Oxidative status and cardiovascular risk in women: Keeping pink at heart

Although cardiovascular disease (CVD) has always been perceived as a pathology regarding essentially males, incidence and death from cardiovascular events dramatically increase after menopause in women. Obviously, while many aspects of CVD are similar in both sexes, it is now clear that there are significant differences as well. Exploration of these gender-related differences in CVD might provide a basis for the development of new strategies in the management of patients with CVD from a gender point of view. In particular, a growing amount of data suggested the possible major role of oxidative stress in female patients and the possibility to integrate this new biomarker in future study evaluating CVD risk in women.     

Phosalone-induced inflammation and oxidative stress in the colon: evaluation and treatment

AIM: To investigate the side effects of phosalone on intestinal cells and to evaluate benefits of ellagic acid(EA) as a remedy.METHODS: In order to conduct an in vivo study, a rat model was used. The rats were divided into ten groups based on the materials used in the experiment and their dosage. The first group was fed normally. The second group was administered EA through gavage. Next Four groups were given(1/3, 1/5, 1/10, 1/20) LD50 phosalone; an organophosphorus compound. The last four groups received(1/3, 1/5, 1/10, 1/20) LD50 phosalone and of EA. After one month, the rats were sacrificed and their colon cells were examined to evaluate the level of inflammation, proteins and oxidative stress markers.RESULTS: The results of this research show that phosalone elevates oxidative stress and changes the level of tumor necrosis factor-a(TNF-α), interlukin-6β(IL-6β) and nuclear factor(NF)-κB proteins. EA administration reduced phosalone toxicity and changed oxidative stress and inflammatory markers for all phosalone doses. Overall changes in reduction of TNF-α(230.47 ± 16.55 pg/mg protein vs 546.43 ± 45.24 pg/mg protein, P 0.001), IL-6β(15.85 ± 1.03 pg/mg protein vs 21.55 ± 1.3 pg/mg protein, P 0.05), and NF-κB(32.47 ± 4.85 pg/mg protein vs 51.41 ± 0.71 pg/mg protein, P 0.05) manifest that the efficacy of EA is more viable for 1/3 LD50 dose of phosalone. Furthermore, EA is effective to counteract the negative outcomes of oxidative stress. When EA was used to treat 1/3 LD50 of phosalone's side effects, it improved the level of ACh E activity(48.5% ± 6% vs 25% ± 7%, P 0.05), TTM(0.391 ± 0.008 mmol/L vs 0.249 ± 0.032 mmol/L, P 0.05), FRAP(46.04 ± 5.005 μmol/L vs 18.22 ± 1.9 μmol/L, P 0.01) and MPO(0.222 ± 0.019 U/mg protein vs 0.387 ± 0.04 U/mg protein, P 0.05). CONCLUSION: This research highlights that EA is effective to alleviate the side effects of phosalone by reducing the level of oxidative stress and inflammatory proteins.     

Comparison of the effect of simvastatin versus simvastatin/ezetimibe versus rosuvastatin on markers of inflammation and oxidative stress in subjects with hypercholesterolemia

Objectives

Statins may exhibit anti-inflammatory and antioxidant effects. Whether different statins at equivalent doses or the combination of low-dose statin with ezetimibe have comparable anti-inflammatory and antioxidant effects is unknown. The aim of this study was to compare the effects of simvastatin, simvastatin/ezetimibe or rosuvastatin at equivalent low-density lipoprotein cholesterol lowering doses on inflammation and oxidative stress indices in subjects with hypercholesterolemia.

Methods

This was a pre-specified analysis of a prospective, randomized, open-label, blinded endpoint (PROBE) study. We enrolled one hundred and fifty three (n = 153) hypercholesterolemic subjects who were randomized to receive simvastatin 40 mg or simvastatin/ezetimibe 10/10 mg or rosuvastatin 10 mg daily. Plasma 8-Epi prostaglandin F2 alpha (8-epiPGF2a), oxidized LDL (oxLDL) and lipoprotein-associated phospholipase A₂ (Lp-PLA₂) activity and mass were measured at baseline and following 12 weeks of treatment.

