Artery Disease In Males Research Articles

Impact of body mass index on the relationship of Epicardial fat volume to coronary artery disease in males

BackgroundEpicardial fat tissue refers to a type of visceral fat tissue that envelops the myocardial and visceral pericardium. It is recognized as a novel risk sign for cardiovascular issues, including coronary artery disease, our aim to assess the influence of body mass index on the amount of epicardial fat volume and its association with coronary artery disease in male patients.MethodsEpicardial fat volume was quantified using cardiac Computed tomography scans in a cohort of 119 male patients who were believed to have coronary artery disease. Patients were categorized into three groups based on their body mass index values: Group I Body Mass Index (BMI ≥ 18.5–24.9 kg/m2), Group II (BMI ≥ 25–29.9 kg/m2), and Group III (BMI ≥ 30 kg/m2).ResultsIn Group I, there were twenty-three patients (19.3%) with a mean epicardial fat volume of 40 ± .42.8 ml. In Group II, there were forty-three patients (36%) with a mean Epicardial Fat Volume (EFV) of 56 ± 21.5 ml. In Group III, there were 53 patients (44%) with a mean EFV of 56 ± 15.8 ml, when compared to the results of Group I, which were considerably higher (p = 0.0004). Regarding prevalence of obstructive coronary artery disease in our patient population, 86 individuals (72.3%) were diagnosed with obstructive coronary artery disease and exhibited a tendency to have a greater value of epicardial fat volume at 56.4 ± 18.9 ml, with a range of 19–121 ml, compared to those without coronary artery disease at 45.2 ± 6.7 ml, with a range of 33–55 ml (P < 0.02). The prevalence of coronary artery disease was 85% in group III and 87% in group II. Patients in group III with coronary artery disease exhibited a substantially higher EFV of 46 ± 6.63 vs 16 ± 3.2 ml (p = 0.001) compared to those without obstructive coronary artery disease.ConclusionsAlthough epicardial fat volume was elevated in patients with coronary artery disease independent of their BMI, the predictive ability of epicardial fat volume for coronary artery disease was more pronounced in individuals with a body mass index more than 25 kg/m2.

Global burden of peripheral artery disease and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Peripheral artery disease is a growing public health problem. We aimed to estimate the global disease burden of peripheral artery disease, its risk factors, and temporospatial trends to inform policy and public measures. Data on peripheral artery disease were modelled using the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019 database. Prevalence, disability-adjusted life years (DALYs), and mortality estimates of peripheral artery disease were extracted from GBD 2019. Total DALYs and age-standardised DALY rate of peripheral artery disease attributed to modifiable risk factors were also assessed. In 2019, the number of people aged 40 years and older with peripheral artery disease was 113 million (95% uncertainty interval [UI] 99·2-128·4), with a global prevalence of 1·52% (95% UI 1·33-1·72), of which 42·6% was in countries with low to middle Socio-demographic Index (SDI). The global prevalence of peripheral artery disease was higher in older people, (14·91% [12·41-17·87] in those aged 80-84 years), and was generally higher in females than in males. Globally, the total number of DALYs attributable to modifiable risk factors in 2019 accounted for 69·4% (64·2-74·3) of total peripheral artery disease DALYs. The prevalence of peripheral artery disease was highest in countries with high SDI and lowest in countries with low SDI, whereas DALY and mortality rates showed U-shaped curves, with the highest burden in the high and low SDI quintiles. The total number of people with peripheral artery disease has increased globally from 1990 to 2019. Despite the lower prevalence of peripheral artery disease in males and low-income countries, these groups showed similar DALY rates to females and higher-income countries, highlighting disproportionate burden in these groups. Modifiable risk factors were responsible for around 70% of the global peripheral artery disease burden. Public measures could mitigate the burden of peripheral artery disease by modifying risk factors. Bill & Melinda Gates Foundation.

