Ten-year mortality from coronary heart disease among 172,000 men classified by occupational physical activity.

A cohort of 172,489 males aged 20--64 years and employed by the Italian railroad system on 1 April 1963 have been classified by habitual physical activity at work and followed-up for death during a ten-year period. The overall crude mortality was 56.59 per 1,000 in ten years, and no significant differences were found between men in sedentary, moderate and heavy work. Age-corrected death rates for coronary heart disease, as manifested by myocardial infarction and sudden coronary death, were substantially different in the three activity groups, moderately active workers ranking first, sedentary workers second, but very close to the former, and very active workers being last. The age-corrected rates for all ages were 14.18, 12.55 and 7.63 per 1,000 in ten years, respectively. All differences were statistically significant, the mortality ratio between the sedentary and moderate groups combined versus the heavy group being of the order of 1.75 to 1.

[How much harm can be caused by a badly recorded or badly interpreted ECG! (author's transl)]. / Quanto danno può fare un elettrocardiogramma male esequito o male interpretato!

Two cases are presented which support the sentence of the title. In a 38 years old man a life insurance company proposed an extra charge on the basis of a pseudoischemic ECG due to exceeding pressure of the writing pen on the ECG paper. In a 28 years old asymptomatic female an abnormal ECG was interpreted as due to ischemic heart disease. Physical activity was restricted and three pregnancies were interrupted. 18 years later an angiography showed normal coronary vessels. Some months later an echocardiogram showed an abnormal pericardial pattern, giving a possible explanation for the abnormal ECG.

[Intramuscular injection of lidocaine in prevention of complications and mortality in acute myocardial infarction: double blind study on 246 cases (author's transl)]. / La lidocaina per via intramuscolare nella prevenzione delle complicazioni e della mortalita' nell'infarto miocardico acuto: studio a doppio cieco di 246 casi

246 cases of acute myocardial infarction in subjects aged 70 or less, with clinical symptoms beginning no more than 8 hours before, altered enzymes, abnormal Q wave, ST segment and T wave, were studied. 99 of them received, on hospital admission, an intramuscular injection of 250 mg of lidocaine, 147 an injection of saline. In the following 3 weeks, significant differences were observed in the appearance of severe arrhythmias (no cases in the treated group and 18 cases in the placebo group, p less than 0,001) and of heart failure (39 cases in the treated group and 79 in the placebo group, p less than 0,05) and in mortality (3 cases in the treated group and 18 in the placebo group, p less than 0,05).

[The prediction of coronary heart disease. A mathimatical model applied to Italian field studies (author's transl)]. / La previsione della cardiopatia coronarica. Applicazione di un modello matematico a materiale epidemiologico italiano

The multiple logistic function (MLF) was applied for the estimation of coronary heart disease (CHD) - "hard criteria" in 5 years as a function of several risk factors in two rural Italian areas belonging to the "Seven Countries Study". CHD was estimated with solutions including 4, 5 and 11 factors respectively. Only serum cholesterol showed a statistically significant contribution; but other factors, like age and physical activity, very likely contributed to a better discrimination between "cases" and "non-cases". By increasing the number of factors the discrimination tends to improve anyway. In the solution with 11 factors, 46% of the observed cases was found in the upper 10% of the estimated risk probabilities; 57% in the upper 20%; while no cases were found in the lowest 20% of the same rank probability list. For practical purposes of selecting high risk individuals for preventive action, a simple 5 factor solution, including age, systolic blood pressure, serum cholesterol, consumption of cigarettes and physical activity is suggested.