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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We surveyed adults with diabetes mellitus and adults without diabetes living in the Mohawk community of Kahnawake, PQ, for clinical characteristics related to vascular disease. People with diabetes were selected from a clinical register; nondiabetic subjects were randomly selected from a community register, with matching for age and sex. The response rates among the two groups were 62% and 39% respectively; groups of 82 and 94 people were obtained. Data were collected by chart review, interview and body measurement. The prevalence rate of ischemic heart disease was 48% for the subjects with diabetes and 22% for those without diabetes. The adjusted odds ratio for development of ischemic heart disease in a person with diabetes was 3.56, for development of cerebrovascular disease 4.57 and for development of peripheral vascular disease 5.51. Logistic regression for macrovascular disease showed that age, sex, smoking, hypertension and obesity could not explain the high rates of complications in the subjects with diabetes. The prevalence rates of ischemic heart disease in adults with and without diabetes are the highest reported in a North American Indian population.
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PMID:Prevalence of diabetic and atherosclerotic complications among Mohawk Indians of Kahnawake, PQ. 339 36

There is growing evidence that differences in fat distribution can be predictive for differences in the prevalence of metabolic disturbances, cardio-vascular disease, stroke and death, independent of commonly used indices of obesity. This study evaluates regional body fat distribution as a possible main reason for hypertension in obese and non-obese type II diabetics. 42% of normal weight diabetics with abdominal obesity are hypertensive versus 47% of obese diabetics; only 5% hypertension could be found when a lower body segment fat distribution is present. A significant (p less than 0.001) correlation exists between fat mass topography and both systolic (r = 0.49) and diastolic (r = 0.49) blood pressure. This correlation remains true after correction for body mass index and percent glycosylated hemoglobin. These results suggest that localization of fat in the upper body segment should be considered as a additive risk for hypertension.
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PMID:Hypertension in obese and non-obese non-insulin dependent diabetics a matter of regional adiposity? 341 Jan 53

The most important risk factors that may predict the transition from borderline to established hypertension are revised, focusing on those pathological changes that have been investigated for their value as predictors of established hypertension. A patient commonly is diagnosed as a borderline hypertensive if several pressure values are somewhere above as well as below 140/90 mm Hg. Patients in this category generally are regarded as hypertensive when they are younger than age 40. Studies largely favor the hypothesis of polygenic inheritance of essential hypertension, yet the detailed nature of heredity continues to be disputed. Several biochemical markers reflect the hereditary etiology of established hypertension, e.g., a variation in the electrophoretic pattern of plasma proteins, urinary concentration of kallikrein, and an alteration of cell membrane transport of cations. In Western populations, arterial pressure increases throughout life. About 40% of the white population and over 50% of the black population over age 65 have hypertension (blood pressure of 160/95 mm Hg or greater) or isolated systolic hypertension (systolic blood pressure greater than 160 mmHg and diastolic blood pressure less than 95 mm Hg). Essential hypertension is more prevalent and vascular disease more severe in blacks than in whites. There is a well-documented association between obesity and hypertension; obesity increases the prevalence of hypertension 3 to 8 times. Numerous studies have been published about the relationship between arterial hypertension and excessive dietary salt intake, but the results continue to be controversial. In a cross-cultural analysis, a strong relationship was observed between salt intake and the prevalence of hypertension. Also noted was the modifying impact of sodium intake on the increasing prevalence of hypertension with age. Premenopausal women have a lower prevalence of essential hypertension and its risk factors than men of the same age because of the influence of estrogen, but if these women take oral contraceptives, arterial pressure increases and transient hypertension, often severe or even malignant, can be induced. Some behavioral patterns and personality traits appear to be associated with borderline hypertension, but evidence that these factors determine the transition from borderline to established hypertension in later life has not been demonstrated thus far. Measurements of resting heart rate and responses to dynamic exercise have some predictive value in predicting the development of hypertension. Ambulatory monitoring of blood pressure might allow for differentiation of patients with transient elevated blood pressure from those with more sustained hypertension.
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PMID:Risks for arterial hypertension. 351 34