Results

A significant reduction in plasma 8-isoprostane and oxLDL levels was observed in all treatment groups [by 10%, 8% and 6% (p < 0.05 compared with baseline) and 41%, 40% and 39% (p < 0.001 compared with baseline) in simvastatin, simvastatin/ezetimibe and rosuvastatin groups, respectively]. In all treatment groups a significant reduction in total plasma Lp-PLA₂ activity and mass was observed (by 36%, 31% and 38% and 36%, 32% and 32% for simvastatin, simvastatin/ezetimibe and rosuvastatin, respectively, p < 0.001 compared with baseline). No intergroup differences were observed.

Conclusions

Simvastatin 40 mg, simvastatin/ezetimibe 10/10 mg and rosuvastatin 10 mg significantly reduced 8-epiPGF2a, oxLDL and Lp-PLA₂ activity and mass to a similar extent.     

C-reactive protein, cardiovascular risk factors and the association with myocardial infarction in men

OBJECTIVES: This study had three objectives: first, to investigate the association of C-reactive protein levels and myocardial infarction amongst men; secondly, to study the associations of C-reactive protein levels with cardiovascular risk factors; and thirdly, to adjust the risk of myocardial infarction for such factors. DESIGN AND SUBJECTS: A case-control study including 560 patients with a first myocardial infarction who had survived at least 6 months, plus 646 control subjects. RESULTS: Patients had significantly higher levels of C-reactive protein (mean 2.2 mg L-1) than control subjects (mean 1.7 mg L-1; P < 0.001). Persons in the highest quintile of C-reactive protein had an unadjusted 1.9-fold increased risk of myocardial infarction compared with persons in the lowest quintile (odds ratio 1.9, 95% CI: 1.3-2.7). C-reactive protein was, in addition to smoking, associated with several cardiovascular risk factors: age, obesity, diabetes, blood pressure, triglycerides and inversely associated to HDL cholesterol. Adjustment for these variables, especially for total cholesterol, HDL cholesterol and triglycerides, substantially decreased the risk of myocardial infarction for persons in the highest quintile of C-reactive protein, compared to those in the lowest quintile, to 1.3 (95% CI: 0.9-1.9). CONCLUSIONS: Our findings confirm previous reports that C-reactive protein predicts the risk of myocardial infarction. However, this association does not appear to be causal, since the increase in risk can to a large extent be explained by the presence of other cardiovascular risk factors.     

Synergy of iron,high sensitivity C-reactive protein and ceruloplasmin with oxidative stress in non-diabetic normo-tensive South Indian obese men

BackgroundOxidative stress and inflammation are implicated in the pathogenesis of obesity and its related complications. Previous studies have suggested a potential link between obesity and altered iron metabolism. The present study was designed to evaluate iron, C-reactive protein, ceruloplasmin and oxidative stress and their association, if any, in non-diabetic normo-tensive South Indian obese men.Methods30 obese men and 30 age-matched males with normal body weight were recruited in the study. Serum iron, copper, ceruloplasmin, high sensitivity C-reactive protein (hs-CRP), malondialdehyde, protein carbonyl, total oxidant status and total antioxidant status were estimated in all the subjects.ResultsSerum iron, ceruloplasmin, high sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), protein carbonyl and total oxidant status were significantly increased and total antioxidant status was significantly reduced in obese men, compared to controls. Linear regression analysis shows highly significant positive association of iron with hs-CRP.ConclusionThe data from the present study concludes that oxidative stress parameters, hs-CRP, iron and ceruloplasmin were significantly elevated in obese Indian men, suggesting they are more prone to develop cardiovascular disease, than age-matched men with normal body weight.     

