Modelo de promoción de salud dirigido a la población con riesgo de cardiopatía isquémica / Model of health promotion directed to population at risk of ischemic heart disease

Introducción: para el desarrollo de esta investigación se partió de reconocer la importancia que tiene la reducción de los factores de riesgo de cardiopatía isquémica y la necesidad de fortalecer las acciones de promoción de la salud y la educación para la salud en el contexto cubano, sustentada en el principio del mejoramiento y desarrollo continuo de los procesos. Se dispone de modelos y teorías internacionales que abordan esta problemática; pero no se ajustan completamente a la impronta cubana. Objetivo: diseñar un modelo de promoción de la salud dirigido a la población con factores de riesgo de cardiopatía isquémica. Materiales y métodos: se utilizó la triangulación metodológica, los grupos focales y encuestas con expertos, usuarios, líderes formales, informales, sujetos con factores de riesgo de cardiopatía isquémica y familias. Resultados: el modelo tiene una estructura que define dos dimensiones y seis categorías que se interrelacionan en forma dinámica. Conclusiones: se demostró la factibilidad y pertinencia del modelo de promoción de salud dirigido a la población con factores de riesgo de cardiopatía isquémica en la atención primaria de salud (AU).

Introduction: the basis to carry out this research was recognizing the importance of reducing the risk factors of ischemic heart disease and the necessity of strengthening the health promotion and educative actions in the Cuban context, on the principle of the continuous improvement and development of the processes. There are international models and theories approaching this topics, but they are not completely adjusted to the Cuban reality. Objective: to design a model of health promotion directed to the population with risk factors of ischemic heart disease. Materials and methods: we used the methodological triangulation, focal groups and surveys with experts, users, formal and informal leaders, persons with heart disease risk factors and relatives. Results: the model has a structure defining two dimensions and six categories interrelated in a dynamical way. Conclusions: the feasibility and pertinence of the health promotion model, directed to the population with risk factors of ischemic heart disease in the primary health care, was showed (AU).

Características de pacientes de 50 años o menos de edad sometidos a intervención coronaria en los años 2006-2015 / Characteristics of Patients Aged 50 Years or Less Undergoing Coronary Intervention from 2006 to 2015

Introducción: las enfermedades cardiovasculares en el adulto joven (menor de 51 años de edad) aumentaron su incidencia en la última década, con el consiguiente aumento en la demanda de atención médica y hospitalización. Objetivos: describir las características clínicas y angiográficas de una serie de pacientes menores de 51 años de edad sometidos a intervención coronaria percutánea. Métodos: estudio descriptivo, transversal y de exposición de las características clínicas y angiográficas de 373 pacientes de 50 años o menos, sometidos a intervención coronaria percutánea en el Hospital Militar Central Dr. Carlos J. Finlay, entre septiembre 2006 y diciembre 2015. Resultados: la edad media fue de 45,7 ± 5,6 años, predominó el sexo masculino (76,4 por ciento). Los principales factores de riesgo fueron la hipertensión arterial (67 por ciento) y el tabaquismo (63,5 por ciento). El síndrome coronario agudo sin elevación del segmento ST fue el diagnóstico más frecuente (61,4 por ciento). Los vasos más afectados fueron la arteria descendente anterior y la coronaria derecha. El 61,7 por ciento de las lesiones se localizó en la porción media de los vasos coronarios. Se realizó el proceder de manera exitosa en el 94,1 por ciento de los pacientes y fallecieron tres pacientes. Existió asociación significativa entre los factores de riesgo y el resultado angiográfico. Conclusiones: la intervención coronaria percutánea en el adulto menor de 50 años no es frecuente, la mayoría de los procederes son exitosos y la mortalidad es baja. Existió asociación significativa entre los factores de riesgo y el resultado del proceder(AU)

