阻塞性睡眠呼吸暂停低通气综合征合并高血压患者血浆内皮素1、血管性假血友病因子及血栓调节蛋白的水平研究

目的 研究阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)及OSAHS合并高血压血浆内皮素1(endothelin-1,ET-1)、血栓调节蛋白(thrombomodulin,TM)、血管性假血友病因子(yon Willebrand factor,vWF)的变化.方法 检测OSAHS、OSAHS合并高血压患者血浆ET-1、TM、vWF含量并与睡眠呼吸监测指标进行相关性分析.结果 单纯OSAHS、OSAHS合并高血压患者与对照组比较,ET-1、TM及vWF水平升高,并与两者病情严重程度有相关性;ET-1、TM、vWF水平的升高在OSAHS合并高血压患者组更明显.结论 OSAHS及OSAHS合并高血压患者均存在血管内皮损伤,内皮功能损伤在OSAHS合并高血压患者中更为明显.血管内皮损伤在OSAHS合并高血压的发病中有重要的作用.     

Circulating endothelial cells, endothelial precursors, VEGF and bFGF concentrations in patients with acute leukemias, lymphomas and myelomas

Circulating endothelial cells and their precursors are suggested by some authors to be novel markers of angiogenesis. The aim of the study was to measure circulating endothelial cells (CEC), circulating endothelial precursors (CEP) and activated endothelial cells (aCEC) and serum concentrations of VEGF (vascular endothelial growth factor) and bFGF (basic fibroblast growth factor), well-known proangiogenic factors in patients with haematological malignancies before and after chemotherapy. Measurements were carried out in 20 patients with acute leukemia, 21 with malignant lymphoma and with 20 with multiple myeloma. The number of CEC, CEP and aCEC was measured by means of 3-color flow cytometry and serum concentrations of VEGF and bFGF with ELISA. In patients with acute leukemias and lymphomas the number of CEC was significantly higher than in controls, and that high number correlated with worse prognosis in patients with lymphomas. The increased number of CEP at diagnosis in patients with acute leukemia and lymphoma correlated with worse prognosis. The number of aCEC was higher in leukemic and lymphoma groups. After chemotherapy the decrease in CEC and CEP numbers in patients with acute leukemia and lymphoma was observed. In patients with lymphoma the increased serum VEGF concentrations in comparison with healthy subjects were noted but in leukemic patients-lower concentrations of VEGF. The initial high concentrations of bFGF in all patients did not change after therapy and in patients with lymphoma correlated with worse prognosis. Results suggest that in patients with acute leukemias and lymphomas CEC and CEP may be the markers of malignant process correlating with clinical outcome. aCEC may have a similar role in both diseases. Also in patients with lymphoma VEGF may be a marker of disease activity. bFGF is connected with pathogenesis of acute leukemia, myeloma and lymphoma and in patients with lymphoma is a predictor of worse prognosis.     

High plasma fibrinogen level is associated with poor clinical outcome in DIC patients

We measured the plasma level of fibrinogen in 560 patients with disseminated intravascular coagulation (DIC) and evaluated its relationship with outcome and with other hemostatic markers. Forty-seven percent of patients had >200 mg/dL of plasma fibrinogen and 24% had <100 mg/dl of plasma fibrinogen, suggesting that plasma fibrinogen level is not a sensitive marker for DIC. In our analysis of outcome and plasma fibrinogen levels, the rate of death was high in leukemia/lymphoma patients with high fibrinogen concentration, but no significant difference in outcome was observed in relation to plasma fibrinogen concentration in non-leukemia/lymphoma patients with DIC. Among patients with leukemia/lymphoma, the frequency of organ failure was markedly high in patients with high plasma levels of fibrinogen. Among patients without leukemia/lymphoma, the frequency of organ failure increased concomitantly with the increase in plasma fibrinogen levels. The international normalized ratio was significantly increased in leukemia/lymphoma patients with low fibrinogen. FDP levels were slightly increased in patients with low fibrinogen. Platelet count was significantly low in patients without leukemia/lymphoma with high fibrinogen. DIC score increased concomitantly with the reduction in plasma fibrinogen levels. Plasma levels of thrombomodulin and tissue factor were significantly high in patients with high fibrinogen levels. Plasma levels of antiplasmin and plasminogen were significantly decreased in patients with low fibrinogen. Plasma levels of plasmin plasmin-inhibitor complex and tissue type plasminogen activator/plasminogen activator inhibitor-1 complex (PAI-I) were significantly higher in patients with low fibrinogen than in those with high fibrinogen. Plasma levels of PAI-I and IL-6 were significantly higher in patients with high fibrinogen than in those with low fibrinogen. Patients with high fibrinogen levels showed less activation of secondary fibrinolysis, which might explain the occurrence of organ failure and poor outcome.     

