Upper-body adiposity and risk of myocardial infarction.

BACKGROUND: The relation between obesity and coronary heart disease (CHD) has long been studied, but no convincing conclusion has been drawn. OBJECTIVE: To estimate the relative risk associated with upper-body adiposity which is at present believed to be a better predictor of CHD. DESIGN: This was a community-based case-control study. METHODS: We studied 338 consecutively admitted patients who had had their first acute myocardial infarction (AMI) and 662 community controls who had not suffered AMI selected as a random sample of adults living in the catchment area of the hospital. We defined three classes of body mass index (BMI) and waist: hip circumference ratio on the basis of tertiles of distribution for controls. Odds ratios (OR) were estimated using unconditional logistic regression. Separate models were built for men and women. RESULTS: In univariate analysis we found a higher risk of AMI for men and women with hypertension, dyslipidaemia, diabetes and lower levels of education, for older women, for male smokers and for men with family histories of CHD. Both for men and for women a higher BMI was associated with a slightly higher risk, whereas the adjusted risk of AMI increased with increasing waist: hip circumference ratio [for men OR (second tertile)= 2.5, 95% confidence interval (CI) 1.3-4.9 and OR (third tertile)= 11.1, 95% CI 6.0-20.6; for women OR (second tertile) = 3.0, 95% CI 0.6-14.8 and OR (third tertile) = 14.1,95% CI 3.2-62.7]. This relation held for each BMI class and was stronger for classes of lower BMI. CONCLUSIONS: Distribution of body fat rather than BMI is a strong marker of risk for AMI and there is a clear interaction between these two variables.     

Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents

OBJECTIVES: To investigate the relationship between body composition (assessed using body mass index (BMI) and body cell mass (BCM)) and all-cause mortality in a sample of older nursing home residents. DESIGN: Prospective study with a median follow-up period of 3.5 years. SETTING: Istituto di Riposo per Anziani, Padua, Italy. PARTICIPANTS: A total of 344 participants (79.1% women) aged 65 and older at baseline. MEASUREMENTS: Anthropometric, nutritional, and metabolic parameters were measured at baseline. BCM was measured using tetrapolar bioelectric impedance analysis. Up to 4 years of follow-up data for vital status were available. Survival analysis was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models. RESULTS: During the follow-up period, there were 179 deaths. After adjustment for age and sex, subjects with low BMI and low BCM (lowest sex-specific tertiles) had significantly higher mortality than those with higher BMI or BCM levels. In a fully adjusted regression model, there was no association between BMI levels and risk of mortality, with subjects in the top tertile having the same likelihood of mortality as subjects in the lowest tertile (relative risk (RR)=0.94, 95% confidence interval (CI)=0.61-1.43). Conversely, there was a strong and significant inverse association between BCM levels and mortality (RR for tertile III=0.55, 95% CI=0.35-0.87; P<.01). Furthermore, participants who had high BCM had comparable survival rates in all BMI tertiles. CONCLUSION: In this sample of older nursing home residents, BCM was a strong and independent risk factor for mortality. BCM assessment might provide more useful prognostic information for clinicians than BMI.     

Inflammation and frailty in older women

OBJECTIVES: To evaluate relationships between white blood cell (WBC) count and interleukin-6 (IL-6) and prevalent frailty. DESIGN: Cross-sectional study. SETTING: Two population-based studies, the Women's Health and Aging Studies (WHAS) I and II, Baltimore, Maryland. PARTICIPANTS: Five hundred fifty-eight women aged 65 to 101 from WHAS I and 548 women aged 70 to 79 from the merged WHAS I and II cohorts. MEASUREMENTS: Frailty was determined using validated screening criteria. WBC counts and IL-6 levels were measured using standard laboratory methods. Odds ratios (ORs) for frailty were evaluated across tertiles of baseline WBC counts and IL-6 levels, adjusting for age, race, education, body mass index, and smoking status. RESULTS: In WHAS I, those in the top tertile of WBC count and IL-6 had ORs of 4.25 (95% confidence interval (CI)=1.89-9.58) and 3.98 (95% CI=1.76-9.00), respectively, for frailty (both P<.001). In the combined models, participants in the top tertile of WBC count had an OR of 3.15 (95% CI=1.34-7.41), adjusting for IL-6 (P<.01), and those in the top tertile of IL-6 had an OR of 2.81 (95% CI=1.19-6.64), adjusting for WBC count (P<.05). Furthermore, participants in the top tertiles of WBC count and IL-6 had an OR of 9.85 (95% CI=3.04-31.99), and those in the middle/top tertiles had an OR of 5.40 (95% CI=1.83-15.92) (P<.001, trend test) for frailty. These results were validated in the merged WHAS I and II. CONCLUSION: Higher WBC counts and IL-6 levels were independently associated with prevalent frailty in community-dwelling older women.     

