PubMed Health⌕ Search

Biomedical subjects

J Cederholm

Publications and source records attributed to J Cederholm.

At least 19 recordsLinked to original sources

Obesity and cardiovascular risk factors in type 2 diabetes: results from the Swedish National Diabetes Register.

OBJECTIVES: To compare obese with normal and overweight type 2 diabetic patients regarding body mass index (BMI) and cardiovascular risk factors, and to analyse changes in weight versus risk factors. DESIGN AND SETTING: A cross-sectional study of 44 042 type 2 patients, and a 6-year prospective study of 4468 type 2 patients. RESULTS: Obese patients (BMI > or = 30 kg m(-2)), 37% of all patients, had high frequencies of hypertension (88%), hyperlipidaemia (81%) and microalbuminuria (29%). Only 11% had blood pressure <130/80 mmHg. Their ratio of triglycerides to HDL cholesterol was considerably elevated, whilst the mean total and LDL cholesterol were similar as in normal weight subjects. Obese patients had elevated odds ratios for hypertension, hyperlipidaemia and microalbuminuria: 2.1, 1.8 and 1.4 in the cross-sectional study, similarly confirmed in the prospective 6-year study. BMI was an independent predictor of these risk factors (P < 0.001), although only slightly associated with HbA1c and not with total or LDL cholesterol. A change in BMI during the prospective study was related to a change in HbA1c in patients treated with diet and oral hypoglycaemic agents (OHAs) but not with insulin. In all patients, an increase in BMI was related to the development of hypertension, and a change in BMI to change in blood pressure, also mostly confirmed when treated with diet, OHAs or insulin. CONCLUSIONS: The high frequencies of risk factors in obese type 2 patients implies an increased risk of cardiovascular disease and the need for therapeutic measures. The paradox that hypoglycaemic treatment accompanied by weight gain may increase cardiovascular risk factors seems to be verified here concerning hypertension but not concerning microalbuminuria.

Aged↗

Microalbuminuria and risk factors in type 1 and type 2 diabetic patients.

A prospective study of normoalbuminuric diabetic patients was performed between 1997 and 2002 on 4097 type 1 and 6513 type 2 diabetic patients from the Swedish National Diabetes Register (NDR); mean study period, 4.6 years. The strongest independent baseline risk factors for the development of microalbuminuria (20-200 microg/min) were elevated HbA(1c) and diabetes duration in both types 1 and 2 diabetic patients. Other risk factors were high BMI, elevated systolic and diastolic BP in type 2 patients, and antihypertensive therapy in type 1 patients. A subsequent larger cross-sectional study in 2002 showed that established microalbuminuria was independently associated with HbA(1c), diabetes duration, systolic BP, BMI, smoking and triglycerides in types 1 and 2 diabetic patients, and also with HDL-cholesterol in type 2 patients. Relatively few types 1 and 2 patients with microalbuminuria achieved treatment targets of HbA(1c) < 6.5% (21-48%), BP < 130/85 mmHg (33-13%), cholesterol < 5 mmol/l (48-46%), triglycerides < 1.7 mmol/l (83-48%) and BMI < 25 kg/m(2) (50-18%), respectively. In conclusion, high HbA(1c), BP and BMI were independent risk factors for the development of microalbuminuria in types 1 and 2 diabetic patients. These risk factors as well as triglycerides, HDL-cholesterol and smoking were independently associated with established microalbuminuria. Treatment targets were achieved by a relatively few patients with microalbuminuria.

Adult↗

The gap between guidelines and reality: Type 2 diabetes in a National Diabetes Register 1996-2003.

