High-density lipoprotein cholesterol and antihypertensive drugs: the Oslo study.
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Biomedical subjects
Publications and source records attributed to I Hjermann.
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Levels of serum lipids, uric acid and body weight are reported from a controlled trial of drug treatment of middle-aged men with uncomplicated mild hypertension. The results come from 300 men after three years of follow up; 150 men in the treatment group and 150 men in the control group. The treatment has been standardized starting with hydrochlorothiazide alone and adding alpha methyldopa when necessary. In case of side effects, alpha methyldopa was replaced with propranolol. Pretreatment results demonstrated a strong covariation among body weight, uric acid and triglycerides. In the entire treatment group, there was no significant change in triglycerides after three years (increase from 1.85 to 2.02 mM/liter, P greater than 0.05). Cholesterol was also unchanged. Further analysis showed that certain patients reacted with an increase in triglycerides during treatment: those prone to a distinct increase in uric acid and those gaining weight. Those who needed combination therapy (having the highest pretreatment blood pressure) showed most of the increase in triglyceride and uric acid. In the group treated with hydrochlorothiazide alone, the triglycerides were unchanged. However, those selected from this group with a distinct increase in uric acid also showed an increase in triglycerides. The treatment increased the pretreatment positive correlation between uric acid and triglycerides.
The association between serum cholesterol and blood pressure (BP) has been studied in 16 525 men. The study reveals that these Oslo men in their forties present with a serum cholesterol value which is on average 0.71 mmol/l (27.4 mg/100 ml) higher at diastolic BP greater than 110 mmHg than at BP less than 70 mmHg. According to earlier studies in Oslo, this cholesterol difference alone imparts a 10-year myocardial infarction morbidity difference of 25--30%. These findings might be of practical importance for epidemiological studies and for preventive measures against the two factors. The influence of other variables on the association between blood pressure and cholesterol has been studied in a multivariate analysis. Of these variables, only body mass index and serum triglycerides significantly influence the relationship between blood pressure and cholesterol, whereas age, cigarette smoking, non-fasting blood sugar, season, socioeconomic status, and physical activity at work and leisure do not influence the correlation.
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Coronary risk factors (CRF) have been recorded for nearly 15 000 men aged between 40 and 49 living in Oslo in 1972. These data are matched with the 1970 census data for Norway so as to analyse CRF within various occupational groups. A fairly good agreement between mortality statistics for Norway and CRF was found in many occupations. For instance, persons in pedagogical work have low total mortality rates consistent with their low coronary risk factors. Taxi and busdrivers, on the other hand, have been reported to have mortality rates from lung cancer and coronary heart disease consistent with their high smoking prevalence, serum triglycerides, and cholesterol levels.
Coronary heart-disease (C.H.D.) had been reviewed as a "manager's disease". However, deaths from C.H.D. are now said to be more common in groups from the lower social classes than in those of higher socioeconomic status. We have examined wheather these differences in C.H.D. mortality can be explained by differences in the conventional risk factors for C.H.D.
A screening for coronary risk factors in 18 000 Oslo men yielded 16 525 "healthy" men, aged 20-49. The intercorrelation of serum cholesterol, body weight and cigarette smoking was found to be more pronounced than described in other studies. Increasing daily exposure to cigarette smoke in the order: never-smoker, ex-smoker, non-inhaling smoker, inhaling smoker and present non-filter smoker, was parallelled by increasing cholesterol levels, but not by increasing body weight. Daily cigarette-smokers had lower body weight and higher serum cholesterol values than never-cigarette-smokers, with the exception of the 20+ cigarette-smokers who had higher serum cholesterol values and body weight than the never-cigarette-smokers. As regards ex-cigarette-smokers, both body weight and serum cholesterol tended to increase with the number of cigarettes smoked before quitting. Possible explanations of these findings are discussed.
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