总胆固醇及甘油三酯与卒中亚型关系的前瞻性研究

目的 研究人群总胆固醇(TC)、甘油三酯(TG)水平与缺血性和出血性卒中发病的关系.方法 1987年5至7月,对在北京等5个城市社区所选取的35岁以上无卒中队列人群进行卒中危险因素调查和体格检查,1998至2000年对入选的队列人群进行全面复查,共10093例完成基线血脂调查及队列随访.采用Cox回归模型估计基线TC和TG中、高三分位组缺血性与出血性卒中发病的相对危险度(风险比,HR)和95%可信区间(95%CI).结果 平均随访8年,新发卒中491例.舒张压模型调整舒张压、年龄和性别等多因素后,与低TC组相比,中、高TC组缺血性卒中发病风险分别增加61%(HR:1.61,95% CI:1.14～2.27)和58%(HR:1.58,95%CI:1.12～2.22).与低TG组相比,高TG组缺血性卒中发病风险增加43%(HR:1.43,95%CI:1.02～2.00).TC与出血性卒中呈负相关,与低TC组相比,中、高TC组人群出血性卒中发病的危险分别减少了12%(HR:0.88,95%CI:0.64～1.22)和33%(HR:0.67,95%CI:0.48～0.95).结论 血清TC和TG升高均为缺血性卒中发病独立危险因素.但TC过低却增加出血性卒中的发病风险.     

Associations of serum sex hormone-binding globulin and sex hormone concentrations with hip fracture risk in postmenopausal women

CONTEXT: Endogenous estradiol, testosterone, and SHBG may influence the risk of hip fracture. DESIGN AND METHODS: From the Women's Health Initiative Observational Study, 39,793 eligible postmenopausal women did not have a previous hip fracture and were not using estrogen or other bone-active therapies. Of these, 400 who had a first-time nonpathological hip fracture (median follow-up, 7 yr) were matched to 400 controls by age, ethnicity, and baseline blood draw date. Estradiol, testosterone, and SHBG were measured in banked baseline serum. RESULTS: Compared with women in the lowest tertiles, those with bioavailable testosterone in the highest tertile had a lower risk [odds ratio (OR) = 0.62; 95% confidence interval (CI) = 0.44-0.88]; those with bioavailable estradiol in the highest tertile had a lower risk (OR = 0.44; 95% CI = 0.29-0.66), and those with SHBG in the highest tertile had a higher risk (OR = 1.90; 95% CI = 1.31-2.74) of hip fracture. In models with all three hormones and potential confounders, high SHBG remained a strong independent risk factor (OR = 1.76; 95% CI = 1.12-2.78), high bioavailable testosterone remained protective (OR = 0.64; 95% CI = 0.40-1.00), but estradiol no longer was associated (OR = 0.72; 95% CI = 0.42-1.23). CONCLUSIONS: High serum SHBG is associated with an increased risk of subsequent hip fracture and high endogenous testosterone with a decreased risk, independent of each other, serum estradiol concentration, and other putative risk factors. But endogenous estradiol has no independent association with hip fracture.     

