Association between low bone mass and aortic valve sclerosis in Koreans

Background  Osteoporosis or low bone mass has been associated with cardiovascular disease and calcification in several clinical studies. However, few studies have assessed the relationship between bone mass and valvular calcification. The aim of this study was to evaluate the relationship between low bone mass and aortic valve sclerosis in Korean men and women.
Methods  A total of 211 men and 117 women were included in this study. Each subject's bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry, and aortic valve sclerosis was assessed using transthoracic echocardiography. Association between low bone mass and aortic valve sclerosis was assessed with multivariate logistic regression analysis in this cross-sectional study.
Results  Of 328 total subjects enrolled in this study, 50 men (23·7%) and 18 women (15·4%) were found to have aortic valve sclerosis. The mean (±SD) BMD T -scores were −0·5 (±0·8) in men and −0·9 (±1·0) in women. After adjusting for covariates, only women with aortic valve sclerosis had significantly lower BMD T -scores than those without it. Multivariate logistic regression analysis showed that age, smoking and hypertension were independently associated with increased risk of aortic valve sclerosis in men. In women, however, logistic regression analysis showed that BMD T -score, as well as age, was an independent variable for aortic valve sclerosis. We also found that a T -score of less than −1·5 was significantly associated with increased risk of aortic valve sclerosis in women compared to normal T -scores.
Conclusion  Low bone mass might be independently associated with increased risk of aortic valve sclerosis in women, but not in men. Women with low bone mass should be further evaluated for the presence of aortic valve sclerosis and related cardiovascular diseases.     

The association between coronary artery calcification and mean platelet volume in the general population

Patients with coronary artery calcification have an increased risk of coronary vascular events and mortality. Coronary artery calcification can be quantified using the coronary calcium score (CCS) from multi-detected row computed tomography (MDCT), and the score is proportionally related to the severity of atherosclerotic disease. Mean platelet volume (MPV) is gaining interest as a new independent cardiovascular risk factor. Accordingly, the aim of our study was to evaluate the relationship between CCS and MPV in the general population. A total of 2116 individuals were enrolled from a health promotion center between July 2007 and June 2010. Among them, 259 subjects were included in the final analysis. MDCT was used to measure CCS and CCS?>?1 was defined as the presence of coronary calcification. The MPV value was significantly higher in the coronary artery calcification group than in the control group. Multivariate analyses showed that MPV was positively associated with coronary calcification (OR, 1.61; 95% CI 1.02–2.55). In summary, there was a significant association between coronary artery calcification and MPV in the general population. Therefore, the detection of elevated MPV should alert clinicians to the coexistence of multiple underlying CVD risk factors warranting early evaluation and treatment.     

The association between coronary artery calcification and mean platelet volume in the general population

Patients with coronary artery calcification have an increased risk of coronary vascular events and mortality. Coronary artery calcification can be quantified using the coronary calcium score (CCS) from multi-detected row computed tomography (MDCT), and the score is proportionally related to the severity of atherosclerotic disease. Mean platelet volume (MPV) is gaining interest as a new independent cardiovascular risk factor. Accordingly, the aim of our study was to evaluate the relationship between CCS and MPV in the general population. A total of 2116 individuals were enrolled from a health promotion center between July 2007 and June 2010. Among them, 259 subjects were included in the final analysis. MDCT was used to measure CCS and CCS?>?1 was defined as the presence of coronary calcification. The MPV value was significantly higher in the coronary artery calcification group than in the control group. Multivariate analyses showed that MPV was positively associated with coronary calcification (OR, 1.61; 95% CI 1.02-2.55). In summary, there was a significant association between coronary artery calcification and MPV in the general population. Therefore, the detection of elevated MPV should alert clinicians to the coexistence of multiple underlying CVD risk factors warranting early evaluation and treatment.     

