Clinical Implications Of Recent Research Results In Arteriosclerosis (german Edition) (abhandlungen Der Rheinisch-westfälischen Akademie Der Wissenschaften)

Coronary heart disease and other vascular disorders are the most common causes of death in the United States and in most industrialized countries (1,4). This is a modem phenomenon; coronary disease as a recognized cause of death was quite rare until the mid-twentieth Century (2). Our epidemic is abating. The United States experienced a 25 % decrease in coronary death in the decade ending in 1978 (1, 3). The decrease in stroke related death began earlier (1950s) and is more dramatic; it may be as high as 40 % (3, 4,5). This decrease is shared by Australia, Canada, and a few Western European countries. The epidemic is still at full force in Eastern Europe and the Soviet Union (6). The explanation for the waxing and more particularly the cause or causes of the retreat of cardiovascular disease is regularly debated with no clear resolution. It is unclear whether the decrease is due to more effective treatment of patient stricken with vascular disease (secondary prevention) or due to primary prevention through modification of risk factors. Clinical, epidemiologic, pathologic, and animal experimental work as well as early clinical trials over the past 30 years clearly identified hypertension, cigarette smoking and hypercholesterolemia as major risk factors for coronary and other cardiovascular disorders (7-16). Given the identification of these antecedants, prevention through modification of these characteristics seemed an exciting possibility. Physicians with varying degrees of enthusiasm have gradually begun to advise risk factor modification. There have been substantial changes in the risk factor profile of the U.S. population in the past 15 years with decreases in cigarette smoking, more vigorous detection and treatment of hypertension and modification of diets in the direction of less saturated fat and cholesterol (3,4). There is thus some support for the premise that risk factor modification may have led to the decline in cardiovascular mortality. The possibility of prevention through risk factor modification led to a number of clinical trials designed to test this set of hypotheses, specifically, whether risk Table I Trial Population Allocation Treatment Control Blind HDFP General Population Random Stepped Care (SC) Front Matter....Pages 1-12 Begrüßung....Pages 13-13 Rheinisch-Westfälische Akadernie der Wissenschaften....Pages 14-14 Prorektor für Forschung und wissenschaftlichen Nachwuchs der Westfälischen Wilhelms-Universität Münster....Pages 15-16 Dekan des Fachbereichs Klinische Medizin der Westfälischen Wilhelms-Universität Münster....Pages 17-18 Vorstand der Gesellschaft für Arterioskieroseforschung e.V. Münster....Pages 18-18 Primary Prevention of Cardiovascular Disease Recent Trials....Pages 19-38 Secondary Trials After Myocardial Infarction: A Review....Pages 39-58 Münster Studies of Coronary Heart Disease....Pages 59-68 Prediction and Early Detection of Coronary Heart Disease....Pages 69-100 Progression of Coronary Artery Disease as Judged from Sequential Angiography....Pages 101-118 New Non-Invasive Ways to Measure Plaque Size, their Development and Implications....Pages 119-130 Endothelial Injury and Repair....Pages 131-138 Extracellular Matrix Proteins of the Vessel Wall: Are they Possible Markers of Atherosclerotic Processes?....Pages 139-156 External Measuring of Myocardial Structure and Function....Pages 157-170 Immunological Anomalies in High Risk Women on the Pill....Pages 171-182 Diet in Experimental Atherosclerosis....Pages 183-194 Cardiovascular Effects of Exercise in Primate Atherosclerosis....Pages 195-212 Prostacyclin and Atherosclerosis — Experimental and Clinical Approach....Pages 213-226 Antirheumatic Drugs and their Influence on Arterial Wall Cells of Normal and Injured Animals....Pages 227-240 Effects of Alfalfa Saponins on Regression of Atherosclerosis in Monkeys....Pages 241-254 The Effect of Alcohol on Human Platelet Function. The Role of Platelet Membrane and Plasma Lipids....Pages 255-269 Effect of the Anthocyanosides of Vaccinium myrtillus on the Vascular Wall....Pages 271-283 Growth Factors and Atherogenesis....Pages 285-292 Significance of Coagulation in Atherogenesis....Pages 293-300 Contribution of Blood Platelets to the Pathogenesis of Myocardial Infarction....Pages 301-306 Isovolemic Hemodilution as a Functional Therapy of Decompensated Arteriosclerotic Stenoses of the Femoral, Cerebral and Ophthalmic Artery....Pages 307-328 The Role of HDL Cholesterol in Preventive Medicine....Pages 329-342 LDL and HDL in Human Arteries — Role in Atherogenesis....Pages 343-358 A New Tracer for the Metabolic Fate of Cholesteryl Ester....Pages 359-367 The Latest Evidence, in vitro and in vivo , on Controlling Smooth Muscle Cell Proliferation and Arterial Wall Cholesterol Ester Accumulation by Controlling LDL Concentration....Pages 369-378 Summary Chapter....Pages 379-383 Final Remarks....Pages 384-384 The survey of the following epidemiologic studies of "Institut fUr Arterioskle roseforschung" in MUnster was given: 1. Follow-up study to analyze longterm mortality after myocardial infarction and individual risk of death. 2. Secondary preventive study after myocardial infarction under the conception of mesenchymal suppression. 3. Prospective study to find out the predictive power of cholesterol sub fractions. 4. Study of old age probands. The advantage of our infrastructure of the epidemiologic work lies in the close connection to the clinical medicine, as the scientific planning and guidance is done by physicians and teachers of university clinic. There is less danger that irrelevant problems are followed or that non-medical researchers like statisticians will domi nate the studies. We have deliberately avoided to join or organize multicenter stu dies believing that a larger output of data cannot outweigh the disadvantages of possible mistakes and errors through lack of contact and controversial conceptions among the coworkers. We hope to show that studies planned for screening of as many as 10 000 probands can be performed at relatively low expense. An im portant point is the adaptability of our system, which enables us to enlarge the already running studies for instance by addition of parameters like blood coagula tion as is being prepared by the team of Professor van de Loo in MUnster. References 1. Assmann, G., Oberwittier, W., Schulte, H., Schriewer, H., Funke, H., Epping, P.H