Relation of weight change to changes in atherogenic traits: the Framingham Study

Evidence for additional blood pressure correlates in adults 20-56 years old

The offspring of parents belonging to the original Framingham Heart Study cohort, and spouses of these offspring, were examined beginning in 1971. Cardiovascular examinations similar to those performed on the parents in 1952-1953 were given to offspring and their spouses. The mean blood pressure (BP) appeared to be lower in the female offspring-spouses than in the cohort mothers. Comparable multivariate analyses on 3588 offspring and spouses of both sexes, ages 20-49 years, and 1842 parents, ages 30-49 years, confirmed the frequently reported importance of weight, heart rate, alcohol consumption, glucose and hematocrit or hemoglobin as independent positive correlates and smoking as an inverse correlate of botsured variables of total serum proteins and plasma triglycerides added significantly to prediction of BP in both sex groups, and a less striking negative association was found for serum phosphorus. The findings for serum proteins and triglycerides were supported in a separate population of middle-aged twin men. Even with the additional measured variables, only 28-34% of the total BP variance is explained in these populations.

High uric acid as an indicator of cardiovascular disease. Independence from obesity

In three groups of patients, we investigated the hypothesis that body weight is not the factor underlying the relation between hyperuricemia and cardiovascular disease. Among 111 subjects with asymptomatic hyperuricemia followed for 108 months, atherosclerotic heart disease (ASHD) developed in six; their mean was 77.4 kg (172 pounds) compared with 79.7 kg (177 pounds) in the remainder; in 25 of the 111 patients hypertension developed; their mean weight was not significantly higher than that of the remainder. Among 156 patients with established gout followed for 133 months, clinical atherosclerosis developed in 25 after a mean of 95 months; their mean weight was 78.3 kg (174 pounds) contrasted with 79.7 kg (177 pounds) in those 81 of the remaining patients who had a weight recorded with 75 +/- 12 months after their initial attack of gout. Among 1,356 men aaged 60 to 69 years who had their serum uric acid recorded in 1967, subsequent deaths from cardiovascular disease showed a stepwise increase when deaths were arranged according to the serum uric acid levels but not when they were arranged according to body weight. Hyperuricemia thus predicts future cardiovascular disease independently of body weight.

The effects of body weight on serum cholesterol, serum triglycerides, serum urate and systolic blood pressure

The effects of body weight and age on serum cholesterol, serum triglycerides, serum urate and systolic blood pressure were examined in 600 male and 400 female blood donors aged 20 to 49 years. In the men significant correlations with body mass index were found for all four variables in each decade. In the women below 40 only the correlation with blood pressure was significant. In the fifth decade the correlations resembled those in the men, save for triglycerides. After adjusting for weight, age had no independent influence on the prevalence of hypertriglyceridaemia or hypertension in either sex. In men the effect of body weight on the prevalence of hypercholesterolaemia was age dependent. Age influenced hyperuricaemia independently of weight. In women only serum cholesterol was affected by age after allowing for weight. There was marked clustering of high values of the four variables in the heavier men and women and this increased with age. The leanest men and women were remarkably free of high values.

Occupational factors in hypertension in the Nigerian African

In cross-sectional surveys of arterial blood pressure carried out in rural and urban communities in the Bendel State of Nigeria, mean systolic and diastolic pressure was generally higher in urban than in rural subjects but the differences in particular age groups were statistically significant only in some of them. Two sample Student's t tests were carried out to compare the blood pressure of rural labourers, rural clerks, and urban clerks. It is not clear from our findings whether the differences in any particular age group between rural labourers and urban clerks should be attributed to occupation or to area of residence. However, the consistently intermediate values for rural clerks over the different age groups provides strong indirect evidence that both these factors are relevant.

The synergistic effect of weight loss and changes in dietary lipids on the serum cholesterol of obese men with hypercholesterolaemia: implications for prevention of coronary heart disease

The hypolipidaemic effect of a low-fat, low-cholesterol diet, alone and in combination with weight reduction, has been evaluated in two groups of obese men with hypercholesterolaemia. In 41 men who lost 10.3 kg over 11 months and maintained their lower weight for 23.5 months serum cholesterol fell by 1.68 mmol/l and remained steady at lower weight. In 20 similar men, the controls, whose weight fell by 0.8 kg over 39.5 months, serum cholesterol fell by 0.80 mmol/l. There was a significant linear correlation between change in weight and change in serum cholesterol. The change in serum cholesterol in the weight losers was greater than could be accounted for by change in dietary lipids. Weight reduction and low-fat, low-cholesterol diets appear to have a synergistic effect in reducing serum cholesterol.

