Speciality
Spotlight

 




 


Family Practice


 

 










Cardiovascular Disease

    

  • Hypertension

    Halbert JA, Silagy CA, Finucane P, Et al [ Flinders Univ of South Australia; edford Park, Repatriation Gen Hosp, Daw Park , South Australia ; Royal Adelaide Hosp, South Australia ] 


    The Effectiveness of Exercise Training in Lowering Blood Pressure : A Meta-analysis of randomised Controlled Trials of 4 Weeks or Longer 


    J Hum Hypertens 11:641-649, 1997

      


    Lack of exercise is an independent cause leading to coronary artery disease.

       


    Aerobic exercise and resistance training programs were evaluated in 1,533 participants.

       


    Reduction of both systolic and diastolic pressures were noticed. The non exercising controls did not reveal this effect. 

      


    Effect of resistance training could not be evaluated. Aerobic exercises three to four times a week are recommended for patients with hypertension.

        
  • Alderman
    MH, Cohen H, Madhaven S.


    Dietary Sodium Intake and Mortality: The National Health and Nutrition Examination Survey [ NHANESI] 


    Lancet 351 : 781-785, 1998

      


    Restriction of Sodium intake to 2,400 mgm a day is recommended on the assumption that morbidity and mortality from cardiovascular disease would be lowered 20,729 adults between 25 and 75 years were first evaluated during 1971 to 1975. In 1992, a revaluation of 11,346 was carried out. Taking all factors into consideration routine reduction of sodium intake was not justified. Advice to increase intake or decrease its concentration in diet was not possible to evaluate.

      


    Effect of resistance training could not be evaluated. Aerobic exercises three to four times a week are recommended for patients with hypertension.

        
  • Berger M, Oksenberg A, Silverberg DS, et al [Loewenstein Rehabilitation Hosp, Roonana, Israel; Tel Aviv Med Ctr, Israel] 


    Avoiding the Supine Position during Sleep Lowers 24 H Blood Pressure in Obstructive Sleep Apnea [OSA] Patients 


    Hum Hypertens 11:641-664, 1997

      


    Patients with essential hypertension are prone to develop OSA more than normal subjects. Six normal and seven hypertensives with breathing problems in the supine position evaluated with the polysomnography. One month of sleep position intervention with the tennis ball technique resulted in lowering of systolic and diastolic pressures.

        
  • Grimm RH, Jr, for the TOMHS Research Group [ Shapiro Ctr for Evidence-Based Medicine, Minneapolis, Minn] 


    Long-term Effects on Sexual Function of Five Antihypertensive Drugs and Nutritional Hygienic Treatment in Hypertensive Men and Women: Treatment of Mild Hypertension Study [TOMHS]


    Hypertension 29: 8-14, 1997

      


    Men and Women between 45 and 69 years of age with stage 1 diastolic hypertension were studied. The effect of a placebo and five drugs [ acebutolol, amlodipine maleate, chlorthalidone, doxazosin maleate and enalapril maleate] on sexual function was evaluated.

       


    Maintenance of erection in men and getting an orgasm in women comprised the parameters, for evaluation. The incidence to sexual dysfunction was least with
    doxazosin.

       
  • Benetos A, Safer M, Rudnichi A, et al [ INSERM, Paris, State Univ of New York, Syracuse ] 


    Pulse Pressure : A Predictor of Long-term Cardiovascular Mortality in a French Male Polulation


    Hypertension 30: 1410-1415, 1997

      


    Blood pressure mensuation include systolic and diastolic and mean levels. Pulse pressure is a measure of a pulsatile artery. Men between 40 and 69 years were examined in the 1970s and again 19.5 years later. Increased PP is a good independent predictor of general and cardiovascular disease.

        
  • Albert CM, Hennekens CH et al

    Fish Consumption and a Risk of Sudden Cardiac
    Death


    JAMA 279: 23-29, 19980.

      


    Male physicians between 40 and 84 age group were followed up for 11 years. Taking all variables into consideration eating fish once a week reduces the risk of sudden cardiac death. White fish meat or darker shades did not make a difference. More frequent fish consumption also did not make a difference. N-3 Fatty Acid content alone does not seem to be the cause of protection noted.

        
  • Rimm EB Willett WC, et al


    Folate and Vitamin B6 from Diet and Supplements in Relation to Risk of Coronary Heart Disease Among Women.


    JAMA 279 :359-364, 1998

      


    Raised blood levels of homocystine increases the incidence of heart disease. 80,082 women nurses studied over a period of one year.

      


    Those taking larger amounts of folic acid and B6 either in diet or as a supplement showed a lower disease rate. The lowest incidence was found in women taking 400 Mg/day of folates and 3 mgm /day of B6.