C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study

Aims Cut-offs for C-reactive protein concentrations have beenrecommended for risk stratification, but little is known abouthow these cut-offs predict cardiovascular risk in population-basedcohorts. We therefore assessed the association of C-reactiveprotein levels with cardiovascular mortality in a population-basedcohort of 2321 middle-aged men stratified by the presence ofcardiovascular disease (CVD) at baseline. Methods and results C-reactive protein concentrations were categorizedaccording to current recommendations (1 and 3 mg/L). Duringthe 15 year follow-up, 77 men without CVD and 121 men with CVDat baseline died of CVD. In men without CVD at baseline (n=1476),age-adjusted cardiovascular mortality was 4.1-fold higher (95%CI 2.1–8.2) for C-reactive protein levels between 3.0and 9.9 mg/L at baseline than for C-reactive protein levels<1.0 mg/L. In men with CVD at baseline (n=845), thecorresponding age-adjusted cardiovascular mortality was 3.3-foldhigher (95% CI 2.0–5.3). Adjustment for conventional CVDrisk factors attenuated the risk somewhat. Further adjustmentfor dietary and lifestyle factors and factors related to insulinresistance did not affect the association. Classification ofC-reactive protein by tertiles gave qualitatively similar results,but identified twice as many men at high risk. C-reactive proteinlevels also predicted overall mortality. Conclusion Currently, recommended cut-offs for C-reactive proteinlevels identify men at risk for cardiovascular and overall deathindependently of conventional and other risk factors in a population-basedsample of middle-aged men with and without CVD at baseline.Lower cut-offs may better identify men at high risk for cardiovasculardeath, but improvement of current recommendations will requirestandardization of C-reactive protein assays.     

Cardiovascular risk factors in Middle Eastern patients undergoing percutaneous coronary intervention: Results from the first Jordanian percutaneous coronary intervention study

Background and aims: Cardiovascular disease (CVD) is the leading cause of death in the Middle East. We sought to study the prevalence and coexistence of 6 cardiovascular risk factors (RFs) among patients who underwent percutaneous coronary intervention (PCI), and to evaluate the impact of age and gender on the presence of multiple RFs. Methods and results. In this prospective, multicenter study, 2426 consecutive patients were enrolled. Mean age was 59.0 ± 10.1 years and 500 (20.6%) were women. Acute coronary syndrome and stable coronary disease were the indications for PCI in 77.1% and 22.9%, respectively. Hypertension was present in 62.3%, diabetes in 53.8%, hypercholesterolemia in 48.8%, smoking in 43.5%, family history of premature CVD 39.4% and obesity in 28.8%. Only 3.8% did not have any of these RFs. Presence of ?3 and ?4 RFS was observed in 57.4% and 29.5% of patients, respectively. Presence of ?3 RFs was more common in women than men (69.0% vs. 54.5%, p < 0.0001), and among patients 41–65 years of age than older or younger patients (60.1% vs. 52.0% vs. 48.3%, respectively, p = 0.017). Conclusions: Cardiovascular RFs are highly prevalent in this PCI Middle Eastern population undergoing PCI. More than half and more than one-fourth of the patients had at least 3 or 4 RFs; respectively. More women than men and more middle aged patients than older or younger patients had significantly higher rates of presence of multiple RFs.     

Arterial cardiovascular risk factors and venous thrombosis: results from a population-based, prospective study (the HUNT 2)

Background

An explanation for the increased risk of myocardial infarction and stroke in patients with venous thrombosis is lacking. The objective of this study was to investigate whether risk factors for arterial cardiovascular disease also increase the risk of venous thrombosis.

Design and Methods

Cases who had a first venous thrombosis (n=515) and matched controls (n=1,505) were identified from a population-based, nested, case-cohort study (the HUNT 2 study) comprising 71% (n=66,140) of the adult residents of Nord-Trøndelag County in Norway.

