Baldness and coronary heart disease risk factors.

The present report focuses on the association between baldness pattern and coronary heart disease risk factors in 872 male factory workers from southern Italy participating in an epidemiological study. Participants were divided according to presence or absence of baldness and baldness pattern. Participants with fronto-occipital baldness (male-type baldness) (n = 280) characterized by hair loss centered over the vertex with an m-shaped frontal-temporal recession had, on the average, higher serum cholesterol and blood pressure compared to participants with no baldness (n = 321) and/or participants with just frontal baldness (n = 273). For serum cholesterol, a significant interaction was detected between age and fronto-occipital baldness (i.e. the association between fronto-occipital baldness and elevated levels of serum cholesterol became weaker with age). No interaction was detectable between age and fronto-occipital baldness for blood pressure. The results of this cross-sectional study indicate that male-type pattern of baldness is associated with elevated CHD risk profile, and that this relation between age and serum cholesterol differs in younger compared to older men.

Coffee and serum lipids: findings from the Olivetti Heart Study.

The relationship between coffee consumption and blood lipids was analyzed in a sample of 900 male workers of southern Italy participating in the Olivetti Heart Study. In the univariate analysis, coffee drinkers (n = 856) had higher values for body mass index (P < or = 0.05) and number of cigarettes smoked per day (P < or = 0.001) and lower levels of serum high-density-lipoprotein cholesterol (P < or = 0.05), compared to noncoffee drinkers (n = 44). In addition, coffee consumption (cups/d) was positively related to serum triglyceride levels (r = 0.105, P < or = 0.01) and cigarette smoking (r = 0.491, P < or = 0.01), and was inversely related to age (r = -0.122, P < or = 0.01). After multivariate adjustment, coffee consumption remained significantly related to age, cigarette smoking, and body mass index (data not shown). After stratification for smoking status, a significant positive linear trend between coffee consumption and serum total cholesterol was observed only in smokers. No significant trend was observed for serum triglycerides and high-density-lipoprotein cholesterol with coffee intake according to smoking status. This finding suggests that the relationship between coffee consumption and serum total cholesterol may change with the smoking status.

Earthquake and coronary heart disease risk factors: a longitudinal study.

The longitudinal association between a number of coronary heart disease risk factors and the experience of a natural disaster (earthquake) was analyzed in a group of workers participating in a longitudinal epidemiologic investigation. The 5-year follow-up examination was interrupted by a major earthquake, and examinations were resumed 2 weeks after the quake. Participants screened after the quake had, on average, higher heart rates, serum cholesterol, and triglycerides than participants examined before the quake; these differences were independent from the coronary heart disease risk factor values measured 5 years previously during the baseline examination. The data collected during the 12-year examination indicated that the observed short-term increase in serum lipids and heart rate was not present long-term (7 years after the quake). These longitudinal data indicate that exposure to a natural disaster can be associated with short-term increases in heart rate, serum cholesterol, and triglycerides but that there is no apparent long-term effect on these coronary heart disease risk factors.

Correlates of high-density lipoprotein cholesterol in a sample of healthy workers.

METHODS: Correlates of high-density lipoprotein cholesterol are analyzed in a sample of 797 male workers in southern Italy participating in the Olivetti Heart Study. At the univariate level high-density lipoprotein cholesterol concentrations are positively related to alcohol consumption (r = 0.127; P less than or equal to 0.001) and sport activity (r = 0.074; P less than or equal to 0.05) and inversely related to body mass index (r = -0.160; P less than or equal to 0.001), serum triglycerides (r = -0.349; P less than or equal to 0.001), cigarette smoking (r = -0.227; P less than or equal to 0.001), and coffee consumption (r = -0.153; P less than or equal to 0.001). RESULTS: In the group as a whole, body mass index, alcohol consumption, cigarette smoking, and serum triglycerides remain significantly related to high-density lipoprotein cholesterol in the multivariate model, while the association with coffee intake and sport activity loses statistical significance. A significant negative interaction is reported between physical activity and cigarette smoking, and a positive significant linear trend between high-density lipoprotein cholesterol and sport activity is observed only in nonsmokers. CONCLUSION: These findings suggest that body mass index, alcohol consumption, cigarette smoking, serum triglycerides, and sport activity are important correlates of high-density lipoprotein cholesterol but that the positive significant association between sport activity and high-density lipoprotein cholesterol is absent in smokers.

