589 inpatients who were at the Yokufukai Geriatric Hospital during the 20 year period from January 1962 to December 1981, and whose death causes were confirmed on autopsy were divided into groups according to their glucose tolerance. After comparing their causes of death, we concluded as follows. (1) Independent of glucose tolerance ability, infections accounted for about the half of the death causes, followed by macroangiopathy and cancer. Ischemic heart disease (IHD) was most frequently seen in diabetic persons (type D), its rate being 4.8 times as high as that in normal patients (type N) and 1.6 times as high as that in borderline cases (type B). The rate of cerebral hemorrhage was significantly lower in type D than in type B. (2) The 20 years were divided into two periods: the first ten years and the second ten years. Infections gave rise to the highest mortality in type D during both the first period and the second period. The first period was characterized by the facts that the death rate due to tuberculosis in type D was significantly high (compared with type B), and the death rate due to cerebral hemorrhage in type D was significantly low (compared with type B). In the second period, the mortality due to urinary tract infection in type D was 2.3 times as high as that in type N and 3.3 times as high as that in type B. The mortality due to IHD in type D was 6.2 times as high as that in type N and 1.8 times as high as that in type B. A comparison of death causes between the first and second periods revealed that, in type D, total infections tended to be lower in the second period (although urinary tract infections were nearly 6 times as frequent), and macroangiopathy and cancers tended to be more prevalent. The mean age of death was found to be significantly prolonged in the second ten years: by 2.1 years in type B, and by 4.3 years in type D. (3) The subjects were grouped on the basis of the age at which the glucose tolerance test was carried out: those under 75 years (in the early stage of senescence); and those 75 years or older (in the late stage of senescence). In the early stage of senescence, the mortality due to IHD was significantly higher in type D than types N and B. However, in the late stage of senescence, no prominent difference was noted among the three types. The mortality due to cerebral hemorrhage was lower in type D than in type B in both stages of senescence, significantly so in the later stage. The death rate due to infections was significantly higher in type D than in types N and B, during the late stage of sensecence. In particular, urinary tract infections gave rise to a high mortality rate: 2.3 times that in type N, and approximately twice that in type B. These findings revealed that the death causes of persons having abnormal glucose tolerance in the 1960s differed from those in the 1970s, and that the age of death was significantly prolonged in the 1970s. In light of the evidence that the death causes and the degree of risk for diseases varied according to the age at which glucose tolerance ability became impaired, we suggest that diseases of persons 60 years of age and over should be discussed only after such persons are divided into two groups (demarcated at about 75 years).
In healthy middle-aged persons (60) of both sexes, changes in dietary and other health-index factors were followed up for 8 years 1974-1981. Of these factors were selected arteriosclerosis-risk factors including blood pressure, relative weight, serum total cholestrol levels, β-lipoprotein (β-Lipo), etc, and fibrinogen (Fbg), GOT, GPT, LDH and alkaline phosphatase (Alk-P); the factors were evaluated for changes with age in each person and each sex. 1) Changes with age were observed for the factors: Fbg, LDH, GOT, GPT, relative weight (in both sexes), Alk-P (only in male) and β-Lipo (only in female). 2) Fbg decreased in both males and females with age. The decrease in Fbg with age observed in our study was not consistent with other reports within the age range examined. 3) LDH, GOT, GPT increased in both sexes with age. Thus, we speculated that the phenomena was due to the decrease in functional activity of the liver. Alk-P levels were lowerd in males and β-Lipo levels significantly elevated in females with age, although the changes varied from case to case. Blood pressure and serum total cholesterol levels changed with age in some but not most of the cases. In conclusion, the levels of plasma fibrinogen and liver function tests changed with age, but there was little variation on the risk factors of arteriosclerosis. This seems to be due to the fact the subjects themselves were affected by the long-term survey, by being more concerned about the prevention of gerontological disease and their health.
