Henry N. Neufeld

Blood Groups, Myocardial Infarction and Angina Pectoris among 10,000 Adult Males

Abstract A five-year prospective investigation of 10,000 Israeli male government employees 40 years of age and over was conducted as part of the Israeli Ischemic Heart Disease Project. The six areas of birth represented were Eastern Europe, Central Europe, Southeastern Europe, Israel, Asia, and North Africa. Subjects with blood Groups A1, B, and A1B tended to have higher incidence rates of myocardial infarction than those with other blood groups. High rates were also noted in A1 and B subjects for angina pectoris. Subjects in blood Group O tended to have lower rates of infarction and angina pectoris than those of other groups, but the differences were not significant. Among the Rhesus, MN, Kell, Duffy and Kidd blood groups, subjects with Kidd negative (JKa-) had the highest rates for both myocardial infarction and angina pectoris. When this group was added to the ABO system, the combinations of A1Jka-, BJka- and, particularly, A1BJka-, had very high incidence rates.

Clinical presentation and natural history of mild discrete subaortic stenosis. Follow-up of 1--17 years.

We report 21 patients with discrete subaortic stenosis (DSS) causing mild obstruction with a peak systolic left ventricular outflow pressure gradients less than 50 mm Hg. They were followed 1-17 years (mean 6.5 years), and eight were recatheterized before surgery, 2-17 years after the first cardiac catheterization.Three patients (14%) had subacute bacterial endocarditis. Ten (48%) had aortic insufficiency, one of whom had no pressure gradient across the left ventricular outflow tract. In three of the 10 patients, aortic insufficiency was found only at the second catheterization. Nine patients (43%) had hyperactive, asymmetric left ventricular contraction; in three, this finding was present only at the second catheterization. Seven of the eight patients who were recatheterized (33% of the entire group) showed an increase in gradient. The increase was from a mean gradient of 35.2 mm Hg to 76.7 mm Hg. Seventeen patients (81 %) had at least one of these four features.In view of these data, we suggest that surgical indications for DSS might be expanded, although definitive recommendations are not possible. All cases of DSS should be carefully followed. Surgery should be performed if signs of progressive complications develop.

The Coronary Arteries in Early Life in Three Different Ethnic Groups

The histologic changes in the coronary arteries in full-term fetuses, infants, and children of 211 consecutive necropsy specimens from Ashkenazy, Yemenite, and Bedouin groups were studied, excluding cardiac deaths.The developmental structural pattern of the coronary arteries is similar in the three ethnic groups.Differences in the intensity and quantity of the structural findings between the sexes and among various ethnic groups are found in early life. The intimal tissue in the Ashkenazy male develops in an eccentric form, has more collagen tissue components, and is more highly developed than in the Ashkenazy female. Structural findings in the internal elastic membrane and the elastic fibers of the intima are less apparent in the Bedouin group, particularly in the female, than in the Ashkenazy and Yemenite groups.Statistical analysis of the quantitative data showed the intima and musculo-elastic layers to be more developed in the Ashkenazy male than in the Yemenite and Bedouin males. However, Ashkenazy males clearly have more intima and musculo-elastic tissue than do the Ashkenazy females. This was not true for Yemenites and was found in only one of three age groups among Bedouins.The relationship between the structural findings in coronary arteries of children under 10 years and the reported prevalence of coronary heart disease in the corresponding adult population in these three different ethnic groups has been pointed out.

Myocardial infarction over a five-year period—I. Prevalence, incidence and mortality experience☆

Abstract A 5-yr (1963–1968) follow-up of 10,059 male government and municipal employees of Israel aged 40 and over, divided into six regions of birth—Central Europe, Eastern Europe, Southeastern Europe, North Africa, Middle East and Israel—was completed. In the first survey (1963), 86.2 per cent of the invited sample participated in the examination. They were re-examined in 1965 and 1968, with 98 per cent of the original respondents participating in the final examination. There was complete coverage in respect of knowing whether the subjects were alive or dead. The results revealed a significant variation between the birth-areas in respect of age-adjusted prevalence and incidence rates of myocardial infarction as well as total mortality for all causes. The infarct incidence rates were higher in the first generation Israelis than in immigrants from the same areas of origin, but were substantially lower for second generation subjects. The age-adjusted annual myocardial infarction rate of 8.7 1000 at risk, places this study population among the highest in the world. In contrast to this, the case-fatality rate of 15.9 per cent after an average period of 2.5 yr of observation is one of the lowest in the world and contrasts markedly with many international studies which report higher figures for deaths within 1 hr after onset of symptoms. One of the possible reasons for this apparent anomaly might be the fact that 39.8 per cent of the 427 first myocardial infarcts were of the ‘silent’ type. The latter seem to have a lower mortality experience than the clinically recognized infarcts.

Clinical myocardial infarction over a five-year period--III. A multivariate analysis of incidence, the Israel ischemic heart disease study.

Abstract Analysis of 5-yr incidence of clinically recognized myocardial infarction is presented. Multivariate techniques identify serum cholesterol, systolic or diastolic blood pressure, cigarette smoking and presence of diabetes and angina pectoris , in addition to age increments, as the main risk factors. M.I. incidence appears directly related to continuous levels of these factors rather than to threshold values. This seems to hold for each variable at all levels of other variables. When incidence of M.I. among non-A.P. subjects is considered alone, the remaining risk factors continue to play the major role. Age gradients of the risk associated with cigarette smoking and serum cholesterol were identified, as well as increased contribution of smoking in the multivariate context. Implications for prevention reemphasize weight control and abstinence or reduction of smoking, as ‘primary’ methods, combined with early detection and control of high levels of cholesterol, blood pressure and clinical or preclinical diabetes. With knowledge lacking regarding reversibility of the risk induced by them, and since atherosclerosis is present in age much younger than covered by this study (and others), the degree of success such prevention will achieve cannot be assessed without actual intervention trials. It was not possible to completely account for incidence difference between ethnic groups. This further enhances the need in understanding which additional differences exists between them, which are not (or not fully) reflected in the levels of the main risk factors associated with incidence.

