Consumption of conjugated linoleic acid (CLA) from CLA-enriched cheese does not alter milk fat or immunity in lactating women

Isomers of conjugated linoleic acid (CLA) decreased milk fat, altered immunity, and reduced the risk for cardiovascular disease (CVD) in some animals. The major form of CLA in the human diet is c9,t11-18:2 (rumenic acid; RA). We studied the effects of high RA consumption on plasma and milk RA concentration, milk composition, immunity, and CVD risk factors in lactating women (n = 36) assigned to 1 of 3 treatments: control, low CLA cheese (LCLA; 160 mg RA/d), or high CLA cheese (HCLA; 346 mg RA/d). The increase in plasma RA concentration between baseline and 8 wk in women consuming HCLA cheese was significantly greater than that of controls. At study completion (8 wk), milk RA concentration among women consuming HCLA cheese was greater (P < 0.05) than that of controls (0.37 vs. 0.26% of fatty acids). Treatment did not affect milk fat, protein, or lactose concentrations, immune indices (e.g., plasma T-helper cells and interleukin-2), or measured risk factors for CVD (e.g., plasma triacylglyceride and cholesterol). In summary, consumption of a RA-enriched cheese modestly increased plasma and milk RA concentrations without affecting total milk fat, plasma and milk indices of immunity, or selected risk factors for CVD.     

Smoking,alcohol drinking and non-fatal coronary heart disease in Hong Kong Chinese

PURPOSE: To examine whether smoking, alcohol drinking and other risk factors were associated with non-fatal coronary heart disease (CHD) in Hong Kong Chinese.

METHODS: A case control study was carried out with 598 CHD hospital cases (431 men, 167 women) and 1100 community controls (663 men, 437 women). Standardized questionnaires were used and blood lipids were measured using standard methods.

RESULTS: Stepwise logistic regression models showed adjusted odds ratios (AOR) of 3.36 [95% confidence interval (CI): 2.35 to 4.81] for smoking and 0.32 (95% CI: 0.22 to 0.45) for alcohol drinking in men, and 6.50 (95% CI: 2.61 to 16.19) and 0.15 (95% CI: 0.08 to 0.30), respectively, in women. The OR increased with decreasing levels of high-density lipoprotein cholesterol (HDL) and increasing levels of triglycerides. No patterns were observed for body mass index (BMI), total and low-density lipoprotein cholesterol (LDL). The protective effect of drinking was observed for different types of drinks and frequency of drinking, although few drank alcohol more than 3 days per week.

CONCLUSIONS: Smoking was a strong risk factor and moderate alcohol drinking was a protective factor for CHD, and low HDL and high triglyceride levels were important risk factors in Hong Kong Chinese.     

Changes in cardiovascular disease risk factors among American Indians. The Strong Heart Study

PURPOSE: This study describes changes in cardiovascular disease (CVD) risk factors in older American Indians over a 4-year period. METHODS: The Strong Heart Study, a longitudinal population-based study of CVD and CVD risk factors among American Indians aged 45-74 years, measured CVD risk factors among 3638 members of 13 tribes in three geographic areas during examinations in 1989 to 1991 and 1993 to 1995. RESULTS: Changes in mean low-density lipoprotein (LDL) cholesterol and the prevalence of elevated LDL cholesterol were inconsistent. Mean high- density lipoprotein (HDL) cholesterol decreased, and the prevalence of low HDL cholesterol increased throughout. Mean systolic blood pressure and hypertension rates increased in nearly all center-sex groups, and hypertension awareness and treatment improved. Smoking rates decreased but remained higher than national rates except among Arizona women. Mean weight and percentage body fat decreased in nearly all center-sex groups but the prevalence of obesity did not change significantly in any group. Diabetes and albuminuria prevalence rates increased throughout the study population. The prevalence of alcohol use decreased, but binge drinking remained common in those who continued to drink. CONCLUSIONS: Improvements in management and prevention of hypertension, diabetes, renal disease, and obesity, and programs to further reduce smoking and alcohol abuse, are urgently needed.     

