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  • 3.

    Hypertension

    • Approximately twothirds of persons 65 years of age or older in the US are hypertensive.

    • Several studies have documented a continuous and graded relation between the level of blood pressure and risk for CAD.

    • Data from Framingham Heart Study revealed: the higher the blood pressure level the greater the CAD risk.

    • Clinical trials have clearly demonstrated that lowering BP can reduce this CAD risk.

    • A metaanalysis of 17 randomized hypertension treatment studies involving 47,653 subjects revealed an overall 15% reduction in MI in treated subjects compared to those receiving placebo.

    • Recent trials have shown that treating Isolated systolic hypertension decreased CVD risk.

Left Ventricular Hypertrophy (LVH)

  • LVH is the response of the heart to chronic pressure load.

  • When LVH is detected on the ECG, it is associated with increased risk for a variety of CVD sequalae, Angina, MI, CV stroke and sudden cardiac death.

  • This risk is further accentuated when the increased voltage pattern of LVH is associated with secondary STT wave changes.

  • Measuring left ventricular wall thickness and internal LV dimension can be used in the calculation of LV mass.

  • LV mass has been linked to level of BP.

  • Increased levels of LV mass have been found to be associated with increased CVD sequelae.

  • This association was statistically significant and remained so even after adjusting for the elevated levels of blood pressure.

  • Regression of LVH was associated with a reduction in CVD risk.

II Risk Factors for Which Intervention Is Likely to Reduce Incidence of CAD

  • 1.

    Diabetes Mellitus (DM)

    • Diabetes seems to double the risk for CAD in men and triple the risk in women during middle age.

    • This tendency may diminish in the elderly, where a relative risk of 1.8 is typical for both sexes.

    • Among patients with insulin – requiring DM, approximately one – third die of CAD, and one

      • third die of renal disease.

    • Among patients with NIDDM (non – insulin – dependant DM) approximately half of deaths seem to be attributed to CVD.

    • Adults with NIDDM commonly have low concentrations of HDL – C, elevated triglycerides (TG) and upper normal LDL – C.

    • Other mechanism that augments CVD in diabetics include higher BP levels, elevated fibrinogen levels, and prothrombotic changes in other haemostatic factors.

    • Persons with impaired glucose tolerance (IGT) also seem to experience increased rates of CAD.

    • A similar relation has been observed between CAD events and elevated serum insulin.

    • Aggressive lowering of LDL – C as well as B.P. beside tight glycemic control is important and has been emphasized from DM guidelines to diminish CVD risk.

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