青年男性冠状动脉病临床与冠状动脉造影分析

目的 探讨青年男性（〈４０岁）心绞痛临床与冠状动脉造影（ＣＡＧ）的特点。方法 将９０例青年男性心绞痛患者按心肌梗塞（ＭＩ）（２０例）、典型心绞痛（３４例）、不典型心绞痛（３６例）分为三组并行ＣＡＧ。结果 有冠状动脉病变（ＣＡＤ）者４７例（５２．２％）。ＭＩ组１８例（９０％）,典型组２２例（６４．７％）,不典型组７例（１９．４％）。三组之间ＣＡＤ检出率比较有显著性差异,ＭＩ组〉典型组〉不典型组。冠脉     

Cardiovascular response to exercise in young women with insulin-dependent diabetes mellitus

Summary To evaluate the cardiovascular response to exercise in diabetes, a graded maximal exercise test was performed on 50 women with insulin-dependent diabetes mellitus, aged 15–40 years, and on 15 healthy women in the same age group. The diabetic subjects were divided into 3 groups according to the duration of disease: group 1: 0–5 years, group 2: 6–14 years, group 3: 15–29 years. The maximal work load was lower in the diabetic subjects than in the controls. The difference was most marked between the controls and group 3 (167±14 Wvs 132±23 W, p<0.001). The maximal heart rate was lower in groups 2 and 3 than in the controls (173±16vs 187±11, p<0.05). The diabetic women with long-standing disease had a slightly higher blood pressure response to exercise resulting in comparable rate-pressure products in the study groups. Two diabetic women in group 3 and one healthy woman had 1 mm ST depressions during the test without appearance of arrhythmias or chest pain. These studies suggest that exercise tolerance is reduced in young diabetic women, especially in patients with long-standing disease. The frequency of pathological exercise ECGs does not, however, seem to be increased.     

Lipophilic thiamine treatment in long-standing insulin-dependent diabetes mellitus

Thiamine plays an important role in the regulation of glucose metabolism and pancreatic β-cell functioning. A role for this vitamin in cellular glucose transport has been indicated in the literature. The aim of this study was to determine whether a lipophilic form of thiamine (benzoyloxymethyl-thiamine, BOM) was able to improve metabolic control in patients with long-standing insulin-dependent diabetes mellitus (type 1). A total of 10 children with type 1 diabetes of long duration (age 11.4 ± 1.2 years, duration of the disease 4.5 ± 0.7 years, means ± SEM) were studied before and after treatment with BOM in a randomized double-blind and placebo-controlled study. Five patients were assigned to the BOM-treated group and five to the placebo-group. In all patients basal and glucagon-stimulated C-peptide secretion was undetectable. Thiamine status was assayed by measuring the plasma content of thiamine and its monophosphate form at entry and after 3 months of treatment. The blood HbA_1C levels and the daily dose of insulin per kg body weight were assessed in both groups before treatment, after 1 month and 3 months of treatment, then 3 months following its suspension. The plasma content of thiamine + thiamine monophosphate in type 1 diabetic patients (35.3 ± 3.6 pmol/mL) was significantly lower when compared with that measured in six age-matched normal subjects (53.2 ± 2.3 pmol/mL, P < 0.05). Received: 29 June 1998 / Accepted in revised form: 2 February 1999     

Coronary artery disease screening in patients with diabetes

Coronary artery disease (CAD) is the most common cause of death in patients with diabetes. Many diabetics have asymptomatic CAD, and may benefit from early diagnosis. We review the recent literature to evaluate whether the current evidence supports screening for CAD in asymptomatic diabetics. Currently, no single screening modality has shown sufficient accuracy to determine which patients will have significant CAD. The combination of imaging modalities may show promise in improving the accuracy of screening, and limited data suggest that screening in this population may be associated with improved outcomes. However, based on the current evidence we presently do not recommend screening for CAD in this population.     

Coronary artery disease in young women: Clinical and angiographic features and correlation with risk factors

Coronary arteriography was performed because of suspected coronary disease in 239 women less than 45 years of age. Normal coronary arteries were found in 112 women, and a further 23 had insignificant stenosis (less than 50 percent narrowing of luminal diameter). Of the remaining 104 women, 56 had one vessel, 22 two vessel and 26 three vessel disease. Hyperlipidemia, hypertension, diabetes, smoking and a family history of coronary disease were significantly more frequent in women with significant stenosis than in women with normal arteries. Significant coronary disease was found in 55 percent (100 of 182) of women with more than two risk factors but in only 7 percent (4 of 57) of those with less than two risk factors (P <0.0001). Evaluation of symptoms and the resting electrocardiogram also discriminated between women with and without coronary disease, but exercise testing was of little value. Only 4 of the 46 women with previous myocardial Infarction had normal or near-normal coronary arteries. Among women with segmental wall motion abnormalities on ventriculography, the site was anterior in 90 percent (19 of 21) of women who used oral contraceptive drugs but in only 60 percent (21 of 35) of nonusers (P <0.05). However, in most respects, coronary artery disease in young women does not appear to differ from coronary disease in other patients.     

Coronary artery disease in postmenopausal women

Opinion statement Many important developments recently have been made in the treatment and prevention of coronary artery disease (CAD) in postmenopausal women. Substantial evidence supports focusing on comprehensive risk factor modification based on the "ABCs" of CAD management from the American College of Cardiology, the American Heart Association, and the American College of Physicians-American Society of Internal Medicine guidelines on chronic stable angina [1•]. This approach emphasizes cardiovascular risk factor interventions that include antiplatelet agents, angiotensinconverting enzyme (ACE) inhibitors, beta-blockers, cholesterol-lowering medications, diabetes control, and counseling on diet and exercise. Despite the expanding available literature, many questions on CAD in postmenopausal women remain unanswered and await the publication of ongoing and future research. The unexpected findings from the HERS (Heart and Estrogen/ progestin Replacement Study) failed to show a benefit of hormone replacement therapy (HRT) in reducing the risk of subsequent events in postmenopausal women with CAD, and instead reported an early increase in CAD events [2]. Based on the data available so far, we advise against starting HRT in postmenopausal women with a recent coronary event for the sole purpose of CAD prevention. For women with acute coronary syndromes, prompt angiography and revascularization should be considered.     

Metabolic syndrome: stronger association with coronary artery disease in young men in comparison with higher prevalence in young women

BACKGROUND: Being overweight, a constituent of the metabolic syndrome, is also an important contributing factor to the development of coronary artery disease in younger patients, compared with the older patient population. Owing to the above-mentioned fact, we sought to assess the association of the metabolic syndrome with premature coronary artery disease. METHODS: In an analytic cross-sectional study, 940 patients (553 women相似文献