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THE WORKSHOP ON THE EPIDEMIOLOGY OF HYPERTENSION in Hispanic Americans, Native Americans, and Asian/Pacific Islander Americans concluded with a panel discussion of the findings from a scientific perspective. Panel members presented their ideas for research direction on measuring and identifying more accurately the frequency, distribution, and determinants of hypertension in minority populations, evaluating mechanisms leading to hypertension, and identifying the implications for public health and medical practice. Several members stressed the need for additional data collections, using standardized methods. They stated that future studies, including longitudinal ones, should target specific ethnic populations and subpopulations and address the role of acculturation, assimilation, modernization, and socio-economic status. They also recommended comparative and collaborative studies among groups. They emphasized the importance of obesity and diabetes or impaired glucose tolerance as determinants of hypertension in all three populations, and suggested that there may be differences in the etiology and pathophysiology of hypertension among the groups, with visceral adiposity or insulin resistance syndrome being more important in Asian populations. The potential for identification of genes involved in blood pressure variation and hypertension risk may help understand the interaction of genes with the environment. Minority groups in the United States share the problem of high prevalence of high blood pressure and low rates of control. For this reason, the panel urged a new era of community-based, culturally sensitive prevention and control projects.
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PMID:NHLBI workshop panel discussion: a scientific perspective. 889 82

PURPOSE OF THE REVIEW. This review of the literature examines the relationship between abdominal fat distribution and specific health outcome measures, modifiable risk factors, the impact of intervention efforts, and the significance of measurement methods. SEARCH METHODS USED. The research material that was received was found through several on-line data bases, including MEDLINE and CINAHL, an examination of references from selected articles, a manual review of recent relevant journals, and interviews with several physicians and epidemiologists who are experts in this field of inquiry. Forty-three research articles were reviewed for the section on health risk outcomes and abdominal fat distribution. Twenty studies were reviewed in the section on modifiable variables associated with fat distribution. Finally, 10 studies which examined the effect of behavior change on fat distribution were included in this review. SUMMARY OF IMPORTANT FINDINGS. Recent research indicates that people whose body fat is deposited more in the central or abdominal area, especially the intra-abdominal area, than it is in the gluteofemoral area are at increased risk for cardiovascular disease. This risk is independent of, but exacerbated by, the degree of obesity. Several nonmodifiable factors such as age, gender, and menopause as well as some modifiable factors such as obesity, smoking, physical inactivity, and alcohol intake are positively associated with abdominal fat deposition. MAJOR CONCLUSIONS. Intervention results indicate that it is possible to decrease abdominal fat with total weight loss or smoking cessation.
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PMID:A review of the association between abdominal fat distribution, health outcome measures, and modifiable risk factors. 1014 11

AIM OF THE STUDY: Heart failure is the final clinical presentation of a variety of cardiovascular diseases, such as coronary artery disease, hypertensive, toxic, and inflammatory heart disease. However, the cellular mechanisms responsible for the progressive deterioration of myocardial function observed in heart failure remain unclear and may result from cell death (programmed or not) and from an increase in number of nuclei and in the degree of their ploidy. METHODS: We examined thirty-eight explanted hearts obtained during transplantation for DNA content in the myocytic population. All thirty-eight patients had severe chronic heart failure: 23 had idiopathic dilated cardiomyopathy, and 15 had ischemic cardiomyopathy. Ten hearts of people whose death was not due to primary heart disease or as a consequence of major risk factors of coronary artery disease, including hypertension, diabetes, obesity, or severe atherosclerosis, were used as controls. DNA content in the myocytic population was evaluated using Image Cytometry. RESULTS: The DNA content per nucleus and per myocyte in cardiomyopathic hearts are characterized by: a) a decrease of the diploid DNA content of myocytic nuclei; b) an increase of DNA ploidies higher than 4c; c) a decrease in mononucleated myocytes; d) an increase in binucleated and multinucleated myocytes. The changes are more prominent in dilated cardiomyopathy. e) The total ploidy index, used to calculate the total DNA content, is related to heart weight and ventricular weight. CONCLUSIONS: Ischemic and dilated cardiomyopathies result in reduction of ventricular mass-to-chamber volume ratio and in discrete foci of myocyte cell death, leading to an elevation in systolic and diastolic stress on the remaining viable cells. Therefore mechanical stimuli generated by global and local loading abnormalities associated with end-stage failure may contribute to activate genes implicated in cell proliferation. Observations in this investigation are consistent with recent results documenting that in the presence of overload conditions the myocytes may retain their capacity to proliferate throughout life and this growth reserve mechanism may become operative in response to severe myocardial dysfuntion and overt failure. Polyploidization and multinucleation are prominent phenomena in the end-stage of ischemic and dilated cardiomyopathy in humans.
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PMID:DNA Content in End-Stage Heart Failure. 1035 69

