Determinants Of Cardiovascular Disease Research Articles

Sex Differences in the Prediction of Type 2 Diabetes by Inflammatory Markers

Although sex differences have been reported for associations between obesity and inflammation, the question of whether there is an effect modification by sex in the association between inflammation and type 2 diabetes has not been investigated in detail. Therefore, the aim of this study was to compare associations of markers of inflammation with type 2 diabetes risk between men and women. Following a case-cohort design, cases of incident type 2 diabetes were identified from 7,936 subjects aged 35-74 years at baseline who participated in the population-based Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA)/Cooperative Research in the Region of Augsburg (KORA) studies conducted between 1984 and 2002. Concentrations of C-reactive protein (CRP) and interleukin (IL)-6 were measured in 527 cases of incident type 2 diabetes (305 men and 222 women) and 1,698 noncases (889 men and 809 women). After adjustment for age and survey and lifestyle factors including smoking, alcohol intake, and physical activity, elevated concentrations of CRP showed a considerably stronger association with risk of type 2 diabetes in women (hazard ratio comparing tertile extremes 7.60 [95% CI 4.43-13.04]) than in men (1.84 [1.27-2.67]). The P value for the sex interaction was <0.001. Further adjustment for metabolic risk factors considerably attenuated these associations, and they became nonsignificant in men but remained significant in women. IL-6 was also more strongly associated with type 2 diabetes in women, but there was no significant sex interaction. Our data suggest that inflammatory processes may be of particular importance in the pathogenesis of type 2 diabetes in women.

Effect of haemodiafiltration with online regeneration of ultrafiltrate on oxidative stress in dialysis patients

Increased oxidative stress (OxSt) as well as inflammation are risk factors for cardiovascular events and determinant of cardiovascular disease which remains the most common cause of excess morbidity and mortality for end-stage renal disease ESRD patients. Haemodiafiltration with on-line regeneration of ultrafiltrate (HFR) has been shown to have a positive impact on markers of inflammation while its effect on OxSt is not known. This study evaluates in haemodialysis patients the effect of HFR on the plasma level of oxidized LDL (OxLDL), a marker of OxSt, and mononuclear cell gene and protein expression of OxSt-related proteins such as p22phox (subunit of NAD(P)H oxidase), PAI-1 (induced by OxSt and atherothrombogenetic) and haeme-oxygenase-1 (HO-1) (induced by OxSt). Fourteen patients were randomized into two groups in a crossover design, treated for 6 month periods with HFR (SG8 Plus-Bellco, Mirandola, Italy) or low-flux bicarbonate dialysis (HD) using a polysulphone dialyser 1.8 m2. Blood samples were collected at the beginning of the study, after 6 months (crossover) and after 12 months. ANOVA analysis of the data performed to rule out any crossover effect in either sequence was not significant and thus data from both sequences were combined and then analysed further statistically. HFR reduced mRNA production and protein expression of p22phox and PAI-1 compared with HD (-9+/-5 vs 2+/-6 Delta%, P<0.0001 and -15+/-20 vs 3+/-17 Delta%, P<0.05 for p22phox; -19+/-6 vs -5+/-5 Delta%, P<0.0001 and -24+/-12 vs 9+/-15 Delta%, P<0.0001 for PAI-1). HO-1 was unchanged (-12+/-8 vs -10+/-8 Delta% and -21+/-12 vs -14+/-8 Delta%) while plasma OxLDL was reduced (-14+/-19 vs 1+/-14 Delta%, P<0.01). The results of our study indicate that HFR treatment, compared with standard dialysis, has a lower impact on OxSt. Given, the strong relationship between OxSt and inflammation and their impact on the long-term cardiovascular complications in end-stage renal disease patients, HFR might have a more beneficial impact in reducing the risk of atherosclerotic cardiovascular disease in dialysis patients.

Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke

Japan's age-adjusted rate for mortality from stroke increased after the Second World War until 1965 and then showed a significant decline until 1990; however, the age-adjusted rate for mortality from all heart disease and coronary heart disease (CHD) increased until 1970 and then declined slowly. A puzzling question is why the rate of mortality from CHD declined in spite of an increase in serum total cholesterol level following an increase in fat consumption. It was confirmed that CHD incidence was far lower in several Japanese populations compared to Western countries in the " Monitoring Trends and Determinants in Cardiovascular Disease " (MONICA) project; therefore, the lower CHD mortality in Japan stems from the lower CHD incidence. CHD risk factors based on epidemiologic cohort studies in Japan were no different from those of other industrialized countries: hypertension, hypercholesterolemia, smoking and diabetes mellitus (DM). So, how can we explain this phenomenon?There are three possible explanations. One is the decline in population blood pressure level and the prevalence of hypertension during the years 1965-1990; the second is the decline in smoking rate in men and women; the third is that the serum total cholesterol level for middle-aged and elderly populations remains 5-15 mg/dL lower than that of the US elderly counterpart, although men aged 40-49 in Japan and the US had similar serum total cholesterol levels. It was also noted that elderly people in Japan, as observed in the Seven Countries Study, had far lower serum total cholesterol levels in midlife, i.e., around 160 mg/dL in the 1960s. This was not the case for elderly in the US where a higher serum total cholesterol level was observed in midlife. In conclusion, the lower serum cholesterol level in the past of Japanese middle-aged and elderly people compared to Western counterparts helps to maintain the low CHD incidence and mortality supported by the declining trend in blood pressure level and smoking rate for both men and women.

Registration and Surveillance of Acute Myocardial Infarction in Japan: Monitoring an Entire Community by the Takashima AMI Registry System and Design

The purpose of this registration is to follow incidence and case fatality trend of acute myocardial infarction (AMI) in Japan, using a whole community population disease registry that surveys the most up-to-date information. Since the 1970s, mortality from coronary heart disease has followed a declining trend in Japan, which has been attributed to a decrease in the incidence of AMI and some evidence suggests that incidence has leveled off during the past couple of decades. These reported decreasing or stable trends in AMI have been observed despite recent worsening of the cardiovascular risk factor situation in Japan (Japanese paradox). Therefore, monitoring the disease course of AMI is of immense importance. The Takashima AMI Registry established in 1988 covers a stable population of approximately 55,000 in Takashima County in central Japan. Registered patients included all Takashima County residents who have been diagnosed with AMI. The criteria of AMI are in accord with those of the World Health Organization's Monitoring of Trends and Determinants in Cardiovascular Disease (WHO-MONICA) project. Comprehensive disease registry data is especially appropriate for determining the incidence as well as the trend of diseases such as AMI. This registration study covering an entire community will enable researchers to follow trends in AMI incidence with a high degree of precision.

Učešće Novosadskog centra (Jugoslavija - Novi Sad) u WHO MONICA projektu

Novi Sad's participation in the WHO MONICA Project (Multinational monitoring of trends and determinants in cardiovascular disease) has been presented in this survey through publications which appeared during several years time, as a result of multi-centered research and cooperation. In this world's largest study of cardiovascular disease in the last century, Novi Sad was one of 38 researches centers from 21 countries. The results of the research un particular centers from late 1980 s to late 1990 s helped in creation of united data basis, which then served for testing the main hypothesis established by the project protocol. In this survey several things have been stated as follows: the monograph, articles published in periodicals as well as publicly available data base, whose creation was contributed by the researches from Novi Sad center and the researches in Novi Sad region. Also, in a separate section the se were noted: the list of publications locally published paper which were, totally or partly based on the data gathered within the WHO MONICA Project. Part of the list covers master s degrees as well as PhD degrees in which the data gathered in Novi Sad region were used.

Thrombolysis for stroke in India: Miles to go...

