Peripheral arterial disease and its relationship to cardiovascular risk factors and coronary heart disease in newly diagnosed non-insulin-dependent diabetics

The prevalence of peripheral arterial disease and its relationship to cardiovascular risk factors was investigated in 133 patients aged 45-64 years with newly diagnosed non-insulin-dependent diabetes and in 144 randomly selected non-diabetic subjects of the same age. History of intermittent claudication, absent foot pulses, decreased ankle-arm blood pressure ratio (less than 0.9) and radiologically detectable arterial calcifications of the lower limbs were used as indicators of the presence of peripheral arterial disease. Peripheral arterial disease tended to be somewhat more common in men with newly diagnosed non-insulin-dependent diabetes than in non-diabetic men, whereas no difference was found in prevalence of peripheral arterial disease between diabetic and non-diabetic women. The association of various indicators of peripheral arterial disease with cardiovascular risk factors and coronary heart disease was low or absent.     

Mortality over a period of 10 years in patients with peripheral arterial disease.

BACKGROUND. Previous investigators have observed a doubling of the mortality rate among patients with intermittent claudication, and we have reported a fourfold increase in the overall mortality rate among subjects with large-vessel peripheral arterial disease, as diagnosed by noninvasive testing. In this study, we investigated the association of large-vessel peripheral arterial disease with rates of mortality from all cardiovascular diseases and from coronary heart disease. METHODS. We examined 565 men and women (average age, 66 years) for the presence of large-vessel peripheral arterial disease by means of two noninvasive techniques--measurement of segmental blood pressure and determination of flow velocity by Doppler ultrasound. We identified 67 subjects with the disease (11.9 percent), whom we followed prospectively for 10 years. RESULTS. Twenty-one of the 34 men (61.8 percent) and 11 of the 33 women (33.3 percent) with large-vessel peripheral arterial disease died during follow-up, as compared with 31 of the 183 men (16.9 percent) and 26 of the 225 women (11.6 percent) without evidence of peripheral arterial disease. After multivariate adjustment for age, sex, and other risk factors for cardiovascular disease, the relative risk of dying among subjects with large-vessel peripheral arterial disease as compared with those with no evidence of such disease was 3.1 (95 percent confidence interval, 1.9 to 4.9) for deaths from all causes, 5.9 (95 percent confidence interval, 3.0 to 11.4) for all deaths from cardiovascular disease, and 6.6 (95 percent confidence interval, 2.9 to 14.9) for deaths from coronary heart disease. The relative risk of death from causes other than cardiovascular disease was not significantly increased among the subjects with large-vessel peripheral arterial disease. After the exclusion of subjects who had a history of cardiovascular disease at base line, the relative risks among those with large-vessel peripheral arterial disease remained significantly elevated. Additional analyses revealed a 15-fold increase in rates of mortality due to cardiovascular disease and coronary heart disease among subjects with large-vessel peripheral arterial disease that was both severe and symptomatic. CONCLUSIONS. Patients with large-vessel peripheral arterial disease have a high risk of death from cardiovascular causes.     

Cholesterol reduction in patients with lower limb atherosclerotic disease

Patients with peripheral arterial disease (PAD) have a 2-3 times increased risk of death and in the most severe stage, critical peripheral ischaemia, the mortality rate is around 50% within 4-5. This poor survival rate is due to concomitant coronary and cerebrovascular atherosclerotic disease. Among the major risk factors for atherosclerosis are dyslipidaemia, smoking, hypertension and diabetes. Large randomised trials have shown that dyslipidaemia is easily modifiable in both patients with and without established coronary artery disease, with significant reductions in cardiovascular morbidity and mortality. Although none of these trials directly measured peripheral vascular status, there is every indication that conclusions submitted for patients with ischaemic heart disease can be translated to patients with peripheral vascular disease. The object of this review was therefore to divulge current evidence available supporting active treatment of dyslipidaemia in patients with peripheral vascular disease.     

