Chronic obliterative arterial disease of the lower limbs in the coronary patient: prevalence and prognostic incidence. The Monica Toulouse register]

PURPOSE: This study was aimed at evaluating the prevalence of peripheral arterial disease of the lower extremities and its prognostic value in a population of patients from the Haute-Garonne department, who were hospitalized for acute coronary artery disease. METHODS: Between 1985 and 1991, four thousands three hundred and sixty-eight patients (3,680 males and 688 females) presenting with acute coronary artery disease were included in the study. RESULTS: The prevalence of peripheral arterial disease of the lower extremities was 13.4%, increasing with age and being higher in male patients. In regard to patients hospitalized for acute myocardial infarction (n = 2,417), independent relationships were observed between the 28-day mortality and the following: patient's age (odds ratio: 1.02; 95% confidence interval: 1.01-1.04; P < 0.0005), female gender (odds ratio: 1.32; 95% confidence interval: 1.17-1.54; P < 0.002), inclusion in the study (odds ratio 0.95; 95% confidence interval: 0.90-0.99; P < 0.02), previous coronary artery disease (odds ratio: 2.88; 95% confidence interval: 2.32-3.48; P < 0.0001), and peripheral arterial disease (odds ratio: 1.61; 95% confidence interval: 1.26-2.06; P < 0.0001). CONCLUSION: The prevalence of peripheral arterial disease of the lower extremities is high in patients with acute coronary artery disease in both genders, whatever the age. This disease is therefore an independent marker of mortality for acute myocardial infarction. Easy diagnosis of peripheral arterial disease of the lower limbs by measurement of the ankle pressure index allows identification of patients prone to death from acute myocardial infarction.     

Incidence of varicose veins in Finland

BACKGROUND: Incidence of varicose veins in the population is unknown. The study aimed at estimating the incidence of varicose veins in complete cohorts of 40-60 year-olds in a general population. PATIENTS AND METHODS: The study was conducted in the city of Tampere, Finland. A validated questionnaire (with 93% sensitivity and 92% specificity) was used in a general population of 6874 individuals (aged 40, 50 or 60). Initially, 3065 of them had no varicose veins and 78% were followed-up for 5 years. RESULTS: 157 individuals reported new varicose veins during the follow-up. The overall incidence was 13.5 per 1000 person years (8.5 for men and 19.2 for women). Female sex was an independent and statistically significant risk indicator of varicose veins (adjusted odds ratio, OR 2.4). The incidence was significantly higher at the age of 50-55 years (OR 1.6). Higher body mass index seemed to be related to higher risk of new varicose veins (OR 1.2-1.8), but the association failed to reach statistical significance. The level of education did not affect the incidence. CONCLUSIONS: New varicose veins appear also in the middle-aged population, and the rate is linked with the female gender, especially at the beginning of the 6th decade.     

Anticardiolipin antibodies and risk of thromboembolic disease in young Jamaican women

BACKGROUND: Anticardiolipin antibodies (aCL) are a heterogeneous group of antiphospholipid antibodies that are associated with arterial and venous thrombosis. We measured aCL in women, aged 15-49 years, to determine if they are an independent risk factor for thromboembolic disease. STUDY DESIGN: Case--control study METHODS: Fifty cases were studied including venous thromboembolism (n=29), stroke and myocardial infarction (n=21), along with 148 age-matched controls. Serum samples were assayed for aCL and anti-beta2 glycoprotein 1 antibodies using the enzyme-linked immunosorbent assay (ELISA). Information on other risk factors was obtained by a standardized questionnaire. RESULTS: aCL were present in 16/50 (32%) of cases compared with 25/148 (17%) of controls (P[?]=[?]0.02). Unadjusted odds ratio (OR) and 95% confidence interval (95% CI) for thromboembolic disease associated with aCL was 2.32 (1.10--4.87). Other risk factors were hypertension, 2.93 (1.20--7.17) and a history of other heart diseases, 12.78 (1.32--123.60). Adjustment for hypertension, diabetes, oral contraceptive use, smoking, alcohol use, varicose veins, a family history of cardiovascular disease and a history of other heart diseases yielded OR (95%CI) 2.99 (1.32--6.80). beta2 glycoprotein 1-dependent aCL were also an independent risk factor, OR 4.56 (1.76--17.83). Subgroup analysis was carried out separately for cases of MI and stroke and for venous thrombosis. Adjusted OR (95% CI) associated with aCL in cases of MI and stroke was 1.76 (0.46--6.73) and 3.32 (1.15--9.54) for venous thromboembolism. CONCLUSION: aCL are a risk factor for thromboembolic disease in young Jamaican women. They confer a strong independent risk for venous thromboembolism.     

