Chronic bronchitis in the general population: influence of age, gender and socio-economic conditions

Chronic bronchitis (CB) is an indicator of an increased risk of developing COPD, but its symptoms are often underestimated. Demographic and socio-economic conditions might influence its prevalence, reporting and impact. Data from a large epidemiological survey of the French general population were analyzed to determine the burden of CB, the magnitude of under-diagnosis and the influence of age, gender and socio-economic conditions. Altogether, 9050 participants aged 45 years or more provided complete data. The prevalence of symptoms and diagnosis of CB was 3.5% and 3.4%, respectively. CB was associated with impaired health status and activity and, in women, work loss. Among subjects with symptoms of CB, only 28.6% declared a known diagnosis of respiratory disease. Factors associated with symptoms of CB in multivariate analysis were male gender, active smoking, lower income and occupational category: the highest prevalence was observed in manual workers (5.6%) and self-employed subjects (5.2%). The under-diagnosis of CB was more marked in men and subjects of higher socio-economic categories. These results confirm that CB is markedly under-diagnosed in the general population. Socio-economic conditions influence both its prevalence (higher in low categories) and rate of diagnosis (lower in high categories), which should be considered when elaborating prevention and detection campaigns.     

Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods

Objective: Childhood obesity is associated with an increased risk for insulin resistance. The underlying mechanism for the physiological increase in insulin levels in puberty is not clearly understood. The aim of the present study was to determine the cut−off values for homeostasis model assessment for insulin resistance (HOMA−IR) in obese children and adolescents according to gender and pubertal status.Methods: Two hundred and eight obese children and adolescents (141 girls, 127 boys) aged between 5 and 18 years were included in the study. The children were divided into prepubertal and pubertal groups. A standard oral glucose tolerance test (OGTT) was carried out in all children. A total insulin level exceeding 300 μU/mL in the blood samples, collected during the test period, was taken as the insulin resistance criterion. Cut−off values for HOMA−IR were calculated by receiver operating characteristic (ROC) analysis.Results: In the prepubertal period, the rate of insulin resistance was found to be 37% in boys and 27.8% in girls,while in the pubertal period, this rate was 61.7% in boys and 66.7% in girls. HOMA−IR cut−off values for insulin resistance in the prepubertal period were calculated to be 2.67 (sensitivity 88.2%, specificity 65.5%) in boys and 2.22 (sensitivity 100%, specificity 42.3%) in girls, and in the pubertal period, they were 5.22 (sensitivity 56%, specificity 93.3%) in boys and 3.82 (sensitivity 77.1%, specificity 71.4%) in girls.Conclusions: Since gender, obesity and pubertal status are factors affecting insulin resistance, cut−off values which depend on gender and pubertal status, should be used in evaluation of insulin resistance.Conflict of interest:None declared.     

Plasma aldosterone levels and development of insulin resistance: prospective study in a general population

Aldosterone plays a role in hypertension, and hypertension is prevalent in patients with insulin resistance. Cross-sectional studies have reported that plasma aldosterone levels are higher in patients with insulin resistance. However, it is not known whether plasma aldosterone levels predict the development of insulin resistance. Subjects of the present study were 1235 local residents (490 men and 745 women) who participated in health screenings in Japan in 1999. Plasma aldosterone levels were measured by radioimmunoassay. We investigated the cross-sectional relationship between plasma aldosterone levels and insulin resistance (homeostasis model assessment index ≥1.73 according to the diagnostic criteria used in Japan) in 1088 nondiabetic participants. At the 10-year follow-up, 141 subjects had died, and 260 subjects refused re-examination. We performed a prospective analysis of 564 subjects to predict incident insulin resistance. We found a significant (P<0.001) cross-sectional relationship between plasma aldosterone and homeostasis model assessment index at baseline. In the prospective analysis, a significantly higher (P<0.05) relative risk (1.71 [95% CI: 1.03-2.84]) was observed in the highest tertile versus lowest tertile of plasma aldosterone for the development of insulin resistance, after adjustment for confounding factors. This 10-year prospective study demonstrated that plasma aldosterone levels predicted the development of insulin resistance in a general population.     