Risk factors and incident coronary heart disease in Chinese, Malay and Asian Indian males: the Singapore Cardiovascular Cohort Study.

OBJECTIVE: This prospective study in Singapore investigated the relationships of established coronary risk factors with incident coronary heart disease (CHD) for Chinese, Malay, and Asian Indian males. SUBJECTS: A cohort (consisting of 2879 males without diagnosed CHD) derived from three previous cross-sectional surveys. METHODS: Individual baseline data were linked to registry databases to obtain the first event of CHD. Hazard ratios (HR) or relative risks for risk factors were calculated using Cox's proportional hazards model with adjustment for age and ethnic group and adjustment for age, ethnic group and all other risk factors (overall adjusted). RESULTS: There were 24,986 person-years of follow-up. The overall adjusted HR with 95% CI are presented here. Asian Indians were at greatest risk of CHD, compared to Chinese (3.0; 2.0-4.8) and Malays (3.4; 1.9-3.3). Individuals with hypertension (2.4; 1.6-2.7) or diabetes (1.7; 1.1-2.7) showed a higher risk of CHD. High low density lipoprotein cholesterol (LDL-C) (1.5; 1.0-2.1), high fasting triglyceride (1.5; 0.9-2.6) and low high density lipoprotein cholesterol (HDL-C) (1.3; 0.9-2.0) showed a lesser but still increased risk. Alcohol intake was protective with non-drinkers having an increased risk of CHD (1.8; 1.0-3.3). Obesity (body mass index > or =30) showed an increased risk (1.8; 0.6-5.4). An increased risk of CHD was found in cigarette smokers of > or =20 pack years (1.5; 0.9-2.5) but not with lesser amounts. CONCLUSIONS: The increased susceptibility of Asian Indian males to CHD has been confirmed in a longitudinal study. All of the examined established risk factors for CHD were found to play important but varying roles in the ethnic groups in Singapore.     

Changes in women's plasma lipid and lipoprotein concentrations due to moderate consumption of alcohol are affected by dietary fat level.

We studied the impact of substituting ethanol for dietary carbohydrate, in high- and low-fat diets, on plasma lipids and lipoprotein concentrations. During a 12-wk, weight maintaining, controlled feeding study, women consumed only food and beverage provided by the Human Studies Facility of the USDA Beltsville Human Nutrition Research Center. Twenty-six women (age 41-59 y) consumed either a high-fat diet (38% of energy from fat) or a low-fat diet (18% of energy from fat) for 12 wk. The 12-wk feeding period was divided into two 6-wk periods in a cross-over design during which either ethanol or carbohydrate was added to the diet (5% of total daily energy intake). When the women consuming the high-fat diet had ethanol added to their diet, they had 6% lower plasma cholesterol (P = 0.003), 11% lower LDL cholesterol (P = 0.001) and 3% higher HDL cholesterol (P = 0.06) than when they had an equal amount (% energy) of carbohydrate added to their diet. The greater HDL cholesterol concentration was due to a 21% greater the HDL(2) subfraction (P = 0. 001). The ratio of LDL to HDL cholesterol was 14% lower. No significant differences existed in plasma lipids in women consuming the low-fat diet between the periods in which they had ethanol or carbohydrate added to their diet. This study suggests that the decreases in cardiovascular disease risk factors typically seen with moderate alcohol consumption may not be evident in individuals consuming a diet low in fat. Therefore changes in the risk factors associated with a low-fat diet and moderate alcohol consumption do not appear to be additive.     

