Showing papers in "The Cardiology in 1993"
TL;DR: Patterns of ethnic diversity in the risk factor and prevalence rates of CHD persisted, as viewed from the angle of mortality rates, over nearly a quarter of a decade, highlighting the enigma of a migrant country as a cardiovascular melting pot.
Abstract: Over 10,000 male civil servants and municipal employees in Israel, aged 40 years and above, underwent an extensive clinical, biochemical, anthropometric, sociodemographic and psychosocial evaluation i
273 citations
TL;DR: Findings indicate great potentials for prevention of the CHD epidemic and for increased longevity with health for men and women, through improved life-styles and consequent lower risk factor levels.
Abstract: The focus here is on relationships between major risk factors and long-term mortality from coronary heart disease (CHD) and all causes, and on longevity, in Chicago cohorts: 25-year follow-up for Peop
266 citations
TL;DR: Preclinical indicators of silent myocardial ischemia greatly augment the risk associated with a poor cardiovascular risk profile, and ECG left ventricular hypertrophy, blocked intraventricular conduction, repolarization abnormalities and abnormal response to exercise on monitoring must be taken into consideration.
Abstract: Atherosclerotic cardiovascular disease is a complex problem involving lipid deposition, pressure, rheologic forces, carbohydrate tolerance and thrombogenesis. The major contributors identified through epidemiologic research include atherogenic personal attributes, living habits which promote them, signs of a compromised coronary circulation and host susceptibility to these risk factors. Of the atherogenic risk attributes, such as blood lipids, blood pressure, glucose tolerance and fibrinogen, each independently contributes to risk, and the risk associated with any one is compounded by the presence of the others. The risk associated with hypertension, hyperlipidemia or diabetes varies widely depending on the level of associated risk factors. Also, at a given level of total cholesterol, risk is greatly affected by the total/HDL cholesterol ratio, which provides a practical means for assessing the two-way traffic of cholesterol. In addition, living habits, such as cigarette smoking or lack of exercise, can independently affect the risk associated with any of the atherogenic traits. These living habits, obesity and diet can also affect the level of atherogenic risk factors and must be taken into account in assessing risk and implementing preventive measures. Finally, preclinical indicators of silent myocardial ischemia greatly augment the risk associated with a poor cardiovascular risk profile. Hence, ECG left ventricular hypertrophy, blocked intraventricular conduction, repolarization abnormalities and abnormal response to exercise on monitoring must be taken into consideration. Optimal risk predictions require a quantitative synthesis of risk factors into a composite estimate. Handbooks, hand calculators and PC software have been devised for office use based on multiple logistic risk formulations. These have been shown to accurately predict disease risk in a variety of American population samples, in elderly as well as young coronary candidates. Preventive management as well as risk estimation should be multifactorial if optimal results are to be achieved. Preventive strategies should include public health measures to alter the ecology so as to shift the distribution of risk factors to a more favorable level, health education to enable people to protect their own health and preventive medicine for high-risk candidates. Greater skill must be developed to carry out such interventions. In selecting drugs to correct hypertension, diabetes and lipid disorders, it is important to choose agents which do not adversely affect the composite risk profile.
141 citations
TL;DR: Data from cardiac catheterization at rest and during exercise in 57 patients with dilated cardiomyopathy (DCM) were analyzed to evaluate the bearing of mitral regurgitation detected by color Doppler echocardiography (CDE) on prognostically important invasive hemodynamic parameters and survival.
Abstract: Data from cardiac catheterization at rest and during exercise in 57 patients with dilated cardiomyopathy (DCM) were analyzed to evaluate the bearing of mitral regurgiation (MR) detected by color Doppl
119 citations
TL;DR: The association of baseline serum total cholesterol, systolic blood pressure, smoking and body mass index with coronary heart disease (CHD) mortality was analyzed and showed large differences in the long-term predictive power of the classical coronary risk factors.