Coronary artery disease and arterial hypertension: clinical, angiographic and follow-up data

OBJECTIVES: To evaluate how the presence of arterial hypertension affects coronary atherosclerosis and prognosis in patients with, or at high risk of, ischaemic heart disease. DESIGN: Retrospective analysis of clinical records and follow-up data. SETTINGS: Single referral centre for ischaemic heart disease. SUBJECTS: All consecutive patients (n = 1700, 38% with hypertension) undergoing coronary angiography for the evaluation of ischaemic heart disease during 1983-92. RESULTS: On angiography, the likelihood of having three-vessel disease was higher amongst hypertensives (odds ratio = 1.41; 95% confidence interval [CI] = 1.08-1.85) after adjustment for age, sex, and angina symptoms. The sum of all visible stenoses (an index of overall atherosclerotic involvement) was 19% higher in hypertensives (262 +/- 204 vs. 220 +/- 194 units, P < 0.005). By multivariate analysis, the presence of hypertension made a modest (+ 28 units), albeit statistically significant, independent contribution to the total atherosclerosis score. On follow-up (median = 96 months), cardiovascular mortality was slightly higher in the hypertensive patients than in the normotensive group (P < 0.05 in a Kaplan-Meier analysis), but a proportional hazard analysis adjusting for age and gender showed no significant independent contribution of hypertension. Hypertensive patients, however, remained at higher risk of non-fatal myocardial infarction following discharge (adjusted odds ratio = 1.21, 95% CI = 1.03-1.46; P < 0.05). CONCLUSIONS: In this referral population, hypertension is a risk factor for presence of three-vessel disease. Distribution, severity and extension of coronary stenosis are similar to those of normotensive patients, and prognosis is only marginally affected.     

Incidence and risk factors of chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism

Background

Early identification and treatment of chronic thromboembolic pulmonary hypertension (CTEPH) are critical to prevent disease progression. We determined the incidence and risk factors for CTEPH in patients with a first episode of acute pulmonary embolism (PE).

Methods

In this study, consecutive patients with first-episode acute PE were followed for ≤5 years. Pulmonary hypertension (PH) was screened for by echocardiography. Suspected cases were evaluated by right heart catheterization (RHC) and pulmonary angiography (PA). If invasive procedures were not permitted, PH was diagnosed by systolic pulmonary artery pressure (SPAP) >50 mmHg. Diagnosis of CTEPH was confirmed by PA, ventilation/perfusion (V/Q) lung scan, or computed tomography (CT) PA (CTPA).

Results

Overall, 614 patients with acute PE were included (median follow-up, 3.3 years). Ten patients were diagnosed with CTEPH: cumulative incidence 0.8% [95% confidence interval (CI), 0.0-1.6%] at 1 year, 1.3% (95% CI, 0.3-2.3%) at 2 years, and 1.7% (95% CI, 0.7-2.7%) at 3 years. No cases of CTEPH developed after 3 years. History of lower-limb varicose veins [hazard ratio (HR), 4.3; 95% CI, 1.2-15.4; P=0.024], SPAP >50 mmHg at initial PE episode (HR, 23.5; 95% CI, 2.7-207.6; P=0.005), intermediate-risk PE (HR, 1.2; 95% CI, 1.0-1.4; P=0.030), and CT obstruction index over 30% at 3 months after acute PE (HR, 42.5; 95% CI, 4.4-409.8; P=0.001) were associated with increased risk of CTEPH.