Preoperative electrocardiogram abnormalities do not predict postoperative cardiac complications in geriatric surgical patients

OBJECTIVES: Preoperative electrocardiograms (ECGs) are routinely performed on older patients before surgery. Whether patients with abnormalities on preoperative ECGs have an increased likelihood of developing postoperative cardiac complications is unknown. This study was designed to determine whether abnormalities on preoperative ECGs were predictive of postoperative cardiac complications. DESIGN: Prospective observational study. SETTING: One of the teaching hospitals of the University of California, San Francisco, Medical Center. PARTICIPANTS: Five hundred thirteen patients aged 70 and older undergoing noncardiac surgery. MEASUREMENTS: Preoperative ECGs were analyzed using the Minnesota Codes. Predefined preoperative risk factors and in-hospital postoperative cardiac complications were measured. The association between ECG abnormalities and postoperative cardiac complications was determined by multivariate logistic regression after controlling for clinical covariates. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS: Three hundred eighty-six of 513 patients (75.2%) had at least one abnormality on their preoperative ECGs. On multivariate analysis, the predictors of postoperative cardiac complications included American Society of Anesthesiologists physical status classification of 3 or greater (OR = 2.5, 95%CI = 1.28-4.89, P = .007) and a history of congestive heart failure (OR = 2.1, 95% CI = 1.1-5.1, P = .034). The presence of abnormalities on preoperative ECGs was not associated with an increased risk of postoperative cardiac complications (OR = 0.63, 95% CI = 0.28-1.40, P = .26). CONCLUSION: Abnormalities on preoperative ECGs are common but are of limited value in predicting postoperative cardiac complications in older patients undergoing noncardiac surgery. These results suggest that obtaining preoperative ECGs based on an age cutoff alone may not be indicated, because ECG abnormalities in older people are prevalent but nonspecific and less useful than the presence and severity of comorbidities in predicting postoperative cardiac complications.     

Risk factors for cardiovascular complications following total joint replacement surgery

OBJECTIVE: To determine risk factors for cardiac complications following total joint replacement (TJR) surgery. METHODS: We performed a case-control study of patients who had undergone a primary or revision total knee or total hip replacement surgery. Cases consisted of those who received a TJR and experienced a cardiac complication during the surgical admission period (myocardial infarction [MI], congestive heart failure [CHF], unstable angina, arrhythmia, symptomatic hypotension, or pulmonary embolus). Controls consisted of those who received a TJR and did not experience a cardiac complication during the surgical admission period. Controls were matched to the cases for age at surgery, year of surgery, and surgeon. Case and control status and identification of potential risk factors were ascertained by review of medical records. Conditional logistic regression analysis was used to identify independent predictors of cardiac complications. RESULTS: The sample included 209 cases and 209 controls. Factors associated with a higher risk of cardiac complications included a history of arrhythmia (adjusted odds ratio [OR] 2.6 [95% confidence interval (95% CI) 1.5-4.3]), a history of coronary artery disease, MI, CHF, or valvular heart disease (OR 1.6 [95% CI 0.9-2.6]), revision surgery (OR 2.2 [95% CI 1.2-3.9]), and bilateral surgery (adjusted OR 3.5 [95% CI 1.6-8.0]). Even though controls were matched for age (within age brackets), age was still associated with a higher risk of cardiac complications (OR 1.7 [95% CI 0.9-3.4]). CONCLUSION: This case-control study identified 2 new risk factors for cardiac complications following TJR: bilateral and revision surgery. The study also confirmed previously documented risk factors, including older age at surgery and a history of arrhythmia and of other cardiac problems. These findings should help clinicians anticipate and prevent cardiac complications following TJR surgery.     