Associations between vascular calcification, arterial stiffness and bone mineral density in chronic hemodialysis patients

Aim:   The aim of our study was to examine the associations between vascular calcification, arterial stiffness and bone mineral density (BMD) in chronic hemodialysis (HD) patients.
Methods:   The study subjects were 83 (70 men and 13 women) HD patients. All patients had computed tomography (CT) to determine aortic calcification index (ACI), pulse wave velocity (PWV) using a volume-plethysmographic apparatus, and BMD estimated by digital image processing (DIP).
Results:   Patients, 84.3% male, 38.6% diabetic, had a mean age of 59.3 ± 11.2 years. In univariate linear regression analysis, ACI correlated positively with age ( r  = 0.586, P  < 0.0001), dialysis vintage ( r  = 0.47, P  = 0.002), pulse pressure ( r  = 0.311, P  = 0.004), C-reactive protein (CRP) ( r  = 0.226, P  = 0.0397) and PWV ( r  = 0.422, P  < 0.0001). There was no significant association between ACI and serum markers of mineral metabolism. There was also a positive association between PWV and systolic blood pressure ( P  = 0.0004) or pulse pressure ( P  < 0.0001), and a trend towards greater PWV with increasing age ( r  = 0.494). In multivariate regression analysis only increasing age, pulse pressure, serum levels of albumin and CRP were significantly associated with ACI and PWV. Mean BMD on DIP was 2.7 ± 0.4 mmAL. ACI was inversely correlated with BMD ( r  = −0.234, P  = 0.0331).
Conclusions:   Vascular calcification is closely associated with arterial stiffness in HD patients. BMD is inversely correlated with ACI, suggesting that measurement of hand BMD by DIP is a useful tool for assessment of renal bone disease in these patients.     

Leptinemia and its association with stroke and coronary heart disease in the Jackson Heart Study

Background  To examine the association of increased plasma leptin concentration with prevalent stroke and coronary heart disease (CHD) and to examine the genetic contributions of leptin to this association in the Jackson Heart Study cohort.
Methods  A cohort of 5170 participants aged 21–84 years who underwent Exam I during 2000–2004 was analysed. Odds ratios (OR) of prevalent stroke and CHD were calculated using a logistic regression model adjusted for age, smoking, hypertension and waist circumference (WC). Variance component analysis was used to partition the phenotypic variance of leptin into the polygenic and environmental components.
Results  The prevalence of stroke and CHD was 4·04% and 5·85% in women, and 4·88% and 8·92% in men, respectively. Body mass index (BMI) and WC were highly correlated with leptin both in men and women. In multivariate analysis stratified by sex, leptin was significantly associated with stroke (OR = 1·97, 95% CI = 1·21–3·21) in women after adjustment for age, smoking, systolic blood pressure, BMI and WC ( P  = 0·0079). No significant association was observed in men. Heritability of sex-, age-adjusted log-transformed leptin for this cohort was 38·0% and 37·8% after further adjustment for WC and hypertension, respectively. In addition, a sibship effect was also found to be significant and explained 12·2% of the total variance of leptin ( P  = 0·007).
Conclusion  There is a significant association of leptin with stroke in women, which is partly influenced by the genetic factor. The findings suggest that leptinemia is an independent risk factor for stroke in African American women.     

A new 'total' activin B enzyme-linked immunosorbent assay (ELISA): development and validation for human samples

