, anxiety, and feelings of aloneness; and 4) marital relationships and marital strain. These psychosocial variables will be analyzed jointly with the physiological risk factors collected at the same time to assess independence and interaction of effects. To date these psychosocial data have not been analyzed or published. There are many studies that have examined the associations between psychological and social characteristics and cardiovascular morbidity and mortality. Findings from these studies, however, are often conflicting and may result from inadequate study designs (e.g., case-control where psychosocial assessment takes place after the health event of interest), use of different measures or scales, study of noncomparable populations, or defining different outcomes. The strength of the Framingham Study involves longitudinal data collection; large numbers of both men and women; a standard and thorough follow-up protocol; careful assessment of heart disease and mortality endpoints; collection of information on other risk factors for disease and death concurrently with psychosocial risk factors (enabling the examination of and control for confounding or causal pathways); and the ability to examine the interrelationships between a number of different psychosocial risk factors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENE-BY-SMOKING ATHEROSCLEROSIS

INTERACTION

AND

RISK

OF

Principal Investigator & Institution: North, Kari E.; Epidemiology; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2006 Summary: (provided by applicant): While cigarette smoking is a well-established and potent risk factor for atherosclerotic vascular disease, individual susceptibility to smoking varies considerably, suggesting modifiers such as genomic variation. Several key enzymes involved in the activation and detoxification of mutagenic tobacco smoke compounds, oxidative stress, and DNA damage are expressed in the tissues of the heart and vasculature and represent mechanistic pathways for tobacco-induced pathology. Many of these enzymes have common polymorphisms (greater than or equal too 10% prevalence in the population) with known functional effects. Although restricted to a

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few enzymes and hampered by shortcomings in design, a small number of studies have suggested that enzymatic activation and detoxification of tobacco smoke modifies the risk of certain cardiovascular outcomes associated with cigarette smoking. The main goal of the proposed study is to evaluate common genetic polymorphisms that, in combination with exposure to tobacco smoke, may modify the risk of atherosclerosis and its clinical sequelae. An average of six polymorphisms, selected on the basis of their prevalence and functional significance, expression in relevant tissues, evaluation in previous studies and biologic plausibility, within 19 genes involved in activation, detoxification, oxidative stress, and DNA repair pathways will be evaluated as an ancillary study to the Atherosclerosis Risk in Communities (ARIC) study. In this wellcharacterized, bi-ethnic cohort of 15,792 men and women under active follow-up since 1987-89 (completeness of follow-up 96%), five endpoints quantifying subclinical atherosclerosis and validated clinical atherosclerotic events will be studied in casecohort/case-control mode: incident coronary heart disease, carotid atherosclerosis, peripheral arterial disease, incident stroke, and MRI-detected cerebral infarcts. The proposed investigation is well designed to study how DNA sequence polymorphisms can promote or inhibit the atherogenic effects of smoking and the risk of clinical events, and to contribute new knowledge on the role of genetic variation in the response to environmental insults and toxicants. The findings are expected to be of clinical and public health significance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENE-DIET INTERACTIONS AND HEART DISEASE Principal Investigator & Institution: Campos, Hannia; Nutrition; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-AUG-1999; Project End 31-JUL-2004 Summary: Evidence is building from epidemiological and laboratory investigations to support the hypothesis that genetic variation can modulate the effect of dietary intake on metabolic parameters to promote atherosclerosis and increase the incidence of coronary heart disease (CHD). Technological advances in molecular and nutritional epidemiology now make it possible to study gene-diet interactions and CHD in human populations at a new level of sophistication. The overall goal of this project is to carry out a population-based case-control study in 2,150 cases of myocardial infarction and 2,150 matched controls from Costa Rica, to test specific hypotheses relating gene-diet induced atherosclerosis susceptibility (GDAS) markers to CHD. Twelve GDAS markers were selected for this study. GDAS markers are defined as common genetic variants that modulate the effect of intake of specific fatty acids, tocopherols, and carotenoids on atherosclerosis. We will determine whether carriers of the GDAS marker variants are at increased risk of CHD compared to wild type homozygotes when exposed to high intakes of lauric 12:0, myristic 14:0, and palmitic 16:0, and trans fatty acids particularly 18:2 trans from partially hydrogenated soybean oil. We will study whether high intakes of alpha-linolenic acid, vitamin E, carotene, particularly alpha- carotene, lutein, and lycopene reduce the risk of CHD, and whether the GDAS marker variants alleles lessen this protective effect. In secondary analyses, we will test the hypotheses that the GDAS variant alleles influence the effect of dietary fiber, cholesterol, physical activity, and smoking on CHD. Haplotypes of metabolically related GDAS markers that are better predictors of CHD than individual markers alone will be established, and for each haplotype, we will determine specific adverse dietary patterns. Dietary exposure variables will be evaluated by simultaneous analyses of a semi-quantitative food frequency questionnaire, and biochemical measures of intake including adipose tissue

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Coronary Heart Disease

tocopherols and carotenoids by HPLC, and fatty acids, including trans isomers of partially hydrogenated soybean oil by GC. This study will provide the most complete data set to study numerous hypotheses relating genes, diet, and CHD, and could lead to specific targeted interventions for reducing the development of CHD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETICS OF INSULIN RESISTANCE IN PCOS: THE PPAR PATHWAY Principal Investigator & Institution: Talbott, Evelyn O.; Faculty; Epidemiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 30-JUN-2005 Summary: (provided by applicant): Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by chronic anovulation, hyperandrogenism, and insulin resistance with an estimated prevalence of 5-10% among all women. Family studies have indicated a genetic predisposition to the development of PCOS and several candidate PCOS susceptibility genes have been explored. Thus far, pedigree studies have mainly focused on steroidogenic pathway dysfunction in women with little success in determining a genetic basis for PCOS. It has more recently been postulated that insulin resistance, rather than hyperandrogenism, is the central defect in PCOS. Peroxisome proliferator-activated receptor gamma (PPAR [gamma]) has been indicated as a potential candidate gene for insulin resistance in Type 2 diabetes. No studies to date have focused on the PPAR. pathway and insulin resistance in PCOS probands and their family members. Given the high prevalence of PCOS and its association with coronary heart disease, PCOS may represent the largest, unique group of women at high-risk for the development of coronary heart disease (CHD). Thus understanding the etiology of PCOS may have a large public health impact for women. This pilot study will examine extended pedigrees by analyzing linkage using both parametric and non-parametric methods in five multigeneration, multiplex families (N= 125). We will explore genetic mechanisms through the following specific aims by: (1) demonstrating our ability to enroll both PCOS probands and their multi generation, multiplex family members to study insulin resistance markers in families with PCOS and (2) genotyping five probands and their multigeneration, multiplex family members for single nucteotide polymorphisms (SNPs) at or near candidate genes P12A and IRS-1 and microsatellite markers near candidate genes lipoprotein lipase and acetyI-CoA carboxylase, to test for linkage of PCOS with these candidate genes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENTS

GENHAT-GENETICS

OF

HYPERTENSION

ASSOCIATED

Principal Investigator & Institution: Arnett, Donna K.; Associate Professor; Epidemiology; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: The Genetics of Hypertension Associated Treatments (GenHAT) is proposed as a prospective study to examine whether the association between selected hypertensive genes and combined fatal coronary heart disease and nonfatal myocardial infarction in high-risk hypertensives is modified by the type of antihypertensive treatment, leading to differential risks of coronary heart disease (CHD). Such genetreatment interactions might shed important light On the variation in patient response

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to antihypertensive agents, and improve our ability to pick the right antihypertensive for specific patients. GenHAT will be an ancillary study to ALLHAT (the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). ALLHAT recruited 42,515 hypertensives and randomized them to one of four antihypertensive agents (lisinopril, chlorthalidone, amlodipine, and doxazosin); followup will be completed in March, 2002. GenHAT will characterize hypertension genetic variants and determine their interaction with antihypertensive treatments in relation to CHD. DNA from frozen clots stored at the ALLHAT Central Laboratory will be used to genotype variants of hypertension genes (angiotensinogen -6, angiotensin converting enzyme insertion/deletion, angiotensin type- 1 receptor, alpha-adducin, beta2 adrenergic receptor, lipoprotein lipase, and 10 new hypertension variants expected to be discovered during the course of the study). In addition to the primary aim, a number of secondary aims will be undertaken to evaluate gene- treatment interactions in relation to other endpoints, including all-cause mortality, stroke, heart failure, left ventricular hypertrophy, decreased renal function, peripheral arterial disease, and blood pressure lowering. Because of the ethnic and gender diversity of ALLHAT, we will also assess effects of these variants on outcomes in key subgroups (age >65 years, women, African Americans, Type II diabetics), and whether the gene-treatment interactions in relation to outcomes are consistent across subgroups. This proposal has the advantages of (1) incorporation into an already funded clinical trial, and (2) collaboration with experienced investigators in genetic analysis (Drs. Boerwinkle and Eckfeldt) and clinical trials (Drs. Davis and Ford). It will, therefore, provide an important and cost-efficient contribution to the knowledge and understanding of the treatment of hypertension. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEART DISEASE IN RHEUMATOID ARTHRITIS Principal Investigator & Institution: Gabriel, Sherine E.; Professor; Mayo Clinic Coll of Medicine, Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2005 Summary: (Applicant's Abstract) The hypotheses to be tested in this proposal are built on findings from two intriguing, but rather disparate lines of investigation. The first is the recent data suggesting that the excess mortality experienced by people with rheumatoid arthritis (RA) may result from increased rates of coronary heart disease (CHD) among RA patients compared to the general population. The second is the rapidly growing body of evidence indicating that chronic systemic inflammation (such as that which occurs in RA) plays an important role of chronic inflammation in CHD. We propose 3 specific aims to investigate this subject: First, we will use a cohort study to test the hypothesis that the incidence of acute MI (the central manifestation of CHD) is higher in RA subjects compared to controls. Second, we will identify high-risk RA subgroups and, using a novel adaptation of the case-cohort design, investigate interactions between RA and the major CHD risk factors (e.g. smoking, hyperlipidemia, exogenous estrogens). Third, we will conduct studies on archived autopsy heart tissue to test the hypothesis that coronary atherosclerosis is more extensive in RA subjects compared to matched controls. A unique set of circumstances allows us to address each of these aims rigorously and efficiently. We will incorporate and extend our already assembled population-based RA incidence cohort and identify validated definite acute MI outcomes using the cardiovascular surveillance techniques developed through out NIH-funded companion study, "Coronary Disease Morbidity and Mortality in a Population" (HL59205). Our population-based data resources, with essentially complete enumeration of a geographically defined population, allowed us to design an analytic

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plan which nearly quadruples the statistical power of our risk factor analyses, compared with typical cohort analyses. Third, the availability of extensive autopsy material (the autopsy rate in this community is four-fold higher than the national rate and all autopsies have been performed at the same center since 1930) provides us with a unique opportunity to assess the pathologic characteristics of atherosclerosis among RA subjects compared to controls. When combined with our experienced multidisciplinary investigative team, these resources lend us a capability, not available elsewhere, to rigorously examine the risks and determinants of coronary heart disease in patients with RA. These results will lay the foundation for a program of research aimed at elucidating the mechanisms for CHD in RA patients and at improving our understanding of the role of inflammation in the pathogenesis of CHD in the general population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEART FAILURE IN THE COMMUNITY Principal Investigator & Institution: Roger, Veronique L.; Mayo Clinic Coll of Medicine, Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2003; Project Start 15-JAN-2003; Project End 31-DEC-2006 Summary: (provided by applicant): Heart failure (HF) is designated as an emerging epidemic. Yet, it is not fully characterized. Most data, derived from hospital discharges, cannot measure incidence, have uncertain validity and cannot capture the full burden of HF because of the shift towards outpatient care. Regarding its etiology, the respective role of hypertension and coronary heart disease (CHD) is controversial. Moreover, the prevalence of obesity and diabetes mellitus is increasing, both conditions linked to HF via several mechanisms such that their contribution to HF could conceivably be increasing but remains to be examined. Finally, while the existence of diastolic HF is recognized, its diagnosis is exclusionary based on symptoms of HF in the absence of LV systolic dysfunction. This approach is unsatisfactory, thus the contribution of DHF to HF remains contentious. These striking gaps in knowledge underscore the necessity of a rigorous investigation of the HF epidemic. Through surveillance of the Olmsted County community, we demonstrated the postponement of CHD towards older ages and the decline over time in the severity of hospitalized MI and the incidence of HF after MI. This implies that, if CHD is the main cause of HF, HF should be postponed towards older ages and its incidence rate relatively stable. During the same period, preliminary findings on HF surveillance suggest that the incidence of first clinical diagnosis of HF may not be increasing as much as implied by hospital discharges and that adverse trends may be occurring preferentially among younger ages. These data from the same community are challenging to reconcile with the concept of an ongoing major contribution of CHD to an epidemic of HF, thereby underscoring the need to rigorously study the epidemiology of HF, which is the focus of this application. We propose 3 specific aims and a community surveillance approach, integrated with our ongoing work on CHD surveillance to investigate the HF epidemic in Olmsted County by characterizing its magnitude and determinants and studying prospectively the contribution of DHF. Aim 1 will estimate the secular trends in the incidence and in the outcome of validated HF to test the hypotheses that there has been an increase in the incidence of HF, which differs by age and sex and that the survival of HF improved while hospitalization for HF has increased. Aim 2 will use a case-control approach to characterize the etiology of HF and its changes over time to test the hypotheses that CHD and hypertension confer an excess risk of HF, the magnitude of which is declining over time, that obesity and diabetes mellitus confer an excess risk of HF the magnitude

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of which is increasing and that the population attributable risk of CHD and hypertension for HF is declining, while that of obesity and diabetes mellitus is increasing over time. Aim 3 will prospectively characterize the contribution of DHF to HF using brain natriuretic peptide (BNP) among persons with HF and define the prognostic value of BNP in all cases of HF. Thus, the completion of these aims will provide important insights into the epidemiology of HF. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEART CARDIOVASCULAR

RATE

VARIABILITY

AND

OUTCOME

IN

THE

Principal Investigator & Institution: Stein, Phyllis K.; Professor; Barnes-Jewish Hospital Ms 90-94-212 St. Louis, Mo 63110 Timing: Fiscal Year 2002; Project Start 05-FEB-2000; Project End 31-AUG-2003 Summary: We will investigate whether standard and newer indices of heart rate variability (HRV) enhance the prediction of clinical and functional outcomes in the Cardiovascular Health Study (CHS). The CHS, an NIH-sponsored population-based longitudinal study of the risk factors for coronary heart disease and stroke in 5,201 men and women aged 65 years and older, includes ambulatory ECG recordings on a subset of 1432 participants at baseline, repeated in 862 during exam year 7-8, and recordings in an additional 387 minority participants in exam year 5. Although measurement of HRV, which quantifies beat-to-beat changes in the normal rhythm of the heart, was among the original purposes of the ambulatory ECG monitoring, only a limited index (5-minute averaged time domain HRV) was determined, and beat-to-beat data were not saved. Thus a more in depth analysis of HRV is impossible without re-analyzing the tapes. Time domain indices of HRV provide generalized information about cardiac autonomic modulation, but frequency domain indices of HRV, because they partition the variance in the heart rate into distinct frequency bands, provide a more precise picture and can provide insights into circadian patterns of the autonomic modulation of the heart. Also, frequency domain HRV has been a better predictor of outcome than time domain HRV. Heart rate tachograms will be generated which reveal periodic and other heart rhythms. The prognostic value of newer HRV indices which provide information independent of that from standard HRV will be determined. To perform frequency domain and other analysis of HRV in the CHS, the tapes will be re-scanned and the beat-to-beat data saved in electronics format. In addition to determining if HRV enhances prediction of outcome in the CHS, the detailed relationship between cardiac autonomic modulation and clinical and functional health in the CHS will be investigated. The changes in HRV over time in healthy older adults will be determined. We will investigate whether there is an effect of gender or race on the relationship between HRV and aging in healthy adults. Clinical outcomes will include cardiovascular and non-cardiovascular morbidity and mortality. Health may also be defined as maintaining the ability to carry out activities of daily living for as long as possible. Therefore, we will also consider the predictive value of HRV for functional status and describe the detailed HRV profile of those who are functionally healthy at baseline and remain so upon follow up. Furthermore, the data generated will provide the basis for a number of studies about HRV and clinical and functional parameters that otherwise would require a large number of separate investigations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HOSTILITY, MARITAL INTERACTION AND HEALTH IN AGING Principal Investigator & Institution: Smith, Timothy W.; Department Chair; Psychology; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002; Project Start 01-JUN-2001; Project End 31-MAY-2005 Summary: Hostility confers increased risk of coronary heart disease, presumably through the mechanism of cardiovascular reactivity to interpersonal stressors. Marriage is an important context for this mechanism. However, an adult developmental perspective suggests that marital conflict may be a more central issue for trait hostility among middle- aged spouses, whereas the stress of collaboration may be important for hostility in older couples. Guided by a model of individual, spouse, and couple effects of hostility, the proposed study examines the effects of hostility on immediate behavioral and psychophysiological responses to marital conflict and collaboration, and on health outcomes of ambulatory blood pressure, coronary artery disease, marital adjustment, and cognitive functioning. The major aims are to examine (a) how the effect of hostility on behavioral and cardiovascular responses may differ for middle-aged and older adults, during conflict and collaborative problem solving, (b) the effect of hostility on ambulatory blood pressure and coronary artery disease, and (c) the role of hostility in the frequency and quality of collaborative problem solving. One-hundred and fifty middle-aged (40-50 years) and 150 older married couples (60-70 years) will be involved in a 4-day study. Hostility will be measured in a multi-method approach with interview, self-report, and spouse report measures. Marital interaction will be examined as couples discuss a source of marital conflict and solve a planning task. Interaction will be coded for components typical of interactions of hostile persons and also detrimental to collaborative cognition. Psychophysiological reactivity will be examined via blood pressure, heart rate, and impedance cardiography during the two tasks. The effects of hostility will be examined on health outcomes such as coronary artery disease (assessed via computed tomography) ambulatory blood pressure, marital adjustment, and general cognitive function (e.g., fluid and crystallized intelligence). The long-term goal of the research is to identify potentially modifiable determinants of cardiovascular risk, marital adjustment, and cognitive aging in adulthood. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMPACT OF LIFESKILLS TRAINING ON BLOOD PRESSURE IN YOUTH Principal Investigator & Institution: Barnes, Vernon A.; Williams Lifeskills, Inc. 2020 W Main St, Ste 100 Durham, Nc 27705 Timing: Fiscal Year 2003; Project Start 25-SEP-2003; Project End 31-AUG-2004 Summary: (provided by investigator): Essential hypertension (EH) affects one out of four adults and is a primary risk factor for coronary heart disease (CHD), the leading cause of death in the US. Essential hypertension (EH) has its patho-biologic origins in childhood. Since blood pressure (BP) ranking tracks from late childhood onward, adolescents with high normal BP are at risk for development of EH. Clinical research has shown behavioral interventions to have great promise in reducing BP levels. To date few such programs targeting students have been implemented in the high school setting. This application requests support to adapt the Williams LifeSkills (WLS) workshop (a protocol-driven 12-session stress/anger management workshop) for use in high schools. This study will develop an innovative intervention designed to reduce ambulatory BP, BP reactivity to stress, hostility, anger, and school-related problem behaviors among a population of adolescents with high normal BP. The specific aim of

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Phase I is to identify adaptations in format and timing necessary to successfully conduct the 12-session WLS Workshop in a high school setting. This aim will be accomplished through-- a) focus groups and interviews with students to guide fine-tuning of the program content; b) conducting two pilot cycles of workshop, to obtain feedback from the students regarding course content, style of presentation and materials. This project will adapt a highly developed anger/stress management program that will become available for Health Education curriculums in schools across the country. If successful, this project presents a tremendous potential for not only reduction in hostility, anger and school-related conduct problems, but more importantly for prevention of cardiovascular disease via reduced BP and a concomitant enormous reduction in health care costs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INFLAMMATORY MARKERS AND IMPROVING CHD RISK ASSESSMENT Principal Investigator & Institution: Wilson, Peter W.; Professor of Endocrinology; Medicine; Medical University of South Carolina P O Box 250854 Charleston, Sc 29425 Timing: Fiscal Year 2003; Project Start 19-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): This application responds to laboratory, analytical, and collaborative components mentioned in the RFA. Specifically, we propose to integrate epidemiological risk factor information with a decision analytical approach, using existing data sets and stored biological specimens, and establishing a multidisciplinary collaboration between the FHS, Boston University Medical Center, Boston University Mathematics Department and the Tufts University Human Nutrition Research Center on Aging. Aim 1. To test the utility of homocysteine (tHcy) (to be measured), C-reactive protein (CRP) (to be measured), lipoprotein (a) [Lp(a] (already determined) as predictors of coronary heart disease (CHD) over and above traditional risk factor measures. Levels of these markers will be determined with a nested case cohort design, utilizing a baseline examination that includes already obtained information on conventional risk factors for the Framingham Offspring and 12 years of follow up for cardiovascular disease events. New measurements of hsCRP will be made in the Framingham laboratory and homocysteine will be done at Tufts University by Dr. Jacob Selhub. Aim 2. To test the ability of new factors (tHcy, CRP and Lp[a]) at different levels of coronary risk as assessed by using the traditional risk factors alone, considering 0-6%, 6-20% and >20% initial risk of a coronary event. The utility of newer risk measures to predict an increase in the absolute risk of coronary events at pre-specified absolute levels of risk will be estimated. Aim 3. To develop new CHD risk prediction equations that will incorporate CRP and homocysteine measurements to assess the risk of coronary heart disease. This aim will include estimates of CHD risk over 12 years for the second generation Offspring and will incorporate data from the older first generation cohort where homocysteine and CRP have already been measured and 12 years of follow up for coronary disease events is also available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: JAPANESE AMERICAN COMMUNITY DIABETES STUDY Principal Investigator & Institution: Boyko, Edward J.; Professor; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002

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Coronary Heart Disease

Summary: This longitudinal study examines the relationship of environmental factors in the development of the insulin resistance syndrome (hyperinsulinemia, central obesity, glucose intolerance, hypertension, dyslipidemia, and coronary heart disease) in Japanese Americans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LAY CHD REPRESENTATIONS AND WOMEN'S SELF REFERRAL FOR MI Principal Investigator & Institution: Martin, Rene E.; Psychology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: This application seeks three years of support to investigate how lay people's cognitive representations of coronary heart disease (CHD) contribute to delays in seeking medical are for symptoms of myocardial infarction (MI), with an emphasis on female victims. In a correlational study, 1,114 post-MI patients and approximately 777 support providers will be interviewed. Analyses will (1) identify gender differences in pre- hospital symptom perceptions, symptom attributions, self-care activities, treatmentseeking behaviors, and perceptions of CHD vulnerability and the implications of such gender differences in self-referral for acute MI; (2) examine the impact of social influence processes in the lay evaluation of cardiac symptoms, including gender differences in information- seeking, advice received from support providers, and pre-hospital interactions with individual possessing medical expertise; and (3) determine whether gender differences in the response to acute MI symptoms are manifested even after controlling for victim age, ethnicity, education, prior CHD knowledge and experience, socioeconomic status, medical status, living arrangements, social support network, and other individual differences. The proposed research will focus on differences in lay CHD cognitive representations that may account for intervention after the onset of cardiac-related symptoms. The proposed project will provide fundamental information to nurses and other health care providers about how the lay interpretation of cardiac symptoms is influenced by the victim's gender, age, and other factors. Finally, the knowledge gained from the proposed project is likely to represent a vital contribution in the development of programmatic nursing interventions targeted at the facilitation of self-referral behaviors and the provision of optimal health care to both women and men at risk of CHD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MARITAL ADJUSTMENT, DEPRESSION AND MYOCARDIAL INFARCTION Principal Investigator & Institution: Gallo, Linda C.; Psychology; San Diego State University 5250 Campanile Dr San Diego, Ca 92182 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Depression and Coronary Heart Disease (CHD) are each prevalent disorders, which frequently co-occur. Approximately 15-23% of individuals recovering from a heart attack (e.g., myocardial infarction; MI) will meet criteria for major depression and up to 65% will experience elevations in depressive symptoms. Yet, history of depression and disease severity are only moderately predictive of this co-morbidity. Importantly, depression is embedded within social context and, in particular, depression is strongly associated with marital adjustment. The primary goal of the current research is to examine if individuals with worse marital

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adjustment experience higher levels and a more persistent course of depressive symptoms following MI, in a 6-mo, 3-wave, prospective study of 150 men and women. Some research suggests that marital distress and depressive symptoms are more closely linked in women than in men. Therefore, the current research will examine if gender moderates the associations between marital adjustment and level and course of depression, with the hypothesis that associations will be stronger for women than for men. Previous research suggests that depression and possibly marital adjustment represent risk factors for negative physical health outcomes following MI. Further, when psychosocial risk factors occur in combination, the probability of negative outcomes is likely to increase substantially due to additive or synergistic effects. A secondary goal of the study will therefore be to examine the joint and independent effects of depression and marital adjustment on quality of life, functional status, and the probability of recurrent events following Ml. Women may experience worse outcomes following MI, and psychosocial factors could contribute to this trend. The proposed research will therefore examine if gender moderates the relationships between depression, marital adjustment, and health outcomes following CHD, with the hypothesis that effects will be stronger for women than for men. The broader goal of the proposed research is to identify aspects of social functioning that could represent potent, modifiable risk factors for CHD and depression co-morbidity, in the hopes of informing more effective prevention and intervention efforts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MODERATE ALCOHOL USE & HEALTH: PREFERENCES & OUTCOMES Principal Investigator & Institution: Mukamal, Kenneth J.; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2002; Project Start 25-SEP-1999; Project End 31-AUG-2004 Summary: This proposal seeks a Mentored Patient-Oriented Research Career Development Award. The candidate proposes to use this award to foster a research career in the study of the effect of moderate alcohol consumption on specific health measures. The aims of the career development plan are fourfold: (1) to develop methodologic expertise in eliciting personal preferences and values from individuals, particularly related to alcohol use; (2) to gain experience in quantifying the effect of behavioral factors on designated health outcomes amongst groups of patients; (3) to develop expertise in the use of decision analysis to inform patient decision-making by combining personal preferences and outcomes data; and (4) to use the results of these studies to establish research independence. In a structured program, the applicant will receive formal training at the Harvard School of Public Health and graduated supervision from Murray Mittleman, MD, DrPH, an active investigator in the behavioral determinants of heart disease at Beth Israel Deaconess Medical Center in Boston. These career development goals closely parallel the research plan, which will employ them as they are mastered in succession. The overall aim of the research program is to understand how individuals view the competing risks and benefits of moderate alcohol consumption and how those competing factors actually influence health. The research program will comprise three related studies: (1) development of a survey instrument to be administered by the applicant to patients in different outpatient settings to determine their preferences about moderate alcohol consumption and its effects; (2) analysis of the effect of alcohol use on survival following acute myocardial infarction in the Determinants of Myocardial Infarction Onset Study; and (3) assessment of the populationwide effect of moderate alcohol use on total mortality with the Coronary

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Heart Disease Policy Model, using the survey results to refine the applicability of the Policy Model findings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR EPIDEMIOLOGY OF ESSENTIAL HYPERTENSION Principal Investigator & Institution: Boerwinkle, Eric A.; Professor; Human Genetics Center; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2002; Project Start 08-JUL-1994; Project End 31-MAY-2004 Summary: Increased arterial blood pressure [BP] in the absence of known causes, essential hypertension [EHYT], is a significant risk factor for coronary heart disease, cerebrovascular disease and renal disease, and reaches epidemic proportions in both non-Hispanic Whites and African-Americans in the United States. In the previous cycle of this research, we evaluated the influence of variation in established candidate genes on variation in BP levels in the population at large and carried out the first genome wide linkage analysis to identify new BP candidate genes (i.e. positional candidate genes). In this proposed cycle of research, we will use DNA sequencing to identify variation in the coding and regulatory regions of newly identified positional candidate genes, and carry out association analyses between this DNA sequence variation and BP levels and EHYT status. In Aim 1, we will use high through-put DNA sequencing in 24 non-Hispanic Whites and 24 African-Americans to identify DNA sequence variation in the coding and 5' regulatory regions of each positional candidate gene. To accomplish Aim 2, we will type the variable sites identified in Aim 1 in a sample of 573 randomly ascertained threegeneration pedigrees containing 3,938 individuals from Rochester, MN, and 515 hypertension cases and 471 normotensive controls from Jackson, MS. We will then use graphical and statistical methods, including transmission disequilibrium tests [TDTs] and regression tree methods, to evaluate the relationship between the DNA sequence variation and the distribution of systolic and diastolic BP and EHYT status. We will also determine whether the influence of the genetic variation is homogeneous among strata defined by gender, age, body size, smoking status and population. The studies proposed here will move us one step closer to defining functional allelic variation influencing interindividual variation in BP levels and the risk of developing EHYT in the population-at-large. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MONITORING COMMUNITY TRENDS IN HEART FAILURE Principal Investigator & Institution: Goldberg, Robert J.; Professor; Medicine; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, Ma 01655 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2007 Summary: (provided by applicant): Heart failure is a syndrome of profound clinical and public health importance. Heart failure (HF) is estimated to contribute to nearly 1 million hospitalizations and approximately 250,000 deaths annually in the U.S. The number of new cases of HF in the U.S. is estimated to exceed 400,000 annually. Though reliable estimates of the magnitude, incidence, and mortality of HF remain sorely lacking, HF is associated with a grim prognosis. However, little recent data exist, particularly from a community-wide perspective, to determine whether the incidence or survival associated with HF, and the management of this clinical syndrome, has changed over time. This study proposes to examine temporal trends (1995 and 2000) in the incidence rates of HF, its therapeutic management, and changes over time in the hospital and long-term survival of patients with HF from a multi-hospital, population-

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based perspective. The study will take place in residents of the Worcester (MA) metropolitan area (1990 census 437,000) and will examine changes over time in these and additional outcomes for patients with validated HF during 1995 and 2000. Complimenting the hospital surveillance of HF, newly diagnosed cases of HF occurring in members of the largest HMO in Central Massachusetts during 1995 and 2000 will be identified and monitored over time. The proposed project will build on the investigators' clinical and epidemiological experience and on data collection efforts and methodologies used in the ongoing community-wide study of coronary heart disease in greater Worcester residents. To accomplish the study objectives, the medical records of residents of the Worcester metropolitan area hospitalized with a discharge diagnosis of HF and related diagnostic rubrics will be individually reviewed and validated according to pre-established diagnostic criteria. The use of traditional criteria for HF as well as development of new criteria for the epidemiological study of HF will be an important focus of this observational study. Records for additional hospitalizations and death certificates will be reviewed to examine trends in long-term survival of discharged hospital patients through the year 2005. The results of this study will provide much needed information about the epidemiology of HF from a more generalizable population-based perspective. Information would be provided about the clinical and descriptive epidemiology of this prevalent and disabling condition in men and women and individuals of different age groups. The proposed surveillance system will provide insights and guidance to public health and clinical efforts of HF and in monitoring trends in this newly emerging chronic disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NURSING INTERVENTIONS TO REDUCE CORONARY RISK Principal Investigator & Institution: Becker, Diane M.; Professor of Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2002 Summary: A. Hypotheses Studies, primarily in white populations, have demonstrated that only 50-70% of premature coronary heart disease (CHD) is accounted for by known traditional risk factors (hypertension, dyslipidemias, and smoking). Several newly identified "nontraditional" risk factors appear promising in explaining a greater portion of CHD. We have shown that occult disease can be identified in asymptomatic apparently healthy siblings of persons with CHD prior to 60 years of age. Certain risk profiles discriminate those with and without occult disease. Further, occult disease at baseline has predicted subsequent CHD events. Virtually no family studies have included a sufficient sample of African Americans. Our hypotheses are proposed for the 480 African American brothers and sisters of persons with premature CHD being accrued in a new National Heart Lung and Blood (NHLBI) Intervention Study commencing April 1, 1998. Hypothesis 1: Traditional risk factors (hypertension, hypercholesterolemia, low HDL cholesterol, obesity (BMI >27), current smoking, increased left ventricular mass and glucose will be significantly associated with occult coronary ischemia. Hypothesis 2: Nontraditional risk factors elevated levels of serum insulin, fibrinogen, apolipoprotein B, homocysteine, and Lp(a)) will be significantly associated with occult coronary ischemia. Hypothesis 3: There will be a significant relationship between abnormal carotid wall intimal thickness and /or carotid plaque and the presence of occult coronary ischemia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OCCUPATIONAL HEALTH GRADIENTS IN HOSPITAL WORKERS: THE Principal Investigator & Institution: Blanc, Paul D.; Professor of Medicine; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 28-SEP-2000; Project End 31-AUG-2005 Summary: (Taken from the Investigators' Abstract) Socioeconomic gradients in health status are ubiquitous in space, persistent in time, and pervasive across diverse health outcomes. Yet little is known of how they arise, and specifically, how great a contribution is made to them by working conditions during adult life. Existing occupational cohort studies, such as the landmark Whitehall publications, have failed to convince some observers that work-related "psychosocial" exposures, e.g., the degree of control felt by employees over their jobs, constitute the key causal influences responsible for socioeconomic gradients in the health of the general adult population, especially gradients in chronic disease. Largely missing in the debate thus far is high-quality evidence on gradients from workplaces with a wide range of jobs -- Whitehall, for example, is fundamentally an office worker study. The present proposal is premised on the view that rich insights into the genesis of such health "gradients" may be gained by studying in detail, over some years, a workplace, such as a hospital, that has a very wide range of jobs, and of employees from different social classes. By far the major "shortterm" occupational health problem of this workforce, and many others, is work-related musculoskeletal disorders (WRMSDs) -- a broad class of outcomes including low back pain and upper extremity injuries, such as tendinitis and carpal tunnel syndrome. Both psychosocial and physical-ergonomic exposures at work are now thought to be joint determinants of these musculoskeletal problems. Thus, psychosocial aspects of work are increasingly recognized as risk factors for both sorts of illness processes: traumatic and chronic disease. Yet there appears to be a dearth of research linking socioeconomic and job-category disparities in the risk of WRMSDs, with well-known gradients in many longer-term health outcomes, particularly coronary heart disease and its risk factors (such as hypertension). The investigators propose a study to shed light on the nature and multi-factorial etiology of hospital gradients, across job categories and employee social class backgrounds, in the occurrence of several potentially work-related health outcomes in hospitals. The outcomes studied will be lost-time, work-related musculoskeletal disorders, non-invasive measures of allostatic load (salivary cortisol and blood pressure), overall health-related quality-of-life and injury-specific functional status, mental health status, and total sickness/injury absence from work. The influence of both directly observed physical-ergonomic factors at work and psychosocial occupational exposures on socioeconomic gradients in the risk of these conditions will be assessed. Finally they propose to examine, through qualitative research methods, the social contextual factors within participating hospitals, which influence working conditions. The study team will also work with a labor-management team to develop possible interventions for the problems that are identified by this study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OXIDATIVE MODIFICATIONS OF PROTEINS AND FIBRINOGEN IN ATHEROGENESIS Principal Investigator & Institution: Ischiropoulos, Harry; Associate Professor; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 31-MAR-2007

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Summary: (provided by the applicant): A potential major cause of vascular injury leading to the development of atherosclerosis is oxidative stress. Oxidative stress is the result of overproduction of reactive species that overwhelms the cellular antioxidant capacity leading to inactivation of key cellular functions and ultimately to cell death. Proteins are major targets of reactive species, and nitration of tyrosine residues is a selective protein modification induced by reactive nitrogen species in human disorders as well as animal and cellular models of disease. We have discovered that circulating fibrinogen is nitrated in patients with acute respiratory distress syndrome (ARDS). Nitration of fibrinogen significantly altered the function of fibrinogen by accelerating the rate of fibrin clot formation producing of fibrin clot with abnormal structure upon electron microscopic examination. Fibrin deposits are abundant in the lungs of patients with ARDS, a common complication of hemorrhagic injury and sepsis, and likely the result of abnormal clotting rather than failure in the fibrinolytic pathways, which are functioning normally in ARDS patients. A number of epidemiological studies have indicated that high levels of circulating fibrinogen is an independent predictor of coronary heart disease and in some cases of premature death from cardiovascular and heart disease although a causative correlation between high levels of fibrinogen and cardiovascular disease has not been established. Based on these data we developed the hypothesis that plasma protein nitration is a marker of oxidative stress and independent predictor of coronary heart disease and that nitration of fibrinogen is a critical posttranslational modification responsible for abnormal functioning of the hemostatic system in atherosclerosis. To test the critical aspects of this hypothesis we propose to: 1) Quantify by the use of LC-MS the levels of 3-nitrotyrosine, dityrosine, the oxidation product of tyrosine and 3- chlorotyrosine, a marker of inflammation, in plasma proteins of smokers and nicotine users (Project 1), subjects in the prospective study of progression in coronary plaque burden (Project 5), the Apobec-l/LDLR double knock out mouse (Project 1) and in the plasma of mice with altered ApoA-I levels (Project 5). Evaluate the degree of nitration of specific proteins, fibrinogen, LDL/ApoB-100, and determine the site(s) of tyrosine nitration by the use of the Proteomics Core. 2) Evaluate the effects of nitration and/or oxidation on the biochemical, biophysical and viscoelastic properties of fibrinogen and fibrin clots by the use of scanning and transmission electron microscopy, and a Plazek torsion pendulum. 3) Determine the effect of nitration on critical functional aspects of fibrinogen and fibrin clot, ADP-induced platelet aggregation, endothelial cell gene expression (Genomics Core), endothelialinflammatory cell interaction (in collaboration with Project 3), and kinetics of fibrinolysis. Overall this project is focused on investigating the possible biochemical and biophysical mechanisms that may underline abnormalities in the hemostatic factors that regulate critical pro- and anti-thrombotic functions in human cardiovascular disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PDAY CARDIOVASCULAR SPECIMEN AND DATA LIBRARY Principal Investigator & Institution: Strong, Jack P.; Boyd Professor and Head; Pathology; Louisiana State Univ Hsc New Orleans New Orleans, La 70112 Timing: Fiscal Year 2002; Project Start 01-AUG-1998; Project End 31-JUL-2003 Summary: (Adapted from the applicant's abstract) This project is for the maintenance of the specimen and data base emanating from the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) and Risk Factors in Early Human Atherogenesis (RFEHA) studies (PDAY Archive) so that it can be used effectively by investigators for continued study of atherosclerosis during the next five years. PDAY and RFEHA were investigator-initiated multi-center cooperative studies based on a rigidly developed

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protocol, which had anatomically standardized samples of aorta and coronary arteries of 3,000 young black and white subjects, age 15-34, who died suddenly of trauma. Risk factor data was also obtained in a majority of the cases. So far these studies have yielded over 75 publications by the PDAY group. These reports in turn have generated a widespread enthusiastic response from investigators throughout the scientific community in the U.S. and abroad. Many of these investigators are currently utilizing or planning to utilize the PDAY Archive as a resource for their studies on atherosclerosis and coronary heart disease. This unique resource, the PDAY Archive, should continue to contribute in important ways to our understanding of atherosclerosis, the underlying cause of coronary heart disease (CHD) and most strokes. CHD and stroke are by far the leading cause of debilitating illnesses and death in this country. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PERIODONTAL DISEASE AND RECURRENT CHD EVENTS Principal Investigator & Institution: Trevisan, Maurizio M.; Professor and Chair; Social and Preventive Medicine; State University of New York at Buffalo Suite 211 Ub Commons Buffalo, Ny 14228 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 30-JUN-2005 Summary: (Adapted from the Investigator's Abstract) This study will analyze the association between periodontal disease and recurrent coronary heart disease (CHD) in individuals who have survived a myocardial infarction (MI). The overall goal is to test the hypothesis that periodontal disease is a significant and independent risk factor for recurrent CHD events. In addition potential mechanisms linking periodontal disease to CHD events will be investigated. At baseline 1,200 participants will undergo a detailed interview and health examination that will include information on lifestyle, sociodemographic, and anthropometric variables and CVD risk factors, and a complete oral health examination including measurement of clinical attachment levels and radiographic assessment of interproximal alveolar crestal height. The two aims are to examine the association between recurrent heart disease and periodontal disease as measured by gingival attachment level and radiographic assessment, and to examine the association between recurrent heart disease and levels of bacterial infection. Participants will be followed prospectively annually for an average of 3 years. The investigators state that the proposed study should provide important new information about the temporal association between periodontal disease and CHD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PLANT-BASED DIETRY INTERVENTION IN TYPE 2 DIABETES Principal Investigator & Institution: Barnard, Neal D.; Physicians Committee for Responsible Med Responsible Medicine Washington, Dc 20016 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Diabetes often leads to serious complications, including coronary heart disease, kidney disease, and blindness, among others. Previous studies have suggested that low-fat, plant-based diets can have a strongly favorable effect on the management of type 2 diabetes mellitus, as well as on the elevations of body weight and serum cholesterol that often accompany it, reducing the risk of complications, and raising the possibility of reducing or even eliminating medication use for many individuals. Evidence suggests that the dietary recommendations that are most effective in diabetes management may be similar to the low-fat, vegetarian diets that have demonstrated utility in reversing coronary artery

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blockages. However, no study to date has examined the effect of a low-fat, vegetarian diet as an intervention for diabetes in a substantial number of participants, and most studies using plant-based (near-vegetarian) diets have also included exercise as a major intervention component, making it impossible to separate the effects of physical activity from those of diet or to reach any definitive conclusion as to which type of dietary intervention is best. This study, which follows an encouraging preliminary trial reported in Preventive Medicine in 1999, will test the hypothesis that a low-fat, vegetarian diet yields significant improvements in key indices of diabetic control, including glycosylated hemoglobin, fasting serum glucose and insulin concentrations, microalbuminuria, and medication requirements, as well as in cardiovascular risk factors, such as body weight, serum lipids, and blood pressure, in a 22-week intervention controlled throughout for exercise, with a 1-year follow-up. Sixty-eight volunteers with type 2 diabetes will be randomly assigned to a low-fat, vegan (intervention) diet or a control diet deriving 15-20percent of energy from protein and < 7percent of energy from saturated fats, with carbohydrate and monounsaturated fats together providing 60-70percent of energy intake, based on current American Diabetes Association guidelines. Participants in both groups will be asked to attend weekly meetings for nutrition and cooking instruction and group support, and will be asked not to alter their exercise patterns. Physical activity will be monitored by use of the Bouchard 3-Day Physical Activity Record. (Bouchard 1983) Diets will be assessed at baseline and 11, 22, and 74 weeks, using a 3-day dietary record. Fasting serum glucose will be monitored for the study duration and will be used to adjust medications according to a set protocol. Glycosylated hemoglobin, insulin concentrations, 24-hour urinary albumin, body weight, blood pressure, serum lipids, and related cardiovascular risk factors will be measured at baseline, 22 weeks, and 74 weeks. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREDICTING SYSTOLIC BP CONTROL IN THE ELDERLY Principal Investigator & Institution: Bailey, Kent R.; Professor; Mayo Clinic Coll of Medicine, Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2004 Summary: NHANES III data show that fewer than 30% of patients who are hypertensive have been treated to the goal blood pressure of less than 140/90 mm Hg. Older patients are more likely to have uncontrolled blood pressure than are younger patients. The SHIELD Study revealed that 41% of people over the age of 65 years and 65% of African Americans over that age have poorly controlled hypertension. Poor blood pressure control also disproportionately causes cardiovascular disease in patient over 60. Systolic blood pressure is the primary predictor in this age group for the development of stroke, congestive heat failure (most common reason for hospitalization in the elderly), renal failure and coronary heart disease. There is even exciting new data showing that control of systolic blood pressure in the elderly reduces the risk for the development of Alzheimer?s dementia. Failure to achieve blood pressure control is determined by three factors: physician practice (behavior), antihypertensive medication efficacy, and adherence to the prescribed medications (patient factors). Our study proposes to develop models that describe each of these factors independently and then develop a model that encompasses all three factors. Specific Aim 1 will identify and quantify differences in physician response to elevated systolic blood pressure in hypertensive patients greater than 60 years of age compared to their younger counterparts. Specific Aim 2 will analyze the differences in responsiveness of systolic blood pressure to treatment regimens using one or more antihypertensive medications. Specific Aim 3

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examines adherence and postulates that adherence is the same between younger and older hypertensives. This study is to be conducted using a unique clinical database. Over 7,000 patients with more than 25,000 observations are present in the Mayo Clinic Rochester Hypertension Continuity Clinic Database. This Sybase database is well constructed to answer the important questions posed in Aims 1-3 regarding the management of hypertension. This study will provide significant and generalizable answers to the question of why control rates for systolic hypertension remain low and will provide direction for altering clinical practice to reduce cardiovascular morbidity and mortality among older hypertensives. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROSPECTIVE STUDY OF HEALTH IN RUNNERS AND WALKERS Principal Investigator & Institution: Williams, Paul T.; Nuclear Science Division; University of Calif-Lawrenc Berkeley Lab Lawrence Berkeley National Laboratory Berkeley, Ca 94720 Timing: Fiscal Year 2002; Project Start 01-JUN-1998; Project End 31-MAY-2004 Summary: (Adapted from Investigator's Abstract) Current government physical fitness guidelines state that: 1) the majority of the health benefits from physical activity can be obtained by walking 2 miles briskly on most days of the week; and 2) the health benefits of physical activity depend principally on the total amount of activity rather than the intensity of the activity. Nevertheless, there are currently no prospective epidemiological studies extant, designed specifically to directly contrast the health benefits and costs of moderate exercise (e.g., walking) versus vigorous exercise (e.g., running). The proposed study plans to compare rates of coronary heart disease (CHD), cancer, total mortality and exercise injuries in 68,000 runners and 68,000 walkers during four years of surveillance. Questionnaires concerning running and other physical activities in 56,000 runners have already been obtained, and additional questionnaires from 13,000 runners are expected before March 1997. The runners will be resurveyed in 1997 along with 68,000 walkers. The walkers will also be solicited through the publication of the questionnaire in Walking magazine followed by a direct mailing of the questionnaire to 425,000 subscribers. Total and cause-specific mortality will be determined from the National Death Index; fatal and nonfatal cancers will be identified from the SEER and 46 state registries; nonfatal coronary heart disease and injuries will be determined from questionnaires. Survival analyses will be used to test whether runners have greater reduction in heart disease, total mortality, and cancer per unit of exercise. Exercise-related injuries from walking and running will also be examined. Power calculations suggest that detection of differences between runners and walkers, as small as 11% for total mortality, 16% for CHD, 12% for total cancers, and 36% for breast cancer, will be possible. The differences will be adjusted for weekly kilocalories expended by walking and running, for walking and running distance, and for time spent on each activity to test whether these variables account for differences in disease rates between walkers and runners. Before the start of the study, 233,000 person-years of follow-up in 56,000 runners (between 1991 and 1997) will have been accumulated. By the end of the study, 517,000 person years in 68,000 runners (between 1991 and 2001) will be available for analysis. Survival analysis will be used to test for a dose-response relationship between running mileage and CHD and cancer risk, and whether this relationship is affected by running intensity, running frequency, running history, gender, adiposity, age or medication use. Using conservative rates (25% below published values), statistical power calculations suggest that detectable reduction in coronary heart disease risk as small as 0.71% per mile will be possible, which is far

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below the estimated reduction from other published studies (2.1%). Additionally, a detectable reduction in breast cancer risk as small as 1.5% per mile run in women is calculated, which is below the 1.7% reduction in risk estimated from other published data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROTECTION FROM CARDIAC REPERFUSION INJURY BY ETHANOL Principal Investigator & Institution: Gray, Mary O.; Assistant Professor of Medicine; Northern California Institute Res & Educ 4150 Clement Street (151-Nc) San Francisco, Ca 941211545 Timing: Fiscal Year 2002; Project Start 30-SEP-1996; Project End 31-MAR-2007 Summary: (provided by applicant): Moderate alcohol intake has been shown to reduce coronary heart disease in numerous epidemiological studies. We propose that moderate ethanol consumption causes cardioprotection by increasing epsilonPKC protein expression in cardiac myocytes. To test this hypothesis, we will use multiple approaches to examine resistance of ischemia-reperfusion injury in hearts receiving ethanol in drinking water for at least 12 weeks. In addition, we will investigate the requirement for epsilonPKC function in ethanol-mediated cardioprotection using techniques routinely available in our laboratory with the following specific aims: Aim A: Examine epsilonPKC enzyme activity and subcellular localization in hearts from ethanol-fed mice and age-matched controls. We plan to identify ethanol-induced changes in epsilonPKC kinase function and distribution among subcellular compartments in adult cardiac myocytes and in left ventricular tissue from ethanol-fed mice and age-matched controls using immunofluorescence staining, confocal microscopy, immunoprecipitation, and western blotting techniques. Aim B: Determine whether acute isozyme-selective inhibition of epsilonPKC function blocks sustained ethanol-mediated cardioprotection. We will examine the effects of peptide modulators of PKC isozyme translocation and function introduced acutely into cultured adult cardiac myocytes or intact hearts on chronic ethanol-induced resistance to ischemia-reperfusion injury and PKC interactions with other signaling proteins. Aim C: Investigate the effects of moderate alcohol consumption on cardiac function and resistance to ischemia-reperfusion injury in epsilonPKC knockout mice. We will use adult cardiac myocytes and intact hearts to determine whether cardioprotection develops in epsilonPKC knockout mice in response to ethanol feeding and whether ethanol-mediated regulation of related signaling pathways is altered by the absence of epsilonPKC. One overall goal of this research is to understand the cellular mechanisms of cardioprotection mediated by chronic moderate alcohol consumption. A second goal is to identify therapeutic targets for sustained protection against coronary heart disease that do not require ethanol ingestion because of concerns regarding alcohol abuse and potential adverse effects on other organ systems in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: QUANTIFICATION OF HEART BETA ADRENERGIC RECEPTORS Principal Investigator & Institution: Muzic, Raymond F.; Radiology; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-MAR-2005 Summary: (Adapted from applicant's abstract): Health Relevance: Beta-adrenergic receptors (beta-ARs) play a fundamental role in the regulation of heart function.

