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The relationship between the degree of obesity and the incidence of cardiovascular disease (CVD) was reexamined in the 5209 men and women of the original Framingham cohort. Recent observations of disease occurrence over 26 years indicate that obesity, measured by Metropolitan Relative Weight, was a significant independent predictor of CVD, particularly among women. Multiple logistic regression analyses showed that Metropolitan Relative Weight, or percentage of desirable weight, on initial examination predicted 26-year incidence of coronary disease (both angina and coronary disease other than angina), coronary death and congestive heart failure in men independent of age, cholesterol, systolic blood pressure, cigarettes, left ventricular hypertrophy and glucose intolerance. Relative weight in women was also positively and independently associated with coronary disease, stroke, congestive failure, and coronary and CVD death. These data further show that weight gain after the young adult years conveyed an increased risk of CVD in both sexes that could not be attributed either to the initial weight or the levels of the risk factors that may have resulted from weight gain. Intervention in obesity, in addition to the well established risk factors, appears to be an advisable goal in the primary prevention of CVD.
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PMID:Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. 621 30

The major premise by which weight reduction is used as a medical therapy is the fact that obesity is a primary risk factor in the onset and severity of many medical diseases. Hypertension, coronary artery disease, adult onset diabetes mellitus, complications of major abdominal and thoracic surgery, cancer of the breast and colon, and degenerative joint disease are prevalent diagnoses. The data to support weight reduction use as a medical therapy derive primarily from studies of cardiovascular disease. These studies show lowering of blood pressure and reduction of risk factors for glucose intolerance, angina, and hyperlipidaemia. The magnitude of weight loss (percent reduction in excess body weight) is important; 10 per cent reduction is a firm threshold in obese patients (greater than 130%- less than 200% ideal body weight). Success at achieving this medical therapy is most frequent using very low calorie diets which average 30-40% reduction of excess body weight. Mild and moderate hypertension will respond in 90% of patients. Type II diabetes mellitus patients can become free of exogenous insulin requirement. Response to general anaesthesia and control of respiratory distress syndrome will improve if preoperative weight loss is achieved. Improved cardiovascular fitness and relief of exertional dyspnoea are other clinically important outcomes of very low calorie diet therapy. A high priority exists to investigate the use of comprehensive professional weight control therapy as medical treatment.
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PMID:Benefits of reducing--revisited. 624 29

In the industrialized countries, the incidence and mortality of myocardial infarction (MI) in young women is much lower than in men of equal ages. This difference decreases with advancing age without any abrupt change at menopause. Scotland and Northern Ireland have the highest mortality rates from coronary heart disease in women, and Scotland the highest in men. Studies on the age variation of the sex ratio based on vital statistics have suggested that male behavior may make a contribution to the elevated mortality in males compared to females regarding not only coronary heart disease but also other causes of death. Studies have shown that uncomplicated angina pectoris has the highest incidence of the various coronary disease manifestations in women. Risk factors include hypertension, serum lipids, smoking, diabetes, obesity, oral contraceptive (OC) use, noncontraceptive estrogen use, and menopause. In a series of 145 women with MI and angina pectoris only 8% had been taking OCs at the time of onset of coronary heart disease. Evidence has been accumulating recently that women using OCs run a higher risk of coronary heart disease with the relative risk increasing with an increasing number of other factors, such as hyperlipemia, hypertension, and cigarette smoking. In 1 study the death rate from circulatory diseases in women who had used OCs was 5 times greater than that of controls who had never used OCs. These findings relate mainly to preparations containing 50 mcg of estrogen. The excess death rate increased with age up to 50 years and with smoking. OCs influence carbohydrate and lipid metabolism in ways similar to those induced by glucocorticoids such as impairment of oral glucose tolerance with hyperinsulinemia and elevated serum pyruvate levels. Serum cholesterol and serum triglyceride levels seem to remain relatively unchanged in OC users with a low estrogen content. In 1 study HDL cholesterol levels appeared to be directly related to the estrogen and conversely related to the progestogen content. OCs with both estrogens and progestogens have an intermediate effect on the level of HDL cholesterol. After menopause, estrogen use has not been conclusively linked with an increased risk, but the importance of estrogen in the causation of the disease should not be ignored. There is support for familial aggregation of coronary heart disease in women but the role of environmental and genetic contributions to this is unclear. Further studies are needed of the sex-related differences in coronary heart disease among men and women of various age groups so that understanding of basic disease factors may be gained.
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PMID:Myocardial infarction in women. 635 23

