Our division has recently reported a new finding by analyzing data of inpatients. Vasospastic angina (VSA) is frequently seen especially in Italy and Japan and the risk factor has been supposed to be smoking, but in the cooperation of the Division of Cardiac Medicine, we found that this disease is associated with obesity, hypertension, glucose intolerance (IGT), hyperinsulinemia and hyperlipidemia and basically, insulin residence is related to it. Such factors are highly associated with not only incipient formulation of plaque, but also accelerated stenotic coronary artery disease. From the cooperative research study with the Division of Cerebral Medicine, we found that these factors are highly associated with atherosclerosis of atherothrombotic cerebral infarction, but are less associated with lacunar infarct which is not accompanied by hypertension and diabetes.

Much effort is being made on removing and controlling known risk factors as well as finding new risk factors, and on primary and secondary prevention and incipient diagnosis by controlling such factor. Follow-up survey in Outpatient Service is also important. In the obesity clinic, special educational cares are provided by a team of physician and dietitian for the diet program. Multiple risk factor control is very important, and we are targeting to keep chol, TG, apo B, BMI, Lp(a), small dense LDL, HDL-C within normal range. Evaluation and maintenance of the normal endocrine and autonomic nervous system, coagulation and fibrinolysis are essentially required. Preventive Atherosclerosis Counseling started in 1989. Two weeks of hospitalized programs given by doctors, nurses, dietitians and pharmaceutists aim to prevent cardiovascular disease primary and secondary. Participants from other division are also join to this counseling. The contents of the programs are as follows:

(1)-(3) by doctors, (4) by dietitians, (5) by pharmaceutists and (6)and (7) by nurses.

(1) Mechanism of each risk factors related to incidence and acceleration of atherosclerosis, thrombogenesis, hemorrhage, ischemia and infarction.

(2) Diagnosis and therapy of each risk factors of obesity, diabetes, hypertension, smoking, hyperlipidemia.

(3) The role of autonomic nervous system and hormones.

(4) Introduction of regulated diet.

(5) How to take the medicine and how does it effect on body.

(6) How to cope with the disease in daily life.

(7) To point out individual problems in diet and exercise.

Long term follow-up survey of patients who were educated here is performed by doctors of Outpatient Service. Progression and regression of atherosclerosis, incidence and relapse of cardiovascular disease are becoming clear by this follow-up survey. If there is any need, they are welcomed to be re-educated or re-inpatient. To join this educational program, participants ask the doctor in charge.

Diabetes education program has been operated every 2 months with twice annual visit to famous temples and gardens aiming outdoor life style adjustment for nearly 10 years. Photo and Haiku contests are included in the program. Those who want to participate are truly welcome.