Stroke is a major health problem worldwide and is more recent published data show a treatment range of associated with high mortality and dependence. In the 5-11% of incident ischemic stroke in USA and West next 30 years the burden of stroke will grow mostly in European nations. The proportion of patients developing countries rather than in developed receiving thrombolysis therapy in acute stroke is countries. World Health Organization Monitoring Trends pathetically low in India. The only incidence study of and Determinants in Cardiovascular Disease (WHO stroke in India determined an incidence of 163 per 100,000 MONICA) project data showed relatively large populations per year (Dr. N. C. Borah personal geographical differences in stroke-related case-fatality communication). The expected number of incident rates, with the rates in less developed countries among ischemic strokes in India is 14, 43, 528 per year (assuming the highest in the world. ischemic stroke account for 80% of all strokes and Indian The major development in the treatment of acute population in 2005: at 1,107 millions). Anticipated cost ischemic stroke has been the introduction of thrombolysis savings and health benefits (in terms of average QALYs) therapy (intravenous tissue plasminogen activator, tPA), of thrombolysis therapy in India, even if a small proportion which has radically changed the perception and of patients are treated, will be enormous. The Indian management of stroke patients. Cochrane mata-analysis regulatory authority has approved tPA for use in acute shows that thrombolysis therapy reduces death or ischemic stroke. There are centers with infrastructure and dependence by an odds ratio (OR) of 0.66 (95% confidence resources to give tPA widespread across the country. It interval (CI) 0.53-0.83) with no significant increase in is feasible to give intravenous tPA for acute ischemic stroke adverse effects (OR 1.13; CI 0.86-1.48) for patients treated in India as shown by Padma and her colleagues in this within 3h of the onset of an ischemic stroke. This issue of the journal and also by others. However there translates to one extra patient being alive and independent are several barriers for safe and effective implementation for every seven patients treated. The safety of routine of thrombolysis therapy in acute ischemic stroke in India. clinical use of tPA within 3h of stroke onset has been Most of the centers with infrastructure and resources confirmed in the Safe Implementation of Thrombolysis to give thrombolysis therapy are in urban India, where as in Stroke-Monitoring Study (SISTS-MOST). This study 80% of the population lives in rural India where the was designed to control for symptomatic intracerebral resources to give thrombolysis therapy are virtually nonhemorrhage, mortality and independence when compared to randomized controlled trials. Thrombolysis therapy has a very favorable economic profile; the therapy results in a net cost savings. When compared with standard acute stroke care, thrombolysis therapy provides, on average, greater health benefits (in terms of average quality adjusted life years, QALYs) at reasonable medical costs. The anticipated savings that would result from even modest, feasible increase in use of thrombolysis therapy is likely to be enormous. In spite of good clinical efficacy and favorable economic profile, even in industrialized nations thrombolysis therapy is underutilized, only a very small proportion, 2%, of stroke patients are actually being treated. A existent. Indian Collaborative Acute Stroke Study, urban hospital-based, has shown 7-24% of patients present to hospital within three hours of onset of stroke (unpublished data, 2004). One of the major reasons for the late arrival is delay in transportation. There is hardly any ambulance service for transportation of the patients from rural India. Even in urban India transportation to the nearest hospital may not be in time. In an urban hospital-based study in northwest India one of the factors for early arrival to stroke unit was living within a 10-km radius from the hospital. The knowledge of stroke is quite low among the population. In a study in northwest India, majority (73%) of the subjects (including both patients and

Anxiety Disorders and Cardiovascular Disease Determinants in a Population Sample

Objective: Epidemiological research can assist with clinical practice and service planning, and can also help to generate hypotheses about disease etiology. The objective of this epidemiological study was to facilitate these goals by determining the distribution of anxiety disorders in sub-regions within a larger health region and a set of disease risk factors. Methods: Sampling and data collection occurred by telephone in a Canadian health region in Alberta of approximately one million people. The telephone survey included 6,578 participants and covered 3 anxiety disorders: panic disorder, generalized anxiety disorder, and social phobia. Results: Regional prevalence differences were not identified. However, associations between anxiety disorders and excessive alcohol consumption, smoking, obesity, hypertension, and elevated cholesterol were found. Conclusions: Integration of mental health services with other health promotion and prevention activities may be an efficient strategy for clinical practice and public health. A better understanding of the connections between anxiety disorders and chronic disease risk factors should be a goal of future research.

