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It has been generally accepted that high density lipoprotein cholesterol (HDL-C) level decreases with menopause in women. However, recent reports show different results. There is very little data concerning perimenopausal women. To verify these findings, lipids and lipoprotein(a) [Lp(a)] levels were compared among pre-, peri- and postmenopausal women of similar mean ages. Postmenopausal women had higher HDL-C levels than premenopausal women (p

Background: Estrogen replacement therapy in post-menopausal women reduces the risk of coronary artery disease. One of the possible mechanisms of this effect is the modification of lipid profiles. However, there is controversy concerning the effects on lipoprotein(a) [Lp (a)] and lipid levels of progestogens administered with estrogen. Methods: Five hundred fifty-one postmenopausal women were divided into 5 groups: group 1,0.625 mg of conjugated equine estrogen (CEE) (n=140); group 2,0.625 mg of CEE plus 5 mg of medroxyprogesterone acetate (MPA) (n=97); group 3, 0.625 mg of CEE plus 10 mg of MPA (n=109); group 4, 2 mg of estradiol valerate plus 0.5 mg of norgestrel (n=134); and group 5, control (n=71). The Lp(a) and lipid levels were measured before and 2,6, and 12 months after hormone replacement therapy. Results: Estrogen replacement therapy for 12 months lowered the Lp(a) level by 37.1%. The addition of progestogen attenuated the Lp(a)-lowering effect of estrogen. The high-density lipoprotein cholesterol (HDL-C) level was markedly increased in group 1 (16.5%), was moderately increased in groups 2 (10.8%) and 3 (11.3%), and was not changed in group 4. The low-density lipoprotein cholesterol level was decreased by 10.9% to 17.6% in all the treatment groups. Estrogen replacement therapy for 2, 6, and 12 months raised the HDL-C level by 7.2%, 17.4%, and 17.8%, respectively. In the group with combined estradiol plus norgestrel therapy, the HDL-C level was decreased after 2 months and was not changed after 6 and 12 months. The groups that received CEE plus MPA showed intermediate effects between the group that received CEE only and the group that received estradiol plus norgestrel. Conclusions: Combined estrogen and progestogen therapy may have effects on the heart different from those of estrogen therapy alone because of adverse impact of progestogens on Lp(a) and HDL-C levels. The effects of progesterones were dependent on the androgenic potency of progestogen and the duration of therapy. Arch Intern Med. 1996;156:1693-1700

Background and Objectives:The octapeptide hormone of the renin-angiotensin system, angiotensin Ⅱ, regulates a wide variety of physiological responses including salt and water balance, blood pressure, and vascular tone. Contradictory results have been reported regarding the effects of angiotensin Ⅱ on vascular smooth muscle cell (VSMC proliferation. The aim of the present study was to investigate the direct effect of angio- tensin Ⅱ on the growth of VSMC. Materials and Method:Rat aortic smooth muscle cells were obtained by the combined collagenase and elastase methods. Cells between the 4th and 8th passages were used for the experiments. Cultures were treated daily for 3 days with either angiotensin Ⅱ alone or angiotensin Ⅱ with equimolar concentrations of saralasin. Incorporated radioactivity of ( 3 H)thymidine and ( 14 C)phenylalanine was measured by liquid scintillation spectrometry. Results:Angiotensin Ⅱ increased ( 14 C)phenyalanine incor- poration about 20-30%, and saralasin completely blocked the stimulation by angiotensin Ⅱ. However, there was no significant increase in ( 3 H)thymidine incorporation by angiotensin Ⅱ stimulation in this study. Conclusion:These results suggest that angiotensin Ⅱ alone induces cellular hypertrophy but has no detectable mitogenic activity in cultured rat aortic VSMC. ( ( ( (Korean Circulation J 1999;29( ( ( (2 :209-215

Chloroma (granulocytic sarcoma) indicates an extramedullary leukemic cell collection. It often develops in the course of, or as a presenting sign of leukemia. Cardiac chloroma is uncommon and rarely detected as a mass. We report the first case of cardiac chloroma in a patient with acute lymphocytic leukemia in Korea. A 73-year-old man was admitted because of exertional dyspnea, orthopnea and generalized weakness. Thrombocytopenia and immature leukocytes were detected in the peripheral blood. An X-ray film of the chest showed mild cardiome-galy and bilateral pleural effusion. Transthoracic and transesophageal echocardiography showed a low echogenic mass at the lateral wall of the right ventricle. The size of the mass was about 6×4 cm. MRI of the chest showed right ventricular mass with slightly increased inhomogeneous signal intensity. Bone marrow aspiration and biopsy confirmed that he had a L3 FAB subtype of acute lymphocytic leukemia. Induction chemotherapy with vincristine, prednisolone, daunorubicin resulted in hematologic complete remission. At 6 weeks after the induction chemotherapy, transesophageal echocardiography demonstrated disappearance of the right ventricular mass which suggested that it was a cardiac chloroma complicating acute lymphocytic leukemia. (Korean Circulation J 1999;29(6):635-638)