钼、锌对克山病心肌坏死的保护作用——钼、锌对缺氧性心肌损伤血浆cGMP血清Mg~(++)Ca~(++)含量变化的实验研究

本实验在分别饲以基础饲料,基础饲料加钼、加锌、加钼锌的基础上.用NaNO_2造成大鼠缺氧性心肌损伤,并与空白对照组进行对照。采用放射免疫法和原子吸收分光光度计测定各组大鼠血浆cGMP.血清Mg~(++)、Ca~(++)含量。结果表明基础饲料中加钼、加锌、加钼锌组较饲用基础饲料组大鼠血浆cGMP含量为低,血清Mg~(++)含量为高差异显著,其中基础饲料加钼锌组差异更为显著。分析其发生机理.说明了钼、锌对克山病心肌坏死具有保护作用,钼锌联合作用效果更为显著。     

The DD genotype of the ACE gene polymorphism is associated with diabetic nephropathy in the type-1 diabetics.

Genetic factors are involved in the development of diabetic nephropathy in type-1 diabetes. We are examining the association of the angiotensin-converting enzyme (ACE), insertion/deletion (I/D) polymorphism with the presence of diabetic nephropathy in type-1 diabetic patients. 52 type-1 diabetic patients with diabetic nephropathy (30 with either microalbuminuria or macroalbuminuria and 22 with end stage renal disease on dialysis) were compared with 10 type-1 diabetic patients with normoalbuminuria and duration of disease longer than 15 years and 27 non-diabetic healthy subjects. We found that the D-allele frequency was higher in patients with nephropathy than in the healthy and normoalbuminuric controls. There was an association in the DD polymorphism of the ACE gene with patients with diabetic nephropathy and not with the control subjects. We conclude that the DD genotype of ACE gene polymorphism is associated with diabetic nephropathy in patients with type-1 diabetes mellitus.     

Enhanced in vivo platelet release reaction and malondialdehyde formation in patients with hyperlipidemia

Plasma level of beta-thromboglobulin (beta TG), a useful marker of in vivo platelet "release reaction,"was determined by radioimmunoassay in 69 patients, with three types of primary hyperlipidemia (IIa, IIb, IV) and compared with the findings in age- and sex-matched healthy controls and 57 patients with established atherosclerosis and peripheral vascular disease. Malondialdehyde (MDA) formation, used for assessment of prostaglandin synthesis, was determined in 51 and plasma platelet factor 4 (PF4), measured by radioimmunoassay, in 48 of the patients with hyperlipidemia. Results were correlated to five serum lipids and lipoprotein levels in the patients with hyperlipidemia. beta TG was significantly increased in the patients with hyperlipidemia and peripheral vascular disease, compared to those in the controls (p < 0.001); it was significantly higher in the patients with hyperlipidemia than in those with peripheral vascular disease. PF4 and MDA formation were also increased in the patients with hyperlipidemia, and significantly higher levels of MDA were obtained in patients with type IIb and type IV hyperlipidemia than in those with type IIa hyperlipidemia (p < 0.02). beta TG and MDA correlated weakly with total serum cholesterol triglycerides and very low density lipoprotein-triglyceride. There was also a significant correlation between beta TG and PF4, and MDA production. These results indicate that in vivo platelet "release reaction" and MDA formation are increased in hyperlipidemic patients. The release reaction is more enhanced in those with hyperlipidemia than in the patients with peripheral vascular disease. They suggest that the abnormal platelet function is related to the elevated levels of serum lipids and lipoproteins in the hyperlipidemic patients and not only to the atherosclerotic changes associated with hyperlipidemia.     

