The role of low grade inflammation as measured by C-reactive protein levels in the explanation of socioeconomic differences in carotid atherosclerosis

BACKGROUND: The role of inflammation as part of the explanation of socioeconomic differences in carotid atherosclerosis has not been specifically investigated. METHODS AND RESULTS: The associations between socioeconomic position (SEP), C-reactive protein (CRP), and preclinical carotid atherosclerosis were investigated in a general population sample of 3921 middle-aged Swedish men and women. Common carotid intima-media thickness (IMT) and presence of carotid plaque (focal IMT > 1.2 mm) were determined by B-mode ultrasound. The results showed that low SEP was associated with increased levels of CRP, independently of established risk factors. Furthermore, common carotid IMT increased with increasing CRP-levels. Presence of carotid plaque increased with increasing CRP-levels in men, but not in women. While the socioeconomic differences in carotid IMT were weak, there were associations between low educational level and carotid plaque prevalence with an age- and sex-adjusted odds ratio (OR) of 1.39 (95% CI: 1.21, 1.59). A similar association was seen for having a manual occupation, OR = 1.23 (95% CI: 1.07, 1.42). The age- and sex-adjusted absolute differences in carotid plaque prevalence were 9% with regard to educational level and 7% with regard to occupational status. Adjustment for CRP caused only a minor attenuation of the association between SEP and carotid atherosclerosis. CONCLUSIONS: The association between SEP and carotid atherosclerosis as measured by carotid IMT and carotid plaque could only to a minor extent be referred to differences in low grade inflammation as measured by CRP.     

Association between Long-Term Exposure to Traffic-Related Air Pollution and Subclinical Atherosclerosis: The REGICOR Study

Background: Epidemiological evidence of the effects of long-term exposure to air pollution on the chronic processes of atherogenesis is limited.Objective: We investigated the association of long-term exposure to traffic-related air pollution with subclinical atherosclerosis, measured by carotid intima media thickness (IMT) and ankle–brachial index (ABI).Methods: We performed a cross-sectional analysis using data collected during the reexamination (2007–2010) of 2,780 participants in the REGICOR (Registre Gironí del Cor: the Gerona Heart Register) study, a population-based prospective cohort in Girona, Spain. Long-term exposure across residences was calculated as the last 10 years’ time-weighted average of residential nitrogen dioxide (NO₂) estimates (based on a local-scale land-use regression model), traffic intensity in the nearest street, and traffic intensity in a 100 m buffer. Associations with IMT and ABI were estimated using linear regression and multinomial logistic regression, respectively, controlling for sex, age, smoking status, education, marital status, and several other potential confounders or intermediates.Results: Exposure contrasts between the 5th and 95th percentiles for NO₂ (25 µg/m³), traffic intensity in the nearest street (15,000 vehicles/day), and traffic load within 100 m (7,200,000 vehicle-m/day) were associated with differences of 0.56% (95% CI: –1.5, 2.6%), 2.32% (95% CI: 0.48, 4.17%), and 1.91% (95% CI: –0.24, 4.06) percent difference in IMT, respectively. Exposures were positively associated with an ABI of > 1.3, but not an ABI of < 0.9. Stronger associations were observed among those with a high level of education and in men ≥ 60 years of age.Conclusions: Long-term traffic-related exposures were associated with subclinical markers of atherosclerosis. Prospective studies are needed to confirm associations and further examine differences among population subgroups.     