PURPOSE OF THE PAPER: To summarize the current health status of Kanaka Maoli (indigenous Hawaiians) with historical background, underlying factors responsible for the Kanaka Maoli health plight and recommendations. METHODS: The author reviewed the available literature and some not readily available, unpublished information. PRINCIPAL FINDINGS: Kanaka Maoli continue to have the worst health and socio­economic indicators of the various ethnic groups in their home islands of Ka Pae'aina (Hawai'i). Cardiovascular disorders, cancer, diabetes, obstructive lung disease, maternal and infant health and mental distress are the prominent maladies. Tobacco smoking, high­fat diet, alcohol drinking, hyperlipidemia and obesity are the major lifestyle risk factors. Societal factors, such as depopulation, foreign transmigration, colonial exploitation, coercive assimilation, cultural conflict and racism persist. Since 1990, Kanaka Maoli communities have established five island­wide Native Hawaiian Health Care Systems to improve availability, accessibility, and acceptability of health services to their people, but with inadequate resources. CONCLUSIONS: Under present conditions, while the future may bring some amelioration of Kanaka Maoli ill health, the price will be progressive acculturation and loss of Kanaka Maoli identity. Accordingly, recommendations include augmented revitalization of the traditional culture, effective recontrol by the Kanaka Maoli of their lives and natural resources and thus, improved total health. KEY WORDS: Pacific Islander Americans, Kanaka Maoli, Hawaiians, Indigenous Health, Culture, Ethnicity, Racism, Colonialism, Sovereignty
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PMID:Health Status of Kanaka Maoli (Indigenous Hawaiians). 1156 47

PURPOSE OF THE STUDY: The purpose of this study is to describe the prevalence of coronary artery disease (CAD) and provide a review of the risk factors associated with CAD in Asian Indians. SEARCH METHODS USED: The authors extensively reviewed numerous British and international studies and the more limited number of studies in India and the US. SUMMARY OF IMPORTANT FINDINGS: Asian Indians have one of the highest rates of CAD. Conventional risk factors such as high blood pressure, high serum total cholesterol level, cigarette smoking, high fat diet, and obesity consistently fail to fully explain these high rates. There appears to be a strong role of insulin resistance and abdominal obesity, both of which have a high prevalence in Asian Indians. Various dyslipidemic disorders in Asian Indians such as low levels of HDL cholesterol, elevation of triglyceride, elevation of LDL cholesterol and elevation of lipoprotein (a) may also have a role. CONCLUSIONS: We hypothesize that against a background of higher susceptibility to CAD among Asian Indians, as characterized by insulin resistance, abdominal obesity and dyslipidemic disorders, conventional risk factors for CAD are also important. A genetic predisposition to CAD is suggested by high levels of lipoprotein (a) in Asian Indians. This would suggest that more aggressive identification and modulation of all known risk factors are necessary among Asian Indians along with a compelling need for further epidemiological studies in this population. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS: The marked differences in the rates of CAD among Asian Indians, compared with Chinese, Japanese, Filipino, other Asians and Whites are discussed. KEY WORDS: Asian Indians, coronary artery disease, epidemiology, disease prevalence, risk factors, insulin resistance, dyslipidemic disorders, triglycedide, high density lipoprotein; lipoprotein (a)
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PMID:Coronary Artery Disease in Asian Indians: Prevalence and Risk Factors. 1156 49

PURPOSE OF THE PAPER. We report on an analysis of the relationship of obesity to self-assessments of physical health for a probability sample of Guam's indigenous (Chamorro) and resident populations. Further, we examine whether Guam's populations fit a Western model, in terms of viewing obesity as an unhealthy condition. As background for our analysis, we review the literature on (1) the relationship between obesity and chronic noninfectious diseases; (2) social and behavioral associations of obesity; and (3) the reliability of self-assessed physical health and measures of obesity. METHODS. The data analyzed were taken from a Behavioral Risk Factor Survery (BRFS) conducted on Guam in 1991. We employed various standard univariate (chi-square analysis, ANOVA) and multivariate (OLS regression and logisitic regression analusis) statistical procedures in exploring our data and testing hypotheses on the correlates and associations of self-reported health and obesity. PRINCIPAL FINDINGS. Controlling for ethnicity, age, gender, marital and socioeconomic status, we found that obesity and being Chamorro was associated significantly with low assessments of physical health and that income was a signifcant predictor of higher self-assessments. A small sample of Micronesians, with a slightly greater level of obesity than the Chamorros, did not show the same tendency towards lower self-evaluation of their health. This probably reflects their lesser degree of internalizaition of Western ideas about obesity, appearance and health. When controlling for self-assessments of physical health, obesity was also shown to be related significantly with dieting by Chamorro women but was not a significant predictor of their increased participation in physical exercise. Young males were significantly more likely to report participation in physical exercise regardless of their weight or ethnicity. CONCLUSIONS. We hypothesize that historical (acculturative) changes to the diet and life ways of Chamorros, together with a likely genetic predisposition to store fat, has led to the relatively high levels of obesity seen on Guam today. Because of internalization of Western ideals about obesity and appearance, and increased community awareness of the health perils of obesity, Chamorros are at a public health crossroads. Effective health interventions must reckon with powerful genetic and cultural cross-currents. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS. Colleagues are encouraged to examine the effects of ethnicity and acculturation on the health attitudes, behaviors, and status of other Pacific Islander and Asian populations. The creation of such a comparative data base will service APIA health interventions. KEY WORDS. Guam, Chamorros, Asian Pacific Islander Americans, survey, obesity, self-evaluated health status, socioeconomic status, cross-cultural comparisons.
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PMID:The Influence of Obesity on the Self-Reported Health Status of Chamorros and other Residents of Guam. 1156 72