No association of the CYP3A5*1 allele with blood pressure and left ventricular mass and geometry: the KORA/MONICA Augsburg echocardiographic substudy

A polymorphism in the cytochrome P450 3A CYP3A5 enzyme has been implicated in BP (blood pressure) control and arterial hypertension. Carriers of the CYP3A5*1 allele had high, whereas homozygous carriers of the CYP3A5*3 allele exhibit low, CYP3A5 expression in the kidney, where CYP3A5 represents the major CYP3A enzyme. The aim of the present study was to investigate the association of the CYP3A5*1 allele with BP, arterial hypertension, LVM [(left ventricular) mass] and LV geometry in a large Caucasian-population-based cohort. We compared BP, LVM and the prevalence of hypertension between carriers (CYP3A5*1/*1 and CYP3A5*1/*3 genotypes) and non-carriers (CYP3A5*3/*3 genotype) of the CYP3A5*1 allele in the echocardiographic substudy of the third MONICA (MONItoring trends and determinants in CArdiovascular disease) Augsburg survey. After exclusion of 269 individuals who were taking antihypertensive medication, 530 women and 554 men were available for analysis, revealing allele frequencies of 5.8 and 94.2% for the CYP3A5*1 and CYP3A5*3 alleles respectively. Overall, the presence of the CYP3A5*1 allele exhibited no effect on systolic or diastolic BP in either gender. One-third of the individuals in this cohort were hypertensive (BP > or =140/90 mmHg), and the genotype distribution between normotensive and hypertensive individuals revealed no association between CYP3A5*1 and hypertension after adjustment for age, BMI and gender (odds ratio, 1.02; P=0.92). Moreover, no effect of CYP3A5*1 on LVM, thickness of the septal and posterior wall and LV end-diastolic diameter was found. We conclude that CYP3A5*1 exhibits no significant effect on BP, LVM and LV geometry in the KORA/MONICA echocardiographic substudy.

Determinants of cardiovascular disease and other non-communicable diseases in Central and Eastern Europe: Rationale and design of the HAPIEE study

BackgroundOver the last five decades, a wide gap in mortality opened between western and eastern Europe; this gap increased further after the dramatic fluctuations in mortality in the former Soviet Union (FSU) in the 1990s. Recent rapid increases in mortality among lower socioeconomic groups in eastern Europe suggests that socioeconomic factors are powerful determinants of mortality in these populations but the more proximal factors linking the social conditions with health remain unclear. The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study is a prospective cohort study designed to investigate the effect of classical and non-conventional risk factors and social and psychosocial factors on cardiovascular and other non-communicable diseases in eastern Europe and the FSU. The main hypotheses of the HAPIEE study relate to the role of alcohol, nutrition and psychosocial factors.Methods and designThe HAPIEE study comprises four cohorts in Russia, Poland, the Czech Republic and Lithuania; each consists of a random sample of men and women aged 45–69 years old at baseline, stratified by gender and 5 year age groups, and selected from population registers. The total planned sample size is 36,500 individuals. Baseline information from the Czech Republic, Russia and Poland was collected in 2002–2005 and includes data on health, lifestyle, diet (food frequency), socioeconomic circumstances and psychosocial factors. A short examination included measurement of anthropometric parameters, blood pressure, lung function and cognitive function, and a fasting venous blood sample. Re-examination of the cohorts in 2006–2008 focuses on healthy ageing and economic well-being using face-to-face computer assisted personal interviews. Recruitment of the Lithuanian cohort is ongoing, with baseline and re-examination data being collected simultaneously. All cohorts are being followed up for mortality and non-fatal cardiovascular events.DiscussionThe HAPIEE study will provide important new insights into social, behavioural and biological factors influencing mortality and cardiovascular risk in the region.

Management of SAH with traditional Chinese medicine in China

China lacks large scale authorized epidemiological study results in allusion to subarachnoid hemorrhage (SAH) within recent 15 years since MONICA (multinational monitoring of trends and determinants in cardiovascular disease) study revealed SAH situation in China in 2000. The main cause of SAH in China is aneurysm which takes up 30–50%, while over 90% aneurysm locates at Willis circle. Early surgery for SAH after aneurysm rupture is the dominant procedure to deal with SAH in China. Moreover, calcium antagonists rank the absolute leading position for cerebral vascular spasm (CVS) among medication-based treatment options. However, traditional Chinese medicine such as Salvia miltiorrhiza, Acanthopanax senticosus, Ginkgo biloba, Pueraria lobata, Liguisticum chuanxiong, cow bezoar, Diospyros kaki and Gynostemma pentaphyllum have been proven beneficial in CVS prevention and treatment, while Salvia miltiorrhiza and TCM soup have unique effects on bleeding absorption. In addition, aescine and some TCM soup might relieve strong headache after SAH. In general, TCM integrated with western medicine have shown unique advantages in the current treatment of SAH in China. However, it is a pity that China still lacks larger scale randomized controlled trials and research on SAH treatment focusing on TCM and the related mechanism of TCM on SAH still need to be investigated further.