Results

The age- and sex-adjusted odds ratio of venous thrombosis for subjects with concentrations of C-reactive protein in the highest quintile was 1.6 (95% confidence interval: 1.2–2.2) compared to subjects with C-reactive protein in the lowest quintile. This association was strongest in subjects who experienced venous thrombosis within a year after blood sampling with a three-fold increased risk of participants in the highest versus the lowest quintile. Having first degree relatives who had a myocardial infarction before the age of 60 years was positively associated with venous thrombosis compared to not having a positive family history [odds ratio 1.3 (95% confidence interval: 1.1–1.6)]. Subjects with blood pressure in the highest quintile had half the risk of developing venous thrombosis compared to subjects whose blood pressure was in the lowest quintile. There were no associations between the risk of venous thrombosis and total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, triglycerides, glucose or smoking. We confirmed the positive association between obesity and venous thrombosis.

Conclusions

C-reactive protein and a family history of myocardial infarction were positively associated with subsequent venous thrombosis. Blood pressure was inversely correlated to venous thrombosis. These findings should be confirmed by further investigations.     

Life course socioeconomic conditions,adulthood risk factors and cardiovascular mortality among men and women: A 17-year follow up of the GLOBE study

Background

Our goal was to study associations between childhood socioeconomic position (SEP), adulthood SEP, adulthood risk factors and cardiovascular disease (CVD) mortality, by investigating the critical period and pathway models.

Methods

The prospective GLOBE study in the Netherlands, with baseline data from 1991, was linked with cause of death register data from Statistics Netherlands in 2007. At baseline, respondents reported information on childhood SEP (i.e. occupational level of respondent's father), adulthood SEP (educational level), and adulthood risk factors (health behaviours, material circumstances, and psychosocial factors). Analyses included 4894 men and 5572 women. Data were analysed by Cox proportional hazard ratios (HR) with CVD mortality as the outcome.

Results

Childhood SEP was associated with CVD mortality among men with the lowest childhood SEP only (HR 1.32, 95% CI 1.00–1.74), and not among women. The majority of childhood SEP inequalities in CVD mortality among men (88%) were explained by material, behavioural and psychosocial risk factors in adulthood, and adulthood SEP. This was mostly due to the association of childhood SEP with adulthood SEP, and the interrelations of adulthood SEP with risk factors, and partly via the direct association of childhood SEP with adulthood risk factors, independent of adulthood SEP.

Conclusion

This study supports the pathway model for men, but found no evidence that socioeconomic conditions in childhood are critical for CVD mortality in later life independent of adulthood conditions. Developing effective methods to reduce material and behavioural risk factors among lower socioeconomic groups should be a top priority in cardiovascular disease prevention.     

Fish intake is associated with lower cardiovascular risk in a Mediterranean population: Prospective results from the Moli-sani study

Background and aims

Fish consumption reportedly reduces the risk of heart disease, but the evidence of cardiovascular advantages associated with fish intake within Mediterranean cohorts is limited. The aim of this study was to test the association between fish intake and risk of composite coronary heart disease (CHD) and stroke in a large population-based cohort adhering to Mediterranean Diet.

Ethnicity is an independent risk indicator when estimating diabetes risk with FINDRISC scores: A cross sectional study comparing immigrants from the Middle East and native Swedes

