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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

A three-community study of rural Afrikaans-speaking Whites in the south-western Cape revealed that the major reversible risk factors hypercholesterolaemia, hypertension and smoking, as well as 'minor' factors such as inactivity, obesity, hyperuricaemia, coronary-prone behaviour and the irreversible risk factors of chest pain, ischaemic changes on the ECG and a family history of ischaemic heart disease (IHD), were exceedingly common. Singly or in combination, the major risk factors were present in the great majority of the study population after the age of 44 years. The interaction of high levels of lifestyle-induced risk factors with constitutional predisposition could adequately explain any excess risk of IHD in the Afrikaans-speaking community. The almost universal risk factor prevalence in this study has major implications for any preventive strategy.
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PMID:Coronary risk factor screening in three rural communities. The CORIS baseline study. 662 18

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

Chest pain is one of the most common complaints in primary care clinics. About 10-30% of patients with chest pain diagnosed as suffering from angina pectoris have normal coronary angiograms. Some of them suffer from psychiatric disorders. We present a 47-year-old man with several risk factors for ischemic heart disease: smoker in the past, obesity, hyperlipidemia and family history of coronary disease. He had complaints typical of anginal syndrome and normal coronary arteriograms. After 1.5 years of unsuccessful medical treatment, he was referred to the psychiatrist in the primary care clinic who diagnosed anxiety and panic disorders with somatization. All cardiac drugs were stopped and psychopharmacological treatment and psychotherapy were started immediately. Within a month he was almost free of symptoms and was treated successfully for a year. Treatment was then stopped and he has remained symptom-free for the past 4 years. We conclude that in such atypical somatic cases, only the collaboration of general practitioner and psychiatrist will lead to quick diagnosis and successful treatment.
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PMID:[Chest pain and anxiety-panic disorders in a primary care clinic]. 849 96

A 32-year-old woman was hospitalized with recurrent left-sided chest pain and dyspnea on exertion, which had progressed for approximately 10 years. Since age 18 she had been spending more than twelve hours per day in a predominantly seated position on a floor mat, engaged in Japanese dressmaking. A chest roentgenogram showed marked dilation of the main pulmonary arteries, bilateral oligemia in the upper lung fields and a peripheral infiltration in the middle field of the left lung. The (99m)Tc-MAA perfusion lung scan showed multiple defects in both lungs, but no abnormal findings were detected on a 133Xe ventilation scan. A pulmonary angiogram showed multiple occlusions of pulmonary arteries in both lungs. Because recurrent chest pain and dyspnea had been present for a long time, and because ultrasonic cardiography revealed pulmonary hypertension repeatedly for several years, pulmonary thromboembolism was considered to be chronic and recurrent. The patient had none of the following risk factors for pulmonary emboli: malignancy, neurological disease, heart disease, obesity, pregnancy, or a congenital coagulative abnormality such as deficiency of AT-III, protein C, protein S, or plasminogen. Because no other cause could be found, the chronic recurrent pulmonary thromboembolism most likely resulted from extensive sedentary work that caused stagnation of venous return and deep vein thrombosis.
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PMID:[Chronic recurrent pulmonary thromboembolism associated with sedentary work]. 862 76