Introduction: Cardiovascular diseases in the young adults (younger than 51 years of age) increased their incidence in the last decade, with the consequent increase in the demand for medical attention and hospitalization. Objectives: Describe the clinical and angiographic characteristics of a series of patients under 51 years of age undergoing percutaneous coronary intervention. Methods: A descriptive, cross-sectional study was conducted in clinical and angiographic characteristics of 373 patients aged 50 years or younger submitted to percutaneous coronary intervention at Dr. Carlos J. Finlay Central Military Hospital from September 2006 to December 2015. Results: Mean age was 45.7 ± 5.6 years, male (76.4%) predominated. The main risk factors were hypertension (67 percent) and smoking (63.5 percent). Acute coronary syndrome without ST segment elevation was the most frequent diagnosis (61.4 percent). The most affected vessels were the anterior descending artery and the right coronary artery. 61.7 percent of the lesions were located in the middle portion of the coronary vessels. The procedure was successful in 94.1 percent of the patients and three patients died. There was a significant association between risk factors and angiographic outcome. Conclusions: Percutaneous coronary intervention in the adult under 50 years is not frequent, most of the procedures are successful and mortality is low. There was a significant association between the risk factors and the outcome of the procedure(AU)

Perfil etiológico y estratificación del riesgo en pacientes con dolor torácico agudo / Etiologic profile and risk stratification in patients with acute chest pain

INTRODUCCIÓN: el dolor torácico agudo es la sensación álgida que se manifiesta en el tórax, entre el diafragma y la base del cuello; se destaca el extracardíaco, el cardíaco y los de origen no determinado; puede ser traumático o de otras causas. OBJETIVO: identificar el perfil etiológico y estratificación del riesgo de pacientes con dolor torácico agudo. MÉTODOS: estudio descriptivo longitudinal tipo serie de casos. Se estudió una muestra de 634 pacientes que acudieron a la consulta de cardiología del Hospital Militar Holguín con dolor torácico entre enero y diciembre de 2011. RESULTADOS: el dolor torácico tuvo una incidencia de 60 por cada 100 pacientes. Inicialmente pudieron identificarse el 59 % de los pacientes con dolor torácico coronario, y mediante el seguimiento clínico y estudios complementarios se pudo definir el resto de los casos que ascendió al 66 %. La escala de los factores de riesgo coronario (de 3 a 5 puntos) identificó el 93 %. Se determinó la etiología del dolor en 58 pacientes de los 115 con diagnóstico inicial del dolor de origen indeterminado; en el 13,9 % fue imposible determinarla. En la estratificación del riesgo, los pacientes con riesgo entre intermedio y alto para enfermedad aterosclerótica fueron los que presentaron dolor coronario para un 57,8 % y 27,6 % respectivamente. CONCLUSIÓN: la etiología del dolor en los pacientes con origen no determinado del dolor es coronaria. La incidencia de casos con dolor torácico agudo en el servicio de consulta externa es alta

INTRODUCTION: acute chest pain (ACP) is manifested by peak feeling in the chest, between the diaphragm and the base of the neck. This pain can be extracardiac, heart or undetermined origin; it can be traumatic or by other causes. OBJECTIVE: to identify the etiologic profile and risk stratification of patients with acute chest pain. METHODS: a longitudinal descriptive study was conducted on case. 634 patients were studied. They had chest pain and they attended the cardiology service at Holguin Military Hospital from January to December 2011. RESULTS: chest pain had an incidence of 60 per 100 patients. Initially 59 % were identified in patients with coronary chest pain, and the rest of the cases could be defined by clinical follow-up studies and amounted 66 %. The scale of the coronary risk factors (3 to 5 points) identified 93 %. The etiology of pain was determined in 58 out of 115 patients with an initial diagnosis of undetermined-origin pain; 13.9 % was impossible to determine. In risk stratification, patients with intermediate to high risk for atherosclerotic disease were those with coronary pain which represents 57.8 % and 27.6 % respectively. CONCLUSION: the etiology of pain with undetermined origin is coronary pain. The incidence of patients with acute chest pain in the outpatient service is high..

