Population-based twin study of the effects of migration from Finland to Sweden on endothelial function and intima-media thickness

Finnish men have higher coronary heart disease (CHD) mortality than Swedish men do. To assess the impact of migration to a country with lower CHD mortality on subclinical atherosclerosis, we measured early functional and structural atherosclerotic vascular changes in twins discordant for migration from Finland to Sweden. Conventional CHD risk factors, flow-mediated dilatation (FMD) of the brachial artery, carotid intima-media thickness, and carotid artery compliance were measured in 74 male twin pairs (20 monozygous, 54 dizygous), aged 42 to 69 years, in which co-one twin had migrated more than 20 years ago permanently to Sweden. There were no significant differences in CHD risk factors except for diastolic blood pressure and body fat percentage, which were higher in Sweden. In all subjects, mean FMD was non-significantly higher in Sweden (5.7+/-4.3% vs 4.9+/-4.2%, P=0.22), but in monozygous twins the difference in FMD was highly significant (7.2+/-4.4 vs 3.7+/-2.9%, P=0.003). There was no significant difference in intima-media thickness or carotid artery compliance between Sweden and Finland. We conclude that in Finnish monozygous twins the endothelial function is better among the twins that have migrated to a country with lower CHD prevalence.     

Effects of aging and sex on progression of carotid intima‐media thickness: A retrospective 6‐year follow‐up study

Aim: We retrospectively examined the relationship of aging, sex and risk factors to increased carotid intima‐media thickness (IMT) over a follow‐up period of 6 years in patients with multiple risk factors. Methods: Subjects were comprised of 463 patients (287 men, 176 women) with a mean age of 64 ± 0.4 years who had undergone carotid ultrasonography twice or more at intervals of 5 years or older. The mean follow‐up period was 6.0 ± 0.1 years. Results: Mean baseline IMT for all subjects was 1.40 ± 0.02 mm, and no significant difference was seen between sexes. Mean IMT after 6 years for all subjects was 1.84 ± 0.03 mm, and was significantly greater in men than in women. Mean annual increase in IMT (ΔIMT) for all subjects was 0.073 ± 0.005 mm/year, with a significant positive correlation between baseline age and ΔIMT (r = 0.11, P < 0.05), and ΔIMT was significantly greater in men than in women (0.087 ± 0.007 mm vs 0.050 ± 0.007 mm, P < 0.001). IMT increased with age in both men and women, but ΔIMT increased with age only in men. Multivariate analysis showed baseline age and diabetes mellitus as significant risk factors with baseline IMT as the objective variable. Age and sex represented significant risk factors with ΔIMT as the objective variable. Conclusion: Sex differences exist in the relationship between increases in IMT and age. Age, sex and diabetes mellitus represented the main risk factors.     

Does immigration contribute to decreasing CHD incidence? Coronary risk factors among immigrants in Göteborg,Sweden

Abstract. Dotevall A, Rosengren A, Lappas G, Wilhelmsen L (Sahlgrenska University Hospital at Ostra, Göteborg University, Göteborg, Sweden). Does immigration contribute to decreasing CHD incidence? Coronary risk factors among immigrants in Göteborg, Sweden. J Intern Med 2000; 247: 331–339. Objectives. To investigate if an increasing proportion of immigrants may have contributed to the decreasing trend in coronary heart disease (CHD) in Sweden during the last few decades and to analyse the cardiovascular risk factor pattern in immigrants compared to Swedish‐born subjects. Population and methods. CVD risk factors were investigated within the framework of the WHO MONICA project. A random sample of 1618 men and women aged 25–64 years responded to the invitation to a screening procedure including questionnaires and physical and laboratory examination. Data on myocardial infarctions (MI) were collected from the Göteborg Myocardial Infarction Register. Data from the City Council secretariat were used to estimate the number of immigrants in the total population. Results. In 1995, immigrants constituted 22.4% of the population between 25 and 64 years of age in Göteborg. The incidence of MI in immigrants, 21.7%, was similar to that in Swedish‐born subjects. Non‐Finnish immigrants reported more unemployment, low physical activity during leisure time and psychological stress than Swedish subjects. Immigrant men also smoked more. BMI and WHR were significantly higher in immigrant women and Finnish immigrants had higher blood pressure than Swedes. Total‐ and LDL‐cholesterol were higher in Finnish men. HDL‐cholesterol was significantly lower and s‐triglycerides significantly higher in non‐Finnish immigrants of both genders. Conclusion. The decreasing trend in CHD in Sweden during the last few decades is not due to an increasing number of immigrants from ‘low‐risk countries’. On the contrary, the immigrants in the present study seem to have a worse CVD risk factor profile than Swedes.     

