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Atherosclerosis and hypertension are, by far, the most common cardiovascular diseases affecting women, and both are influenced by diet. Atherosclerosis occurs more commonly in men than women; generally women are 10 to 15 years older than men when symptoms develop. The prevalence of hypertension is about equal in the two sexes, particularly in middle aged and older persons. These cardiovascular diseases are major causes of death and disability in this country. Atherosclerosis results in myocardial infarction, thrombotic strokes, and claudication. Hypertension, when severe, damages small blood vessels, causing kidney failure, hemorrhage, strokes, and heart failure; when the condition is mild to moderate, it produces atherosclerosis. Nutritional factors are of primary importance in both atherosclerosis and hypertension. Risk factors for atherosclerosis related to nutrition are hypercholesterolemia, hyperglycemia-diabetes, and for hypertension, obesity, high salt intake, and excessive use of alcohol. Of all these risk factors, obesity seems to be the most important because it is strongly linked to hypertension and diabetes. Dietary intake of saturated fat is a potent factor in determining the blood cholesterol level, and reducing intake often decreases the level, thus lessening the risk of atherosclerotic complications. Although high salt intake and excessive alcohol use produce hypertension in susceptible people, less is known about the frequency of this adverse effect than is known about obesity.
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PMID:Nutrition and cardiovascular diseases of women. 312 Feb 15

A three-decade examination of the prevalence, incidence, secular trends, and prognosis of cardiac failure in the Framingham Study provides insights into its epidemiology. Annual incidence of CHF is observed to increase from 3 to 1000 at ages 35-64, to 10 per 1000 at ages 65-94. There is a slight male predominance, owing to a higher rate of coronary disease, which conferred a fourfold risk of cardiac failure. Most cardiac failure is on the basis of long-standing hypertension or CHD. Silent infarctions were as predisposing for CHF as symptomatic MIs surviving 1 year. Hypertension is a major predisposing factor that at least triples the CHF risk, the systolic component being more predictive than the diastolic component. Correctable predisposing risk factors for CHF include: elevated blood pressure, impaired glucose tolerance, elevated cholesterol, low HDL-cholesterol, obesity, and a high hematocrit. Risk factors reflecting deteriorating cardiac function also were highly predictive, including: an enlarged heart, poor vital capacity, sinus tachycardia, and ECG-LVH. Commonly encountered ECG abnormalities such as intraventricular block, nonspecific repolarization abnormality, and ECG-LVH are all associated with a substantial risk of CHF. ECG-LVH carries a higher risk than x-ray enlargement. Sudden death was a common feature with CHF, occurring at 5 times the general population rate, even excluding those with overt CHD. Using the standard cardiovascular risk factors (age, systolic blood pressure, cholesterol, glucose, cigarettes, and ECG-LVH) jointly, it is possible to identify one tenth of the population from which 40% of CHF events evolve, in the absence of interim CHD or RHD.
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PMID:Epidemiology and risk profile of cardiac failure. 315 46

Several animal models of obesity have been reviewed with respect to the cardiovascular adaptations to this disorder. While some cardiovascular data are available for each model reviewed, the spontaneously obese rat has been most extensively characterized. Biochemical adaptations of the myocardium to experimental obesity have been reported, but this area has not been investigated extensively. The combined effects of obesity and hypertension upon the heart have been observed recently in the aortic-coarcted, obese rat, which may serve in the future as a useful model for investigating the basis of heart failure that occurs when these disorders are observed concurrently in the clinical setting.
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PMID:Assessment of animal models for investigating the cardiovascular adaptations to obesity. 332 41

Mortality is examined in patients with cardiac failure in the Framingham study of 5209 subjects. During 30 years of follow-up, the incidence of cardiac failure doubled with each decade of age with a male predominance produced by higher rates of coronary heart disease. Most cardiac failure was associated with hypertension or coronary heart disease. Among 232 men and 229 women in whom cardiac failure developed, sudden death occurred at nine times the general age-adjusted population rate. Cardiac failure alone increased the risk of sudden death fivefold. In those who also had coronary heart disease there was a further doubling of risk. The major predisposing factors for cardiac failure included hypertension, obesity, glucose intolerance, heavy smoking, cardiac enlargement, ECG abnormality, and atrial fibrillation. These were also risk factors for sudden death. These shared modifiable risk factors and cardiac impairments did not entirely account for the markedly increased risk of sudden death in cardiac failure. This suggest that either the damaged myocardium or treatment needed to control the cardiac failure may be at fault.
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PMID:Cardiac failure and sudden death in the Framingham Study. 335 16

