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The prevalence of clinical and sub-clinical occlusive arterial disease and of risk factors implicated in the pathogenesis of arteriosclerosis was assessed in 21 patients with chronic renal failure, 27 on maintenance haemodialysis and 51 renal allograft recipients. Clinical occlusive arterial disease was present in 27 patients, and sub-clinical arterial disease in 34. Myocardial infarction, cerebral thrombosis and lower limb arterial thrombosis had occurred only in the transplant recipients; these patients had, however, been followed for a longer period of time than the other two groups. In the allograft recipients, the cumulative incidence of any occlusive arterial disease was 416 per 1000, and that of coronary heart disease was 267 per 1000 at six years. Hypertension was present in 76 per cent of patients prior to renal replacement therapy. Following institution of definitive therapy, hypertension was of shorter duration and less common in haemodialysis patients than in renal transplant recipients. Uraemic and haemodialysis patients with occlusive arterial disease had required antihypertensive medication for significantly longer than those free of arterial disease. Transplant recipients with hypertension had a greater mean serum creatinine, were receiving a larger maintenance dosage of corticosteroids and less frequently had undergone prior bilateral nephrectomy than those transplant patients without hypertension. Serum lipid levels were elevated in 62 per cent of patients. In the uraemic and haemodialysis patients hypertriglyceridaemia was the predominant abnormality while in the transplant recipients combined hypertriglyceridaemia/hypercholesterolaemia was more frequent. Despite regular aluminium hydroxide therapy 81 per cent of uraemic and haemodialysis patients had a calcium X phosphate product higher than normal. Arterial and/or soft tissue calcification as demonstrable in 20-38 per cent of patients within each group, but could not be related to the calcium X phosphate product of radiographic evidence of hyperparathyroidism. Glucose intolerance was present in 71 per cent of the uraemic and haemodialysis patients and 33 per cent of the transplant recipients. Hyperuricaemia, cigarette smoking, obesity and a sedentary existence were also prevalent. The majority of patients had several risk factors implicated in the pathogenesis of arteriosclerosis. Occlusive arterial disease is a major problem in patients with end stage renal disease, being no less common after transplantation than with long-term maintenance dialysis. The aetiology is multifactorial.
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PMID:Occlusive arterial disease in uraemic and haemodialysis patients and renal transplant recipients. A study of the incidence of arterial disease and of the prevalence of risk factors implicated in the pathogenesis of arteriosclerosis. 32 93

The seeds of premature coronary heart disease are often sown in childhood and it is the developing arteries of children which are the most susceptible. Paediatricians and all who work with them have the earliest and most promising opportunities for prevention. Coronary protection can be added to the potential advantages of breast feeding and to ensure appropriate fatty acid balance throughout weaning. It is reasonable to accept the strong consensus of opinion on diet reflected in the reports of the eighteen national committees. They are: to reduce total fat intake to 30-35% of the energy, to restrict consumption of saturated fat, cholesterol, sugar, and salt, to increase unrefined carbohydrate and polyunsaturated fat, and to maintain a P/S balance of 1.0-1.5:1. Food is the fundamental coronary risk factor, but others may add insult to injury. Smoking, hypertension, obesity, lack of exercise, and stress, each of which is related to behaviour, may start in childhood. Smoking doubles the overall risk CHD and increases it ten times in males under 45 years old. Good habits, including food preferences and eating patterns learned early, are those most likely to be continued. School meals require and should match revised nutritional education. The co-operation of the food industry is essential and can be anticipated, but it requires a clear lead by paediatricians. The nutritional advice should come from the medical profession. Every contact with children and their parents provides an opportunity for enquiry and giving advice.
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PMID:Perspectives in coronary prevention. 34 32

This paper reviews and discusses the evidence supporting the involvement of defective fibrinolysis in the pathogenesis of atherosclerosis, with emphasis on diabetes mellitus. According to the literature, defective fibrinolysis has been observed in association with virtually every major "risk factor" for coronary heart disease, including diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, hypertension, obesity, cigarette smoking and lack of physical exercise. The interrelationships between disturbances in carbohydrate and fat metabolism and fibrinolysis are considered. Attention is drawn to the need for increased clinical attention to the potential role of defective fibrinolysis in atherogenesis, and periodic assessments of the fibrinolytic status are suggested as a promising approach toward early recognition of atherosclerotic tendency and risk. The judicious use of physiologic, dietary and pharmacologic means to correct defective fibrinolysis prophylactically and for the treatment of some forms of atherosclerosis is advocated.
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PMID:Fibrinolysis and risk factors of atherosclerotic disease, with special emphasis on diabetes mellitus. 35 70

Coronary heart disease (CHD) is rare in South African Blacks, even in urban dwellers, but very common in Whites. The disease is multifactorial in causation. Habitual pattern of diet undoubtedly is strongly involved. Epidemiological and other evidence suggests that for the primary and secondary dietary prevention of CHD, intake of fat (also cholesterol) should be reduced, with an increase in the polyunsaturated moiety, and obesity should be controlled. Less specific general recommendations are increased consumptions of unrefined or partially refined grain products, and fruit and vegetables. Controversies over interpretations of evidence, over dietary recommendations, and also over the changes of their adoption, are discussed.
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PMID:Diet and coronary heart disease. 35 44

