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

Coronary and left ventricular angiography repeated after an interval of 19 months in 84 patients showed progression of coronary sclerosis in 42 and of ventricular lesions in 7. No relation between the morphology and seriousness of the initial coronary lesions and their progression was noted. No significant differences were observed between patients with and without progression as far as the clinical data and risk factors (angina pectoris, prior myocardial infarct, cholesterol, arterial hypertension, and diabetes) were concerned, though there was a significantly higher percentage in obese subjects.
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PMID:[Progression of coronary sclerosis demonstrated by repeated coronarography. Experience with 80 cases]. 101 15

Exercise electrocardiograms were done on one thousand patients referred to the laboratory of exercise tests for: suggestive symptoms of acute heart failure, old miocardial infarction abnormal resting ECG, or evaluation of coronary reserve. The average value of cardiac rate reached for the group, was close to 80%. The maximum exercise loads managed by the men were superior to those of the women, and in general those managed in the negative test were superior in relation to the positive tests. Of the one thousand cases, 20.2% had positive exercise ECG's. There was no difference inthe percentages of positivity between the two sexes, 20.75% and 19.11% for men and women respecitvely. The percentages of positivity are greater in those subjects sent to the laboratory for suspicion of angina pectoris, old MI, or abnormal resting ECG, than in those referred for detection of ischemic heart disease. The groups of patients with diabetes mellitus, arterial hypertension, old MI, and abnormal resting ECG had the highest incidence of positive tests: 41%, 37.5%, 30.6%, and 28.2% respectively. The most frequent localization of the ST segment alterations was the anterior portion, with percentages of 85.1% similar to those mentioned in the literature. The frequency of arrithmias, of 12.4% in this group, is a little less than that described in similar groups, but it corroborates the predominance of non-lethal ventricular arrithmias. The mortality in the tests performed was null.
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PMID:[Results of 1000 electrocardiographic exercise tests. Their correlation with previous ischemic cardiopathy and arteriosclerotic risk factors]. 102 33

Patients having coronary bypass for stable angina pectoris were grouped on the basis of the two hour plasma sugar of the glucose tolerance test: Group I, 120 mgs% (159 grafts); Group II, 120-150 (93 grafts); Group III, 150-200 (131 grafts) and Group IV, 200 (57 grafts) or patients receiving therapy for diabetes mellitus (10 patients, 21 grafts). Five of 10 diabetic patients had genetic evidence of diabetes and an average duration of therapy of 6.5 years. Blood flow was measured in 461 grafts with an electromagnetic flow probe after discontinuation of cardiopulmonary bypass in a stable state, after a 30 second graft occlusion and after injection of 15 mg of papaverine into the graft. Mean arterial pressure, graft flow and coronary resistance for each succeeding group did not vary significantly when compared with Group I. Analysis of phasic flow in 10 grafts to the left anterior descending indicates that the same proportion of flow occurs during systole and diastole in the basal state and after pappaverine. Coronary flow and resistance in patients with abnormal glucose metabolism and maturity onset diabetes do not provide evidence for the existence of myocardial microangiopathy.
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PMID:Coronary graft flow and glucose tolerance: evidence against the existence of myocardial microvascular disease. 108 98

In a population of 744 diabetics composed mainly of elderly female patients, 172 developed hypertension after the onset of diabetes. Compared to normotensive diabetics, they had an increased prevalence of diabetic retinopathy (p less than 0.001), cerebral accidents, ischemic disorders of the lower limbs and a decreased glomerular filtration rate (p less than 0.05); they are frequently insulin-dependent and difficult to manage. In 173 other indivuals the diabetes emerged several years after the hypertension. This group was characterized by relatively easily controlled blood sugar and increased prevalence of angina and myocardial infarction (p less than 0.001). The association of hypercholesteremia with hypertension increases the risk of coronary disease (p less than 0.02) and, to a lesser degree, of glomerular insufficiency. The prevalence of coronary symptoms increases with obesity (p less than 0.05) while retinopathy increases with insulin dependence (p less than 0.001). From this information it may be concluded that the importance of various risk factors in the diabetic chiefly varies according to the vascular territory involved: cerebral vascular accidents occur mainly in hypertensives, while the presence of retinopathies, proteinuria and peripheral ischemia is directly related to the diabetes and particularly to insulin dependence. The risk of coronary lesions increases considerably when hypertension is added to the diabetes, with an even greater risk in the case of a diabetic, hypertensive, hypercholesterolemic nexus.
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PMID:[Factors of arterial and renal complications in diabetes]. 112 60

