SUMMARY We studied 40 patients with a total of 44 retinal arterial macroaneurysms. All

Abstract-British Indian Asian men aged Ͻ40 years have a twofold to threefold increased risk of death from coronary heart disease (CHD) compared with British whites. Epidemiological studies have suggested an association between glucose intolerance and hyperinsulinemia with premature CHD in Indian Asians. We tested the association of insulin action with myocardial infarction (MI) by using the hyperinsulinemic-euglycemic clamp in 17 MI patients: 8 Punjabi Sikhs (PSMIs), 9 British whites (BWMIs), and 17 control subjects (9 PSCs and 8 BWCs Key Words: myocardial infarction Ⅲ abdominal obesity Ⅲ nonesterified fatty acids Ⅲ insulin resistance P remature CHD mortality is higher in British Indian Asians than in British whites. 1 Increased mortality in Indian Asians is particularly marked in men aged 30 to 39 years, in whom the relative risk of death from CHD is 2, and in men aged 20 to 29, for whom the relative risk is 3, compared with age-matched whites.1 Conventional risk factors, including smoking, hypercholesterolemia, or hypertension, do not account for the higher cardiovascular mortality in this population group.2 In fact, the prevalence of these risk factors is generally reduced in Indian Asians compared with whites.2 Insulin resistance and its metabolic consequences are increasingly recognized as risk factors for CHD.3-11 However, the association of insulin action with MI has not been formally examined in Indian Asians or in British whites. We studied Punjabi Sikh (Indian Asian [PS]) survivors of premature MI for defects of insulin action. A comparable group of white MI survivors (BWMI) was also studied. Familial aggregation of defective insulin action was examined by investigating first-degree relatives of Sikh MI patients to search for early markers of MI. Methods SubjectsSeventeen male MI patients (8 PSMIs and 9 BWMIs) and 17 control subjects (9 PSCs and 8 BWCs) underwent the hyperinsulinemiceuglycemic clamp study to test the association of insulin action with MI. Fifty-one male MI patients (24 PSMIs and 27 BWMIs) and 53

To explore whether antithrombotic medication may protect against cognitive decline, tests of verbal memory, attention, abstract reasoning, verbal fluency, and mental flexibility were administered to 405 men at risk of cardiovascular disease. These subjects were a subgroup of those who had been participating in a randomised double blind factorial trial of low dose aspirin (75 mg daily) and low intensity oral anticoagulation with warfarin (international normalised ratio of 1.5) at 35 general practices across the United Kingdom for at least five years, were at least 55 years old at trial entry, and had been randomly allocated to one of four groups: active warfarin and active aspirin, active warfarin and placebo aspirin, placebo warfarin and active aspirin, and double placebo. Verbal fluency and mental flexibility were significantly better in subjects taking antithrombotic medication than in subjects taking placebo. Aspirin may have contributed more than warfarin to any beneficial effect. These results provide tentative evidence that antithrombotic medication may protect cognitive function in men at risk of cardiovascular disease. (3 Neurol Neurosurg Psychiatry 1997;62:269-272) Keywords: cognitive; aspirin; warfarin; cardiovascular; antithrombotic A growing body of evidence suggests an association between cardiovascular risk factors and cognitive impairment during aging. These risk factors include hypertension, diabetes, hypercholesterolaemia, and cardiac disease such as atrial fibrillation and angina, all of which may promote neuropathological changes resulting from microthromboses in cerebral blood vessels. Antithrombotic medication may therefore protect cognitive function. In a randomised placebo controlled trial, Meyer et alI found that aspirin improved cognitive function in patients with multi-infarct dementia. Little is known, however, about the effect of antithrombotic medication on cognitive function in those without frank dementia. Population based studies have either reported no association2 or a modest trend towards protection of cognitive function3 from medication (non-steroidal anti-inflammatory drugs and aspirin). However, these authors relied on recall of use of medication and, in both studies, employed a single, global measure of current cognitive status.In the present study we measured cognitive function in patients already enrolled in a double blind placebo controlled factorial trial of low dose aspirin and low intensity oral anticoagulation with warfarin for their effect on the prevention of coronary and cerebral thrombosis. The purpose was to assess whether those who were on active treatment showed differences in cognitive performance compared with those who were receiving placebo. Because this cognitive study was conducted after the trial was already in progress, no baseline cognitive test data are available for comparison. Nevertheless, we were able to take advantage of the randomised design and detailed monitoring during a five year interval. The content of our neuropsychological te...