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In a prospective population study of middle aged women socioeconomic factors and physical activity as initially reported were related to the 12 year incidence of ischaemic heart disease and to total mortality. There was a significant age specific correlation between low socioeconomic status according to the husband's occupation and myocardial infarction. No such association was seen between the socioeconomic status of the women themselves and myocardial infarction. Women with a low educational level had a significantly increased age specific incidence of angina pectoris. There was no significant correlation between marital status or number of children and incidence of ischaemic heart disease or overall mortality. Women who initially reported low physical activity at work during the last year had a significantly increased age specific 12 year incidence of stroke and death, as did those who reported low physical activity during leisure hours in whom the incidence of myocardial infarction and electrocardiographic changes indicating ischaemic heart disease were also increased. Multivariate analyses showed that the association between low educational level and incidence of angina pectoris was independent of socioeconomic group, smoking habits, systolic blood pressure, indices of obesity, serum triglycerides, and serum cholesterol. Similarly, low physical activity during leisure hours seemed to be an independent risk factor for stroke, and low physical activity at work was an independent risk factor for overall mortality.
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PMID:Socioeconomic factors and physical activity in relation to cardiovascular disease and death. A 12 year follow up of participants in a population study of women in Gothenburg, Sweden. 395 12

A prospective study has been carried out to determine the causes of death and risk factors for survival in 4994 patients referred with a diagnosis of hypertension to hospital specialist clinics and 457 patients treated by their general practitioners for this condition. At the time of entering the prospective study, 69% of the patients were already being treated for hypertension. Four hundred and eleven patients have died, and their causes of death and death rates have been compared with the rates for the population of England and Wales. Ischaemic heart disease accounted for over one-third of the deaths and stroke for one-fifth. The death rates for these conditions were two to five times those expected for men and women aged 50-59 years and up to twice the rate expected for the age group 60-69 years. Survival in these selected patients was impaired by the following independent risk indicators: cigarette smoking, previous history of myocardial infarction or stroke, diagnosis of angina, impaired renal function and raised blood sugar. The following factors were not independent positive risk factors: smoking a pipe or cigars, obesity, a low plasma potassium and an elevated serum uric acid.
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PMID:The survival of treated hypertensive patients and their causes of death: a report from the DHSS hypertensive care computing project (DHCCP). 395 86

The concentrations of cholesterol (C) and phospholipid (PL) levels in the high density lipoprotein (HDL) fraction and the HDL2 and HDL3 subfractions were determined in 74 men with incapacitating angina pectoris and coronary artery disease (CAD) verified by angiography. An equal number of randomly sampled healthy men matched for age, occupation and place of living constituted the control group. The HDL2 and HDL3 fractions were separated by a combination of ultracentrifugation and precipitation. The levels of HDL-C and HDL-PL were reduced in the CAD patients. The reduction of HDL lipids was attributed to both the HDL2 and HDL3 fractions. Proportionally there was a greater reduction of C and PL in HDL2 than in HDL3. The decrease of HDL2-C and HDL3-PL were significant also after allowance for the influences of obesity and triglyceride level. The reductions of HDL2 and HDL3 were significant as well in smoking as in nonsmoking CAD patients and both in patients with and without beta-adrenoceptor blocking drugs.
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PMID:HDL2 and HDL3 lipid levels in coronary artery disease. 396 40

We determined gastrin and pepsinogen I in serum samples obtained in 1968-69 from 256 women (175 women 54 years old and 81 women 60 years old when sampled). The concentration of gastrin in serum was significantly (p less than 0.01) and positively correlated with the incidence of myocardial infarction during a 12-year follow-up, with age taken into account as a background variable in multivariate analysis. It was not correlated with overall mortality or with the 12-year incidences of angina pectoris, electrocardiographic changes indicating ischemic heart disease, or stroke. The correlation with myocardial infarction was independent of smoking, systolic blood pressure, indices of obesity, concentrations of blood glucose during fasting and of serum triglycerides and cholesterol, and of the presence of diabetes mellitus at screening or during follow-up. Serum gastrin was significantly (p less than 0.05) related to body mass index (positive age-specific relation) and to smoking (negative age-specific relation). These findings may provide a new aspect to analysis of risk factors for myocardial infarction.
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PMID:Hypergastrinemia--a risk factor for myocardial infarction? 397 91