       
  • Wald NJ, Law MR etc


    Helicobacter pylori infection and mortality from Ischaemic Heart Disease : Negative results from a large, prospective study


    BMJ 315: 1999 -1201, 1997

      


    After a study of 21,520 men it was concluded that treatment of such infected stomachs does not prevent ischaemic heart
    disease

        
  • Myocardial Infarction

    Boden WE, for the Veterans Affairs Non-Q-Wave Infarction Strategies. in Hospital [VANQWISH] Trial Investigators [State Univ of New York, Syracuse; Veterans Affairs Med Ctr, San Antonio, Tex; Veterans Affairs Med Ctr. Albuquerque NM; et al]


    Outcomes in Patients With Acute Non-Q-Wave Myocardial Infarction Randomly Assigned to an Invasive as Compared With a Conservative Management Strategy


    N Engl J Med 338: 1785-1792, 1998

     

    A large group of patients with myocardial infarcts of the non-Q-wave type were divided into 2 groups : One was treated conservatively and the other with invasive intervention.

         


    Conservative treatment with ischaemia-guided management was more useful than the other, in terms of mortality and
    mobidity.

        
  • Muldoon MF, Flory JD, Marsland A, et al [Univ of Pittsburgh, Pa]


    Effects of Lovastatin on the Immune System 


    Am J Cardiol 80: 1391-1394, 1997

       


    3-hydroxy-3-methaglutaryl coenzyme A [HMG-coA] reductase inhibitor is a cholesterol lowering drug belonging to the statin group. Its effects on inducing infections or carcinogenesis are not known. 67 adults taking 20 mg/day of the drug or a placebo for 6 months for raised low density lipoprotein [LDL] 160 mg/dL were subjected to a study of their immune systems before and after treatment. No changes were observed.

        
  • Malinow MR, Duell PB, Hess DL, et al [Oregon Regional Primate Research Ctr, Beaverton; Oregon Health Sciences Univ, Portland; Providence St Vincent Med Ctr, Portland, Ore; et al]


    Reduction of Plasma Homocyst(e)ine Levels by Breakfast Cereal Fortified With Folic Acid in Patients with Coronary Heart Disease


    N Engl J Med 338:1009-1015, 1998

      


    Interest in folic acid supplementation was generated by the observation of prevention in the occurrence of congenital neural tube defects. This is led to increasing its consumption by women in the child bearing age to 127 (G / day.

       


    High plasma levels of homocysteine increase the risk of coronary artery disease. Reduction of such levels are correlated with the dose of `folic acid. Thus at 127 (G the reduction in homocysteine was by 4% at 449 (G by 11% and at 665 (G it was 14%.)

            

Secondary Prevention of Coronary Artery Disease

  

  • Lewis SJ, for the CARE investigators [Legacy Good Samaritan Hosp. Portland, Ore; Brigham and Women’s Hosp. Boston; Baylor Univ, Dallas; et al ]


    Effect of Pravastatin on Cardiovascular Events in Women After Myocardial Infarction: The Cholesterol and Recurrent Events [CARE] Trial


    J Am Coll Cardiol 32:140-146, 1998

       


    The Study includes 576 post menopausal women after a myocardial infarction and with average level of cholesterol. They were below the age of 75 years and had their infarcts between 3 and 20 months earlier.

       


    A follow up period with 40 mgm/day of pravastatin for 5 years showed marked reduction in coronary events in this group.

        

Vascular Disease 

 

  • Carotid Artery Disease

    Mackey AE, and the Asymptomatic Cervical Bruit Study Group [Laval Univ, Quebec; McGill Univ, Montreal Gen Hosp]


    Outcome of Asymptomatic Patients With Carotid Disease


    Neurology 48:896-903, 1997

       


    715 patients with asymptomatic cervical bruits at an average of 65 years were followed up for about 3.6 years. Subjects had arterial narrowing due to atherosclerosis. With stenosis less than 50% the incidence of neurologic episodes was 4.2 and beyond 50% was 11%. Annual stroke and vascular death were 1.9% and 5.5% respectively. A marked increase was observed with stenosis over 80%. Control of hypertension and smoking are suggested to prevent progression of disease.

         
  • Decousus H, for the Prevention du Risque d’Embolie Pulmonaire par interuption Cave Study Group [Bellevue Hosp, Saint-Etiemme, France; Cardiological Hosp, Lyons, France; Antoine Beclere Hosp, Clamart, France; et al]


    A Clinical Trial of Vena Caval Filters in the Prevention of Pulmonary Embolism in Patients With Proximal Deep-Vein Thrombosis


    N Engl J Med 338: 409-415, 1998

       


    400 patients with proximal deep-vein thrombosis and thus at risk of pulmonary embolism were studied. All of them received low molecular weight heparin or unfractionated heparin. One group received the filter and the other did not. On the 12th day those with filters had a pulmonary embolism rate of 1.1% and the other 4.8%. By 2 years the rates were 20.8% and 11.6% respectively. Mortality and other outcomes were the same in the two groups. Low-molecular weight heparin and unfractionated heparin were effective in prevention of embolism.

