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Objective: To evaluate the effects of the angiotensin converting enzyme inhibitor perindopril on six minute walking distance and quality of life in very old patients with left ventricular systolic dysfunction. [...]

Coronary heart disease is a condition in which the arteries supplying blood to the heart (coronary arteries) become narrowed, resulting in a decreased supply of blood and oxygen to the cardiac muscle (myocardial ischemia). This can compromise the ability of the heart to pump blood to the body which, in an extreme case, can be fatal. The prevalence of coronary heart disease varies by geographical region, and there is much interest in identifying the variables that cause these variations. A large study (10,359 men and women), carried out in 22 districts of Scotland, attempted to correlate the prevalence of coronary heart disease with various factors relating to lifestyle, medical status, and sex. Cigarette smoking was highly correlated with the incidence of coronary heart disease in both men and women, as was low vitamin C consumption. Blood pressure in men, and high density lipoprotein cholesterol (HDL) levels in women were weakly correlated with coronary heart disease. Clustering, or the tendency of multiple risk factors to be present in single individuals, was associated with coronary heart disease in both sexes: smoking, alcohol consumption, and diets of high saturated fat, and low fiber in men; and smoking, similar diets, and obesity in women. The relation of obesity and coronary heart disease in women has not been previously reported. This study suggests that either obesity in women is a more serious risk factor than has been thought, or that risk factors among Scottish women differ from those among women elsewhere. (Consumer Summary produced by Reliance Medical Information, Inc.)

An introduction to randomized controlled clinical trials. J N S Matthews. (Pp 189; price not stated). London: Arnold. This book sets as its aim to provide an introduction to the [...]

The Scottish Heart Health Study is a study of lifestyle and coronary heart disease risk factors in 10,359 men and women aged 40–59 years, in 22 districts of Scotland. The study was conducted during 1984–86, when Scotland had the highest national coronary heart disease mortality reported by the World Health Organisation. A self-completed questionnaire, complemented by a 40 minute visit to a survey clinic, staffed by nurses, enabled the classical major risk factors and some more newly described ones to be measured. The study emphasised quality control and representativeness, and incorporated a World Health Organisation protocol for measurement of key items to allow comparisons in place and time, and therefore also to provide a definitive baseline against which interventions can be assessed. This paper describes the overall findings.Current cigarette smokers constitute 39% of men and 38% of women, higher levels than those reported in England but lower than previous Scottish reports. Mean blood pressure levels were 134/84 mmHg for men and 131/81 mmHg in women, lower than in British studies of the 1960s and 1970s. Mean body mass index levels, 26.1 Kg/m2in men and 25.7 Kg/m2in women, were not high by international standards. However, mean serum cholesterol levels were 6.4 mmol/l in men and 6.6 mmol/l in women — as high as those in previous British studies and high by international standards. Levels of high density lipoprotein cholesterol, non-fasting triglycerides and fibrinogen are also reported. Physical activity both at work and in leisure time was low. Many participants did not eat fresh fruit or green vegetables.High cholesterol and cigarette smoking levels provide a classical explanation for the excess of coronary deaths in Scotland, justifying action, but other factors, such as the dietary deficiencies, also merit further investigation.

Between 1984 and 1986 the Scottish Heart Health Study recorded coronary risk factors and lifestyle in 10,359 men and women aged 40–59 years across 22 districts of Scotland — districts whose standardised mortality ratio for coronary heart disease in men varied from 61 in Eastwood to 136 in Monklands. This paper presents the results by district. Cigarette smoking levels showed the greatest variation, from 29% to 52% in men and 24% to 51 % in women. Blood pressure means varied but were not high (129–138mmHg systolic in men, 126–137mmHg in women, 81–88mmHg diastolic in men and 77–84mmHg in women). Mean serum cholesterol values were high and varied little by district in men, (6.1 to 6.5mmol/l), although there was more variation in women (6.3 to 1.0mmol/l). Body mass index (25.3 to 26.6kg/m2in men and 24.8 to 26.3kg/m2in women) also varied little. Distribution of other lipids, fibrinogen, exercise levels and fruit and vegetable consumption is also described. When district mean levels of major coronary risk factors are entered into predictive formulae, cigarette smoking and blood pressure could explain part of the regional variation in mortality, but much remains unaccounted for. Nonetheless, these levels provide data for local preventive initiatives. While the overall pattern and interaction of the factors will repay further study, the high levels of serum cholesterol in all districts, and the level and variation in cigarette smoking, are a challenge for action.

BackgroundChildren with parents who smoke are often exposed to high levels of environmental tobacco smoke, and children with asthma are particularly susceptible to the detrimental effects of passive smoking. Data were collected from parents who smoke and from their asthmatic children. The families are currently taking part in a randomised controlled trial to test an intervention designed to reduce passive smoking in children with asthma. This paper reports on the baseline data. Questionnaire data and cotinine levels were compared in an attempt to assess exposure and to identify factors which influence exposure of the children. The aim of the study was to identify the scope for a reduction in passive smoking by these children.MethodsA sample of 501 families with an asthmatic child aged 2-12 years was obtained. Factors influencing passive smoking were assessed by interviewing parents. Cotinine levels were measured from saliva samples using gas liquid chromatography with nitrogen phosphorous detection.ResultsCotinine levels in children were strongly associated with the age of the child, the number of parents who smoked, contact with other smokers, the frequency of smoking in the same room as the child, and crowding within the home. Parental cotinine levels, the amount smoked in the home, and whether the home had a garden also exerted an independent effect on cotinine levels in the children.ConclusionsMany children are exposed to high levels of environmental tobacco smoke and their cotinine levels are heavily dependent upon proximity to the parent who smokes. Parents who smoke have a unique opportunity to benefit their child's health by modifying their smoking habits within the home.