Individual Cardiovascular Risk Factors Research Articles

Relation between age and coronary heart disease (CHD) risk in Asian Indian patients with diabetes: A cross-sectional and prospective cohort study

Objective Non-migrant Asian Indians have a high prevalence of diabetes and coronary heart disease (CHD). Since the relation between age and CHD risk in this population is not known, the appropriateness of existing age threshold for patients with diabetes to be suitable for primary CHD prevention with statins is not known. We aimed to determine an age threshold above which patients develop a higher risk of CHD and would merit routine statin prescription. Design Cross-sectional analysis of 1087 patients with diabetes from the Chennai Urban Rural Epidemiological Studies (CURES). CHD risk assessment was calculated using the United Kingdom Prospective Study (UKPDS) risk engine, externally validated by using data obtained from the 7-year follow-up cohort of the Chennai Urban Population Study (CUPS). Relation between age and CHD risk was determined and the age threshold for increased CHD risks was calculated using line of best fit. Results UKPDS risk engine overestimates CHD event rates by 50% in this population. Age is a strong independent predictor of CHD risk. Transition from low to moderate-risk category for men and women with diabetes occurred at ages 37 and 50 years, respectively. Sensitivity for fulfilling this CHD risk criteria are 98.7% for men and 87.1% for women. Conclusions Statins should be routinely prescribed to all Asian Indian men and women with diabetes above the ages of 37 and 50 years, respectively. For patients below these age thresholds, decision to initiate statins should be based on patient's individual cardiovascular risk factors. This strategy may facilitate public health efforts to reduce CHD events in India.

Learning from children: the emergence of pediatric exercise science

which unique insights can be gained from the investigations of the physiology of the growing child? Are there pragmatic outcomes to research in children's exercise science that bear specific utility to this age group or to their future life? What importance do exercise responses in youth bear to our

Exploring The Relationship Between Cardiovascular Disease Risk & Physical Activity As Measured By Accelerometers

PURPOSE: 1. To explore the inverse relationship between global cardiovascular (CV) risk & physical activity (PA). 2. To determine the PA intensity & duration best associated with reduced CV risk. The inverse relationship between physical activity & CV risk is well established. However, much dispute remains about the optimal intensity & duration related to health benefits & to lower CV risk. Accelerometry is a non-invasive, objective measure of total daily activity that can monitor activity intensity & duration in real time which may help clarify these relationships. METHODS: Subjects included 45 men & 65 women aged 18- 65, both sedentary & fit. To obtain global CV risk ranks, individual CV risk factors were measured, absolute risk ranks were developed based on gender-specific established values & absolute risk ranks were summated for each individual. To quantify habitual PA, an accelerometer was worn for 7 days. Habitual PA was examined using multiple methods including total activity, average daily counts per minute, & time in sedentary, light, moderate & vigorous levels. Individual minutes of highest intensity achieved for each day were examined for durations of 5 minutes (Hi5) to 120 minutes (Hi120) in 5 to 15 minute increments. T-tests analyses determined gender differences & ANOVAs evaluated age group differences at the various intensity levels. CV risk scores & PA patterns were correlated. PA methods with highest correlations were regressed with age by gender to develop prediction scores for CV risk. RESULTS: Participants spent 73% of time sedentary, 19.6% in light activity, 5.5% in moderate activity & 1.8% in vigorous activity. For men, total daily activity & age provided the best fit regression line with CV risk (r = − 0.53, SEE =0.58). For women, Hi30 & age had the best fit (r = −0.44, SEE = 0.50). When analyzed by age group, the best fit line for group 1 (ages 18-24) was with Hi5, r = −0.45, SEE = 0.40 & the best fit line for group 2 (ages 25-44) was with total counts, r = − 0.41 & the SEE = 0.71. CONCLUSIONS: Total daily activity & total time in moderate activity were inversely related to CVD risk. However, reaching higher intensity levels for 1 minute periods accumulated for at least 5 minutes a day appears to be better related to lower risk of CVD than longer durations of moderate or vigorous activity per day, particularly at younger ages.

