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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Quantitative electrocardiographic (ECG) and vectorcardiographic (VCG) analysis was carried out in 113 newly diagnosed, middle-aged, non-insulin-dependent diabetics (61 men, 52 women) and 125 non-diabetic control subjects (56 men, 69 women) in order to explore changes attributable to non-coronary heart disease (diabetic cardiomyopathy) in diabetics. Diabetic men had a prolonged PQ interval and women a more negative P-terminal force and a more leftward frontal QRS axis than their non-diabetic counterparts, but no other significant differences we found between diabetic and non-diabetic subjects in various quantitative ECG and VCG variables when the effect of confounding factors (age, obesity, coronary heart disease, hypertension, drugs) was taken into account. The more negative P-terminal force and left axis deviation in diabetic women could be explained by a concomitant left ventricular hypertrophy among them. Non-insulin-dependent (type 2) diabetes, which is commonly preceded by a long duration of asymptomatic hyperglycaemia, is not associated, early in its clinical course, with major ECG and VCG abnormalities suggestive of diabetic cardiomyopathy.
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PMID:Quantitative electrocardiographic and vectorcardiographic study on newly-diagnosed non-insulin-dependent diabetic and non-diabetic control subjects. 334 19

The National High Blood Pressure Education Program has released three Joint National Committee reports and a task force report on the detection, evaluation, and treatment of high blood pressure. Like its predecessors, the 1988 Joint National Committee report was developed using the consensus process; it is based on the latest scientific research and reflects the state of the art regarding hypertension management. This report updates findings of previous reports in several respects: it broadens the step-care approach to provide more flexibility for clinicians; encourages greater patient involvement in the treatment program; emphasizes a consideration of the quality of life in the management of patients; and addresses the cost of care. It also provides more emphasis on control of other risk factors for cardiovascular disease; includes a discussion of the new cholesterol guidelines; recommends a reduction in alcohol consumption; and discusses the use of calcium and fish oil supplementation. This document expands earlier reports on special populations, including blacks and other racial and ethnic minority groups, young and elderly patients, pregnant patients, surgical candidates, and hypertensive patients with cerebrovascular disease, coronary artery disease, left ventricular hypertrophy, congestive heart failure, peripheral vascular disease, renal disease, chronic obstructive pulmonary disease or bronchial asthma, gout, diabetes mellitus, and hyperlipidemia. The report also updates previous drug tables to include new drugs, revised recommended doses of some drugs, and drug interactions. Consideration of step-down therapy after blood pressure has been controlled is suggested. This report is intended as a guide for practicing physicians and other health professionals in their care of hypertensive patients and as a reference for those participating in the many community high blood pressure control programs throughout the country.
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PMID:The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. 256

Although cardiovascular disease remains the leading cause of death in the United States, its incidence has decreased steadily during the past 20 years. This trend is largely attributable to improved detection and management of cardiovascular risk factors. The pioneering work of the Framingham Heart Study, which has followed subjects since the late 1940s, has helped shed light on the risks conferred by factors such as advancing age, hypertension, smoking, elevated serum cholesterol, diabetes, left ventricular hypertrophy, and obesity. As a result of this ongoing investigation, clinicians have gained a better understanding of the ways in which cardiovascular risks can be modified so that mortality rates will hopefully continue to decline.
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PMID:Cardiovascular risks: new insights from Framingham. 339 38

Acromegaly involves cardiovascular complications mostly due to the presence of hypertension, diabetes and atherosclerosis. However the appearance of cardiac decompensation and arrhythmias in the absence of predisposing factors tends to support the hypothesis of a specific myocardiopathy caused by excess GH. In order to assess the existence and course of subclinical cardiac alterations, 8 acromegaly patients were examined: 4 males and 4 females aged 31-56 with GH levels of 24-70 ng/ml (M + CD X 47 +/- 16) and no cardiovascular symptoms. One of the patients had moderate hypertension and 2 reduced glucose tolerance. The basal ECG showed sporadic ventricular extrasystoles in 2 cases and alterations compatible with left ventricular hypertrophy in another, while the effort ECG produced an asymptomatic depression of the ST segment in the hypertensive patient. The chest X-ray was normal in all cases. The echocardiography study investigated: the thickness of the interventricular septum (IVS = 13.9 +/- 2.8 mm), the thickness of the posterior wall of the left ventricle (LPW = 10.6 +/- 2.9 mm), the septum/posterior wall ratio (IVS/LPW = 1.3 +/- 0.2 the diastolic diameter (DD = 15.4 +/- 11.4 mm), the fraction of shortening (FS = 39.1 +/- 14.5%), the ejection fraction (EF = 64.1 +/- 18.4%) and revealed asymmetrical septal hypertrophy in 3 cases, concentric hypertrophy in another two. In two cases the DD and EF were distinctly altered. The patients were re-examined 2-4 years after surgical or radiation treatment. GH levels (M +/- SD = 10.3 +/- 10.1 ng/ml) were normal in 4 cases and still high, though lower in another two. The remaining two patients had borderline GH levels with high Sm-C. The ECG and chest X-ray were unchanged while echocardiography revealed a significant deterioration in heart function as far as DD (56.4 +/- 10.8 mm, p less than 0.05) were concerned with frankly pathological results in 4 and 3 cases respectively. These data confirm the view that most acromegalic patients present subclinical abnormalities in cardiac function and that the evolution of these is slightly influenced by the reduction in GH and Sm-C. levels. In fact, while the persistence of high GH and Sm-C. levels may explain the progression of cardiac alterations in some cases, it does not in others. It is also emphasised that echocardiography appears to be the most sensitive non-invasive technique for the diagnosis and follow-up of cardiac involvement in acromegaly.
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PMID:[Cardiological findings in acromegaly]. 343 27