The clinical and pathological data from 46 patients who died during or shortly after coronary bypass surgery and one patient who died shortly after angiography were studied. Each patient was placed into one of three clinical categories of angina pectoris. Twelve were classified as having unstable angina pectoris, 20 as stable severe angina, and 15 as stable moderate angina. No significant difference was found between the three catagories whem age, sex, presence of hypertension, lipid abnormalities, diabetes, smoking, family history of myocardial infarction, or history of previous mycardial infarction were examined. Most patients in all classes of angina had extensive atherosclerotic coronary disease: 12 patients had triple vessel plus left main disease; 25, triple vessel disease; nine double vessel disease; and only one, single vessel disease. There was no difference in severity or distribution of coronary disease when the three catagories of angina were compared. Thirty-six of the 47 patients had evidence of scarring of one or more aspects of the left ventricular wall. There was likewise no significant difference between extent and distribution of myocardial scarring between the three clinical categories. Four of the 12 patients with unstable angina pectoris had pathologic evidence of preoperative myocardial infarction, whereas this was not found in any of the 35 patients with stable angina.
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PMID:Pathology of stable and unstable angina pectoris. 113 96

1) Patients with myocardial infarction constituted 2.36% of all the hospitalized patients during 1961-1968. The mortality of the hospitalized patients with myocardial infarction during the same term was 19.1%. The ratio of the male to female patients with myocardial infarction was 5.2. 2) As the risk factors of myocardial infarction, the following items were considered to be of importance: 1. gout in past history, 2. angina pectoris in family history, 3. diabetes mellitus in family history, 4. cigaret smoking over 40 pieces per day, 5. diabetes mellitus in past history, 6. administrative occupation, 7. serum cholesterol level over 250 mg/100 ml, 8. obesity of 20% excess over standard body weight, 9. hypertension in family history. 3) According to the statistical analysis, several groups of risk factors and interrelationship of risk factors are recognized.
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PMID:The incidence of myocardial infarction in hospitalized patients and the risk factors of myocardial infarction. 115 99

The relationship of cigarette-smoking and nonfatal myocardial infarction (AMI) was evaluated using the case-control approach. Overall, the association was present for smokers of one and two packs per day, the standardized rate-ratio estimates being 1.5 and 1.7, respectively. The association was strongest in those who had a low risk score for AMI and particularly strong for people in the earliest (fifth) decade of age. People with diabetes and/or angina manifested no association between cigarette-smoking and AMI.
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PMID:Cigarette-smoking and nonfatal myocardial infarction: rate ratio in relation to age, sex and predisposing conditions. 124 10

This letter was written in response to the paper by Mann et al. (British Medical Journal 2: 241-245, 1975) which reported an association between oral contraceptive (OC) use and acute myocardial infarction. Rosenberg et al. found that among 34 patients with myocardial infarction, 4 were current users of OCs and 2 used other estrogen-containing drugs. Among 1213 reference women the use was 79 and 26, respectively. The "relative risk" for OC users was 1.9 (95% confidence interval) and for other estrogen users it was 2.8 as compared with nonusers. When standardized for age these estimates became 2.2 and 2.1 and when standardized for the effects of cigarette smoking, history of hypertension, angina, and/ or diabetes the summary rate-ratio estimate for OC users decreased to 1.3 and left essentially unchanged the estimate for other estrogen users. These results are compatible with a modest increase, if any, in risk of myocardial infarction in premenopausal women associated with estrogen use, such as that reported by Mann et al.
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PMID:Letter: Myocardial infarction and estrogen therapy in premenopausal women. 126 57