Increased High-Density Lipoprotein Cholesterol Predicts the Pioglitazone-Mediated Reduction of Carotid Intima-Media Thickness Progression in Patients With Type 2 Diabetes Mellitus

Measurement of carotid intima-media thickness (CIMT) has been validated as a measure of atherosclerosis and as a predictor of future cardiovascular events. Compared with glimepiride, pioglitazone has been shown to slow the progression of atherosclerosis measured by CIMT in patients with type 2 diabetes mellitus. We evaluated individual cardiovascular risk factors as predictors of the change in CIMT produced by pioglitazone treatment by determining whether their addition to a baseline model resulted in loss of significance for the treatment effect on CIMT. Pioglitazone treatment led to improvement in levels of multiple cardiovascular risk markers, including high-sensitivity C-reactive protein, apolipoprotein B, apolipoprotein A1, high-density lipoprotein (HDL) cholesterol, triglyceride, insulin, and free fatty acid. At 24 weeks, there were significant differences in HDL cholesterol, triglyceride, total cholesterol, low-density lipoprotein cholesterol, insulin, body mass index, hip circumference, and high-sensitivity C-reactive protein between the pioglitazone and glimepiride treatment groups. After adjustment for 24-week on-treatment values of cardiovascular risk factors, only inclusion of the changes in HDL cholesterol and insulin significantly impacted the magnitude and significance of the treatment effect on CIMT. Furthermore, irrespective of treatment assignment, increased HDL cholesterol at 24 weeks was a significant predictor of reduced CIMT progression at 72 weeks. The beneficial effect of pioglitazone on HDL cholesterol at 24 weeks predicted its beneficial effect for reducing CIMT progression at 72 weeks. Changes in HDL cholesterol at 24 weeks, irrespective of treatment, predicted less progression of CIMT at 72 weeks. These results suggest that suppression of atherosclerosis with pioglitazone therapy is linked to its ability to raise HDL cholesterol.

Association of Arterial Stiffness and Endothelial Dysfunction with Metabolic Syndrome in Obese Children

We investigated whether metabolic syndrome, defined in 3 different ways (2 commonly used and 1 novel) is associated with arterial alterations in obese children. The study group comprised 384 obese children age 2.5 to 18 years. Blood pressure, fasting blood glucose, blood insulin, plasma lipids, and body composition were measured. Noninvasive ultrasound measurements were obtained in 161 patients to investigate arterial mechanical properties and endothelial function. The prevalence of metabolic syndrome was 10.4%. Intima-media thickness correlated positively with low-density lipoprotein cholesterol (r = .21; P < .01) and negatively with high-density lipoprotein cholesterol (r = -.17; P < .05). In adolescents (11 to 18 years), cross-sectional vascular compliance correlated negatively with abdominal fat (r = -.22; P = .02). The only synergistic effects among individual metabolic syndrome components was an effect of insulinemia and systolic blood pressure on cross-sectional compliance (4.05; P < .05). No significant difference in vascular variables was found between the patients with and without metabolic syndrome using any of the 3 definitions. Metabolic syndrome in obese children is not related to arterial variables, whereas several of its individual components are associated with vascular alterations. These data suggest that the value of the metabolic syndrome as a predictor of future cardiovascular events in children remains to be prospectively evaluated. In the meantime, individual cardiovascular risk factors should be evaluated and controlled.

Prevalence of Obesity, Diabetes, Hypertension, Hypercholesterolemia, and Metabolic Syndrome in Over 50-Year-Olds in Sanlúcar de Barrameda, Spain

