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 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although several previous studies have been done on the nature and prevalence of cardiovascular disease in Papua New Guinea no study has looked exclusively at a highlander population. This article reviews 154 cardiac patients who first presented to the Mt Hagen adult outpatient department over a period of one year. The study excluded non-highlanders, patients under 12 years of age, and patients with heart disease secondary to anaemia or diseases of the blood vessels. Heart disease was found to constitute a significant proportion of outpatient visits and admissions. Cor pulmonale secondary to chronic lung disease was the commonest condition seen, occurring in higher frequency than reported elsewhere, and accounting for the majority of cases of congestive heart failure. Valvular heart disease was also common, often presenting in a precocious and severe form. Congenital bicuspid aortic values were important in the generation of aortic valve disease in this population. Arrhythmias and conduction disturbances were also common. Diseases of the myocardium and pericardium occurred infrequently and were of the same nature as those reported in other studies in Papua New Guinea. Hypertension was probably underreported in this study, with renal disease being a contributing factor in the cases seen. Ischaemic heart disease represented a small number of the total cases, but was probably underreported.
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PMID:Adult heart disease in Mt Hagen: a study of 154 patients. 208 Jun 72

We investigated the association of elevated serum low density lipoprotein (LDL) cholesterol levels, smoking and hypertension with different manifestations of carotid atherosclerosis in a population-based sample of 720 Eastern Finnish men aged 42, 48, 54 or 60 years, examined in the Kuopio Ischaemic Heart Disease Risk Factor Study. Carotid atherosclerosis was assessed with high-resolution B-mode ultrasonography. Men who had neither a history nor symptoms of cardiovascular disease with serum LDL cholesterol concentration in the highest tertile (4.17 mM or more) had 3.40-fold (95% confidence interval (CI) 1.98-5.84) age-, smoking- and hypertension-adjusted probability of intimal-medial thickening as compared to men in the lowest serum LDL cholesterol tertile. The odds ratio for carotid plaque versus intimal-medial thickening was only 1.03 (95% CI 0.47-2.28). The respective odds ratios for smoking (28 pack-years or more) were 1.62 (95% CI 0.79-3.32) and 3.02 (95% CI 1.41-6.47) and those for hypertension were 1.10 (95% CI 0.70-1.73) and 0.99 (95% CI 0.53-1.84). Our findings suggest that elevated serum LDL cholesterol concentration associates with an increased risk of common carotid arterial wall thickening, whereas smoking is associated more strongly with carotid plaques than intimal-medial thickening. Our cross-sectional data do not support association between hypertension and either manifestation of carotid atherosclerosis.
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PMID:Association of serum low density lipoprotein cholesterol, smoking and hypertension with different manifestations of atherosclerosis. 208 21

Six hundred and eighteen men and 993 women ranging in age from 30-69, living in Kamo Village, Shizuoka Prefecture, underwent baseline health examinations in 1964-1966. During the follow-up period of 20-years, 175 men and 170 women died. The most frequent cause of death was malignant neoplasms (57 men and 45 women), followed by stroke (47 men and 44 women) and heart disease (29 men and 37 women). The relationship of 22 cerebro-cardiovascular disease variables investigated in the baseline examination to stroke and heart disease mortalities, and, in addition, to cancer and all-cause mortalities were analyzed using Cox's proportional hazard model. In univariate analysis controlled for age and sex, systolic and diastolic blood pressures, albuminuria, hypertensive and sclerotic changes in fundus oculi, body mass index, atrial fibrillation, and use of antihypertensive drugs had significant positive relationships to stroke mortality. As for heart disease mortality, albuminuria, glucosuria, high R wave, and ST and/or T changes in ECG were positively and significantly related. Only Q.QS in ECG significantly correlated with cancer mortality. Variables showing significant relationship to all-cause mortality were systolic and diastolic blood pressures, albuminuria, glucosuria, hypertensive changes in fundus oculi, Q.QS, high R wave, ST and/or T changes, atrial fibrillation, use of antihypertensive drugs, and history of stroke. In multivariate analysis (step-wise) of all examination variables including age and sex, stroke mortality was significantly related to age, atrial fibrillation, use of antihypertensive drugs, and hypertensive changes in fundus oculi. Age, albuminuira, and ST changes in ECG were significantly related to heart disease mortality. Age, sex, and Q.QS in ECG were significantly related to cancer mortality. The relationship of age, sex, albuminuria, Q.QS, and ST changes in ECG to all-cause mortality was significant.
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PMID:[Correlation of cerebro-cardiovascular findings to mortality of middle-aged and elderly in a population from a fishing village in Shizuoka Prefecture]. 213 61

