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Query: UMLS:C0028754 (obesity)
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Shown to be associated with new coronary events in elderly men and women are cigarette smoking, systolic or diastolic hypertension, hypercholesterolemia, low serum HDL cholesterol, increased ratio of serum total cholesterol to serum HDL cholesterol, hypertriglyceridemia, diabetes mellitus, obesity, physical inactivity, increased age, prior coronary artery disease, and electrocardiographic and echocardiographic left ventricular hypertrophy. The greater the number of major coronary risk factors, the higher the incidence of new coronary events. Risk factor modification should therefore be considered in elderly persons.
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PMID:Cardiac risk factors: still important in the elderly. 213 42

Left ventricular hypertrophy (LVH) has been studied as a condition predisposing to cardiovascular disease over a 34 year period in the Framingham study. Whether present on the electrocardiogramme, chest X-ray or echocardiography, LVH is a harbinger of cardiovascular disease. It increases the risks of coronary artery disease, cardiac failure, cerebral haemorrhage and peripheral arterial disease. Its contribution to global cardiovascular risk is three times greater than that of hypertension which is the principal cause of LVH. Age, blood pressure and obesity are the three essential factors predisposing to LVH. Each contributes independently to the development of electrocardiographic hypertrophy (ECG-LVH). Increased left ventricular mass detected by echocardiography is commoner with age but apparently as the consequence of an increased prevalence of hypertension, obesity, coronary artery and valvular heart disease with age. The increase of left ventricular mass with age seems largely to be due to fatty hypertrophy and to hypertension. The risk associated with ECG-LVH is particularly important when St-T wave changes are associated with increased voltage. The outcome and prognosis of ECG-LVH and of silent myocardial infarction are similar. When overt coronary artery disease is present, ECG-LVH further increases the risk of cardiovascular events. Electrocardiographic LVH carries a worse prognosis than radiographic LVH which corresponds to anatomic hypertrophy. As the two forms of LVH contribute independantly to the cardiovascular risk, it is probable that they result from different physiopathological mechanisms.
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PMID:[Prognostic implications of left ventricular hypertrophy in arterial hypertension]. 215 Apr 70

A detailed family history questionnaire collected from families of 35,000 sixteen year old high school students in Utah was used to identify population-bases sibships with two or more living adults affected with hypertension under age 60 or coronary artery disease before age 55. Detailed clinical and biochemical evaluations performed during a four-hour visit to a research clinic provided data to test for concordant abnormalities in siblings with either early hypertension or early coronary heart disease. A new syndrome, familial dyslipidemic hypertension (FDH), was found in 48% of the hypertensive sibships. In these FDH subjects, 68% had HDL-cholesterol below the 10th percentile, 49% had triglyceride level above the 90th percentile, and 27% had LDL levels above the 90th percentile. When compared to normolipidemic hypertensive subjects, persons with FDH had significantly elevated fasting plasma insulin levels, increased subscapular skinfold thickness, increased knee width and wrist circumference, and increased levels of VLDL cholesterol and apolipoprotein B. In coronary sibships, concordant abnormalities for lipids were consistent with familial combined hyperlipidemia in 30-40% of sibships, FDH in 15-45% of sibships, and low HDL-C (with normal cholesterol) in 10%. Concordant normal lipids were found in only 15% of sibships. These data suggest that inherited metabolic abnormalities likely explain some co-aggregation of hyperinsulinemia, obesity, hypertension, and early coronary heart disease. Current knowledge also suggests these metabolic abnormalities could be treated or prevented with appropriate modification in lifestyle factors such as diet and exercise as well as through the use of prescription medications.
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PMID:Concordant dyslipidemia, hypertension and early coronary disease in Utah families. 218 41

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

Obesity is associated with an increased risk of coronary artery disease, hypertension, diabetes, hypercholesterolemia, cancer and other conditions. Although generalized obesity is associated with increased risk, the android pattern of body fat distribution may be a more sensitive predictor of coronary artery disease. A gradual weight reduction program, including adherence to a low-fat, calorie-restricted diet and participation in daily exercise, is the best approach to reduce weight and body fat.
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PMID:Overweight: assessment and management issues. 220 35

Nutrition plays an important role in health and disease, both in prevention and treatment. Increasing emphasis is being placed upon nutrition as a therapeutic tool to decrease the morbidity and mortality associated with obesity, hypertension, coronary artery disease, and cancer. Adequate nutrition should be a concern for all health care workers because of its impact on the overall health of patients. Health care professionals should be familiar with the essentials of nutritional assessment and basic nutritional requirements and be able to improve their patients' care in the face of nutritional deficiencies or excesses.
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PMID:Nutritional assessment and requirements. 220 96

