The effect of menopausal status and sequential mestranol and norethisterone on serum cholesterol, triglyceride and electrophoretic lipoprotein patterns

The serum cholesterol, triglycerides and electrophoretic lipoprotein patterns of 35 postmenopausal women, who subsequently received sequential mestranol and norethisterone, were compared with those of 35 premenopasual women of the same age and weight. The postmenopausal women had a significantly higher level of serum cholesterol (p less than 0.01) than the premenopausal women, and a significant reduction (p less than 0.001) occurred in this group after two months of therapy. There was no significant difference in level of serum cholesterol between the premenopausal group and the postmenopausal group receiving sequential mestranol and norethisterone for two months. The serum triglycerides were not significantly higher in the postmenopausal group but there was a significant increase (p less than 0.001) after two months of therapy. The marked alteration in lipid levels at the menopause may in part account for the great increase in coronary artery disease in postmenopausal women but whether these changes are reversible by giving hormone therapy remains speculative.

Increased risk of thrombosis due to oral contraceptives: a further report

In a previously reported case-control study of the relationship between oral contraceptives and thromboembolism, there were 461 cases and 1302 controls, individually matched on age, race, marital status, hospital, and date of admission. Initially, the control patients had not been matched with the cases for the presence or absence of six factors thought to predispose to or precipitate thromboembolic disease. The present paper reports the effects of taking into consideration these factors in the controls. Two methods of analysis (matched set, and logistic regression) gave closely similar results. Where the case series consisted of idiopathic cases, the revised estimate of the relative risk was reduced from 7.2 to 4.7 by these procedures; for predisposed cases, it was increased from 1.2 to 2.2. The explanation suggested in the previous report for the failure to find an increased risk for cases with predisposition receives support from these findings. Variation in the relative risk was examined for four separate diagnostic categories: venous thrombosis alone, pulmonary embolism alone, venous thrombosis and pulmonary embolism together, and myocardial infarction. The relative risk estimates were greater than unity for each thrombosis category for both predisposed and non-predisposed cases. The relative risk was not found to vary significantly according to age or smoking status.

Heart disease risk factors and hormone use in postmenopausal women

A population of 1,496 women aged 55 to 74 years was studied for the distribution of heart disease risk factors in the presence or absence of postmenopausal estrogens. Current hormone use was reported by 39%. Hormone users were significantly slimmer than nonusers at all ages. After adjustment for the effect of obesity, hormone users had significantly lower mean levels of plasma cholesterol and higher mean levels of plasma triglycerides than nonusers. Blood pressure and fasting plasma glucose concentration tended to be lower among hormone users, although the differences were not statistically significant in all age groups. This article discusses the theoretical implications of these observations for cardiovascular disease mortality and contrasts them with the cancer risk of postmenopausal estrogen use.

Exogenous hormones and other drug exposures of children with congenital heart disease

A history of oral contraceptive use, hormonal pregnancy tests, prescribed hormones and other drugs was obtained from 390 mothers of infants with congenital heart disease and 1254 mothers of normal infants in Massachusetts. The data show a small positive association between estrogen/progesterone exposure and cardiac malformation, the prevalence ratio estimate of exposed to non-exposed being 1.5 (90 per cent confidence limits are 1.0, 2.1). No association was evident, however, between hormones and trunco-conal or any other class of defect among the cases, an observation which casts doubt on a causal relationship betweem hormones and cardiovascular malformations. Several other drugs were reported more frequently by cases' mothers. These include: ampicillin; aspirin; a combined anti-nausea agent (doxylamine succinate, dicyclomine hydrochloride and pyridoxine hydrochloride); chlordiazopoxide, codeine, diazepam, diphenylhydantoin; insulin; phenobarbital; phenothiazine; phenylephrine; and tetracycline.

Premature mortality attributable to smoking and hazardous drinking in Canada

All causes of death related to the two risk factors, smoking and hazardous drinking, have been reviewed followed by a selection of those causes of death for which the causal role of the risk factor appears to be quasi-certain. For each cause, existing epidemiologic data were reviewed and used to determine the fraction of premature mortality which could be attributed to each factor (called the attributable fraction). This fraction was then multiplied by the corresponding Canadian premature mortality measured in terms of deaths between ages one and 70 and potential years of life lost (PYLL) between ages one and 70, which gives a higher weight to younger deaths. Of the 73,440 deaths between ages one and 70 in Canada in 1974, 12% (or 8718 deaths) were found to be attributable to current smoking and 6% (4716) to hazardous drinking. In terms of PYLL between ages one and 70, hazardous drinking ranks ahead of current smoking with 10% (or 132,044 PYLL) of the total PYLL, whereas current smoking represents 8% (105,085 PYLL) of the total . Regardless of whether premature mortality is expressed in terms of deaths or PYLL, about 18% of Canadian premature mortality is attributable to current smoking and/or drinking (with the range of possible values being 14-22%).

