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

A large number of individuals currently diagnosed as having diabetes mellitus are asymptomatic. In order to provide rational therapy for this patient population, it is necessary to focus upon the differences between these patients and the classic prototypes with polyuria and weight loss, who require insulin for survival. Patients with asymptomatic diabetes do not need insulin for survival, and, by definition, they do not need it to alleviate symptoms. They tend to be middle-aged and overweight, but they can be young and thin. Their degree of hyperglycemia is moderate, often indistinguishable from that of normal individuals in their day-to-day existence. Indeed, they can often be differentiated from normal persons only on the basis of their blood glucose response to the stress of a large dextrose challenge; in this regard, the potential problem of over-diagnosing diabetes has been discussed. Since the major problem facing patients with asymptomatic diabetes is accelerated atherogenesis, the therapeutic approach must be based upon efforts to delay or prevent the onset of vascular disease. It has yet to be shown that any therapeutic intervention helps such patients, but an argument has been made in support of the following goals in subjects with asymptomatic diabetes whose fasting blood glucose level is less than 170 mg/100 ml: (1) stop smoking, (2) control hypertension, (3) attain ideal body weight, and (4) maintain blood triglyceride and cholesterol levels well within normal limits. Attempts to lower blood glucose with either insulin or oral agents do not seem indicated in the majority of patients within this defined diabetic population.
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PMID:Treatment of asymptomatic diabetes mellitus. 97 61

Thirty-nine white men aged 51-84 years with established vascular disease were studied to investigate the effect of fish oil capsules on the regression of these lesions. This article deals with the baseline data of the study. The subjects completed a 7-day dietary record, weight and height were measured and a fasting blood sample was analysed for proteins, haematological values and certain vitamins. Dietary analysis indicated that the mean energy intake was 8,552 kJ (SD = 2,095). The energy distribution was 15.5% protein, 33.6% fat and 46.4% carbohydrate. In the light of the recommended dietary allowances the diet was lacking in zinc, vitamin B6 and folic acid, which suggests that the subjects might be deficient in these micronutrients. Although the diets were lacking in these nutrients, no clinical stigmata were observed. The subjects averaged a body mass index of 26.1 and could therefore be classified as overweight. The mean haematological values as well as the plasma vitamins were within the normal range. In conclusion it can be said that the men consumed a diet that was too high in fat and that the diet lacked certain micronutrients.
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PMID:Dietary patterns and nutritional status in free-living older white men with established vascular disease. 141 18

Whether there is a diabetic osteopathy" or osteopathy in diabetes mellitus", is still unclear. Epidemiological studies show in part discrepant results: bone mass was diminished in some studies, unchanged in others--even more positive trends were reported. Increases in osteoporotic fractures were observed in smaller collectives whereas no general trends for fracturing bones were found in diabetics. There are many in part favouring, in part impairing factors to be taken into consideration: Diabetes mellitus type I is a disease including immune phenomena. As inflammation leads to bone loss (inflammation-mediated osteopenia = IMO), peak bone mass may be influenced by such a process. The lack of insulin-like growth factors may be decisive, too. Complications of diabetes mellitus include hypogonadism--this may be disadvantageous for the skeleton. Diabetic complications like retinopathy, neuropathy, and angiopathy may influence the fracture event independently from bone mass. On the other hand, diabetes mellitus type II may be somehow protected against bone loss: Increased adipose tissue in connection with the frequently seen overweight yields metabolically active steroid hormones, insulin related growth factors may stimulate bone formation (e.g. in Forestier's disease). Older diabetics do not show diminished life expectancy any more due to their regular medical care--whether this includes the risk of bone diseases, is not yet clear. It may be worth to further analyse these "positive" effects seen in bones of type II diabetics because they may be useful in osteoporosis even in non-diabetics.
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PMID:Diabetes mellitus and bone metabolism. 149 Jul

The present study aimed at a description of the sickness absence pattern during 1982-1989 in 32 men who divorced in 1984. Another purpose was to carry through a health screening of the men within six months after the marital disruption focusing on risk factors concerning cardio-vascular disease (smoking, overweight, hypertension) and high alcohol consumption (elevated GGT). The year of divorce and the successive three years (1984-1987) were characterized by high sickness rates (average 21,7 days/year, variation 19,4-26,6) compared to a reference group (average 16,6, variation 14,9-18,1). In the remaining four years (1982-1983 and 1988-1989) the sickness absence was lower in the divorced group (average 12,2, variation 8,7-18,0, reference group: average 17,3, variation 14,8-20,0). The increase was mainly due to short absence periods (self-certifications). The health screening (health examination and record analysis) (n = 29) revealed high frequency of daily smoking and alcohol overconsumption. Overweight and hypertension were not overrepresented. The findings are discussed in relation to a supposed male reaction style to separation. The impact of social isolation is stressed.
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PMID:Separation and distress--sickness absence and health screening in newly divorced middle-aged Swedish men. 164 28

