Effects of a multifactorial prevention trial of coronary heart disease on the seasonal variation of the incidence of major cardiovascular events.

Under the influence of a primary prevention trial of coronary heart disease carried out for 10 years (1971-1982) in male subjects aged 40 to 60 years at entry, the curves of the seasonal variation of the incidence of myocardial infarction, sudden death and stroke were changed. The most important reductions of the incidence of these events were registered in spring and in September. In the rest of the year the effect of the action becomes variable according to the month and to the particular major events. These observations are discussed as related to their possible cause and to the necessity of a change of action methodology according to the period of investigation.

Seasonal variations of serum cholesterol detected in the Bucharest Multifactorial Prevention Trial of Coronary Heart Disease. Ten years follow-up (1971-1982).

A group of 4800 men, aged fourty to sixty at entry, subjected to a multifactorial prevention trial of coronary heart disease for a ten-year period, showed spontaneous seasonal variations of serum cholesterol, characterized by increases in winter and decreases in summer. The authors discuss the relationship between the food changes and the seasonal variation of serum cholesterol values.

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.

A longitudinal study, for 15 years, of the myocardial infarction, in a population of middle aged men.

The long-term evolution of the patients with incident myocardial infarction (MI) was studied in a group of 5,000 men ranging in age from 40 to 60 years, included in an action of primary prevention of arterial hypertension (AHT) and coronary heart disease, in comparison with a second group of 5,000 other men with similar age and occupation, selected at random, who received medical assistance without primary prevention. The incidence of MI was of 2.34% (111 cases) in the group of intervention, with a cardiovascular mortality of 46.84%, while in the control group it amounted to 2.88%, with an overall mortality by cardiovascular diseases of 52.7%. The highest mortality rate was recorded in the patients with recurrent infarctions (72.6% and 60% of deaths, respectively). During a follow-up period of 15 years, the presence of AHT before the occurrence of MI proved to be an aggravation factor for the cardiovascular mortality which, in the group of intervention, was two times more frequent in such patients than in those with pre-existent angina. The pathologic association angina--AHT as well as the AHT alone, preceding the MI occurrence, have significantly increased the risk of cardiovascular mortality. The action of primary prevention has evidently reduced the immediate mortality, as well as that of the patients with angina before the MI.

Ischemic heart disease in relation with the type of behavior and the emotional state.

The relationship between the cardiovascular state, on the one hand, and the type of behavior and emotional state on the other, was investigated in a professional type community of 550 subjects (280 men and 270 women) ranging in age from 20 to 64 years. The subjects were submitted to medical examination (clinical, electrocardiographic and biochemical) for the detection of ischemic heart disease and its risk factors (arterial hypertension, smoking, over weight, hypercholesterolemia) and concomitantly to a psychologic examination consisting of anxiety test as a state and as a trait, multiple affectivity test and the test of self-rating behavioral type, for the study of the emotional state and the type of behavior. The relation between the results of the two examinations showed that ischemic heart disease (irrespective of the form) and its risk factors are associated to various extents and in different manners to the psychologic factors. Thus, significantly, ischemic heart disease was proved four times more frequent in subjects with type A behavior than in those with type B; arterial hypertension was more frequent in anxious (1.6 times) and aggressive subjects (1.4 times); overweight was more often encountered in nondepressive (2 times) and adaptable subjects (1.4 times), and in subjects with type B (1.3 times); the anxious subjects were found to smoke less than the non-anxious ones (2 times).

Statistical methods for longitudinal study of risk factors in cardiovascular diseases.

The purpose of this paper is to study the risks of developing a cardiovascular disease, under conditions of primary prevention. The risk factors were studied as a synthetic index, representing a linear weighted combination, called by us prognostic index. For the longitudinal study and prediction the multiple regression analysis was used.

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.

The predictive value of some major ECG changes.

Out of a group of 5,000 men included in an action of primary prevention of coronary heart disease and arterial hypertension, started in 1971 in the "N. Gh. Lupu" Institute of Internal Medicine--Bucharest, the authors have selected the subjects presenting major ST--T changes and conduction troubles. The predictive value of some ST--T changes for the subsequent occurrence of major coronary accidents was also investigated in 3,000 male subjects of similar age and occupation, also selected at random, but who were not included in the action of primary prevention of the risk factors. The results obtained demonstrated the value of such an early intervention upon the risk factors of coronary heart disease, the incidence of coronary accidents (myocardial infarction, sudden death) being smaller in the group of intervention than in the control one.

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.

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.

An efficient technique for the development of computer programs for electrocardiogram interpretation.

In this paper is presented an efficient technique for the development of electrocardiogram (ECG) interpretation software, executed rapidly on inexpensive specialized mini or microcomputers; the method--based on the author's experience--is under medical control. The first part of the paper presents the ideal characteristics of an ECG computer interpretation program which in the author's opinion are not yet implemented by any of the present equipment of ECG analysis. The second part presents the author's approach of the problem and the last part gives a description of the programming techniques used.

The logical structure of electrocardiographic diagnosis.

The description of a mathematical model of structure of electrocardiographic (ECG) diagnosis is given, starting from the automatically measurable characteristics of bioelectrical currents generated in the course of cardiac activity. The "dynamic diagnosis", established for rhythm and for atrioventricular conduction disturbances--by analysis in real time of the periodicity of electrical phenomena--is differentiated from the "static diagnosis", established for the other situations--by the logical intersection of amplitude conditions with duration of the waves belonging to a given ECG lead. Likewise, mathematical rationale separates atrial from infraatrial electrical activity.

Multidimensional statistical data analysis of viral hepatitis report records.

The internal connections between the variables defined by the data obtained from viral hepatitis (VH) report records completed ih a Romanian county durihg 1973 are analysed. The mathematical model for linear factorial analysis allowed a simultaneous processing of all variables and the distinction of representative factors. The conclusions of the study suggest new possible approaches by the introduction of supplementary questions in the VH report records.