AimsThis study sought to compare type 2 diabetes (T2D) risk indicators in Iraqi immigrants with those in ethnic Swedes living in southern Sweden.MethodsPopulation-based, cross-sectional cohort study of men and women, aged 30–75 years, born in Iraq or Sweden conducted in 2010–2012 in Malmö, Sweden. A 75 g oral glucose tolerance test was performed and sociodemographic and lifestyle data were collected. T2D risk was assessed by the Finnish Diabetes Risk Score (FINDRISC).ResultsIn Iraqi versus Swedish participants, T2D was twice as prevalent (11.6 vs. 5.8%, p < 0.001). A large proportion of the excess T2D risk was attributable to larger waist circumference and first-degree family history of diabetes. However, Iraqi ethnicity was a risk factor for T2D independently of other FINDRISC factors (odds ratio (OR) 2.5, 95% CI 1.6–3.9).The FINDRISC algorithm predicted that more Iraqis than Swedes (16.2 vs. 12.3%, p < 0.001) will develop T2D within the next decade. The total annual costs for excess T2D risk in Iraqis are estimated to exceed 2.3 million euros in 2005, not accounting for worse quality of life.ConclusionsOur study suggests that Middle Eastern ethnicity should be considered an independent risk indicator for diabetes. Accordingly, the implementation of culturally tailored prevention programs may be warranted.     

Socioeconomic position and cardiovascular risk factors among people with screen-detected Type 2 DM: Six-year follow-up of the ADDITION-Denmark trial

AimsTo examine whether socioeconomic position (SEP) was associated with change in cardiovascular risk factors and meeting treatment targets for cardiovascular risk factors among individuals with screen-detected Type 2 DM at six-year follow-up.MethodsThe study population was 1533 people with Type 2 DM identified from at stepwise diabetes screening programme in general practice during 2001–2006 in the ADDITION-Denmark study. The ADDITION-study was performed as a randomised trial but the two randomisation groups were analysed as one cohort in this study. Cardiovascular risk factors were measured at baseline and repeated at follow-up (mean: 5.9 [1.4] years). Information on SEP, redeemed antihypertensive and lipid-lowering treatment were obtained from Danish registers. Multivariate analyses were performed to estimate change in cardiovascular risk factors and difference in meeting treatment targets.ResultsThe change in HbA_1c, cholesterol, blood pressure and BMI were virtually the same across educational level, income level, occupational status or cohabiting status. Overall, the ability to meet treatment targets for HbA_1c, cholesterol and blood pressure was not modified by SEP-group. A higher proportion of people with lower educational level or lower income level in the intensive care redeemed anti-hypertensive treatment compared to people with higher educational or income levels.ConclusionScreen-detection and early treatment onset did not introduce socioeconomic inequality in metabolic control in people with screen-detected Type 2 DM at six-year follow-up.     

Metabolic and cardiovascular risk factors in subjects with impaired fasting glucose: the 100 versus 110 mg/dL threshold

BACKGROUND: In 2003, the American Diabetes Association (ADA) established a new cutoff for impaired fasting glucose (IFG) by reducing it from 110 to 100 mg/dL. This change was challenged as to its appropriateness. A few studies have examined the impact of the ADA(2003) threshold of IFG on metabolic and cardiovascular risk factors. METHODS: We examined whether metabolic and cardiovascular risk factors, including inflammatory biomarkers, differ in subjects with the new ADA(2003) threshold of IFG (IGF100) as compared with subjects with the old ADA(1997) threshold of IFG (IFG110) in a cohort of 946 nondiabetic Italian Caucasians (fasting plasma glucose < 126 mg/dL). RESULTS: As compared with normal fasting glucose (NFG), subjects with IFG100 and IFG110 had higher body mass index (BMI), waist circumference, total and low density lipoprotein (LDL) cholesterol, triglyceride, fasting and 2-h post-challenge plasma glucose, fasting insulin, systolic blood pressure, and lower levels of high density lipoprotein (HDL) and insulin-like growth factor I (IGF-I). In a logistic regression analysis with adjustment for age and gender, IFG110 was associated with higher risk of post-challenge glucose intolerance as compared with IFG100. As compared with IFG100, subjects with IFG110 have significantly lower levels of circulating IGF-I. As compared with NFG, IFG110, but not IFG100, showed a significant association with increased levels of inflammatory markers including white blood cell count (WBCC), and C-reactive protein (CRP). Both CRP and WBCC were correlated with 2-h plasma glucose but not with fasting plasma glucose (FPG). CONCLUSIONS: The data show that IFG110 is associated with a worse metabolic and cardiovascular risk profile as compared with IFG100.     

