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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiovascular disease has become the major cause of death in the Western countries. There is strong evidence that elevations of serum lipids contribute to the pathogenesis of premature atherosclerosis. The classification of the hyperlipoproteinemias has been most beneficial as a guide to development of dietary and pharmacological regimens for lowering serum lipid concentrations. The results of dietary and drug prevention trials are discussed. Insight into the mechanisms involved in lipoprotein metabolism as well as the mode of action and of side-effects of hypolipidemic drugs is reviewed. Using present knowledge of heart disease research, it is reasonable to suggest dietary and drug treatments for the high risk patient.
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PMID:[Drug treatment of primary hyperlipoproteinemia (author's transl)]. 62 99

In a 22-year followup of 3686 San Francisco longshoremen, the roles of physical activity, cigarette smoking habit, and systolic blood pressure level were evaluated independently in relation to risk of death from a broad range of diseases. Smoking pattern and blood pressure status were established in 1951 and job activity was assessed annually during the followup period. Lower levels of energy expenditure predicted increased risk of fatal heart attack and perhaps of stroke. Heavy cigarette smoking predicted increased risk of death from heart attack, cancer, chronic obstructive respiratory disease, and pneumonia. Higher levels of systolic blood pressure were associated with death from all cardiovascular diseases, diabetes mellitus, and cirrhosis. Tacit to these findings: sedentary living takes its toll largely through heart disease and stroke; the toxicity of cigarette smoking is associated with a broader range of diseases, including heart attack, cancer, and respiratory disease; and higher level of blood pressure related to an even broader range of cardiovascular disease than either of the other characteristics studied.
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PMID:Energy expenditure, cigarette smoking, and blood pressure level as related to death from specific diseases. 68 71

Prior to the discovery of the circulation of the blood and the advent of modern mind-body dualism, heart disease was conceived as invariably psychosomatic. Familiar vestiges of premodern theory are found in such expressions as "bighearted," "warmhearted," "brokenhearted," and so on. The original medical meanings of such expressions are explained. The historical disappearance of the psychosomatic approach to cardiovascular disease is explained as a product of dualistic thinking and the mechanistic physiopathology it created. It is urged that contemporaries could profit from a return to a holistic view of the disease process.
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PMID:The psychosomatic approach to heart disease. A study in premodern medicine. 77 93

There is little doubt that high blood serum lipid levels are related to a higher incidence of atherosclerotic disease in humans. Experimental evidence to date suggests that dietary intervention can reduce blood lipid levels in most cases and that some small reduction in occurrence of cardiovascular disease will probably result. On the other hand no reduction in total mortality has been demonstrated in the well constructed dietary studies. It appears that there is considerable variation in the human population with regard to their patterns of lipid metabolism. Some apparently regulate body production of cholesterol in response to dietary changes, others do not. Some seem to excrete excess sterols efficiently, while some do not. It seems likely, therefore, that dietary manipulation would be useful for those disposed by heredity and other conditions to accumulation of excessive sterols in the body. On the other hand drug control of cholesterol biosynthesis and/or sterol excretion may be more effective solutions to the problem of sterol accumulation. Irrespective of whether diet or drugs prove to be the best answer to control of sterol balance, these should be applied only to that segment of the population known to require such treatment. The egg is an important dietary source of cholesterol and as a result is used sparingly in low cholesterol diets. On the other hand normal egg consumption of two eggs per day does not appear to overload cholesterol balance in the healthy human adult since depression in cholesterol biosynthesis and increased sterol excretion will result. Investigation of the lipid metabolism of the laying hen has shown that most of the cholesterol found in the egg is synthesized in the liver where it is under both dietary and drug control. Most of the cholesterol deposited in egg yolk may be essential for embryonic development. Drugs that severely limit cholesterol biosynthesis probably also limit synthesis of adrenal and sex hormones and hence limit reproduction. Moderate depressions in lipogenesis achieved without feeding of large amounts of dietary fat may offer a means for moderating cholesterol deposition in eggs. On the other hand, it also seems clear that genetic selection could be used to moderate egg cholesterol concentration. In any event, a great deal more evidence from well constructed human diet studies will be needed before low cholesterol diets can be recommended to the general population as an aid to control of cholesterol balance and heart disease.
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PMID:The cholesterol problem, the egg and lipid metabolism in the laying hen. 77 20

This report details our total experience with documented chronic His bundle block in 24 patients. Ten patients had second-degree block (eight with 2:1 block and two with type-1 block), and 14 patients had complete heart block. There were 16 women (67 percent) and eight men (33 percent) with ages ranging from 17 to 87 years. Diagnoses were as follows: hypertensive cardiovascular disease, nine patients (38 percent); arteriosclerotic heart disease, six patients (25 percent); aortic valvular disease, three patients (13 percent); primary conduction disease, two patients (8 percent); primary myocardial disease, two patients (8 percent); congenital heart block, one patient (4 percent); and traumatic heart block, one patient (4 percent). Pacing was instituted in 20 patients because of the following; congestive heart failure, seven patients; syncope, seven patients; fatigue, four patients; and recurrent dizziness, two patients. Permanent pacing was indicated within ten days of initial diagnosis in 13 patients, from 20 to 80 days in four patients, and later than 100 days in three patients. An additional two asymptomatic patients were treated with prophylactic pacing.
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PMID:The clinical spectrum of chronic His bundle block. 100 Oct 51