Abstract: The association of baseline serum total cholesterol, systolic blood pressure, smoking and body mass index with coronary heart disease (CHD) mortality was analyzed among 1,619 men aged 40-59 at baselin
60 citations
TL;DR: Unstable angina is associated with an increase in endothelin-1 plasma levels during the acute phase, suggesting a role of this endothelium-derived vasoactive peptide in the pathophysiology of acute coronary artery syndromes.
Abstract: Plasma levels of endothelin-1 are elevated in acute myocardial infarction with higher levels in complicated infarctions. Measurements of levels in unstable angina could help clarify whether the elevat
54 citations
TL;DR: Highly significant correlations between ECG and echocardiographic parameters of hypertrophy were demonstrated and there was no correlation between LVM assessed by eChocardiography and ventricular ectopic activity assessed by Holter monitoring in this normotensive population.
Abstract: Thirty top level athletes, 30 athletic students and 30 sedentary controls underwent electrocardiographic and echocardiographic investigation. Resting ECG in athletes showed increased indices of hypertrophy compared to controls. The echocardiographic examination demonstrated an increase in left ventricular mass (LVM) of 47% in top athletes and 23% in athletic students compared to controls. The relationship between wall thickness and diameter was similar in all groups, as were parameters of systolic and diastolic left ventricular function at rest. There was no correlation between LVM assessed by echocardiography and ventricular ectopic activity assessed by Holter monitoring in this normotensive population. Highly significant correlations between ECG and echocardiographic parameters of hypertrophy were demonstrated.
50 citations
TL;DR: It is concluded that sotalol significantly improves exercise tolerance and is effective in suppressing both supraventricular and ventricular arrhythmias in patients with HCM.
Abstract: The effect of sotalol on exercise tolerance and incidence of arrhythmias was studied in 30 patients with hypertrophic cardiomyopathy (HCM) In this short-term, double-blind, crossover study, exercise
50 citations
TL;DR: A 70-year-old man who had an atrial myxoma and two metastatic myxomas in the brain is presented, and high concentrations of interleukin-6 were present in the patient's serum and cardiacMyxoma.
Abstract: Metastasis of a cardiac myxoma to the brain is extremely rare. We present the case of a 70-year-old man who had an atrial myxoma and two metastatic myxomas in the brain. The intra-cranial lesions were
48 citations
TL;DR: DMP728 is a novel antiplatelet agent with high affinity and specificity for platelet GPIIb/IIIa as compared to other integrins on endothelial cells (vitronectin receptors), platelets GPIb/1X, alpha v/beta 3, and other integRins on leukocytes or nonintegrin-related systems.
Abstract: The present study was undertaken to define the platelet GPIIb/IIIa affinity and specificity of DMP728, the cyclic [(D-2-aminobutyrate-N-methyl-L-arginyl-glycyl-L-aspartyl)-3-aminomethyl-benzoic acid]
44 citations
TL;DR: In a group of 13 patients with severe heart failure, both forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) significantly improved after intensive medical therapy, probably positively affected pulmonary interstitial edema and bronchial wall congestion, thus enhancing pulmonary function.
Abstract: In a group of 13 patients with severe heart failure, both forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) significantly improved after intensive medical therapy (FVC: from 77 ±
TL;DR: No differences in mean values of left and right ventricular diastolic function indexes obtained by Doppler echocardiography were found between patients and controls, however, in 26% of patients with RA, left ventricular abnormalities probably secondary to myocardial fibrosis were observed.
Abstract: Thirty-nine consecutive patients with rheumatoid arthritis (RA) and 40 control subjects were studied by echocardiography in order to assess the incidence of cardiac involvement in this disease. The occurrence of anatomic lesions in our series was lower than that observed in other studies. No differences in mean values of left and right ventricular diastolic function indexes obtained by Doppler echocardiography were found between patients and controls. However, in 26% of patients with RA, left ventricular abnormalities probably secondary to myocardial fibrosis were observed.