       


    A short lerim benefit of filter is counterbalanced by a greater incidence of recurrence of proximal deep vein thrombosis in the long run.

        
  • Wolfe TR, Allen TL [Univ of Utah, Salt Lake City; Univ of Pittsburgh, Pal


    Syncope as an Emergency Department Presentation of Pulmonary Embolism 


    J Emerg Med 16:27-31, 1998

       


    A 38 year man suffering from hypertension receiving diltiazem, atenolol and chlorthalidone without any risk factors for pulmonary embolism is described as developing dizziness as the sole symptom. He died and the diagnosis was made at autopsy.

       

Metabolism and Endocrinology

 

  • Lipids


    Hu FB, Stampfer MJ, Manson JE, et al [Havard Med School, Boston]


    Dietaey Fat Intake and the Risk of Coronary Heart Disease in Women


    N Engl J Med 337:1491-1499, 1997

       


    Most previous studies have been in males. This study comprised 80,082 female nurses in the age group of 34 to 59 years. At the outset in 1980, they were free of coronary artery disease, stroke, malignancy hypercholesterolemia and diabetes.

       


    Coronary heart disease incidence increases as the consumption of saturated fat is increased. This applies to trans unsaturated fats but to a lesser extent and is progressively lower for mono and poly unsaturated fat. Conclusions were derived over a 14 year period. 

        
  • Lamarche B, Tchernof A, Mauriege P, et al [Laval Univ, Ste-Foy, Quebec; Univ of Montreal]


    Fasting Insulin and Apolipoprotein B levels and Low-Density Lipoprotein Particle Size as Risk Factors for Ischemic Heart Disease


    JAMA 279: 1955-1961, 1998

       


    Many patients with myocardial ischemia present with normal total cholesterol levels. Finding high fasting levels of insulin, apolipoprotein B levels and low density as well as very low density levels of cholesterol add to the finesse in preventing and treating ischemic heart disease.

       
  • Ridker PM, Glynn RJ, Hennekens CH [Brigham and Women’s Hosp, Boston: Havard Med School, Boston]


    C-Reactive Protein Adds to the Predictive Value of Total and HDL Cholesterol in Determining Risk of First Myocardial Infraction


    Circulation: 97:2007-2011, 1998

        


    14,916 men free from heart disease, chronic infections, and malignancy were studied. Baseline levels of Total cholesterol, HDL-C and C-reactive protein were established. 246 of these developed a first MI in the next 9 years whereas 543 that comprised the control were normal for this paramater.

       


    Elevated CRP had a predictive value even in those with normal cholesterol studies. This is expected as C.R.P. is an indicator of inflammation.

       
  • Willett WC [Harvard Med. School, Boston]


    Is Dietary Fat a Major Determinant of Body Fat ?


    Am J Clin Nutr 67: 556S-562S, 1998

       


    Over short periods of time fat restriction leads to weight loss. In a study over a period of 1 year fat restriction to 18 and 40 percent of energy intake had no such effect. Despite fat restriction in diet over the last 20 years obesity continue to be a major concern. Other adjustment by metabolic needs is possible. 

        
  • Coakley EH, Rimm EB, Colditz G, et al [Harvard Med School, Boston]

    Predictors of Weight Change in Men : Results from
    the Health Professionals Follow-up Study

    Int J Obes 22: 89-96, 1998

       


    In 1986, 51,529 men between the ages of 40 and 75, were selected for study. Information was asked for in 1988 and 1992. Details were available for 19,478 men. Weight gain was observed in those who ate between meals. Watched TV or had given up smoking or had lost weight on their own before entering the study. Group not eating between meals, reduction in time spent on TV watching and exercise led to loss of weight, or maintaining a constant level.

       
  • Kiberd BA, Jindal KK
    [Dalhousie Univ. Halifax, Nova Scotia, Canada]


    Routine Treatment of Insulin-Dependent Diabetic patients With ACE Inhibitors to prevent Renal Failure: An Economic Evaluation


    Am J Kidney Dis 31: 49-54, 1998

       

    If a patient of diabetes is being controlled with insulin and is candidate for diabetic nephropathy, the latter can be prevented by introducing ACE inhibitors. If he or she already has microalbuminuria its progression can be stopped.

       


    It is not known whether this would occur in Non-Insulin Dependent Diabetes.

