41-month follow-up of risk factors correlated with new coronary events in 708 elderly patients

A prospective study correlated coronary risk factors with new coronary events in 192 elderly men and 516 elderly women, mean age 82 +/- 8 years. Follow-up was 41 +/- 6 months (range 24-44). Coronary events (myocardial infarction, primary ventricular fibrillation, and sudden cardiac death) occurred in 64 of 192 men (33%) and in 149 of 516 women (29%), P not significant. Using univariate analysis, significant risk factors for coronary events were antecedent coronary artery disease, cigarette smoking, hypertension, diabetes mellitus, serum total cholesterol (TC) greater than or equal to 200 mg/dL and greater than or equal to 250 mg/dL, serum high-density lipoprotein cholesterol (HDL-C) less than 35 mg/dL, and serum TC/HDL-C greater than or equal to 6.5 in men and women, and obesity in women. Using multivariate analysis, significant risk factors for coronary events were age, antecedent coronary artery disease, cigarette smoking, hypertension, diabetes mellitus, and serum TC in men and women and serum HDL-C and serum triglycerides in women. Using univariate analysis, significant risk factors for coronary events in men and women with antecedent coronary artery disease were cigarette smoking, diabetes mellitus, serum TC greater than or equal to 250 mg/dL, and serum TC/HDL-C greater than or equal to 6.5. Using multivariate analysis, significant risk factors for coronary events in men and women with antecedent coronary artery disease were age, cigarette smoking, diabetes mellitus, serum TC, serum HDL-C, and serum triglycerides.(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum lipids and lipoproteins are correlated to skin vessel reactivity in healthy women

Objectives. To investigate whether serum lipids and lipoproteins are correlated to the results of skin vessel reactivity tests.
Design. Healthy, non-smoking individuals of various ages without atopic constitution and medication were selected for the study.
Setting. Subjects blood sampled and examined with iontophoresis and a newly developed laser Doppler perfusion imager at Huddinge University Hospital.
Subjects. Thirteen men, 20–80 years of age, and 21 women, 18–76 years of age, who fulfilled the inclusion criteria.
Main outcome measures. Normalized perfusion values (%) after iontophoresis of acetylcholine (ACh), nitroprusside and isoprenaline. Fasting concentrations of total cholesterol, high-density lipoprotein cholesterol and triglyceride values.
Results. Skin vessel reactivity tests to ACh and isoprenaline, and to a lesser extent, nitroprusside were positively correlated to high-density lipoprotein cholesterol (HDL-C) levels ( P =0.014, 0.005 and 0.113, respectively), and negatively correlated to both the ratio of total cholesterol/HDL-C ( P =0.029, 0.011, 0.005) and the level of triglycerides ( P = 0.045, 0.011, 0.005) in young and middle-aged women. There was also a negative correlation between isoprenaline and triglycerides ( P =0.042) in elderly women. No correlations between serum lipids and lipoproteins and skin vessel reactivity were found in men.
Conclusions. The results of the study suggest that serum lipids and lipoproteins, primarily HDL-C, influence skin vessel reactivity in healthy women. Furthermore, HDL-C seems to influence the function of the vascular smooth muscle as well as the endothelium.     

High-density lipoprotein cholesterol and objective measures of lower extremity performance in older nondisabled persons: the InChianti study

OBJECTIVES: To evaluate the independent association between high-density lipoprotein cholesterol (HDL-C) levels and objective measures of lower extremity performance.
DESIGN: Cross-sectional cohort study.
SETTING: Community-based.
PARTICIPANTS: Eight hundred thirty-six nondisabled women and men aged 65 and older enrolled in the Invecchiare in Chianti study.
MESASUREMENTS: Lower extremity performance was assessed using 4-m walking speed at fast pace, 400-m walking speed, and knee extension torque. Fasting HDL-C levels were determined using commercial enzymatic tests.
RESULTS: The mean age of participants was 73.7 (65–92), and 55.6% were women. After adjusting for potential confounders (sociodemographic factors, smoking, physical activity, body composition, and clinical conditions including cardiovascular and cerebrovascular disease, inflammatory markers, and serum testosterone) HDL-C levels were significantly associated with knee extension torque in men and women and with 4-m and 400-m walking speed in men. Men in the highest tertile of the HDL-C distribution (>55 mg/dL) had, on average, a three times greater probability of belonging to the best tertile of all indexes of lower extremity performance, including 4-m fast walking speed (odds ratio (OR)=2.57, 95%=confidence interval (CI)=1.07–6.17), 400-m walking speed (OR=3.74, 95% CI=1.20–11.7), and knee extension torque (OR=3.63, 95%=CI 1.41–9.33). Path analysis suggested a direct relationship between HDL-C and knee extension torque.
CONCLUSION: In older nondisabled persons, HDL-C levels are highly correlated with knee extension torque and walking speed. Further research should focus on the biological mechanism of this association.     

