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ELEMENTS OF ISCHEMIC HEART DISEASE* LESLIE M. KLEVAYÎ Ischemic heart disease is the leading cause of death in the United States [I]. Previously termed coronary heart disease [2], this disease causes about 35 percent of deaths, twice as many as are caused by malignant neoplasms or cancer. Considering the number of people of various ages in the population of the United States [3] and the prevalence of coronary heart disease [4], 11.5 percent of men and 8.8 percent of women between the ages of 45 and 79 have definite or suspect disease. In the United States, risk of ischemic heart disease is higher among men than among women, among smokers of cigarettes than among nonsmokers, among diabetics, and among those with certain abnormalities of the electrocardiogram. Risk also increases with age, with blood pressure, and with the concentration of cholesterol in serum [5]. Other factors associated with risk of this disease are protean and are apparently dissimilar. These factors, the dissimilarity of which may be more apparent than real, may modify those enumerated above. Risk is high in the industrialized part of the world where diets usually contain large amounts of fat and sucrose and small amounts of vegetable fiber. Within industrialized countries there is no epidemiologic association of risk with the amount or type of fat consumed [6-8]. Within these countries risk is high where soft water is available [9, 10]. Sedentary men have a higher risk than do men who exercise [H]. Consumption of human milk in infancy [12] and cirrhosis of the liver [13, 14] apparently are protective; chronic kidney disease seems to increase risk [15, 16]. Many other environmental factors such as stress and the consumption of coffee , tea, aspirin, and vitamin D have been associated with increased or decreased risk. In addition to these factors, 29 elements (fig. 1) have been related to the epidemiology of ischemic heart disease or to the metabolism of cholesterol or other lipids. This list of elements is meant to be inclusive rather than exclusive. Reviews were selected for references in prefer- *Based upon a lecture at the 169th National Meeting of the American Chemical Society, April 9, 1975, Philadelphia. tResearch Medical Officer at the Human Nutrition Laboratory, U.S. Department of Agriculture, Agricultural Research Service, Grand Forks, North Dakota 58201. 186 J Leslie M. Klevay ¦ Ischemic Heart Disease ?a Mg 2Ö~~ 21 Ca IVB VB VI B VII Cr 25 Mn 26 Fe 27 Co 2T Ni Cu 30 Zn III ? 5 VA VI A VII A 32 Ge As Se Zr Nb 42 Mo! 43 46 47 48 Cd 49 50 Sn Sb 52 Te 75 Hg Pb 85 88 89 • * 6 Ce 90 95 100 101 102 103 Fig. 1.—Elements of ischemie heart disease. Elements identified by symbol have been implicated in the epidemiology of ischemic heart disease or in the metabolism of cholesterol or other lipids. References to fig. 1 follow (numbers refer to the atomic numbers of the elements). 3. A. W. Voors. Am. J. Epidemiol. 93:259, 1971. 9. D. S. Bernstein, N. Sadowsky, D. M. Hegsted, C. D. Gurí, and F. J. Stare. J. Am. Med. Assoc. 198:499, 1966. L. K. Dahl. J. Exp. Med. 112:635, 1960. M. S. Seelig and H. A. Heggtveit. Am. J. Clin. Nutr. 27:59, 1974. J. Stamler, R. Pick, and L. N. Katz. Circ. Res. 6:442, 1958. G. R. Meneely and C. O. T. Ball. Am. J. Med. 25:713, 1958. See text reference [25]. L. L. Hopkins and H. E. Mohr. Fed. Proc. 33:1773, 1974. W. Mertz. Physiol. Rev. 49:163, 1969. E. A. Doisy, Jr. In: D. D. Hemphill (ed.). Trace substances in environmental health—VI, pp. 193-199. Columbia: Univ. Missouri Press, 1973. E.K. Amine and D. M. Hegsted. J. Nutr. 101:1575, 1971. D. B. Louria, M. M. Joselow, and A. A. Browder. Ann. Intern. Med. 76:307, 1972. F.H. Nielsen, D. R. Myron, S. H. Givand, T.J. Zimmerman, and D. A. Ollerich. J. Nutr. 105:1620, 1975. 29, 30. See text reference [24]. 32.H. A. Schroeder. J. Nutr. 94:475, 1968. 33,34, 40, 41. See 32 above. 42. E...


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