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Changes in the amount and binding properties of beta-ARs are implicated in coronary heart disease, congestive and ischemic heart failure, cardiomyopathy, sudden death, arrhythmia, and mitral valve disease. Drugs that interact with the beta-ARs, betablockers, are widely prescribed to treat heart disease. Since the in vitro behavior of receptors often differs from their in vivo behavior, a method to assess beta-ARs in vivo is essential for improving our understanding and treatment of heart diseases. Moreover, a relatively noninvasive test could be used to assess patients individually. Proposed Work: a significant component of the tissue uptake of (S)-[18F]fluorocarazolol as measured by positron emission tomography (PET) reflects specific binding to beta-ARs. However, it also reflects nonspecific uptake, radioactive metabolites in the myocardium, and possibly uptake related to the norepinephrine transporter. Therefore, quantitative assessment of beta-AR specific binding and of beta-AR concentration requires a mathematical model of fluorocarazolol pharmacokinetics. To formulate this model, details of fluorocarazolol pharmacokinetics will be clarified via in vitro and in vivo experiments (Aims 1 to 2) and via computer simulation to compare compartmental and distributed pharmacokinetic models (Aim 3). A mathematical model of fluorocarazolol pharmacokinetics will be formulated in accordance with the results of Aims 1 to 3. This model will then be used to analyze PET data collected from pigs with normal and elevated concentrations of beta-AR. The validity of the model and its utility to assess beta-AR concentration and binding properties in vivo will be evaluated based on comparison to results obtained via in vitro assay of myocardial samples (Aim 4). Significance: Although [11C]CGP 12177 has been used to estimate myocardial beta-AR concentration in vivo, there are numerous advantages for using [18F]fluorocarazolol. Perhaps the most significant is that fluorocarazolol reaches internalized receptors whereas CGP 12177 does not. Completion of the proposed work could lead to a method for estimating the fraction of receptors that are internalized. It would entail two PET experiments using [18F]fluorocarazolol; one at baseline and one following administration of unlabeled 9commercially available) CGP 12177 to block surface receptors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESPONSIVITY OF HOMOCYSTEINE TO BEHAVIORAL STRESS Principal Investigator & Institution: Emery, Charles F.; Associate Professor; Psychology; Ohio State University 1960 Kenny Road Columbus, Oh 43210 Timing: Fiscal Year 2003; Project Start 10-AUG-2002; Project End 31-JUL-2006 Summary: (provided by applicant): Homocysteine is putative risk factor for coronary heart disease (CHD). It is an amino acid associated with endothelial damage, which may cause direct injury to intimal cells and assist in the deposition of lipoproteins within atherosclerotic lesions. Homocysteine is bound to lipoproteins. Although several psychological characteristics are associated with CHD, few investigations of psychological risk factors and homocysteine exist. We have shown that homocysteine increases during stress, and that hostility is positively associated with resting homocysteine. The major goals of this proposal are to investigate the etiological significance of stress-induced and personality-associated elevations in homocysteine; to evaluate the relationship between lipids and homocysteine during stress; and to test one viable mechanism for homocysteine reactivity. Study 1 will test whether the stressassociated increases in homocysteine are etiologically meaningful, by comparing individuals with above average risk for CHD (based on American Heart Association/American College of Cardiology recommendations and family history), to those at below average risk. This study will also build on our earlier findings, by

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comparing homocysteine reactivity among high hostile individuals to low hostile individuals. Study 2 will test whether individuals with exaggerated homocysteine reactivity have greater stress-induced alterations in vitamin B6, vitamin B12, and folate than do those with smaller homocysteine reactivity. An additional purpose of this study will be to test whether individuals given B vitamin supplements for 4 weeks prior to an acute stressor display smaller elevations in stress-induced homocysteine, relative to individuals given placebo. Because homocysteine is bound to lipoproteins, and because it appears to modify the atherogenicity of low density lipoprotein, both studies will test the relationships between homocysteine and lipid reactivity. The results of this research will extend the available but limited data testing the impact of stress and hostility on homocysteine concentrations; will allow one test of the etiological significance of stressrelated homocysteine elevations; will allow us to examine the relationship between lipid reactivity and homocysteine reactivity; and will test a viable mechanism for the homocysteine elevations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ROLE ATHEROGENESIS

OF

CHLAMYDIA

PNEUMONIAE

INFECTION

IN

Principal Investigator & Institution: Kuo, Cho-Chou; Professor; Pathobiology; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-APR-1997; Project End 31-MAR-2004 Summary: (Adapted from the Applicant's Abstract): Chlamydia pneumoniae (TWAR) is a common human respiratory pathogen. In recent years, there has been mounting evidence showing that this organism might play a role in atherosclerosis. Because coronary heart disease is a leading cause of death in this country, the overall goal is to investigate the immunopathogenic mechanisms by which C. pneumoniae infection contributes to the development of vascular disease. The proposed studies will exploit our recent findings from mouse model studies linking C. pneumoniae infection and atherosclerosis and in vitro cell culture studies on C. pneumoniae infection of arterial wall cells. The mouse models that will be used are C57BU6 and strains derived from this background strain including, apoE-deficient and TNF-A receptor and apoE double knockout mice. Atherosclerosis in C57BU6 mice can be induced by feeding with a high fat/high cholesterol diet, while apoE mice develop atherosclerosis spontaneously on a regular diet. The specific aims are to 1) further evaluate the synergistic effect of C. pneumoniae infection and hyperlipidemia on atherogenesis by infecting mice with C. pneumoniae followed by feeding animals with a high fat/high cholesterol diet and measuring the atherosclerotic lesion development using computer assisted morphometry; 2) study the effects of C. pneumoniae infection on key components in the inflammatory process of atherosclerosis that promote atherosclerotic lesion development by recruiting lymphocytes/macrophages and eliciting inflammatory responses at lesion sites. In vitro, in vivo, and ex vivo systems will be used to assay the expression of leukocyte adhesion molecules and adherence of macrophages to the endothelial surface. The effect of TNF-A on lesion development will be investigated by infecting TNF-A receptor and apoE double knockout mice and measuring lesion development using computer assisted morphometry; 3) assess the role of macrophages in the establishment of persistent C. pneumoniae infection of atheromatous lesions using cell culture to analyze vascular cell interactions and the effect on infectivity, growth and persistence of C. pneumoniae, and characterize the growth of C. pneumoniae in macrophages loaded with low density lipoproteins (foam cells). The proposed studies should prove invaluable for understanding the disease process and

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developing better measures for eradication or prevention of C. pneumoniae infection and for reducing atherosclerosis and coronary heart disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SLEEP HEART HEALTH STUDY Principal Investigator & Institution: O'connor, George T.; Associate Professor; Medicine; Boston University Medical Campus 715 Albany St, 560 Boston, Ma 02118 Timing: Fiscal Year 2002; Project Start 30-SEP-1994; Project End 31-AUG-2004 Summary: The Sleep Heart Health Study (SHHS) was started in 1994 as a multicenter cohort study of the cardiovascular consequences of sleep-disordered breathing (SDB). The study's principal aims are to assess SDB as a risk factor for adverse cardiovascular outcomes, including incident coronary heart disease events, stroke, and hypertension, and accelerated increase in blood pressure with age. The SHHS protocol added an assessment of SDB to ongoing cohort studies of cardiovascular and other diseases, including the Framingham Offspring and Omni cohorts, the Hagerstown and Minneapolis/St. Paul sites of the Atherosclerosis Risk in Communities (ARIC) Study, the Hagerstown, Sacramento, and Pittsburgh sites of the Cardiovascular Health Study (CHS), the Strong Heart Study (SHS) sites South Dakota, Oklahoma, and Arizona, and cohort studies of respiratory disease in Tucson and of hypertension in New York. During its first four years (1994-1998), the SHHS was successfully started with full and high quality polysomnography (PSG) data obtained in the home from 6,440 participants, exceeding the recruitment target. The SHHS cohort, includes 3,039 men and 3,401 women 40 years of age or more, of whom 8.2 percent are African American, 9.6 percent are Native American, 1.3 percent are Asian, and 4.2 percent are Hispanic. In addition to PSG, data collection covered snoring and sleepiness and quality of life (QOL). Outcome assessment protocols are in place for all cohorts and the second SHHS examination is now in progress. Initial cross-sectional findings show that SDB is common and associated with hypertension and self-reported cardiovascular disease (CVD). This application requests five years additional support to continue the SHHS. Further followup is needed to have sufficient power to test the primary SHHS hypotheses. Additionally in Years 7-9, PSG will be repeated to further characterize SDB in the participants and to describe the natural history of SDB. During the first five years, the SHHS has shown that large-scale research on sleep, SDB, and disease risk can be conducted in the community. Follow-up of the SHHS cohort will provide the data needed to characterize the cardiovascular consequences of SDB, along with its natural history. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: STRESS REDUCTION AND CVD MORBIDITY AND MORTALITY-II Principal Investigator & Institution: Schneider, Robert H.; Dean; None; Maharishi University of Management Db 1133 Fairfield, Ia 52556 Timing: Fiscal Year 2003; Project Start 15-AUG-1992; Project End 31-JUL-2007 Summary: (provided by applicant): African Americans suffer from disproportionately high rates of cardiovascular disease morbidity and mortality compared to white Americans. Substantial evidence indicates that high levels of psychosocial and socioenvironmental stress contribute to the excessive morbidity and mortality in this population. In earlier controlled trials with African Americans and other populations at high risk for CVD, the current collaborative team demonstrated that a selected stress reduction approach, the Transcendental Meditation (TM) program, was associated with

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significant reductions in CVD risk factors and surrogate markers for clinical CVD. These include clinically significant decreases in hypertension, myocardial ischemia and carotid atherosclerosis, as well as improvements in psychosocial stress and quality of life. In the previous NHLBI-sponsored clinical trial, 201 African American men and women with documented coronary heart disease (mean age 59 years) were randomized to either stress reduction with the TM program or a health education control. The results showed 50 percent lower risk of combined mortality and CVD morbidity in the stress reduction group compared to control (RR =.50, p <.05) after a median three year follow-up period. Preliminary analysis, in preparation for the proposed study, suggests lower risk of "hard" events alone--mortality, MI and stroke (RR=.42; p =.15). The proposed study will conduct long-term follow-up of intervention and testing of the previous trial of 201 African American participants for an additional five funded years. This study will definitively evaluate long-term effects of behavioral stress reduction compared to control on "hard" CVD endpoints and sustainability of disease-free survival on combined "hard" and "soft" CVD endpoints (all-cause mortality, MI, stroke, coronary revascularizations, and hospitalizations for heart failure and ischemic heart disease, non-MI). Secondary outcomes will include traditional CVD risk factors (BP, lipids, diet, exercise, weight), psychosocial risk factors (depression, hostility, anger), quality of life, medication use, compliance, and cost effectiveness. To our knowledge, this is the only randomized controlled trial of behavioral stress reduction for the secondary prevention of CVD in African American men and women. The results of this unique long-term study will contribute critical new knowledge for the elimination of racial and ethnic diparities in health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SURVEILLANCE AND ANALYSIS OF THE UNC ALUMNI HEART STUDY Principal Investigator & Institution: Siegler, Ilene C.; Professor of Medical Psychology; Psychiatry; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 01-MAY-1996; Project End 31-JUL-2005 Summary: (investigator's abstract): The UNC Alumni Heart Study continues to examine the impact of hostility on health behaviors and psychological status at midlife to test the prospective associations of hostility with coronary heart disease (CHD) events and other health outcomes. The Specific Aims of the proposed research are: [1] To better understand the dynamic interrelationships of psychosocial and behavioral risk factors of the adult life span, we will map the trajectories of hostility, depression, smoking, body mass, exercise patterns, and alcohol consumption using multiple assessments from age 19 to age 60. It is predicted that a significant proportion of the change in risk behavior will be due to trajectories of hostility and depression, operating singly and in combination over time. [2] To test the prospective associations of hostility, depression, and other psychosocial variables (e.g., social support and job strain) with coronary events and mortality observed while the cohort is middle-aged. [3] To broaden the scope of the psychosocial variables to examine individual differences in personality over the life course and dietary practices at midlife in addition to the indicators noted above, and [4] To better understand the effect of gender on the natural history of coronary disease and coronary risk profiles in women, we will monitor changes in menopausal status, and patterns of hormone replacement therapy use among women during midlife and study the associations of these factors with the other risk indicators. In sum, although the literature suggesting that psychosocial factors play a significant role in the etiology of CHD in older samples is convincing, major gaps remain with respect to

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understanding the associations between psychosocial factors and premature coronary heart disease and mortality during the middle years. Adding additional measures to the present rich data base, places the UNC Alumni Heart Study in an excellent position to help fill these gaps in the next 5 years, as these members of the early Baby Boom Cohort approach age 60. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE SLEEP HEART HEALTH STUDY Principal Investigator & Institution: Quan, Stuart F.; Professor of Medicine; Medicine; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2002; Project Start 30-SEP-1994; Project End 31-AUG-2004 Summary: The Sleep Heart Health Study (SHHS) was started in 1994 as a multicenter cohort study of the cardiovascular consequences of sleep-disordered breathing (SDB). The study's principal aims are to assess SDB as a risk factor for adverse cardiovascular outcomes, including incident coronary heart disease events, stroke, and hypertension, and accelerated increase in blood pressure with age. The SHHS protocol added an assessment of SDB to ongoing cohort studies of cardiovascular and other diseases, including the Framingham Offspring and Omni cohorts, the Hagerstown and Minneapolis/St. Paul sites of the Atherosclerosis Risk in Communities (AMC) Study, the Hagerstown, Sacramento, and Pittsburgh sites of the Cardiovascular Health Study (CHS), the Strong Heart Study (SHS) sites in South Dakota, Oklahoma, and Arizona, and cohort studies of respiratory disease in Tucson and of hypertension in New York. During its first four years (1994-1998), the SHHS was successfully started with full and high quality polysomnography (PSG) data obtained in the home from 6,440 participants, exceeding the recruitment target. The SHHS cohort, includes 3,039 men and 3,401 women 40 years of age or more, of whom 8.2 percent are African American, 9.6 percent are Native American, 1.3 percent are Asian, and 4.2 percent are Hispanic. In addition to PSG, data collection covered snoring and sleepiness and quality of life (QOL). Outcome assessment protocols are in place for all cohorts and the second SHHS examination is now in progress. Initial cross-sectional findings show that SDB is common and associated with hypertension and self-reported cardiovascular disease (CVD). This application requests five years additional support to continue the SHHS. Further followup is needed to have sufficient power to test the primary SHHS hypotheses. Additionally in Years 8-9, PSG will be repeated to further characterize SDB in the participants and to describe the natural history of SDB. During the first five years, the SHHS has shown that large-scale research on sleep, SDB, and disease risk can be conducted in the community. Follow-up of the SHHS cohort will provide the data needed to characterize the cardiovascular consequences of SDB, along with its natural history. This proposal is a request to fund the University of Arizona Field Center of the SHHS to fulfill its role performing repeat PSG and cardiovascular follow-up of 909 participants in this multicenter study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: THE SLEEP HEART HEALTH STUDY: READING CENTER APPLICATION Principal Investigator & Institution: Redline, Susan S.; Professor of Pediatrics, Medicine & Epid; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 31-AUG-2004

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Summary: The Sleep Heart Health Study (SHHS) was started in 1994 as a multicenter cohort study of the cardiovascular consequences of sleep-disordered breathing (SDB). The study's principal aims are to assess SDB as a risk factor for adverse cardiovascular outcomes, including incident coronary heart disease events, stroke, and hypertension, and accelerated increase in blood pressure with age. The SHHS protocol added an assessment of SDB to ongoing cohort studies of cardiovascular and other diseases. During its first four years (1994-1998), the SHHS was successfully started with full and high quality polysomnography (PSG) data obtained in the home from 6,440 participants. Initial cross-sectional findings show that SDB is common and associated with hypertension and self-reported cardiovascular disease (CVD). The clinical centers are now requesting another five years of support to collect additional endpoints needed for testing primary SHHS hypotheses. Additionally in Years 7-9, PSG will be repeated to further characterize SDB in the participants and to describe the natural history of SDB. This application requests support that will allow Case Western Reserve University to continue to serve as the Polysmongraphy Reading Center for the SHHS. In this capacity, we will: a. Provide centralized training for aspects of SHHS related to the performance and interpretation of sleep studies. b. Provide ongoing technical support to the clinical sites for the performance of sleep studies; c. Provide timely review (for quality and medical alerts) and scoring of all records, generating reports needed for participant feedback and data analysis; d. Participate in on-going quality assurance efforts to maintain high levels of scoring accuracy and reliability; e. Develop, implement and monitor the technical performance of PSGs at clinical the field sites; f. Provide reports on study quality to the Steering Committee and QA Committee; g. Collaborate with other SHHS investigators to assist in protocol development, data analysis, data interpretation, and manuscript preparation. The SHHS has shown that large-scale research on sleep, SDB, and disease risk can be conducted in the community and high quality PSG data can be collected from multiple sites by using centralized and intensive methods for training filed technicians and polysomnologists, and for monitoring data quality. Follow-up of the SHHS cohort will provide reliable and accurate data needed to characterize the cardiovascular consequences of SDB, along with its natural history. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THROMBOSIS GENE POLYMORPHISMS AND EARLY CHD RISK IN HERS Principal Investigator & Institution: Herrington, David M.; Professor; Internal Medicine; Wake Forest University Health Sciences Winston-Salem, Nc 27157 Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2004 Summary: (provided by applicant): The Heart and Estrogen/progestin Replacement Study (HERS) and several other clinical studies and clinical trials have observed a transient increase in risk for coronary heart disease (CHD) events after initiation of hormone replacement therapy (HRT). Some evidence suggests that this adverse effect of HRT may be limited to a subgroup of women who are uniquely at risk for a thrombotic complication of estrogen therapy. There are several well-described polymorphisms in genes whose products regulate coagulation or fibrinolysis that could augment thrombotic risk in the setting of estrogen therapy. These polymorphisms include Factor V Leiden, prothrombin 20210A, Factor VII R353Q. plasminogen activator inhibitor-1 (PAI-1) 4G/5G, fibrinogen B-beta-455A, and platelet GP IIIa P1-A1.A2. We propose a nested case-control study among HERS women with CHD (n = 361) or venous thrombotic events (VTEs) (n = 95) and two clinic-matched controls to assess the relation between the above listed polymorphisms, HRT, and risk for CHD or VTEs. We will

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estimate the absolute and relative risk of HRT among women with and without the six candidate thrombosis gene polymorphisms and test for evidence of a genotype * HRT interaction. In secondary analyses, we will focus on events that occurred in the first year, evaluate the effect of triglycerides on risk associated with the Factor VII and PAI-1 polymorphisms, and explore the impact of combinations of polymorphisms on risk. DNA for this project will be acquired from centrally stored Pap smears that were collected during the trial. If this project reveals a high-risk subgroup based on thrombosis gene polymorphisms, women could be screened for this condition and cautioned not to use HRT. Conversely, low-risk women might be able to use HRT more safely in pursuit of various health benefits, including a possible reduction in CHD risk. Thus, this project may lead to more effective strategies to prevent CHD in women, enhance the safety of HRT, and add to the expanding body of knowledge concerning drug/gene interactions as they relate to treatment and prevention of disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ULTRAFINE PARTICULATE MATTER & CARDIORESPIRATORY HEALTH Principal Investigator & Institution: Delfino, Ralph J.; Associate Professor; Medicine; University of California Irvine Irvine, Ca 926977600 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant) Heart disease is the leading cause of death and hospitalization among the elderly population, which makes the identification of preventable causes for heart disease morbidity and mortality a major goal of epidemiologic research. Numerous studies have shown associations of outdoor particulate matter (PM) air pollution with cardiovascular hospital admissions and mortality. The causal pollutant components and physiologic mechanisms for these associations are not fully understood. There is evidence that airway inflammation resulting from airway deposition of ultrafine particles (< 0.1 mu/m in diameter) could lead to an increase in thrombogenic and inflammatory activity in the blood, and to a disturbance in cardiovascular function, resulting from oxidant stress responses at extrapulmonary sites, including the vascular endothelium of the heart. This is expected to increase the risk of adverse cardiovascular outcomes, particularly in people with underlying coronary heart disease (CHD). We propose to conduct a panel study with repeated measurements to evaluate acute cardiovascular and respiratory health effects of ultrafine PM personal, indoor and outdoor exposures. Over seven month periods, we will follow 72 nonsmoking elderly individuals with CHD living in areas with high air pollution levels in the Los Angeles Air Basin of California. The design will maximize the utility of intensive exposure assessments by measuring multiple interrelated clinical, physiological and biochemical outcomes. The specific aims will address the following hypotheses: 1) Exposure to ultrafine particles will be associated with increased circulating biomarkers of inflammation and thrombosis, increased blood pressure, adverse cardiac clinical outcomes, and increases in a biomarker of airway inflammation, exhaled nitric oxide; and 2) These associations will be stronger for measurements of particle components and certain ambient sources thought to influence inflammatory processes through oxidant damage. We will also evaluate relationships of outcomes with accumulation mode PM (0.18-2.5 mu/m) and coarse mode PM (2.5-10 fm). We will assess whether estimates of association for predicted (adjusted) personal or indoor exposure to ultrafine or accumulation mode PM of outdoor origin are stronger than estimates of association for unadjusted (raw) personal or indoor exposures. Results of this study will advance knowledge on the cardiovascular and respiratory effects of

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ultrafine particles. Our results are expected to clarify findings in the literature of associations between ambient particulate air pollution (PM10 and PM2.5) and severe cardiovascular outcomes, including mortality and hospital admissions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WISCONSIN EPIDEMIOLOGICAL STUDY OF CARDIOVASCULAR DISEAS Principal Investigator & Institution: Klein, Ronald; Professor; Ophthalmology and Visual Sci; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2002; Project Start 01-FEB-1999; Project End 31-JAN-2003 Summary: This proposal describes a population-based cohort aimed at determining the prevalence and incidence of cardiovascular disease morbidity and mortality in people with Type 1 diabetes of long-duration. For this epidemiologic study, subjects include all insulin-taking persons who: (1) were less than 30 years of age at the time of their diagnosis, (2) had received primary medical care in an 11-county area of south-central Wisconsin, and (3) were first identified in 1979-80. Standardized protocols for examinations and interviews have been employed during the baseline, 4-, 10-, and 14year follow up examinations. Refusal rates have been low. The mean age of the cohort and the long duration of diabetes provide an opportunity to document the prevalence and incidence of coronary heart disease, myocardial infarction, angina, congestive heart failure, stroke, transient ischemic attacks, peripheral vascular disease, and cardiovascular disease mortality in a large population-based group of persons with Type 1 diabetes. Retinal photographs of each study participant were taken at the baseline examination. This will permit us to test the predictive ability of focal and generalized retinal arteriolar narrowing and arterio-venous cross changes (i.e. A/V nicking) for subsequent macrovascular events controlling for other risk factors. These factors include blood pressure, cigarette smoking, serum lipids, body mass index, duration of diabetes, and glycemia. We plan to reexamine this cohort to obtain ECGs, blood lipid fractions not previously measured, and fibrinogen, as well as upper and lower extremity blood pressures, urine specimens, and medical records. This will provide information about silent about silent infarctions and other cardiographic abnormalities as well as previously doctor-diagnosed macrovascular events in longterm survivors of Type 1 diabetes. Study examinations will be performed in a mobile van. Participants will provide two urine specimens for determination of urinary albumin excretion. Fasting blood will be obtained for determination of glycosylated hemoglobin Alc, blood sugar, serum cholesterol, triglycerides, HDL- cholesterol, LDLcholesterol, VDL-cholesterol, LDL particle size, serum creatinine, and fibrinogen. Additional study procedures include measurements of weight and height, waist and hip girth, and brachial and ankle blood pressures. Electrocardiography will also be performed. A questionnaire will be administered Participants will subsequently be interviewed yearly and clinical and hospital records and death certificates will be collected to document new cardiovascular disease events. Findings regarding the prevalence and incidence of cardiovascular disease and associated risk factors will be of great public health importance in directing further at preventing these conditions in people with Type 1 diabetes of long duration. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “coronary heart disease” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for coronary heart disease in the PubMed Central database: •

"I don't like Mondays" ---day of the week of coronary heart disease deaths in Scotland: study of routinely collected data. by Evans C, Chalmers J, Capewell S, Redpath A, Finlayson A, Boyd J, Pell J, McMurray J, Macintyre K, Graham L.; 2000 Jan 22; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=32257

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A longitudinal analysis of the risk factors for diabetes and coronary heart disease in the Framingham Offspring Study. by Bhargava A.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=156626

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Analysis of predicted coronary heart disease risk in England based on Framingham study risk appraisal models published in 1991 and 2000. by Nanchahal K, Duncan JR, Durrington PN, Jackson RT.; 2002 Jul 27; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=117447

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Chlamydia pneumoniae Serology: Importance of Methodology in Patients with Coronary Heart Disease and Healthy Individuals. by Schumacher A, Lerkerod AB, Seljeflot I, Sommervoll L, Holme I, Otterstad JE, Arnesen H.; 2001 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=88039

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Cluster randomised controlled trial to compare three methods of promoting secondary prevention of coronary heart disease in primary care. by Moher M, Yudkin P, Wright L, Turner R, Fuller A, Schofield T, Mant D.; 2001 Jun 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=32168

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Comparison of estimates and calculations of risk of coronary heart disease by doctors and nurses using different calculation tools in general practice: cross sectional study. by McManus RJ, Mant J, Meulendijks CF, Salter RA, Pattison HM, Roalfe AK, Hobbs FD.; 2002 Feb 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=65668

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Conversion from chronic to acute coronary heart disease syndromes. Role of platelets and platelet products. by Willerson JT.; 1995; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=325205

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Early growth and coronary heart disease in later life: longitudinal study. by Eriksson JG, Forsen T, Tuomilehto J, Osmond C, Barker DJ.; 2001 Apr 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31033

3 Adapted 4

from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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•

Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study. by Hu FB, Stampfer MJ, Manson JE, Rimm EB, Colditz GA, Rosner BA, Speizer FE, Hennekens CH, Willett WC.; 1998 Nov 14; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28714

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Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. by Bhopal R, Unwin N, White M, Yallop J, Walker L, Alberti KG, Harland J, Patel S, Ahmad N, Turner C, Watson B, Kaur D, Kulkarni A, Laker M, Tavridou A.; 1999 Jul 24; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28170

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Hyperlipidemia in Coronary Heart Disease I. LIPID LEVELS IN 500 SURVIVORS OF MYOCARDIAL INFARCTION. by Goldstein JL, Hazzard WR, Schrott HG, Bierman EL, Motulsky AG.; 1973 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=302425

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Incidence of coronary heart disease in a health authority in London: review of a community register. by Sutcliffe SJ, Fox KF, Wood DA, Sutcliffe A, Stock K, Wright M, Akhras F, Langford E.; 2003 Jan 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=139498

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Insertion/deletion polymorphism of the angiotensin-converting enzyme gene is strongly associated with coronary heart disease in non-insulin-dependent diabetes mellitus. by Ruiz J, Blanche H, Cohen N, Velho G, Cambien F, Cohen D, Passa P, Froguel P.; 1994 Apr 26; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=43641

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Is cardiothoracic ratio in healthy middle aged men an independent predictor of coronary heart disease mortality? Whitehall study 25 year follow up. by Hemingway H, Shipley M, Christie D, Marmot M.; 1998 May 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28534

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Probucol prevents early coronary heart disease and death in the high-density lipoprotein receptor SR-BI/apolipoprotein E double knockout mouse. by Braun A, Zhang S, Miettinen HE, Ebrahim S, Holm TM, Vasile E, Post MJ, Yoerger DM, Picard MH, Krieger JL, Andrews NC, Simons M, Krieger M.; 2003 Jun 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=165867

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Relationship between apolipoprotein(a) size polymorphism and coronary heart disease in overweight subjects. by Emanuele E, Peros E, Minoretti P, Falcone C, D'Angelo A, Montagna L, Geroldi D.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=327094

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Risk factors for coronary heart disease and infection with Helicobacter pylori: metaanalysis of 18 studies. by Danesh J, Peto R.; 1998 Apr 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28515

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Role of endogenous oestrogen in aetiology of coronary heart disease: analysis of age related trends in coronary heart disease and breast cancer in England and Wales and Japan. by Lawlor DA, Ebrahim S, Davey Smith G.; 2002 Aug 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=117771

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Sex matters: secular and geographical trends in sex differences in coronary heart disease mortality. by Lawlor DA, Ebrahim S, Davey Smith G.; 2001 Sep 8; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=48158

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Systematic review of lipid lowering for primary prevention of coronary heart disease in diabetes. by Gami AS, Montori VM, Erwin PJ, Khan MA, Smith SA.; 2003 Mar 8; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150463

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with coronary heart disease, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “coronary heart disease” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for coronary heart disease (hyperlinks lead to article summaries): •

A common variant in the ABCA1 gene is associated with a lower risk for premature coronary heart disease in familial hypercholesterolaemia. Author(s): Cenarro A, Artieda M, Castillo S, Mozas P, Reyes G, Tejedor D, Alonso R, Mata P, Pocovi M, Civeira F; Spanish FH group. Source: Journal of Medical Genetics. 2003 March; 40(3): 163-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12624133

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A long-term follow-up study of serum lipid levels and coronary heart disease in the elderly. Author(s): Li JZ, Chen ML, Wang S, Dong J, Zeng P, Hou LW. Source: Chinese Medical Journal. 2004 February; 117(2): 163-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14975195

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A polymorphism in thrombospondin-1 associated with familial premature coronary heart disease causes a local change in conformation of the Ca2+-binding repeats. Author(s): Hannah BL, Misenheimer TM, Annis DS, Mosher DF. Source: The Journal of Biological Chemistry. 2003 March 14; 278(11): 8929-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12643280

6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A prospective study of microalbuminuria and incident coronary heart disease and its prognostic significance in a British population: the EPIC-Norfolk study. Author(s): Yuyun MF, Khaw KT, Luben R, Welch A, Bingham S, Day NE, Wareham NJ. Source: American Journal of Epidemiology. 2004 February 1; 159(3): 284-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14742289

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A qualitative study of barriers to the use of statins and the implementation of coronary heart disease prevention in primary care. Author(s): Kedward J, Dakin L. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2003 September; 53(494): 684-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15103875

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A twin study of C-Reactive Protein compared to other risk factors for coronary heart disease. Author(s): Retterstol L, Eikvar L, Berg K. Source: Atherosclerosis. 2003 August; 169(2): 279-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12921979

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Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. Author(s): Klein S, Fontana L, Young VL, Coggan AR, Kilo C, Patterson BW, Mohammed BS. Source: The New England Journal of Medicine. 2004 June 17; 350(25): 2549-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15201411

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Absolute coronary risk analyser--a tool for managing coronary heart disease risk. Author(s): Mitrabasu PP, Shahapurkar JS, Sreekumar TP, Vyawahare MK, Sarma CG. Source: Indian Journal of Medical Sciences. 2003 June; 57(6): 238-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14510340

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Alcohol consumption and its contribution to the burden of coronary heart disease in middle-aged and older New Zealanders: a population-based case-control study. Author(s): Wells S, Broad J, Jackson R. Source: N Z Med J. 2004 March 12; 117(1190): U793. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15107896

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Alcohol consumption and risk of coronary heart disease among individuals with type 2 diabetes. Author(s): Tanasescu M, Hu FB. Source: Curr Diab Rep. 2001 October; 1(2): 187-91. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12643115

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Alcohol inflammation and coronary heart disease. Author(s): Imhof A, Koenig W. Source: Addiction Biology. 2003 September; 8(3): 271-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13129828

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An assessment of correlations between endogenous sex hormone levels and the extensiveness of coronary heart disease and the ejection fraction of the left ventricle in males. Author(s): Dobrzycki S, Serwatka W, Nadlewski S, Korecki J, Jackowski R, Paruk J, Ladny JR, Hirnle T. Source: J Med Invest. 2003 August; 50(3-4): 162-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13678385

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An epidemiological study on coronary heart disease in PR. The Puerto Rico Heart Health Program. 1969. Author(s): Garcia-Palmieri MR, Feliberti M, Costas R Jr, Colon AA, Cruz-Vidal M, Cortes-Alicea M, Ayala AM, Sobrino R, Torres R. Source: Bol Asoc Med P R. 2002 January-December; 94(1-12): 61-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12898736

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Antibiotics and coronary heart disease. Author(s): Nieto FJ. Source: Jama : the Journal of the American Medical Association. 2004 January 21; 291(3): 302-3; Author Reply 303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14734587

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Antibiotics and coronary heart disease. Author(s): Modest GA, Kaufmann J. Source: Jama : the Journal of the American Medical Association. 2004 January 21; 291(3): 302; Author Reply 303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14734586

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Apolipoprotein B and apolipoprotein A-I: risk indicators of coronary heart disease and targets for lipid-modifying therapy. Author(s): Walldius G, Jungner I. Source: Journal of Internal Medicine. 2004 February; 255(2): 188-205. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14746556

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Appropriateness of anthropometric obesity indicators in assessment of coronary heart disease risk among Finnish men and women. Author(s): Silventoinen K, Jousilahti P, Vartiainen E, Tuomilehto J. Source: Scandinavian Journal of Public Health. 2003; 31(4): 283-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15099034

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Assessing low levels of high-density lipoprotein cholesterol as a risk factor in coronary heart disease: a working group report and update. Author(s): Gotto AM Jr, Brinton EA. Source: Journal of the American College of Cardiology. 2004 March 3; 43(5): 717-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14998606

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Asymptotic dental score and prevalent coronary heart disease. Author(s): Janket SJ, Qvarnstrom M, Meurman JH, Baird AE, Nuutinen P, Jones JA. Source: Circulation. 2004 March 9; 109(9): 1095-100. Epub 2004 February 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14967717

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Azithromycin for the secondary prevention of coronary heart disease events: the WIZARD study: a randomized controlled trial. Author(s): O'Connor CM, Dunne MW, Pfeffer MA, Muhlestein JB, Yao L, Gupta S, Benner RJ, Fisher MR, Cook TD; Investigators in the WIZARD Study. Source: Jama : the Journal of the American Medical Association. 2003 September 17; 290(11): 1459-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13129985

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Balancing between observational studies and randomized trials in prevention of coronary heart disease by estrogen replacement: HERS study was no revolution. Author(s): Ylikorkala O. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2000 December; 79(12): 1029-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11130082

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Barriers to preventive interventions for coronary heart disease. Author(s): Chiriboga DE, Ockene JK, Ockene IS. Source: Cardiology Clinics. 2003 August; 21(3): 459-70. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14621458

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Barriers to uptake of services for coronary heart disease: qualitative study. Author(s): Tod AM, Read C, Lacey A, Abbott J. Source: Bmj (Clinical Research Ed.). 2001 July 28; 323(7306): 214. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11473916

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Baseline health-related quality of life in postmenopausal women with coronary heart disease: the Estrogen Replacement and Atherosclerosis (ERA) trial. Author(s): Sherman AM, Shumaker SA, Kancler C, Zheng B, Reboussin DM, Legault C, Herrington DM; ERA Trial Investigators. Source: Journal of Women's Health (2002). 2003 May; 12(4): 351-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804342

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Beneficial antithrombotic effects of the association of pharmacological oral magnesium therapy with aspirin in coronary heart disease patients. Author(s): Shechter M, Merz CN, Paul-Labrador M, Meisel SR, Rude RK, Molloy MD, Dwyer JH, Shah PK, Kaul S. Source: Magnes Res. 2000 December; 13(4): 275-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11153897

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Benefits of cardiac rehabilitation in the ninth decade of life in patients with coronary heart disease. Author(s): Vonder Muhll I, Daub B, Black B, Warburton D, Haykowsky M. Source: The American Journal of Cardiology. 2002 September 15; 90(6): 645-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12231096

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Benefits of lipid-lowering agents in stroke and coronary heart disease: pharmacoeconomics. Author(s): Rockson SG. Source: Current Atherosclerosis Reports. 2000 March; 2(2): 144-50. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11122738

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Benefits of pravastatin on cardiovascular events and mortality in older patients with coronary heart disease are equal to or exceed those seen in younger patients: Results from the LIPID trial. Author(s): Hunt D, Young P, Simes J, Hague W, Mann S, Owensby D, Lane G, Tonkin A. Source: Annals of Internal Medicine. 2001 May 15; 134(10): 931-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11352694

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Beta-fibrinogen gene -455G/A polymorphism and coronary heart disease incidence: the Atherosclerosis Risk in Communities (ARIC) Study. Author(s): Folsom AR, Aleksic N, Ahn C, Boerwinkle E, Wu KK. Source: Annals of Epidemiology. 2001 April; 11(3): 166-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11293402

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Biochemical evaluation of oxidative stress during exercise in patients with coronary heart disease. Author(s): Andican G, Koldas L, Seven A, Ayan F, Sirmaci N, Burcak G. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2001 March; 39(3): 234-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11350021

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Birth weight is inversely associated with coronary heart disease in post-menopausal women: findings from the British women's heart and health study. Author(s): Lawlor DA, Davey Smith G, Ebrahim S. Source: Journal of Epidemiology and Community Health. 2004 February; 58(2): 120-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14729890

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Blood glucose concentrations < or = 125 mg/dl and coronary heart disease risk. Author(s): Hoogwerf BJ, Sprecher DL, Pearce GL, Acevedo M, Frolkis JP, Foody JM, Cross JA, Pashkow FJ, Robinson K, Vidt DG. Source: The American Journal of Cardiology. 2002 March 1; 89(5): 596-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11867048

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Blood pressure control and hormone replacement therapy in postmenopausal women at risk for coronary heart disease. Author(s): McCubbin JA, Helfer SG, Switzer FS 3rd, Price TM. Source: American Heart Journal. 2002 April; 143(4): 711-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11923810

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Blood pressure is insufficiently controlled in European patients with established coronary heart disease. Author(s): Boersma E, Keil U, De Bacquer D, De Backer G, Pyorala K, Poldermans D, Leprotti C, Pilotto L, de Swart E, Deckers JW, Heidrich J, Sans S, Kotseva K, Wood D, Ambrosio GB; EUROASPIRE I and II Study Groups. Source: Journal of Hypertension. 2003 October; 21(10): 1831-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14508188

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Blood pressure, smoking and body mass in relation to mortality from stroke and coronary heart disease in the elderly. A 10-year follow-up in Norway. Author(s): Ellekjaer H, Holmen J, Vatten L. Source: Blood Pressure. 2001; 10(3): 156-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11688763

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Body height is associated with decreased long-term stroke but not coronary heart disease mortality? Author(s): Goldbourt U, Tanne D. Source: Stroke; a Journal of Cerebral Circulation. 2002 March; 33(3): 743-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11872898

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Body iron stores and coronary heart disease. Author(s): Ma J, Stampfer MJ. Source: Clinical Chemistry. 2002; 48(4): 601-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11901057

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Body mass index, hypertension and 5-year coronary heart disease incidence in middle aged men: the PRIME study. Author(s): Mahamat A, Richard F, Arveiler D, Bongard V, Yarnell J, Ducimetiere P, Ruidavets JB, Haas B, Bingham A, Evans A, Amouyel P, Dallongeville J. Source: Journal of Hypertension. 2003 March; 21(3): 519-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12640245

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Broadsheet: Biochemical markers of coronary heart disease. Author(s): Naidoo D; Board of Education of the Royal College of Pathologists of Australasia. Source: Pathology. 2001 August; 33(3): 329-37. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11523935

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Changing patterns of risk factors and mortality for coronary heart disease among Alaska Natives, 1979-2002. Author(s): McLaughlin JB, Middaugh JP, Utermohle CJ, Asay ED, Fenaughty AM, Eberhart-Phillips JE. Source: Jama : the Journal of the American Medical Association. 2004 June 2; 291(21): 2545-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15173144

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Changing sex ratio in acute coronary heart disease: data from Swedish national registers 1984-99. Author(s): Rosengren A, Thelle DS, Koster M, Rosen M. Source: Journal of Internal Medicine. 2003 March; 253(3): 301-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12603497

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Cholesterol, coronary heart disease, and stroke in the Asia Pacific region. Author(s): Zhang X, Patel A, Horibe H, Wu Z, Barzi F, Rodgers A, MacMahon S, Woodward M; Asia Pacific Cohort Studies Collaboration. Source: International Journal of Epidemiology. 2003 August; 32(4): 563-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12913030

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Circulating soluble adhesion molecules ICAM-1 and VCAM-1 and incident coronary heart disease: the PRIME Study. Author(s): Luc G, Arveiler D, Evans A, Amouyel P, Ferrieres J, Bard JM, Elkhalil L, Fruchart JC, Ducimetiere P; PRIME Study Group. Source: Atherosclerosis. 2003 September; 170(1): 169-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12957696

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Commissions start review of service framework for coronary heart disease. Author(s): Macdonald S. Source: Bmj (Clinical Research Ed.). 2003 March 1; 326(7387): 468. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12609935

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Comparison of coronary artery calcium detected by electron beam tomography in patients with to those without symptomatic coronary heart disease. Author(s): Cheng YJ, Church TS, Kimball TE, Nichaman MZ, Levine BD, McGuire DK, Blair SN. Source: The American Journal of Cardiology. 2003 September 1; 92(5): 498-503. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943866

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Comparison of current guidelines for primary prevention of coronary heart disease: risk assessment and lipid-lowering therapy. Author(s): Broedl UC, Geiss HC, Parhofer KG. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2003 March; 18(3): 190-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12648250

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Comparison of the risk of fatal coronary heart disease in treated xanthomatous and non-xanthomatous heterozygous familial hypercholesterolaemia: a prospective registry study. Author(s): Neil HA, Huxley RR, Hawkins MM, Durrington PN, Betteridge DJ, Humphries SE; Simon Broome Familial Hyperlipidaemia Register Group and Scientific Steering Committee. Source: Atherosclerosis. 2003 September; 170(1): 73-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12957684

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Comparison of the short form (SF)-12 health status instrument with the SF-36 in patients with coronary heart disease. Author(s): Muller-Nordhorn J, Roll S, Willich SN. Source: Heart (British Cardiac Society). 2004 May; 90(5): 523-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15084550

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Coronary heart disease in a patient with cerebrotendinous xanthomatosis. Author(s): Valdivielso P, Calandra S, Duran JC, Garuti R, Herrera E, Gonzalez P. Source: Journal of Internal Medicine. 2004 June; 255(6): 680-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15147532

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Coronary heart disease in South Asians. Author(s): Kuppuswamy V, Gupta S. Source: The Practitioner. 2003 March; 247(1644): 181-2, 186-8, 190 Passim. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12640827

