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The work-related aspects of coronary heart disease have been studied from the view-point of work physiology. The purpose of the following three studies has been to clarify how physical load at work and at leisure affects the risk of developing coronary heart disease. The first study included 120 men, mean age 41 years. They were intensively studied in the laboratory and field conditions, and were classified into four activity categories according to their work and leisure time activities. The results indicated that the highest prevalence rates of obesity, hypertension and angina pectoris symptoms were found among men doing heavy physical work and having no sporting leisure activities. The second study included a postal questionnaire to Finnish municipal employees in 1981 and 1985. Altogether 1999 women and 1419 men responded in both years. Their mean ages at the two survey times were 50.5 and 54.7 years, respectively. The 4-year incidence rates of coronary heart diseases diagnosed by the doctor (myocardial infarction, angina pectoris, coronary insufficiency, hypertension) were the highest in occupations with physical demands, both among women and especially among the men. The incidence rate of hypertension was commonest (greater than 7.0%). Among men doing physical work the incidence rate of coronary artery disease was 5.0%. The risk ratios for muscular work among men were 5.8 in the 44--49 year age group and 2.2 in the 50--58 year age group. The third project was a case-control study.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Work and cardiovascular health: viewpoint of occupational physiology. 278 39

Early detection of heart failure requires criteria by which to define the initial stages of a syndrome which often has an insidious onset and which may progress slowly for many years. The most specific definitions of heart failure are those obtained towards the end of the disease process, but reliance upon these means that, although few cases are misclassified, only manifest cases can be detected. Since prevention is the ultimate goal, early detection of subjects at risk and a wider understanding of the pathophysiological mechanisms and risk factors are necessary. The principal causes of heart failure in the Western world are coronary artery disease and hypertension; valvular heart disease and other cardiac disorders are relatively uncommon causes. The major risk factors are obesity, tobacco smoking and diabetes mellitus, and in a prospective large-scale study we have also shown that individuals who develop manifest symptoms of heart failure often have a long history of exercise-induced dyspnoea. Clearly, identification of the early symptoms of heart failure and prompt treatment of risk factors such as hypertension and obesity are important objectives. However, a better understanding of the underlying biochemical and structural abnormalities would help to define more appropriate preventive treatments.
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PMID:Improving the detection and diagnosis of congestive heart failure. 280 86

In this study 74 men, 40-60 years old, with incapacitating angina pectoris and angiographically verified coronary artery disease (CAD) were compared to an equal number of randomly sampled healthy men matched for age, occupation and place of living. Obesity and smoking were more common in patients than in controls. The patients had elevated cholesterol (C), triglycerides (TG), and phospholipid (PL) levels dependent on raised concentrations of these lipids in the VLDL and LDL. The C and PL levels in the HDL fraction were decreased. Obesity had a significant influence on the VLDL and HDL levels. Also after taking this influence into account, the CAD patients had higher VLDL and LDL levels and a lower HDL concentration than the controls. Furthermore, regardless of the influence of the TG concentration, the HDL level was reduced in the patients. Smoking habits had no significant influence on the lipoprotein levels. Treatment with beta-adrenoceptor blocking drugs was not associated with any significant alteration of the VLDL or the HDL level. The results strengthen the importance of lipoprotein aberrations as risk factors for coronary heart disease also if observed in association with obesity, smoking and treatment with beta-adrenoceptor blocking drugs.
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PMID:Aberrations in lipoprotein lipids in men with coronary artery disease and the influence of obesity, smoking and beta-adrenoceptor blocking drugs. 285 66

Few data are available regarding the prevalence and causes of false-negative auscultation (mis-auscultation) of aortic (AR), mitral (MR), or tricuspid regurgitation (TR), and there are no such data that are relevant when the patient's pretest probability of having regurgitation is unknown. The authors therefore studied 294 patients examined by pulsed Doppler echocardiography. On 755 examinations (2.57 examinations per patient), Doppler velocity patterns typical of AR, MR, or TR were found in 63, 96, and 49 patients, respectively. For all three murmurs, mis-auscultation was the rule, rather than the exception, with sensitivities of auscultation ranging from 0 to 37%, depending (but weakly) on the site of the murmur and the years of training of the observer. Specificity of auscultation was high (85% to 100%). The factors associated with the mis-auscultation of AR were poor image quality in the echocardiograms, absence of cardiomegaly, and less experience of the examiner. The probability of missing MR increased in the presence of coronary artery disease (CAD) or if the examiner had less experience. The likelihood of missing TR by auscultation was increased by CAD, obesity, chronic obstructive pulmonary disease, or the absence of cardiomegaly. This study suggests that there is a high prevalence of "silent" murmurs, and that not hearing a regurgitant murmur does not suffice to rule out the presence of regurgitation.
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PMID:Causes of false-negative auscultation of regurgitant lesions: a Doppler echocardiographic study of 294 patients. 297 89