Cardiovascular risk factors and non-invasive assessment of subclinical atherosclerosis in youth

Our understanding of the natural history of atherosclerosis in childhood and its response to cardiovascular (CV) risk factor reduction have been hampered by the lack of a reliable, non-invasive measure of atherosclerosis. Carotid intima media thickness (IMT), a surrogate marker of atherosclerosis in adults, is increased in youth heterozygous for familial hypercholesterolemia (FH) and declines with lipid lowering pharmacotherapy. The age at which vascular changes can be reliably identified using IMT and the influence of CV risk factors beyond FH on IMT remains unclear.ObjectiveTo examine the influence of demographic, family history, anthropometric characteristics and traditional CV risk factors on IMT in children 5–16 years of age (mean age 11 year).MethodsIn a cross-sectional study, we assessed IMT in 148 children (51 with elevated low density lipoprotein (LDL)-cholesterol, 44 with overweight and 53 controls). Measures included: family history of premature coronary heart disease (CHD), physical activity, pubertal stage, smoking history, fasting glucose, insulin, lipid profile, apolipoproteins A1 and B, anthropometry, blood pressure and IMT.ResultsThe groups were similar for age and family history of premature CHD. Compared to controls, average maximum IMT (0.403 ± 0.04 vs 0.387 ± 0.029) and average mean IMT were elevated in the hyperlipidemia group (p < 0.05), but not in the overweight group (max IMT 0.393 ± 0.034; p vs control = 0.17). Using multiple regression modelling, age, family history of premature CHD and apoliprotein A1 and B predicted 17% of the variability in IMT. No measure of adiposity predicted IMT.ConclusionAge is an important predictor of IMT in youth. Among traditional CV risk factors, dyslipidemia and family history of premature CHD are independent predictors of IMT.     

Additional value of carotid artery intima-media thickness in cardiovascular risk assessment by Framingham risk-score in Type 2 diabetes: a retrospective cohort study

Background: The intima–media thickness (IMT) of the carotid artery is highly correlated with cardiovascular events in Type 2 diabetes mellitus (T2DM). The aim of the present study was to undertake a cardiovascular risk assessment in a group of patients (n = 102) who had been followed‐up for 10 years. Methods: Framingham risk score (FRS), IMT, and various other clinical parameters were evaluated retrospectively using Student’s t‐test, regression analysis, and χ² tests. Primary endpoints were defined as cardiovascular death, non‐fatal myocardial infarction, angina, and ischemic stroke. Results: The IMT (1.09 ± 0.32 vs 0.89 ± 0.25; P < 0.001) and percentage coronary risk as determined by the FRS (24.33 ± 11.07 vs 16.54 ± 8.35; P = 0.001) were significantly higher in patients presenting with any of the primary endpoints compared with patients in whom no cardiovascular morbidity or mortality was recorded. Other factors that significantly predicted cardiovascular mortality and morbidity included diastolic blood pressure and urinary albumin excretion (UAE; P < 0.001). The likelihood of primary endpoints could be predicted by UAE >30 mg/day, carotid artery IMT ≥0.9 mm, and FRS ≥20 (odds ratios 8.800, 3.377, and 2.807, respectively). Conclusion: Although FRS predicts 10‐year risk for cardiovascular mortality and morbidity in T2DM, we suggest that UAE and carotid artery IMT should also be considered in risk assessments.     

Lymphopenia is a risk factor in the progression of carotid intima‐media thickness in juvenile‐onset systemic lupus erythematosus

Objective

To characterize the atherosclerotic risk factors in the progression of subclinical atherosclerosis in patients with juvenile‐onset systemic lupus erythematosus (SLE).

