In this study of patients with symptomatic heartfailure, metoprolol CR/XL improved survival, reduced the need for hospitalizations due to worsening heart failure, improved NYHA functional class, and had beneficial effects on patient well-being.

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In a randomly selected population of 9067 individuals, 32-64 years of age in 1967-1970, 25 (0.28%) had chronic atrial fibrillation (CAF). Eight had lone atrial fibrillation. In 1984 the cases were compared with an age- and sex-matched control group of 50 and found to have more cerebrovascular accidents (6 versus 2; P less than 0.05), congestive heart failure (9 versus 1; P less than 0.001), and valvular rheumatic heart disease (3 versus 0) or history consistent with rheumatic fever (6 versus 0; P less than 0.01). The mortality in the CAF group was 60% higher due to an excess in cardiovascular (relative risk 6.1; P less than 0.05) and cerebrovascular (relative risk 12.2; P less than 0.05) causes. The prevalence or incidence of ischaemic or hypertensive heart disease or the presence of coronary risk factors did not significantly differ in the two groups. By M-mode echocardiography the left atrial size, left ventricular enddiastolic dimension and left ventricular mass were increased in the CAF patients, while the systolic left ventricular shortening was significantly less. Thus, the prevalence of CAF is low in a randomly selected population 32-64 years of age and CAF is not strongly associated with ischaemic heart disease or hypertension. The CAF patients have an increased risk of dying prematurely particularly from cerebrovascular causes, even in the absence of valve disease.

To assess the aortic stiffness (AS) in young (15-35 year old) insulin-dependent diabetics without manifestations of atherosclerotic disease or hypertension, M-mode echocardiography was used to measure relative changes in aortic diameter expressed as Aortic strain = Diameter change/Diastolic diameter-100% Aortic stiffness can be calculated from the formula AS = Pulse pressure/Aortic strain. Fifty-seven diabetics were investigated, 31 men (aged 23.6 +/- 5.6 years, mean +/- SD) and 26 women (aged 25.7 +/- 6.4 years). There were 26 healthy controls with similar blood pressure, 14 men (aged 25.0 +/- 5.5 years) and 12 women (aged 24.6 +/- 7.1). The AS in diabetic men was 14 +/- 8.0 (mean +/- SD) compared to 3.6 +/- 0.7 in controls (p less than 0.001). In diabetic women the AS was 5.8 +/- 3.1 compared to 4.3 +/- 1.3 in controls (p less than 0.05). Diabetic men also had much stiffer aortas than diabetic women (p less than 0.001). There was a linear correlation between AS and duration of diabetes in men (R = 0.70; (p less than 0.001). For females no such correlation was found, the AS frequently being within the range of the controls in spite of long duration of the disease. In males there was a significant correlation between AS and retinopathy (R = 0.49; p less than 0.01) and an inverse correlation with HDL-cholesterol/total cholesterol ratio (R = 0.51; p less than 0.01). In diabetic females AS was significantly greater in smokers (7.0 +/- 3.7) than in non-smokers (4.2 +/- 2.2; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

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