High obesity incidence in northern Sweden: How will Sweden look by 2009?

The study objective was to evaluate the incidence of overweight and obesity in two rural areas of Sweden and the U.S. Previously collected data were used from 1990 to 1999 Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) studies in northern Sweden. Health censuses of adults in Otsego County, New York were collected in 1989 and 1999. Adults aged 25-64 year in 1989 with reports from both surveys were included. The 10-year change in body mass index (BMI), overweight (BMI 25-29.9 kg/m2) and obesity (BMI>or=30) were obtained from panel studies. Incidences of overweight and obesity were calculated and compared between countries. The 10-year incidence of obesity was 120/1000 in Sweden and 173/1000 in the U.S. (p<0.001 for difference between countries). In 1999, prevalence of obesity rose to 18.4% (Sweden) and 32.3% (U.S.). Cumulative distribution curves show that the BMI distribution in Sweden during 1999 is nearly identical to the U.S. during 1989. The obese proportions of these rural populations increased from 1989 to 1999. Sweden's obesity epidemic has a progression similar to that of the U.S., implying that by 2009, the prevalence of obesity in rural northern Sweden may mimic that present in rural New York during 1999. Attention should be paid to the increased obesity rates in rural areas.

Lipoprotein-associated phospholipase A2, vascular inflammation and cardiovascular risk prediction

Circulating lipoprotein-associated phospholipase A2 (Lp-PLA2) is a marker of inflammation that plays a critical role in atherogenesis; its inhibition may have antiatherogenic effects. Studies from the West of Scotland Coronary Prevention Study (WOSCOPS), Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) and Rotterdam cohorts have shown that Lp-PLA2 is an independent predictor of coronary heart disease (CHD), and the association is not attenuated upon multivariate analysis with traditional risk factors and other inflammatory markers. Studies in subjects with coronary artery disease (CAD) have also shown associations between Lp-PLA2 and cardiovascular risk. At least two recent studies have shown that Lp-PLA2 is a risk predictor for stroke. Overall, epidemiological studies suggest that measurement of Lp-PLA2 in plasma may be a useful in identifying individuals at high risk for cardiovascular events.

Chemokines as risk factors for type 2 diabetes: results from the MONICA/KORA Augsburg study, 1984–2002

The chemokines monocyte chemoattractant protein-1 (MCP-1), IL-8 and interferon-gamma-inducible protein-10 (IP-10) are released by adipocytes and appear to be involved in atherosclerosis. We hypothesised that these chemokines may be risk factors for the development of type 2 diabetes. Using a case-cohort design based on data from the population-based Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA)/Kooperative Gesundheitsforschung in der Region Augsburg/Cooperative Health Research in the Region of Augsburg (KORA Augsburg) study, chemokine levels at baseline were analysed in 526 individuals with and 1,695 individuals without incident type 2 diabetes. The mean follow-up time was 10.8 years. MCP-1 was associated with type 2 diabetes, largely independently of classic risk factors, whereas various clinical and metabolic parameters as well as lifestyle factors were major confounders of the association of IL-8 and IP-10 with type 2 diabetes. Further adjustment for C-reactive protein (CRP) and IL-6 had no impact on the observed associations. The hazard ratio (HR) for subjects with systemic concentrations of all three chemokines (MCP-1, IL-8 and IP-10) above the respective median compared with those with all chemokines below or equal to the median was 1.79 (95% CI 1.18-2.72) and was comparable with the HR for elevated CRP and IL-6 together (adjusted for age, sex, survey, BMI, systolic blood pressure, total cholesterol:HDL cholesterol ratio, physical activity, alcohol intake, smoking and parental history of diabetes). Elevated concentrations of MCP-1, IL-8 and IP-10 are associated with incident type 2 diabetes. Whereas the association of IL-8 and IP-10 with diabetes was attenuated by multivariable adjustment, high MCP-1 levels contributed to diabetes risk independently of previously described clinical, metabolic and immunological risk factors.

