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Large prospective studies and intervention trials have identified major risk factors for premature heart disease in men, while the Framingham Heart Disease Study has provided the leading evidence of predictors of cardiovascular disease in women. We evaluated the role of these risk factors in a 13-year follow-up study of 8935 premenopausal and 2716 postmenopausal women in the Walnut Creek Contraceptive Drug Study cohort in Northern California. Elevated cholesterol levels, high blood pressure, smoking, obesity, family history of heart disease, and diabetes were investigated for their contribution to premature death due to all causes and due to cardiovascular disease. In addition, risk factor profiles were developed separately for users and nonusers of Premarin (conjugated estrogen) in the postmenopausal cohort. The results show that the strongest predictors of cardiovascular mortality among premenopausal women were smoking, high blood pressure, and diabetes, with relative risks of 2.8, 10.5, and 11.6, respectively. A disparity between high cardiovascular risk factor prevalence and low rates of premature heart disease indicates that the high relative risks will not be accompanied by large attributable risks. Nevertheless, the study reconfirms the need for screening women for heart disease risk because life-style changes can improve cardiovascular risk factors and can potentially reduce the chance of premature death even further.
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PMID:Cardiovascular risk factors, premature heart disease, and all-cause mortality in a cohort of northern California women. 337 34

During the tenth biennial examination of the Framingham Study, 1315 participants who were free of cardiovascular disease had fibrinogen levels measured. During the ensuing 12 years, cardiovascular disease developed in 165 men and 147 women. For both sexes, the risk of cardiovascular disease was correlated positively to antecedent fibrinogen values higher than the 1.3 to 7.0 g/L (126 to 696 mg/dL) range. The magnitude of the risk diminished with advancing age in women but not in men. Risk for coronary heart disease also was significantly related to fibrinogen level. Here, the magnitude of risk displayed diminishing impact with age, again only in women. Risk of stroke increased progressively with fibrinogen level in men but not in women. The impact of fibrinogen value, considered as a separate variable, on cardiovascular disease was comparable with the major risk factors, such as blood pressure, hematocrit, adiposity, cigarette smoking, and diabetes. Fibrinogen values were also significantly related to these risk factors. Taking all these into account in a multivariate analysis, fibrinogen level was still significantly related to the incidence of cardiovascular disease in men and marginally significant in women. For coronary heart disease, the fibrinogen level was significant for both men and women. Elevated fibrinogen level is a predictor of cardiovascular disease that should be added to the cardiovascular risk factor profile.
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PMID:Fibrinogen and risk of cardiovascular disease. The Framingham Study. 362 1

In the Whitehall study of 18 403 male civil servants aged 40-64 years the 10 year mortality rates from coronary heart disease and stroke showed a non-linear relation to two hour blood glucose values, with a significantly increased risk for glucose intolerant subjects with concentrations above the 95th centile point (5.4-11.0 mmol/l; 96-199 mg/100 ml) and for diabetics (blood glucose greater than or equal to 11.1 mmol/l; greater than or equal to 200 mg/100 ml). Multiple logistic analysis showed that between one half and three quarters of the relative risks for deaths from coronary heart disease and stroke were "unexplained" by between group differences in risk factors such as age, blood pressure, obesity, smoking, cholesterol concentration, and electrocardiographic abnormalities. Within the glucose intolerant and diabetic groups the risk factors most strongly related to subsequent death from coronary heart disease were age and blood pressure, with less consistent relations for smoking, cholesterol concentration, and obesity. This study confirms the importance of hypertension as a cardiovascular risk factor in groups with glucose intolerance and diabetes, and this may have important preventive implications.
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PMID:Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall study. 641 62