Regional differences in risk factor distributions, food habits and coronary heart disease mortality and morbidity in Belgium

Belgium can be divided in 4 major geographical areas: two Dutch speaking areas in the north (Campine and Flanders), a French speaking area in the south (Wallonia) and the Brussels area in between. Significant differences in mean serum cholesterol levels were observed with the lowest level in Campine, intermediate in Flanders and Brussels, and the highest level in Wallonia. Similar differences were observed in the prevalence of CHD and mortality from CHD is also higher in the French speaking part of the country. A survey of food habits since 1959 shows a higher butter and lower soft margarine consumption in the south. However, differences in smoking habits and personality traits also exist.

[Tobacco, mortality and morbidity of atherosclerotic cardiovascular diseases--a prospective study in Paris]

In the Paris Prospective Study, after a 6,5 year follow-up, mortality and atherosclerotic disease incidence are studied according to the tobacco consumption measured at entry among 7746 middle-aged men in the same administrative group. Mortality is 3 times higher among smokers; the excess mortality of smokers concerns particularly cancers, especially cancers of the upper part of the digestive tube or lung cancers and coronary heart disease. The incidences of leg atherosclerosis and of hard coronary diseases increase very much with the quantity smoked and inhaled. The cigarette consumption is linked with the development of coronary diseases independently of other risk factors; it is taken into account in a five risk factor combination which gives the best estimation of individual risk of future disease. The theoretical effects of the reduction of cigarette consumption on the individual risk or on the incidence of coronary diseases are given. A multifactorial prevention with a small reduction of the level of several risk factors might reduce that incidence in the population.

The evidence for the antiatherogenicity of high density lipoprotein in man

It has long been recognized that patients with clinical coronary heart disease (CHD) have, on average, higher concentrations of plasma very low density and low density lipoproteins than do healthy subjects. The same studies clearly demonstrated that coronary victims tend also to have low plasma concentrations of high density lipoprotein (HDL). It is only recently, however, that the possible significance of this second observation has been examined. Direct evidence for an inverse relationship between HDL cholesterol concentration and the prevalence of clinical CHD, independent of other plasma lipoproteins, has been provided by the Honolulu Heart and Cooperative Lipoprotein Phenotyping Studies. The Tromsø Heart and Framingham Studies subsequently demonstrated that this relationship precedes the clinical manifestation of coronary disease. More recently, angiographic studies have confirmed that the severity of existing coronary atherosclerosis is inversely related to HDL cholesterol concentration. Other investigations have shown that coronary victims also have low mean concentrations of apolipoproteins AI and AII (the major protein components of HDL), although the reduction of apoAI concentration may be less marked that that of HDL cholesterol, and preliminary findings from Tromsø have suggested that apolipoprotein AI may be less powerful that HDL cholesterol as a predictor of CHD. Such observations have supported the porposal that HDL may exert a protective effect against coronary atherosclerosis. Final comfirmation (or otherwise) of this hypothesis, however, must await the results of carefully controlled animal experiments and of regression studies in patients with angiogrphically defined atherosclerosis.

Myocardial infarction in the Kathmandu Valley: relation to two ethnic groups

The incidence of 57 cases of acute cardiac infaraction in two major ethnic groups living in the Kathmandu Valley, Nepal, under similar cultural and socioeconomic conditions is reported. Although there was no statistically significant difference in the age distribution in the two groups, a higher incidence of cardiac infarction was found in the Indo-Aryan ethnic group.

[Coronary thrombosis on oral contraception (author's transl)]

A case of myocardial infarction observed in a 27 years old female taking an oestrogen-progestogen combination for contraception, who died suddenly two months after the resection of a left ventricular aneurysm, provided unprecedented anatomical documents. Their histological examination allowed to state the thrombotic mechanism of the coronary occlusion and brought arguments in favour of an alteration of the coronary arterial wall in the form of thickening of the intima, likely to have been the starting point of this thrombosis.

Coronary Drug Project Research Group. Gallbladder disease as a side effect of drugs influencing lipid metabolism. Experience in the Coronary Drug Project

We analyzed data obtained during the Coronary Drug Project to discover the influence of the drugs used on the frequency of gallbladder disease. Of 2680 placebo-treated men who had had myocardial infarction, gallbladder disease developed in 69. Corresponding figures for those given 2.5 mg of estrogen, 5.0 mg of estrogen and 1.8 g of clofibrate per day were 46 of 1061, 47 of 1081 and 42 of 1051, respectively. Each treatment group differed from placebo by over twice the standard error of the difference, life-table analysis yielding P less than 0.05 for each drug-placebo comparison. Forty-five variables, including age, body weight, blood pressure, serum lipids and blood sugar, were evaluated as risk factors. Age significantly correlated with prevalence of known gallbladder disease at entry (r = 0.066, P less than 0.001). No variable yielded a strong and consistent correlation with the incidence of subsequent new gallbladder disease. Gallstone formation is a risk whenever clofibrate or estrogen is prescribed.