Work-related psychosocial factors and carotid atherosclerosis

BACKGROUND: In order to better understand the role of work environment in the earlier stages of the cardiovascular disease process, we wanted to investigate the influence of work-related psychosocial factors on preclinical atherosclerosis. METHODS: Cross-sectional data was used to examine the association between psychological job demands, job decision latitude, and carotid atherosclerosis in 2658 vocationally-active Swedish men and women, ages 46-65, from the general population. Odds ratios of carotid plaque prevalence and carotid artery intima-media thickness (IMT), determined by B-mode ultrasound, were estimated across combinations of job demands and decision latitude. RESULTS: Women in job situations with high demands and low decision latitude ('job strain') showed a high plaque prevalence odds (odds ratio [OR] = 1.68, 95% CI: 1.14, 2.48), and a thicker IMT in the carotid bifurcation area (mean difference: 0.15 mm, 95% CI: 0.07, 0.23) compared with women in job situations with low demands and high decision latitude ('relaxed'). Adjustment for covariates only slightly reduced the magnitude of these associations. No such associations were seen in men. However, women in job situations with high demands and high decision latitude ('active') also showed high odds for carotid plaque, and a thicker IMT in the carotid bifurcation, compared with women in 'relaxed' job situations. In men, those in 'active' job situations had a low carotid plaque prevalence odds, while IMT in the carotid bifurcation did not differ from those in 'relaxed' job situations. Results showed only weak associations with IMT in the common carotid artery (CCA) in both men and women. CONCLUSION: The specific hypothesis that high job demands interact synergistically with low decision latitude in the development of carotid atherosclerosis could not be supported in this study, neither in men nor in women. Instead a more complex pattern of interaction between job demands and decision latitude was shown.     

Serum Non-Esterified Fatty Acids,Carotid Artery Intima-Media Thickness and Flow-Mediated Dilation in Older Adults: The Cardiovascular Health Study (CHS)

Backgrounds and aims: Elevated common carotid artery intima-media thickness (carotid IMT) and diminished flow-mediated dilation (FMD) are early subclinical indicators of atherosclerosis. Serum total non-esterified fatty acid (NEFA) concentrations have been positively associated with subclinical atherosclerosis. The relations between individual NEFA, carotid IMT and FMD have as yet to be assessed. Methods: We investigated the associations between fasting serum individual NEFA, carotid IMT and FMD among Cardiovascular Health Study (CHS) participants with (n = 255 for carotid IMT, 301 for FMD) or without (n = 1314 for carotid IMT, 1462 for FMD) known atherosclerotic cardiovascular disease (ASCVD). Using archived samples (fasting) collected from 1996–1997 (baseline), 35 individual NEFAs were measured using gas chromatography. Carotid IMT and estimated plaque thickness (mean of maximum internal carotid IMT) were determined in 1998–1999. FMD was measured in 1997–1998. Linear regression adjusted by the Holm-Bonferroni method was used to assess relations between individual NEFA, carotid IMT and FMD. Results: In multivariable adjusted linear regression models per SD increment, the non-esterified trans fatty acid conjugated linoleic acid (trans-18:2 CLA) was positively associated with carotid IMT [β (95% CI): 44.8 (19.2, 70.4), p = 0.025] among participants with, but not without, ASCVD [2.16 (−6.74, 11.5), p = 1.000]. Non-esterified cis-palmitoleic acid (16:1n-7c) was positively associated with FMD [19.7 (8.34, 31.0), p = 0.024] among participants without, but not with ASCVD. No significant associations between NEFAs and estimated plaque thickness were observed. Conclusions: In older adults, serum non-esterified CLA and palmitoleic acid were positively associated with carotid IMT and FMD, respectively, suggesting potential modifiable biomarkers for arteriopathy.     