This study was designed to compare the prevalence of obesity, high blood pressure, diabetic vascular disease, and risk factors in Black West Indians who had emigrated to Britain (WIB) with those in Whites in England and among diabetic Jamaicans in Jamaica. Seventy-seven consecutive WIB patients were matched for age, sex, known duration of diabetes, and type of treatment of diabetes with 74 Whites from the same diabetes clinic in England. In Jamaica, a systematic random sample (95 women, 36 men) was studied. There was no difference in age at diagnosis between WIBs and Jamaicans. Effort chest pain (possible angina) was less frequent in WIBs (9%) or Jamaicans (3%) than in Whites (25%). Cigarette smoking was more common in WIBs than in Whites but still low in Jamaicans. Body mass index was greatest in WIB women (85%), significantly more than in matched White (52%) or Jamaican women (45%); 40% of White men and WIB men were obese, significantly more than Jamaicans (15% obese). Systolic blood pressure was similar, but diastolic blood pressure was significantly greater in WIBs than in matched White subjects. The prevalence of casual hypertension was high (greater than 40%) in all groups, often despite treatment. Cataracts were significantly more frequent in WIB and Jamaican groups than in Whites. Total background retinopathy after correcting for duration of diabetes did not differ between groups, and there were no significant differences in other complication rates. Levels of HbA1 were lower in Whites than in the other groups. Regression analysis showed that systolic blood pressure was most consistently related to complications, particularly retinopathy, independent of ethnic group and duration.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Black West Indian and matched white diabetics in Britain compared with diabetics in Jamaica: body mass, blood pressure, and vascular disease. 358 77

Factors potentially associated with adult-onset diabetes mellitus in the elderly were reviewed, using the Framingham Heart Study data and other population data. Incidence data for diabetes mellitus in the elderly are sparse, but they indicate that the prevalence of diabetes increases greatly with age. Prevalence rates commonly exceeded 10 percent in those over the age of 60. Men and women in the Framingham Study who were overweight by more than 40 percent had twice the prevalence of diabetes mellitus compared with those of normal weight. Hypertension and coexistent vascular disease were particularly common in elderly diabetic patients, with rates markedly greater than those found among younger adult-onset diabetic patients. In those 50 years of age or older, the later development of diabetes mellitus was associated with increased levels of very-low-density lipoprotein cholesterol, decreased levels of high-density lipoprotein cholesterol, obesity, elevated casual glucose levels, use of diuretics, and preexisting vascular disease.
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PMID:Epidemiology of diabetes mellitus in the elderly. The Framingham Study. 370 88

The major predictors of left ventricular function after coronary artery occlusion were assessed in 108 consecutive patients who had complete occlusion of the left anterior descending artery as the only important lesion demonstrated at angiography between June 1978 and June 1983. A scoring system was used to identify regional damage on left ventriculograms. Forty two patients were classified as having good left ventricular function and 66 as having varying degrees of impairment. Apart from a history of myocardial infarction, the only variables discriminating between those with good and those with impaired left ventricular function were the area of distribution of the artery beyond the occlusion and cigarette smoking. Hypertension, hypercholesterolaemia, family history of vascular disease, diabetes, obesity, duration of angina, age, and presence of identifiable collaterals were not discriminators. Smoking was itself significantly associated with a history of infarction; but after controlling for this, smoking exerted a significant additional effect on the amount of left ventricular damage. It is concluded that smoking is not only a risk factor for myocardial infarction in patients with single left anterior descending artery occlusion, but that it is also a major factor in determining the extent of associated left ventricular damage.
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PMID:Smoking: a major predictor of left ventricular function after occlusion of the left anterior descending coronary artery. 380 Dec 40

The quantitative analyses of the concentration and composition of main plasma lipoprotein fractions in diabetic patients have so far not revealed such abnormalities that they could explain any major part of the excess atherosclerotic vascular disease present in both insulin-dependent and noninsulin-dependent diabetes. In insulin-treated patients the characteristic lipoprotein profile with low VLDL, normal LDL and elevated HDL levels prevents atherosclerosis rather than promotes it. However, the pattern will change to more atherogenic direction in the presence of either poor diabetic control or obesity or renal disease. It is possible that the patients who develop manifest clinical cardiovascular disease are in fact derived from these subcategories. In noninsulin-dependent diabetic patients the most common lipoprotein abnormality is an increase of VLDL and of total triglyceride, neither of which are currently held as strong risk factors. HDL is often at low side and may contribute to atherosclerosis, but may also represent a special hypercatabolic form of hypo-HDL-emia which is less atherogenic than the usual HDL deficiency.
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PMID:Are plasma lipoproteins responsible for the excess atherosclerosis in diabetes? 386 24