Correlation between atherogenic index of plasma and coronary artery disease in males of different ages: a retrospective study

BackgroundAtherogenic index of plasma (AIP) as a newly discovered blood lipid parameter was shown to be strongly correlated with coronary artery disease (CAD). However, the blood lipid levels changed with age, so we speculated that the correlation between AIP and CAD was also affected by age.MethodsA retrospective study was performed on male patients with confirmed or suspected CAD who underwent coronary angiography (CAG) from July 2017 to March 2021. Patients were divided into younger, middle early, middle late, and elderly groups. Patients in each age group were further divided into the non-coronary artery disease (n-CAD) and CAD subgroups according to the CAG diagnostic results. The relationship between blood lipid parameters and CAD was assessed in each age group.ResultsAge-dependent changes of blood lipid levels were mainly found in CAD patients but not in n-CAD patients. With increased age, the levels of triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C) and AIP were gradually decreased, whereas high-density lipoprotein cholesterol concentration was increased in CAD patients. Multivariate logistic regression analyses showed that AIP was an independent risk factor for CAD in middle early (OR 2.601; CI 1.160–5.832, P = 0.02) and middle late age group (OR 2.707, CI 1.201–6.100, P = 0.016), but not in the younger and elderly groups. LDL-C was an independent risk factor for CAD in all age groups. The areas under curve of AIP for detecting CAD in the middle early and middle late age groups were not higher than that of other blood lipid parameters.ConclusionAlthough this was a single-center study for males only, the correlation between AIP level and CAD risk was age-dependent. AIP was an independent risk factor for CAD in the middle-aged groups. However, the predictive value of AIP for detecting CAD was not better than that of the traditional blood lipid parameters such as LDL-C.

Double Product as a Predictor of Coronary Artery Disease in Males with Normal Blood Pressure

Abstract Aim: This study investigates whether in males with normal blood pressure that underwent exercise stress test Double Product (DB) or Double Product Ratios to workload (DPR) are self-sufficient in predicting the presence of coronary artery disease (CAD). Method: 78 male patients with normal blood pressure went through bicycle exercise stress test (EST) and within four weeks they underwent coronary angiography. 34 of them resulted with normal coronary arteries and 44 of them were diagnosed with one or multiple vessel CAD. Pressure rate double product was calculated in rest, in the first stage of the exercise test, in the peak of exercise, and also in the second, fourth and sixth minutes of recovery of the stress test. Also, the ratios of pressure rate double product with the workload, which reflects the relative growth of double product to the workload, were calculated. The results were compared between the two groups, the one with normal coronary arteries, and those with abnormal coronary angiography. Results: DP in rest and in the first stage of the exercise are not significantly different for normotensive males with or without CAD, while the peak DB value of the exercise, as well as the econd and sixth minutes of the recovery are significantly lower for the group of patients with CAD. The starting peak workloads were significantly lower in the patients’ group with CAD (p=0.0002 and p&lt;0.0001). On the other hand, the double product to workload ratio at the first stage was significantly lower in males with normal blood pressure and CAD. Significant lower DPR are detected also in the fourth and sixth minutes of recovery. Conclusion: The values of DP in the peak exercise and at the second and sixth minutes of the recovery phase are significantly lower in normotensive males with abnormal coronary angiography compared to those with normal coronary arteries, and these findings can be used to detect the presence of CAD despite the ECG changes and they are not affected by the baseline characteristics of the patients. The ratios between DP and workload at the first stage, and in the fourth and sixth minutes of recovery are significantly lower in normotensive male patients with coronary artery disease compared to those without CAD and can be independent predictive parameters for the disease.

Pattern of coronary artery disease in young males with acute coronary syndrome.

Objective: The aim behind this study was to scientifically assess the pattern of coronary artery disease in young males with acute coronary syndrome. Study Design: Prospective Observational study. Setting: Department of Cardiology, Isra University Hospital, Hyderabad. Period: March 2014 to February, 2019, Material &amp; Methods: Data of 260 patients were enrolled who were males and having age less than 50 years and more than 25 years and presented with acute coronary syndrome. All the patients underwent coronary angiography for the assessment of pattern of coronary artery disease. Data were entered and analyzed by using Statistical Package for the Social Sciences version 21.0. Results: Out of total 260 patients, the mean age and SD of admitted patients was 42.21 ± 4.69 years and the age ranging between 33 to 50 years. The most common risk factors among young males who were admitted with ACS were cigarette smoking (39.61%, N = 103) and Hypertension (19.61%, N = 51) while least common was alcohol consumption (6.53%, N = 17). The most common pattern of CAD we have observed in our study was presence of three vessels coronary artery disease (25%, N = 65) and Branched Vessel Disease (23.07%, N = 60) while two Vessels CAD was least common (17.30%, N = 45). Conclusion: Our study shows that overall burden of coronary artery disease in males belongs to above 40 years of age residing at urban areas and belongs to middle socioeconomic background. The most common risk factor was cigarette smoking and the most common pattern of coronary artery disease was 3 vessel coronary artery disease and Branched Vessel Disease, respectively.