A possible role of immunoglobulin E in patients with hyperthyroid Graves' disease.

To investigate the possible participation of immunoglobulin E (IgE) in the autoimmune process of Graves' disease, incidence of elevation of serum IgE level, TSH receptor antibody (TRAb), and thyroid status were studied in 66 patients with hyperthyroid Graves' disease, 54 patients with Hashimoto's thyroiditis, 19 patients with bronchial asthma, and 15 patients with pollen allergy. In hyperthyroid Graves' patients, elevation of serum IgE levels (> or = 170 U/mL) was found in 19 of 66 patients (29%), 11 of whom had hereditary and/or allergic conditions. Elevations of serum IgE levels were found in 63% of patients with bronchial asthma and in 40% of patients with pollen allergy. Mean values of serum IgE were the same in patients with hyperthyroid Graves' disease and with bronchial asthma. During methimazole treatment TRAb decreased without fluctuation of IgE levels in both groups. The decrease in TRAb was significantly greater in patients with normal IgE than in patients with IgE elevation. After prednisone administration, reduction in TRAb was greater in patients with normal IgE than that in patients with IgE elevation. High incidence of IgE elevation in hyperthyroid Graves' disease and slower reduction in TRAb in association with IgE elevation suggest a difference in the autoimmune processes in Graves' disease with and without elevation of IgE.     

Prevalence of microscopic colitis in patients with irritable bowel syndrome with diarrhea predominance

Background: Microscopic colitis (MC) and irritable bowel syndrome with diarrhea (IBSD) have a similar clinical and endoscopic presentation. The prevalence of MC in Mexican patients with IBS-D is unknown. Objectives: To find out the prevalence of MC in patients with IBS-D and compare it with the one observed in patients with IBS with constipation (IBS-C). Methods: All patients with IBS (Rome III) seen consecutively from January 2008 to August 2010 were included. Those with organic disease, alarm signs, mixed IBS or unsubtyped- IBS (Rome III) were excluded. Colonoscopy with biopsies was performed in all patients that were examined by two pathologists who did not know the clinical characteristics of the subjects. MC was defined according with the universally accepted histological criteria. Results: 155 patients with IBS-D and 145 with IBS-C were studied. Both groups were matched from the standpoint of age, gender ratio and time course of disease. MC was detected in 28 patients with IBS-D and in one with IBS-C (18% vs. 0.7%, p <0.0001). Fifteen patients with lymphocytic colitis and 14 with collagenous colitis were detected. The endoscopic appearance of the colon mucosa was normal in 20 of the 29 patients with MC (69%). Conclusions: The prevalence of MC in patients with IBS-D was 18%, significantly higher than the one observed in patients with IBS-C. Colonic mucosa had a normal appearance in most of the patients with MC. Systematic biopsies are recommended in patients with IBS-D.     