Background and objective  There are currently no sensitive and specific assays for activin B that could be utilized to study human biological fluids. The aim of this project was to develop and validate a 'total' activin B ELISA for use with human biological fluids and establish concentrations of activin B in the circulation and fluids from the reproductive organs.
Design  The new ELISA was validated and then used to measure activin B levels in the circulation of healthy participants, IVF patients, pregnant women and in ovarian follicular fluid and seminal plasma.
Patients and measurements  Healthy adult subjects ( n  = 143), subjects from an IVF clinic ( n  = 27) and pregnancy groups ( n  = 29) were sampled.
Results  The sensitivity of the assay was 0·019 ng/ml. Validation of the activin B ELISA showed good recovery (90·7 ± 9·8%) and linearity in biological fluid and cell culture media and low cross-reactivity with related analytes (inhibin B = 0·077% and activin A = 0·0034%). There was a negative correlation between activin B concentration ( r  = −0·281, P  < 0·011) and females with increasing age. Patients attending IVF clinics had significantly lower levels of activin B compared with gender-matched control subjects. Ovarian follicular fluid and seminal plasma had 50–80 fold higher levels of activin B (mean = 5·35 and 3·66 ng/ml respectively) than sera (mean = 0·071 ng/ml).
Conclusions  This fully validated ELISA for activin B offers a tremendous utility for measuring this protein in a variety of normal physiological processes and in various clinical pathologies.     

Spinal volumetric trabecular bone mass in acromegalic patients: a longitudinal study

Objective  Data on trabecular bone mass in acromegaly are controversial. All the studies are cross-sectional and bone mineral density (BMD) has been evaluated largely by dual X-ray absorptiometry (DXA), which is influenced by bone enlargement. In this study we assessed in acromegalic patients the effects overtime of GH excess on trabecular bone mass measured by single-energy quantitative computed tomography (QCT) which is not influenced by bone size.
Design  Longitudinal retrospective study.
Patients  A total of 46 acromegalic patients followed-up for 48 months (median), subdivided into four groups: group A (eugonadal patients with active disease: n  = 13), group B (hypogonadal patients with active disease; n  = 9), group C (eugonadal patients with controlled disease; n  = 10), group D (hypogonadal patients with controlled disease; n  = 14).
Measurements  Serum GH and IGF-I levels, spinal trabecular BMD, and vertebral fractures were evaluated in all patients. BMD variations were reported as change (Δ) in Z -values (Z-QCT) measured at baseline and end of follow-up per year (Δ Z-QCT).
Results  Δ Z-QCT was greater in group A vs. group B and D ( P = 0·002 and P  = 0·0001, respectively) and in group C vs. group D ( P = 0·009). Multivariate regression analysis showed that hypogonadal status (β = –0·69; P  = 0·001) and baseline duration of hypogonadism (β = 0·44; P  = 0·02) but not baseline duration of acromegaly, length of follow-up and disease activity, were significantly associated with Δ Z-QCT.
Conclusions  This longitudinal study suggests that the effect of chronic GH excess on spinal trabecular bone mass seems to be anabolic in active eugonadal patients but not in hypogonadal ones.     

Small, dense low-density lipoproteins (LDL) are predictors of cardio- and cerebro-vascular events in subjects with the metabolic syndrome

Objective  Small, dense low-density lipoproteins (LDL) are a feature of the metabolic syndrome (MS) but their predictive role still remains to be established. We performed a 2-year follow-up study in 124 subjects with MS (63 ± 6 years), as defined by the American Heart Association/National Heart, Lung and Blood Institute guidelines, to assess clinical and biochemical predictors of cerebro- and cardio-vascular events.
Methods and results  Beyond traditional cardiovascular risk factors, we measured LDL size and subclasses by gradient gel electrophoresis. Clinical events were registered in the 25% of subjects. At univariate analysis subjects with events had increased prevalence of elevated fasting glucose ( P  = 0·0117), smoking ( P  = 0·0015), family history of coronary artery disease ( P  = 0·0033) and higher levels of total- and LDL-cholesterol ( P  = 0·0027 and P  = 0·0023, respectively); LDL size was lower ( P  < 0·0001), due to reduced larger subclasses and increased small, dense LDL (all P  < 0·0001). At multivariate analysis the following were independent predictors of events (univariate odd ratios were calculated): low HDL-cholesterol (OR 15·4, P  = 0·0238), elevated fasting glucose (OR 12·1, P  = 0·0102), elevated small, dense LDL (OR 11·7, P  = 0·0004), elevated blood pressure (OR 9·2, P  = 0·0392), smoking (OR 4·8, P  = 0·0054).
Conclusions  This is the first study that assessed the predictive role of small, dense LDL beyond traditional cardiovascular risk factors in subjects with MS.     

Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid

The optimal management of menorrhagia among women with abnormal laboratory haemostasis is uncertain. In a crossover study, 116 women with menorrhagia [pictorial blood assessment chart (PBAC) score >100], negative gynaecological evaluation and abnormal laboratory haemostasis were randomly assigned to either intranasal desmopressin (IN-DDAVP) or tranexamic acid (TA) therapy for two menstrual cycles. The subjects then crossed over to the second study drug for two additional cycles. Menstrual blood loss (MBL) was measured by PBAC scores at baseline and after each menstrual cycle. Quality of life (QOL) was assessed with four validated instruments. There was a statistically significant decrease in PBAC scores for both treatments. On average, the estimated decrease in the PBAC from baseline was −64·1 [95% confidence interval (CI) = −88·0, −40·3] for IN-DDAVP and −105·7 (95% CI = −130·5, −81·0) for TA. The decrease in PBAC score was greater for TA than IN-DDAVP (a difference of 41·6, P -value = 0·0002, 95% CI = 19·6, 63·6). The test for treatment-type effect was significant ( P  < 0·0001) suggesting a greater reduction in PBAC score with TA. Use of both IN-DDAVP and TA improved QOL by all four instruments. We conclude that both medications reduced MBL and improved QOL among females with menorrhagia and abnormal laboratory haemostasis, but TA proved more effective.     

Iodine status in pregnancy: role of dietary habits and geographical origin

Objectives  A study was conducted on iodine status during pregnancy and its dependence on dietary habits, racial and geographical origin, and time since arrival in Italy.
Design and methods  We enrolled 322 consecutive pregnant women: 217 Italians, 62 Eastern Europeans and 43 from Northern and Central Africa. All women completed a food frequency questionnaire on their dietary habits. The urinary iodide concentration (UIC) was determined in spot morning urine samples.
Results  In the group as a whole, the median UIC was 83 µg/l; the UIC was < 50 in 33% and of 150 µg/l or more in 27%; it was significantly lower in Africans and Eastern Europeans than in Italians (medians 45 and 46 vs. 100 µg/l, respectively, P  = 0·005). For the foreign women, there was a significant correlation between UIC and time since arrival in Italy ( r  = 0·22, P  = 0·02). A significant link emerged between UIC and cow's milk intake ( P =  0·0001). Iodine supplements were used by 40% of the women, and UIC were higher in those who did so than in those who did not (median 103 vs. 75 µg/l, P  = 0·03), particularly if the latter did not drink milk (median 98 vs. 42 µg/l, P  = 0·01). Multivariate analysis showed that milk was the only variable influencing UIC (OR 1·29, P  = 0·0005).
Conclusions  (i) Iodine levels are too low among pregnant women in our region, and particularly in foreign women. (ii) Cow's milk intake is their main source of iodine. (iii) Iodine supplementation is mandatory during pregnancy, particularly for women do not drink milk.     

Association of plasma visfatin levels with inflammation, atherosclerosis and acute coronary syndromes (ACS) in humans