Mortality in relation to alcohol consumption: a prospective study among male British doctors

BACKGROUND: To relate alcohol consumption patterns to mortality in an elderly population. METHODS: We undertook a 23-year prospective study of 12 000 male British doctors aged 48-78 years in 1978, involving 7000 deaths. Questionnaires about drinking and smoking were completed in 1978 and once again in 1989-91. Mortality analyses are standardized for age, follow-up duration, and smoking, and (during the last decade of the study, 1991-2001) subdivide non-drinkers into never-drinkers and ex-drinkers. RESULTS: In this elderly population, with mean alcohol consumption per drinker of 2 to 3 units per day, the causes of death that are already known to be augmentable by alcohol accounted for only 5% of the deaths (1% liver disease, 2% cancer of the mouth, pharynx, larynx, or oesophagus, and 2% external causes of death) and were significantly elevated only among men consuming >2 units/day. Vascular disease and respiratory disease accounted for more than half of all the deaths and were both significantly less common among current than among non-drinkers; hence, overall mortality was also significantly lower (relative risk, RR 0.81, CI 0.76-0.87, P = 0.001). The non-drinkers, however, include the ex-drinkers, some of whom may have stopped recently because of illness, and during the last decade of the study (1991-2001) overall mortality was significantly higher in the few ex-drinkers who had been current drinkers in 1978 than in the never-drinkers or current drinkers. To avoid bias, these 239 ex-drinkers were considered together with the 6271 current drinkers and compared with the 750 men who had been non-drinkers in both questionnaires. Even so, ischaemic heart disease (RR 0.72, CI 0.58-0.88, P = 0.002), respiratory disease (RR 0.69, CI 0.52-0.92, P = 0.01), and all-cause (RR 0.88, CI 0.79-0.98, P = 0.02) mortality were significantly lower than in the non-drinkers. CONCLUSIONS: Although some of the apparently protective effect of alcohol against disease is artefactual, some of it is real.     

Alcohol consumption, binge drinking, and early coronary calcification: findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study

It is unclear to what extent the apparently beneficial cardiovascular effects of moderate alcohol consumption are mediated by protection against atherosclerosis. Alcohol consumption, coronary heart disease risk factors, and coronary calcification (a marker of atherosclerosis) were measured during 15 years of follow-up in the Coronary Artery Risk Development in Young Adults (CARDIA) Study (1985-2001). Among 3,037 participants aged 33-45 years after follow-up (55% women, 45% Black), the prevalence of coronary calcification was 8% for consumption of 0 drinks/week (n = 1,435), 9% for 1-6 drinks/week (n = 1,023), 13% for 7-13 drinks/week (n = 341), and 19% for > or = 14 drinks/week (n = 238) (p < 0.001 for trend). Calcification was also more common among binge drinkers (odds ratio = 2.1, 95% confidence interval: 1.6, 2.7). These associations persisted after adjustment for potential confounders (age, gender/ethnicity, income, physical activity, family history, body mass index, smoking) and intermediary factors (lipids, blood pressure, glucose, C-reactive protein, and fibrinogen). Stratification showed the dose-response relation most clearly in Black men; only heavier alcohol consumption (> or = 14 drinks/week) was associated with coronary calcification in other race/sex subgroups. These surprising findings suggest the presence of proatherogenic effects of alcohol in young adults, especially Black men, which may counterbalance high density lipoprotein cholesterol elevation and other possible benefits of alcohol consumption.     

Effect of a low glycemic index diet with soy protein and phytosterols on CVD risk factors in postmenopausal women