      
  • Riley MD, Dwyer T [Univ of Tasmania, Hobart, Australia]


    Microalbuminuria is Positively Associated with Usual Dietary Saturated Fat Intake and Negatively Associated with Usual Dietary Protein Intake in People with Insulin-Dependent Diabetes Mellitus


    Am J Clin Nutr 67: 50-57, 1998

       


    Development of nephropathy in IDDM is a significant cause of morbidity and mortality. Linking this to protein intake has been taken for granted. It is the increasing saturated fat intake that is associated with renal involvement. High protein intake is not thus associated, and rather prevents its occurrence. Mono and poly-unsaturated fat intake does not correlate with nephropathy. 

        
  • Purnell JQ, Hokanson JE, Marcovina SM [Univ of Washington, Seattle; George Washington Univ, Rockville, Md: Univ of Minnesota, Minneapolis]


    Effect of Excessive Weight Gain with Intensive Therapy of Type 1 Diabetes on Lipid Levels and Blood Pressure: Results from the DCCT


    JAMA 280: 140-146, 1998

       


    18 Years and over constituted the study group of 1168 individuals. A tight control of diabetes with insulin led to weight gain and change in lipid levels. The latter included a rise in low-density lipo-protein component of cholesterol. Weight gain in the truncal region was more than elsewhere.

       


    Thus the chances of cardiovascular complications are raised at the cost of reducing renal and ocular involvement.

       
  • Balkau B, Shipley M, Jarrett RJ, et al [INSERM, Villejuif, France; Univ of Kuopio, Finland; Univ College Med School, London; et al ]


    High Blood Glucose Concentration is a Risk Factor for Mortality in Middle-aged 

    Nondiabetic Men : 20-Year Follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study


    Diabetes Care 21: 360-367, 1998

       


    High blood glucose levels not tantamount to a diagnosis of diabetes were evaluated as risk factors involved in causation of death due to all causes. Men between 44-55 years were given a standard 2 hour glucose tolerance test and followed up for 20 years. The total was made up of 10,025 in the Whitehall Study, 6629 in the Paris group and 631 in the Helsinki police men. Deaths from cardiovascular disease, coronary heart disease [CHD] and neoplasms were evaluated.

       


    Policemen had the maximum incidence in the all cause group except neoplasms. Deaths from cardiovascular and CHD were more than would be expected. Information of this type may suggest early control of glucose levels.

        
  • Landau Z [Kaplan Hosp, Rehovot Israel]


    Topical Hyperbaric Oxygen and Low Energy Laser for the Treatment of Diabetic Foot Ulcers


    Arch Orthop Trauma Surg 117: 156-158, 1998 

       


    50 diabetic subjects had nonhealing foot ulcers of 9 months mean duration. 15 received topical hyperbaric oxygen alone and 35 in addition were given low energy laser. 25 treatments over a period of 3 months resulted in curing 43 ulcerated feet.

        
  • Endocrine-Miscellaneous


    Bartalena L, Marcocci C, Bogazzi F, et al [Istituto di Endocrinologia, Pisa, Italy; Clinica Oculistica, 

    Pisa, Italy; Univ of Pisa, Italy; et al]


    Relation Between therapy for Hyperthyroidism and the Course of Graves’ Ophthalmopathy


    N Engl J Med 338: 73-78, 1998

       


    443 patients of ‘Graves’ disease were treated with methimazole for 3 to 4 months. Radiotherapy [120 to 150 (G ] for 18 months radioiodine and prednisone [ 0.4 to 0.5 mg/kg] for 3 months were given to some and methimazole was continued for others.

        


    Opthalmopathy began or became worse in 6 months of treatment with radioiodine alone. This was observed in 23 of the 150 subjects. Those who smoked outnumbered the non-smokers. 140 subjects treated with radioiodine and prednisone revealed either regression of ocular changes or non development of such changes if they had none at the onset. In the group of 148 on methimazole 3/74 with ocular changes improved, four developed them or became worse. 141 maintained their status quo.

        


    This study is important as it emphasizes the role of autoimmunity in the pathogenisis of opthalmopathy in hyperthyroidism thus bringing out the role of a corticosteriod in both prevention and therapy of the evolved state.

        
  • Gravholt CH, Juul S, Naeraa RW, et al [ Aarhus Univ, Denmark]


    Morbidity in Turner Syndrome


    J Clin Epidermiol 51: 147-158, 1998

    Absence of an X-chromosome or a part of it in a female gives a myriad of abnormalities described as Turner’s syndrome.

        


    This article emphasizes the occurrence of fractures in children. Colonic cancers and cirrhosis of the liver are other, features described in women with Turner’s syndrome. Ischaemic heart disease, diabetes mellitus and strokes are more frequent.

