Hans Hedstrand

Serum triglycerides are a risk factor for myocardial infarction but not for angina pectoris: Results from a 10-year follow-up of Uppsala primary preventive study

At a follow-up 7-10 years after a health survey of men born in 1920-1924 in the municipality of Uppsala, 31 of the participants (n = 2322) had died from ischaemic heart disease (IHD). In response to a letter to all men alive in 1980, 106 men declared that they had had a myocardial infarction (MI) (verified or suspected). In 58 cases MI was verified from the hospital records. 28 other men had had typical central chest pain (angina pectoris) only. In another 20 men other diagnoses explained the chest pain for which they were treated in hospital. The health screening values for S-cholesterol and S-triglycerides, blood pressure and smoking habits were analysed in relation to the occurrence of IHD. In this prospective study, smoking, hypertension, S-cholesterol and S-triglycerides were identified as risk factors for fatal and non-fatal MI. The risk factor values were similar in subjects suffering from angina pectoris only to those in subjects who also developed ECG and/or transferase changes, with the exception of S-triglyceride concentration, which was normal in the group with angina pectoris. The subjects who had a fatal MI had a significantly higher blood pressure than those with non-fatal MIs, but otherwise these two groups did not differ. The results emphasize the importance of scrutinizing questionnaire data with regard to chest pain and of selection of end-points when risk factor patterns are described for cardiovascular diseases.

Familial history in males at low and high risk for cardiovascular disease.

Abstract Various epidemiological studies have shown the relative importance of different risk factors for cardiovascular disease. In the present paper a systematic scoring of these factors within a group of 2.322 men in their early fifties was performed. Two subsamples were selected: one with a high sum of scores of different risk factors and the other with a low sum. These two groups were compared with regard to the occurrence of familial disease. The study demonstrates that parents of middle-aged men with a pronounced cardiovascular risk profile show increased cardiovascular morbidity and mortality. Also, the number of parents who had died was increased in this group. However, whether or not a positive family history is an independent risk factor remains to be proven. This investigation stresses the fact that cardiovascular morbidity and mortality in a family should be given importance when considering an individual for preventive measures.

Dietary and drug treatment of hyperlipidaemia. A feasibility study in asymptomatic middle-aged men.

83 middle-aged men with different types of hyperlipoproteinaemia were recruited from a health examination survey. They were treated with diet for 3 months and with diet and drugs in combination over a 2-year period (63 men used drugs). The serum lipid reductions after the dietary period were 14% and 27% for serum cholesterol and triglycerides, respectively. After 2 years the corresponding reductions were 21% and 42%, indicating an additional effect of diet and drugs. There was an average body weight reduction of 4.3% during the first 3 months which was maintained over the 2-year period. Special considerations in treating asymptomatic individuals are discussed.

Detection and Characterization of Hyperlipoproteinaemia in Middle-aged Men

Serum lipoprotein (LP) concentrations were determined and LP patterns were classified in 261 middle-aged men, recruited from a health examination survey, with serum lipid values above the 80th percentile of the same population. Individuals with hyperlipoproteinaemia (HLP) and normolipidaemic controls were characterized also regarding family history of cardiovascular disease, socio-economic factors and clinical and laboratory variables. Subjects with HLP type IV-V and IIB were overweight and showed hyperuricaemia and hyperinsulinaemia compared with normolipidaemic controls and subjects with HLP type IIA. The latter showed elevated erythrocyte sedimentation rate. In spite of being overweight, subjects with HLP type III showed normal fasting values of insulin and uric acid in serum and normal early insulin response to intravenous glucose. The glucose tolerance did not differ significantly between the groups. Men with HLP types IV-V had predominantly sedentary occupations, in contrast to those with type IIA. There were significantly more smokers in the groups with HLP type IIB and IV-V than in the control group. Thus, individuals with different types of HLP tend to show different metabolic profiles but also different socioeconomic and clinical patterns, suggesting that exogenous factors are of importance in the expression of the LP abnormalities.

Dopamine-β-hydroxylase and Plasma Renin Activity in Twenty Hypertensive Subjects

Dopamines-β-hydroxylase (DBH), the enzyme responsible for the biosynthesis of noradrenalin from dopamine, was assayed in the blood plasma of 20 men with primary hypertension. At the same time plasma was taken for measurement of plasma renin activity. Renin release as well as the plasma level of DBH is dependent upon the activity of the sympathetic nervous system, at least to some extent. A possible relationship between the two enzymes was therefore investigated. However, no relationship could be found in this series of 20 hypertensive patients. Another aim was to study the levels of DBH in venous and arterial blood simultaneously. No difference in the DBH level was found in venous and in arterial blood in 11 patients undergoing heart catheterization.

Electrocardiographic Changes in 50-Year-Old Men with Different Levels of Diastolic Arterial Blood Pressure

An ECG study of P wave abnormalities and signs of left ventricular hypertrophy (LVH) was performed in a series of 76 50-year-old men with hypertension detected in a population study. Two control groups were obtained from the same study. P wave abnormalities were common (36/76) among the hypertensives but were frequently seen also among the controls (41/152). Thus it seems that P wave abnormality, with the current criteria, is not a reliable early sign to discriminate hypertensives from persons with a normal blood pressure. High QRS voltage or left axis deviation was not uncommon in the control groups, while any combination of at least two criteria of LVH (high voltage, prolonged ventricular activation time, ST-T changes or left axis deviation) was far more common in the hypertensive group. In cases with high voltage as the single criterion of LVH examination of the P wave may be helpful to discriminate hypertensives from persons with a normal blood pressure.