The intensity of oscillations of the photoplethysmographic waveform variability at frequencies 0.04–0.4 Hz is effective marker of hypertension and coronary artery disease in males

Background: It is believed that the intensity of oscillations in the photoplethysmographic waveform variability reflects the activity of vascular regulatory mechanisms. However, the relationship of such fluctuations with the state of health is poorly understood.Purpose: The aim of our study was to assess the possibility of using spectral indices that reflect the intensity of oscillations of the photoplethysmographic waveform variability at frequencies 0.04-0.4 Hz as markers of hypertension and coronary artery disease. We did not study women to exclude the influence of menopause and sex hormones on the results.Materials and Methods: We compared synchronous 10-minute records of finger photoplethysmogram and respiration at rest in 30 healthy males (48.8 ± 4.5 years; data presented as Mean ± SD) versus 30 patients with hypertension (aged 49.0 ± 4.3 years) versus 30 patients with stable coronary artery disease (49.2 ± 4.8 years). Percentages of high-frequency and low-frequency ranges in the total power of photoplethysmographic waveform variability spectrum (HF% and LF%), and LF/HF ratio were assessed.Results: HF% are subject to by 2- to 5-fold increase in hypertensive patients (p < .001) and up to an 8-fold increase in patients with coronary artery disease (p < .001) when compared with healthy persons. On the contrary, LF% is reduced by 1.5-5 times in all patients when compared with healthy people (p < .001). We identified cut-off points for each photoplethysmographic index to distinguish patients with coronary artery disease or hypertension from healthy subjects. Multiple logistic regression models based on photoplethysmographic waveform variability indices had sufficient sensitivity and specificity for patients with hypertension or coronary artery disease.Conclusion: Frequency-domain indices of photoplethysmographic waveform variability (in particular, HF%, LF%, and LF/HF) are sufficiently sensitive and specific markers of hypertension and coronary artery disease in adult males.

Prognostic Differences between Men and Women with Acute Coronary Syndrome. Data from a Brazilian Registry

BackgroundGender-related differences have been reported in patients with acute coronary syndrome. The description of this comparative finding in a Brazilian registry has not yet been documented.ObjectiveTo compare male vs. female patients regarding the baseline characteristics, coronary findings, treatment and in-hospital and long-term prognosis.MethodsThis is a retrospective, multicenter and observational study that included 3,745 patients (2,437 males and 1,308 females) between May 2010 and May 2015. The primary in-hospital outcome was all-cause mortality. The secondary outcome consisted of combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed using the chi-square and the t test, considering p < 0.05 as significant. In the long term, mortality and combined events were assessed using the Kaplan-Meier method, with a mean follow-up of 8.79 months.ResultsThe mean age was 60.3 years for males and 64.6 for females (p < 0.0001). The most prevalent risk factor was systemic arterial hypertension in 72.9% of the women and 67.8% of the men (p = 0.001). Percutaneous coronary intervention was carried out in 44.9% of the males and 35.4% of the females (p < 0.0001), and coronary artery bypass grafting (CABG) was performed in 17% of the males and 11.8% of females (p < 0.0001), with a higher prevalence of three-vessel coronary artery disease in males (27.3% vs. 16.2%, p < 0.0001). Approximately 79.9% of the female patients received a diagnosis of acute coronary syndrome without ST-segment elevation, while in the male patients, this diagnosis was attained in 71.5% (p < 0.0001). No significant differences were observed between the groups in the short and long term, regarding both mortality and the combined events.ConclusionSeveral gender-related differences were observed in patients with acute coronary syndrome regarding the demographic characteristics, coronary artery disease pattern and implemented treatment. However, the prognostic evolution was similar between the groups.