The results of a survey carried out in Marseilles between 1972 and 1979 are reported. A common protocol was used to compare results with two other surveys performed conjointly in Paris and Brussels. The protocol was designed with special emphasis on the psychological factors with respect to the risk factors for ischaemic heart disease (IHD). Seven hundred and eighty six men in a Marseilles administrative department, aged 40 to 60 years (mean age 48.5 +/- 4.5 years) were followed-up for 74 months. Apart from cardiovascular clinical examination with measurement of height, weight, blood pressure and ECG recording, the initial check-up included serum cholesterol, triglycerides and glucose determination and a study of psychological risk factors based on the Bortner's scale for the evaluation of type A profile, and on a questionnaire : the SHEPI for evaluation of the N score (neuroticism). The annual IHD incidence was 9.5% with 4.2% of major events (death or infarction), and 5.3% of minor events (angina pectoris, suggestive ECG changes). Age, tobacco consumption, average systolic blood pressure, serum cholesterol and obesity index were higher in patients who became ill than in those who remained healthy, but overall and separate analysis of major and minor events showed no significant difference apart from age. On the other hand, the study of increased risk according to the level of each of these major factors gave significantly positive results except for the serum glucose level. The correlations between incidence of IDH and the value of each risk factor were not always the same according to the clinical expression (major or minor events). Psychological factors also differed according to the clinical expression of IHD : the Bortner scale was higher in patients developing IHD than in healthy subjects, and higher in those who suffered major events than in those who suffered minor events. On the other hand, the N score was higher in patients with minor events than in those suffering major events. These differences which were not statistically significant in the Marseilles study alone, became significant in the Franco-Belgian cooperative study. The increased risk with the number of associated factors (including psychological) is significant from the association of 2 factors, but only in the fifth decade.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Physical and psychological risk factors of ischemic heart diseases. Apropos of a prospective survey in Marseilles]. 642 24

The influence of the efficacy of triglyceride and cholesterol correction on cardiovascular complications and mortality was analysed in a follow-up study with 260 patients with primary HLP (triglycerides before entry greater than 2.9 mmol/l and/or cholesterol greater than 7.8 mmol/l). The follow-up time was 67.4 +/- 27 months. It was hypothesised that reduction of elevated levels of triglycerides and/or cholesterol influenced favourably the incidence of angina pectoris, MI, stroke and total mortality. For ethical reasons, it was not possible to carry out the investigations with a control group. Therefore, we performed an internal comparison of 3 categories of lipid correction achieved during the trial (effective, moderate, insufficient). A substantial improvement of the lipid disorder was obtained by individualizing the therapy. Triglycerides and cholesterol decreased on average by 50% and 20%, respectively. The incidence of MI was 10 times higher than in the general population. With respect to the type of HLP, hypertriglyceridemia revealed a significantly higher incidence of MI compared with hypercholesterolemia and mixed HLP. The therapy variant was only of importance with respect to gallstone diseases accumulating in the CPIB-treated subgroups. We found a majority of cases with newly manifested angina pectoris and stroke in the group with moderate correction of both triglycerides and cholesterol. Patients with effective triglyceride and cholesterol correction suffered less frequently from MI than those with insufficient correction. This was also the case with secondary prevention in cases with MI prior to entry. There was no significant difference in the distribution of lipid categories at entry between those with and without recurrent infarction. In the group without reinfarction, however, the percentage with insufficient control diminished significantly. Associated risk factors such as hypertension, diabetes, smoking and obesity were of minor or no significance. In subjects with effective triglyceride correction, the total mortality was 0.97/1000 treatment months vs. 3.63 in insufficiently treated patients. The figures for MI mortality were 0.36 and 1.91, respectively.
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PMID:Reduced incidence of cardiovascular complications and mortality in hyperlipoproteinemia (HLP) with effective lipid correction. The Dresden HLP study. 649 44

