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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The results of large epidemiological studies dealing with the prognosis and unfavourable outcome of essential hypertension, clearly show that the pharmacological reduction of the elevated blood pressure of hypertensive patients significantly reduces the risk of at least some major cardiovascular complications. Satisfactory antihypertensive efficacy reflects, nevertheless, merely a minimal requirement for a modern antihypertensive drug. Additional pharmacological properties, which counteract the typical concomitant diseases like CHD, heart failure and other cardiovascular complications would be desirable. In this respect, the oral CE-inhibitors captopril and enalapril offer an exciting new approach to the treatment of arterial hypertension. As the most predictive international studies on prevention of hypertension were conducted before CE-inhibitors were available, the present review evaluates the pharmacological profile of this new class of antihypertensive compounds in the light of previously available baseline drugs, including the calcium channel antagonists. Until now, captopril and enalapril have been the best investigated and documented representatives. Besides new experimental results concerning the molecular mechanism of these drugs, clinical and experimental approaches to verify protective effects on the cardiovascular and the renal system are addressed. These offer a rational basis for the preferential treatment of hypertensive patients with reduced renal function, diabetes and chronic heart failure. In addition, some distinct advantages of enalapril over captopril, resulting mainly from the long-term reduction of high blood pressure, are discussed.
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PMID:[Differential therapeutic topics in antihypertensive therapy. What can angiotensin-converting enzyme inhibitors accomplish?]. 285 Jun 83

Human plasma contains a factor capable of stimulating vascular prostacyclin generation even in atherosclerotic vessels with minimal in-vitro capacity for PGI2-synthesis. The activity of this prostacyclin stimulating plasma factor (PSPF) has been reported to be elevated in renal failure and hepatic coma. We are not aware of any data as to whether this PSPF plays a role in maintaining hemostatic balance in patients with peripheral vascular lesions. Therefore, we examined 62 patients with peripheral vascular disease (PVD). This study group was subdivided into normo- and hyperlipemic subjects, patients with and without maturity onset diabetes, and plasma beta-thromboglobulin levels higher and lower than 50 ng/ml. 10 healthy sex and age matched persons served as controls. Vascular prostacyclin formation was studied in vitro after incubation of the patients' plasma and a buffer control with various tissue samples (human femoral artery, rat abdominal and thoracic aorta of healthy and of streptozotocin induced diabetic animals, swine endothelial layer and remaining tissue (media and adventitia) and cultured endothelial (EC) and smooth muscle cells (SMC) of minipig arota. In addition, 6-oxo-PFG1 alpha formation by cultured EC and SMC (minipig aorta source) after incubation with tris HCl-buffer or plasma were estimated by means of specific radioimmunoassays. In general, tissue samples and cells incubated in plasma exhibit a marked increase of in-vitro PGI2-formation as compared to buffer. No difference could be found between PSPF of CHD-patients and healthy controls. Similar findings were obtained using incubated vascular tissue and cultured cells by means of the bioassay and specific RIA, respectively. These findings indicate that the PSPF does not seem to be of any clinical relevance in hemostatic regulation in patients with advanced atherosclerosis.
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PMID:Prostacyclin synthesis stimulating plasma factor in patients with peripheral vascular disease. 295 84

A computer-assisted staged system of a follow-up of factory workers with CHD and diabetes mellitus was developed. It included automated screening by questionnaire, ECG and biochemical screening, physical examination, investigation of the basic carbohydrate-lipid indices, more detailed examination in out- or inpatients settings using up-to-date diagnostic methods (bicycle ergometry, monitoring after Holter, etc.), identification of groups for a follow-up, and therapeutic and sanitary measures. A total of 27750 persons were investigated. The most important group was that including persons with risk factors: vegetovascular dystonia developing into CHD (6%) or essential hypertension (20%). Sanitary measures by unified methods caused a decrease in temporary disability with the economic effect of 197,000 rubles.
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PMID:[Characteristics of the dynamic outpatient observation of workers at an industrial enterprise]. 297 90

A random sample of men (319) aged 20 to 59 was examined in one of the administrative districts in Moscow. A study was made of the blood plasma content of HDL2 and HDL3 cholesterol, triglycerides with relation to insulinemia and glycemia both on an empty stomach and during the GTT. An analysis of the data obtained led to a conclusion that the level of insulinemia was a factor influencing the level of HDL2 and HDL3. Derangements in the metabolism of the above lipoproteins were likely to be associated with a high risk of CHD development especially among patients with diabetes mellitus. Therapeutic measures aimed at insulin secretion reduction were recommended for the normalization of lipid metabolism including the content of HDL2 and HDL3.
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PMID:[Indices of carbohydrate metabolism and levels of HDL2 and HDL3 cholesterol in the blood plasma of males]. 332 Oct 31

The impact of risk factors for sudden and non-sudden coronary death was investigated in 3,589 Finnish men aged 40-59 years at entry from a prospective population survey. During a mean follow-up time of 11 years, 234 coronary deaths occurred, 150 of which were sudden, i.e. ensuing within 1 hour of the onset of symptoms. The severity of the manifestations of CHD at baseline investigation appeared to be a powerful predictor of sudden coronary death. Smoking and high serum cholesterol were significant predictors of sudden coronary death. High serum cholesterol was an equally significant predictor of sudden and non-sudden coronary death. High blood pressure did not appear to significantly increase sudden coronary death but increased the incidence of non-sudden death significantly. Obesity and diabetes did not appear to be independent risk factors for sudden coronary death. Smoking and high serum cholesterol were significant risk factors for sudden coronary death in men with manifestations of coronary heart disease. The results suggest that reduction of primary risk factors, especially smoking and high serum cholesterol, is important even after coronary heart disease has become manifest.
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PMID:Risk factors for sudden and non-sudden coronary death. 334

