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Biomedical subjects

S Heyden

Publications and source records attributed to S Heyden.

At least 37 records · Page 2Linked to original sources
PubMed1988

Status of patients seven years after completion of the hypertension detection and follow-up program in Evans County, Georgia.

The Evans County, Georgia, cohort of the Hypertension Detection and Follow-up Program (HDFP) was reexamined seven years after termination of the trial in 1979. Of the 510 survivors, 91 percent of the black and 91 percent of the white hypertensive subjects were evaluated by blood pressure (BP) levels, electrocardiograms (ECG), height-weight measurements, and questionnaire. The HDFP had treated a randomly selected half of the patients in an intensive stepped care (SC) program and the other half was referred to usual care (RC). At the beginning of the five-year trial, diastolic blood pressure (DBP) levels were higher in blacks in both SC and RC. At the completion of the trial in 1979, black women had mean DBP levels comparable to whites in both SC and RC, but black men displayed higher levels. During the five years of the trial there were no cases of left ventricular hypertrophy (LVH) in SC in either race. In RC the incidence of LVH was slightly higher in blacks than in whites. During the seven-year post-trial period, the incidence of LVH in blacks rose to 13 percent, more than double that of whites. Medication compliance was reduced in black men during this time, most likely because of removal of the supporting elements of HDFP (frequent medical contacts, free medication).In both races, hypertensive subjects underwent weight changes during the seven years of the post-trial period. Weight loss of 15 lb was associated with normotension. Weight gain of 9 to 10 lb over seven years was associated with hypertensive BP levels.The supportive or detrimental effect of weight loss or weight gain on BP levels was thus reconfirmed in this biracial cohort.

Adult↗
PubMed1987

Failure to reduce cholesterol as explanation for the limited efficacy of antihypertensive treatment in the reduction of CHD. Examination of the evidence from six hypertension intervention trials.

Over the past 6 years, major hypertension intervention studies in Europe, Australia, and the USA have shown disappointing results in the prevention of coronary heart disease (CHD) in spite of adequate treatment and good compliance. Recently, it has become increasingly clear that hypertensives with or without treatment display higher cholesterol levels than normotensive persons. The present review examines cholesterol levels in six intervention studies, none of which offered dietary or drug therapy for hypercholesterolemic patients. The Oslo study and the British MRC Trial reported very high average cholesterol levels and both showed no protection from CHD through intensive therapy in comparison to control patients. The Australian and the American MRFIT studies produced evidence for reduced coronary mortality among hypertensives with low in contrast to those with high cholesterol levels. The European Working Party showed indirectly that patients with marked reduction in blood pressure and cholesterol had a significantly lower cardiac mortality compared to placebo-treated patients. The IPPPSH study found that increasing cholesterol levels in hypertensives under beta blocker or diuretic therapy increased the risk of myocardial infarction. Failure to reduce cholesterol in hypertensive patients apparently is a major reason for the limited efficacy of antihypertensive treatment in the reduction of CHD.

Antihypertensive Agents↗
PubMed1987

Coffee and cholesterol in epidemiological and experimental studies.

Twenty-two cross-sectional studies involving 130,000 persons from 8 different countries have reported their findings on the association between coffee consumption and cholesterol levels. Results of these reports display a variety of trends in the association between coffee intake and serum cholesterol concentrations: 8 (36%) studies demonstrated a significant positive association in both sexes, and 5 (23%) studies showed no association in men or women. In 3 other reports where both sexes were included, significant positive association was observed only in women. The remaining 6 investigations examined only men with 4 (18%) reporting a significant correlation between coffee and cholesterol. This unexplained incongruity of cross-sectional data points to a relationship between coffee and cholesterol in some populations, which needs to be further explored. In addition, HDL cholesterol levels appeared unrelated to coffee intake in the 11 studies in which it was measured. The 7 available human experiments showed the same low level of agreement in the results among small numbers of volunteers. Experiments involving different brewing methods suggest that a major part of the cholesterol-increasing effect can be explained by different brewing methods. A critical assessment of the published reports leads to the conclusion that the data are insufficient to warrant public health admonitions against coffee drinking, but that it may be of clinical importance in some hypercholesterolemic individuals.

Cholesterol↗
PubMed1987

Lipid and lipoprotein levels of Newfoundland school children.

Serum concentrations of total cholesterol, HDL, LDL, and VLDL cholesterol were measured in 1,033 boys and girls age 8-10 years and 14-16 years who were living in two geographically distinct areas on the East and West coast of Newfoundland. The respondents enrolled to this study were school children attending four schools selected at random from all schools in the area. Ninety percent of the invited students participated in the study. The Newfoundland children had higher total cholesterol levels than those reported for children matched for age, sex and race living in the United States. However, their LDL cholesterol levels were found to be similar to those observed in US samples. It was concluded, therefore, that the higher total cholesterol levels of the Newfoundland children were due to their higher HDL cholesterol levels.