Conclusions

CTEPH was not rare after acute PE in this Chinese population, especially within 3 years of diagnosis. Lower-limb varicose veins, intermediate-risk PE with elevated SPAP in the acute phase, and residual emboli during follow-up might increase the risk of CTEPH.     

Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom

BACKGROUND: Venous thromboembolism (VTE) manifesting as deep vein thrombosis (DVT) and pulmonary embolism (PE) remains a common vascular disease with high mortality and morbidity. Our aim was to study the clinical spectrum of VTE, assess its incidence in the general population, and evaluate potential risk factors. METHODS: Prospective cohort study with nested case-control analysis using the General Practice Research Database (1994-2000). Venous thromboembolism was newly diagnosed in 6550 patients. Cases were compared with a random sample of 10,000 controls and frequency-matched by age, sex, and year. RESULTS: The incidence rate of VTE was 74.5 per 100,000 person-years. Overweight, varicose veins, inflammatory bowel disease, cancer, and oral corticosteroid use were associated with a greater risk of VTE. Ischemic heart disease, heart failure, and cerebrovascular diseases were associated with an increased risk of PE but not with DVT. Venous thromboembolism was strongly associated with fractures (odds ratio [OR], 21.3; 95% confidence interval [CI], 15.7-28.9) and surgery (OR, 25.0; 95% CI, 14.4-43.5). In women, the risk of VTE was 1.9 (95% CI, 1.5-2.3) among those receiving opposed hormone therapy (in which the woman takes estrogen throughout the month and progesterone for 10-14 days later in the month) and 1.9 (95% CI, 1.4-2.5) among those taking oral contraceptives. Cancer and cerebrovascular diseases presented a greater relative risk of fatal PE compared with nonfatal PE. CONCLUSIONS: Overweight, varicose veins, cancer, inflammatory bowel disease, fractures, surgery, and use of oral corticosteroids, oral contraceptives, and opposed hormone therapy were independent risk factors for both DVT and PE. The magnitude of the association with some risk factors varied between DVT and PE, as well as between fatal and nonfatal PE.     

Clinical features of venous insufficiency and the risk of venous thrombosis in older people

Venous thrombosis is common in older age, with an incidence of 0·5–1% per year in those aged >70 years. Stasis of blood flow is an important contributor to the development of thrombosis and may be due to venous insufficiency in the legs. The risk of thrombosis associated with clinical features of venous insufficiency, i.e., varicose veins, leg ulcers and leg oedema, obtained with a standardized interview was assessed in the Age and Thrombosis Acquired and Genetic risk factors in the Elderly (AT‐AGE) study. The AT‐AGE study is a case–control study in individuals aged 70 years and older (401 cases with a first‐time venous thrombosis and 431 control subjects). We calculated odds ratios (ORs) and corresponding 95% confidence intervals (CI) adjusted for age, sex and study centre. Varicose veins and leg ulcer were associated with a 1·6‐fold (95% CI 1·2–2·3) and 3·3‐fold increased risk of thrombosis (95% CI 1·6–6·7), respectively, while the risk was increased 3·0‐fold (95% CI 2·1–4·5) in the presence of leg oedema. The risk of thrombosis was highest when all three risk factors occurred simultaneously (OR: 10·5; 95% CI 1·3–86·1). In conclusion, clinical features of venous insufficiency, i.e., varicose veins, leg ulcers and leg oedema, are risk factors for venous thrombosis in older people.     