Guidelines for the treatment of risk factors in diabetes care have been updated recently, due to indisputable results from clinical end-point trials. This study evaluates risk factor control compared with current national and international targets during the period 1996-2003 in Type 2 diabetes (DM2). Patients were registered in primary-care and hospital outpatient clinics using computer software, or via the Internet. The clinical characteristics of the patients, treatment, HbA(1c), and risk factors were reported after screening by local methods. The numbers of cases of DM2 reported were 17547 in 1996 and 57119 in 2003. The mean HbA(1c) decreased from 7.8 to 7.2%, while blood pressure decreased from 150/82 to 143/78 mmHg during the same period. Longitudinal analysis of results was performed in 5356 patients repeatedly reported, showing slightly lower effects. The new European treatment targets of HbA(1c)< or = 6.1%, blood pressure < 130/80 mmHg and total cholesterol < 4.5 mmol/l were attained by 16, 13 and 28% of the patients in 2003, respectively. The prevalence of the metabolic syndrome in 2003 was 77%. Aspirin was prescribed in 36% of cases. Lipid-lowering, anti-hypertensive drugs, and treatment with oral hypoglycaemic agents in combination with insulin were increasingly employed during the period studied. Risk factor control in DM2 reported to the National Diabetes Register (NDR) is slowly improving, although multiple risk factors and the metabolic syndrome are found in most patients. The majority of subjects do not achieve current target levels for HbA(1c), blood pressure and blood lipids. Thus, giving up smoking and increased use of aspirin are called for, as well as more aggressive treatment of hyperglycaemia, elevated blood pressure and blood lipid levels, in accordance with updated international guidelines.

Administration, Oral↗

Smoking is associated with increased HbA1c values and microalbuminuria in patients with diabetes--data from the National Diabetes Register in Sweden.

OBJECTIVES: The aim was to examine trends in the proportion of smoking in diabetes patients, and to study associations between smoking, glycaemic control, and microalbuminuria. METHODS: Smoking habits were reported to the Swedish National Diabetes Register (NDR), with data from hospitals and primary health care. Patient characteristics included were age, gender, type of treatment, diabetes duration, HbA1c, BMI, blood pressure, antihypertensive and lipid-lowering drugs, and microalbuminuria. RESULTS: The proportion of smokers in type 1 diabetes was 12-15% during 1996-2001, it was high in females<30 years (12-16%), and was higher in the age group 30-59 years (13-17%) than in older (6-9%) patients. The corresponding proportion of smoking in type 2 diabetes was 10-12%, higher in those less than 60 years of age (17-22%) than in older (7-9%) patients. Smoking type 1 and type 2 patients in 2001 had higher mean HbA1c but lower mean BMI values than non-smokers. Smokers also had higher frequencies of microalbuminuria, in both type 1 (18 vs 14%) and type 2 (20% vs 13%) diabetes. Multiple logistic regression analyses disclosed that smoking was independently associated with elevated HbA1c levels (p<0.001) and microalbuminuria (p<0.001), but negatively with BMI (p<0.001), in both type 1 and type 2 diabetes. CONCLUSIONS: Smoking in patients with diabetes was widespread, especially in young female type 1, and in middle-aged type 1 and type 2 diabetes patients, and should be the target for smoking cessation campaigns. Smoking was associated with both poor glycaemic control and microalbuminuria, independently of other study characteristics.

Adult↗

Hypertension in diabetes: trends in clinical control in repeated large-scale national surveys from Sweden.

Hypertension in diabetes is an important and treatable cardiovascular risk factor. Treatment targets from guidelines cannot always be achieved in everyday clinical practice. It is therefore of great importance to monitor trends in hypertension control in defined populations. Patients with type I diabetes (range 6685-10,100; treated hypertension 21-29%) or with type II diabetes (range 15,935-22,605; treated hypertension 47-56%) were included in four national samples between 1996 and 1999. This screening was part of the procedures for the National Diabetes Register in Sweden, which monitors trends in clinical practice and risk factors for patients with diabetes, recruited both in primary health care and at the hospital level. A favourable trend in mean and median blood pressure levels was noticed during the 4-year study period, based either on data from repeated surveys or on repeated measures in the same individual, both for type I diabetes (mean: -2/-2 mmHg; P < 0.01) and for type II diabetes (mean: -5/-3 mmHg; P < 0.001). Correspondingly, the proportion of hypertensive patients in acceptable control of blood pressure (< or =140/85 mmHg) increased (P < 0.001) both in type I diabetes (52.0-57.9%) and in type II diabetes (22.4-33.3%). It was concluded that hypertension is a widespread cardiovascular risk factor in patients with diabetes, especially systolic hypertension. A trend for a better systolic blood pressure control during the late 1990s in hypertensive patients with type II diabetes in Sweden could translate into substantial (estimated) clinical benefits in cardiovascular and diabetes-related morbidity. The National Diabetes Register makes a quality assessment of the hypertension treatment possible.

Adult↗

What causes impaired glucose tolerance to deteriorate or normalize?