Adolescent↗
PubMed1987

Smoking habits and antihypertensive treatment.

Five hypertension intervention trials (HDFP, MRFIT, Australian National BP Study, IPPPSH, MRC) were analyzed for the effect of smoking on antihypertensive therapy and final outcome in coronary and all-cause mortality. In addition, an observational study of primary screenees for MRFIT was reviewed. Thus, the hypertensive population evaluated in this paper amounts to 135,851 patients. HDFP revealed that smokers had about twice the mortality rates compared to nonsmokers regardless of the treatment group to which they were randomized. The annual incidence of events in the Australian Study among nonsmokers in the placebo group was even lightly lower than in smokers under active therapy. The results of the MRFIT showed that smoking had a particularly deleterious impact on those hypertensives whose cholesterol levels were elevated. In this group, the coronary death rates were 10 times higher than in nonsmokers with lower cholesterol levels. Although the treatment with beta-blockers reduced the coronary event rates in the MRC and in IPPPSH, this beneficial effect was absent in smokers. However, in trials in which diuretic treatment is effective in nonsmokers, it is equally effective in smokers.

Adrenergic beta-Antagonists↗
PubMed1987

Failure to reduce cholesterol as explanation for the limited efficacy of antihypertensive treatment in the reduction of coronary heart disease. Evidence from the Hypertension Detection and Follow-up program (1973-1979).

The recent experience of six large trials of antihypertensive therapy has not clearly demonstrated any beneficial effect on the prevention of coronary heart disease (CHD). The data from the HDFP study have been analyzed by three cholesterol strata at baseline. The higher the baseline cholesterol levels, the greater the risk for CHD. In hypertensive patients, the slope of the relationship between cholesterol and CHD event rate was examined. There is indication of an increase of about 6 CHD events per 1,000 patients for each 50 mg/mdl increase in cholesterol (p less than 0.05). This population was further divided into those with major end organ damage (EOD) and those without EOD at baseline. In patients who had no EOD, examination of baseline cholesterol level and 5-year CHD death rates indicates a similar relationship. In contrast, the lack of correlation between baseline cholesterol level and CHD death rates in those hypertensives with EOD, suggests the need to reduce hypercholesterolemia before EOD occurs.

Adult↗
PubMed1986

[Hypercholesterolemia in patients with hypertension and diabetes mellitus. The need for cholesterol control in the prevention of ischemic heart disease].

Between 1980 and 1985, a total of seven hypertension intervention studies were published. The present report reviews the associations between cholesterol levels and their influence on the incidence of coronary heart disease among these hypertensive patients. It can be demonstrated that coronary heart disease in hypertensives may not be reduced even with good blood pressure control as long as cholesterol levels are not normalized. Examples are the Oslo Study, the International Prospective Primary Prevention Study in Hypertension and the British Medical Research Council Study. A low-normal cholesterol level is an essential requirement of successful prevention of coronary heart disease among hypertensive patients. Autopsy studies in diabetics have shown a lack of evidence of coronary heart disease in diabetic patients in Afro-Asian countries in contrast to diabetics in Western industrialized nations, where 40% have died with significant coronary heart disease. Therefore, normalization of cholesterol values in diabetics is a cornerstone of treatment of diabetes mellitus.

Cholesterol↗
PubMed1986

[Therapeutic use of lowering blood pressure, especially in mild hypertension. Results of a hypertension detection and treatment program].

The results of the Hypertension Detection and Follow-up Program (HDFP), one of the largest hypertension intervention trials will be reported. 5,485 hypertensives received systematic antihypertensive drug therapy (stepped care) and 5,455 were referred to community medical therapy (referred care) with less intensive treatment. In contrast to other hypertension intervention studies, HDFP did not have any exclusion criteria. The results of the HDFP confirmed that intensive antihypertensive therapy can significantly lower the five-year mortality from all causes of all hypertensive patients. This is also true for the range of mild hypertension (diastolic blood pressure (DBP) 90-104 mm Hg): reduction in all cause mortality by 20.3%. A reduction of the average DBP in this mild range to 83.4 mm Hg was achieved, which is much lower than 90 mm Hg, usually recommended. The reduction of mortality included a decrease of the stroke and myocardial infarction rate, which reached nearly 50% among mild hypertensives of the stepped care group in comparison to the referred care group. Incidences of nonfatal stroke, myocardial infarction, angina pectoris und left ventricular hypertrophy could also be lowered. The best results were achieved if therapy was started early, before end-organ-damage was present. On the other hand, antihypertensive therapy was of benefit in patients with end-organ-damage and in the elderly. The noncardiovascular mortality was also reduced, which was due to improvement of cardiac reserve under antihypertensive therapy. The side effects of drug treatment have been within the known range and did not negate the therapeutic benefit.

Adult↗
PubMed1986

Coffee consumption and fibrocystic breasts: an unlikely association.

