Evolution of ischemic heart disease risk factors in "The Bucharest Multifactorial Preventive Trial of Coronary Heart Disease" after 15-year follow-up.

The paper presents the evolution of the levels of smoking, hypercholesterolemia, essential hypertension and obesity in the course of a prophylactic action carried out for 15 years (1971-1986) in a group of 5000 males aged 40-60 years. In the group still available after 15 years of follow up consisting of 2000 subjects, a decrease was obtained in the number of smokers, from 22.3% to 5.6% of hypercholesterolemia from 31.3% to 23.7%. The cumulated incidence of essential hypertension has increased from 15.5% to 36.7% and of obesity from 12.6% to 14.4%. At the same time the incidence of angina pectoris and myocardial infarction increased from 1.1% to 5.3%. For comparison are presented data obtained in a similar control group.

The evolution of essential hypertension in a primary prophylactic survey. Ten-year longitudinal epidemiologic study (1971-1982).

The present work presents the evolution over a ten-year period of subjects with essential hypertension (EH) detected in a group of 5,000 men, aged 40-60 years, randomly selected in an urban environment. The prevalence of EH in the group studied was 20.5%, whereas "borderline" hypertension presented a prevalence of 21.4% reported in an earlier study. A proportion of 76.6% of the hypertensive patients were cared for in an outpatient unit; normal blood pressure values were obtained in about one third of the cases. This result is consistent in itself and, all the more so, bearing in mind ageing of the patients in the course of the study. The study had in view the annual incidence of essential hypertension and the evolution of atherogenic risk factors in hypertensive patients. The incidence of cerebrovascular accidents during the follow up period in this group was 6.85%, sudden death 1.7% and myocardial infarction 6.2%.

The evolution of atherosclerotic risk factors in a primary prophylactic survey. Ten-year longitudinal epidemiologic study (1971-1982).

The present work is a study of the evolution of atherosclerotic risk factors in the course of ten years, in a group of 5,000 male subjects, aged 40 to 60 years, from an urban district, undergoing a programme of primary prevention against ischemic heart diseases. The general intervention methodology and the results after five years follow-up were published in earlier papers. The present work describes the ten year evolution of the prevalence of the main atherogenic risk factors studied, the yearly rate of prevalences, first appearance and correction potency of the risk factors detected.

Influence of pregnancy, birth and abortion on the evolution of systemic lupus erythematosus.

The effect of pregnancy, birth and abortion on systemic lupus erythematosus (SLE) was studied in 225 patients with or without a history of pregnancy and abortion. It was observed that pregnancy, birth and abortion aggravate the evolution of disease in patients with active SLE. The tissue autoantibodies studies presented a low titer in patients in whom pregnancy had occurred in the course of disease. Antimeasles antibodies presented a high titer in patients with a history of gestation. These data suggest that gestation induces immune changes which aggravate SLE.

The Bucharest Multifactorial Prevention Trial of Coronary Heart Disease--ten year follow-up: 1971-1982.

The trial begun in 1971 and the paper brings the results after a ten-year follow-up. Both the intervention and control group contained 5000 men with a similar socioeconomic and professional structure; the intervention group was examined every six months in the first 5 years and annually in the second phase. The control group was examined "only after" 5 years and a second time at the final moment. The decreases of the cumulative ten-year incidences were: for hard events--26.7%; for myocardial infarction--20%; for fatal myocardial infarction--52%; for stroke--31%; for cardiovascular mortality--38%; for total mortality--14%. The trend of serum cholesterol and cigarettes/day was downward, but the blood pressure had a rather flat evolution in the intervention group. The control group disclosed also some downward trends.

Vaccination with vicilin in systemic lupus erythematosus.

