SUMMARY A genetic-epidemiologic study was undertaken of a white Colorado population of 207 patients who had a myocardial infarction before age 55 years. Nineteen independent variables were compared between the 207 cases and 621 controls, matched 3:1. The highest risk ratios were associated with a positive family history for ischemic heart disease (IHD). The heritability of IHD was 63% when families with the monogenic forms of hyperlipoproteinemia were included, and 56% when they were excluded. A risk index was developed that incorporates family history into a data base of risk factors, which can be readily assessed by the clinician obtaining a screening history, physical and standard laboratory tests. A scale of 0-10 was devised and the predictive value of the index was tested against another data set. The efficiency of the index was maximal at a screening level of 5. This study suggests that it is logistically feasible to seek patients at high risk for intensive management in a clinical setting (high-risk strategy) using risk indices similar to the one developed for this study, which emphasize the very important familial component to IHD. determinant for entry. The intake period for this study began in January 1976.A control group of 621 subjects was matched 3:1 with the patients for age, sex and race. These subjects were drawn from over 3000 subjects who were selfreferred to two community-wide heart disease screening programs in which our group participates. On the basis of the screening evaluation, all control subjects were judged to be free of IHD before and at the time of intake.All subjects completed a questionnaire and were examined according to a protocol that obtained height (without shoes), weight (in indoor clothing), blood pressure and fasting cholesterol and triglycerides. Certain data were obtained in one group and not the other. Information on juvenile diabetes and hypertension in first-degree relatives and IHD in second-degree relatives was called for in the protocols of patients with infarcts, but only in the protocol of one of the screening programs. Therefore, these three factors were compared in a subset of only 140 patients matched 1:1 with controls of the same age, sex and race.Lipid and lipoprotein determinations were performed in our laboratory by the methods outlined for the Lipid Research Clinics Program.' Blood pressures were taken according to the protocol of the Pooling Project Research Group,2 except that diastolic pressure was taken as the abrupt muffling of sound (phase IV). The threshold for diagnosis of hypertension in a patient or first-degree relative was 140/90 mm Hg. Only first-degree relatives 12 years and older were included in the family study because a blood pressure of this level is not found as a ninety-fifth percentile discriminant until this age. Relative weight was determined according to published standards of the Metropolitan Life Insurance Company.The self-administered questionnaires were designed to cover a priori risk factors that have been implicated in IHD in...

In the Medical Clinic at the University of Basle, the immunosuppressive drug cyclosporin‐A has been employed recently for kidney transplant patients. A side effect of this drug appears to be pronounced gingival enlargement. This report documents 3 such cases, with a discussion of etiology and possible treatment modalities

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The actual survival rate of 25 primary cadaveric kidney grafts in recipients treated initially with cyclosporin A (CyA) alone was 84%. The survival rate in 37 patients under conventional immunosuppression was 76%. The mean number of dialyses required in the first 4 weeks after transplantation was 1.2 per patient in both groups. At 15-28 months posttransplant, mean serum creatinine levels have remained stable at 175 mumol/l in the CyA group. The mean daily dose of steroids (including methylprednisolone i.v.) in the first two months was 2.07 mg/kg/d in patients under conventional immunosuppression and 0.76 mg/kg/d in the patients receiving CyA (p less than 0.001). The combination of CyA with low-dose steroids enabled the dose of CyA to be rapidly tapered off in once-weekly steps. CyA levels were monitored by determination of whole blood trough concentrations (target level: 300-800 ng/ml). At 60 days posttransplant the average dose of CyA was 6.0 +/- 0.5 mg/kg/d compared with an average daily dose of 11.4 +/- 0.9 as recommended for CyA alone in the protocol for the European multicentre study. This more rapid reduction in the CyA dose reduced nephrotoxicity (serum creatinine levels 174 +/- 14 as compared with 289 +/- 31 mumol/l) (p less than 0.05) and almost halved the number of methylprednisolone pulses given up to the end of the second month. We conclude from these results (1) that previously the dosage of CyA administered at this centre was probably too high, and (2) early adjustment of dose levels on the basis of blood concentrations and with low-dose prednisone cover appears to be safe and effective, but requires further verification.

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