Impaired glucose tolerance is a risk factor for stroke in a Japanese sample--the Funagata study

Impaired glucose tolerance (IGT) is a known risk factor for cardiovascular disease, which includes stroke as well as coronary heart disease (CHD). We investigated whether IGT is a risk factor for stroke. The incidence of stroke and CHD in a cohort population (n = 2938) consisting of participants of the 1990-1997 Funagata study was assessed through interviews with the participants and their family members and reviews of death certificates and residence transfer documents through 2002. Glucose tolerance at the baseline was classified according to the criteria of the 1998 World Health Organization (normal glucose tolerance, n = 2189; IGT, n = 320; and diabetes, n = 286). The cumulative incidences among the groups were compared using the Kaplan-Meier product-limit method, and the risks of these conditions were evaluated by person-year and Cox proportional hazard methods. During the 147-month (mean, 116.5 months) follow-up, 158 (normal glucose tolerance, IGT, and diabetes: 94, 35, and 29, respectively) participants experienced a stroke and 94 (54, 16, and 24, respectively) experienced CHD. By the person-year method, IGT and diabetes were shown to be significant risk factors for stroke and CHD (odds ratio, 1.87 [95% confidence interval, 1.73-2.03] and 3.57 [3.21-3.98] for stroke; 1.53 [1.31-1.78] and 3.47 [2.91-4.14] for CHD, respectively). Cox proportional hazard analysis showed that IGT was a risk factor for stroke (age-, sex-, and hypertension-adjusted hazard ratio: 1.51 [95% confidence interval, 1.02-2.24], P = .039) but not for CHD (1.21 [0.69-2.313], .509). Impaired glucose tolerance is a risk factor for future stroke in a Japanese population.     

Smooth muscle cell hypertrophy in varicose veins is associated with expression of estrogen receptor-beta

Varicose veins are characterized by dilated and thickened vein walls. This study examined whether the changes that occur in varicose veins are associated with smooth muscle cell (SMC) hypertrophy, cellular proliferation or apoptosis. Moreover, the association between SMC hypertrophy and the expression of the estrogen receptor-beta (ERbeta) was investigated. Varicose veins were obtained from male patients during vascular stripping surgery (n = 11) and nonvaricose veins during coronary bypass surgery, also from male subjects (n = 12). The cellular volume of the SMC in both the longitudinal and circular layer of the vessel wall was measured using stereological methods. Apoptosis was detected using the TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling) technique. SMC proliferation and ERbeta expression were investigated by immunohistochemistry. Neither in the longitudinal nor in the circular layer of the varicose vein wall were signs of apoptosis or proliferation present. However, the mean cellular volume of the SMC in the circular layer of the varicose veins was strongly increased (5,291 +/- 363 microm3) as compared to non-varicose veins (2,812 +/- 212 microm3, p < 0.001). Moreover, ERbeta expression in the circular layer of varicose veins (63 +/- 4%) significantly differed from nonvaricose veins (39 +/- 4%; p = 0.001). Interestingly, the SMC volume correlated with ERbeta expression (r = 0.71, p < 0.001). These data show that cell death or proliferation of SMC do not, or only rarely, occur in varicose veins. However, remodeling of varicose veins can mainly be attributed to increased volumes of the SMC of the circular layer and this increase correlates with ERbeta expression.     

Prevalence and risk factors of varicose veins in Japanese women

The prevalence and risk factors of varicose veins in Japan were investigated in 541 Japanese women. Varicose veins were defined as any dilated, tortuous, and elongated veins of the lower extremity and classified into four types. The total prevalence rate was 45%. Saphenous type was observed in 22%, segment type in 35%, reticular type in 28%, and web type in 16%. Varicose veins in Japan seem to be less common than in the United States and Europe but more prevalent than in Africa. Concerning risk factors for varices, age, sex, heredity, and childbirth were related to the incidence of varicosities, as reported by others. However, these risk factors were shown to differ according to type of varicose veins.     