Correlation of Treadmill Stress Test with Coronary Angiography to Predict Coronary Artery Disease in Males versus Females

Background Treadmill stress test (TMT) is the most commonly performed stress test for diagnosis of coronary artery disease (CAD) in outpatient setting. The present study was conducted to find correlation of TMT with coronary angiography (CAG) in males versus female patients. Methods Total 422 patients who had undergone CAG and TMT were enrolled in present study. TMT test was done using Bruce protocol, and results were classified as inconclusive, low, intermediate, and high probability for inducible ischemia. Results Of 422 patients enrolled in the present study, 290 (69%) were males and 132 (31%) were females. Clinical presentation was angina on exertion CCS class II–III in 302 (71.6%) patients and angina equivalent in 124 (29.4%) patients. Out of these, 211 (50.2%) were diabetic and 308 (72.9%) were hypertensive. TMT was inconclusive, low, intermediate, and high probability for inducible ischemia in 35 (8.2%), 40 (9.7%), 19 (4.5%), and 328 (77.7%) patients, respectively. CAGs were normal in 149 (35.4%) patients and abnormal in 273 (64.6%) patients. Out of 328 patients with strongly positive TMT, 104 (31.7%) had normal coronaries, 56 (17%) had mild CAD, while 75 (22.8%) had SVD. LMCA disease, DVD, and TVD were found in 5 (1.5%), 48 (14.6%), and 40 (12.1%) patients, respectively. Of 132 female patients, 70 (53%) were found to have CAD and 62 (47%) had normal coronaries on CAG. Of 290 males, 241(83.1%) were found to have CAD and 49 (16.8%) had normal coronaries on CAG. Positive predictive value (PPV) in females was 53% and in males was 83%. Subgroup analysis showed that if there was high-probability TMT along with older age (p &lt; 0.00), male sex (p &lt; 0.01), and diabetes (p &lt; 0.00), chances of having CAD were more. Conclusion PPV of positive TMT in female is 53% and in male is 83%. High-probability TMT along with the older age, male sex, and presence of diabetes mellitus (DM) makes the probability of having CAD is high.

Abstract 407: Use of a Previously Validated Blood-based Test Demonstrates Increased Diagnostic Accuracy as Measured by AUC over Usual Care in the Evaluation of Obstructive Coronary Artery Disease in Males and Females.

Background: Current evaluation of stable, non-acute patients presenting with symptoms suggestive of obstructive coronary artery disease (CAD) is costly and often exposes patients to radiation and contrast-dye side effects. These risks are coupled with relative poor diagnostic accuracy, as consistently demonstrated by low yields at invasive coronary angiography. We hypothesized that the use of a previously validated blood-based test incorporating age, sex and whole-blood gene expression, in conjunction with a clinician’s clinical assessment, may improve on usual care methods for the evaluation of these patients. Methods and Results: This analysis includes evaluable data from two prospective multicenter clinical studies [[Unable to Display Character: &amp;#8211;]] PREDICT (NCT005617, N=523) and COMPASS (NCT1117506, N=431) where patients were assessed for both pre-test CAD risk according to Diamond-Forrester (D-F) criteria as well as for obstructive CAD using either invasive coronary angiography or cardiac computed tomography angiography (CCTA). All patients in COMPASS were also assessed by myocardial perfusion imaging (MPI); a subset of N=307 subjects were assessed by MPI in PREDICT. Previously, we demonstrated diagnostic superiority, as measured by AUC, for a score combining patient age, sex and whole-blood gene expression (ASGES), in a combined set of men and women from both PREDICT (ASGES = 70%, D-F = 66%, MPI = 54%) and COMPASS (ASGES = 79%, D-F = 69%, MPI = 59%). In this expanded analysis, we report results stratified by sex and demonstrate superiority of the ASGES, as measured by AUC, to MPI for males and females in PREDICT (male ASGES = 66%, MPI = 55%; female ASGES = 65%, MPI = 48%) and in COMPASS (male ASGES = 73%, MPI=60%; female ASGES 73%, MPI = 55% respectively). In addition, we demonstrate that ASGES improves CAD risk classification when compared to D-F criteria in females in both PREDICT (ASGES = 65%, D-F = 51%) and COMPASS (ASGES = 73%, D-F = 58%). Conclusions: We demonstrate that use of a gender-specific, blood-based test incorporating age, sex, and gene expression provides better diagnostic accuracy for patients considered for referral to cardiology and advanced cardiac testing, when compared to usual care methods of D-F type risk classification and MPI.