Controversy persists about whether hyperinsulinemia and hyperproinsulinemia are independent risk markers for coronary atherosclerosis. A common limitation of most previous studies has been imprecise categorization of disease status in normal and coronary artery disease (CAD) groups. We assessed the relationship of pancreatic beta-cell secretory products and premature CAD in a case-control study of 134 nondiabetic subjects, aged < or = 55 years old, carefully defined for CAD status by catheterization and/or thallium stress studies. Case patients comprised 66 patients with premature CAD, and control subjects (non-CAD group) included 68 patients without CAD but with traditional CAD risk factors and chest pain and/or abnormal electrocardiograms but normal catheterization and/or thallium stress studies. In addition to the CAD and non-CAD group comparison, both groups were compared with a reference group of 27 mixed lean and obese control volunteers. All CAD and non-CAD patients had a 3-h 75-g oral glucose tolerance test with measurement of fasting and post-glucose load immunoreactive insulin (IRI), specific insulin (INS), proinsulin-like material (PI), and C-peptide. Increased fasting insulin and fasting proinsulin levels both were statistically significantly associated with higher odds of being in either the premature CAD and the non-CAD groups when compared with the reference group in a polychotomous logistic regression model (odds ratio of at least 1.20 for a 20% increase in each beta-cell secretory product in both comparisons, P < 0.05). However, increased pancreatic beta-cell secretory hormone levels did not show a statistically significant relative risk for being in the premature CAD group when compared with the non-CAD group. After adjustment for BMI, all statistically significant associations disappeared for IRI, INS, and PI when the odds favoring being in the CAD and non-CAD groups were compared versus the reference group. Furthermore, the odds of being in the premature CAD and non-CAD groups when compared with the reference group were not significantly associated to the ratio of PI to insulin and C-peptide. Thus, although there is a statistically significant association between the odds of having premature CAD with elevated insulin and proinsulin levels compared with the reference group, these findings are equally common in subjects with traditional CAD risk factors without detectable CAD. Furthermore, the association of higher insulin and proinsulin levels with the likelihood of a patient having or not having CAD disappears after adjustment for BMI, suggesting that insulin and proinsulin are not independent risk markers but are primarily dependent on obesity.
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PMID:Are insulin and proinsulin independent risk markers for premature coronary artery disease ? 863 46

The purpose of the present study was to delineate a health profile of professional Danish army personnel. Two-hundred twenty officers, noncommissioned officers, and gunners on active duty at Varde Barracks, housing the South Jutland Artillery Regiment and the Danish Army Artillery School, were asked about their physical and psychological health, interpersonal relations, and working conditions as well as their dietary, drinking, and smoking habits. Measurements were made of resting pulse rate, blood pressure, height, weight, waist and hip girth, and pulmonary function. The ratio of waist-to-hip girth and body mass index (BMI) were calculated. Psychological well-being was evaluated using the 12-item version of the General Health Questionnaire (GHQ). Psychosomatic symptoms were frequently reported, but very few of those surveyed appeared to have psychiatric disorders as measured by the GHQ. Also, somatic health problems were frequently reported, the most frequent being lower-back pain, mild chest pain, and sensory disorders. Differences in interpretation and reporting of "lasting health problems" may explain the relatively high score for this question. The interpersonal relations, both upward and downward in the hierarchy rank order, received high scores. Compared with the general population, alcohol consumption was very low, whereas smoking-in particular heavy smoking-was much more frequent among professional Danish army personnel. Lung function testing showed significantly poorer mean values of forced expiratory volume in 1st second of expiration and mean forced expiratory flow 25 to 75% of forced vital capacity among smokers compared with nonsmokers, although the mean values for the whole group of both smokers and nonsmokers were well above reference values for all lung function parameters. The frequency of moderately overweight individuals (25 < BMI < or = 30) was significantly higher among the male army personnel than in the general population, whereas this was not the case for obesity (BMI > 30). Abdominal obesity, regarded as an independent risk factor for the development of ischemic heart disease, stroke, diabetes, hypertension, and all-cause mortality, was present in 5%, and 3% belonged to the highest-risk group by having a low BMI as well as abdominal obesity.
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PMID:Health profile of Danish army personnel. 918 68

Between January 1990 and May 1995, 117 patients were admitted to the Intensive Care Unit at Holberton Hospital, Antigua, for chest pain due to suspected acute myocardial infarction. 39 (45%) of 86 patients whose records were available for retrospective review had confirmed (27 patients) or probable (12 patients) acute myocardial infarction. Risk factors identified among the patients included hypertension, diabetes, tobacco smoking, hypercholesterolaemia and obesity. On admission, 82% were Killip class I and 18% were Killip class II. Medications in the Intensive Care Unit included nitrates, aspirin, calcium channel blockers, beta-adrenergic blockers, heparin and angiotensin converting enzyme inhibitors (21%). No thrombolytic agents were available. The average hospital stay was 10 days and the in-hospital mortality rate was 13%. These data indicate that early mortality from acute myocardial infarction can be reduced in developing countries by early admission to an Intensive Care Unit and use of drugs known to be effective in its treatment.
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PMID:Myocardial infarction in Antigua. 1990 to 1995. 936 95

