Nonlinear relation between alcohol intake and high-density lipoprotein cholesterol level: results from the Copenhagen City Heart Study

BACKGROUND: It has been suggested that the level of high-density lipoprotein cholesterol (HDL-C) in the blood can be used as a marker of recent alcohol intake. However, before using HDL-C as a predictor of alcoholism, the relation between alcohol intake and HDL-C in the entire range of consumption must be explored. Most studies model the relation between alcohol intake and HDL-C linearly, although a threshold effect is expected. The objective of this study was to evaluate the shape of the relation between intake of alcohol and HDL-C and to determine whether there are differential effects of beer, wine, and spirits on HDL-C and whether they remain after adjusting for total alcohol. METHOD: The relation between alcohol intake and HDL-C was investigated by means of generalized additive models using data from the Copenhagen City Heart Study. RESULTS: A nonlinear effect of alcohol improved the model fit significantly, and the nonlinearity of alcohol was highly significant in both men and women. The relation was concave: HDL-C was stable in men and women who drank more than approximately 35 and 20 drinks per week, respectively. We found a significant nonlinear term of wine on HDL-C in men after adjustment for total alcohol intake. CONCLUSIONS: There was a concave relation between alcohol intake and HDL-C, indicating a threshold effect of alcohol on HDL-C. The association between wine and HDL-C in men after adjusting for total alcohol intake may be due to residual lifestyle confounding.     

Amount and type of alcohol and risk of dementia: the Copenhagen City Heart Study

OBJECTIVE: To assess whether amount or type of alcohol is associated with risk of dementia. Methods and subjects: Case-control nested in a cohort study among participants in the third Copenhagen City Heart Study (1991 to 1994), aged 65 years or more, who where screened using the Mini-Mental State Examination and subsequently examined for dementia. There were 83 subjects diagnosed with dementia and the remaining 1,626 nondemented subjects were included as controls. The two groups were compared with regard to alcohol intake and type of alcohol assessed 15 years before. RESULTS: Average weekly total alcohol intake had no significant effect on risk of dementia. Monthly and weekly intake of wine was significantly associated with a lower risk of dementia. For beer and spirits, only a monthly intake of beer was significantly associated with an increased risk of dementia. The effect of alcohol on risk of dementia did not differ between men and women. CONCLUSIONS: Monthly and weekly intake of wine is associated with a lower risk of dementia. The results do not indicate that people should start drinking or increase wine consumption to avoid dementia, but instead suggest that certain substances in wine may reduce the occurrence of dementia.     

Time course of threshold elevation in ON-OFF ganglion cells ofNecturus retina: Effects of lateral interactions

A flashed background field can elevate threshold in ON-OFF ganglion cells in both a transient and sustained phase. Changing the size of this flashed background field, conditioning field, demonstrated that larger fields further increase the magnitude of the transient threshold elevation and decrease the magnitude of threshold elevation during the sustained phase. Decentered discs that transiently elevate thresholds in the ganglion cells affected bipolar responses only minimally. These experiments suggest amacrine cells, conducting signals laterally across the retina, contribute to the transient threshold elevation observed in the ganglion cells.     

Platelet glycoprotein IIb/IIIa Pl(A2)/Pl(A2) homozygosity associated with risk of ischemic cardiovascular disease and myocardial infarction in young men: the Copenhagen City Heart Study

OBJECTIVES: We tested the hypothesis that platelet glycoprotein (GP) IIb/IIIa Pl(A2)/Pl(A2) homozygotes or Pl(A1)/Pl(A2) heterozygotes versus Pl(A1)/Pl(A1) noncarriers have increased risk of ischemic cardiovascular disease and myocardial infarction (MI), stratified for age and gender. BACKGROUND: The GP IIb/IIIa Pl(A1)/Pl(A2) polymorphism influences aggregation of platelets; however, an association between ischemic cardiovascular disease and heterozygosity remains controversial, and association with homozygosity is largely unexplored. METHODS: We genotyped the participants of the Copenhagen City Heart Study, a prospective cardiovascular investigation of the Danish general population (n = 9,149, 22-year follow-up) and assessed the risk of ischemic cardiovascular disease in heterozygotes or homozygotes versus noncarriers. RESULTS: Of the participants, 70.0%, 27.3%, and 2.7% were noncarriers, heterozygotes, or homozygotes, respectively. Incidence of ischemic cardiovascular disease was 167 and 103 per 10,000 person-years in homozygous and noncarrier men (log-rank: p = 0.006), whereas this difference was not observed in women (p = 0.33) (genotype.gender interaction: p = 0.03). In homozygous versus noncarrier men <40 years of age, 40 to 50 years, and >50 years at entry, age-adjusted relative risks (RRs) of ischemic cardiovascular disease were 3.6 (1.4 to 9.0), 2.4 (1.3 to 4.6), and 1.0 (0.6 to 1.8), respectively (age.genotype interaction in men: p = 0.04); equivalent multifactorially adjusted RRs were 3.0 (1.1 to 8.0), 2.0 (1.0 to 3.9), and 1.0 (0.6 to 1.8), respectively. The corresponding age-adjusted RR values of MI in men were 5.2 (1.5 to 18), 3.5 (1.6 to 7.5), and 0.5 (0.1 to 1.5), respectively (age.genotype interaction in men: p = 0.002); equivalent multifactorially adjusted RRs were 3.8 (1.0 to 15), 3.1 (1.4 to 6.9), and 0.5 (0.2 to 1.5), respectively. CONCLUSIONS: Pl(A2)/Pl(A2) homozygosity is associated with a three-fold and four-fold risk of ischemic cardiovascular disease and MI in young men.     