In order to evaluate whether and to what extent elevated blood lipid concentrations and clinical expressions of coronary heart disease (CHD) are associated in the elderly, we studied the risk of CHD (myocardial infarction and angina pectoris) in a population of elderly hospitalized patients (210 subjects, 126 men and 84 women, average age 76 +/- 6 years) exposed to risk factors. 210 patients, free from current and previous cardiovascular diseases, age and sex matched, were recruited as the control group. Advanced senile decline, severe hepatic or renal failure and malignancies were considered exclusion criteria for both groups. The following dichotomic variables (familial history of CHD, cigarette smoking, clinical history of arterial hypertension or diabetes mellitus, hypercholesterolemia, hypertriglyceridemia) and continuous variables (total, LDL and HDL cholesterol, triglycerides, total/HDL cholesterol ratio, body mass index (BMI), years of exposure to risk factors) were considered. Using a stepwise multiple logistic regression forward method, the following variables resulted significantly associated with the risk of CHD: total/HDL cholesterol ratio (OR 1,89), BMI (OR 1,04), period of hypertension (OR 1,04) and cigarette smoke exposure (OR 1,007). We conclude that in the elderly the total/HDL cholesterol ratio can be a more predictive and reliable index of coronary risk than blood total cholesterol concentration.
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PMID:[Lipid parameters and cardiovascular risks in elderly patients hospitalized for ischemic cardiopathy. A case-control study]. 129 23

Without treatment, about 60% of atrial arrhythmia patients suffer a relapse within 3 months and 70% within one year. Antiarrhythmic treatment intended to reduce this percentage is therefore justified, on condition that it is well tolerated. Several preliminary questions have to be settled before this medical prophylaxis: 1) Justification of antiarrhythmic treatment (sometimes pointless to deal with very occasional episodes); 2) Treatment of the underlying heart disease (valve disease, cardiothyrotoxicosis, etc.) or promoting factors (potassium depletion etc.); 3) Accurate assessment of any associated conduction abnormalities, which may constitute a contraindication to antiarrhythmic treatment (WPW syndrome in the case of verapamil and the digitalis-like drugs) or require additional treatment (pacemaker); 4) Definition of the mechanism (vagal or sympathotonic) inducing arrhythmia; 5) Evaluation of the hemodynamic parameters of the underlying heart disease (size of the atria, ventricular function, coronary or valvular lesions) which may limit the efficacy of the treatment. Once these parameters have been identified, the primary treatment should be type la or lb antiarrhythmics, which have been shown to be effective, despite the fact that they are not without arrhythmic risks (the Ib antiarrhythmics are less effective and have a poor safety profile). The beta-blockers have preferential indications (hypersympatheticotonia, hyperthyroidism, hypertrophic myocardiopathy, mitral prolapse, angina etc.) and can be replaced by verapamil or bepridil if there are non-cardiac contraindications (ulcers, asthma, diabetes). Amiodarone is extremely effective, but its poor extracardiac safety restricts its long-term use. Complementary treatments (digitalis-like, anticoagulants or anti-PAF and cardiostimulant drugs) should be added if necessary. Recurrences (to be confirmed by ECG or Holter) should lead to rigorous confirmation of therapeutic compliance and observance of simple hygienic and dietary measures (no excessive exertion, elimination of stimulants etc.). With strict clinical and ECG monitoring, it would then be possible either to increase the dose levels (accompanied by plasma determinations if possible) or to switch to a treatment with more effective, but more aggressive drugs (amiodarone, flecainide) or to use drug associations (la and lb, la and II etc.). Repeated failure of such attempts should lead to a non-medical approach to treatment.
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PMID:[Preventive drug therapy of recurrence of atrial fibrillation]. 129 92


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