Circulating levels of heart-type fatty acid-binding protein in a general Japanese population: effects of age, gender, and physiologic characteristics.

BACKGROUND: Serum heart-type fatty acid-binding protein (H-FABP) has been widely used as a marker of cardiac myocyte injury. This study was carried out to examine the relationships of H-FABP levels with age, gender, and other physiologic characteristics in a large population of community-dwelling residents. METHODS AND RESULTS: Serum H-FABP levels were measured in 2,099 subjects who received an annual health check-up (age 40-87 years). The relationships between H-FABP and blood pressure, laboratory data, electrocardiogram (ECG) findings, and lifestyle factors were cross-sectionally analyzed. Mean H-FABP values were significantly higher in men than in women. Serum H-FABP levels were increased with aging significantly. Both the multivariate regression and multiple logistic regression analyses indicated that serum H-FABP levels were independently affected by age, body mass index, creatinine clearance, and ECG abnormality score. CONCLUSION: Serum H-FABP levels were affected by age, gender, obesity, renal function, and ECG abnormality in a large group of volunteers. These effects should be taken into account in determining appropriate reference values for H-FABP. In addition, high serum H-FABP levels may represent latent cardiac injury and have important clinical implications.     

南宁市健康体检老年人胆石症患病情况调查及其与性别和年龄关系的分析

目的调查南宁市健康体检老年人胆石症患病情况及其与性别、年龄的关系,为临床诊治策略的制定提供依据。方法统计2011年全年在广西壮族自治区人民医院健康体检中心进行健康体检的本市60岁及以上老年人2 257名（男1 294名,女963名）的胆石症患病率,按年龄分为三组：A组60~69岁,B组70~79岁,C组≥80岁,采用SPSS for windows 17.0统计学软件对数据进行分析。结果 （1）该组老年人群中胆石症总的患病率为12.5%,除肝内胆管结石和胆总管结石各1例外,其余全部为胆囊结石。（2）男性和女性胆石症患病率分别为8.2%和18.2%,女性胆石症患病率显著高于男性,差异有统计学意义（P〈0.01）。女性各年龄组胆石症患病率均高于同年龄组男性,差异有统计学意义（P〈0.01）;女性各年龄组间胆石症患病率比较差异有统计学意义（P〈0.05）,女性胆石症患病率随年龄增长而升高,80~93岁组患病率最高。男性各年龄组间胆石症患病率差异无统计学意义（P〉0.05）。结论南宁市健康体检老年人胆石症以胆囊结石为主,胆管结石所占比例小。女性老年人胆石症患病率显著高于男性,女性老年人胆石症患病率随年龄增长而升高。     

Age and gender trends in implantable cardioverter defibrillator utilization: A population based study

INTRODUCTION: Implantable cardioverter-defibrillators improve mortality in selected high risk patients, yet population based data regarding utilization of these devices, particularly in the elderly, are limited. METHODS: To address this, we reviewed all ICD implantations performed in Olmsted County, MN, a geographically defined population, between December 1989 and December 2004. RESULTS: The study population comprised 179 patients (147 male, 82%, mean age 65 +/- 14 years). Baseline ejection fraction and creatinine were 35% +/- 16% and 1.38 +/- 1.08 mg/dl, respectively. Over the study period, the incidence of congestive heart failure in patients undergoing ICD implantation and referrals for primary prevention ICDs increased, while baseline ejection fraction and etiology of cardiomyopathy remained unchanged. The incidence of ICD implantations increased significantly in the elderly (p < 0.001) and especially in male patients when compared to female patients (p < 0.001). CONCLUSIONS: Age of patients undergoing ICD implantation is increasing. However, fewer females compared to males are undergoing ICD implantation, suggesting a gender bias in ICD therapy and utilization.     

