Strategies for reducing stroke frequency.
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The purpose of our experiments was to clarify the relationship between the susceptibility to atherosclerosis and chemical composition in the human cerebral, coronary arteries and aorta, and the concentration and composition of human arterial intimal elastic tissues were measured. In the cerebral arteries, the concentration of hot alkali-insoluble elastin was higher than that of the coronary arteries and aortas, and gradually decreased with age. Age-related changes of the elastin in the coronary arteries were quite small. The total polar amino acids and crude ash contents of arterial elastins were affected by age and treatment of elastic tissue wheteher or not EDTA-decalcification was applied prior to alkali-extraction. No significant differences in the amino acid composition of elastin was founded between the cerebral, coronary and aortic intimas and no significant changes to elastin, and or collagen, which can explain the slow development of atherosclerosis in the cerebral artery, were founded. Therefore, from these results, the slower development rate of cerebral atherosclerosis, as compared with other arteries, can not be sufficiently concluded.
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The effect of serum cholesterol on aortic, cerebral, coronary and femoral atherosclerosis as well as on the incidence of cerebral and myocardial infarctions were analyzed in 3,236 consecutive autopsies in the elderly. Serum cholesterol levels declined over the age of 80 in both genders. The cholesterol levels of females were significantly higher than that of males in each age group from the sixties through the nineties. The increase in serum cholesterol was correlated with the progression of coronary atherosclerosis in both genders, but not with cerebral or femoral atherosclerosis. Slight progression of aortic atherosclerosis was observed when serum cholesterol was over 160 mg/dl. Cholesterol induced progression of coronary atherosclerosis was found in cases with hypertension, but not in the normotensive group. In accordance with the progression of coronary atherosclerosis, the incidence of myocardial infarction increased with an elevation of serum cholesterol levels, and this relationship between myocardial infarction and cholesterol levels was found only in patients with hypertension. No correlation was found between the incidence of cerebral infarction and serum cholesterol levels. It was concluded that hypercholesterolemia in the elderly is a risk factor of myocardial infarction in cases with hypertension, but is not a risk factor of cerebral infarction.
Among 535 cases of simple CABG, cerebral infarction was complicated in 5 cases (0.9%). Their mean age (65.2 years old) was high, and 80% of them had the history of hypertension or diabetes mellitus or both. The causes of the cerebral infarction were considered to be the embolism of atheromatous debris from the ascending aorta (3 cases), the cerebral hypoperfusion due to cerebral arterial disease and hypotension during cardiopulmonary bypass (1 cases), and the embolism of the left atrial thrombus formed during repeated supraventricular tachyarrhythmias (1 case). Both cases of the multiple infarctions were lost in-hospital 10 months and 21 months postoperatively. Two of the three cases of single infarction suffered from the permanent neurological deficits. To prevent cerebral infarction which might totally deprive of the efficacy of the CABG, it is important to check and properly manage the atheromatous change of the ascending aorta, the cerebral arterial disease, and also postoperative supraventricular tachyarrhythmias.
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