Low risk of coronary heart disease in female type II diabetic subjects with diabetic relatives

Possible risk factors for cardiovascular disease were studied in 52 type II diabetic subjects, 19 with and 33 without a history of coronary heart disease (CHD). None of the recognized risk factors, such as hypertension, hyperlipidaemia, smoking and blood glucose imbalance, could be related to CHD. However, all female patients with CHD were lacking a family history of diabetes, while seven of nine female diabetic subjects without a history of CHD had diabetes in the family (p less than 0.02). This was confirmed in a second study of 150 type II diabetic subjects; CHD was more common among female patients without compared to those with diabetes in the family; 9/38 and 1/28, respectively (p less than 0.03). Diabetes increases the risk of CHD, and it does so for women more than it does for men. The finding of a possible low CHD risk in female diabetic subjects with diabetes in the family supports the hypothesis of genetic factors being important for the pathogenesis of cardiovascular disease in diabetes mellitus.     

2型糖尿病患者糖尿病足的相关危险因素分析

目的 探讨2型糖尿病患者糖尿病足的危险因素。方法 对2004年3月至2008年1月深圳市人民医院497例2型糖尿病患者（糖尿病足组56例、非糖尿病足组441例）的临床资料和生化指标进行回顾性分析，包括病人性别、年龄、病程、体重、血压、吸烟史、高血压病史、周围神经病变、视网膜病变、外周血管病变等。然后进行多因素非条件Logistic回归分析。结果 糖尿病足组和非糖尿病足组相比．年龄、平均动脉压、空腹血糖、餐后2h血糖、血胆固醇、血甘油三酯、估测的肾小球滤过率（eGFR）、高血压病史、周围神经病变史、外周血管病、视网膜病变差异有统计学意义（P〈0．05）。结论 周围神经病变、外周血管病变、糖尿病肾病是糖尿病足发生的独立危险因素。     

Metabolic syndrome in subjects with type-2 diabetes mellitus

BACKGROUND: Each component of metabolic syndrome (MS) conveys increased cardiovascular disease risk, but as a combination they become much more powerful. Vigorous early management of the syndrome may have a significant impact on the prevention of both diabetes and cardiovascular disease. AIM: This study aims to determine the frequency of occurrence of MS and its relation to cardiovascular events among patients with type-2 diabetic mellitus. METHODS: The study group consisted of 218 type-2 diabetic patients. These were screened for hypertension, hyperlipidemia, obesity, microalbuminuria, and cardiovascular events. RESULTS: There were 128 (58.7%) males and 90 (41.3%) females. The mean age was 53.4 +/- 6.3 years and a mean body mass index (BMI) of 25.5 +/- 5.4 (males-23.4 +/- 4.2; females-26.2 +/- 5.7). MS was present in 55 (25.2%) of the study population. Systemic hypertension was the most common component of MS seen in 84 (38.5%) patients. The mean serum total cholesterol was 168.6 +/- 25.8 mg% (men 153 +/- 23; women 169 +/- 19; p > 0.05). Eight female and 12 male patients had serum total cholesterol > or = 200 mg%. Dyslipidemia occurs more commonly in males than females. Obesity was more common in female patients than in males. Out of 128 male type-2 patients with diabetes seen, 111 (86.7%) were without microalbuminuria. The corresponding figure among the females was 90% (81 out of 90 patients). CONCLUSIONS: The study demonstrated that MS was present in 25.2% of the study population. The syndrome and its different components were positively associated with a higher risk of stroke, peripheral vascular disease, and occurrence of microalbuminuria, p < 0.001. Ischemic heart disease occurs rarely in the population. A long-term, targeted, intensive intervention involving multiple cardiovascular risk factors is recommended to reduce the risk of both cardiovascular and microvascular events among patients with type-2 diabetic mellitus.     

Symptomatic peripheral arterial disease: the value of a validated questionnaire and a clinical decision rule

BACKGROUND: If a validated questionnaire, when applied to patients reporting with symptoms of intermittent claudication, could adequately discriminate between those with and without peripheral arterial disease, GPs could avoid the diagnostic measurement of the ankle brachial index. AIM: To investigate the Edinburgh Claudication Questionnaire (ECQ) in general practice and to develop a clinical decision rule based on risk factors to enable GPs to easily assess the likelihood of peripheral arterial disease. DESIGN OF STUDY: An observational study. SETTING: General practice in The Netherlands. METHOD: This observational study included patients of > or =55 years visiting their GP for symptoms suggestive of intermittent claudication or with one risk factor. The ECQ and the ankle brachial index were performed. The prevalence of peripheral arterial disease, defined as an ankle brachial index <0.9, was related to risk factors using logistic regression analyses, on which a clinical decision rule was developed and related to the presence of peripheral arterial disease. RESULTS: Of the 4790 included patients visiting their GP with symptoms suggestive of intermittent claudication, 4527 were eligible for analyses. The prevalence of peripheral arterial disease in this group was 48.3%. The sensitivity of the ECQ was only 56.2%. The prevalence of peripheral arterial disease in a clinical decision rule that included age, male sex, smoking, hypertension, hypercholesterolemia, and a positive ECQ, increased from 14% in the lowest to 76% in the highest category. CONCLUSION: This study indicates that the ECQ alone has an inadequate diagnostic value in detecting patients with peripheral arterial disease. The ankle brachial index should be performed to diagnose peripheral arterial disease in patients with complaints suggestive of intermittent claudication, although our clinical decision rule could help to differentiate between extremely high and lower prevalence of peripheral arterial disease.     