The Spanish province of Cádiz has some of the poorest socioeconomic conditions and the highest cardiovascular morbidity and mortality rates in the country. The aim of this study was to investigate the prevalence of cardiovascular risk factors in the adult population of the city of Sanlúcar de Barrameda in Cádiz. This cross-sectional population-based study involved 858 randomly selected individuals aged 50-75 years. Age- and sex-adjusted prevalences of the main cardiovascular risk factors were obtained. The mean age of the study population was 61.5 years and 53.6% were women. Overall, 46% of men and 61.7% of women were illiterate; 23.7% and 7.9%, respectively, were current smokers; 30.9% and 44.8% had a sedentary lifestyle; 54% and 55.9% were obese; 29.4% and 26.1% had diabetes; 45% and 52.4% had hypertension; 40.9% and 45.1% had hypercholesterolemia; and 58.8% and 57% had metabolic syndrome as defined by NCEP/ATP-III criteria. The prevalence of all cardiovascular risk factors, except smoking, increased with age. Significant inverse associations were observed between educational level and obesity in men and between educational level and diabetes and metabolic syndrome in women. The prevalence of cardiovascular risk factors in individuals aged 50-75 years in Sanlúcar de Barrameda was extremely high. The prevalences of obesity, diabetes and metabolic syndrome were among the highest ever reported in Spain. A very low educational level may underlie these adverse findings.

Influence of Diabetes and Cardiovascular Disease on the Long-Term Incidence of Cataract: The Blue Mountains Eye Study

Purpose: To assess associations between diabetes and selected cardiovascular risk factors and long-term incident cataract and cataract surgery. Methods: A cohort of initially 3654 elderly Australians were followed over a period of 10 years. Questionnaires ascertained relevant history and fasting blood samples were taken. Impaired fasting glucose (IFG) and metabolic syndrome were defined using World Health Organization criteria. Discrete logistic models were used to assess risk of incident cataract. Results: After controlling for age, sex, and other factors, baseline diabetes predicted nuclear cataract (relative risk, RR, 1.64; 95% confidence interval (CI), 1.02–2.64) and IFG predicted cortical cataract (RR, 2.01; CI, 1.20–3.36). Each standard deviation (SD) increase in glucose was positively associated with cortical cataract (RR, 1.13; CI, 1.01–1.27). Higher body mass index (BMI) was positively associated with posterior subcapsular cataract (RR per SD, 1.20; CI, 1.03–1.41). Persons using anti-hypertensive medication had a higher incidence of cataract surgery (RR, 1.61; CI, 1.18–2.20). Metabolic syndrome was associated with an increased risk of all 3 cataract subtypes. Few other significant associations were found between cardiovascular disease, cardiovascular risk factors, and incident cataract or cataract surgery. Conclusions: We confirmed diabetes as a risk factor for age-related cataract and IFG as a possible risk factor for cortical cataract. BMI and hypertension were also related to incident cataract. Overall, few associations were found between cardiovascular risk factors and long-term incident cataract. A cluster of metabolic abnormalities attributable to insulin resistance appears more likely to contribute to cataract formation than any individual cardiovascular risk factor alone.

Lack of association between glucocorticoid use and presence of the metabolic syndrome in patients with rheumatoid arthritis: a cross-sectional study

IntroductionRheumatoid arthritis (RA) associates with excessive cardiovascular morbidity and mortality, attributed to both traditional and novel cardiovascular risk factors. The metabolic syndrome, a cluster of classical cardiovascular risk factors, including hypertension, obesity, glucose intolerance, and dyslipidaemia, is highly prevalent in RA. Reports suggest that long-term glucocorticoid (GC) use may exacerbate individual cardiovascular risk factors, but there have been no studies in RA to assess whether it associates with the metabolic syndrome. We examined whether GC exposure associates with the presence of metabolic syndrome in patients with RA.MethodsRA patients (n = 398) with detailed clinical and laboratory assessments were categorised into three groups according to GC exposure: no/limited (<3 months) exposure (NE), low-dose (<7.5 mg/day) long-term exposure (LE), and medium-dose (greater than or equal to 7.5 mg to 30 mg/day) long-term exposure (ME). The metabolic syndrome was defined using the National Cholesterol Education Programme III guidelines. The association of GC exposure with the metabolic syndrome was evaluated using binary logistic regression.ResultsThe metabolic syndrome was present in 40.1% of this population and its prevalence did not differ significantly between the GC exposure groups (NE 37.9% versus LE 40.7% versus ME 50%, P = 0.241). Binary logistic regression did not demonstrate any increased odds for the metabolic syndrome when comparing ME with LE (odds ratio = 1.64, 95% confidence interval 0.92 to 2.92, P = 0.094) and remained non significant after adjusting for multiple potential confounders.ConclusionsLong-term GC exposure does not appear to associate with a higher prevalence of the metabolic syndrome in patients with RA. The components of the metabolic syndrome may already be extensively modified by other processes in RA (including chronic inflammation and treatments other than GCs), leaving little scope for additive effects of GCs.