Methods

This was a longitudinal study of 76 patients with juvenile‐onset SLE. Carotid arteries were evaluated using ultrasonography at baseline and at followup visits at 6‐month intervals over the 6‐year study period. Clinical and laboratory parameters, disease activity, treatment, and traditional risk factors for atherosclerosis were evaluated. Data were analyzed using generalized estimating equations.

Results

The mean ± SD age of the patients at baseline was 15.01 ± 3.48 years and the mean ± SD disease duration was 2.65 ± 2.5 years. The mean ± SD duration of followup was 3.74 ± 1.24 years. The mean ± SD intima‐media thickness (IMT) of the common carotid arteries differed significantly between the patient and control (n = 38) groups (0.63 ± 0.08 mm versus 0.54 ± 0.06 mm; P < 0.001). The presence of lymphopenia at diagnosis and at baseline and higher levels of serum creatinine and C‐reactive protein at baseline were positively associated with progression of carotid IMT (P = 0.006, P = 0.043, P = 0.037, and P = 0.049, respectively). In multivariate analysis, only lymphopenia at baseline and at diagnosis were consistently associated with progression of IMT (P = 0.012 and P = 0.045, respectively).

Conclusion

In patients with juvenile‐onset SLE, some nontraditional risk factors for the progression of subclinical atherosclerosis were identified. Lymphopenia was the only independent risk factor for the progression of IMT. The pathogenic mechanisms warrant further investigation.

     

Partial growth hormone deficiency is associated with an adverse cardiovascular risk profile and increased carotid intima‐medial thickness

Objective To quantify the relative prevalence of surrogate markers of vascular risk in adults with partial GH deficiency (GH insufficiency, GHI). Context Hypopituitary adults with untreated GH deficiency (GHD) have an excess vascular mortality and demonstrate clustering of adverse vascular risk factors. The vascular risk profile of GHI adults has yet to be comprehensively studied. Design A cross‐sectional case controlled study. Patients Thirty GHD adults, 24 GHI, and 30 age‐ and sex‐matched controls. GHI adults were defined biochemically using two GH stimulation tests (peak GH 3–7 μg/l). Measurements Serum lipids and apolipoproteins, plasminogen activator inhibitor type‐I (PAI‐I), C‐reactive protein (CRP), lipoprotein (a) [Lp(a)], fibrinogen, blood pressure and carotid intima‐medial thickness (IMT). Results IGF‐I levels of GHI adults were lower than controls (373 ± 123 vs 295 ± 104 μg/l; P < 0·001). Total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐C) and triglycerides (TG) values were consistently between those of, but not significantly different from, GHD and control subjects. GHI adults showed significantly elevated PAI‐I levels [80 (13–98) vs 50·5 (3–98) ng/ml; P = 0·01], although no there were differences in CRP, Lp(a), and fibrinogen levels compared with control subjects. No differences in systolic or diastolic blood pressure were shown between study groups. In parallel with the increased vascular risk profile of GH‐insufficient adults, carotid IMT was significantly increased (0·503 ± 0·08 vs 0·578 ± 0·130 mm; P = 0·02). TC, LDL‐C, Waist‐Hip Ratio (WHR), truncal fat mass, and IMT correlated with IGF‐I levels and GH status. TG, K_ITT, and PAI‐I additionally correlated with GH status, but not with IGF‐I levels. Conclusion GHI adults are at elevated vascular risk, reflected by adverse surrogate markers and increased carotid IMT. The surrogate risk marker profile parallels GHD adults, but is less divergent from that observed in healthy individuals. No data are yet available as to whether these anomalies will be reflected in an increased vascular mortality in GHI adults.     

