摘要:

SUMMARY1.The aim of this study was to evaluate the utility of measurement of left ventricular function in assessing the efficacy of thrombolytic agents.2.All published studies were reviewed.3.The major effect of the introduction of thrombolytic therapy on mortality after myocardial infarction has been a dramatic decrease in the number of patients dying from cardiac failure. In the thrombolytic era, left ventricular function has remained the most important prognostic factor after recovery from acute myocardial infarction. There are three trials with the statistical power to evaluate left ventricular function, where both left ventricular function and survival were improved compared to placebo or control treatment. The recent Global Utility of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) Trial supports these findings, with left ventricular function being strongly correlated with mortality reduction. Left ventricular function, measured at 90 min either as ejection fraction, end‐systolic volume or infarct zone contractility, closely correlated with 30 day mortality,P<0.01.4. Left ventricular function remains an important factor in the evaluation of the efficacy of different thrombolytic and adjuvant regimen

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb01975.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. Salt intake is not only known to play an important role in determining blood pressure (BP) but has been shown to have other deleterious effects independent of BP.2. Epidemiological and animal studies have provided evidence that salt intake may have an adverse effect on stroke mortality independent of BP.3. Significant correlation between sodium excretion (as a measure of salt intake) and left ventricular (LV) hypertrophy has been shown in many clinical studies. Salt restriction has also been found to produce a significant reduction in LV mass.4. In animal studies, salt restriction in uninephrectomized spontaneously hypertensive rats retarded renal glomerular injury and suppressed compensatory growth independent of hypertension. Moreover, a high sodium diet accelerated cerebral arterial disease even when no increases in BP could be detected.5. Epidemiological data have shown an association between asthma mortality and regional purchases of table salt. Furthermore, dietary salt restriction in asthmatic patients results in improvement of symptomatology with lower consumption of bronchodilators.6. Patients with essential hypertension are known to have increased urinary calcium excretion, and hypertension may be one factor that may increase the likelihood of osteoporosis. High salt intake is also associated with increased hydroxyproline excretion indicating increased resorption of bone. Sodium restriction reduces calcium excretion and may reduce bone demineralization and hip fractures in a similar manner to that seen with diuretics.

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb01976.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. Regular alcohol consumption is a significant contributor to the prevalence of hypertension in drinking communities.2. The effect is additive to that of obesity and is partly reversible over 2–4 weeks with moderation of ethanol intake.3. In heavy drinkers acute alcohol withdrawal may lead to more blood pressure elevation following an initial depressor response.4. Heavy drinking is also associated with an increased risk of haemorrhagic stroke and cardiomyopatby.5. Lighter drinking habits appear to offer significant protection against ischaemic heart deaths and ischaemic strokes.6. Antihypertensive drug treatment for alcohol related hypertension may mask some of the adverse cardiovascular effects of alcohol.7. Arguments as to whether alcohol is a cause of essential hypertension are tautological, given the many reversible lifestyle factors now known to contribute to the rise in blood pressure with agein

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb01977.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. The association between alcohol and hypertension has been recognized for several years.2. However, it remains a paradox that if alcohol does cause hypertension there is little convincing evidence that alcohol is related to the cardiovascular complications of hypertension such as strokes and heart attacks. The relationship between alcohol and strokes remains inconclusive and there is evidence that moderate alcohol consumption may be protective against heart attacks.3. It is possible, therefore, that alcohol does not so much cause hypertension, but rather a rapidly reversible rise in blood pressure which does not cause cardiovascular damage. When managing hypertensive patients, however, relevant counselling can bring about a useful fall in blood pressure.

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb01978.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. Evidence that vegetarian dietary patterns lower blood pressure (BP) comes from both population studies and randomized controlled trials in normotensive and hypertensive subjects.2. The effect has been shown most clearly in those who keep to a strict lacto‐ovo vegetarian diet characterized by a relatively low intake of saturated fat, a high polyunsaturated/saturated fat ratio, and a high intake of fruit, vegetables and other fibre containing products. Randomized controlled dietary trials suggest the effects are independent of dietary sodium, additive to that of calorie restriction, and not due to the absence of meat proteinper se. Indeed, recent population studies suggest an inverse relationship between dietary protein and BP.4. Dietary fats, fibre, potassium, magnesium and calcium do not independently seem to account for the effects. A possible role for complex carbohydrate in conjunction with the other dietary factors has yet to be fully explore

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb01979.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. The ability of the n‐3 fatty acids in fish oil to lower blood pressure has been established. Dietary fish oil supplementation is effective in mild hypertension and, in certain cases, as an adjunct therapy in drug‐treated hypertension. Efficacy may be enhanced by restricting sodium intake.2. The overall benefit of fish oil in hypertension, however, has not yet been fully evaluated. We still need further information on the relative efficacy of individual omega‐3 fatty acids and on additional cardiovascular benefits and possible disadvantages of increasing their consum