The quantitative insulin sensitivity check index QUICKI predicts the onset of type 2 diabetes better than fasting plasma insulin in obese subjects: a 5-year follow-up study

The aim of the present study was to evaluate the predictive value of QUICKI and fasting plasma insulin (FPI0 as predictors of the onset of type 2 diabetes mellitus. We performed a five-year follow-up study in a sample of middle-aged subjects with at least one of the following risk factors; hypertension defined as systolic blood pressure >or=160 mmHg and/or diastolic blood pressure >or=90 mmHg or medication for hypertensin, obesity defined as a body mass index >or=30 kg/m(2) and/or a waist-to-hip ratio >or=1.00 in men and >or=0.88 in women, or a family history of type 2 DM. When the QUICKI index was used to compare the tertile with the lowest risk to the tertile of the highest risk of obese subjects. Odd's Ratio (OR) for type 2 diabetes was 7.77 (95% CI 1.39-202.24). For FPI, the respective OR's were 2.84 (95% CI 0.82-9.82) and 3.96 (95% CI 1.02-15.48). QUICKI and fasting insulin did not have a statistically significant predictive value among non-obese subjects. Concerning QUICKI, the subjects in the tertiles at the medium and highest risk had a higher risk for type 2 DM than the corresponding tertiles of FPI among obese subjects.     

A prospective study of maternal serum C-reactive protein concentrations and risk of preeclampsia

BACKGROUND: We measured C-reactive protein (CRP), a clinical marker of systemic inflammation, in maternal serum collected at 13 weeks gestation on average, to determine whether elevations precede the clinical manifestation of preeclampsia. METHODS: Using a prospective, nested, case-control study design we measured CRP concentrations using a competitive immunoassay in 60 women who developed preeclampsia and in 506 women who remained normotensive throughout pregnancy. Logistic regression procedures were used to calculate odds ratio (OR) and 95% CI. Because maternal serum CRP is highly correlated with maternal prepregnancy body mass index (BMI), all analyses were repeated after stratification by maternal prepregnancy overweight status (BMI <25 v > or =25 kg/m(2)). RESULTS: Overall, the risk of preeclampsia increased across successively higher tertiles of CRP (OR = 1.0, 1.6, and 3.5, with the lowest tertile as the referent group; P <.001 for trend). After adjusting for parity and first-degree family history of chronic hypertension, the OR in the highest tertile was 3.2 (95% CI = 1.5 to 6.7). Further adjustment for BMI greatly attenuated this association (OR = 1.8, 95% CI = 0.8 to 4.1). Elevated CRP concentrations (> or =4.9 mg/L) were associated with a 2.5-fold increased risk of preeclampsia (95% CI = 1.1 to 5.5) in lean women. No similar association was observed among overweight women. CONCLUSIONS: Elevated CRP is highly correlated with prepregnancy adiposity and appears to be an independent predictor of preeclampsia in lean women. Further work is needed to identify modifiable risk factors for systemic inflammation in early pregnancy and to explore further the extent to which CRP and prepregnancy adiposity independently and jointly contribute to preeclampsia risk.     

Separate and combined influence of body mass index and waist circumference on arthritis and knee osteoarthritis

OBJECTIVE: To determine if the combination of body mass index (BMI) and waist circumference (WC) explains an additional component of arthritis and knee osteoarthritis risk than is accounted for by either anthropometric measure alone. DESIGN: Cross-sectional study. PARTICIPANTS: Participants were part of the Third National Health and Nutrition Examination Survey, a representative sample of Americans conducted from 1988 to 1994. The arthritis analyses included 15 570 participants aged 18 years and older. The knee osteoarthritis analyses included 2323 participants aged 60 years and older. Body mass index and WC were measured in all participants and classified into sex-specific tertiles. OUTCOME MEASURES: Arthritis (determined by self-report) and knee osteoarthritis (determined by radiograph). RESULTS: Independent of sex, the likelihood of arthritis and knee osteoarthritis increased in a graded fashion when moving from the lowest to highest BMI tertile and when moving from the lowest to highest WC tertile (Ptrend < 0.01). In the next phase of analyses, subjects were divided into WC tertiles within each of the BMI tertiles. Within the lowest BMI tertile, the likelihood of arthritis and knee osteoarthritis was not different in the lowest, middle and highest WC tertiles (P > 0.1). Within the middle BMI tertile, the middle and high WC tertiles were more likely to have knee osteoarthritis compared to the lowest WC tertile (P < 0.05). Within the highest BMI tertile, the highest WC tertile was more likely to have arthritis and knee osteoarthritis compared to the lowest WC tertile (P < 0.05). CONCLUSIONS: Both BMI and WC were strong predictors of arthritis and knee osteoarthritis. When a categorical approach was used for BMI and WC, similar to that in the clinical setting, independent effects of these anthropometric variables were observed.     

