Is the prevalence of coronary heart disease falling in British men?

OBJECTIVE—To assess whether long term trends over time in acute coronary heart disease (CHD) event rates have influenced the burden of prevalent CHD in British men.
DESIGN—Longitudinal cohort study.
PARTICIPANTS—7735 men, aged 40-59 at entry (1978-80), selected from 24 British towns.
METHODS—The prevalences of current angina symptoms and history of diagnosed CHD were ascertained by questionnaire in 1978-80, 1983-85, 1992, and 1996. New major CHD events (fatal and non-fatal) were ascertained throughout the study from National Health Service central registers and general practice record reviews. Age adjusted trends in CHD prevalence were compared with trends in major CHD event rates.
RESULTS—From 1978-1996 there was a clear decline in the prevalence of current angina symptoms: the age adjusted annual percentage change in odds was -1.8% (95% confidence interval (CI) -2.8% to -0.8%). However, there was no evidence of a trend in the prevalence of history of diagnosed CHD (annual change in odds 0.1%, 95% CI -1.0% to 1.2%). Over the same period, the CHD mortality rate fell substantially (annual change -4.1%, 95% CI -6.5% to -1.6%); rates of non-fatal myocardial infarction, all major CHD events, and first major CHD event fell by -1.7% (95% CI -3.9% to 0.5%), -2.5% (95% CI -4.1% to -0.8%), and -2.4% (95% CI% -4.3 to -0.4%), respectively.
CONCLUSIONS—These results suggest that middle aged British men are less likely to experience symptoms of angina than in previous decades but are just as likely to have a history of diagnosed CHD. Despite falling rates of new major events and falling symptom prevalence, the need for secondary prevention among middle aged men with established CHD is as great as ever.


Keywords: coronary heart disease; angina; prevalence; trends     

Are major risk factors for myocardial infarction the major predictors of degree of coronary artery disease in men?

Although numerous cross-sectional studies have reported associations of hypertension, hypercholesterolemia, diabetes, smoking, and/or obesity with the presence of coronary artery disease (CAD), correlations of these risk factors for myocardial infarction (MI) with the degree or progression of CAD have been less consistent. Nevertheless, these risk factors are generally assumed to be major determinants not only of MI, but of the degree of CAD as well. The present study is an attempt to evaluate the relationship of major risk factors for MI to degree of CAD. From 182 men who underwent diagnostic coronary arteriography, the 154 with CAD were selected for study. These 154 patients were divided into 2 groups, those with hypertension, hypercholesterolemia, diabetes, smoking, and/or obesity (n = 121) and those with none of these risk factors (n = 33). The mean degree of CAD in the group with risk factors for MI (44.4%) and in the group without (50.6%) was not significantly different (P =.15); nor was the increase in CAD with age augmented by the presence of these risk factors. On multiple regression analysis, none of these risk factors was associated with degree of CAD. Three other variables that were considered in this study, age, high-density lipoprotein-cholesterol (HDL-C), and free testosterone (FT), did show an independent association with degree of CAD. These findings, together with the findings of previous studies from other laboratories, raise the possibility that in men selected for coronary arteriography, age, HDL-C, and FT may be stronger predictors of degree of CAD than are blood pressure, cholesterol, diabetes, smoking, and body mass index (BMI).     

Is coronary risk an accurate surrogate for cardiovascular risk for treatment decisions in mild hypertension? A population validation

OBJECTIVE: To examine the relationship between coronary (CHD) and cardiovascular (CVD) risk in patients with uncomplicated mild hypertension and to determine the accuracy of using CHD risk > or = 15% over 10 years to identify for antihypertensive treatment those patients with CVD risk > or = 20% over 10 years as advised in recent British guidelines. DESIGN: Comparison of decisions made using CHD risk > or = 15% over 10 years calculated by the Framingham risk function and estimated using a simple table with CVD risk > or = 20% over 10 years. SETTING: British population. SUBJECTS: People aged 35-64 years with uncomplicated mild systolic hypertension (SBP 140-159 mmHg, n = 624) from the 1995 Scottish Health Survey. MAIN OUTCOME MEASURES: Relationship between CHD and CVD risk. Sensitivity, specificity, positive and negative predictive values (PPV and NPV). RESULTS: CHD risk 15% over 10 years was equivalent to CVD risk 21% over 10 years. Exact CHD risk > or = 15% over 10 years had sensitivity 79%, specificity 98%, PPV 94% and NPV 93% in detecting CVD risk > or = 20% over 10 years. Use of the table to estimate CHD risk > or = 15% over 10 years gave sensitivity 88%, specificity 90%, PPV 76% and NPV 95%. CONCLUSION: CHD risk appears acceptably accurate for targeting treatment in mild hypertension. The risk assessment table, which slightly overestimates CHD risk, was more sensitive in identifying patients with CVD risk > or = 20% over 10 years and may be preferable to using exact CHD risk. European guidelines which suggest targeting treatment for mild hypertension at CHD risk > or = 20% over 10 years are over-conservative compared with British guidelines.     

