SUMMARY Ten annual cohorts of men suffering from their first myocardial infarction have been followed up to a maximum period of 10.5 years. One thousand and twenty-three male patients of 1306 were smokers. Three months after the infarction 55% had stopped smoking and 45% continued smoking. These two groups were then compared and followed with regard to non-fatal reinfarctions and deaths.Preinfarction characteristics were shown to be similar for the two groups. The prognostic comparability of the two groups was tested using two multiple logistic models. Those who stopped smoking had a slightly higher predicted two year mortality after the infarction. In different age groups it is shown with life table technique that those who stopped smoking had a considerably higher survival rate and lower cumulative frequency of reinfarction.The present study shows a reversion of the expected prognosis after myocardial infarction caused by changing the smoking habit.Cigarette smoking is one of the major risk factors for the development of coronary heart disease.' I-In a previous report we have shown the beneficial effects of stopping smoking after myocardial infarction. Those who stopped smoking had only half the cardiovascular mortality rate and only half the rate of non-fatal recurrences compared with those who continued to smoke.4 An increased death rate among those who continue to smoke has also been shown by others. S-7 The aim of the present study was to investigate whether our early findings were stable or even enhanced during a prolonged follow-up, and if the proposed effect of changing the smoking habit differed in certain age-groups.
Patients and methodsAs from 1 January 1968, all cases of myocardial infarction occurring in Goteborg have been registered by the MI Register.8 The present study comprised men who suffered their first myocardial infarction and
The effect of drinking grapefruit juice on the acute pharmacokinetic and haemodynamic actions of the dihydropyridine calcium antagonist felodipine given as a 5 mg plain tablet has been studied in nine, healthy, middle-aged males. Compared to water, grapefruit juice caused an increase in Cmax from mean 6 to 16 nmol.l-1, and in the AUC from 23 to 65 nmol.h.l-1. The change in AUC corresponded to an increase in the systemic availability of felodipine from 15 to 45%, assuming no change in its clearance. This change was probably caused by inhibition of the oxidation of felodipine to the inactive dehydrofelodipine by flavonoids in grapefruit juice. The interaction with grapefruit juice is believed to be a class effect for the dihydropyridines, as oxidation of the dihydropyridine ring to the corresponding pyridine derivative is a major metabolic route for all these drugs. The higher plasma concentrations of felodipine taken with grapefruit juice resulted in a greater change in blood pressure measured in the morning 3 h after dosing (-9%) than did water (0%).
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