[Coronary diseases, causes, treatment, rehabilitation. Current status of our knowledge].
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Biomedical subjects
Publications and source records attributed to M Kornitzer.
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Belgians have been gradually shifting from a low ratio of polyunsaturated/saturated fat in their food to a higher one with lower total fat and cholesterol. This has occurred predominantly in the north, where the most obvious change is a decrease in butter consumption and an increase in margarine consumption. The northerners have a four to five times smaller intake of butter than the southerners and nearly double the intake of margarine. Evidence gathered over the past ten years reveals in the north a decreasing serum-cholesterol and in the south a significantly higher serum-cholesterol, associated with higher coronary morbidity and mortality. Life expectancy of males in the north is 2-4 years higher at birth and 2-2 years higher at the age of 30. It is concluded that the food habits of a population can be changed, with great benefit.
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A study during a five-year period has been conducted on the incidence of ischaemic heart disease (IHD) among two cohorts of Belgian employees who were free of IHD at entry. As regards the final outcome these incidences differ significantly. The chief difference between the two cohorts is their systolic blood pressure. These pressure differences may be attributed to differences in the level of work pressure. The increased work pressure in Cohort I might account, through stress, for the greater incidence of sudden death or myocardial infarction.
Various sociological and biological parameters have been studied in a population of 420 subjects - 335 men and 85 women - living in a semi rural country and having presented a myocardial infarct. Our study shows big differences in epidemiology between men and women: 1. The age of women is on an average seven years older than men (63 years against 56). 2. The women's average rate of cholesterol oversteps men's rate by 21 mg% (291 mg % against 271). 3. The blood pressure, systolic and diastolic, is distinctly higher by women (mean 171/97) tan by men (148/98). Amid women, 63% have a S.B.P. equal to or higher than 160 mm Hg against 23% by men and 56% have a D.B.P. equal to or higher than 100 mm Hg against 21 % by men. 4. Hyperglycemia is more frequent among women; man rate: 103 mg % against 88 mg % by men; 17 % of the women have an equal to or higher rate than 110 mg % (8 % among men). 5. Obesity, expressed by a weight index, equal to or higher than 120, is found in 76 % of the women and 34 % of the men. The mean index is 123 by the women and 115 by the men. 6. Cigarette smoking is far more important by men: 65 % of the men smoke at least 15 cigarettes a day with smoke inhalation. This factor is practically not met by women. The smokers get their myocardial infarct at a significantly lower age than no smoking men and women. The women of our infarct population have thus an age, a cholesterol rate, a blood pressure and a glycemia higher than men of the same population; they are more frequently overweight but they don't smoke. Consequently, metabolic agents seem to play an essential part in coronary risk in women.
The authors study the long-term prognosis of a population of male subjects having survived 24 to 48 hours to their first myocardial infarction. The mean annual mortality is 6%. The long-term cumulated survival is particualarly influenced by a high blood pressure and by heart failure occurring during the acute episode and in a lesser proportion by age; the prognosis at long-term is not or little influenced by family history, cholesterolemia, cigarette smoking or the presence of angina before infarction. The presence or absence of heart failure and high blood pressure allows to make sub-groups with very different long-term prognosis. In the framework of secondary prevention of ischaemic heart diseases, the authors propose to start a controlled study implying both a programme of physical activity and a long-term energical treatment of arterial hypertension.
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