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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Risk factors for intermittent claudication (IC) were studied in 54 patients--that is, all patients with IC on the lists of two general practices--and 108 controls. Smoking was the factor most strongly associated with the development of IC, but systolic and diastolic blood pressures and concentrations of triglyceride, urate, and fibrinogen were all significantly higher among the patients with IC than the controls. The presence of more than one factor appeared to be associated with a multiplicative increase in risk. Cholesterol, an important risk factor for ischaemic heart disease, was not associated with an increased risk of IC. IC was present in about 2% of the men and 1% of the women, who were aged 45-69 years. These findings suggest that IC, a common and disabling manifestation of atheroslcerosis, may be largely preventable.
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PMID:Intermittent claudication: prevalence and risk factors. 64 1

The pathophysiology and histopathology caused by feeding rabbits a diet containing 2% cholesterol is described. Cholesterol deposition was seen in almost all organs after 15 weeks on the diet. Lesions were seen as early as 7 weeks in the aorta and pulmonary vessels and by 11 weeks in the small intramyocardial arteries and arterioles. Evidence of myocardial ischemia could be elicited by stressing the heart by electrical pacing at rapid rates or by administration of pharmacological agents which increased oxygen consumption (isoproterenol) or decreased oxygen supply (ergonovine). Susceptibility to such stress was increased by isovolumic hemodilution which decreased the oxygen-carrying capacity of the blood. Myocardial fibrosis and infarction were evident by 15 weeks on the diet and cardiac reserve was depleted by 25 weeks as evidenced by the presence of ascites in all animals examined. The preliminary results reported here suggest that further evaluation of the atherosclerotic rabbit as a cardiac toxicity model is warranted.
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PMID:Pathophysiology of the atherosclerotic rabbit. 72 Mar 16

Subjects with plasma cholesterol levels greater than 240 mg/dl (6.21 mmol/liter) and those with greater than 200 mg/dl (5.18 mmol/liter) who have coronary artery disease, or those with 2 risk factors for ischemic heart disease who do not respond to a hypocholesterolemic diet should all be treated. Lovastatin, which is an inhibitor of hydroxymethygluteryl coenzyme A reductase, is a new agent for treating hypercholesterolemia and is administered in a dose of 20 to 80 mg/day. A study was conducted in which only 10 mg of lovastatin was given to 28 subjects with plasma cholesterol of 200 to 240 mg/dl (5.18 to 6.21 mmol/liter). Cholesterol plasma levels decreased in 19% and low-density lipoprotein cholesterol decreased by 24% from baseline levels after 20 weeks of treatment. All 28 patients decreased their cholesterol values to less than 200 mg% (5.18 mmol/liter), and only 1 had a low-density lipoprotein level greater than 130 mg% (3.36 mmol/liter) at termination of the study. Achievement of desirable values of cholesterol with 10 mg of lovastatin was accompanied by less adverse effects and with significant financial saving. The calculated saving for lovastatin consumers in the USA could be an amount of $60,000,000. Thus, it is recommended that this drug be manufactured in 10 mg tablets.
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PMID:Cholesterol-lowering effects of a 10 mg daily dose of lovastatin in patients with initial total cholesterol levels 200 to 240 mg/dl (5.18 to 6.21 mmol/liter). 195 Oct 68