Associations between markers of subclinical atherosclerosis and dietary patterns derived by principal components analysis and reduced rank regression in the Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND: The association between diet and cardiovascular disease (CVD) may be mediated partly through inflammatory processes and reflected by markers of subclinical atherosclerosis. OBJECTIVE: We investigated whether empirically derived dietary patterns are associated with coronary artery calcium (CAC) and common and internal carotid artery intima media thickness (IMT) and whether prior information about inflammatory processes would increase the strength of the associations. DESIGN: At baseline, dietary patterns were derived with the use of a food-frequency questionnaire, and inflammatory biomarkers, CAC, and IMT were measured in 5089 participants aged 45-84 y, who had no clinical CVD or diabetes, in the Multi-Ethnic Study of Atherosclerosis. Dietary patterns based on variations in C-reactive protein, interleukin-6, homocysteine, and fibrinogen concentrations were created with reduced rank regression (RRR). Dietary patterns based on variations in food group intake were created with principal components analysis (PCA). RESULTS: The primary RRR (RRR 1) and PCA (PCA factor 1) dietary patterns were high in total and saturated fat and low in fiber and micronutrients. However, the food sources of these nutrients differed between the dietary patterns. RRR 1 was positively associated with CAC [Agatston score >0: OR (95% CI) for quartile 5 compared with quartile 1 = 1.34 (1.05, 1.71); ln(Agatston score = 1): P for trend = 0.023] and with common carotid IMT [>or=1.0 mm: OR (95% CI) for quartile 5 compared with quartile 1 = 1.33 (0.99, 1.79); ln(common carotid IMT): P for trend = 0.006]. PCA 1 was not associated with CAC or IMT. CONCLUSION: The results suggest that subtle differences in dietary pattern composition, realized by incorporating measures of inflammatory processes, affect associations with markers of subclinical atherosclerosis.     

The female advantage in cardiovascular disease: do vascular beds contribute equally?

The female advantage in coronary heart disease occurrence is not completely understood. To characterize gender differences in cardiovascular disease by vascular site, the authors compared degrees of coronary, carotid, peripheral, and aortic atherosclerosis in men and women aged>or=55 years from the population-based Rotterdam Study (Rotterdam, the Netherlands). Data were collected between 1997 and 2000. A subset of 2,013 participants had data on both coronary calcification and one or more measures of extracoronary atherosclerosis, including intima-media thickness (IMT), carotid plaques, ankle-arm index (AAI), and aortic calcification. The multivariable-adjusted male:female odds ratios for calcium score>1,000 were 7.8 (95% confidence interval (CI): 3.2, 19.3), 5.4 (95% CI: 2.8, 10.2), and 3.0 (95% CI: 1.7, 5.2) in the lowest, middle, and highest age tertiles, respectively. For IMT>1.0 mm, severe carotid plaques, AAI<0.90, and severe aortic calcification, ratios did not decline with age. Overall multivariable-adjusted male:female odds ratios for these measures were 2.9 (95% CI: 2.0, 4.1), 2.0 (95% CI: 1.4, 2.8), 0.9 (95% CI: 0.7, 1.3), and 1.0 (95% CI: 0.8, 1.5), respectively. The authors conclude that the gender difference in atherosclerosis is larger in the coronary vessels than in other vascular beds. Remarkably, it is absent in the aorta and the lower-extremity vessels. Factors causing this site-specific gender difference require further investigation.     

Endogenous postmenopausal hormones and carotid atherosclerosis: a case-control study of the atherosclerosis risk in communities cohort

Studies examining the relation between endogenous postmenopausal hormone levels and cardiovascular disease have yielded conflicting results. After excluding women with a history of hormone replacement therapy (HRT) use, the authors conducted a US case-control study in 1987-1992 comparing endogenous postmenopausal hormone levels in women with and without significant carotid atherosclerosis in the Atherosclerosis Risk in Communities (ARIC) cohort. Atherosclerosis was assessed by using B-mode ultrasound to measure carotid artery intimal-medial thickness (IMT). Cases (n = 182) were postmenopausal women with average IMT measurements greater-than-or-equal the 95th percentile. Controls (n = 182) were frequency matched to cases on age and ARIC center and had IMT measurements < the 75th percentile. After adjustment for cardiovascular risk factors, no association was found between the odds of atherosclerosis and increasing quartiles of estrone, dehydroepiandrosterone sulfate, or androstenedione. Compared with participants in the lowest quartile of sex hormone-binding globulin (SHBG), those in the highest quartile had a significantly lower odds of atherosclerosis (odds ratio = 0.48, 95% confidence interval: 0.24, 0.97). Similarly, participants in the highest quartile of total testosterone had a lower odds of atherosclerosis (odds ratio = 0.38, 95% confidence interval: 0.20, 0.74). The authors found higher total testosterone and SHBG to be inversely related to carotid atherosclerosis, suggesting their potential importance in reducing atherosclerotic risk in postmenopausal women not using HRT.     