川省松潘县藏族成人脉压异常与心血管病危险因素和心功能的相关性（英文）

目的：通过调查中国四川省松潘县藏族成人脉压的分布特点,探讨藏族成人脉压异常与心血管病危险因素和心功能的相关性。方法：采用流行病学横断面的研究方法,对中国四川省松潘县18～74岁的1015名藏族成人的身体健康状况进行随机、分层、整群抽样问卷调查和体格检查。结果：四川松潘县藏族成人平均脉压是（45.59±14.22）mmHg,脉压异常的有143例（14.09%）。多因素线性回归和Logistic回归分析结果显示：脉压异常与年龄呈正相关（OR=1.05,P〈0.05）,与高密度脂蛋白水平呈负相关（OR=-2.69,P〈0.05）。与正常脉压组相比,脉压异常组全身血管阻力（SVR）显著增加[（1112.61±346.74）kPa/L比（1308.27±354.87）kPa/L,t=-4.87],每搏量指数（SI）[（45.68±12.76）ml/m2比（39.45±9.52）ml/m2,t=4.37]]、心输出量指数（CI）[（3.55±1.00）L/min.m2比（3.22±0.54）L/min.m2,t=3.08]显著降低（P均〈0.05）。结论：中国四川省松潘县18～74岁藏族成人中脉压异常的比例较高。脉压异常与心血管病危险因素和心功能指标有关。对脉压异常藏族成人进行健康管理具有重要的公共卫生意义。     

Cardiovascular risk in healthy men and markers of oxidative stress in diabetic men are associated with common variation in the gene for uncoupling protein 2.

BACKGROUND: Oxidative stress reduces total antioxidant status (TAOS) and is implicated in atherogenesis. Mitochondrial uncoupling protein 2 (UCP2) negatively regulates reactive oxygen species generation. The UCP2 gene demonstrates a common functional promoter variant (-866G>A). METHODS AND RESULTS: Amongst 465 diabetic men (age 61.7 +/- 13.3 years), an association of the UCP2-866A allele with significantly lower TAOS in those without CHD was even more pronounced in those with CHD (TAOS 30.1 +/- 16.1% vs. 41.6 +/- 12.4% for AA vs. GG; P=0.016). In a sample of 20 diabetic men selected for homozygosity for the UCP2-866G>A variant, matched for baseline characteristics, plasma markers of oxidative stress in those with CHD were significantly higher in AA genotype men (TAOS 31.7 +/- 7.3% vs. 52.6 +/- 6.3%; P=0.001 and F2-isoprostanes 220.6 +/- 37.2 pg ml(-1) vs. 109.9 +/- 51.1 pg ml(-1); P=0.005 for AA vs. GG). Amongst 2695 healthy men (age 56.1 +/- 3.5 years) prospectively studied for a median 10.2 years, AA homozygotes had a highly significant doubling in CHD risk after adjustment for established risk factors (HR 1.99 [1.37-2.90]; P=0.002). Risk associated with this genotype was substantially increased by the presence of other risk factors (obesity, hypertension and diabetes). CONCLUSIONS: This study provides the first in vivo evidence of a role for UCP2 in modifying oxidative stress and CHD risk in humans.     

Size at birth, weight gain over the life course, and low-grade inflammation in young adulthood: northern Finland 1966 Birth Cohort study.