Association between fluorescent antinuclear antibodies, capillary patterns, and clinical features in scleroderma spectrum disorders

Antinuclear antibody and in vivo capillary patterns were studied in 33 patients with Raynaud's phenomenon only and in 68 patients with scleroderma spectrum disorders; the results were correlated with clinical and laboratory findings. In addition, antinuclear antibody results in the groups with Raynaud's phenomenon only and scleroderma spectrum disorders were compared with those found in 70 patients with systemic lupus erythematosus (SLE). Distinct antinuclear antibody profiles were observed in the three diagnostic groups. Comparison of patients with anticentromere antibodies with others in the group with scleroderma spectrum disorders demonstrated that anticentromere antibody-positive patients tended to have a milder disease: less skin and visceral involvement, less frequent presence of hypertension, anemia, and elevated sedimentation rate. These differences did not, however, reach statistical significance. Comparison of patients with scleroderma spectrum disorders according to in vivo capillary patterns revealed that those with an "active" pattern had significantly more extensive skin involvement than those with a "slow" pattern. Visceral involvement tended to be greater in all organ systems in the group with an "active" pattern and reached statistical significance for muscle and kidney. Hypertension was also significantly more frequent in the group with an "active" pattern than in the group with a "slow" one. The latter was positively correlated with the presence of anticentromere antibody.     

Effect of thyroliberin on the prolactin level in the blood serum of primary hypothyroid patients

Results of study of the basic prolactin level and its response to the stimulating action of exogenous thyroliberin in 23 women with primary hypothyroidism are presented; alteration of prolactin secretion in these patients under the effect of replacement thyroid hormone therapy is shown. In the majority of patients with primary hypothyroidism prolactin level was elevated in comparison with the normal, and its secretion in response to TRH was considerably increased. There were no significant differences in the basic prolactin level and in its response to TRG in patients with primary hypothyroidism with or without lactorrhea, and with lactorrheaamenorrhea. Lactorrhea can develop in the patients with increased or with normal blood serum prolactin level. Sensitivity of thyrotrophs and lactotrophs to the inhibitory action of thyroid hormones proved to differ. The efficacy of replacement therapy in patients with primary hypothyroidism combined with lactorrhea-amenorrhea, leading to restoration of the patients' fertility, was demonstrated.     

Increased ethane exhalation, an in vivo index of lipid peroxidation, in alcohol-abusers.

Ethane exhalation was measured in 42 control subjects, 52 patients with various non-alcoholic liver diseases, and 89 alcohol abusers who had been admitted to hospital for alcohol withdrawal and assessment of liver disease (six with normal liver tests, 10 with steatosis with or without fibrosis, six with alcoholic hepatitis, 29 with cirrhosis, 34 with both cirrhosis and alcoholic hepatitis, and four with both cirrhosis and a hepatocellular carcinoma). Ethane exhalation was similar in control subjects and in patients with non-alcoholic liver diseases, but was five times higher in alcohol abusers. Ethane exhalation in alcohol abusers was significantly, but very weakly, correlated with the daily ethanol intake before hospital admission, and the histological score for steatosis, but not with the inflammation or alcoholic hepatitis scores. Ethane exhalation was inversely correlated with the duration of abstinence before the test. In nine alcoholic patients, the exhalation of ethane was measured repeatedly, and showed slow improvement during abstinence. Ethane exhalation was significantly but weakly correlated with the Pugh's score in patients with alcoholic cirrhosis. It is concluded that the mean ethane exhalation is increased in alcohol abusers. One of the possible mechanisms may be the presence of oxidizable fat in the liver. The weak correlation with the Pugh's score is consistent with the contribution of many other factors in the progression to severe liver disease.     

Analysis of hepatitis G virus infection markers in blood donors and patients with hepatitis