This study's objectives were to determine the influence of age and occupational factors on cardiovascular disease (CVD) incidence among U.S. Navy pilots diagnosed with CVD during a 12.5-year time period (n = 150) and to identify precursory diseases associated with CVD. Results showed a relationship between CVD and age; pilots, on the average, were more than 3 years younger at the time of CVD onset than other officers. No occupational factor was associated with CVD; fighter pilots had the highest rates of acute myocardial infarction and chronic ischemic heart disease. Angina pectoris was observed as a precursory disease of chronic ischemic heart disease, and several behaviorally related disorders (e.g., alcoholism) occurred with hypertension. Subsequent research should include all U.S. military pilots to examine, in a larger population, the influence on CVD of such occupational factors as flight in high-performance aircraft. An intervention program should be implemented to modify the lifestyles of pilots who had been hospitalized for hypertension and/or such conditions as obesity and alcoholism.
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PMID:Cardiovascular disease among U.S. Navy pilots. 400 72

In view of recent interest in the relationship of haematocrit and blood viscosity to hypertension and vascular disease, we have analysed retrospectively the relationship of haematocrit to blood pressure, vascular complications and other variables in 2,381 patients referred to the Glasgow Blood Pressure Clinic. Haematocrit correlated negatively with age and systolic pressure in men, and positively with age and systolic pressure in females. Positive correlations were found in both sexes between haematocrit and serum alanine aminotransferase (possibly due to mutual correlation with alcohol); and between haematocrit and overweight (Quetelet Index) but not obesity (Ponderal Index). Increased haematocrit was also associated with cigarette smoking; and with history of angina, myocardial infarction and intermittent claudication in females. No correlation was observed between haematocrit and history of stroke. These findings suggest that prospective studies of haematocrit in hypertensives may be of interest.
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PMID:Haematocrit in patients attending a hypertension clinic. 405 4

The clinical epidemiology of coronary artery disease (CAD) among black patients has not been well described, particularly in relation to the impact of the major risk factors. Lipoprotein profiles and other risk factors were measured in 114 black patients undergoing cardiac catheterization for probable CAD. Patients (coronary narrowing of 50% or greater; n = 63) were compared to those without significant stenoses (n = 51). Total cholesterol and low-density lipoprotein cholesterol (LDLC) were both significantly associated with the presence of CAD in men and women; however, high-density lipoprotein cholesterol (HDLC) had discriminatory value only for women. The ratio of total cholesterol to HDLC (TC:HDL) separated patients from control subjects in both sexes, most efficiently among women, and was the only lipid variable associated with CAD in the age group over 55 years. Hypertension and angina were frequent in both groups and did not identify those with disease. In summary, LDLC was the best predictor among the lipids for men (likelihood ratio = 9.4) and TC:HDL was the best indicator of disease among women (likelihood ratio = 15.7). Low HDLC levels may, in part, account for the increased incidence of CAD among black women. Further population studies of factors leading to reduced HDLC, namely, obesity and diabetes, are needed.
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PMID:High-density lipoprotein cholesterol and angiographic coronary artery disease in black patients. 406 Dec 53