OBJECTIVES: Cardiovascular disease (CVD) is the leading cause of death in women. Hyperlipidemia is a major risk factor for CVD, but research suggests that metabolic syndrome and type 2 diabetes are also key factors in CVD in postmenopausal women. Most dietary programs, however, focus only on hyperlipidemia and not on insulin resistance associated with diabetes and metabolic syndrome. This 12-wk trial compared the effects of a dietary program combining a low glycemic index diet with a functional food delivering 30 g of soy protein and 4 g of phytosterols per day (LGID) with a standard dietary program (American Heart Association Step 1 diet; AHAD) in postmenopausal women. METHODS: Fifty-nine postmenopausal women (average age 54.6 y, range 44-65 y) with a body mass index of 27 to 39 kg/m2 were randomly assigned to the LGID or the AHAD program for 12 wk. Total caloric intake and exercise were matched in each arm. RESULTS: Twenty-seven women completed the LGID program, and 26 completed the AHAD program. The participants on the LGID program showed statistically significant decreases in total cholesterol (15.8%, P = 0.0036 between-group comparison), low-density lipoprotein cholesterol (14.8%, P = 0.004 between-group comparison), and triacylglycerol (44.8%, P = 0.006 between-group comparison). In addition, significant improvements were observed in ratios of total to high-density lipoprotein cholesterol and of triacylglycerol to high-density lipoprotein cholesterol, blood pressure, and Framingham risk assessment for coronary heart disease compared with the AHAD program. CONCLUSIONS: A significantly greater improvement was observed in CVD risk factors in postmenopausal women on the LGID program (incorporating 30 g of soy protein and 4 g of phytosterols per day) than with a standard therapy.     

Do trans fatty acids from industrially produced sources and from natural sources have the same effect on cardiovascular disease risk factors in healthy subjects? Results of the trans Fatty Acids Collaboration (TRANSFACT) study

BACKGROUND: The consumption of monounsaturated trans fatty acids (TFAs) increases the risk of cardiovascular disease (CVD). Putative differences between the effects of TFAs from industrially produced and natural sources on CVD risk markers were not previously investigated in healthy subjects. OBJECTIVE: We aimed to compare the effects of TFAs from industrially produced and natural sources on HDL and LDL cholesterol, lipoprotein particle size and distribution, apolipoproteins, and other lipids in healthy subjects. DESIGN: In a randomized, double-blind, controlled, crossover design, 46 healthy subjects (22 men and 24 women) consumed food items containing TFAs (11-12 g/d, representing approximately 5% of daily energy) from the 2 sources. RESULTS: Forty subjects (19 men and 21 women) completed the study. Compared with TFAs from industrially produced sources, TFAs from natural sources significantly (P = 0.012) increased HDL cholesterol in women but not in men. Significant (P = 0.001) increases in LDL-cholesterol concentrations were observed in women, but not in men, after the consumption of TFAs from natural sources. Apolipoprotein (apo)B and apoA1 concentrations confirmed the changes observed in LDL and HDL cholesterol. Analysis of lipoprotein subclass showed that only large HDL and LDL concentrations were modified by TFAs from natural sources but not by those from industrially produced sources. CONCLUSIONS: This study shows that TFAs from industrially produced and from natural sources have different effects on CVD risk factors in women. The HDL cholesterol-lowering property of TFAs seems to be specific to industrial sources. However, it is difficult in the present study to draw a conclusion about the effect of TFAs from either source on absolute CVD risk in these normolipidemic subjects. The mechanism underlying the observed sex- and isomer-specific effects warrants further investigation.     

Smoking,blood pressure and serum cholesterol-effects on 20-year mortality

BACKGROUND: To study the impact of smoking and blood pressure conditional on serum total cholesterol levels, we investigated the 20-year mortality risk associated with high systolic blood pressure (> or =140 mmHg) and smoking, at low (<5.2 mmol/Liter), medium (5.2-6.49mmol/Liter), and high (> or =6.5 mmol/Liter) serum total cholesterol levels. METHODS: The study population comprised a cohort of 50,000 men and women age 30-54 years, examined between 1974 and 1980, in five Dutch towns. The duration of follow-up averaged 20 years. Age-adjusted relative risks (RRs) for mortality from coronary heart disease (CHD), cardiovascular diseases (CVD) and all causes were estimated, for six risk profiles (based on levels of total cholesterol, systolic blood pressure and smoking), using Cox proportional hazards analysis. RESULTS: Given a low cholesterol level, smoking had a larger impact than elevated blood pressure on CHD, CVD and all-cause mortality. The combination of elevated blood pressure and smoking among persons with low cholesterol was associated with RRs of 3.0 for CHD, 6.0 for CVD and 4.1 for all-cause mortality in men, and 2.3, 3.6 and 2.6, respectively, in women. Among persons with high cholesterol, the combination of high blood pressure and smoking was associated with RRs of 9.7 for CHD, 13.9 for CVD and 5.7 for all-cause mortality in men, and 15.9, 9.3 and 4.3, respectively, in women. For each risk profile, the absolute number of CHD, CVD and total deaths was larger in men than in women. CONCLUSIONS: The results demonstrate the potential power of a multifactorial approach to risk factor reduction in the prevention of cardiovascular diseases and all-cause mortality.     