Data from the National Heart Foundation Risk Factor Prevalence Surveys of 1980 and 1983 were analysed to detect national trends in risk factors for vascular disease in Australia. After statistical adjustment for differences in the demographic characteristics of the two populations of survey participants, our results show trends in smoking and blood pressure that are likely to result in a continuing fall in the incidence of vascular disease. There was a fall in the prevalence of current smoking from 32% to 29% but little change in the average daily consumption of cigarettes by current smokers. The prevalence of previously-undetected hypertension fell significantly from 10% to 7%. A small increase occurred in the proportion of all hypertensive patients who were treated and whose blood pressure was controlled, and a decline of 2.0 mmHg (P less than 0.0001) in mean diastolic blood pressures, but no significant change in mean systolic pressures. Mean total plasma cholesterol levels did not change; average levels of plasma triglycerides fell by 0.11 mmol/L (P less than 0.0001); and mean high-density lipoprotein cholesterol levels increased by 0.03 mol/L (P less than 0.0001). All indices of relative body weight increased between 1980 and 1983; mean body mass index rose by 0.23 with associated rises in the prevalence of obesity and of overweight status. The changes in other factors such as use of added salt, the consumption of alcohol, the level of physical activity and adherence to a special diet, all were in the desirable direction, although minor changes in the survey questionnaire might have served to exaggerate the apparent trends.
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PMID:Trends in risk factors for vascular disease in Australia. 278 48

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

In view of recent interest in the relationship of haematocrit and blood viscosity to hypertension and vascular disease, we have analysed retrospectively the relationship of haematocrit to blood pressure, vascular complications and other variables in 2,381 patients referred to the Glasgow Blood Pressure Clinic. Haematocrit correlated negatively with age and systolic pressure in men, and positively with age and systolic pressure in females. Positive correlations were found in both sexes between haematocrit and serum alanine aminotransferase (possibly due to mutual correlation with alcohol); and between haematocrit and overweight (Quetelet Index) but not obesity (Ponderal Index). Increased haematocrit was also associated with cigarette smoking; and with history of angina, myocardial infarction and intermittent claudication in females. No correlation was observed between haematocrit and history of stroke. These findings suggest that prospective studies of haematocrit in hypertensives may be of interest.
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PMID:Haematocrit in patients attending a hypertension clinic. 405 4

Systemic hemodynamics, intravascular volume, and plasma renin activity were determined in 135 lean, midly obese, or distinctly overweight subjects who were normotensive or had borderline or established essential hypertension. Cardiac output (but not index) was higher and peripheral resistance lower in obese than in lean subjects, except in borderline hypertension. Intravascular volume was increased in obese patients, and more so when corrected for body height; correction for body weight led to relative volume contraction. Intravascular volume correlated directly with cardiac output in the entire population, as well as in the subgroups. Intravascular volume correlated inversely with total peripheral resistance in all subjects and in each subgroup. Both correlations remained significant when an approximation was used to correct influences of obesity on total blood volume. Sodium excretion was higher in obese than in lean subjects. Thus, despite the expanded intravascular volume in obesity, the pathophysiologic relationship between systemic hemodynamics and intravascular volumes remains unchanged. Relatively low peripheral resistance in obesity may decrease the risk of systemic vascular disease. Nevertheless, since circulating volume is increased, the greater venous return adds an additional load to a left ventricle that is already burdened by a high afterload caused by arterial hypertension.
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PMID:Obesity and essential hypertension. Hemodynamics, intravascular volume, sodium excretion, and plasma renin activity. 700 72

Psychosocial adaption during or after somatic illness is relatively little studied--quite in difference to the better known psychosocial predictors of somatic illness. This study is concerned with a group of 31 female patients who suffered from a terminal vascular disease (primary vascular pulmonary hypertension)--an iatrogenic disease which with high probability is the consequence of a drug for weight reducing (Menocil), prescribed by their family doctors to these moderate overweight middle aged women. Psychosocial adaptions was assessed on a 5-point-scale, including the following dimensions: work-situation, socio-economic conditions, family adaption, social activities. Psychosocial adaption before illness was very good (just 10% below maximal values). Two or three years after illness started, however, there was a highly significant drop in all dimensions (most significant in "work" and "social activities"). To some extent success or failure of psychosocial adaption had a predictive power for the terminal course of this illness. Possible interaction between course of illness and psychosocial adaption is discussed and illustrated. There was also a significant correlation between psychosocial adaption and defense-processes.
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PMID:[Modification of psychosocial adjustment by terminal disease]. 718 Feb 15

A five-year follow-up of 53 diabetic patients admitted for their first stroke in 1972--73 has been performed. They were compared with two groups of 53 non-diabetic patients each with cerebrovascular disease (CVD), one randomly selected and one matched with the diabetics for age, sex and diagnosis of CVD at discharge. All patients could be traced at follow-up. The mean age at the time of first stroke was 66.5 years in male and 73.2 years in female diabetics. Manifest diabetes was diagnosed in 19% during hospitalization for stroke; of the remainder, 74% had had diabetes since less than ten years. In 85% of the diabetics there were no signs of severe angiopathy affecting eyes, kidneys or lower extremities. The majority of diabetic as well as non-diabetic CVD patients had a history of hypertension and/or heart disease. Few were overweight. Case fatality rate was significantly higher in diabetics than in non-diabetics throughout the follow-up (p less than 0.01 for diabetics vs. matched non-diabetics, p less than 0.001 for diabetics vs. randomly selected non-diabetics). The presence of heart disorder predicted mortality in the diabetic subjects. Surprisingly, hypertension diagnosed before stroke involved a more favourable long-term prognosis in all three groups (p less than 0.05). The major causes of death in diabetic CVD patients were cardiac disorders (50%) and stroke (47%). Previous investigations have identified diabetes as a risk factor for stroke. This study shows that diabetes also adversely affects the short-term as well as the long-term outcome in stroke.
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PMID:The natural history of stroke in diabetic patients. 738 35


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