AIMS: Low-grade inflammation might mediate associations between size at birth, early life growth, excessive weight gain, and subsequent risk of cardiovascular disease in adult life. Our aim was to investigate relationships between fetal growth, weight over the life course, and low-grade inflammation measured by serum high sensitivity C-reactive protein (CRP) levels at 31 years. METHODS AND RESULTS: General population-based northern Finland 1966 Birth Cohort study of 5840 participants attending a clinical examination at 31 years, including measurement of CRP. Weight and height were assessed at birth, 12 months, and 14 and 31 years of age. CRP levels at 31 years were 16% [95% confidence interval (CI) 8, 23] higher per 1 kg lower birth weight, 21% (95% CI 2, 37) higher per 10 cm lower birth length, and 24% (95% CI 10, 36) higher per 1 kg/m3 lower ponderal index, after adjustment for potential confounders. Participants with highest tertile body mass index (BMI) at 31 years and lowest tertile birth weight had the highest average CRP levels. Per unit increase in BMI from 14 to 31 years was associated with 16% (95% CI 14, 17) higher CRP levels; the association was larger for those in the top BMI tertile at age 14 years. CONCLUSION: Systemic low-grade inflammation may lie on the causal pathway that relates impaired fetal growth and weight gain from childhood to adulthood to adverse adult cardiovascular health. Lifestyle changes from early life might be an important step in reducing cardiovascular risk in adults.     

Prevalence of cardiovascular risk factors in patients with type 1 diabetes in end-stage renal disease: changes in the trend from 1999 to 2006

ObjectiveThe aim of this study was to describe the prevalence of cardiovascular disease risk factors (CVDRFs) and the degree of control in a Spanish population of patients with type 1 diabetes (DM1) and end-stage renal disease (ESRD) as well as the changes observed in this setting over 8 years.Design and MethodsPatients with DM1 and ESRD were evaluated from 1999 to 2006. Clinical variables, smoking habit, glycosylated hemoglobin (HbA_1c) and lipids values, and drug treatment were evaluated. The cohort was divided into four biannual groups for analysis. HbA_1c >7, LDL >100 mg/dl, blood pressure (BP) >140/90 mmHg, and tobacco use were considered as CVDRFs.ResultsA total of 177 patients (65% male) with a mean age of 37.2±6.2 years were studied. They had 24.3±5.9 years of diabetes evolution. Mean HbA_1c was 7.9±1.5% with 29.6% of patients having values less than 7%. Mean LDL was 109.3±40.4 mg/dl and 41.1% were below 100 mg/dl. Over the years these proportions increased significantly (P=.028 and .0015, respectively). Mean systolic and diastolic BP were 142.5±22.9 and 82.2±14.9 mmHg, respectively, with 53.8% of patients having BP <140/90 mmHg with no changes over the years (P=.11). The proportion of never smokers was 51.5%, reaching 65.5% in the last biannual period (P=.01). In the whole cohort, 89.3% had one or more CVDRFs. There was a statistically significant trend to a reduction in the number of CVDRFs over time (r=?.208, P=.005).ConclusionsCVDRFs are highly prevalent in patients with DM1 and ESRD. The control of these CVDRFs is still insufficient; however, there has been a clear improvement in the control over the years.     

Clusters of AMI risk factors and their association with left ventricular hypertrophy: A population-based study within the Skaraborg Project,Sweden

Objectives

Risk factors for acute myocardial infarction (AMI) are known to cluster and to be differently distributed in men and women. The aim of this study was to sex-specifically explore clusters of acknowledged AMI risk factors by factor analysis, and to study whether such clusters are associated with left ventricular hypertrophy (LVH), used as a subclinical measure of CHD.

Methods

In 2001–2005, 2328 subjects (30–74 years) were randomly selected from two municipalities in Sweden (participation-rate 76%) and were assessed with regard to cardiovascular risk factors; 852 participants also had an echocardiographic examination performed.

Results

Factor analysis identified three identical factors in men and women. WHR, HOMA-ir, systolic blood pressure, and ApoB/ApoA1 loaded significantly on the principal “metabolic factor”, leisure-time physical activity and self-rated health loaded significantly on the “vitality factor”, and smoking and alcohol consumption loaded significantly on the “addiction factor”. The metabolic factor was associated with LVH in both men (P < 0.001) and women (P < 0.001), whereas the addiction factor was associated with LVH solely in men (P = 0.002).