Accuracy of lipoprotein lipids and apoproteins in predicting coronary heart disease in diabetic American Indians. The Strong Heart Study

PURPOSE: To evaluate the accuracy of lipoprotein lipids and apoproteins in predicting coronary heart disease (CHD) in diabetic American Indians. METHODS: This study included 2099 diabetic participants of the Strong Heart Study, which is a longitudinal study of cardiovascular disease (CVD) and its risk factors in American Indians in Arizona, Oklahoma, and South and North Dakota. Diabetic participants with incident CHD (N = 126) were selected as the case group, and those without CHD or any cardiovascular events were the control group (N = 1732). Previous vascular events such as stroke were the sole exclusion criterion (N = 241). Baseline measurements of lipoprotein lipids and apoproteins were used to predict CHD diagnosed at the 4-year follow-up examination by using Receiver-Operating Characteristic (ROC) curve analysis. RESULTS: The ratio of high-density lipoprotein (HDL) to total cholesterol had the highest area under the ROC curve (0.69 +/- 0.02). The areas for the ratios of HDL to low-density lipoprotein (LDL) cholesterol (0.68 +/- 0.02), apo AI/B (0.66 +/- 0.02), and the single component of total cholesterol (0.64 +/- 0.03) and LDL cholesterol (0.63 +/- 0.05) were not significantly different from the area for HDL/total cholesterol. However, the areas for apo B (0.64 +/- 0.02), HDL cholesterol (0.62 +/- 0.03), triglycerides (0.58 +/- 0.03), and apo AI (0.57 +/- 0.05) were significantly lower than the area for HDL/total cholesterol. Logistic regression analysis indicates that only HDL and LDL cholesterol were significant independent lipoprotein lipid and apoprotein predictors for CHD. The other significant predictors in the model were study center, age, gender, and albuminuria. The ROC area for this model is 0.75. CONCLUSIONS: HDL and LDL cholesterol were the most important independent predictors for incident CHD in diabetic American Indians. The ratios of HDL/total cholesterol, HDL/LDL cholesterol, and apo AI/B had higher accuracy for predicting CHD. Although the values for all lipoprotein lipids and apoproteins and their ratios were not large enough to definitely predict CHD, they can be used as screening tools for CHD in diabetic American Indians.     

Egg consumption, serum total cholesterol concentrations and coronary heart disease incidence: Japan Public Health Center-based prospective study

Limited egg consumption is often recommended to reduce serum cholesterol concentration for the prevention of CHD. We examined the association of egg consumption and total cholesterol concentration with the risk of CHD. A total of 90 735 subjects (19 856 men and 21 408 women, aged 40-59 years in cohort I; 23 463 men and 26 008 women, aged 40-69 years in cohort II) were followed from 1990-4 to the end of 2001 under the Japan Public Health Center-based prospective study. Total cholesterol was obtained in 36 % of the subjects. Men and women were combined for the analyses. The subjects were categorised into four groups according to egg consumption. Subjects with total cholesterol >or=2200 mg/l were less frequent in frequent egg consumption groups in both cohorts (trend P<0.0001). Subjects with <1 d/week of egg consumption were more likely to avoid a cholesterol-rich diet. Egg consumption was not associated with the risk of CHD, although total cholesterol was significantly related to the risk of CHD. The multivariate hazard ratio of CHD in subjects with total cholesterol >or=2400 v. <1800 mg/l was 2.17 (95 % CI 1.22, 3.85; trend P=0.0018). In conclusion, eating eggs more frequently, up to almost daily, was not associated with an increase in CHD incidence for middle-aged Japanese men and women. Subjects with hypercholesterolaemia were less frequently in frequent egg consumption groups, probably because they avoided eating eggs.     