Distribution of plasma levels of adiponectin and leptin in an adult Caucasian population

Objectives  Little is known regarding the distribution and the determinants of leptin and adiponectin levels in the general population.
Design  Cross-sectional study.
Patients  Women (3004) and men (2552) aged 35–74 living in Lausanne, Switzerland.
Measurements  Plasma levels of leptin and adiponectin (ELISA measurement).
Results  Women had higher leptin and adiponectin levels than men. In both genders, leptin and adiponectin levels increased with age. After adjusting for fat mass, leptin levels were significantly and negatively associated with age in women: 18·1 ± 0·3, 17·1 ± 0·3, 16·7 ± 0·3 and 15·5 ± 0·4 ng/ml (adjusted mean ± SE) for age groups [35–44], [45–54], [55–64] and [65–75], respectively, P  < 0·001. A similar but nonsignificant trend was also found in men. Conversely, the age-related increase of adiponectin was unrelated to body fat in both genders. Post-menopausal women had higher leptin and adiponectin levels than premenopausal women, independently of hormone replacement therapy. Although body fat mass was associated with leptin and adiponectin, the associations were stronger with body mass index (BMI), waist and hip in both genders. Finally, after adjusting for age and anthropometry, no relationships were found between leptin or adiponectin levels with alcohol, caffeine consumption and physical activity, whereas smoking and diabetes decreased leptin and adiponectin levels in women only.
Conclusions  The age-related increase in leptin levels is attributable to changes in fat mass in women and probably also in men. Leptin and adiponectin levels are more related to BMI than to body fat mass. The effects of smoking and diabetes appear to be gender-specific.     

Subjective well-being as a predictor of all-cause mortality among middle-aged and elderly people living in an urban Japanese community: A seven-year prospective cohort study

Background:   Research has reported a close relationship between subjective well-being and maintenance of physical and psychological health in later life. We explored an intergender difference in subjective well-being, correlates of subjective well-being, and a subjective well-being–mortality association among middle-aged and elderly people, using a prospective population-based study.
Methods:   The participants were 1034 men and 1413 women aged 52–77 years at the baseline, living in an urban Japanese community. The baseline data on age, number of years of education, hospitalization, chronic conditions, living alone and subjective well-being (measured by the 17-item Philadelphia Geriatric Center Morale Scale) collected in 1993.
Results:   Analysis of covariance controlling for potential confounders, revealed no intergender difference in subjective well-being. Multiple regression analysis to explore factors related to subjective well-being showed that age in men, and the number of years of education in both genders were significantly, independently and positively associated with subjective well-being, and that hospitalization, chronic conditions and living alone in both genders were significantly, independently and negatively related to subjective well-being. In the Cox's multivariate hazard model adjusted for the confounders, there was a significant and independent association between a low level of subjective well-being and the risk for all-cause mortality in men (1-standard-deviation decrement; risk ratio [RR] = 1.22, 95% confidence interval [CI]: 1.07–1.46) and women (RR = 1.50, 95% CI: 1.15–1.83).
Conclusion:   Subjective well-being is a reliable predictor for all-cause mortality among middle-aged and elderly people in both genders.     