The results of prophylactic examination of a district population were compared with medical documents. Information on 85.7% of patients with CHD, 70.5% with arterial hypertension, 80.3% with chronic bronchitis and 83.3% with diabetes mellitus detected during the examination was absent in the medical documents. Prophylactic examination of the population, education of a district physician in methods of primary and secondary prophylaxis of chronic incommunicable diseases, the availability of health educational literature brought about an increase in the volume of therapeutic, diagnostic and preventive activities in this district, however they did not have great influence on the prevalence of risk factors in the population over a 2-year period.
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PMID:[Preventive activities of a district physician-internist]. 336 6

The paper is devoted to the characterization of the spectrum of lipoproteins (LP) including the determination of the content of apoproteins AI and B by quantitative "rocket" immunoelectrophoresis in 75 male patients aged 40 to 59 with normal body mass, with types I and II diabetes mellitus, in the state of compensation of carbohydrate metabolism, with and without signs of coronary heart disease. Sixty healthy men were controls. It was shown that in diabetic (types I and II) patients with CHD changes in LP spectrum values were similar to those in CHD patients without diabetes. In patients with type I diabetes without clinical signs of CHD, LP spectrum values including the content of apo-AI, apo-B and the ratio of apoB/apo-AI did not differ from those of the controls. Changes in LP-containing apo-AI expressed not only in the reduction of the total content of CH-HDIP but also in change of the composition of HDLP particles, were found in diabetic (type II) patients without clinical signs of CHD.
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PMID:[Quantitative characterization of the main lipid and apoprotein components of plasma lipoproteins in men with types I and II diabetes mellitus with and without coronary heart disease]. 344 60

Prophylactic examination of the population in a district of a city out-patients clinic was performed. Altogether 689 persons (298 men and 391 women) aged 16 to 64 were examined. A great prevalence of chronic non-communicable diseases (CND) and common risk factors were revealed: CHD in 16.7% of the examinees, cerebral changes in 0.6%, diabetes mellitus in 3.9%, chronic bronchitis in 9.3%, arterial hypertension (AH) in 29.6%, smoking in 26.1%, disturbed carbohydrate tolerance in 15.7%, hypercholesterolemia in 13.5% and excess body mass in 35.5%. In 40% of the patients with AH it was combined with other chronic diseases necessitating a multidisciplinary approach to CND control in the patients with AH. The study showed that the population was not ready enough for prophylactic examination.
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PMID:[Preventive examination of the population of the medical district of an urban polyclinic]. 356 23

In over 30 years of surveillance of 2873 women, 574 developed initial clinical manifestations of CHD. A number of antecedent metabolic risk factors proved atherogenic, including blood lipids, glucose tolerance, uric acid, and menopause. Serum total cholesterol predicts as strongly in women as in men. The predictive power of cholesterol is strengthened when the total cholesterol is partitioned into its atherogenic LDL and protective HDL fractions. Contrary to the case in men, triglyceride may be a contributor to risk in older women. A total-to-HDL cholesterol ratio exceeding 7.5 equalizes the risk in men and women. Impaired glucose tolerance also eliminates the female CHD risk advantage over men, conferring a three-fold increased risk. Serum uric acid, although lower in women than in men, is equally predictive in the sexes. Central obesity confers an increased CHD risk in women and predisposes to diabetes, hyperuricemia, hypertension, and an unfavorable LDL/HDL cholesterol ratio. A combination of obesity, low HDL cholesterol, and impaired glucose tolerance predisposes especially. Age-adjusted risk of CHD is increased two- to threefold compared to pre menopausal women, even when induced surgically without removing the ovaries. It is not clear whether post menopausal estrogen replacement eliminates this excess risk. Fibrinogen is higher in women than in men, and is increased with hypertension, diabetes, hypercholesterolemia, high hematocrit, and cigarette smoking. At any level of multivariate risk, fibrinogen added to the CHD risk in women.
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PMID:Metabolic risk factors for coronary heart disease in women: perspective from the Framingham Study. 360

Contributors to CHD include atherogenic personal attributes, living habits which promote these, signs of preclinical disease, and host susceptibility to these influences. Atherogenic traits include the blood lipids, blood pressure, and glucose tolerance. High LDL cholesterol is positively and high HDL cholesterol inversely related to CHD incidence. Hypertension, whether systolic or diastolic, labile or fixed, casual or basal, at any age in either sex contributes powerfully to coronary heart disease. The impact of diabetes on CHD is greater for women than for men and varies according to the level of the foregoing risk factors. The faulty life-style is typified by a diet excessive in calories, fat, and salt, a sedentary habit, unrestrained weight gain, and cigarettes. Alcohol used in moderation may be beneficial. Oral contraceptives worsen atherogenic traits and, when used for long periods beyond age 35 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 a compromised coronary circulation include silent MI, ECG-LVH, blocked intraventricular conduction, and repolarization abnormalities. Exercise ECG may elicit still earlier evidence. Measures of innate susceptibility include a family history of premature cardiovascular disease, diabetes, hypertension, and gout. Optimal prediction of CHD requires a quantitative combination of risk factors in multiple logistic risk formulations that identify high-risk persons with multiple marginal abnormalities. Preventive management should also be multifactorial.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Psychosocial and other features of coronary heart disease: insights from the Framingham Study. 377 1


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