In a prospective study in young people, associations between changes in smoking behavior and risk factors for cardiovascular disease were complex

OBJECTIVE: This study investigates how voluntary changes in tobacco consumption are related to changes in biological risk factors for cardiovascular disease in 21- to 36-year-old men and women. STUDY DESIGN AND SETTING: Data of the Amsterdam Growth and Health Longitudinal Study (AGAHLS) were used to study the association between voluntary changes in tobacco consumption and changes in biological risk factors for cardiovascular disease (CVD) during 4-6 years of follow-up in 165 men and 195 women aged 21-36 years. We used multiple linear regression analyses with corrections for age and changes in other lifestyles. RESULTS: In both sexes, we found trends for a reduction in blood pressure, high-density lipoprotein cholesterol (HDL-C), body weight, and waist-to-hip ratio (WHR) and a rise in the ratio between total serum cholesterol (TC) and HDL-C (TC/HDL-C) with increasing tobacco consumption. Opposite trends were found with reducing tobacco consumption. In women, body weight, WHR, and waist circumference reduced significantly and independently with increasing tobacco consumption and increased significantly with decreasing tobacco consumption. CONCLUSION: These results suggest that voluntary changes in tobacco consumption go together with both healthy and unhealthy changes in biological risk factors for CVD.     

Adherence index based on the AHA 2006 diet and lifestyle recommendations is associated with select cardiovascular disease risk factors in older Puerto Ricans

In 2006, the AHA released diet and lifestyle recommendations (AHA-DLR) for cardiovascular disease (CVD) risk reduction. The effect of adherence to these recommendations on CVD risk is unknown. Our objective was to develop a unique diet and lifestyle score based on the AHA-DLR and to evaluate this score in relation to available CVD risk factors. In a cross-sectional study of Puerto Rican adults aged 45-75 y living in the greater Boston area, information was available for the following variables: diet (semiquantitative FFQ), blood pressure, waist circumference (WC), 10-y risk of coronary heart disease (CHD) (Framingham risk score), and fasting plasma lipids, serum glucose, insulin, and C-reactive protein (CRP) concentrations. We developed a diet and lifestyle score (AHA-DLS) based on the AHA-DLR. The AHA-DLS had both internal consistency and content validity. It was associated with plasma HDL cholesterol (P = 0.001), serum insulin (P = 0.0003), and CRP concentrations (P = 0.02), WC (P < 0.0001), and 10-y risk of CHD score (P = 0.01 in women). The AHA-DLS was inversely associated with serum glucose among those with a BMI < 25 (P = 0.01). Women and men in the highest quartile of the AHA-DLS had lower serum insulin (P-trend = 0.0003) and CRP concentrations (P-trend = 0.002), WC (P-trend = 0.0003), and higher HDL cholesterol (P-trend = 0.008). The AHA-DLS is a useful tool to measure adherence to the AHA-DLR and may be used to examine associations between diet and lifestyle behaviors and CVD risk.     

Gamma-glutamyltransferase, alcohol, and blood pressure. A four year follow-up study