Clinical risk factors for portopulmonary hypertension

Portopulmonary hypertension affects up to 6% of patients with advanced liver disease, but the predictors and biologic mechanism for the development of this complication are unknown. We sought to determine the clinical risk factors for portopulmonary hypertension in patients with advanced liver disease. We performed a multicenter case-control study nested within a prospective cohort of patients with portal hypertension recruited from tertiary care centers. Cases had a mean pulmonary artery pressure > 25 mm Hg, pulmonary vascular resistance > 240 dynes x second x cm(-5), and pulmonary capillary wedge pressure < or = 15 mm Hg. Controls had a right ventricular systolic pressure < 40 mm Hg (if estimable) and normal right-sided cardiac morphology by transthoracic echocardiography. The study sample included 34 cases and 141 controls. Female sex was associated with a higher risk of portopulmonary hypertension than male sex (adjusted odds ratio = 2.90, 95% confidence interval 1.20-7.01, P = 0.018). Autoimmune hepatitis was associated with an increased risk (adjusted odds ratio = 4.02, 95% confidence interval 1.14-14.23, P = 0.031), and hepatitis C infection was associated with a decreased risk (adjusted odds ratio = 0.24, 95% confidence interval 0.09-0.65, P = 0.005) of portopulmonary hypertension. The severity of liver disease was not related to the risk of portopulmonary hypertension. CONCLUSION: Female sex and autoimmune hepatitis were associated with an increased risk of portopulmonary hypertension, whereas hepatitis C infection was associated with a decreased risk in patients with advanced liver disease. Hormonal and immunologic factors may therefore be integral to the development of portopulmonary hypertension.     

Association of C677T polymorphism in the methylenetetrahydrofolate reductase gene with hypertension in pregnancy and pre-eclampsia: a meta-analysis

OBJECTIVE: To evaluate whether the C677T polymorphism of the methylenetetrahydofolate reductase (MTHFR) gene is consistently associated with hypertension in pregnancy. DESIGN: Meta-analysis of studies comparing women with and without hypertension in pregnancy for the C677T MTHFR polymorphism. METHODS: Studies were identified with MEDLINE and EMBASE searches complemented with perusal of bibliographies of retrieved articles and communication with investigators. Between-study heterogeneity was estimated and data were combined with random effects models. Sensitivity analyses examined the effect of population and disease characteristics. Bias diagnostics evaluated the evolution of the postulated genetic effect over time and the potential for publication bias. RESULTS: Across 23 comparisons (3169 hypertensive women, 3044 controls), having the T allele (TT or CT) increased the odds of hypertensive disease of pregnancy by 1.21-fold (95% confidence interval, 1.01-1.44), but there was large between-study heterogeneity (P = 0.003). The results were similar and heterogeneity persisted when sensitivity analyses were limited to studies of Caucasian populations, or those of patients with significant proteinuria. While patients with diastolic hypertension > or = 110 mmHg showed an odds ratio of 1.41 (95% confidence interval, 1.03-1.73), no association was seen in patients with less severe diastolic hypertension (odds ratio, 1.00; 95% confidence interval, 0.61-1.65). Early published studies tended to show stronger associations than the subsequent studies. CONCLUSIONS: While bias cannot be excluded, the meta-analysis suggests that the T allele may increase the risk of severe diastolic hypertension during pregnancy.     

Association of the C-344T aldosterone synthase gene variant with essential hypertension: a meta-analysis

BACKGROUND: The CYP11B2 gene (CYP11B2) encoding aldosterone synthase has been associated with essential hypertension and some, but not all, studies have reported that the C-344T variant may influence the risk of the disease. OBJECTIVE: We performed a systematic review of the literature by means of a meta-analysis to evaluate the influence of the C-344T CYP11B2 polymorphism on arterial hypertension and intermediate phenotypes. METHODS: From 485 reports, we included 42 observational studies, case-control and cohort at baseline. Fixed and random effect models were used to pool data from individual studies. RESULTS: From 19 heterogeneous studies including 5343 essential hypertensive and 5882 control subjects, we found a significant association between hypertension and the C-344T variant in fixed but not in random effect models [for homozygous CC: odds ratio (OR), 0.834; 95% confidence interval (CI), 0.760-0.914; P < 0.0001, n = 11 225]. Besides, homozygous CC subjects had lower plasma renin activity (D, -0.161; 95% CI, -0.279 to -0.043; P < 0.01, n = 1428) but no difference in plasma aldosterone levels (D, -0.006; 95% CI, -0.081 to 0.07; P = 0.88, n = 2872). Limiting the quantitative analysis of blood pressure to 13 studies including only untreated individuals, no significant association was found for systolic arterial blood pressure (D, 0.042; 95% CI, -0.057 to 0.141; P = 0.41, n = 1775) and diastolic arterial blood pressure (D, 0.026; 95% CI, -0.073 to 0.125; P = 0.61, n = 1775). CONCLUSION: Homozygous individuals for the -344C CYP11B2 allele are at 17% lower risk of hypertension with respect to homozygous TT subjects.     