Objectives  Visfatin is a new cytokine that act as an insulin analogue on the insulin receptor and may link obesity and insulin resistance. It was recently shown that visfatin plays a role in plaque destabilization. However, the role of visfatin in atherosclerosis remains to be elucidated. We sought to assess whether plasma visfatin level is independently associated with inflammation, atherosclerosis and acute coronary syndromes (ACS).
Design and patients  Two hundred and fifty-three patients undergoing coronary angiography were divided into three subgroups: chronic coronary artery disease (CAD) ( n  = 102), ACS ( n  = 100) and control patients ( n  = 51). The plasma samples were thawed and analysed for circulating visfatin, monocyte chemoattractant protein 1 (MCP-1), interleukin-6 (IL-6), high sensitivity C-reactive protein (hs-CRP). The association of visfatin with risk factors, inflammation, atherosclerosis, and ACS was determined.
Results  Plasma visfatin levels were significantly higher in chronic CAD and ACS compared with control patients. Multiple regression analysis demonstrated that plasma visfatin levels correlated with inflammatory factors and were associated with chronic CAD (odds ratio [OR][95% confidence interval], for second, third and fourth quartiles were 1·74 [0·96–2·69], 1·54 [0·85–2·28] and 1·84 [0·98–2·87], respectively) and ACS (ORs for second, third and fourth quartiles were 2·56 [1·57–3·34], 4·61 [1·94–10·96] and 6·52 [2·34–18·12], respectively) following adjustment for established risk factors and other inflammatory factors.
Conclusions  Plasma visfatin levels are significantly associated with CAD, particularly ACS, independent of well-known CAD risk factors.     

Accelerated bone loss in post-menopausal women with mild primary hyperparathyroidism

OBJECTIVES Osteopenia is regarded as an indication for parathyroidectomy in primary hyperparathyroidism. However, uncertainty exists as to the extent and degree of the skeletal effects in those with mild disease. We sought to determine whether mild primary hyperparathyroidism affects the rate of bone loss in post-menopausal women.
DESIGN Prospective 2-year comparison of rates of bone loss throughout the skeleton in 17 post-menopausal women with untreated mild asymptomatic primary hyperparathyroidism, and 48 age-matched, eucalcaemic controls.
RESULTS The women with primary hyperparathyroidism had a greater annual rate of loss of bone mineral density (BMD) of the total body (mean ± SE, primary hyperparathyroidism −1.15 ± 0.31%, controls −0.39 ± 0.10%; P  = 0.04) and its spine subregion (primary hyperparathyroidism −2.08 ± 0.88%, controls 0.04 ± 0.35%; P  = 0.02). Lumbar spine BMD tended to decline in the primary hyperparathyroidism group (−0.35 ± 0.33%) in contrast to the control group (+ 0.28 ± 0.22%) ( P  = 0.10). There were no significant differences between the groups in rates of change of BMD in the legs or the proximal femur. In the primary hyperparathyroidism group, the rate of total body bone loss in the eight women known at study entry to have had long-standing (>5 years) primary hyperparathyroidism was −1.52 ± 0.61%/year, similar to that of the whole group.
CONCLUSION Primary hyperparathyroidism is associated with an increased rate of loss of total body bone mineral density in post-menopausal women. Prolonged disease duration is therefore likely to be associated with an increasing risk of osteopenia, such that skeletal surveillance and interventions designed to reduce bone loss should be considered.     

Effect of metformin, orlistat and pioglitazone treatment on mean insulin resistance and its biological variability in polycystic ovary syndrome

Context  Mean insulin resistance (IR) is greater and it is also more variable in overweight women with polycystic ovarian syndrome (PCOS) compared to weight matched controls. Whilst treatment will reduce the mean IR, it is not known if the IR variability is also reduced.
Objective  To compare the change in IR and its variability before and after treatment with insulin sensitization through metformin and pioglitazone, compared to that induced by weight loss with orlistat.
Design  Randomized, open labelled parallel study.
Setting  Endocrinology outpatient clinic at a referral centre.
Patients  Thirty obese PCOS patients [BMI 36·0 ± 1·2 kg/m² (mean ± SEM)] participated in the study.
Intervention  The change in biological variability (BV) was assessed by measuring IR (homeostasis model assessment method) at 4-day intervals on 10 consecutive occasions before and 12 weeks after randomization to metformin, pioglitazone or orlistat.
Outcome measured  The primary end point of the study was a change in BV of IR.
Results  Treatment with pioglitazone, orlistat and metformin reduced the overall IR by 41·0 ± 4·1%, 19·7 ± 6·4% and 16·1 ± 6·8% ( P =  0·005, P  = 0·013, P  = 0·17, respectively) and IR variability by 28·5 ± 18·0%, 41·8 ± 11·6% and 23·7 ± 17·0 ( P =  0·20, P  = 0·015 and P  = 0·28, respectively). Free androgen index reduced significantly with all treatments.
Conclusion  Only orlistat reduced both IR and its variability significantly, though all three drugs were effective in reducing hyperandrogenism within the 12-week period of the study.     