Raised blood pressure is the strongest single risk factor for stroke in the general population. Diabetics are at increased risk of both hypertension and stroke. It is not clear if diabetes mellitus confers an excess risk of stroke that is independent of blood pressure. The authors examined the relation of diabetic status (personal history of diabetes and/or fasting plasma glucose greater than 7.8 mmol per liter) to stroke risk in a population-based cohort of 3,778 adults aged 50-79 years in Rancho Bernardo, California who were followed from 1972 for an average of 12 years. There were 232 stroke cases, 139 of which were ascertained from death certificates. Diabetics had higher mean systolic blood pressures, significantly so in females, and diabetics of both sexes were significantly more obese. Diabetics had greater univariate age-adjusted stroke mortality and morbidity rates than nondiabetics. The increased stroke rates were still apparent in diabetics after stratifying for systolic blood pressure. In multivariate analyses, the relative risks (RRs) for stroke mortality and morbidity associated with diabetes were not significantly changed in men (RR = 1.8) and women (RR = 2.2), after adjusting for the effect of risk factors including age, systolic blood pressure, cholesterol level, obesity, and smoking habits, and excluding persons with personal history of heart attack, heart failure, or stroke. These findings support the hypothesis that diabetes may confer excess risk of stroke independent of blood pressure.
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PMID:Diabetes mellitus: an independent risk factor for stroke? 338 20

Methods of clinico-instrumental investigation and biochemical monitoring (CPK and its membranous fraction) were employed for examination of 432 patients with acute myocardial infarction (AMI). Among them there were patients with an uncomplicated course of disease (19.4%), recurrences (13.7%) and AMI spreading (9%). Lung edema, a cardiogenic shock, ventricular fibrillation and complicated cardiac rhythm disorders were not detected on the 1st day of disease. Clinico-anamnestic data provided no opportunity for defining factors promoting AMI recurrences whereas AMI spreading frequently developed in patients with repeated AMI, suffering from essential hypertension, obesity and heart failure. Higher diastolic pressure in the pulmonary artery, an increase in the cardiac volume, a decrease in the ejection fraction and left ventricular stroke work--changes which were most pronounced in AMI spreading, were noted in patients with AMI lingering forms. Signs of disseminated intravascular blood coagulation were noted in the venous and arterial blood of patients with lingering AMI forms. A high blood enzyme level was shown to be accompanied by a low level of antibodies to LDH and CPK.
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PMID:[Clinico-pathogenetic variants of protracted forms of acute myocardial infarct]. 361 39

Synthetic progestins derived from nortestosterone provide a promising contraceptive alternative for women with contraindications for estrogens. Progesterone and synthetic progestins reduce vasodilatation and edema induced by estrogens and stop estrogen-dependent cellular multiplication in target tissue. Progestins have 2 kinds of contraceptive affect: antigonadotropic action at sufficient doses, and peripheral action at lower doses. The cervical mucus is modified in composition and volume, becoming hostile to sperm; the endometrial mucus atrophies; and tubal motility is slowed. High dose progestins are administered from the 5th or 10th to the 25th cycle day, with the earlier date preferred for women with shorter cycles. They are an ideal method for women with endometrial hyperplasia or benign breast disease or histories of breast or uterine cancer, as well as for women over 40 with dysovulatory cycles. Contraindications to high dose progestins include obesity, hypertension, lipid metabolic anomalies, and diabetes. Low dose progestin-only pills are administered at the exact same time each day including during menstruation. They are attractive for some women because they contain no estrogen, a reduced progestin dose causing fewer headaches and less somnolence, and fewer metabolic effects. Low dose progestins are indicated for lactating women, those with contraindications to estrogens such as obesity, hypertension, hyperlipidemia, and diabetes, and those with renal or cardiac insufficiency with valvulopathy. Low dose progestins are also indicated for nulliparas and other women for whom IUDS are contraindicated. Women using low dose progestins should never take drugs that act as enzymatic inductors, which speed hepatic degradation of steroids and reduce their efficiency. A resulting pregnancy is likely to be extrauterine because of slowed tubal transport. The failure rate of low dose progestins ranges from .9-3%, with higher failure rates among younger women. About 30% of users initially experience spotting, which despite its usual disappearance after 2-3 months of use is the most common reason for discontinuing the method. Low dose progestins have no metabolic or vascular effects, but they may cause a relative hyperestrogenism is some users. Other modes of administration of progestin contraception include continuous high doses, never justified solely for contraception. Trimonthly injections of medroxyprogesterone acetate of norethindrone enanthate provide contraception through a long lasting antigonadotropic effect. Metrorrhagia and amenorrhea are among possible side effects. The method is used primarily in developing countries where its ease of use is a major advantage. Subcutaneous implants releasing continuous doses of levonorgestrel provide contraceptive protection for over 5 years. The cumulative failure rate is 1.7 at 5 years. Metabolic tolerance is good. The major side effect is menstrual irregularity.
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PMID:[Progestational contraception]. 365 94