Serum vitamin D level is negatively associated with carotid atherosclerosis in Korean adults

The present study investigated the associations between serum vitamin D levels and carotid intima-media thickness (CIMT), carotid plaque and atherosclerosis in 71 Korean adults. CIMT and the presence of carotid plaque were assessed with a high-resolution B-mode ultrasound system, and carotid atherosclerosis was defined as a mean CIMT value >0.9?mm or the presence of carotid plaque. A vitamin D deficiency was associated with the presence of carotid plaque (adjusted odds ratio [aOR]: 9.25, 95% confidence interval [CI]: 1.52–56.3; p?=?0.016). As serum vitamin D levels increased, the presence of high-risk carotid plaque decreased (aOR: 0.84, 95%CI: 0.72–0.99; p?=?0.039). Serum vitamin D levels was negatively associated with carotid atherosclerosis (aOR: 0.86, 95%CI: 0.76–0.97; p?=?0.018). Further studies are needed to investigate whether vitamin D supplementation would be effective for the prevention of atherosclerosis and cardiovascular diseases.     

Dietary intake of cholesterol is positively associated and use of cholesterol-lowering medication is negatively associated with prevalent age-related hearing loss

We aimed to assess associations between dietary intake of fats (saturated and monounsaturated fats and cholesterol) and certain food groups (butter, margarine, and nuts) with the prevalence, incidence, and progression of age-related hearing loss. We also aimed to investigate the link between serum lipids and cholesterol-lowering medication (statins) and hearing loss. The Blue Mountains Hearing Study is a population-based survey of age-related hearing loss. Hearing loss was measured in 2956 participants (aged ≥50 y) and was defined as the pure-tone average (PTA) of frequencies 0.5, 1.0, 2.0, and 4.0 kHz > 25 dB hearing level (PTA(0.5-4 kHz)). Dietary data were collected using a semiquantitative FFQ. After multivariable adjustment, the likelihood of prevalent hearing loss increased from the lowest (reference) to the highest quartile of dietary cholesterol intake (P-trend = 0.04). Among persons self-reporting statin use (n = 274), a 48% reduced odds of prevalent hearing loss was observed after multivariable adjustment [OR = 0.52 (95% CI = 0.29-0.93)]. Participants in the second and 3rd quartiles of dietary monounsaturated fat intake compared with those in the first quartile (reference) had a significantly reduced risk of hearing loss progression 5 y later [multivariable-adjusted OR = 0.39 (95% CI = 0.21-0.71)] and [OR = 0.51 (95% CI = 0.29-0.91)], respectively. Our results suggest that a diet high in cholesterol could have adverse influences on hearing, whereas treatment with statins and consumption of monounsaturated fats may have a beneficial influence.     