Factores de riesgo coronarios en pacientes con prótesis aórtica durante rehabilitación cardiaca / Risk coronary factors in patients with aortic prosthetic during cardiac rehabilitation

Introducción: se realizó un estudio de intervención con todos los pacientes sometidos a cirugía de sustitución valvular protésica aórtica que acudieron a rehabilitarse en el Departamento de Rehabilitación Cardiovascular del Hospital Hermanos Ameijeiras durante el año 2011. Objetivo: caracterizar el comportamiento de los factores de riesgo coronario. Métodos: la muestra estuvo conformada por 16 pacientes. Se halló que el rango etario más frecuente fue el de 55-64 años, el sexo masculino y el color de piel blanca. La prótesis valvular de tipo mecánica fue implantada en todos los pacientes. Se observó mejoría en la capacidad funcional posterior a la rehabilitación cardíaca, se logró reducir el sedentarismo, la obesidad y el hábito de fumar, así como el incremento del número de pacientes hipertensos y diabéticos controlados. No ocurrieron complicaciones en la mayoría de los pacientes durante la rehabilitación. Conclusión: mediante la rehabilitación cardíaca se logró disminuir los FRC asociado a un bajo índice de complicaciones

Background: an intervention study was performed in all patients that were submitted to aortic prosthetic valve replacement surgery that began rehabilitation at the Cardiac Rehabilitation Unit Department of Hermanos Ameijeiras Hospital during the year 2011. Objective: to characterize the behavior of coronary risk factors. Methods: the sample was comprised of 16 patients. It was observed that the most frequent age rank was 55-64 years and most of the patients were male and white. All patients received mechanical aortic valve replacement. An improvement in the functional capacity in patients after cardiac rehabilitation was observed. Sedentary life, obesity and smoking habit were cut down and there was an increase in the number of controlled diabetic and hypertensive patients. Complications did not occur in the majority of patients during rehabilitation. Conclusions: cardiac rehabilitation diminished FRC associated to a low rate of complications

Anestesia intravenosa total en pacientes con factores de riesgo coronario / Total intravenous anesthesia in patients with coronary risks factors

Introducción: La cardiopatía isquémica es una determinante principal de la morbimortalidad peroperatoria. Objetivo: Comparar dos técnicas de anestesia intravenosa total en pacientes con factores de riesgo coronario en proceder quirúrgico mayor electiva. Material y Método: Se realizó una investigación descriptiva, prospectiva, longitudinal en 42 pacientes ASA III en el Hospital Universitario "General Calixto García", entre abril de 2008 y abril de 2010. Se crearon dos grupos según mantenimiento de la anestesia. (1): propofol/fentanil y (2): propofol/ketamina. Se estudiaron los cambios en la glucemia, tensión arterial media, frecuencia cardiaca y CO2 espirado durante el intraoperatorio, así como los tiempos de recuperación con cada una de las técnicas. Los datos se resumieron usando medias y desviaciones estándar para variables cuantitativas y porcentajes para variables cualitativas. Se utilizó la Prueba de comparación de medias de muestras independientes para la comparación entre los dos grupos. Resultados: Los valores de glucemia y CO2 espirado intraoperatorios se comportaron de manera similar en ambos grupos sin diferencias significativas. Durante la inducción, la tensión arterial media y la frecuencia cardiaca fueron significativamente menores en el grupo 1 en comparación al grupo 2 que se mantuvo prácticamente sin variaciones en los diferentes momentos. La recuperación total de la anestesia fue significativamente más rápida en el grupo 2. Conclusión: La anestesia intravenosa total con ketamina/propofol, proporciona resultados positivos finales y sin ninguna complicación mayor, lo que constituye una herramienta más para disminuir la morbilidad perioperatoria en pacientes con factores de riesgo coronario.

Introduction: The ischemic heart disease is a major determinant of perioperative morbility and mortality. Objective: To compare two techniques of total intravenous anesthesia in patients with coronary risk factors in an elective major surgical procedure. Material and Methods: A longitudinal, prospective and descriptive research was conducted in 42 ASA III patients in the "General Calixto GArcía" University Hospital from April, 2008 to April, 2010. Two groups were created according to the anesthesia maintenance (1): propofol/fentanyl and (2): propofol/ketamine. Authors studied the changes in glycemia, mean blood pressure, cardiac frequency and CO2 exhalated during the intraoperative period, as well as the recovery times of each of the techniques. Data were summarized using means and standard deviations (SD) for quantitative variables and percentages for qualitative variables. The test of comparison of means of independent samples was used to comparison between both groups. Results: The intraoperative glycemia and exhalated CO2 values were similar en both groups without significant differences. During induction, the mean blood pressure and the cardiac frequency were significantly lower in the group 1 compared with group 2 which remains practically without variations in the different moments. The total recovery from anesthesia was faster in the group 2. Conclusion: The total intravenous anesthesia using ketamine/propofol, yield final positive results and without any major complication, being another tool to decrease the perioperative morbility in patients with coronary risk factors.