Insulin-like growth factor I levels during growth hormone (GH) replacement in GH-deficient adults: a gender difference

To evaluate the variation of serum IGF-1 levels during GH replacement and observe gender differences, 29 adults with GH deficiency (mean age 42.5 ± 10.1 year), were studied. Serum IGF-1 was assessed every 4 weeks during the titration period and afterwards every 3 months of GH therapy. At baseline 77.7% of women and 45.4% of men had serum baseline IGF-1 levels below the lower limit of normal age-related reference range. The time to reach the maintenance dose was lower in men than women (p < 0.05). There was an increase in IGF-1 levels after one year of GH therapy, significant only in men (p < 0.01). IGF-1 concentrations were higher in men than women (p < 0.05), at the 12th and 18th months of GH therapy. GH dose was reduced by 25% in men (p < 0.01). At the end of the study the mean GH dose was lower in men than in women (p < 0.05). The factor responsible for these findings is not known, however a possible role of androgens has been suggested.     

Sex and age differences in fragility in a heart failure population

BACKGROUND: Heart failure (HF) patients have a high degree of fragility and dependence from physical, cognitive and psychological points of view, and are a mainly geriatric population. AIM: To detect the existence of fragility in all patients treated in a Heart Failure Unit and to evaluate age and sex differences. METHODS: All patients underwent a basic geriatric evaluation to detect possible loss of autonomy for doing basic and instrumental activities, cognitive deterioration, emotional disturbance or social risk. RESULTS: Three hundred sixty patients (mean age 65.2 years, 41.7% > or = 70 years, 27.5% women) were evaluated. Fragility was detected in 41.7% of patients, being more prevalent in patients > or = 70 years (p<0.001) and in women (p<0.001). A Barthel Index < 90 was found in 22.5% of patients and an anomalous OARS Scale was found in 18.3%. Pfeiffer test's score was abnormal in 7.8% of patients. A positive depression response in abbreviate GDS was observed in 29.7%. All items analysed were more prevalent in patients > or = 70 years and in women, with the unexpected exception of depression symptoms that were as prevalent in younger as in older patients. CONCLUSION: Fragility is common in patients with heart failure, even in younger patients, and can be detected easily using standardised geriatric scales. Prevalence of fragility was significantly higher in older patients and in women, although the presence of depression symptoms was as prevalent in younger as in older patients.     

Biochemical correlates of lipoprotein(a) in a general adult population. Possible implications for cardiovascular risk assessment

Background Evidence has been provided that lipoprotein(a) (Lp(a)) may be an important cardiovascular risk factor. Recognition of potential Lp(a) variability associated with common diseases, such as diabetes, chronic renal dysfunction, impaired liver function and acute/chronic inflammation, is important to optimize the clinical usefulness of this measurement. Methods We performed a retrospective analysis on our Laboratory Information System to retrieve results of fasting plasma glucose (FPG), creatinine, albumin, high sensitivity-C reactive protein (Hs-CRP) and Lp(a) tests, which were performed on all outpatients referred by general practitioners for routine blood testing during the last 5 years. Results Cumulative results for all of the above parameters were retrieved for 1,195 adults. After stratifying Lp(a) results according to the respective threshold values of albumin, estimated glomerular filtration rate (e-GFR), FPG and Hs-CRP, a significant difference was observed only among subjects with increased Hs-CRP levels (170 mg/l vs. 125 mg/l; P < 0.001). The frequency of Lp(a) values ≥300 mg/l was greater in those with increased Hs-CRP levels (36 vs. 26%; P = 0.037)—but not in those with abnormal values of albumin, e-GFR or FPG—compared with their counterparts with normal values of these parameters. In multiple regression analysis, age (r = 0.112; P < 0.001), Hs-CRP (r = 0.102; P = 0.001) and e-GFR (r = 0.106; P = 0.003) were independent predictors of Lp(a). Conclusions The evaluation of laboratory markers of glucose homeostasis and liver function seems unnecessary when measuring Lp(a) for cardiovascular risk assessment. Conversely, Hs-CRP and probably GFR might be of clinical value to identify individuals whose serum Lp(a) levels can be transiently or chronically increased.     

Microalbuminuria and arterial stiffness in a general population: the Shimanami Health Promoting Program (J-SHIPP) study.