Background:In Korea, cerebrovascular accident (CVA) is the most significant cause of death among older people, and the incidence of cerebral hemorrhage is much higher than that of developed countries. There have been many investigations about the risk factors for CVA in both Korea as well as developed countries. A few papers reported various risk factors for cerebral hemorrhage in developed countries;however, well-designed studies of risk factors for the various causes of CVA were rare in Korea. Therefore, the purpose of this study was to compare the risk factors for the various causes of CVA and to evaluate the risk factors compared with ageand sex-matched control groups. In addition, duplex sonographic findings of the carotid artery were evaluated in patients with cerebral infarction. Methods:One hundred and sixty-four patients admitted to the hospital in 1996 were enrolled. The four groups were divided based on the following states: cerebral infarction (n=63), cerebral hemorrhage (n=64), cerebral infarction with atrial fibrillation (n=19), and lacunar infarction (n=18). Major risk factors were compared with ageand sex-matched control groups and among CVA groups. Duplex sonography of the carotid artery was done in 14 patients with cerebral infarction. Results:In multiple logistic regression analysis, patients with cerebral infarction had higher prevalence of diabetes mellitus and lower high density lipoprotein-cholesterol level than the control group, and hypertension showed borderline significance. Patients with cerebral hemorrhage had higher prevalence of hypertension, higher high density lipoprotein-cholesterol level, and more frequent prevalence of smoking compared with the control group. Patients with cerebral infarction showed lower high density lipoprotein-cholesterol, higher low density lipoprotein-cholesterol levels, more frequent diabetes mellitus, lower prevalence of hypertension and older age than patients with cerebral hemorrhage. Patients with cerebral infarction and atrial fibrillation showed only older age than patients with cerebral infarction only. There were no differences in risk factors 논문접수일:1998년 2월 28일 심사완료일:1998년 4월 27일 교신저자:류왕성, 140-757 서울 중구 필동 2가 82-1 중앙대학교 의과대학 내과학교실 전화:(02) 798-4745·전송:(02) 748-9882

Background:Atherosclerosis is a diffuse disease process that produce thickening of the vascular wall because of intimal deposition of lipid, fibrous tissue, and calcific material. Nowadays it is possible to evaluate atherosclerotic changes of carotid arteries accurately by developed noninvasive techniques such as ultrasonography. Left ventricular hypertrophy (LVH) is known to be an important risk factor for cardiovascular events in hypertension. The purpose of this study was to establish whether the carotid intimal-medial thickness (IMT) correlates with the severity of LVH. Method:We measured intimal-medial thickness (IMT) for 12 sites in carotid arteries (near and far walls in common carotid, bifurcation, and internal carotid arteries of both sides) by B-mode ultrasonography in both 38 normotensive and 72 hypertensive patients. Left ventricular measurements were made according to the recommendations of the American Society of Echocardiography. Left ventricular mass was derived from the formula described by Devereux et al. and each left ventricular mass value was indexed to body surface area. And then we have investigated whether hypertensive patients have significant changes of carotid IMT and IMT correlates with left ventricular mass index (LVMI). Results:1) Most hypertensive patients had diffuse thickening of the carotid artery and some had focal or multiple plaques. 2) In general, mean IMT was widest in the carotid bifurcation. 3) The mean IMT of all 12 segments increased about 40% in hypertensive patients compared with normal control group. 4) LVMI significantly correlates with IMT of carotid artery, especially bifurcation site and mean all 12 segments. Conclusion:The mean IMT may serve as a useful marker of the severity of atherosclerosis in hypertensive patients. The significant association between carotid IMT and LVMI suggests a simultaneous correlation of carotid atherosclerosis with left ventricular hypertrophy in hypertension. (Korean Circulation J 1998;28(9):1480-1486)

National Cholesterol Treatment Guidelines are different according to race and country, and change year by year, because the distribution of lipid and lipoprotein levels are different by genetic background, dietary habit and life style. So it is mandatory to set-up the national cholesterol treatment guidelines based on the epidemiologic results. To establish the cutpoints for hypercholesterolemia specific to the Korean population, we selected the laboratories, whose inaccuracies of cholesterol measurement were less than 5%, in the external laboratory quality assessment survey, and performed epidemiological survey on the distribution of cholesterol levels, and other risk factors of coronary heart disease (CHD). As a result, prevalence of CHD risk factors was very high in hypertension (28.0%) and relatively low in diabetes (2.8%). Smokers were 42.6% of total subjects. Thirteen percent of subjects had a family member(s) who was suffering from or had of hypertension, stroke, and heart diseases. The average cholesterol level of a Korean was 187 mg/dL, which was about 25 mg/dL lower than that of United States. The 75th percentile to total cholesterol was 210 mg/dL and 90th percentile 235 mg/dL. The cutpoint for borderline-high cholesterol levels provide a major guideline for initiation of dietary and exercise therapy. We propose the cutpoint for borderline-high cholesterol levels as 200 instead of 210 mg/dL to initiate more active dietary and exercise therapy, and we also propose the temporary cutpoint for high blood cholesterol levels as 240 mg/dL instead of 235 mg/dL, which is a reasonable cutpoint considering medical insurance policy of the country. In conclusion, we suggest the cutpoints for borderline-high and high serum cholesterol levels as 200 and 240 mg/dL, respectively.