Many advances have now been made in understanding the early natural history of coronary artery disease and essential hypertension, an understanding that these diseases begin in childhood and that CVD relates to clinical cardiovascular risk factors. Methods have now been established to determine risk factors in the pediatric age and, with a family history, to begin to identify children at potential risk for premature heart disease. Advances have also been made in developing models for intervention and beginning prevention through both high-risk and population strategies directed at schoolchildren. Obviously, both approaches are needed and complement each other. An impressive future is ahead for effective preventive cardiology beginning with children by incorporation of cardiovascular health education and health promotion in elementary schools. Applying behavioral concepts to intervention programs can strengthen their chances of success. The overall good of having children adopt healthy life-styles with an understanding of their necessity is now attainable. It will be the responsibility of physicians to guide the direction of programs being promoted for children.
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PMID:Prevention of adult heart disease beginning in the pediatric age. 218 63

Screening for dyslipoproteinemias should be undertaken in all individuals older than 20 years of age at least once every 5 years. The initial screening, as recommended by the Adult Treatment Guidelines Panel of the National Cholesterol Education Program, is to determine the concentration of total blood cholesterol. This initial determination can be made on blood obtained in the nonfasting state. Further evaluation of the patient's lipoprotein concentrations is dependent upon the presence of other cardiovascular risk factors. in the absence of definite coronary heart disease, hypertension, diabetes mellitus, a family history of coronary artery disease, cigarette smoking, or severe obesity, the patient with a total blood cholesterol concentration less than 200 mg/dL requires no specific instruction and should have a repeated screening performed within 5 years. Patients with blood cholesterol concentrations greater than 200 mg/dL should have their lipoprotein profiles determined if they have atherosclerotic cardiovascular disease or two other cardiovascular disease risk factors. The lipoprotein profile includes the determination of fasting cholesterol and triglyceride and HDL cholesterol concentrations. From these values, the LDL cholesterol concentration can be calculated. This LDL cholesterol concentration is central in selecting the appropriate therapy. HDL cholesterol concentrations may be useful in evaluating patients with ischemic heart disease. Concentrations of HDL cholesterol less than 35 mg/dL are associated with increased risk for coronary artery disease. Although there is currently no convincing evidence that support the specific treatment of depressed HDL cholesterol concentrations, therapy directed to modulating lipoprotein metabolism in patients with heart disease and low HDL concentrations may be of benefit. Patients with recurrent abdominal pain, pancreatitis, and eruptive xanthomatosis frequently have fasting hypertriglyceridemia concentrations exceeding 1000 mg/dL. These patients should be identified in order to effectively reduce their triglyceride concentrations, which can prevent these complications.
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PMID:Detection and evaluation of dyslipoproteinemia. 219 76

Cardiovascular disease is the leading cause of mortality in the United States regardless of gender. Women infrequently present with myocardial infarction as the initial presentation of coronary heart disease and have unrecognized infarctions more frequently than men. Myocardial infarction in women has a similar clinical presentation as in men, with the exception of an increased incidence of non-Q wave myocardial infarctions. Complications of acute infarction in women are probably similar although the majority of data has been drawn from studies involving predominantly men. Women do however experience more strokes and have less postinfarction pericarditis than their male counterparts. Left ventricular function remains the key prognostic determinant in both sexes. Recurrent infarction is increased in women with resultant elevated mortality rates. However, complex ventricular ectopy following myocardial infarction is not predictive of cardiovascular mortality in women. Early and late survival is decreased in women, an effect probably related to the increase in mean age of women as compared with men. Overall, gender distinctions are not usually made in the majority of studies involving myocardial infarction. As epidemiologic, pathophysiologic and clinical factors may be different regarding heart disease in women, further research in this important area is warranted.
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PMID:Myocardial infarction in women. 219 94