Food groups,diet quality and colorectal cancer risk in the Basque Country

BACKGROUND The results obtained to date concerning food groups, diet quality and colorectal cancer(CRC) risk vary according to criteria used and the study populations.AIM To study the relationships between food groups, diet quality and CRC risk, in an adult population of the Basque Country(North of Spain).METHODS This observational study included 308 patients diagnosed with CRC and 308 ageand sex-matched subjects as controls. During recruitment, dietary, anthropometric, lifestyle, socioeconomic, demographic and health status information was collected. Adherence to the dietary recommendations was evaluated utilizing the Healthy Eating Index for the Spanish Diet and the Med Diet Score. Conditional logistic regressions were used to evaluate the associations of food group intakes, diet quality scores, categorized in tertiles, with CRC risk.RESULTS The adjusted models for potential confounding factors showed a direct association between milk and dairy products consumption, in particular high-fat cheeses [odds ratio(OR) third tertile vs first tertile = 1.87, 95% confidence intervals(CI): 1.11-3.16], and CRC risk. While the consumption of fiber-containing foods, especially whole grains(OR third tertile vs first tertile = 0.62, 95%CI: 0.39-0.98), and fatty fish(OR third tertile vs first tertile = 0.53, 95%CI: 0.27-0.99) was associated with a lower risk for CRC. Moreover, higher MD adherence was associated with a reduced CRC risk in adjusted models(OR third tertile vs first tertile = 0.40, 95%CI: 0.20-0.80).CONCLUSION Direct associations were found for high-fat cheese, whereas an inverse relation was reported for fiber-containing foods and fatty fish, as well as adherence to a Mediterranean dietary pattern.     

Different effects of blood pressure on mortality from stroke subtypes depending on BMI levels: a 19-year cohort study in the Japanese general population--NIPPON DATA80

To evaluate the relationship between blood pressure and cerebrovascular death depending on body mass index (BMI) levels, we analysed a database of 9338 subjects from the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged, which was originally conducted a baseline survey in 1980 and followed up in 1999. Relative risk (RR) and a 95% confidence interval (CI) of death from total stroke, cerebral infarction, and intracerebral haemorrhage after adjusting for age, sex, serum cholesterol, albumin, glucose, the use of antihypertensive agents, a past history of diabetes, BMI, smoking, and drinking were estimated with the Cox-proportional hazard model in the BMI tertile groups of a representative Japanese population. Cutoff points of BMI tertiles are 21.2 and 23.8 kg/m2. The results indicated that a 10 mmHg systolic blood pressure (SBP) increase was associated with mortality from intracerebral haemorrhage at low and middle BMI groups (RR= 1.38 and 1.23; 95% CI=1.17-1.62 and 1.03-1.47, respectively). SBP was positively associated with mortality from cerebral infarction in middle and high BMI groups (RR=1.19 and 1.21; 95% CI=1.06-1.33 and 1.06-1.38, respectively). The effects of diastolic blood pressure on intracerebral haemorrhage and infarction had the same tendency as those of SBP. These results suggested that the causal effect of blood pressure on stroke subtypes might be modified by BMI.     

Plasma adiponectin levels and incident glucose intolerance in Japanese-Brazilians: a seven-year follow-up study

