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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite recent advances in both prevention and treatment, cardiovascular disease (CVD) remains the leading cause of mortality in the US. The Framingham Study was a landmark in defining CHD-related risk factors; unfortunately, very few minorities were included. A major preventable risk factor for CHD continues to be lipid abnormalities, but its association within minority populations is unclear. The few studies that have examined the association of hyperlipidemia with CHD in minorities have shown that total cholesterol was a predictor of CHD risk (e.g., black men aged 35-64). Several researchers have reported higher levels of HDL for black men and women compared to white men and women. Since HDL was shown to be inversely related to CHD, this discrepancy in HDL is hypothesized to account for the lower than expected mortality rate. Lipoprotein(a) has been identified as an independent risk factor for CHD; blacks have considerably higher levels than whites. Data also indicate the following: Hispanics have lower CVD mortality rates than the general population despite having known risk factors (e.g., obesity, diabetes, low socioeconomic status); Hispanic women have lower levels of HDL cholesterol; Native-American populations have lower prevalence of CHD associated with lower LDL-cholesterol and higher HDL-cholesterol. Understanding epidemiologic and pathophysiologic data regarding differences between various racial groups should help reduce CVD-related morbidity and mortality in minority populations.
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PMID:Lipids, lipoproteins and coronary heart disease in minority populations. 780 31

The relationship of dyslipidemia, particularly hypercholesterolemia to coronary heart disease is now well established. Although ischemic heart disease and stroke share many of the same risk factors, the relationship of cholesterol to stroke remains controversial. The 6-year and 12-year follow-up of the MRFIT study showed that elevated cholesterol significantly increased the risk for fatal nonhemorrhagic stroke. Atkins found no evidence that lowering plasma cholesterol influenced the incidence of fatal or nonfatal stroke and regression analysis showed no statistical association between the magnitude of cholesterol reduction and the risk for fatal stroke. We cannot preclude the possibility that more effective cholesterol lowering over a longer period of time might be effective. Hypertension is the most powerful risk factor for stroke. The San Antonio Heart Study reported a clustering of cardiovascular risk factors in individuals who developed hypertension during an eight-year follow-up period (higher levels of BP, fasting TC and LDLC, TG, glucose and insulin, and BMI, less favourable fat deposition, and lower HDL). Insulin resistance may be the unifying factor that results in those phenomena, the so-called syndrome X. The important factor underlying syndrome X may be central or visceral obesity, suggesting that maintenance or attainment of ideal weight would be a powerful preventive factor against both CHD and nonhemorrhagic stroke. There is evidence from the Treatment of Mild Hypertension Study that nutritional/hygienic measures can reduce the syndrome X risk factors and hence the risk of coronary heart disease and stroke.
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PMID:Dyslipidemia and metabolic factors in the genesis of heart attack and stroke. 791 92

Hyperlipidemia is an important risk factor of arteriosclerotic diseases. In Japan, as heart disease and cerebrovascular disorders rank second and third as the causes of death, demand has intensified for measures to prevent these diseases. In the U.S., the National Cholesterol Education Program (NCEP) was initiated as a means to prevent CHD by reducing th prevalence of hypercholesterolemia. Since 1988, this program has demonstrated effectiveness in this regard. In Japan, there are no consistent guidelines for the management of hyperlipidemia such as are espoused by the NCEP. In this study, in an endeavor to resolve this problem, a worksite population (1343 adult males) was classified according to the NCEP guidelines and the role and effectiveness of NCEP in this population were studied. A questionnaire concerning life-style and some biochemical findings were also used to classify the subjects according to the NCEP guidelines. Of the subjects, 22.8% were classified as hypercholesterolemic (> or = 240 mg/dl) and another 34.9% as being borderline high risk (> or = 200 < 240 mg/dl). Twenty-five percent of subjects required diet or drug therapy. The percentage of subjects requiring therapeutic intervention increased with age. The therapy group subjects tended to have a larger number of risk factors compared to the normal group. They also featured a significantly high age-adjusted odds ratios for hypertension, diabetes mellitus, obesity, and elevated serum triglyceride. This study suggests that in the health management of those in the therapy group, educational instruction on coronary risk factors is required.
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PMID:[Classification of hyperlipidemia in a worksite population in Japan using criteria of the U.S. National Cholesterol Education Program]. 804 15