Does genetic heterogeneity account for the divergent risk of type 2 diabetes in South Asian and white European populations?

Aims/hypothesis

South Asians are up to four times more likely to develop type 2 diabetes than white Europeans. It is postulated that the higher prevalence results from greater genetic risk. To evaluate this hypothesis, we: (1) systematically reviewed the literature for single nucleotide polymorphisms (SNPs) predisposing to type 2 diabetes in South Asians; (2) compared risk estimates, risk alleles and risk allele frequencies of predisposing SNPs between South Asians and white Europeans; and (3) tested the association of novel SNPs discovered from South Asians in white Europeans.

Methods

MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane registry were searched for studies of genetic variants associated with type 2 diabetes in South Asians. Meta-analysis estimates for common and novel bi-allelic SNPs in South Asians were compared with white Europeans from the DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) consortium. The population burden from predisposing SNPs was assessed using a genotype score.

Results

Twenty-four SNPs from 21 loci were associated with type 2 diabetes in South Asians after meta-analysis. The majority of SNPs increase odds of the disorder by 15–35% per risk allele. No substantial differences appear to exist in risk estimates between South Asians and white Europeans from SNPs common to both groups, and the population burden also does not differ. Eight of the 24 are novel SNPs discovered from South Asian genome-wide association studies, some of which show nominal associations with type 2 diabetes in white Europeans.

Conclusions/interpretation

Based on current literature there is no strong evidence to indicate that South Asians possess a greater genetic risk of type 2 diabetes than white Europeans.     

Is smoking history a risk factor of arterial hypertension in men?

Former smokers exhibit decreased cardiovascular risk as compared to smokers who continue to smoke. However, smoking discontinuation results in weight gain which may be important and influence arterial pressure. From January 1st to June 30th, 1998, 12,417 volunteers (aged 20 to 69) were examined at the "Institut régional pour la santé" (IRSA, Regional Institute for Health), a group of 9 social medical centres in Western and Central France. The subjects were screened for a routine medical and biological check-up provided by their medical insurance. All of the subjects were interviewed by a trained nurse who completed a standardised questionnaire regarding personal medical history, current treatments and lifestyle behaviours (especially alcohol and smoking habits). A physician recorded clinical parameters including age, weight, height, systolic and diastolic arterial pressure. Body mass index (BMI) was calculated. Non smokers and former smokers represented 40.0% and 23.8% of the population respectively. The prevalence of a BMI 27.0 kg/m2 or greater was higher in former smokers than non smokers and current smokers. Systolic and diastolic arterial pressure in former smokers exceeded those of current smokers and non smokers by 4.2/1.1 mmHg and 2.8/1.6 mmHg respectively. Using logistic regression analysis, the relative risk of hypertension in former smokers was 1.24 (CI 95%: 1.10-1.39, p < 0.001) and 1.13 (0.995-1.29, p = 0.055) as compared to non smokers and current smokers, after adjustment for age and alcohol intake. Differences became non significant when BMI was entered in the model. The results of the present study suggest that former smoking status is associated with a higher prevalence of overweight which may cause a higher prevalence of hypertension.     

Is QUOTE-IBD a valid questionnaire for measurement of quality of care in IBD? A validation study of the Swedish version

Abstract

Background: Quality of care has gained increased attention in IBD. The questionnaire Quality of Care Through the Patient’s Eyes – Inflammatory Bowel Disease (QUOTE-IBD) was the first published validated IBD-specific quality of care questionnaire. The aim of this study was to validate the Swedish version of the QUOTE-IBD.

Methods: Adult outpatients (n?=?400) at a gastroenterology clinic in the south-east of Sweden were asked to fill in the questionnaire. For evaluation of construct validity, patients also responded to one global item for each health care dimension in the QUOTE-IBD, as well as for their overall experience of quality of health care.

Results: All quality of care dimensions (QI) correlated significantly (p?<?.05) with their respective global dimensional item (r?=?0.016–0.43), except for accommodation (r?=?–0.02. Test–retest (n?=?32) gave significant results for all the dimensions r?=?0.31–0.80 (p?<?.05), except for accommodation (–0.15, p?=?ns).

