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Precursors of sudden death were sought in men--1838 civil servants in Albany, New York, and 2282 residents of Framingham, Massachusetts--under continuous surveillance for 16 years. In men 45-74 years old there were 234 deaths attributed to coronary heart disease (CHD) of which 109 occurred within one hour of onset of symptoms. More than half of all deaths due to CHD occurred outside the hospital and about 80 per cent of these were sudden. Most were unheralded by prior symptoms of CHD. Persons at high risk of death from CHD, including sudden death, can be identified long before the terminal unexpected catastrophe. The same precursive stigmata exist in persons subject ot coronary attacks whether or not immediately fatal. The risk of sudden death in these two populations was positively correlated with high blood pressure, the electrocardiographic pattern of left ventricular enlargement, obesity, and heavy cigarette usage. Sudden death is a common and possibly incidental expression of lethal coronary heart disease. The potential candidate for sudden death cannot be confidently distinguished from the individual who succumbs more slowly of myocardial infarction. The inescapable conclusion is that the prevention of sudden death requires the prevention of coronary attacks.
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PMID:Precursors of sudden coronary death. Factors related to the incidence of sudden death. 12 82

To ascertain the frequency of defined hyperlipoproteinemia and to investigate the relation between lipoprotein fractions and coronary heart disease, we measured serum lipoprotein cholesterol levels in a population-based sample of Hawaii Japanese men 50 to 72 years old. Type II hyperlipoproteinemia was present in 3 per cent of 1859 men, and Type IV in 26 per cent. Relative risks for coronary heart disease, based on 264 prevalence cases, were found to be 1.8, 1.8 and 0.46, between the upper and lower quartiles of total, beta, and alpha cholesterol, respectively. We found no significant relation between triglyceride and coronary heart disease. The inverse relation of alpha cholesterol of prevalence of coronary heart disease was independent of beta cholesterol, obesity, and other factors. The data suggest the need for further evaluation of the protective effect of the alpha lipoprotein fraction on the development of coronary heart disease.
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PMID:Serum lipoproteins and coronary heart disease in a population study of Hawaii Japanese men. 17 94

Diabetes and a low high-density lipoprotein cholesterol level are associated with each other and with a higher coronary heart disease risk in women. Moreover, both are strongly associated with obesity. These findings are reported from the Framington Study, in which persons aged 49 to 82 were characterized, after overnight fast, for blood lipids by the method of Fredrickson and Levy and then followed for the subsequent development of coronary heart disease. Low-density lipoprotein cholesterol was also associated with coronary heart disease risk in women, but fasting triglycerides were not associated with risk after allowing for the association with high-density lipoprotein cholesterol and diabetes. A low high-density lipoprotein cholesterol in the presence of diabetes appeared to raise the coronary heart disease risk in women relative to that of men.
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PMID:Diabetes, blood lipids, and the role of obesity in coronary heart disease risk for women. The Framingham study. 19 96

Cardiovascular diseases are the leading cause of death in Western countries, with an enormous increase in death rate and involvement of younger age groups during the last decades. This applies especially to coronary heart disease and is mainly caused by first-degree risk factors: hypertension, hyperlipoproteinemia, cigarette smoking, gout, obesity, polycythemia, lack of physical activity, and stress. These risk factors are discussed with special reference to overnutrition and increased cholesterol levels. Recent resuults of research concerning lipids and their relation to atherosclerosis are reviewed.
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PMID:[Etiology and pathogenesis of arteriosclerosis]. 20 5

The incidence of TIA, stroke, and neuropathy was studied in a community-based maturity-onset diabetic population. The frequencies of TIA and stroke were increased in maturity-onset diabetic patients as compared to the population of Rochester, Minnesota. The median age of occurrence of TIA and stroke in diabetics was 74 years, not significantly different from that in non-diabetics. Diabetic patients with hypertension at the time of diagnosis of diabetes mellitus had an increased frequency of TIA and stroke. Control of hypertension and/or diabetes mellitus was associated with a decreased frequency of TIA or stroke. Obesity, clinical coronary heart disease, and an abnormal electrocardiogram at the time of diagnosis of diabetes mellitus were not associated with a significantly increased frequency of TIA or stroke. The most common type of peripheral neuropathy in diabetes mellitus was distal polyneuropathy. Mononeuropathy and autonomic neuropathy were much less frequent. The frequency of distal polyneuropathy increased with the duration of diabetes mellitus. The frequency of neuropathy was increased in patients with poor control, reemphasizing the importance of diabetic control in the prevention of diabetic complications.
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PMID:Neurologic complications of diabetes mellitus: transient ischemic attack, stroke, and peripheral neuropathy. 21 54