Cognition and Screening for Hearing Loss in Nursing Home Residents

ObjectivesTo compare hearing screening results using pure tones and distortion product otoacoustic emissions (DPOAEs) with nursing home residents who have dementia and explore the relationship of hearing impairment and cognitive function using the Mini- Mental Status Evaluation (MMSE).Design and SettingA correlational design was implemented to evaluate residents in a large inner city nursing home.ParticipantsOne hundred one nursing home residents 65–108 years.MeasurementsDPOAEs and pure tone screenings were conducted at 30 dB HL and 40 dB HL at 1, 2, and 3 kHz. Pure tone thresholds at 1, 2, and 3 kHz were obtained. The MMSE was administered to all participants.ResultsResults showed that all residents failed the DPOAE screen, 97.1% failed at 30 dB HL, and 90.0% failed at 40 dB HL. Kendall’s tau, phi correlation, linear by linear association, and χ² results indicated no significant relationship for any of the screening protocols and cognitive status other than a significant finding with left ear screening at 40 dB HL. Logistic regression analysis indicated that individuals who passed the screen had better MMSE scores. Results of the t test and Mann-Whitney U test revealed a significant difference in cognitive function for residents with a mild hearing loss compared with those with a more significant hearing loss.ConclusionFor screening nursing home residents, 40 dB HL screening level or DPOAEs can be used. The significant finding that residents with greater than a mild hearing loss have poorer cognitive function reinforces the importance of identifying residents with a hearing loss and providing rehabilitation and follow-up.     

Military combat and burden of subclinical atherosclerosis in middle aged men: The ARIC Study

BackgroundStudies of the cardiovascular consequences of combat stress are few and inconclusive.ObjectiveThe association between combat exposure and subclinical atherosclerosis at Atherosclerosis Risk in Communities (ARIC) Study visits 1 (1987–1989) and 2 (1990–1992) was assessed among 5347 men from four U.S. communities.MethodsMeasured an average of 36 years after military entry, carotid intima-media thickness (CIMT) and carotid plaque among non-combat veterans (n = 2127) were compared with non-veterans (n = 2042) and veterans reporting combat experience (n = 1178).ResultsCompared to non-combat veterans, non-veterans (risk difference (RD): 10.61; 95% confidence interval (CI): 0.81, 20.41) and combat veterans (RD: 12.79; 95% CI: 0.72, 24.86) had higher age-adjusted mean CIMT. Differences remained for combat veterans after adjustment for race, father's education and age at service entry but not years of service and for non-veterans after adjustment for race but not father's education. No differences in carotid plaque were noted.ConclusionResults do not suggest that combat has a long-term detrimental effect on subclinical atherosclerosis among men.     

男性吸烟状况与颈动脉粥样硬化的剂量一反应关系研究

目的 探讨男性中老年人吸烟状况与颈动脉粥样硬化的剂量-反应关系.方法 从<广州生物库队列研究--心血管疾病亚队列>中随机抽取959名≥50岁相对健康的男性中老年人的个人资料与病史、体格检查(包括检测空腹血糖、血脂和血压)及应用彩色多普勒超声测量颈总动脉中-内膜厚度(IMT)及斑块形成.结果 (1)不吸烟者占39.1%、已戒烟者为25.7%和现在吸烟者为35.2%.受检者的平均颈动脉中-内膜厚度为0.78(95%CI:0.77～0.79)mm.其中18.4%受检者单侧或双侧颈动脉中-内膜厚度≥1.0 mm,34.1%的受检者检出颈动脉斑块.(2)在调整年龄、教育、体力活动、体重指数、空腹血糖、甘油三酯、高密度脂蛋白胆固醇、SBP和DBP等混杂因素后,现在吸烟者较从不吸烟者,颈动脉内膜增厚和斑块形成的危险明显增加(OR=1.82,95%CI:1.30～2.55和OR=1.95,95%CI:1.38～2.75,P值均＜0.001);颈动脉IMT和斑块形成的危险随每日吸烟量(支/日)、吸烟时间(年)和吸烟总量(包·年)的增加而明显增加(趋势检验P值均≤0.01).结论 广州市中老年男性人群中吸烟显著增加颈动脉粥样硬化的危险,且存在明显的剂量-反应关系.     

Contemporary exposure to cigarette smoke and noise of automobile manufacturing company workers

Background

Noise-induced hearing loss (NIHL) is one of the oldest occupational diseases. Evidence has accumulated in recent years on the adverse effects of smoking on hearing among the working population, but the absence of such an association has also been reported. Both cigarette smoking and noise exposure have a common pathway to produce hearing loss.