Association between intercellular adhesion molecule-1 K469E polymorphism and coronary heart disease in people with Uygur ethnicity, in Xinjiang

To explore the distribution on K469E single nucleotide polymorphism of ICAM-1 gene among people with Uygur ethnicity, in Xinjiang and to analyze the correlation between ICAM-1 gene polymorphism and coronary heart disease. 245 patients with coronary heart disease patients and 377 healthy controls in Xinjiang Uygur population were studied. ICAM-1 gene K469E genotype located in exon 6 were detected by polymerase chain reaction-restricted fragments length polymorphism. Distribution of genotypes in the two groups appeared to be in Hardy-Weinberg equilibrium (P > 0.05). The distribution of genotypes showed significant difference between the two groups (P = 0.039)and the distributions of K and E allele also presented statistically significant difference (P = 0.031). Significant difference was also observed in males(P = 0.029 for genotype, P = 0.025 for allele)but not in females. After adjusted for confounding factors, results from logistic regression analysis indicated that KK genotype was a risk factor for CHD in Uygur male population (OR = 2.389, 95% CI:1.458-3.915, P = 0.001). Genetic polymorphism of ICAM-1 K469E might increase the risk for coronary artery disease in males of Uygur patients in Xinjiang.

Waist Circumference and Metabolic Syndrome: The Risk for Silent Coronary Artery Disease in Males

Waist circumference (WC) is a component used to define metabolic syndrome. However, its role as an independent predictor of silent coronary artery disease (CAD), above its contribution to metabolic syndrome, remains unknown. Male veterans without known CAD, undergoing cardiac stress testing for indications other than typical angina or its equivalent, were evaluated for the presence of silent CAD. High WC and metabolic syndrome were defined per the revised National Cholesterol Education Program (NCEP-R) and the International Diabetes Federation (IDF) criteria. Data on 1,071 patients (age 61±11 years) were analyzed retrospectively. On multivariable logistic regression analysis [odds ratio (OR), 95% confidence interval (CI), P value), a WC ≥94 cm (1.42, 1.04-1.93; P=0.026), metabolic syndrome by NCEP-R (1.73, 1.29-2.33; P<0.0001), and metabolic syndrome by IDF (1.57, 1.17-2.11; P=0.003) were independent predictors of silent CAD. When comparing patients meeting criteria for metabolic syndrome defined by either NCEP-R or IDF, the prevalence of silent CAD was not statistically different (P=0.86). The prevalence of silent CAD associated with a high WC was not inferior to that seen between silent CAD and metabolic syndrome as defined by either criterion. Last, among patients with metabolic syndrome defined by NCEP-R, those with a high WC as a defining component of metabolic syndrome had a higher prevalence of silent CAD (30% vs. 20%; P=0.026). A WC ≥94 cm in males is independently associated with an increased prevalence of silent CAD. In patients with metabolic syndrome, this prevalence is increased by the presence of high WC.

