Atherosclerotic vascular disease and its risk factors in non-insulin-dependent diabetic and nondiabetic subjects in Finland

A cross-sectional study on the prevalence of atherosclerotic vascular disease (ASVD) and its risk factors in non-insulin-dependent diabetic and nondiabetic subjects was carried out from 1982 to 1984 in East Finland (Kuopio) and West Finland (Turku), two areas known to differ markedly in prevalence of ASVD in the nondiabetic population. A total of 510 diabetic and 649 nondiabetic subjects aged 45-64 yr were examined in East Finland and 549 diabetic and 724 nondiabetic subjects of the same age in West Finland. In both areas and in both sexes the prevalence of coronary heart disease (CHD), stroke, and intermittent claudication was higher in diabetic than in nondiabetic subjects. Both in diabetic and nondiabetic subjects the prevalence of ASVD was higher in East Finland than in West Finland. In men, the East-West difference in the prevalence of symptomatic CHD and claudication was greater in diabetic than in nondiabetic subjects. In both areas and in both sexes the serum lipid pattern was more atherogenic and hypertension was more frequent in diabetic than in nondiabetic subjects. In both diabetic and nondiabetic subjects, serum total-cholesterol level was somewhat higher and hypertension was more frequent in East Finland than in West Finland. The East-West difference in serum total-cholesterol was greater in diabetic than in nondiabetic subjects. In multiple logistic analyses including cardiovascular risk factors, diabetes status, and area of residence, residence in East Finland was found to be, in addition to diabetes, a strong independent factor associated with CHD, particularly in men.     

Basedow's disease and atypical ophthalmologic signs

The authors report a case of BASEDOW's disease discovered with CT scan. The beginning was uncommon, characterized by orbital pains associated with optic neuropathy without any other signs of hyperthyroidism.     

Effects of oleic acid-, alpha-naphthylthiourea-, and phorbol myristate acetate-induced microvascular damage on indexes of pulmonary endothelial function in anesthetized dogs

To study the value of indexes of endothelial cell function in experimentally induced pulmonary microvascular injury, lung damage was produced in anesthetized dogs by intravenous injection of oleic acid (OA; n = 6), alpha-naphthylthiourea (ANTU; n = 5), or phorbol myristate acetate (PMA; n = 6). Angiotensin-converting enzyme (ACE) activity in serum and simultaneous measurements of serotonin (SER) and propranolol (PROP) pulmonary extraction along with several physiologic parameters were determined and compared with those obtained in a control group (n = 5) before and then at 2-h intervals for 8 h after administration of the toxic agent. ACE activity in serum showed a sustained and significant increase in the PMA and OA groups throughout the whole study period, whereas it decreased significantly at 4 h in the ANTU group. SER pulmonary uptake decreased significantly, but slightly, only in the PMA group at 8 h (-5%). At 6 and 8 h respectively, PROP extraction dropped significantly in the PMA (-11 and -13%) and OA (-13 and -19%) groups. This decrease in PROP extraction was likely to result from physiologic changes due to the development of pulmonary edema as suggested by the correlation between the changes in amine uptake and those affecting pulmonary artery pressure and total static respiratory compliance. The lack of effects on SER uptake by the lungs under these experimental conditions indicate that dissociation exists between metabolic dysfunction of pulmonary endothelial cells and fluid leakage.     

Plasma insulin response to oral glucose load in Menière's disease

Oral glucose tolerance tests and plasma insulin measurements were carried out in 74 patients with Menière's disease and 74 control subjects. No statistically significant differences were observed in fasting, one-hour, and two-hour blood glucose levels or in fasting, one-hour, and two-hour plasma insulin levels between patients with Menière's disease and control subjects. The results do not confirm the hypothesis that disturbances in glucose metabolism or plasma insulin response are etiologic factors in Menière's disease.     

Effects of natural oestrogen/progestogen substitution therapy on carbohydrate and lipid metabolism in post-menopausal women

Oral glucose tolerance tests were performed in 30 post-menopausal women before and after 1 mth and 6 mth of cyclic 17 beta-oestradiol/norethisterone acetate substitution therapy. Before undergoing treatment the patients were divided into three groups comprising subjects with normal glucose tolerance, subjects with impaired glucose tolerance and diabetic subjects receiving oral diabetic treatment respectively. Carbohydrate metabolism was evaluated during a 2-h oral glucose tolerance test following a 100 g glucose load. Both blood glucose and plasma insulin values were measured. The fasting serum cholesterol and triglyceride levels were also determined. Hormone substitution therapy had no effect on fasting blood glucose values in any of the three groups. At the end of the 6 mth substitution therapy, however, it was found that the blood glucose values in the subjects with impaired glucose tolerance were significantly lowered by the end of the 2-h test period. The glucose areas under the curve during oral glucose tolerance tests following the hormone treatment were also reduced in this same group. In the case of insulin, the areas under the curve remained unchanged in all three groups. Fasting serum cholesterol levels tended to fall, while the triglyceride levels remained unaltered, during the hormone treatment periods. However, a slight increase in triglyceride levels was observed in the subjects with impaired glucose tolerance.     

