The role of health examinations in preventing sudden death was analyzed in 75 sudden death cases from information gathered by questionnaire from their families. Out of the 75 cases, 17 (22.7%) had received health examinations within 2 years before death, 19 cases (25.3%) more than 2 years prior to death, and 39 cases (52. 0%) did not receive health examinations. The percentage of sudden death cases who had been medically treated was significantly higher for those cases which had received health examination than in those which had not (88. 9% vs 64.1%, p<0.05). Those who had been medically treated had a higher prevalence of past history than those who had not (85.2% vs 55.6%, p<0.05). Therefore, assuming that medical treatment would have postponed death, health examination had an indirect effect in preventing sudden death by identifying and referring those with abnormal findings to medical facilities. Fourteen cases (18.7%) neither received health examinations nor medical treatment. Since nine of these had past histories, successful life saving intervention, or at least postponed death, may have been possible had they received medical treatment. Similarly the five cases reportedly having no past history, may have had any abnormalities identified by health examination and treated.
Three cases out of four who had received health examinations had no past history, and the ages of two of these three were in the early thirties. The existence of these caces makes apparent that there are limitations for health examinations in preventing sudden death.

View full abstract

The incidence of type A behavior in patients with cardiovascular diseases and the influence of psychological stress on the onset of ischemic heart disease were investigated. Type A behavior was assessed using a brief questionnaire established by Maeda. Incidences of type A behavior in patients with ischemic heart disease, non-ischemic heart diseases, essential hypertension, secondary hypertension and healthy volunteers were 77%, 24%, 51%, 19% and 30%, respectively. The incidence of type A bahavior was significantly higher in ischemic heart disease. There was no significant correlation between type A scores and the prevalence of other coronary risk factors. Therefore, type A bahavior may be considered to be an independent coronary risk factor. In these patients with acute myocardial infarction or unstable angina pectoris, 36% of the type A patients reported feeling stressful just before the onset, whereas, on the contrary, only 6% of type B patients reported so. Therefore, stressful situation may function as a trigger of ischemic attack, especially in type A patients.

View full abstract

In order to study effects of smoking on electrocardiographs, Holter Electrocardiographic examination concurrent with tobacco smorking were performed in 28 smokers, average age 52 years old, with no abnormal findings in usual resting ECGs.. Positive inchemic STT changes, iscluding deep T wave inversion and prominent arrhythmias were identified by the Maruquette 8200 System Analysis. These positive changes generally appeared 4-5 minutes after commencing smorking. Thirteen out of 28 (43%) of the subjects had positive findings. The positive group also had significantly elevated values for the Coronary Atherogenic Index : (TC/ HLD-C × Apo B/ Apo A-I), compared to the negative group.
After premedication with Ca-antagonists, ischemic STT changes did not appear. These ischemic STT changes which did not always appear at smoking, had a tendency to show when smoking occurred during driving, in cold environment, after micturition at midnight, upon waking in the morning, probably at times of low levels of threshold.

View full abstract

Insulin resistance and/or hyperinsulinemia induces an increase in renal Na⁺/water reabsorption and overactivity of the sympathetic nervous system, and whether this condition has a role as an important factor in the development of hypertension is a question, the accumulation of longitudial epidemiologic data is indispensable. An 11-year follow-up study was performed and results analyzed by multiple logistic regression analysis to study the association of insulin levels to the development of hypertension. Results are as follows :
1) Insulin concentration at 120 minutes after a 50 gram oral glucose loading showed a significant correlation with diastolic blood pressure at the entry examination. However, other parameters, ie, insulin concentrations at preload, 30, 60, and 180 minutes postload and the ratios of insulin : glucose levels, did not show significant correlations with systolic and diastolic blood pressure.
2) The Log transformed insulin concentration at preload, 60 miniutes, and summed values ; and the ratios of preload and area of insulin : glucose at the entry examination correlated significantly with systolic blood pressures at the follow-up examination. Both insulin concentration at preload, 60, and 120 minutes and summed values ; and the ratios of preload, summed values, and area of insulin : glucose were shown to have significant correlations with diastolic blood pressures.
3) Insulin levels at preload and 180 miniutes, the preload ratio of insulin : glucose, insulinogenic index and uric acid were statistically significant in predicting future hypertension, even after adjusting for age, sex, and systolic blood pressure at entry.
In conclusion, insulin resistance and/or hyperinsulinemia was found to be strongly associated with future hypertension.

View full abstract