We evaluated 675 men and 190 women who had no symptoms or history of clinical CHD, to determine the prevalence and risk factor correlates of CAC deposits as a marker of atherosclerosis. Measurements were taken noninvasively by ultrafast CT. The presence and extent of CAC deposits as measured by ultrafast CT was determined in all subjects, who also received personal and family medical history and risk factor questionnaire. The prevalence of CAC deposits increased significantly with age, ranging from 15% and 30% in men and women, respectively, < 40 years of age to 93% and 75% in those aged > or = 70 years. Prevalence and total score also increased by the number of risk factors present, although in those aged > 60 years a high prevalence (> 80% in men) of calcium was present regardless of the presence of risk factors. In multiple logistic regression, age, male gender, hypertension, diabetes, hypercholesterolemia, and obesity were independently associated with CAC deposits. These results suggest a high prevalence of atherosclerosis with increasing age and the presence of risk factors in men and women who have no symptoms. Studies to determine the prognostic value of CAC in individuals with no symptoms are needed to determine which populations may benefit most from CAC deposit screening.
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PMID:Coronary calcium and atherosclerosis by ultrafast computed tomography in asymptomatic men and women: relation to age and risk factors. 829 11

In this presentation an effort has been made to review the impact of resistance to insulin-mediated glucose uptake and/or hyperinsulinaemia on various metabolic end-points and clinical syndromes. Insulin resistance is present in the great majority of patients with states of glucose intolerance, but frank decompensation of glucose homoeostasis does not occur if individuals can maintain a state of compensatory hyperinsulinaemia. Although compensatory hyperinsulinaemia may prevent the development of NIDDM in insulin-resistant individuals, there is substantial evidence that insulin resistance and/or hyperinsulinaemia is associated with higher plasma concentrations of triglyceride, uric acid and plasminogen activator inhibitor 1 and with lower HDL cholesterol concentrations. Obesity, decreased physical activity and possibly cigarette smoking accentuate the degree of insulin resistance and its manifestations, and a genetic basis is also involved. Resistance to insulin-mediated glucose uptake and/or hyperinsulinaemia have been shown to be associated with high blood pressure, microvascular angina and CHD. Thus, resistance to insulin-mediated glucose uptake is a common phenomenon, which makes a major contribution to the aetiology and clinical course of common and serious diseases. Based on the above considerations, it is difficult to over-emphasize the health-related implication of a defect in insulin-mediated glucose uptake.
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PMID:Insulin resistance and risk factors for coronary heart disease. 830 13

The hypothesis that a causal relationship exists between insulin resistance and atherogenesis was first proposed over 23 years ago, and has given rise to a vast literature. Biological plausibility has been lent to the hypothesis by studies in which insulin has produced some effects in cell and tissue culture, and in vivo in arterial tissue, consistent with our understanding of the pathogenesis of atherosclerosis. Clinical studies demonstrating a complex interrelationship between insulin resistance-hyperinsulinaemia and established risk factors for CHD--hypertension, hypertriglyceridaemia, low HDL cholesterol levels and abdominal obesity--are reviewed. A review of the studies examining an independent association between hyperinsulinaemia and coronary heart disease is presented. Cross-sectional studies in both the general population and diabetes support the relationship; however, prospective studies in the general population provide limited and inconsistent support for this hypothesis and highlight the confounding effects of blood pressure, dyslipidaemia and obesity on the effects of hyperinsulinaemia. In subjects with NIDDM and impaired glucose tolerance, prospective studies have not shown a deleterious effect of insulin treatment per se, nor have they consistently shown a significantly increased risk for those with higher endogenous insulin levels. The therapeutic implications of the evidence to date are less complex and involve weight reduction by diet and exercise, the lowering of elevated blood pressure with metabolically neutral agents, the judicious use of lipid lowering drugs and, in diabetes, the use of insulin where clinically indicated.
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PMID:Relationship between insulin resistance and coronary heart disease in diabetes mellitus and the general population: a critical appraisal. 830 14