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Coronary heart disease risk assessment in diabetes mellitus: comparison of UKPDS risk engine with Framingham risk assessment function and its clinical implications. Author(s): Song SH, Brown PM. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2004 March; 21(3): 238-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15008833

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Coronary heart disease risk factors and menopause: a study in 1980 Tehranian women, the Tehran Lipid and Glucose Study. Author(s): Azizi F, Ainy E. Source: Climacteric : the Journal of the International Menopause Society. 2003 December; 6(4): 330-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15006254

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Coronary heart disease risk in people 65 years of age and older. Author(s): Levine BS, Kannel WB. Source: Progress in Cardiovascular Nursing. 2003 Summer; 18(3): 135-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12893975

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Coronary heart disease risk prediction by general practitioners in Victoria. Author(s): Peeters A, Ting J, Nelson MR, McNeil JJ. Source: The Medical Journal of Australia. 2004 March 1; 180(5): 252. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14984351

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Coronary heart disease risk prediction in the Atherosclerosis Risk in Communities (ARIC) study. Author(s): Chambless LE, Folsom AR, Sharrett AR, Sorlie P, Couper D, Szklo M, Nieto FJ. Source: Journal of Clinical Epidemiology. 2003 September; 56(9): 880-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14505774

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Coronary heart disease, hypertension, and angiotensinogen gene variants in Indian population. Author(s): Nair KG, Shalia KK, Ashavaid TF, Dalal JJ. Source: Journal of Clinical Laboratory Analysis. 2003; 17(5): 141-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12938141

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Coronary heart disease: the big picture. Author(s): Ganguli P. Source: Nurs Times. 2003 August 26-September 1; 99(34): 20-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14515561

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Coronary risk assessment of university students in Crete with premature parental coronary heart disease. Author(s): Lionis C, Antonopoulou M, Volitaki K, Thireos E. Source: Journal of American College Health : J of Ach. 2004 March-April; 52(5): 237-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15029946

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C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. Author(s): Danesh J, Wheeler JG, Hirschfield GM, Eda S, Eiriksdottir G, Rumley A, Lowe GD, Pepys MB, Gudnason V. Source: The New England Journal of Medicine. 2004 April 1; 350(14): 1387-97. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15070788

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Declining coronary heart disease mortality in Iceland: contribution by incidence, recurrence and case fatality rate. Author(s): Sigfusson N, Sigurdsson G, Agnarsson U, Gudmundsdottir II, Stefansdottir I, Sigvaldason H, Gudnason V. Source: Scandinavian Cardiovascular Journal : Scj. 2002 December; 36(6): 337-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12626199

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Dental disease, coronary heart disease and stroke, and inflammatory markers: what are the associations, and what do they mean? Author(s): Lowe GD. Source: Circulation. 2004 March 9; 109(9): 1076-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15007017

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Depression, mortality, and medical morbidity in patients with coronary heart disease. Author(s): Carney RM, Freedland KE. Source: Biological Psychiatry. 2003 August 1; 54(3): 241-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12893100

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Design and development of a coronary heart disease decision support tool. Author(s): Brekke MJ, Kottke TE, Brekke LN, Wu LA. Source: International Journal of Technology Assessment in Health Care. 2003 Summer; 19(3): 555-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12962343

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Developing primary care review criteria from evidence-based guidelines: coronary heart disease as a model. Author(s): Hutchinson A, McIntosh A, Anderson J, Gilbert C, Field R. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2003 September; 53(494): 690-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15103876

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Diabetes abolishes the gender gap in coronary heart disease. Author(s): Mak KH, Haffner SM. Source: European Heart Journal. 2003 August; 24(15): 1385-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12909066

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Diabetes: preventing coronary heart disease in a high risk group. Author(s): Feher MD. Source: Heart (British Cardiac Society). 2004 June; 90 Suppl 4: Iv18-21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15145907

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Diagnostic cardiac catheterization and revascularization rates for coronary heart disease. Author(s): Faris PD, Grant FC, Galbraith PD, Gong Y, Ghali WA; Canadian Cardiovascular Outcomes Research Team. Source: The Canadian Journal of Cardiology. 2004 March 15; 20(4): 391-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15057314

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Diagnostic value of C-reactive protein in patients with angiographically documented coronary heart disease. Author(s): Eren E, Yilmaz N, Pence S, Kocoglu H, Goksu S, Kocabas R, Kadayifci S. Source: Acta Medica (Hradec Kralove). 2002; 45(4): 155-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12587783

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Diet and coronary heart disease in diabetes. Author(s): Ann Intern Med. 2004 Jan 6;140(1):I26 Source: Acta Diabetologica. 2003 December; 40 Suppl 2: S389-400. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14706994

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Dietary fat and stroke: a different story from coronary heart disease. Author(s): He K. Source: Ital Heart J. 2003 December; 4(12): 821-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14976844

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Dietary fat predicts coronary heart disease events in subjects with type 2 diabetes. Author(s): Soinio M, Laakso M, Lehto S, Hakala P, Ronnemaa T. Source: Diabetes Care. 2003 March; 26(3): 619-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12610011

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Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Author(s): Pereira MA, O'Reilly E, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, Hallmans G, Knekt P, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Ascherio A. Source: Archives of Internal Medicine. 2004 February 23; 164(4): 370-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14980987

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Dietary fiber intake and reduced risk of coronary heart disease in US men and women: the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Author(s): Bazzano LA, He J, Ogden LG, Loria CM, Whelton PK; National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Source: Archives of Internal Medicine. 2003 September 8; 163(16): 1897-904. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12963562

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Dietary magnesium intake and the future risk of coronary heart disease (the Honolulu Heart Program). Author(s): Abbott RD, Ando F, Masaki KH, Tung KH, Rodriguez BL, Petrovitch H, Yano K, Curb JD. Source: The American Journal of Cardiology. 2003 September 15; 92(6): 665-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12972103

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Differences in coronary microvascular lesions in coronary heart disease and hypertension: an autopsy study of elderly patients. Author(s): Li XY, Li R, Yu W, Shi HY, Wei LX. Source: Chinese Medical Journal. 2004 February; 117(2): 207-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14975204

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Does job strain increase the risk for coronary heart disease or death in men and women? The Framingham Offspring Study. Author(s): Eaker ED, Sullivan LM, Kelly-Hayes M, D'Agostino RB Sr, Benjamin EJ. Source: American Journal of Epidemiology. 2004 May 15; 159(10): 950-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15128607

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Coronary Heart Disease

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Effect of endogenous estrogen on endothelial function in women with coronary heart disease and its mechanism. Author(s): Li XP, Zhou Y, Zhao SP, Gao M, Zhou QC, Li YS. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 2004 January; 339(1-2): 183-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687908

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Effect of smoking and sedentary behavior on the association between depressive symptoms and mortality from coronary heart disease. Author(s): Brummett BH, Babyak MA, Siegler IC, Mark DB, Williams RB, Barefoot JC. Source: The American Journal of Cardiology. 2003 September 1; 92(5): 529-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12943871

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Effect of statins versus untreated dyslipidemia on serum uric acid levels in patients with coronary heart disease: a subgroup analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study. Author(s): Athyros VG, Elisaf M, Papageorgiou AA, Symeonidis AN, Pehlivanidis AN, Bouloukos VI, Milionis HJ, Mikhailidis DP; GREACE Study Collaborative Group. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2004 April; 43(4): 589-99. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15042535

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Effects of exercise intensity on physical fitness and risk factors for coronary heart disease. Author(s): Okura T, Nakata Y, Tanaka K. Source: Obesity Research. 2003 September; 11(9): 1131-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12972684

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Effects of exercise training on coronary heart disease risk factors in renal transplant recipients. Author(s): Painter PL, Hector L, Ray K, Lynes L, Paul SM, Dodd M, Tomlanovich SL, Ascher NL. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 August; 42(2): 362-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12900820

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Effects of race on lipid-lowering management in hospitalized patients with coronary heart disease. Author(s): Dressler DD, Jacobson TA. Source: The American Journal of Cardiology. 2004 May 1; 93(9): 1167-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15110215

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Elevated plasma homocysteine level is an independent predictor of coronary heart disease events in patients with type 2 diabetes mellitus. Author(s): Soinio M, Marniemi J, Laakso M, Lehto S, Ronnemaa T. Source: Annals of Internal Medicine. 2004 January 20; 140(2): 94-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14734331

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Emotional and functional outcomes in women with coronary heart disease. Author(s): King KB. Source: The Journal of Cardiovascular Nursing. 2001 April; 15(3): 54-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12968771

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Endodontic variables and coronary heart disease. Author(s): Frisk F, Hakeberg M, Ahlqwist M, Bengtsson C. Source: Acta Odontologica Scandinavica. 2003 October; 61(5): 257-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14763775

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Epidemiology of coronary heart disease in women. Author(s): Bello N, Mosca L. Source: Progress in Cardiovascular Diseases. 2004 January-February; 46(4): 287-95. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14961452

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Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk. Author(s): Roumeguere T, Wespes E, Carpentier Y, Hoffmann P, Schulman CC. Source: European Urology. 2003 September; 44(3): 355-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12932936

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Established risk factors for coronary heart disease are unrelated to androgen-induced baldness in female-to-male transsexuals. Author(s): Giltay EJ, Toorians AW, Sarabdjitsingh AR, de Vries NA, Gooren LJ. Source: The Journal of Endocrinology. 2004 January; 180(1): 107-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14709149

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Estrogen plus progestin and the risk of coronary heart disease. Author(s): Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL, Trevisan M, Black HR, Heckbert SR, Detrano R, Strickland OL, Wong ND, Crouse JR, Stein E, Cushman M; Women's Health Initiative Investigators. Source: The New England Journal of Medicine. 2003 August 7; 349(6): 523-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12904517

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Exercise tolerance testing to screen for coronary heart disease: a systematic review for the technical support for the U.S. Preventive Services Task Force. Author(s): Fowler-Brown A, Pignone M, Pletcher M, Tice JA, Sutton SF, Lohr KN; U.S. Preventive Services Task Force. Source: Annals of Internal Medicine. 2004 April 6; 140(7): W9-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15069009

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Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Author(s): Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N. Source: The American Journal of Medicine. 2004 May 15; 116(10): 682-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15121495

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Explaining gender differences in coronary heart disease: hunting for clues with the ophthalmoscope. Author(s): Maguire MG. Source: Archives of Ophthalmology. 2003 September; 121(9): 1328-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12963619

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Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000. Author(s): Unal B, Critchley JA, Capewell S. Source: Circulation. 2004 March 9; 109(9): 1101-7. Epub 2004 Mar 01. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14993137

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Extensive association analysis between polymorphisms of PON gene cluster with coronary heart disease in Chinese Han population. Author(s): Wang X, Fan Z, Huang J, Su S, Yu Q, Zhao J, Hui R, Yao Z, Shen Y, Qiang B, Gu D. Source: Arteriosclerosis, Thrombosis, and Vascular Biology. 2003 February 1; 23(2): 32834. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12588779

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Factors influencing attendance at cardiac rehabilitation among coronary heart disease patients. Author(s): Farley RL, Wade TD, Birchmore L. Source: European Journal of Cardiovascular Nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. 2003 September; 2(3): 205-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14622628

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Factors relating to patients' reports about hospital care for coronary heart disease in England. Author(s): Jenkinson C, Coulter A, Bruster S, Chandola T, Jones P. Source: Journal of Health Services Research & Policy. 2003 April; 8(2): 83-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12820669

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Familial transmissability of early age at initial diagnosis in coronary heart disease (CHD): males only, and mediated by psychosocial/emotional distress? Author(s): Ketterer MW, Denollet J, Chapp J, Keteyian S, Farha AJ, Clark V, Hudson M, Hakim A, Greenbaum A, Schairer J, Cao JJ. Source: Journal of Behavioral Medicine. 2004 February; 27(1): 1-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15065472

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Family history is a coronary heart disease risk factor in the Second Northwick Park Heart Study. Author(s): Hawe E, Talmud PJ, Miller GJ, Humphries SE; Second Northwick Park Heart Study. Source: Annals of Human Genetics. 2003 March; 67(Pt 2): 97-106. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12675686

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Family history, longevity, and risk of coronary heart disease: the PRIME Study. Author(s): Yarnell J, Yu S, Patterson C, Cambien F, Arveiler D, Amouyel P, Ferrieres J, Luc G, Evans A, Ducimetiere P. Source: International Journal of Epidemiology. 2003 February; 32(1): 71-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12690013

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Family history--and independent risk factors for coronary heart disease, it is time to be practical. Author(s): Simon J, Rosolova H. Source: European Heart Journal. 2002 November; 23(21): 1637-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12398817

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Family income a strong predictor of coronary heart disease events but not of overall deaths among Turkish adults: a 12-year prospective study. Author(s): Keles I, Onat A, Toprak S, Avci GS, Sansoy V. Source: Preventive Medicine. 2003 August; 37(2): 171-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12855217

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Family-centered approaches to understanding and preventing coronary heart disease. Author(s): Kardia SL, Modell SM, Peyser PA. Source: American Journal of Preventive Medicine. 2003 February; 24(2): 143-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12568820

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Fasting insulin levels independently associated with coronary heart disease in nondiabetic Turkish men and women. Author(s): Onat A, Ceyhan K, Sansoy V, Basar O, Erer B, Uysal O, Hergenc G. Source: International Journal of Cardiology. 2002 November; 86(1): 61-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12243850

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Features of serum beta-lipoprotein electrophoretogram in patients with coronary heart disease. Author(s): Chen YQ, Yin J, Zhang M, Yin BS. Source: Di Yi June Yi Da Xue Xue Bao. 2003 July; 23(7): 740-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12865238

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Fibrinogen, C-reactive protein and coronary heart disease: does Mendelian randomization suggest the associations are non-causal? Author(s): Davey Smith G, Harbord R, Ebrahim S. Source: Qjm : Monthly Journal of the Association of Physicians. 2004 March; 97(3): 163-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14976273

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Fire-and-forget in prevention of coronary heart disease. Author(s): Karpe F, Holman R. Source: Lancet. 2002 December 14; 360(9349): 1984; Author Reply 1984. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12493308

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Folate improves endothelial function in patients with coronary heart disease. Author(s): Doshi S, McDowell I, Moat S, Lewis M, Goodfellow J. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2003 November; 41(11): 1505-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14656033

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Food labeling: health claims; soluble dietary fiber from certain foods and coronary heart disease. Final rule. Author(s): Food and Drug Administration, HHS. Source: Federal Register. 2003 July 28; 68(144): 44207-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12884876

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Forty-years (1961-2001) of all-cause and coronary heart disease mortality and its determinants: the Corfu cohort from the Seven Countries Study. Author(s): Panagiotakos DB, Chrysohoou C, Pitsavos C, Menotti A, Dontas A, Skoumas J, Stefanadis C, Toutouzas P; Corfu Cohort from the Seven Countries Study. Source: International Journal of Cardiology. 2003 July; 90(1): 73-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12821222

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Four paraoxonase gene polymorphisms in 11212 cases of coronary heart disease and 12786 controls: meta-analysis of 43 studies. Author(s): Wheeler JG, Keavney BD, Watkins H, Collins R, Danesh J. Source: Lancet. 2004 February 28; 363(9410): 689-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15001326

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Framingham risk function overestimates risk of coronary heart disease in men and women from Germany--results from the MONICA Augsburg and the PROCAM cohorts. Author(s): Hense HW, Schulte H, Lowel H, Assmann G, Keil U. Source: European Heart Journal. 2003 May; 24(10): 937-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12714025

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Framingham-based tools to calculate the global risk of coronary heart disease: a systematic review of tools for clinicians. Author(s): Sheridan S, Pignone M, Mulrow C. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2003 December; 18(12): 1039-52. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687264

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Functional status during immediate recovery after hospitalization for coronary heart disease. Author(s): LaPier TK. Source: Journal of Cardiopulmonary Rehabilitation. 2003 May-June; 23(3): 203-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12782905

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Gemfibrozil reduces release of tumor necrosis factor-alpha in peripheral blood mononuclear cells from healthy subjects and patients with coronary heart disease. Author(s): Zhao SP, Ye HJ, Zhou HN, Nie S, Li QZ. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 2003 June; 332(1-2): 61-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12763281

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Gender differences in secondary prevention of coronary heart disease: reasons to worry or not? Author(s): Nilsson P, Brandstrom H, Lingfors H, Erhardt L, Hedback B, Israelsson B, Sjoberg G; National Programme of Quality Assurance in Secondary Prevention in Sweden. Source: Scandinavian Journal of Primary Health Care. 2003 March; 21(1): 37-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12718459

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Gender, self-care and functional status among older persons with coronary heart disease: a national perspective. Author(s): Burnette D, Mui AC, Zodikoff BD. Source: Women & Health. 2004; 39(1): 65-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15002883

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Gene therapy for coronary heart disease. Author(s): Yla-Herttuala S. Source: Journal of Internal Medicine. 2001 November; 250(5): 367-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11887969

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Gene:environment interaction in lipid metabolism and effect on coronary heart disease risk. Author(s): Talmud PJ, Humphries SE. Source: Current Opinion in Lipidology. 2002 April; 13(2): 149-54. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11891417

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Gene-gene interaction of PPARgamma and ApoE affects coronary heart disease risk. Author(s): Peng DQ, Zhao SP, Nie S, Li J. Source: International Journal of Cardiology. 2003 December; 92(2-3): 257-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14659862

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General practice workload implications of the national service framework for coronary heart disease: cross sectional survey. Author(s): Hippisley-Cox J, Pringle M. Source: Bmj (Clinical Research Ed.). 2001 August 4; 323(7307): 269-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11485958

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Generating information from electronic patient records in general practice: a description of clinical care and gender inequalities in coronary heart disease using data from over two million patient records. Author(s): Horsfield P, Teasdale S. Source: Informatics in Primary Care. 2003; 11(3): 137-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14680536

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Genetic epidemiological studies of coronary heart disease. Author(s): Keavney B. Source: International Journal of Epidemiology. 2002 August; 31(4): 730-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12177010

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Genetic markers for coronary heart disease. Author(s): Breslow JL. Source: Clin Cardiol. 2001; 24(7 Suppl): Ii-14-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11444649

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Genetic polymorphisms of clotting factors and coronary heart disease. Author(s): Donati MB, Iacoviello L. Source: Haematologica. 2001 November; 86(11 Suppl 2): 28-30. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11926770

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Genetic testing for coronary heart disease: the approaching frontier. Author(s): Agah R, Topol EJ. Source: Expert Review of Molecular Diagnostics. 2002 September; 2(5): 448-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12271816

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Genetic variability of von Willebrand factor and risk of coronary heart disease: the Rotterdam Study. Author(s): van der Meer IM, Brouwers GJ, Bulk S, Leebeek FW, van der Kuip DA, Hofman A, Witteman JC, Gomez Garcia EB. Source: British Journal of Haematology. 2004 February; 124(3): 343-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14717782

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Genetic variation in coronary heart disease and myocardial infarction: methodological overview and clinical evidence. Author(s): Winkelmann BR, Hager J. Source: Pharmacogenomics. 2000 February; 1(1): 73-94. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11258599

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Genome-wide linkage analysis reveals evidence of multiple regions that influence variation in plasma lipid and apolipoprotein levels associated with risk of coronary heart disease. Author(s): Klos KL, Kardia SL, Ferrell RE, Turner ST, Boerwinkle E, Sing CF. Source: Arteriosclerosis, Thrombosis, and Vascular Biology. 2001 June; 21(6): 971-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11397706

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Geographic variation in incidence of coronary heart disease in Britain: the contribution of established risk factors. Author(s): Morris RW, Whincup PH, Lampe FC, Walker M, Wannamethee SG, Shaper AG. Source: Heart (British Cardiac Society). 2001 September; 86(3): 277-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11514478

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Glucose metabolism and coronary heart disease in patients with normal glucose tolerance. Author(s): Sasso FC, Carbonara O, Nasti R, Campana B, Marfella R, Torella M, Nappi G, Torella R, Cozzolino D. Source: Jama : the Journal of the American Medical Association. 2004 April 21; 291(15): 1857-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15100204

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Glycemic load and the risk of coronary heart disease. Author(s): Katz DL. Source: The American Journal of Clinical Nutrition. 2001 January; 73(1): 131-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11124769

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Greek adolescents, fitness, fatness, fat intake, activity, and coronary heart disease risk. Author(s): Bouziotas C, Koutedakis Y, Nevill A, Ageli E, Tsigilis N, Nikolaou A, Nakou A. Source: Archives of Disease in Childhood. 2004 January; 89(1): 41-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14709501

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Growth of girls who later develop coronary heart disease. Author(s): Forsen T, Osmond C, Eriksson JG, Barker DJ. Source: Heart (British Cardiac Society). 2004 January; 90(1): 20-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14676233

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Haemochromatosis gene mutations and risk of coronary heart disease: a west of Scotland coronary prevention study (WOSCOPS) substudy. Author(s): Gunn IR, Maxwell FK, Gaffney D, McMahon AD, Packard CJ. Source: Heart (British Cardiac Society). 2004 March; 90(3): 304-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14966054

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Haptoglobin phenotype and prevalent coronary heart disease in the Framingham offspring cohort. Author(s): Levy AP, Larson MG, Corey D, Lotan R, Vita JA, Benjamin EJ. Source: Atherosclerosis. 2004 February; 172(2): 361-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15019547

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Health behaviors, body composition, and coronary heart disease risk in women with multiple sclerosis. Author(s): Slawta JN, Wilcox AR, McCubbin JA, Nalle DJ, Fox SD, Anderson G. Source: Archives of Physical Medicine and Rehabilitation. 2003 December; 84(12): 182330. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14669190

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Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease: The Stockholm Female Coronary Risk Study. Author(s): Janszky I, Ericson M, Mittleman MA, Wamala S, Al-Khalili F, SchenckGustafsson K, Orth-Gomer K. Source: Journal of Internal Medicine. 2004 January; 255(1): 13-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687234

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Heart rate-corrected QT interval prolongation predicts risk of coronary heart disease in black and white middle-aged men and women: the ARIC study. Author(s): Dekker JM, Crow RS, Hannan PJ, Schouten EG, Folsom AR; ARIC Study. Source: Journal of the American College of Cardiology. 2004 February 18; 43(4): 565-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14975464

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Heart to Heart: a computerized decision aid for assessment of coronary heart disease risk and the impact of risk-reduction interventions for primary prevention. Author(s): Pignone M, Sheridan SL, Lee YZ, Kuo J, Phillips C, Mulrow C, Zeiger R. Source: Preventive Cardiology. 2004 Winter; 7(1): 26-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15010625

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Helicobacter pylori and coronary heart disease: which directions for future studies? Author(s): Pellicano R, Fagoonee S, Rizzetto M, Ponzetto A. Source: Critical Reviews in Microbiology. 2003; 29(4): 351-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14636044

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High coronary heart disease rates among Dutch women of the baby boom, born 19451959: age-cohort analysis and projection. Author(s): Bonneux L, Looman CW. Source: European Journal of Public Health. 2003 September; 13(3): 226-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14533724

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High density lipoprotein subfractions and the risk of coronary heart disease: 9-years follow-up in the Caerphilly Study. Author(s): Yu S, Yarnell JW, Sweetnam P, Bolton CH. Source: Atherosclerosis. 2003 February; 166(2): 331-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12535746

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High oxidative stress in patients with stable coronary heart disease. Author(s): Weinbrenner T, Cladellas M, Isabel Covas M, Fito M, Tomas M, Senti M, Bruguera J, Marrugat J. Source: Atherosclerosis. 2003 May; 168(1): 99-106. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12732392

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High-intensity statin treatment for coronary heart disease. Author(s): Sacks FM. Source: Jama : the Journal of the American Medical Association. 2004 March 3; 291(9): 1132-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14996784

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Homocysteine and coronary heart disease: the importance of a distinction between low and high risk subjects. Author(s): De Bree A, Verschuren WM, Kromhout D, Mennen LI, Blom HJ. Source: International Journal of Epidemiology. 2002 December; 31(6): 1268-72; Author Reply 1271-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12540734

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Hormone replacement therapy and coronary heart disease: results of randomized trials. Author(s): Petitti D. Source: Progress in Cardiovascular Diseases. 2003 November-December; 46(3): 231-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14685941

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How will practices cope with information for the new GMS contract? Coronary heart disease data recording in five Scottish practices. Author(s): Morris L, Taylor M, Campbell LM, Sullivan FM. Source: Informatics in Primary Care. 2003; 11(3): 121-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14680534

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Human CRP gene polymorphism influences CRP levels: implications for the prediction and pathogenesis of coronary heart disease. Author(s): Brull DJ, Serrano N, Zito F, Jones L, Montgomery HE, Rumley A, Sharma P, Lowe GD, World MJ, Humphries SE, Hingorani AD. Source: Arteriosclerosis, Thrombosis, and Vascular Biology. 2003 November 1; 23(11): 2063-9. Epub 2003 July 03. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12842840

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Human paraoxonase gene cluster polymorphisms as predictors of coronary heart disease risk in the prospective Northwick Park Heart Study II. Author(s): Robertson KS, Hawe E, Miller GJ, Talmud PJ, Humphries SE; Northwick Park Heart Study II. Source: Biochimica Et Biophysica Acta. 2003 November 20; 1639(3): 203-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14636952

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Hyperlipidemia in children at risk for coronary heart disease. Author(s): Chotivittayatarakorn P, Chewataworn A, Sathapoldeja R, Sirimonkol P. Source: J Med Assoc Thai. 2003 June; 86 Suppl 2: S195-200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12929989

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Hypertension and coronary heart disease. Author(s): Baguet JP, Mallion JM. Source: Blood Pressure. 2003; 12(4): 255-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14596363

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Hypertriglyceridemia but not diabetes status is associated with VLDL containing apolipoprotein CIII in patients with coronary heart disease. Author(s): Lee SJ, Moye LA, Campos H, Williams GH, Sacks FM. Source: Atherosclerosis. 2003 April; 167(2): 293-302. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12818412

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Immune activation and degradation of tryptophan in coronary heart disease. Author(s): Wirleitner B, Rudzite V, Neurauter G, Murr C, Kalnins U, Erglis A, Trusinskis K, Fuchs D. Source: European Journal of Clinical Investigation. 2003 July; 33(7): 550-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12814390

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Impact of subclinical hypothyroidism on serum total homocysteine concentrations, the prevalence of coronary heart disease (CHD), and CHD risk factors in the New Mexico Elder Health Survey. Author(s): Lindeman RD, Romero LJ, Schade DS, Wayne S, Baumgartner RN, Garry PJ. Source: Thyroid : Official Journal of the American Thyroid Association. 2003 June; 13(6): 595-600. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12930604

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Implications of estimating coronary heart disease risk in the US population. Author(s): Berman DS, Wong ND. Source: Journal of the American College of Cardiology. 2004 May 19; 43(10): 1797-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15145102

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Importance of high-density lipoprotein cholesterol and triglyceride levels in coronary heart disease. Author(s): Sprecher DL, Watkins TR, Behar S, Brown WV, Rubins HB, Schaefer EJ. Source: The American Journal of Cardiology. 2003 March 1; 91(5): 575-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12615263

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Improvements in treatment of coronary heart disease and cessation of stroke mortality rate decline. Author(s): Peeters A, Bonneux L, Barendregt JJ, Mackenbach JP; Netherlands Epidemiology and Demography Compression of Morbidity Research Group. Source: Stroke; a Journal of Cerebral Circulation. 2003 July; 34(7): 1610-4. Epub 2003 June 19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12817102

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Incidence, prevalence and coronary heart disease risk level in known Type 2 diabetes: a sentinel practice network study in the Basque Country, Spain. Author(s): Arteagoitia JM, Larranaga MI, Rodriguez JL, Fernandez I, Pinies JA. Source: Diabetologia. 2003 July; 46(7): 899-909. Epub 2003 June 27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12830379

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Indices related to apo CII and CIII serum concentrations and coronary heart disease: a case-control study. Author(s): Gerber Y, Goldbourt U, Segev S, Harats D. Source: Preventive Medicine. 2003 July; 37(1): 18-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12799125

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Individuals at increased coronary heart disease risk are characterized by an impaired microvascular function in skin. Author(s): IJzerman RG, de Jongh RT, Beijk MA, van Weissenbruch MM, Delemarre-van de Waal HA, Serne EH, Stehouwer CD. Source: European Journal of Clinical Investigation. 2003 July; 33(7): 536-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12814388

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Inflammatory markers in coronary heart disease: coronary vascular versus myocardial origin? Author(s): Heusch G, Schulz R, Erbel R. Source: Circulation. 2003 July 8; 108(1): E4; Author Reply E4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12847058

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Insulin resistance and other risk factors for coronary heart disease in elderly men. The Study of Men Born in 1913 and 1923. Author(s): Welin L, Bresater LE, Eriksson H, Hansson PO, Welin C, Rosengren A. Source: European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology. 2003 August; 10(4): 2838. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14555884

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Insulin resistance, hypertension, and coronary heart disease. Author(s): Reaven G. Source: Journal of Clinical Hypertension (Greenwich, Conn.). 2003 July-August; 5(4): 269-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12939567

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Interactions between the renin-angiotensin system and dyslipidemia: relevance in the therapy of hypertension and coronary heart disease. Author(s): Singh BM, Mehta JL. Source: Archives of Internal Medicine. 2003 June 9; 163(11): 1296-304. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12796065

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Interleukin-18 and the risk of coronary heart disease in European men: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). Author(s): Blankenberg S, Luc G, Ducimetiere P, Arveiler D, Ferrieres J, Amouyel P, Evans A, Cambien F, Tiret L; PRIME Study Group. Source: Circulation. 2003 November 18; 108(20): 2453-9. Epub 2003 October 27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14581397

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Is alcohol anti-inflammatory in the context of coronary heart disease? Author(s): de Lorgeril M, Salen P. Source: Heart (British Cardiac Society). 2004 April; 90(4): 355-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15020492

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Is coronary heart disease a communicable disease? Author(s): Biswas R, Bagchi S. Source: Indian J Public Health. 2003 July-September; 47(3): 3-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15129860

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Is maternal transmission of coronary heart disease risk stronger than paternal transmission? Author(s): Kinra S, Davey Smith G, Okasha M, McCarron P, McEwen J. Source: Heart (British Cardiac Society). 2003 August; 89(8): 834-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12860850

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Is periodontitis associated with an increased risk of coronary heart disease and preterm and/or low birth weight births? Author(s): Madianos PN, Bobetsis GA, Kinane DF. Source: Journal of Clinical Periodontology. 2002; 29 Suppl 3: 22-36; Discussion 37-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12787204

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Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with child-rearing? Findings from the British Women's Heart and Health Study and the British Regional Heart Study. Author(s): Lawlor DA, Emberson JR, Ebrahim S, Whincup PH, Wannamethee SG, Walker M, Smith GD; British Women's Heart and Health Study; British Regional Heart Study. Source: Circulation. 2003 March 11; 107(9): 1260-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12628945

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Is type A behavior really a trigger for coronary heart disease events? Author(s): Gallacher JE, Sweetnam PM, Yarnell JW, Elwood PC, Stansfeld SA. Source: Psychosomatic Medicine. 2003 May-June; 65(3): 339-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12764205

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Ischemic preconditioning in coronary heart disease: a therapeutic golden fleece? Author(s): Amsterdam EA, Schaefer S. Source: Journal of the American College of Cardiology. 2004 May 5; 43(9): 1515-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15120804

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Job strain and major risk factors for coronary heart disease among employed males and females in a Swedish study on work, lipids and fibrinogen. Author(s): Alfredsson L, Hammar N, Fransson E, de Faire U, Hallqvist J, Knutsson A, Nilsson T, Theorell T, Westerholm P. Source: Scand J Work Environ Health. 2002 August; 28(4): 238-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12199425

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Job strain, job demands, decision latitude, and risk of coronary heart disease within the Whitehall II study. Author(s): Kuper H, Marmot M. Source: Journal of Epidemiology and Community Health. 2003 February; 57(2): 147-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12540692

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Leisure time physical activity and coronary heart disease mortality in men symptomatic or asymptomatic for ischaemia: evidence from the Whitehall study. Author(s): Batty GD, Shipley MJ, Marmot M, Davey Smith G. Source: Journal of Public Health Medicine. 2003 September; 25(3): 190-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14575192

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Leukocytes and coronary heart disease. Author(s): Hoffman M, Blum A, Baruch R, Kaplan E, Benjamin M. Source: Atherosclerosis. 2004 January; 172(1): 1-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14709350

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Licking prostate and other cancers and coronary heart disease with an Asian style diet. Author(s): Scobie B. Source: N Z Med J. 2002 December 13; 115(1167): U285. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12552271

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Lifestyle intervention of hypocaloric dieting and walking reduces abdominal obesity and improves coronary heart disease risk factors in obese, postmenopausal, AfricanAmerican and Caucasian women. Author(s): Nicklas BJ, Dennis KE, Berman DM, Sorkin J, Ryan AS, Goldberg AP. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2003 February; 58(2): 181-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12586858

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Lifetime risk of coronary heart disease by cholesterol levels at selected ages. Author(s): Lloyd-Jones DM, Wilson PW, Larson MG, Leip E, Beiser A, D'Agostino RB, Cleeman JI, Levy D. Source: Archives of Internal Medicine. 2003 September 8; 163(16): 1966-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12963571

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Life-years gained from coronary heart disease mortality reduction in Scotland: prevention or treatment? Author(s): Critchley JA, Capewell S, Unal B. Source: Journal of Clinical Epidemiology. 2003 June; 56(6): 583-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12873654

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Lipid changes on hormone therapy and coronary heart disease events in the Heart and Estrogen/progestin Replacement Study (HERS). Author(s): Shlipak MG, Chaput LA, Vittinghoff E, Lin F, Bittner V, Knopp RH, Hulley SB; Heart and Estrogen/progestin Replacement Study Investigators. Source: American Heart Journal. 2003 November; 146(5): 870-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14597937

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Lipids and coronary heart disease in Asia. Author(s): Khoo KL, Tan H, Liew YM, Deslypere JP, Janus E. Source: Atherosclerosis. 2003 July; 169(1): 1-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12860245

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Lipoprotein-associated phospholipase A2, high-sensitivity C-reactive protein, and risk for incident coronary heart disease in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study. Author(s): Ballantyne CM, Hoogeveen RC, Bang H, Coresh J, Folsom AR, Heiss G, Sharrett AR. Source: Circulation. 2004 February 24; 109(7): 837-42. Epub 2004 Feb 02. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14757686

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Long-term changes in exercise capacity, quality of life, body anthropometry, and lipid profiles after a cardiac rehabilitation program in obese patients with coronary heart disease. Author(s): Yu CM, Li LS, Ho HH, Lau CP. Source: The American Journal of Cardiology. 2003 February 1; 91(3): 321-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12565088

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Low fractional diastolic pressure in the ascending aorta increased the risk of coronary heart disease. Author(s): Nakayama Y, Hayashi T, Yoshimaru K, Tsumura K, Ueda H. Source: Journal of Human Hypertension. 2002 December; 16(12): 837-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12522464

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Low-density lipoprotein apheresis in the prevention of recurrent coronary heart disease: a review. Author(s): Tasaki H. Source: Therap Apher Dial. 2003 August; 7(4): 408-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12887723

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Lung function and incident coronary heart disease: the Atherosclerosis Risk in Communities Study. Author(s): Schroeder EB, Welch VL, Couper D, Nieto FJ, Liao D, Rosamond WD, Heiss G. Source: American Journal of Epidemiology. 2003 December 15; 158(12): 1171-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14652302

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Magnesium intake and risk of coronary heart disease among men. Author(s): Al-Delaimy WK, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Source: Journal of the American College of Nutrition. 2004 February; 23(1): 63-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14963055

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Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. Author(s): Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB, Wilson PW. Source: Jama : the Journal of the American Medical Association. 2003 August 20; 290(7): 891-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12928465

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Men deny and women cry, but who dies? Do the wages of "denial" include early ischemic coronary heart disease? Author(s): Ketterer MW, Denollet J, Chapp J, Thayer B, Keteyian S, Clark V, John S, Farha AJ, Deveshwar S. Source: Journal of Psychosomatic Research. 2004 January; 56(1): 119-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14987973

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Meta-analysis of 4 coronary heart disease genome-wide linkage studies confirms a susceptibility locus on chromosome 3q. Author(s): Chiodini BD, Lewis CM. Source: Arteriosclerosis, Thrombosis, and Vascular Biology. 2003 October 1; 23(10): 18638. Epub 2003 August 28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12947017

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Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Author(s): Sattar N, Gaw A, Scherbakova O, Ford I, O'Reilly DS, Haffner SM, Isles C, Macfarlane PW, Packard CJ, Cobbe SM, Shepherd J. Source: Circulation. 2003 July 29; 108(4): 414-9. Epub 2003 Jul 14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12860911

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Metacarpal cortical area and risk of coronary heart disease: the Framingham Study. Author(s): Samelson EJ, Kiel DP, Broe KE, Zhang Y, Cupples LA, Hannan MT, Wilson PW, Levy D, Williams SA, Vaccarino V. Source: American Journal of Epidemiology. 2004 March 15; 159(6): 589-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15003963

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Microvascular dysfunction: a link between pre-eclampsia and maternal coronary heart disease. Author(s): Ramsay JE, Stewart F, Greer IA, Sattar N. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 November; 110(11): 1029-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14592589

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Missing, mediocre, or merely obsolete? An evaluation of UK data sources for coronary heart disease. Author(s): Unal B, Critchley JA, Capewell S. Source: Journal of Epidemiology and Community Health. 2003 July; 57(7): 530-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12821703

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Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. Author(s): Critchley JA, Capewell S. Source: Jama : the Journal of the American Medical Association. 2003 July 2; 290(1): 8697. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12837716

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NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Author(s): Alexander CM, Landsman PB, Teutsch SM, Haffner SM; Third National Health and Nutrition Examination Survey (NHANES III); National Cholesterol Education Program (NCEP). Source: Diabetes. 2003 May; 52(5): 1210-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12716754

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Negative emotion and coronary heart disease. A review. Author(s): Sirois BC, Burg MM. Source: Behavior Modification. 2003 January; 27(1): 83-102. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12587262

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Negative emotions and coronary heart disease: causally related or merely coexistent? A review. Author(s): Smith DF. Source: Scandinavian Journal of Psychology. 2001 February; 42(1): 57-69. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11273579

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Neighborhood socioeconomic environment and incidence of coronary heart disease: a follow-up study of 25,319 women and men in Sweden. Author(s): Sundquist K, Winkleby M, Ahlen H, Johansson SE. Source: American Journal of Epidemiology. 2004 April 1; 159(7): 655-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15033643

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Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden. Author(s): Sundquist K, Malmstrom M, Johansson SE. Source: Journal of Epidemiology and Community Health. 2004 January; 58(1): 71-7. Erratum In: J Epidemiol Community Health. 2004 March; 58(3): 259. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14684730

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Nitric oxide production and arachidonic acid metabolism in platelet membranes of coronary heart disease patients with and without diabetes. Author(s): Tretjakovs P, Kalnins U, Dabina I, Erglis A, Dinne I, Jurka A, Latkovskis G, Zvaigzne A, Pirags V. Source: Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre. 2003 January-March; 12(1): 10-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12566962

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No inverse association between fish consumption and risk of death from all-causes, and incidence of coronary heart disease in middle-aged, Danish adults. Author(s): Osler M, Andreasen AH, Hoidrup S. Source: Journal of Clinical Epidemiology. 2003 March; 56(3): 274-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12725883

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Novel risk factors for coronary heart disease. Author(s): Solomon HA. Source: Ann Dent. 2003 December; 7(1): 7, 10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15042979

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Nurse practitioners improve risk factor management for patients with coronary heart disease. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2002 November 15; 13(22): 9-10, 12. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12643261

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Obesity and hypertension in coronary heart disease: two independent PRIMErs? Author(s): Kelm M, Strauer BE. Source: Journal of Hypertension. 2003 March; 21(3): 475-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12640234

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Obesity as the core of the metabolic syndrome and the management of coronary heart disease. Author(s): Shirai K. Source: Current Medical Research and Opinion. 2004 March; 20(3): 295-304. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15025838

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Obesity in 70-year-old subjects as a risk factor for 15-year coronary heart disease incidence. Author(s): Dey DK, Lissner L. Source: Obesity Research. 2003 July; 11(7): 817-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12855750

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Opportunities to prevent sudden out-of-hospital death due to coronary heart disease in a community. Author(s): Wu LA, Kottke TE, Brekke LN, Brekke MJ, Grill DE, Goraya TY, Roger VL, Belau PG, White RD. Source: Resuscitation. 2003 January; 56(1): 55-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12505739

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Optimal nutrition for the prevention of coronary heart disease: a worldwide challenge. Author(s): Pasternak RC. Source: Ethn Dis. 2003 Summer; 13(2 Suppl 2): S91-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13677421

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Oral health indicators poorly predict coronary heart disease deaths. Author(s): Tuominen R, Reunanen A, Paunio M, Paunio I, Aromaa A. Source: Journal of Dental Research. 2003 September; 82(9): 713-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12939356

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Organizational instability and cardiovascular risk factors in white-collar employees: an analysis of correlates of structural instability of workplace organization on risk factors for coronary heart disease in a sample of 3,904 white collar employees in the Stockholm region. Author(s): Westerlund H, Theorell T, Alfredsson L. Source: European Journal of Public Health. 2004 March; 14(1): 37-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15080389

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Outcomes in patients with coronary heart disease who do not undergo lipid testing. Author(s): Ho PM, Maynard C, Starks H, Sun H, Sloan K, Sales A. Source: The American Journal of Cardiology. 2003 April 15; 91(8): 986-8, A7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12686344

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Overweight and obesity in patients with established coronary heart disease: are we meeting the challenge? Author(s): De Bacquer D, De Backer G, Cokkinos D, Keil U, Montaye M, Ostor E, Pyorala K, Sans S. Source: European Heart Journal. 2004 January; 25(2): 121-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14720528

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Physical activity and coronary heart disease. Author(s): Batty GD, Lee IM. Source: Bmj (Clinical Research Ed.). 2004 May 8; 328(7448): 1089-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15130959

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Plasma levels of IL-8 predict early complications in patients with coronary heart disease after percutaneous coronary intervention. Author(s): Qi X, Li J, Gu J, Li S, Dang Y, Wang T. Source: Japanese Heart Journal. 2003 July; 44(4): 451-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12906027

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Poor oral health is associated with coronary heart disease and elevated systemic inflammatory and haemostatic factors. Author(s): Montebugnoli L, Servidio D, Miaton RA, Prati C, Tricoci P, Melloni C. Source: Journal of Clinical Periodontology. 2004 January; 31(1): 25-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15058371

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Possible angina detected by the WHO angina questionnaire in apparently healthy men with a normal exercise ECG: coronary heart disease or not? A 26 year follow up study. Author(s): Bodegard J, Erikssen G, Bjornholt JV, Thelle D, Erikssen J. Source: Heart (British Cardiac Society). 2004 June; 90(6): 627-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15145862

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Potential errors resulting from sex and age difference in assessing family history of coronary heart disease. Author(s): Saito T, Furukawa T, Nanri S, Saito I. Source: J Epidemiol. 2004 March; 14(2): 51-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15162978

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Prediction of coronary heart disease in middle-aged adults with diabetes. Author(s): Folsom AR, Chambless LE, Duncan BB, Gilbert AC, Pankow JS; Atherosclerosis Risk in Communities Study Investigators. Source: Diabetes Care. 2003 October; 26(10): 2777-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14514579

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Prevalence of conventional risk factors in patients with coronary heart disease. Author(s): Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis SG, Lincoff AM, Topol EJ. Source: Jama : the Journal of the American Medical Association. 2003 August 20; 290(7): 898-904. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12928466

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Primary prevention of coronary heart disease in general practice: a cross sectional population study. Author(s): Devroey D, Kartounian J, Vandevoorde J, Betz W, Cogge M, De Man B, De Ridder L, Block P, Van Gaal L. Source: Int J Clin Pract. 2004 February; 58(2): 130-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15055860

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Prospective study of serum homocysteine and risk of ischemic stroke among patients with preexisting coronary heart disease. Author(s): Tanne D, Haim M, Goldbourt U, Boyko V, Doolman R, Adler Y, Brunner D, Behar S, Sela BA. Source: Stroke; a Journal of Cerebral Circulation. 2003 March; 34(3): 632-6. Epub 2003 February 20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12624283

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Quality of care for coronary heart disease in two countries. Author(s): Ayanian JZ, Quinn TJ. Source: Health Aff (Millwood). 2001 May-June; 20(3): 55-67. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11585182

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Quality of care for secondary prevention for patients with coronary heart disease: results of the Hastening the Effective Application of Research through Technology (HEART) trial. Author(s): Goff DC Jr, Gu L, Cantley LK, Sheedy DJ, Cohen SJ. Source: American Heart Journal. 2003 December; 146(6): 1045-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14660997

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Refinement of the association of serum C-reactive protein concentration and coronary heart disease risk by correction for within-subject variation over time: the MONICA Augsburg studies, 1984 and 1987. Author(s): Koenig W, Sund M, Frohlich M, Lowel H, Hutchinson WL, Pepys MB. Source: American Journal of Epidemiology. 2003 August 15; 158(4): 357-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12915501

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Rehabilitation after coronary heart disease: spouses' views of support. Author(s): Karner AM, Dahlgren MA, Bergdahl B. Source: Journal of Advanced Nursing. 2004 April; 46(2): 204-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15056334

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Relation between conduit vessel stiffness (assessed by tonometry) and endothelial function (assessed by flow-mediated dilatation) in patients with and without coronary heart disease. Author(s): Nigam A, Mitchell GF, Lambert J, Tardif JC. Source: The American Journal of Cardiology. 2003 August 15; 92(4): 395-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12914868

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Relation of parental history of coronary heart disease to obesity in young adults. Author(s): Grotto I, Huerta M, Kark JD, Shpilberg O, Meyerovitch J. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 2003 March; 27(3): 362-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12629564

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Relationship between apolipoprotein(a) size polymorphism and coronary heart disease in overweight subjects. Author(s): Emanuele E, Peros E, Minoretti P, Falcone C, D'Angelo A, Montagna L, Geroldi D. Source: Bmc Cardiovascular Disorders [electronic Resource]. 2003 December 12; 3(1): 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14670093

