Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease. The Caerphilly and Speedwell collaborative heart disease studies.

BACKGROUND Recent studies have suggested that hemostatic factors and white blood cell count are predictive of ischemic heart disease (IHD). The relations of fibrinogen, viscosity, and white blood cell count to the incidence of IHD in the Caerphilly and Speedwell prospective studies are described. METHODS AND RESULTS The two studies have a common core protocol and are based on a combined cohort of 4,860 middle-aged men from the general population. The first follow-up was at a nearly constant interval of 5.1 years in Caerphilly and 3.2 years in Speedwell; 251 major IHD events had occurred. Age-adjusted relative odds of IHD for men in the top 20% of the distribution compared with the bottom 20% were 4.1 (95% confidence interval, 2.6-6.5) for fibrinogen, 4.5 (95% confidence interval, 2.8-7.4) for viscosity, and 3.2 (95% confidence interval, 2.0-4.9) for white blood cell count. Associations with IHD were similar in men who had never smoked, exsmokers, and current smokers, and the results suggest that at least part of the effect of smoking on IHD is mediated through fibrinogen, viscosity, and white blood cell count. Multivariate analysis shows that white blood cell count is an independent risk factor for IHD as is either fibrinogen or viscosity, or possibly both. Jointly, these three variables significantly improve the fit of a logistic regression model containing all the main conventional risk factors. Further, a model including age, smoking habits, fibrinogen, viscosity, and white blood cell count predicts IHD as well as one in which the three hemostatic/rheological variables are replaced by total cholesterol, diastolic pressure, and body mass index. CONCLUSION Jointly, fibrinogen, viscosity, and white blood cell count are important risk factors for IHD

Aspirin and secondary mortality after myocardial infarction

A randomised controlled double-blind trial of aspirin in the prevention of death was conducted in 1682 patients (including 248 women) who had had a confirmed myocardial infarct (MI). 25% of the patients were admitted to the trial within 3 days of the infarction and 50% within 7 days. Aspirin, 300 mg three times daily, was given for 1 yr. Total mortality was 12·3% in patients given aspirin and 14·8% in those given placebo, a reduction by aspirin of 17%, which was not statistically significant at p<0·05. The reduction in specific ischæmic-heart-disease (IHD) mortality was 22% and in total mortality plus IHD morbidity (readmission to hospital for MI in survivors) was 28%

Visit frequency for controlled essential hypertension: general practitioners' opinions

A survey of 50 randomly selected South Glamorgan general practitioners was undertaken to determine how often they would treat and see patients with uncomplicated controlled essential hypertension. The decision to treat for high blood pressure depended on the level of diastolic pressure, patient age and sex, and interactions between diastolic pressure and age and diastolic pressure and sex. The range of responses for visit frequently was every two weeks to once yearly. On average, patients would be seen every 14.8 weeks (standard deviation, 9.2 weeks). The follow-up interval was significantly affected by level of pretreatment diastolic pressure (16 weeks for pressures 95 to 100 mmHg; 13.6 weeks for pressures greater than 105 mmHg), the patient's age (13.9 weeks for those 40 to 49 years old; 15.6 weeks for those 60 to 65 years old), and the decision to treat for high blood pressure (13.4 weeks for those treated; 17.9 weeks for those not treated). If the variability of physician opinion observed in this study is reflected in practice patterns, then it is important to know whether these variations affect outcome. Follow-up intervals can be related to physician, patient, illness characteristics, and outcomes. Visit frequency is a useful variable for studying the process of care

Exposure to carbon disulphide and ischaemic heart disease in a viscose rayon factory

The cohort of viscose rayon workers previously described by Tiller et al has been reconstructed and followed up to the end of 1982. The pattern of mortality at ages 45 to 64 for the extended period 1950-82 is similar to that described by Tiller et al for 1950-64. The spinners, the workers most heavily exposed to carbon disulphide, have a significantly higher mortality from all causes than the least exposed group. The excess mortality is largely accounted for by ischaemic heart disease (IHD) for which the spinners have an SMR of 172. When mortality is related to an exposure score in the same group, both all cause (p less than 0.01) and IHD (p less than 0.001) mortality increase with increasing exposure level. When this analysis is repeated covering all ages these trends become much less strong and only that for IHD remains significant (p less than 0.05). Over the age of 65 there is a tendency for mortality to decline with increasing exposure. This is contrary to expectation under the usual hypothesis that carbon disulphide promotes atherosclerosis. Instead it suggests that carbon disulphide has some type of reversible, direct cardiotoxic or thrombotic effect. This is supported by the findings that there is a strong trend (p less than 0.01) for IHD mortality to increase with increasing exposure in the previous two years. Further, both IHD (p less than 0.001) and total (p less than 0.01) mortality show highly significant trends with exposure among current workers but no such trends among workers who have left the industry

Drug prescribing by GPs in Wales and in England

There is a large excess in prescribing costs by GPs in Wales compared with England. This excess amounts to about 30%, equivalent at present to over pounds 11 m a year. The pattern of drug prescribing by GPs and of patient consultation was studied in random samples of electors in Cardiff and Bristol. Overall, more subjects in Cardiff had received prescriptions, and the average number of scripts for each person was higher than in England in the same period. The pattern for consultations was similar. For both prescriptions and consultations the rates were higher in Wales and the difference from those in England seemed to be greater for women than for men. There was no consistent difference between the two cities in the proportions of those who had consulted who received a script, nor was there any evidence that subjects in Cardiff received more prescriptions without a consultation. In both cities similar proportions of subjects bought drugs from chemists without a prescription

Respiratory disability in ex-cotton workers

A high proportion of textile workers handling cotton and flax complain of respiratory symptoms and show a loss in lung function. These effects are reversible in the early stages but the degree to which they lead to permanent respiratory disability is unknown. Two surveys were therefore conducted in which respiratory function and symptoms were compared in ex-textile workers and in control subjects who had never been exposed to textile dusts. One survey was of ex-flax workers in Northern Ireland. The present survey was of ex-cotton workers in Lancashire. A survey of random population samples in Oldham and Bolton, in both of which cotton had formerly been the most important source of employment, was conducted. After allowing for age, height, and smoking, lung function was about 2-8% lower in the ex-textile workers than in controls who had never been exposed to any dust. Ex-textile workers were slightly shorter than the controls, suggestive of past social and nutritional deprivation which may have contributed to the decrement in lung function. There was evidence of a small but increasing decrement in lung function with an increase in a "dust exposure" score. For men, about 15 years of heavy dust exposure was associated with a loss in FEV, equivalent to that shown by light or ex-smokers. For women, 15 years of heavy dust exposure appeared to be associated with a decrement in FEV, about half that of light smoking