Recent studies of vegetarian diets and their effects on morbidity and mortality are reviewed. Vegetarian diets are heterogeneous as are their effects on nutritional status, health, and longevity. Mortality rates are similar or lower for vegetarians than for nonvegetarians. Risks of dietary deficiency disease are increased on vegan but not on all vegetarian diets. Evidence for decreased risks for certain chronic degenerative diseases varies. Both vegetarian dietary and lifestyle practices are involved. Data are strong that vegetarians are at lesser risk for obesity, atonic constipation, lung cancer, and alcoholism. Evidence is good that risks for hypertension, coronary artery disease, type II diabetes, and gallstones are lower. Data are only fair to poor that risks of breast cancer, diverticular disease of the colon, colonic cancer, calcium kidney stones, osteoporosis, dental erosion, and dental caries are lower among vegetarians. Reduced risks for chronic degenerative diseases can also be achieved by manipulations of omnivorous diets and lifestyles.
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PMID:Health aspects of vegetarian diets. 304 2

Coronary artery disease (CAD) is the leading cause of death among whites with non-insulin-dependent diabetes mellitus (NIDDM). Several risk factors--dyslipidemia induced by NIDDM, obesity, hypertension and hyperglycemia--likely contribute to accelerated atherosclerosis. The dyslipidemia in NIDDM is characterized by abnormalities in composition and metabolism of very low density lipoproteins, low-density lipoproteins (LDL) and high-density lipoproteins (HDL). However, because of the lack of long-term prospective epidemiologic studies, the relative importance of lipoprotein risk factors in the causation of CAD in diabetic patients is not clear. The World Health Organization Multinational Study of vascular disease in diabetics observed increased prevalence of CAD in diabetic populations with relatively high levels of plasma cholesterol and supports the concept that lowering cholesterol levels may significantly reduce coronary risk in NIDDM. To determine the effectiveness of lovastatin, an inhibitor of HMG CoA reductase, for lowering cholesterol levels, 16 patients with NIDDM and mild to moderate increases in plasma cholesterol were given lovastatin (20 mg twice daily) in a randomized, double-blind, placebo-controlled manner for 4 weeks. Compared with the placebo, lovastatin reduced concentrations of total cholesterol (233 +/- 10 vs 172 +/- 7 mg/dl [standard error of the mean], p less than 0.001), LDL cholesterol (140 +/- 9 vs 101 +/- 6 mg/dl, p less than 0.001), and LDL apolipoprotein-B (108 +/- 16 vs 80 +/- 16 mg/dl, p less than 0.001). Plasma triglycerides and very low density lipoprotein cholesterol levels also decreased by 31 and 42%, respectively. Although HDL cholesterol levels did not increase, the total cholesterol/HDL cholesterol ratio decreased significantly with lovastatin therapy. No adverse effects were noted and glycemic control was well-maintained.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of dyslipidemia in non-insulin-dependent diabetes mellitus with lovastatin. 305 23

Clinical studies suggest that serum levels of apolipoproteins A-I and B may be more strongly related to coronary artery disease than are their respective lipoprotein-cholesterol fractions. Therefore, we assessed the association between levels of apolipoprotein B, apolipoprotein A-I, lipids, and lipoprotein cholesterols in children and the reported histories of myocardial infarction in their parents in a survey of 2416 black and white school-age children. As compared with children whose fathers did not report a myocardial infarction, those whose fathers reported having had an infarction (n = 139) had a lower mean level of apolipoprotein A-I (137 vs. 141 mg per deciliter; P = 0.04) and a lower ratio of low-density lipoprotein cholesterol to apolipoprotein B (1.08 vs. 1.11; P = 0.007), along with a higher ratio of apolipoprotein B to apolipoprotein A-I (0.64 vs. 0.61; P = 0.04). These associations existed independently of the children's race, sex, age, and history of obesity, smoking, alcohol intake, and use of oral contraceptives. Children whose mothers reported having had a myocardial infarction (n = 56) had no decrease in the ratio of low-density lipoprotein cholesterol to apolipoprotein B, but they tended to have an elevated ratio of apolipoprotein B to apolipoprotein A-I. In contrast, serum lipoprotein-cholesterol fractions in children were not related to myocardial infarctions in either parent. These results provide further evidence that apolipoproteins are more strongly related to the risk of cardiovascular disease than are lipoprotein-cholesterol fractions.
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PMID:The relation of apolipoproteins A-I and B in children to parental myocardial infarction. 309 50