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Relationship of endogenous sex hormones to coronary heart disease: a twin study. Author(s): Mikulec KH, Holloway L, Krasnow RE, Javitz H, Swan GE, Reed T, Marcus R, Carmelli D. Source: The Journal of Clinical Endocrinology and Metabolism. 2004 March; 89(3): 12405. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15001617

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Relative intensity of physical activity and risk of coronary heart disease. Author(s): Lee IM, Sesso HD, Oguma Y, Paffenbarger RS Jr. Source: Circulation. 2003 March 4; 107(8): 1110-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12615787

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Renin-angiotensin system gene polymorphisms: assessment of the risk of coronary heart disease. Author(s): Buraczynska M, Pijanowski Z, Spasiewicz D, Nowicka T, Sodolski T, Widomska - Czekajska T, Ksiazek A. Source: Kardiologia Polska. 2003 January; 58(1): 1-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14502296

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Reporting the cost-effectiveness of interventions with nonsignificant effect differences: example from a trial of secondary prevention of coronary heart disease. Author(s): Johnston K, Gray A, Moher M, Yudkin P, Wright L, Mant D. Source: International Journal of Technology Assessment in Health Care. 2003 Summer; 19(3): 476-89. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12962334

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Risk factors for coronary heart disease in women. Author(s): Newton KM. Source: Nurs Clin North Am. 2004 March; 39(1): 145-63. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15062733

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Screening individuals and families with premature coronary heart disease: a clinical and public health challenge. Author(s): Hennekens CH. Source: European Heart Journal. 2003 February; 24(3): 212-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12590896

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Screening of family members of patients with premature coronary heart disease; results from the EUROASPIRE II family survey. Author(s): De Sutter J, De Bacquer D, Kotseva K, Sans S, Pyorala K, Wood D, De Backer G; EUROpean Action on Secondary Prevention through Intervention to Reduce Events II study group. Source: European Heart Journal. 2003 February; 24(3): 249-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12590902

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Serum albumin and risk of stroke, coronary heart disease, and mortality: the role of cigarette smoking. Author(s): Shaper AG, Wannamethee SG, Whincup PH. Source: Journal of Clinical Epidemiology. 2004 February; 57(2): 195-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15125630

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Sodium/lithium countertransport and intracellular calcium concentration in patients with essential hypertension and coronary heart disease. Author(s): Gruska S, Jendral I, Rettig R, Kraatz G. Source: Clinical Science (London, England : 1979). 2003 March; 104(3): 323-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12605593

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Soluble intercellular adhesion molecule 1 and flow-mediated dilatation are related to the estimated risk of coronary heart disease independently from each other. Author(s): Witte DR, Broekmans WM, Kardinaal AF, Klopping-Ketelaars IA, van Poppel G, Bots ML, Kluft C, Princen JM. Source: Atherosclerosis. 2003 September; 170(1): 147-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12957693

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Statins and secondary prevention of coronary heart disease. Author(s): Ahmed M, Griffiths P. Source: British Journal of Community Nursing. 2004 April; 9(4): 160-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15150487

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Substantial potential for reductions in coronary heart disease mortality in the UK through changes in risk factor levels. Author(s): Critchley JA, Capewell S. Source: Journal of Epidemiology and Community Health. 2003 April; 57(4): 243-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12646537

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Swimming and hemostasis during rehabilitation in patients with coronary heart disease. Author(s): Lins M, Speidel T, Bastian A, Zurborn KH, Bruhn HD, Simon R. Source: Thrombosis Research. 2002 November 1; 108(2-3): 191-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12590957

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Systematic review of lipid lowering for primary prevention of coronary heart disease in diabetes. Author(s): Gami AS, Montori VM, Erwin PJ, Khan MA, Smith SA; Evidence in Diabetes Enquiry System (EVIDENS) Research Group. Source: Bmj (Clinical Research Ed.). 2003 March 8; 326(7388): 528-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12623912

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Temperature at birth, coronary heart disease, and insulin resistance: cross sectional analyses of the British women's heart and health study. Author(s): Lawlor DA, Davey Smith G, Mitchell R, Ebrahim S. Source: Heart (British Cardiac Society). 2004 April; 90(4): 381-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15020510

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The 2756A>G variant in the gene encoding methionine synthase: its relation with plasma homocysteine levels and risk of coronary heart disease in a Dutch case-control study. Author(s): Klerk M, Lievers KJ, Kluijtmans LA, Blom HJ, den Heijer M, Schouten EG, Kok FJ, Verhoef P. Source: Thrombosis Research. 2003 May 1; 110(2-3): 87-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12893022

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The distribution of 10-Year risk for coronary heart disease among US adults: findings from the National Health and Nutrition Examination Survey III. Author(s): Ford ES, Giles WH, Mokdad AH. Source: Journal of the American College of Cardiology. 2004 May 19; 43(10): 1791-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15145101

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The emerging problem of coronary heart disease in Kenya. Author(s): Jablonski-Cohen MS, Kosgei RJ, Rerimoi AJ, Mamlin JJ. Source: East Afr Med J. 2003 June; 80(6): 293-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12953737

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The Enhancing Recovery in Coronary Heart Disease Trial (ENRICHD): strategies and techniques for enhancing retention of patients with acute myocardial infarction and depression or social isolation. Author(s): Froelicher ES, Miller NH, Buzaitis A, Pfenninger P, Misuraco A, Jordan S, Ginter S, Robinson E, Sherwood J, Wadley V. Source: Journal of Cardiopulmonary Rehabilitation. 2003 July-August; 23(4): 269-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12894001

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The need for pharmaceutical care in the prevention of coronary heart disease: an exploratory study in acute myocardial infarction patients. Author(s): Chinwong S, Reid F, McGlynn S, Hudson S, Flapan A. Source: Pharmacy World & Science : Pws. 2004 April; 26(2): 96-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15085944

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The potential impact of nonpharmacologic population-wide blood pressure reduction on coronary heart disease events: pronounced benefits in African-Americans and hypertensives. Author(s): Erlinger TP, Vollmer WM, Svetkey LP, Appel LJ. Source: Preventive Medicine. 2003 October; 37(4): 327-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14507489

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The reality of treating dyslipidaemia in patients with coronary heart disease: a primary care survey. Author(s): Wright DJ, Grayson AD, Jackson M, Dainty C. Source: Int J Clin Pract. 2003 July-August; 57(6): 488-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12918888

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The risk of coronary heart disease in men with erectile dysfunction. Author(s): Speel TG, van Langen H, Meuleman EJ. Source: European Urology. 2003 September; 44(3): 366-70; Discussion 370-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12932938

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The role of decision-analytic models in the prevention, diagnosis and treatment of coronary heart disease. Author(s): Siebert U. Source: Zeitschrift Fur Kardiologie. 2002; 91 Suppl 3: 144-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12641030

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UGT1A1*28 allele and coronary heart disease: the Rotterdam Study. Author(s): Bosma PJ, van der Meer IM, Bakker CT, Hofman A, Paul-Abrahamse M, Witteman JC. Source: Clinical Chemistry. 2003 July; 49(7): 1180-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12816916

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Under treatment with lipid-lowering drugs of high-risk coronary heart disease patients of the GENICA study. Author(s): Cesari M, Maiolino G, Colonna S, Zanchetta M, Pedon L, Maiolino P, Pessina AC, Rossi GP. Source: Journal of Cardiovascular Pharmacology. 2003 October; 42(4): 484-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14508233

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Update on the role of triglycerides as a risk factor for coronary heart disease. Author(s): Miller M, Cosgrove B, Havas S. Source: Current Atherosclerosis Reports. 2002 November; 4(6): 414-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12361487

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Urinary 8-iso-prostaglandin F2alpha as a risk marker in patients with coronary heart disease: a matched case-control study. Author(s): Schwedhelm E, Bartling A, Lenzen H, Tsikas D, Maas R, Brummer J, Gutzki FM, Berger J, Frolich JC, Boger RH. Source: Circulation. 2004 February 24; 109(7): 843-8. Epub 2004 Feb 02. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14757688

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Use of coronary calcification scores to predict coronary heart disease. Author(s): Budoff MJ, Ehrlich J, Hecht HS, Rumberger JA. Source: Jama : the Journal of the American Medical Association. 2004 April 21; 291(15): 1832; Author Reply 1832-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15100195

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Use of coronary calcification scores to predict coronary heart disease. Author(s): Pletcher MJ, Tice JA, Pignone M. Source: Jama : the Journal of the American Medical Association. 2004 April 21; 291(15): 1831-2; Author Reply 1832-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15100194

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Use of coronary calcification scores to predict coronary heart disease. Author(s): Wierzbicki AS, Twomey PJ, Reynolds TM. Source: Jama : the Journal of the American Medical Association. 2004 April 21; 291(15): 1831; Author Reply 1832-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15100193

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Use of statins in primary and secondary prevention of coronary heart disease and ischemic stroke. Meta-analysis of randomized trials. Author(s): Vrecer M, Turk S, Drinovec J, Mrhar A. Source: Int J Clin Pharmacol Ther. 2003 December; 41(12): 567-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14692706

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Usefulness of finger blood flow during exercise as a marker of functionally significant coronary heart disease. Author(s): Qureshi E, Diamond GA, Chouraqui P, Saef J, Reed G, Armenia AB, Rozanski A. Source: The American Journal of Cardiology. 2002 October 1; 90(7): 756-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12356392

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Usefulness of quinapril and irbesartan to improve the anti-inflammatory response of atorvastatin and aspirin in patients with coronary heart disease. Author(s): Lauten WB, Khan QA, Rajagopalan S, Lerakis S, Rahman ST, Parthasarathy S, Khan BV. Source: The American Journal of Cardiology. 2003 May 1; 91(9): 1116-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12714159

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Validity of death certificates for coding coronary heart disease as the cause of death in Bahrain. Author(s): al-Mahroos R. Source: East Mediterr Health J. 2000 July; 6(4): 661-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11794072

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Value of coronary artery calcium scanning by computed tomography for predicting coronary heart disease in diabetic subjects. Author(s): Qu W, Le TT, Azen SP, Xiang M, Wong ND, Doherty TM, Detrano RC. Source: Diabetes Care. 2003 March; 26(3): 905-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12610057

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Value of HDL cholesterol, apolipoprotein A-I, lipoprotein A-I, and lipoprotein A-I/AII in prediction of coronary heart disease: the PRIME Study. Prospective Epidemiological Study of Myocardial Infarction. Author(s): Luc G, Bard JM, Ferrieres J, Evans A, Amouyel P, Arveiler D, Fruchart JC, Ducimetiere P. Source: Arteriosclerosis, Thrombosis, and Vascular Biology. 2002 July 1; 22(7): 1155-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12117731

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Variation in the fatty acid binding protein 2 gene is not associated with markers of metabolic syndrome in patients with coronary heart disease. Author(s): Erkkila AT, Lindi V, Lehto S, Pyorala K, Laakso M, Uusitupa MI. Source: Nutr Metab Cardiovasc Dis. 2002 April; 12(2): 53-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12189904

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Variation in the matrix metalloproteinase-1 gene and risk of coronary heart disease. Author(s): Ye S, Gale CR, Martyn CN. Source: European Heart Journal. 2003 September; 24(18): 1668-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14499230

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Visceral adipose tissue cutoffs associated with metabolic risk factors for coronary heart disease in women. Author(s): Nicklas BJ, Penninx BW, Ryan AS, Berman DM, Lynch NA, Dennis KE. Source: Diabetes Care. 2003 May; 26(5): 1413-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12716798

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Vitamin C preserves endothelial function in patients with coronary heart disease after a high-fat meal. Author(s): Ling L, Zhao SP, Gao M, Zhou QC, Li YL, Xia B. Source: Clin Cardiol. 2002 May; 25(5): 219-24. Erratum In: Clin Cardiol 2002 August; 25(8): A28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12018880

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Vitamin E use in preventing coronary heart disease in patients undergoing dialysis. Author(s): Rein J. Source: Mayo Clinic Proceedings. 2002 March; 77(3): 295. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11888036

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von Willebrand factor and coronary heart disease: prospective study and metaanalysis. Author(s): Whincup PH, Danesh J, Walker M, Lennon L, Thomson A, Appleby P, Rumley A, Lowe GD. Source: European Heart Journal. 2002 November; 23(22): 1764-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12419296

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Waist circumference is a better predictor than body mass index of coronary heart disease risk in overweight premenopausal women. Author(s): Lofgren I, Herron K, Zern T, West K, Patalay M, Shachter NS, Koo SI, Fernandez ML. Source: The Journal of Nutrition. 2004 May; 134(5): 1071-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15113947

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Waist circumference versus body mass index in risk prediction of coronary heart disease: comparing apples and oranges. Author(s): Cheng TO. Source: Journal of Internal Medicine. 2004 June; 255(6): 690-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15147535

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Wall shear stress is associated with intima-media thickness and carotid atherosclerosis in subjects at low coronary heart disease risk. Author(s): Irace C, Cortese C, Fiaschi E, Carallo C, Farinaro E, Gnasso A. Source: Stroke; a Journal of Cerebral Circulation. 2004 February; 35(2): 464-8. Epub 2004 January 15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14726547

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Water, other fluids, and fatal coronary heart disease: the Adventist Health Study. Author(s): Chan J, Knutsen SF, Blix GG, Lee JW, Fraser GE. Source: American Journal of Epidemiology. 2002 May 1; 155(9): 827-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11978586

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What do we gain from the sixth coronary heart disease drug? Author(s): Warburton RN. Source: Bmj (Clinical Research Ed.). 2003 November 29; 327(7426): 1237-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14644934

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When reciprocity fails: effort-reward imbalance in relation to coronary heart disease and health functioning within the Whitehall II study. Author(s): Kuper H, Singh-Manoux A, Siegrist J, Marmot M. Source: Occupational and Environmental Medicine. 2002 November; 59(11): 777-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12409537

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Why do professionals disagree? The case of hormone replacement therapy and coronary heart disease prevention. Author(s): Derry PS. Source: Women & Health. 2003; 38(3): 3-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14664302

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Why is coronary heart disease of uraemic patients so frequent and so devastating? Author(s): Amann K, Ritz C, Adamczak M, Ritz E. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 April; 18(4): 631-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12637626

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Women and coronary heart disease risk factors. Author(s): Bittner V. Source: Journal of Cardiovascular Risk. 2002 December; 9(6): 315-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12478200

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Women and coronary heart disease: redressing the balance. Author(s): Albarran JW. Source: Nursing in Critical Care. 2003 March-April; 8(2): 47-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12737187

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Youth characteristics and contextual variables influencing physical activity in young adolescents of parents with premature coronary heart disease. Author(s): Gilmer MJ, Harrell JS, Miles MS, Hepworth JT. Source: Journal of Pediatric Nursing. 2003 June; 18(3): 159-68. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12796857

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CHAPTER 2. NUTRITION AND CORONARY HEART DISEASE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and coronary heart disease.

Finding Nutrition Studies on Coronary Heart Disease The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “coronary heart disease” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following is a typical result when searching for recently indexed consumer information on coronary heart disease: •

Association between fish intake and coronary heart disease mortality. Source: Feskens, E.J.M. Bowles, C.H. Kromhout, D. Diabetes-care (USA). (July 1993). volume 16(7) page 1029-1034.

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Therapeutic nutrition: an alternative approach to coronary heart disease management. Author(s): North Colorado Medical Center, Greeley, CO. Source: Nelson, K. Nutrition-today (USA). (June 1995). volume 30(3) page 114-122.

Additional consumer oriented references include: •

Abnormal glucose tolerance and other coronary heart disease risk factors in an isolated aboriginal community in central Australia. Author(s): Deakin Institute of Human Nutrition, Deakin University, Malvern, Victoria, Australia. Source: Gault, A O'Dea, K Rowley, K G McLeay, T Traianedes, K Diabetes-Care. 1996 November; 19(11): 1269-73 0149-5992

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Childhood origins of lifestyle-related risk factors for coronary heart disease in adulthood. Author(s): Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Canada. Source: Cunnane, S C Nutr-Health. 1993; 9(2): 107-15 0260-1060

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Diet, serum lipids and coronary heart disease in women. Author(s): University of Texas, Southwestern Medical Center, Dallas, TX Source: Denke, M.A. Food-and-nutrition-news (USA). (Nov-December 1992). volume 64(5) page 31-33. diet circulatory disorders lipaemia women 0015-6310

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Glucose intolerance and 23-year risk of coronary heart disease and total mortality: the Honolulu Heart Program. Author(s): Department of Medicine, University of Hawaii at Manoa, USA. [email protected] Source: Rodriguez, B L Lau, N Burchfiel, C M Abbott, R D Sharp, D S Yano, K Curb, J D Diabetes-Care. 1999 August; 22(8): 1262-5 0149-5992

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Konjac-mannan (glucomannan) improves glycemia and other associated risk factors for coronary heart disease in type 2 diabetes. A randomized controlled metabolic trial. Author(s): Department of Nutritional Sciences, St. Michael's Hospital, Faculty of Medicine, University of Toronto, Ontario, Canada. [email protected] Source: Vuksan, V Jenkins, D J Spadafora, P Sievenpiper, J L Owen, R Vidgen, E Brighenti, F Josse, R Leiter, L A Bruce Thompson, C Diabetes-Care. 1999 June; 22(6): 9139 0149-5992

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Low-fat diets, triglycerides and coronary heart disease risk. Source: Nestle, M. BNF-nutr-bull. London : The British Nutrition Foundation. March 2000. volume 25 (1) page 49-53. 0141-9684

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Metabolic changes induced by sugar in relation to coronary heart disease and diabetes. Author(s): University of London. Source: Yudkin, J Nutr-Health. 1987; 5(1-2): 5-8 0260-1060

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Omega-3 fatty acids alter soluble markers of endothelial function in coronary heart disease patients. Author(s): Vascular Biology Program, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA. Source: Meydani, M Nutr-Revolume 2000 February; 58(2 Pt 1): 56-9 0029-6643

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Prevalences of type 2 diabetes, the insulin resistance syndrome, and coronary heart disease in an elderly, biethnic population. Author(s): Department of Medicine, University of New Mexico School of Medicine, Albuquerque, USA. [email protected] Source: Lindeman, R D Romero, L J Hundley, R Allen, A S Liang, H C Baumgartner, R N Koehler, K M Schade, D S Garry, P J Diabetes-Care. 1998 June; 21(6): 959-66 0149-5992

The following information is typical of that found when using the “Full IBIDS Database” to search for “coronary heart disease” (or a synonym): •

A note on evaluating agricultural policy in the presence of health care cost externalities: dairy production quotas and coronary heart disease costs. Source: Gray, R. Malla, S. Can-j-agric-econ. Ottawa : Canadian Agricultural Economics and Farm Management Society,. July 1998. volume 46 (2) page 247-256. 0008-3976

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Canadian dietary fat substitutions, 1955-93, and coronary heart disease costs. Source: Gray, R. Malla, S. Stephen, A. Can-j-agric-econ. Ottawa : Canadian Agricultural Economics and Farm Management Society,. July 1998. volume 46 (2) page 233-246. 00083976

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Clinical trials update: The Heart Protection Study, IONA, CARISA, ENRICHD, ACUTE, ALIVE, MADIT II and REMATCH. Impact Of Nicorandil on Angina. Combination Assessment of Ranolazine In Stable Angina. ENhancing Recovery In Coronary Heart Disease patients. Assessment of Cardioversion Using Transoesophageal Echocardiography. AzimiLide post-Infarct surVival Evaluation. Randomised Evaluation of Mechanical Assistance for Treatment of Chronic Heart failure. Author(s): Department of Academic Cardiology, Castle Hill Hospital, Cottingham, HU16 5JQ, Kingston upon Hull, UK. Source: Louis, Amala A Manousos, I Renata Coletta, Alison P Clark, Andrew L Cleland, John G F Eur-J-Heart-Fail. 2002 January; 4(1): 111-6 1388-9842

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Cod liver oil consumption, smoking, and coronary heart disease mortality: three counties, Norway. Author(s): National Health Screening Service, Research Department, P.O. Box 8155, 0033 Oslo, Norway. [email protected] Source: Egeland, G M Meyer, H E Selmer, R Tverdal, A Vollset, S E Int-J-CircumpolarHealth. 2001 April; 60(2): 143-9 1239-9736

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Diet and drug therapy: a dynamic duo for reducing coronary heart disease risk. Author(s): Nutrition Department, Pennsylvania State University, S126 Henderson Bldg., University Park, PA 16802, USA. Source: Clemmer, K F Binkoski, A E Coval, S M Zhao, G Kris Etherton, P M CurrAtheroscler-Repage 2001 November; 3(6): 507-13 1523-3804

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Dietary catechins in relation to coronary heart disease death among postmenopausal women. Author(s): National Institute of Public Health and the Environment, Department of Chronic Diseases Epidemiology, Bilthoven, The Netherlands.

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Source: Arts, I C Jacobs, D R Jr Harnack, L J Gross, M Folsom, A R Epidemiology. 2001 November; 12(6): 668-75 1044-3983 •

Frequent nut intake and risk of death from coronary heart disease and all causes in postmenopausal women: the Iowa Women's Health Study. Author(s): Division of Epidemiology, School of Public Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN 55454-1015, USA. Source: Ellsworth, J L Kushi, L H Folsom, A R Nutr-Metab-Cardiovasc-Dis. 2001 December; 11(6): 372-7 0939-4753

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High density lipoprotein fractions in males with coronary heart disease and perivascular disease and normal plasma lipid level. Source: Sznajderman, M. Kancelarczyk, W.J. Rymaszewski, Z. Mamont, B. Dev-FoodSci. Amsterdam : Elsevier Scientific Pub. Co. 1985. volume 11 (pt.B) page 857-866.

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L-arginine improves post-ischemic vasodilation in coronary heart disease patients taking vasodilating drugs. Author(s): Department of Clinical and Experimental Medicine, School of Medicine, Federico II University, Naples, Italy. Source: Iannuzzi, A Iannuzzo, G Sapio, C Pauciullo, P Iorio, D Spampinato, N Mancini, M Rubba, P J-Cardiovasc-Pharmacol-Ther. 2001 April; 6(2): 121-7 1074-2484

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Mercury and the risk of coronary heart disease in men. Author(s): Department of Nutrition, Harvard School of Public Health, Boston, USA. Source: Yoshizawa, K Rimm, E B Morris, J S Spate, V L Hsieh, C C Spiegelman, D Stampfer, M J Willett, W C N-Engl-J-Med. 2002 November 28; 347(22): 1755-60 1533-4406

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Migraine and coronary heart disease in women and men. Author(s): Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. Source: Cook, N R Bensenor, I M Lotufo, P A Lee, I M Skerrett, P J Chown, M J Ajani, U A Manson, J E Buring, J E Headache. 2002 September; 42(8): 715-27 0017-8748

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Nutritional strategies efficacious in the prevention or treatment of coronary heart disease (CHD). Source: Anonymous Geriatr-Nurs. 2001 Jan-February; 22(1): 47-56 0197-4572

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One hundred and seven middle-aged and senile cases of coronary heart disease with ventricular premature beat treated by qing xin an shen fang. Author(s): Department of Traditional Chinese Medicine, First PLA Military Medical University, Guangzhou 510515. Source: Jia, Y Sun, X Jia, M Cui, Z Li, C J-Tradit-Chin-Med. 2001 December; 21(4): 247-51 0254-6272

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Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. Author(s): Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. [email protected] Source: Mukamal, K J Conigrave, K M Mittleman, M A Camargo, C A Jr Stampfer, M J Willett, W C Rimm, E B N-Engl-J-Med. 2003 January 9; 348(2): 109-18 1533-4406

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Socio-economic position and coronary heart disease risk factors in children and young people. Evidence from UK epidemiological studies. Author(s): Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Source: Batty, G D Leon, D A Eur-J-Public-Health. 2002 December; 12(4): 263-72 11011262

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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to coronary heart disease; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Folic Acid Source: Integrative Medicine Communications; www.drkoop.com Pyridoxine Source: Integrative Medicine Communications; www.drkoop.com Vitamin B6 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B9 (Folic Acid) Alternative names: Folate, Folic Acid Source: Integrative Medicine Communications; www.drkoop.com Vitamin C Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin E Source: Healthnotes, Inc.; www.healthnotes.com Vitamin E Source: Prima Communications, Inc.www.personalhealthzone.com

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Minerals Copper Source: Healthnotes, Inc.; www.healthnotes.com Folate Source: Integrative Medicine Communications; www.drkoop.com Folate Source: Prima Communications, Inc.www.personalhealthzone.com HMG-CoA Reductase Inhibitors (Statins) Source: Integrative Medicine Communications; www.drkoop.com Iron Source: Healthnotes, Inc.; www.healthnotes.com Iron Alternative names: Ferrous Sulfate Source: Integrative Medicine Communications; www.drkoop.com

Nutrition

Pravastatin Source: Healthnotes, Inc.; www.healthnotes.com Simvastatin Source: Healthnotes, Inc.; www.healthnotes.com •

Food and Diet Chondroitin Sulfate Source: Healthnotes, Inc.; www.healthnotes.com Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Fat Alternatives and Fat Replacers Source: Healthnotes, Inc.; www.healthnotes.com Ferrous Sulfate Source: Integrative Medicine Communications; www.drkoop.com Hazelnuts Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,307,00.html High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com High-Fiber Diet Source: Healthnotes, Inc.; www.healthnotes.com Low-Fat Diet Source: Healthnotes, Inc.; www.healthnotes.com Olives Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,318,00.html Omega-3 Fatty Acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,992,00.html Sprains and Strains Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND CORONARY HEART DISEASE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to coronary heart disease. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “coronary heart disease” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

Soybeans: Good for Your Heart. Patient Education Source: Advance for Nurse Practitioners. 10(5): 85. May 2002. Summary: This article provides information on the health benefits of soybeans and foods made from soybeans. The possible benefits that soy proteins may have on certain diseases, such as coronary heart disease, menopause, osteoporosis, cancer, allergies, diabetes, and kidney disease, are briefly noted. The article also describes the soy products currently available, including edamame, miso, tofu, soy nuts, tempeh, soy milk, soy sauce, and natto. It lists two Web sites for additional information on soybeans.

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National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to coronary heart disease and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “coronary heart disease” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to coronary heart disease: •

A primary care intervention programme for obesity and coronary heart disease risk factor reduction. Author(s): Read A, Ramwell H, Storer H, Webber J. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2004 April; 54(501): 272-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15113494

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Antiproliferative coatings for the treatment of coronary heart disease:. what are the targets and which are the tools? Author(s): Smith EJ, Rothman MT. Source: Journal of Interventional Cardiology. 2003 December; 16(6): 475-83. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14632944

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Blood lipids, fatty acids, diet and lifestyle parameters in adolescents from a region in northern Norway with a high mortality from coronary heart disease. Author(s): Brox J, Bjornstad E, Olaussen K, Osterud B, Almdahl S, Lochen ML. Source: European Journal of Clinical Nutrition. 2002 July; 56(7): 694-700. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12080412

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Cardiology Grand Rounds from the University of North Carolina at Chapel Hill. The antioxidant vitamins and coronary heart disease: Part 1. Basic science background and clinical observational studies. Author(s): Riley SJ, Stouffer GA. Source: The American Journal of the Medical Sciences. 2002 December; 324(6): 314-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12495298

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Cardiology Grand Rounds from the University of North Carolina at Chapel Hill. The antioxidant vitamins and coronary heart disease: Part II. Randomized clinical trials. Author(s): Riley SJ, Stouffer GA. Source: The American Journal of the Medical Sciences. 2003 January; 325(1): 15-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544080

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Chelation therapy for coronary heart disease. Author(s): Prabha A, Shetty M, Thomas J, Chowta N, Prabhu MV. Source: American Heart Journal. 2002 November; 144(5): E10; Author Reply E11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12422161

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Clinical observation in 40 cases of postmenopausal coronary heart disease treated with yanghuo sanzi tang. Author(s): Zhang P, Qiu R, Shen R, Liang J. Source: J Tradit Chin Med. 2003 September; 23(3): 182-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14535179

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Coronary heart disease in Indians: a review of literature. Author(s): Mohan S, Wilkes LM, Jackson D. Source: Contemp Nurse. 2003 October; 15(3): 274-86. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14649532

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Diet and coronary heart disease in diabetes. Author(s): Cernea S, Hancu N, Raz I. Source: Acta Diabetologica. 2003 December; 40 Suppl 2: S389-400. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14704874

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Diet and coronary heart disease. Author(s): Daniels L. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2002 July 10-16; 16(43): 47-52; Quiz 54-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12216321

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Diet and prevention of coronary heart disease in the Arab Middle East countries. Author(s): Musaiger AO. Source: Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre. 2002; 11 Suppl 2: 9-16. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12444306

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Dietary alpha-linolenic acid is associated with reduced risk of fatal coronary heart disease, but increased prostate cancer risk: a meta-analysis. Author(s): Brouwer IA, Katan MB, Zock PL. Source: The Journal of Nutrition. 2004 April; 134(4): 919-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15051847

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Dietary fats and coronary heart disease pathogenesis. Author(s): Renaud S, Lanzmann-Petithory D.

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Source: Current Atherosclerosis Reports. 2002 November; 4(6): 419-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12361488 •

Dietary fatty acids and coronary heart disease. Author(s): Wolfram G. Source: European Journal of Medical Research. 2003 August 20; 8(8): 321-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12915326

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Dietary Intake and Coronary Heart Disease: A Variety of Nutrients and Phytochemicals Are Important. Author(s): Tucker KL. Source: Current Treatment Options in Cardiovascular Medicine. 2004 August; 6(4): 291302. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15212724

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Dietary monounsaturated versus polyunsaturated fatty acids: which is really better for protection from coronary heart disease? Author(s): Lada AT, Rudel LL. Source: Current Opinion in Lipidology. 2003 February; 14(1): 41-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544660

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Dietary prevention of coronary heart disease: focus on omega-6/omega-3 essential fatty acid balance. Author(s): de Lorgeril M, Salen P. Source: World Review of Nutrition and Dietetics. 2003; 92: 57-73. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14579683

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Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Author(s): Jenkins DJ, Kendall CW, Marchie A, Parker TL, Connelly PW, Qian W, Haight JS, Faulkner D, Vidgen E, Lapsley KG, Spiller GA. Source: Circulation. 2002 September 10; 106(11): 1327-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12221048

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Drug-eluting stents in the treatment of atherosclerotic coronary heart disease. Author(s): Lemos PA, Regar E, Serruys PW. Source: Indian Heart J. 2002 March-April; 54(2): 212-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12086391

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Dynamics of interrelationships between the content of lipoprotein particles, fibrinogen, and leukocyte count in the plasma from patients with coronary heart

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disease treated with Kwai. Author(s): Chernyad'eva IF, Shil'nikova SV, Rogoza AN, Kukharchuk VV. Source: Bulletin of Experimental Biology and Medicine. 2003 May; 135(5): 436-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12910280 •

Effect of alpha-tocopherol and beta-carotene supplementation on coronary heart disease during the 6-year post-trial follow-up in the ATBC study. Author(s): Tornwall ME, Virtamo J, Korhonen PA, Virtanen MJ, Taylor PR, Albanes D, Huttunen JK. Source: European Heart Journal. 2004 July; 25(13): 1171-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15231376

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Effect of plasma C-reactive protein levels in modulating the risk of coronary heart disease associated with small, dense, low-density lipoproteins in men (The Quebec Cardiovascular Study). Author(s): St-Pierre AC, Bergeron J, Pirro M, Cantin B, Dagenais GR, Despres JP, Lamarche B; Quebec Cardiovascular Study. Source: The American Journal of Cardiology. 2003 March 1; 91(5): 555-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12615259

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Effect of xuezhikang, a cholestin extract, on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease. Author(s): Zhao SP, Liu L, Cheng YC, Li YL. Source: Atherosclerosis. 2003 June; 168(2): 375-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12801622

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Effects of an antioxidant-rich juice (sea buckthorn) on risk factors for coronary heart disease in humans. Author(s): Eccleston C, Baoru Y, Tahvonen R, Kallio H, Rimbach GH, Minihane AM. Source: The Journal of Nutritional Biochemistry. 2002 June; 13(6): 346-354. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12088800

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Effects of dietary alpha-linolenic acid from blended oils on biochemical indices of coronary heart disease in Indians. Author(s): Ghafoorunissa, Vani A, Laxmi R, Sesikeran B. Source: Lipids. 2002 November; 37(11): 1077-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12558058

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Effects of intermittent hypobaric hypoxia on blood lipid concentrations in male coronary heart disease patients. Author(s): Tin'kov AN, Aksenov VA.

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Source: High Altitude Medicine & Biology. 2002 Fall; 3(3): 277-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12396881 •

Efficacy of omega-3 fatty acid supplementation in primary and secondary prevention of coronary heart disease. Author(s): Weisman D, Motro M, Schwammenthal E, Fisman EZ, Tenenbaum A, Tanne D, Adler Y. Source: Isr Med Assoc J. 2004 April; 6(4): 227-32. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15115262

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Epidemiologic studies on dietary fats and coronary heart disease. Author(s): Ascherio A. Source: The American Journal of Medicine. 2002 December 30; 113 Suppl 9B: 9S-12S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12566133

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Fish and long-chain omega-3 fatty acid intake and risk of coronary heart disease and total mortality in diabetic women. Author(s): Hu FB, Cho E, Rexrode KM, Albert CM, Manson JE. Source: Circulation. 2003 April 15; 107(14): 1852-7. Epub 2003 March 31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12668520

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HDL-C and triglyceride levels: relationship to coronary heart disease and treatment with statins. Author(s): Gaw A. Source: Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 2003 January; 17(1): 53-62. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12843687

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Homocyst(e)ine and coronary heart disease: pharmacoeconomic support for interventions to lower hyperhomocyst(e)inaemia. Author(s): Nallamothu BK, Fendrick AM, Omenn GS. Source: Pharmacoeconomics. 2002; 20(7): 429-42. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12093299

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Intake of refined carbohydrates and whole grain foods in relation to risk of type 2 diabetes mellitus and coronary heart disease. Author(s): Liu S. Source: Journal of the American College of Nutrition. 2002 August; 21(4): 298-306. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12166526

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Life satisfaction in patients with chest pain subsequently diagnosed as coronary heart disease--connection through depressive symptoms?

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Author(s): Valkamo M, Koivumaa-Honkanen HT, Hintikka J, Niskanen L, Honkalampi K, Viinamaki H. Source: Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 2003 December; 12(8): 1099-105. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14651427 •

Long-chain omega-3 fatty acids from fish reduce sudden cardiac death in patients with coronary heart disease. Author(s): Richter WO. Source: European Journal of Medical Research. 2003 August 20; 8(8): 332-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12915328

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Lycopene, tomatoes, and the prevention of coronary heart disease. Author(s): Rao AV. Source: Experimental Biology and Medicine (Maywood, N.J.). 2002 November; 227(10): 908-13. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12424333

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Mercury and the risk of coronary heart disease in men. Author(s): Yoshizawa K, Rimm EB, Morris JS, Spate VL, Hsieh CC, Spiegelman D, Stampfer MJ, Willett WC. Source: The New England Journal of Medicine. 2002 November 28; 347(22): 1755-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12456851

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Meta-analysis of observational studies on fish intake and coronary heart disease. Author(s): Whelton SP, He J, Whelton PK, Muntner P. Source: The American Journal of Cardiology. 2004 May 1; 93(9): 1119-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15110203

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Moderate intakes of intact soy protein rich in isoflavones compared with ethanolextracted soy protein increase HDL but do not influence transforming growth factor beta(1) concentrations and hemostatic risk factors for coronary heart disease in healthy subjects. Author(s): Sanders TA, Dean TS, Grainger D, Miller GJ, Wiseman H. Source: The American Journal of Clinical Nutrition. 2002 August; 76(2): 373-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12145009

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Myths and science of dietary fat and coronary heart disease. Author(s): Higgs J. Source: Nurs Times. 2002 August 20; 98(34): 49-52. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12239864

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n-3 Long-chain polyunsaturated fatty acids reduce risk of coronary heart disease death: extending the evidence to the elderly. Author(s): Harris WS. Source: The American Journal of Clinical Nutrition. 2003 February; 77(2): 279-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12540382

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Optimal diets for prevention of coronary heart disease. Author(s): Hu FB, Willett WC. Source: Jama : the Journal of the American Medical Association. 2002 November 27; 288(20): 2569-78. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12444864

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Platelet fatty acids in coronary heart disease, dyslipidemia, hypertension and healthy controls. Author(s): Hongtong K, Boonnim D, Pakpeankitwatana R, Hamroongroj T, Chantaranipapong Y, Changbumrung S. Source: Southeast Asian J Trop Med Public Health. 2003 September; 34(3): 675-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15115150

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Risk stratification of coronary heart disease in Greece: final results from the CARDIO2000 Epidemiological Study. Author(s): Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C, Toutouzas P. Source: Preventive Medicine. 2002 December; 35(6): 548-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12460522

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Selectin-P and interleukin-8 plasma levels in coronary heart disease patients. Author(s): Romuk E, Skrzep-Poloczek B, Wojciechowska C, Tomasik A, Birkner E, Wodniecki J, Gabrylewicz B, Ochala A, Tendera M. Source: European Journal of Clinical Investigation. 2002 September; 32(9): 657-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12486864

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Serum fatty acid levels, dietary style and coronary heart disease in three neighbouring areas in Japan: the Kumihama study. Author(s): Nakamura T, Azuma A, Kuribayashi T, Sugihara H, Okuda S, Nakagawa M. Source: The British Journal of Nutrition. 2003 February; 89(2): 267-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12575911

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Serum plant sterols as a potential risk factor for coronary heart disease. Author(s): Sudhop T, Gottwald BM, von Bergmann K. Source: Metabolism: Clinical and Experimental. 2002 December; 51(12): 1519-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12489060

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Short-term high-dose folic acid does not alter markers of endothelial cell damage in patients with coronary heart disease. Author(s): Doshi SN, Moat SJ, Lewis MJ, McDowell IF, Giddings JC, Goodfellow J. Source: International Journal of Cardiology. 2004 April; 94(2-3): 203-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15093982

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Soy food consumption is associated with lower risk of coronary heart disease in Chinese women. Author(s): Zhang X, Shu XO, Gao YT, Yang G, Li Q, Li H, Jin F, Zheng W. Source: The Journal of Nutrition. 2003 September; 133(9): 2874-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12949380

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Statins and omega-3 fatty acids in the treatment of dyslipidemia and coronary heart disease. Author(s): Nordoy A. Source: Minerva Med. 2002 October; 93(5): 357-63. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12410168

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The effects of acupuncture in treatment of coronary heart diseases. Author(s): Meng J. Source: J Tradit Chin Med. 2004 March; 24(1): 16-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15119162

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The natural cure of coronary heart disease. Author(s): Withnell A. Source: Nutr Health. 2003; 17(1): 55-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12803281

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The use of antioxidant supplements in coronary heart disease. Author(s): Kritharides L, Stocker R. Source: Atherosclerosis. 2002 October; 164(2): 211-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12204790

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To what extent are the effects of diet on coronary heart disease lipid-mediated? Author(s): Serrano-Martinez M, Martinez-Losa E, Prado-Santamaria M, BrugarolasBrufau C, Fernandez-Jarne E, Martinez-Gonzalez MA. Source: International Journal of Cardiology. 2004 May; 95(1): 35-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15159035

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Vitamin C and risk of coronary heart disease in women. Author(s): Osganian SK, Stampfer MJ, Rimm E, Spiegelman D, Hu FB, Manson JE, Willett WC.

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Source: Journal of the American College of Cardiology. 2003 July 16; 42(2): 246-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12875759 •

Xuezhikang decreases serum lipoprotein(a) and C-reactive protein concentrations in patients with coronary heart disease. Author(s): Liu L, Zhao SP, Cheng YC, Li YL. Source: Clinical Chemistry. 2003 August; 49(8): 1347-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12881451

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMD®Health: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to coronary heart disease; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Angina Source: Healthnotes, Inc.; www.healthnotes.com Angina Source: Integrative Medicine Communications; www.drkoop.com

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Atherosclerosis Source: Healthnotes, Inc.; www.healthnotes.com Atherosclerosis and Heart Disease Prevention Source: Prima Communications, Inc.www.personalhealthzone.com Cancer Prevention (Reducing the Risk) Source: Prima Communications, Inc.www.personalhealthzone.com Cancer Prevention and Diet Source: Healthnotes, Inc.; www.healthnotes.com Cardiomyopathy Source: Healthnotes, Inc.; www.healthnotes.com Cardiovascular Disease Overview Source: Healthnotes, Inc.; www.healthnotes.com Cataracts (Prevention) Source: Prima Communications, Inc.www.personalhealthzone.com Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com Heart Attack Source: Healthnotes, Inc.; www.healthnotes.com High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com High Homocysteine Source: Healthnotes, Inc.; www.healthnotes.com High Triglycerides Source: Healthnotes, Inc.; www.healthnotes.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Hypertension Source: Healthnotes, Inc.; www.healthnotes.com Insulin Resistance Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Lung Cancer Source: Healthnotes, Inc.; www.healthnotes.com Menopause Source: Integrative Medicine Communications; www.drkoop.com

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Wound Healing Source: Healthnotes, Inc.; www.healthnotes.com •

Alternative Therapy Nutrition Source: Integrative Medicine Communications; www.drkoop.com Prayer Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,728,00.html Relaxation Techniques Source: Integrative Medicine Communications; www.drkoop.com

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Chinese Medicine Guanxin Danshen Pian Alternative names: Guanxin Danshen Tablets Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Jingzhi Guanxin Pian Alternative names: Jingzhi Guanxin Tablets Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Shuxin Koufuye Alternative names: huxin Oral Liquid; Shuxin Koufuye (Shu Xin Kou Fu Ye Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Shuxiong Pian Alternative names: huxiong Tablets; Shuxiong Pian (Shu Xiong Pi An Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Tanxiang Alternative names: Sandalwood; Lignum Santaii Albi Source: Chinese Materia Medica

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Herbs and Supplements ALA Source: Integrative Medicine Communications; www.drkoop.com Alpha2-Adrenergic Agonists Source: Integrative Medicine Communications; www.drkoop.com

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Alpha-Linolenic Acid (ALA) Source: Integrative Medicine Communications; www.drkoop.com Angelica sinensis Source: Integrative Medicine Communications; www.drkoop.com Aortic Glycosaminoglycans Source: Prima Communications, Inc.www.personalhealthzone.com Astragalus Mem Alternative names: Huang-Qi; Astragalus membranaceus Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Beta-Blockers Source: Integrative Medicine Communications; www.drkoop.com Beta-Carotene Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10103,00.html Biguanides Source: Integrative Medicine Communications; www.drkoop.com Bromelain Source: Healthnotes, Inc.; www.healthnotes.com Carotenoids Source: Healthnotes, Inc.; www.healthnotes.com Chinese Angelica Source: Integrative Medicine Communications; www.drkoop.com Danggui Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.drkoop.com Dipyridamole Source: Healthnotes, Inc.; www.healthnotes.com Dong Quai Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.drkoop.com Eicosapentaenoic Acid (EPA) Source: Integrative Medicine Communications; www.drkoop.com

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EPA Source: Integrative Medicine Communications; www.drkoop.com Estrogens (Combined) Source: Healthnotes, Inc.; www.healthnotes.com Fiber Source: Healthnotes, Inc.; www.healthnotes.com Fibric Acid Derivatives Source: Integrative Medicine Communications; www.drkoop.com Glucomannan Source: Healthnotes, Inc.; www.healthnotes.com Melatonin Source: Integrative Medicine Communications; www.drkoop.com Metformin Source: Healthnotes, Inc.; www.healthnotes.com Panax Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Phenothiazine Derivatives Source: Integrative Medicine Communications; www.drkoop.com SAMe Source: Healthnotes, Inc.; www.healthnotes.com Sulfonylureas Source: Integrative Medicine Communications; www.drkoop.com Tang Kuei Source: Integrative Medicine Communications; www.drkoop.com Thiazide Diuretics Source: Integrative Medicine Communications; www.drkoop.com Thioxanthene Derivatives Source: Integrative Medicine Communications; www.drkoop.com Tribulus Puncture Alternative names: Puncture Vine, Goathead; Tribulus terrestris L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Tricyclic Antidepressants (TCAs) Source: Integrative Medicine Communications; www.drkoop.com Vasodilators Source: Integrative Medicine Communications; www.drkoop.com

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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON CORONARY HEART DISEASE Overview In this chapter, we will give you a bibliography on recent dissertations relating to coronary heart disease. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “coronary heart disease” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on coronary heart disease, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Coronary Heart Disease ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to coronary heart disease. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A DEMOGRAPHIC ANALYSIS OF HETEROGENEOUS CORONARY HEART DISEASE MORTALITY RATES OVER SPACE AND TIME by EL-BOLKINY, MOHAMED TAWFIK, PHD from THE UNIVERSITY OF CONNECTICUT, 1986, 183 pages http://wwwlib.umi.com/dissertations/fullcit/8709026

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A QUALITATIVE ASSESSMENT OF SUSCEPTIBILITY TO CORONARY HEART DISEASE AS PERCEIVED BY SELECTED MIDDLE-AGED WOMEN by BOUDREAU, MARGARET A., PHD from SOUTHERN ILLINOIS UNIVERSITY AT CARBONDALE, 1995, 133 pages http://wwwlib.umi.com/dissertations/fullcit/9536518

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COMPARISON OF RISK FACTORS FOR CORONARY HEART DISEASE IN SEDENTARY AND PHYSICALLY ACTIVE COLLEGE STUDENTS by JENSEN, MARIAN, EDD from BRIGHAM YOUNG UNIVERSITY, 1992, 112 pages http://wwwlib.umi.com/dissertations/fullcit/9220176

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Correlates and risk factors associated with coronary heart disease and the likelihood of engaging in selected nutrition health-promoting behaviors among women by Covington, Carolyn Frances, PhD from HOWARD UNIVERSITY, 2002, 241 pages http://wwwlib.umi.com/dissertations/fullcit/3066487

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Differences in knowledge of coronary heart disease risks and modifiable risk factor behaviors by gender, age, and ethnicity by Reitz, Sharon Margaret, PhD from UNIVERSITY OF MARYLAND COLLEGE PARK, 1997, 333 pages http://wwwlib.umi.com/dissertations/fullcit/9736622

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Effect of almonds in diets to reduce coronary heart disease risk factors by Marchie, Augustine, MSc from UNIVERSITY OF TORONTO (CANADA), 2003, 111 pages http://wwwlib.umi.com/dissertations/fullcit/MQ84449