TL;DR: The most marked findings with increasing fitness were lower heart rate, increased prevalence of bradycardia, increased precordial ST segment elevation, and increased T wave amplitudes.
Abstract: We have investigated 52 ECG parameters in 1,299 athletes and 151 control subjects. Data on fitness were available in 840 athletes. They were split in three groups according to level of fitness and com
TL;DR: A single oral dose of aspirin has long-acting effects on AA-induced platelet activation and reduces plasma levels of PAI-1 as well.
Abstract: Previous reports documented the inhibitory efficacy of different doses of aspirin on arachidonic acid (AA)-induced platelet aggregation, however, the sensitivity of platelets toward other agonists as
TL;DR: A patient who, secondary to transient regional left ventricular dysfunction (despite normal coronary arteries), developed acute pulmonary edema and the diagnosis of pheochromocytoma was made by plasma catecholamine levels, abdominal ultrasound and finally at operation.
Abstract: Cardiac injury caused by elevated levels of circulating catecholamines is a well-known phenomenon. We report a patient who, secondary to transient regional left ventricular dysfunction (despite normal
TL;DR: It is suggested that diabetes mellitus patients with normal resting left ventricular (LV) filling pattern (group DM-1) had LV diastolic filling abnormalities with isometric handgrip exercise.
Abstract: Left ventricular diastolic filling properties during isometric handgrip exercise were measured by pulsed Doppler echocardiography in 33 noninsulin-dependent diabetic patients with a normal ejection fr
TL;DR: Only blood pressure was an independent risk factor for CHD during the last 10 years of follow-up in multivariate analysis, but not by smoking habits in univariate analyses.
Abstract: We followed 845 50-year-old men initially free of coronary heart disease (CHD) for 25 years. Blood pressure, serum cholesterol and smoking habits were significant and independent risk factors for CHD during the first 15 years of follow-up and for the whole follow-up period. CHD during the last 10 years of follow-up could be predicted by blood pressure, serum cholesterol and triglycerides and also by body mass index, but not by smoking habits in univariate analyses. Only blood pressure was an independent risk factor for CHD during the last 10 years of follow-up in multivariate analysis.
TL;DR: A very strong association between delay time to thrombolysis and mortality during 2 weeks and 1 year of follow-up was observed.
Abstract: In 292 patients with suspected acute myocardial infarction given thrombolytic agents, we describe the delay time between the onset of pain and the start of thrombolysis and relate the observations to the prognosis. In 3%, treatment was started 1 h or less and in 22% 2 h or less after onset of symptoms. The median delay time between onset of symptoms and arrival in hospital was 1 h 38 min, and the median delay time between the arrival in hospital and start of thrombolysis was 1 h 25 min. A very strong association between delay time to thrombolysis and mortality during 2 weeks and 1 year of follow-up was observed.
TL;DR: There was a statistically significant correlation between the carotid wall thickness and the left ventricular mass in the whole population and in borderline hypertensives than in normotensive subjects.
Abstract: We measured the intima-media thickness of the common carotid artery (CCA) and of its bifurcation (BIF) in 20 borderline hypertensives (age 24 +/- 4 years) and in 20 normotensive subjects (age 23 +/- 6 years), as a control group. Both carotid axes have been scanned from different views on a transversal and longitudinal section. Carotid diameter and thickness were measured in the longitudinal section. CCA parameters were assessed 20 mm caudally to the flow divider. In borderline patients blood pressure (147.8 +/- 10.5/90.7 +/- 6.6 mm Hg) and left ventricular mass index (102.5 +/- 15.3 g/m2) were significantly higher than in normotensive subjects (blood pressure 120.5 +/- 11.5/78.0 +/- 5.4 mm Hg; left ventricular mass 90.5 +/- 14.3 g/m2, p < 0.01 and p < 0.05 respectively). The intima-media thickness of both the CCA and BIF was significantly higher in borderline hypertensives than in normotensives (CCA 0.6 +/- 0.08 vs. 0.4 +/- 0.05 mm, p < 0.01; BIF 0.7 +/- 0.08 vs. 0.5 +/- 0.08, p < 0.01). In the whole population there was a statistically significant correlation between the carotid wall thickness and the left ventricular mass.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Noninvasive imaging methods such as radionuclide ventriculography and Doppler echocardiography may be valuable to detect diastolic impairment as an early sign of cardiac involvement in Behçet's disease.
Abstract: Behcet’s syndrome is a multisystem disease; however, cardiac involvement in this disorder has been relatively less recognized. Noninvasive imaging methods may reveal a cardiac disorder which has not m
TL;DR: This study compared several measures of cardiac perception and related them to patient' spontaneous reports of palpitations to find accurate patients had significantly lower levels of amplification, somatization, hypochondriacal symptoms, and psychiatric morbidity.
Abstract: This study compared several measures of cardiac perception and related them to patient' spontaneous reports of palpitations. One hundred and forty-five ambulatory patients referred for Holter monitoring for the evaluation of palpitations were compared with 70 asymptomatic nonpatients. Reports of palpitations during monitoring were compared with the ECG to determine whether they coincided with an arrhythmia. Subjects also completed a heartbeat detection task to determine whether they were accurately aware of cardiac systole while at rest. 20.7% of palpitation patients and 4.7% of asymptomatic controls demonstrated an accurate awareness of resting heartbeat (p = 0.01). Performance was unrelated to bodily amplification, somatization, hypochondriacal symptoms, ECG findings, or psychiatric morbidity. 34.3% of palpitation patients reported symptoms that consistently coincided with arrhythmias on ECG. These accurate patients had significantly lower levels of amplification, somatization, hypochondriacal symptoms, and psychiatric morbidity. Accuracy of symptom reporting and accuracy of heartbeat awareness were not statistically associated.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: The results show that treatment with triflusal can reduce the incidence of myocardial infarction in patients with unstable angina.
Abstract: A multicenter, double-blind, placebo-controlled study was carried out to evaluate the effect of a new antiplatelet agent, triflusal (2-acetoxy-4-trifluoromethyl benzoic acid), in the prevention of nonfatal myocardial infarction and cardiac or vascular death (principal end-points) in patients with unstable angina. 281 patients were randomly assigned to triflusal (300 mg t.i.d.; n = 143) or placebo (n = 138). After 6 months of treatment, the incidence of nonfatal acute myocardial infarction was significantly lower in the triflusal than in the placebo group: 6 patients (4.2%) versus 17 (12.3%), p = 0.013. The low number of deaths (2/143 triflusal versus 0/138 placebo recipients) hampered statistical analysis of mortality rates. The need for revascularization was similar in the two groups: 24 patients (16.8%) in the triflusal group and 28 (20.3%) in the placebo group, p = 0.449. In conclusion, the results show that treatment with triflusal can reduce the incidence of myocardial infarction in patients with unstable angina.
TL;DR: With the exception of patients with manifest or strongly suspected coronary heart disease who are not receiving beta-blocker treatment, selective alpha 1-inhibitors should be recommended as first-line agents for the treatment of hypertension.
Abstract: It is well documented that in the treatment of mild or moderate hypertension selective α1-inhibitors such as doxazosin and prazosin lower blood pressure to approximately the same extent as β-blockers, diuretics, ACE inhibitors and calcium antagonists. However, treatment with selective αi-inhibitors is also associated with a number of other favourable effects. For example, in contrast to most β-blockers, selective αi-inhibitors have a favourable effect on serum lipids, primarily lowering the triglycerides but also increasing the ratio of high-density lipoprotein (HDL) cholesterohtotal cholesterol. In addition, selective αi-inhibitors do not aggravate glucose metabolism or increase uric acid concentration, as thiazide diuretics frequently do. Some patients gain particular benefit from treatment with a selective α1-inhibitor, namely those with non-insulin-dependent diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease, and kidney failure. While no controlled mortality trials with selective α1-inhibitors have yet been completed, new vasodilator drugs such as these do lower blood pressure in a more physiological manner than traditional antihypertensive agents, and appear to cause fewer side effects. In this respect, with the exception of patients with manifest or strongly suspected coronary heart disease who are not receiving β-blocker treatment, selective α1-inhibitors should be recommended as first-line agents for the treatment of hypertension.