Insulin effect on adipose tissue (AT) adiponectin expression is regulated by the insulin resistance status of the patients

Objective  The objective of the present study was to determine a possible depot-specific effect of insulin-stimulation on adiponectin gene expression in adipose tissue (AT) explants from subcutaneous and visceral AT. A secondary aim was to analyse the associations of adiponectin plasma levels, as well as control and insulin-stimulated gene expression levels with different features of the metabolic syndrome.
Design  Visceral and subcutaneous AT biopsies were obtained from 20 subjects (10 men and 10 women) with morbid obesity. Metabolic syndrome and other clinical features were studied. Adiponectin expression from isolated adipocytes was measured both in control and after insulin-stimulation conditions by quantitative PCR.
Results  Subcutaneous adipocytes expressed significantly higher amounts of adiponectin mRNA than visceral tissue ( P =  0·027). Insulin increased adiponectin expression specifically in the omental tissue ( P =  0·011). In these patients, waist : hip ratio was directly correlated with adiponectin expression in the visceral depot ( r  = 0·660; P  = 0·014), while fasting glucose levels were inversely associated with adiponectin mRNA in the subcutaneous tissue ( r  = – 0·604; P  = 0·022). Adiponectin expression after addition of insulin was positively correlated with some metabolic risk factors (cholesterol, LDL-cholesterol, insulin, C-peptide). Interestingly, local insulin induced an up-regulation of adiponectin expression in the AT of those patients with higher metabolic syndrome disturbances.
Conclusions  Our results clearly demonstrate that insulin exerts a stimulating effect on adiponectin gene expression in a depot-specific manner. The AT response to insulin stimulus depends on the physiopathological situation, being higher in those individuals with impaired insulin-sensitivity and lipid metabolism.     

A randomized comparison of transfusion triggers in elective orthopaedic surgery using leucocyte-depleted red blood cells

Objective  In elective orthopaedic hip- and knee replacement surgery patients, we studied the effect of implementation of a uniform transfusion policy on RBC usage.
Study Design and Methods  A randomized, controlled study. A new uniform, restrictive transfusion policy was compared with standard care, which varied among the three participating hospitals. Only prestorage leucocyte-depleted RBC(s) were used. Primary end-point was RBC usage, related to length of hospital stay. Secondary end-points were Hb levels, mobilization delay and postoperative complications.
Results  Six hundred and three patients were evaluated. Adherence to the protocol was over 95%. Overall mean RBC usage was 0·78 U/patient in the new policy group and 0·86 U/patient in the standard care policy group (mean difference 0·08;95% CI [−0·3; 0·2]; P  = 0·53). In two hospitals, the new transfusion policy resulted in a RBC reduction of 30% (0·58U RBC/patient) ( P  = 0·17) and 41% (0·29 U RBC/patient) ( P  = 0·05) respectively. In the third hospital, however, RBC usage increased by 39% (0·31 U RBC/patient) ( P  = 0·02) with the new policy, due to a more restrictive standard care policy in that hospital. Length of hospital stay was not influenced by either policy.
Conclusions  Implementation of a uniform transfusion protocol for elective lower joint arthroplasty patients is feasible, but does not always lead to a RBC reduction. Length of hospital stay was not affected.     