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EFFECTS OF CORONARY HEART DISEASE RISK FACTOR REDUCTION ON EXERCISE PERFORMANCE IN MEN AT HIGH RISK OF FUTURE CORONARY HEART DISEASE by RINGHOFER, KEVIN RICHARD, PHD from UNIVERSITY OF MINNESOTA, 1991, 142 pages http://wwwlib.umi.com/dissertations/fullcit/9122205

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PREVALENCE OF CORONARY HEART DISEASE RISK FACTORS IN SCHOOL CHILDREN, AGES 6-11 YEARS by BURKS, WILLIAM SCOTT, PHD from THE UNIVERSITY OF SOUTHERN MISSISSIPPI, 1986, 230 pages http://wwwlib.umi.com/dissertations/fullcit/8705054

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PSYCHOSOCIAL VARIABLES, TYPE A BEHAVIOR PATTERN, AND CORONARY HEART DISEASE IN WOMEN by LOW, KATHRYN GRAFF, PHD from STANFORD UNIVERSITY, 1991, 202 pages http://wwwlib.umi.com/dissertations/fullcit/9115811

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THE ASSOCIATION OF SELECTED CORONARY HEART DISEASE RISK FACTOR VARIABLES BETWEEN FAMILY MEMBERS, WITH SPECIFIC REFERENCE TO PHYSICAL ACTIVITY by MITCHELL, JAYNE, PHD from UNIVERSITY OF EXETER (UNITED KINGDOM), 1991, 697 pages http://wwwlib.umi.com/dissertations/fullcit/DX95418

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The effect of social support and health behavior on psychosocial adjustment of coronary heart disease patients by Drewniak, Theresa Annette, PhD from INDIANA STATE UNIVERSITY, 2000, 101 pages http://wwwlib.umi.com/dissertations/fullcit/9991543

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THE EFFECTS OF A PHYSICAL EDUCATION ENDURANCE RUNNING PROGRAM ON CORONARY HEART DISEASE RISK FACTORS IN HIGH SCHOOL SOPHOMORES by GAYLE, RICHARD CARLTON, EDD from THE UNIVERSITY OF TENNESSEE, 1979, 79 pages http://wwwlib.umi.com/dissertations/fullcit/8005390

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THE EFFECTS OF BETA-ADRENERGIC BLOCKADE ON THE TRAINING RESPONSES AND LIPOPROTEIN-LIPID PROFILES OF PATIENTS WITH CORONARY HEART DISEASE (EXERCISE TRAINING) by FORBES, WILLIAM J., PHD from UNIVERSITY OF MARYLAND COLLEGE PARK, 1990, 155 pages http://wwwlib.umi.com/dissertations/fullcit/9121340

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The relationship of coronary heart disease and spirituality by Morris, Edwin Lee, PhD from THE UNION INSTITUTE, 1998, 55 pages http://wwwlib.umi.com/dissertations/fullcit/9907568

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THE RELATIONSHIP OF INTRINSIC AND EXTRINSIC WORK MOTIVATIONS TO OCCUPATIONAL STRESS AND CORONARY HEART DISEASE RISK by HOUSE, JAMES STEPHEN, PHD from THE UNIVERSITY OF MICHIGAN, 1972, 484 pages http://wwwlib.umi.com/dissertations/fullcit/7229094

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Twenty-year trends in the total diet quality for coronary heart disease prevention among adults in the Minneapolis-St. Paul metropolitan area by Lee, Seungmin, PhD from UNIVERSITY OF MINNESOTA, 2003, 132 pages http://wwwlib.umi.com/dissertations/fullcit/3109357

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON CORONARY HEART DISEASE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “coronary heart disease” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on coronary heart disease, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Coronary Heart Disease By performing a patent search focusing on coronary heart disease, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on coronary heart disease: •

2-substituted-1-acyl-1,2-dihydroquinoline derivatives Inventor(s): Babiak; John (Martinsville, NJ), Elokdah; Hassan Mahmoud (Yardley, PA), Miller; Christopher Paul (Wayne, PA), Sulkowski; Theodore Sylvester (Wayne, PA) Assignee(s): American Home Products Corporation (Madison, NJ) Patent Number: 5,939,435 Date filed: January 29, 1998 Excerpt(s): This invention relates to the use of 2-substituted-1-acyl-1,2-dihydroquinoline derivatives to increase high density lipoprotein cholesterol (HDL-C) concentration and as therapeutic compositions for treating atherosclerotic conditions such as dyslipoproteinamias and coronary heart disease. Numerous studies have demonstrated that both the risk of coronary heart disease (CHD) in humans and the severity of experimental atherosclerosis in animals are inversely correlated with serum HDL cholesterol (HDL-C) concentrations (Russ et al., Am. J. Med., 11 (1951) 480-493; Gofman et al., Circulation, 34 (1966) 679-697; Miller and Miller, Lancet, 1 (1975) 16-19; Gordon et al., Circulation, 79 (1989) 8-15; Stampfer et al., N. Engl. J. Med., 325 (1991) 373-381; Badimon et al., Lab. Invest., 60 (1989) 455-461). Atherosclerosis is the process of accumulation of cholesterol within the arterial wall which results in the occlusion, or stenosis, of coronary and cerebral arterial vessels and subsequent myocardial infarction and stroke. Angiographical studies have shown that elevated levels of some HDL particles appears to be correlated with a decrease in the number of sites of stenosis in the coronary arteries of humans (Miller et al, Br. Med. J., 282 (1981) 1741-1744). There are several mechanisms by which HDL may protect against the progression of atherosclerosis. Studies in vitro have shown that HDL is capable of removing cholesterol from cells (Picardo et al., Arteriosclerosis, 6 (1986) 434-441). Data of this nature suggests that one antiatherogenic property of HDL may lie in its ability to deplete tissues of excess free cholesterol and eventually lead to the delivery of this cholesterol to the liver (Glomset, J. Lipid Res., 9 (1968) 155-167). This has been supported by experiments showing efficient transfer of cholesterol from HDL to the liver (Glass et al, Circulation, 66 (Suppl. II) (1982) 102; MacKinnon et al., J. Biol. Chem., 261 (1986) 2548-2552). In addition, HDL may serve as a reservoir in the circulation for apoproteins necessary for the rapid metabolism of triglyceride-rich lipoproteins (Grow and Fried, J. Biol. Chem., 253 (1978) 1834-1841; Lagocki and Scanu, J. Biol. Chem., 255 (1980) 3701-3706; Schaefer et al., J. Lipid Res., 23 (1982) 1259-1273). Accordingly, agents which increase HDL cholesterol concentrations are useful as anti-atherosclerotic agents, particularly in the treatment of dyslipoproteinemias and coronary heart disease. Web site: http://www.delphion.com/details?pn=US05939435__

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Acetylsalicylic acid and micronutrient supplementation for nutritional losses and coronary heart disease Inventor(s): Christakis; George (Sunrise, FL), Riley; Patricia A. (Sunrise, FL) Assignee(s): Medical Doctor's Research Institute, Inc. (Sunrise, FL) Patent Number: 5,948,443 Date filed: February 21, 1997

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Abstract: The present invention pertains generally to the field of Public Health, including the prevention and treatment of coronary heart disease which is currently the first cause of death in the American population. More specifically, the present invention concerns a total modular system of multivitamin and mineral supplementation composed of 7 distinct modules for improving public health by insuring adequate intake of micronutrients needed for disease prevention and protection against nutritional losses and deficiencies due to, for example, lifestyle factors and common inadequate dietary patterns. A module, as used herein throughout, is defined as a separate and distinct combination of vitamin-mineral and other health promoting compounds which are directed to specific target populations. The formulations of the present invention which, when combined in one capsule or tablet or as separate modules, exert a joint and enhancing effect on the major pathogenetic factors involved in the atherosclerotic process. Moreover, certain modular formulations of the present invention incorporate both antioxidants and acetylsalicylic acid (aspirin) as a single preventive modality. Such a combination of antioxidants and aspirin is believed to act to prevent oxidation of low density lipoproteins within coronary arterial walls and to cause platelet deagluttination thereby inhibiting thrombus formation. The benefit of preventing these two major processes is believed to reduce the risk of coronary heart disease. Excerpt(s): The present invention concerns a total modular system of multivitamin and mineral supplementation composed of 7 distinct modules for improving public health by insuring adequate intake of micronutrients needed for disease prevention and protection against nutritional losses and deficiencies due to, for example, lifestyle factors and common inadequate dietary patterns. A module, as used herein throughout, is a separate and distinct combination of vitamin-mineral and other health promoting compounds which are directed to specific target populations. Micronutrients are elements or compounds which are present in foods in small or trace amounts and includes vitamins, minerals or other elements; and compounds found in foods for which a Recommended Dietary Allowance (RDA) has not yet been determined (pantothenic acid, biotin, choline, etc.). The macronutrients consist of carbohydrates, fats and proteins which supply nutrients and calories. Some elements such as calcium, sodium, potassium, chloride and phosphorus are elements consumed in relatively large amounts, while many such as iron, iodine, and zinc are consumed in small amounts (milligrams). Vitamins such as vitamin B12, and folic acid and the minerals copper, selenium and chromium are consumed in very small, or trace amounts (micrograms). Inasmuch as the human body, does not synthesize many "essential compounds", these specific vitamins and minerals can be obtained from only two sources: foods and supplements. The primary source of all nutrients is food. Over the past four decades, ample evidence documents that major portions of various subgroups of Americans stratified by age, gender, socioeconomic status and other variables, cannot meet the "Recommended Dietary Allowances" of the foods containing these essential compounds and elements. Thus vitamin and mineral supplementation has become a recognized method of meeting accepted medical and public health nutrition standards. The enrichment of bread with iron and B vitamins in 1940 is considered a major factor in assuring favorable nutritional status for the general population of that time, and has been retained as a major advance for public health. In 1993, the Interagency Board of Nutrition Monitoring and Related Research reported that women did not meet the RDA's of 6 out of 15 micronutrients: B6, E, calcium, iron, magnesium and zinc. Men also failed to met the RDA's for 4 of 15 micronutrients: B6, E, magnesium and zinc. Their findings reveal significant prevalence and incidence of various population subgroups deficient in specific vitamins and minerals. The importance of these findings relate to the prevention of micronutrient deficiency diseases such as scurvy (vitamin C

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deficiency), pellagra (niacin deficiency), beri-beri (vitamin B1 deficiency), iron deficiency anemia and other vitamin and mineral deficiency states. The effect of marginal deficiency states is only now being considered as a cause of suboptimal health status. Moreover, research conducted and published in the past three decades indicates that antioxidant micronutrients are involved in preventing molecular biological processes affecting health and disease at the subcellular and submolecular level. It is current thought that free-radical effects on cells and tissues can be modified by antioxidant micronutrients reducing cellular damage. Specific micronutrients maintain immune system integrity, moderate the aging process, and play a role in the prevention of atherogenesis and cancer. Furthermore, substantial segments of the population do not manifest desirable eating patterns, that is, an adequate intake in both the quantity and variety of food to fulfill the Recommended Dietary Allowances, as indicated by recent government survey. Only 22% of the subjects of a National Cancer Institute Study, consumed the recommended number of dietary servings of fruits and vegetables. Web site: http://www.delphion.com/details?pn=US05948443__ •

Administration of resveratrol to prevent or treat restenosis following coronary intervention Inventor(s): Goodman; David William (Quebec, CA) Assignee(s): Pharmascience Inc. (Montreal, CA) Patent Number: 6,022,901 Date filed: May 13, 1998 Abstract: A method for preventing or treating restenosis and for preventing the recurrence or progression of coronary heart disease is provided. The method involves administration of a selected active agent to a patient following coronary intervention, e.g., coronary artery bypass surgery, endarterectomy, heart transplantation, heart balloon angioplasty, atherectomy, laser ablation or endovascular stenting. The active agent comprises cis-resveratrol, trans-resveratrol, a mixture thereof, or a pharmacologically acceptable salt, ester, amide, prodrug or analog thereof. Administration may be oral, parenteral, or the like. Pharmaceutical compositions for use in conjunction with the therapeutic method are also provided. Excerpt(s): This invention relates generally to therapeutic use of resveratrol (3,5,4'trihydroxy stilbene). More particularly, the invention relates to a method for preventing or treating restenosis following coronary intervention and to a method for preventing the progression or recurrence of coronary artery disease by administering resveratrol to a patient in need of such treatment. The invention additionally relates to pharmaceutical compositions useful in conjunction with the presently disclosed and claimed therapeutic methods. Resveratrol (3,5,4'-trihydroxystilbene) has been identified as a constituent not only of grape skins (Soleas et al. (1995) Am. J. Enol. Vitic. 46(3):346-352) but has also been found to be present in ground nuts, eucalyptus, and other plant species. Goldberg et al. (1995), Am. J. Enol. Vitic. 46(2):159-165. A great deal of interest has been focused on the compound's antifungal activity and its correlation with resistance to fungal infection. Id at 159. Resveratrol may be obtained commercially (typically as the trans isomer, e.g. from the Sigma Chemical Company, St. Louis, Mo.), or it may be isolated from wine or grape skins, or it may be chemically synthesized. Synthesis is typically carried out by a Wittig reaction linking two substituted phenols through a styrene double bond, as described by Moreno-Manas et al. (1985) Anal. Quim. 81:157-61 and subsequently modified by others (Jeandet et al. (1991) Am. J. Enol. Vitic. 42:41-46;

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Goldberg et al. (1994) Anal. Chem. 66: 3959-63). There are more studies concerning trans-resveratrol than the cis isomer; however, the cis isomer also appears to be equally important from a biological standpoint. Numerous uses have been proposed and evaluated for the resveratrol isomers. Jang et al. (1997) Science 275:218-220, show that resveratrol has cancer chemopreventive activity in assays representing three major stages of carcinogenesis. That is, the authors found that the compound: (1) acted as an antioxidant and antimutagen and induced phase II drug-metabolizing enzymes ("antiinitiation" activity); (2) mediated anti-inflammatory effects and inhibited cyclooxygenase and hydroperoxidase ("antipromotion" activity); and (3) induced human promyelocytic leukemia cell differentiation ("antipromotion" activity). In addition, as noted above, resveratrol has been extensively studied for its correlation to the cardiovascular utility of red wine. See, e.g., Bertelli et al., supra; Pace-Asciak et al. (1995), Clinica Chimica Acta 235:207-2191; and Frankel et al. (Apr. 24, 1993), The Lancet 341:1104. Neurologic uses have also been proposed (Lee et al. (1994), Society for Neuroscience Abstracts 20(12):1648). Web site: http://www.delphion.com/details?pn=US06022901__ •

Catechin multimers as therapeutic drug delivery agents Inventor(s): Larson; Drake (P.O. Box 355, Thermal, CA 92274) Assignee(s): none reported Patent Number: 6,562,864 Date filed: May 3, 2002 Abstract: Described herein are catechin multimers, and particularly substituted catechin multimers, and their use as carrier moieties for the delivery of nucleophilic and cationic bioactive therapeutic agents to target sites in vivo. For example, substituted catechin multimers of the present invention may be administered alone, for the treatment of stenotic vascular diseases and disorders, such as atherosclerosis (also known as arteriosclerosis) and coronary heart disease (also known as coronary artery disease and ischemic heart disease). Alternatively, catechin multimers, substituted and otherwise, may be complexed with nucleophilic and/or cationic bioactive therapeutic agents, such as anti-thrombotic agents, cholesterol lowering agents, anti-plaque agents, anti-cancer agents, chemotherapeutic agents, anti-inflammatory agents, antibiotics, antimicrobials, wound healing agents, and the like, for the treatment of a variety of diseases and disorders, including but not limited to cardiac and vascular stenoses, cancer, inflammatory conditions, neurological conditions, infection, wounds, burns and the like. The catechin multimers, particularly the substituted catechin multimers, described herein have a strong affinity for polar proteins residing in the vascular endothelium as well as cell walls and membranes, and, accordingly, are able to provide targeted delivery of bioactive agents embedded therein and/or complexed therewith so as to potentiate their therapeutic effects. The therapeutic complexes may be pharmaceutically formulated "neat" (e.g., without additives) or with additives such as pharmaceutical carriers, diluents, buffers, adjuvants, excipients, surfactants, and stabilizers. Excerpt(s): The present invention is related to catechin multimers and their use as carrier moieties for the delivery of nucleophilic and/or cationic bioactive therapeutic agents to target sites in vivo. For example, substituted catechin multimers of the present invention may be administered alone, for the treatment of stenotic vascular diseases and disorders, such as atherosclerosis (also known as arteriosclerosis) and coronary heart disease (also known as coronary artery disease and ischemic heart disease).

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Alternatively, catechin multimers, substituted and otherwise, may be complexed with nucleophilic and/or cationic bioactive therapeutic agents, such as anti-thrombotic agents, cholesterol lowering agents, anti-plaque agents, anti-cancer agents, chemotherapeutic agents, anti-inflammatory agents, antibiotics, antimicrobials, wound healing agents, and the like, for the treatment of a variety of diseases and disorders, including but not limited to, vascular and cardiac stenoses, cancer, inflammatory conditions, neurological conditions, infections, burns, wounds, etc. Catechin multimers, particularly the substituted catechin multimers described herein, have a strong affinity for polar proteins residing in the vascular endothelium as well as the walls and membranes of other select cells and tissues, and, accordingly, are able to provide targeted delivery of bioactive agents embedded therein and/or complexed therewith so as to potentiate their therapeutic effects. Many diseases or disorders are characterized by localized pathology, i.e., affecting only select cells, tissues or organs. Examples of such diseases or disorders include but are not limited to cancers, stenotic vascular disorders such as atherosclerosis (or arteriosclerosis), inflammatory disorders, infections, wounds, burns, and certain neurological conditions. Treatment modalities for such diseases often rely on the ability to target bioactive agents to a diseased region or tissue in the body of a patient, while minimizing or preventing action of the bioactive agents on other regions or tissues in the body, such as undiseased regions or tissues. In other words, in treating such conditions, it is desirable to direct the appropriate drug to the affected area while at the same time avoiding unacceptable or toxic side effects to healthy tissue. Targeted drug delivery means are particularly important where the toxicity of the drug is an issue. Specific tissue targeting drug delivery methods potentially serve to minimize toxic side effects, lower the required dosage amounts, and decrease costs for the patient. Various methods for targeted delivery of bioactive agents are described in the literature. For example, one method involves the use of liposomes as delivery vehicles. Alternatively, structural features, such as receptor proteins and cell-specific antigens, have also been used in targeting delivery of a bioactive agent to a particular region or tissue. However, such structural features are associated with one or, at most a few, disease states. In addition, incomplete or irregular expression of such structural features may further limit their usefulness in targeted delivery of bioactive agents. Moreover, delivery of effective doses of bioactive agents to target cells is hampered by many factors, including but not limited to, low residence times in serum, ineffective targeting, loss of the therapeutic agent in solution before it may be taken up by the target cell, and degradation of the therapeutic in the endosomic/lysosomic pathway. Web site: http://www.delphion.com/details?pn=US06562864__ •

Chromosome 11-linked coronary heart disease susceptibility gene CHD1 Inventor(s): Ballinger; Dennis G. (Menlo Park, CA), Ding; Wei (Salt Lake City, UT), Hess; Mark A. (Salt Lake City, UT), Wagner; Susanne (Murray, UT) Assignee(s): Myriad Genetics, Inc. (Salk Lake City, UT) Patent Number: 6,225,451 Date filed: March 4, 1999 Abstract: Human coronary heart disease susceptibility gene (CHD1), some alleles of which are related to susceptibility to coronary heart disease. Germline mutations in the CHD1 gene and their use in the diagnosis of predisposition to coronary heart disease and to metabolic disorders, including hypoalphalipoproteinemia, familial combined hyperlipidemia, insulin resistant syndrome X or multiple metabolic disorder, obesity,

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diabetes and dyslipidemic hypertension. Presymptomatic therapy of individuals who carry deleterious alleles of the CHD1 gene (including gene therapy, protein replacement therapy, and administration of protein mimetics and inhibitors). The screening of drugs for dyslipidemic therapy. Excerpt(s): The present invention relates generally to the field of human genetics. The present invention specifically relates to a human coronary heart disease susceptibility gene (CHD1), some alleles of which are related to susceptibility to coronary heart disease. More specifically, the present invention relates to germline mutations in the CHD1 gene and their use in the diagnosis of predisposition to coronary heart disease and to metabolic disorders, including hypoalphalipoproteinemia, familial combined hyperlipidemia, insulin resistant syndrome X or multiple metabolic disorder, obesity, diabetes and dyslipidemic hypertension. The invention also relates to presymptomatic therapy of individuals who carry deleterious alleles of the CHD1 gene (including gene therapy, protein replacement therapy, and administration of protein mimetics and inhibitors). Also within the scope of this invention is the screening of drugs for coronary heart disease or metabolic disorder therapy. Web site: http://www.delphion.com/details?pn=US06225451__ •

Feed compositions comprising purslane leaves and methods of using thereof Inventor(s): Ezekwe; Michael O. (Colonial Heights, VA), Mebrahtu; Tadesse (Prince George, VA), Omara-Alwala; Thomas R. (Chester, VA) Assignee(s): Virginia State University (Petersburg, VA) Patent Number: 5,688,508 Date filed: February 21, 1995 Abstract: The present invention is drawn to feed compositions including purslane leaves harvested at bloom. The present invention is further drawn to methods of reducing serum cholesterol and triglycerides with the present feed compositions of purslane leaves, as well as methods of preventing and treating coronary heart disease with the feed compositions. Excerpt(s): The present invention relates to the process of reducing plasma cholesterol and triglycerides by the use of a naturally-occurring component of purslane (genus, portulaca). This invention pertains to the U.S. Utility Patent Classification definition. Sixty million Americans have elevated blood cholesterol levels which, in combination with other risk factors e.g. high triglyceride levels, place them at risk of coronary heart disease (Inform, Dietary fat: New directions in research AOCS 1:238-260 (1990)). In view of the fact that Omega-3 fatty acids have been associated with decreasing mortality from coronary artery disease, it has become necessary to identify sources of Omega-3 fatty acids in the food supply. Recent reports indicate that reduction in plasma cholesterol in high risk groups is associated with more lives saved. Purslane, a ubiquitous garden weed in the U.S., is the richest vegetable source of Omega-3 fatty acids (Simopoulos et al., Purslane: A terrestrial source of Omega-3 fatty acids, New England J. 315(13):833 (1986); Simopoulos et al., Common Purslane: A source of Omega-3 fatty acids and antioxidants. J. Am. Coll. Nutr. 11:374-382 (1992); Omara-Alwala et al., Omega-3 fatty acids in purslane (Portulaca oleracea) tissue, J. Am. Oil Chem. Soc. 68:198-199 (1991)). Although Omega-3 fatty acids lower serum cholesterol and triglycerides and consequently reduce the incidence of cardiovascular diseases in human, no one has yet demonstrated this using purslane plant.

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Web site: http://www.delphion.com/details?pn=US05688508__ •

Method for detecting a risk of cancer and coronary heart disease and kit therefor Inventor(s): Salonen; Jukka (Jannevirta, FI) Assignee(s): Oy Jurilab Ltd. (Jannevirta, FI) Patent Number: 6,242,186 Date filed: June 1, 1999 Abstract: The present invention is directed to a method and a kit for detecting a risk of cancer and coronary heart disease in a subject, comprising isolating genomic DNA from said subject, determining the allelic pattern for the codon 54 of the paraoxonase encoding PON1 gene in the genomic DNA, identification of M54L mutation indicating said risk being reduced. Excerpt(s): The present invention relates to a method for detecting or predicting the risk of, or predisposition to, cancer and coronary heart disease in a subject. The present invention also relates to a kit for carrying out the said method. The present invention was based on the hypothesis that homozygosity of the L54 allele in the PON1 gene might protect against certain diseases associated with oxidative stress, in particular cancer and coronary heart disease. For this purpose, the said hypothesis was tested in a prospective population-based cohort study. The results of this study show that our hypothesis is true and that there is a clear association between homozygosity of the L54 allele, and a reduced risk for cancer and coronary heart disease. The present invention is thus directed to a method for detecting a risk of cancer and coronary heart disease, in a subject, comprising isolating genomic DNA from said subject, determining the allelic pattern for the codon 54 of the paraoxonase encoding PON1 gene in the genomic DNA, and identification of M54L mutation indicating said risk being reduced. Web site: http://www.delphion.com/details?pn=US06242186__

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Methods for identifying cardiovascular agents Inventor(s): Karas; Richard H. (Franklin, MA), Mendelsohn; Michael E. (Wellesley, MA) Assignee(s): New England Medical Center Hospitals, Inc. (Boston, MA) Patent Number: 6,692,928 Date filed: October 12, 1999 Abstract: The invention features assays to identify cardiovascular agents, such as vasoprotective agents, antihypertensive agents, cardiomyopathy therapeutic agents, coronary heart disease therapeutic agents, or heart failure therapeutic agents. The assays include culturing cells in the presence or absence of a predetermined amount of the candidate agent and measuring the expression or activity of selected genes or reporter constructs known to be responsive to estrogen. Excerpt(s): Vascular diseases are the major cause of morbidity and mortality in the United States. Despite decades of intensive research, the mechanisms responsible for these diseases are poorly understood. The low incidence of vascular diseases in premenopausal women and the rapid increase in vascular diseases, including cerebrovascular and ischemic heart disease, in women following menopause are well recognized. It is now recognized that the hormone estrogen plays a significant role in

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preventing atherosclerotic vascular disease. Most attempts to explain the effects of estrogen on the development of vascular disease in women focus on indirect effects of estrogen on known risk factors, such as lipid and/or carbohydrate metabolism, counterbalancing of androgen-mediated effects, or indirect effects of sex hormones on the thrombotic milieu. Estrogen replacement therapy has been rather successful in reducing the incidence of vascular disease in post-menopausal women. It can reduce the incidence of coronary artery disease by as much as 30-50 percent. However, estrogen replacement therapy has a number of significant drawbacks, including an increased risk of endometrial cancer, an increased risk of breast cancer in women, and side effects such as endometrial bleeding and breast tenderness. In addition, though estrogen therapy may theoretically have beneficial effects for vascular disease in men as well as women, attempts to examine this possibility have been limited by adverse effects observed with currently available agents and the possibility of feminization that such therapy harbors. Web site: http://www.delphion.com/details?pn=US06692928__ •

Milk lacking.beta.-casein A1 Inventor(s): McLachlan; Corran Norman Stuart (29 Summer St, North Shore, NZ) Assignee(s): none reported Patent Number: 6,570,060 Date filed: July 18, 2001 Abstract: A milk which is free of.beta.-casein A.sup.1 protein in the prevention or treatment of coronary heart disease is disclosed. In addition, a process for the testing of DNA from cells obtained from lactating bovines for the presence of DNA encoding certain.beta.-casein proteins, selecting the bovines on the basis of the testing, and then milking those bovines to produce milk free of.beta.-casein A.sup.1 for use in the prevention or treatment of coronary heart disease is disclosed. Excerpt(s): This invention relates to the use of milk which is free of the.beta.-casein A.sup.1 protein in the prevention or treatment of coronary heart disease. The invention also relates to the testing of DNA from cells obtained from lactating bovines for the presence of DNA encoding certain.beta.-casein proteins, selecting the bovines on the basis of the testing, and then milking those bovines to produce milk free of.beta.-casein A.sup.1 for use in the prevention or treatment of coronary heart disease. Coronary heart disease is a major cause of death, particularly in countries where the populations are well-nourished, such as in the western world. Many factors are implicated as risk factors for this disease including obesity, smoking, genetic predisposition, diet, hypertension, and cholesterol. Dairy products, especially milk, are a major contributor to the dietary intake of humans, again particularly in western world populations. Milk contains numerous components of nutritional and health benefit. Calcium is one example. However, milk is also a significant source of dietary fat. It is widely accepted that saturated fats found in milk are a risk factor for coronary heart disease. However, the inventor has discovered an additional risk factor present in some bovine milk unrelated to the fat content. What is entirely surprising is the source of the risk. The source is not dependent on the fat content of milk. Instead, it is a milk protein,.beta.-casein, which is linked to coronary heart disease. Web site: http://www.delphion.com/details?pn=US06570060__

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Nutritional supplement for cardiovascular health Inventor(s): Vester; Samuel Russell (Cincinnati, OH) Assignee(s): Coventry Group, Ltd. (Cincinnati, OH) Patent Number: 6,203,818 Date filed: March 20, 1998 Abstract: A nutritional supplement for improving cardiovascular health via aiding in preventing, delaying the onset of and/or slowing the progression of atherosclerosis and coronary heart disease, the supplement comprising one or more flavonoids and folic acid or folate; and a method for aiding in preventing, delaying the onset of and/or slowing the progression of atherosclerosis and coronary heart disease are described. Excerpt(s): This invention relates to a nutritional supplement composition, more particularly, to a nutritional supplement composition that is intended to benefit cardiovascular health via aiding in preventing, delaying the onset of and/or slowing the progression of atherosclerosis and coronary heart disease (CHD), and to a method for aiding in preventing, delaying the onset of and/or slowing the progression of atherosclerosis and CHD by administration of the nutritional supplement composition to an individual. According to the 1996 American Heart Association statistical summary, 42% of all deaths in America are from some form of cardiovascular disease. Since cardiovascular disease is the leading cause of death in the United States and many other developed countries, it is not surprising that heart specialists and physicians in general arc frequently asked to provide advice concerning nutritional factors that may aid in preventing, delaying the onset of and/or slowing the progression of atherosclerosis and CHD. The use of vitamin and mineral supplements in one's diet is well established. Specifically, vitamin and mineral supplements heretofore devised and used for the purpose of providing daily nutrients are known to consist basically of familiar, predictable and obvious combinations. While many of the known supplements are adequate to fulfil their objectives, few have been specifically composed for improving cardiovascular health via aiding in preventing, delaying the onset of and/or slowing the progression of atherosclerosis and coronary heart disease. Web site: http://www.delphion.com/details?pn=US06203818__

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Soy containing breakfast cereal Inventor(s): Holbrook; James L. (Troy, IL), Kerr; Phillip S. (Wildwood, MO), Ning; Luping L. (Valley Park, MO) Assignee(s): Protein Technologies International, Inc (St. Louis, MO) Patent Number: 6,303,177 Date filed: March 6, 2000 Abstract: The present invention provides a breakfast cereal for human consumption that contains at least one cereal grain and a soy material selected from soy flour, soy grits, soy flakes, a comminuted whole soybean material, or combinations thereof. The soy material contains at most 20.mu.mol/g raffinose and 35.mu.mol/g stachyose, and at least 200.mu.mol/g sucrose. A process for producing such a breakfast cereal is also provided in which at least one cereal grain and a soy material selected from a soy flour, soy grits, soy flakes, a comminuted whole soybean material, or combinations thereof are blended, cooked to form a cereal dough, and a ready-to-eat cereal is formed from the

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cereal dough. The soy material contains at most 20.mu.mol/g raffinose and 35.mu.mol/g stachyose, and at least 200.mu.mol/g sucrose. A process of reducing coronary heart disease risk in a human is also provided in which a cereal containing a soy material containing at most 20.mu.mol/g raffinose and 35.mu.mol/g stachyose, and at least 200.mu.mol/g sucrose is administered to a human. Excerpt(s): The present invention relates to a novel breakfast cereal composition and the process of making the same. Ready-to-eat breakfast cereals are popular food items which provide a good source of nutrition. Typical ready-to-eat breakfast cereals are prepared in a variety of ways to provide different textures and mouthfeel. Such breakfast cereals include flaked cereals, puffed cereals, and shredded cereals. Ready-toeat cereals are formulated primarily with cereal grains, and may contain one or more cereal grains. The cereal grains utilized, such as corn, wheat, rice, barley, and the like, have a high starch content but relatively little protein. A cereal having more protein content, therefore, is desirable from a nutritional standpoint. Web site: http://www.delphion.com/details?pn=US06303177__

Patent Applications on Coronary Heart Disease As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to coronary heart disease: •

Acoustic window identification Inventor(s): Stearns, Scott Donaldson; (Rochester, NY) Correspondence: Myers Bigel Sibley & Sajovec; PO Box 37428; Raleigh; NC; 27627; US Patent Application Number: 20020072684 Date filed: November 29, 2001 Abstract: Methods for identifying and/or visualizing an acoustic window suitable for passive acoustic coronary heart disease evaluations by mapping the relative SNR distribution on the channels on an array of a plurality of sensors to nominal locations on a person's chest of each sensor in the acoustic sensor array and identifying a plurality of sensor locations that correspond to the highest channel SNR's is described and/or sizing the acoustic sensor array to correspond with the identified acoustic window. Excerpt(s): This application is a divisional of U.S. patent application Ser. No. 09/433,211, filed Nov. 4, 1999, which claims priority from Provisional Application No. 60/107,616 filed on Nov. 9, 1998. The contents of these applications are hereby incorporated by reference as if recited in fill herein. This application is related to co-pending and coassigned U.S. Pat. No. 6,278,890, entitled "Non-Invasive Turbulent Blood Flow Imaging System," filed Nov. 9, 1998, which corresponds to PCT/US97/20186 filed Nov. 10, 1997 ("the 20186 application"). This application is also related to co-assigned U.S. Pat. No. 6,193,668, entitled "Acoustic Sensor Array for Non-Invasive Detection of Coronary Artery Disease." This application is also related to co-assigned U.S. Pat. No. 6,261,237, entitled "Thin Film Piezoelectric Polymer Sensor." The contents of the above-identified applications are hereby incorporated by reference as if recited in fall herein. This

9 This

has been a common practice outside the United States prior to December 2000.

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invention relates to the non-invasive detection of abnormal blood flow sounds by an array of acoustic sensors. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Breeding and milking cows for milk free of beta-casein A1 Inventor(s): McLachlan, Corran Norman Stuart; (North Shore, NZ) Correspondence: Young & Thompson; 745 South 23rd Street 2nd Floor; Arlington; VA; 22202 Patent Application Number: 20030221200 Date filed: February 21, 2003 Abstract: A milk or other dairy product, capable of minimising the onset of disease such as coronary heart disease or enhancing the immune response is derived from animals which are substantially free of the.beta.-casein A.sup.1 allele. Bulk milk can be produced by testing for and culling cows who test positive for the.beta.-casein A.sup.1 allele, or by producing immunoglobulins and other immune response proteins, in cow's milk from animals not possessing the.beta.-casein A.sup.1 allele, or other commercial milk producing animals, to this allele, to counteract the immnunosuppressant substances present that are produced from it, in commercial milking cows such as Holsteins, together with its blending with non-treated milk or the recovery of such immunoproteins. Excerpt(s): This invention relates to milk free of the.beta.-casein A.sup.1 protein. Such milk is useful for the prevention or treatment of coronary heart disease. In particular, the invention relates to the breeding of bovine bulls that do not have DNA encoding for.beta.-casein A.sup.1 with bovine cows that do not have DNA encoding for.beta.casein A.sup.1 and then milking the progeny cows. The milk produced is free of.beta.casein A.sup.1. Coronary heart disease is a major cause of death, particularly in western world countries where the populations are generally well-nourished. Many factors are implicated as risk factors for this disease including obesity, smoking, genetic predisposition, diet, hypertension, and cholesterol. Dairy products, especially milk, are a major contributor to the dietary intake of humans, again particularly in western world populations. Milk contains numerous components of nutritional and health benefit. Calcium is one example. However, milk is also a significant source of dietary fat. It is widely accepted that saturated fats found in milk are a risk factor for coronary heart disease. However, an additional risk factor present in some bovine milk unrelated to the fat content has been discovered. What is entirely surprising is the source of the risk. The source is not dependent on the fat content of milk. Instead, it is a milk protein,.beta.casein, which is linked to coronary heart disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Herbal pharmaceutical compositions for prophylaxis and/or cardiovascular diseases and the method of preparing the same

treatment

of

Inventor(s): Shen, Chung Guang; (Foster City, CA), Sheu, Shuenn-Jyi; (Taipei, TW) Correspondence: Venable; P.O. Box 34385; Washington; DC; 20043-9998; US Patent Application Number: 20030124206 Date filed: June 10, 2002 Abstract: The present invention provides an herbal pharmaceutical compositions comprising the root of scutellaria, the rhizome of coptis, the root and rhizome of rhubarb, and the dry powders of the root of ginseng (or American ginseng) or the rhizome of ginger. The herbal pharmaceutical compositions are effective in preventing patients from developing or treating patients with cardiovascular diseases, which include, but are not limited to, hypertension, coronary heart disease, cerebrovascular disease, peripheral vascular disease, heart failure, rheumatic heart disease, congenital heart disease, and cardiomyopathies. The present invention also provides methods for preparing and using the herbal pharmaceutical compositions. Excerpt(s): The present invention claims priority on Taiwanese application number 90131897, filed on Dec. 21, 2001, which is herein incorporated by reference. The present invention relates to herbal pharmaceutical compositions which contain the root of scutellaria (Radix Scutellariae), the rhizome of coptis (Rhizoma Coptidis), the root and rhizome of rhubarb (Radix et Rhizoma Rhei), and the root of ginseng (Radix Ginseng) or American ginseng (Radix Panacis Quinquefolii) for prophylaxis or treatment of cardiovascular diseases. Optionally, the root of ginseng or American ginseng can be replaced with the rhizome of ginger (Rhizoma Zingiberis). The herbs can be prepared as dry powders or extracts. The present invention also relates to the methods of preparing and using the herbal pharmaceutical compositions. Based on data from the World Health Organization (WHO), cardiovascular diseases contribute to a third of global deaths in 1999 and are estimated to be the leading cause of death in developing countries by 2010. Cardiovascular diseases are the name for a group of disorders in the heart and blood vessels, including, but not limited to, hypertension (high blood pressure), coronary heart disease (heart attack), cerebrovascular disease (stroke), peripheral vascular disease, heart failure, rheumatic heart disease, congenital heart disease, and cardiomyopathies. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

INDUCTION OF NEOANGIOGENESIS IN ISCHEMIC MYOCARDIUM Inventor(s): STEGMANN, THOMAS J.; (PETERSBERG, DE) Correspondence: Knobbe Martens Olson & Bear Llp; 620 Newport Center Drive; Sixteenth Floor; Newport Beach; CA; 92660; US Patent Application Number: 20020122792 Date filed: July 22, 1999 Abstract: The present invention relates to the treatment of coronary heart disease by revascularization therapy, and more particularly to the intramyocardial injection of a pharmaceutical composition comprising fibroblast growth factor-1 and a physiologic glue for inducing local neoangiogenesis in ischemic myocardium.

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Excerpt(s): This application claims priority under.sctn.119(e) to Provisional Application No. 60/093,962, filed on Jul. 24, 1998. The present invention is related to the treatment of coronary heart disease by revascularization therapy, and more particularly to pharmaceutical compositions containing neoangiogenic compounds, procedures for preparing such compounds, and methods for delivering the pharmaceutical compositions to the ischemic myocardium. Heart attack, or myocardial infarction, due to coronary heart disease (CHD) is the single leading cause of death in the U.S. according to the American Heart Association. Myocardial infarction occurs when the blood supply to part of the heart muscle, or myocardium, is severely reduced or stopped, thereby depriving the myocardium of oxygen. This oxygen deprivation, or ischemia, occurs when one of the coronary arteries which supply blood to the myocardium is blocked. The blockage, or stenosis, most frequently results from atherosclerosis, a condition associated with the buildup of fatty deposits in the vessel walls. Statistics based upon the National Heart, Lung, and Blood Institute's Atherosclerotic Risk in Communities (ARIC) Study (1987-1994) and the Framingham Heart Study, indicate that the CHD-related mortality rate in the U.S. is one of every 4.8 deaths (481,287 deaths in 1995). Over one million new and recurrent cases of heart attack and almost 14 million victims of myocardial ischemia, angina and other manifestations of CHD (7.1 million men and 6.8 million women) are reported each year. Moreover, as many as 3 to 4 million individuals in the U.S. alone ii may have ischemic episodes (silent ischemia) without knowing it. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method of treating the syndrome of coronary heart disease risk factors in humans Inventor(s): Clemens, Anton H.; (Madison, WI) Correspondence: Michael Best & Friedrich, Llp; One South Pinckney Street; P O Box 1806; Madison; WI; 53701 Patent Application Number: 20030149076 Date filed: March 3, 2003 Abstract: The invention provides an improved method of treating a human suffering from one or more conditions included within the Coronary Heart Disease Risk Factor (CHDRF) syndrome. The method includes administering, by a pharmaceutically effective mode, a drug composition having an opioidergic agent including an opiate antagonist, opiate having.mu.-agonist activity or combination thereof, and an insulin secretagogue. Excerpt(s): This application is a continuation-in-part of and claims priority to U.S. application Ser. No. 09/639,061 filed on Aug. 15, 2000. Coronary Heart Disease Risk Factors (CHDRFs) are major causes of death in the industrialized world. CHD risk factors include Type 2 Diabetes (and its precursor, Impaired Glucose Tolerance (IGT)), hyperlipidemia or dyslipidemia, overweight, obesity and essential hypertension, i.e., a form of hypertension that occurs without a discoverable organic cause. The CHDRF syndrome may, therefore, be defined as a group of interrelated disorders: Type 2 Diabetes, IGT, Dyslipidemia, Overweight, Obesity and essential hypertension. It has also become apparent that Type 2 Diabetes, by itself, represents a syndrome of various, in part sequential, disease states which interact with other components of the CHDRF syndrome. However, the exact interrelationships between the disease states that make up these syndromes is not fully understood. A wide variety of chemical and physical abnormalities associated with these syndromes exist. They include elevations in fasting

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blood glucose and gluconeogenesis in spite of significant increases in fasting insulin and C-peptide concentrations and increases in lipogenesis. Typically associated with lipogenesis are increases in levels of fasting Free Fatty Acid (FFA), fasting triglycerides (TG) and total cholesterol concentrations, increases in levels of fasting Low Density Lipoprotein (LDL)-cholesterol, decreases in levels of fasting High Density Lipoprotein (HDL)-cholesterol, an increased LDL/HDL ratio, increases in body weight and increases in systolic and diastolic blood pressure. Although these syndromes are interrelated and typically result from derangements in nutrient metabolism, all the associated symptoms may not be present in individual patients. Accordingly, in some patients lipid metabolism problems may predominate, while in others, carbohydrate metabolism problems may be predominant. While these factors, which lend one aspect of the syndrome to dominate over another, are not well understood, it is clear that each portion of the syndrome, or combinations of portions of the syndrome, represents risk factors in coronary heart disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method to alter the isomeric profile of trans fatty acid in ruminant meat and milk and to increase the concentration of $I(cis)-11 conjugated linoleic acid Inventor(s): Focant, Michel; (Brussel, BE), Griinari, Juha Mikko; (Espoo, FI), Larondelle, Yvan; (Brussel, BE), Mignolet, Eric; (Amay, BE) Correspondence: Knobbe Martens Olson & Bear Llp; 2040 Main Street; Fourteenth Floor; Irvine; CA; 92614; US Patent Application Number: 20040116513 Date filed: January 22, 2004 Abstract: The present invention relates to methods for altering the fatty acid composition in milk or tissue fat directly derived from a milk producing ruminant The methods consist of administering to said milk producing ruminant a suitable amount of a chemical compound selected from the vitamin E family, or a structurally or functionally related compound or derivative thereof. At high doses, vitamin E influences ruminal biohydrogenation and allows the production of milk or tissue fat with a highly desirable fatty acid profile: high trans-11 C.sub.18:1, high cis-9, trans-11 C.sub.18:02 (CLA), low trans-10 C.sub.18:1. Methods are disclosed to obtain said desirable fatty acid profile, thereby improving the nutritional benefits to human health associated with CLA. Milk and tissue fat obtained by said methods are also disclosed. Dietary intakes of cis-9, trans-11 C.sub.18:2 CLA and trans-11 C.sub.18:1 fatty acids in milk or meat, or products thereof, produced in accordance with the present invention in ruminant animals, can be effective in preventing cancer in different sites, reduce risk of coronary heart disease and to enhance immune function. Excerpt(s): The present invention generally relates to a method of improving the quality of milk and meat products and to the derived products thereof. In a first aspect, it relates to a method for altering the fatty acid composition in milk or tissue fat directly derived from a ruminant. More particularly, the inventors pertain to a method of increasing the cis-9, trans-11 conjugated linoleic acid C.sub.18:2 (CLA) content and the level trans-11 C.sub.18:1 fatty acids in said milk or tissue fat. Milk and tissue fat containing said increased levels of CLA and trans fatty acids are also disclosed. In another aspect the invention relates also to a suitable feed for use in said method. Conjugated linoleic acid (CLA) refers to a collection of eighteen carbon fatty-acids with conjugated double bonds in variable positions and geometric configurations. Researchers first became interested

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in CLA as an anticarcinogenic factor found in ruminant fat (Pariza et al. 1985). Since the initial identification by Pariza and coworkers, the list of potential health effects demonstrated in animal models has been further extended and includes today antidiabetic, antiatherogenic, antiobesity, and immune stimulating effects (Pariza 1999). Milk fat typically contains one major isomer, cis-9, trans-11 CLA and several other minor isomers (Sehat et al. 1998; Bauman et al. 2000a). The cis-9, trans-11 isomer possesses anticarcinogenic activity and is effective when consumed as a component of foods. The anticarcinogenic effect was demonstrated in a rat model using NMU (methylnitroso-urea) as the carcinogen (Ip et al. 1999). Intake of dairy products, in particular full fat milk, has been associated with decreased risk of breast cancer (Knekt et al. 1996). In another study examining the relationship between dietary intakes of CLA from natural foods and breast cancer risk in postmenopausal women, intake of cheese was found to be correlated with lower risk of breast cancer (Aro et al. 2000). Increased serum levels of cis-9, trans-11 CLA were also predictive of lower breast cancer risk in this study. Protective effect of whole milk against breast cancer was associated in these study populations with two to three fold variation in CLA intakes estimated to be from 320 to 700 mg/d in the study by Knekt et al. (1996) and 70 to 200 mg/d in the study by (Aro et al. 2000). If CLA will be confirmed to be an important contributing factor to the lower risk of breast cancer in human population, enhancement of the concentration of CLA in dairy products by two to three fold could have a major impact. In addition to its anticarcinogenic effect, the cis-9, trans-11 isomer of CLA may also stimulate the immune function and reduce the atherogenesis in the cardiovascular system. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods for providing personalized lipoprotein-based risk assessments Inventor(s): Otvos, James D.; (Apex, NC) Correspondence: Myers Bigel Sibley & Sajovec; PO Box 37428; Raleigh; NC; 27627; US Patent Application Number: 20030119194 Date filed: November 14, 2002 Abstract: Methods for assessing a patient's risk of having or developing coronary heart disease based on lipoprotein measurements include: (a) generating an NMR spectroscopic signal of a blood plasma or serum sample of a patient; (b) measuring the values of a plurality of selected lipoprotein subclass constituents in the sample; (c) analyzing the measured values of the lipoprotein subclass constituents according to predetermined test criteria to identify when there is an increased and/or decreased risk of having and/or developing coronary heart disease associated with the measured lipoprotein subclass constituent values; (d) outputting the measured lipoprotein subclass values onto a report; (e) providing a plurality of risk analysis portions that depicts the identified risk of the measured lipoprotein subclass values from the predetermined test criteria analysis, a respective one for each measured lipoprotein subclass value, wherein each risk analysis portion defines a plurality of risk segments that are associated with lower, negative, or decreased risk and higher, positive, or increased risk, each risk segment associated with predetermined ranges of measured numerical values; (f) positioning the respective risk analysis portions in the report adjacent its measured corresponding lipoprotein subclass value; and (g) drawing a selectively adjustable perimeter line on the report so that it has an increased size, intensity and/or contrasting color for the risk segment associated with the measured lipoprotein subclass value relative to the non-associated risk segments for each risk