Caffeine and other methylxanthines have recently come under scrutiny as substances that may cause breast tissue to undergo fibrocystic changes. The authors present a retrospective 5-year study of 358 women with fibrocystic breast disease and a 6-month prospective study of 72 women with this condition. Although methylxanthine consumption was constant, the clinical findings in semiannual or monthly examinations in both studies were inconsistent. On the basis of their results and a review of available studies, the authors believe there is no scientific basis for an association between the consumption of methylxanthines and the development of fibrocystic breast disease.

Adult↗
PubMed1985

The relationship of weight change to changes in blood pressure, serum uric acid, cholesterol and glucose in the treatment of hypertension.

In the Hypertension Detection and Follow-up Program (HDFP), elevated blood pressure (BP) was treated by rigorous, stepped care (SC) therapy among half the participants, while the other half were referred to usual sources of care (referred care, RC). There was no program to reduce weight, however, some participants changed weight voluntarily over the first 2 yr, providing an opportunity to examine the role of weight change in the development of diuretic-induced hyperuricemia, hyperglycemia and hypercholesterolemia. There was a stepwise progression from decreased glucose, uric acid and cholesterol concentrations, and BP associated with maximum weight loss to increased values with maximum weight gain. In SC, systolic BP declined by 22.4% among weight-losers and by 17.1% among weight-gainers; in RC, it was 14.4 and 8.1%, respectively. The pattern in diastolic blood pressure and weight change was similar but not as marked. These findings suggest the potential importance of weight loss in enhancing effectiveness of antihypertensive drug treatment and attenuating increases in glucose, uric acid, and cholesterol associated with diuretic treatment of hypertension. The weight change analyses are based on postrandomization observations and do not reflect experimental changes.

Blood Glucose↗
PubMed1985

Prevention of fatal and nonfatal ischemic heart disease by early treatment of hypertension.

Between 1979 and 1984 two major hypertension intervention studies involving 14,000 patients have demonstrated convincing evidence for the effectiveness of blood pressure reduction on both primary and secondary prevention of ischemic heart disease. Previous treatment trials using insufficient numbers and shorter observation periods had produced inconclusive results as far as coronary heart disease is concerned. More recently, warnings have been voiced that untoward effects of diuretics on serum lipids might possibly harm the hypertensive patient because of transient slight increases of cholesterol levels. In this regard, two antihypertensive treatment studies, one lasting 5 years and the other 6 years, are reassuring as they provide unequivocal proof that there is no undesirable increase in lipid levels. The myocardium and its coronary arteries today appear as the major target organ among patients with untreated hypertension. 'Mild' blood pressure elevation is very frequent and, since poorly controlled hypertension was shown to contribute the largest number of cases of fatal and nonfatal ischemic heart disease, it is recommended that the present conservative therapeutic approach toward 'mild' hypertension should be re-evaluated.

Adult↗
PubMed1984

Ischemic heart disease risk factors and twenty-year mortality in middle-age Evans County black males.

Ischemic heart disease (IHD) risk factors and 20-year mortality rates were studied in middle-aged Evans County black males. We hypothesized, a priori, that blood pressure, cholesterol, and smoking would be predictive of mortality in black males; that black-white differences in mortality would be due to differences in risk factor levels and not risk functions per se; and that social status would be associated with risk factor levels and would be a predictor of mortality. Multivariate analyses of cumulative risk of dying and time to death suggest that the major IHD risk factors are predictors of all-cause and IHD mortality in black males. Black-white differences in risk functions, specifically for cholesterol, were explained by social status: black males and lower social status white males had similar risk functions, different from those of higher social status white males. Black males and lower social status white males had almost identical survival curves, each less favorable than those of higher social status white males.

Adult↗
PubMed1984

Black-white differences in plasma levels of apolipoproteins: the Evans County Heart Study.

Evans County black males had lower ischemic heart disease (IHD) prevalence, incidence, and mortality than white males. High-density lipoprotein (HDL) cholesterol was lower in IHD cases than in subjects without IHD. HDL cholesterol and apolipoprotein A-I (Apo A-I) were higher and low-density lipoprotein (LDL) cholesterol, very low-density lipoprotein (VLDL) cholesterol, and Apo C-II were lower in black than white males. Of the black-white male HDL cholesterol difference, 22% was statistically explained by Apo A-I. Controlling for Apo C-II reduced the black-white differences in total cholesterol 87%, LDL cholesterol 44%, VLDL cholesterol 83%, and total triglyceride 83%. There were negative associations between Apo A-I and age, Quetelet index, and cigarettes smoked; the association between Apo A-I and alcohol was positive. Only body mass index and race were strong correlates of Apo C-II. The ratios of Apo A-I to Apo A-II and of HDL cholesterol to Apo A-II were higher in black than white males with adjustment for age, body mass, and cigarette and alcohol consumption. Thus black-white differences in total lipids, lipoprotein lipids, and lipoprotein apoproteins were observed, indicating a relatively antiatherogenic profile in black males only partially explained by known correlates.

Adult↗