DE NOVO DIABETES AND CARDIOVASCULAR RISK: Certain kidney transplant recipients who develop de novo diabetes have an unfavorable cardiovascular risk profile, comparable to patients with type 2 diabetes mellitus, with advanced age, dyslipidemia, obesity and high blood pressure. MYOCARDIAL INFARCTION IN THE PERIOPERATIVE PERIOD: Among kidney transplant recipients, those whose risk factors include male gender diabetes, age over 50 years and prior revascularization procedure for coronary artery disease have a higher risk for myocardial infarction in the perioperative period. The usefulness of anticoagulant or beta-blockers as preventive treatment for these high-risk patients remains to be determined. HYPERLIPIDEMIA: A retrospective analysis of 530 kidney transplant recipients demonstrated that a very significant proportion of those with dyslipidemia are not receiving appropriate care although their lipid profile is indicative of a high or very high cardiovascular risk. MASSIVE PROTEINURIA: An angiotensin II inhibitor, losartan, has been found to be effective against massive proteinuria (> 3.5 g/l) occurring after kidney transplantation. CALCINEURIN-INHIBITOR-INDUCED HEMOLYTIC UREMIA SYNDROME: Five to ten percent of patients given calcineurin inhibitors develop a hemolytic uremia syndrome. Sirolimus appears to be a very interesting alternative for immunoprophylaxys against acute rejection.
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PMID:[Complications in kidney transplantation]. 1157 77

CARDIOVASCULAR RISK OF LEFT VENTRICULAR HYPERTROPHY: Because of the rhythmic, mechanical and ischemic risk related to it, the left ventricular hypertrophy (LVH) is considered to be a major independent risk factor for cardiovascular disease which should be screened for and treated early. In patients with type 2 diabetes, left ventricular hypertrophy is mainly due to high blood pressure, but also to reduced elasticity of the large vessels, defective vasomotricity and dysfunction of the arterial endothelium. Obesity, elevated blood viscosity, hyperinsulinism and/or autonomous cardiac neuropathy can also have a favoring effect. THE LIVE STUDY: Is the first multicentric European study comparing the efficacy of a thiazide-like diuretic, slow-release indapamid, with a converting enzyme inhibitor, enalapril 20 mg, on the reduction of the left ventricular mass index (LVMI) in hypertensive subjects with LVH. The study involved a randomized centralized reading of the echocardiograms as well as a randomized and blinded reading at the end of the study. DEMONSTRATED SUPERIORITY OF INDAPAMID SR: The LIVE study clearly demonstrated the superiority of indapamid SR over enalapril 20 mg in reducing the LVMI in hypertensive subjects with LVH while the blood pressure lowering effect was comparable for the two treatments.
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PMID:[Management of hypertensive patients with left ventricular hypertrophy]. 1235 99

CERTAIN OF THE ACUTE PHASE REACTANT TESTS WERE PERFORMED ON THE SAME SPECIMEN OF BLOOD FROM PERSONS WITH THE FOLLOWING STATES: Normal, acute respiratory disease, streptococcosis, acute rheumatic fever, acute glomerulonephritis, acute rheumatoid arthritis, inactive rheumatic fever, lupus erythematosus, malignant disease, obesity, asthma, and allergic rhinitis. Of the tests performed, the mucoprotein-tyrosine and the antistreptolysin-0 titer when done together appeared to be the most discriminating. It is suggested that the performance of such tests on the same sample of blood might aid in differentiating mild acute rheumatic fever and acute rheumatoid arthritis from each other and also from other disease states.
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PMID:Diagnosis of rheumatic fever and like conditions; evaluation of certain of the acute phase reactants in a single specimen of blood. 1334 8

AMONG THE BIOLOGICAL MEDIATORS OF INSULIN RESISTANCE: two compounds released by the adipocyte are found, such as free fatty acids and tumor necrosis factor-alpha. They are incriminated in the deleterious role of visceral adiposity on the metabolic parameters. INTRA-CELL CORTISOL: Attention is also focused on the potential implication of cortisol in the genesis of metabolic syndrome, because cortisol is a potent antagonist of the effect of insulin and its presence in excess enhances visceral obesity and insulin resistance. GENETIC ASPECTS: Although no major locus has yet been identified, recent findings of several mutations or polymorphisms in genes acting in different regulation systems (adiponectin, PPARgamma2) also provide an interesting insight into the pathogenesis of this syndrome. Moreover, there is growing epidemiological evidence that intra-uterine factors could induce a so-called programming of the individual that may, at least in part, account for the difficulties encountered by the classical genetic approach.
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PMID:[Insulin resistance physiopathology]. 1525 41


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