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analysis portion to visually enhance the identified risk and provide a contemporaneous risk assessment guide useful for interpretation of the risk associated with the measured values. Excerpt(s): This application is a continuation of U.S. patent application Ser. No. 09/258,740, filed Feb. 26, 1999, the contents of which are hereby incorporated by reference as recited in full herein. The present invention relates generally to reporting and analyzing information related to patient-specific measured lipoprotein results. Recently, a significant advance in measurement techniques used to analyze blood plasma lipoprotein samples was achieved. Lipoproteins are the spherical particles that transport cholesterol, trigylcerides, and other lipids in the bloodstream. The advanced measurement technique employs NMR spectroscopy to provide additional (higher order) increased patient-specific information over the types of information typically provided under routine conventional analysis methods. See U.S. Pat. No. 4,933,844 to Otvos, entitled "Measurement of Blood Lipoprotein Constituents by Analysis of Data Acquired From an NMR Spectrometer" and U.S. Pat. No. 5,343,389 to Otvos, entitled "Method and Apparatus for Measuring Classes and Subclasses of Lipoproteins." The contents of these documents are hereby incorporated by reference as if recited in full herein. Unlike conventional "routine" type laboratory lipoprotein blood tests, the lipoprotein analysis provided by the NMR spectral analysis now more easily provides lipoprotein subclass information, which had, until this advance, been generally inaccessible to clinicians. This subclass information can provide information corresponding to the sizes of the lipoprotein particles that make up a person's lipoprotein constituents. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel benzimidazole derivatives Inventor(s): Fukami, Takehiro; (Tsukuba-shi, JP), Kanatani, Akio; (Tsukuba-shi, JP), Matsuda, Kenji; (Tokyo, JP), Moriya, Minoru; (Tsukuba-shi, JP), Nagae, Yoshikazu; (Tsukuba-shi, JP), Ogino, Yoshio; (Tsukuba-shi, JP), Otake, Norikazu; (Tsukuba-shi, JP) Correspondence: Wenderoth, Lind & Ponack, L.L.P.; 2033 K Street N. W.; Suite 800; Washington; DC; 20006-1021; US Patent Application Number: 20040054177 Date filed: June 18, 2003 Abstract: The present invention relates to a compound of the formula (I): 1(wherein A, B, C and D are independently nitrogen or optionally substituted methine; E is nitrogen, methine or hydroxy substituted methine; n is 0 or 1; T, U, V and W are independently nitrogen or optionally substituted methine; X is --N(SO.sub.2R.sup.4)--, --N(COR.sup.5)- or --CO--; Y is --C(R.sup.6)(R.sup.7)--, --O-- or --N(R.sup.8)--, provided that the compound (I) when E is nitrogen, n is 0, X is --CO--, and Y is --O-- is excluded) and the like, which are useful as an agent for the treatment of various diseases related to NPY, for example cardiovascular disorders such as angina, acute or congestive heart failure, myocardial infarction, hypertension, nephropathy, electrolyte abnormality, vasospasm, arteriosclerosis, etc., central nervous system disorders such as bulimia, depression, anxiety, seizure, epilepsy, dementia, pain, alcoholism, drug withdrawal, circadian rhythm disorders, schizophrenia, memory impairment, sleep disorders, cognitive impairment, etc., metabolic diseases such as obesity, diabetes, hormone abnormality, hypercholesterolemia, hyperlipidemia, gout, fatty liver, etc., genital or reproductive disorders such as infertility, preterm labor, sexual dysfunction, etc., gastro-intestinal

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disorders, respiratory disorder, inflammatory diseases or glaucoma, and the like, also for example, atherosclerosis, hypogonadism, hyperandrogenism, polycystic ovary syndrome (Pickwickian syndrome), hirsutism, gastro-intestinal motility disorder, obesity-related gastro-esophageal reflux, obesity hypoventilation, sleep apnea, inflammation, systemic inflammation of the vasculature, osteoarthritis, insulin resistance, bronchoconstriction, alcohol preference, metabolic syndrome, Alzheimer's disease, cardiac hypertrophy, left ventricular hypertrophy, hypertriglyceridemia, low HDL cholesterol, cardiovascular disorders such as coronary heart disease (CHD), cerebrovascular disease, stroke, peripheral vascular disease, sudden death, gallbladder diseases, cancer (breast, endometrial, colon), breathlessness, hyperuricemia, impaired fertility, low back pain, or increased anesthetic risk, and the like. Excerpt(s): The present invention is useful in medical fields. In more detail, novel benzimidazole derivatives of the present invention have an effect as neuropeptide Y receptor antagonists and are useful as agents for the treatment of various kinds of cardiovascular disorders, central nervous system disorders, metabolic diseases and the like. Neuropeptide Y (hereinafter referred to as NPY), a peptide consisting of 36 amino acids, was first isolated from porcine brain by Tatemoto et al in 1982 (NATURE, vol. 296, p. 659(1982)). NPY is widely distributed in central nervous system and peripheral nervous system, and plays various roles as one of the most abundant peptides in the nervous system. That is, NPY acts as an orexigenic substance in the central nervous system and markedly promotes fat accumulation via the mediation of secretion of various hormones or the action of the nervous system. It is known that continuous intracerebroventricular administration of NPY induces obesity and insulin resistance due to these actions (INTERNATIONAL JOUNAL OF OBESITY, vol.19, p.517(1995); Endocrinology, vol.133, p.1753(1993)). It is also known that NPY has central actions such as depression, anxiety, schizophrenia, pain, dementia, circadian rhythm control and the like (DRUGS, vol.52, p.371(1996); THE JOURNAL OF NEUROSCIENCE, vol.18, p.3014(1998)). Furthermore, in the periphery, NPY coexists with norepinephrine in sympathetic-nerve terminals and is related to the tonicity of the sympathetic nervous system. It is known that peripheral administration of NPY causes vasoconstriction and enhances the activities of other vasoconstrictive substances such as norepinephrine (BRITISH JOURNAL OF PHARMACOLOGY, vol.95, p.419(1988)). It is also reported that NPY could participate in the development of cardiac hypertrophy as a result of the sympathetic stimulation (PROCEEDING NATIONAL ACADEMIC SCIENCE USA, vol.97, p.1595(2000)). On the other hand, it is reported that NPY is also involved in the secretory function of sexual hormones and growth hormone, sexual behavior and reproductive function, gastro-intestinal motility, bronchoconstriction, inflammation and alcohol preference (LIFE SCIENCE, vol.55, p.551(1994); THE JOURNAL OF ALLERGY AND IMMUNOLOGY, vol.101, p.S345(1998); NATURE, vol.396, p.366(1998)). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Patient data mining for cardiology screening Inventor(s): Krishnan, Sriram; (Exton, PA), Rao, R. Bharat; (Berwyn, PA) Correspondence: Siemens Corporation; Intellectual Property Department; 186 Wood Avenue South; Iselin; NJ; 08830; US Patent Application Number: 20030120134 Date filed: November 4, 2002

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Abstract: A system and method for screening for coronary heart disease is provided. The method includes the steps of retrieving a test for assessing risk of coronary heart disease, the test including a plurality of data fields relating to coronary risk factors; accessing a database to populate the data fields with information of an individual patient; and calculating a risk assessment of the individual patient developing coronary heart disease. A system includes a first database including a plurality of structured computerized patient records; a second database including a knowledge base relating to coronary heart disease, the second database including at least one test for determining coronary heart disease risk; and a processor for retrieving the at least one test from the second database, populating the at least one test with patient information retrieved from the first database and calculating a risk assessment for at least one patient. Excerpt(s): This application claims the benefit of U.S. Provisional Application Ser. No. 60/335,542, filed on Nov. 2, 2001, which is incorporated by reference herein in its entirety. The present invention relates to medical information processing systems, and, more particularly to a computerized system and method for screening patients for coronary heart disease (CHD), assessing a risk factor for a person to develop CHD and managing a person with CHD. Coronary heart disease is the number one killer in the western world. By detecting coronary heart disease as early as possible, appropriate, effective, and cost-effective treatment can be implemented. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Propionic acid derivatives Inventor(s): Bischoff, Hilmar; (Wuppertal, DE), Dittrich-Wengenroth, Elke; (Wuppertal, DE), Hinzen, Berthold; (Velbert, DE), Hirth-Dietrich, Claudia; (Wuppertal, DE), Lustig, Klemens; (Wuppertal, DE), Nikolic, Susanne; (Wuppertal, DE), Pernerstorfer, Josef; (Wuppertal, DE), Urbahns, Klaus; (Wuppertal, DE), Woltering, Michael; (Wuppertal, DE) Correspondence: Jeffrey M. Greenman; Vice President, Patents And Licensing; Bayer Corporation; 400 Morgan Lane; West Haven; CT; 06516; US Patent Application Number: 20030187041 Date filed: January 22, 2003 Abstract: This invention relates to novel potent PPAR-alpha-activating compounds which are useful in the treatment of diseases such as coronary heart disease. The invention also relates to methods of preparation of PPAR-alpha-activating compounds. Excerpt(s): The present invention relates to novel potent PPAR-alpha-activating compounds for treating, for example, coronary heart disease, and to their preparation. In spite of many successful therapies, coronary heart disease (CHD) remains a serious public health problem. Treatment with statins, which inhibit HMG-CoA reductase, successfully lowers both LDL cholesterol plasma concentrations and the mortality of patients at risk; however, convincing treatment strategies for the therapy of patients having an unfavourable HDL/LDL cholesterol ratio or hypertriglyceridaemia are still not available to date. Currently, fibrates are the only therapy option for patients of these risk groups. They act as weak agonists of the peroxisome-proliferator-activated receptor (PPAR)-alpha (Nature 1990, 347, 645-50). A disadvantage of the fibrates which have hitherto been approved is that their interaction with the receptor is only weak, requiring high daily doses and causing considerable side-effects. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Regulations of lipids and/or bone density and compositions therefor Inventor(s): Husband, Alan James; (New South Wales, AU) Correspondence: Finnegan, Henderson, Farabow, Garrett & Dunner; Llp; 1300 I Street, NW; Washington; DC; 20005; US Patent Application Number: 20040116498 Date filed: January 6, 2004 Abstract: A method and compositions for regulating bone density and/or circulating lipid levels in a subject based on the combined administration of at least one isoflavone or functional derivative, equivalent or analogue thereof and at least one lipid regulating drug. The method and compositions are applicable to the beneficial alteration of blood lipoprotein levels, the improvement of vascular compliance, the decrease in the propensity of thrombogenic events, the reduction in the risk of vascular disease, coronary heart disease, and arteriosclerosis, and to the treatment or prevention of osteoporosis. Excerpt(s): The present invention relates to the regulation of lipids and/or bone density in mammals using lipid regulating drugs in combination with isoflavone compounds, and particularly but not exclusively to methods of treatment and/or prevention of osteoporosis and hyperlipidemia and compositions useful for same. Cholesterollowering therapy has emerged as a mainstay in treating and preventing cardiovascular disease (CVD). Reducing elevated concentrations of low-density lipoprotein (LDL) cholesterol, or increasing high-density lipoprotein (HDL) cholesterol in patients with evidence of coronary heart disease (CHD), or with a family history of heart disease, may prevent strokes, heart attacks and reduce cardiac events as well as mortality in high-risk individuals [Sacks FM et al; Hebert PR et al; Scandinavian Simvastatin Survival Study Group; Parfitt]. However, many of the lipid regulating drugs have known deleterious side effects including: gastro-intestinal disturbances such as heartburn, epigastric pain, nausea, and diarrhoea; peripheral vasodilation resulting in flushing, itching, and a sensation of heat; headaches; dizziness; vertigo; fatigue; and skin rashes. In addition, reversible increases in serum-aminotransferase concentrations may occur and liver function should be monitored [Parfitt]. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Ultrasonic apparatus and method for providing quantitative indication of risk of coronary heart disease Inventor(s): Stein, James H.; (Madison, WI) Correspondence: Quarles & Brady Llp; 411 E. Wisconsin Avenue, Suite 2040; Milwaukee; WI; 53202-4497; US Patent Application Number: 20030229284 Date filed: November 7, 2002 Abstract: An ultrasound machine measures coronary intima-medial thickness and relates it to a statistically derived vascular age. Quantitative risk of coronary heart disease may be calculated using vascular age to substitute for chronological age in publicly available risk assessment data.

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Excerpt(s): This application is based on provisional application No. 60/386,905 filed Jun. 5, 2002 and entitled "Mathematical Algorithms Allowing Determination of Vascular Age" and claims the benefit thereof. The present invention relates to ultrasonic medical equipment, and in particular, to a method employable with such equipment to assess risk of coronary heart disease (CHD). A key challenge in healthcare is identifying individuals who are at high risk for CHD and who thus would be candidates for intensive medical intervention either in the form of additional diagnostic testing or the initiation of proven therapeutic strategies. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with coronary heart disease, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “coronary heart disease” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on coronary heart disease. You can also use this procedure to view pending patent applications concerning coronary heart disease. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON CORONARY HEART DISEASE Overview This chapter provides bibliographic book references relating to coronary heart disease. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on coronary heart disease include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “coronary heart disease” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on coronary heart disease: •

Insulin Resistance Source: Malden, MA: Blackwell Science, Inc. 2002. 190 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail: [email protected]. Website: www.blackwell-science.com. PRICE: $49.95. ISBN: 0632056622. Summary: Insulin resistance, defined as a reduced biological action of insulin, has emerged as a major factor in the development and progression of a number of common noncommunicable diseases in humans. The role of insulin resistance in the etiology of type 2 diabetes is particularly well established. However, insulin resistance has also come to be regarded as a key component of a broader syndrome of common metabolic defects that conspire to increase the risk of atherosclerotic coronary heart disease. This

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book summarizes the current state of knowledge about insulin resistance, a condition that embraces many different medical specialties. Three sections cover the pathophysiology of insulin resistance, insulin resistance in clinical medicine, and the management of insulin resistance and associated conditions. Key points are highlighted in the margins of the text and chapters include tables and illustrations; reference lists are provided at the end of each major section. A subject index concludes the handbook. •

Cigars: Health Effects and Trends Source: Bethesda, MD: National Cancer Institute (NCI), National Institutes of Health (NIH). February 1998. 348 p. Contact: Available from National Cancer Institute (NCI). Publications Ordering Service, P.O. Box 24128, Baltimore, MD 21227. Voice (800) 422-6237. TTY (800) 332-8615. Fax (301) 330-7968. Website: rex.nci.nih.gov. PRICE: Single copy free. NIH Publication Number 98-4302. Summary: The recent increase in cigar consumption began in 1993 and was dismissed by many in public health as a passing fad that would quickly dissipate. Recently released data from the U.S. Department of Agriculture (USDA) suggests that the upward trend in cigar use might not be as temporary as some had predicted. This monograph from the National Cancer Institute addresses the questions that arise from this dramatic surge in tobacco use. Eight chapters cover an overview of cigar smoking, trends in cigar consumption and smoking prevalence, chemistry and toxicology, the disease consequences of cigar smoking, indoor air pollution from cigar smoke, pharmacology and abuse potential of cigars, marketing and promotion of cigars, and policies regulating cigars. There is sufficient evidence to conclude that a causal relationship exists between regular cigar use and cancers of the lung, larynx, oral cavity, and esophagus. Heavy cigar smoking, particularly for those who inhale, causes an increased risk of coronary heart disease and chronic obstructive pulmonary disease. There is also suggestive evidence for a relationship between cigar smoking and cancer of the pancreas, but the evidence is insufficient at this time to draw a causal inference. Each chapter concludes with references.

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Towards a better understanding of physical fitness and activity: Selected topics Source: Scottsdale, AZ: Holcomb Hathaway Publishers. 1999. 212 pp. Contact: Available from Holcomb Hathaway Publishers, 6207 North Cattle Track Road, Scottsdale, AZ 85250. Telephone: (602) 991-7881 / fax: (602) 991-4770 / e-mail: [email protected] / Web site: http://www.hh- pub.com. $26.95 plus shipping. Summary: This book contains 22 papers originally published for the President's Council on Physical Fitness and Sports (PCPFS) Physical Activity and Fitness Research Digest. The papers are grouped into six sections. The first section is on physical activity antecedents and includes chapters on readiness for physical activity, hereditary and health related fitness, personalizing physical activity prescriptions, influences on physical activity on all age groups, and physical activity and intrinsic motivation. The second section deals with general health benefits of physical activity and includes a chapter on that topic as well as a chapter commenting on the Surgeon General's Report on Physical Activity and Health and a chapter about physical activity and women's health. Sections III is about physical activity and the reduction of risk of chronic health problems. It has separate chapters about physical activity and the following conditions or diseases: coronary heart disease, cancer, prevention of Type II diabetes, and healthy low back function. Section IV is about economic and mental health benefits of physical

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activity. Chapter topics are resistance training for health; exercise, obesity, and weight control; the influence of exercise on mental health; and economic benefits of physical activity. Section V deals with physical activity and children and includes chapters about appropriate physical activity levels for youth, health benefits of physical activity in childhood and adolescence, youth sports in America, and psychophysiological contributions of physical activity and sports for girls. Section VI is about physical activity and ergogenic aids, including nutritional ergogenics and sports performance. •

Nutrition Counseling Skills for Medical Nutrition Therapy Source: Gaithersburg, MD: Aspen Publishers, Inc. 1997. 409 p. Contact: Available from Aspen Publishers, Inc. Fulfillment, 7201 McKinney Circle, Frederick, MD 21704. (800) 234-1660 or (800) 638-8437. PRICE: $55.00. ISBN: 0834207559. Summary: This book focuses on increasing the effectiveness of nutrition counselors as facilitators of behavioral change. The author uses the term 'nutrition counselor' to describe all health professionals involved in counseling clients or patients to provide dietary information or facilitate dietary adherence. The author encourages readers to apply communication and counseling skills and strategies to the discipline of nutrition, particularly in situations that require specific dietary modifications. Ten chapters cover an overview of nutrition counseling; communication skills; counseling skills to facilitate self-management; nutrition counseling in treatment and prevention of obesity, coronary heart disease, diabetes, renal disease, and hypertension; nutrition counseling for cancer risk prevention; and evaluation and follow up strategies. The chapter on renal disease covers theories and facts about nutrition and chronic renal failure (CRF), eating patterns in the treatment of renal disease, inappropriate eating behaviors, the assessment of eating behaviors, and treatment strategies. Eighteen patient education materials and monitoring forms are included in this chapter, including those designed for a lowprotein diet. The book concludes with eight appendices, including a checklist of nutrition counselor self-image, a checklist of nutrition counselor's nonverbal behavior, measures of nutritional status, a behavioral chart and log, thoughts related to food, a daily record of cognitive restructuring, and answers to the review questions at the end of each chapter. Each chapter includes references, and a subject index concludes the text. (AA-M).

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Psychological Perspectives on Women's Health Contact: Taylor & Francis, Publishers, 1101 Vermont Ave Ste 200, Washington, DC, 20005-3521, (202) 289-2174. Summary: This book is a comprehensive review of the current and future directions of research concerning psychological aspects of women's health issues. The book contains contributions from recognized experts on ten critically important areas of women's health. Each of the ten chapters aims at illustrating the multifaceted nature of gender, highlighting the role of psychological factors, broadly construed as encompassing behavioral and sociocultural influences, and demonstrating the ways in which psychological and biological factors interact to influence women's health. The first section of the book presents a broad overview of gender, health, and aging. The second section covers stress, coronary heart disease, and cancer. The third section is devoted to substance abuse and weight. The fourth section reviews menstruation and pain. The fifth section examines sex, infertility, and AIDS. The concluding chapter in the book considers the challenges and future directions of research on women's health.

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Healthy women, healthy lives: A guide to preventing disease from the landmark Nurses' Health Study Source: New York, NY: Simon and Schuster. 2001. 546 pp. Contact: Available from Simon and Schuster, 866 Third Avenue, New York, NY 10022. $26.00. Summary: This book presents information from the Nurses' Health Study on a woman's probability of developing specific diseases and suggests how that probability may change with certain alterations in diet, weight control, physical activity, and other lifestyle changes. Part one discusses the Nurses' Health Study and what observations have been made by researchers and what they mean to the study of women's health issues. Part two provides information and suggestions on lowering the risk of diseases. Topics covered include coronary heart disease, different types of cancers, stroke, diabetes, osteoporosis, asthma, arthritis, age-related eye disease, and Alzheimer's disease. The third part provides information on changing behaviors including physical activity, weight control, smoking, nutrients, foods, alcohol, vitamins and minerals, postmenopausal hormones, birth control, and pain relievers. The appendices give information on types of epidemiological studies; being an informed consumer of health information; and a section on tables on weight and nutrition. The book concludes with a glossary, selected readings, and an index.

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Taking our pulse: The health of America's women Source: Stanford, CA: Stanford University Press. 1997. 349 pp. Contact: Available from Stanford University Press, 521 Lomita Mall, Stanford, CA 94305-2235. Telephone: (650) 723-9434 or (800) 872-7423 / fax: (650) 725-3457 / Web site: http://www.sup.org. $19.95. Summary: This book presents women's health issue throughout the life cycle. Part one discusses lifespan differences in females from adolescence, early adulthood, perimenopausal years, to older years. Topics include physical and reproductive changes during puberty, psychosocial development, health consequences of entering the paid labor force, fertility and pregnancy, stress, urogenital problems, high blood pressure, menopause, estrogen replacement therapy, breast cancer, ovarian cancer, osteoporosis, stroke, and coronary heart disease. Part two discusses special health issues for women in each life stage, involving sexually transmitted diseases, pregnancy and its prevention, assisted reproductive technologies, mental health, substance abuse, violence against children and women, nutrition, and exercise. Part three addresses health policy issues for women including the standards and costs of care for women in the United States, women as doctors, choosing a physician, and the status of research in women health, particularly study of drug dosages and their interaction with female hormones. Appendices include ten leading causes of death in women at each life stage, comprehensive geriatric assessment, glossary of reproductive technology terms, DSMIV diagnostic criteria for anorexia nervosa and bulimia nervosa, and recommended daily allowances. The book concludes with references and an index.

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Handbook of Exercise in Diabetes Source: Alexandria, VA: American Diabetes Association. 2002. 699 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-

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9742. Website: www.diabetes.org. PRICE: $69.95 plus shipping and handling. ISBN: 1580400191. Summary: This book provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. The book reflects the interests and opinions of the American Diabetes Association's Council on Exercise and the American College of Sports Medicine. Forty chapters are provided in eight sections: introduction, basic considerations, exercise and diabetes prevention, the treatment plan, exercise in patients with diabetic complications, exercise in special patient groups, practical advice and experience regarding sports, and reimbursement and resources. Topics include exercise physiology, the risk benefit profile of diabetes and exercise, adaptations to training, fuel metabolism during exercise in health and diabetes, signal transduction and glucose transport in muscle, psychological benefits of exercise, physical activity in the prevention of type 2 diabetes, reduction in risk of coronary heart disease (CHD) and diabetes, primary prevention of type 2 diabetes with lifestyle modification, guidelines for the evaluation of the patient with diabetes before recommending an exercise program, the exercise prescription, initiation and maintenance of exercise in patients with diabetes, resistance training, nutrition and physical activity, nutritional strategies to optimize athletic performance, exercise and weight control, adjustment of insulin and oral agent therapy, insulin pump therapy, the diabetic foot, retinopathy (eye disease), cardiovascular complications, early and advanced nephropathy (kidney disease), neuropathy (nerve disease), musculoskeletal disorders and sports injuries, women and exercise, exercise and gestational (a type of diabetes that occurs during pregnancy) diabetes, children and adolescents, exercise and aging, patients on various drug therapies, exercise in diabetic patients with disabilities, the diabetic athlete as role model, strength training and nutritional supplements, scuba diving, mountain hiking, fitness facility guidelines for diabetes and exercise, and medical reimbursement and managed care issues. Each chapter concludes with a list of references and the book concludes with a list of resources and a subject index. •

Health Professional's Guide to Diabetes and Exercise Source: Alexandria, VA: American Diabetes Association. 1995. 335 p. Contact: Available from American Diabetes Association, Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (404) 442-9742. PRICE: $39.95 (members) or $49.95 (nonmembers) plus $4 shipping and handling (as of 1996). Order Number PMHDE. ISBN: 094544852X. Summary: This book provides 'hands on' advice to health care providers in their daily clinical practices on diabetes and exercise. Thirty-six chapters are presented in six sections: basic considerations, the treatment plan, exercise in patients with diabetic complications, exercise in special patient groups, practical advice and experience in sports, and resources and reimbursement. Topics include exercise physiology; reduction in risk of coronary heart disease and diabetes; the psychological benefits of exercise; resistance training; nutritional strategies; adjustment of insulin therapy; long-term exercise programs; musculoskeletal injuries; retinopathy; cardiovascular complications; exercise and aging; exercise programs in minority populations; specific sports, including marathon running, weight lifting, tennis, swimming, scuba diving, mountain hiking, and ice hockey; and reimbursement issues. Each chapter includes references and suggestions for other resources; a subject index concludes the book.

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Insulin Resistance: The Metabolic Syndrome X Source: Totowa, NJ: Humana Press, Inc. 1999. 384 p. Contact: Available from Humana Press, Inc. Customer Service, 999 Riverview Drive, Suite 208, Totowa, NJ 07512. (973) 256-1699. Fax (973) 256-8341. E-mail: [email protected]. PRICE: $145.00 plus shipping and handling. ISBN: 0896035883. Summary: This book summarizes the current understanding of how insulin resistance and its compensating hyperinsulinemia play a role in the pathogenesis and clinical course of high blood pressure, cardiovascular disease, and polycystic ovary disease. Part one focuses on genetic and lifestyle factors that contribute to the differences in insulin action that exist in the population at large. Topics include the genetic determinants of insulin resistance, ethnic variation in insulin resistance and risk of type 2 diabetes, fetal effects on insulin resistance and glucose tolerance, obesity and insulin resistance, the role of body fat distribution in insulin resistance, physical activity and insulin resistance in humans, and insulin resistance in smokers and other long-term users of nicotine. Part two focuses on the pathophysiologic consequences of insulin resistance and the efforts made to compensate for this defect to prevent decompensation of glucose homeostasis. Topics include insulin resistance and inhibitors of insulin receptor tyrosine kinase, nuclear magnetic resonance studies on the mechanism of insulin resistance, skeletal muscle insulin resistance in humans, the role of the liver in insulin action and resistance, the pathophysiological consequences of adipose tissue insulin resistance, and insulin action and endothelial function. Part three considers the clinical syndromes excluding type 2 diabetes, that are related to insulin resistance. Topics include the implications of insulin resistance and dyslipidemia for coronary heart disease risk; insulin resistance and blood pressure; microalbuminuria and insulin resistance; plasminogen activation inhibitor, obesity, and insulin resistance; insulin resistance and cardiovascular disease; and insulin resistance effects on sex hormones and ovulation in the polycystic ovary syndrome. Numerous figures. 31 tables. Numerous references.

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Choices for a Healthy Heart Source: New York, NY: Workman Publishing Company. 1987. 580 p. Contact: Available from Workman Publishing Company. 708 Broadway, New York, NY 10003. (800) 722-7207 ext. 7509 or (212) 614-7509. PRICE: $16.95. ISBN: 0894801384. Summary: This cookbook is designed as a companion volume to Don't Eat Your Heart Out in which the author stressed the relationship of coronary heart disease to a diet rich in fat, cholesterol, salt, sugar, and total calories. In this book, the author builds on the concept of low-fat eating with current information based on scientific research, practical cooking tips and meal plans, and over 200 tested recipes. The author stresses three areas: changing unhealthy recipes into healthy ones; lowering the fat content of an entire meal; and the 500-calorie solution, a realistic method for losing weight and keeping it off. This book also covers the other critical aspects of lifestyle that impact health and longevity: exercise, stress, smoking, and attitude. Recipes are presented in 12 categories: pancakes, waffles and breads, sandwiches, soups, salads, dressings, sauces and spreads, seafood, poultry, meat, pasta and bean entrees, vegetables, grain, bean and pasta side dishes, and desserts. A bibliography, a general index, and a recipe index complete the book. 154 references. (AA-M).

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Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “coronary heart disease” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “coronary heart disease” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “coronary heart disease” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Biobehavioral Bases of Coronary Heart Disease (Karger Biobehavioral Medicine Series) by T. M. Dembroski (Editor), et al; ISBN: 3805536291; http://www.amazon.com/exec/obidos/ASIN/3805536291/icongroupinterna

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Cholesterol lowering in the patient with coronary heart disease : physician monograph (SuDoc HE 20.3202:C 45/31) by U.S. Dept of Health and Human Services; ISBN: B00010V8UU; http://www.amazon.com/exec/obidos/ASIN/B00010V8UU/icongroupinterna

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Chronic Infection, Chlamydia and Coronary Heart Disease (Developments in Cardiovascular Medicine, 218) by Sandeep Gupta, Camm. A. John; ISBN: 0792357973; http://www.amazon.com/exec/obidos/ASIN/0792357973/icongroupinterna

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Clinicians' Guide to Lipids and Coronary Heart Disease (Clinicians' Guides) by John Betteridge, et al; ISBN: 0340764082; http://www.amazon.com/exec/obidos/ASIN/0340764082/icongroupinterna

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Consultation with a cardiologist: Coronary heart disease and heart attack management by Jacob I Haft; ISBN: 0882294873; http://www.amazon.com/exec/obidos/ASIN/0882294873/icongroupinterna

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Contribution of Long-term Follow-up to the Prediction of Coronary Heart Disease (Cardiology) by M. Kornitzer, R. Goldberg; ISBN: 3805557906; http://www.amazon.com/exec/obidos/ASIN/3805557906/icongroupinterna

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Dear to Our Hearts?: Commissioning Services for the Treatment and Prevention of Coronary Heart Disease (National Report); ISBN: 0118864262; http://www.amazon.com/exec/obidos/ASIN/0118864262/icongroupinterna

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Diagnosis and Treatment of Coronary Heart Disease in Women: Systematic Reviews of Evidence on Selected Topics: Summary (Evidence Report/Technology Assessment) by Deborah Grady (Other Contributor); ISBN: 1587630869; http://www.amazon.com/exec/obidos/ASIN/1587630869/icongroupinterna

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Diet and Prevention of Coronary Heart Disease and Cancer: Fourth International Berzelius Symposium/Order No 1677 by Bo Hallgren, et al; ISBN: 088167219X; http://www.amazon.com/exec/obidos/ASIN/088167219X/icongroupinterna

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Genetic Approaches of Coronary Heart Disease and Hypertension by Kare Berg (Other Contributor); ISBN: 3540544763; http://www.amazon.com/exec/obidos/ASIN/3540544763/icongroupinterna

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Health Promotion in Older People for the Prevention of Coronary Heart Disease and Stroke (Effectiveness Review Series); ISBN: 0752107054; http://www.amazon.com/exec/obidos/ASIN/0752107054/icongroupinterna

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Honolulu Heart Program: An Epidemiological Study of Coronary Heart Disease and Stroke by Clifford J. Rosen, et al; ISBN: 3718658038; http://www.amazon.com/exec/obidos/ASIN/3718658038/icongroupinterna

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Lifestyle Management for Patients With Coronary Heart Disease (Current Issues in Cardiac Rehabilitation, Monograph No. 2) by Nancy Houston Miller, Craig Barr Taylor; ISBN: 0873224418; http://www.amazon.com/exec/obidos/ASIN/0873224418/icongroupinterna

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Living conditions in childhood and coronary heart disease in adulthood: A mortality and morbidity study in two areas of Finland (Commentationes scientiarum socialium) by Veijo Notkola; ISBN: 9516531318; http://www.amazon.com/exec/obidos/ASIN/9516531318/icongroupinterna

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Masculinity and Men's Health: Coronary Heart Disease in Medical and Public Discourse by Elianne Riska; ISBN: 0742529002; http://www.amazon.com/exec/obidos/ASIN/0742529002/icongroupinterna

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NovaCon - Coronary Heart Disease (CD-ROM) by Frank H. Netter; ISBN: 0914168479; http://www.amazon.com/exec/obidos/ASIN/0914168479/icongroupinterna

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Nutrition, Lipids and Coronary Heart Disease (Nutrition in Health and Disease Ser.: Vol. 1) by Robert I. Levy, et al; ISBN: 0890041814; http://www.amazon.com/exec/obidos/ASIN/0890041814/icongroupinterna

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Physical Activity and Coronary Heart Disease (Contributions to Nephrology) by Vesa Manninen (Other Contributor); ISBN: 3805523564; http://www.amazon.com/exec/obidos/ASIN/3805523564/icongroupinterna

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Physical activity in the prevention and management of coronary heart disease (SuDoc HE 20.114:2/1) by William L. Haskel; ISBN: B000116WH8; http://www.amazon.com/exec/obidos/ASIN/B000116WH8/icongroupinterna

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Preventing Coronary Heart Disease in Primary Care: The Way Forward by Imogen Sharp; ISBN: 0113220006; http://www.amazon.com/exec/obidos/ASIN/0113220006/icongroupinterna

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Preventing Illness Among People With Coronary Heart Disease (Prevention and Intervention in the Community Series) by John D. Piette, et al; ISBN: 0789000067; http://www.amazon.com/exec/obidos/ASIN/0789000067/icongroupinterna

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Prevention of Coronary Heart Disease (WHO Technical Report Series); ISBN: 9241206780; http://www.amazon.com/exec/obidos/ASIN/9241206780/icongroupinterna

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Prevention of Coronary Heart Disease in Scotland: Report of the Working Group on Prevention and Health Promotion by W. Keith Davidson; ISBN: 0114941114; http://www.amazon.com/exec/obidos/ASIN/0114941114/icongroupinterna

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Preventive Aspects of Coronary Heart Disease (Cardiovascular Clinics, Vol 20, No 3) by Edward D. Frohlich; ISBN: 0803638698; http://www.amazon.com/exec/obidos/ASIN/0803638698/icongroupinterna

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Relationships between coronary heart disease risk factors and serum ionized calcium in a Kennedy Space Center cohort (SuDoc NAS 1.15:100979) by NASA; ISBN: B000105FKE; http://www.amazon.com/exec/obidos/ASIN/B000105FKE/icongroupinterna

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Results of Systematic Review of Research on Diagnosis and Treatment of Coronary Heart Disease in Wom (Evidence Report/Technology Assessment) by Deborah Grady

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(Other Contributor); ISBN: 1587630842; http://www.amazon.com/exec/obidos/ASIN/1587630842/icongroupinterna •

Serum fatty acids in Finnish children and adolescents: With special reference to relationships with other coronary heart disease risk factors (Acta Universitatis Tamperensis) by Teemu Moilanen; ISBN: 9514421280; http://www.amazon.com/exec/obidos/ASIN/9514421280/icongroupinterna

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Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease (Commonwealth Fund Publications) by Ancel Benjamin Keys; ISBN: 0674802373; http://www.amazon.com/exec/obidos/ASIN/0674802373/icongroupinterna

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Take Heart: Good Practices in Coronary Heart Disease Prevention by Judy Berry, et al; ISBN: 1854481185; http://www.amazon.com/exec/obidos/ASIN/1854481185/icongroupinterna

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Trans Fatty Acids and Coronary Heart Disease Risk by P. M. Kris-Etherton, et al; ISBN: 0944398677; http://www.amazon.com/exec/obidos/ASIN/0944398677/icongroupinterna

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Trends in Coronary Heart Disease Mortality: The Influence of Medical Care by Millicent W. Higgins, Russell V. Luepker; ISBN: 0195052978; http://www.amazon.com/exec/obidos/ASIN/0195052978/icongroupinterna

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Triglyceride, high density lipoprotein, and coronary heart disease : January 1989 through February 1992 plus selected earlier literature : 1636 citations (SuDoc HE 20.3615/2:91-16) by Naomi Miller; ISBN: B000109KM8; http://www.amazon.com/exec/obidos/ASIN/B000109KM8/icongroupinterna

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Understanding Coronary Heart Disease (Family Doctor Series) by Christopher Davidson; ISBN: 1898205434; http://www.amazon.com/exec/obidos/ASIN/1898205434/icongroupinterna

Chapters on Coronary Heart Disease In order to find chapters that specifically relate to coronary heart disease, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and coronary heart disease using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “coronary heart disease” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on coronary heart disease: •

Reduction in Risk of Coronary Heart Disease and Diabetes Source: in Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p. 155-181. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $69.95 plus shipping and handling. ISBN: 1580400191. Summary: This chapter is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. In this

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chapter, the authors consider strategies that may result in a reduction in risk of coronary heart disease (CHD) and type 2 diabetes. Increased physical activity improves the cardiovascular risk factor profile; its effects include reducing adiposity, blood pressure, dyslipidemia, and platelet adhesives, as well as enhancing fibrinolysis. Increased physical activity may also reduce CHD risk independently of favorably alterations in traditional coronary risk factors. The estimated reduction in the risk of CHD with the maintenance of an active, compared with a sedentary, lifestyle is estimated to be 35 to 55 percent. Physical activity improves insulin sensitivity and glycemic control among nondiabetic individuals, as well as among those with impaired glucose tolerance (IGT) or overt type 2 diabetes. The addition of exercise to caloric restriction facilitates loss of adipose tissue, assists in maintenance of reduced body weight, and may independently improve insulin sensitivity. The potential reduction in the risk of type 2 diabetes associated with an active, compared with a sedentary, lifestyle is 30 to 50 percent. 2 tables. 101 references. •

Diabetic Neuropathy and Coronary Heart Disease Source: in Reece, E.A. and Coustan, D.R., eds. Diabetes Mellitus in Pregnancy. 2nd ed. New York, NY: Churchill Livingstone. 1995. p. 345-351. Contact: Available from Churchill Livingstone. 300 Lighting Way, Secaucus, NJ 07094. (800) 553-5426. PRICE: $92.00. ISBN: 0443089795. Summary: This chapter, from a text on diabetes mellitus in pregnancy, focuses on diabetic neuropathy and coronary heart disease. The authors discuss the potential serious impact of autonomic neuropathy on the pregnancy complicated by diabetes, and reviews other forms of neuropathy so that the reader will be able to recognize them, should they become manifested during pregnancy. Topics include autonomic neuropathy, peripheral neuropathy, cranial neuropathy, neuropathic fractures, and coronary artery disease. The authors conclude that the presence of either coronary artery disease or gastroparesis may lead to increased morbidity and mortality risks for pregnant women with IDDM. 2 figures. 1 table. 26 references. (AA-M).

•

Regional Body Fat Distribution, the Insulin Resistance-Dyslipidemic Syndrome, and the Risk of Type 2 Diabetes and Coronary Heart Disease Source: in Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p. 197-234. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $69.95 plus shipping and handling. ISBN: 1580400191. Summary: Visceral adipose tissue accumulation is an important factor to consider in the evaluation of health risks associated with obesity. This chapter is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. In this chapter, the authors consider regional body fat distribution, the insulin resistance-dyslipidemic syndrome, and the risk of type 2 diabetes and coronary heart disease. The simultaneous presence of hyperinsulinemia, hyperapolipoprotein B, and small, dense LDL particles is associated with a 20 fold increase in the risk of ischemic heart disease. A simple and inexpensive screening test to identify a high risk form of abdominal obesity is to determine if the patient has the following: a waist circumference greater than 90 centimeters and triglyceride levels greater than 2.0 mmol per liter. Improvements in the metabolic risk profile resulting

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from endurance exercise training are more related to the volume of exercise than to its intensity. The authors conclude that from a public health standpoint, the greatest benefit would be to transform the largely sedentary population into moderately active individuals. Physicians and health professionals should keep in mind that the changes in lifestyle associated with the best compliance are those that are likely to have the greatest long term impact on cardiovascular health. 8 figures. 3 tables. 148 references.

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CHAPTER 7. MULTIMEDIA ON CORONARY HEART DISEASE Overview In this chapter, we show you how to keep current on multimedia sources of information on coronary heart disease. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on coronary heart disease is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “coronary heart disease” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “coronary heart disease” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on coronary heart disease: •

Diabetes Management: A Clinical Update Source: Secaucus, NJ: Network for Continuing Medical Education. 1994. (videocassette). Contact: Available from Network for Continuing Medical Education. 1425 Broad Street, Clifton, NJ 07013. (800) 223-0272 or (973) 473-9500. Fax (973) 591-1224. PRICE: Call for pricing information. Order number 667. Summary: In this video, Dr. F. Xavier Pi-Sunyer provides suggestions for implementing updated American Diabetes Association (ADA) nutritional recommendations and the results of the Diabetes Control and Complications Trial (DCCT) into daily practice. Six sections address management issues, ADA nutrition recommendations, DCCT results, patient compliance, and complications management. Because it is now known that diabetes predisposes a person to coronary heart disease, health care professionals must be concerned with blood lipids and hypertension, as well as blood glucose control. According to the ADA, the goals of medical nutrition therapy include maintaining near-

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normal blood glucose, achieving optimum lipids, maintaining reasonable body weight, preventing and treating complications, and improving overall health. Dr. Pi-Sunyer notes that therapy should be individualized according to the patient's insulin resistance, activity levels, body weight, and body fat distribution. Primary care physicians should have some knowledge of diet therapy and the benefits of exercise; they should not simply resort to oral agents and insulin. The video notes that referring patients to a registered dietitian is sometimes advantageous. After completing this telecourse, physicians should be able to apply the updated ADA dietary recommendations, list management goals for people with type 1 and type 2 diabetes, describe the DCCT results, and list the benefits of self monitoring blood glucose. Viewers should consult their Network for Continuing Medical Education program guides for credit information, learning objectives, and instructions for completing the telecourse. (AA-M).

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CHAPTER 8. PERIODICALS AND NEWS ON CORONARY HEART DISEASE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover coronary heart disease.

News Services and Press Releases One of the simplest ways of tracking press releases on coronary heart disease is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “coronary heart disease” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance.

Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to coronary heart disease. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “coronary heart disease” (or synonyms). The following was recently listed in this archive for coronary heart disease: •

Task force recommends against routine coronary heart disease screening Source: Reuters Industry Breifing Date: February 16, 2004

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “coronary heart disease” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “coronary heart disease” (or synonyms). If you know the name of a company that is relevant to coronary heart disease, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “coronary heart disease” (or synonyms).

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Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “coronary heart disease” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on coronary heart disease: •

Vegetarian Diets--Good to Go! Source: Running and Fitnews. 19(12):2. December 2001. Contact: The American Running Association. 4405 East West Highway, Number 405, Bethesda, MD 20814. Summary: A study initially published in the American Journal of Clinical Nutrition found that although a vegetarian diet does not provide any athletic performance advantages, it has no harmful effects on athletic ability. All evidence indicates that a well-balanced vegetarian diet is as effective as a traditional diet for athletic performance. Moreover, vegetarians may have an advantage over those who eat traditional diets because they tend to consume adequate fruit, vegetables, whole grains, and legumes. Vegetarians also are usually at lower risk for coronary heart disease and cancer.

•

How to Cut Your Risk of Diabetes Source: Nutrition Action Healthletter. 28(4): 1, 3-8. May 2001. Contact: Center for Science in the Public Interest. 1875 Connecticut Avenue NW, Suite 300, Washington, DC 20009-5728. Summary: The author explores reducing the risk of developing diabetes. As the incidence of obesity increases in the United States, so too have diabetes rates. The article discusses the risks of high-blood sugar levels and above- optimal blood sugar. According to Frank Vinicor of the Centers for Disease Control and Prevention (CDC), 'as of 1997, the total direct and indirect cost of diabetes was roughly 100 billion dollars a year. The major direct costs are due to hospitalization for coronary heart disease and kidney disease,' although 'blindness and amputations take the greatest toll on quality of life.' To cut diabetes risk, the article advocates losing weight if overweight, walking or being physically active for at least 30 minutes a day, eating whole-grain breads and cereals rather than refined starches and sugars, eating more fruits and vegetables, getting fasting blood sugar tested every 3 years starting at age 45, and using diet and exercise to keep blood pressure and cholesterol at optimal levels if fasting blood glucose consistently exceeds 110 mg/dL. Liebman also discusses a test for a longer term indication of blood sugar called glycated hemoglobin and lists risk factors and warning signs for diabetes, including tips on how to eat wisely to lower diabetes risk. A chart shows how to check Body Mass Index (BMI) to rate weight and diabetes risk.

•

Diabetes and Heart Disease: New Strategies Emerge Source: Harvard Heart Letter. 10(11): 1-4. July 2000.