Serum selenium and coronary heart disease risk factors in southern Italian men.

The association between serum selenium concentration and a number of coronary heart disease risk factors is studied in 364 males from southern Italy participating in the Olivetti Heart Study. Selenium correlates positively and significantly with serum cholesterol (r = 0.120; P = 0.022), and this positive association persists after adjustment for age and body mass index. Selenium levels in heavy smokers are lower than both light smokers and current non-smokers, but these differences do not reach statistical significance. Selenium is not significantly associated with any of the other CHD risk factors (e.g., triglycerides, HDL cholesterol, blood pressure, age, and body mass index). It is hypothesized that the association between selenium and serum cholesterol reported in this and previous studies could be due to dietary interrelationships between selenium intake and foods that affect serum cholesterol concentrations.

[Hypopotassemia and prolongation of the Q-T interval in a patient with severe malnutrition caused by bulimia and post-prandial vomiting]. / Ipopotassiemia ed allungamento dell'intervallo Q-T in una paziente con grave malnutrizione da bulimia e vomito post-prandiale.

Patient L.A. (f., 20 yrs), affected by bulimia and self-induced vomiting, was hospitalized because of severe malnutrition (BMI 13.1), hypopotassemia (2.8 mEq/l) and prolonged QTc interval (0.469"). Intensive care treatment aimed to normalize mineral balance mainly serum potassium, consisted of administering e.v. potassium (mg 2346/day), magnesium (mg 72/day), calcium (mg 80/day), phosphorus (mg 769/day), chloride (mg 710/day), iron (mg 40/day). Dietary treatment was deliberately chosen to be slightly above minimum energy requirements in order to avoid possible side effects of forced hyperalimentation. The patient, immediately after hospitalization, interrupted vomiting and 2 wks later weight increased by 5 kg (from 34.9 kg to 40.0 kg). On the other hand normalization of serum potassium levels was slow and QTc interval reached normal range only after the 10th day of treatment (0.447"). This case supports the hypothesis that major ECG abnormalities may be present in severe malnutrition due to anorexia nervosa or bulimia with self-induced vomiting. The dangers of these complications were substantiated by the fact that intensive care treatment allowed prompt body weight recovery but normalization of electrolytic balance and cardiac function was very slow. For such patients, electrocardiographic monitoring should be routine.

A comparison of the random-zero and standard mercury sphygmomanometers.

Both the standard mercury sphygmomanometer and the random-zero sphygmomanometer have been used in epidemiological studies and clinical trials. Problems arise in comparing studies since, in addition to other methodological differences, the readings obtained with the random-zero sphygmomanometer have been found to be lower than those obtained with the standard mercury sphygmomanometer. In the present study, blood pressures were measured in 66 subjects to examine the comparability of findings with the two instruments. Trained observers measured blood pressures simultaneously using a double-headed stethoscope and one cuff connected to the two sphygmomanometers. Use of instrument was randomly assigned for each blood pressure measurement; each observer was unaware of the other's blood pressure reading. Readings were lower with the random-zero sphygmomanometer; mean difference ranged from 2.5 to 3.3 mm Hg for systolic pressure and 1.9 to 2.7 mm Hg for diastolic pressure. Digit distributions recorded by the two observers for the standard mercury sphygmomanometer and the random-zero sphygmomanometer were not significantly different for either systolic or diastolic blood pressure. Intraindividual variation was greater with the random-zero sphygmomanometer than with the standard mercury sphygmomanometer. These data do not indicate that one instrument is clearly superior to the other, although in studies where the observer seeks to reduce the bias of multiple readings per person, the random-zero sphygmomanometer may be the more appropriate instrument. Critical to the use of either instrument are careful training, standardization, certification, and periodic recertification of observers.

Short-term effect of natural disasters on coronary heart disease risk factors.