Materials and Methods

We surveyed the effect of smoking on NIHL in 478 workers in a large automobile manufacturing company who were exposed to unauthorized levels of noise. All required data were obtained using direct interviews and questionnaires. The results of the chi-square test and the regression models are expressed as odds ratios (OR) with 95% confidence intervals (95% CI).

Results

The frequency of hearing loss in smokers was higher than in non-smokers based on model 1 (hearing threshold differences ≥30 dB between 4,000 Hz and 1,000 Hz in both ears; OR 23, 95% CI: 11.90–44.42; p?<?0.001) and model 2 (hearing threshold level of >25 dB at 4,000 Hz in the better ear; OR 6.94, 95% CI: 4.53–10.64; p?<?0.001). These results were confirmed by the logistic regression statistical method.

Conclusion

It can be concluded that smoking may accelerate noise-induced hearing loss, and smoking cessation may be useful for prevention of NIHL, but more studies are required to confirm this.     

Self-reported Snoring and Carotid Atherosclerosis in Middle-aged and Older Adults: The Korean Multi-Rural Communities Cohort Study

Background

We investigated the relation of self-reported snoring with carotid intima-media thickness (IMT) and plaque in community-dwelling middle-aged and older adults.

Methods

In total, 7330 community-dwelling subjects in the Korean Multi-Rural Communities Cohort Study were included in the analysis. Common carotid artery IMT (CCA-IMT) and plaque were evaluated by high-resolution B-mode ultrasonography. Snoring status was evaluated using a structured interview.

Results

Snorers had a significantly greater average CCA-IMT than non-snorers (0.726 vs 0.713 mm; P < 0.001), after adjusting for age and gender. The odds ratios (OR) for high CCA-IMT (fifth quintile) were significantly higher for snorers than for non-snorers in multivariate-adjusted analysis (OR 1.25, 95% confidence interval [CI] 1.10–1.42). However, there was no significant relationship between snoring and carotid plaques.

Conclusions

Our data suggest that self-reported snoring is significantly associated with increased IMT, but not with the presence of plaques. These findings suggest that early screening and intervention for snoring in the general population are needed to prevent adverse cardiovascular events.Key words: snoring, atherosclerosis, carotid intima-media thickness, carotid artery plaque     

2型糖尿病颈动脉粥样硬化与血脂及胰岛素抵抗的关系

目的 探讨2型糖尿病(T2DM)患者颈动脉粥样硬化(AS)与血脂及胰岛素抵抗的关系,为有效预防和控制AS的发生发展提供科学依据.方法 选择沈阳医学院沈洲医院93例T2DM患者作为研究对象,测量患者颈动脉内中膜厚度(IMT)、斑块情况.根据IMT值将T2DM患者分为3组:单纯糖尿病(DM)组32例,中膜增厚组31例,斑块组30例.选取健康对照组30例.测定血脂、血糖、胰岛素抵抗指数(HOMA-IR).结果 IMT与空腹血糖(FPG)、空腹胰岛素(FINS)、HOMA-IR、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白a(Lp-a)呈正相关,与高密度脂蛋白胆固醇( HDL-C)、载脂蛋白A1(ApoA1)呈负相关,均有统计学意义(P＜0.01).logistic回归分析结果显示,TC是T2DM颈AS的危险因素(OR=23.649,95％ CI:2.410～232.104),HDL-C(OR=0.008,95％ CI:0.000～0.279)、载脂蛋白B(OR=0.000,95％CI:0.000～0.101)是保护因素.结论 T2DM颈AS与血脂及胰岛素抵抗密切相关.     