The incidence and clinical significance of hepatitis G virus (HGV) is still not fully known. The aim of our study was to assess the frequency of HGV RNA and antibody to HGV E2 protein (anti-E2) in Polish blood donors and patients with hepatitis, and to compare the sequence of HGV clones with those reported by others. Two-hundred and nineteen blood donors and 83 patients with hepatitis were studied. HGV was detected in 3.2% and anti-E2 in 24.2% of blood donors and in 26.5% and 8.4% of patients with hepatitis, respectively. HGV was detected as a co-infection with HCV in four of 18 patients with chronic hepatitis, in four of 16 patients with acute hepatitis and in one of six patients with fulminant liver failure (FLF), and as a co-infection with HBV in one of six patients with FLF and in three of 10 patients with chronic hepatitis. In non-A–C hepatitis, eight of 23 patients with acute hepatitis and one of four patients with FLF were positive for HGV but all 10 patients with chronic cryptogenic hepatitis were negative. In the follow-up studies of patients with HGV alone, a correlation with viraemia and clinical symptoms was observed in two patients, but in three others HGV RNA was detected in spite of clinical resolution. Two HGV clones were sequenced, and the sequence of the HGV helicase region of the HGV isolates from donor and patient were homologous to those described by others. Hence, the frequency of HGV RNA in blood donors is similar to that obtained in other countries but the anti-E2 (marker of a past infection) frequency is higher. The incidence of HGV RNA and anti-E2 in hepatitis patients suggests that HGV plays a role in liver pathology, but careful analysis of individual cases does not confirm this.     

Heterogeneous changes in electrophysiologic properties in the paroxysmal and chronically fibrillating human atrium

INTRODUCTION: The regional changes in atrial electrophysiologic properties related to atrial fibrillation (AF) in patients with paroxysmal AF (PAF) and chronic AF (CAF) remain unclear. The purpose of this study was to investigate the regional changes in atrial electrophysiology in patients with AF. METHODS AND RESULTS: We evaluated the atrial electrophysiology at different sites (high right atrium, low right atrium [LRA], and distal coronary sinus [DCS]) in 11 patients with CAF, 8 patients with PAF, and 10 controls. Patients with CAF had significantly prolonged interatrial conduction and corrected sinus node recovery time, and shortened atrial effective refractory period (ERP) with loss of rate-related adaptation in the DCS, but had paradoxic prolongation of atrial ERP in the LRA, as compared with patients with PAF and the controls. As a result, the spatial distribution of atrial ERP that was observed in the controls and in patients with PAF was reversed in patients with CAF, without an increase in the dispersion of atrial refractoriness. Patients with PAF showed intermediate changes in atrial conduction times and atrial refractoriness as compared with patients with CAF and controls. CONCLUSION: There was a regional heterogeneity on the changes of atrial electrophysiology in different parts of the atrium, and the "normal" spatial distribution of atrial refractoriness was reversed in patients with CAF. The electrophysiologic changes observed in patients with PAF appear to behave as if in transition from the control state to CAF, suggesting progressive changes in atrial electrophysiologic properties.     

Clinical aspect of aortitis syndrome with special reference to the relation between prognosis and hypertension

The present study was done to investigate the relation between the prognosis and hypertension, especially hypertension due to renal arterial stenosis, atypical coarctation of the aorta and aortic regurgitation in patients with aortitis syndrome. Sixty-five patients including 25 with normotension and 40 with hypertension who were hospitalized during the last 20 years were included in this study. Out of the 40 patients with hypertension, a cause of hypertension was found in 37 patients: renovascular hypertension alone in 13, renovascular hypertension with atypical coarctation in 11, renovascular hypertension and aortic regurgitation in 2, atypical coarctation alone in 5, aortic regurgitation alone in 5 and all of the three in the remaining one. Thirty-two hypertensive patients out of 40 were treated with antihypertensive drugs and the remaining 8 underwent surgical operation (renal vascular repair in 6 and nephrectomy in 2 for relief of hypertension. In the present data, 13 out of 40 patients with hypertension died despite of the treatment, while only one out of 25 patients with normotension died. According to the mortality in each type of cardiovascular lesion, 6 patients died out of 13 with renovascular hypertension alone, 5 patients died out of 11 with renovascular hypertension associated with atypical coarctation and 2 patients with renovascular hypertension associated with aortic regurgitation died. In contrast, there was no death in hypertensive patients with aortic regurgitation alone or atypical coarctation of the aorta alone. These results indicate that hypertension, especially renovascular hypertension is one of the major determinant of the prognosis in the patient with aortitis syndrome.     