Telomere length and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study

Short telomeres are associated with aging and age-related diseases. Our aim was to determine whether short leukocyte telomere length is associated with risk factors and cardiovascular diseases in a high-risk hypertensive population. We measured leukocyte telomere lengths at recruitment in 1271 subjects with hypertension and left ventricular hypertrophy (LVH) participating in the Lifestyle Interventions and Independence for Elders (LIFE) study. At baseline, short mean telomere length was associated with coronary artery disease in males (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.39-0.95), and transient ischemic attack in females (OR 0.62 95% CI 0.39-0.99). Proportion of short telomeres (shorter than 5 kb) was associated with Framingham risk score (r=0.07, P<0.05), cerebrovascular disease (OR 1.18, 95% CI 1.01-1.15) and type 2 diabetes in men (OR 1.07, 95% CI 1.02-1.11). During follow-up, proportion of short telomeres was associated with combined cardiovascular mortality, stroke or angina pectoris (hazard ratio 1.04, 95% CI 1.01-1.07). Telomere length was not associated with smoking, body mass index, pulse pressure or self-reported use of alcohol. Our data suggest that reduced leukocyte telomere length is associated with cardiovascular risk factors and diseases as well as type 2 diabetes, and is a predictor of cardiovascular disease in elderly patients with hypertension and LVH.

Prevalence and determinants of coronary artery disease in males and females with familial combined hyperlipidaemia

Background Familial combined hyperlipidaemia (FCH) is an inherited dyslipidaemia that is related to a high risk of coronary artery disease (CAD). We evaluated the prevalence of CAD in a large FCH population and the association of risk factors with CAD according to gender. Methods In this single-center, observational study, lipid and lipoprotein variables were measured in untreated patients with FCH (565 males and 302 females). CAD was defined as a documented history of myocardial infarction or coronary revascularization, or an abnormal coronary angiogram (stenosis of >50% in an epicardial coronary artery), or angina plus abnormal imaging stress test. Results Males had higher triglyceride level ( P < 0.001) but lower total cholesterol ( P < 0.001) and HDL-cholesterol level ( P < 0.001) compared to women. The prevalence of CAD was 22.2% in men and 4.6% in women ( P < 0.001). In logistic regression analysis, male gender was associated with a higher risk of CAD independent of lipid parameters and other risk factors (adjusted ORs for CAD 9.4, P < 0.001). In gender-specific analysis, age (OR = 1.06 per 1-year increase, P < 0.001), diabetes (OR = 2.42, P < 0.01) and Lp(a) (OR = 1.09 per 1-mg/dL increase, P < 0.01) were independent predictors of CAD in men. In women, age (OR = 1.24, P < 0.01), total cholesterol (OR = 1.022 per 1-mg/dL increase, P < 0.05) and fasting glucose (OR = 1.031 per 1-mg/dL increase, P < 0.05) were independently associated with CAD. Conclusions In FCH patients, the prevalence of CAD is higher in males than in females, independent of lipidaemic profile and other risk factors. Among lipid variables, Lp(a) and cholesterol level are predictors of CAD in males and females respectively.

A genome scan for loci influencing anti-atherogenic serum bilirubin levels.

Epidemiological studies have shown an association of decreased serum bilirubin levels with coronary artery disease. Two segregation analyses in large pedigrees have suggested a major gene responsible for high bilirubin levels occurring in about 12% of the population. Based on a recessive model from a previous segregation analysis, we performed a genome scan using 587 markers genotyped in 862 individuals from 48 Utah pedigrees to detect loci linked to high bilirubin levels. As a complementary approach, non-parametric linkage (NPL) analysis was performed. These two methods identified four regions showing evidence for linkage. The first region is on chromosome 2q34-37 with multipoint LOD and NPL scores of 3.01 and 3.22, respectively, for marker D2S1363. This region contains a previously described gene, uridine diphosphate glycosyltransferase 1, which has been associated with high bilirubin levels. A polymorphism in the promoter of this gene was recently shown to be responsible for Gilbert syndrome which is associated with mild hyperbilirubinemia. The other regions were found on chromosomes 9q21, 10q25-26, and 18q12 with maximum NPL scores of 2.39, 1.55, and 2.79, respectively. Furthermore, we investigated in these pedigrees the association between bilirubin levels and coronary artery disease. One-hundred and sixty-one male and 41 female subjects had already suffered a coronary artery disease event. Male patients showed significantly lower bilirubin concentrations than age-matched controls. This association, however, was not observed in females. These results provide evidence that loci influencing bilirubin variation exist on chromosomes 2q34-37, 9q21, 10q25-26, and 18q12 and confirms the association of low bilirubin levels with coronary artery disease in males.