In this analysis of the data from a longitudinal study on coronary heart disease risk factors, it was found that participants screened a few weeks after a major disaster (earthquake) had a higher heart rate, serum cholesterol levels, and serum triglyceride levels than matched participants that were screened shortly before the catastrophic event. The two groups of participants did not differ with regard to their characteristics at the baseline examination carried out 5 years previously. The lack of difference in blood pressure between exposed and nonexposed participants could be explained by the lag-time between the earthquake and the blood pressure measurements. We conclude that the acute stress associated with major disasters can influence risk factors for coronary heart disease. Permanent elevation of these risk factors due to the disruption of the social environment of the individuals affected by major disasters might be responsible for the apparent long-term adverse effects on cardiovascular mortality discussed previously in the literature.

Serum lipid response to oat product intake with a fat-modified diet.

Healthy adult volunteers (no. = 208), men and women aged 30 to 65 years, participated in a 12-week study on dietary fat modification plus oat product ingestion (60 gm/day) to test whether moderate daily intake of oat bran and oatmeal enhanced serum lipid response. During weeks 0 to 6, all participants followed the American Heart Association fat-modified eating style. At 6 weeks, participants were randomly assigned to one of three groups. All participants continued to follow the fat-modified eating pattern; groups 1 and 2 were asked during weeks 7 to 12 to consume two servings of either oat bran or oatmeal per day, for a total of 60 gm/day isocalorically substituted for other carbohydrates. Group 3 ingested no oat products. At baseline, the group mean cholesterol level was 208.4 mg/dl. After 6 weeks of dietary fat intervention, the level was 197.6--a fall of 10.8 mg/dl (5.2%). At 12 weeks, the mean serum cholesterol level fell further, by 5.6, 6.5, and 1.2 mg/dl for groups 1, 2, and 3, respectively. Group mean weight loss was small--1.9 lb during the first 6 weeks and 0.6 to 0.8 for the three groups during weeks 7 to 12. Reported oat product ingestion was 39 and 35 gm per person per day, respectively, for groups 1 and 2 (2.2 and 1.4 servings per person per day, respectively). Dietary fat composition remained similar among the three groups during weeks 7 to 12. Pooled results indicated that the addition of oat products at a moderate and practical level enhanced serum lipid response (p less than .05) to a fat-modified eating pattern among free-living adults.

Need to prevent and control high-normal and high blood pressure, particularly so-called "mild" hypertension: epidemiological and clinical data.

The need to prevent and control high blood pressure (HBP), including so-called "mild" hypertension [diastolic blood pressure (DBP) 90-104 mm Hg in adults age 30+] stems from the extensive data on the increased risks due to these common blood pressure (BP) levels, including risk of catastrophic cardiovascular events (coronary, cerebrovascular, etc.), both nonfatal and fatal. Prospective population data from the national cooperative Pooling Project and the Chicago Heart Association Detection Project in Industry illustrate the extensively documented facts. They also show that only a small minority of middle-aged and older Americans have optimal low-normal BP levels, i.e., DBP less than 80 mm Hg (SBP less than 120). Thus, the problem of BP above optimal level for health over a long life span is a population-wide problem. The data also show that the great majority of excess catastrophic events attributable to elevated BP occur among people with DBP 90-104 and 80-89 mm Hg, levels very common in the population. Most people with such BP levels also have one or more other major risk factors (e.g., hypercholesterolemia, cigarette use, ECG abnormalities) and thus are at markedly increased risk, both relative and absolute. In addition to these excess risks for major illness, disability, and death, people with BP above optimal levels are more highly prone to other events, clinical and subclinical, that have adverse effects on long-term prognosis, including development of target organ damage and severe hypertension. These data lead to the following inferences about medical care and public health strategy: (a) A key task is, by safe nutritional-hygienic means, to shift the entire population distribution of BP downward, for both primary and secondary prevention of HBP. Such means include prevention and control of obesity, high sodium and alcohol intake, and sedentary habit, from early childhood on. (b) People with DBP 80-89 mm Hg need to be identified promptly, with institution of nutritional-hygienic measures to prevent development of frank hypertension and to correct other risk factors. (c) People with DBP 90-104 and higher need to be identified promptly, with institution of measures to normalize BP and control other major risk factors, by nutritional-hygienic means alone whenever possible or in combination with drug treatment for HBP when necessary to prevent organ system damage, serious illness, disability, and premature death.(ABSTRACT TRUNCATED AT 400 WORDS)

Peripheral circulation in hypertensive patients: findings by digital pulse plethysmography.