Lower levels of serum albumin and total cholesterol associated with decline in activities of daily living and excess mortality in a 12-year cohort study of elderly Japanese

OBJECTIVES: To examine the association between levels of serum albumin and total cholesterol (TC) and risk of subsequent mortality and future decline in activities of daily living (ADLs) in elderly people.
DESIGN: Population-based cohort study.
SETTING: National Integrated Project for Prospective Observation of Non-Communicable Disease and Its Trends in the Aged, 1980.
PARTICIPANTS: One thousand eight hundred forty-four Japanese individuals aged 60 to 74 randomly selected throughout Japan and followed for 12.4 years.
MEASUREMENTS: Decline in ADLs and mortality.
RESULTS: After adjusting for other covariates, the multivariable odds ratios (ORs) of impaired ADLs were highest in the lowest albumin quartile (≤40 g/L) for women. The multivariable OR of having a composite outcome of death or impaired ADL for the lowest albumin quartile compared with the highest was 1.56 (95% confidence interval (CI)=1.94–2.57) for men and 3.06 (95% CI=1.89–4.95) for women. Serum albumin was significantly and inversely associated with a composite outcome of death or impaired ADLs in the group below the median of TC in both sexes (multivariable OR for 1-g/L increase in serum albumin=0.88 for men (95% CI=0.79–0.97) and 0.79 for women (95% CI=0.72–0.87)), which was not significantly associated in the group with TC at or above the median.
CONCLUSION: In the Japanese general population, low-normal serum albumin and TC levels are associated with loss of activity during old age, especially for women.     

Risk factors for symptomatic peripheral arterial disease in older persons in an academic hospital-based geriatrics practice

OBJECTIVE: To investigate risk factors for symptomatic peripheral arterial disease (PAD) in older persons. DESIGN: A retrospective analysis of charts from all older persons seen from January 1, 1998, through June 15, 1999, at an academic, hospital-based geriatrics practice. SETTING: An academic, hospital-based geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians. PATIENTS: A total of 467 men, mean age 80 +/- 8 years, and 1444 women, mean age 81 +/- 8 years, were included in the study. MEASUREMENTS AND MAIN RESULTS: Symptomatic PAD was present in 93 of 467 men (20%) and in 191 of 1444 women (13%) (P = .001). Significant risk factors for symptomatic PAD by univariate analysis were: age (P = .021 in women); cigarette smoking, hypertension, diabetes mellitus, serum total cholesterol, serum high-density lipoprotein (HDL) cholesterol (inverse association), and serum low-density lipoprotein (LDL) cholesterol (P < .001 in men and women); obesity (P = .013 in men and .002 in women); and serum triglycerides (P = .027 in women). Significant independent risk factors for symptomatic PAD by stepwise logistic regression analysis were: age (odds ratio = 1.052 in men and 1.025 in women); cigarette smoking (odds ratio = 2.552 in men and 4.634 in women); hypertension (odds ratio = 2.196 in men and 2.777 in women); diabetes mellitus (odds ratio = 6.054 in men and 3.594 in women); serum HDL cholesterol (odds ratio = .948 in men and .965 in women); and serum LDL cholesterol (odds ratio = 1.019 in men and women). CONCLUSIONS: Significant independent risk factors for symptomatic PAD in older men and women were age, cigarette smoking, hypertension, diabetes mellitus, serum HDL cholesterol (inverse association), and serum LDL cholesterol.     

High density lipoprotein-cholesterol levels increase with age in American women but not in Hong Kong Chinese women

Objectives  High-density lipoprotein (HDL) cholesterol is a powerful cardiovascular risk factor. Important gender and ethnic differences in plasma HDL levels exist and warrant investigation.
Design  Cross-sectional survey in two different general populations.
Patients  7700 participants of the National Health and Nutrition Examination Survey (NHANES) 1999–2002 and 1944 participants of the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS2) 2000–2004.
Measurements  Plasma HDL levels.
Results  Plasma HDL levels were higher in women than in men in both populations. In the United States women, it increased with age, whereas in Chinese women, it declined with age and converged with male HDL levels. In the United States, 37·1 ± 1·2% men and 38·9 ± 1·1% women had low HDL levels. In Hong Kong, 34·3 ± 1·6% men and 34·5 ± 1·5% women had low HDL levels. In Americans, the independent predictors of low HDL levels were lower age, being non-Mexican Hispanic, waist circumference, triglycerides and not drinking alcohol in men, and lower age, being Hispanic, waist circumference, triglycerides, current smoking and not drinking alcohol in women. In Hong Kong Chinese, the independent predictors of low HDL levels were body mass index, triglycerides, current smoking and not drinking alcohol in men, and lower age, waist circumference, triglycerides, diabetes and former smoking in women.
Conclusions  The decline in plasma HDL with age in Chinese women is opposite to that seen in American women. The increased cardiovascular risk in elderly Chinese women requires further study.     