Conclusions: The construct validity of the Swedish version of QUOTE-IBD is moderate. This indicates that the QUOTE-IBD may not fully cover the health care aspects important to patients. The high number of item non-response for Performance may be related to the questions being too specific, which may also contribute to the moderate level of construct validity. The reliability is moderate and the internal consistency is good.     

Is there a 'window of opportunity' for intervention to reduce risk of coronary artery disease in SLE?

Patients with systemic lupus erythematosus (SLE) have a substantially enhanced risk for cardiovascular complications, especially coronary artery disease (CAD). Evidence from a recent study by Urowitz et al. indicates that the incidence not only of classic CAD risk factors but also of nontraditional CAD risk factors increases within the first 3 years after onset of SLE. The data indicate that patients with SLE require careful management of hypertension and hypercholesterolemia, smoking cessation, and increased physical activity in order to reduce the risk of CAD. Intensive immune intervention is likely to be related to reduction of risk from nontraditional CAD risk factors, but it is not known if this treatment approach also affects classic CAD risk factors. Although established in patients with rheumatoid arthritis in recent years, the effect of immune intervention on classic risk factors for CAD needs to be evaluated in patients with SLE, through either clinical studies or international registries.     

Is glutamine essential for the maintenance of intestinal function? A study in the isolated perfused rat small intestine

Glutamine has received considerable interest as a gut-targeted nutrient due to its proposed key role in the maintenance of intestinal structure and function. We used a preparation of isolated vascularly perfused rat small intestine to investigate whether glutamine is essential for the maintenance of intestinal function. When glutamine was available, arterial glutamine was extracted at 15±2%, and net uptake was –89±5 nmol min^–1 g^–1. Nitrogenous metabolites ammonia, alanine, and citrulline (41±7, 41±4, and 11±2 nmol min^–1 g^–1, respectively) were released into the venous perfusate, but only ammonia was also excreted into the lumen (36±3 nmol min^–1 g^–1). In the absence of exogenous glutamine alanine release was halved and that of citrulline and ammonia nullified. Additional inhibition of glutamine synthetase yielded the same results. In all cases variables of tissue function were fully maintained also in the absence of exogenous and/or endogenous glutamine. The inhibition of glutaminase/amidotransferase reactions, however, was accompanied by a reduction in glutamine consumption and a graded deterioration in tissue function. In conclusion, glutamine seems to be dispensable as a metabolic fuel to be fully oxidized by the mucosa. However, the inhibition of major glutamine consuming pathways was associated with impaired tissue function and viability. Therefore the role of intestinal glutamine metabolism seems to be threefold: (a) providing affluent amounts of nitrogen precursors for mucosal anabolic pathways to maintain intestinal structure and function, (b) feeding the liver with an optimal substrate mix, and (c) providing citrulline and thereby arginine for the whole organism. Accepted: 4 March 1999     

The tumour necrosis factor-α-238A allele increases the risk of chronic HBV infection in European populations

Tumour necrosis factor-α (TNF-α) plays a pivotal role in viral clearance and host immune response to hepatitis B virus (HBV) infection, of which the production capacity in individuals is demonstrated to be influenced by a single nucleotide polymorphism within the promoter region of TNF-α genes. However, there have been conflicting results reported in previous studies on TNF-α-238 and TNF-α-863 gene promoter polymorphisms in chronic HBV infection. To derive a more precise estimation of their relationship, we searched Pubmed (January, 1966-August, 2010) and China Biological Medicine Database (January, 1978-August, 2010) and carried out a meta-analysis involving nineteen studies that included 5245 chronic HBV infection cases and 3181 controls describing G238A genotypes, and eleven studies totalling 3576 cases and 2044 controls describing C863A genotypes. The overall meta-analysis did not suggest significant associations of TNF-α-238 and TNF-α-863 gene promoter polymorphisms with chronic HBV infection. However, in subgroup analysis by ethnicity, it indicated that TNF-α-238A allele carriers (GA + AA) in European populations had an increased risk of developing chronic HBV infection (OR = 2.22, 95% CI: 1.07-4.58, P = 0.032; OR = 4.46, 95% CI: 1.75-11.38, P = 0.002, respectively), when compared with spontaneous recovered and healthy populations, respectively. However, no significant associations were found in Asian populations in all genetic models. So, we draw the conclusion that the TNF-α-238A allele may increase the risk of chronic HBV infection in European populations.     

Is alcohol anti-inflammatory in the context of coronary heart disease?

Although the cardioprotective effect of alcohol has been primarily explained by its effect on blood lipids and platelets, could an anti-inflammatory mechanism be involved?