AN INVERSE ASSOCIATION BETWEEN PREDICTED 50%VO₂MAX PER BODY WEIGHT AND CORONARY RISK FACTORS / 体力科学

The aim of this study is to elucidate the relationship between the predicted 50%VO₂max/wt (ml/kg/min) and coronary risk factors (CRFs).Seven hundred eighty six men (37.3 +/- 13.5 years old) and 1,268 women (41.5 +/- 13.6 years old) were studied. The predicted 50%VO₂max/wt was calculated by utilizing data from the continuous incremental exercise test with a stationary bicycle ergometer and the age-predicted heart rate at 50%VO₂max (=138-age/2). As CRFs, percent body fat, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, fasting blood sugar and HbA1c were measured.The age-adjusted odds ratio of having abnormal values in CRFs across quartiles of the predicted 50%VO₂max/wt (highest to lowest) were 1.00 (reference), 1.39, 2.64, and 6.78 in men, and 1.00, 1.73, 2.33 and 3.44 in women (for trend, <i>p</i><0.001), respectively.This study indicated that the lower 50%VO₂max/wt resulted in the higher odds ratio of having abnormal values in CRFs among Japanese. It was also confirmed that the sub-maximal aerobic capacity was associated with CRFs.

Relationship between depression and apolipoproteins A and B: a case-control study

OBJECTIVE: To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease. INTRODUCTION: Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein. METHODS: This case-control study included 153 patients with major depressive disorder who fulfilled the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and 147 healthy individuals. All participants completed a demographic questionnaire and Hamilton rating scale for depression. Anthropometric characteristics were recorded. Blood samples were taken and total cholesterol, high-and low-density lipoproteins and apolipoproteins A and B were measured. To analyze the data, t-test, χ2 test, Pearson correlation test and linear regression were applied. RESULTS: Depression was a negative predictor of apolipoprotein A (β = -0.328, p<0.01) and positive predictor of apolipoprotein B (β = 0.290, p<0.05). Apolipoprotein A was inversely predicted by total cholesterol (β = -0.269, p<0.05) and positively predicted by high-density lipoprotein (β = 0.401, p<0.01). Also, low-density lipoprotein was a predictor of apolipoprotein B (β = 0.340, p<0.01). The severity of depression was correlated with the increment in serum apolipoprotein B levels and the decrement in serum apolipoprotein A level. CONCLUSION: In view of the relationship between apolipoproteins A and B and depression, it would seem that screening of these metabolic risk factors besides psychological interventions is necessary in depressed patients.

Prevalência de fatores de risco coronarianos e alterações da perfusão miocárdica à cintilografia em pacientes diabéticos assintomáticos ambulatoriais / Prevalence of coronary risk factors and myocardial perfusion scintigraphy abnormalities in asymptomatic diabetic outpatients