Targeted screening for peripheral arterial disease in general practice: a pilot study in a high risk group

BACKGROUND: Screening of high-risk groups for peripheral arterial disease has been advocated because the condition underdiagnosed and secondary prevention can reduce cardiovascular event rates. AIM: To establish the feasibility of screening for peripheral arterial disease in people aged 60 years or over with hypertension, and to estimate the potential to improve secondary preventive treatment. DESIGN OF STUDY: Pilot study and cross-sectional survey. SETTING: Large general practice in north-east Scotland. METHOD: People aged 60 years or over with hypertension but no cardiovascular disease or diabetes were identified from computer records and invited to a screening clinic. Data were collected on ankle brachial pressure index (ABPI), preventive treatment, and risk factors. RESULTS: Of 705 potentially eligible patients, 443 (63%) agreed to participate. Sixty-four were excluded and 364 of 379 patients (96%) attended screening. Thirty patients had peripheral arterial disease (ABPI of 0.9 or less), of whom 24 (7%; 95% confidence interval [CI] = 4 to 10%) were previously undiagnosed. Fifteen (50%) patients took antiplatelets, 13 (45%) had cholesterol <5 mmol/l, and 16 (53%) had blood pressure below 140/85 mmHg. Twenty-two (73%) patients were non-smokers, 14 (47%) had low-fat diets, two (7%) were physically active, and three (10%) ate recommended amounts of fruit and vegetables. CONCLUSIONS: It is feasible to screen for peripheral arterial disease in primary care, but its prevalence is lower than anticipated. There is room for improvement in secondary preventive treatment and lifestyle, so a structured programme could still have important benefits for survival.     

Skin tags and the atherogenic lipid profile

This report details four patients who had skin tags, mainly on their torso, neck, and axillae, and who also displayed an abnormal lipid profile. All showed an increased serum triglyceride (fasting > 1.70 mmol/litre) and a decreased high density lipoprotein (HDL) cholesterol (< 1.1 mmol/litre in women and 1.0 mmol/litre for men) concentration. The displayed lipid profile is also known as the atherogenic profile and is associated with insulin resistance, type 2 diabetes mellitus, and an increased risk of cardiovascular disease. Two of the patients had impaired glucose tolerance and one had type 2 diabetes mellitus. Three of the individuals had coronary artery disease. Skin tags might be a useful clinical sign that could alert clinicians to screen such individuals for abnormal lipids, type 2 diabetes mellitus, and cardiovascular disease.     

Breast arterial calcifications (BACs) found on screening mammography and their association with cardiovascular disease

OBJECTIVE: Breast arterial calcifications (BACs) are common but unreported findings on screening mammograms. This study correlated mammographically detected BACs with coronary artery disease (CAD) risk factors and a history of atherosclerotic cardiovascular disease (ASCVD), estimating the relative risk of ASCVD in patients with BACs. DESIGN: Women arriving for breast cancer screening mammography gave their consent to complete a questionnaire and to allow their mammograms to be analyzed independently for the presence of BACs by certified radiologists, who were blinded to the results of the questionnaire. The questionnaire assessed major risk factors for CAD and gathered information on hormone therapy use. RESULTS: Of the 1,919 women with results, 268 were BAC positive, giving a BAC prevalence of 14%. Five cardiovascular risk factors (age, hypertension, hypercholesteremia, diabetes mellitus, and menopause) were significantly more prevalent in the BAC-positive population (P < 0.001). The BAC-positive group also had a significantly higher (P < 0.001) occurrence of ASCVD events (angina, previous myocardial infarction, previous abnormal angiography, previous stroke, and previous coronary artery bypass graft). Multiple logistic regression analysis found BACs to be strongly associated with ASCVD events (odds ratio = 2.29, 95% CI: 1.40-3.74) as compared with other CAD risk factors (including hypertension, cigarette smoking, diabetes mellitus, age, and family history of ASCVD). The association of BAC with ASCVD was present even after accounting for age. CONCLUSIONS: BACs are associated with an increased prevalence of both cardiovascular risk factors and cardiovascular morbidity. BACs may be a practical tool to use as a risk indicator for CAD in women.     

