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Using questionnaires, the authors evaluated the risk of coronary heart disease in different groups of Hungarian society. Among physicians, teachers, factory workers and agricultural workers, the latter seem to be at the highest risk. On the basis of these results obtained in a population of 363 agricultural employees, a detailed risk factor analysis was made. These results were compared with those of the Framingham Offspring Study. Hungarians show alarmingly often a high blood cholesterol level, hypertension, smoking and obesity (the latter factor in women). The more frequent occurrence of the three main risk factors (high blood cholesterol, hypertension, smoking) in young Hungarians is concordant with the fact that the incidence of myocardial infarction in young people in Hungary is one of the highest in the world. The frequency of a positive parental history and obesity in men is lower in the Hungarian population than in the American one. The risk of coronary heart disease in the examined Hungarian population is considered high. The authors have launched a preventive programme.
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PMID:An attempt to evaluate the risk factors related to coronary heart disease in Hungary. 174 19

The incidence of impaired glucose tolerance, the relation of blood glucose levels to the prevalence of risk factors for coronary heart disease (CHD) and to myocardial infarction morbidity and mortality were studied over 15 years among males aged 45-59 years, excluding patients with diabetes mellitus. The data analysis was made in quintils of glucose levels. Impaired glucose tolerance was detected in 20.6% of the males. In the fifth versus the first quintil, there was an increase in the prevalence of systolic and diastolic arterial hypertension (p less than 0.001), obesity (p less than 0.001), low physical activity and hypercholesterolemia (p less than 0.05). As compared with the first, the fifth quintil showed higher total mortality rates and higher myocardial infarction morbidity and cardiovascular disease and CHD morbidity rates. But for age, and major risk factors, the risk for CHD, total and cardiovascular mortality increase at low and high blood glucose concentrations.
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PMID:[Disorders of glucose tolerance and ischemic heart disease]. 177 10

The most common cause of death in hypertensive patients is myocardial infarction (MI), being three times more common than stroke. Lowering raised BP results in 40% fewer strokes, but only 14% fewer MIs. This may be because other coronary risk factors that often accompany hypertension (e.g. obesity, lipid and thrombotic disturbances, insulin insensitivity, increased plasma renin activity and increased sympathetic activity) are either unaffected or exacerbated by some of the traditional antihypertensive agents. Some of these risk factors show a diurnal rhythm peaking at 07.00-10.00 hours, thus this time constitutes a 'vulnerable period' for sudden death or death from MI. beta-blockers and diuretics have been effective in preventing stroke, but diuretics (at least potassium-losing diuretics) might actually increase the incidence of sudden death and MI in young to middle-aged hypertensive subjects (though elderly patients may benefit). Quality of life can be impaired by some beta-blockers, and diuretics can cause metabolic upset and male impotence. Thus, antihypertensive agents that are not only effective and well tolerated but are beneficial to the broader coronary risk profile are desirable. ACE inhibitors should prove particularly useful in terms of: good quality of life; non-exacerbation or improvement of coronary risk factors; treating patients with impaired left ventricular function; reversing left ventricular hypertrophy and vascular wall hypertrophy, thus improving coronary flow reserve; atheroma regression; renal protection, particularly in diabetes; and prevention or regression of LV dilatation (remodelling) following MI.
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PMID:What does the future hold for ACE inhibitors? 179 18

The paper presents the dynamics of risk factors which was traced during prophylactic medical examinations and its relation to death rates among 40-59-year-old males from Frunze over 5 years. Prophylactic measures were found to lead to a positive dynamics of risk factors such as smoking, low physical activity, hypercholesterolemia, arterial hypertension in groups of active prevention. There was a decrease in death rates due to cardiovascular diseases, including myocardial infarction, stroke, among individuals with arterial hypertension, obesity, and low activity in the same group.
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PMID:[Relation between coronary disease risk factors and mortality among men aged 40-59 years in the city of Frunze (5-year follow-up)]. 183 17

The authors investigated the relationship of plasma insulin to some risk factors of ischaemic heart disease (IHD). They examined 79 healthy men--drivers of international truck transport with a normal glucose tolerance. The group comprised 21 men with hyperinsulinaemia. This group was compared with 21 men from the same group with normal insulin levels. The two groups were comparable (matched pairs) for age, occupation, cigarette and alcohol consumption and education. Significantly higher values of the body mass index (BMI), systolic and diastolic blood pressure were found in the group with hyperinsulinaemia. The latter group had a significantly more frequent positive family-history as regards cardiovascular diseases. After 48 months all subjects were checked. Two men from the entire group had died (43 and 48 years) from fatal myocardial infarction, both had hyperinsulinaemia. Manifestations of cardiovascular diseases (IHD and hypertension) developed in 12 subjects from the group with hyperinsulinaemia, as compared with two subjects with hypertension but normal insulin levels. To conclude, it may be stated that healthy subjects with hyperinsulinaemia and a normal glucose tolerance have a higher level of some risk factors of coronary heart disease (hypertension, obesity, positive family-history), as compared with the normoinsulinaemic group, and a poorer prognosis as regards cardiovascular morbidity and mortality.
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PMID:[Risk factors for ischemic heart disease in healthy persons with hyperinsulinemia and normal glucose tolerance]. 184 43