Over the past years, research efforts have been focused on the pathophysiologic role of calcium ions, and the implication for the potential role of calcium channel blockers in the management of essential hypertension. Numerous studies have shown that nifedipine and verapamil are effective antihypertensive agents, initial experience with diltiazem is also encouraging. The magnitude of blood pressure reduction with these drugs is related to the pre-treatment blood pressure. In refractory hypertension, combination with other antihypertensive agents provide additive effect. In the elderly population and in patients with ischemic heart disease, supraventricular arrhythmia, bronchospastic disease, peripheral vascular disease or diabetes mellitus, the calcium channel blockers offer potential advantages over other antihypertensive agents. Experimental studies also suggest that these drugs may reverse ventricular hypertrophy. When long-term safety with these drugs is documented from well-controlled clinical trials, the calcium channel blockers may be our first line of therapy for the management of hypertension.
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PMID:Calcium channel blockers and treatment of hypertension. 351 92

Risk factors for cardiovascular disease include atherogenic personal attributes, living habits that promote them, signs of preclinical disease and host susceptibility. Atherogenic traits include the blood lipids, blood pressure and glucose tolerance. An increased low density lipoprotein cholesterol level is positively related, and an increased high density lipoprotein cholesterol level is inversely related, to cardiovascular disease incidence. Hypertension, whether systolic or diastolic, labile or fixed, casual or basal, at any age in either sex contributes greatly. The impact of diabetes is greater for women than men and varies depending on the level of the foregoing risk factors. An atherogenic lifestyle is typified by a diet excessive in calories, fat and salt, sedentary habits, unrestrained weight gain and smoking. Alcohol used in moderation may be beneficial. Oral contraceptives worsen atherogenic traits and, when used for long periods beyond age 35 and in conjunction with cigarettes, predispose to thromboembolism. Type A persons with an overdeveloped sense of time urgency, drive and competitiveness develop an excess of angina pectoris. Men married to more highly educated women are at increased risk as are men married to women in white collar jobs. Preclinical signs of compromised coronary circulation include silent myocardial infarction, left ventricular hypertrophy on the electrocardiogram, blocked intraventricular conduction and repolarization abnormalities. An electrocardiogram obtained during exercise may elicit still earlier evidence. Measures of innate susceptibility include a family history, history of premature cardiovascular disease, diabetes, hypertension and gout. Optimal prediction of risk requires a quantitative combination of risk factors in multiple logistic risk formulations to identify high risk persons with multiple marginal abnormalities.
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PMID:Status of risk factors and their consideration in antihypertensive therapy. 354 87

The relationship of blood pressure to fasting and postglucose serum insulin and lipid levels was examined in 133 (70 men, 63 women) newly diagnosed, non-insulin-dependent diabetic patients and 144 (62 men, 82 women) non-diabetic control subjects. In addition, the frequency of left ventricular hypertrophy by ECG criteria and left ventricular mass determined by M-mode echocardiography in diabetic patients were compared to that in non-diabetic subjects. Fasting serum insulin showed a significant correlation with systolic and diastolic blood pressure levels in male non-diabetic subjects, but not in male and female diabetic or in female non-diabetic subjects. Postglucose serum insulin levels showed no significant correlations with systolic or diastolic blood pressure levels in men, but in female diabetic and non-diabetic subjects significant correlations were found in particular with systolic blood pressure level. The correlations between serum insulin and blood pressure levels could not be accounted for by obesity. In male and female diabetic subjects serum triglycerides correlated positively with systolic and diastolic blood pressure levels even after adjustment for obesity. No significant difference was found in the prevalence of left ventricular hypertrophy based on ECG criteria between diabetic and non-diabetic subjects, but female diabetic subjects showed in echocardiography an increased left ventricular mass related to body surface area compared to their non-diabetic counterparts. Elevated systolic blood pressure and high postglucose serum insulin levels showed an independent, significant association with left ventricular mass in female diabetic subjects.
Diabetes Res 1987 Jan
PMID:Relationship of blood pressure and left ventricular mass to serum insulin levels in newly diagnosed non-insulin-dependent (type 2) diabetic patients and in non-diabetic subjects. 355 63