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb01980.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. Fat deposition in the arterial intima is fundamental to the atheroma process. Circulating lipoproteins are thought to be the source of much of the deposited fat. The interplay of dietary fat has not been fully clarified.2. Observational studies have furnished evidence of relationships between the different dietary fats and clinical cardiovascular events. In these, total fat and in particular, saturated fat appear culprit. Mono‐unsaturated (MUFA) and polyunsaturated (PUFA) fats have less consistent relationships with cardiovascular disease, though all classes of fatty acid are found in atheroma.3. Comparing the effects on lipoproteins of saturates, mono‐unsaturates and polyunsaturates, they all increase high density lipoproteins (HDL) and reduce triglycerides when substituted isocalorically for carbohydrate. Saturates increase low density lipoproteins (LDL), while PUFA>MIJFA reduce LDL.4. Upon oxidative modification, lipoproteins are more liable to arterial deposition and,in vitroat least, LDL oxidizability is enhanced by enrichment with PUFA.5. Trans‐MUFA have some unique properties in that they somewhat resemble saturates and seem to predispose to coronary disease, quite possibly because of their adverse effects on LDL, HDL and Lp(a) levels.6. ω‐3 fatty acids seem unique among the dietary fats in that they inhibit thrombosis and platelet aggregation, and can lower blood pressure.7. The net effect of these various potential influences of fatty acids on atherogenesisin vivois unclear. It may well be that all fats, with the exception of the ω‐3 class, are detrimental with respect to atherogenesis. Modification of the diet, with particular attention to fat, has been demonstrated to reduce clinical coronary events in several studies. Restriction of all fats, save for that in fish, preferably along with weight reduction, appears desirable in order to effectively reduce cardiovascular d

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb01981.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. Regular aerobic exercise causes cardiovascular, neural, humoral and metabolic changes. Many of these are likely to influence cardiovascular risk and the changes vary according to the level and duration of increased physical activity.2. The case for exercise exerting beneficial effects derives from epidemiological data showing that sedentary subjects have, on average, double the risk of cardiovascular disease of active individuals. Post‐infarct rehabilitation studies are also consistent with a beneficial effect of exercise. Large randomized controlled intervention studies have not been performed.3. These benefits may be due to the effects of regular exercise on risk factors, direct effects on atheromatous vessels, or improvement in survivability in established coronary heart disease by reducing arrythmias or increasing tolerance of ischaemia.4. There are direct effects of regular exercise on blood pressure (BP) and lipid profiles. These occur at different levels of physical activity. Other changes which would be expected to reduce cardiovascular risk include increased insulin sensitivity, reduced sympathetic activity and increased gain of the baro‐receptor‐heart rate reflex and increased arterial compliance.5. In hypertensives these changes may improve outcomes, irrespective of the reduction in BP reported in some randomized controlled intervention st

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb01982.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. Studies in children relating blood lipids to the extent of atherosclerosis at post‐mortem suggest a link between risk factors for cardiovascular disease in childhood and adult life. Tracking of blood pressure (BP) and cholesterol from childhood also supports this association. However, prospective studies have not yet established the outcome in children with increased levels of risk factors.2. In a controlled trial in Perth, Western Australia, involving over 1000 10–12 year old children, fitness was improved by physical activity programmes which were associated with a greater fall in diastolic BP and triceps skinfolds in girls compared with controls. Sugar intake decreased in boys and fat intake fell in girls, mainly affecting participants in home nutrition programmes.3. In higher risk children, identified by cluster analysis, major benefits were associated with the fitness and home nutrition programmes. Physical activity combined with involvement of the family in nutrition education is likely to be the most successful approach to modifying lifestyle in children, including those with higher levels of risk.4. Undernutrition by too rigid restriction of fat intake must be avoided in young children who need calorie‐dense foods. Undernutrition, in itself, may predispose to cardiovascular disease in later life. Programmes should aim to establish a prudent diet appropriate to the age of the child combined with physical activity. As regular activity and a healthy diet in adult life will reduce risks of cardiovascular disease it is likely that childhood education will establish lifestyle habits of potential long‐term

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb01983.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY1. Lifestyle interventions are routinely used in the treatment of cardiovascular risk factors in individual patients but their cost‐effectiveness relative to drug treatment is largely unknown.2. Drug treatment is effective at normalizing risk factors and is known to decrease morbidity and mortality though costs may be high. Lifestyle interventions carry a significant potential to reduce expenditure on drugs, but prospective studies on cost‐effectiveness of lifestyle interventions favour drug treatment.3. According to current evidence, lifestyle intervention in high‐risk patients is not more cost‐effective than drug tr

ISSN:0305-1870    

DOI:10.1111/j.1440-1681.1995.tb01984.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY