Ischaemic Heart Disease in Young Women

Oliver, M.F.

doi:10.1136/bmj.4.5939.253

Cited by 109 publications

(28 citation statements)

References 22 publications

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“…First, 2 studies have linked a lifelong history of menstrual irregularity with a significantly increased risk for acute myocardial infarction. 175,176 A third study has shown that irregularly menstruating women, in comparison with normally cycling control women, have elevated plasma fibrinogen concentrations (a risk factor for CAD) and a thickened arterial intima. 177 The possibility that these observations might reflect the reduced concentrations of endogenous estrogen characteristic of ovary-impaired women is supported by the finding that premenopausal women with angiographically confirmed CAD have significantly lower plasma estradiol concentrations than do control subjects and that such levels resemble those observed in subordinate female monkeys.…”

Section: Sex Differencesmentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

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Abstract-Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis.Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys.Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. ...

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Section: Sex Differencesmentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

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“…Evidence of myocardial ischaemia in the electrocardiogram of the resting patient was as defined by Oliver (1974), namely Code 4,1 or 5,1: ST depression of 1.0 mm or more, or T wave inversion of 5.0 mm or more, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…In only two patients was there electrocardiographic evidence of ischaemia as defined in the methods section; however, both these patients had identical patterns before the drug was given. Two other patients had slight deepening of T wave inversion on the day following labetalol administration (code 5, 3 to 5, 2), but in neither instance did this exceed 2 mm, and did not satisfy Oliver's (1974) criteria for ischaemia. One patient showed disappearance of a 4, 2 abnormality (ST depression of 0.6 mm) after labetalol treatment.…”

Section: Changes In Heart Ratementioning

confidence: 97%

Treatment of severe hypertension by repeated bolus injections of labetalol.

Cumming¹,

Brown²,

Lever³

et al. 1979

Brit J Clinical Pharma

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1 Repeated intravenous bolus injections of labetalol were administered to 15 severely hypertensive patients. In 11 instances, a standard protocol was followed in which a loading dose of 1 mg/kg was given intravenously over 1 min, followed by up to five bolus injections of 50 mg at 10-min intervals. In two further patients, bolus doses varying from 25-100 mg were given after the loading dose, and in two others the loading dose was omitted. 2 Falls in systolic BP ranging from 26-194 mmHg were seen in 14 patients and of diastolic BP from 16-76 mmHg in 13. In one patient there was no appreciable fall in either systolic or diastolic BP and in one no marked fall in diastolic BP, although systolic BP dropped by 42 mmHg. 3 The reduction in arterial BP was smooth in ten patients. 4 In four patients a steep fall in BP, of 194 to 101 mmHg systolic, was seen within 10 min of an injection of labetalol; in all four hypotension was readily controlled by elevating the foot of the bed. 5 Side-effects included nausea, vomiting, epigastric discomfort, scalp tingling, burning sensations in the throat and groin, shivering, and pain at the site of injection. Side-effects limited the dose given in four patients. 6 In no case was there clinical or electrocardiographic evidence of myocardial ischaemia induced by labetalol. 7 Labetalol, given by bolus injection, appeared less efficient in controlling arterial pressure, and more likely to cause side-effects, than when given, as in a previous study, by incremental infusion. 8 When labetalol is to be given intravenously for the control of severe hypertension, incremental infusion, rather than bolus injection, is preferred.

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“…Although reports of associations of coronary disease risk with parity, age at menarche, or incidence of miscarriage are not all consistent (7,8) (10,14). (17)(18)(19)(20).…”

Section: Abstract: a Woman's Reproductive History May Affect Her Riskmentioning

confidence: 99%

High Density Lipoprotein (HDL) Cholesterol levels in young pregnant Women

Suman¹,

Nasar²,

Sinha³

2017

IOSR JDMS

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A woman's reproductive history may affect her risk for coronary heart disease. Parity has been associated with increased coronary disease risk in some studies, while other studies have shown that nulliparous women are at increased risk (1-3). Pregnancy frequency (including frequency of spontaneous abortion (4,5)) and age at first pregnancy (6) have also been associated with increased coronary disease risk. Although reports of associations of coronary disease risk with parity, age at menarche, or incidence of miscarriage are not all consistent (7,8) (10,14). (17)(18)(19)(20). In order to examine further relations of parity with lipid risk factors, we assessed plasma lipids at baseline and at the year 1 and year 2 follow-up examinations among young adult women in an ongoing epidemiologic study. Lipoprotein, Pregnancy, HDL Cholesterol, Primipara, Nullipara, LDL Cholesterol Although triglycerides have been reported to decrease rapidly during the postpartum period, total and LDL cholesterol levels may require several months to return to baseline (10, 14). High density lipoprotein (HDL) cholesterol, which has been shown to be inversely associated with coronary disease risk among women (15, 16), peaks at mid-gestation and then falls to levels approximately 15 percent above baseline at term (12). Few data are available on the long-term effects of pregnancy on lipoproteins; however, there are reports of inverse associations between parity and postpartum HDL cholesterol levels Keywords: I. Materials And Methods Study populationThe Coronary Artery Risk Development in Young Adults (CARDIA) Study is a prospective epidemiologic study designed to identify determinants of the evolution of cardiovascular risk factors among young adults. The study design and characteristics of the cohort have been detailed previously (21,22). In brief, young adults aged 18-30 years were recruited from different locations in and around Patna, India by community based sampling. Baseline examinations were performed on 5,115 young adults (including 2,787 women), 51 percent of the eligible persons contacted. Recruitment efforts were successful in achieving a study population that was approximately balanced according to age (45 percent aged 18-24 years and 55 percent aged 25-30 years), sex (46 percent men and 54 percent women), race (52 percent black and 48 percent white), and education (40 percent having completed ≤ 12 years of education and 60 percent having completed >12 years).Data were available on 91 percent (2,534 women) and 86 percent (2,393 women) of participants from the years2015 and 2016 follow-up examinations, respectively. In analyses of baseline to year 2 lipid change, we sequentially excluded 402 women, leaving 2,140 available for analyses; some women were excluded for more than one reason. Women who were pregnant at their baseline (n = 5) or year 2 (n = 82) examinations, women with missing (n = 27) or inconsistent pregnancy data (e.g., women who reported they had previously been pregnant at baseline but reported they had ...

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Ischaemic Heart Disease in Young Women

Cited by 109 publications

References 22 publications

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Treatment of severe hypertension by repeated bolus injections of labetalol.

High Density Lipoprotein (HDL) Cholesterol levels in young pregnant Women

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