Absence Of Coronary Heart Disease Research Articles

Serum lipoprotein(a) in healthy Japanese children 5 years of age

Serum lipoprotein(a) [Lp(a)] concentrations were investigated in 155 Japanese children aged 5 years. The frequency distribution of Lp(a) concentrations was highly skewed and ranged from 1 to 109 mg/dL. The mean and median values of Lp(a) were 16.5 mg/dL (s.d. 17.3 mg/dL) and 12 mg/dL. The incidence of Lp(a) concentrations > or = 30 mg/dL was significantly high in children with total cholesterol > or = 200 mg/dL, not including the case of familial hypercholesterolaemia. Log Lp(a) values showed an inverse correlation with bodyweight and body mass index. No significant differences in Lp(a) levels could be seen between the groups according to the presence or absence of coronary heart disease and cerebral vascular accident in family histories. The results suggest that Lp(a) in Japanese children aged 5 years was essentially the same as that in adults. Further study may be needed to disclose the factors that influence Lp(a) concentration in childhood.

The value of thallium scintigraphy in a district general hospital.

The usefulness of exercise Tl scintigraphy (combined with electrocardiography) in a district general hospital has been assessed in 80 patients in whom a previous exercise electrocardiogram (ECG) had not been definitive. Seventy-five of the patients presented with chest pain and five with no pain but an abnormal ECG. Case notes and test results were examined to establish the clinicians' judgment of the likelihood of having coronary heart disease (CHD) and the patient's outcome. The mean time of follow-up was 27 months. In the majority of patients the test was found to help the clinician come to a decision on the presence or absence of CHD. It was found to be particularly useful in patients with abnormal resting ECGs. There was a shorter time to discharge for patients classified as highly unlikely of having CHD. Only four patients were re-referred following discharge from the outpatient clinic. Nine patients were referred for coronary angiography with five being found to have significant stenosis. None of the 16 patients in whom the exercise ECG was normal had ischaemic myocardial segments in the Tl scintigraphy.

Age, cardiovascular risk factors and coronary heart disease as determinants of platelet function in men. A multivariate approach

Older age, the cardiovascular risk factors and arteriosclerosis have been reported to be associated with stimulated platelet function. To evaluate the relative importance of these factors in determining platelet function, a cross-sectional multivariate study in 191 men, 113 healthy subjects and 78 patients with angiographically documented coronary heart disease, was performed. In healthy subjects, stepwise multiple linear regression identified age to be a major determinant of platelet aggregability. After induction with both ADP and collagen the platelet aggregatory response markedly increased with age. In the patients, platelet function was not age dependent. In multivariate analysis of variance, neither smoking status nor hypercholesterolemia (>- 240 mg/dl) were determinants of platelet function in either group. An increase in systolic blood pressure was associated with slightly more inhibited ADP induced aggregation in both healthy subjects and patients with coronary heart disease. In patients compared to healthy subjects, aggregation after induction with ADP and collagen was markedly enhanced and the in vitro formation of thromboxane after collagen stimulation increased. Thus, by multivariate analysis, age and the presence or absence of coronary heart disease were found to be major determinants of platelet function. In contrast, the cardiovascular risk factors smoking, hypercholesterolemia and hypertension were associated with only minor or no alterations of platelet function.

Correlation between histopathological changes and mechanical dysfunction in diabetic rat hearts

Recent clinical and experimental studies have suggested that diabetic patients may develop myocardial dysfunction in the absence of coronary heart disease and hypertension. In this study, the correlation between histopathological changes and myocardial dysfunction was studied in experimental diabetic rat hearts. Male Wistar rats were made diabetic at 9 weeks of age with a single intravenous injection of streptozotocin 50 mg/kg. The diabetic rats were studied along with age-matched control and insulin-treated rats at 4, 8, 12 and 24 weeks after the induction of diabetes to investigate isolated papillary muscle contraction and the histopathological picture simultaneously. In the isometric contractions, resting and developed tensions were similar. Time to peak tension and time to 1/2 relaxation were prolonged and the peak rate of tension rise and tension fall was depressed. On histological examination of left ventricular walls, diameters of myocytes were similar at all disease durations. Interstitial fibrosis and disarrangement of myocytes after 12 weeks were slightly increased in the diabetic hearts. Mechanical parameters did not worsen in parallel with the duration of diabetes and histological changes, but correlated with the blood glucose level. These data suggest that short-term mechanical defects in the experimental diabetic rat heart result from the metabolic disorder itself, with histopathological changes occurring later.

Predictors of high functional capacity and mortality in elderly Finnish men

Factors predicting high functional capacity in old age and 25-year mortality were studied in 1711 men aged 40 to 59 years. The study population was that of the East-West Study, i.e. the Finnish part of the Seven Countries Study. After the 25-year follow-up (in 1984) 766 men were still alive. Nonsmoking and good pulmonary function in earlier middle-age and the absence of coronary heart disease, cerebrovascular disease or emphysema in later middle-age predicted high functional capacity in old age. High systolic blood pressure, low forced vital capacity, smoking, and the presence of coronary heart disease predicted mortality in the next 10 to 25 years. Although mortality rates were higher in eastern Finland, the predictors were similar in both the eastern and the southwestern parts of the country.