Association of a single-nucleotide polymorphism in the promoter region of leukemia inhibitory factor receptor gene with low bone mineral density in adult women

Background:   Osteoporosis is believed to result from the interaction among multiple environmental and genetic determinants that regulate bone-mineral density (BMD).
Methods:   To investigate a potentially predisposing genetic factor in the onset of osteoporosis, we looked for a possible association between BMD in adult Japanese women and known polymorphisms in the leukemia inhibitory factor receptor gene (LIFR).
Results:   An association analysis of chromosomes from 384 volunteer subjects revealed significant correlation between the −603T > C variant of LIFR and radial BMD ( r  = 0.11, P  = 0.032) in this test population. Comparisons of mean values of adjusted radial BMD among separate genotypic groups implied an allelic dosage effect, because homozygous carriers of T alleles of that SNP had the highest adjusted BMDs (0.403 ± 0.054 g/cm²); women homozygous for the C-allele had the lowest (0.373 ± 0.042 g/cm²), and heterozygous individuals had intermediate scores (0.394 ± 0.056 g/cm²).
Conclusion:   This polymorphism in LIFR may be an important determinant of predisposition to postmenopausal osteoporosis.     

Maternal thyroid hormone concentration during late gestation is associated with foetal position at birth

Objective  To evaluate whether there is an association between maternal thyroid hormone and foetal cephalic head position at term gestation.
Context  Rotation and flexion of the head enables the foetus to negotiate the birth canal. Low-normal range thyroid hormone concentrations in euthyroid pregnant women constitute a risk of infant motor abnormality. We hypothesized that low normal maternal thyroid hormone levels are associated with increased risk of abnormal foetal position at delivery.
Design  In 960 healthy Dutch women with term gestation and cephalic foetal presentation, thyroid parameters [foetal T4 (FT4), TSH and thyroid peroxidase antibody] were assessed at 36 weeks of gestation, and related to foetal head position (anterior cephalic vs. abnormal cephalic) and delivery mode (spontaneous vs. assisted delivery).
Results  Women presenting in anterior position ( n  = 891) had significantly higher FT4 levels at 36 weeks of gestation than those with abnormal cephalic presentation ( n  = 69). There were no between-group differences for TSH. Regression analyses indicated that the risk of abnormal head position decreased as a function of increasing FT4 [single odds ratio (OR) = 0·87, 95% confidence intervals (CI) 0·77–0·98; multivariate OR = 0·88, 95% CI 0·72–0·99)]. A similar inverse relationship between maternal FT4 and risk of assisted delivery was obtained (OR = 0·86, 95% CI 0·79–0·95; OR = 0·91, 95% CI 0·84–0·98).
Conclusion  The lower the maternal FT4 concentration at 36 weeks of gestation, the higher the risk of abnormal cephalic foetal presentation and assisted delivery.     

Risk factors for coronary calcification in older subjects. The Rotterdam Coronary Calcification Study.

AIMS: We examined associations between cardiovascular risk factors and coronary calcification assessed by electron-beam tomography (EBT) in an unselected population of older subjects. METHODS AND RESULTS: The Rotterdam Coronary Calcification Study is a population-based study in subjects > =55 years. Participants underwent EBT scanning. Coronary calcification was quantified according to the Agatston score. Cardiovascular risk factors were assessed 7 years before and concurrently to scanning. We used the first 2013 participants for the present analyses. Risk factors assessed 7 years before scanning were strongly associated with calcium score. Associations with blood pressure and cholesterol attenuated when measured concurrently to scanning. Although the number of risk factors was strongly associated with a high calcium score in asymptomatic subjects, 29% of the men and 15% of the women without risk factors had a high calcium score. CONCLUSIONS: This population-based study in older subjects shows that cardiovascular risk factors are associated with coronary calcification. Associations were stronger for risk factors measured at earlier age. Almost 30% of the men and 15% of the women without risk factors had extensive coronary calcification.     