Aging and metabolic syndrome effect on carotid atherosclerosis assessed by ultrasonography

Objective:   To investigate the relationships between carotid atherosclerosis, age and metabolic syndrome (MetS), by ultrasonographically examining the carotid arteries of subjects who ranged from young adults to centenarians.
Methods:   Carotid intima-media thickness (IMT) was evaluated by B-mode ultrasonography in 1540 patients (685 men, aged 70 ± 15 years, and 855 women, aged 74 ± 13 years) in the Medical Department of Seiyo Municipal Nomura Hospital. We investigated the association between carotid IMT as well as plaque, and confounding risk factors including MetS by using the 2005 Japanese criteria.
Results:   MetS increased with age until the fifth to seventh decade of life but began to decrease in the more elderly subjects. Carotid IMT increased in a linear manner with age ( r  = 0.442, P  < 0.001) and occurrence of plaques also increased up to the ninth decade of life ( P for trend <0.001). Multiple logistic regression analysis for carotid IMT ≥1.10 mm and plaque occurrence was performed using age, sex, smoking status, low-density lipoprotein cholesterol and MetS as variables. In subjects less than 80 years old, male sex and MetS were significant factors for carotid IMT ≥1.10 mm. However, in subjects 80 years or older, MetS was not related to carotid IMT ≥1.10 mm. The appearance of plaque was associated with age and smoking status, but not with MetS.
Conclusion:   MetS confers an increased risk of cardiovascular morbidity in subjects aged less than 80 years, and its identification may thus be important in risk assessment and treatment of patients.     

Risk factors for coronary artery disease in old persons in an academic hospital-based geriatrics practice

BACKGROUND: Risk factors for coronary artery disease (CAD) in old men and women include age, cigarette smoking, hypertension, diabetes mellitus, dyslipidemia, and obesity. OBJECTIVE: To investigate the association of risk factors with prevalence of CAD. METHODS: We performed a retrospective analysis of charts for all old persons seen during the period from 1 January 1998 through 15 June 1999 at an academic hospital-based geriatric practice to investigate associations of risk factors with prevalence of CAD among old persons. We studied 467 men, mean age 80 +/- 8 years, and 1444 women, mean age 81 +/- 8 years. RESULTS: CAD was present in 201 of 467 men (43%) and in 473 of 1444 women (33%; P < 0.0001). Risk factors for CAD according to univariate analysis were age (P < 0.0001 for women), cigarette smoking (P < 0.0001 for men and women), hypertension (P < 0.0001 for men and women), diabetes mellitus (P < 0.0001 for men and women), obesity (P < 0.0001 for men and women), and serum levels of total cholesterol (P < 0.0001 for men and P = 0.0001 for women), low-density lipoprotein (LDL) cholesterol (P < 0.0001 for men and P = 0.001 for women), and high-density lipoprotein (HDL) cholesterol (inverse association; P = 0.0001 for men and women). Stepwise logistic regression analysis showed that significant independent risk factors for CAD were cigarette smoking (odds ratio 6.7 for men), hypertension (odds ratios 3.3 for men and 2.7 for women), and serum levels of HDL cholesterol (odds ratio 0.83 for men and women) and LDL cholesterol (odds ratios 1.10 for men and 1.09 for women). CONCLUSIONS: Significant independent risk associations with prevalence of CAD among old persons were found for cigarette smoking by men, hypertension in men and women, and serum levels of HDL cholesterol (inverse association) in men and women, and of LDL cholesterol in men and women.     

