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The major atherosclerosis risk factors hypertension, diabetes, hyperlipidemia and cigarette smoking are examined along with blood vessel anatomy, hemodynamics, histopathology and known experimental results. A common factor of blood vessel hypoxia, specifically endothelial and intimal hypoxia, is shown to exist. Arguments are presented suggesting endothelial hypoxia as the commonest initiating event for atherosclerosis. Cholesterol appears to be a secondary and opportunistic villain. Explanations are given for the lack of increased atherosclerosis risk in familial lipoprotein lipase deficiency (type I hyperlipoproteinemia) and for the increased incidence and severity of atherosclerosis in the human abdominal aorta in comparison with the thoracic aorta. It is suggested that effective prevention of atherosclerosis can be accomplished by lowering blood pressure and blood glucose, among others, even though these may be within acceptable normal limits. Suggestions are given for experiments to test the hypothesis of hypoxia being the major initiating factor in atherosclerosis.
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PMID:Mechanisms of atherogenesis: endothelial hypoxia proposed as the major initiator. 385 84

The approach to management of cardiovascular risk factors has been greatly enhanced by the recent publication of results from several large intervention studies. This increased knowledge has led to rapid changes in perspective and to some controversies regarding cardiovascular risk management. The major cardiovascular disease risk factors are high blood pressure, elevated serum cholesterol, and cigarette smoking. In the past, physicians have paid little attention to the latter two factors, focusing primarily on severe hypertension. Initially, the pharmacologic treatment of hypertension consisted mostly of thiazide diuretics, since they were the only agents generally available that were well-tolerated by most patients. Over the past decade, however, new data from large-scale intervention studies and the development of many new classes of antihypertensive agents have considerably improved the approach to managing all three primary risk factors. Recently published results of major clinical trials are likely to further alter physicians' perspectives and influence their practice habits. This article proposes an approach to comprehensive risk management that simultaneously involves all the major risk factors, with emphasis on blood pressure and lipids. The rationale for this integrated approach is based on the following facts: Hypertension trials have not convincingly demonstrated that lowering blood pressure alone reduces the risk for coronary heart disease; Cholesterol lowering has been shown conclusively to reduce the risk of coronary heart disease; Several classes of antihypertensive agents have now been found to significantly affect blood lipids, either adversely or beneficially; and Past observational epidemiologic studies have shown a positive association between blood lipids (cholesterol and triglycerides) and blood pressure, implying that these two conditions commonly occur together. The background supporting these facts, as well as a practical approach to the treatment of hypertension that takes into consideration the management of blood lipids, is provided in this article.
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PMID:Lipids and hypertension. Implications of new guidelines for cholesterol management in the treatment of hypertension. 394 62

General physical fitness of 475 metallurgists, 203 subjects working under heat stress and 272 subjects working under normal environment conditions, has been determined. Evaluation of physical fitness was based on the maximal oxygen consumption (VO2max), the Harvard "Step test" and some laboratory examinations. Physical fitness was below average, poor and very poor in both groups without statistically significant differences between the exposed and control groups. A statistically significant correlation has been found between VO2max and Harvard "Step test". Arterial hypertension greater than or equal to 21,3/12,7 kPa has been found in 27% of subjects of the exposed group and in 23% of the control group. Cholesterol level greater than or equal to 6,7 nmol/l has been found in 14,8% of the exposed and in 17,6% of the control group. A statistically significant negative correlation between the cholesterol concentration and the score of the Harvard "Step test" of both groups has been found, and also between VO2max of the exposed group only. Above 50% of subjects exhibited various abnormalities in electrocardiogram mainly of type IV, VII, IX, according to the Minnesota Code. General physical fitness of metallurgists has been considerably lower as compared to the literature data. It is concluded that periodic examinations of general physical fitness should be performed for evaluation of the health condition. Industrial physicians should utilize the results of those examinations for prevention.
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PMID:[General physical fitness of metallurgy workers exposed to thermal load]. 406 83

Cholesterol embolism after left heart catheterisation by the femoral approach was diagnosed in seven men (mean age 59.6 years) out of a total of 4587 catheterisations. Diabetes was present in four patients, systemic hypertension in three, and signs of extensive atherosclerosis in six; five patients were taking anticoagulant drugs. Acute pain in the legs or abdomen occurred in six patients, two of whom had abdominal angina; renal failure was present in six patients, cutaneous manifestations in five, and a cholesterol embolus was seen in the retina in one. Six out of six patients had an appreciable increase in the erythrocyte sedimentation rate and five out of five had eosinophilia within a week of catheterisation. Renal failure was progressive in five patients, one of whom required haemodialysis. Three patients required amputation of the toes because of gangrene. Four patients died within four and a half months of catheterisation from causes not directly related to cholesterol embolism. At necropsy cholesterol emboli were found in all four patients. Cholesterol embolism is a rare but serious complication of left heart catheterisation.
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PMID:Cholesterol embolism as a complication of left heart catheterisation. Report of seven cases. 646 20