Twenty-five middle-aged subjects with impaired glucose tolerance (IGT) were analysed 5 years later, showing normal glucose tolerance in 28% and persistent glucose deterioration in 72%. Body mass index (strongly) and 2-h glucose levels were clinically useful predictors, in the newly detected IGT-subjects, of persistent glucose deterioration (IGT or NIDDM) 5 years later. The frequency of hypertension was 36% in the newly-detected IGT subjects. Five years later this frequency increased to 54% in the persistently hyperglycaemic group, and decreased to none in the normalized group. Predictors of hypertension at the follow-up were baseline blood pressure and parts of the hyperinsulinaemic syndrome, such as serum triglyceride at baseline, BMI and 2-h glucose at the follow-up. Microalbuminuria (greater than 20 mg day-1) was not found at the 5-years follow-up, either if the subjects then had NIDDM, IGT or normal glucose tolerance. ECG abnormalities (ST segment and T wave changes) were two-fold more prevalent in the group with IGT or NIDDM than in the normalized group at the follow-up. Predictors were baseline BMI and incremental BMI. In conclusion, obesity and high 2-h glucose in newly-detected IGT-subjects seemed to predict the persistence of IGT 5 years later. Hypertension, but not microalbuminuria, was frequent when glucose deterioration persisted.

Albuminuria↗

Prevalences of risk factors and angiopathy in diabetic patients in Uppsala.

The prevalences of risk factors and angiopathy were studied in 260 diabetic patients, 100 females and 160 males, 35-54 years old, in Uppsala. The prevalence, in females and males separately, of hypertension (WHO-criteria) was 46-34%, of hypercholesterolaemia (greater than or equal to 6.7 mmol.l-1) 32-29%, and of obesity (relative BMI greater than or equal to 120%) 25-20%. Those smoking greater than 15 cigarettes/day were 11-20%. Mean HbA1 was 10.6-10.5%. The prevalence of angina pectoris was 11-6%, of possible infarction 4-6%, and of major ECG abnormalities 6-4%. Large vessel (cardiovascular) disease was independently related to HbA1 (strongly), hypertension, cholesterol, age and familial NIDDM. The prevalence of severe retinopathy (blindness, new vessels or large hemorrhage) was 0% with 7-13 years of diabetes duration, and 26% with greater than or equal to 14 years of duration. The prevalence of severe proteinuria was 4% with 7-13 years of diabetes duration, and 15% with greater than or equal to 14 years of duration. Small vessel (retinopathy and nephropathy) disease was independently related to diabetes duration (strongly), HbA1 and hypertension. The data were discussed related to data from the London, Berlin and Tokyo centres of the WHO Multinational Study of Vascular Disease in Diabetics, using the same study protocol in the present study.

Adult↗

Pulse pressure, mean blood pressure and impaired glucose tolerance--a study in middle-aged subjects.

In a study of 695 middle-aged subjects, without antihypertensive agents, and without more pronounced obesity, both pulse pressure (PP) and mean blood pressure (MBP) were strongly related to 2-h blood glucose in 75 g OGTTs (p < 0.001). All hypertensives (DBP > or = 90 mm Hg) were separated into 39 with higher PP (> or = 60 mm Hg) and 137 with lower PP (< 60 mm Hg). The high PP hypertensives, compared with the low PP hypertensives and all 519 normotensives, had higher frequency of impaired glucose tolerance (IGT; WHO-criteria), 33%, 6%, and 4%, respectively (p < 0.001), and also higher mean 2-h blood glucose, 5.9, 4.5, and 4.2 mmol.l-1, respectively (p < 0.001). These differences were independent of MBP levels. Similarly, all 54 hypertensives with higher MBP (> or = 110 mm Hg) had more IGT and higher 2-h glucose than the 122 hypertensives with lower MBP (< 110 mm Hg) or the normotensives, 30%, 5% and 4%, respectively (p < 0.001), and 5.8, 4.4, 4.2 mmol.l-1, respectively (p < 0.001), independently of PP. Thus, both high PP and high MBP were related to IGT, independently of each other.

Analysis of Variance↗

Insulin resistance in the oral glucose tolerance test--a link with hypertension.