OBJETIVO: Determinar a prevalência de fatores de risco (FR) para doença arterial coronariana (DAC) e isquemia miocárdica em uma amostra de diabéticos assintomáticos atendidos ambulatorialmente. MÉTODOS: De 80 diabéticos tipo 2 inicialmente recrutados no ambulatório de endocrinologia do nosso Hospital Universitário, sem sintomas e/ou diagnóstico de DAC, apenas 61 completaram o protocolo da pesquisa, sendo 52,5 por cento do sexo feminino, com uma média de idade de 56,3±10,9anos. Os pacientes foram submetidos a entrevista procurando-se identificar os FR e à realização de eletrocardiograma, ecocardiograma e cintilografia miocárdica perfusional (CMP), em repouso e sob estresse. De acordo com o resultado da CMP, foram distribuídos em dois grupos: um isquêmico e outro normal. RESULTADOS: Os FR identificados foram: sexo masculino (48 por cento), idade > 55 anos (51 por cento), história familiar de doença aterosclerótica precoce (16 por cento), passado de tabagismo (46 por cento), hipertensão arterial (44 por cento), sedentarismo (62 por cento), sobrepeso / obesidade (67 por cento), HDL-colesterol < 45 mg/dl (69 por cento), LDL-colesterol > 100 mg/dl (85 por cento) e triglicérides > 150 mg/dl (54 por cento). A CMP foi positiva para isquemia em 15 por cento dos pacientes. As variáveis associadas a esse diagnóstico foram sexo masculino (p=0,007), HDL baixo (p=0,046), história de tabagismo (p=0,038), hipertrofia ventricular esquerda (HVE) (p=0,043) e fração de ejeção do ventrículo esquerdo (FEVE) < 60 por cento (p=0,01). CONCLUSÃO: Observou-se uma alta prevalência de FR associados, bem como uma expressiva prevalência, de 15 por cento, de isquemia miocárdica. Sexo masculino, HDL-colesterol baixo, passado de tabagismo, HVE e FEVE < 60 por cento foram as variáveis identificadas como preditoras do diagnóstico de isquemia miocárdica.

OBJECTIVE: To determine the prevalence of coronary artery disease (CAD) risk factors (RF) and myocardial ischemia in a sample of asymptomatic diabetic patients treated on an outpatient basis. METHODS: From 80 type 2 diabetic patients initially recruited at an university outpatient endocrinology clinic, with no symptoms and/or CAD diagnosis, only 61 patients completed the study protocol, being 52,5 percent females, with a mean age of 56.3 ± 10.9 years. The patients were interviewed searching for RF and underwent electrocardiogram, echocardiogram and perfusional myocardial scintigraphy (PMS) at rest and under stress. According to the PMS results they were divided into two groups: an ischemic and a normal one. RESULTS: The RF identified were: male gender (48 percent), age > 55 years (51 percent), family history of premature atherosclerotic disease (16 percent), history of smoking (46 percent), hypertension (44 percent), sedentary lifestyle (62 percent), overweight / obesity (67 percent), HDL- cholesterol < 45 mg/dl (69 percent), LDL- cholesterol > 100 mg/dl (85 percent) and triglycerides > 150 mg/dl (54 percent). Ischemic MPS were diagnosed in 15 percent of the patients. The variables associated with this diagnosis were: male gender (p=0.007), low HDL levels (p=0.046), history of smoking (p=0.038), left ventricular hypertrophy (LVH) (p=0.043) and left ventricle ejection fraction (LVEF) < 60 percent (p=0.01). CONCLUSION: A high prevalence of associated RF was observed, as well as a significant prevalence of 15 percent for myocardial ischemia. The variables identified as predictors of a myocardial ischemia diagnosis were: male gender, low HDL-cholesterol, past smoking, LVH and LVEF < 60 percent.

WALKING 10,000 STEPS PER DAY IS EFFECTIVE TO IMPROVE CORONARY RISK FACTORS AMONG JAPANESES MIDDLE-AGED MEN / 体力科学

The purpose of this study is to investigate the effects of walking 10,000 steps per day on coronary risks including insulin resistance in Japanese. Twenty-one white-collar male workers (46.1±5.3 year-old) perform preventive lifestyle prescription. After 6 month, they showed improvements in BMI (p<0.05), VLDL (p<0.05), HDL cholesterol (p<0.001), and plasma insulin at 2 hr. post 75 g OGTT (p〈0.05). The participants increased their walk steps from 8,239±4,302 to 10,083±4,115 steps/day (p=0.09), and the increments of steps correlated with those of body mass index (r=−0.58, p<0.05), VLDL (r=−0.57, p<0.05), tryglycerides (r=−0.54, p<0.05), and blood glucose at 1 hr. post OGTT (r=−0.50, p<0.05) respectively. Especially 8 subjects with improved HOMA-R demonstrated more favorable modifications, and their gained 3,900 steps/day can meet the ACSM recommendation of physical activity. These outcomes could support a scientific aspect of anecdotal belief that walking 10,000 steps per day is effective to maintain one's optimum health.

Prevalencia de factores de riesgo coronarios en adultos jóvenes estudiantes de la UMSA de la ciudad de La Paz, 2005 / Prevalence of factors riesgo en coronary adults jóvenes estudiantes de la umsa de la ciudad de La Paz, 2005

Pregunta de investigación. ¿cual sera la prevalencia de factores de riesgo coronarios en adultos jóvenes estudiantes de la UMSA de la ciudad de La Paz periodo 2005?. Objetivo. Determinar la prevalencia de factores de riesgo coronarios en la población adulta joven universitaria de la UMSA. Diseño. Descriptivo, de corte transversal. Lugar. Instalaciones de los centros de estudiantes de las diferentes facultades de la Universidad Mayor de San Andrés. Participantes. 500 estudiantes de las diferentes facultades de la UMSA comprendidos entre 18 y 30 años matriculados en el periodo 2005. Intervención. ninguna. Mediciones principales. Colesterol total sanguineo, triglicéridos sanguíneos, presión arterial, índice de masa corporal, patrón de conducta tipo A, actividad física y habitos tóxicos. Resultados. La prevalencia de factores de riesgo coronarios en los universitarios de la UMSA alcanza un porcentaje de dos (30,80 por ciento) y tres (27,6 por ciento) factores por individuo, se halló tabaquismo en un 33,4 por ciento, sobrepeso y obesidad en un 29,6 por ciento, hipertensión arterial en un 2,8 por ciento, hipercolesteromia en un 7,4 por ciento, y un 26,4 por ciento de hipertrigliceridemia, el 83,6 por ciento presentaron patrón de conducta tipo A y un 15,2 por ciento presentaron inactividad física. Conclusiones. Los resultados obtenidos del presente estudio mostraron que existen factores de riesgo coronarios y se encuentran ampliamente distribuidos en la población adulta joven de estudiantes de la UMSA; la mayoría de ellos agrupan más de dos factores de riesgo; esto sugiere que al tener un alto grado de riesgo cardiovascular desarrollen con gran probabilidad, como se sabe, morbilidad y mortalidad durante las siguientes décadas.

Research question What is the prevalence of coronary risk factors in young adult students of UMSA in La Paz in 2005? Objective To determine the prevalence of coronary risk factors in the young adult university population of UMSA. Design Descriptive, cross sectional study Location Student centres of the different faculties of the Universidad Mayor de San Andres Participants 500 students of the different faculties of the Universidad Mayor de San Andres, between 18 and 30 years of age enrolled during the period of 2005. Intervention None Principal measurements Total blood cholesterol, triglicerides, blood pressure, body mass index, pattern of conduct type A, physical activity, and toxical habits. Results The prevalence of coronary risk factors in the students of UMSA reaches a percentage of two (30.8%) and three (27.6%) factors per individual , smoking was found in 33.4%, overweight and obesity in 29.6%, hypertension in 2.8%, hypercholesterolemia in 7.4% and hypertrigliceridemia in 26.4% ; 83.6% showed pattern of conduct type A and 15.2% were physically inactive. Conclusions The results of the present study show that there exist coronary risk factors and that they are widely distributed in the young adult student population of UMSA, the majority having two risk factors. Our results suggest that by having a high degree of cardiovascular risk the students will develop, as is well known, morbility and mortality during the next decades.

Possible effects of diets on serum lipids, fatty acids and blood pressure levels in male and female Japanese university students

<p><b>OBJECTIVES</b>To prepare a dietary recommendation for young Japanese for the prevention of coronary heart disease, we surveyed the dietary habits, serum lipids, serum fatty acids and blood pressure levels among male and female students.</p><p><b>METHODS</b>In this study, 175 male and 246 female university students were interviewed for the frequency of consumption of selected food items and the habit of skipping breakfast. Serum fatty acids were analyzed by gas chromatography.</p><p><b>RESULTS</b>The frequencies of consumption of dishes cooked with oil and intake of vegetables were higher in female students than in male students. Serum n-6 polyunsaturated fatty acids were slightly higher in females students than in male students while that of serum n-3 polyunsaturated fatty acids was 6.4% in both sexes. For both males and females, those who skipped breakfast at least once a week were less likely to consume vegetables and fruits than those who did not. Female students who skipped breakfast were also less likely to consume fish and had lower composition of n-3 polyunsaturated fatty acid and higher systolic and diastolic blood pressure levels than males. For female, the intake of milk and dairy products correlated inversely with systolic blood pressure levels and the intake of n-3 polyunsaturated fatty acids correlated inversely with diastolic blood pressure levels. For males, the intake of fruits and consumption of dishes cooked with oil correlated inversely with systolic and diastolic blood pressure levels.</p><p><b>CONCLUSION</b>Our findings suggest that increased intake of fish, milk and dairy products, fruits and vegetables from early adulthood and a regular dietary pattern are important to reduce the risk factors for coronary heart disease.</p>

Possible Effects of Diets on Serum Lipids, Fatty Acids and Blood Pressure Levels in Male and Female Japanese University Students

Objectives: To prepare a dietary recommendation for young Japanese for the prevention of coronary heart disease, we surveyed the dietary habits, serum lipids, serum fatty acids and blood pressure levels among male and female students. Methods: In this study, 175 male and 246 female university students were interviewed for the frequency of consumption of selected food items and the habit of skipping breakfast. Serum fatty acids were analyzed by gas chromatography. Results: The frequencies of consumption of dishes cooked with oil and intake of vegetables were higher in female students than in male students. Serum n-6 polyunsaturated fatty acids were slightly higher in female students than in male students while that of serum n-3 polyunsaturated fatty acids was 6.4% in both sexes. For both males and females, those who skipped breakfast at least once a week were less likely to consume vegetables and fruits than those who did not. Female students who skipped breakfast were also less likely to consume fish and had lower composition of n-3 polyunsaturated fatty acid and higher systolic and diastolic blood pressure levels than males. For female, the intake of milk and dairy products correlated inversely with systolic blood pressure levels and the intake of n-3 polyunsaturated fatty acids correlated inversely with diastolic blood pressure levels. For males, the intake of fruits and consumption of dishes cooked with oil correlated inversely with systolic and diastolic blood pressure levels. Conclusion: Our findings suggest that increased intake of fish, milk and dairy products, fruits and vegetables from early adulthood and a regular dietary pattern are important to reduce the risk factors for coronary heart disease.

Low fasting serum insulin in Japanese alcohol consumers does not imply improved coronary risk factors

<p><b>OBJECTIVE</b>The effects of alcohol consumption on coronary risk factors (CRFs) and insulin resistance (IR) have seemed equivocal in previous studies. This study aimed to clarify the implications of low fasting blood insulin observed in alcohol consumers as related to CRFs and IR.</p><p><b>METHODS</b>A cross-sectional observation in 2133 middle-aged healthy Japanese men for associations of increases in alcohol consumption, fasting serum insulin concentration and serum gammaglutamyltransferase (GGT) activity with the major CRFs of high systolic blood pressure (SBP), fasting serum glucose, triglycerides (TG), total- and LDL-cholesterol (tCh&LDLc) and low serum HDL-cholesterol (HDLc).</p><p><b>RESULTS</b>Increased alcohol consumption was related to higher SBP, serum GGT, glucose and HDLc, and lower serum LDLc and insulin. Although high serum insulin was significantly related to all of the CRFs in all nondrinkers, moderate drinkers consuming up to 59 ml of alcohol per day and excessive drinkers consuming more, the means of SBP, serum glucose and HDLc were significantly higher and serum LDLc was lower in drinkers than in nondrinkers at any level of serum insulin, indicating that the good and bad profiles of CRFs in alcohol consumers are independent of their low fasting serum insulin. High serum GGT related to increased alcohol consumption and/or body weight was significantly associated with high serum insulin and all of the CRFs in all categories of alcohol consumption.</p><p><b>CONCLUSIONS</b>Low fasting serum insulin observed in drinkers does not imply improved CRFs, and thus may not imply improved IR. High serum GGT may reflect increased IR in both drinkers and nondrinkers.</p>