Hypertension and the risk of acute myocardial infarction in Argentina. The Argentine Factores de Riesgo Coronario en America del Sur (FRICAS) Investigators

The relationship between a history of hypertension and the quality of its control in routine clinical practice and the risk of acute myocardial infarction was examined in a multicenter, case-control study conducted in Argentina between November 1991 and August 1994, within the framework of the FRICAS study. The cases were 939 patients with acute myocardial infarction and without a history of ischemic heart disease. The controls were 949 subjects identified in the same centers as the cases and admitted with a wide spectrum of acute disorders unrelated to known or suspected risk factors for acute myocardial infarction. The odds ratios and the 95% confidence intervals were derived from multiple logistic regression equations, including terms for age, gender, education, social status, exercise, smoking status, cholesterolemia, history of diabetes, body mass index, and family history of myocardial infarction. The quality of hypertension control was assessed with the most recent blood pressure reading reported by the subjects. Seventy-two percent of hypertensive cases and 62.6% of hypertensive controls had a history of antihypertensive therapy by self-report, when admitted to the medical center. The adjusted odds ratio for acute myocardial infarction due to hypertension was 2.58 (95% confidence interval, 2.08-3.19). The odds ratio was 2.42 (95% confidence interval, 1.88-3.11) when hypertensives reported that their greatest systolic value was below 200 mm Hg (moderate status) and 4.12 (95% confidence interval, 2.87-5.89) when it was above 200 mm Hg (severe status). When the highest diastolic blood pressure value was below 120 mm Hg (moderate status), the risk increased to 2.48 (95% confidence intervals, 1.90-3.24) and to 4.12 (95% confidence interval, 2.83-5.99) when it was above 120 mm Hg (severe status). If the most recent systolic blood pressure was less-than-or-equal140 mm Hg, the odds ratio was 2.59 (95% confidence interval, 1.96-3.41), and it was 3.42 (95% confidence interval, 2.40-4.87) when the value was >140 mm Hg. If the most recent diastolic blood pressure was less-than-or-equal90 mm Hg, the risk increased more than two fold (odds ratio=2.48; 95% confidence interval, 1.91-3.22), and if it was >90 mm Hg, it increased nearly four-fold (odds ratio=3.72; 95% confidence interval, 2.33-5.96). In smokers, the odds ratio was 2.28 in the absence of hypertension and increased to 7.51 when hypertension was present. In this Argentine population, hypertension is a strong and independent risk factor for acute myocardial infarction. In routine clinical practice, the control of blood pressure to levels below 140/90 seems to be required in order to reduce part (but not all) of the risk of acute myocardial infarction in hypertensive patients. (c) 2001 by CHF, Inc.     

Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension

To examine the long-term effects of weight loss and dietary sodium reduction on the incidence of hypertension, we studied 181 men and women who participated in the Trials of Hypertension Prevention, phase 1, in Baltimore, Md. At baseline (1987 to 1988), subjects were 30 to 54 years old and had a diastolic blood pressure (BP) of 80 to 89 mm Hg and systolic BP <160 mm Hg. They were randomly assigned to one of two 18-month lifestyle modification interventions aimed at either weight loss or dietary sodium reduction or to a usual care control group. At the posttrial follow-up (1994 to 1995), BP was measured by blinded observers who used a random-zero sphygmomanometer. Incident hypertension was defined as systolic BP > or =160 mm Hg and/or diastolic BP > or =90 mm Hg and/or treatment with antihypertensive medication during follow-up. Body weight and urinary sodium were not significantly different among the groups at the posttrial follow-up. After 7 years of follow-up, the incidence of hypertension was 18.9% in the weight loss group and 40.5% in its control group and 22.4% in the sodium reduction group and 32.9% in its control group. In logistic regression analysis adjusted for baseline age, gender, race, physical activity, alcohol consumption, education, body weight, systolic BP, and urinary sodium excretion, the odds of hypertension was reduced by 77% (odds ratio 0.23; 95% confidence interval 0.07 to 0.76; P=0.02) in the weight loss group and by 35% (odds ratio 0.65; 95% confidence interval 0.25 to 1.69; P=0.37) in the sodium reduction group compared with their control groups. These results indicate that lifestyle modification such as weight loss may be effective in long-term primary prevention of hypertension.     