The risk of embolic stroke in patients with atrial fibrillation is largely related to the underlying disorders responsible for the arrhythmia. Atrial fibrillation associated with rheumatic mitral valve disease has the highest stroke risk (about 17 times greater than unaffected controls), but even with nonvalvular heart disease, the risk is increased fivefold. The stroke risk is greater with chronic than with paroxysmal atrial fibrillation, is highest in the year after onset of the arrhythmia, and is lower in younger patients with idiopathic ("lone") atrial fibrillation. Major bleeding episodes, the most important risk of anticoagulation, occur in about 5% to 10% of patients. The decision to anticoagulate a patient with atrial fibrillation depends on the cause of the arrhythmia, especially any associated cardiovascular disease, and the individual's risk from anticoagulation. Growing evidence supports the effectiveness of anticoagulation of most patients with nonvalvular, as well as valvular, cardiac disease for the prevention of both primary and recurrent strokes.
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PMID:Atrial fibrillation. Thromboembolic risk and indications for anticoagulation. 220 Mar 78

The cardiovascular effects of oral contraceptives, as predicted by studies on serum lipid changes in users, are based on the progestin dose, androgenic potency and biologic effect of the estrogen in the pill. Women suffer 250,000 deaths per year in the U.S. resulting from cardiovascular disease, almost half as many as men. They have the same risk factors: high cholesterol, high blood pressure and smoking, and also have more risk from diabetes than men do. The serum HDL, especially HDL2, correlates closely and inversely with heart disease risk. Exogenous estrogens raise HDL and HDL2, and lower LDL, conferring protection against coronary disease, in direct proportion to dose. Progestins usually have adverse effects, in proportion to dose, but progestin potency and type also determine their effects. The estrane progestins norethindrone, norethindrone acetate and ethynodiol diacetate are less potent and much less androgenic, while the gonanes norgestrel and especially levonorgestrel are 5-20 times as potent and androgenic. Each pill needs to be considered as a unit. Several comparative studies are reviewed, corroborating the prediction that pills with higher progestin potency have adverse effects on serum lipids, compared to those with higher estrogen effect. For new lower dose multiphasics, the effects either way are minimal, but HDL2 is still significantly lowered by pills containing levonorgestrel. Progestin-only pills lower HDL2 17- 21%. It is prudent to follow and treat the long-term effects of oral contraceptives on blood lipids.
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PMID:Oral contraceptives and cardiovascular risk. Taking a safe course of action. 220 2

Based on postmortem records at the Wayne County Medical Examiners' Office from 1982 to 1986, autopsy results indicated that the deaths of 129 persons aged 20-34 resulted from heart disease: 51 of these deaths were attributed to atherosclerotic cardiovascular disease (ASCVD), 29 to hypertensive cardiovascular disease, 28 to cardiomyopathy, and 21 to other cardiac causes. The majority of the deaths due to ASCVD occurred among men, both black and white, followed by black women, and the incidence increased with age. All of these deaths due to ASCVD were sudden and accounted for all deaths due to ischemic heart disease in this age group among Wayne County residents. Diabetes mellitus, left ventricular hypertrophy, a history of seizures, and the recent ingestion of alcohol were all found to be associated with sudden death from ASCVD in this group. Obesity did not seem to be a significant factor. These data suggest that ASCVD is not rare as a cause of death in young adults and some of the risk factors identified in older subjects also operate in this age group.
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PMID:Atherosclerotic cardiovascular disease and sudden deaths among young adults in Wayne County. 222 Jul 3

The 497 members of the London Cohort of the WHO Multinational Study of Vascular Disease in Diabetics have been followed for mortality from 1975 to 1987. During this period 92 patients died. The most common cause of death was myocardial infarction: 36 (39.1%) deaths, heart disease was responsible for 51.1% of deaths and all cardiovascular disease for 55.4%. Neoplastic disease accounted for 25% of the deaths and diabetic nephropathy for 5.4%. Age-standardised mortality rates were higher in men than in women in both Type 1 (insulin-dependent) diabetes and Type 2 (non-insulin-dependent) diabetes. Standardised mortality ratios for the first and second five year follow-up periods were higher for men than for women in Type 2 diabetes but were higher for women than men in Type 1. The results suggest that the female survival advantage seen in the general population may persist in Type 2 but not in Type 1 diabetes.
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PMID:A prospective study of mortality among middle-aged diabetic patients (the London Cohort of the WHO Multinational Study of Vascular Disease in Diabetics) I: Causes and death rates. 225 30


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