The purpose of the present study is to determine accurate incidence rates of stroke and acute myocardial infarction among the residents in Okinawa, where the census population was 1,222,398 in 1990 and mortality due to cerebrovascular and heart diseases is lowest in Japan. A co-operative study group including almost all hospitals and clinics in Okinawa was established for the survey. Between April 1, 1988 and March 31, 1991, 4,756 cases of stroke and 1,059cases of acute myocardial infarction were identified. The average age-adjusted annual incidence per 100,000 population was 137 for stroke and 31 for acute myocardial infarction. In the population aged 40 years and older, the respective values were 315 and 72, indicating the stroke incidence to be 4.4 times higher than that of acute myocardial infarction. The incidence ratio for men to women was 1.7: 1 for stroke and 2.9: 1 for acute myocardial infarction. Among stroke cases, 51.3% were diagnosed as cerebral infarction, 35.7% as cerebral hemorrhage, 7.7% as subarachnoid hemorrhage and 5.3% as others. Computed tomography of the head was performed in 98.4% of all stroke cases. The case ascertainment, evaluated by comparing the registered cases and death certificates in a certain city, was almost complete. The incidence of acute myocardial infarction is still much lower than that of stroke in Japan. (Hypertens Res 1992;15: 111-119)
SUMMAWe report a 64-year-old man who complained of headache without chest pain at the onset of acute myocardial infarction (AMI). He had no history of chest pain or headache. Severe headache in this case was the first symptom of AMI. The headache was reproduced during stress test. During the angioplasty procedure, he also complained of headache without vasospastic change in the coronary artery. These findings suggest that the headache which accompanied AMI or myocardial ischemia in this case was due to referred pain rather than a generalized vasospastic
The objective of the present study was to investigate the differences between coronary hyperresponsiveness without ischemia and vasospastic angina in an ergonovine provocation test using multivariate analysis. We have sometimes experienced a more than 50% narrowing response of vascular diameter without ischemia in a coronary response to ergonovine. We studied 107 patients with less than 50% stenosis in a coronary arteriogram. Their vascular responses to ergonovine were measured and the patients were divided into three groups, as follows: Group 1 had 50% or less vascular narrowing response without ischemia; Group 2 had a vascular hyperresponsiveness of more than 50% narrowing response without ischemia; and Group 3 experienced a hyperresponsiveness with ischemia. The degree of coronary response was found to be related to smoking, inpaired glucose tolerance (IGT) and the Gensini score by multiple regression analysis. A multiple logistic analysis revealed that the Gensini score and smoking were significant predictive factors for Group 3 (odds ratio: 1.20 and 8.97). The only factor different between Group 2 and Group 1 was gender. The coronary hyperresponsiveness to ergonovine without ischemia differs from vasospastic angina in the degree of coronary atherosclerosis and smoking habits. The patients with hyperresponsiveness had similar characteristics to those with atypical chest pain rather than vasospastic angina, except for a gender difference.
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