Sudden death victims share most of the major risk factors for coronary disease in general; and the key to prevention is to reduce the risk of coronary attacks, especially by avoidance of cigarettes, correction of obesity, and reduction of blood pressure. The incidence increases with age, with sudden death incidence in women only a third that in men. By incorporating CHD risk factors into a multivariate logistic formulation, a composite estimate of risk is obtained over a wide range. A severely compromised coronary circulation manifested only by ECG abnormalities carries a high risk of sudden death. VPBs associated with sudden death often occur concurrently with ECG signs of LVH, intraventricular block, and nonspecific ST-T abnormalities. Convalescent MI patients with a low risk of sudden death are usually asymptomatic; have a normal creatinine, normal post-MI ECG, no tachycardia, a normal exercise ECG, few VPBs on monitoring, and normotension; and show no signs of cardiac failure.
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PMID:Epidemiology of sudden death: insights from the Framingham Study. 383 69

Both risk factors and the incidence of cardiovascular disease are higher in diabetic patients. Total serum cholesterol has the same impact on coronary heart disease (CHD) incidence in diabetic patients as in nondiabetic individuals. Abnormal blood lipids in diabetic patients include elevated very low-density lipoproteins (VLDL) and triglyceride and reduced levels of high-density lipoproteins (HDL). These are associated with obesity and precede the onset of diabetes. Diabetes increases the risk of all clinical manifestations of CHD, has a greater impact in women, and predisposes to cardiac failure and fatal outcome. In men, it predisposes to silent myocardial infarctions. CHD risk reduction in the diabetic patient requires multifactorial control. In evaluating the lipid-induced CHD risk, the level of low-density lipoprotein (LDL) cholesterol is not as valuable as the LDL/HDL cholesterol ratio, which is the most reliable criterion. Triglyceride levels make no independent contribution. Most CHD preventive measures, including weight control, exercise, avoidance of cigarettes, and improvement of glucose tolerance also increase HDL cholesterol, reduced levels of which are chiefly responsible for the poor LDL/HDL ratio in diabetics. Weight control merits a high priority because of its favorable influence on the lipid profile, glucose tolerance, and blood pressure.
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PMID:Lipids, diabetes, and coronary heart disease: insights from the Framingham Study. 406 Dec 65

Zinc, an important enzymatic cofactor, takes part in numerous metabolic pathways. In man, zinc deficiencies may be due either to deficient absorption or to excessive use. In this study in 285 patients hospitalized in a department of internal medicine for acute or chronic conditions, serum zinc assays have shown the following results: serum zinc concentrations are significantly decreased in acute critical conditions (cardiovascular ischemic disorders, heart failure, infections); in chronic conditions, serum zinc is decreased in some instances (renal failure, cancer, alcoholism, diarrhea), while it remains normal in others (compensated heart failure, non-insulin dependent diabetes, arterial hypertension, obesity). The fall in serum zinc concentrations is usually correlated with the severity of the clinical condition.
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PMID:[The effect of various diseases on the zinc plasma level]. 630 73


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