Screening for dyslipoproteinemias should be undertaken in all individuals older than 20 years of age at least once every 5 years. The initial screening, as recommended by the Adult Treatment Guidelines Panel of the National Cholesterol Education Program, is to determine the concentration of total blood cholesterol. This initial determination can be made on blood obtained in the nonfasting state. Further evaluation of the patient's lipoprotein concentrations is dependent upon the presence of other cardiovascular risk factors. in the absence of definite coronary heart disease, hypertension, diabetes mellitus, a family history of coronary artery disease, cigarette smoking, or severe obesity, the patient with a total blood cholesterol concentration less than 200 mg/dL requires no specific instruction and should have a repeated screening performed within 5 years. Patients with blood cholesterol concentrations greater than 200 mg/dL should have their lipoprotein profiles determined if they have atherosclerotic cardiovascular disease or two other cardiovascular disease risk factors. The lipoprotein profile includes the determination of fasting cholesterol and triglyceride and HDL cholesterol concentrations. From these values, the LDL cholesterol concentration can be calculated. This LDL cholesterol concentration is central in selecting the appropriate therapy. HDL cholesterol concentrations may be useful in evaluating patients with ischemic heart disease. Concentrations of HDL cholesterol less than 35 mg/dL are associated with increased risk for coronary artery disease. Although there is currently no convincing evidence that support the specific treatment of depressed HDL cholesterol concentrations, therapy directed to modulating lipoprotein metabolism in patients with heart disease and low HDL concentrations may be of benefit. Patients with recurrent abdominal pain, pancreatitis, and eruptive xanthomatosis frequently have fasting hypertriglyceridemia concentrations exceeding 1000 mg/dL. These patients should be identified in order to effectively reduce their triglyceride concentrations, which can prevent these complications.
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PMID:Detection and evaluation of dyslipoproteinemia. 219 76

Reasons for the current emphasis on cholesterol as coronary risk factor are multiple. On one hand current studies have shown that primary as well as secondary prevention of ischemic heart disease is a realistic possibility with lipid lowering measures. On the other hand new drugs are actually available which permit a potent and adapted therapy of hyperlipidemias. According to new guidelines of the Swiss "lipid task force" screening for hypercholesterolemia is recommended. A cholesterol value greater than 6.5 mmol/l should be investigated and treated. Because a great proportion of adult Swiss fall into this category (approximately 1/3) it is essential that all those are efficiently treated that have markedly abnormal cholesterol values or present with other risk factors such as smoking and hypertension or have a personal or familiar history of ischemic heart disease. Because progression is likely in patients with or after manifest ischemic heart disease even when hypercholesterolemia is mild (over 5.2 mmol/l) all patients presenting with an infarct should be investigated for dyslipidemia. Cholesterol, triglycerides and HDL should be determined. Dietary measures are the basis of every attempt to reduce hyperlipidemia. Most importantly intake of saturated fats prevailing in animal products should be restricted. The next important step is reduction of dietary cholesterol and in obese patients also caloric restriction. Lipid lowering agents are recommended in patients at risk who do not respond to or comply with dietary regimens. According to type of dyslipidemia bile-acid-binding resins, fibrates, nicotinic acid or HMG-CoA reductase inhibitors are available.
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PMID:[Lipid-lowering therapy in the prevention of coronary heart disease]. 221 47

A within-group risk factor analysis was conducted to predict angiographic change in the Cholesterol Lowering Atherosclerosis Study, a randomized, placebo-controlled trial of colestipol plus niacin therapy in men with previous coronary bypass surgery. Global angiographic change, including both native coronary arteries and bypass grafts after 2 treatment years, was the end point. Risk factors included on-trial clinical measures, plasma lipids, lipoproteins, and apolipoproteins. Univariate analysis indicated that risk factors previously observed by others in epidemiologic investigation of ischemic heart disease--total cholesterol, LDL cholesterol, non-HDL cholesterol, triglycerides, apolipoprotein B, and diastolic blood pressure--had significant effects in the placebo-treated group. Univariate analysis indicated significant effects of apolipoprotein C-III in drug- and placebo-treated groups. Multivariate analysis indicated the predominant risk factor predicting the probability of global coronary progression was non-HDL cholesterol in placebo-treated subjects and the content of apolipoprotein C-III in high density lipoproteins of drug-treated subjects. Both drug- and placebo-treated group findings point to an important role for triglyceride-rich lipoproteins in progression and regression of human atherosclerosis.
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PMID:Prediction of angiographic change in native human coronary arteries and aortocoronary bypass grafts. Lipid and nonlipid factors. 229 71