      




 

 

Speciality Spotlight

 

 

Cardiovascular Disease
    

  • Hypertension
    Halbert JA, Silagy CA, Finucane P, Et al [ Flinders Univ of South Australia; edford Park, Repatriation Gen Hosp, Daw Park , South Australia ; Royal Adelaide Hosp, South Australia ] 
    The Effectiveness of Exercise Training in Lowering Blood Pressure : A Meta-analysis of randomised Controlled Trials of 4 Weeks or Longer 
    J Hum Hypertens 11:641-649, 1997
      
    Lack of exercise is an independent cause leading to coronary artery disease.
       
    Aerobic exercise and resistance training programs were evaluated in 1,533 participants.
       
    Reduction of both systolic and diastolic pressures were noticed. The non exercising controls did not reveal this effect. 
      
    Effect of resistance training could not be evaluated. Aerobic exercises three to four times a week are recommended for patients with hypertension.
        
  • Alderman MH, Cohen H, Madhaven S.
    Dietary Sodium Intake and Mortality: The National Health and Nutrition Examination Survey [ NHANESI] 
    Lancet 351 : 781-785, 1998
      
    Restriction of Sodium intake to 2,400 mgm a day is recommended on the assumption that morbidity and mortality from cardiovascular disease would be lowered 20,729 adults between 25 and 75 years were first evaluated during 1971 to 1975. In 1992, a revaluation of 11,346 was carried out. Taking all factors into consideration routine reduction of sodium intake was not justified. Advice to increase intake or decrease its concentration in diet was not possible to evaluate.
      
    Effect of resistance training could not be evaluated. Aerobic exercises three to four times a week are recommended for patients with hypertension.
        
  • Berger M, Oksenberg A, Silverberg DS, et al [Loewenstein Rehabilitation Hosp, Roonana, Israel; Tel Aviv Med Ctr, Israel] 
    Avoiding the Supine Position during Sleep Lowers 24 H Blood Pressure in Obstructive Sleep Apnea [OSA] Patients 
    Hum Hypertens 11:641-664, 1997
      
    Patients with essential hypertension are prone to develop OSA more than normal subjects. Six normal and seven hypertensives with breathing problems in the supine position evaluated with the polysomnography. One month of sleep position intervention with the tennis ball technique resulted in lowering of systolic and diastolic pressures.
        
  • Grimm RH, Jr, for the TOMHS Research Group [ Shapiro Ctr for Evidence-Based Medicine, Minneapolis, Minn] 
    Long-term Effects on Sexual Function of Five Antihypertensive Drugs and Nutritional Hygienic Treatment in Hypertensive Men and Women: Treatment of Mild Hypertension Study [TOMHS]
    Hypertension 29: 8-14, 1997
      
    Men and Women between 45 and 69 years of age with stage 1 diastolic hypertension were studied. The effect of a placebo and five drugs [ acebutolol, amlodipine maleate, chlorthalidone, doxazosin maleate and enalapril maleate] on sexual function was evaluated.
       
    Maintenance of erection in men and getting an orgasm in women comprised the parameters, for evaluation. The incidence to sexual dysfunction was least with doxazosin.
       
  • Benetos A, Safer M, Rudnichi A, et al [ INSERM, Paris, State Univ of New York, Syracuse ] 
    Pulse Pressure : A Predictor of Long-term Cardiovascular Mortality in a French Male Polulation
    Hypertension 30: 1410-1415, 1997
      
    Blood pressure mensuation include systolic and diastolic and mean levels. Pulse pressure is a measure of a pulsatile artery. Men between 40 and 69 years were examined in the 1970s and again 19.5 years later. Increased PP is a good independent predictor of general and cardiovascular disease.
        
  • Albert CM, Hennekens CH et al
    Fish Consumption and a Risk of Sudden Cardiac Death
    JAMA 279: 23-29, 19980.
      
    Male physicians between 40 and 84 age group were followed up for 11 years. Taking all variables into consideration eating fish once a week reduces the risk of sudden cardiac death. White fish meat or darker shades did not make a difference. More frequent fish consumption also did not make a difference. N-3 Fatty Acid content alone does not seem to be the cause of protection noted.
        
  • Rimm EB Willett WC, et al
    Folate and Vitamin B6 from Diet and Supplements in Relation to Risk of Coronary Heart Disease Among Women.
    JAMA 279 :359-364, 1998
      
    Raised blood levels of homocystine increases the incidence of heart disease. 80,082 women nurses studied over a period of one year.
      
    Those taking larger amounts of folic acid and B6 either in diet or as a supplement showed a lower disease rate. The lowest incidence was found in women taking 400 Mg/day of folates and 3 mgm /day of B6.
       