Gypsies are a cohesive cultural group who may have difficult relations with the American medical community. There are several hundred thousand Gypsies in this country; they maintain a private society with an internal moral code and legal system. There is a strong cultural basis for obesity, tobacco use, fatty diet, and inbreeding among Gypsies. These traits predispose them to hypertension, diabetes, hyperlipidemia, and occlusive vascular disease. When ill they present a striking dichotomy of primitive fears of disease process with surprising sophistication for medical terms and the workings of the hospital hierarchy. Specific recommendations are made for more effective and compassionate relations with Gypsy patients.
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PMID:Gypsies and American medical care. 388 25

The heterogeneity within Type II diabetes (NIDDM) and within Maturity-Onset type Diabetes of Young people (MODY), a subset of NIDDM which is inherited in an autosomal dominant fashion, is discussed. Aspects of the definition and phenotypic expression of MODY are reviewed. Within NIDDM there are differences in patterns of inheritance between subgroups. HLA antigen associations are not found in most NIDDM populations but exist in three specific population groups with Type II diabetes. Within NIDDM and within MODY there are differences in the magnitude of insulin responses to glucose, differences in target tissue responsiveness to insulin in vivo, and differences in receptor and post-receptor effects of insulin. Structurally abnormal variant and biologically defective insulin molecules have been found in some Type II diabetic patients and in members of certain MODY families. The presence or absence of obesity may mark heterogeneous groups of Type II diabetic patients, in addition to the importance of obesity in uncovering an insulin secretory defect by causing insulin resistance. There is heterogeneity in susceptibility to vascular disease within NIDDM and MODY. The natural history of carbohydrate metabolism and of insulin secretory responses to glucose in early Type I diabetes and in MODY with low insulin secretory responses are illustrated and similarities and dissimilarities compared and contrasted. Failure to recognize young patients with MODY may contribute to incorrect diagnosis, management, and assignment of prognosis of this form of diabetes in the young by many practicing physicians. The recognition that Type I or insulin-dependent diabetes (IDDM) and Type II or noninsulin-dependent (NIDDM) differ from each other not only phenotypically but also in etiology and pathogenesis led the National Diabetes Data Group (NDDG) to devise the present nomenclature and classification of diabetes mellitus. These were adopted by the World Health Organization. As suggested by the NDDG report, the classification should be reexamined periodically to reflect improved understanding of the disease, to stimulate further research, and to be of help to practicing physicians.
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PMID:Heterogeneity within type II and MODY diabetes. 389 67

This report summarizes the major design features, methods, and baseline characteristics of patients enrolled in a Veterans Administration Cooperative Study. In eleven V.A. centers, 231 male diabetic patients who had either a recent amputation for gangrene (N = 207) or active gangrene (N = 24) were randomly assigned to a group which received aspirin (325 mg t.i.d.) plus dipyridamole (75 mg t.i.d.) (N = 110) or two placeboes t.i.d. (N = 121). Major end point were vascular death and amputation of the opposite extremity for gangrene. Forty-one percent of the 563 patients screened were enrolled during a 39 month period. Enrollment errors were found in 8.7%. Historically, the two groups were well matched regarding the following variables: age, duration of diabetes, insulin therapy, previous oral agent therapy, hypertension, myocardial infarction, congestive heart failure, renal disease, sensory neuropathy, and smoking. The drug therapy group had an increased frequency of a history of cerebrovascular disease (19% vs 7%, p = 0.01). The groups were well matched regarding amputation site, obesity, extent of lower extremity vascular disease, retinopathy, and neuropathy upon examination. Their baseline fasting values of glucose, cholesterol, triglycerides, and creatinine were also comparable. We conclude that this study should provide definitive data on the efficacy of these antiplatelet agents in preventing further vascular disease in this patient group. It should also provide new prospective data on the natural history of vascular disease, and the association of vascular risk factors with subsequent vascular events in this patient population.
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PMID:V.A. Cooperative Study on antiplatelet agents in diabetic patients after amputation for gangrene: III. Definitions and review of design and baseline characteristics. 390 83


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