Plasma carotenoids are related to intima--media thickness of the carotid artery wall in men from eastern Finland

Abstract. Karppi J, Kurl S, Laukkanen JA, Rissanen TH, Kauhanen J (Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio; Lapland Central Hospital, Rovaniemi; Finland). Plasma carotenoids are related to intima – media thickness of the carotid artery wall in men from eastern Finland. J Intern Med 2011; 270 : 478–485. Background. Several previous epidemiological studies have suggested that high plasma concentrations of carotenoids may slow the development of early atherosclerosis, but results have been inconclusive. Methods. We examined the effect of carotenoids on early atherosclerosis in a population‐based study. The association between plasma carotenoid concentrations and intima–media thickness of the common carotid artery (CCA‐IMT) was investigated in 1212 elderly men (aged 61–80 years) in Eastern Finland. They were examined by B‐mode ultrasound to detect early signs of carotid atherosclerosis, and plasma concentrations of carotenoids were measured by high‐performance liquid chromatography. Results. Men in the lowest quartile of CCA‐IMT had significantly higher concentrations of plasma β‐cryptoxanthin, lycopene and α‐carotene than men in the highest quartile (P for the differences: 0.043, 0.045 and 0.046, respectively), after adjustment for age, examination year, body mass index, smoking, alcohol intake, years of education, symptomatic coronary heart disease (CHD) or CHD history, diabetes, low‐density lipoprotein cholesterol, medications and season. The concentrations of plasma β‐cryptoxanthin, lycopene and α‐carotene decreased linearly with increasing CCA‐IMT. Conclusions. The results of this study suggest that high plasma concentrations of β‐cryptoxanthin, lycopene and α‐carotene may be associated with decreased carotid atherosclerosis in elderly men from eastern Finland.     

Carotid intima‐media thickness is increased in Turner syndrome: multifactorial pathogenesis depending on age,blood pressure,cholesterol and oestrogen treatment

Objective Carotid intima‐media thickness (IMT) may potentially supplement cardiovascular risk assessment in Turner syndrome (TS), where cardiovascular risk is high and appropriate risk stratification difficult. Knowledge of IMT in TS is scarce, and this study aimed to enhance insight into the cardiovascular risk marker. Design, Patients and Measurements IMT was cross‐sectionally assessed by ultrasonography of the common carotid artery (cIMT) and carotid bulb (bIMT) in TS (n = 69, age 40 ± 10 years) and age‐matched, healthy female controls (n = 67). Additional prospective IMT assessment was performed in TS over 2·4 ± 0·3 years. Metabolic biomarkers and 24‐h ambulatory blood pressure were also assessed. Results cIMT and bIMT (body surface area indexed) were increased in TS (P < 0·05) with 17–18% having IMTs that exceeded the 95th percentile of the controls (P < 0·05). Blood pressure, heart rate, glycosylated haemoglobin A1c and high‐density lipoprotein cholesterol were increased in TS, where 43% received antihypertensive treatment. cIMT decreased during follow‐up, coinciding with intensified cardiovascular risk prophylaxis, whereas bIMT was unchanged. In multiple regression analyses (R = 0·52–0·69, P < 0·05), baseline IMT in TS increased with age, blood pressure and cholesterol as well as in the presence of diabetes whilst IMT was inversely associated with duration of oestrogen replacement. In an analogue analysis, the prospective changes in cIMT (R = 0·37, P < 0·05) were beneficially influenced by antihypertensive treatment and oestrogen therapy and adversely by the presence of diabetes. Conclusion Carotid IMT was abnormal in TS and negatively influenced by age, metabolic biomarkers, blood pressure and short duration of oestrogen treatment. Attention to common cardiovascular and endocrine risk markers over more than 2 years appeared to influence IMT beneficially.     

Atherosclerosis in patients with biopsy‐proven giant cell arteritis

Objective

To examine the presence of atherosclerosis in a series of giant cell arteritis (GCA) patients attended to in a community hospital and to determine whether clinical features or steroid therapy might be associated with the development of atherosclerotic disease.

Methods

Forty consecutive patients diagnosed with biopsy‐proven GCA, periodically followed at the rheumatology outpatient clinic of Hospital Xeral‐Calde, Lugo (Spain), who had ended steroid therapy and had at least 3 years of followup were assessed for the presence of atherosclerosis by determination of the carotid intima‐media thickness (IMT) and carotid plaques using high‐resolution B‐mode ultrasound. Forty matched controls were also studied.

