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Therapeutic interventions in patients with myocardial infarction, whether during the first hours after coronary occlusion or several days later, aim to reduce mortality and morbidity by several mechanisms: Prevention of fatal ventricular fibrillation, limitation of infarct size, and inhibition of platelet aggregation are some examples of such mechanisms. Results from early intervention trials with beta blocking agents, particularly from ISIS-I, suggest that 1-year mortality is significantly lower in selected patients randomized to active treatment. Late intervention studies also suggest a significant reduction in coronary mortality and morbidity with beta blockade, particularly when data are pooled. Studies with the calcium channel blockers nifedipine and verapamil were unable to demonstrate any beneficial effects of these drugs on mortality or reinfarction. In this review article, attention will be directed to the most recent information about the preventive value of beta adrenergic blocking drugs and slow calcium channel inhibitors.

The relation between consumption of alcohol (established by interview), two of its typical markers (gamma-glutamyltransferase activity and mean corpuscular volume), and the composition of fatty acids in plasma cholesterol esters was investigated in an epidemiological study of 1467 actively employed men aged 35-45. In this group of subjects mean consumption of alcohol was 34.6 (SD 25.2) g/day. Palmitoleic acid and oleic acid were positively correlated with consumption of alcohol, gamma-glutamyltransferase activity, and mean corpuscular volume, while linoleic acid was negatively correlated with these variables. When these three fatty acids, gamma-glutamyltransferase activity, mean corpuscular volume, and the fat content of the diet were introduced into a multivariate regression analysis, with consumption of alcohol as the dependent variable, only palmitoleic acid, gamma-glutamyltransferase activity, mean corpuscular volume, and the monounsaturated fat content of the diet remained significant. Palmitoleic acid seems to be an independent correlate of consumption of alcohol and could be useful in epidemiological and clinical studies as a variable of consumption.

To detect the response of different strains of rats to an hypercholesterolemic diet, 9 different strains of male rats were fed successively a control diet (C) containing 20% casein for 4 weeks, then a high-protein, cholesterol-rich diet (HC) containing 50% casein and 1.2% cholesterol for 12 weeks. When the rats were fed the control diet, the highest cholesterolemia was found in the LOU strain and the lowest in the WAG and Brown-Norway (BN) strains. The latter strain had the highest free to esterified cholesterol ratio and showed a marked band in beta position (LDL) on agarose gel electrophoresis. Administration of the HC diet induced an increase of cholesterolemia in all the strains except in Fisher (FIS) and LOU. This hypercholesterolemic diet decreased the free to esterified cholesterol ratio only in the BN and FIS strains. On agarose gel, all the strains showed a highly increased band in pre-beta position (VLDL). On polyacrylamide gel, a single, tight band in HDL position was revealed in the BN strain, while a large band or two bands were seen in the other strains. The percentages of some apoproteins in serum total lipoproteins were determined in rats fed the HC diet; the apoprotein E level was inversely correlated to the difference between the cholesterolemia of the rats given the HC and C diets (r = - 0.72; P less than 0.05). So, the BN rats had the lowest apo E level with the highest cholesterolemia increase due to the HC diet.

The authors undertook a retrospective study of 200 cases of documented ischaemic heart disease. Seven variables were considered in a statistical analysis: age, sex, localisation of myocardial lesions, left ventricular function, ventricular arrhythmias in density and grade, and death due to cardiac or other causes. The statistical analysis using the Chi squared test showed no correlation between death and the variables: age, sex and localisation of the infarct. However, statistically significant relationship was observed between death, in particular when due to cardiac causes, and: left ventricular function, especially when the ejection fraction was less than 0.40, ventricular arrhythmias, especially with a density of between 10 and 50% and when repetitive were observed. Analysis of correspondences confirmed these results. Log-linear analysis of the variables or combinations of variables which allows prediction of the prevalence of death showed ventricular arrhythmias to be more important than left ventricular function when these two variables were considered singly. When the association of two variables was considered, the best predictive association was ventricular arrhythmias with repetitive ectopic rhythms; the second best predictive association was ventricular arrhythmias with abnormal ventricular function. These results should be interpreted taking into consideration the patient group studied, the criteria of selection and the limitations of 24 h ECG monitoring; in addition, some arrhythmias may have added importance (e.g. ventricular parasystole).

The relations between the fatty acids of cholesterol esters and some cardiovascular risk factors have been investigated in a sample of 3,348 middle-aged men examined at entry into the Paris Prospective Study 2. The partial associations between the risk factors and the various fatty acids have been evaluated using a special regression method that takes into account the structural dependencies among the percentages of fatty acids. The results show that palmitoleic acid is strongly associated with alcohol consumption and blood pressure and that its association with blood pressure is absent in nondrinkers. High density lipoprotein cholesterol and apolipoprotein A1 are negatively associated with palmitic and dihomogammalinolenic acids and positively associated with oleic and linoleic acids. An inverse relation of low density lipoprotein cholesterol and apolipoprotein B to these fatty acids is also observed. Simultaneous high levels of palmitic and dihomogammalinolenic acids and low levels of oleic and linoleic acids could then be related to profiles of lipids and apolipoproteins exposing one to a high risk of coronary heart disease. These associations may be of interest in interpreting the relations observed in other studies between the fatty acid composition of cholesterol esters or other lipids and coronary heart disease.