The strongest predictors of cardiovascular disease in women have been shown to be diabetes, high blood pressure, cigarette smoking, and, to a lesser degree, hypertriglyceridemia. The difference in risk between men and premenopausal women has been explained by the following widely held hypothesis: androgens lower plasma concentrations of high-density lipoprotein (HDL), particularly the HDL-2 subfraction, and increase plasma concentrations of low-density lipoprotein (LDL). In contrast, estrogens have the opposite effect, raising plasma concentrations of HDL, particularly HDL-2, and lowering plasma concentrations of LDL. After the menopause, it is believed that the protective effect of estrogens in women is lost and the incidence of heart disease rises to equal that in men. This paper provides a brief review of the effect of endogenous and exogenous androgens on lipoprotein metabolism in men and women, and considers the relevance of these findings to the choice of progestogens used in oral contraceptive preparations.
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PMID:Mechanism of action/effects of androgens on lipid metabolism. 135 63

Cardiovascular medicine is based on high-technology management of end-stage disease. Preventive medicine is preferable but, before magnetic resonance (MR), there was no noninvasive, safe, repeatable method of detecting occlusive vascular disease, which accounts for more deaths than any other disease at a presymptomatic stage. Demographic and animal studies show that occlusive vascular disease is not a normal aging process and is reversible. There was no method of monitoring the efficacy of preventive and therapeutic measures other than long, expensive, and sometimes inconclusive clinical trials. The rate of precession of atomic nuclei in a magnetic field is related to field strength. Creating a unique magnetic field in each volume of interest allows analysis of emitted radio signals to produce an image containing information about movement and local biochemical environments. MR produces accurate high resolution anatomical images and functional information including blood flow. It is already established as a method of choice in clinical cardiology for congenital heart disease and aortic disease. It is becoming established as a method of evaluating cardiovascular-active drugs, and in the future MR will be used for diagnosis and as a population-screening instrument for all cardiovascular disease including coronary artery disease.
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PMID:Studies of the heart using magnetic resonance. 138

In 1989 we mailed a questionnaire to all 461 general practitioners (GPs) identified as currently practising in the Eastern Metropolitan Health Region of Sydney. This was the first phase of a program to assess, amplify and reassess GPs' knowledge of the risk factors for heart disease and measure their attitudes and beliefs about their role in the prevention of cardiovascular disease. The second phase was an education program designed to meet the needs identified by the first questionnaire. Phase three was a postintervention questionnaire. Fifty-six per cent (260/461) responded to the first questionnaire. This follow-up group were mailed the second questionnaire, to which 52 per cent (135/260) responded. Thirty per cent of the original sample (139/461) attended the education program and 30 per cent (79/260) of the follow-up group did so. At baseline, the respondents' level of risk factor knowledge was good, but after the education program there was still a large gap between what they said they knew and the amount of advice they said they would give to patients. The only significant increase in the amount of advice after the intervention was to 'control blood pressure'. This applied whether the GP had participated in the intervention or not. When GPs were asked how often in the last month they had actually given advice to reduce cardiovascular disease risk, program attenders reported offering it more frequently than nonattenders. We also attempted to determine whether any particular demographic characteristics could predict respondents to the questionnaires and/or the educational program.
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PMID:Evaluation of a heart disease survey and education program for general practitioners. 139 Nov 58

The renin-angiotensin system (RAS) plays a major role in the control of blood pressure and cardiovascular homeostasis and is involved in the pathogenesis of a number of cardiovascular disorders. The efficacy of angiotensin-converting enzyme (ACE) inhibitors in the treatment of hypertension and congestive heart failure has led to the widespread clinical use of ACE inhibitors in primary or secondary prevention of heart disease. The demonstration of the expression of the components of the RAS in several extrarenal tissues, as well as local generation of angiotensin II, has confirmed the existence of a tissue RAS that may serve organ-specific functions and act independently from the plasma RAS. The concept of paracrine/autocrine functions of the local RAS has changed our understanding of the functions of the RAS and suggests that tissue ACE inhibition may be of greater importance than inhibition of circulating ACE in the treatment of congestive heart failure and other cardiovascular disorders. Whereas the circulating endocrine RAS appears to be responsible for mediation of acute effects, the tissue RAS seems to be involved in more chronic situations, such as secondary structural changes of the cardiovascular system, and therefore could contribute to the pathogenesis of hypertension as well as other cardiovascular disorders, such as cardiac hypertrophy, coronary artery disease, and atherosclerosis. Several experimental and clinical findings suggest that reversal of cardiovascular structural changes secondary to cardiovascular disease and enhancement of renal sodium excretion by ACE inhibitors are important long-term antihypertensive actions possibly mediated by inhibition of the tissue RAS.
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PMID:Effects of angiotensin-converting enzyme inhibitors on tissue renin-angiotensin systems. 141 88

This investigation evaluated the effect of a peer-education program on preventing cardiovascular disease in older persons. Peer leaders at two urban senior housing residences were provided with training on cardiovascular disease and its risk factors, strategies to reduce the risk factors, and communication skills. Baseline and follow-up data were collected on residents at the two intervention and two control sites. The dependent variables were knowledge of cardiovascular disease risk factors; perceived self-efficacy to reduce calories, dietary fat and salt intake, to lose weight, to stop smoking, and to exercise regularly; and self-reported cardiovascular risk behaviors. Analysis of individual change scores between baseline and follow-up surveys showed a statistically significant increase in overall knowledge of heart disease, dietary self-efficacy, and exercise self-efficacy for the intervention group compared with the control group. This program appeared to benefit the individuals who lived in housing residences where the peer educators also resided.
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PMID:Evaluation of a peer-education program on heart disease prevention with older adults. 148 14


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