PURPOSE: We performed this study to see: 1) whether gamma-glutamyltransferase (GGT) was a predictor for hypertension irrespective of amount of alcohol consumption; and 2) whether the relationship between alcohol consumption and blood pressure (BP) was different depending on GGT. METHODS: This study included 8170 healthy male workers in a steel manufacturing company who had undergone health examinations in both 1994 and 1998. RESULTS: The adjusted relative risk (RR) for hypertension over four years among those with GGT >or=30 U/L at baseline was 1.6 (95% confidence interval (CI): 1.1-2.4), compared to those with GGT < 30 U/L. This relationship was shown only in drinkers. Among subjects with GGT < 30U/L, no matter how much the subjects drank, the risk of hypertension in drinkers was similar with that of non-drinkers. However, among those with GGT >or=30 U/L, adjusted RRs for light, moderate, and heavy drinkers compared to non-drinkers were 1.4 (95% CI: 0.5-4.5), 5.2 (95% CI: 1.5-18.0), and 5.3 (95% CI: 1.0-27.6). CONCLUSIONS: This study showed that elevated GGT could be a predictor for hypertension in drinkers and the relationship between alcohol consumption and hypertension was shown only among those with GGT >or= 30 U/L at baseline. These findings suggest that increased serum GGT levels may reflect individual susceptibility to the blood pressure raising effect of alcohol.     

Obesity and associated coronary heart disease risk factors in a population of low-income African-American and white women: the North Carolina WISEWOMAN project

BACKGROUND: Obesity has been associated with many co-occurring coronary heart disease (CHD) risk factors as well as CHD mortality. These associations have been shown to vary between African-American and white sample populations. METHODS: The authors examined whether obesity co-occurs with several CHD risk factors (diabetes, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol (HDL-C)), and estimated the 10-year risk for CHD in the North Carolina WISEWOMAN (Well Integrated Screening and Evaluation for Women Across the Nation) study sample. This sample includes low-income African-American and white women (> or = 50 years of age). RESULTS: Among white women (n = 1,284), 34% were overweight (BMI = 25.0-29.99 kg/m(2)) and 35% obese (BMI > or = 30 kg/m(2)); among African-American women (n = 754), 28% were overweight and 59% obese. Among obese and nonobese African-American women, the prevalence of three or more co-occurring risk factors was similar (obese = 17.7% (95% confidence interval (CI): 13.9, 21.6) and nonobese = 13.3% (95% CI: 8.7, 17.8)). By contrast, the prevalence among white women was greater among the obese (26.9% (95% CI: 22.9, 31.0)) than the nonobese (13.0% (95% CI: 9.7, 16.2)). CONCLUSIONS: The differences between and within African-American and white women may be accounted for by the high levels of HDL-C among obese and nonobese African-American women.     

High density lipoprotein cholesterol increases with living altitude

BACKGROUND: The relationship between high density lipoprotein cholesterol (HDL) serum level and the altitude at which people live is controversial. METHODS: A cross-sectional study was carried out in the adult population (30-64 years) of the Island of El Hierro (Canary Islands, Spain). In all, 594 individuals representative of the El Hierro population for gender, age, district and the altitude at which they lived were included. The factors measured included HDL, living altitude, body mass index (BMI), smoking habits, alcohol consumption, diabetes, menopause in women, and physical activity and dietary habits. RESULTS: The HDL showed a correlation with living altitude (r = 0.14, P < 0.01) and with BMI (r = -0.19, P < 0.01). Smokers had lower HDL levels than ex-smokers and non-smokers (P < 0.05). Men who were moderate drinkers had higher HDL levels than heavy or mild drinkers and non-drinkers (P < 0.01). Physical activity was only related to HDL in men with levels >1.52 mmol/l, who walked on the average more than the rest (P < 0.05). Variables not showing the expected relationship with HDL were diabetes and the menopause in women (probably due to a low statistical power of their subsamples). Regression analysis, with HDL as dependent variable showed that the association between HDL and altitude persists when taking altitude as a categorical or a continuous variable. CONCLUSIONS: High density lipoprotein cholesterol levels are linearly and significantly increased when living at a higher altitude. This fact should be taken into account when comparing cardiovascular risk in populations living at different altitudes.     