High total cholesterol is an important risk factor for coronary heart disease, and high levels in adulthood can be linked to high levels in childhood. We evaluated total cholesterol and lipoprotein levels and their relationship to body composition and reported family medical history of premature myocardial infarction or high total cholesterol in 800 children, aged 10 to 13, of Hispanic (n = 612), Asian (n = 100), and white or other (n = 88) ethnic descent. Mean total cholesterol levels were similar among boys (168.6 mg/dL; n = 399) and girls (167.5 mg/dL; n = 401) and among ethnic groups; however, high-density lipoprotein cholesterol was highest in boys and in Asian children. Forty-six percent of all children tested had total cholesterol levels of 170 mg/dL or greater (13.4% were 200 mg/dL or higher). Body mass index and skinfold (triceps and subscapular) measurements were least in Asian children. A high prevalence of obesity was noted in white and Hispanic children. Body mass index was positively correlated with total cholesterol in Hispanic children; in all ethnic groups, body mass index was positively associated with triglyceride levels and negatively associated with high-density lipoprotein cholesterol. Skinfold measurements were also significantly correlated with total cholesterol (in Hispanic children) and triglycerides and were negatively associated with high-density lipoprotein cholesterol. Among children with family history data available, only 52% with a low-density lipoprotein cholesterol level of 130 mg/dL or higher had a reported family history of high total cholesterol or myocardial infarction in a parent or grandparent aged 55 or younger, although rates varied substantially by ethnic group. The present study demonstrates the importance of population-based lipid screening in Hispanic, Asian, or multiethnic children, where more than a third of the children have total cholesterol levels in need of dietary management. The majority of children with elevated total or low-density lipoprotein cholesterol levels will not be identified if screening is recommended on the basis of a positive family history alone. Finally, there is evidence that body composition in children may be more closely correlated with total cholesterol or lipoprotein levels in certain ethnic groups.
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PMID:Relationship of blood lipids to anthropometric measures and family medical history in an ethnically diverse school-aged population. 184 49

The purpose of this study was to determine if the major risk factors for clinical myocardial infarction also predicted coronary artery stenosis as defined by arteriography. Of a cohort of 7,591 men who were free of cardiovascular disease at entry, 357 had arteriographic studies during a 20-year follow-up period. Risk factor levels were therefore known prior to the onset of clinical symptoms and arteriographic studies. Men with arteriograms were divided into groups with and without prior clinical myocardial infarction. High blood pressure, serum cholesterol, obesity, and low alcohol intake predicted both severe coronary stenosis and incident myocardial infarction, thus indicating that these variables were associated with clinical events through the underlying process of atherosclerosis. Dietary intake of cholesterol and serum glucose also had similar but not always statistically significant patterns of association with both coronary stenosis and myocardial infarction. In contrast, serum triglyceride and cigarette smoking predicted clinical myocardial infarction, but not severe coronary stenosis. This suggests that these variables play a stronger role in the precipitation of acute clinical events than in the underlying process of atherosclerosis. The findings were quite different for several risk factors when analyzed in a case-control format using the arteriography series from this same data set. Examination of possible explanations for the differences raises questions concerning the use of arteriography series for etiologic studies of coronary atherosclerosis.
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PMID:Predictors of arteriographically defined coronary stenosis in the Honolulu Heart Program. Comparisons of cohort and arteriography series analyses. 186 96

The Indian (Asian) population in South Africa has a high rate of coronary artery disease. Fasting serum lipid and lipoprotein levels were measured in 620 consecutive male survivors of myocardial infarction and compared with those of 524 healthy male volunteer controls, and the presence of hypercholesterolaemia and hypertriglyceridaemia in the patient group was related to other non-lipid coronary risk factors. All survivors and controls were below age 61 years. Total cholesterol, triglyceride and low-density-lipoprotein cholesterol concentrations varied significantly with age both in patient and control groups, whereas high-density-lipoprotein (HDL) cholesterol did not vary with age in either group. Using the 90th-percentile age-adjusted values of controls for total cholesterol (7.1 mmol/l) and triglyceride (3.0 mmol/l) as cut-off points, 287 (46%) survivors were hyperlipidaemic. Hypercholesterolaemia with or without associated hypertriglyceridaemia was the commonest abnormality: 125 (20%) patients showed hypercholesterolaemia without associated hypertriglyceridaemia; 73 (12%) had both hypercholesterolaemia and hypertriglyceridaemia and 89 (14%) hypertriglyceridaemia without associated hypercholesterolaemia. The frequency of hyperlipidaemia did not vary with age. HDL cholesterol levels below 0.66 mmol/l (10th percentile) were observed in 131 (22%) survivors. Obesity was significantly more frequent among hypertriglyceridaemic survivors, whilst diabetes and hypertension were seen more frequently in survivors with combined hypercholesterolaemia and hypertriglyceridaemia. No significant difference was noted in the frequency of smoking and family history of coronary artery disease in hyperlipidaemia and normolipidaemic patients.
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PMID:Lipid and lipoprotein abnormalities in South African Indian men with myocardial infarction. 188 54