The objective of this study was to investigate whether decreased baseline adiponectin levels are an independent risk factor for development of glucose intolerance in a population-based study of Japanese-Brazilians, a group with one of the highest prevalence rates of diabetes worldwide. We examined 210 Japanese-Brazilians (97 male and 113 female, aged 56.7+/-10.1 years) with normal glucose tolerance (NGT). Plasma adiponectin, insulin, fasting and 2-h plasma glucose and lipid profile were evaluated at baseline and also at 7-year follow-up. Plasma adiponectin levels were significantly lower in glucose intolerance progressors compared with subjects who remained NGT. By increasing tertiles of adiponectin, the frequencies of subjects who progressed to glucose intolerance were 40%, 33% and 27% and the frequencies of subjects who remained NGT were 13%, 35% and 52% (chi2=15.8, p=0.001). Logistic regression analyses showed that adiponectin levels (OR for the highest versus lowest tertile: 0.31; 95% CI: 0.12-0.84, p=0.021), male sex (OR: 2.61, 95% CI: 1.21-5.65, p=0.015), fasting plasma glucose (0R: 3.05, 95% CI: 1.35-6.91, p=0.008) and waist circumference (OR: 1.04, 95% CI: 1.00-1.08, p=0.046) were independent risk factors for the progression to glucose intolerance. In conclusion, low plasma levels of adiponectin is one of several independent predictors of glucose intolerance in a Japanese-Brazilian population.     

Estradiol and its metabolites and their association with knee osteoarthritis

OBJECTIVE: To determine if levels of endogenous estrogen or estrogen metabolites are associated with an increased risk of developing knee osteoarthritis (OA) in women. METHODS: Serum estradiol (E2) and 2 urinary estrogen metabolites (2-hydroxyestrone and 16alpha-hydroxyestrone) with radiographically defined prevalent and incident knee OA in 842 white and African American women from the Southeast Michigan Arthritis Cohort. RESULTS: The mean age and body mass index (BMI) of women in the cohort were 42.3 years and 28.5 kg/m2, respectively. Women who developed radiographically defined knee OA had significantly greater odds of having baseline endogenous early follicular phase estradiol concentrations in the lowest tertile (<47 pg/ml; odds ratio [OR] 1.88, 95% confidence interval [95% CI] 1.07-3.51) compared with those with estradiol concentrations in the middle tertile [47-77 pg/ml]), after adjustment for age, BMI, and other covariates. Women who developed knee OA also had greater odds of having baseline urinary concentrations of 2-hydroxyestrone in the lowest tertile (OR 2.9, 95% CI 1.49-5.68) compared with women with 2-hydroxyestrone concentrations in the middle tertile), after adjustment for covariates. Women who developed knee OA were more likely to have a ratio of 16alpha-hydroxyestrone to 2-hydroxyestrone in the highest tertile (>0.86; OR 1.86, 95% CI 1.01-3.44 compared with women with ratios in the 0.54-0.86 range), after adjustment for other covariates. CONCLUSION: There were significant associations of lower baseline serum estradiol and urinary 2-hydroxyestrone with developing knee OA in middle-aged women.     

Prediagnostic Plasma Antibody Levels to Periodontopathic Bacteria and Risk of Coronary Heart Disease

Many epidemiological studies have indicated that periodontitis is an important risk factor for coronary heart disease (CHD). We examined whether plasma antibody levels to 3 major periodontal pathogens, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia predicted the risk of CHD events. A nested case-control research design (case: n = 191, control: n = 382), by matching gender, age, study area, date of blood collection, and time since last meal at blood collection, was employed in a large cohort of Japanese community residents.Antibody levels of periodontopathic bacteria were associated with risk of CHD after adjusting for BMI, smoking status, alcohol intake, history of hypertension, history of diabetes mellitus, exercise during leisure time, and perceived mental stress. The association was different by age subgroup. For subjects aged 40-55 years, the medium (31.7-184.9 U/mL) or high tertile plasma antibody level (> 184.9 U/mL) of A. actinomycetemcomitans showed higher risk of CHD (medium: OR = 3.72; 95% CI = 1.20-11.56, high: OR = 4.64; 95% CI = 1.52-14.18) than the low tertile level (< 31.7 U/mL). The ORs of CHD incidence became higher with an increase in IgG level of A. actinomycetemcomitans (P for trend = 0.007). For subjects aged 56-69 years, the high tertile level (> 414.1 U/mL) of P. intermedia was associated with higher risk of CHD (OR = 2.65; 95% CI = 1.18-5.94) in a dose-response fashion (P for trend = 0.007). The possible role of periodontopathic bacteria as a risk factor for CHD incidence was suggested by the results of this study by the elevated antibody level to these bacteria with the increased risk of CHD.     

