Adipose tissue and platelet fatty acids and coronary heart disease in Scottish men

The relation between coronary heart disease (CHD) and fatty acid composition of adipose tissue and platelets was examined in a random sample of 448 middle-aged Scottish men. The linoleic acid (18:2n6) content in adipose tissue of 28 men with previously unidentified CHD was significantly lower than that in the rest of the group. Platelet linoleic and other fatty acids were not significantly different in men with new CHD. Fatty acid content of adipose tissue reflects long-term dietary intake, and a 7-day weighed dietary record in a random sub-sample of 164 men confirmed that intake of linoleic acid in 10 of the 28 new CHD cases was significantly lower than in the healthy men. In a multiple logistic analysis adipose tissue linoleic acid, age, high density lipoprotein cholesterol, and weight/height index each made an independent contribution to the explanation of new CHD. When all fatty acids were included in a second regression analysis, low concentrations of dihomo-gamma-linolenic (20:3n6) acid in adipose tissue showed a more significant relation with new CHD than did linoleic acid.

Management of hypertension--a study of hospital outpatient practice

In this third report on the management of hypertension by general practitioners and hospital physicians we review hospital outpatient practice in a representative sample of 90 new patients and 436 returning patients attending the clinics of three Edinburgh hospitals. Seventyeight per cent of the new patients were seen by a consultant or senior registrar. An unacceptable number of deficiencies was found in clinical assessment and these are discussed. Consultants are shown to be more conservative than junior hospital doctors in their treatment of hypertension.

Aerobic fitness and emotional arousal: a reply to Jamieson, Evans, and Cox

Jamieson, Evans, and Cox discuss several issues regarding our previous attempt to replicate their work. Three aspects of their reply are addressed as they relate to our research.

The management of hypertension--a survey of opinions among general practitioners

In order to clarify current opinion on aspects of the management of hypertension, a postal questionnaire was sent to all 420 general practitioners in the Lothian Health Board Area. Three hundred and nine doctors (74 per cent) replied.A high proportion were willing to undertake the investigation and follow-up of most hypertensive patients in general practice but there were conflicting opinions on the use of Phase 4 and Phase 5 in the measurement of blood pressure, the number and type of investigations which were appropriate, the level of diastolic blood pressure at which treatment should begin, and the level to which the diastolic blood pressure should be reduced with treatment.

The management of hypertension--a study of records in general practice

We investigated the management of a group of 322 hypertensive patients by 71 general practitioners in the Lothian Health Board Area by a survey of the general practitioners' records. Eighty-five per cent of patients were diagnosed by the general practitioner and 57 per cent were cared for entirely by him. Two thirds of the patients were women. Hospital referral was more common in men and in patients with high initial blood pressures. One third of patients had only one blood pressure recorded before treatment. The result of treatment as measured by the latest diastolic blood pressure was similar for patients treated by the general practitioner and those referred to hospital, being 100 mm Hg or less in 77 per cent of patients.

Palmerston North mice, a new animal model of systemic lupus erythematosus

This report describes a previously unrecognized animal model of SLE, the PN mouse. Although outbred PN mice were studied originally as models of polyarteritis nodosa, their inbred descendants have autoimmune disease which closely resembles SLE. In the current study, positive indirect immunofluorescence tests for ANA appeared when the mice were 5 months old, and 80% of mice were ANA-positive at 10 months of age. Anti-DNA were detected in sera from newborn mice and from 53% of mice under 2 months of age. Seventy-six percent of PN mice developed anti-DNA at the age of 10 months. Glomerular deposits of IgG, IgM, IgA, and complement appeared at 2 to 4 weeks of age, and examination of renal tissue by electron microscopy showed basement membrane thickening and dense intramembranous deposits. Neoplasms arose in 14% of PN mice. Female mice died earlier than male mice, and the most common causes of death were glomerulonephritis and arteritis. It was concluded that the serologic and histologic characteristics of disease in PN mice resembled SLE.

Regional variations in mortality from ischaemic heart and cerebrovascular disease in Britain

In middle-aged men and women, mortality from ischaemic heart disease and cerebrovascular disease is highest in the north and west of Britain. The worst region is West Central Scotland. Statistical analysis using a linear logistic model shows that the differences between the regions are significant and the yearly fluctuation in numbers of deaths contributes little to the overall variation.

Prognosis of new and worsening angina pectoris

The natural history of new and worsening angina pectoris was studied in 251 men aged under 70 years. Most were ambulant and all were referred by selected general practitioners to a special hospital clinic over two and a half years. Heart attacks developed in 39 patients, nine of whom died. Seventy-two per cent of the attacks occurred within six weeks of the onset or worsening of angina. Of the 212 patients who did not suffer myocardial infarction and who were clinically reviewed six months after their first attendance 66 had been pain free for the previous three months and 14 had experienced only infrequent attacks of angina. Of the 128 men aged under 65 years who were previously in employment 81% had returned to full-time work six months after their first attendance. A discriminant function analysis using many variables was made to develop a predictive index that would allow patients with new or worsening angina who were likely to develop serious cardiac complications to be identified. This did not prove possible, and the only predictive factor of significance was an increased cardiothoracic ratio. The syndrome of new and worsening angina has a low risk of early death, and many patients are symptom free six months later. In general, emergency coronary arteriography and surgery is not indicated.

Predisposing factors in sudden cardiac death in Tecumseh, Michigan. A prospective study

In an epidemiologic study of the total population of Tecumseh, Michigan, 98 deaths from coronary heart disease were observed between 1959 and 1965. Forty-five of the fatalities occurred within 1 hour of the onset of symptoms and were classified as sudden. The proportion of sudden deaths among men was nearly twice that among women, and the incidence increased progressively with age in both sexes.

Hypertensive heart disease, coronary heart disease, or diabetes mellitus had been detected on prior examination in 62% of those who died suddenly. Physiologic abnormalities associated with a high risk of coronary heart disease were also found more frequently than in the total Tecumseh population.

All but seven of the persons who died suddenly had abnormalities including arrhythmias and conduction defects which were detected in the standard 12-lead electrocardiogram.

Although sudden deaths often seem to occur without warning, the victims are predisposed by conditions which are detectable long before the catastrophic event. The identification of conditions which are precursors of sudden death from coronary heart disease permits a rational consideration of possible preventive measures.