Long-Term Residential Exposure to Traffic and Peripheral Arterial Disease in the Heinz Nixdorf Recall Study

ISEE-363 Objective: Results from animal experiments suggest that long-term exposure to particulate matter (PM) accelerates atherogenesis. Two recent epidemiologic studies have shown an association between air pollution and different measures of atherosclerosis, namely coronary artery calcification and carotid intima-media thickness. We examined the relationship between long-term residential exposure to traffic, a major source of urban PM air pollution, and the prevalence of peripheral arterial disease. Material and Methods: We used baseline data from a population-based, prospective cohort study. Long-term traffic exposure was assessed by calculating distances between residences and major roads (mean daily vehicle count 10,000–130,000). Annual mean PM2.5 exposure values were derived from a small-scale dispersion model. The outcomes were the ankle brachial index (ABI) on a continuous scale, excluding participants with Moenckeberg's medial calcinosis (ABI >1.3), and the prevalence of peripheral arterial disease (PAD), defined as an ABI of less than 0.9 and/or a history of prior PAD treatment. We evaluated the association between proximity to major roads and ABI as well as prevalence of PAD with linear and logistic regression, controlling for background PM2.5 concentrations and individual level risk factors for atherosclerosis. Results: Mean ABI values and prevalence of PAD were dependent on age, sex, and smoking status in the 4616 participants with complete information on outcome and explanatory variables. Living within 50 m of a major road (reference >200 m) was associated with a 3.0% decrease in ABI (95% CI 0.8%–5.3%) in the unadjusted model and a 2.1% (0.0%–4.3%) decrease in the model adjusted for background PM2.5 and individual cardiovascular risk factors. Stronger associations were seen in elderly subjects (3.7%; 0.4%–7.1%), women (5.2%; 2.4%–8.0%), and smokers (8.1%; 3.6%–12.6%). The adjusted OR for PAD in the complete group was elevated by 1.87 (95% CI 1.10–3.20). Conclusions: This study provides epidemiologic evidence that long-term residential exposure to traffic is associated with atherosclerosis.

Supplementation of Conventional Therapy With the Novel Grain Salba (Salvia hispanica L.) Improves Major and Emerging Cardiovascular Risk Factors in Type 2 Diabetes

To determine whether addition of Salba (Salvia hispanica L.), a novel whole grain that is rich in fiber, alpha-linolenic acid (ALA), and minerals to conventional treatment is associated with improvement in major and emerging cardiovascular risk factors in individuals with type 2 diabetes. Using a single-blind cross-over design, subjects were randomly assigned to receive either 37 +/- 4 g/day of Salba or wheat bran for 12 weeks while maintaining their conventional diabetes therapies. Twenty well-controlled subjects with type 2 diabetes (11 men and 9 women, aged 64 +/- 8 years, BMI 28 +/- 4 kg/m2, and A1C 6.8 +/- 0.9%) completed the study. This study was set in the outpatient clinic of the Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada. Compared with the control treatment, Salba reduced systolic blood pressure (SBP) by 6.3 +/- 4 mmHg (P < 0.001), high-sensitivity C-reactive protein (hs-CRP) (mg/l) by 40 +/- 1.6% (P = 0.04), and vonWillebrand factor (vWF) by 21 +/- 0.3% (P = 0.03), with significant decreases in A1C and fibrinogen in relation to the Salba baseline but not with the control treatment. There were no changes in safety parameters including liver, kidney and hemostatic function, or body weight. Both plasma ALA and eicosapentaenoic polyunsaturated fatty acid levels were increased twofold (P < 0.05) while consuming Salba. Long-term supplementation with Salba attenuated a major cardiovascular risk factor (SBP) and emerging factors (hs-CRP and vWF) safely beyond conventional therapy, while maintaining good glycemic and lipid control in people with well-controlled type 2 diabetes.