Risk factors for diabetes,but not for cardiovascular disease,are associated with family history of Type 2 diabetes in subjects from central Mexico

Background: Independent of obesity, family history of type 2 diabetes mellitus (FHT2DM) is another important risk factor for developing diabetes.

Aim: To establish the association among FHT2DM, risk factors for diabetes and cardiovascular disease in subjects from central Mexico.

Subjects and methods: Clinical and biochemical studies were performed in 383 first-degree relatives of patients with type 2 diabetes and 270 subjects unrelated to patients with type 2 diabetes—all subjects were from the city of Puebla in central Mexico. Logistic regressions were used to assess the association between FHT2DM and metabolic parameters. Cardiovascular risk was classified by dyslipidemia and the Framingham Risk Score (FRS).

Results: FHT2DM was associated with risk factors for diabetes, such as increased fasting insulin levels (OR = 1.731, 95% CI = 1.041–2.877), decreased insulin sensitivity (OR = 1.951, 95% CI = 1.236–3.080) and pre-diabetes (OR = 1.63, 95% CI = 1.14–2.33). FHT2DH was not associated with risk factors for cardiovascular disease, such as dyslipidemia (OR = 1.12, 95% CI = 0.70–1.79) and FRS (OR = 0.74, 95% CI = 0.40–1.36) when adjusted for gender, age, smoking and obesity.

Conclusion: Diabetic risk factors, but not cardiovascular disease risk factors, are associated with a positive family history of diabetes in subjects from central Mexico, independent of the presence of obesity.     

Profile of Cardiovascular Risk Factors and Mortality in Patients with Symptomatic Peripheral Arterial Disease

INTRODUCTION:

The present study examines cardiovascular risk factor profiles and 24-month mortality in patients with symptomatic peripheral arterial disease.

DESIGN STUDY:

Prospective observational study including 75 consecutive patients with PAD (67 ± 9.7 years of age; 52 men and 23 women) hospitalized for planned peripheral vascular reconstruction. Doppler echocardiograms were performed before surgery in 54 cases. Univariate analyses were performed using Student’s t-test or Fisher’s exact test. Survival analysis at 24-month follow-up was performed using the Cox regression model and Kaplan-Meier method including age and chronic use of aspirin as covariates. Survival curves were compared using the log-rank test.

RESULTS:

Hypertension and smoking were the most frequent risk factors (52 cases and 51 cases, respectively), followed by diabetes (32 cases). Undertreated dyslipidemia was found in 26 cases. Fasting glycine levels (131 ± 69.1 mg/dl) were elevated in 29 cases. Myocardial hypertrophy was found in 18 out of 54 patients. Thirty-four patients had been treated with aspirin. Overall mortality over 24 months was 24% and was associated with age (HR: 0.064; CI₉₅: 0.014–0.115; p=0.013) and lack of use of aspirin, as no deaths occurred among those using this drug (p<0.001). No association was found between cardiovascular death (11 cases) and the other risk factors.

CONCLUSION:

There is a high prevalence of uncontrolled (treated or untreated) cardiovascular risk factors in patients undergoing planned peripheral vascular reconstruction, and chronic use of aspirin is associated with reduced all-cause mortality in these patients.     