Insulin resistance was evaluated in 807 middle-aged subjects at a health survey, with use of an index measured in 75 g oral glucose tolerance tests. The mean value of insulin resistance was higher in a hypertensive group than among the normotensives, independent of body mass index, physical activity, smoking sex, age, and thiazide treatment. One-third of the hypertensives had a high resistance value. Another third of the hypertensives, and also about one-third of the normotensives, had a slightly increased resistance. The remaining third of the hypertensives had a normal-low resistance. A high resistance was also independently related to obesity, low physical leisure time activity, and a family history of NIDDM, but not to a family history of hypertension. The statistical analysis implied a sequence of events: low physical activity might cause high resistance, which in turn might cause high blood pressure.

Age Factors↗

Influences of familial and environmental factors on hypertension.

A group of 293 middle-aged subjects with a parental history of hypertension was compared with 210 middle-aged subjects without this history. The adjusted odds ratio for hypertension (WHO-criteria) was 2.0 with parental hypertension - independent of obesity, physical leisure time activity, age and sex. Comparatively in all 503 participants, the independent odds ratio for hypertension was 3.3 with obesity. Analysis of variance in all participants disclosed that blood pressure was independently related to three predictors, parental hypertension (p less than 0.05), body mass index (p less than 0.001), and 2-h blood glucose (p less than 0.001). Additional analysis of variance in all subjects, to estimate if these three predictors were interrelated, disclosed that parental hypertension was not related to either 2-h glucose or body mass index. A clear association was seen between 2-h glucose and body mass index (p less than 0.001). This was underlined in a separate analysis of the 88 hypertensives, among which 25% had impaired glucose tolerance (WHO-criteria). In conclusion, own obesity (environment) had about 1.5 times stronger influence on hypertension than parental hypertension (heredity). Parental hypertension seemed to have a separate influence on the blood pressure. Body mass index and 2-h glucose seemed to have partly separate, and partly interrelated, influences on the blood pressure.

Blood Glucose↗

Familial influence on type 1 (insulin-dependent) diabetes mellitus by relatives with either insulin-treated or type 2 (non-insulin-dependent) diabetes mellitus.

In 161 patients with Type 1 (insulin-dependent) diabetes mellitus, the familial influences by first-degree relatives with insulin-treated diabetes mellitus (ITDM), and by first-degree relatives with Type 2 (non-insulin-dependent) diabetes mellitus were investigated. A control group consisted of 730 subjects with normal glucose tolerance. Independent odds ratios (adjusted for covariates) for Type 1 diabetes in offspring were 7.0 (p < 0.001) with first-degree ITDM relatives, and 2.5 (p < 0.01) with first-degree Type 2 diabetic relatives. When relatives were separated into parents and siblings, odds ratios for Type 1 diabetes in offspring were higher due to paternal ITDM and paternal Type 2 diabetes, than in cases of maternal diabetes. Siblings with ITDM, but not siblings with Type 2 diabetes, also showed increased odds ratios. Thus, both familial ITDM and familial Type 2 diabetes showed influences in separate ways on the presence of Type 1 diabetes in offspring, indicating separate genetic mechanisms.

Analysis of Variance↗

Insulin release and peripheral sensitivity at the oral glucose tolerance test.

With the use of a 75 g oral glucose tolerance test, both insulin release (IRG) and the degree of peripheral sensitivity (SI) were evaluated simultaneously in groups with normal (NGT) and impaired (IGT) glucose tolerance as well as NIDDM. IRG was expressed as the ratio of the area under the insulin curve to that of the glucose curve above fasting levels. The peripheral glucose uptake rate (M) during the OGTT was measured as the difference between the glucose load and the increase in the amount of glucose in the glucose space during the oral glucose tolerance test (OGTT). SI was expressed as the ratio of the metabolic clearance rate (M/mean blood glucose) to log mean serum insulin. In the non-obese groups, both mean IRG and mean SI values were decreased with an increasing degree of hyperglycemia from NGT to NIDDM. Decreased mean SI values were also found in obese subjects. IGT-subjects given 3 months of diet and exercise achieved improved SI values. A non-obese NIDDM-group had higher mean IRG and mean SI values after 6 months of treatment with glipizide. The results were comparable to data obtained with more complicated techniques, such as the insulin clamp and suppression tests, and should be easy to apply on a large scale in epidemiological studies.