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Contact: Available from Harvard Medical School Health Publications Group. Harvard Heart Letter, P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. E-mail: [email protected]. Website: www.health.harvard.edu. Summary: This article explores the relationship between diabetes and cardiovascular disease. Diabetes is a risk factor for atherosclerosis in the blood vessels of the heart and throughout the body. In addition, other risk factors for heart disease are closely associated with diabetes, including obesity, hypertension, and lipid abnormalities. Although the death rates due to coronary heart disease have been steadily declining over the last few decades, this has not been the case for people who have diabetes. Middle aged women with diabetes have the same increased risk for heart disease as do men. In addition, people who have diabetes and have had heart attacks have a less favorable prognosis than heart attack victims without diabetes. Therefore, most experts recommend that physicians regard all people who have diabetes as heart disease patients, even if they show no signs of cardiovascular problems. Studies have shown that beta blockers such as atenolol, metoprolol, nadolol, and propranolol are among the best drugs to treat coronary artery disease. Doctors traditionally have avoided prescribing beta blockers for people who have diabetes because they can mask the warning signs of low blood glucose and can worsen some problems common in people who have diabetes such as impotence and fatigue. However, research suggests that people who have diabetes may derive even greater benefits from beta blockers when compared with people who do not have diabetes. In addition, research suggests that tight diabetes control can reduce the risk of other diabetes complications. Other studies have investigated the outcomes between people with and without diabetes following balloon angioplasty. Results suggest that angioplasty in people who have diabetes leaves more heart muscle in danger than does bypass surgery. Thus, most physicians create treatment plans under the assumption that bypass surgery is the best form of treatment for people who have diabetes and severe symptoms of coronary disease that has not responded to drug treatment.

Academic Periodicals covering Coronary Heart Disease Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to coronary heart disease. In addition to these sources, you can search for articles covering coronary heart disease that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “coronary heart disease” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 146330 2083 1070 112 189 149784

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “coronary heart disease” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on coronary heart disease can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to coronary heart disease. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to coronary heart disease. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “coronary heart disease”:

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Angina http://www.nlm.nih.gov/medlineplus/angina.html Coronary Disease http://www.nlm.nih.gov/medlineplus/coronarydisease.html Heart Attack http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Diseases http://www.nlm.nih.gov/medlineplus/heartdiseases.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on coronary heart disease. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Is total fat consumption really decreasing? Source: United States Departments of Agriculture (USDA) Center for Nutrition Policy and Promotion (CNPP). Contact: CNPP, 1120 20th Street, NW, Suite 200, North Lobby, Washington, DC 20036. (202) 418-2312. Summary: A major contributor to many diet-related diseases is the overconsumption of fat. The type and quantity of dietary fat are risk factors for the development of coronary heart disease and some types of cancer. This fact sheet discusses the American dietary fat consumption.

•

About High Blood Pressure: Control, Risk, Lifestyle, Weight Source: Dallas, TX: American Heart Association. 1995. 17 p. Contact: Available from Channing L. Bete Company/American Heart Association Fulfillment Center. 200 State Road, South Deerfield, MA 01373-0200. (800) 611-6083. Fax (800) 499-6464. E-mail: [email protected]. PRICE: $7.50 for 50 copies. Summary: This booklet provides basic information about hypertension (high blood pressure). The booklet notes that adults have hypertension if their blood pressure remains above the threshold of 140 over 90. Approximately 90 percent of the cases of high blood pressure have no known causes. However, researchers have determined that

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some controllable risk factors for high blood pressure include obesity, excessive salt intake, excessive alcohol consumption, lack of exercise, and stress. Uncontrollable risk factors include race, heredity, and age. The booklet points out that an inactive lifestyle makes it easier for people to become overweight and therefore increases the chance of high blood pressure. High blood pressure has no symptoms, so adults should have a health care professional check their blood pressure at least once a year. Although high blood pressure cannot be cured, it can usually be controlled. When compared with people who have controlled high blood pressure, people with uncontrolled high blood pressure are on average three times more likely to develop coronary heart disease, six times more likely to develop congestive heart failure, and seven times more likely to have a stroke. Most treatments for high blood pressure involve a combination of diet, exercise, and medication. The booklet concludes with a list of related brochures available from the American Heart Association. •

Inside Look at Diabetes and Cardiovascular Disease Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 15 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. PRICE: $1.60 each; plus shipping and handling; quantity discounts available. Order number 75504. Summary: This illustrated booklet provides people who have diabetes with information on the relationship between diabetes and cardiovascular disease (CVD). Some types of CVD include coronary heart disease, stroke, and heart failure. Higher than normal levels of blood glucose may lead to unhealthy blood lipid levels. CVD risk factors that can be controlled include high cholesterol, smoking, high blood pressure, body weight, and lack of physical activity. The booklet provides guidelines for reducing CVD risk by lowering blood pressure, controlling blood sugar, improving cholesterol levels, losing weight, eating healthy food, exercising, quitting smoking, and taking appropriate medications. The booklet includes a list of organizations that can provide additional information about diabetes and cardiovascular disease.

•

Diabetes and Dyslipidemia: Beyond Glucose Control: Some Questions and Answers About Diabetes and Lipids Source: Morris Plains, NJ: Parke-Davis. 1992. 19 p. Contact: Available from Parke-Davis. Medical Affairs, Morris Plains, NJ 07950. (800) 223-0432. PRICE: Single copy free. Summary: This question-and-answer booklet presents some commonly asked questions about diabetes and lipids and is based on material from the symposium Current Approaches to Treating Dyslipidemia in the Diabetic Patient, held in June 1991 in conjunction with the 73rd Annual Meeting of the Endocrine Society. Topics include general considerations of dyslipidemia in diabetes; elevated triglycerides and low HDL; coronary heart disease (CHD) risk factors; management of the dyslipidemic patient; and the patient with diabetes who has multiple CHD risk factors. The booklet concludes with the package insert information for the drug Lipid (Gemfibrozil tablets). 2 figures. 3 tables. 34 references.

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The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “coronary heart disease” (or synonyms). The following was recently posted: •

Secondary prevention of coronary heart disease following myocardial infarction. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2000 January; 26 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2303&nbr=1529&a mp;string=coronary+AND+heart+AND+disease Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Facts About Coronary Heart Disease (CHD) Summary: This consumer health education fact sheet contains information for the patient diagnosed with this form of heart disease, caused by a narrowing of the coronary arteries that feed the heart. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2613 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to coronary heart disease. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

Patient Resources

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

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Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to coronary heart disease. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with coronary heart disease. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about coronary heart disease. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “coronary heart disease” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “coronary heart disease”. Type the following hyperlink

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into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “coronary heart disease” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “coronary heart disease” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

205

CORONARY HEART DISEASE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal fat: Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk. [NIH] Ablation: The removal of an organ by surgery. [NIH] Absolute risk: The observed or calculated probability of an event in a population under study, as contrasted with the relative risk. [NIH] Acatalasia: A rare autosomal recessive disorder resulting from the absence of catalase activity. Though usually asymptomatic, a syndrome of oral ulcerations and gangrene may be present. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acute myeloid leukemia: AML. A quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. Also called acute myelogenous leukemia or acute nonlymphocytic leukemia. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adhesives: Substances that cause the adherence of two surfaces. They include glues

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(properly collagen-derived adhesives), mucilages, sticky pastes, gums, resins, or latex. [NIH] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenal insufficiency: The reduced secretion of adrenal glands. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic Agents: Drugs that act on adrenergic receptors or affect the life cycle of adrenergic transmitters. Included here are adrenergic agonists and antagonists and agents that affect the synthesis, storage, uptake, metabolism, or release of adrenergic transmitters. [NIH]

Adrenergic beta-Antagonists: Drugs that bind to but do not activate beta-adrenergic receptors thereby blocking the actions of beta-adrenergic agonists. Adrenergic betaantagonists are used for treatment of hypertension, cardiac arrythmias, angina pectoris, glaucoma, migraine headaches, and anxiety. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Aetiology: Study of the causes of disease. [EU] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association

Dictionary 207

constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Age-Adjusted: Summary measures of rates of morbidity or mortality in a population using statistical procedures to remove the effect of age differences in populations that are being compared. Age is probably the most important and the most common variable in determining the risk of morbidity and mortality. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alpha-Linolenic Acid: A fatty acid that is found in plants and involved in the formation of prostaglandins. [NIH] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH]

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Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amlodipine: 2-((2-Aminoethoxy)methyl)-4-(2-chlorophenyl)-1,4-dihydro-6-methyl-3,5pyridinedicarboxylic acid 3-ethyl 5-methyl ester. A long-acting dihydropyridine calcium channel blocker. It is effective in the treatment of angina pectoris and hypertension. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgen-Binding Protein: Carrier proteins produced in the Sertoli cells of the testis, secreted into the seminiferous tubules, and transported via the efferent ducts to the epididymis. They participate in the transport of androgens. Androgen-binding protein has the same amino acid sequence as sex hormone binding-globulin. They differ by their sites of synthesis and post-translational oligosacaccharide modifications. [NIH] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]

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Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Angiotensin-Converting Enzyme Inhibitors: A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Anovulation: Suspension or cessation of ovulation in animals and humans. [NIH] Anthropometry: The technique that deals with the measurement of the size, weight, and proportions of the human or other primate body. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticarcinogenic: Pertaining to something that prevents or delays the development of cancer. [NIH]

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Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidiabetic: An agent that prevents or alleviates diabetes. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Antihypertensive Agents: Drugs used in the treatment of acute or chronic hypertension regardless of pharmacological mechanism. Among the antihypertensive agents are diuretics (especially diuretics, thiazide), adrenergic beta-antagonists, adrenergic alpha-antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, ganglionic blockers, and vasodilator agents. [NIH] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Anti-Obesity Agents: Agents that increase energy expenditure and weight loss by neural and chemical regulation. Beta-adrenergic agents and serotoninergic drugs have been experimentally used in patients with non-insulin dependent diabetes mellitus (NIDDM) to treat obesity. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Apheresis: Components plateletpheresis. [NIH]

being

separated

out,

as

leukapheresis,

plasmapheresis,

Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH]

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Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arcus Senilis: A corneal disease in which there is a deposition of phospholipid and cholesterol in the corneal stroma and anterior sclera. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH] Atherectomy: Endovascular procedure in which atheromatous plaque is excised by a cutting or rotating catheter. It differs from balloon and laser angioplasty procedures which enlarge vessels by dilation but frequently do not remove much plaque. If the plaque is removed by

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surgical excision under general anesthesia rather than by an endovascular procedure through a catheter, it is called endarterectomy. [NIH] Atherogenic: Causing the formation of plaque in the lining of the arteries. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [NIH] Autopsy: Postmortem examination of the body. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary Artery: The continuation of the subclavian artery; it distributes over the upper limb, axilla, chest and shoulder. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophages: Viruses whose host is a bacterial cell. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around

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smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Beta blocker: A drug used to slow the heart rate and reduce pressure inside blood vessels. It also can regulate heart rhythm. [NIH] Beta-Thromboglobulin: A platelet-specific protein which is released when platelets aggregate. Elevated plasma levels have been reported after deep venous thrombosis, preeclampsia, myocardial infarction with mural thrombosis, and myeloproliferative disorders. Measurement of beta-thromboglobulin in biological fluids by radioimmunoassay is used for the diagnosis and assessment of progress of thromboembolic disorders. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological Factors: Compounds made by living organisms that contribute to or influence a phenomenon or process. They have biological or physiological activities. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotin: Hexahydro-2-oxo-1H-thieno(3,4-d)imidazole-4-pentanoic acid. Growth factor present in minute amounts in every living cell. It occurs mainly bound to proteins or polypeptides and is abundant in liver, kidney, pancreas, yeast, and milk.The biotin content of cancerous tissue is higher than that of normal tissue. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the

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heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Artery: The continuation of the axillary artery; it branches into the radial and ulnar arteries. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchoconstriction: Diminution of the caliber of a bronchus physiologically or as a result of pharmacological intervention. [NIH] Bronchus: A large air passage that leads from the trachea (windpipe) to the lung. [NIH] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]

Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder)

Dictionary 215

and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capillary Fragility: The lack of resistance, or susceptibility, of capillaries to damage or disruption under conditions of increased stress. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiac catheterization: A procedure in which a thin, hollow tube is inserted into a blood vessel. The tube is then advanced through the vessel into the heart, enabling a physician to study the heart and its pumping activity. [NIH] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU]

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Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular Agents: Agents that affect the rate or intensity of cardiac contraction, blood vessel diameter, or blood volume. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carotenoids: Substance found in yellow and orange fruits and vegetables and in dark green, leafy vegetables. May reduce the risk of developing cancer. [NIH] Carpal Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catalase: An oxidoreductase that catalyzes the conversion of hydrogen peroxide to water and oxygen. It is present in many animal cells. A deficiency of this enzyme results in acatalasia. EC 1.11.1.6. [NIH] Catechin: Extracted from Uncaria gambier, Acacia catechu and other plants; it stabilizes collagen and is therefore used in tanning and dyeing; it prevents capillary fragility and abnormal permeability, but was formerly used as an antidiarrheal. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Causality: The relating of causes to the effects they produce. Causes are termed necessary when they must always precede an effect and sufficient when they initiate or produce an effect. Any of several factors may be associated with the potential disease causation or outcome, including predisposing factors, enabling factors, precipitating factors, reinforcing factors, and risk factors. [NIH] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are

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made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Central fat distribution: The waist circumference is an index of body fat distribution. Increasing waist circumference is accompanied by increasing frequencies of overt type 2 diabetes, dyslipidemia, hypertension, coronary heart disease, stroke, and early mortality. In the body fat patterns called android type (apple shaped) fat is deposited around the waist and upper abdominal area and appears most often in men. Abdominal body fat is thought to be associated with a rapid mobilization of fatty acids rather than resulting from other fat depots, although it remains a point of contention. If abdominal fat is indeed more active than other fat depots, it would then provide a mechanism by which we could explain (in part) the increase in blood lipid and glucose levels. The latter have been clearly associated with an increased risk for cardiovascular disease, hypertension, and type 2 diabetes. The gynoid type (pear-shaped) of body fat is usually seen in women. The fat is deposited around the hips, thighs, and buttocks, and presumably is used as energy reserve during pregnancy and lactation. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrotendinous Xanthomatosis: A primary fatty degeneration of the cornea occurring physiologically as an arcus senilis. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemopreventive: Natural or synthetic compound used to intervene in the early precancerous stages of carcinogenesis. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that

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contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chondrocytes: Polymorphic cells that form cartilage. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary Neurotrophic Factor: A neurotrophic factor that promotes the survival of various neuronal cell types and may play an important role in the injury response in the nervous system. [NIH] Circadian: Repeated more or less daily, i. e. on a 23- to 25-hour cycle. [NIH] Circadian Rhythm: The regular recurrence, in cycles of about 24 hours, of biological processes or activities, such as sensitivity to drugs and stimuli, hormone secretion, sleeping, feeding, etc. This rhythm seems to be set by a 'biological clock' which seems to be set by recurring daylight and darkness. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of

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certain fractures. [NIH] Claudication: Limping or lameness. [EU] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Codon: A set of three nucleotides in a protein coding sequence that specifies individual amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collagen disease: A term previously used to describe chronic diseases of the connective tissue (e.g., rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis), but now is thought to be more appropriate for diseases associated with defects in collagen,

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which is a component of the connective tissue. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Communicable disease: A disease that can be transmitted by contact between persons. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Competency: The capacity of the bacterium to take up DNA from its surroundings. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH]

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Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computer Simulation: Computer-based representation of physical systems and phenomena such as chemical processes. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The

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comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Creatinine clearance: A test that measures how efficiently the kidneys remove creatinine and other wastes from the blood. Low creatinine clearance indicates impaired kidney function. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Cultured cells: Animal or human cells that are grown in the laboratory. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cystathionine beta-Synthase: A multifunctional pyridoxal phosphate enzyme. In the second stage of cysteine biosynthesis it catalyzes the reaction of homocysteine with serine to form cystathionine with the elimination of water. Deficiency of this enzyme leads to hyperhomocysteinemia and homocystinuria. EC 4.2.1.22. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH]

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Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] De novo: In cancer, the first occurrence of cancer in the body. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Death Certificates: Official records of individual deaths including the cause of death certified by a physician, and any other required identifying information. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss

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of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Dexfenfluramine: The S-isomer of fenfluramine. It is a serotonin agonist and is used as an anorectic. Unlike fenfluramine, it does not possess any catecholamine agonist activity. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Foot: Ulcers of the foot as a complication of diabetes. Diabetic foot, often with infection, is a common serious complication of diabetes and may require hospitalization and disfiguring surgery. The foot ulcers are probably secondary to neuropathies and vascular problems. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH] Diastolic pressure: The lowest pressure to which blood pressure falls between contractions of the ventricles. [NIH] Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [NIH]

Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are

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the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disease-Free Survival: Period after successful treatment in which there is no appearance of the symptoms or effects of the disease. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4-benzothiadiazine-1,1dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Diving: An activity in which the organism plunges into water. It includes scuba and bell diving. Diving as natural behavior of animals goes here, as well as diving in decompression experiments with humans or animals. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dogfish: Sharks of the family Squalidae. The subfamily Squalinae are called dogfish sharks and comprise eight genera with about 44 species. Dogfish often appear in schools near shore and are destructive to fish and fishing gear. Their liver is valued for its oil and its flesh is often made into fertilizer. The Squalus acanthias or spiny dogfish figures heavily in biological research, especially with reference to its rectal gland in water-electrolyte studies. [NIH]

Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity

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of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejection fraction: A measure of ventricular contractility, equal to normally 65 8 per cent; lower values indicate ventricular dysfunction. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH]

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Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endodontics: A dental specialty concerned with the maintenance of the dental pulp in a state of health and the treatment of the pulp cavity (pulp chamber and pulp canal). [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometrium: The layer of tissue that lines the uterus. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs. [NIH] Energy Intake: Total number of calories taken in daily whether ingested or by parenteral routes. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences,

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or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythema Nodosum: An erythematous eruption commonly associated with drug reactions or infection and characterized by inflammatory nodules that are usually tender, multiple, and bilateral. These nodules are located predominantly on the shins with less common occurrence on the thighs and forearms. They undergo characteristic color changes ending in temporary bruise-like areas. This condition usually subsides in 3-6 weeks without scarring or atrophy. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH]

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Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Eucalyptus: A genus of Australian trees of the Myrtaceae family that yields gums, oils, and resins which are used as flavoring agents, astringents, and aromatics, and formerly to treat diarrhea, asthma, bronchitis, and respiratory tract infections. [NIH] Excipients: Usually inert substances added to a prescription in order to provide suitable consistency to the dosage form; a binder, matrix, base or diluent in pills, tablets, creams, salves, etc. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Factor V: Heat- and storage-labile plasma glycoprotein which accelerates the conversion of prothrombin to thrombin in blood coagulation. Factor V accomplishes this by forming a complex with factor Xa, phospholipid, and calcium (prothrombinase complex). Deficiency of factor V leads to Owren's disease. [NIH]

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Faecal: Pertaining to or of the nature of feces. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fatty Liver: The buildup of fat in liver cells. The most common cause is alcoholism. Other causes include obesity, diabetes, and pregnancy. Also called steatosis. [NIH] Fenfluramine: A centrally active drug that apparently both blocks serotonin uptake and provokes transport-mediated serotonin release. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibroblast Growth Factor: Peptide isolated from the pituitary gland and from the brain. It is a potent mitogen which stimulates growth of a variety of mesodermal cells including chondrocytes, granulosa, and endothelial cells. The peptide may be active in wound healing and animal limb regeneration. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fish Products: Food products manufactured from fish (e.g., fish flour, fish meal). [NIH] Flavoring Agents: Substances added to foods and medicine to improve the quality of taste. [NIH]

Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Foam Cells: Lipid-laden macrophages originating from monocytes or from smooth muscle cells. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Foetoplacental: Pertaining to the fetus and placenta. [EU] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH]

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Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglionic Blockers: Agents having as their major action the interruption of neural transmission at nicotinic receptors on postganglionic autonomic neurons. Because their actions are so broad, including blocking of sympathetic and parasympathetic systems, their therapeutic use has been largely supplanted by more specific drugs. They may still be used in the control of blood pressure in patients with acute dissecting aortic aneurysm and for the induction of hypotension in surgery. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g.,

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fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Markers: A phenotypically recognizable genetic trait which can be used to identify a genetic locus, a linkage group, or a recombination event. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Geriatric Assessment: Evaluation of the level of physical, physiological, or mental functioning in the older population group. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Germline mutation: A gene change in the body's reproductive cells (egg or sperm) that becomes incorporated into the DNA of every cell in the body of offspring; germline mutations are passed on from parents to offspring. Also called hereditary mutation. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Ginger: Deciduous plant rich in volatile oil (oils, volatile). It is used as a flavoring agent and has many other uses both internally and topically. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and

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immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]

Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycerophospholipids: Derivatives of phosphatidic acid in which the hydrophobic regions are composed of two fatty acids and a polar alcohol is joined to the C-3 position of glycerol through a phosphodiester bond. They are named according to their polar head groups, such as phosphatidylcholine and phosphatidylethanolamine. [NIH] Glycolysis: The pathway by which glucose is catabolized into two molecules of pyruvic acid with the generation of ATP. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [NIH] Gonads: The gamete-producing glands, ovary or testis. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH]

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Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Hawaii: A group of islands in Polynesia, in the north central Pacific Ocean, comprising eight major and 114 minor islands, largely volcanic and coral. Its capital is Honolulu. It was first reached by Polynesians about 500 A.D. It was discovered and named the Sandwich Islands in 1778 by Captain Cook. The islands were united under the rule of King Kamehameha 1795-1819 and requested annexation to the United States in 1893 when a provisional government was set up. Hawaii was established as a territory in 1900 and admitted as a state in 1959. The name is from the Polynesian Owhyhii, place of the gods, with reference to the two volcanoes Mauna Kea and Mauna Loa, regarded as the abode of the gods. (From Webster's New Geographical Dictionary, 1988, p493 & Room, Brewer's Dictionary of Names, 1992, p2330 [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Status: The level of health of the individual, group, or population as subjectively

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assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Transplantation: The transference of a heart from one human or animal to another. [NIH]

Heartbeat: One complete contraction of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Hereditary mutation: A gene change in the body's reproductive cells (egg or sperm) that becomes incorporated into the DNA of every cell in the body of offspring; hereditary mutations are passed on from parents to offspring. Also called germline mutation. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heritability: The proportion of observed variation in a particular trait that can be attributed to inherited genetic factors in contrast to environmental ones. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hirsutism: Excess hair in females and children with an adult male pattern of distribution. The concept does not include hypertrichosis, which is localized or generalized excess hair. [NIH]

Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH]

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Homodimer: Protein-binding "activation domains" always combine with identical proteins. [NIH]

Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Homozygotes: An individual having a homozygous gene pair. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Hospital Records: Compilations of data on hospital activities and programs; excludes patient medical records. [NIH] Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hyperandrogenism: A state characterized or caused by an excessive secretion of androgens by the adrenal cortex, ovaries, or testes. The clinical significance in males is negligible, so the term is used most commonly with reference to the female. The common manifestations in women are hirsutism and virilism. It is often caused by ovarian disease (particularly the polycystic ovary syndrome) and by adrenal diseases (particularly adrenal gland hyperfunction). [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperhomocysteinemia: An inborn error of methionone metabolism which produces an excess of homocysteine in the blood. It is often caused by a deficiency of cystathionine betasynthase and is a risk factor for coronary vascular disease. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperlipoproteinemia: Metabolic disease characterized by elevated plasma cholesterol and/or triglyceride levels. The inherited form is attributed to a single gene mechanism. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions

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upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrichosis: Localized or generalized excess hair. The concept does not include hirsutism, which is excess hair in females and children with an adult male pattern of distribution. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypertrophy, Left Ventricular: Enlargement of the left ventricle of the heart. This increase in ventricular mass is attributed to sustained abnormal pressure or volume loads and is a contributor to cardiovascular morbidity and mortality. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypogonadism: Condition resulting from or characterized by abnormally decreased functional activity of the gonads, with retardation of growth and sexual development. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoventilation: A reduction in the amount of air entering the pulmonary alveoli. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Idiopathic: Describes a disease of unknown cause. [NIH] Ileum: The lower end of the small intestine. [NIH] Illusion: A false interpretation of a genuine percept. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunofluorescence: A technique for identifying molecules present on the surfaces of cells

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or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulins: Glycoproteins present in the blood (antibodies) and in other tissue. They are classified by structure and activity into five classes (IgA, IgD, IgE, IgG, IgM). [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunoproteins: Blood proteins whose activities affect or play a role in the functioning of the immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU]

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Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interindividual: Occurring between two or more individuals. [EU] Interleukin-8: A cytokine that activates neutrophils and attracts neutrophils and Tlymphocytes. It is released by several cell types including monocytes, macrophages, Tlymphocytes, fibroblasts, endothelial cells, and keratinocytes by an inflammatory stimulus. IL-8 is a member of the beta-thromboglobulin superfamily and structurally related to platelet factor 4. [NIH] Interleukins: Soluble factors which stimulate growth-related activities of leukocytes as well as other cell types. They enhance cell proliferation and differentiation, DNA synthesis, secretion of other biologically active molecules and responses to immune and inflammatory stimuli. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among individuals. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques.

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[EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Isoflavones: 3-Phenylchromones. Isomeric form of flavones in which the benzene group is attached to the 3 position of the benzopyran ring instead of the 2 position. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactation: The period of the secretion of milk. [EU] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning

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secondarily as the organ of voice. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Leptin: A 16-kD peptide hormone secreted from white adipocytes and implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukapheresis: The preparation of leukocyte concentrates with the return of red cells and leukocyte-poor plasma to the donor. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocyte Count: A count of the number of white blood cells per unit volume in venous blood. A differential leukocyte count measures the relative numbers of the different types of white cells. [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipaemia: The presence of an excess of fats or lipids in the blood. [NIH] Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. It is produced by glands on the tongue and by the pancreas and initiates the digestion of dietary fats. (From Dorland, 27th ed) EC 3.1.1.3. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lipoprotein Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. The enzyme hydrolyzes triacylglycerols in chylomicrons, very-low-density lipoproteins, low-density lipoproteins, and diacylglycerols. It occurs on capillary endothelial surfaces, especially in

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mammary, muscle, and adipose tissue. Genetic deficiency of the enzyme causes familial hyperlipoproteinemia Type I. (Dorland, 27th ed) EC 3.1.1.34. [NIH] Lipoprotein(a): A family of lipoprotein particles varying in density and size depending on the protein-lipid ratio and the protein composition. These particles consist of apolipoprotein B-100 covalently linked to apolipoprotein-a by one or two disulfide bonds. There is a correlation between high plasma levels of this lipoprotein and increased risk for atherosclerotic cardiovascular disease. [NIH] Liposomes: Artificial, single or multilaminar vesicles (made from lecithins or other lipids) that are used for the delivery of a variety of biological molecules or molecular complexes to cells, for example, drug delivery and gene transfer. They are also used to study membranes and membrane proteins. [NIH] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lovastatin: A fungal metabolite isolated from cultures of Aspergillus terreus. The compound is a potent anticholesteremic agent. It inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It also stimulates the production of low-density lipoprotein receptors in the liver. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood.

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LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lycopene: A red pigment found in tomatoes and some fruits. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysosome: A sac-like compartment inside a cell that has enzymes that can break down cellular components that need to be destroyed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macronutrients: Nutrients in the diet that are the key sources of energy, namely protein, fat, and carbohydrates. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mammogram: An x-ray of the breast. [NIH] Manic: Affected with mania. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Masticatory: 1. subserving or pertaining to mastication; affecting the muscles of mastication.

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2. a remedy to be chewed but not swallowed. [EU] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Meat Products: Articles of food which are derived by a process of manufacture from any portion of carcasses of any animal used for food (e.g., head cheese, sausage, scrapple). [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Lipids: Lipids, predominantly phospholipids, cholesterol and small amounts of glycolipids found in membranes including cellular and intracellular membranes. These lipids may be arranged in bilayers in the membranes with integral proteins between the layers and peripheral proteins attached to the outside. Membrane lipids are required for active transport, several enzymatic activities and membrane formation. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH]

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Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH] Microfibrils: Components of the extracellular matrix consisting primarily of fibrillin. They are essential for the integrity of elastic fibers. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microviridae: A large family of lytic bacteriophages infecting enterobacteria. It contains two genera: Microvirus and Spiromicrovirus. [NIH] Midaxillary line: An imaginary vertical line that passes midway between the anterior and

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posterior axillary (armpit) folds. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Minority Groups: A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group. [NIH] Mitral Valve: The valve between the left atrium and left ventricle of the heart. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monocyte: A type of white blood cell. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monounsaturated fat: An unsaturated fat that is found primarily in plant foods, including olive and canola oils. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucociliary: Pertaining to or affecting the mucus membrane and hairs (including eyelashes, nose hair, .): mucociliary clearing: the clearance of mucus by ciliary movement ( particularly in the respiratory system). [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Mutagenic: Inducing genetic mutation. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU]

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Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardial Reperfusion: Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing myocardial reperfusion injury. [NIH] Myocardial Reperfusion Injury: Functional, metabolic, or structural changes in ischemic heart muscle thought to result from reperfusion to the ischemic areas. Changes can be fatal to muscle cells and may include edema with explosive cell swelling and disintegration, sarcolemma disruption, fragmentation of mitochondria, contraction band necrosis, enzyme washout, and calcium overload. Other damage may include hemorrhage and ventricular arrhythmias. One possible mechanism of damage is thought to be oxygen free radicals. Treatment currently includes the introduction of scavengers of oxygen free radicals, and injury is thought to be prevented by warm blood cardioplegic infusion prior to reperfusion. [NIH]

Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Nephropathy: Disease of the kidneys. [EU] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural Pathways: Neural tracts connecting one part of the nervous system with another.

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[NIH]

Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU]

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Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occupational Exposure: The exposure to potentially harmful chemical, physical, or biological agents that occurs as a result of one's occupation. [NIH] Occupational Health: The promotion and maintenance of physical and mental health in the work environment. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]

Oligomenorrhea: Abnormally infrequent menstruation. [NIH] Omega-3 fatty acid: A type of fat obtained in the diet and involved in immunity. [NIH] Ophthalmoscope: A lighted instrument used to examine the inside of the eye, including the retina and the optic nerve. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU]

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Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Ornithosis: Infection with Chlamydophila psittaci (formerly Chlamydia psittaci), transmitted to man by inhalation of dust-borne contaminated nasal secretions or excreta of infected birds. This infection results in a febrile illness characterized by pneumonitis and systemic manifestations. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation)

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from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papilla: A small nipple-shaped elevation. [NIH] Papillary: Pertaining to or resembling papilla, or nipple. [EU] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]

Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Particle: A tiny mass of material. [EU] Pathogen: Any disease-producing microorganism. [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pedigree: A record of one's ancestors, offspring, siblings, and their offspring that may be

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used to determine the pattern of certain genes or disease inheritance within a family. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perimenopausal: The time of a woman's life when menstrual periods become irregular. Refers to the time near menopause. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]

Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Perivascular: Situated around a vessel. [EU] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phagocyte: An immune system cell that can surround and kill microorganisms and remove dead cells. Phagocytes include macrophages. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU]

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Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phentermine: A central nervous system stimulant and sympathomimetic with actions and uses similar to those of dextroamphetamine. It has been used most frequently in the treatment of obesity. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plant sterols: Plant-based compounds that can compete with dietary cholesterol to be absorbed by the intestines. This results in lower blood cholesterol levels. They may have some effect in cancer prevention. Also known as phytosterols. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH]

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Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasmapheresis: Procedure whereby plasma is separated and extracted from anticoagulated whole blood and the red cells retransfused to the donor. Plasmapheresis is also employed for therapeutic use. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Adhesiveness: The process whereby platelets adhere to something other than platelets, e.g., collagen, basement membranes, microfibrils, or other "foreign" surfaces. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelet Factor 4: A high-molecular-weight proteoglycan-platelet factor complex which is released from blood platelets by thrombin. It acts as a mediator in the heparin-neutralizing capacity of the blood and plays a role in platelet aggregation. At high ionic strength (I=0.75), the complex dissociates into the active component (molecular weight 29,000) and the proteoglycan carrier (chondroitin 4-sulfate, molecular weight 350,000). The molecule exists in the form of a dimer consisting of 8 moles of platelet factor 4 and 2 moles of proteoglycan. [NIH]

Plateletpheresis: The preparation of platelet concentrates with the return of red cells and platelet-poor plasma to the donor. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polycystic Ovary Syndrome: Clinical symptom complex characterized by oligomenorrhea or amenorrhea, anovulation, and regularly associated with bilateral polycystic ovaries. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called

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tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Postoperative Period: The period following a surgical operation. [NIH] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Pravastatin: An antilipemic fungal metabolite isolated from cultures of Nocardia autotrophica. It acts as a competitive inhibitor of HMG CoA reductase (hydroxymethylglutaryl CoA reductases). [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precipitating Factors: Factors associated with the definitive onset of a disease, illness, accident, behavioral response, or course of action. Usually one factor is more important or more obviously recognizable than others, if several are involved, and one may often be regarded as "necessary". Examples include exposure to specific disease; amount or level of an infectious organism, drug, or noxious agent, etc. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Pre-Eclampsia: Development of hypertension with proteinuria, edema, or both, due to pregnancy or the influence of a recent pregnancy. It occurs after the 20th week of gestation, but it may develop before this time in the presence of trophoblastic disease. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a

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women's menstrual periods stop permanently; also called "change of life." [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progeny: The offspring produced in any generation. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Promyelocytic leukemia: A type of acute myeloid leukemia, a quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. [NIH]

Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the

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prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximate cause: The abnormal event in a causal chain lying closest to an accidental event. [NIH]

Psittaci: Causal agent of ornithosis. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH]

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Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Alveoli: Small polyhedral outpouchings along the walls of the alveolar sacs, alveolar ducts and terminal bronchioles through the walls of which gas exchange between alveolar air and pulmonary capillary blood takes place. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Raffinose: A trisaccharide occurring in Australian manna (from Eucalyptus spp, Myrtaceae) and in cottonseed meal. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not

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influence allocation.

[NIH]

Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU]

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Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Reproductive cells: Egg and sperm cells. Each mature reproductive cell carries a single set of 23 chromosomes. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory distress syndrome: A lung disease that occurs primarily in premature infants; the newborn must struggle for each breath and blueing of its skin reflects the baby's inability to get enough oxygen. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH]

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Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rheumatic Heart Disease: Disease of the heart resulting from rheumatic fever and characterized by inflammatory changes in the myocardium or scarring of the valves. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Root Canal Therapy: A treatment modality in endodontics concerned with the therapy of diseases of the dental pulp. For preparatory procedures, root canal preparation is available. [NIH]

Sagittal: The line of direction passing through the body from back to front, or any vertical plane parallel to the medial plane of the body and inclusive of that plane; often restricted to the medial plane, the plane of the sagittal suture. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones,

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and parotid glands. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scurvy: A deficiency disease due to lack of vitamin C in the diet. [NIH] Seafood: Marine fish and shellfish used as food or suitable for food. (Webster, 3d ed) shellfish and fish products are more specific types of seafood. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Secular trends: A relatively long-term trend in a community or country. [NIH] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Selection Bias: The introduction of error due to systematic differences in the characteristics between those selected and those not selected for a given study. In sampling bias, error is the result of failure to ensure that all members of the reference population have a known chance of selection in the sample. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light,

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magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Sequence Analysis: A multistage process that includes the determination of a sequence (protein, carbohydrate, etc.), its fragmentation and analysis, and the interpretation of the resulting sequence information. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sex Hormone-Binding Globulin: A glycoprotein migrating as a beta-globulin. Its molecular weight, 52,000 or 95,000-115,000, indicates that it exists as a dimer. The protein binds testosterone, dihydrotestosterone, and estradiol in the plasma. Sex hormone-binding protein has the same amino acid sequence as androgen-binding protein. They differ by their sites of synthesis and post-translational oligosacaccharide modifications. [NIH] Sex Ratio: The number of males per 100 females. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Sharks: A group of elongate elasmobranchs. Sharks are mostly marine fish, with certain species large and voracious. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell

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activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Simvastatin: A derivative of lovastatin and potent competitive inhibitor of 3-hydroxy-3methylglutaryl coenzyme A reductase (hydroxymethylglutaryl CoA reductases), which is the rate-limiting enzyme in cholesterol biosynthesis. It may also interfere with steroid hormone production. Due to the induction of hepatic LDL receptors, it increases breakdown of LDL-cholesterol (lipoproteins, LDL cholesterol). [NIH] Sinusitis: An inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin graft: Skin that is moved from one part of the body to another. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Snoring: Rough, noisy breathing during sleep, due to vibration of the uvula and soft palate. [NIH]

Social Class: A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Isolation: The separation of individuals or groups resulting in the lack of or minimizing of social contact and/or communication. This separation may be accomplished by physical separation, by social barriers and by psychological mechanisms. In the latter, there may be interaction but no real communication. [NIH] Social Security: Government sponsored social insurance programs. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH]

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Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Soy Proteins: Proteins which are present in or isolated from soybeans. [NIH] Soybean Oil: Oil from soybean or soybean plant. [NIH] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation

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or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steatosis: Fatty degeneration. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by

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clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic blood pressure: The maximum pressure in the artery produced as the heart

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contracts and blood begins to flow. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Terminator: A DNA sequence sited at the end of a transcriptional unit that signals the end of transcription. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thoracic: Having to do with the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Plasminogen Activator: A proteolytic enzyme in the serine protease family found in many tissues which converts plasminogen to plasmin. It has fibrin-binding activity and is immunologically different from urinary plasminogen activator. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases. EC 3.4.21.68. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for

Dictionary 269

increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonometry: The standard to determine the fluid pressure inside the eye (intraocular pressure). [NIH] Tooth Loss: The failure to retain teeth as a result of disease or injury. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicologic: Pertaining to toxicology. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transforming Growth Factor beta: A factor synthesized in a wide variety of tissues. It acts synergistically with TGF-alpha in inducing phenotypic transformation and can also act as a negative autocrine growth factor. TGF-beta has a potential role in embryonal development, cellular differentiation, hormone secretion, and immune function. TGF-beta is found mostly as homodimer forms of separate gene products TGF-beta1, TGF-beta2 or TGF-beta3. Heterodimers composed of TGF-beta1 and 2 (TGF-beta1.2) or of TGF-beta2 and 3 (TGF-

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beta2.3) have been isolated. The TGF-beta proteins are synthesized as precursor proteins. [NIH]

Transient Ischemic Attacks: Focal neurologic abnormalities of sudden onset and brief duration that reflect dysfunction in the distribution of the internal carotid-middle cerebral or the vertebrobasilar arterial system. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Tunica Intima: The innermost coat of blood vessels, consisting of a thin lining of endothelial cells longitudinally oriented and continuous with the endothelium of capillaries on the one hand and the endocardium of the heart on the other. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and

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constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Uvula: Uvula palatinae; specifically, the tongue-like process which projects from the middle of the posterior edge of the soft palate. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagal: Pertaining to the vagus nerve. [EU] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the

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body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virilism: Development of masculine traits in the female. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Visceral fat: One of the three compartments of abdominal fat. Retroperitoneal and subcutaneous are the other two compartments. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Waist circumference: To define the level at which the waist circumference is measured, a bony landmark is first located and marked. The subject stands, and the technician, positioned to the right of the subject, palpates the upper hip bone to locate the right ileum. Just above the uppermost lateral border of the right ileum, a horizontal mark is drawn and then crossed with a vertical mark on the midaxillary line. The measuring tape is then placed around the trunk, at the level of the mark on the right side, making sure that it is on a level horizontal plane on all sides. The tape is then tightened slightly without compressing the skin and underlying subcutaneous tissues. The measure is recorded in centimeters to the nearest millimeter. [NIH] Walkers: Walking aids generally having two handgrips and four legs. [NIH] Weight Lifting: A sport in which weights are lifted competitively or as an exercise. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality

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disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

275

INDEX A Abdomen, 205, 213, 214, 228, 239, 242, 252, 265, 266, 271 Abdominal, 16, 17, 36, 37, 97, 174, 205, 206, 217, 251, 272 Abdominal fat, 36, 37, 205, 217, 272 Ablation, 146, 205 Absolute risk, 15, 49, 205 Acatalasia, 205, 216 Acceptor, 205, 241, 251 Acetylcholine, 205, 218, 248 Acoustic, 153, 205 Activities of Daily Living, 47, 205 Acute myeloid leukemia, 205, 256 Acyl, 144, 205 Adaptability, 205, 217 Adaptation, 45, 205 Adenosine, 205, 253 Adhesives, 174, 205 Adipocytes, 206, 241 Adipose Tissue, 43, 111, 170, 174, 205, 206, 242 Adjustment, 4, 6, 8, 48, 50, 140, 169, 205, 206 Adolescence, 31, 167, 168, 206 Adrenal Cortex, 206, 222, 228, 236, 249, 260 Adrenal Glands, 206 Adrenal insufficiency, 28, 206 Adrenal Medulla, 206, 216, 228, 248 Adrenergic, 45, 59, 134, 206, 207, 210, 211, 225, 228, 245, 247, 256, 267 Adrenergic Agents, 206, 210 Adrenergic beta-Antagonists, 206, 210 Adverse Effect, 32, 59, 65, 151, 206, 263 Aerobic, 32, 38, 206, 229 Aerobic Exercise, 32, 38, 206 Aetiology, 69, 206 Afferent, 28, 206, 241 Affinity, 147, 148, 206, 207, 265 Agar, 207, 253 Age Groups, 53, 166, 207 Age of Onset, 207, 270 Age-Adjusted, 25, 207 Aged, 80 and Over, 207 Agonist, 156, 207, 224, 248 Airway, 21, 66, 207, 264 Albumin, 17, 57, 67, 106, 207, 245, 254

Algorithms, 29, 163, 207, 213 Alimentary, 207, 224, 251 Alkaline, 207, 208, 215 Alkaloid, 207, 248 Alleles, 43, 148, 149, 207 Allograft, 12, 207 Alpha-1, 207, 225 Alpha-Linolenic Acid, 43, 125, 127, 135, 207 Alprenolol, 207, 245 Alternative medicine, 180, 208 Amenorrhea, 208, 209, 254 Amino Acid Sequence, 208, 209, 232, 263 Amino Acids, 160, 208, 209, 219, 232, 248, 252, 254, 257, 263, 268, 270 Amlodipine, 45, 208 Ammonia, 208, 270 Anaesthesia, 208, 238 Anal, 45, 109, 146, 208, 228, 242 Analog, 146, 208 Anaphylatoxins, 208, 220 Anatomical, 25, 208, 212, 217, 221, 225, 227, 238, 262 Androgen-Binding Protein, 208, 263 Androgens, 206, 208, 236 Anemia, 146, 208, 231 Anesthesia, 207, 208, 212, 227 Aneurysm, 209, 210, 271 Angina, 6, 24, 27, 28, 67, 103, 117, 132, 156, 159, 192, 206, 208, 209, 245, 247, 256 Angina Pectoris, 27, 28, 206, 208, 209, 245, 247, 256 Angioplasty, 28, 146, 182, 209, 211, 247 Angiotensin-Converting Enzyme Inhibitors, 209, 210 Angiotensinogen, 45, 79, 209, 260 Animal model, 20, 158, 209 Anions, 207, 209, 240 Ankle, 67, 209 Anorexia, 168, 209 Anorexia Nervosa, 168, 209 Anovulation, 44, 209, 254 Anthropometry, 98, 209 Antibacterial, 209, 265 Antibiotic, 20, 209, 265 Antibodies, 19, 209, 234, 237, 238, 254 Antibody, 207, 209, 210, 220, 234, 236, 238, 244, 265

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Anticarcinogenic, 158, 209 Anticoagulant, 210, 257 Antidiabetic, 158, 210 Antifungal, 146, 210 Antigen, 20, 206, 209, 210, 220, 236, 237, 238, 244 Antigen-Antibody Complex, 210, 220 Antihypertensive, 38, 44, 57, 150, 207, 210 Antihypertensive Agents, 45, 150, 210 Anti-infective, 210, 236, 240 Anti-inflammatory, 18, 95, 110, 147, 148, 210, 211, 232 Anti-Inflammatory Agents, 147, 148, 210, 211 Anti-Obesity Agents, 12, 210 Antioxidant, 22, 55, 124, 127, 131, 146, 147, 210, 211, 251 Antithrombotic, 39, 74, 210 Anus, 208, 210, 220, 259 Anxiety, 13, 26, 32, 42, 159, 160, 206, 210, 256 Anxiety Disorders, 13, 26, 210 Aorta, 17, 36, 37, 56, 98, 210, 222, 272 Aortic Aneurysm, 21, 210, 231 Apheresis, 98, 210 Apnea, 210 Apolipoproteins, 19, 210, 241 Applicability, 52, 211 Aqueous, 211, 212, 223, 236 Arachidonic Acid, 101, 211, 241, 256 Arcus Senilis, 211, 217 Arginine, 7, 118, 208, 211, 248 Arterial, 24, 32, 33, 43, 45, 52, 61, 144, 145, 211, 218, 237, 257, 267, 270 Arteries, 25, 56, 144, 156, 194, 210, 211, 212, 214, 222, 240, 243, 247, 268 Arteriolar, 67, 211, 214, 260 Arterioles, 211, 214, 215, 247 Arteriolosclerosis, 211 Arteriosclerosis, 84, 89, 92, 99, 111, 144, 147, 159, 162, 211, 237 Articular, 211, 250 Ascorbic Acid, 24, 211 Aspirin, 9, 18, 74, 110, 145, 211 Assay, 38, 60, 61, 211 Astringents, 211, 229 Asymptomatic, 9, 53, 96, 205, 211 Atenolol, 182, 211 Atherectomy, 146, 211, 227 Atherogenic, 6, 8, 20, 43, 212 Atrial, 42, 212 Atrial Fibrillation, 42, 212