Atherosclerosis and hypercholesterolemia have been produced in rabbits since 1913 by feeding them cholesterol. These experiments have a great influence on current thinking about the etiology and possible prevention of ischemic heart disease. Male, New Zealand White rabbits were fed 0.5% dietary cholesterol. Cholesterol and copper in plasma increased sixty-fold and 50%, respectively. Liver copper decreased 74% and hematocrit decreased 26%. Iron was unchanged in heart and liver, but was increased in kidney. Zinc was decreased in heart, but was unchanged in liver or kidney. Changes in organ iron and zinc were smaller than the decrease in liver copper. Similar experiments with higher doses of dietary cholesterol may have resulted in copper deficiency. It may be appropriate to revise interpretations of data from these experiments and to reformulate hypothesis based on the data. Results are consonant with the theoretical implication of copper metabolism and copper deficiency in the etiology and pathogenesis of ischemic heart disease.
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PMID:Dietary cholesterol lowers liver copper in rabbits. 248 35

Established drugs used in the treatment of hypertension have reduced stroke but have had disappointingly little impact on coronary artery disease and its complications. This could be due to inadequate falls in blood pressure (or excessive falls). It is possible that the role of blood pressure in ischaemic heart disease has been over-estimated compared to other risk factors. Alternatively, the drugs used previously may have adversely affected other factors. Mortality in treated hypertensives remains higher than normotensives but so does their blood pressure. The blood pressure on treatment is a much better predictor of outcome than initial blood pressure. This suggests that improved blood pressure control may be desirable. In our hospital-based hypertension clinic many patients have more than one risk factor. In spite of intensive efforts between 1980 and 1988, smoking habits changed little and serum cholesterol and random blood glucose actually rose. Cholesterol is high in our population of hypertensive patients and the mean (+/- SD) rose from 6.4 +/- 1.3 to 6.6 +/- 1.3 (n = 127; P less than 0.01). These observations highlight the importance of a multiple risk factor approach. The benefits of alternative drugs which can lower total cholesterol and/or low-density lipoprotein (LDL) and/or raise high-density lipoprotein (HDL) deserve study in this population. A final possibility is that the widely observed association between hypertension and ischaemic heart disease is not causal (or is weak compared to other risk factors). If a common underlying mechanism caused both atheroma and hypertension then reduction of blood pressure would not be expected to reverse atheroma and its complications. At present this possibility cannot be excluded.
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PMID:Treatment of high blood pressure--the effect on coronary morbidity and mortality. 269 93

Cholesterol levels in high density lipoprotein subfractions (HDL2 and HDL3) were evaluated in 69 patients (55 males, average age +/- SD 58.3 +/- 8.8, and 14 females, average age +/- SD 63.1 +/- 10.3) with extra-coronary arteriosclerosis (lower limbs, supraaortic trunks and both sites), and in 79 healthy age-matched control subjects. HDL cholesterol was significantly reduced in male and female patients. The HDL cholesterol decrease was due to a fall in both HDL2 and HDL3 cholesterols; nonetheless, an analysis of the HDL2-cholesterol/HDL3-cholesterol ratio disclosed that HDL2 cholesterol was the most reduced. Slightly higher plasma cholesterol and triglyceride levels were found in the patients as well as a higher plasma cholesterol/HDL-cholesterol ratio. On the contrary, the HDL2-cholesterol/HDL3-cholesterol ratio was significantly reduced in the patients. These preliminary findings suggest that, as in ischemic heart disease, the HDL cholesterol reduction in cerebral and peripheral arteriosclerosis is also mainly due to a reduction in the HDL2 subfraction. These results also lend further support to the proposal that determination of the HDL subfractions is useful for a better assessment of the risk profile for arteriosclerosis.
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PMID:Selective determination of cholesterol in high density lipoprotein subfractions (HDL2 and HDL3) in patients with cerebral and peripheral arteriosclerosis. 399 73

Signs of copper depletion were produced in a healthy man by an amount of dietary copper (0.83 mg/day) similar to that in some contemporary diets. Urinary and fecal loss of copper exceeded intake. Plasma copper, ceruloplasmin, and superoxide dismutase activity in erythrocytes decreased. Cholesterol in plasma increased, and hematologic indices were unchanged. Lipid metabolism may be a more sensitive index of copper nutriture than are changes in hematology. The findings support the hypothesis that inadequate copper nutriture or altered copper metabolism contributes to the occurrence of ischemic heart disease.
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PMID:Increased cholesterol in plasma in a young man during experimental copper depletion. 650 10


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