Resting heart rates were ascertained during the 1978-1979 school year in 3590 children aged 5-17 years in the biracial geographic population of Bogalusa, Louisiana. These rates were found to be relatively independent of the method of measurement, whether supine by physician's stethoscope or dressed sitting radial pulse taken by a nurse, and in either case adhering to a strict measurement protocol. Apart from the known influences of age and sex, the authors found a small but consistent racial influence, with whites having 3-4 beats/min higher rates than blacks. Controlling for age, the authors found heart rate to be positively correlated with blood pressure in whites and with subcapsular skinfold thickness in boys. No consistent relation between heart rate and amount of cigarettes smoked was observed. Boys in the upper five percentiles of blood pressure-heart rate ("double") product values were found to have about twice the subscapular skinfold thickness compared to the lower five percentiles. Likewise, boys in the upper five percentiles of subscapular skinfold thickness had significantly increased double products. Since the double product is an index of cardiac oxygen consumption, this finding could point to a possible etiologic link between obesity and chronic cardiac stress in males beyond the mediation of lipoproteins, cholesterol, and diabetes mellitus in contributing to atherosclerotic heart disease, but this issue needs further study. Ascertainment of resting heart rate provides an additional parameter in the study of cardiovascular risk factor variables, in youth as in adulthood, to supplement the natural history of the atherosclerosis-hypertension syndrome with its sequelae.
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PMID:Resting heart rate and pressure-rate product of children in a total biracial community: the Bogalusa Heart Study. 711 38

Insulin resistance is associated to hypertension, obesity and diabetes and may be an independent cardiovascular risk factor. The exact assessment of insulin resistance requires complex metabolic studies. However, there is a good correlation between this parameter and fasting serum insulin levels. The aim of this work was to study fasting serum insulin levels by radio immuno analysis in 43 hypertensive patients aged 56 +/- 5.5 years old (27 male, 17 obese and 8 diabetics) and 20 normotensive controls aged 50 +/- 4.8 years old (13 male). Insulin levels were 3.8 UI/L in controls, 12.1 UI/L in normal weight, 15.5 UI/L in obese and 18.3 UI/L in diabetic hypertensives (ANOVA p < 0.001). These levels were above two standard deviations of control values in 50% of normal weight, 66% of obese and 62% of diabetic hypertensives. It is concluded that normal weight, obese and diabetic hypertensive subjects have high fasting insulin levels.
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PMID:[Blood insulin in fasting conditions as a simple marker of insulin resistance in hypertensive patients]. 756 42

Diabetes mellitus is often associated with hypertension and is an additional cardiovascular risk factor. It is therefore important that antihypertensive drugs should have no negative metabolic effects. We present here the results of two distinct studies investigating the clinical efficacy and the metabolic effects of lacidipine in hypertensive patients without concomitant diabetes. Patients in the first study (group A) were hypertensive with non-insulin-dependent diabetes mellitus (NIDDM) and stable blood glucose levels in the 3 months before entering the study. Patients in the second study (group B) were hypertensive without diabetes mellitus. Before the commencement of the study, antihypertensive treatment was discontinued in all patients for a 4-week washout period, followed by 4 weeks of run-in with placebo. Patients were then treated with lacidipine (4 mg o.d.) for 6 months. After 1-2 months, the dose was doubled in patients with uncontrolled blood pressure. Every 2 months, lipid and carbohydrate metabolism were investigated by blood chemistry analyses. The results demonstrate that lacidipine 4-8 mg o.d. is efficacious and well tolerated in hypertensive patients, even in the presence of diabetes mellitus.
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PMID:Antihypertensive and metabolic effects of lacidipine in patients with NIDDM and/or hypertension. 760 95

Low-density lipoproteins (LDLs) exist as discrete subfractions that vary in size and density. A predominance of small, dense LDLs is seen in patients with ischaemic heart disease and non-insulin-dependent diabetes, and is more common in men than in women. Because small, dense LDLs are associated with increased levels of triglycerides and low levels of high-density-lipoprotein cholesterol, their exact role as an independent cardiovascular risk factor is unknown. These lipoproteins exhibit abnormal characteristics, however, such as increased susceptibility to oxidation and decreased LDL receptor binding, which may result in increased atherogenicity.
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PMID:Biological importance of low-density-lipoprotein subfractions. 762 Dec 99