Body mass index, physical activity and erectile dysfunction: an U-shaped relationship from population-based study

OBJECTIVE: To investigate the relationships between body mass index (BMI), physical activity and erectile dysfunction (ED). DESIGN AND SUBJECTS: A population representative cross-sectional analytic study of ED in Hong Kong, with two-stage stratified random sampling, and face-to-face interviews conducted by trained interviewers with structured questionnaires. Study subjects were 1506 men aged 26-70. RESULTS: Age (odds ratio (OR)=1.30; 95% confidence interval (CI) 1.20-1.40), physical activity (OR=0.91 per 500 kcal/week; 95% CI 0.84-0.98), and general psychological distress (OR=1.03 per GHQ score; 95% CI 1.00-1.06) were independently associated with ED after multivariate adjustments. An U-shaped relationship between BMI and ED was observed only among men with no exercise ( or =25.0 (OR=2.47; 95% CI 1.08-5.67) using BMI 21.0-21.9 as reference, adjusted for age, GHQ and smoking status. Being physically active (> or =1000 kcal/week) only reduced the risk of ED (OR=0.40, 95% CI 0.16-0.95) in men who were obese, adjusted for age, GHQ, smoking status and BMI. CONCLUSIONS: BMI and physical activity independently and differentially affected ED risk. BMI had greatest influence with low physical activity, and physical activity exerted greatest influence when BMI was high. This is the first study to demonstrate an U-shaped relationship between BMI and ED risk, but only in men with no exercise, and to identify underweight as a risk factor for ED. This relationship has clinical implications for obese as well as underweight individuals.     

Aortic pulse pressure and aortic pulsatility are associated with angiographic coronary artery disease in women

Background. Studies indicated that both aortic pulse pressure (PP) and aortic pulsatility are independently associated with angiographic coronary artery disease (CAD). However, most of these studies included a majority of male subjects, and women were underrepresented. Objective. We investigated the relation of aortic PP and aortic pulsatility derived from invasively measured ascending aortic pressure waveform and presence of angiographic CAD in women undergoing diagnostic coronary angiography. Methods and results. From September 2003 to April 2004, 262 unselected female subjects undergoing first cardiac catheterization were consecutively included in the study. Systolic, diastolic and mean pressure waveforms of the ascending aorta were measured during cardiac catheterization with a fluid-filled system. Aortic pulsatility was estimated as the ratio of aortic PP to mean pressure. Angiographic CAD was detected in 175 (67%) patients. In multiple-adjusted logistic regression, both aortic PP and aortic pulsatility were significantly associated with the presence of CAD (for a 10-mmHg increase in PP: odds ratio [OR] = 1.3, 95% confidence interval [CI] = 1.1-1.76; for a 0.1 increase in aortic pulsatility: OR = 1.8, 95% CI = 1.3-2.4). When patients were divided into tertiles according to the level of aortic pulsatility, it was noted that multiple-adjusted OR of presence CAD was 2.2 (95% CI = 1.1-4.4) for the middle tertile of the aortic pulsatility level and 5.9 (95% CI = 2.7-12.8) for the highest tertile of the aortic pulsatility level compared with the lowest tertile. Conclusion. In female subjects referred to coronary angiography, ascending aorta PP and aortic pulsatility are significantly associated with the presence of angiographic CAD and these associations are independent of age and other cardiovascular risk factors.     