TL;DR: A case of cardiac amyloidosis is described, proven by endomyocardial biopsy, which presented as ischaemic heart disease, and the literature on the same is reviewed.
Abstract: Cardiac amyloidosis can have varied clinical presentations, but it uncommonly leads to typical angina. The exact cause of ischaemia in this condition is not known, though various mechanisms have been postulated. We describe here a case of cardiac amyloidosis, proven by endomyocardial biopsy, which presented as ischaemic heart disease, and we also review the literature on the same.
TL;DR: The combination of a beta blocker and a vasodilator is logical in the treatment of high blood pressure and systemic arteriolar dilatation is beneficial to reduce the elevated peripheral resistance and hence to decrease cardiac afterload.
Abstract: The combination of a beta blocker and a vasodilator is logical in the treatment of high blood pressure. Systemic arteriolar dilatation is beneficial to reduce the elevated peripheral resistance and hence to decrease cardiac afterload. beta-Adrenoceptor blockade exerts its own antihypertensive activity and also suppresses the reflex tachycardia induced by vasodilation. The combined beta- and alpha-adrenoceptor blockade exerted by carvedilol imposes these beneficial hemodynamic effects. Carvedilol is a nonselective beta-adrenoceptor antagonist, devoid of intrinsic sympathomimetic activity and possessing selective alpha 1-adrenoceptor-blocking activity, although this is considerably weaker than its beta-adrenoceptor antagonistic activity. One isomer [S(-)-carvedilol] contains both the beta- and alpha-adrenoceptor activity, whereas R(+)-carvedilol is only a weak alpha blocker. Carvedilol is produced as the racemate. The hemodynamic profile is in accordance with that to be expected from the combination of beta and alpha blockade.
TL;DR: The potential of beta-blocking drugs to improve the clinical state in some patients with heart failure is, however, being further explored in two prospective randomized trials.
Abstract: The efficacy of beta-blocking drugs in the treatment of chronic heart failure remains controversial. A major obstacle to their acceptance in this pharmacotherapeutic role has been their reputed negative inotropic effects and the resulting depression of cardiac function when given acutely to patients in heart failure. However, in a number of uncontrolled studies in patients in mild or moderate heart failure due to dilated cardiomyopathy, these drugs, when titrated from a low-dose starting point, have been shown to improve the surrogate endpoints of symptoms and certain haemodynamic parameters. It is presumed that this benefit is related to the improvement in myocardial contractile activity secondary to the gradual up-regulation of the depressed myocardial beta-receptors in patients with chronic heart failure. At present, the data regarding the improvement in exercise tolerance are conflicting and there are no published data on the influence of beta-adrenoceptor-blocking drugs on survival. The potential of beta-blocking drugs to improve the clinical state in some patients with heart failure is, however, being further explored in two prospective randomized trials.
TL;DR: It is inferred that increases and decreases of the three major risk factors around the entry levels are associated with higher and lower levels of coronary risk in the 15 years after the changes have occurred.
Abstract: A pool of two Italian rural population samples made up of 1,712 men aged 40-59 at entry was studied in 1960 and than followed up for 25 years. The multivariate analysis of the first major coronary event using the Cox model showed, in men aged 40-59, 45-64 and 50-69, the significant predictive role of age, systolic blood pressure, serum cholesterol and cigarette smoking, but not of body mass index, without marked differences attributable to the aging process. Changes in systolic blood pressure, serum cholesterol and cigarette smoking occurring between year 0, 5 and 10 of follow-up, as defined by two different indicators, increased significantly the predictability of coronary events occurring between years 10 and 25 of follow-up when added to the model including the baseline factors. It is inferred that increases and decreases (even of relative nature) of the three major risk factors around the entry levels are associated with higher and lower levels of coronary risk in the 15 years after the changes have occurred.