Clinical and risk factor profile of 101 consecutive female patients subjected to coronary angiography was analysed. Coronary angiography showed single vessel disease (SVD) in 15.8 per cent, double vessel disease (DVD) in 12.9 per cent, triple vessel disease (TVD) in 39.6 per cent and normal coronary arteries (NC) in 30.7 per cent. Risk factor profile in patients with angiographic coronary artery disease (group II) included hypertension (HT) in 52.9 per cent, diabetes mellitus (DM) in 44.3 per cent, post menopausal state in 84.3 per cent, positive family history in 51.4 per cent, obesity in 58.3 per cent, low density and high density lipoprotein ratio (LDL/HDL) more than 3.0 in 58 per cent and smoking in 4.3 per cent. Risk factors in 31 patients with NC (group I) included HT in 29 per cent, DM in 6.5 per cent, positive family history in 45.2 per cent, obesity in 45.2 per cent, post menopausal state in 48.4 per cent, LDL/HDL ratio more than 3.0 in 30 per cent and smoking in none. The clinical presentation in group II was unstable angina in 64.3 per cent, stable angina pectoris in 24.3 per cent, myocardial infarction in 4.3 per cent and atypical chest pain in 2.8 per cent. In group I half the patients presented with atypical chest pain. The other modes of presentation included unstable angina 25.8 per cent, stable angina pectoris in 16.2 per cent and myocardial infarction in 6.5 per cent. Predictive value of exercise electrocardiography (Ex ECG) or exercise radionuclide studies (Ex RNU) was 61.7 and 68.4 per cent respectively. DM, post-menopausal state and LDL/HDL ratio more than 3 were significant risk factors in women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Profile of coronary artery disease in Indian women: correlation of clinical, non invasive and coronary angiographic findings. 189 97

This paper attempts to define the theory and practice of a modern approach to the initial workup of the patient with hypertension. The process includes a complete general medical evaluation along with special measures to enable the fullest characterization and clinical differentiation of the disease. The initial workup aims to (a) establish that the hypertension is sustained and should be treated; (b) identify all definable and curable causes for the hypertension; (c) identify the presence and degree of attendant risk factors such as smoking, alcohol use, obesity, diabetes, and abnormal lipid metabolism; (d) characterize the hypertension in terms of its pathophysiology; and (e) assess the presence and degree of target organ damage to the heart, brain, and kidneys. Because all diastolic hypertension is due to arteriolar vasoconstriction, a fundamental strategy of this process is to distinguish between renin-mediated and sodium-related vasoconstrictive forces and to evaluate which is preponderant. The chief instruments of this strategy are the renin-sodium profile and the response of plasma renin activity and blood pressure to specific antirenin system drugs. The captopril test, an important protocol in making this distinction, is primarily a powerful screening tool for confirming the possible presence or absence of curable renovascular disease or curable primary aldosteronism. That renin profiling cannot accurately discriminate between the contributions of either the renin or sodium-volume factors in that large fraction of medium-renin patients is not a viable reason for not performing the test. The test has its greatest strength for identifying sizable numbers of otherwise unrecognizable patients with very high or very low renin concentrations who might have curable disorders and who likely reflect different pathophysiologic vasoconstrictive mechanisms for which entirely different drug therapies are appropriate. However, the baseline renin test is also useful for assessing prognosis and the likelihood of a heart attack and it is valuable for deciding whether to use an anti-renin system drug (for medium and high renin concentrations) as opposed to natriuretic agents (low-renin patients) such as a diuretic or calcium antagonists as the primary step. In our present state of knowledge, the basic diagnostic biochemical workup includes the renin-sodium profile and the 24-h urinary sodium, potassium, and microalbumin excretion rates. This package is further enriched by baseline electrocardiography and echocardiography and the evaluation of glucose and lipid patterns.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Clinical evaluation and differential diagnosis of the individual hypertensive patient. 191 3


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