Aged↗

The relationship of blood pressure to blood glucose and physical leisure time activity. A study of hypertension in a survey of middle-aged subjects in Uppsala 1981-82.

Hypertension was detected in 56 of 436 women and 34 of 371 men in an urban population sample of 47-54-year-old individuals. The prevalence of glucose intolerance according to WHO criteria was 22.2% in the hypertensive group and 4.3% among the normotensives, with mean 2-hour blood glucose values of 5.8 and 4.4 mmol X 1(-1), respectively. The difference in mean 2-hour blood glucose was independent of body mass index, physical activity during leisure time or at work, age and smoking in covariance analysis. Subjects with high physical leisure time activity (n = 125) had a lower mean blood pressure and a lower prevalence of hypertension, 4.8%, than those with low activity (n = 682), 12.3%. The increase in diastolic blood pressure in the latter group and the male subgroup appeared to be independent of body mass index, physical job activity, age and smoking. Multiple regression analyses with blood pressure as dependent variable and six metabolic and clinical characteristics as predictors identified 2-hour blood glucose and body mass index as the most important predictors. Physical leisure time activity was associated with diastolic blood pressure, however only when 2-hour blood glucose was not included as predictor. Thus, physical activity may exert an influence on the blood pressure level mainly through changes in glucose tolerance and/or body weight, although alternative mechanisms cannot be excluded.

Age Factors↗

The impact of treatment on insulin release and relative peripheral resistance during the oral glucose tolerance test. A study of noninsulin-dependent diabetes mellitus and glucose intolerance.

Using 75 g oral glucose tolerance tests (OGTTs), insulin release and relative peripheral resistance were studied in two groups of subjects before and after treatment; ten mostly obese subjects with glucose intolerance (GI), who had improved glucose tolerance after six months of diet and exercise with weight reduction; nine nonobese patients with noninsulin-dependent diabetes mellitus (NIDDM), who received a daily dose of 5 mg glipizide for three months. Total insulin release was measured as the total area under the insulin curve during the OGTT. The insulin response to glucose was expressed as the ratio of the incremental area under the insulin curve to that of the glucose curve above fasting levels (delta AUCI/delta AUCG), during the first 30 minutes and the latter part of the test. The glucose uptake rate (M) was measured as the difference between the glucose load and the increase of glucose in the glucose space after compared to before the OGTT. The relative peripheral resistance (rel-R) against glucose-uptake-promoting factors was expressed as 1/M. The main effects of therapy in the GI-group appeared to be a decrease of the mean rel-R value and a decrease of the mean total insulin release. This implies a mainly peripheral action of therapy at receptor and/or postreceptor levels. The mean [delta AUCI/delta AUCG]0-30 value was unchanged and the mean [delta AUCI/delta AUCG]30-120 value was only slightly increased at follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗

Glucose intolerance in middle-aged subjects--a cause of hypertension?

At a health survey of 819 middle-aged, 47-54-year-old, males and females in a Swedish urban area with a participation rate of 70%, the prevalence of glucose intolerance (GI) was 6.2%, 51 subjects (7.0% of females and 5.3% of males), as the result of two subsequent 75 g oral glucose tolerance tests according to the WHO criteria. In comparison with normoglycemic subjects from the same health survey, with both fasting and 2-hour glucose values less than 5.0 mmol X l-1, the GI group was characterized by higher mean relative body mass index, higher mean blood pressure and rate of hypertension, higher rate of low-degree physical activity during leisure and had more often a family history of diabetes in first-degree relatives. Smoking was less prevalent in GI subjects. Hypertension was more frequent in obese (relative body mass index (BMI) 120-150%) GI subjects than NGT subjects. Finally, comparison of all GI subjects with all normoglycemic subjects of the survey, with use of analysis of covariance, showed that mean systolic and diastolic blood pressures were higher in GI subjects, independently of age, BMI and also smoking.

Blood Glucose↗

Glucose tolerance and physical activity in a health survey of middle-aged subjects.