TL;DR: The results confirm the long-term predictive power of the three major modifiable coronary risk factors when measured once in middle-aged male subjects.
Abstract: Two cohorts of male bank employees aged 40-59 at baseline and free of coronary heart disease were pooled and followed during 25 years for all-cause and coronary mortality. The vital status was known f
Journal Article•
TL;DR: In this article, the relationship between major risk factors and long-term mortality from coronary heart disease (CHD) and all causes, and on longevity, in Chicago cohorts was investigated.
Abstract: The focus here is on relationships between major risk factors and long-term mortality from coronary heart disease (CHD) and all causes, and on longevity, in Chicago cohorts: 25-year follow-up for Peoples Gas (PG) men aged 25-39 (n = 1,119), 30-year follow-up for PG men aged 40-59 (n = 1,235), 24-year follow-up for Western Electric (WE) men aged 40-55 (n = 1,882); also 15-year follow-up for five cohorts of the Chicago Heart Association (CHA) Study: men aged 25-39 (n = 7,873), 40-59 (n = 8,515), 60-74 (n = 1,490), and women aged 40-59 (n = 7,082) and 60-74 (n = 1,243); also 12-year findings for very low risk men (n = 11,098) and other men (n = 350,564) screened for the Multiple Risk Factor Intervention Trial (MRFIT). With a high degree of consistency, multivariate analyses showed independent positive relationships of baseline serum cholesterol, blood pressure and cigarette use to risk of death from CHD and all causes. For the WE cohort, with baseline nutrient data, dietary cholesterol was also independently related to these mortality risks. Combined risk factor impact was strong for both men and women of all baseline ages. Thus, for WE men, favorable compared to observed levels of serum cholesterol, blood pressure, cigarette use and dietary cholesterol were estimated to result in 24-year risk of CHD death 69% lower, all-cause death 42% lower and longevity 9 years greater. For CHA middle-aged and older women, favorable baseline levels of serum cholesterol, blood pressure and cigarette use were estimated to yield 15-year-CHD risk lower by about 60% and longevity greater by about 5 years. For MRFIT, very low risk men (serum cholesterol < 182 mg/dl, systolic/diastolic blood pressure < 120/<80), nonsmokers, nondiabetic, no previous heart attack), compared to all others, observed 12-year death rates were lower by 89% for CHD, 79% for stroke, 86% for all cardiovascular diseases, 30% for cancers, 21% for other causes, 53% for all causes, and longevity was estimated to be more than 9 years longer. These findings indicate great potentials for prevention of the CHD epidemic and for increased longevity with health for men and women, through improved life-styles and consequent lower risk factor levels.
TL;DR: Black men were less likely to die of CHD than white men, and this relative protectiveness increased upon adjusting for risk factors and also increased with age, which reflected in lower black than white CVD and all-cause mortality in men 65 years of age and older.
Abstract: The Evans County Heart Study was initiated to compare the epidemiology of coronary heart disease (CHD) of black and white residents of a southeastern United States community. The study was prompted by a clinical observation that CHD appeared to be less frequent in black than white patients, despite a much higher prevalence and greater severity of hypertension in blacks. A total community-based, closed cohort study was initiated with a prevalence survey in 1960-1962. The 20-year follow-up experience of the Evans County cohort confirmed the importance of the major risk factors of serum cholesterol, smoking and blood pressure for middle age and older, black and white men and women for CHD, cardiovascular disease (CVD) and all-cause mortality. Black men were less likely to die of CHD than white men, and this relative protectiveness increased upon adjusting for risk factors and also increased with age. The relative protectiveness of black men for CHD mortality was also reflected in lower black than white CVD and all-cause mortality in men 65 years of age and older.