Association of conventional and exertional coronary heart disease risk factors in 5,000 apparently healthy men.

BACKGROUND AND HYPOTHESIS: The aim of this study was to define the prevalence of previously undetected coronary heart disease among asymptomatic males, aged 30-65 years, by means of resting and exercise electrocardiography in conjunction with an analysis of conventional and exertional coronary risk factors. METHODS: Between January 1985 and December 1989 we examined 5,000 clinically asymptomatic subjects. A detailed case history was obtained for each individual, followed by a complete physical examination, comprehensive blood (including lipid) profile, lung function tests, chest x-ray, a resting 12-lead electrocardiogram (ECG), and a maximal treadmill exercise ECG. Whenever possible, on-line computerized respiratory analysis (Beckman Metabolic Measurement Cart) was carried out during the exercise tests. Conventional and exertional coronary heart disease risk factors were also recorded. RESULTS: A total of 162 persons (3.2%) showed abnormal S-T segment responses during the exercise or recovery period. Of these, 92 subjects underwent further investigations: coronary angiography (79), 201thallium scanning (13), 201thallium scanning followed by coronary angiography (7). Of the 86 patients who proceeded to coronary angiography, 19 (22%) had either normal coronary artery anatomy or only insignificant disease. Among the 67 (78%) of patients with significant angiographically demonstrable disease, 26 received coronary artery bypass grafting, 7 underwent coronary angioplasty, and the remainder continued on medical management. CONCLUSIONS: These results are discussed in relation to a variety of conventional and exertional coronary risk factors.

The Manchester detoxification service. Description and evaluation.

The service of Manchester's hospital-based purpose-built alcohol detoxification centre is described, together with demographic data, drinking history, findings on admission, disposal arrangements, and outcome of 235 police referrals. Police referrals under-used the centre, which now accepts from magistrates' courts, the local alcoholism council, accident and emergency departments, and general practice. Police referrals, mostly homeless and without family support, contained many episodic drinkers; this explains the low incidence of severe withdrawal symptoms. Prophylactic treatment was not routine. Very high blood alcohol levels were recorded from some conscious patients. There was little serious medical morbidity. Many discharged themselves within 24 hours. Few accepted the recommended treatment, medical or social; prolonged abstinence was achieved by only 1% but substantially more had short abstinent periods and some social betterment, especially if offered follow-up help. Visits to general practitioners' surgeries fell during the follow-up period, as did admissions to general units for withdrawal symptoms, though not from all causes. Almost half had readmissions to the centre. Referrals from other sources were more likely to stay for assessment and accept help. More referrals from medical sources had severe withdrawal symptoms. Detoxification centres need not be in hospitals but must have close and rapid links with specialist medical services. They must be integrated into the total provision of alcoholism services and assessed in relation to them.