This article reviews the literature on women and coronary artery disease (CAD) and seeks to answer 4 questions: Are there differences in risk factors between men and women? Do the clinical manifestations of CAD differ between the sexes? What is the course of the disease for women? What, if any, are the rehabilitation factors specific to women? Most of the research was conducted prior to 1979, and its focus is on the male response to CAD. Nonetheless, available research suggests that women have basically the same risk factors as men--smoking, hypertension, diabetes mellitus, hypercholesteremia, sedentary life style, obesity, Type A personality, and family history. A female specific risk factor is pre- and postmenopausal exogenous estrogen therapy. Smoking is a major contributing risk factor in women, especially when associated with estrogen therapy. In healthy premenopausal women who take oral contraceptives (OCs) and smoke, the risk of nonfatal myocardial infarction ranges from 1/8400/year in women 27-37 years to 1/250 for women 44-45 years. Women under the age of 45 years who take OCs and have 3 other risk factors increase their risk of CAD 128-fold. In terms of clinical manifestations, women tend to present with symptoms of angina while men usually present with a myocardial infarction or sudden death. Women with angina have a better prognosis and lower mortality rate than men with angina. There are no apparent differences in the medical management of men and women with CAD. There is virtually no information on how women adapt to CAD after the initial cardiac ischemic event, so it its difficult to say whether women have different needs or concerns in the recovery process. It is important for health professionals to research the natural history of CAD in women and to describe women's susceptibility, preclinical risk factors, clinical manifestations, and outcome.
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PMID:Women and coronary artery disease: a review of the literature. 657 Oct 2

The Social Insurance Institution's Coronary Heart Disease Study is a prospective population study designed to investigate the prevalence, risk factors and incidence of coronary heart disease (CHD) in middle-aged Finnish men and women. The study population consisted of 5 738 men and 5 224 women, aged 30-59 years at entry, drawn from 12 cohorts from south-western, western, central and eastern Finland. The cohorts consisted of whole or random samples of rural or semiurban dwellers or employees of a factory. The participation rate was 90 per cent. The prevalence of symptoms was determined by the Rose questionnaire and abnormalities on resting ECG were coded according to the Minnesota code. Blood pressure, smoking habits, serum cholesterol, triglycerides, postload plasma glucose and obesity were the risk factors analysed at the baseline examination. The mortality of examinees has been followed continuously. This report deals with the main findings at the baseline examination and the mortality follow-up experience in 5 years. The prevalence of typical angina pectoris was 4.4 per cent in men and 5.4 per cent in women. Unequivocal ECG signs of past myocardial infarction were observed in 1.0 per cent of men and 0.3 per cent of women. Other ECG findings suggesting CHD were observed in 9.2 per cent of men and 11.1 per cent of women. The 5-year mortality was 4.3 per cent in men and 0.9 per cent in women. Men with typical chest pain symptoms had a seven-fold risk to die from CHD, compared to men without symptoms. Men with ECG abnormalities compatible with an old infarction had a 19.5-fold and men with other ECG findings suggesting CHD a 7.1-fold risk to die from CHD compared to men without resting ECG abnormalities. Men with ECG findings as the only indicator of CHD had worse survival than men with symptoms as the only indicator of CHD. The value of symptoms and ECG findings as predictors of CHD mortality in women was very low.
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PMID:The Social Insurance Institution's coronary heart disease study. Baseline data and 5-year mortality experience. 657 75