Coexistent diabetes and hypertension affect an estimated 2.5 million persons in the United States. Hypertension occurs approximately twice as frequently in persons with diabetes as without and contributes to most of the chronic complications of diabetes, including coronary artery disease, stroke, lower extremity amputations, renal failure and, perhaps, to diabetic retinopathy and blindness. The proportions of complications in the diabetic population attributable to hypertension range from 35 to 75 percent. Hypertension in the diabetic population increases with age and is particularly associated with obesity and nephropathy. Limited data suggest the control of hypertension in the diabetic population may be better than in the general population, perhaps due to greater contact that persons with diabetes have with the health care system. Yet, in approximately half, hypertension is not controlled. Control strategies for hypertension in the diabetic population must take into account the higher frequency of hypertension, increased risks for adverse sequelae from the coexistent conditions, more complicated clinical management, and the greater contact with the health care system experienced by persons with diabetes. Community programs to improve hypertension control in the diabetic population may target a subset of the diabetic population and should tailor strategies to meet the needs of the target population. Hypertension control in the diabetic population must be addressed at multiple levels in the health care system, including improved detection, evaluation, and treatment of hypertension; improved adherence to antihypertensive therapy and long-term followup; provision of quality professional education and patient education and support; and systematic health care monitoring and program evaluation. Hypertension control should be emphasized in all comprehensive diabetes control programs.The treatment and control of hypertension may significantly reduce morbidity and mortality in the diabetic population.
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PMID:The control of hypertension in persons with diabetes: a public health approach. 311 83

Although it is often stated that proximal atherosclerotic coronary artery disease occurs more frequently than distal disease, several autopsy studies have disputed this. To examine the prevalence of proximal vs mid and distal disease and its relationship with cardiac risk factors, we studied more than 14,000 sections from 102 hearts with coronary artery disease at autopsy. After postmortem angiography, the coronary arteries were removed, divided into proximal, mid, and distal thirds, sectioned at 2.5 mm intervals, and graded for percentage reduction in cross-sectional area by atherosclerosis. Of 252 vessels in 84 patients with greater than or equal to 75% stenosis, 166 (66%) has proximal disease vs 107 (42%) with mid disease and 40 (16%) with distal disease (p less than 0.001). No patient had a mid or distal stenosis greater than 75% without proximal disease. When atherosclerosis of any severity was assessed, proximal atherosclerotic lesions were long and diffuse, whereas distal lesions were more often short and discrete. Proximal circumflex lesions were shorter in length than those in the right or left anterior descending coronary arteries. The prevalence of proximal, mid, and distal stenoses in 25 diabetic patients was similar to that in nondiabetic persons (53%, 47%, and 17%, p greater than 0.3). Similarly, hypertension, smoking, and obesity were not associated with an increase in prevalence of distal disease. Patients with distal stenoses were younger than patients without (mean age, 64 +/- 13 vs 73 +/- 10 years, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The distribution of atherosclerotic lesions in the coronary arterial tree: relation to cardiac risk factors. 318 39

More and more people are turning to exercise as a means of achieving long-term health. The World Health Organization has endorsed this concept. The best available evidence suggests that an employee fitness programme will result in decreased health-care costs, decreased absenteeism and increased productivity for the employer. Regular physical activity is also associated with lower mortality rates. Appropriate physical activity may be a valuable tool in therapeutic regimens for the control and amelioration (rehabilitation) of cardiovascular disease, coronary artery disease, hypertension, congenital heart disease, peripheral vascular disease, obesity, chronic obstructive pulmonary disease, diabetes mellitus, musculoskeletal disorders, end-stage renal disease, stress, anxiety and depression, etc. Regular physical activity, independent of other factors, reduces the probability of coronary artery disease and early death. Patients with risk factors for coronary artery disease need more intensive preexercise evaluation than those not a risk, and those with known or suspected cardiovascular disease need the most intensive evaluation and follow-up. Participation in vigorous sports activities, such as jogging, swimming, tennis, etc., helps to protect against the development of hypertension, even when other predisposing factors are present. Several studies have been conducted on the use of exercise in the treatment of hypertension. Physical exercise also contributes to the control of body weight. Consideration of the metabolic abnormalities in patients with type II (adult onset) diabetes indicates that they would make excellent candidates for an exercise programme. Osteoporosis is an important health problem for the elderly. The best treatment available at present is prevention, and a high level of physical activity throughout life can result in a larger skeletal mass during old age.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The role of physical activity in the prevention and treatment of noncommunicable diseases. 323 11


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