Microalbuminuria is an early marker of renal damage and has been shown to predict future cardiovascular mortality and morbidity in patients with diabetes or hypertension, as well as in subjects in the general population. In this study, we investigated the hypothesis that the presence of microalbuminuria reflects the advancement of arterial stiffness by using a study group of 136 community residents who had no cardiovascular diseases except for hypertension and who were not taking any medications. Urinary albumin concentration was determined by the standard method and corrected by creatinine. Microalbuminuria was defined as a urinary albumin/creatinine ratio of 2.0-30.0 mg/mmol creatinine. Arterial stiffness was evaluated by pulse wave velocity (PWV) determined at three points: from the heart to the carotid artery, to the brachial artery, and to the ankle. Carotid arterial pressure was determined using a tonometric sensor. Carotid ultrasonography was performed to measure carotid intima-media thickness (IMT) and carotid arterial internal dimension. Subjects with microalbuminuria had higher blood pressure and wider pulse pressure not only in the brachial artery but also in the carotid artery. Microalbuminuria was associated with significantly higher PWV compared with that of normoalbuminuric subjects at all sites studied (mean PWV: 821.2+/-137.4 cm/s vs. 933.8+/-137.5 cm/s, p<0.0001). Stepwise regression analysis revealed that the presence of mircroalbuminuria (p=0.047) was a significant independent predictor of PWV in addition to age, sex, and systolic blood pressure. These findings suggest that microalbuminuria is associated with advanced atherosclerosis in the general population. Underlying arterial stiffness may explain the high cardiovascular mortality in subjects with microalbuminuria. Hypertension may be the mechanism linking microalbuminuria and arterial stiffness in the general population.     

Frequency of a low ankle brachial index in the general population by age, sex and deprivation: cross-sectional survey of 28,980 men and women.

OBJECTIVES: An increasing interest is observed in the use of the ankle brachial index (ABI, ratio of systolic blood pressure at the ankle to that in the arm) to assess cardiovascular risk. The aim of this study was to provide information on the distribution of ABI in a large healthy population, essential for planning implementation of ABI measurement in preventive strategies in the general population. STUDY DESIGN AND SETTING: Cross-sectional survey of the ABI was conducted in 28,980 men and women aged over 50 years, living in central Scotland and free of clinical cardiovascular disease. RESULTS: The ABI was approximately normally distributed in both men (mean 1.06, SD 0.13) and women (mean 1.01, SD 0.11). A total of 10.9% of participants had an ABI相似文献   

Reference values of right ventricular end-diastolic area defined by ethnicity and gender in a young adult population: the CARDIA study

Background: Despite increasing availability of three‐dimensional imaging modalities for estimating right ventricular (RV) size, linear and two‐dimensional measures of RV size are the most universally accessible clinical methods. Right ventricular end‐diastolic area (RVED area) is known to identify pulmonary pathologies and have prognostic value for cardiovascular mortality in various disease states. To date, there is a paucity of adequately powered studies to define gender‐ and ethnicity‐related differences in normal RVED area. Therefore, we derived gender‐based normative values for echocardiographic measurements of RVED area, in a large bi‐racial cohort of young adults. Methods: Healthy young adults participants (n = 2088) in the Coronary Artery Risk Development in Young Adults (CARDIA) study, aged 23–35 years, at the time of echocardiogram, were evaluated. RVED area was stratified according to gender and race. The contributions of clinical, allometric and left heart morphology and function to the variability in RVED area were determined. Results: RVED area in males was significantly larger than in females of similar age, but whites had similar values compared to same‐gender blacks. RVED area for men and women of >24.7 cm² and 20.7cm², or RVED area indexed to BSA (cm²/m²) of >12.6 and >11.7, respectively, are at the 97.5th percentile of normal values. RVED area correlated significantly with left ventricular volume and left atrial size. Lung capacity measured as FVC showed significant body size adjusted correlation with RVED area only in black males. Conclusions: This study provides normative values for echocardiographically defined RV end‐diastolic area, and highlights the necessity to use gender‐specific normative values. (Echocardiography 2011;28:142‐149)     

Serum lipopotein (a) levels in a large sample of subjects affected by familial combined hyperlipoproteinaemia and in general population