Free plasma testosterone and estradiol and the extent of coronary artery disease in males

Free plasma testosterone and estradiol and the extent of coronary artery disease in males

Expression of a Paternal History of Premature Myocardial Infarction on Fibrinogen, Factor VIIC and PAI-1 in European Offspring - The EARS Study

To assess the role of genetic and environmental factors in the predisposition to atherosclerosis, 682 students whose father had suffered a myocardial infarction before the age of 55 ("cases") and 1312 controls matched for age and sex, were recruited from 14 Universities in Europe. Fibrinogen, factor VIIc and PAI-1 were compared between cases and controls across European regions. Fibrinogen and factor VIIc were positively correlated with BMI, smoking and contraception. PAI-1 was positively and independently correlated with BMI and waist-to-hip ratio, and negatively with contraception. Factor VIIc and PAI-1 were correlated with cholesterol and triglycerides, and fibrinogen was weakly correlated with LDL-cholesterol. After adjustment for covariates and lipids, fibrinogen level was significantly higher in male cases than in controls (2.38 vs 2.29, p < 0.01). No such difference was found in females (2.59 vs 2.57 - NS). There was no significant case/control difference for factor VIIc and PAI-1. These results support the hypothesis that fibrinogen is a transmissible risk factor of coronary artery disease in males. No such evidence was provided for factor VIIc and PAI-1.

The cardiointegram: Detection of coronary artery disease in males with chest pain and a normal resting electrocardiogram

The cardiointegram is a non-invasive technique for the analysis of the electrical signals of the heart obtained by a transformation of the voltage vs. time format by a series of integrations. This multicenter study compares the results of the cardiointegram with coronary arteriography in 140 male patients with chest pain and a normal resting electrocardiogram. The cardiointegram was determined on two resting complexes of Leads I, II, V4, V5 and V6 and called abnormal if greater than or equal to four of ten complexes were abnormal, i.e., fell outside of a previously determined template of normality. The sensitivity was 73% and specificity was 78% for the diagnosis of occlusive coronary artery disease. When greater than or equal to five of ten abnormal complexes were used as the cut-off for an abnormal test and "equivocal" results (four of ten abnormal, n = 18) were excluded from analysis there was a sensitivity of 69% and specificity of 88%. Thirty-seven of 38 patients (97%) with an abnormal cardiointegram and a positive exercise stress test had coronary artery disease. Thus, the cardiointegram appears to be a useful non-invasive test for the detection of coronary artery disease in males with chest pain and a normal resting electrocardiogram in whom the diagnosis of coronary artery disease is being considered.

Does It Matter Where I Live?

"The traditional view of the overall health field is criticized and a new perspective embracing the environment, life style, human biology and health care is presented. Spatial variations and distributional patterns in the UK of premature death from coronary artery disease in males and females, lung-bronchus cancer in males, cancer of the female breast, and 'All Causes' for both sexes are described and analysed at national, regional, district and intra-urban scale. High risk and low risk areas/communities for premature death from selected diseases are listed as indicators of local health status."

Lipid-shifting properties of 17 alpha-methyl-17-hydroxy-5(10)-estren-3-one, a steroid with both estrogenic and androgenic activities.

17α-Methyl-17-hydroxy-5(10)-estren-3-one (SC-6582) possessed approximately 11 to 40% the activity of estrone in depressing the plasma cholesterolphospholipid ratio in cholesterol-fed cockerels, whereas, it had only 0.1 to 0.9% the activity of estrone when tested on uterine growth of mice, and only about 0.2% when evaluated with rat vaginal smears. The reduction in cholesterolphospholipid ratio for both estrone and the compound was due to an increase in plasma phospholipids with no reduction in plasma cholesterol. In addition to lipid-shifting and estrogenic activities, the compound was a weak androgenic and myotrophic agent. The possible effects of a compound possessing such a mixture of activities on the blood lipids of man have been discussed. THE predominance of coronary artery disease in males over premenopausal females and the blood lipid-shifting activity of estrogens have resulted in the exploration of the possible utility of estrogens in the treatment of atherosclerosis (1). Although the inhibitio...