Pattern of declining blood pressure across replicate population surveys of the WHO MONICA project, mid-1980s to mid-1990s, and the role of medication

Objective Declining mean systolic and diastolic blood pressures were observed in most populations of the World Health Organization MONICA (monitoring trends and determinants in cardiovascular disease) project from the mid-1980s...

Metabolic Syndrome and its Associated Risk Factors in Healthy Adults: APopulation-Based Study in Iran

Metabolic syndrome includes obesity, hypertriglyceridemia, glucose intolerance, hypertension, and lipid profile abnormalities. The risk of cardiovascular diseases with this syndrome is higher than with each of its components alone. Currently, cardiovascular disorders have a great burden and a high mortality rate in Iran. This study was performed to determine prevalence of the metabolic syndrome and its underlying components in an urban population of Tehran. The 25-64-year-old individuals in the Population Laboratory of Tehran University of Medical Sciences were studied through a single-stage cluster sampling; 1573 participants were studied. The response rate was 94.08%. The study was designed according to the World Health Organization (WHO) MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) project using the Adult Treatment Panel III (ATPIII) criteria. The parameters used for the risk analysis were waist circumference, fasting serum triglycerides, high density lipoprotein (HDL)-cholesterol, blood pressure, and fasting plasma glucose. The crude prevalence rate of the metabolic syndrome was 29.9% (age-adjusted: 27.5%). The prevalence was significantly higher in women than in men (35.9% vs. 20.3%). The prevalence increased with age in both genders. In the whole population, 88% met at least one of the metabolic syndrome criteria. The most prevalent metabolic abnormalities were hypertriglyceridemia and hypertension that were present in more than half of the population. Also, means of HDL was significantly higher in metabolic syndrome positive group. By further adjustment for age and sex in multivariate analysis, the difference disappeared and even HDL-C level was slightly lower in people with metabolic syndrome. RESULTS demonstrate high metabolic syndrome rate among target population especially in women. In view of correlation between metabolic syndrome and cardiovascular disease, it must be the priority for interventional preventive measures.

Assessing the quality of risk factor survey data: lessons from the WHO MONICA Project

Survey data quality is a combination of the representativeness of the sample, the accuracy and precision of measurements, data processing and management with several subcomponents in each. The purpose of this paper is to show how, in the final risk factor surveys of the WHO MONICA Project, information on data quality were obtained, quantified, and used in the analysis. In the WHO MONICA (Multinational MONItoring of trends and determinants in CArdiovascular disease) Project, the information about the data quality components was documented in retrospective quality assessment reports. On the basis of the documented information and the survey data, the quality of each data component was assessed and summarized using quality scores. The quality scores were used in sensitivity testing of the results both by excluding populations with low quality scores and by weighting the data by its quality scores. Detailed documentation of all survey procedures with standardized protocols, training, and quality control are steps towards optimizing data quality. Quantifying data quality is a further step. Methods used in the WHO MONICA Project could be adopted to improve quality in other health surveys.

Do Energy Density and Dietary Fiber Influence Subsequent 5‐Year Weight Changes in Adult Men and Women?

We examined whether associations between dietary components and, in particular, energy density (ED) predicted subsequent 5-year weight changes. The present longitudinal population study was part of the Danish World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) and the 1936 cohort dietary studies. Effects of components were studied in relation to subsequent 5-year weight changes in 862 men and 900 women, 30 to 60 years old. Linear multiple regression analyses were conducted. Mean 5-year changes in body weight (BW) were 1.2 +/- 3.9 and 1.3 +/- 4.6 kg for men and women, respectively. In general, neither ED nor any of the dietary components was associated with subsequent change in BW. In women, ED was positively associated with weight gain among the obese (BMI > 30 kg/m2) and inversely associated with weight gain in normal-weight women (BMI < 25 kg/m2) (p = 0.01). However, in men there was a non-significant inverse trend between ED and weight gain in the obese and no significant interaction. To our knowledge, this is the first prospective study to examine the associations between ED and subsequent changes in BW, and despite a general belief that ED is a major determinant of obesity, the present study did not generally lend support for an association. However, among certain subgroups, an energy-dense diet may be a risk factor for weight development.