In Switzerland 278 diabetic men and 256 women in the age group 35 to 54 were examined for the presence of angiopathic lesions, according to a standardized protocol of a multinational study comprising 6,695 diabetics from 14 countries. The diabetics were distributed according to sex, age, and duration of the disease into groups of equal size. Macro-angiopathy, as the sum of coronary heart disease, stroke, and vascular disease of the legs was found in 28% of men and in 29% of women in the Swiss group. The prevalence of myocardial infarction alone was 6.8% in men and 5.5% in women. These rates did not differ from those found in the other national groups. Micro-angiopathy was found in the form of retinopathy in 35% and as nephropathy in 32% of the Swiss diabetics. These rates were not different from those of all groups. Severe retinopathy was found more frequently in Swiss diabetics than in the whole study. Micro-angiopathy was strongly related to duration, hypertension, and type of treatment in all centres. Japanese diabetics showed a higher frequency of micro-angiopathy, although macrovascular disease was found at a low rate. Systolic blood pressure (BP) in the Swiss diabetics did not differ from the results of the whole group. In 14% of the Swiss diabetic men and in 18% of the women, systolic BP was over 160 mmHg. These rates were remarkably higher than in an age- and sex-matched sample of a randomly selected sample of a Swiss population (3.2% in men, 2.4% in women). Cholesterol was high in the Swiss diabetic groups, whereas body mass index was in the intermediate range. Of the Swiss diabetic men 38% smoked regularly. The frequency of coronary heart disease in Swiss men and women was similar. This is different from the lower rate usually found in non-diabetic women. Age, and not duration of the disease was the most important factor relating to macro-angiopathy. The different rates of macro- and microvascular complications in various populations, selected according to the same protocol, suggests that the risk factors for macrovascular disease differ from those of microvascular complications. Race, nutrition, treatment, exercise, and hypertension may further influence the prevalence of angiopathy in diabetics of same sex, age, and duration of the disease.
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PMID:[Vascular diseases in 534 Swiss diabetics within the scope of a multinational study]. 684 41

The interrelations of lipid levels, arterial hypertension and relative body mass were studied in 3907 men aged 40 to 59 years. Growing body weight was seen to be associated with marked increases in cholesterol and triglyceride levels and a decrease in alpha-cholesterol level. Growing relative body mass was further associated with elevated systolic and diastolic pressures. Cholesterol, triglycerides and alpha-cholesterol concentrations increase with elevation of arterial pressure. The latter finding is not related to increase in body weight and is relatively independent. However its mechanisms are still obscure.
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PMID:Lipids, relative body mass and arterial hypertension. 714 Mar 7

A detoxification regimen has been found to be safe for use by individuals exposed to recreational (abused) and medical drugs, patent medicines, occupational and environmental chemicals. Patients with high blood pressure had a mean reduction of 30.8 mm systolic, 23.3 mm diastolic. Cholesterol level mean reduction was 19.5 mg/100ml, while triglycerides did not change. Medical complications associated with the program were rare, occurring in less than three percent of the subjects. The program resulted in improvements in psychological test scores. The mean increase in Wechsler Adult Intelligence Scale IQ was 6.7 points. High Minnesota Multiphasic Personality Inventory profiles decreased on the third scale (10.7), the fourth scale (8.0), the fifth scale (4.5) and the sixth scale (8.0). The decrease in the fourth scale suggests hope for sociopaths, a group with fourth scale scores not improved by National Institute for Mental Health or Narcotic Addict Rehabilitation Act inpatient programs.
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PMID:Evaluation of a detoxification regimen for fat stored xenobiotics. 714 34

The Prospective Pravastatin Pooling (PPP) project is a pooled evaluation of 3 large, placebo-controlled, randomized trials of cholesterol-lowering treatment with pravastatin. It is designed to more reliably evaluate the effect of treatment on coronary and all-cause mortality and on total coronary artery disease (CAD) events for specific populations of interest, including women and the elderly. The trials--Long-Term Intervention With Pravastatin in Ischemic Disease trial, the Cholesterol and Recurrent Events trial, and the West of Scotland Coronary Prevention Study--each have common design features, including drug, dose, and duration. The project prospectively defines the objectives, end points, and analytic plans in a protocol developed before results are known of any individual trial. More than 2,000 (or 10%) of the participants in the pooled data set are women, 1,841 are aged > or = 70 years at trial entry, and > 6,000 have a total cholesterol < 5.5 mmol/L (213 mg/dl). The mean low-density lipoprotein cholesterol level is 4.2 mmol/L (162 mg/dl). The mean blood pressure level is 134/81 mm Hg and 20% are current smokers. Half of the PPP participants have had a prior myocardial infarction. More than 7% have a history of diabetes and 26% have a history of hypertension. PPP is projected to have data on about 1,100 CAD deaths, 500 non-CAD deaths, and > 1,000 cancers by study completion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Design, rational, and baseline characteristics of the Prospective Pravastatin Pooling (PPP) project--a combined analysis of three large-scale randomized trials: Long-term Intervention with Pravastatin in Ischemic Disease (LIPID), Cholesterol and Recurrent Events (CARE), and West of Scotland Coronary Prevention Study (WOSCOPS). 748 29