In a health survey in 1981-82 in the city of Uppsala 819 subjects (443 females and 376 males), 47-54 years old, were examined. A 75 g oral glucose tolerance test OGTT was performed in each subject, and fasting and 2-h venous whole blood glucose values were determined. The 2-h value was somewhat higher in females, 4.7 mmol X l-1, than in males, 4.4 mmol X l-1 (p less than 0.01). Known or probable manifest diabetes was present in 1.9% of all subjects. Glucose values within the limits for WHO criteria of glucose intolerance were found in another 7.1% of all subjects after one OGTT. The rates were similar in both sexes. A history of diabetes in first-degree relatives was noted in 13.2% of all subjects. According to a questionnaire, 1.1% of all subjects had had hospital care for myocardial infarction, 4.7% had angina pectoris and 2.4% had intermittent claudication. The rate of subjects on antihypertensive treatment or with untreated high blood pressure greater than or equal to 170/105 mm Hg was 11.2%; of these only 1.8% had untreated high blood pressure. Of the treated subjects, the treatment was adequate in 82.9%. Obesity, defined as relative body mass index greater than or equal to 120%, was found in 34.0% of all subjects, more frequently in females than in males. The rate of smokers was 28.5%. A comparison was made with the results of a similar health survey of about 2 300 middle-aged men in Uppsala in 1970-73. The prevalence of angina pectoris was higher among the men of the present survey than among those of the 1970-73 survey, which may at least partly be due to differences in methodology. Relative body weight was higher, and fewer men were regularly active during leisure for at least 2-3 h per week in the present study. The rates of hypertension were similar, but fewer men had untreated high blood pressure and more men were on antihypertensive treatment in the present study. There was a lower frequency of smokers in this study.
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PMID:Findings in a health survey of middle-aged subjects in Uppsala 1981-82. Risk factors for diabetes mellitus and cardiovascular disease. 409 18

The first partial ileal bypass operation specifically for the reduction of plasma lipids was performed by us in 1963. Since then we have operated upon and followed for more than three months 126 hyperlipidemic patients. Clinical metabolic studies, before and after the procedure, have demonstrated a 60% decrease in cholesterol absorption, a 3.8-fold increase in total fecal steroid excretion, a 5.7-fold increase in cholesterol synthesis, a 3-fold increase in cholesterol turnover, and a one-third decrease in the miscible cholesterol pool. Circulating cholesterol levels have been lowered an average 41.1% from the preoperative but postdietary baseline. An average 53% cholesterol reduction has been achieved from a pretreatment baseline using a combination of dietary and surgical management. Plasma triglycerides have been reduced in primary hypertriglyceridemic patients (type IV) an average of 52.6% from their preoperative but postdietary baseline. One patient died in the hospital and there have been 13 late deaths over the past 10 years. Four cases of postoperative bowel obstruction required reoperation. Diarrhea following partial ileal bypass is, as a rule, transistory and not a significant problem. No appreciable weight loss results from partial ileal bypass, which is an obvious distinction from the results of the far more massive jejuno-ileal bypass procedure for obesity. We have not encountered hepatotoxic, lithogenic, or nephrolithiasis complications in our partial ileal bypass patients. Sixty-nine per cent of our patients with preoperative angina pectoris have postoperative improvement or total remission of this symptom complex. Serial appraisal of followup coronary arteriographic studies offers preliminary evidence for lesion regression. It is concluded that partial ileal bypass is the most effective means for lipid reduction available today; it is obligatory in its actions, safe, and associated with minimal side effects.
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PMID:Ten years clinical experience with partial ileal bypass in management of the hyperlipidemias. 441 64

The first objective is to correct any existing coronary risk factors but this must be achieved with discrimination. Smoking should be strictly forbidden, hypertension reduced and a more active life style encouraged. However, a more nuanced approach should be adopted towards dietetic problems, obesity and disorders of lipid metabolism. It is also very important to teach the patient to use glyceryl trinitrate correctly in the double objective of relieving pain as quickly as possible and of preventing pain by using it in certain critical situations. Clinical practice shows that patients often use glyceryl trinitrate too sparingly. When these general measures have been settled, treatment must be adapted to each particular situation. The patient's age, the frequency of attacks, trigger factors, the repercussions of the disease on the patient's life all have to be considered before deciding on the individual's treatment. In younger patients, a controlled exercise ECG is essential for selecting patients for surgery. The drugs of choice for stable angina are the betablockers which have been shown to be effective and well tolerated. When this group of drugs cannot be used or is ineffective, other major anti-anginal drugs may be chosen according to the individual terrain and their known secondary effects.
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PMID:[Strategy of the medical treatment of angina pectoris]. 613 3


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