Coronary microangiopathy and cardiac hypertrophy

Even in the absence of coronary heart disease, coronary vasodilator reserve is frequently impaired in hypertensive patients. To study, whether the reduced coronary reserve is due to the degree of left ventricular hypertrophy or is a consequence of primary vascular alterations, coronary reserve was determined in 54 hypertensive patients with angina pectoris and angiographically normal coronary arteries. Twelve normotensive persons were studied for control purposes. Coronary blood flow was measured quantitatively by the gas chromatographic argon method. Coronary reserve was determined by measuring coronary resistance before and after dipyridamole (0.5 mg (kg body weight)-1 i.v.). Left ventricular muscle mass was determined by ventriculography. In hypertensive patients, minimal coronary resistance was markedly increased by 124% and coronary reserve significantly reduced by about 38% compared with healthy normotensives. Hypertensives and normotensives did not differ with respect to myocardial oxygen consumption per unit weight myocardium (11.9 +/- 2.3 vs 11.4 +/- 2.4 ml O2 100g-1 min, n.s.) and resting coronary flow (92.1 +/- 20.8 vs 91.4 +/- 18.9 ml min-1. 100 g, n.s.). No significant correlation was found between minimal coronary resistance and coronary reserve and left ventricular muscle mass and between coronary reserve and diastolic wall stress. Accordingly, the reduced coronary regulation capacity in hypertensives does not parallel the degree of left ventricular hypertrophy and is not due to an increased myocardial oxygen consumption under resting conditions. Consequently, the impaired coronary reserve in hypertensive patients seems to be the consequence of primary microvascular lesions, which are independent of the process of left ventricular hypertrophy.

Exercise induced non ischemic angina pectoris due to abnormal left ventricular compliance.

ABSTRACT. In 27 patients (pts.) with a history of exercise induced angina pectoris coronary heart disease (CHD), hypertrophic or congestive cardiomyopathy and mitral valve prolapse were excluded by coronary and left ventricular angiography and echocardiography. The pts. were divided into two subgroups: 12 pts. with normal (groups A) and 15 pts. with abnormal exercise ECG (group B). All but two pts. showed a positive reaction on nitroglycerin. The results of a retrospective analysis of clinical and hemodynamic findings are reported. No age differences were detected. There was an over‐representation of females in group B (12:3). In group B ST‐depression (0,1 − 0,3 mV) during exercise and angina occured in 4 pts., in the remainder only ST‐depression between 0,1 and 0,3 mV was observed. At submaximal exercise (mean in group A 75 watt, group B 82 watt) in both groups left ventricular enddiastolic pressure (LVEDP) and\ or mean pulmonary artery pressure (PAP) increased to abnormal values. The main difference between the two groups beyond the ST‐segment reaction with exercise was the difference in enddiastolic volume indices (EDVI): 74±15 in group A and 90±16 ml/m2 in group B. By these findings exercise induced angina in absence of CHD can occur with two different patterns both showing pathologic LVEDP values with exercise: type A with normal exercise ECG and normal LV volumes, type B with abnormal exercise ECG and borderline or abnormal EDVI, increase of end‐systolic volume index during exercise and constant stroke volume index during rest and exercise. The positive effect of nitroglycerin in both groups can be explained by the reduction of elevated LVEDP during exercise. The etiology of this type of left ventricular compliance disorder is unknown. Long term therapy with isosorbiddinitrate should be discussed in spite of absence of coronary heart disease.

Sick sinus syndrome treated with permanent pacemaker in 109 patients. A follow-up study.

During the last decade implantation of permanent pacemakers has become the treatment of choice for patients suffering from the sick sinus syndrome (SSS). We have followed up 112 SSS patients treated with permanent pacemakers in Haukeland Hospital in the period 1966--76. The pacemakers were later removed from three of the patients. In the remaining 109 patients the SSS was characterized by tachy-bradyarrhythmias (TBA) in 44 and bradyarrhythmias (BA) in 65. Before implantation, 68 patients had syncopes and 27 severe dizziness. After implantation, symptomatic improvement was apparent in 104 patients; only three still had syncopes. During the follow-up period (mean 34.4 months), 29 patients died (yearly mortality 9.3%). There was no significant difference in total mortality between patients with TBA and with BA. Concomitant disturbances in atrioventricular (AV) conduction occurred in 35.8% of the patients. Among 79 of 80 patients still alive, five had developed total AV block, 19 had stable atrial fibrillation, 12 of these were possibly pacemaker-independent (ventricular rate greater than 60/min). Systemic embolization was observed in 16 patients, more frequently in the TBA (12/44) than in the BA group (4/65) (p less than 0.001). It is concluded that permanent pacemakers have an excellent symptomatic effect in patients with SSS. The prognosis is mainly determined by the presence or absence of coronary heart disease and/or heart failure.