Low Fasting Serum Insulin in Japanese Alcohol Consumers Does Not Imply Improved Coronary Risk Factors

Objective: The effects of alcohol consumption on coronary risk factors (CRFs) and insulin resistance (IR) have seemed equivocal in previous studies. This study aimed to clarify the implications of low fasting blood insulin observed in alcohol consumers as related to CRFs and IR. Methods: A cross-sectional observation in 2133 middle-aged healthy Japanese men for associations of increases in alcohol consumption, fasting serum insulin concentration and serum gamma-glutamyltransferase (GGT) activity with the major CRFs of high systolic blood pressure (SBP), fasting serum glucose, triglycerides (TG), total- and LDL-cholesterol (tCh & LDLc) and low serum HDL-cholesterol (HDLc). Results: Increased alcohol consumption was related to higher SBP, serum GGT, glucose and HDLc, and lower serum LDLc and insulin. Although high serum insulin was significantly related to all of the CRFs in all nondrinkers, moderate drinkers consuming up to 59 ml of alcohol per day and excessive drinkers consuming more, the means of SBP, serum glucose and HDLc were significantly higher and serum LDLc was lower in drinkers than in nondrinkers at any level of serum insulin, indicating that the good and bad profiles of CRFs in alcohol consumers are independent of their low fasting serum insulin. High serum GGT related to increased alcohol consumption and/or body weight was significantly associated with high serum insulin and all of the CRFs in all categories of alcohol consumption. Conclusions: Low fasting serum insulin observed in drinkers does not imply improved CRFs, and thus may not imply improved IR. High serum GGT may reflect increased IR in both drinkers and nondrinkers.

The Relationship between Physical Fitness and Coronary Risk Factor Profiles in Japanese Women

The purpose of this study was to investigate the relationship between physical fitness and coronary risk factor profiles in Japanese women. The subjects were 1, 483 women (ages 30 to 69) who participated in a practical health promotion program. After medical examination, physical fitness was evaluated by conducting a symptom limited maximal exercise test by ergometer to measure maximum oxygen uptake (peakVO2) with an expired gas analyzer. The subjects were classified into 3 groups (high fitness, moderate fitness, and low fitness) according to age and physical fitness level. The results showed that the subjects in higher fitness groups had lower levels in: body mass index (BMI), percentage of body fat, waist−hip ratio, resting blood pressure, and atherogenic index, and higher HDL−cholesterol compared to those in lower fitness group. Even after adjustment for the effects of age and BMI, the subjects in the higher fitness groups had better coronary risk factor profiles. These results suggest that among Japanese women a high level of physical fitness is related to favorable coronary risk factor profiles.

A Comparison of Reoperation and PTCA for Postoperative Angina / 日本心臓血管外科学会雑誌

Ten patients after coronary artery bypass grafting had reoperatinons and eight patients underwent postoperative PTCA at Nihon University Hospital from 1970 to July 1991. The difference of age between the reoperation group and the postoperative PTCA group is not significant. Most patients of the reoperation group and all of the PTCA group were male. Symptoms of the patients who required again surgical treatment or PTCA were almost reattack of angina and many cases were complicated by the coronary risk factors, particularly uncontrolled hypercholesterolemia and smoking. The bypass numbers of the reoperation group in the first operation were 2.1 and those of the PTCA group were 3.5. The difference of them was statistically significant (<i>p</i><0.05). The period from the primary operation to the second treatment also showed statistically significant difference between two groups (<i>p</i><0.05) (reoperation group: 81.8 months, PTCA group: 55.7 months). In the reoperation group, there were two operative deaths, two late deaths (not caused by heart disease), and the others remained asymptomatic. In PTCA group, no one had died, but four patients repeated attacks of chest pain after PTCA (mean interval 2.3 months), and two of them underwent re-PTCA. For a symptomatic case whose native coronary arteries or vein grafts show progressive stenosis and who have undergone PTCA, reoperation is recommendable as an effective treatment to relieve the symptom.