Vaccination with a vegetal protein--vicilin--was performed in patients with systemic lupus erythematosus (SLE) and antitissue autoantibodies (vessel, myocardium, striated muscle, liver, lung, kidney) were determined before and after vaccination. It was observed that the titer of these autoantibodies decreased gradually after vaccination down to total disappearance from the circulation. Local and general reaction after vaccination was also followed in comparison with a control group (subjects without SLE). The local reaction and the general phenomena were found to be of lesser intensity in the SLE patients. It is emphasized that after vaccination the general state of the SLE patients was improved. It is assumed that vicilin interferes in the pathogeny of disease by competitive nonspecific immune mechanisms which reduce the autoaggressive processes, by immunosuppressive mechanisms or other mechanisms which have a favourable effect on the evolution of disease. These observations should be further investigated using clinical and laboratory parameters for a better estimation of the favourable effect observed.

The Bucharest multifactorial prevention trial. The changes of morbidity and of general and specific mortality.

The paper presents the results of the Bucharest multifactorial prevention trial of coronary heart disease, concerning changes in cardiovascular morbidity and mortality during the first 5-year-period of follow-up. The age adjusted 5-year-rates disclose important reductions in the intervention group in comparison with the control one: for hard events (myocardial infarction, stroke, acute coronary insufficiency)--by 41%; for myocardial infarction--by 35%; for coronary mortality--by 38%; for stroke--by 39%; for cardiovascular mortality--by 30%. The decrease of hard events, myocardial infarction and stroke incidences are statistical significant. The evolution curves of cardiovascular morbidity and mortality show that both groups (the intervention as well as the control one) began with near the same values, but on the way and especially after 5 years they are differently located, those of the control group being higher than those of the intervention group.

The relationship between systemic lupus erythematosus and tuberculosis.

Investigation of 280 cases of systemic lupus erythematosus (SLE) admitted during 15 consecutive years to the "N. Gh. Lupu" Institute of Internal Medicine, Bucharest, revealed association of this disease with tuberculosis (tb) in 51 cases (19%). In most of these patients, tb onset preceded that of SLE; in the others it was either concomitant or it occurred later, in the course of SLE evolution. It is assumed that tb is favouring SLE development, probably by antigenic oversollicitation in patients with genetic immune deficiencies. When it occurs in the late stages of SLE, association of tb is of severe prognosis.

The Bucharest multifactorial prevention trial of coronary heart disease. General methodology and risk factor correction after five year follow-up (1971-1977).

Both the intervention and the control group included each 5000 men aged 40-60 years, randomly selected by their home address in five districts of the city of Bucharest. The intervention group underwent an "at entry" examination for risk factor detection (high serum cholesterol, high blood pressure, overweight, diabetes, minor ECG abnormalities, family history) and subsequently a five-year multifactorial intervention aimed to reduce the risk factors. Both groups were followed up in this lapse of time for major end-points: myocardial infarction, stroke, sudden death. The qualitative analysis of the results used ten evolution indices based on a quantal counting and lead to a classification of risk factors which allowed the setting up of a strategy for their correction. The quantitative analysis showed the following decreases between the first and the last examination in the intervention group: for serum cholesterol greater than or equal to 250 mg/dl -17%; for cigarettes/day greater than or equal to 15-53%; for overweight greater than or equal to 30% - 13.57%; for high blood pressure -8%; for the overall risk computed by multiple regression -33.8%.

Immunochemical assays for an early diagnosis of endemic nephropathy.

Comparative studies aiming at the detection of certain tubular protein elements by means of Ouchterlony's immunodiffusion, in parallel with lysozyme and guanase assays, were carried out in the unconcentrated urines of 746 subjects, of whom 655 apparently healthy inhabitants (mostly children) from a region with endemic nephropathy (EN) and from Bucharest, as well as 91 adults with EN or various other diseases with renal involvement. The presence of light chains, of lysozymuria exceeding 2 microgram/ml, of beta2 microglobulin and of guanase in the urines of children and adults from the endemic area was significantly more frequent than in the control groups. These immunochemical changes are hence considered as valuable criteria for the detection of EN prior to the uremic stage. They should be looked for, first and foremost, in the young relatives of patients with this disease. In the stage of nitrogen retention the diagnostic value of these tests is reduced, since the same changes can also be found in the urines of patients suffering from other diseases with renal involvement, which show nitrogen retention as well.