Objective: To investigate the serial changes in Lp(a) lipoprotein levels with the loss of female sex hormones by surgical menopause and with estrogen replacement therapy in the same women. Patients and Methods: Forty-four premenopausal women who underwent a transabdominal hysterectomy (TAH) because of benign gynecological disorders were divided into two groups: women who underwent a TAH and unilateral salpingo-oophorectomy (n=31) and women who underwent a TAH and bilateral salpingo-oophorectomy (n=13). In the group of women who underwent a TAH and bilateral salpingo-oophorectomy, 0.625 mg of conjugated equine estrogen was given daily 2 months after the operation. The levels of Lp(a) lipoprotein and lipids were measured before and at 2 and 4 months after the operation. Results: In the group of women who underwent a TAH and bilateral salpingo-oophorectomy, the mean (±SD) concentration of Lp(a) lipoprotein was increased by 24.5% from 0.48±0.47 mmol/L (18.4± 18.3 mg/dL) to 0.59±0.54 mmol/L (22.9±21.0 mg/dL) after 2 months ( P P P Conclusions: The Lp(a) lipoprotein levels appear to be closely associated with female sex hormones. This association might play a pivotal role in postmenopausal increases of atherosclerotic diseases and cardioprotective effect of estrogen in postmenopausal women. (Arch Intern Med. 1996;156:500-504)

Although recent advances in the treatment of pulmonary tuberculosis have succeeded in reducing morality rate, some western and Japanese studies indicated an increase in the incidence of pulmonary tuberculosis in the aged. The purpose of present study was to survey the incidence of pulmonary tuberculosis in the aged in Korea and to investigate the characteristics of pulmonary tuberculosis in the aged in comparison with the same disease in the young adult. For this purpose we collected 821 cases of pulmonary tuberculosis in various age groups including 508 cases of below 40 years of age, 222 cases of between 40 and 49 years of age and 91 cases of over 50 years of age. We observed the incidence of pulmonary tuberculosis, motives of detection, degree of pulmonary lesions, symptoms, duration of illness, and results of various laboratory examinations in these three age groups and following conclusions were obtained. 1. The incidence of pulmonary tuberculosis in the group of over 50 years of age was 12.4percent and this was twice as high as those in young adult-age group. 2. The relatively high motives of detection of pulmonary tuberculosis in young adult-age group was hospital visit with the complaint of related symptoms. Howeever, in the aged group relatively high percentage of patients were found to have pulmonary tuberculosis by incidental finding while they were checked by X-Ray during treatment of other illness. 3. Wherease the duration of illness was within one year in 54 percent of young adult-age group, there were many cases of pulmonary tuberculosis with the duration of illness of more than one year in the aged patients. 4. The severity of disease process was higher among aged group in comparison with young adult-age group and the extent of lesions was also more widespread and fairly advanced in the aged in comparison with the relatively localized lesions in the young adult-age group. 5. The symptomatology did not differ much from that of the adult-age group but the disease process was much slower and dyspnea was found much frequently in the aged group. 6. The erythrocyte sedimentation rate was observed to be much more rapid in the aged tuberculosis patients. 7. The incidence of positive sputum was also much higher in the aged group. 8. The incidence of complications and associated diseases, especially of hypertension, heart diseases, diabetes, bronchial asthma and atelectasis was much higher in the aged group and two cases showed complication of lung cancer.

The frequency distribution of cardiovascular disease are changing recently due to the development of living environment. Unfortunately there are few epidemiological studies of cardiovascular diseases in general population, we tried to estimate the recent trend of cardiovascular diseases studying hospitalized patients in nationwide 13 large hospitals during a year of 1985. The hypertensive disease (24.1%) was the most common cardiovascular disease and the next were cerebrovascular disease (15.8%), arrhythmias (12.2%), ischemic heart disease (9.7%), congenital heart disease (9.1%), and rheumatic heart disease (5.4%) in order. This results showed that hypertensive disease and cerebrovascular disease are still the major cardiovascular disease and ischemic heart disease and arrhythmias are increased. But chronic rheumatic heart disease is declined compared with previous studies in hospitalized patients.