The associations between current recommendation for physical activity and cardiovascular risks associated with obesity

OBJECTIVE: To examine associations between current recommended physical activity levels and body mass index (BMI) with some cardiovascular disease (CVD) risk factors (total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-cholesterol (non-HDL-C), C-reactive protein (CRP), fibrinogen, and blood pressure), general health score (GHQ12) and predicted coronary heart disease (CHD) risk. DESIGN: Further analysis of the cross-sectional Scottish Health Survey 1998 data. SUBJECTS: Five thousand four hundred and sixty adults 16-74 years of age. RESULTS: After controlling for some confounding factors, obesity was significantly associated with higher odds ratio (OR) for elevated cholesterol, CRP, systolic blood pressure, non-HDL-C and lower HDL-C (P<0.001), and with greater predicted CHD risk compared to BMI <25 kg/m(2). Regular self-reported physical activity was associated with smaller OR of lower HDL-C and higher CRP, and average predicted 10-year CHD risk in obese subjects, but did not eliminate the higher risk of the measured CVD risk factors in this group. The OR of these two risk factors were still high 4.39 and 2.67, respectively, when compared with those who were inactive with BMI <25 kg/m(2) (P<0.001). Those who reported being physically active had better GHQ scores in all BMI categories (P<0.001). CONCLUSION: Reporting achievement of recommended physical activity levels may reduce some CVD risk factors, predicted CHD risk and improve psychosocial health, but may not eliminate the extra risk imposed by overweight/obesity. Therefore, increasing physical activity and reducing body weight should be considered to tackle CVD risk factors.     

Lack of association between tea and cardiovascular disease in college alumni

BACKGROUND: Epidemiological studies suggest that tea intake, a major dietary source of flavonoids, may be associated with a decreased risk of cardiovascular disease (CVD). METHODS: We prospectively followed 17 228 subjects (mean age, 59.5 years) initially free of CVD and cancer from the College Alumni Health Study. Participants provided baseline self-reports of tea consumption (cups/day) and coronary risk factors. During a median follow-up of 15 years, there were 3372, 2615, and 757 cases of CVD, coronary heart disease (CHD), and stroke, respectively, ascertained from either self-reports or death certificates. RESULTS: Overall, the median level of tea consumption was 1 cup/day. Compared with participants consuming no tea, the multivariate relative risks (RR) of CVD for those drinking <1, 1, 2, 3, and >/=4 cups/day were 0.99, 0.96, 0.95, 0.91, and 0.95, respectively (P, trend = 0.19). The multivariate RR were 0.97, 0.98, 0.93, 0.85, and 0.98 for CHD (P, trend = 0.25), and 1.05, 0.89, 1.00, 1.09, and 0.83 for stroke (P, trend = 0.53). There was no evidence of effect modification. Changes in tea intake were assessed in a subgroup of 7730 men, with those continuing to drink tea having a non-significant 33% reduction in the risk of stroke. CONCLUSIONS: Tea intake, likely consumed as black tea, was not strongly associated with a reduced risk of CVD in this population of US college alumni.     

脂蛋白(a)与年轻人脑梗死

目的 研究脂蛋白(a)与年轻人脑梗死发病的关系。方法 检测90例发病年龄16—45岁脑梗死患者脂蛋白(a)与甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A—I、载脂蛋白B等，同时分析患者的高血压、吸烟、饮酒、卒中家族史等因素。结果 与对照组相比，脑梗死患者的脂蛋白(a)无显著性增高。而甘油三酯、载脂蛋白B在脑梗死患者中却显著增高。相关分析显示，脂蛋白(a)与血清总胆固醇和低密度脂蛋白胆固醇正相关(P＜0．01)。logistic回归分析示高脂蛋白(a)的相对危险度比值比(OR)为0．74，95％CI：0．27一1．98。高甘油三酯对于脑梗死的OR值为3．57，95％CI：1．34—9．49；高血压对于脑梗死的OR值为8．18，95％CI：2．54—26．33；心脏病对于脑梗死的OR值为8．5l，其95％CI：2．27—31．85；吸烟的OR值为3．2l，95％CI：1．27—8．13。结论 脂蛋白(a)可能不是年轻人脑梗死的危险因素。高甘油三酯、高血压、心脏病和吸烟是年轻人脑梗死重要的危险因素。