Since 1965, the Honolulu Heart Program has followed 8006 men of Japanese ancestry, aged 45-70 yr at study entry, for the development of cardiovascular disease. To investigate the role of glucose concentration 1 h after a 50-g challenge on the risk of fatal coronary heart disease (CHD) and nonfatal myocardial infarction (MI), 6394 nondiabetic men were followed for 12 yr for the first development of CHD. The rate of fatal CHD increased linearly with amount of glucose. Men in the fourth quintile of postchallenge glucose (157-189 mg/dl) had twice the age-adjusted risk of fatal CHD of those in the lowest quintile (P less than .05). Relative risk increased to threefold among those in the top quintile and remained statistically significant after adjustment for other risk factors including body mass, total cholesterol, hypertension, left ventricular hypertrophy, and hematocrit (P less than .001). When glucose was considered as a linear term in the proportional hazards model, a highly significant relation was noted with fatal CHD alone and when combined with nonfatal MI (P less than .001). We conclude that a continuously increasing risk gradient exists between postchallenge glucose and subsequent CHD that is independent of other known risk factors.
Diabetes 1987 Jun
PMID:Postchallenge glucose concentration and coronary heart disease in men of Japanese ancestry. Honolulu Heart Program. 356 69

Criteria for the diagnosis of exercise hypertension have not yet been established. Published values for blood pressure increase during dynamic exercise in normotensive healthy persons differ greatly dependent on age, sex, heart frequency and load of dynamic exercise. Upper normal systolic values during exercise reach levels between 200 and 230 mm Hg. The incidence of exercise hypertension is therefore reported to range from 1 to 10% of the total population. Follow-up studies show that 10 to 60% of persons with isolated exercise hypertension proceed to chronic arterial hypertension. No results are available on exercise hypertension as a risk factor in contrast to the well-known link between increased systolic and diastolic casual blood pressure and cardiovascular diseases. The development of left-ventricular hypertrophy depends mainly on the average systolic blood pressure during a 24-hour period. Peak values of systolic blood pressure during the day or blood pressure variability are less important. Drug treatment of isolated exercise hypertension is not generally accepted. Non-drug treatment is to be preferred, e.g. weight reduction in overweight, dietary sodium restriction and endurance training. Drug treatment must be considered, if non-drug treatment is unsuccessful and/or risk factors, for example hypercholesterolemia, diabetes, cigarette smoking, or complications of target organs, i.e. coronary heart disease or cerebral infarction, do exist. In antihypertensive treatment of increased exercise blood pressure, the influence of the drugs on the hemodynamic and metabolic parameters must be observed, especially in patients with concomitant coronary heart disease. Increases in blood pressure due to dynamic exercise are better attenuated by antihypertensive drugs than those caused by isometric exercise. The drugs of choice are beta-blockers, preferably beta 1-blockers without ISA. Alternatively, calcium antagonists of the verapamil-type or ACE-inhibitors may be used. In contrast to other antihypertensive drugs, labetalol, calcium antagonists and ACE-inhibitors have no influence on the exercise-induced increase of cardiac index and therefore little effect on the work capacity of the circulatory system.
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PMID:[Differential therapy of exercise hypertension]. 358 8

The prevalence, incidence, secular trends, precursors and prognosis of cardiac failure (CHF) is investigated over 3 decades of follow-up of 5209 subjects. Some 485 men and women developed first evidence of CHF. Annual incidence increased from 3 per 1000 at ages 35-64 years to 10 per 1000 at ages 65-94 years with a male predominance because of higher rates of coronary disease. Half developing CHF had coronary disease, but only 10% were free of concomitant hypertension. Appearance of coronary disease conferred an 8-fold increased risk of CHF. Hypertension is the dominant precursor of CHF, increasing risk 2-6 fold; 70% had antecedent hypertension. Systolic pressure was more predictive than diastolic. Non-specific S-T and T-wave changes, intraventricular conduction disturbances and left ventricular hypertrophy were powerful predictors, even taking blood pressure into account. Other independent risk factors include: low vital capacity, rapid heart rate, diabetes, cardiac enlargement, overweight (in women), serum cholesterol (in men under 65 years of age), cigarettes, proteinuria and hematocrit. Risk of CHF can be estimated over a 30-fold range from profiles made up of these independent risk factors. A preventive approach is essential. Despite potent glycosides, diuretics, vasodilators and antihypertensive treatment CHF continues to be a lethal end-stage of heart disease with a 50% 5 year mortality rate. Sudden death is a prominent terminal feature occurring at 9 times the general population rate.
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PMID:Epidemiology and prevention of cardiac failure: Framingham Study insights. 366 63


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