Longitudinal assessment of fibrinogen in relation to subclinical cardiovascular disease: the CARDIA study

Summary. Objective: To examine the strength of the associations of fibrinogen with subclinical atherosclerosis in healthy persons. Methods: A population‐based, prospective, observational study of black and white men and women (Coronary Artery Risk Development in Young Adults [CARDIA]). Fibrinogen levels were measured at year 7 (ages 25–37, n = 2969), and again at year 20 (ages 38–50, n = 2832). Measures of subclinical atherosclerosis (coronary artery calcification [CAC] and carotid intimal‐medial thickness [CIMT]) were recorded at year 20. Results: Over the 13‐year study interval (1992–1993 to 2005–2006), fibrinogen rose from a mean of 3.32 to 4.05 g L^?1. After adjusting for age, gender and race, fibrinogen was positively associated with greater incidence of CAC and increased CIMT cross‐sectionally as well as after 13 years of follow‐up (all P‐trend < 0.001). After further adjustment for field center, BMI, smoking, education, systolic blood pressure, diabetes, antihypertensive medication use, total and HDL cholesterol, and CRP, significant positive relationships between fibrinogen and incidence of CAC remained for the total cohort longitudinally (P‐trend = 0.037), but not cross‐sectionally (P‐trend = 0.147). Conclusion: This 13‐year study demonstrates that higher levels of fibrinogen during young adulthood are positively associated with incidence of CAC and increased CIMT in middle‐age, but the strength of the association declines with increasing age.     

Molecular forms of gastrin in peptic ulcer: comparison of serum and tissue concentrations of G17 and G34 in gastric and duodenal ulcer subjects

Abstract We have studied the relationships between the main molecular forms of gastrin (G17 and G34) in the serum, antral and duodenal mucosa of duodenal (DU) and gastric (GU) ulcer patients. Fasting serum G17 was similar in both DU and GU (about 6 pmol/1) and in both groups increased about three-fold with feeding. In contrast, basal serum G34 was significantly higher in GU (29 pmol/1) than in DU (12 pmol/1) and the peak post prandial increase over basal of G34 was also higher in GU (57 pmol/1) compared with DU (10 pmol/1). In sharp contrast, in the same groups of DU and GU patients mean total antral gastrin concentrations were similar (about 12 nmol/g), and in both groups 95% of antral gastrin was G17, most of the remainder being G34. In both groups total duodenal gastrin concentrations were about 20% those in antral mucosa and about 70% of duodenal gastrin was attributable to G34. The higher serum G34 in GU could therefore be explained by increased secretion of duodenal gastrin, but further work is needed to examine whether there might also be preferential secretion of antral G34 in GU, or a difference in the metabolism (or volume of distribution) of gastrin variants in GU and DU.     

The Water Surrounding the Iceberg: Cultural Racism and Health Inequities

Policy Points

• Cultural racism—or the widespread values that privilege and protect Whiteness and White social and economic power—permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities.
• Overt forms of racism, such as racial hate crimes, represent only the “tip of the iceberg,” whereas structural and institutional racism represent its base. This paper advances cultural racism as the “water surrounding the iceberg,” allowing it to float while obscuring its base.
• Considering the fundamental role of cultural racism is needed to advance health equity.