Prevalence of Cardiac Diastolic Dysfunction in HIV-Infected Patients: Results of the HIV-HEART Study

Abstract

Purpose: Antiretroviral therapy has improved the prognosis for many individuals with HIV infection. Consequently, HIV infection has become a chronic and manageable disease with increased risk of cardiovascular disease. Isolated diastolic dysfunction (DD) may be the first indication of underlying cardiac disease and an early marker of coronary artery disease. Our aim was to assess the prevalence of DD in HIV-infected patients. Methods: In this cross-sectional cohort study, 698 unselected patients were included. All subjects underwent two-dimensional transthoracic echocardiography with tissue Doppler imaging. Results: The prevalence of DD among the HIV-infected patients was 48%. Patients with DD were characterized by older age, higher body mass index, higher total cholesterol, arterial hypertension, and diabetes mellitus. Diabetes mellitus and arterial hypertension were associated with approximately four times the risk for DD (odds ratio [OR] 3.9, 95% CI 1.65–9.17; OR 3.8, 95% CI 2.49–5.71, respectively). Persons with hyperlipidemia were approximately one and a half times more likely to have DD than those without hyperlipidemia (OR 1.5, 95% CI 1.12–2.07). Conclusions: In our study, an impressive high prevalence of DD in HIV-infected patients was demonstrated. Traditional cardiovascular risk factors substantially contributed to the development of DD in the HIV-infected cohort.     

Prevalence and severity of atherosclerosis in different arterial territories and its relation with obesity

BackgroundThere is uneven association between obesity, traditional risk factors, and cardiovascular events. We aimed to analyze the relation between cardiovascular risk factors, including obesity, with the severity of atherosclerosis in different arterial territories.MethodsArteries from five territories (circle of Willis, carotids, coronaries, aorta, and renal) were taken from 185 persons, newborn to 90 years undergoing autopsy in the Forensic Medical Service in Mexico City, to determine atherosclerotic lesions by histopathological study. Lesions were classified according to the American Heart Association grading system as early (types I–III) and advanced (types IV–VI). The degree of atherosclerosis was correlated with arterial territories and risk factors.ResultsFrequencies of advanced lesions according to arterial territories were as follows: circle of Willis, 28%; right carotid, 36%; left carotid, 25%; right coronary, 71%; left coronary, 85%; right renal, 26%; left renal, 29%; and aorta, 52%; P=.0001, for all analyses. There was a higher risk for advanced lesions with increasing body mass index (BMI) (P=.004). However, after adjusting for age, gender, smoking status, hypertension, and diabetes mellitus, BMI was not independently associated with advanced lesions.ConclusionsCoronary arteries are significantly more affected than other arterial territories regardless of risk factors, showing the effect of local and systemic factors in the severity of atherosclerosis. We did not find an independent association between advanced atherosclerotic lesions and obesity.     

Association between ear creases and peripheral arterial disease

INTRODUCTION:

Peripheral arterial disease is a severe manifestation of atherosclerosis that can lead to critical ischemia of the lower limbs and is also associated with high cardiovascular risk. Diagonal lobular and anterior tragal ear creases have been associated with coronary artery disease, but they have not yet been investigated in patients with peripheral arterial disease.

OBJECTIVES:

To evaluate the prevalence of ear creases among patients with peripheral arterial disease of the lower limbs, compared with patients without documented atherosclerotic disease.

METHODS:

Cross‐sectional study including 60 male patients with peripheral arterial disease of the lower limbs and 60 dermatologic outpatients matched for age and gender. The associations were adjusted for other risk factors by conditional logistic regression.

RESULTS:

The prevalence of diagonal and anterior tragal ear creases was higher among cases (73% vs. 25% and 80% vs. 43%, respectively) than controls; these associations remained significant even when adjusting for other known risk factors of atherosclerosis (odds ratio  =  8.1 and 4.1, respectively).

CONCLUSIONS:

Ear creases are independently associated with peripheral arterial disease and may be an external marker for risk identification.     

Multimorbidity and risk among patients with established cardiovascular disease: a cohort study

BACKGROUND: Most patients managed in primary care have more than one condition. Multimorbidity presents challenges for the patient and the clinician, not only in terms of the process of care, but also in terms of management and risk assessment. AIM: To examine the effect of the presence of chronic kidney disease and diabetes on mortality and morbidity among patients with established cardiovascular disease. DESIGN OF STUDY: Retrospective cohort study. SETTING: Random selection of 35 general practices in the west of Ireland. METHOD: A practice-based sample of 1609 patients with established cardiovascular disease was generated in 2000-2001 and followed for 5 years. The primary endpoint was death from any cause and the secondary endpoint was a cardiovascular composite endpoint that included death from a cardiovascular cause or any of the following cardiovascular events: myocardial infarction, heart failure, peripheral vascular disease, or stroke. RESULTS: Risk of death from any cause was significantly increased in patients with increased multimorbidity (P<0.001), as was the risk of the cardiovascular composite endpoint (P<0.001). Patients with cardiovascular disease and diabetes had a similar survival pattern to those with cardiovascular disease and chronic kidney disease, but experienced more cardiovascular events. CONCLUSION: Level of multimorbidity is an independent predictor of prognosis among patients with established cardiovascular disease. In such patients, the presence of chronic kidney disease carries a similar mortality risk to diabetes. Multimorbidity may be a useful factor in prioritising management of patients in the community with significant cardiovascular risk.     