Issuing from the epidemiological situation of the angiocardiopathies the importance of the factors of risk for the coronary heart disease are emphasized with special consideration of the disturbances of lipometabolism. Essential constituent in the reduction of the factors of risk, particularly obesity, hyperlipoproteinaemia and hypertension, is the change of the habits of nutrition. An increased supply of manifold unsaturated fatty acids, an adequate to the disturbances of lipometabolism type-specific restriction of the cholesterol and carbohydrate intake and a reduction of the saline supply are to be recommended. The importance of measures in the field of health education which should begin already at school age is emphasized.
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PMID:[Role of life style and nutrition in the etiology, prevention and therapy of coronary disease with special reference to lipid metabolism]. 37 80

Coronary heart disease (CHD) risk factors were studied in 250 monozygotic (MZ) and 264 dizygotic (DZ) male veteran twin pairs, aged 42-56. All coronary heart disease risk factors studied showed significant correlations in both MZ and DZ twins. Substantial genetic variation was detected for height, blood pressure, glucose intolerance, uric acid, plasma triglyceride, and relative weight but little or no significant genetic variability in low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), total plasma cholesterol or hematocrit was demonstrable. These findings suggest that familial aggregation results from genetic influence on blood pressure, glucose intolerance, uric acid, triglyceride and, possibly, obesity, while largely shared environmental factors contribute to familial similarities in HDL, LDL, total cholesterol and hematocrit.
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PMID:The NHLBI twin study of cardiovascular disease risk factors: methodology and summary of results. 56 66

In 500 obese patients (146 men, mean age 37 +/- 13 years, Broca index 147 +/- 24; 354 women, mean age 36 +/- 14 years, Broca index 151 +/- 28) cardiovascular risk factors (RF) were investigated. The most frequent RF was hypertension (71 per cent), followed by glucose intolerance (49 per cent), hypertriglyceridemia (31 per cent), hypercholesterolemia (22 per cent) and hyperuricemia (22 per cent). Only 12 per cent of the patients were without RF. These patients were younger and less obese than the patients with RF. The prevalence of RF increased with increasing age and overweight. Analysis revealed significant correlations between overweight and blood pressure, blood glucose, insulin and age. Significant correlations between age and hypertension, blood glucose cholesterol, triglycerides and overweight were detected. The correlation between overweight and the sum of all RF was higher (r = 0.35) than the one between age and the sum of all (r = 0.23). Obese patients had a high prevalence of RF. Increasing overweight and (to a lesser extent) age are both associated with increased prevalence of RF. On the basis of the prevalence of RF, patients with gross obesity (Broca index greater than around 150) were considered to be at a high risk in respect of coronary heart disease.
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PMID:Cardiovascular risk factors in gross obesity. 61 33

An association of coronary artery occlusion, as determined by coronary arteriography with age, prevalence of risk factors and alcohol intake was studied in 1635 male and 371 female heart patients. The degree of coronary artery occlusion was positively related to elevated cholesterol, elevated triglycerides, diabetes, age and history of smoking for both male and female patients. Hypertension was related to the degree of occlusion only for female patients. Male and female patients who had a higher alcohol intake tended to have less extensive occlusion. No positive association was found between obesity and the degree of occlusion. When the patients were divided on the basis of age (less than 50 and greater than or equal to 50 years) the findings did not differ. The lack of finding a relation between obesity and occlusion or between hypertension and occlusion for males differs from the general findings of epidemiologic studies on the relation between these risk factors and coronary heart disease. The authors believe that this discrepancy may either be explained by the way they selected patients (i.e., they selected patients who underwent a diagnostic angiographic examination), or that obesity and hypertension are not directly related to coronary occlusion but influence occlusive disease through some secondary mechanism.
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PMID:Risk factors and angiographically determined coronary occlusion. 62 92

Epidemiological studies on the relationship of obesity, morbidity and mortality revealed the following results: In life insurance studies, excess mortality of obese people was found with more than 30 percent overweight. Mortality was caused by cardiovascular disease and diabetes mellitus. Obesity at issue of the policy in younger age was a greater risk than in the older age group. In prospective studies with long follow-up periods (greater than 16 years) it could be shown that obesity alone was a risk factor for coronary heart disease, the risk being greatest for men and middle aged women. However, the prevalence of accepted risk factors in an obese population is so high that the question whether obesity alone is a risk factor for coronary heart disease is of little interest. The correlations between obesity and risk factors were of minor magnitude; therefore other factors, such as age or HDL-cholesterol, should be considered in the elucidation of the relationship between obesity and coronary heart disease. HDL-cholesterol appears to be a powerful independent protective factor which is diminished in obesity. Despite the fact that studies proving a prolongation of life by treating obesity are not available, the treatment of obesity may be beneficial for the patient by diminishing risk factors.
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PMID:[Obesity and cardiovascular risk]. 64 7

Both the quality and the quantity of food ingested are relevant to the genesis of risk factors for coronary heart disease and the two are inseparable. Nevertheless they have a major common pathway through hypertension, which may well be the most important consequence of a high-protein, high-carbohydrate, high-fat, high-energy and high-sodium diet. Because body fatness is a strongly genetically determined characteristic and because it evolves over the whole period of childhood a vigorous and sustained programme of health education is required at all levels. The aim of such a programme is to effect a small shift in the fatness of the whole population; such a shift would dramatically and disproportionately reduce the incidence of obesity. Since the morbidity and mortality which is found in obese subjects arises primarily from cardiovascular disease in general, and coronary heart disease in particular, nutritional influences have obvious relevance to the prevention of coronary heart disease.
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PMID:Influence of nutrition in childhood on the origins of coronary heart disease. 65 80


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