What is the role of non-invasive measurements of atherosclerosis in individual cardiovascular risk prediction?

Primary prevention of CVD (cardiovascular disease) is mainly based on the assessment of individual cardiovascular risk factors. However, often, only the most important (conventional) cardiovascular risk factors are determined, and every level of risk factor exposure is associated with a substantial variation in the amount of atherosclerosis. Measuring the effect of risk factor exposure over time directly in the vessel might (partially) overcome these shortcomings. Several non-invasive imaging techniques have the potential to accomplish this, each of these techniques focusing on a different stage of the atherosclerotic process. In this review, we aim to define the current role of various of these non-invasive measurements of atherosclerosis in individual cardiovascular risk prediction, taking into account the most recent insights about validity and reproducibility of these techniques and the results of recent prospective outcome trials. We conclude that, although the clinical application of FMD (flow-mediated dilation) and PWA (pulse wave analysis) in individual cardiovascular risk prediction seems far away, there may be a role for PWV (pulse wave velocity) and IMT (intima-media thickness) measurements in the near future.

Gain in Patients' Knowledge of Diabetes Management Targets Is Associated With Better Glycemic Control

Optimal glycemic, lipid, and blood pressure control has been shown to decrease the microvascular and macrovascular complications of diabetes (1–10). However, the status of control of these cardiovascular risk factors in individuals with diabetes is far from optimal (11,12). Lack of patients' knowledge of the targets of diabetes care might be one of the reasons for the low level of control of risk factors. Some studies showed that only 23–25% of individuals with diabetes know what the target A1C level is (<7%), and about the same percent of patients know how to interpret A1C values in relation to their own glycemic control (13,14). Improving patients' knowledge might help attain the goals of diabetes management, but the supporting studies are limited (14–18). We investigated whether the gain in the knowledge of the targets of diabetes care after receiving diabetes self-management education (DSME) predicts the achievement of target A1C levels (<7%) at 6 months. This is a retrospective study of adult diabetic subjects who received DSME in the American Diabetes Association–certified Diabetes Center of John H. Stroger, Jr. Hospital of Cook County between 2001 and 2004. Patients with baseline A1C levels ≥7% measured within 1 month of receiving DSME and with an ∼6-month follow-up A1C measurement (ranging 3–12 months and at least 3 months from the baseline A1C) were selected for this study. A1C was measured by the high-performance liquid chromatography method throughout the study period. After the educational sessions, patients received follow-up medical care by endocrinologists in conjunction with their primary …

Rosiglitazone

Rosiglitazone (Avandia) is an antihyperglycaemic agent of the thiazolidinedione class that improves glycaemic control (as indicated by glycosylated haemoglobin [HbA1c] and fasting plasma glucose [FPG] levels) primarily by increasing hepatic and peripheral insulin sensitivity, and in addition may help to preserve pancreatic beta-cell function. In general, rosiglitazone as monotherapy or in combination with other antihyperglycaemic agents, including metformin or sulfonylureas, improves glycaemic control in adults with type 2 diabetes mellitus and may slow disease progression associated with pancreatic beta-cell function decline. Rosiglitazone is generally well tolerated; however, additional long-term and comparative studies are required to further evaluate the effects of rosiglitazone on bone and the potential cardiovascular risk of the drug, including the risk relative to pioglitazone. Thus, in light of recent cardiovascular safety concerns and the need for further long-term data to clarify the potential risk of rosiglitazone in this regard, it would be prudent to use rosiglitazone in the treatment of type 2 diabetes on a case-by-case basis, taking into account individual patient cardiovascular risk factors.