The impact of long term estrogen support after hysterectomy. A report of 1016 cases

1016 Women were placed on estrogen support following hysterectomy and have been followed for a total of 14,318 patient/years. Support was principally conjugated estrogen with the customary dose 1.5 mg/day. The follow-up studies in this group of women shows a marked drop in deaths from all causes over those which might have been expected. This improvement in mortality is principally the result of diminished number of deaths from heart attack and from cancer. Those causes of death which would not be expected to be related to hormonal therapy show the anticipated number of mortalities. There is also a marked improvement in the clinical evidence of osteoporosis. In this group there is an increase in the number of breast cancers over those which might have been expected, but there is a lower mortality from breast cancer than the anticipated mortality. The general impact of long-term estrogen therapy following hysterectomy is favorable over those figures for the expected incidence of cancer and heart disease.

Steroids in the treatment of clinical septic shock

A prospective (Part I) and a retrospective (Part II) study were used to determine the safety and efficacy of corticosteroids in the treatment of septic shock. In Part I, 172 consecutive patients in septic shock admitted over an 8-year period were treated with either steroid or saline: 43 received dexamethasone (DMP), 43 received methylprednisolone (MPS), and 86 received saline. The study was double-blind and randomized, and the three groups were compared for age, severity of shock, presence of underlying disease, and year of study. In the 86 saline-treated patients, the mortality rate was 38.4% (33/86); in the steroid-treated patients, it was 10.4% (9/86). With MPS the mortality rate was 11.6% (5/43), and with DMP it was 9.3% (4/43). Thus, overall mortality was significantly less in the steroid-treated group than in the control group. Further, there was no significant difference in mortality rate between the DMP- and the MPS-treated patients. In Part II, 328 patients were studied retrospectively. One-hundred sixty were treated without steroid, and 168 were treated with either DMP or MPS. Again, the two groups of patients were compared for severity of shock, underlying disease, age, and year of study. Mortality among patients treated without steroid was 42.5% (68/160) and among patients treated with steroid was 14% (24/168); there was no significant difference in mortality rate between DMP- and MPS-treated patients. In Parts I and II combined, complications occurred in 6% of steroid-treated patients with no significant difference between DMP- and MPS-treated groups.

Risk factors in pulmonary embolism

The influence of several diseases and conditions upon the prevalence of pulmonary embolism in autopsies performed during a ten year period at the University of Michigan has been analyzed. The major factors contributing to an increase in risk of development of pulmonary embolism include heart disease, certain types of cancer, obesity, acute paraplegia and accidental and operative trauma. These and several other risk factors defined in other studies should be used in a selective program designed to increase the rate of detection of deep venous thrombosis before pulmonary embolism occurs, or alternatively, patients at increased risk should receive prophylactic low dosage heparin therapy during hospitalization.

Genetic counseling for congenital heart disease

The genetic knowledge of parents of children with congenital heart disease, who had received genetic counseling, was compared with that of a control noncounseled group attending the same cardiac clinic. A follow-up questionnaire showed that both groups had excellent knowledge of the nature of their children's heart lesions. The counseled group had significantly more accurate knowledge of their recurrence risks. Inasmuch as the reproductive attitudes of some of these parents were found to be influenced by genetic information, parents of children with CHD should be given a better understanding of recurrence risks for CHD than many of them possess.

Studies on cerebrovascular stroke. I. Epidemiology of first-time strokes in persons under 70 years of age

The present investigation was carried out to study the incidence of new cerebrovascular strokes (cerebral haemorrhage, cerebral infarction and cerebral embolism) in people under the age of 70. SUCH INFORMATION HAS HITHERTO BEEN LACKING. The material comprises all cases from Uppsala county occurring between 1967 and 1971. The incidence was found to be 36/100,000 inhabitants. Of the total number of strokes, 25% were recurrences. During the period of study the incidence showed a moderate but significant decrease. It is assumed that this decrease is due to an extended and improved treatment of hypertension. It was observed that there were 6 females below 40 years of age. All had been on oral contraceptives at the time of the stroke. There was a high incidence of diabetes and symptoms of cardiovascular impairment (hypertension, transient ischaemic attack (TIA), cardiosclerotic disease) in the series. A high incidence of myocardial infarction was found among the parents of the cases of cerebral haemorrhage. A high incidence of strokes was found among the parents of those having cerebral infarctions.