Results

GCA patients exhibited less carotid artery IMT than did matched controls (mean ± SD 1.01 ± 0.16 mm versus 1.13 ± 0.20 mm; P = 0.005; difference in means 0.12, 95% confidence interval 0.04–0.20). Patients who required steroid therapy for >2 years had greater mean ± SD carotid IMT (1.04 ± 0.17 mm versus 0.95 ± 0.15 mm) but the difference was not statistically significant (P = 0.10). A positive correlation between age at the time of the study and the carotid artery IMT in GCA patients was observed (r = 0.673, P < 0.001). However, adjusting for age, sex, and classic atherosclerosis risk factors, no significant correlation between carotid IMT and the routine laboratory markers of inflammation assessed at the time of disease diagnosis, disease duration, or cumulative prednisone dose was found.

Conclusion

The present study demonstrates that atherosclerotic macrovascular disease is not increased in patients with GCA.     

Coronary heart disease risks in first- and second-generation immigrants in Sweden: a follow-up study

OBJECTIVES: To analyse whether there is an association between country of birth in first-generation immigrants and first hospitalization for or death from coronary heart disease (CHD) and to analyse whether this association remains in second-generation immigrants. DESIGN: In this follow-up study, the MigMed database at the Karolinska Institute, Stockholm, was used to identify all hospital diagnoses of and deaths from incident CHD in first- and second-generation immigrants in Sweden between 1 January 1987 and 31 December 2001. Incidence ratios standardized by age, geographical region and socio-economic status were estimated by sex in first- and second-generation immigrants; the reference group was Swedish-born people whose parents were both born in Sweden. SUBJECTS: The total Swedish population aged 25-69 years. RESULTS: First-generation immigrants from Finland, central European countries, other eastern European countries and Turkey had higher rates of CHD than men or women in the reference group. First-generation immigrant women born in southern Europe, other western European countries and Baltic countries had lower CHD risks than the reference group. Sons of both male and female first-generation immigrants showed CHD risks similar to or slightly higher than those of their parents. Amongst second-generation women, only subjects with Finnish fathers or mothers had higher risks of developing CHD than the reference. CONCLUSIONS: Increased risks of CHD found in some first-generation immigrant groups often persist in second-generation immigrant men. Healthcare professionals and policy makers should take this into account when designing and undertaking measures to prevent CHD.     

Alcohol-related disorders in first- and second-generation immigrants in Sweden: a national cohort study

Aims The risk of alcohol‐related disorders in first‐ and second‐generation immigrants in Sweden were investigated and compared with the Swedish majority population to assess how alcohol habits are modified over generations in a new society. Design Register study based on multivariate analyses of demographic data, including information on country of birth, from the Swedish Population and Housing Census of 1985 linked to data on hospital admissions for alcohol‐related disorders during 1990–99 in the National Hospital Discharge Register. Participants The study population consisted of a national cohort of 1.25 million youth born 1968–79 and 1.47 million adults born 1929–65. Results First‐ and second‐generation immigrants from Finland had higher relative risks (RRs) for hospital admission because of an alcohol‐related disorder compared to the Swedish majority population (socio‐economic adjusted RRs 2.1 and 1.9, respectively), while first‐generation immigrants born in southern Europe, the Middle East and other non‐European countries had lower risks. Second‐generation immigrants with heritage in southern Europe, the Middle East and other non‐European countries had socio‐economic adjusted RRs that were higher relative to the first generation immigrants but lower relative to the Swedish majority population. Intercountry adoptees had the highest adjusted RR (2.5). Conclusions Patterns of alcohol abuse in the country of origin are strong determinants of alcohol‐related disorders in first‐generation immigrants. The patterns in second‐generation immigrants are influenced by parental countries of origin as well as patterns in the majority population. The Finnish minority and intercountry adoptees are of particular concern in prevention.     

Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study

OBJECTIVES: To determine the prognostic role of orthostatic hypotension for cardiovascular disease (CVD) and all‐cause mortality in elderly people. DESIGN: Prospective study. SETTING: Community based. PARTICIPANTS: Five thousand sixty‐four subjects from the Rotterdam study aged 55 and older. MEASUREMENTS: Orthostatic hypotension was measured using a Dinamap automatic blood pressure recorder. Orthostatic hypotension is defined as a decline in systolic blood pressure of 20 mmHg or more or a decline in diastolic blood pressure of 10 mmHg or more from supine to standing position at any of three measurements taken 1, 2, and 3 minutes after standing. RESULTS: At baseline, 901 subjects had orthostatic hypotension. During follow‐up, 668 subjects had coronary heart disease (CHD) (mean follow‐up 6.0 ± 3.5 years), and 1,835 subjects died (mean follow‐up period 7.8 ± 3.8 years). Orthostatic hypotension increased the risk of CHD (hazard ratio (HR)=1.31, 95% confidence interval (CI)=1.08–1.57) and all‐cause mortality (HR=1.22, 95% CI=1.09–1.36), in models adjusted for age and sex. The risk was slightly lower after additional adjustment for cardiovascular risk factors. In analyses stratified for age, the HRs for all‐cause mortality were 1.80 (95% CI 1.25–2.60), 1.13 (0.89–1.42), and 1.27 (95% CI=1.11–1.44), in the first, second, and third tertile of age, respectively. CONCLUSION: Orthostatic hypotension increases the risk of CHD and all‐cause mortality in elderly people. The risk of CVD and mortality is strongest in younger and very old subjects.     

Intima Media Thickness and Endothelial Function in Chronic Hemodialysis Patients

The purpose of our study was to evaluate the intima‐media thickness (IMT) of the carotid and brachial arteries, flow‐mediated dilatation (FMD), and nitroglycerin‐mediated dilatation (NMD) in diabetic and non‐diabetic hemodialysis patients. We also examined the effects of traditional and other risk factors on carotid and brachial IMT, FMD and NMD in all hemodialysis patients. Fifty‐eight adult hemodialysis patients, 14 of whom had diabetes, were studied. They had been on hemodialysis for 1–340 months. Using B‐mode ultrasonography, we measured the carotid and brachial IMT, FMD and NMD, and correlated the values with cardiovascular risk factors. FMD and NMD were significantly lower in diabetic patients (FMD 4.01 ± 0.99 vs. 6.69 ± 2.37 mm; NMD 9.1 ± 1.95 vs. 11.23 ± 2.86 mm), while no such differences were found between the two groups with respect to carotid or brachial IMT. In all patients with respect to age a positive correlation was found with carotid and brachial IMT, and a negative one with FMD and NMD. With respect to hypertension as well as diabetes, a negative correlation was found with FMD and NMD. Age is the most important factor that significantly affected all studied markers of atherosclerosis in hemodialysis patients. The endothelial and smooth vascular functions are significantly impaired in diabetic and hypertensive hemodialysis patients, and hypertension is shown to be an independent risk factor for smooth vascular dysfunction in hemodialysis patients. According to our results, intensive antihypertensive treatment is recommended in hypertensive chronic hemodialysis patients.     

A myocardial infarction genetic risk score is associated with markers of carotid atherosclerosis

Abstract. Hamrefors V, Hedblad B, Engström G, Almgren P, Sjögren M, Melander O (Lund University, Malmö, Sweden). A myocardial infarction genetic risk score is associated with markers of carotid atherosclerosis. J Intern Med 2012; 271 : 271–281. Objective. To assess whether or not a genetic risk score that was previously shown to be associated with myocardial infarction (MI) and coronary artery disease (CAD) is also associated with markers of carotid atherosclerosis. Design. A total of 4022 middle‐aged subjects from the general Swedish population were genotyped and individually assigned a genetic risk score based on 13 single‐nucleotide polymorphisms (SNPs), previously associated with MI and CAD. The genetic score (Score‐MI) was then related to carotid bulb intima–media thickness (IMT), common carotid artery (CCA) IMT and to the occurrence of carotid plaques in the study population. Results. Score‐MI was associated with IMT of the bulb (P < 0.001) and the CCA (P < 0.001) in unadjusted analyses, and with IMT of the bulb after adjustment for cardiovascular risk factors (P = 0.003). The effect size of Score‐MI on IMT of the bulb was similar to that of LDL cholesterol. After adjustment for cardiovascular risk factors, Score‐MI was also associated with the occurrence of carotid plaques (odds ratio per quintile of Score‐MI = 1.11; 95% confidence interval 1.04–1.18; P = 0.001). In addition to SNPs with known effects on LDL levels, Score‐MI showed nominal associations with increasing systolic blood pressure and decreasing C‐reactive protein levels. Conclusions. This genetic risk score was independently associated with carotid bulb IMT and carotid plaques, providing evidence of an association with early markers of atherosclerosis. This might imply that the genetic MI risk conferred by the score is related to early atherosclerosis and that the risk score may identify at an early stage candidates at risk of developing intermediate phenotypes of atherosclerosis. Further studies should test whether or not assessing the genetic score could be valuable for early treatment decisions in these subjects.     