The effect of methylenetetrahydrofolate reductase C677T common variant on hypertensive risk is not solely explained by increased plasma homocysteine values

The C677T transition of methylenetetrahydrofolate reductase (MTHFR) gene causes a moderate increase in total plasma homocysteine (tHcy). We studied the effect of MTHFR TT homozygosity and mild hyperhomocysteinemia on arterial hypertension. Normotensive controls (n = 223) and hypertensive subjects (n = 235) were matched for age, gender, and history of cardiovascular disease. Homocysteine levels were measured by a polarization immunoassay method. Methylenetetrahydrofolate reductase we determined by polymerase chain reaction and restriction fragment analysis. Hypertensives showed elevated tHcy compared to normotensive group in men (P = 0.039). Homocysteine values higher than 15 micromol/L were associated with increased hypertensive risk in the male population [odds ratios (OR) = 1.63; 95% confidence interval (CI) = 1.06-2.52; P = 0.027]. In multivariate analysis, TT genotype was associated with an increased risk of hypertension in males (OR = 2.27; 95% CI = 1.12-4.60; P = 0.022) An increased hypertensive risk was observed in those TT males with tHcy levels higher than 15 micromol/L (OR = 2.78; 95% CI = 1.05-7.3; P = 0.032) but not in those non-TT males with tHcy levels higher than 15 micromol/L (P = 0.33). Our findings do not support the possibility that mild hyperhomocysteinemia my solely account for the hypertensive risk associated to the TT genotype.     

Incidence, epidemiology, and prognosis of residual pulmonary hypertension after mitral valve repair for degenerative mitral regurgitation

Pulmonary hypertension (PH) is a common sequela of degenerative mitral valve disease, but the regression of PH after mitral surgery is often incomplete. We sought to identify the preoperative risk factors for residual PH after mitral valve repair and its effect on the clinical outcome. The outcomes in 71 patients with preoperative PH (mean pulmonary arterial pressure ≥25 mm Hg) were compared according to the presence or absence of residual PH 24 hours after mitral valve surgery. Of 71 patients, 33 (46%) had residual PH. The remainder experienced significant reductions in the mean pulmonary arterial pressure without changes in pulmonary vascular resistance. Patients with residual PH had significantly elevated postoperative pulmonary vascular resistance (despite a significant decrease from the preoperative baseline) compared to those without residual PH. Residual PH was an independent risk factor for postoperative morbidity, mortality, and a prolonged intensive care unit stay (odds ratio 4.0, 95% confidence interval 1.2 to 13.1, p = 0.02), independent of the preoperative mean pulmonary arterial pressure. A decreased left ventricular ejection fraction (odds ratio 0.9, 95% confidence interval 0.8 to 1.0, p = 0.007) and fibroelastic deficiency (odds ratio 3.6, 95% confidence interval 1.1 to 11.8, p = 0.03) were independent predictors of residual PH. In conclusion, residual PH is a clinically important entity common after mitral valve repair for degenerative disease and is associated with clinical variables that aid in the preoperative prediction of at-risk patients.     