  • Wald NJ, Law MR etc
    Helicobacter pylori infection and mortality from Ischaemic Heart Disease : Negative results from a large, prospective study
    BMJ 315: 1999 -1201, 1997
      
    After a study of 21,520 men it was concluded that treatment of such infected stomachs does not prevent ischaemic heart disease
        
  • Myocardial Infarction
    Boden WE, for the Veterans Affairs Non-Q-Wave Infarction Strategies. in Hospital [VANQWISH] Trial Investigators [State Univ of New York, Syracuse; Veterans Affairs Med Ctr, San Antonio, Tex; Veterans Affairs Med Ctr. Albuquerque NM; et al]
    Outcomes in Patients With Acute Non-Q-Wave Myocardial Infarction Randomly Assigned to an Invasive as Compared With a Conservative Management Strategy
    N Engl J Med 338: 1785-1792, 1998
     
    A large group of patients with myocardial infarcts of the non-Q-wave type were divided into 2 groups : One was treated conservatively and the other with invasive intervention.
         
    Conservative treatment with ischaemia-guided management was more useful than the other, in terms of mortality and mobidity.
        
  • Muldoon MF, Flory JD, Marsland A, et al [Univ of Pittsburgh, Pa]
    Effects of Lovastatin on the Immune System 
    Am J Cardiol 80: 1391-1394, 1997
       
    3-hydroxy-3-methaglutaryl coenzyme A [HMG-coA] reductase inhibitor is a cholesterol lowering drug belonging to the statin group. Its effects on inducing infections or carcinogenesis are not known. 67 adults taking 20 mg/day of the drug or a placebo for 6 months for raised low density lipoprotein [LDL] 160 mg/dL were subjected to a study of their immune systems before and after treatment. No changes were observed.
        
  • Malinow MR, Duell PB, Hess DL, et al [Oregon Regional Primate Research Ctr, Beaverton; Oregon Health Sciences Univ, Portland; Providence St Vincent Med Ctr, Portland, Ore; et al]
    Reduction of Plasma Homocyst(e)ine Levels by Breakfast Cereal Fortified With Folic Acid in Patients with Coronary Heart Disease
    N Engl J Med 338:1009-1015, 1998
      
    Interest in folic acid supplementation was generated by the observation of prevention in the occurrence of congenital neural tube defects. This is led to increasing its consumption by women in the child bearing age to 127 (G / day.
       
    High plasma levels of homocysteine increase the risk of coronary artery disease. Reduction of such levels are correlated with the dose of `folic acid. Thus at 127 (G the reduction in homocysteine was by 4% at 449 (G by 11% and at 665 (G it was 14%.)
            

Secondary Prevention of Coronary Artery Disease
  

  • Lewis SJ, for the CARE investigators [Legacy Good Samaritan Hosp. Portland, Ore; Brigham and Women’s Hosp. Boston; Baylor Univ, Dallas; et al ]
    Effect of Pravastatin on Cardiovascular Events in Women After Myocardial Infarction: The Cholesterol and Recurrent Events [CARE] Trial
    J Am Coll Cardiol 32:140-146, 1998
       
    The Study includes 576 post menopausal women after a myocardial infarction and with average level of cholesterol. They were below the age of 75 years and had their infarcts between 3 and 20 months earlier.
       
    A follow up period with 40 mgm/day of pravastatin for 5 years showed marked reduction in coronary events in this group.
        

Vascular Disease 
 

  • Carotid Artery Disease
    Mackey AE, and the Asymptomatic Cervical Bruit Study Group [Laval Univ, Quebec; McGill Univ, Montreal Gen Hosp]
    Outcome of Asymptomatic Patients With Carotid Disease
    Neurology 48:896-903, 1997
       
    715 patients with asymptomatic cervical bruits at an average of 65 years were followed up for about 3.6 years. Subjects had arterial narrowing due to atherosclerosis. With stenosis less than 50% the incidence of neurologic episodes was 4.2 and beyond 50% was 11%. Annual stroke and vascular death were 1.9% and 5.5% respectively. A marked increase was observed with stenosis over 80%. Control of hypertension and smoking are suggested to prevent progression of disease.
         
  • Decousus H, for the Prevention du Risque d’Embolie Pulmonaire par interuption Cave Study Group [Bellevue Hosp, Saint-Etiemme, France; Cardiological Hosp, Lyons, France; Antoine Beclere Hosp, Clamart, France; et al]
    A Clinical Trial of Vena Caval Filters in the Prevention of Pulmonary Embolism in Patients With Proximal Deep-Vein Thrombosis
    N Engl J Med 338: 409-415, 1998
       
    400 patients with proximal deep-vein thrombosis and thus at risk of pulmonary embolism were studied. All of them received low molecular weight heparin or unfractionated heparin. One group received the filter and the other did not. On the 12th day those with filters had a pulmonary embolism rate of 1.1% and the other 4.8%. By 2 years the rates were 20.8% and 11.6% respectively. Mortality and other outcomes were the same in the two groups. Low-molecular weight heparin and unfractionated heparin were effective in prevention of embolism.
       
