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Biomedical subjects

S Heyden

Publications and source records attributed to S Heyden.

At least 19 recordsLinked to original sources
PubMed1991

Reduction of atherogenic risk factors by short-term weight reduction. Evidence of the efficacy of National Cholesterol Education Program guidelines for the obese.

Five hundred and ninety-nine overweight patients participated for at least 4 weeks in the weight reducing and physical activity promoting Diet and Fitness Center program at Duke University. Twenty-three percent were diabetic and 49% hypertensive. With only modest weight loss (11.8 kg in males and 8.2 kg in females) abnormal levels of blood pressure, fasting blood sugar, total cholesterol, LDL-cholesterol and triglycerides normalized. It was very rewarding to see these results achieved in a very limited period of time. Improvements in the lipid profile were consistent with the predicted outcome of obesity treatment stated by the National Cholesterol Education Program guidelines.

Adult↗
PubMed1991

Effectiveness of education-screening on cholesterol levels of students.

Increases of cholesterol levels from the age of 16 years have been demonstrated in community-based studies. Cholesterol education to students aged 15-17 years in 5 high schools was presented prior to cholesterol screening with the Reflotron. First screening took place in March 1987. An identical program was repeated 11 months later, again followed by screening in March 1988. Of the 5 schools, 2 were assigned to involve teachers. There was a significant cholesterol reduction in these 2 schools, i.e., -17 and -19 mg/dl (p less than 0.05). The effectiveness of the physicians' education and the compliance of the students with the teachers' recommendations certainly must have been enhanced by a different family environment with a higher socioeconomic stratum prevailing in these 2 high schools. However, these factors did not influence the baseline in all 5 schools. In the 3 remaining schools no increases in cholesterol levels expected for this age were observed.

Adolescent↗
PubMed1990

Obesity and hypertension: epidemiological aspects of the relationship.

A large proportion of hypertensive men and women in Europe and North America are overweight. In obesity, the expanded blood volume increases cardiopulmonary volume, cardiac filling, left ventricular preload, stroke volume and, thereby, left ventricular work. Given enough exposure time, it is probable that all obese persons in the Western hemisphere would become hypertensive unless they succumb to competing causes of death. A postulated causal role of obesity in hypertension is based on epidemiological observations. In prospective studies weight gainers in adolescence are more often hypertensive than weight stable individuals. In the lower socio-economic strata of industrialized countries there is a higher prevalence of obesity and hypertension. Persons with high body weight show the greatest rise of BP with age. More relevant demonstration of a causal relationship is weight reduction in hypertensive patients. The evidence from a variety of sources, a) risk factor reduction and enhanced BP reduction in the Hypertension Detection and Follow-up Program patients on antihypertensive medication who experienced modest weight loss, b) clinical observations of formerly obese hypertensives who can forego BP lowering drugs, and c) the reversibility of haemodynamic change found in many overweight hypertensive patients after losing 10 kg, strongly suggests that the impact of obesity on hypertension is considerable.

Adult↗
PubMed1989

Effects of fish oil capsules in two dosages on blood pressure, platelet functions, haemorheological and clinical chemistry parameters in apparently healthy subjects.

The effects of a fish oil concentrate with an omega-3 fatty acid content of 42% was determined in two dosages in a double-blind, placebo-controlled study with a parallel group comparison over a period of 5 weeks with 30 healthy subjects. The daily intake chosen was four and eight capsules corresponding to 1.26 or 2.52 g omega-3 fatty acids. Plasma viscosity, erythrocyte rigidity and systolic blood pressure were significantly decreased (p less than 0.01) after a 5-week administration of 2.52 g omega-3 fatty acid daily. The reduction in vitamin E concentration was significant (p less than 0.01) only in the low-dose fish oil group. Lipids and lipoproteins remained unchanged throughout this experiment.

Adult↗
PubMed1988

Mortality patterns among hypertensives by reported level of caffeine consumption.

The effect of caffeine consumption on mortality was evaluated in a historical cohort study of 10,064 diagnosed hypertensive individuals participating in the Hypertension Detection and Follow-up Program from 1973 to 1979. Total caffeine intake level from beverages (coffee and tea) and certain medications, was estimated at the 1-year visit. No evidence was found supporting an association between increased level of caffeine consumption and increased all-cause mortality or cardiovascular disease mortality during the following 4 years. Cigarette smoking was significantly associated with mortality; the association being more pronounced among non- and low-caffeine consumers for all-cause mortality and among non-caffeine consumers for all cardiovascular mortality except cerebrovascular mortality.

Adult↗
PubMed1988

Coronary heart disease in hypertensives: a need to reduce cholesterol.

Ten international long-term hypertension intervention trials between 1980 and 1987 have resulted in significant reduction in the incidence of stroke in the treatment groups. Yet, eight of these studies have shown disappointing results in the prevention of coronary heart disease (CHD). Five hypertension intervention trials revealed high average cholesterol values at baseline. No cholesterol treatment was provided and the incidence of CHD was high. In four other trials with stratification into 'low' and 'high' baseline cholesterol levels, the incidence of CHD was considerably less in the 'low' cholesterol groups. Only the 10th, the Gothenburg trial, has demonstrated a marked reduction in CHD by combining antihypertensive medication with cholesterol lowering treatment. Failure to reduce cholesterol in hypertensives with hypercholesterolaemia may be one explanation for the limited efficacy of antihypertensive treatment in the reduction of CHD. We postulate that successful treatment of hypercholesterolaemia will reduce the incidence of CHD in well-controlled hypertensive patients to the same extent as it lowers the incidence of CHD in normotensive people.

Cholesterol↗
PubMed1988

Reflotron cholesterol measurement evaluated as a screening technique.

We evaluated the analytical performance of Boehringer Mannheim Diagnostics' "Reflotron" analyzer for the measurement of cholesterol. Coefficients of variation (CVs) for whole-blood cholesterol were: within-day 2.0% and 2.2% at 1680 and 2670 mg/L, respectively; between-day 1.8% and 2.4% (n = 9 and 8). Results were similar for serum and heparinized or EDTA-treated single-donor plasma (CV 1.4% to 2.6%). CVs of results for two reconstituted commercial quality-control materials were 3.4% and 4.6%. Heparin and hematocrit were evaluated as interferents, and critical limits for interference were identified for bilirubin, hemoglobin, and triglyceride in blood and plasma or serum. When sample collection and analysis were controlled by trained personnel, results with the Reflotron (y) compared well with those by the Ektachem procedure (x) for both blood and serum samples: r = 0.950, y = 0.944x + 130 mg/L; and r = 0.955, y = 0.93x + 43.5 mg/L, respectively. The same comparability was observed when the analysis was performed by briefly trained high-school students: r = 0.980, y = 0.949x + 23 mg/L. Performance decreased when both collection and analysis were performed by laymen: r = 0.880, y = 0.870x + 186 mg/L.

Autoanalysis↗
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↗