Hypercholesterolemia is a risk factor for the development of coronary disease. It does not present with symptoms and can be diagnosed by laboratory examination only. Screening is the only means to detect subjects at risk at a time when preventive measures can effectively be applied. We therefore initiated the Bavarian Cholesterol Screening Project (BCSP). Occasional screening was performed in 150,089 subjects (81,286 women, 68,803 men) in 214 campaigns. The mean cholesterol value was 243 +/- 52 mg/dl for women and 231 +/- 53 mg/dl for men; 37.3% of women and 38.1% of men had values of 201-250 mg/dl, 42.2% of women and 33.7% of men values > 250 mg/dl. Also, the following risk factors were recorded: smoking in 11.3% of women and in 20.2% of men, hypertension in 19.8% of women and 17.4% of men, diabetes mellitus in 4.2% of women and 4.1% of men, obesity in 16.8% of women and 20.9% of men, and a family history of myocardial infarction in 34.8% of women and 26.0% of men. Of the 27,084 men who had their cholesterol checked for the first time, 35.6% had levels between 201 and 250 mg/dl, and 22.9% had levels above 250 mg/dl. Of the 27,870 women whose cholesterol level had not been checked before, 38.8% had levels between 201 and 250 mg/dl, and 27.1% had levels above 250 mg/dl. More than 70% of the subjects with levels between 200 and 250 mg/dl had at least one additional risk factor. We conclude, on the basis of this study, that the risk factor hypercholesterolemia is unknown in as much as 20% of the population of Bavaria. These newly detected subjects were offered the opportunity to recognize this risk and take subsequent measures of prevention. Screening projects for hypercholesterolemia therefore can be an effective means of improving public health.
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PMID:Results and efficacy of public screening for hypercholesterolemia: the Bavarian Cholesterol Screening Project. 749 May 93

The Strong Heart Study, a study of cardiovascular disease among American Indians, was conducted to determine cardiovascular disease rates and the prevalence of risk factors among members of 13 tribal groups in South Dakota/North Dakota (SD/ND), southeastern Oklahoma, and Arizona. From 1989 to 1992, 4,549 tribal members aged 45-74 years (62% of eligible participants) were surveyed and examined for cardiovascular disease and its risk factors. Mean total cholesterol concentrations were over 20 mg/dl lower among the men and 27 mg/dl lower among the women than national mean levels for the same age groups. Cholesterol levels varied by tribal group; Arizona Indians had mean levels more than 20 mg/dl lower than those of SD/ND Indians. The prevalence of hypercholesterolemia was almost twice as high among SD/ND Indians as among Arizona Indians, but the rates for all three groups were much lower than total US rates (all races). Mean levels of high density lipoprotein cholesterol were lower among Indian men and women than in the US population as a whole. The prevalence of hypertension among Arizona and Oklahoma Indians was higher than that for the entire United States. SD/ND Indians had significantly lower mean blood pressures and prevalence rates of hypertension than Oklahoma and Arizona Indians and the United States as a whole. The prevalence of cigarette smoking was higher for all Indian groups except Arizona women in comparison with US rates. Smoking rates were highest in SD/ND and lowest in Arizona. Indian smokers smoked fewer cigarettes per day than the average US smoker. Arizona Indians had the highest prevalence of diabetes mellitus; over 60% of those participants were diabetic. In Oklahoma and SD/ND, one third of the men and over 40% of the women were diabetic. In addition, 13-20% of the participants had impaired glucose tolerance. Proteinuria was also a common problem; almost half of the Arizona Indians had micro- or macroalbuminuria, and 20% of Oklahoma and SD/ND Indians had significant proteinuria. The prevalence of obesity was high in all three groups, with Arizona Indians having the highest rates and the highest mean body mass indices. The prevalence of current alcohol use was lower among Indians than in the nation as a whole, but binge drinking was common among those who used alcohol. These results indicate that cardiovascular disease risk factors vary significantly among tribal groups. Prevention programs tailored toward decreasing the prevalence of risk factors are recommended for long-term reduction of cardiovascular disease rates in American Indian communities.
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PMID:Cardiovascular disease risk factors among American Indians. The Strong Heart Study. 763 31


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