Dyslipidaemia and global cardiovascular risk: clinical issues

Improvements in cardiovascular outcomes have occurred in recent decades, but a serious burden of cardiovascular morbidity and mortality remains. Data from large, prospective observational studies, such as the PROspective CArdiovascular Munster (PROCAM) Study, have facilitated the design of simple risk factor scoring systems suitable for the estimation of global cardiovascular risk in routine clinical practice. These systems show that dyslipidaemia remains an important contributor to global cardiovascular risk, despite the increased success in controlling LDL cholesterol in recent years. Data from PROCAM have shown that low HDL cholesterol is prognostically important, especially in patients at high global risk due to the presence of concomitant risk factors and in patients with concomitant low HDL cholesterol and hypertriglyceridaemia. Newer techniques, including neural network analysis, myocardial imaging, and genotyping, are likely to add to the precision with which patients requiring cardiovascular intervention are identified in the future. The management of global cardiovascular risk is based on addressing individual cardiovascular risk factors, including hypercholesterolaemia, low HDL cholesterol, and hypertension. In particular, consideration should be given to correcting low HDL cholesterol by the addition of nicotinic acid or a fibrate to the therapeutic regimen in addition to treatments to control LDL cholesterol.

A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes

We sought to investigate whether a low-fat vegan diet improves glycemic control and cardiovascular risk factors in individuals with type 2 diabetes. Individuals with type 2 diabetes (n = 99) were randomly assigned to a low-fat vegan diet (n = 49) or a diet following the American Diabetes Association (ADA) guidelines (n = 50). Participants were evaluated at baseline and 22 weeks. Forty-three percent (21 of 49) of the vegan group and 26% (13 of 50) of the ADA group participants reduced diabetes medications. Including all participants, HbA(1c) (A1C) decreased 0.96 percentage points in the vegan group and 0.56 points in the ADA group (P = 0.089). Excluding those who changed medications, A1C fell 1.23 points in the vegan group compared with 0.38 points in the ADA group (P = 0.01). Body weight decreased 6.5 kg in the vegan group and 3.1 kg in the ADA group (P < 0.001). Body weight change correlated with A1C change (r = 0.51, n = 57, P < 0.0001). Among those who did not change lipid-lowering medications, LDL cholesterol fell 21.2% in the vegan group and 10.7% in the ADA group (P = 0.02). After adjustment for baseline values, urinary albumin reductions were greater in the vegan group (15.9 mg/24 h) than in the ADA group (10.9 mg/24 h) (P = 0.013). Both a low-fat vegan diet and a diet based on ADA guidelines improved glycemic and lipid control in type 2 diabetic patients. These improvements were greater with a low-fat vegan diet.

Emergence of Cardiovascular Risk Factors From Mild Obesity in Japanese Elementary School Children

Clustering of individual cardiovascular risk factors, such as central obesity, insulin resistance, hypertension, and dyslipidemia, together known as metabolic syndrome, is largely confined to obese populations in both children and adults (1,2). The underlying pathophysiology of metabolic syndrome is thought to be related to insulin resistance (3). In Asian countries, especially Japan, obesity-associated disorders arise in mildly to moderately obese adults (4,5). The association between mild obesity in children and individual risk factors in Asian countries is not well defined. The purpose of the present study is to determine the prevalence of, and sex differences in, abdominal obesity and insulin resistance, key features of metabolic syndrome, and assess whether risk of these factors is associated with mild obesity in Japanese elementary school children. Subjects were elementary school children aged 6–12 years who were screened as having a percent relative body weight (%RBW) ≥35% (6). A total of 863 children (561 boys, 302 girls) participated in a screening program for comorbidity of obesity conducted in 2002 and 2003 by the Kagoshima City Board of Education and Kagoshima City Medical Association, Japan. Of these, 754 obese children (490 boys, 264 girls) were included in the present study. One hundred nine subjects were excluded: 9 subjects (6 boys, 3 girls) were excluded because they had normal %RBW, and 100 subjects (65 boys, 35 girls) were excluded because of incomplete information. For 146 subjects (93 boys, …

Genome-wide linkage analysis of population variation in high-density lipoprotein cholesterol