Risk factors for atherothrombotic brain infarction in persons over 62 years of age in a long-term health care facility

A history of systolic (greater than or equal to 160 mm Hg) or diastolic (greater than or equal to 90 mm Hg) hypertension, diabetes mellitus (fasting venous plasma glucose greater than or equal to 140 mg/dl), a history of cigarette smoking, fasting serum total cholesterol greater than or equal to 200 mg/dl and greater than or equal to 250 mg/dl, and obesity (greater than or equal to 20% above ideal body weight) were examined as risk factors for atherothrombotic brain infarction (ABI) in 144 men, mean age 81 +/- 8 years, and 391 women, mean age 82 +/- 8 years, in a long-term health care facility. ABI occurred in 33 of 144 men (23%) and in 68 of 391 women (17%), P not significant. A history of systolic or diastolic hypertension correlated with ABI in both men and women (P less than 0.001). Diabetes mellitus correlated with ABI in both men and women (P less than 0.001). A history of cigarette smoking correlated with ABI in men (P less than 0.02) but not in women. Serum total cholesterol greater than or equal to 200 mg/dl and greater than or equal to 250 mg/dl did not significantly correlate with ABI in men or in women. Obesity did not significantly correlate with ABI in men or in women. Systolic or diastolic hypertension, diabetes mellitus, and cigarette smoking are risk factors for ABI in elderly men. Systolic or diastolic hypertension and diabetes mellitus are risk factors for ABI in elderly women.     

Low serum cholesterol is not associated with depression in the elderly: data from an Australian community study

Background: Low serum cholesterol may contribute to depressive symptoms in the elderly.
Aims: To test the relationship between depressive symptoms and low serum cholesterol in an elderly cohort.
Methods: This was an examination of cross-sectional data in a community study of 1237 men and 1568 women aged 60 + years in Dubbo, NSW. Quintiles of serum cholesterol were defined for men and women. The Center for Epidemiological Studies Depression Scale was used as a continuous, dependent variable in multiple regression analyses.
Results: Low serum cholesterol was not associated with depressive symptoms in older men or women. Health status, measured by poorer self-ratings, recent hospitalisation, higher disability levels and higher consumption of prescribed and self-prescribed drugs, predicted depressive symptoms. As well, the significance in the statistical model of financial difficulties, low self esteem, low feelings of self efficacy, the adequacy of practical help and emotional support, and recent widowhood, confirmed the importance of social origins of depressive symptoms. (Aust NZ J Med 1994; 24: 561–564.)     

Quantitative analysis of carotid atherosclerotic lesions and high-sensitivity C-reactive protein in community-dwelling elderly 80 years or older

Aim:   To investigate the association between the carotid atherosclerotic lesions assessed by high-resolution ultrasonography and high-sensitivity C-reactive protein (hs-CRP) in the community-dwelling elderly aged 80 years or older.
Methods:   One hundred and seventy-nine community-dwelling elderly aged 65 years or older (78 ± 6 years, 69 men and 113 women) participated in this study. High-resolution B-mode ultrasonography was performed on the common carotid arteries. Intima-media thickness (IMT) was measured using automatic measuring system and compared with standardized examinations included blood pressure, body mass index, hemoglobin-A1c, cholesterol, creatinine, uric acid, fibrinogen and hs-CRP.
Results:   Subjects were divided into two age groups: young-old aged 65–79 years (113 subjects, 74 ± 3 years) and old-old aged 80 years or older (66 subjects, 84 ± 3 years). The maximum (max) IMT was significantly increased in the old-old compared to that of the young-old (1.7 ± 1.0 vs 1.4 ± 0.6 mm; P  = 0.02). Multivariate analysis showed that hs-CRP was the strongest predictor of thickened max IMT in the young-old ( P  = 0.022). However, it was not the predictor of thickened max IMT in the old-old.
Conclusions:   Depending on age, hs-CRP may have different meanings in the atherosclerotic process. In particular, the predictive power of hs-CRP as a marker of atherosclerotic process was less significant in subjects aged 80 years or older.     

Relation of serum total cholesterol and other factors to risk of cerebral infarction in Japanese men with hypercholesterolemia.

BACKGROUND: Risk factors for cerebral infarction have not been well clarified, except for hypertension (HT), and few studies have examined the risk factors in the elderly. METHODS AND RESULTS: Clinical and behavioral risk factors for cerebral infarction were examined in 4,349 Japanese men aged 45-74 years with a serum total cholesterol (TC) concentration of 220 mg/dl or greater who participated in the Kyushu Lipid Intervention Study. A total of 81 men developed definite cerebral infarction in a 5-year follow-up period. The Cox proportional hazards model was used with serum TC at baseline and during the follow-up, serum high-density lipoprotein-cholesterol (HDL-C), HT, diabetes mellitus (DM), and other factors as covariates. Serum TC during the follow-up, not at baseline, was positively associated with cerebral infarction, showing a stronger association in the elderly (>or=65 years old) than in the middle-aged (<65 years old). Statin use was related to a moderate decrease in the risk of cerebral infarction when follow-up TC was not considered, but the decrease was almost nullified after adjustment for follow-up TC. A low concentration of serum HDL-C, diabetes mellitus, hypertension, and angina pectoris were each related to an increased risk. No clear association was observed for body mass index, smoking or alcohol use. CONCLUSIONS: Lowering cholesterol is important in the prevention of cerebral infarction in men with moderate hypercholesterolemia. A low concentration of HDL-C, DM, and HT are independent predictors of cerebral infarction.     