Glucose tolerance and reported physical leisure time activity were studied in middle-aged, 47-54 years old, subjects in a health survey. The mean 2-hour blood glucose value after 75 g oral glucose tolerance tests was higher (p less than 0.001) in 682 subjects with a lower degree of leisure time activity than in 125 subjects who were regularly active at least 2-3 hours per week. The mean 2-hour glucose values in the inactive and active groups, respectively, were 4.61 and 4.09 mmol X l-1 after adjustment for the influence of age, body mass index, smoking and physical job activity by analysis of covariance. The difference between adjusted mean 2-hour glucose values was also significant (p less than 0.001) in the subgroups of 280 low leisure time activity males (4.53 mmol X l-1) and 91 active males (3.93 mmol X l-1). Thus, a relation between physical leisure time inactivity and raised post load blood glucose values seems to exist in the general population.

Age Factors↗

Evaluation of insulin release and relative peripheral resistance with use of the oral glucose tolerance test: a study in subjects with normoglycaemia, glucose intolerance and non-insulin-dependent diabetes mellitus.

With use of 75 g oral glucose tolerance tests (OGTTs), insulin release and relative peripheral resistance were evaluated in groups of normoglycaemic subjects, subjects with glucose intolerance (GI) and patients with non-insulin-dependent diabetes mellitus (NIDDM). Insulin release was expressed as the total area under the insulin curve (AUCI) and as the area under the insulin curve above the fasting insulin level (delta AUCI). The insulin response to glucose was expressed as the ratio of the area under the insulin curve to that of the glucose curve above fasting levels (delta AUCI/delta AUCG). The glucose uptake rate during the OGTT (M) was measured as the difference between the glucose load and the increase of the amount of glucose in the glucose space after, compared to before, the OGTT. The relative peripheral resistance against glucose uptake promoting factors (rel-R) was expressed as 1/M. With application of these indices in the non-obese groups, there was an increased mean total insulin release (AUCI, delta AUCI) while the mean insulin response to glucose (delta AUCI/delta AUCG) was decreased in GI-subjects compared with normoglycaemic subjects. The mean relative peripheral resistance (rel-R) was higher in GI-subjects than in normoglycaemics. Mean values of AUCI and delta AUCI were decreased (lower than in the normoglycaemics, NS), mean values of delta AUCI/delta AUCG were further decreased and mean values of rel-R were further increased in the NIDDM-groups compared with the GI-group. Insulin release was delayed in GI and NIDDM. Obese normal and obese GI-subjects with similar rel-R values as the corresponding non-obese normal and non-obese GI-subjects, had higher mean values of insulin release than the non-obese counterparts. Thus, it seemed possible to use a technique in general use, the OGTT, with a partly new approach to simultaneously obtain indices for insulin release and relative peripheral resistance, which may have clinical applicability.

Aged↗

Findings in a health survey of middle-aged subjects in Uppsala 1981-82. Risk factors for diabetes mellitus and cardiovascular disease.

In a health survey in 1981-82 in the city of Uppsala 819 subjects (443 females and 376 males), 47-54 years old, were examined. A 75 g oral glucose tolerance test OGTT was performed in each subject, and fasting and 2-h venous whole blood glucose values were determined. The 2-h value was somewhat higher in females, 4.7 mmol X l-1, than in males, 4.4 mmol X l-1 (p less than 0.01). Known or probable manifest diabetes was present in 1.9% of all subjects. Glucose values within the limits for WHO criteria of glucose intolerance were found in another 7.1% of all subjects after one OGTT. The rates were similar in both sexes. A history of diabetes in first-degree relatives was noted in 13.2% of all subjects. According to a questionnaire, 1.1% of all subjects had had hospital care for myocardial infarction, 4.7% had angina pectoris and 2.4% had intermittent claudication. The rate of subjects on antihypertensive treatment or with untreated high blood pressure greater than or equal to 170/105 mm Hg was 11.2%; of these only 1.8% had untreated high blood pressure. Of the treated subjects, the treatment was adequate in 82.9%. Obesity, defined as relative body mass index greater than or equal to 120%, was found in 34.0% of all subjects, more frequently in females than in males. The rate of smokers was 28.5%. A comparison was made with the results of a similar health survey of about 2 300 middle-aged men in Uppsala in 1970-73. The prevalence of angina pectoris was higher among the men of the present survey than among those of the 1970-73 survey, which may at least partly be due to differences in methodology. Relative body weight was higher, and fewer men were regularly active during leisure for at least 2-3 h per week in the present study. The rates of hypertension were similar, but fewer men had untreated high blood pressure and more men were on antihypertensive treatment in the present study. There was a lower frequency of smokers in this study.

Angina Pectoris↗