Status of the epidemiology of atrial fibrillation

Atrial fibrillation (AF), an increasingly common dysrhythmia, is responsible for substantial morbidity and mortality. Currently in the United States, approximately 2.3 million people are diagnosed with AF and, based on the census, this number may rise to 5.6 million by 2050. Risk factors for AF include advancing age and cardiovascular disease and its risk factors. The chief hazard of AF is embolic stroke, which is increased four- to fivefold, assuming great importance in advanced age when it becomes a dominant factor. AF is associated with about a doubling of mortality.     

The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study.

OBJECTIVE.--To determine the relationship of varying degrees of obesity with left ventricular mass and geometry. DESIGN.--Survey. SETTING.--Population-based epidemiologic study. PARTICIPANTS AND METHODS.--M-mode echocardiograms, which were adequate for estimation of left ventricular mass, were obtained in 3922 healthy participants of the Framingham Heart Study. Measured height and weight were used to calculate body-mass index, a measure of obesity. RESULTS.--Body-mass index was strongly correlated with left ventricular mass. After adjusting for age and blood pressure, body-mass index remained a strong independent predictor of left ventricular mass, left ventricular wall thickness, and left ventricular internal dimension (P less than .01 for all). Body-mass index was associated with prevalence of echocardiographic left ventricular hypertrophy, particularly in subjects with a body-mass index exceeding 30 kg/m2. CONCLUSIONS.--Obesity is significantly correlated with left ventricular mass, even after controlling for age and blood pressure. The increase in left ventricular mass associated with increasing adiposity reflects increases in both left ventricular wall thickness and left ventricular internal dimension.     

Long-term results of surgical treatment for pulmonary valve stenosis

109 children who survived surgical treatment for isolated pulmonary valve stenosis were followed for up to 17 years. In all the postoperative status was assessed as satisfactory. Cardiac catheterization repeated in 43 gave a resting valve gradient below 40 mmHg. The 22 children whose pulmonary valves had been excised were as healthy as the 87 who had undergone pulmonary valvotomy. Consideration was given to the desirable length of postoperative review. Except for the few children with symptoms before operation, a postoperative increase in exercise tolerance was not a feature.     

Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study

Context  The long-term risk for developing hypertension is best described by the lifetime risk statistic. The lifetime risk for hypertension and trends in this risk over time are unknown. Objectives  To estimate the residual lifetime risk for hypertension in older US adults and to evaluate temporal trends in this risk. Design, Setting, and Participants  Community-based prospective cohort study of 1298 participants from the Framingham Heart Study who were aged 55 to 65 years and free of hypertension at baseline (1976-1998). Main Outcome Measures  Residual lifetime risk (lifetime cumulative incidence not adjusted for competing causes of mortality) for hypertension, defined as blood pressure of 140/90 mm Hg or greater or use of antihypertensive medications. Results  The residual lifetime risks for developing hypertension and stage 1 high blood pressure or higher (140/90 mm Hg regardless of treatment) were 90% in both 55- and 65-year-old participants. The lifetime probability of receiving antihypertensive medication was 60%. The risk for hypertension remained unchanged for women, but it was approximately 60% higher for men in the contemporary 1976-1998 period compared with an earlier 1952-1975 period. In contrast, the residual lifetime risk for stage 2 high blood pressure or higher (160/100 mm Hg regardless of treatment) was considerably lower in both sexes in the recent period (35%-57% in 1952-1975 vs 35%-44% in 1976-1998), likely due to a marked increase in treatment of individuals with substantially elevated blood pressure. Conclusion  The residual lifetime risk for hypertension for middle-aged and elderly individuals is 90%, indicating a huge public health burden. Although the decline in lifetime risk for stage 2 high blood pressure or higher represents a major achievement, efforts should be directed at the primary prevention of hypertension.      

Glucocorticoid receptor and heat shock protein 90 in peripheral blood mononuclear cells from asthmatics

目的探讨糖皮质激素受体(GR)和热休克蛋白90(HSP90)mRNA在糖皮质激素敏感型(SS)、依赖型(SD) 和抵抗型(SR)哮喘中的表达及其在SR哮喘发病中的作用。 方法采用反转录-聚合酶链(RT-PCR)的方法分别测定正常人(10例)、SS哮喘(10例)、SD哮喘(5例)和 SR哮喘(6例)的外周血单个核细胞(PBMC)中GR mRNA和HSP90 mRNA的表达,并在体外用IL-2、IL-4分 别、联合刺激上述细胞观察其受刺激后GR mRNA和HSP90 mRNA表达的改变情况。 结果 SR哮喘的GR和HSP90 mRNA表达水平最高(分别为0.730±0.171和1.122±0.165),SS哮喘次之 (分别为0.359±0.350和0.885±0.250),SD哮喘最低(分别为0.017±0.008和0.078±0.039)。正常人有 一定表达(分别为0.052±0.013和0.362±0.101)。GR和HSP90 mRNA的表达各组间相比P＜0.05。正 常人、SS、SD和SR哮喘HSP90/GR的比值分别为7.15±1.84、8.39±7.95、5.51±3.30、1.57±0.18,SR哮喘 HSP90/GR比值明显低于前三组(P＜0.05)。IL-2和IL-4单独刺激对SS、SD和SR哮喘的GR、HSP90 mRNA表达无明显影响,二者联合刺激可使SS、SD和SR哮喘GR mRNA表达以及SS、SD哮喘HSP90 mRNA 表达增强,但不能使SR哮喘HSP90 mRNA表达增强。 结论 SR哮喘中HSP90 mRNA表达相对不足造成HSP90/GR比值降低可能是SR哮喘形成的原因之一, IL-2+IL-4对GR和HSP90 mRNA表达的不同调节作用可能是形成SR哮喘HSP90/GR比值降低的原因之一。