Coronary heart disease and upper airway obstruction

SUMMARY  Coronary heart disease (CHD) is a leading cause of death among middle-aged men. In the same age group the spectrum of upper airway obstruction from habitual snoring to obstructive sleep apnoea syndrome (OSAS) is frequent. In several studies snoring was found to be an important risk factor for ischaemic heart disease. The prevalence of OSAS in patients with CHD, profile of risk factors and ventricular arrhythmias was determined in a prospective manner in 78 patients with stenosis of one or more coronary arteries at coronary arterography. OSAS was found in 27 patients (34.6%). Mean respiratory disturbance index (RDI) was 23.9. RDI increased with higher age. No significant differences in both groups could be found in ventricular arrhythmias, left ventricular ejection fraction and risk factors, except hyperuricaemia and adiposity. OSAS is frequent in patients with CHD and may be an additional risk factor besides the known coronary risk factors. Patients with the combination of CHD and OSAS have to be regarded as a group at particular risk because of several interactions between OSAS and coronary haemodynamics. Furthermore the microstructure of sleep in patients with nocturnal myocardial ischaemia is disturbed.     

Cardiovascular risk factors and disease in general practice: results of the Nijmegen Cohort Study.

The relationship between risk factors and cardiovascular disease (CVD) was determined using data from the Nijmegen Cohort study, an 18-year prospective study. In 1977, cardiovascular risk factors were measured in 7092 Caucasian males and females from six general practices: age, smoking, serum cholesterol, blood pressure, body mass index and a family history of CVD were related to subsequent CVD mortality and morbidity. Most patients had more than one risk factor in particular among men. A significant relationship between risk factors and CVD was demonstrated. In men, a relative risk (RR) of 1.8 was found for both high blood pressure and smokers. A positive family history yielded a RR of 1.8. The risk increased gradually with the number of risk factors; 38% of the group with all risk factors suffered a CVD within 18 years. In women, comparable RRs were found but the low absolute risk of CVD should indicate against the treatment of cardiovascular risk factors.     

The relationship between sleep-disordered breathing and high-sensitivity C-reactive protein in Japanese men

STUDY OBJECTIVES: Elevated C-reactive protein (CRP), an inflammatory marker and emerging risk factor for atherosclerosis and coronary heart disease, has been reported in overweight patients with sleep-disordered breathing (SDB). However, the contribution of C-reactive protein to this disease among non-overweight individuals is uncertain. We thus examined the relationship between serum C-reactive protein levels and nocturnal arterial oxygen desaturation, stratified by category of body mass index (BMI). DESIGN: Cross-sectional study. PARTICIPANTS: Subjects were 316 men with a mean BMI of 25.4 kg/m2, aged 20-79 years, who attended a sleep clinic at Osaka, Japan. MEASUREMENTS AND RESULTS: SDB was assessed by oxygen desaturation index (ODI) measured by pulse oximetry during sleep. We used 3% oxygen desaturations per hour (3% ODI), as the indicator of SDB. We also measured serum levels of C-reactive protein (CRP). After adjustment for age, BMI, hypertension, diabetes mellitus, hypercholesterolemia, smoking status, alcohol consumption, and daily sleep duration, mean high-sensitivity CRP levels were 0.63, 0.65, and 0.96 mg/L for SDB severity levels of 3%ODI<5, 5 to 19.9, and >=20, respectively (p for trend=0.015). This association with SDB tended to be stronger in non-overweight men (BMI<25 kg/m2) (0.47, 0.48 and 1.02 mg/L, p for trend=0.017) than in overweight men (BMI > or = 25 kg/m2) (0.92, 0.87 and 1.21 mg/L, p for trend=0.11). CONCLUSION: SDB is associated with increased levels of CRP, especially in non-overweight men. Our results suggest the importance of follow-up and control of SDB in the prevention of cardiovascular disease even in non-overweight SDB patients.