High-density Lipoprotein Cholesterol Concentration and other Serum Lipids in an Isolated Island Community Free of Coronary Heart Disease

Fasting serum high-density lipoprotein (HDL) cholesterol, other lipid concentrations and related characteristics have been measured in 87% of 261 residents aged over 5 years on the small isolated island of Salt Cay, Turks and Caicos Isles. Only one subject, a hypertensive woman, had a major electrocardiographic Q wave abnormality, and none of the islanders had clinical coronary heart disease. These findings, together with local clinical experience indicated a low incidence of coronary heart disease in this community. Adult mean concentrations of HDL cholesterol (1.6 mmol/l) and serum total triglyceride (0.81 mmol/l) were relatively high and low respectively compared with those of men and women in North American communities. Unlike findings in North America, there was no significant sex difference in HDL cholesterol concentration apparent in adulthood and this was not explained by sex differences in alcohol consumption (positively correlated with HDL cholesterol in both sexes) or adiposity (negatively correlated with HDL cholesterol in men only). Residents who were recovering from an epidemic of mild upper respiratory infection had on average a 9% reduction in HDL cholesterol concentration compared with the remainder of the community. The lipoprotein lipid pattern in these people is consistent with a low cardiovascular risk status, and might account for the apparent absence of coronary heart disease on the island.

T-wave abnormalities of intermittent left bundle-branch block.

Ischemia is traditionally considered a cause of intermittent left bundle-branch block (LBBB), and some patients have right precordial T-wave inversion in the normally conducted beats. Clinical correlates of T-wave abnormalities were examined in 46 consecutive patients with intermittent LBBB. Thirty-three patients (72%) had at least transient right precordial (V-14) T-wave inversion suggesting ischemia in normally conducted beats. Seventeen such patients had no evidence of coronary heart disease, including five with normal arteriograms. During LBBB conduction, T-wave abnormalities (upright T-waves I, aVL, V5-6) were frequent (48%) and more common than among patients with permanent LBBB (p less than 0.005). The T-wave abnormalities during LBBB conduction occurred in the absence of coronary heart disease in nine patients, including two with normal arteriograms. Thus, right precordial T-wave inversion may result from recent LBBB itself, associated with T-wave abnormalities during the LBBB, in the absence of coronary artery disease.

Psychologic and Psychosocial Aspects of Medical Practice

Excerpt In 1976Annals of Internal Medicinepublished a series of suggested readings for physicians reviewing medicine and its subspecialty fields, including neurology and dermatology, in preparation...

Basis for Recurring Ventricular Fibrillation in the Absence of Coronary Heart Disease and Its Management

A 39-year-old man twice experienced ventricular fibrillation and exhibited numerous ventricular premature beats. Coronary arteries were normal, and no impaired cardiac function was found upon catheterization. Evidence was adduced that the ventricular premature beats were related to higher nervous activity. The patient had serious psychiatric problems; the ventricular premature beats were provoked by psychophysiologic stress, increased during REM sleep, were reduced by meditation, and were controlled by beta-adrenergic blockade, phenytoin and digitalization. We conclude that psychologic and neurophysiologic factors may predispose to life-threatening cardiac arrhythmia in the absence of organic heart disease. Effective management of the recurrent ventricular arrhythmia involved; acute drug testing for assessing antiarrhythmic efficacy; use of programmed trendscription to provide on-line information on drug action; a treatment program involving more than one agent; and use of measures to reduce sympathetic nervous activity.

Insulinopenic diabetes in Africa.

The high proportion of unrefined carbohydrates (maize meal) in the diet of Africans could be responsible for their low insulin secretion. The consequent insulinopenia in the general African population may explain the comparative rarity of typical non-insulin dependent diabetes mellitus, and also the virtual absence of coronary heart disease. Changes in growth hormone secretion and in serum lipids, known to be associated with diabetes in Europeans, are also found in African patients.

Risk factors and the absence of coronary heart disease in aborigines in West Malaysia.

Risk factors and the absence of coronary heart disease in aborigines in West Malaysia.

Some factors associated with absence of coronary heart disease in persons aged 65 or older.

Some factors associated with absence of coronary heart disease in persons aged 65 or older.

The candidate for coronary heart disease; discriminating power of biochemical hereditary and anthropometric measurements.

It is desirable to develop criteria with which to judge whether given persons or groups of persons are likely to have coronary heart disease later in life. The technique of discriminant function analysis of variance has been applied to data on 100 normotensive patients under the age of 40 with coronary heart disease and to 146 putatively normal subjects. The presence or absence of coronary heart disease was correlated with the logarithms of height and of total serum cholesterol, serum phospholipids, and serum uric acid levels and with four anthropometric indexes and familial incidence. The highest correlation was between coronary heart disease and total serum cholesterol level. There was a negative correlation with stature, the taller subjects being less likely to develop coronary heart disease. The correlations found have been combined in a multiple regression equation which has a measurable predictive value in groups of persons and promises to be useful as a research tool.