Self-Reported Dietary Intake of Omega-3 Fatty Acids and Association with Bone and Lower Extremity Function

OBJECTIVES: To assess the relationship between self-reported omega-3 fatty acid (O3FA) intake and bone mineral density (BMD) and lower extremity function in older adults.
DESIGN: Cross-sectional analysis of baseline information from three separate ongoing studies of older adults, pooled for this analysis.
SETTING: Academic health center.
PARTICIPANTS: Two hundred forty-seven men (n=118) and women (n=129) residing in the community or an assisted living facility.
MEASUREMENTS: Self-reported dietary intake (O3FA, omega-6 fatty acids (O6FA), protein, and total calorie); BMD of the hip or heel; and lower extremity function including leg strength, chair rise time, walking speed, Timed Up and Go, and frailty.
RESULTS: The mean reported intake of O3FA was 1.27 g/day. Correlation coefficients ( r ) between O3FA and T-scores from total femur (n=167) were 0.210 and 0.147 for combined femur and heel T scores. Similar correlations were found for leg strength ( r =0.205) and chair rise time ( r =−0.178), but the significance was lost when corrected for protein intake. Subjects with lower reported O3FA intake (<1.27 g/day) had lower BMD than those with higher reported O3FA intake. In a multiple regression analysis with femoral neck BMD as the dependent variable and reported intake of O3FA, O6FA, protein, and vitamin D as independent variables, reported O3FA intake was the only significant variable, accounting for 6% of the variance in BMD.
CONCLUSION: Older adults had low reported intakes of O3FA. There was an association between greater reported O3FA intake and higher BMD. There was no independent association between reported O3FA intake and lower extremity function. Results from this preliminary report are promising and suggest further investigation.     

Early detection of premature subclinical coronary atherosclerosis in systemic lupus erythematosus patients

ObjectiveTo elucidate early coronary atherosclerotic changes in premenopausal systemic lupus erythematosus (SLE) female patients without clinical cardiovascular manifestation using a 64-slice Multi-detector computed tomography (MDCT) scan to detect coronary calcification and measure coronary calcium score (CCS), and to find out its correlation to some traditional and non-traditional risk factors.MethodologySixty consecutive premenopausal SLE female patients, and sixty age and sex matched healthy subjects without known systemic, immunological, or cardiovascular disease (served as a control group) underwent clinical examination, serological analysis, and 64-slice MDCT-based coronary calcium scoring. All the clinical, serological, and MDCT parameters of the patients were correlated.ResultsCoronary calcification (CC) was seen in 21 patients (35%), the number of atherosclerotic calcified plaques ranged from 0 to 19. Calcium scores ranged from 0 to 843. In contrast to control subjects, SLE patients had significantly higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total cholesterol level, low-density lipoprotein (LDL), immunoglobulin G (IgG) and IgM anti-cardiolipin antibodies, serum intracellular adhesion molecule (sICAM) and E-selectin levels. SLE patients had highly significantly more atherosclerotic plaques (3 ± 0.66 compared to 0.1 ± 0.07, p < 0.001) and higher CCS (59.2 ± 20.3 compared to 2.6 ± 1.85, p < 0.001). Significant positive correlation was found between both number of atherosclerotic plaques and CCS and total cholesterol level, LDL, cumulative prednisone dose, SLE disease activity index (SLEDAI), ESR, CRP, sICAM-1, E-Selectin, and anti-cardiolipin antibodies (p < 0.05 in all).ConclusionPre-menopausal SLE female patients free from clinical atherosclerotic vascular disease have an increased number of atherosclerotic plaques and CCS, which correlate positively with SLEDAI disease activity score, serum CRP, anticardiolipin antibodies, sICAM-1, E-Selectin, LDL level, total cholesterol level, and cumulative prednisone dose. In addition, we conclude that MDCT is a non-invasive, sensitive, reproducible, and reliable tool for accurate measurement of coronary calcification.