In the present study the prevalence of obesity and its association with ischemic heart disease, recognized according to clinical criteria (chest pain or previous infarction) and/or instrumental data, were described in 8,847 normotensive subjects and in 867 hypertensive subjects, hospitalized during a ten years period (1983-1992), through a cross-sectional study. In view of this all the subjects were considered as lean or obese according to their body mass index (BMI) and to sex specific cut-off values reported in the Italian Consensus Conference on Obesity. In particular, according to BMI values, the subjects were grouped as lean, overweight, moderate and severe obese subjects. Our results indicated that 3,982 normotensive subjects (45%) could be considered lean, whereas 2,654 of them (30%) were overweight, 1,769 of them (20%) were moderate obese and 442 of them (5%) were severe obese. On the contrary only 206 hypertensives (23.7%) might be considered lean, whereas 313 (36.1%) were overweight, 302 (34.8%) were moderate obese and 46 (5.3%) were severe obese. According to age subgrouping (lower than or equal to 65 years or higher than 65 years) the distribution of hypertensives within the lean, overweight, moderate and severe obese groups did not change significantly, but, according to sex subgrouping, the distribution of hypertensives within the BMI groups was significantly different (chi 2, p < 0.001). When we considered the degree of hypertension, distribution of hypertensives was significantly different according to c2 test (p < 0.004), suggesting that the percentage of the subjects with severe hypertension increased only in subjects with severe obesity. Concomitant ischaemic heart disease (IHD) was also documented in 350 normotensives (4%) and in 119 hypertensives (13.8%). The prevalence of IHD was not significantly different in lean, overweight, moderate and severe obese hypertensives, also when sex and smoking habits were considered. Our data indicated a strong association between obesity and hypertension. In addition they may be consistent with the suggestion that obese hypertensives were not characterized by a lower risk of ischaemic heart disease (IHD), than lean hypertensives.
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PMID:Prevalence of obesity and ischaemic heart disease in hypertensive subjects. 944 2

The clinical significance of coronary arteriosclerosis and coronary risk factors was investigated in patients with coronary spasm. Coronary spasm induction test with acetylcholine was performed in 140 consecutive patients (85 males and 55 females) with chest pain in our hospital. The patients were divided into positive, borderline, and negative groups according to the results of the test. The positive and borderline groups were categorized as the coronary contractive group. The coronary sclerosis index was used to evaluate the degree of coronary arteriosclerosis. Coronary risk factors were evaluated in terms of hypertension, diabetes mellitus, hyperlipidemia, obesity, history of smoking and drinking, and family history of cardiovascular events. Patients could be divided into 34.3% in the positive group and 23.6% in the borderline group, i.e. 57.9% in the coronary contractive group, and 42.1% in the negative group. There were more males than females in both positive and coronary contractive groups. The proportion of males in the coronary contractive group was higher in patients over 60 years of age than in patients under 60. In contrast, the proportion of females was higher in patients under 60 than in patients over 60. In male patients, the coronary sclerosis indices in the positive, borderline, and coronary contractive groups were higher than those in the negative group. The indices in female patients in the positive and coronary contractive groups were higher than the index in the negative group. There were no differences in terms of the presence or absence, or the degree of organic stenosis between spastic sites and nonspastic branches in the positive group. The history of smoking in male patients was significantly more common in the positive group than in the negative group. The family history was more relevant in female patients in the positive or coronary contractive group compared to the negative group. Moreover, the history of smoking in the coronary contractive group was significantly more common than that in the negative group. The development of coronary spasm may be determined, at least in part, by the degree of coronary sclerosis as well as by gender and age. Smoking habits in both sexes and family history in females are proposed as the most important risk factors for coronary spasm.
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PMID:[Significance of coronary risk factors and coronary arteriosclerosis for coronary vasospasm]. 955 76


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