    A short lerim benefit of filter is counterbalanced by a greater incidence of recurrence of proximal deep vein thrombosis in the long run.
        
  • Wolfe TR, Allen TL [Univ of Utah, Salt Lake City; Univ of Pittsburgh, Pal
    Syncope as an Emergency Department Presentation of Pulmonary Embolism 
    J Emerg Med 16:27-31, 1998
       
    A 38 year man suffering from hypertension receiving diltiazem, atenolol and chlorthalidone without any risk factors for pulmonary embolism is described as developing dizziness as the sole symptom. He died and the diagnosis was made at autopsy.
       

Metabolism and Endocrinology
 

  • Lipids
    Hu FB, Stampfer MJ, Manson JE, et al [Havard Med School, Boston]
    Dietaey Fat Intake and the Risk of Coronary Heart Disease in Women
    N Engl J Med 337:1491-1499, 1997
       
    Most previous studies have been in males. This study comprised 80,082 female nurses in the age group of 34 to 59 years. At the outset in 1980, they were free of coronary artery disease, stroke, malignancy hypercholesterolemia and diabetes.
       
    Coronary heart disease incidence increases as the consumption of saturated fat is increased. This applies to trans unsaturated fats but to a lesser extent and is progressively lower for mono and poly unsaturated fat. Conclusions were derived over a 14 year period. 
        
  • Lamarche B, Tchernof A, Mauriege P, et al [Laval Univ, Ste-Foy, Quebec; Univ of Montreal]
    Fasting Insulin and Apolipoprotein B levels and Low-Density Lipoprotein Particle Size as Risk Factors for Ischemic Heart Disease
    JAMA 279: 1955-1961, 1998
       
    Many patients with myocardial ischemia present with normal total cholesterol levels. Finding high fasting levels of insulin, apolipoprotein B levels and low density as well as very low density levels of cholesterol add to the finesse in preventing and treating ischemic heart disease.
       
  • Ridker PM, Glynn RJ, Hennekens CH [Brigham and Women’s Hosp, Boston: Havard Med School, Boston]
    C-Reactive Protein Adds to the Predictive Value of Total and HDL Cholesterol in Determining Risk of First Myocardial Infraction
    Circulation: 97:2007-2011, 1998
        
    14,916 men free from heart disease, chronic infections, and malignancy were studied. Baseline levels of Total cholesterol, HDL-C and C-reactive protein were established. 246 of these developed a first MI in the next 9 years whereas 543 that comprised the control were normal for this paramater.
       
    Elevated CRP had a predictive value even in those with normal cholesterol studies. This is expected as C.R.P. is an indicator of inflammation.
       
  • Willett WC [Harvard Med. School, Boston]
    Is Dietary Fat a Major Determinant of Body Fat ?
    Am J Clin Nutr 67: 556S-562S, 1998
       
    Over short periods of time fat restriction leads to weight loss. In a study over a period of 1 year fat restriction to 18 and 40 percent of energy intake had no such effect. Despite fat restriction in diet over the last 20 years obesity continue to be a major concern. Other adjustment by metabolic needs is possible. 
        
  • Coakley EH, Rimm EB, Colditz G, et al [Harvard Med School, Boston]
    Predictors of Weight Change in Men : Results from the Health Professionals Follow-up Study
    Int J Obes 22: 89-96, 1998
       
    In 1986, 51,529 men between the ages of 40 and 75, were selected for study. Information was asked for in 1988 and 1992. Details were available for 19,478 men. Weight gain was observed in those who ate between meals. Watched TV or had given up smoking or had lost weight on their own before entering the study. Group not eating between meals, reduction in time spent on TV watching and exercise led to loss of weight, or maintaining a constant level.
       
  • Kiberd BA, Jindal KK [Dalhousie Univ. Halifax, Nova Scotia, Canada]
    Routine Treatment of Insulin-Dependent Diabetic patients With ACE Inhibitors to prevent Renal Failure: An Economic Evaluation
    Am J Kidney Dis 31: 49-54, 1998
       
    If a patient of diabetes is being controlled with insulin and is candidate for diabetic nephropathy, the latter can be prevented by introducing ACE inhibitors. If he or she already has microalbuminuria its progression can be stopped.
       
    It is not known whether this would occur in Non-Insulin Dependent Diabetes.
      