The prevalence of gout in the United States has been rising steadily for the past two decades. Hyperuricemia is considered a necessary but not sufficient precondition for gout. Known risk factors for gout include male sex, hypertension, renal insufficiency, obesity/weight gain, diuretic use, lead exposure, and family history. The association of gout and hyperuricemia with coronary artery disease is controversial. Current evidence from the Framingham Study suggests that gout is in fact an independent risk factor for CHD. These data suggest that patients with gout should be screened for modifiable risk factors for CHD, and that early intervention in such patients may be worthwhile. Finally, the effect of AHU as risk factor for CHD remains unclear but is probably a weak one.
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PMID:Gout and hyperuricemia. 221 57

The effects of insulin treatment on the pathophysiology of non-insulin-dependent diabetes mellitus (NIDDM) are reviewed herein. Short-term studies indicate variable and partial reduction in excessive hepatic glucose output, decrease in insulin resistance, and enhancement of beta-cell function. These beneficial actions may be due to a decrease in secondary glucose toxicity rather than a direct attack on the primary abnormality. Insulin should be used as initial treatment of new-onset NIDDM in the presence of ketosis, significant diabetes-induced weight loss (despite residual obesity), and severe hyperglycemic symptoms. In diet-failure patients, prospective randomized studies comparing insulin to sulfonylurea treatment show approximately equal glycemic outcomes or a slight advantage to insulin. A key goal of insulin therapy is to normalize the fasting plasma glucose level. In contrast to the conventional use of morning injections of intermediate- and long-acting insulin, preliminary studies suggest potential advantages of administering the same insulins only at bedtime. Obese patients may require several hundred units of insulin daily and still not achieve satisfactory control. In some, addition of a sulfonylurea to insulin may reduce hyperglycemia, the insulin dose, or both. However, long-term benefits from such combination therapy remain to be demonstrated conclusively. Established adverse effects of insulin treatment in NIDDM are hypoglycemia, particularly in the elderly, and weight gain. Self-monitoring of blood glucose can identify patients in whom excessive weight gain is caused by subtle hypoglycemia. Whether insulin causes weight gain by direct effects on appetite or energy utilization remains controversial. A potential adverse effect of insulin has been suggested by epidemiological studies showing associations between hyperinsulinemia or insulin resistance and increased risk for coronary artery disease, stroke, and hypertension. Although potential mechanisms for an atherogenic action of insulin exist, current evidence does not prove cause and effect and does not warrant withholding insulin therapy (or compromising on dosage) when it is needed.
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PMID:Insulin use in NIDDM. 227 9

The overall risk of oral contraceptive (OC) use is minimal when women over 35 years of age, smokers, and those with multiple risk factors (thromboembolic disorders, cerebrovascular or coronary artery disease, liver tumors, breast cancer, estrogen-dependent neoplasms, undiagnosed abnormal genital bleeding, and congenital hyperlipidemia) are excluded. OC use increases the risk of hypertension by 1-5%, depending on age, parity, and duration of use, but even this small risk is decreased when multiphasic OCs are prescribed. Deep venous thrombosis in the leg is 4 times more prevalent in OC users than nonusers and the risk of superficial thrombosis is doubled. Again, fewer thromboembolic complications occur when the estrogen dosage is low. The risk of myocardial infarction is not believed to increase with OC use as long as other risk factors--smoking, obesity, hypertension, age over 35 years, hypercholesterolemia--are not present. Studies involving the original high-dose OCs revealed a 3-fold increase in the risk of thrombotic stroke and a 2-fold increase in the risk of hemorrhagic stroke, but low-dose OCs appear to have no effect on the potential for stroke. The impact of OC use on breast cancer cannot yet be determined given the very long latency period of this cancer. In terms of benign breast disease, OC users have been shown to be at substantially reduced risk of lesions, fibroadenomas, and fibrocystic changes. OCs also protect women from endometrial and ovarian cancer, although the pill seems to accelerate the progression of cervical dysplasia. Other beneficial effects of OC use include reductions in the incidence of pelvic inflammatory disease, endometriosis, ectopic pregnancy, and ovarian cysts.
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PMID:Oral contraceptive pills. Part II: Potential complications and health benefits. 228 19

The past three decades have seen coronary artery disease investigated almost exclusively in men. Data about this disease in women come from the longitudinal Framingham study and mortality statistics. According to the Framingham study, angina is more often the first symptom of coronary disease in women, while for men it is more often myocardial infarction. Post menopausal women are two to three times more likely to have a heart attack than premenopausal. Forty per cent of female cardiac patients versus 13% of men suffered a second heart attack. Sudden death, a frequent manifestation of coronary disease in men, occurs rarely in women until old age. Women aged 35 to 64 years were more vulnerable to risk factors of systolic blood pressure, blood glucose and excess weight than men. Cigarette smoking, highly correlated in men, was not a significant risk factor in women. The greater the number of risk factors, the greater the risk of developing coronary artery disease. Central or truncal obesity is associated with higher blood pressure and hyperinsulinemia which is thought to result in increases in atherogenic lipoproteins and decreases in high density lipoprotein cholesterol.
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PMID:Coronary artery disease in women. 234 65


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