Vascular and Autonomic Function in Preschool‐aged Children with Congenital Heart Disease

Objective. To compare indices of vascular health and heart rate variability in preschool‐aged children with repaired congenital heart disease (CHD) including tetralogy of Fallot (n = 6) and coarctation of the aorta (n = 6). Design. A cross‐sectional study design was used. All measures were noninvasive and collected over a single testing session under the supervision of a parent/guardian. Setting. Data collection took place in a quiet, temperature‐controlled room (23°± 1°C) with the participant in a supine position. Patients. Twelve (six females, six males) preschool‐aged children with repaired CHD (CHD: 4 ± 1 years) and 12 age‐ and gender‐matched healthy controls (CON: 5 ± 1 years) participated in the study. Outcome Measures. Supine, resting measures of heart rate variability (time, frequency, and nonlinear domains), whole‐body pulse wave velocity (ventricular depolarization to dorsalis pedis artery), brachial blood pressures, and carotid artery distensibility, lumen diameter, intima‐media thickness, and wall/lumen ratio were collected in both groups. Results. The groups were similar in age, height, and weight; however, CON had significantly higher body mass index values (CON: 16.9 ± 2.2, CHD: 15.1 ± 1.0, P < .05) and body mass index percentiles (CON: 69 ± 27%tile, CHD: 36 ± 24%tile, P < .01) compared to CHD. No group differences were found for resting brachial blood pressures, whole‐body pulse wave velocity, heart rate variability, and carotid artery distensibility, lumen diameter, and intima‐media thickness (P > .05). Carotid artery pulse pressures (CHD: 38 ± 6 mm Hg, CON: 31 ± 6 mm Hg, P < .05) and wall/lumen ratios (CHD: 0.091 ± 0.007, CON: 0.085 ± 0.006, P < .01) were significantly higher in the CHD group. Conclusions. These results may indicate that preschool‐aged children with repaired CHD display early signs of vascular remodeling, but not autonomic or vascular dysfunction. The effects of larger wall/lumen ratios on cardiovascular disease risk require further investigation.     

Prevalence of coronary heart disease and cardiovascular risk factors in a sample of older Australians: Australian Longitudinal Study of Ageing

Objectives: To describe the prevalence of coronary heart disease (CHD) and characterise cardiovascular risk factors in elderly Australians. Methods: At entry into the Australian Longitudinal Study of Ageing (ALSA), 1075 participants aged 70 years and over provided cardiovascular data by questionnaire, clinical assessment and laboratory measurements. Results and Conclusion: A total of 201 participants (18.7%) were defined as having CHD, 138 participants (12.9%) had diabetes and 652 (61.3%) had systolic hypertension. Prevalent CHD was associated with male sex, older age, lower high‐density lipoprotein (HDL) cholesterol, low diastolic blood pressure and use of antihypertensive medication. While many ‘traditional’ cardiovascular risk factors were not significantly associated with CHD in this cross‐sectional analysis, follow‐up of this sample will allow a longitudinal assessment of their relationship with CHD in older Australians.     