外周动脉粥样硬化预测非心肌梗死冠心病多支病变的价值

目的探讨外周动脉粥样硬化与冠状动脉粥样硬化的关系。方法对60例可疑非心肌梗死患者行冠状动脉造影，明确诊断为冠心病43例，无冠状动脉病变17例。同时超声检查颈、股动脉内膜-中层厚度（IMT）及斑块，并进行统计学分析。结果冠状动脉造影阳性者颈、股动脉的IMT和斑块发生率高于冠状动脉造影阴性者（P〈0．05），其粥样硬化的程度与冠心病的发生呈正相关。对左、右颈动脉和左、右股动脉的IMT与冠状动脉病变支数进行秩和检验，相关系数分别为0．466、0．312、0．273、0．378；颈、股动脉斑块与冠状动脉病变支数相关系数分别为0．823、0．738。颈、股动脉斑块诊断冠心病的灵敏度、特异度分别为60．47％和76．47％以及53．49％、70．59％。结论外周动脉IMT预测冠状动脉粥样硬化的灵敏度较高；但是预测冠状动脉病变支数的灵敏度较低；外周动脉斑块预测血管病变支数的灵敏度较高，对非心肌梗死冠心病多支病变有一定的诊断价值。     

A faceoff with hazardous noise: Noise exposure and hearing threshold shifts of indoor hockey officials

Noise exposure and hearing thresholds of indoor hockey officials of the Western States Hockey League were measured to assess the impact of hockey game noise on hearing sensitivity. Twenty-nine hockey officials who officiated the league in an arena in southeastern Wyoming in October, November, and December 2014 participated in the study. Personal noise dosimetry was conducted to determine if officials were exposed to an equivalent sound pressure level greater than 85 dBA. Hearing thresholds were measured before and after hockey games to determine if a 10 dB or greater temporary threshold shift in hearing occurred. Pure-tone audiometry was conducted in both ears at 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz. All noise exposures were greater than 85 dBA, with a mean personal noise exposure level of 93 dBA (SD = 2.2), providing 17.7% (SD = 6.3) of the officials' daily noise dose according to the OSHA criteria. Hearing threshold shifts of 10 dB or greater were observed in 86.2% (25/29) of officials, with 36% (9/25) of those threshold shifts equaling 15 dB or greater. The largest proportion of hearing threshold shifts occurred at 4000 Hz, comprising 35.7% of right ear shifts and 31.8% of left ear shifts. The threshold shifts between the pre- and post-game audiometry were statistically significant in the left ear at 500 (p=.019), 2000 (p=.0009), 3000 (p<.0001) and 4000 Hz (p=.0002), and in the right ear at 2000 (p=.0001), 3000 (p=.0001) and 4000 Hz (p<.0001), based on Wilcoxon-ranked sum analysis. Although not statistically significant at alpha = 0.05, logistic regression indicated that with each increase of one dB of equivalent sound pressure measured from personal noise dosimetry, the odds of a ≥ 10 dB TTS were increased in the left ear at 500 (OR=1.33, 95% CI 0.73-2.45), 3000 (OR=1.02, 95% CI 0.68-1.51), 4000 (OR=1.26, 95% CI 0.93-1.71) and 8000 Hz (OR=1.22, 95% CI 0.76-1.94) and in the right ear at 6000 (OR=1.03, 95% CI 0.14-7.84) and 8000 Hz (OR=1.29, 95% CI 0.12-13.83). These findings suggest that indoor hockey officials are exposed to hazardous levels of noise, experience temporary hearing loss after officiating games, and a hearing conservation program is warranted. Further temporary threshold shift research has the potential to identify officials of other sporting events that are at an increased risk of noise-induced hearing loss.     

A cross-sectional survey of environmental health in remote Aboriginal communities in Western Australia

Introduction: The Australian Aboriginal population experiences significantly poorer health than the non-Aboriginal population. The contribution of environmental risk factors in remote communities to this health disparity is poorly understood.

Objective: To describe and quantify major environmental risk factors and associated health outcomes in remote Aboriginal communities in Western Australia.

Methods: The association between environmental health indicators, community infrastructure and reported health outcomes was analysed using linear and logistic regression of survey data.