Atrium, 212, 246, 271 Atrophy, 212, 228 Attenuated, 36, 212 Autoimmune disease, 212, 246 Autologous, 25, 212 Autonomic Nervous System, 32, 212, 252, 265, 267 Autonomic Neuropathy, 174, 212 Autopsy, 25, 45, 81, 212 Axillary, 212, 214, 246 Axillary Artery, 212, 214 B Bacteria, 7, 14, 205, 209, 210, 212, 223, 226, 227, 245, 263, 265, 269, 271 Bacterial Physiology, 205, 212 Bactericidal, 212, 229 Bacteriophages, 212, 245 Bacterium, 212, 220 Base, 55, 64, 161, 212, 229, 232, 240, 268 Basement Membrane, 212, 229, 254 Beta blocker, 182, 213 Beta-Thromboglobulin, 213, 239 Bilateral, 213, 228, 254 Bile, 213, 231, 242, 266 Bilirubin, 207, 213 Biochemical, 30, 40, 43, 55, 66, 75, 76, 127, 207, 213, 250, 263 Biological Factors, 42, 167, 213 Biomarkers, 25, 66, 213 Biopsy, 213, 252 Biosynthesis, 211, 213, 222, 242, 263, 264 Biotechnology, 68, 70, 180, 187, 213 Biotin, 145, 213 Bladder, 212, 213, 221, 246, 257, 271 Bloating, 213, 231 Blood Coagulation, 213, 215, 229, 268 Blood Glucose, 157, 177, 181, 182, 193, 213, 235, 239 Blood Platelets, 213, 254, 263 Blood pressure, 7, 8, 10, 16, 17, 31, 36, 37, 38, 45, 48, 52, 54, 57, 62, 64, 65, 66, 67, 75, 108, 155, 168, 170, 174, 181, 192, 193, 210, 213, 216, 224, 231, 237, 246, 248, 252, 265 Blood Volume, 214, 216 Body Composition, 20, 90, 214 Body Fluids, 213, 214, 215, 226, 265, 270 Body Mass Index, 7, 8, 12, 16, 36, 37, 41, 67, 112, 181, 214, 250 Bone Density, 162, 214 Bone Marrow, 205, 214, 231, 237, 243, 256 Bone scan, 214, 262

277

Bowel, 18, 208, 214, 239, 266 Brachial, 32, 38, 67, 214, 244 Brachial Artery, 32, 38, 214 Bradykinin, 214, 248, 254 Breeding, 154, 214 Bronchi, 214, 228, 269 Bronchitis, 21, 214, 218, 229 Bronchoconstriction, 160, 214 Bronchus, 214 Buffers, 147, 214 Bulimia, 159, 168, 214 Bypass, 25, 28, 182, 215, 247 C Calcification, 35, 36, 110, 211, 215 Calcium Channel Blockers, 210, 215 Calculi, 215, 233 Capillary, 214, 215, 216, 232, 241, 258, 272 Capillary Fragility, 215, 216 Capsules, 215, 232 Carbohydrate, 21, 29, 33, 57, 151, 157, 215, 233, 255, 263 Carcinogen, 158, 215 Carcinogenesis, 18, 147, 215, 217 Carcinogenic, 215, 238, 266 Cardiac catheterization, 13, 80, 215 Cardiomyopathy, 33, 60, 133, 150, 215 Cardiorespiratory, 206, 215 Cardioselective, 211, 215, 256 Cardiovascular Agents, 150, 216 Cardiovascular System, 40, 158, 212, 216 Carotene, 43, 127, 135, 216, 261 Carotenoids, 43, 135, 216 Carpal Tunnel Syndrome, 54, 216 Carrier Proteins, 216, 254 Catabolism, 19, 216 Catalase, 40, 205, 216 Catechin, 147, 216 Catecholamine, 216, 224 Catheter, 211, 216, 227 Catheterization, 209, 216, 247 Caudal, 216, 237, 255 Causal, 7, 9, 23, 42, 54, 66, 86, 166, 216, 228, 239, 257 Causality, 9, 216 Cause of Death, 13, 24, 25, 28, 32, 34, 40, 48, 61, 66, 110, 145, 151, 152, 154, 155, 156, 216, 223 Cell Death, 55, 217, 247 Cell Differentiation, 28, 147, 217, 263 Cell Division, 212, 217, 253 Cell membrane, 215, 216, 217, 223, 253 Cell proliferation, 211, 217, 239, 263

Central fat distribution, 28, 217 Central Nervous System, 28, 159, 160, 205, 212, 217, 224, 226, 231, 233, 241, 246, 250, 253, 263 Cerebral, 43, 76, 94, 104, 112, 144, 217, 228, 268, 270 Cerebrotendinous Xanthomatosis, 78, 217 Cerebrovascular, 12, 17, 52, 150, 155, 160, 215, 216, 217 Cerebrum, 217 Character, 209, 217, 223 Chemopreventive, 18, 147, 217 Chemotactic Factors, 217, 220 Chemotherapeutic agent, 147, 148, 217 Chest Pain, 128, 217 Chin, 17, 118, 125, 131, 217, 245 Cholesterol Esters, 218, 241 Choline, 145, 218 Cholinergic, 218, 248 Chondrocytes, 218, 230 Chromatin, 218, 243, 248 Chromium, 145, 218 Chromosome, 99, 148, 218, 241 Chronic Disease, 20, 53, 54, 117, 218, 219 Chronic Obstructive Pulmonary Disease, 166, 218 Chronic renal, 12, 16, 167, 218, 254 Chylomicrons, 218, 241 Ciliary, 13, 218, 246 Ciliary Neurotrophic Factor, 13, 218 Circadian, 47, 159, 160, 218 Circadian Rhythm, 159, 160, 218 CIS, 146, 147, 157, 218, 261 Clamp, 38, 218 Claudication, 21, 219 Clinical Medicine, 166, 219, 255 Clinical study, 219, 221 Clinical trial, 11, 39, 40, 45, 63, 65, 117, 187, 219, 221, 222, 225, 246, 257, 259 Cloning, 213, 219 Coagulation, 65, 213, 219, 235, 254 Codon, 150, 219, 232 Coenzyme, 211, 219, 242, 264 Cofactor, 4, 219, 257, 268 Cognition, 48, 219 Cognitive restructuring, 167, 219, 266 Cohort Studies, 4, 54, 62, 64, 65, 76, 81, 219, 228 Collagen, 206, 213, 216, 219, 229, 230, 236, 244, 254 Collagen disease, 219, 236 Collapse, 220, 264

278

Coronary Heart Disease

Colloidal, 207, 220 Colon, 18, 72, 160, 220 Combination Therapy, 220, 229 Communicable disease, 95, 220 Comorbidity, 27, 220 Competency, 23, 220 Complement, 32, 208, 220, 243, 254 Complementary and alternative medicine, 123, 124, 137, 220 Complementary medicine, 124, 220 Compliance, 38, 63, 162, 175, 221 Computational Biology, 187, 221 Computed tomography, 35, 36, 37, 48, 111, 214, 221, 262 Computer Simulation, 60, 221 Computerized axial tomography, 221, 262 Computerized tomography, 221 Concomitant, 49, 221 Cones, 221, 261 Confounding, 5, 6, 42, 221 Congestion, 221, 228 Congestive heart failure, 29, 67, 159, 193, 221, 242 Conjugated, 39, 157, 221 Connective Tissue, 211, 214, 219, 221, 230, 231, 243 Consciousness, 221, 223, 225, 257 Constriction, 221, 240, 271 Constriction, Pathologic, 221, 271 Contractility, 209, 221, 226 Contraindications, ii, 221 Control group, 27, 32, 221, 258 Controlled clinical trial, 11, 221, 259 Controlled study, 32, 38, 222 Coordination, 222, 246 Cornea, 217, 222 Coronary Arteriosclerosis, 222, 247 Coronary Artery Bypass, 146, 222 Coronary Circulation, 209, 222 Coronary Thrombosis, 222, 247 Coronary Vessels, 222 Cortex, 222 Cortical, 99, 222 Cortisol, 28, 54, 207, 222 Cranial, 174, 222, 250, 251, 252, 271 Creatinine, 12, 16, 17, 67, 222 Creatinine clearance, 12, 222 Cross-Sectional Studies, 222, 228 Cultured cells, 19, 222 Curative, 222, 248, 268 Cyclic, 40, 222, 234, 248, 257 Cystathionine beta-Synthase, 222, 236

Cytokine, 29, 222, 239 Cytomegalovirus, 35, 223 Cytoplasm, 217, 223, 234, 243, 248 Cytotoxic, 223, 264 D Dairy Products, 158, 223 Data Collection, 25, 40, 42, 53, 62, 64, 223, 230 De novo, 12, 16, 223 Deamination, 223, 270 Death Certificates, 6, 53, 67, 110, 223 Decompensation, 170, 223 Decompression, 223, 225 Degenerative, 223, 250, 261 Deletion, 45, 69, 223 Delivery of Health Care, 223, 234 Dementia, 57, 159, 160, 223 Dental Caries, 22, 223 Depolarization, 223, 264 Depressive Disorder, 27, 223, 242 Deprivation, 101, 156, 224 Detoxification, 42, 224 Deuterium, 224, 236 Developed Countries, 21, 152, 224 Developing Countries, 155, 224 Dexfenfluramine, 12, 224 Dextroamphetamine, 224, 253 Diabetes Mellitus, 5, 8, 9, 10, 19, 33, 46, 56, 78, 83, 128, 133, 174, 210, 224, 233, 235 Diabetic Foot, 169, 224 Diagnostic procedure, 25, 143, 180, 224 Diarrhea, 224, 229 Diarrhoea, 162, 224 Diastole, 224 Diastolic, 32, 33, 46, 52, 98, 157, 224, 237 Diastolic blood pressure, 157, 224 Diastolic pressure, 32, 98, 224, 237 Dietary Fats, 128, 224, 241 Dietary Fiber, 5, 6, 43, 86, 224 Dietitian, 178, 224 Digestion, 207, 213, 214, 224, 231, 239, 241, 242, 266 Digestive tract, 212, 224, 264 Dihydrotestosterone, 225, 259, 263 Dilatation, Pathologic, 225, 271 Dilation, 23, 211, 214, 225, 271 Direct, iii, 20, 33, 58, 60, 148, 181, 219, 225, 259, 267 Disease Progression, 24, 29, 225 Disease-Free Survival, 63, 225 Disinfectant, 225, 229 Dissociation, 206, 225

279

Distal, 222, 225, 252 Diuretics, Thiazide, 210, 225 Diving, 169, 225 Dizziness, 162, 225, 272 Dogfish, 13, 225 Double-blind, 11, 225 Doxazosin, 45, 225 Drug Interactions, 225 Drug Tolerance, 226, 268 Duct, 216, 226, 229, 261, 266 Dyslipidemia, 9, 10, 28, 30, 50, 82, 95, 130, 131, 156, 170, 174, 193, 217, 226 Dysphoric, 223, 226 Dyspnea, 223, 226 E Echocardiography, 38, 117, 226 Edema, 223, 226, 240, 247, 255 Effector, 28, 205, 220, 226 Efferent, 28, 208, 226 Efficacy, 22, 57, 128, 226 Ejection fraction, 72, 226 Elasticity, 211, 222, 226 Elective, 13, 24, 226 Electrocoagulation, 219, 226 Electrolyte, 159, 225, 226, 255, 265 Electrons, 210, 212, 226, 240, 251, 258 Embolus, 226, 238 Embryo, 217, 226, 238, 249 Emphysema, 218, 226 Empirical, 23, 227 Enamel, 223, 227 Endarterectomy, 146, 209, 212, 227 Endocrine System, 227, 248 Endodontics, 227, 261 Endogenous, 69, 72, 82, 105, 227 Endometrial, 151, 160, 227 Endometrium, 227, 244 Endothelial cell, 55, 131, 227, 230, 239, 268, 270 Endothelium, 66, 147, 148, 227, 248, 270 Endothelium, Lymphatic, 227 Endothelium, Vascular, 227 Endothelium-derived, 227, 248 Endotoxic, 227, 241 Endotoxin, 227, 270 End-stage renal, 12, 16, 218, 227, 254 Energy balance, 227, 241 Energy Intake, 57, 227 Environmental Exposure, 20, 227 Environmental Health, 186, 188, 227 Enzymatic, 43, 215, 216, 220, 223, 228, 230, 244, 261

Enzyme Inhibitors, 228, 254 Epidemic, 16, 46, 52, 228 Epidemiologic Studies, 18, 26, 33, 228 Epigastric, 162, 228, 251 Epinephrine, 206, 228, 248, 270 Epithelial, 21, 228 Epithelial Cells, 21, 228 Epithelium, 212, 227, 228 Erectile, 83, 109, 228 Erection, 228 Erythema, 21, 228 Erythema Nodosum, 21, 228 Erythrocytes, 208, 214, 228 Esophageal, 160, 228 Esophagus, 166, 225, 228, 235, 259, 266 Estradiol, 228, 263 Estrogen, 38, 39, 65, 73, 74, 82, 83, 97, 150, 168, 228, 229 Estrogen Replacement Therapy, 151, 168, 229 Ethanol, 39, 59, 129, 229 Ethnic Groups, 6, 26, 229 Eucalyptus, 146, 229, 258 Excipients, 147, 229 Exercise Test, 36, 229 Exocrine, 229, 251 Exogenous, 39, 45, 227, 229, 270 Extracellular, 221, 229, 230, 244, 245, 265 Extracellular Matrix, 221, 229, 230, 244, 245 Extracellular Matrix Proteins, 229, 244 Extraction, 11, 229 Extremity, 54, 67, 229, 244 F Factor V, 5, 22, 65, 229 Faecal, 224, 230 Family Planning, 187, 230 Fatigue, 162, 182, 230, 235 Fatty acids, 29, 43, 124, 126, 130, 149, 157, 173, 207, 217, 230, 233, 256 Fatty Liver, 159, 230 Fenfluramine, 12, 224, 230 Fibrin, 55, 213, 230, 254, 268 Fibrinogen, 7, 9, 17, 22, 35, 53, 55, 65, 67, 74, 86, 96, 126, 230, 254, 268 Fibrinolysis, 55, 65, 174, 230 Fibrinolytic, 55, 230 Fibroblast Growth Factor, 155, 230 Fibroblasts, 19, 230, 239 Fibrosis, 230, 261, 262 Fish Products, 230, 262 Flavoring Agents, 229, 230

280

Coronary Heart Disease

Flushing, 30, 162, 230 Foam Cells, 20, 61, 230 Focus Groups, 15, 49, 230 Foetoplacental, 230, 249 Folate, 61, 86, 120, 152, 230, 231 Fold, 7, 21, 46, 158, 174, 230 Folic Acid, 12, 120, 131, 145, 152, 230, 231 Foot Ulcer, 224, 231 Forearm, 214, 231, 244 Free Radicals, 210, 225, 231, 247 Fructose, 34, 231, 239 G Gallbladder, 160, 205, 231 Ganglia, 205, 231, 247, 252, 267 Ganglionic Blockers, 210, 231 Gas, 208, 231, 236, 248, 258, 271 Gastric, 231, 235 Gastric Emptying, 231 Gastrin, 231, 236 Gastrointestinal, 214, 228, 229, 231, 241, 263, 265, 267, 270 Gastrointestinal tract, 229, 231, 241, 263, 270 Gastroparesis, 174, 231 Gene Expression, 14, 19, 28, 55, 231 Gene Therapy, 149, 231 General practitioner, 78, 232 Genetic Code, 232, 249 Genetic Markers, 29, 232 Genetics, 20, 41, 44, 52, 70, 85, 148, 149, 232 Genital, 14, 159, 212, 232, 271 Genitourinary, 232, 271 Genotype, 45, 66, 232, 253 Geriatric, 168, 232 Geriatric Assessment, 168, 232 Germ Cells, 232, 250, 268 Germline mutation, 148, 149, 232, 235 Gestation, 232, 255 Gestational, 169, 232 Ginger, 155, 232 Gingivitis, 6, 232 Ginseng, 136, 155, 232 Gland, 206, 225, 232, 236, 237, 243, 251, 253, 257, 262, 266, 268 Glomerular, 7, 232, 239, 260 Glomerular Filtration Rate, 7, 232 Glomerulus, 232 Glucocorticoid, 232, 236 Gluconeogenesis, 157, 233 Glucose Intolerance, 50, 224, 233

Glucose tolerance, 10, 90, 116, 170, 174, 233 Glucose Tolerance Test, 233 Glutamic Acid, 231, 233, 248 Glutathione Peroxidase, 233, 262 Glycerol, 233, 253 Glycerophospholipids, 233, 253 Glycolysis, 34, 233 Glycoprotein, 229, 230, 233, 263, 268, 270 Goats, 223, 233 Gonads, 233, 237 Gout, 159, 233 Governing Board, 233, 255 Grade, 30, 233 Graft, 24, 234, 247 Grafting, 222, 234, 238 Granulocytes, 234, 264, 272 Grasses, 231, 234 Gravidity, 234, 251 Guanylate Cyclase, 40, 234, 248 H Half-Life, 234, 247 Haplotypes, 29, 43, 234 Haptens, 206, 234 Hawaii, 36, 37, 116, 199, 234 Health Behavior, 63, 140, 234 Health Care Costs, 32, 49, 234 Health Education, 49, 63, 194, 234 Health Expenditures, 234 Health Policy, 168, 234 Health Status, 54, 77, 146, 234 Heart attack, 4, 50, 155, 156, 162, 171, 182, 216, 235 Heart failure, 16, 19, 33, 45, 46, 52, 60, 63, 117, 150, 155, 193, 209, 235 Heart Transplantation, 146, 235 Heartbeat, 235, 267 Heartburn, 162, 235 Hematuria, 16, 235 Hemoglobin, 35, 57, 67, 181, 208, 228, 235 Hemoglobin A, 181, 235 Hemoglobinopathies, 232, 235 Hemorrhage, 226, 235, 247, 266 Hemostasis, 107, 235, 263 Hepatic, 39, 207, 233, 235, 264 Hereditary, 166, 232, 233, 235 Hereditary mutation, 232, 235 Heredity, 193, 231, 232, 235 Heritability, 17, 235 Heterogeneity, 14, 69, 207, 235 Hirsutism, 160, 235, 236, 237 Homeostasis, 170, 235, 265

281

Homodimer, 236, 269 Homogeneous, 52, 211, 236 Homologous, 207, 231, 236, 267 Homozygotes, 43, 236 Hormonal, 212, 229, 236 Hormone, 38, 39, 63, 65, 72, 75, 92, 97, 113, 150, 159, 160, 208, 218, 222, 228, 229, 231, 236, 239, 240, 241, 244, 261, 263, 264, 268, 269 Hormone Replacement Therapy, 63, 65, 75, 113, 236 Hormone therapy, 97, 236 Hospital Records, 67, 236 Hydrocortisone, 28, 236 Hydrogen, 40, 205, 212, 214, 215, 216, 224, 229, 233, 236, 241, 246, 250, 252, 257 Hydrogen Peroxide, 40, 216, 233, 236, 241 Hydrophobic, 233, 236, 241 Hyperandrogenism, 44, 160, 236 Hypercholesterolemia, 6, 53, 133, 159, 226, 236 Hyperglycemia, 8, 236 Hyperhomocysteinemia, 12, 222, 236 Hyperlipidemia, 45, 61, 69, 83, 93, 148, 149, 156, 159, 162, 226, 236 Hyperlipoproteinemia, 236, 237, 242 Hypersensitivity, 236, 241, 261 Hyperthyroidism, 237, 256 Hypertrichosis, 235, 237 Hypertriglyceridemia, 93, 160, 226, 237 Hypertrophy, 16, 45, 160, 237 Hypertrophy, Left Ventricular, 160, 237 Hyperuricemia, 160, 233, 237 Hypogonadism, 160, 237 Hypothalamic, 28, 237 Hypothalamus, 28, 212, 237, 253, 268 Hypoventilation, 160, 237 Hypoxia, 127, 237 I Idiopathic, 237, 261 Ileum, 237, 272 Illusion, 237, 272 Imidazole, 213, 237 Immune response, 154, 210, 212, 234, 237, 238, 243, 267, 272 Immune Sera, 237 Immune system, 146, 237, 238, 241, 243, 246, 252, 271, 272 Immunity, 22, 237, 238, 249, 269 Immunization, 22, 237, 256 Immunofluorescence, 59, 237 Immunogenic, 238, 241

Immunoglobulins, 154, 238, 254 Immunologic, 217, 237, 238 Immunology, 20, 206, 238 Immunoproteins, 154, 238 Impairment, 12, 19, 159, 238, 245 Implantation, 238, 249 Impotence, 182, 228, 238 In situ, 167, 238 In vitro, 18, 60, 61, 144, 231, 238 In vivo, 18, 20, 30, 34, 60, 61, 147, 231, 238, 268 Incision, 238, 239 Induction, 34, 208, 231, 238, 264 Infant, Newborn, 207, 238 Infarction, 6, 8, 23, 24, 27, 28, 36, 40, 43, 44, 50, 51, 56, 67, 89, 95, 108, 111, 144, 156, 159, 194, 213, 222, 238, 247, 256, 260 Infertility, 14, 159, 167, 238 Inflammation, 24, 33, 39, 45, 55, 66, 72, 79, 160, 207, 210, 211, 214, 218, 230, 231, 232, 236, 238, 241, 252, 254, 261 Ingestion, 59, 233, 238, 254 Initiation, 65, 147, 163, 169, 238 Inotropic, 211, 238 Insight, 28, 33, 39, 239 Insulator, 239, 246 Insulin-dependent diabetes mellitus, 69, 239 Interindividual, 52, 239 Interleukin-8, 130, 239 Interleukins, 39, 239 Intermittent, 127, 239, 242 Interstitial, 239, 260 Intervention Studies, 5, 239 Intervertebral, 239, 242 Intervertebral Disk Displacement, 239, 242 Intestinal, 159, 160, 162, 216, 233, 239 Intestine, 214, 239, 259, 264 Intoxication, 239, 273 Intracellular, 14, 34, 106, 215, 238, 239, 244, 248, 255, 257, 259, 262, 263 Intramuscular, 239, 251 Intraocular, 239, 269 Intraocular pressure, 239, 269 Intravenous, 239, 251 Intrinsic, 31, 166, 207, 213, 239 Inulin, 232, 239 Invasive, 24, 36, 54, 153, 237, 239, 243 Involuntary, 240, 247, 259 Iodine, 145, 240 Ionizing, 227, 240

282

Coronary Heart Disease

Ions, 212, 214, 225, 226, 236, 240, 257 Ischemia, 24, 53, 59, 156, 212, 240, 247, 260 Ischemic stroke, 104, 110, 240 Isoflavones, 129, 240 K Kb, 186, 240 Keratinocytes, 239, 240 Keratolytic, 223, 240 Kidney Disease, 7, 56, 82, 123, 169, 181, 186, 240 Kidney Failure, 227, 240 Kidney stone, 240, 271 Kinetics, 55, 240 L Labile, 220, 229, 240 Lactation, 217, 240, 249 Larynx, 166, 240, 269, 271 Latent, 241, 255 Leptin, 13, 241 Lesion, 20, 61, 222, 231, 241, 242 Leukapheresis, 210, 241 Leukemia, 205, 232, 241 Leukocyte Count, 126, 241 Leukotrienes, 211, 241 Life cycle, 168, 206, 241 Ligament, 241, 257, 265 Linkage, 16, 44, 52, 89, 99, 232, 241 Lipaemia, 116, 241 Lipase, 28, 241 Lipid A, 10, 38, 89, 151, 182, 217, 241 Lipid Peroxidation, 241, 251 Lipopolysaccharides, 241 Lipoprotein Lipase, 28, 44, 45, 241 Lipoprotein(a), 126, 132, 242 Liposomes, 148, 242 Lisinopril, 45, 242 Lithium, 106, 242 Liver scan, 242, 262 Localization, 59, 242 Localized, 148, 223, 235, 237, 238, 242, 253 Longitudinal Studies, 24, 222, 242 Longitudinal study, 15, 47, 50, 68, 242 Long-Term Care, 26, 242 Loop, 28, 242 Lovastatin, 18, 242, 264 Low Back Pain, 54, 160, 242 Low-density lipoprotein, 8, 10, 38, 98, 126, 127, 162, 226, 241, 242 Lumbar, 239, 242, 243 Lycopene, 43, 129, 243 Lymph, 212, 227, 243, 261 Lymph node, 212, 243, 261

Lymphatic, 227, 238, 243, 265, 268 Lymphocytes, 61, 210, 237, 239, 243, 265, 268, 272 Lymphoid, 209, 243 Lysosome, 21, 243 Lytic, 243, 245, 263 M Macronutrients, 145, 243 Macrophage, 20, 243 Magnetic Resonance Imaging, 243, 262 Major Histocompatibility Complex, 234, 243 Malnutrition, 207, 212, 243 Mammary, 222, 242, 243 Mammogram, 215, 243, 245 Manic, 242, 243 Manifest, 146, 243 Mastication, 243 Masticatory, 22, 243 Matrix metalloproteinase, 111, 244 Meat, 157, 170, 224, 244 Meat Products, 157, 224, 244 Medial, 33, 35, 162, 211, 244, 250, 261 Median Nerve, 216, 244 Mediator, 24, 244, 254, 263 Medical Records, 6, 53, 67, 236, 244 MEDLINE, 187, 244 Megaloblastic, 231, 244 Melanin, 244, 253, 270 Membrane, 217, 220, 223, 240, 242, 244, 246, 250, 252, 253, 255, 260, 264, 270 Membrane Lipids, 244, 253 Membrane Proteins, 242, 244 Memory, 159, 209, 223, 244 Meninges, 217, 244 Menopause, 78, 123, 133, 150, 168, 244, 249, 252, 255, 256 Menstrual Cycle, 244, 249 Menstruation, 167, 208, 244, 245, 249 Mental Disorders, 245, 256 Mental Health, iv, 11, 54, 166, 168, 186, 188, 245, 249, 256, 258 Mental Processes, 225, 245, 257 Mentors, 27, 245 Meta-Analysis, 15, 69, 84, 87, 112, 125, 245 Metabolic disorder, 33, 148, 149, 233, 245 Metabolite, 242, 245, 255, 256 Metastasis, 244, 245 Metoprolol, 182, 245 Microbe, 245, 269 Microbiology, 33, 91, 205, 245 Microcalcifications, 215, 245

283

Microfibrils, 245, 254 Micronutrients, 12, 145, 245 Microorganism, 219, 245, 251, 272 Micro-organism, 223, 245 Microscopy, 55, 59, 213, 245 Microviridae, 14, 245 Midaxillary line, 245, 272 Milliliter, 214, 246 Millimeter, 246, 272 Minority Groups, 26, 246 Mitral Valve, 23, 60, 246 Mobilization, 217, 246 Modification, 20, 55, 100, 169, 246, 258 Molecule, 107, 210, 212, 219, 220, 225, 226, 227, 235, 246, 251, 254, 259, 263 Monitor, 24, 63, 65, 222, 246, 249 Monocyte, 20, 246 Mononuclear, 20, 87, 246, 270 Monounsaturated fat, 57, 246 Morphological, 25, 226, 246 Morphology, 20, 246 Motility, 160, 246, 263 Motion Sickness, 246, 247 Mucociliary, 246, 264 Multicenter study, 64, 246 Multiple sclerosis, 90, 246 Mutagenic, 42, 246 Mydriatic, 225, 246 Myelin, 246, 247 Myocardial Ischemia, 32, 63, 156, 209, 247 Myocardial Reperfusion, 247, 260 Myocardial Reperfusion Injury, 247, 260 Myocardium, 60, 155, 156, 209, 247, 261 N Nadolol, 182, 247 Nausea, 162, 231, 247, 271 NCI, 1, 166, 185, 218, 247 Necrosis, 238, 247, 260, 261 Nephropathy, 9, 159, 169, 240, 247 Neural, 13, 206, 210, 231, 247 Neural Pathways, 13, 247 Neuroendocrine, 38, 41, 248 Neurologic, 147, 248, 270 Neuronal, 218, 248 Neurons, 231, 248, 267 Neuropathy, 169, 174, 212, 248, 252 Neuropeptide, 160, 248 Neurotransmitter, 205, 214, 233, 248, 263, 267 Neutrophils, 234, 239, 248 Niacin, 146, 248, 270 Nicotine, 55, 170, 248

Nitric Oxide, 19, 40, 66, 126, 248 Nitrogen, 55, 159, 207, 208, 229, 248, 270 Norepinephrine, 13, 60, 160, 206, 248 Normotensive, 52, 248 Nuclear, 58, 170, 226, 247, 249 Nuclei, 226, 231, 243, 249, 250, 257 Nucleic acid, 20, 232, 248, 249 Nucleus, 218, 222, 223, 224, 239, 243, 246, 248, 249, 257, 265 Nutritional Status, 145, 167, 249 O Observational study, 53, 249 Occult, 53, 249 Occupational Exposure, 16, 54, 249 Occupational Health, 54, 249 Ocular, 14, 249 Odds Ratio, 249, 260 Oestrogen, 69, 249 Oligomenorrhea, 249, 254 Omega-3 fatty acid, 36, 37, 117, 128, 129, 131, 149, 249 Ophthalmoscope, 84, 249 Opiate, 156, 249 Opium, 249, 250 Opsin, 250, 261 Optic Chiasm, 237, 250 Optic Nerve, 249, 250, 260 Oral Health, 7, 22, 56, 103, 250 Ornithosis, 250, 257 Osmotic, 207, 250 Osteoarthritis, 160, 250 Osteoporosis, 31, 123, 162, 168, 229, 249, 250 Outpatient, 46, 51, 250 Ovaries, 236, 250, 254, 263 Ovary, 44, 170, 228, 233, 249, 250 Overweight, 5, 12, 16, 31, 69, 103, 105, 112, 119, 156, 181, 193, 250 Ovulation, 170, 209, 250 Ovum, 232, 241, 250 Oxidation, 20, 33, 40, 55, 145, 205, 210, 233, 241, 250, 251 Oxidative Stress, 19, 24, 42, 55, 75, 91, 150, 251 Oxygen Consumption, 229, 251, 260 P Palate, 251, 264, 271 Palliative, 249, 251, 268 Pancreas, 166, 205, 213, 239, 241, 251, 270 Papilla, 251 Papillary, 23, 251 Paranasal Sinuses, 251, 264

284

Coronary Heart Disease

Parasite, 251 Parasitic, 14, 251 Parenteral, 146, 227, 251 Parity, 96, 251 Parotid, 251, 262 Paroxysmal, 209, 251 Particle, 66, 67, 251, 269 Pathogen, 14, 21, 61, 251 Pathologic, 23, 46, 213, 222, 236, 251 Pathophysiology, 23, 32, 166, 251 Patient Compliance, 177, 251 Patient Education, 123, 167, 192, 198, 200, 203, 251 Pedigree, 44, 251 Pelvic, 252, 257 Pelvis, 205, 240, 243, 250, 252, 271 Peptide, 34, 47, 59, 157, 160, 230, 241, 252, 254, 257 Percutaneous, 103, 252 Perfusion, 28, 237, 252 Perimenopausal, 168, 252 Periodontal disease, 4, 6, 11, 22, 33, 56, 252 Periodontitis, 4, 6, 9, 11, 33, 95, 232, 252 Perioperative, 24, 252 Peripheral blood, 39, 87, 252 Peripheral Nervous System, 160, 248, 252, 267 Peripheral Neuropathy, 174, 252 Peripheral Vascular Disease, 12, 16, 35, 67, 155, 160, 252 Perivascular, 118, 252 PH, 89, 96, 106, 112, 214, 252 Phagocyte, 20, 252 Pharmacokinetic, 60, 252 Pharmacologic, 208, 234, 252, 269 Phenotype, 17, 90, 253 Phentermine, 12, 253 Phenylalanine, 253, 270 Phospholipases, 253, 264 Phospholipids, 19, 230, 241, 244, 253 Phosphorus, 145, 215, 253 Photocoagulation, 219, 253 Physical Fitness, 58, 82, 166, 253 Physiologic, 12, 66, 155, 207, 213, 234, 239, 244, 245, 253, 256, 259, 270 Physiology, 20, 94, 169, 215, 253 Pigment, 213, 243, 253 Pilot study, 17, 44, 253 Pituitary Gland, 230, 253 Plant sterols, 130, 253 Plants, 207, 214, 216, 218, 232, 233, 239, 246, 248, 253, 255, 269, 270

Plaque, 7, 36, 53, 55, 147, 148, 209, 211, 212, 253 Plasma cells, 209, 254 Plasma protein, 55, 207, 227, 254, 257 Plasmapheresis, 210, 254 Plasmin, 254, 268 Platelet Activation, 254, 264 Platelet Adhesiveness, 9, 254 Platelet Aggregation, 55, 208, 248, 254, 268 Platelet Factor 4, 239, 254 Plateletpheresis, 210, 254 Platelets, 68, 213, 248, 254, 268 Pneumonia, 20, 21, 221, 254 Poisoning, 239, 247, 254 Polycystic, 44, 160, 170, 236, 254 Polycystic Ovary Syndrome, 160, 170, 236, 254 Polymers, 254, 257, 266 Polymorphism, 69, 70, 74, 92, 105, 254 Polypeptide, 208, 219, 230, 254, 273 Polysaccharide, 210, 255 Polyunsaturated fat, 126, 130, 255, 268 Posterior, 208, 246, 251, 255, 271 Postmenopausal, 38, 39, 74, 75, 97, 117, 118, 125, 158, 168, 229, 250, 255 Postoperative, 23, 24, 255 Postoperative Period, 24, 255 Postprandial, 127, 255 Postsynaptic, 255, 263, 267 Post-translational, 55, 208, 255, 263 Potassium, 145, 225, 255 Potentiation, 255, 264 Practice Guidelines, 188, 194, 255 Pravastatin, 74, 121, 255 Precancerous, 217, 255 Precipitating Factors, 216, 255 Precursor, 16, 156, 209, 211, 218, 226, 228, 248, 253, 255, 256, 257, 270 Predisposition, 44, 148, 149, 150, 151, 154, 255 Pre-Eclampsia, 99, 213, 255 Premenopausal, 112, 255 Primary Prevention, 70, 77, 91, 107, 169, 256 Problem Solving, 48, 256 Prodrug, 146, 256 Progeny, 154, 256 Progression, 16, 20, 28, 30, 35, 36, 55, 144, 146, 152, 165, 209, 256 Progressive, 34, 211, 217, 218, 223, 226, 229, 247, 250, 254, 256, 260 Projection, 91, 248, 250, 256

285

Promyelocytic leukemia, 147, 256 Prone, 27, 36, 256 Prophylaxis, 155, 256, 261 Propranolol, 182, 211, 256 Prospective Studies, 10, 16, 256 Prospective study, 16, 44, 51, 55, 71, 85, 104, 112, 242, 256 Prostaglandin, 109, 209, 256, 268 Prostaglandins A, 256, 257 Prostate, 97, 125, 213, 249, 257, 270 Protease, 220, 257, 268 Protein C, 104, 132, 153, 207, 208, 210, 219, 241, 242, 257, 270 Protein S, 213, 232, 257 Proteinuria, 9, 16, 255, 257 Proteolytic, 207, 220, 230, 254, 257, 268 Prothrombin, 65, 229, 257, 268 Protocol, 42, 48, 56, 57, 62, 64, 65, 257 Protons, 236, 240, 257, 258 Proximate cause, 33, 257 Psittaci, 14, 22, 250, 257 Psychic, 245, 257, 258 Psychoactive, 257, 273 Psychology, 27, 48, 50, 60, 63, 100, 225, 257 Psychopathology, 27, 258 Psychosomatic, 32, 96, 99, 258 Puberty, 168, 258 Public Policy, 187, 258 Publishing, 4, 9, 10, 68, 170, 258 Pulmonary, 66, 126, 213, 229, 237, 240, 241, 258, 271 Pulmonary Alveoli, 237, 258 Pulmonary Artery, 213, 258, 271 Pulse, 168, 246, 258 Pupil, 222, 225, 246, 258 Q Quality of Life, 32, 34, 51, 62, 63, 64, 74, 98, 129, 181, 258 R Race, 7, 16, 26, 27, 36, 47, 82, 193, 258 Radiation, 209, 227, 231, 240, 258, 262, 273 Radioactive, 60, 214, 234, 236, 238, 242, 249, 258, 262 Radiological, 252, 258 Raffinose, 152, 258 Random Allocation, 258 Randomization, 12, 86, 258 Randomized, 11, 18, 23, 24, 31, 32, 34, 38, 39, 45, 63, 73, 84, 92, 110, 116, 124, 126, 226, 259 Randomized clinical trial, 39, 124, 259 Randomized Controlled Trials, 84, 259

Receptor, 21, 34, 44, 45, 61, 69, 148, 160, 161, 170, 205, 210, 259, 263 Receptors, Serotonin, 259, 263 Recombination, 231, 232, 259 Rectal, 225, 259 Rectum, 210, 220, 225, 231, 257, 259 Recurrence, 79, 146, 218, 259 Reductase, 120, 161, 242, 255, 259, 264 Refer, 1, 220, 225, 242, 259, 269 Reflex, 13, 259 Reflux, 160, 259 Refraction, 259, 265 Regeneration, 230, 259 Regimen, 226, 251, 259 Registries, 58, 259 Regurgitation, 23, 235, 259 Reinfection, 21, 259 Relative risk, 15, 66, 205, 260 Reliability, 31, 65, 260 Remission, 259, 260 Renal failure, 57, 260 Renin, 95, 105, 209, 260 Renin-Angiotensin System, 95, 209, 260 Reperfusion, 59, 247, 260 Reperfusion Injury, 59, 260 Reproductive cells, 232, 235, 260 Respiration, 210, 246, 260 Respiratory distress syndrome, 55, 260 Retina, 221, 249, 250, 260, 261 Retinal, 67, 250, 261 Retinoids, 261, 272 Retinol, 261 Retinopathy, 169, 253, 261 Retrospective, 40, 261 Retroviral vector, 231, 261 Rheumatic Heart Disease, 155, 261 Rheumatoid, 45, 219, 261 Rheumatoid arthritis, 45, 219, 261 Rhodopsin, 250, 261 Rod, 212, 218, 261 Root Canal Therapy, 33, 261 S Sagittal, 16, 261 Saliva, 261 Salivary, 7, 54, 223, 261, 273 Salivary glands, 223, 261 Saphenous, 222, 261 Saphenous Vein, 222, 261 Sarcoidosis, 21, 261 Scans, 29, 262 Schizoid, 262, 272 Schizophrenia, 159, 160, 262, 272

286

Coronary Heart Disease

Schizotypal Personality Disorder, 262, 273 Sclerosis, 211, 219, 246, 262 Screening, 12, 30, 37, 106, 117, 149, 160, 161, 174, 179, 219, 262 Scurvy, 145, 262 Seafood, 170, 262 Secretion, 160, 206, 218, 236, 239, 240, 262, 269 Secretory, 160, 262, 267 Secular trends, 46, 262 Sedentary, 31, 82, 174, 175, 262 Selection Bias, 5, 262 Selenium, 145, 262 Self Care, 205, 262 Semen, 257, 262 Senile, 118, 250, 262 Sensor, 153, 262 Sepsis, 55, 263 Sequence Analysis, 14, 263 Sequencing, 52, 263 Serine, 222, 263, 268 Serologic, 35, 263 Serotonin, 13, 224, 230, 248, 259, 263, 270 Serous, 227, 263 Sex Characteristics, 206, 208, 249, 258, 263, 268 Sex Hormone-Binding Globulin, 39, 263 Sex Ratio, 76, 263 Sexually Transmitted Diseases, 168, 263 Sharks, 13, 225, 263 Shock, 236, 263, 270 Side effect, 13, 148, 151, 162, 206, 237, 263, 269 Signal Transduction, 40, 169, 263 Simvastatin, 10, 18, 121, 162, 264 Sinusitis, 21, 264 Skeletal, 170, 208, 218, 264 Skeleton, 256, 264 Skin graft, 264, 266 Skull, 264, 268 Sleep apnea, 160, 264 Small intestine, 218, 236, 237, 239, 264 Smoking Cessation, 34, 100, 264 Smooth muscle, 25, 208, 215, 230, 260, 264, 267 Snoring, 62, 64, 264 Social Class, 54, 264 Social Environment, 258, 264 Social Isolation, 108, 262, 264 Social Security, 259, 264 Social Support, 15, 34, 50, 63, 140, 264, 266 Sodium, 106, 145, 225, 233, 265

Solitary Nucleus, 212, 265 Solvent, 229, 233, 250, 265 Somatic, 206, 252, 265, 271 Soy Proteins, 123, 265 Soybean Oil, 43, 255, 265 Spatial disorientation, 225, 265 Specialist, 195, 225, 265 Species, 55, 146, 225, 228, 251, 258, 263, 265, 267, 270, 272, 273 Specificity, 207, 265 Spectroscopic, 158, 265 Spectrum, 22, 40, 265 Sperm, 208, 218, 232, 235, 260, 265 Sphincter, 240, 265 Spinal cord, 214, 217, 218, 244, 247, 248, 252, 259, 265, 267 Spinal Nerves, 252, 265 Spleen, 223, 243, 261, 265 Sprains and Strains, 121, 242, 265 Staging, 262, 266 Statistically significant, 4, 7, 266 Steatosis, 230, 266 Steel, 218, 266 Stenosis, 21, 144, 156, 266 Stents, 126, 266 Sterility, 238, 266 Steroid, 222, 249, 264, 266 Stimulant, 224, 253, 266 Stimulus, 221, 239, 259, 266, 268 Stomach, 205, 225, 228, 231, 233, 236, 247, 259, 264, 265, 266 Stool, 220, 266 Stress management, 34, 49, 266 Stricture, 266 Styrene, 146, 266 Subacute, 27, 238, 264, 266 Subclinical, 16, 36, 37, 43, 93, 238, 266 Subcutaneous, 13, 206, 226, 251, 267, 272 Subspecies, 265, 267 Substance P, 245, 262, 267 Sudden cardiac death, 13, 25, 129, 267 Sudden death, 60, 160, 267 Supplementation, 127, 128, 144, 145, 267 Sympathetic Nervous System, 32, 160, 209, 212, 267 Sympathomimetic, 224, 228, 248, 253, 267 Symphysis, 218, 257, 267 Symptomatic, 77, 96, 267 Synapse, 206, 267, 270 Synaptic, 248, 264, 267 Synaptic Transmission, 248, 267 Synergistic, 51, 61, 267

287

Systemic, 7, 24, 33, 45, 103, 160, 210, 214, 219, 228, 238, 250, 261, 267, 269 Systemic disease, 7, 267 Systolic, 23, 32, 33, 35, 46, 52, 57, 157, 237, 267 Systolic blood pressure, 35, 57, 267 T Temporal, 52, 56, 268 Terminator, 219, 268 Testis, 208, 228, 233, 249, 268 Testosterone, 259, 263, 268 Therapeutics, 268 Third Ventricle, 237, 268 Thoracic, 17, 244, 268 Threshold, 192, 237, 268 Thrombin, 229, 230, 254, 257, 268 Thrombocytes, 254, 268 Thrombomodulin, 257, 268 Thrombosis, 66, 84, 89, 92, 99, 107, 108, 111, 213, 257, 266, 268 Thromboxanes, 211, 268 Thymus, 237, 243, 268 Thyroid, 93, 237, 240, 268, 270 Thyroxine, 207, 253, 268 Tissue, 19, 20, 22, 25, 34, 40, 45, 59, 60, 148, 149, 157, 206, 207, 210, 212, 213, 214, 215, 217, 219, 220, 221, 226, 227, 228, 229, 230, 231, 234, 237, 238, 239, 241, 243, 244, 247, 248, 252, 253, 254, 259, 260, 263, 266, 268, 270, 273 Tissue Plasminogen Activator, 22, 268 Tolerance, 84, 156, 205, 233, 268 Tomography, 27, 60, 77, 269 Tone, 248, 269 Tonicity, 160, 269 Tonometry, 105, 269 Tooth Loss, 22, 269 Tooth Preparation, 205, 269 Topical, 211, 229, 236, 269 Torsion, 55, 238, 269 Toxic, iv, 148, 227, 234, 237, 248, 262, 266, 269 Toxicity, 148, 225, 269 Toxicologic, 25, 269 Toxicology, 166, 188, 269 Toxin, 227, 268, 269 Trace element, 218, 269 Trachea, 214, 240, 268, 269 Traction, 218, 269 Transduction, 263, 269 Transfection, 213, 231, 269 Transfer Factor, 237, 269

Transforming Growth Factor beta, 129, 269 Transient Ischemic Attacks, 67, 270 Translational, 270 Translocation, 59, 270 Transmitter, 205, 244, 248, 270 Transplantation, 113, 218, 237, 243, 270 Trauma, 56, 247, 270 Trees, 229, 270 Tremor, 247, 270 Triglyceride, 8, 93, 128, 144, 149, 173, 174, 236, 237, 270 Tryptophan, 93, 219, 263, 270 Tumor marker, 213, 270 Tumor Necrosis Factor, 87, 270 Tunica, 227, 270 Tunica Intima, 227, 270 Tyrosine, 55, 170, 270 U Urea, 158, 270, 271 Uremia, 240, 260, 271 Urethra, 257, 271 Uric, 82, 233, 237, 271 Urinary, 17, 57, 67, 109, 215, 232, 268, 271 Urine, 17, 67, 213, 222, 235, 240, 257, 271 Urogenital, 168, 232, 271 Uterus, 227, 245, 250, 271 Uvula, 264, 271 V Vaccine, 21, 257, 271 Vagal, 13, 271 Vagina, 245, 271 Vagus Nerve, 265, 271 Valves, 23, 261, 271 Vasoconstriction, 160, 228, 271 Vasodilation, 118, 162, 209, 271 Vasodilator, 210, 214, 247, 271 Vasomotor, 32, 229, 271 VE, 7, 271 Vein, 209, 239, 249, 251, 261, 271 Venous, 65, 67, 213, 223, 241, 257, 271 Venous blood, 241, 271 Ventricle, 72, 237, 246, 258, 267, 268, 271, 272 Ventricular, 16, 23, 34, 38, 45, 53, 59, 118, 226, 237, 247, 272 Ventricular Dysfunction, 226, 272 Venules, 214, 215, 227, 272 Vertigo, 162, 272 Veterinary Medicine, 187, 272 Viral, 22, 269, 272 Virilism, 236, 272

288

Coronary Heart Disease

Virulence, 21, 212, 269, 272 Virus, 253, 261, 269, 272 Visceral, 28, 111, 174, 212, 271, 272 Visceral Afferents, 212, 271, 272 Visceral fat, 28, 272 Vitamin A, 145, 152, 261, 272 Vitro, 60, 61, 272 Vivo, 21, 60, 61, 272 W Waist circumference, 112, 174, 217, 272 Walkers, 58, 272 Weight Lifting, 169, 272

White blood cell, 209, 241, 243, 246, 254, 272 Withdrawal, 12, 159, 272 Wound Healing, 134, 147, 148, 230, 244, 273 X Xenograft, 209, 273 Xerostomia, 7, 273 X-ray, 214, 221, 243, 249, 262, 273 Y Yeasts, 253, 273 Z Zymogen, 257, 273

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