“Basal blood pressure”defined as the average of multiple readings obtained during a two hour observation at supine rest was compared with a casual blood pressure in middle and old-aged 46 patients (40-78 years) with mild essential hypertension (diastolic blood pressure, 90-104mmHg) in a outpatient setting. After approximately 60 minutes of supine rest, systolic and diastolic blood pressures were reduced to a minimum level. Basal systolic and diastolic blood pressures were significantly less than casual blood pressures by 21.1±12.5 and 12.1±8.6mmHg respectively. Since basal blood pressures in these patients were almost normal, it is indicated that they should be offered close observations and appropriate non-drug therapies at first. Age was not related to the extent of the differences between the casual and basal values in either blood pressures or heart rate. On the other hand, plasma norepinephrine level was significantly higher in the patients who showed a greater extent of the differences between casual and basal blood pressures than those with a less extent of the differences, suggesting that sympathetic nervous activity may be involved in the variability of blood pressure in these patients.
To determine the characteristics of ischemic cerebrovascular diseases in the aged, 429 patients with ischemic neurological deficit, divided into four groups by decades, were studied with regard to clinical signs, CT findings and angiographic findings. Group I (49 years old or less) consisted of 50 patients, group II (50-59 years old) 97 patients, group III (60-69 years old) 161 patients, and group IV (70 years old or more) 121 patients. About half of the patients in each group were hypertensive. Diabetes mellitus was present in 21% of group III while atrial fibrillation occurred in 25% of group IV. The most commonly encountered clinical sign was hemiparesis or hemiplegia, which increased with age from 24% in group I to 39% in group IV. In group I, 40% of the patients did not show abnormal CT findings, while infarction of the basal ganglia and cortical region were seen in 34% and 18% of this group, respectively. Angiographic abnormalities such as stenosis, occlusion and/or early venous filling were seen in only 30%. In group II angiography demonstrated abnormalities in 38% of the patients, while CT indicated the basal ganglia lacunae in 41%. In group III CT revealed infarction of the cortical area in 32% while that of the basal ganglia occured in 34%. In group IV, infarction of these regions occured at the same frequency of 31%. Infarction of the cortical region was frequently caused by embolism, which tended to increase with age. In group IV large and medium-sized infarctions were present in 17%. Angiography demonstrated pathological abnormalities in 43% of group III and 49% of group IV. The above findings suggested that the high frequency of lacunae and embolism in aged patients was casually associated with arteriosclerosis and atrial fibrillation, increasing with age. The prevention of cerebral infarction in aged patients with atrial fibrillation is therefore an important task for the physician.
To elucidate the clinical significance of hyper-HDL-cholesterolemia, the subjects with HDL-c above 100mg/dl were studied, serving those with HDL-c below 30mg/dl as the control. Among 22, 876 persons (male 17, 657, female 5, 219) who visited Keio Health Councelling Center for their health check from the beginning of 1981 to the end of 1984, we found 177 subjects (male 94, female 83) whose HDL-c was above 100mg/dl, and 195 subjects (male 187, female 7) whose HDL-c below 30mg/dl. Their incidence was 0.8% (male 0.5%, female 1.8%) for hyper-HDL-c vs 0.9% (male 0.9%, female 1.1%) for hypo-HDL-c. Their percent body weight deviation was -5% vs +15%, daily alcohol intake 18g (male 26g, female 7g), vs 16g (male 17g, female 4g), and cigarett smoking 6 pieces/day vs 21 pieces/day, respectively. Their total cholesterol averaged as 226mg/dl vs 197mg/dl, triglycerides as 69mg/dl vs 262mg/dl, respectively. They had no significant difference in the liver and renal function tests including blood sugar and uric acid, except for elevated γ-GTP in hyper-HDL-c group. In short, the subjects with hyper-HDL-c were rather slim with the habit of smoking less and drinking more, though the drinking had no deteriorative effect in this group, while the subjects with hypo-HDL-c were obese and high in serum triglycerides in spite of moderate drinking. These indicated that the subjects with hyper- and hypo-HDL-c were different in their constitution in particular with lipid metabolism. It may be of interest to study the complication (s) of theses two types of HDL-c group.