In the United Arab Emirates, coronary heart disease has emerged as the leading cause of mortality over a 20-year period of rapid socioeconomic development. CHD risk factors of non-insulin dependent diabetes mellitus (NIDDM), obesity and hypertension were investigated by community based survey among a bedouin-derived Emirati population sample of 322 subjects (> or = 20 years). Diagnosis of diabetes was based on a random capillary blood glucose level > or = 11.1 mmol l-1. Overall diabetes prevalence was 6% (11% in male and 7% in female subjects aged 30-64 years). Urban residence was associated with higher blood glucose levels (P = 0.000), and with higher Body Mass Index (BMI) values (P = 0.002): 27% of all urban residents were obese (BMI > or = 30). The Shamsi were positively associated with higher blood glucose levels compared with other tribal groups (P = 0.000). Female gender was associated with higher BMI values (P = 0.000). Between 19 and 25% of all subjects (male or female; urban or rural residents) have systolic hypertension (> 140 mm Hg). Male gender was associated with raised diastolic BP (P = 0.023). Diabetes was associated with higher mean systolic (P = 0.0274) and diastolic (P = 0.0132) BP levels. Differences in lifestyle between urban and rural residents are becoming blurred with further socioeconomic development and it is expected that the incidence of these CHD risk factors will continue to rise. Further studies are needed to specify changes associated with urbanization. Tribal influence also merits further study given the tradition of consanguinity in the UAE and the genetic basis to NIDDM.
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PMID:Diabetes, obesity and hypertension in urban and rural people of bedouin origin in the United Arab Emirates. 854 23

Clinical as well as basic research in the field of atherogenesis indicates that the progression of this disease process can be slowed down or even reversed. It is well established that nutrition plays an important role in the prevention and treatment of the classical atherogenic risk factors such as obesity, diabetes mellitus and hyperlipidemia. In addition, some nutrients such as the polyunsaturated n-3-fatty-acids or antioxidative vitamins can intervene directly by influencing one or more steps of the atherogenetic and/or thrombogenetic process. A comprehensive understanding of the pathogenesis of this disease as well as of the mechanisms of nutrient action are essential to the planning of successful nutritional prevention strategies. Because most nutrients influence mainly the slow and long-standing development of the atherosclerotic lesion, their inclusion in primary nutritional prevention should be started at an early age. Few nutrients such as the n-3 fatty acids, which also reduce the thrombogenetic risk factors, have demonstrated some success in the secondary prevention of CHD. Given the complexity with which nutrients intervene in the atherosclerotic process and their interactions with each other, nutritional prevention strategies should be based on well-grounded dietary modifications rather than supplementation with individual nutrients.
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PMID:[Nutrition in prevention of coronary heart disease]. 865 Sep 57

Plasma levels of fasting and post-prandial blood sugar, serum levels of total cholesterol (TC), triglycerides (TG), HDL cholesterol (HDLc), LDL cholesterol (LDLc) and free fatty acids (FFA) were estimated in 213 diabetic patients (NIDDM) with coronary heart disease (CHD-group 4), 252 CHD patients (non-diabetic CHD-group 3), 164 non-insulin dependent diabetics (NIDDM-group 2) and 173 healthy subjects (controls-group 1) who did not have any clinical evidence of CHD, diabetes mellitus or any family history of the above diseases. Data was analysed by ANOVA along with the Duncan procedure and multiple logistic regression. Lipid profile of diabetic CHD patients was characterised by significantly higher concentration of TC, TG, LDLc, FFA, LDLc/HDLc ratio and lower concentration of HDLc. However, in a multivariate logistic regression analysis using 14 known risk factors, diastolic blood pressure (BP), body mass index (BMI), alcohol consumption and higher FFA levels seemed to be predictors of CHD in diabetics, overriding the influence of lipoprotein abnormalities. The same was true for nondiabetic patients also in whom BMI, FFA and alcohol consumption were found to be significant predictors of CHD. Thus, even though lipid abnormalities are more prominent in diabetics, the coexistence of obesity and hypertension seem to be important factors in diabetics for the development of CHD.
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PMID:Risk factors for coronary heart disease in noninsulin dependent diabetes mellitus (NIDDM). 871

Obesity carries a penalty of an associated adverse cardiovascular risk profile. Largely as a consequence of this, it is associated with an excess occurrence of cardiovascular disease morbidity and mortality. It is concluded on the basis of data from the Framingham study and other large prospective studies that the rate of development of cardiovascular disease rises rapidly in relation to even modest amounts of adiposity. The abdominal pattern of adiposity, and specifically visceral adiposity, appears to be the most hazardous. First identified as a cause of glucose intolerance, abdominal adiposity has been identified as promoting insulin resistance, hypertension and dyslipidemia, as well as CHD. While the impact of epidemic obesity on the health of white Americans is becoming more fully understood, there are important gaps in the knowledge about the nature of influence of adiposity on CHD in large subgroups of the population. The dearth of detailed and long term prospective studies of African-Americans is the most conspicuous shortcoming of the research base. Finally, because there is a great potential benefit of remaining lean or achieving a sustained weight loss when indicated, and given the high prevalence of obesity, research on adiposity prevention and more effective weight reduction methodology are urgently needed.
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PMID:Obesity and coronary heart disease. 888 94


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