Socioeconomic trajectories and incident hypertension in a biracial cohort of young adults

We assessed the impact of initial socioeconomic status and change in socioeconomic status across 10 years, ie, status trajectories, on the development of essential hypertension among black and white young men and women. Three thousand eight hundred twenty-seven normotensive individuals ages 18 to 30 years at study entry were followed for 10 years, with blood pressure, body mass index, and socioeconomic status characteristics measured at years 0, 2, 5, 7, and 10. Socioeconomic status trajectory measures were a new educational degree earned by year 10; difficulties paying for basics during years 2 to 10; and change in income category from year 5 to 10, defined in relation to year 0 status. Hypertension was defined as systolic blood pressure > or =140, diastolic blood pressure > or =90, or antihypertensive medication use at year 10. Reporting difficulties paying for basics at study entry (odds ratio=1.45, 95% confidence interval, 1.05 to 2.02) and continued difficulties during year 2 to 10 follow-up (odds ratio=1.62, 95% confidence interval, 1.04 to 2.53) were independently associated with incident hypertension, adjusted for race-gender group, body mass index, site, age, and initial systolic blood pressure. Decline in income from year 5 to 10 tended to be associated with hypertension, P=0.07, but a new educational degree after study onset was not. Socioeconomic trajectories are independently associated with incidence of hypertension. A dynamic index of socioeconomic status may be a useful concept in understanding the effects of socioeconomic status on the natural history of hypertension.     

Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study? Coronary Artery Risk Development in Young Adults

BACKGROUND: Hypertension has been linked to several psychological factors, including depression, but the relation between hypertension incidence and depressive symptoms has not been adequately examined. OBJECTIVE: To determine if depressive symptoms independently predict hypertension incidence. DESIGN AND SETTING: A prospective, multicenter, epidemiological cohort of young adults (aged 23-35 years at study entry) from the general community without hypertension followed up for 5 years. SUBJECTS: A sample of 3343 adults from 4 urban areas stratified for race (black and white) from the CARDIA (Coronary Artery Risk Development in Young Adults) study. MAIN OUTCOME MEASURE: Hypertension incidence, which was defined as blood pressure higher than 160/95 mm Hg (assessed on a single occasion) or the use of prescribed antihypertensive medication. RESULTS: Participants with high scores (> or = 16) on the Center for Epidemiological Studies Depression (CES-D) Scale were at significant risk for hypertension incidence compared with those with low CES-D scores (< or =7; odds ratio, 2.10; 95% confidence interval, 1.22-3.61) after adjustment for other hypertension risk factors (eg, age, resting systolic blood pressure at the 5-year examination, physical activity, daily alcohol use, parental history of hypertension, education, presence of diabetes mellitus or heart disease, sex, and race) in fixed logistic models. Those with intermediate depressive symptoms (CES-D scores 8-15) were also at significant risk (adjusted odds ratio, 1.78; 95% confidence interval, 1.06-2.98). These associations were significant in blacks alone but were not found in whites, who had a lower hypertension incidence (29 [2%] of 1806) than blacks (89 [6%] of 1537). CONCLUSIONS: Depressive symptoms were predictive of later hypertension incidence in young adults, and young blacks with depressive symptoms were at high risk of developing hypertension.     

Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity

Snoring was investigated in a survey of respiratory disease in Hispanic-Americans of a New Mexico community. A population-based sample of 1222 adults was studied with questionnaires and measurements of height, weight, and blood pressure. The age-adjusted prevalence of regular loud snoring was 27.8% in men and 15.3% in women. Snoring prevalence increased with age and obesity in both men and women. Cigarette smoking was also associated with snoring, but chronic obstructive lung disease and alcohol consumption were not. Snorers more frequently had hypertension, ischemic heart disease, and excessive daytime sleepiness. In contrast to other studies, after adjustment for confounding factors, there was no effect of snoring on hypertension (odds ratio, 1.0; 95% confidence interval, 0.7 to 1.5), but an effect on myocardial infarction was still demonstrable (odds ratio, 1.8; 95% confidence interval, 0.9 to 3.6). The association of snoring with sleepiness suggests that respiratory disturbance of sleep related to upper airway obstruction, such as sleep apnea, occurs more frequently in snorers in this population.