高频超声评价颈动脉粥样硬化与冠状动脉病变的关系

目的利用高频超声检测颈动脉内中膜厚度(IMT)、斑块形成情况,并与冠状动脉(冠脉)病变程度的关系进行分析。方法应用ASPEN彩色多普勒超声诊断仪,对428例健康人(对照组)及89例冠心病患者(冠心病组)进行颈动脉IMT、斑块形成的检测。冠心病组患者以冠脉病变支数分为3个亚组。结果冠心病组患者颈动脉IMT为(1.19±0.14)mm,而对照组为(0.92±0.13)mm,(P<0.01);IMT增厚检出率及斑块形成检出率冠心病组为43.21%、74.65%,而对照组为14.49%、34.35%,(P<0.01)。1支冠脉病变组IMT为(1.00±0.014)mm,斑块形成检出率为42.86%;2支冠脉病变组IMT为(1.15±0.018)mm,斑块形成检出率为65.52%;3支及以上冠脉病变组IMT为(1.31±0.018)mm,斑块形成检出率为74.49%,(P<0.01)。结论颈动脉IMT增厚、斑块形成对冠心病具有预测价值;颈动脉IMT增厚、斑块形成与冠脉病变严重程度呈正相关。     

Immigrants from the Middle‐East have a different form of Type 2 diabetes compared with Swedish patients

Aims To compare the clinical characteristics of Type 2 diabetes (T2DM) between immigrants from the Middle‐East and Swedish patients. Methods The study group included 450 consecutive patients with T2DM, 379 Swedish‐born aged 61 ± 12 years and 71 patients originally from the Middle‐East aged 50 ± 11 years from the diabetes clinic of Malmo University Hospital. Results Onset of diabetes had occurred 12 years earlier in the Middle‐East immigrants compared with the Swedish‐born patients (43 ± 10 vs. 55 ± 12 years, P < 0.001). Immigrants had lower fasting serum C‐peptide [0.7 (0.1–2.6) vs. 0.9 (0.1–4.0) nmol/l, P = 0.013], lower homeostasis model assessment (HOMA)‐β[1.7 (0.1–9.1) vs. 2.7 (0.1–59.0), P = 0.010], lower HOMA‐IR [0.4 (0.02–1.19) vs. 0.4 (0.01–2.8), P = 0.005] than the Swedish group. A first‐degree family history of diabetes was reported in 61% of immigrants, compared with 47% of Swedish‐born (P = 0.022). Conclusions Immigrants from the Middle‐East have an earlier onset, stronger family history and more rapid decline of pancreatic B‐cell function than Swedish patients, suggesting that they have a different form of T2DM compared with Swedish patients.     

Carotid IMT Variability (IMTV) and Its Validation in Symptomatic versus Asymptomatic Italian Population: Can This Be a Useful Index for Studying Symptomaticity?

The carotid intima‐media thickness (IMT) is a validated marker of cerebrovascular disease risk. This paper presents a new parameter, the IMT variability (IMTV), and compares it between symptomatic and asymptomatic patients taken from a cohort of Italian population. One hundred forty‐two patients were analyzed (age 59 ± 112 years, 59% males), 42 of these patients suffered from TIA or minor stroke. The lumen‐intima (LI) and media‐adventitia (MA) interfaces of the far wall were manually traced by a Reader. We also used a computer‐based automated system (called AutoEdge) to obtain the LI/MA interfaces. The LI/MA interfaces were used to measure the IMT and the IMTV along the distal wall of the common carotid artery. Wilcoxon and Pearson correlation analyses were performed. The agreement between the Reader's IMT and the AutoEdge IMT values was 98.7% for the symptomatic (0.83 ± 0.44 mm for Reader, 0.82 ± 0.35 mm for AutoEdge) and 94.9% for the asymptomatic patients (0.78 ± 0.45 mm for Reader, 0.74 ± 0.30 mm for AutoEdge). Correlation was 65% for symptomatic and 68% for asymptomatic patients, respectively. The IMT measured using AutoEdge was 1.2% lower compared to manual measurements in symptomatic population, while 5.12% lower in asymptomatic. The IMTV was 11% higher in symptomatic patients compared to asymptomatic when using manual delineations, 8% higher when using AutoEdge. There was no statistical difference between the manual and automated IMTV measurements (Wilcoxon signed rank, P > 0.7). We conclude that the IMT and IMTV values were very similar between Reader and AutoEdge software when studying symptomatic and asymptomatic patients in Italian population.