Elevated Markers of Endothelial Dysfunction Predict Type 2 Diabetes Mellitus in Middle-Aged Men and Women From the General Population

Using the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA)/Cooperative Research in the Region of Augsburg (KORA) database, we investigated prospectively whether increased levels of soluble E-selectin (sE-selectin), soluble intercellular adhesion molecule 1 (sICAM-1), and von Willebrand factor (vWF), all considered to be sensitive markers of endothelial dysfunction, are associated with an increased risk of incident type 2 diabetes mellitus. In a case-cohort study, concentrations of adhesion molecules were measured in stored samples of 532 case subjects and 1712 noncase subjects. VWF was measured in a subsample with available plasma samples (n=191 case and 580 noncase subjects). Men and women with elevated levels of sE-selectin had a significantly increased risk of type 2 diabetes after multivariable adjustment. Hazard ratios (95% CIs) comparing tertile extremes of sE-selectin were 2.63 (1.79 to 3.88) and 1.71 (1.07 to 2.75) for men and women, respectively. Elevated levels of sICAM-1 were also associated with an increased risk of type 2 diabetes; however, the association was not independent of other diabetes risk factors including E-selectin [hazard ratio (95% CI) for tertile 3 versus tertile 1: men, 1.32 (0.89 to 1.96); women, 1.03 (0.64 to 1.67)]. In this study, vWF was not associated with risk of type 2 diabetes. These data support a role of endothelial dysfunction in the etiology of type 2 diabetes.

Can adverse effects of dietary fat intake be overestimated as a consequence of dietary fat underreporting?

To describe the consequences of systematic reporting bias by the obese for diet-disease relationships. The present report used 24-hour urinary nitrogen and estimates of 24-hour energy expenditure to assess error in diet reporting, and examined the consequence of accounting for this error for associations between dietary fat intake and serum low-density lipoprotein (LDL)-cholesterol. Sub-study to the Danish MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) project, carried out in 1987-1988. A random sub-sample of the adult Danish male population (n = 152). Correcting dietary fat for underreporting error weakened, rather than strengthened, the association between dietary fat intake and LDL-cholesterol by reducing the slope of the regression from beta = 3.4, P = 0.02 to beta = 2.7, P = 0.04. This example illustrates that systematic underreporting of dietary fat by high-risk groups such as the obese may produce an overestimated association. These results imply that previous epidemiological studies showing a positive association between percentage of energy from fat and other health outcomes, e.g. cancer and heart disease, may have overestimated the negative effects of a high-fat diet. If we were able to correctly assess dietary fat intake in general populations, recommendations for fat intake may be more liberal than the 30% suggested today. Improved assessment of fat intake in epidemiological studies is necessary for future development of evidence-based recommendations for diet and health .

Effect on Trend Estimates of the Difference between Survey Respondents and Non-respondents: Results from 27 Populations in the WHO MONICA Project

In the World Health Organization (WHO) MONICA (multinational MONItoring of trends and determinants in CArdiovascular disease) Project considerable effort was made to obtain basic data on non-respondents to community based surveys of cardiovascular risk factors. The first purpose of this paper is to examine differences in socio-economic and health profiles among respondents and non-respondents. The second purpose is to investigate the effect of non-response on estimates of trends. Socio-economic and health profile between respondents and non-respondents in the WHO MONICA Project final survey were compared. The potential effect of non-response on the trend estimates between the initial survey and final survey approximately ten years later was investigated using both MONICA data and hypothetical data. In most of the populations, non-respondents were more likely to be single, less well educated, and had poorer lifestyles and health profiles than respondents. As an example of the consequences, temporal trends in prevalence of daily smokers are shown to be overestimated in most populations if they were based only on data from respondents. The socio-economic and health profiles of respondents and non-respondents differed fairly consistently across 27 populations. Hence, the estimators of population trends based on respondent data are likely to be biased. Declining response rates therefore pose a threat to the accuracy of estimates of risk factor trends in many countries.