Adherence to gluten-free diet and serum antigliadin antibodies in celiac disease

In 134 patients with celiac disease the compliance with a gluten-free diet (GFD) and the presence of antigliadin antibodies (AGA) were evaluated. Compliance with the GFD was good in 71%, moderate in 11% and poor in 18%. High levels of AGA (IgA and IgG) were found in 24.2% of patients with good GFD, in 40% of those with moderate GFD and in 75% of those with poor GFD compliance. Our data suggest that the presence of AGA is correlated with the degree of adherence to the GFD, and that AGA measurement may be of some value in the monitoring of GFD in patients with celiac disease.     

肝硬化患者血清脂联素与瘦素的相关性

目的测定肝硬化患者血清脂联素与瘦素的水平并探讨二者的相关性。方法测定73例肝硬化患者和30例健康对照的血清脂联素和瘦素及相关的临床生化参数,计算血清脂联素/瘦素比值。结果肝硬化患者血清脂联素、瘦素水平明显高于正常对照组(P<0.05);脂联素/瘦素比值>1;血清脂联素与瘦素水平呈正相关。血清脂联系、瘦素水平与胰岛素、胰岛素抵抗指数呈正相关,与胰岛素敏感指数呈负相关。结论肝硬化患者血清脂联素、瘦素水平和脂联素/瘦素比值明显升高,可能与肝硬化患者胰岛素抵抗有关。     

Pneumonia associated with lung cancer in the elderly

We investigated the clinical characteristics separating pneumonia as a complication in elderly lung cancer patients into obstructive and non-obstructive pneumonia. Two hundred and five patients with pneumonia as a complication in elderly lung cancer patients were classified into two groups; 64 patients with obstructive pneumonia and 141 patients with non-obstructive pneumonia. Most of the patients in both groups were male. Concerning histological findings, while most of the patients with obstructive pneumonia had squamous cell carcinoma, those with non-obstructive pneumonia had the same proportion of squamous cell carcinoma as all elderly patients with lung cancer. Most of the patients with obstructive pneumonia were in good general condition including their nutritional condition, but the patients with non-obstructive pneumonia were in significantly poor condition. A low percent of microorganisms were isolated from the sputum obtained from the patients with non-obstructive pneumonia, but a high percentage were obtained from those with non-obstructive pneumonia. Frequent involvement of gram-negative bacilli such as Pseudomonas aeruginosa and Klebsiella pneumoniae or Staphylococcus aureus containing MRSA was also found in these patients. Regarding treatment, although carbapenem was used either alone or in combination therapy as the regimen of treatment for pneumonia as a complication in elderly lung cancer patients with both the obstructive and non-obstructive pneumonia patients, the efficacy rate was poor in 50% with obstructive pneumonia and in 26% with non-obstructive pneumonia. The mortality rate was 11% in the patients with obstructive pneumonia, while it was 61% in the patients with non-obstructive pneumonia. The prognosis was significantly poorer in the patients with non-obstructive pneumonia. We concluded that although the prognosis was not so poor for patients with obstructive pneumonia if the appropriate treatment was given, in the patients with non-obstructive pneumonia, the treatment for underlying diseases and the improvement of their general condition, including the determination of causative microorganisms, was important.     

Esophageal dysfunction in patients with progressive systemic sclerosis and mixed connective tissue diseases

Esophageal motility was studied in 37 patients with progressive systemic sclerosis (PSS), 12 patients with mixed connective tissue disease (MCTD) and 40 controls by the manometry method, using an open tube and continuous perfusion, and by radiological examination. Radiology was normal in 17 patients with PSS and five patients with MCTD, and abnormal in 15 patients with PSS and three with MCTD. The most frequent abnormality was slow transit time of barium. Manometry of the esophageal body was normal in 20 patients with PSS and six patients with MCTD, and abnormal in 17 patients with PSS and six with MCTD. Lack of contraction in the middle lower segments of the esophagus was the abnormality most frequently observed. Lower esophageal sphincter pressure was significantly lower among patients with PSS and MCTD than among the controls. Dysphagia was reported by ten patients with PSS and by six patients with MCTD. Radiology and manometry showed similar changes in PSS and MCTD, but dysphagia was more frequent among patients with MCTD.     