BACKGROUND: Serum lipoprotein (a) [Lp(a)] is a lipidic parameter, strictly under genetic control. Lp(a) levels vary in different dyslipidaemias according to the underlying disease. DESIGN: The aim of this study was to evaluate and compare serum Lp(a) mean levels distribution in a large familial combined hyperlipoproteinaemia (FCH) patients sample with a normolipidaemic group. METHODS: FCH group included 138 subjects (74 males and 65 females) aged from 16 to 88 years; the control group included 438 normolipidaemic subjects (238 males and 200 females) aged from 16 to 91 years. In both groups we have measured Lp(a) concentrations and other lipidic parameters. RESULTS: Serum lipid levels as well as Lp(a) log-transformed concentrations were on average higher in FCH patients than in control subjects. Lp(a) concentrations were not significantly different between sexes and among 20-year age classes in both groups. CONCLUSIONS: The relationship between FCH and Lp(a) remains controversial. However, since both are considered independent risk factors for premature CHD development, even if their pathogenic interaction is still unclear, we suggest that Lp(a) values should be carefully monitored in dyslipidaemic subjects and particularly in FCH ones. In FCH subjects with elevated Lp(a) levels, aggressive intervention could be required.     

Prevalence of prothrombin gene mutation (G-A 20210 A) in general population: a pilot study.

The objective of this study was to determine the prevalence of prothrombin gene mutation in a sample population from Pakistan. Two hundred apparently healthy unrelated adults (older than 18 years) were included in the study. The sample population comprised 100 Punjabis (male 50, female 50) and 100 Pathans (male 50, female 50). Patients with a history of previous thromboembolism were excluded from the study. Five milliliters (5 mL) of whole blood was drawn in an EDTA bottle. The DNA was extracted by the standard phenol-chloroform method. The DNA was amplified between exon number 14 and the 3'-untranslated region of the prothrombin gene by a polymerase chain reaction in a thermal cycler. Amplified products were digested overnight with HindIII at 37 degrees C. The digested products were electrophoresed on 6% polyacrylamide gel. The fragments were visualized by silver nitrate staining. A heterozygous wild type and an uncut amplified product were included in the electrophoresis strip for quality control. The wild type of DNA ran as a 350-bp fragment and internal control was cut as 550- and 150-bp fragments. The abnormal prothrombin gene was cut into 350-, 322-, and 28-bp fragments. Only two cases of heterozygous prothrombin gene mutation G-A 20210A were found in the sample studied, giving an overall carrier rate of 01% (95% CI 0.4-2.4%) in the target population. Prothrombin gene mutation is present in our population but at a lower frequency than in the white population.     

Serum complement (C3 and C4) levels in the Malaysian adult population.

Serum C3 and C4 values were determined in 236 normal adults of three racial groups, using the single radial immunodiffusion techniques. The C3 levels varied from 47 to 119 mg/dl and C4 levels from 16 to 66 ml/dl (mean +/- 2SD). The values were found to be comparable to the normals reported in some Western series. No significant differences in the levels related to sex and race were found.     

The gender difference of snore distribution and increased tendency to snore in women with menopausal syndrome: a general population study

Purpose

Sleep-disordered breathing (SDB) is a prevalent disorder with a major impact in women, especially postmenopausal women. However, few studies have investigated the prevalence of a specific SDB, snoring, among women especially those with menopausal syndrome.

Methods

Computer-assisted telephone interviews were conducted in Taiwan. Adults over 20 years of age were interviewed. The number of successful interviews was calculated based on the population prior to the study. Demographic data and information about snoring, menopausal syndrome, and medical conditions were obtained.

Results

In total, 3624 adults, 1473 males and 2151 females, completed the interviews. Both men and women shows an increase in snoring until age 50 to 59 years, followed by a decline in snoring that is less steep among women. The prevalence of snoring increased significantly in females after age 50 years, which is the mean menopausal age in our country (p < 0.05). After adjusting for age, body mass index, and other major diseases, the percentage of women with snoring was significantly higher among those with menopausal syndrome than those without menopausal syndrome (p = 0.021, odds ratio = 1.629).

Conclusions

This population-based study revealed different snoring percentages among men and women and diminishing differences in the older population. Additionally, the percentage of women with snoring was increased among those women who were older than 50 years and those with menopausal syndrome.