Corrected transposition of the great arteries: A modified approach to the clinical diagnosis in 30 cases

Abstract A simplified approach to the diagnosis of corrected transposition of the great arteries is proposed. Patients are divided into 3 groups —those without obstruction to pulmonary blood flow, those with obstruction to pulmonary blood flow and those without associated defects—each presenting a uniform clinical, electrocardiographic and roentgenographic picture. Patients without obstruction to pulmonary blood flow had the clinical findings of a large ventricular septal defect with pulmonary hypertension and a large, predominant left to right shunt. Observations in patients with corrected transposition of the great arteries and with obstruction to pulmonary blood flow clinically resembled those of patients who had a large ventricular septal defect with pulmonic stenosis and a predominant right to left shunt. A case of corrected transposition of the great arteries without associated defects is reported. A review of reports of similar cases revealed that the majority had insufficiency of the left atrioventricular valve or atrioventricular block, or both; very few cases without these latter anomalies were reported. We believe that this group of patients also has distinctive clinical, electrocardiographic and roentgenographic findings.

Factors related to diabetes incidence: a multivariate analysis of two years observation on 10,000 men. The Israel Ischemic Heart Disease study.

Abstract The 2-yr incidence of diabetes (131 cases) among 8369 Israeli men is related to area of birth and 15 other variables using a multiple logistic risk function. The variables found to be most strongly related to diabetes incidence are age, wt ht ratio and the presence of peripheral vascular disease or intermittent claudication. Also related to diabetes incidence were: cholesterol, education (negative relationship), being born in Eastern Europe (negative relationship) and being born in Africa. The model predicts markedly increased risk of diabetes incidence for persons with increased wt ht ratio and presence of peripheral vascular disease or intermittent claudication. The failure to find a relationship between the presence of ischemic heart disease and diabetes incidence suggests that the well known association between these two diseases lie only in the direction of increased risk of IHD for diabetics. None of the food variables studied was related to diabetes incidence. Other variables found unrelated to diabetes incidence in our study were diastolic blood pressure, uric acid, non-specific T-wave and an anxiety index.

The Coronary Arteries in Coarctation of the Aorta

The histological changes found in the coronary arteries in 15 patients with coarctation of the aorta have been described. Qualitative and quantitative studies were performed and the results compared with the findings of a matched control group of patients without heart disease.Severe changes in the intima during early life and even the severe atheroma which appears in young persons are considered to be a reaction to coronary hypertension. The striking thickening of the media in the coronary arteries is also thought to be a reaction to the altered hemodynamic forces.In coarctation of the aorta the coronary arteries are of greater than normal capacity, and it is suggested that this histological feature parallels the increased metabolic requirements of the left ventricle.

Serum uric acid: Correlation with biochemical, anthropometric, clinical and behavioral parameters in 10,000 israeli men☆

Abstract Serum uric acid (SUA) was measured in a group of 10,000 middle-aged male civil servants and municipal employees in Israel ( x = 4.77 mg% , S.D. = 0.96 mg% ). SUA levels did not vary appreciably by age or country of birth. There were small significant correlations between SUA and weight [absolute (0.28) and relative (0.30)], triceps and subscapular skinfolds (0.13 and 0.23), systolic blood pressure (SBP) (0.10), diastolic blood pressure (DBF) (0.20) and serum cholesterol (0.13). SUA was elevated in men with coronary heart disease (CHD) and rose with increased level of education. It was negatively correlated with high-density lipoprotein (HDL) cholesterol (− 0.10) and total fat intake (− 0.10), and was significantly reduced among cigarette smokers and in men with diabetes mellitus or peptic ulcer. Multiple regression analysis revealed that 11 variables were significantly related to SUA, together accounting for about 16% of SUA variance (multiple r = 0.40). The Quetelet index [ weight (W) height (H) 2 ] (QI) made most of the contribution. Among the other variables, only blood pressure and the presence of diabetes mellitus accounted for more than 1 % of the variance.

Isolated hypoplasia of the right ventricle and tricuspid valve in siblings.

This paper describes the clinical and morbid anatomical findings in two siblings having hypoplasia of the right ventricle and tricuspid valve without other cardiac defects, and it discusses the possible hemodynamic consequences and differential diagnosis of this malformation. Hypoplasia of the right ventricular chamber is seen in tricuspid atresia (Taussig, 1947) and in some cases of pulmonary atresia with intact ventricular septum, and it may be associated with tricuspid hypoplasia in the latter condition (Chiche, 1952). Apparently however, there have been no previous descriptions of isolated hypoplasia of the right ventricle and tricuspid valve, although Keith et al. (1958) list this combination as one that can be mistaken for tricuspid atresia. It is convenient to distinguish pathologically congenital tricuspid stenosis, in which the orifice is narrow because of failure of commissural separation, from tricuspid hypoplasia, in which the orifice is reduced by the small size of the valvular ring but the small valvular leaflets are otherwise essentially normal. In our cases the right ventricular hypoplasia consisted in abnormally small external size, wall thickness, and chamber capacity.