Total cholesterol and mortality in the elderly

OBJECTIVE: To evaluate, at a population level, whether total cholesterol (TC) is a risk factor of mortality. To verify whether or not this is true for both genders. DESIGN: Population-based, long-lasting, prospective study. SETTING: Institutional epidemiology in primary care. SUBJECTS: A total of 3257 subjects aged 65-95 years, recruited from Italian general population. INTERVENTION: None. MAIN OUTCOME MEASURES: Total cholesterol was measured, analysed as a continuous variable and then divided into quintiles and re-analysed. For each quintile, the multivariate relative risk (RR) of mortality adjusted for confounders was calculated in both genders. Stratification of mortality risk by TC quintiles, body mass index and cigarette smoking was also performed in both genders. RESULTS: Total cholesterol levels directly predicted coronary mortality in men [RR being in the fifth rather than in the first quintile: 2.40 (1.40-4.14)] and any other mortality in women. It also inversely predicted miscellaneous mortality in both genders. This trend was more evident when low cholesterol was associated with malnutrition or smoking. CONCLUSIONS: High TC remains a strong risk factor for coronary mortality in elderly men. On the other hand, having a very low cholesterol level does not prolong survival in the elderly; on the contrary, low cholesterol predicts neoplastic mortality in women and any other noncardiovascular mortality in both genders.     

Relationship between bite force and body mass index in the institutionalized elderly

Background:   The aim of this study was to evaluate the possible relationship between nutritional status and chewing ability in the institutionalized elderly.
Methods:   We examined the oral condition and bite force in relation to the age, sex and body mass index (BMI) in 559 institutionalized elderly (155 men and 404 women). The data were analyzed statistically using Spearman's rank correlation coefficient and the Mann–Whitney U -test.
Results:   The total bite force of men was stronger than that of women ( P  = 0.0007), and had a negative correlation with aging. There was a significant positive correlation between the total bite force and the BMI ( P  = 0.036).
Conclusion:   Chewing ability, which was evaluated by total bite force, significantly correlated with BMI in the institutionalized elderly. It appears that diminished chewing ability is associated with the development of malnutrition among the institutionalized elderly.     

Relation of age and smoking to serum levels of total testosterone and dehydroepiandrosterone sulfate in aged men

Background:   Hormonal factors have been extensively investigated in the area of geriatric medicine in the search for potential anti-aging agents or useful biomarkers for senescence in men. However, inconsistent results have been published so far concerning the relation of anthropometric and life-style factors to endocrine factors. To confirm the relationships between epidemiological parameters and sex hormone levels, we examined the relation of age and smoking to serum levels of total testosterone (T) and dehydroepiandrosterone sulfate (DHEA) in aged men.
Methods:   The subjects included men aged 50–74 years, 40 current smokers and 27 never smokers. Serum levels of T and DHEA were assayed with a radioimmunoassay kit.
Results:   Serum T did not decrease with age, and was significantly higher in smokers than for non-smokers. Serum DHEA decreased with age more sharply in non-smokers than for smokers.
Conclusion:   These data suggest that serum DHEA decreases with aging, but serum T does not, and that serum levels of these hormones are influenced by cigarette smoking.     