Results: Housing/overcrowding was significantly associated with increased reports of hearing/eyesight (OR 3.01 95?% CI 1.58–5.73), skin (OR 2.71 95?% CI 1.31–5.60), gastrointestinal (OR 3.51 95 % CI 1.49–8.26) and flu/colds (OR 2.47 95 % CI 1.27–4.78) as health concerns. Dust was significantly associated with hearing/eyesight (OR 3.16 95 % CI 1.82–5.48), asthma/respiratory (OR 2.48 95 % CI 1.43–4.29) and flu/colds (OR 3.31 95 % CI 1.88–5.86) as health concerns.

Conclusion: Poor environmental health is prevalent in remote Aboriginal communities and requires further delineation to inform environmental health policy.     

Association of serum low density lipoprotein cholesterol, smoking and hypertension with different manifestations of atherosclerosis

We investigated the association of elevated serum low density lipoprotein (LDL) cholesterol levels, smoking and hypertension with different manifestations of carotid atherosclerosis in a population-based sample of 720 Eastern Finnish men aged 42, 48, 54 or 60 years, examined in the Kuopio Ischaemic Heart Disease Risk Factor Study. Carotid atherosclerosis was assessed with high-resolution B-mode ultrasonography. Men who had neither a history nor symptoms of cardiovascular disease with serum LDL cholesterol concentration in the highest tertile (4.17 mM or more) had 3.40-fold (95% confidence interval (CI) 1.98-5.84) age-, smoking- and hypertension-adjusted probability of intimal-medial thickening as compared to men in the lowest serum LDL cholesterol tertile. The odds ratio for carotid plaque versus intimal-medial thickening was only 1.03 (95% CI 0.47-2.28). The respective odds ratios for smoking (28 pack-years or more) were 1.62 (95% CI 0.79-3.32) and 3.02 (95% CI 1.41-6.47) and those for hypertension were 1.10 (95% CI 0.70-1.73) and 0.99 (95% CI 0.53-1.84). Our findings suggest that elevated serum LDL cholesterol concentration associates with an increased risk of common carotid arterial wall thickening, whereas smoking is associated more strongly with carotid plaques than intimal-medial thickening. Our cross-sectional data do not support association between hypertension and either manifestation of carotid atherosclerosis.     

Impact of multiple cardiovascular risk factors on the carotid intima-media thickness in young adults: the Kangwha Study.

OBJECTIVES: Although risk factors for coronary artery disease are also associated with increased carotid intima-media thickness (IMT), there is little information available on the asymptomatic, young adult population. We examined the association between multiple cardiovascular risk factors and the common carotid IMT in 280 young Korean adults. METHODS: The data used for this study was obtained from 280 subjects (130 men and 150 women) aged 25 years who participated in the Kangwha Study follow-up examination in 2005. We measured cardiovascular risk factors, including anthropometrics, blood pressure, blood chemistry, carotid ultrasonography, and reviewed questionnaires on health behaviors. Risk factors were defined as values above the sex-specific 75th percentile of systolic blood pressure, body mass index, total cholesterol/high-density lipoprotein cholesterol ratio, fasting blood glucose and smoking status. RESULTS: The mean carotid IMT +/- standard deviation observed was 0.683 +/- 0.079 mm in men and 0.678 +/- 0.067 mm in women (p=0.567) and the evidence of plaque was not observed in any individuals. Mean carotid IMT increased with an increasing number of risk factors(p for trend <0.001) and carotid IMT values were 0.665 mm, 0.674 mm, 0.686 mm, 0.702 mm, and 0.748 mm for 0, 1, 2, 3, and 4 to 5 risk factors, respectively. The odds ratio for having the top quartile carotid IMT in men with 3 or more risk factors versus 0-2 risk factors was 5.09 (95% CI, 2.05-12.64). CONCLUSIONS: Current findings indicate the need for prevention and control of cardiovascular risk factors in young adults and more focus on those with multiple cardiovascular risk factors.