Urinary albumin excretion in a population based sample of 1011 middle aged non-diabetic subjects

Jensen JS, Feldt-Rasmussen B, Borch-Johnsen K, Jensen G and The Copenhagen City Heart Study Group. Urinary albumin excretion in a population based sample of 1011 middle-aged non-diabetic subjects. Scand J Clin Lab Invest 1993; 53: 867-872

Increased urinary albumin excretion rate (UAER) especially in the range of 20-200 μg min^?1, termed microalbuminuria, has been proposed as a risk marker and predictor for cardiovascular disease in non-diabetic subjects. Thus it would be of importance to describe the distribution of UAER in the non-diabetic population. Among 1011 30-70-year-old subjects without diabetes mellitus or urinary tract infection, who were invited to participate in a population based epidemiological study, the albumin concentration was measured in an overnight urine sample. The measurement was performed by an ELISA method. The UAER was calculated in units of μgmin^?1 as urinary albumin concentration × urine volume/urine collection time. The distribution of UAER was positively skewed with a median value of 2.3μgmin^?1 and a 5-95 inter-percentile range of 0-11.0μgmin^?1. The UAER held constant with age, but males had higher UAER than females, 2.6 (0-13.5)μgmin^?1 vs 2.2 (0-8.3)μgmin^?1; p < 0.005. The prevalence of microalbuminuria, defined as an UAER in the range of 15-150μgmin^?1 in an overnight urine sample, was 3% (95% C.I. interval: 1.9-4.0). These findings suggest, that the level of UAER which might notify increased cardiovascular risk, is lower than in patients with diabetes mellitus, if it is considered to be of any clinical relevance.     

Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study

BACKGROUND AND PURPOSE: The very old are expected to become a growing part of the stroke population in the industrialised part of the world. The aims of this study were to evaluate clinical characteristics of patients aged 85 years or more at stroke onset and to investigate very old age as an independent predictor of short- and long-term outcome. METHODS: In the community-based Copenhagen Stroke Study we recorded admission clinical characteristics in 1197 consecutive stroke patients. Patients were stratified according to age groups on admission. Follow-up was performed at a mean of 7 years after stroke onset. By way of multiple logistic regression and survival analyses very old age was independently related to short- and long-term mortality and nursing home placement independent of other clinical characteristics. RESULTS: 16% of patients were 85 years or older at the time of stroke onset. More of the very old were women (75% versus 50%, P<0.0001), living alone (84% versus 54%, P<0.0001), had atrial fibrillation (37% versus 15%, P<0.0001), had pre-existing disability (29% versus 22%, P = 0.04), and had more severe strokes (Scandinavian Stroke Scale score 31 versus 37 points, P = 0.004). Fewer very old had hypertension (25% versus 34%, P = 0.02) and diabetes (14% versus 22%, P = 0.01). In adjusted multiple regression models, very old age predicted short-term mortality (OR 2.5; 95% CI 1.5-4.2), and discharge to nursing home or in-hospital mortality (OR 2.7; 95% CI 1.7-4.4). Five years after stroke very old age predicted mortality or nursing home placement (OR 3.9; 95% CI 2.1-7.3), and long-term mortality (HR 2.0; 95% CI 1.6-2.5). However, other factors such as onset stroke severity, pre-existing disability and atrial fibrillation were also significant independent predictors of prognosis after stroke. CONCLUSIONS: In this study very old age per se was a strong predictor of outcome and mortality after stroke. Apart from very old age, factors such as prestroke medical and functional status, and onset stroke severity should be taken into consideration when planning treatment and rehabilitation after stroke.