Changes in plasma lipoproteins accompanying diet therapy in obese diabetics

Plasma lipoprotein cholesterol and triglyceride levels were measured in 24 obese not-insulin dependent Pima Indian diabetics and 9 obese nondiabetic controls before and after 1-8 months on a 500 calorie diet. The diabetics were divided into 3 groups--severe, recent onset (n = 10), severe long-term (n = 6), and borderline (n = 8). The diet regimen resulted in weight loss and improved glucose tolerance in all of the diabetics, and insulin secretion increased in the 2 groups of severe diabetics. After the period of weight loss, total plasma cholesterol had declined greater than 20%, and LDL cholesterol decreased 25% in all diabetic groups and in the controls. In all diabetic groups, HDL cholesterol did not decline; therefore the ratio of HDL/LDL cholesterol after diet therapy was significantly increased. In the controls HDL cholesterol declined with weight loss, and the distribution of HDL/LDL cholesterol remained constant. Plasma and VLDL triglyceride levels decreased in all groups in those with initial triglyceride levels greater than 150 mg/dl. The results indicate that weight loss in not-insulin dependent diabetics not only improves glucose tolerance, but also lowerss plasma lipids and reverses the dyslipoproteinemia often associated with this disorder. This may influence the risk of arteriosclerotic heart disease in these individuals.

[Weight changes and risk factors during a 10-year period. Observations on subjects in the Basel study]

The change in body mass index (MI) over a 10 year period was compared to different risk factors for cardiovascular disease in 1663 men (aged 15-64) of the Basle Study. Blood pressure and betalipoproteins correlated significantly (alpha less than 0,01) with changes in MI as well as triglycerides (alpha less than 0,05). No correlation was observed between MI and cholesterol or smoking habits. Our results confirme that the age dependent increase in blood pressure, beta-lipoproteins and triglycerides is largely due to the increment of obesity in the adult.

Serum lipid concentrations and blood pressure in obese women

In 70 obese women no correlation was found between body weight and serum cholesterol or triglyceride concentrations, but there was a significant correlation between weight and blood pressure. Weight reduction by diet or jejunoileal shunt was not accompanied by any significant change in serum lipid concentrations other than the decrease in serum cholesterol expected after intestinal bypass. Twelve months after bypass surgery was carried out on 14 patients, however, both systolic and diastolic blood pressures were significantly reduced and at levels appropriate to the patients' new weights. These results suggest that obesity in women cannot be taken to indicate the presence of hyperlipidaemia and that sustained weight loss may lower blood pressure.

Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: the Manitoba Study

The role of overweight as a risk factor for ischemic heart disease remains controversial. Therefore, in the Manitoba Study of a cohort of 3,983 men with a mean age at entry of 30.8 years, initial measurements of body weight, represented by body mass index (weight/height2), were compared with the 26 year incidence of ischemic heart disease. After adjustment for the effects of age and blood pressure in univariate and multivariate analysis, body mass index was a significant predictor of the 390 cases of ischemic heart disease. To elucidate this relation further, the cohort was further analyzed after categorization by age at entry, time of occurrence of disease after entry and manifestation of ischemic heart disease. The association with weight was most apparent in men less than 40 years of age and was not evident until 16 years of follow-up. A high body mass index was significantly associated with development of myocardial infarction, sudden death and coronary insufficiency or suspected myocardial infarction; the relation was strongest with sudden death. Among men who had a myocardial infarction, body mass index was more strongly associated with sudden death and was the best predictor of myocardial infarction occurring after 20 years of observation. Thus, after adjustment for the effect of age and blood pressure, overweight is a definite risk factor but primarily in younger men, after long periods of observation and for certain manifestations of ischemic heart disease.

Preventive cardiology. What should the clinician be doing about it?

Candidates for a major cardiovascular event can be identified by ordinary office procedures and simple laboratory tests, and the degree of risk estimated. There are compelling reasons to believe that much is to be gained by lowering risk through preventive measures advocated for atherosclerotic cardiovascular disease.

Body fat: its relationship to coronary heart disease, blood pressure, lipids and other risk factors measured in a large male population

Obesity is variably considered to be a major contributor to hypertension and hyperlipidemia, and its treatment is recommended in the management of coronary heart disease. Total body fat was measured by tritium dilution in a large male population and its relationship to age, blood pressure, serum lipids, uric acid and the diagnoses of coronary heart disease, hypertension and glucose intolerance was examined. In addition, three commonly used weight: height indices of obesity were correlated with each of these parameters. The correlation of body fat with blood pressure, serum cholesterol and triglycerides, although statistically significant, was of only small magnitude. Mean levels of body fat were not significantly different between patients with coronary disease and control subjects, whereas serum cholesterol and, to a lesser extent, systolic blood pressure were potent risk factors for the disease. It is concluded that obesity is only a minor determinant of blood pressure and lipid level, and that its contribution to coronary heart disease is small or nonexistent.