  • Riley MD, Dwyer T [Univ of Tasmania, Hobart, Australia]
    Microalbuminuria is Positively Associated with Usual Dietary Saturated Fat Intake and Negatively Associated with Usual Dietary Protein Intake in People with Insulin-Dependent Diabetes Mellitus
    Am J Clin Nutr 67: 50-57, 1998
       
    Development of nephropathy in IDDM is a significant cause of morbidity and mortality. Linking this to protein intake has been taken for granted. It is the increasing saturated fat intake that is associated with renal involvement. High protein intake is not thus associated, and rather prevents its occurrence. Mono and poly-unsaturated fat intake does not correlate with nephropathy. 
        
  • Purnell JQ, Hokanson JE, Marcovina SM [Univ of Washington, Seattle; George Washington Univ, Rockville, Md: Univ of Minnesota, Minneapolis]
    Effect of Excessive Weight Gain with Intensive Therapy of Type 1 Diabetes on Lipid Levels and Blood Pressure: Results from the DCCT
    JAMA 280: 140-146, 1998
       
    18 Years and over constituted the study group of 1168 individuals. A tight control of diabetes with insulin led to weight gain and change in lipid levels. The latter included a rise in low-density lipo-protein component of cholesterol. Weight gain in the truncal region was more than elsewhere.
       
    Thus the chances of cardiovascular complications are raised at the cost of reducing renal and ocular involvement.
       
  • Balkau B, Shipley M, Jarrett RJ, et al [INSERM, Villejuif, France; Univ of Kuopio, Finland; Univ College Med School, London; et al ]
    High Blood Glucose Concentration is a Risk Factor for Mortality in Middle-aged 
    Nondiabetic Men : 20-Year Follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study

    Diabetes Care 21: 360-367, 1998
       
    High blood glucose levels not tantamount to a diagnosis of diabetes were evaluated as risk factors involved in causation of death due to all causes. Men between 44-55 years were given a standard 2 hour glucose tolerance test and followed up for 20 years. The total was made up of 10,025 in the Whitehall Study, 6629 in the Paris group and 631 in the Helsinki police men. Deaths from cardiovascular disease, coronary heart disease [CHD] and neoplasms were evaluated.
       
    Policemen had the maximum incidence in the all cause group except neoplasms. Deaths from cardiovascular and CHD were more than would be expected. Information of this type may suggest early control of glucose levels.
        
  • Landau Z [Kaplan Hosp, Rehovot Israel]
    Topical Hyperbaric Oxygen and Low Energy Laser for the Treatment of Diabetic Foot Ulcers
    Arch Orthop Trauma Surg 117: 156-158, 1998 
       
    50 diabetic subjects had nonhealing foot ulcers of 9 months mean duration. 15 received topical hyperbaric oxygen alone and 35 in addition were given low energy laser. 25 treatments over a period of 3 months resulted in curing 43 ulcerated feet.
        
  • Endocrine-Miscellaneous
    Bartalena L, Marcocci C, Bogazzi F, et al [Istituto di Endocrinologia, Pisa, Italy; Clinica Oculistica, 
    Pisa, Italy; Univ of Pisa, Italy; et al]
    Relation Between therapy for Hyperthyroidism and the Course of Graves’ Ophthalmopathy
    N Engl J Med 338: 73-78, 1998
       
    443 patients of ‘Graves’ disease were treated with methimazole for 3 to 4 months. Radiotherapy [120 to 150 (G ] for 18 months radioiodine and prednisone [ 0.4 to 0.5 mg/kg] for 3 months were given to some and methimazole was continued for others.
        
    Opthalmopathy began or became worse in 6 months of treatment with radioiodine alone. This was observed in 23 of the 150 subjects. Those who smoked outnumbered the non-smokers. 140 subjects treated with radioiodine and prednisone revealed either regression of ocular changes or non development of such changes if they had none at the onset. In the group of 148 on methimazole 3/74 with ocular changes improved, four developed them or became worse. 141 maintained their status quo.
        
    This study is important as it emphasizes the role of autoimmunity in the pathogenisis of opthalmopathy in hyperthyroidism thus bringing out the role of a corticosteriod in both prevention and therapy of the evolved state.
        
  • Gravholt CH, Juul S, Naeraa RW, et al [ Aarhus Univ, Denmark]
    Morbidity in Turner Syndrome
    J Clin Epidermiol 51: 147-158, 1998
    Absence of an X-chromosome or a part of it in a female gives a myriad of abnormalities described as Turner’s syndrome.
        
    This article emphasizes the occurrence of fractures in children. Colonic cancers and cirrhosis of the liver are other, features described in women with Turner’s syndrome. Ischaemic heart disease, diabetes mellitus and strokes are more frequent.
      

 

By |2022-07-20T16:43:29+00:00July 20, 2022|Uncategorized|Comments Off on Cardiovascular Disease

About the Author: