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Systolic and diastolic time intervals were measured in 655 men who did not have coronary or hypertensive heart disease. The correlation between systolic and diastolic intervals (STI) and the heart rate, age, height, weight, weight/height index, blood pressure and work heaviness were calculated using multiple stepwise regression analysis. There was a significant correlation between heart rate and the majority of STI. Also there was a significant influence of systolic and diastolic blood pressure and age on the ejection variables (QS2, LVET, S1S2). The PEP and ICT were influenced by heart rate, and systolic and diastolic blood pressure. The PEP/LVET ratio was dependent on diastolic and systolic blood pressure. The height of the A wave of apex cardiogram was significantly dependent on diastolic and systolic blood pressure, obesity, heart rate, and age. The IRT was dependent on heart rate, obesity, and height. When interpreting systolic time intervals one must use systolic time interval indices which are calculated by using the effect of heart rate on them, but in some cases the effect of other factors must be taken into account because blood pressure, age, and obesity also have a significant physiological effect on the STI values.
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PMID:The influence of heart rate, age, blood pressure, obesity, and work on systolic and diastolic time intervals. 67 98

With improvements in life expectancy and as more and more people have access to modern medicine, non-communicable diseases are emerging as a health problem in both urban and rural communities in Myanmar. Of all non-communicable diseases, cardiovascular diseases (CVD) are known to be the major health problem. Since many studies that have been conducted in both developed and developing countries have shown a difference between rural and urban communities with regard to cardiovascular diseases, our study had the objective of finding out the prevalence of ischemic heart disease, hypertensive heart disease and rheumatic heart disease in a rural and urban community. The risk of obesity and smoking in the occurrence of CVD was also studied. A cross-sectional survey was conducted in three urban townships of Yangon City (Sanchaung, Latha and Pabedan) and one rural township of Hmawbi. The results showed that CVD were a health problem in both the urban and rural communities. Coronary heart disease was seen to be more prevalent in the urban townships than in the rural Hmawbi Township, but hypertension (HT) and rheumatic heart diseases (RHD) were more prevalent in the rural township of Hmawbi. Obesity which has been blamed as the major risk factor for CHD and HT in the developed countries was not found to be a risk factor in the study townships, but smoking was.
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PMID:Prevalence of cardiovascular diseases in rural area of Hmawbi and urban Yangon city. 134 45

Cardiovascular disease is the third most common cause of death in Tshepong Hospital in the western Transvaal, and the most common cause of death in patients older than 35 years. A prospective study was undertaken which included limited necropsies in 90 of the 167 cardiovascular disease deaths over 1 year. A reliable mortality pattern for cardiovascular deaths is described. Additionally, attention is paid to co-existing conditions. Conditions relating to cardiovascular disease, such as hypertension, benign hypertensive nephrosclerosis, atherosclerosis and obesity, were also evaluated. Cerebrovascular conditions were found in 32% of cardiovascular deaths. Intracerebral haemorrhage was found in 50% and cerebral infarction in 29% of cases. Fifty-seven per cent of cardiovascular deaths were due to cardiac conditions, the most common being pulmonary hypertension (31%), dilated cardiomyopathy and chronic rheumatic valvular disease (17% each) and hypertensive heart disease (14%). Forty-nine per cent of subjects were hypertensive, while 40% exhibited benign nephrosclerosis and only 3% of the examined vessels had signs of severe atherosclerosis. Tuberculosis was present in 13% of cases. The clinical diagnosis was the same as the final necropsy diagnosis in 38% of cases. These results emphasise the importance of performing necropsies to obtain reliable mortality statistics.
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PMID:Cardiovascular causes of death at Tshepong Hospital in 1 year, 1989-1990. A necropsy study. 173 52

The heart may play an active, passive, or incidental role in the pathogenesis of hypertension. Echocardiography probably contributes little to understanding of active mechanisms, although it may provide important information relative to structural and functional adaptive changes associated with development of left ventricular hypertrophy. Moreover, because other clinical conditions frequently coexist with hypertensive heart disease, echocardiography may provide another dimension in the assessment of obesity, coronary heart disease, mitral valve prolapse, idiopathic hypertrophic subaortic stenosis, and asymmetric septal hypertrophy in the overall problem. Critical in this understanding are the subtle changes that occur in the individual patient, reflecting the natural history of the disease or response to its treatment. Since technical problems preclude echocardiographic evaluation in all patients with hypertension, particular care must be exercised in making epidemiologic generalizations.
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PMID:Future directions in the use of echocardiography. 380 1

To obtain epidemiologic information on extra echocardiographic spaces immediately posterior to the left ventricular free wall, 2,028 subjects in the original Framingham cohort study (mean age 70 +/- 7 years) and 3,624 of the offspring of the cohort (and their spouses) (mean age 44 +/- 10 years) with adequate echocardiograms were evaluated. Extra echocardiographic spaces were detected in 370 (6.5%) of the 5,652 subjects. The prevalence ranged from less than 1% in subjects in the 20- to 30-year age decade to greater than 15% for those in their 80s. Extra echocardiographic spaces tended to be more common in subjects who were older, female, obese, more hypertensive, and who had higher blood sugar levels and higher low density lipoprotein cholesterol levels (measured 8 years earlier). The high prevalence of extra echocardiographic spaces and the independent association with age (cohort and offspring), obesity (cohort and male offspring), and ventricular septal hypertrophy (cohort and male offspring) is compatible with at least 2 hypotheses among others that should be tested: (1) Subepicardial fat may often masquerade as pericardial fluid producing a posterior extra echocardiographic space, especially in obese elderly subjects. (2) Small posterior extra echocardiographic spaces may often be early markers of subclinical hypertensive heart disease.
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PMID:Prevalence and correlates of posterior extra echocardiographic spaces in a free-living population based sample (the Framingham study). 622 May 97

Maori mortality is compared with that of other New Zealanders aged 15-64 in the period 1974 to 1978. For males, it is estimated that approximately 20% of the Maori excess in mortality is associated with marked ethnic differences in socio-economic status. Of the remaining excess, an estimated 15% is linked with cigarette smoking, 10% with alcohol consumption (excluding accidental cause of deaths), 5% with obesity and 17% was due to accidents. However 36% of the non-social class related excess involved rheumatic and hypertensive heart disease, nephritis, bronchiectasis, diabetes and tuberculosis which were all associated with a Maori mortality five or more times that for non-Maoris. It is recommended that resources should be allocated so that Maori people can be employed to maintain contact with Maori patients with these diseases in order to improve health services utilisation and compliance with therapy. While it was not possible to determine socio-economic status for females from national mortality data, other findings were similar to those found for males except that mortality from coronary heart disease and cerebrovascular disease also contributed to the Maori excess.
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PMID:Determinants of differences in mortality between New Zealand Maoris and non-Maoris aged 15-64. 658 48

The prognostic significance of risk factors for ischemic and hypertensive heart disease in the aged differs in many respects from that in younger persons. In old age, most risk factors for ischemic heart disease such as an elevated level of total serum cholesterol, cigarette smoking, obesity, Type A personality and abnormal glucose tolerance have a less adverse effect on morbidity and mortality from ischemic heart disease, while an elevated level of high density lipoprotein, and moderation in the use of alcohol each have a favorable effect. A high level of low-density lipoprotein cholesterol exerts an adverse effect. Both systolic and diastolic hypertension have an adverse influence on morbidity and mortality from ischemic and hypertensive heart disease, as does the electrocardiogrpahic pattern of left ventricular strain. Long-term controlled studies are needed to determine the effects on mortality and morbidity of the modification of risk factors by means of drugs, diet, and change of lifestyle. Such studies are necessary if we are to determine whether hoped-for favorable changes are offset by potential side effects on physical and mental health.
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PMID:Ischemic and hypertensive heart disease in the aged: prognostic and therapeutic factors. 741 Jul 62

In order to study left ventricular hypertrophy patterns in obese hypertensives, we examined 132 patients with essential hypertension by 2D, M-mode and Doppler echocardiography. The patients were classified in four comparable groups, corresponding to the values of Quetelet's body mass index (BMI) and grades of obesity. More obese hypertensives had on average larger left ventricles with thicker walls and larger left atria than less obese, or lean ones. Left ventricular mass increased significantly and progressively with advancing grades of obesity, but relative wall thickness (wall thickness/cavity size ratio) did not diminish. Doppler echocardiography revealed significantly higher prevalence of left ventricular diastolic dysfunction among obese than among lean hypertensives. In the second part of our study, we analyzed the subgroups defined by the severity of hypertension and the age of the patients. The correlation of the indices of left ventricular and left atrial hypertrophy with the BMI values was considerably better in the group of moderate than in the group of mild hypertension. The r values were 0.62 vs. 0.22 for left ventricular mass and 0.64 vs. 0.26 for left atrial dimension. The group of patients with severe hypertension was characterized by left ventricular cavity enlargement in correlation with increasing BMI values, but without corresponding left ventricular wall thickening. So called left ventricular "eccentricity index", as the reverse value of relative wall thickness, correlated well (r = 0.76) with the BMI values. The indices of left ventricular hypertrophy correlated with the BMI values slightly better in middle age groups than in the groups of the youngest (< or = 30 years) or the eldest (> or = 61 years) hypertensives. In conclusion, eccentric left ventricular hypertrophy does not seem to be a distinctive feature of hypertensive heart disease in obesity. There is only some tendency toward the "eccentricity" of left ventricular geometry which becomes more apparent in more severe forms of hypertension, especially in very obese persons.
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PMID:Left ventricular hypertrophy in obese hypertensives: is it really eccentric? (An echocardiographic study). 1089 44

This article discusses risk factors for cardiovascular disease in the minority community, including hypertension, obesity, diabetes,and diet. The minority community exhibits important population differences regarding risk and outcomes for cardiovascular disease. The complete explanation for these differential outcomes is lacking and likely to be multifactorial in origin; however, disparities in health care (differences in the quality of health care that are not due to access-related factors or clinical needs, to preferences, or to the appropriateness of the intervention) may emanate from decisions made by the patient, provider, or health care system. Hypertension as a disease entity is strikingly pathologic in African Americans. Correspondingly, the incidence of cardiovascular mortality due to hypertensive heart disease is fourfold higher in African Americans than in non-Hispanic whites. Hypertension and heart failure can be treated effectively in the minority community with a regimen of agents not dissimilar from that used for the general population. Treatment regimens should be individualized based on the disease presentation, associated comorbidity, and disease severity and not on something as arbitrary as race.
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PMID:The prevention of heart failure in minority communities and discrepancies in health care delivery systems. 1533 20

Hypertension and hypertensive heart disease (HHD) are inter-related phenotypes frequently observed with other comorbidities such as diabetes, obesity, and dyslipidemia, which probably reflect the complex gene-gene and/or gene-environment interactions resulting in HHD. The complexity of HHD led us to examine intermediate phenotypes (e.g., echocardiographically-derived measures) for simpler clues to the genetic underpinnings of the disease. We applied the method of independent component analysis to a prospective study of the metabolic predictors of left ventricular hypertrophy and extracted latent traits of HHD from panels of multi-dimensional anthropomorphic, hemodynamic echocardiographic and metabolic data. Based on the latent trait values, classification of subjects into different risk groups for HHD captured meaningful subtypes of the disease as reflected in the distributions of primary clinical indicators. Furthermore, we detected genetic associations of the latent HHD traits with single nucleotide polymorphisms in three candidate genes in the peroxisome proliferator-activated receptors complex, for which no significant association was found with the original clinical indicators of HHD. Consensus analysis of the results from repeated independent component analysis runs showed satisfactory robustness and estimated about 3-4 separate unseen sources for the observed HHD-related outcomes.
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PMID:Enhanced detection of genetic association of hypertensive heart disease by analysis of latent phenotypes. 1843 73


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