Homocysteine Slovakia study: study design and occurrence of hyperhomocysteinaemia and other risk factors.

BACKGROUND: Slovakia belong to the European Union countries with the high incidence and prevalence of cardiovascular diseases in general and IHD in particular. METHOD: Homocystein-Slovakia is crossectional population study realised in subjects in high risk age 35-75 years in two groups. The first consists of patients with verified stable ischemic heart disease (IHD) (M= 152; F = 167) aged 60.8±9.37 yrs (males) res. 63.1±7.56 years (females) (NS) who were randomly selected from two cardiological registrars. Second population was formed by general population who were dichotomised according their medical records into IHD patients (M= 31, F= 53) and apparently healthy controls (M= 47; F = 55), the later in significantly younger age as patients, but in same age for intergender comparison 49.6±10.3 vs 46.6±9.2 yrs (NS). RESULTS: We found very high prevalence of classic as well as newer risk factors and risk markers both in IHD patients and in controls. Increased homocysteinen (Hcy >15 µmo/l for males and Hcy >13 µmo/l for females) was found even in 32.9 % of patients and 13.6 % of controls (p<0.001). Comparison of regulating vitamins levels between IHD patients and controls demonstrated similar prevalence. CONCLUSION: Homocystein Slovakia study found very high prevalence of hyperhomocysteinemia in patients with stable ischemic heart disease. Even the prevalence in healthy controls correspond to data reported for MI patients in Western countries. Vitamins regulating metabolism of homocysteine also shown high prevalence, however, without differences between IHD patients and controls (Tab. 5, Fig. 1, Ref. 27).

Coronary heart disease in hypertensives: a need to reduce cholesterol.

Ten international long-term hypertension intervention trials between 1980 and 1987 have resulted in significant reduction in the incidence of stroke in the treatment groups. Yet, eight of these studies have shown disappointing results in the prevention of coronary heart disease (CHD). Five hypertension intervention trials revealed high average cholesterol values at baseline. No cholesterol treatment was provided and the incidence of CHD was high. In four other trials with stratification into 'low' and 'high' baseline cholesterol levels, the incidence of CHD was considerably less in the 'low' cholesterol groups. Only the 10th, the Gothenburg trial, has demonstrated a marked reduction in CHD by combining antihypertensive medication with cholesterol lowering treatment. Failure to reduce cholesterol in hypertensives with hypercholesterolaemia may be one explanation for the limited efficacy of antihypertensive treatment in the reduction of CHD. We postulate that successful treatment of hypercholesterolaemia will reduce the incidence of CHD in well-controlled hypertensive patients to the same extent as it lowers the incidence of CHD in normotensive people.

Failure to reduce cholesterol as explanation for the limited efficacy of antihypertensive treatment in the reduction of CHD. Examination of the evidence from six hypertension intervention trials.

Over the past 6 years, major hypertension intervention studies in Europe, Australia, and the USA have shown disappointing results in the prevention of coronary heart disease (CHD) in spite of adequate treatment and good compliance. Recently, it has become increasingly clear that hypertensives with or without treatment display higher cholesterol levels than normotensive persons. The present review examines cholesterol levels in six intervention studies, none of which offered dietary or drug therapy for hypercholesterolemic patients. The Oslo study and the British MRC Trial reported very high average cholesterol levels and both showed no protection from CHD through intensive therapy in comparison to control patients. The Australian and the American MRFIT studies produced evidence for reduced coronary mortality among hypertensives with low in contrast to those with high cholesterol levels. The European Working Party showed indirectly that patients with marked reduction in blood pressure and cholesterol had a significantly lower cardiac mortality compared to placebo-treated patients. The IPPPSH study found that increasing cholesterol levels in hypertensives under beta blocker or diuretic therapy increased the risk of myocardial infarction. Failure to reduce cholesterol in hypertensive patients apparently is a major reason for the limited efficacy of antihypertensive treatment in the reduction of CHD.