Reports on the incidence and predictors of diabetes in minority populations are infrequent. The 6-year cumulative incidence of diabetes between 1965 and 1974 was estimated among 7210 Japanese-American men aged 45 to 68 years who were enrolled in the Honolulu Heart Program and were free of clinically recognized diabetes at baseline. The incidence of "possible" diabetes (based on history, medication, or hospital diagnosis) was 12.8% and the incidence of "probable" diabetes (based on diabetic medication) was 5.7%. Estimates of incidence in subjects with a nonfasting glucose concentration less than 225 mg/dL 1 hour after a 50-g load were 9.7 and 4.0%, respectively. Multivariate adjusted odds ratios (ORs) for probable diabetes in all subjects comparing the upper quintile with the lower four quintiles combined for continuous variables indicated statistically significant direct associations with body mass index (OR, 1.69; 95% confidence interval (CI), 1.31 to 2.18), 1-hour postchallenge glucose level (OR, 5.79; 95% CI, 4.58 to 7.33), triglyceride levels (OR, 1.47; 95% CI, 1.14 to 1.91), systolic blood pressure (OR, 1.36; 95% CI, 1.05 to 1.76), and parental history of diabetes (OR, 1.73; 95% CI, 1.29 to 2.33), and an inverse association with physical activity (OR, 0.49; 95% CI, 0.34 to 0.72), using logistic regression models including these variables as well as age, subscapular/triceps skinfold ratio, and hematocrit simultaneously. Associations were similar but slightly weaker in men with glucose levels less than 225 mg/dL and in those who remained free of cardiovascular disease. When older men (55 to 68 years old) were compared with younger (45 to 54 years old) men, associations among the older group were stronger for body mass index, physical activity, and systolic blood pressure and they were weaker for glucose levels, triglyceride values, and parental diabetes. Results suggest that body mass index, physical inactivity, glucose level, and parental diabetes appear to be independent risk factors for diabetes, while triglyceride and systolic blood pressure levels may be markers for an adverse cardiovascular risk factor profile associated with diabetes and may reflect an insulin resistance syndrome.
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PMID:Incidence and predictors of diabetes in Japanese-American men. The Honolulu Heart Program. 772 83

The aim of the study was to assess the current cardiovascular risk factor profile including data on treatment of a representative population over the age of 65 in Germany. From a total of 1190 inhabitants > or = 65 years living in two Bavarian villages near Munich, 982 could be visited at home ("door-to-door" survey), where a questionnaire and the measurement section were performed (response rate 82.5%). Blood pressure was measured three times in the sitting position with a standard sphygmomanometer, ("actual") hypertension was defined as systolic blood pressure > or = 160 mm Hg and/or diastolic blood pressure > or = 95 mm Hg or effective antihypertensive treatment. Obesity was defined as body mass index > or = 27.8 kg/m2 for men or > or = 27.3 kg/m2 for women, hypercholesterolemia as total cholesterol > or = 250 mg/dl (6.5 mmol/l), diabetes as fasting serum glucose > 120 mg/dl, glucosuria or treatment with insulin or oral antidiabetics. With a prevalence of 53% hypertension was the leading risk factor, followed by obesity with 35% and hypercholesterolemia with 21%; smoking and diabetes were observed in < 10%. Hypertension and obesity tended to be more prevalent in women, diabetes in men; hypercholesterolemia was significantly more prevalent in women. While the prevalence of hypertension increased up to the age groups "75-79 years" in men and "80-84 years" in women, there was a constant decrease with age for obesity, hypercholesterolemia and smoking. Three-quarters of the participants showed a minimum of one cardiovascular risk factor, the risk factor combination "hypertension/hypercholesterolemia/smoking" was observed however only in 1%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cardiovascular risk factors in patients over 65-years of age in Germany. Results of the STEPHY Study (Starnberg Trial on Epidemiology of Parkinsonism and Hypertension in the Elderly)]. 782 73

Sixty-one children with insulin-dependent diabetes mellitus and twenty-three healthy subjects were investigated. The patients with diabetes mellitus aged 4 to 20 years (13.4 +/- 4.0) had had diabetes for 1 to 16 years (6.4 +/- 3.5). There were no cardiovascular risk factor other than diabetes. Patients received no medication other than insulin. The following echocardiographic and Doppler parameters of the left ventricle were analyzed in both groups: systolic and diastolic dimensions, systolic time intervals, fractional shortening, mean velocity of circumferential fiber shortening, percent relaxation of the left ventricular posterior wall at 50% of diastole, peak velocity of early (E) and late atrial (A) mitral flow. E/A ratio, deceleration of the E-wave, and the isovolumetric relaxation time. None of the parameters were significantly different between the groups. There was no relation observed between duration of diabetes and any of the parameters analyzed. It is concluded that there is not echocardiographic data to support the concept of diabetic cardiomyopathy in adolescents with type I (insulin-dependent) diabetes mellitus.
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PMID:Left ventricular function determined by Doppler echocardiography in adolescents with type I (insulin-dependent) diabetes mellitus. 783 62


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