Marjolein van't Leven

BACKGROUND: Most knowledge on chronic fatigue (CF) and chronic fatigue syndrome (CFS) is based on clinical studies, not representative of the general population. This study aimed to assess the prevalence of fatigue in an adult general population and to identify associations with lifestyle factors. METHODS: Total 22,500 residents of Nijmegen were selected at random and interviewed by questionnaire. Data on 9062 respondents (43% response) were analysed, taken into account age, gender and concomitant disease. Subjects were classified into four groups: not fatigued (NF, reference group), short-term fatigue (SF, <6 months), chronic fatigue (CF, >or=6 months) and CFS-like fatigue (in accordance with the Center for Disease Control criteria for CFS, without clinical confirmation). RESULTS: Our study population showed the following breakdown: NF 64.4% (95% CI 63.6-65.6%), SF 4.9% (95% CI 4.5-5.4%), CF 30.5% (95% CI 29.5-31.4%) and CFS-like fatigue 1.0% (95% CI 0.8-1.2%). Compared with the NF group, more of the CFS respondents were female [odds ratio (OR) = 1.9], obese (OR = 4.1), using analgesics (OR = 7.8), had a low alcohol intake (OR = 0.4), were eating less healthy food (OR = 0.5) and were physically less active (OR = 0.1). These associations largely applied to the SF and CF group. The fatigue could have been due to a concomitant disease in 34 and 55.5% of the SF and CF cases, respectively. CONCLUSION: The prevalence of CF in the general population appears to be much higher than previously indicated. Even with strict criteria for CFS, it is estimated that approximately 1% of the adult population experiences this condition. Interestingly, a large part of this group remains unrecognized by the general practitioner. A striking similarity in lifestyle pattern between SF, CF and CFS calls for further research.

BACKGROUND: Celiprolol, a novel beta-blocker, may be more effective than propranolol in unstable angina pectoris because of both its beta 1-receptor selectivity and its vasodilatory property. METHODS: Fifty-three patients with angiographic coronary artery disease but uncompromised left ventricular function and with recurrent angina pectoris in spite of bed rest, aspirin, and repeated sublingual administration of nitroglycerin were randomized for 1 week of treatment with equipotent doses of either the nonselective beta-blocker propranolol (80 mg/day) or celiprolol (200 mg/day). RESULTS: Angina frequency was higher in the propranolol group (p < 0.01), whereas myocardial oxygen demand as estimated by the double product (systolic blood pressure x heart rate) was equally reduced by the two beta-blockers. Forearm blood flow was higher in the celiprolol group (p < 0.001). A stepwise logistic regression analysis showed that the beneficial effects of the beta-blockers were largely dependent on their effect on peripheral flow, in addition to reduction of the double product. CONCLUSIONS: Both celiprolol and propranolol largely reduce angina pectoris frequency in unstable angina pectoris. Celiprolol contributes to nearly complete relief in three times as many patients as propranolol; after adjustment for double product, it did so in eight times as many patients. The similar effects of the two compounds on the double product, and the essentially different effects on peripheral flow, support the theory that celiprolol exerts its beneficial effect to a large extent through its vasodilatory property.

Celiprolol, a novel beta blocker, may be more effective than propranolol in unstable angina pectoris because of both its beta-1-receptor selectivity and its vasodilator property. In the present report 53 patients with angiographic coronary artery disease but uncompromised left ventricular function and with electrocardiographically documented recurrent angina pectoris in spite of bed rest, aspirin, and repeated sublingual administration of nitroglycerin were studied. They were randomized for treatment with equipotent doses of either the nonselective beta blocker propranolol (80 mg/day) or the selective beta blocker with beta-2-agonistic property, celiprolol (200 mg/day) during one week. Angina frequency was higher in the propranolol group (P < 0.01), whereas myocardial oxygen demand as estimated by the double product (DP = SBP x HR, systolic blood pressure x heart rate) was equally reduced by the two beta blockers. Forearm blood flow was essentially higher in the celiprolol group (P < 0.001). A stepwise logistic regression analysis showed that the beneficial effects of the beta blockers were largely dependent on their effect on peripheral flow, in addition to reduction of the double product. The authors conclude that (1) Both celiprolol and propranolol largely reduce angina pectoris frequency in unstable angina pectoris. (2) Celiprolol contributes to nearly complete relief in three times as many patients as propranolol; after adjustment for double product or for systolic blood pressure plus heart rate it performs even eight times better. (3) The similar effects of the two compounds on the double product and the essentially different effects on peripheral flow support the conclusion that celiprolol exerts its beneficial effect to a large extent through its vasodilator property.