Conclusions

The consistent pattern in the clustering of acknowledged AMI risk factors suggests common underlying mechanisms in both men and women. However, whereas the metabolic factor was paramount in both men and women in the association with LVH, the addiction factor had an impact solely in men. As LVH often precedes AMI, a deeper understanding of risk factors for LVH, including consideration of the supposed sex differences, can be useful in order to explore prevention strategies for AMI.     

Fishing for health: Neighborhood variation in fish intake,fish quality and association with stroke risk among older adults in the Cardiovascular Health Study

Background and aimsFish consumption has been associated with better health outcomes. Dietary patterns may vary substantially by neighborhood of residence. However, it is unclear if the benefits of a healthy diet are equivalent in different communities. This study examines associations of fish consumption with stroke incidence and stroke risk factors, and whether these differ by neighborhood socioeconomic status (NSES).Methods and resultsWe studied 4007 participants in the Cardiovascular Health Study who were 65 years or older and recruited between 1989 and 1990 from 4 US communities. Outcomes included fish consumption type (bakes/broiled vs. fried) and frequency, stroke incidence, and stroke risk factors. Multilevel regressions models were used to estimate fish consumption associations with clinical outcomes. Lower NSES was associated with higher consumption of fried fish (aOR = 1.47, 95% CI: 1.10–1.98) and lower consumption of non-fried fish (0.64, 0.47–0.86). Frequent fried fish (11.9 vs. 9.2 person-years for at least once weekly vs. less than once a month, respectively) and less frequent non-fried fish (17.7 vs. 9.6 person-years for less than once a month vs. at least once weekly, respectively) were independently associated with an increased risk of stroke (p-values < 0.05). However, among those with similar levels of healthy fish consumption, residents with low NSES had less benefit on stroke risk reduction, compared with high NSES.ConclusionFish consumption type and frequency both impact stroke risk. Benefits of healthy fish consumption differ by neighborhood socioeconomic status.     

Associations between γ-glutamyl transferase, metabolic abnormalities and inflammation in healthy subjects from a population-based cohort: A possible implication for oxidative stress

AIM: To examine the relationships between γ -glutamyltransferase (GGT), alanine-aminotransferase (ALT),aspartate-aminotransferase (AST) and various metabolic parameters, C-reactive protein (CRP) and an oxidative stress marker (nitrotyrosine, NT) in subjects without any metabolic abnormalities from a population-based sample.METHODS: Two hundred and five subjects with normal body mass index (BMI), glucose tolerance, and without any metabolic abnormality were studied out of 1339subjects, without known liver diseases, alcohol abuse or use of hepatotoxic drugs, who are representative of the 45-64 aged population of Asti (north-western Italy).RESULTS: In all patients metabolic parameters and hs-CRP levels linearly increase from the lowest to the highest ALT and GGT tertiles, while in subjects without metabolic abnormalities, there is a significant association between fasting glucose, uric acid, waist circumference,hs-CRP, triglyceride values, and GGT levels. In these subjects, male sex, higher hs-CRP and glucose levels are associated with GGT levels in a multiple regression model, after adjustments for multiple confounders.In the same model, median NT levels are significantly associated with the increasing GGT tertile (β = 1.06;95%CI 0.67-1.45), but not with the AST and ALT tertiles.In a multiple regression model, after adjusting for age,sex, BMI, waist, smoking, and alcohol consumption, both NT (β = 0.05; 95%CI 0.02-0.08) and hs-CRP levels (β =0.09; 95%CI 0.03-0.15) are significantly associated with fasting glycemia.CONCLUSION: GGT, an easy, universally standardized and available measurement, could represent an early marker of sub-clinical inflammation and oxidative stress in otherwise healthy individuals. Prospective studies are needed to establish if GGT could predict future diabetes in these subjects.