Circulating vascular endothelial growth factor and active renin concentrations and prostaglandin E2 urinary excretion in patients with adrenal tumours

OBJECTIVES: The aim of the present study was to determine vascular endothelial growth factor (VEGF), prostaglandin E(2) (PGE(2)) and active renin levels in patients with hormonally active adrenal tumours. DESIGN: The study was comprised of 16 patients with primary aldosteronism, 13 patients with active Cushing's syndrome due to adrenal adenomas, 8 patients with adrenal carcinomas, 19 patients with phaeochromocytoma and 19 healthy volunteers. METHODS: Active renin in plasma was determined by a two-site immunoradiometric assay. VEGF in sera samples and PGE(2) in 24-h urine were measured by ELISA. RESULTS: VEGF was significantly elevated in all the four groups of patients as compared with the controls. VEGF levels in patients with Cushing's syndrome were higher than those in patients with primary aldosteronism. Patients with adrenal carcinomas had the highest VEGF levels and the differences reached significance as compared with patients with primary aldosteronism and phaeochromocytoma. PGE(2) levels were not significantly different among groups. Active renin was significantly the lowest in patients with primary aldosteronism and significantly the highest in patients with phaeochromocytoma compared with the controls. Active renin in patients with primary aldosteronism was significantly lower than in those with Cushing's syndrome, phaeochromocytoma and adrenal carcinoma. CONCLUSIONS: Our data indicated that the mean level of VEGF in patients with all investigated adrenal tumours was significantly higher than in healthy controls. The cortisol-producing tumours appear to have increased angiogenic potential. Angiogenesis is probably associated not only with malignancy but also with functional activity of the adrenal tumors.     

Prevalence and association of ventricular tachycardia and complex ventricular arrhythmias with new coronary events in older men and women with and without cardiovascular disease

BACKGROUND: We report the prevalence of ventricular tachycardia (VT) and of complex ventricular arrhythmias (VA) and their association with new coronary events in older men and women. METHODS: The prevalence of VT and of complex VA detected by 24-hour ambulatory electrocardiograms and the incidence of new coronary events in older persons with coronary artery disease (CAD), with hypertension, valvular disease, or cardiomyopathy without CAD, and with no cardiovascular disease was investigated in 915 men (mean age 80 +/- 8 years) and in 1,874 women (mean age 81 +/- 8 years) in a long-term health care facility. Follow-up was 45 +/- 30 months in men and 47 +/- 30 months in women. RESULTS: The prevalence of VT was 16% in men and 15% in women with CAD, 9% in men and 8% in women with hypertension, valvular disease, or cardiomyopathy without CAD, and 3% in men and 2% in women with no cardiovascular disease. The prevalence of complex VA was 69% in men and 68% in women with CAD, 54% in men and 55% in women with hypertension, valvular disease, or cardiomyopathy without CAD, and 31% in men and 30% in women with no cardiovascular disease. In men and in women with CAD or with hypertension, valvular disease, or cardiomyopathy, VT and complex VA increased the incidence of new coronary events (p <.0001). Within each of the groups of patients, the incidences of new coronary events in men and in women with and without VT or complex VA were similar. CONCLUSIONS: The prevalence of VT and of complex VA were similar in older men and women. VT and complex VA were associated with a higher incidence of new coronary events in men and women with CAD or with hypertension, valvular disease, or cardiomyopathy without CAD, but not in men and women with no cardiovascular disease.