Effect of smoking habit on age-related changes in serum lipids: a cross-sectional and longitudinal analysis in a large Japanese cohort

To observe the effect of smoking habit on age-related serum lipid levels, we examined a large cohort of Japanese cross-sectionally and longitudinally. The participants included 103,648 Japanese men and women 17-94 years of age, who had received annual health examinations from 1989 to 2003. In cross-sectional analysis, total and LDL cholesterol levels of smokers were lower than those of nonsmokers up to an elderly age in men and up to middle age in women. Smoking was associated with decreased HDL cholesterol levels up to the 65-74 years age group in men and 55-64 years in women. The triglyceride levels were higher in smokers in both genders than those of nonsmokers below 55-64 years. In the longitudinal analysis, although smoking was associated with lower total and LDL cholesterol up to 60 years of age in women, beyond the sixties an inverted association was observed. The associations of smoking with lower LDL cholesterol levels in men and lower HDL cholesterol in both genders were fairly consistent at any given age. The increase of triglyceride levels in female smokers remained rather constant between 25 and 75 years, whereas the increase in triglyceride levels in male smokers was greater with older ages up to middle age. These results suggest that the effect of smoking on the serum lipid levels is dependent on age and gender.     

Higher Level of Systemic C-Reactive Protein Is Independently Predictive of Coronary Heart Disease in Older Community-Dwelling Adults: The Three-City Study

OBJECTIVES: To assess the association between systemic C-reactive protein (CRP) and incident coronary heart disease (CHD) in community-dwelling elderly people.
DESIGN: A French population-based multicenter prospective cohort study.
SETTING: Three cities in France: Bordeaux in the southwest, Dijon in the northeast, and Montpellier in the southeast.
PARTICIPANTS: After 4 years of follow-up, a case–cohort study was designed including 1,004 subjects randomly selected from the initial cohort of 9,294 subjects free of CHD at baseline and 174 subjects who developed first CHD events during follow-up.
MEASUREMENTS: Hazard ratios (HRs) were estimated using a Cox proportional hazard model adapted for the case–cohort design using a CRP level less than 1 mg/L as the reference category.
RESULTS: Of the random sample, 24.3% had a CRP level less than 1.0 mg/L, 45.8% had a CRP level of 1.0 to 2.9 mg/L, and 29.9% had a CRP level of 3.0 to 10.0 mg/L. The HRs for CHD, adjusted for age, sex, and study center, were 1.69 (95% confidence interval (CI)=1.04–2.75) for CRP from 1.0 to 2.9 mg/L and 2.32 (95% CI=1.41–3.82) for CRP from 3.0 to 10.0 mg/L ( P for trend <.001). After additional adjustment for smoking, body mass index, diabetes mellitus, systolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, statin use, and antihypertensive treatment, a baseline CRP of 3.0 to 10.0 mg/L remained associated with risk of CHD (HR=1.87, 95% CI=1.09–3.25), although CRP did not improve the discriminative ability of a predicting model based on traditional risk factors (receiver operating characteristic curves from 0.740 to 0.749).
CONCLUSION: CRP is an independent CHD risk marker but does not improve CHD risk prediction in community-dwelling elderly people.     

Influence of angiotensin-converting enzyme I/D gene polymorphism on clinical and histological correlates of chronic hepatitis C

Aim:  This study aimed to verify the relationship between the insertion–deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE) and clinical and histological correlates of chronic hepatitis C.
Methods:  Two-hundred and fifty-eight, treatment naive, unselected hepatitis C virus (HCV) RNA-positive patients and 210 controls were studied. ACE allelic variants were determined by polymerase chain reaction.
Results:  Mean staging scores adjusted for age, body mass index (BMI) and alcohol consumption were: men, D/* = 2.283; men, I/I = 2.092; women, D/* = 2.241; and women, I/I = 3.283 ( P  = 0.028). Age-adjusted mean BMI were: men, D/* = 25.01; men, I/I = 24.87; women, D/* = 23.73; and women, I/I = 22.50 ( P  = 0.006). Age and BMI-adjusted mean low-density lipoprotein (LDL)/ high-density lipoprotein (HDL) cholesterol ratios were: men, D/* = 2.344; men, I/I = 2.283; women, D/* = 1.916; and women, I/I = 1.903 ( P  = 0.004). Histological grading correlated positively with triglycerides and negatively with HDL and LDL cholesterol ( P  < 0.0001).
Conclusion:  Female ACE I/I homozygotes have higher liver fibrosis scores in comparison to D/* women and to men; moreover, they are leaner and have a lower LDL/HDL cholesterol ratio. These observations suggest a possible mutual influence between ACE polymorphism, serum lipid concentrations and outcome of chronic HCV infection.