Sixty one non diabetic, asymptomatic patients with untreated primary hypertension and 122 age and sex matched non diabetic controls have been investigated in the peripheral circulation of the lower limbs by digital pulse plethysmography. The inclination time of the ascending ramp has been chosen as index of arterial wall elasticity. Inclination time was prolonged in the hypertensive group as compared to the control one (123 +/- 29 vs 107 +/- 13 msec; p less than .001). In addition, by using a cut-off point of 120 msec (X +/- 1SD of controls) 23/61 hypertensives and 26/122 controls presented an inclination time above this value (p less than .05 by chi square test). Since no other difference was observed in the main cardiovascular risk factors, we conclude that high blood pressure may produce early structural lesions of the vessel wall.

[Tracking of blood cholesterol and arterial pressure in adolescence]. / Il tracking della colesterolemia e della pressione arteriosa nell'adolescenza.

Early identification of atherosclerosis precursors and assessment of secular trends are key factors in organizing primary prevention programs. Tracking phenomenon for serum cholesterol and blood pressure has been evaluated at two years' interval in a group of students of both sexes, aged 11-15 years, in the municipality of Mugnano, near Naples. Serum cholesterol has been followed in 77 students and blood pressure--systolic and diastolic--in 160. Forty-three % serum cholesterol levels, 44% of systolic blood pressure measurements, and 25% of diastolic blood pressure values, that were in the upper quintile at the first visit, were found in the upper quintile again at the second visit. Our results point out that: there is a chance to identify "high" values, that may persist over time, especially for serum cholesterol and systolic blood pressure; great caution must be exercised in taking isolated measurements of serum cholesterol, systolic and particularly diastolic blood pressure at a young age as indicators in implementing prevention programs.

Once a day indapamide therapy in hypertension. Effects on the heart and peripheral arterial circulation.

Indapamide, a sulphonamide derivative, was prescribed for 8 weeks at low dose (2.5 mg once a day) to 14 hypertensive patients in order to investigate its effects on systolic and diastolic blood pressure (SBP, DBP), cardiac function and peripheral arterial resistance (PAR). During treatment we observed decreases in both SBP and DBP without any change in HR in the supine and standing positions and on exercise. As a result cardiac work was significantly reduced. Slight changes in pre-ejection period (PEP) and left ventricular ejection time (LVET) along with a more significant decrease in rate of rise of left ventricular pressure (DBP to PEP ratio) were observed during treatment. An increase in RBF and a decrease in PAR were also detected in the peripheral circulation. These findings may indicate that indapamide antagonizes the cardiovascular effects of catecholamines.

Serum lipid and lipoprotein profiles in childhood.

Serum lipids and lipoproteins as well as other factors have been shown to be predictive of future symptomatic coronary heart disease in adult populations. Many epidemiologic data are available on serum lipids in adults in different populations; similar data in children indicate a large geographic variability between different populations and even among individuals of the same population, suggesting that both genetic and environmental factors are determinants of serum lipid concentrations. Serum cholesterol at birth and during childhood is carried predominantly by low-density lipoprotein (LDL) and high-density lipoprotein (HDL) whereas very low-density lipoprotein (VLDL) remains very low during the same period. Longitudinal studies show that serum cholesterol level decreases slightly with age in boys but not in girls; the decreasing trend is most evident between 10 and 14 years of age. LDL cholesterol follows the same trend. A continuous slight increase in serum total and VLDL triglyceride has been shown with age. HDL cholesterol seems to maintain a constant level with only slight variation with age. Moreover, LDL cholesterol has great consistency with future levels. Measurements made in children confirm that high levels of cholesterol may be present at early ages, suggesting the need for follow-up studies in young populations in order to evaluate whether hypercholesterolemia in childhood is predictive of future coronary events.