The validity of hospital discharge register data on coronary heart disease in Finland

We studied the validity of the Finnish hospital discharge register data on coronary heart disease (CHD) for the purposes of epidemiologic studies and health services research. The Finnish nationwide hospital discharge register (HDR) was linked with the FINMONICA acute myocardial infarction (AMI) register for the years 1983–1990. The frequency of errors in the HDR was assessed separately. Between 8% and 13% of hospitalized AMI events registered in the AMI Register were not found in the HDR with an ICD code for CHD. Problems with the register linkage and the use of some ICD code other than one of the codes for CHD explained these missing events. The frequency of errors in the personal identification number was about 5% in the early 1980s. After 1986 errors were found only occasionally. The diagnosis recorded in the HDR was the same as that in the discharge sheet in about 95% of hospitalizations. The positive predictive value of the ICD code 410 (AMI), compared with the FINMONICA definite+possible AMI category, was very high and stable, about 90% in all areas and all hospitals, but it sensitivity varied from 50% at local hospitals to 80% at central hospitals. In summary, data on CHD obtained from the Finnish hospital discharge register give, on average, a correct picture on changes in the occurrence of AMI in Finland and can, with necessary caution, be used in epidemiological studies and health services research. However, the classification of individual cases is not standardized in the HDR, but varies over time, between geographical areas and the levels of care. Therefore, these data should not be used without confirmation in studies where correct classification of individual outcomes is of crucial importance, such as follow-up studies and case-control studies.     

Age of onset and type of diabetes

The age of onset and the clinical type of diabetes mellitus were evaluated on the basis of a cross-sectional study of medical records of 14 municipal health centers in East Finland. Altogether 281 patients were classified as having insulin-dependent (IDDM) and 2713 as having non-insulin-dependent (NIDDM) diabetes. Nearly all patients diagnosed before the age of 19 had IDDM, but a large proportion (37%) of all diagnoses of IDDM were made after that age. Six percent of all diabetic subjects in the age group 15-19 yr were classified as NIDDM and the proportion increased rapidly in older age groups. Half of the patients with NIDDM were diagnosed over the age of 64.     

Depression after coronary heart disease events

OBJECTIVE: To study the prevalence of depression at least 6 months after various coronary heart disease (CHD) events (bypass grafting, coronary angioplasty, myocardial infarction, myocardial ischaemia without infarction) and the associations between depression and clinical variables. DESIGN: In the course of the study 414 (284 males, 130 females) patients younger than 71 years (mean age for men 60.9 years and for women 63.6 years) were interviewed and examined. Smoking habits, body mass index, lipid levels and diabetic status were recorded. The New York Heart Association (NYHA) class was assessed. Depression was screened using a self-rated depression scale. RESULTS: In the four diagnostic categories, one-sixth of the patients (14-19%) suffered from depression. Depression was associated with smoking (OR 1.7, 95% CI 1.2; 2.4) and poor NYHA class (OR 1.9, 95% CI 1.4; 2.6). CONCLUSION: Depression is common after CHD events, and is associated with smoking and poor NYHA class. The identification and treatment of depression should be one of the elements in the rehabilitation of cardiac patients.     

Preventive cardiology: a progress report

The progress to the current era of preventive cardiology covers a period of more than 40 years, beginning with epidemiological studies on coronary heart disease and other forms of atherosclerotic disease and related factors and progressing through prevention trials and community demonstration projects to the actual implementation of preventive measures by combined population and high-risk strategies. The scientists of the United States have played a leading role in the data collection which forms the scientific basis for preventive cardiology and the fruitful collaboration in the United States between the scientists and governmental, as well as nongovernmental, organizations in the implementation of preventive cardiology has served as a good example for other countries. The Section on Epidemiology and Prevention of the International Society and Federation of Cardiology and the Cardiovascular Diseases Unit of the World Health Organization, working in close liaison, have had key roles in the worldwide promotion of preventive cardiology. The rapid progress in preventive cardiology during the past 4 years, since the 1st International Conference of Preventive Cardiology, has been dominated by a "snowballing" movement toward more intensive application of cholesterol-lowering measures at both the population and the individual level. Promising progress has also been made in the field of nonpharmacological control of elevated blood pressure.