Risk factors for first nonfatal myocardial infarction (MI) in women younger than age 50 years were evaluated in a case-control study of 255 women with MI and 802 controls. The relative risk of MI increased with the amount smoked. The estimated risk of MI for current smokers of 35 or more cigarettes per day was ten times that of women who never smoked; an estimated 65% of MIs were attributable to cigarette smoking. The relative risk of MI increased markedly with increasing levels of total plasma cholesterol and decreasing levels of high-density lipoproteins, and the effects of the two factors appeared to be independent. Other factors significantly associated with MI were hypertension, angina pectoris, diabetes mellitus, blood group A, and a history of MI or stroke before age 60 years in a mother or sibling. Factors not significantly associated with MI were obesity, history of preeclamptic toxemia, and type A personality. Women who were postmenopausal appeared to have a lower risk of MI than premenopausal women of similar ages. Of the identified risk factors, the most prominent was cigarette smoking, a habit that is amenable to change.
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PMID:Myocardial infarction in women under 50 years of age. 664 58

A prospective study of 208 consecutive survivors of acute myocardial infarction was undertaken to determine the differences between Q- and non-Q-wave infarction, concerning data from the history, clinical course, and 6-month follow-up. There were 177 patients with Q-wave infarction and 31 patients with non-Q-wave infarction. There were no significant differences for the following variables: age, sex, diabetes mellitus, smoking, positive family history, hypertension, obesity, previous infarction, history of unstable angina, heart failure or chronic obstructive pulmonary disease (COPD), Killip class in the Coronary Care Unit (CCU), arrhythmias and conduction defects in the CCU as well as drugs used. Patients with non-Q wave infarction had a higher incidence of stable angina before the myocardial infarction and a lower value of creatine kinase (CK) and serum glutamic oxalacetic transferase (SGOT). During the 6-month follow-up, 9 cardiac deaths and 17 reinfarctions occurred, while 74 patients presented angina. There were no differences between the two groups concerning the incidence of cardiac death or angina, but patients with non-Q-wave infarction had a higher incidence of reinfarction at 6 months (p less than 0.001). We conclude that although patients with non-Q-wave myocardial infarction have a lesser degree of myocardial damage, they have a high incidence of early reinfarction which puts them in a high-risk group.
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PMID:Q- versus non-Q-wave myocardial infarction: clinical characteristics and 6-month prognosis. 671 48

An epidemiological and clinical study was carried out on 31 patients with spasm of normal coronary arteries. The series comprised 24 males and 7 females aged 30 to 68 years (mean age: 48 years) with isolated resting chest pain (61 p. 100) or with resting and effort chest pains (39 p. 100). Their cardiovascular risk factors were compared to 735 unselected patients with coronary insufficiency undergoing coronary coronary angiography. Abnormalities of lipid metabolism (45 p. 100) and obesity (14 p. 100) were less common but there was a higher incidence of smoking (74 p. 100 compared to 48 p. 100). Sixteen patients had a psychological test: repressed aggressivity and severe anxiety were found in all patients, a state of separation coincided wtih the onset of the illness in 10 of the 16 patients. On admission, 13 patients presented with attacks of Prinzmetal variant angina, with myocardial infarction in 2 cases. Eighteen patients had non-invalidating angina with sporadic attacks. Coronary angiography was normal in 8 patients and showed lesions with less than 50 p. 100 narrowing in the other 23 patients. Mitral valve prolapse was found on left ventriculography in four patients. Exercise electrocardiography was positive in 7 out of 20 patients, and notably in those who had not had effort angina. All patients were treated with calcium antagonist drugs (25 Nifedipine, 6 Diltiazem), the efficacity of which was tested in 20 patients with a control ergometrine test. Thirty patients were followed up for 6 to 46 months (mean: 15 months). The exercise stress tests were repeated in the 7 patients with positive results before treatment and the results were negative in all cases. Twenty three patients were completely pain free or significantly improved, although 25 p. 100 of control tests remained positive (4/16). Six patients continued to have as much chest pain, and three had positive control tests. One patient with a negative control test developed acute myocardial infarction six months later in the territory of the spasm: during hospitalisation the ergometrine test became positive again.
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PMID:[Coronary insufficiency caused by spasm with arteries injured slightly or not at all (31 cases)]. 681 Jul 88


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