Relation between coronary-prone behavior pattern, excretion of urinary catecholamines, heart rate, and heart rhythm.
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Biomedical subjects
Publications and source records attributed to M Kornitzer.
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Belgium can be divided in 4 major geographical areas: two Dutch speaking areas in the north (Campine and Flanders), a French speaking area in the south (Wallonia) and the Brussels area in between. Significant differences in mean serum cholesterol levels were observed with the lowest level in Campine, intermediate in Flanders and Brussels, and the highest level in Wallonia. Similar differences were observed in the prevalence of CHD and mortality from CHD is also higher in the French speaking part of the country. A survey of food habits since 1959 shows a higher butter and lower soft margarine consumption in the south. However, differences in smoking habits and personality traits also exist.
Epidemiological information on the prevalence, incidence and natural history of intermittent claudication and peripheral vascular disease is limited, partially by the limitation of techniques of their study. The available data from the literature are review and supplemented by results from an on-going survey the ankle blood pressure measurement with Doppler ultrasound.
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Two methods developed in U.S.A. for measuring the Type A coronary-prone behavior pattern--the Structured Interview and the self-administered Activity Survey, were translated into French and Flemish and utilized in a large preventive cardiology study in Belgium. The distribution of behavior-type judgments made by trained interviewers were compared to similar data from North America and found to be similarly symmetrical but clustering more toward central categories in Belgium. The Activity Survey, when scored by the scoring key developed in California, yielded averages for this Belgian group which appeared to be more in the Type B direction than the California sample, particularly in terms of Job-Involvement and tendencies toward haste and impatience. The Activity Survey scales and Structured Interview judgments showed a strong correspondence, with a 70% agreement observed between the Interview and Type A scores. This comparability between findings in Belgium and U.S.A. suggests that the concept of the Type A behavior pattern has sufficient cross-cultural validity to permit the derivation of reliable measurements and to make feasible the determination of whether Type A behavior is a risk factor for coronary disease internationally.
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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.