The impact of upper gastrointestinal surgical volume on short term pancreaticoduodenectomy outcomes for pancreatic adenocarcinoma in the SEER-Medicare population

BackgroundPatients undergoing pancreaticoduodenectomy (PD) at low volume PD hospitals with high volume for other complex operations have comparable outcomes to high volume PD centers. We evaluated the impact of upper gastrointestinal operations (UGI) hospital volume on the outcomes of elderly, high risk patients undergoing PD.MethodsPatients >65 years old who underwent PD for pancreatic adenocarcinoma were identified from SEER-Medicare (2008–2015). Four volume cohorts were created using PD tertiles and UGI median: low (1st tertile PD), mixed-low (2nd tertile PD, low UGI), mixed-high (2nd tertile PD, high UGI) and high (3rd tertile PD). Multivariable logistic and negative binomial regression assessed short-term complications.ResultsIn total, 2717 patients were identified with a median age of 74.5 years. Patients treated at low, mixed-low and mixed-high volume hospitals, versus high volume, had higher risk of short-term complications, including major complications (low: OR 1.441, 95%CI 1.165–1.783; mixed-low: OR 1.374, 95%CI 1.085–1.740; mixed-high: OR 1.418, 95%CI 1.098–1.832) and 90-day mortality (low: OR 2.16, 95%CI 1.454–3.209; mixed-low: OR 2.068, 95%CI 1.347–3.175; mixed-high: OR 1.96, 95%CI 1.245–3.086).ConclusionPatients with pancreatic adenocarcinoma who are older and more medically complex benefit from undergoing surgery at high volume PD centers, independent of the operative experience of that center.     

Perceived health status in patients over 70 before and after open-heart operations

AIM: to evaluate improvement and predictors of improvement in patients' perceived health status after cardiac surgery in older patients. METHODS: three hundred and seventy-seven patients from three different departments of cardiac surgery completed the Nottingham Health Profile questionnaire before and 1 and 2 years after open-heart surgery. We analysed pre- and postoperative data and pre- and postoperative Nottingham Health Profile scores. RESULTS: the mean age was 74+/-3 years. The comparison between pre- and postoperative scores showed an improvement in all but the social isolation section. Logistic regression showed that the predictors of patients who became worse after surgery were (i) in the energy section: age over 75 [odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.02-3.2], coronary artery disease (OR = 2.4, 95% CI = 1.04-3.6) and postoperative events (OR = 1.9, 95% CI = 1.01-3.7); (ii) in the physical mobility section: diabetes mellitus (OR = 2.4, 95% CI = 1.2-4.7); and (iii) in the social isolation section: physical mobility impairment (OR = 3.4, 95% CI = 1.3-8.7). CONCLUSIONS: cardiac surgery improves perceived health status in patients over 70. This improvement is better for those undergoing aortic valve replacement than for those undergoing coronary artery bypass surgery. Comparison with reference scores for a standard population shows that, even when successful, cardiac surgery results in fatigue and persistent sleep disturbance in older patients.     

Impact of body mass index on early outcome and late survival in patients undergoing coronary artery bypass grafting or valve surgery or both

The influence of body mass on outcome after cardiac surgery remains controversial. The aim of this study was to analyze the impact of body mass index (BMI) on early and late outcomes in a large series of patients who underwent cardiac surgery. We retrospectively analyzed 5,950 consecutive patients who underwent cardiac surgery between January 1998 and September 2006. Patients were divided into 4 groups defined by BMI (weight divided by square of height [kilograms divided by meters squared]): underweight (20 to 25 to 30 kg/m2): 22%, n=1,292. Analysis was further refined by performing subgroup analysis according to the surgical procedure (valve surgery, coronary artery bypass grafting, and combined valve/coronary artery bypass grafting). Main outcome measure was the association between BMI and hospital mortality, postoperative morbidities, and late survival. Hospital mortality was 3.4% (n=203). There was no association between BMI and hospital mortality in the entire patient population. Multivariate analysis revealed obesity as an independent predictor of hospital mortality in patients who underwent valve surgery (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.2 to 4.5, p=0.018). Obesity was associated with an increased risk for sternal infection (OR 1.8, 95% CI 1.1 to 2.9, p=0.013), whereas underweight correlated with postoperative bleeding (OR 2.0, 95% CI 1.1 to 3.6, p=0.017). Underweight was an independent predictor for decreased long-term survival (OR 1.8, 95% CI 1.3 to 2.5, p<0.001). In conclusion, cardiac surgery can be performed safely in both underweight and obese patients but carries a higher postoperative rate of major complications.