High density lipoprotein (HDL) cholesterol is inversely related to coronary heart disease prevalence. Despite the fact that obese patients have lower plasma HDL-cholesterol concentrations, there are few prospective studies on the effect of weight loss on HDL-cholesterol. Consequently, plasma lipoprotein levels were measured in 15 obese females before and after a 10 week weight loss program. Mean weight loss was 8.6 +/- 3.9 kg (P less than 0.001). Total plasma cholesterol and low density lipoprotein-cholesterol did not change significantly. Plasma triglyceride levels decreased (P less than 0.05) as did HDL-cholesterol (P less than 0.02). A subgroup of 11 of the subjects had repeat lipid measurements 8 months after the start of treatment. Mean weight loss at this time was 12.8 +/- 0.8 kg (P less than 0.01). No subject had returned to her pretreatment weight but mean weight loss was not significantly different from the 10 week value. At 8 months all lipid values, including HDL-cholesterol, had returned to their pretreatment value. By multiple regression analysis HDL-cholesterol decreased with increasing relative weight but also decreased with increasing rate of weight loss. These results suggest that negative caloric balance produces a decrease in HDL-cholesterol that in prospective studies may obscure the inverse relationship between HDL-cholesterol and indices of obesity.
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PMID:Unexpected decrease in plasma high density lipoprotein cholesterol with weight loss. 22 48

Despite the advances in therapy, the high incidence, high mortality, and prematurity of coronary heart disease demonstrate the need for prevention. Measurement of a series of easily determined risk factors permits the early recognition of subjects at risk with remarkable reliability. However, reduction of risk factors affords protection against the illness only if they are causally connected with the disease mechanisms. The major evidence for linking atherosclerosis and its consequences with risk factors is reviewed. Particular attention is focused on serum lipids and the "lipid theory", smoking, elevated blood pressure, and physical inactivity, which are, on the basis of current knowledge, not only the most important factors but those most readily influenced by changes in daily living habits. Among the multiple risk factors mention is also made of obesity, diabetes, psychosocial stress, and hereditary predisposition. The probability of a causal relationship between risk factors and disease mechanisms justifies every effort to prevent the development of these precursors, or to treat them prophylactically if already present.
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PMID:[Prevention of arteriosclerosis. Current basis]. 22 49

The diets and nutrition of hunter-gatherers are discussed with the !Kung Bushmen (San) of the Dobe area, Botswana as the example. In general they show no qualitative deficiency of specific nutrients though they are thin and may be undernourished (by our standards) at some seasons. They show little or no obesity, dental caries, high blood pressure or coronary heart disease; their blood lipid concentrations are very low; and they can live to a good old age if they survive infections or accidents.
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PMID:Diet and nutrition of hunter-gatherers. 24 10

Two-hundred-and-forty-eight full-blood tribal Aborigines from the West Kimberley region of Western Australia were surveyed for the prevalence of coronary heart disease, and compared with the known prevalence in whites in the country town of Busselton, WA. The prevalence was found to be greater among the Aborigines, with 7% of men, and 11% of women being found to have "probable" coronary heart disease. Seven per cent of the population had electrocardiographic changes characteristic of frank ischaemia. The major risk factors contributing to this high prevalence were hypertension, diabetes mellitus, and obesity. Thirty-seven per cent of the Aborigines were hypertensive, and 17% had diabetes mellitus.
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PMID:Coronary heart disease in tribal Aborigines--the West Kimberley survey. 28 96

Epidemiological studies have laid the basis for a preventive approach to coronary heart disease (CHD). On balance, present evidence indicates that the following should form the basis of a preventive programme: low-fat diet, cessation of smoking, and control of blood pressure. Other factors likely to produce a beneficial effect on CHD occurrence include reduction of obesity and increased physical activity. Although psychosocial factors are most likely to be causally related to CHD, it is not possible at present to provide clear guidelines as to their role in a preventive programme.TRIALS ARE BEING CONDUCTED TO INVESTIGATE THE POSSIBILITY OF PREVENTING CHD BY A VARIETY OF APPROACHES: a doctor-centred approach or health education in certain sectors of a community or in whole communities. These trials have shown that it is possible to achieve behavioural changes and a reduction in the levels of risk factors in a proportion of the participants. It is not yet clear to what extent these changes in levels of risk factors in middle-aged people will lead to a reduction in the incidence of CHD. It can be calculated, however, that the greatest benefit is likely to come from approaches to prevention that involve the whole community, rather than only high-risk groups.
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PMID:Epidemiological basis for the prevention of coronary heart disease. 31 48


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