Lower plasma levels of high-density lipoprotein cholesterol (HDL-C) are associated with the metabolic syndrome (insulin resistance, obesity, hypertension) and higher cardiovascular risk. Recent association studies have suggested rare alleles responsible for very low HDL-C levels. However, for individual cardiovascular risk factors, the majority of population-attributable deaths are associated with average rather than extreme levels. Therefore, genetic factors that determine the population variation of HDL-C are particularly relevant. We undertook genome-wide and fine mapping to identify linkage to HDL-C in healthy adult nuclear families from the Victorian Family Heart Study. In 274 adult sibling pairs (average age 24 years, average plasma HDL-C 1.4 mmol/l), genome-wide mapping revealed suggestive evidence for linkage on chromosome 4 (Z score = 3.5, 170 cM) and nominal evidence for linkage on chromosomes 1 (Z = 2.1, 176 cM) and 6 (Z = 2.6, 29 cM). Using genotypes and phenotypes from 932 subjects (233 of the sibling pairs and their parents), finer mapping of the locus on chromosome 4 strengthened our findings with a peak probability (Z score = 3.9) at 169 cM. Our linkage data suggest that chromosome 4q32.3 is linked with normal population variation in HDL-C. This region coincides with previous reports of linkage to apolipoprotein AII (a major component of HDL) and encompasses the gene encoding the carboxypeptidase E, relevant to the metabolic syndrome and HDL-C. These findings are relevant for further understanding of the genetic determinants of cardiovascular risk at a population level.

Association of depression with Alzheimer's disease and vascular dementia in an elderly Arab population of Wadi‐Ara, Israel

Because dementia and depression share common risk factors, we investigated risk factors for depression in Arab subjects with Alzheimer's disease (AD) and vascular dementia (VaD). In a cross-sectional population-based study, we conducted a door-to-door survey of all adults over age 60 in an Arab community of rural Israel. We conducted interviews, gave questionnaires, and collected DNA blood specimens for determination of ApoE genotype. Of the 823 individuals in this naturalistic sample, 168 had dementia of Alzheimer's type (DAT) and 49 had VaD. Vascular risk factors, including the ApoE-epsilon4 allele, were more prevalent among VaD than DAT subjects. Depressive symptoms were present in 57% of DAT patients and 86% of VaD patients. Depressed DAT individuals had a greater history of ischemic cardiovascular or cerebrovascular (CV/CBV) disease than non-depressed DAT subjects, but depressed DAT subjects were less likely to have the ApoE-epsilon4 allele. Within the VaD group, there was no difference in the distribution of cardiovascular risk factors in individuals with and without depressive symptoms, and ApoE-epsilon4 was more prevalent among subjects with depressive symptoms. Depressive symptomatology is prevalent among subjects with dementias in this Arab community. History of CV/CBV is associated with the presence of depressive symptoms in DAT. Further studies are needed to clarify the role of ApoE in depression onset in different ethnic groups with DAT.

The metabolic syndrome: a call to action

Metabolic syndrome, a cluster of risk factors that enhances the risk for atherosclerotic cardiovascular disease, has received increasing attention in recent years, especially as the worldwide prevalence of obesity has become better defined. Recent controversy has questioned the scientific basis for metabolic syndrome, but does not negate its value as a description of a common phenotype of patients encountered in clinical practice. Revised and refined diagnostic criteria may be useful for physicians. While more research is needed to understand the pathology of the metabolic syndrome, there is no ambiguity that physicians should treat cardiovascular risk factors in individuals with metabolic syndrome.

Erectile dysfunction and statin treatment in high cardiovascular risk patients

Erectile dysfunction (ED) has been associated with risk factors for atherosclerosis. Medications used for atherosclerosis have also been implicated in ED. The aim of this study is to investigate the relationship of erectile function to cardiovascular risk factors and specific drug therapies before and after 6 months of statin therapy. In this prospective observational study, International Index of Erectile Function (IIEF) scores were measured in 93 men attending cardiovascular risk clinics. Cardiovascular risk factors and drug therapies were assessed prior to initiation and after 6 months of statin therapy. Prior to statin therapy, the median IIEF score was 21 (range 0-25), and 57% had impairment of erectile function. After statin therapy, IIEF scores were reduced to 6.5 (range 0-25) (p < 0.001), and 22% experienced new onset ED. Before statin therapy no correlation was observed between IIEF score and any individual cardiovascular risk factor. After 6 months of statin therapy, correlations were observed between lower IIEF scores (r = 0.62; p < 0.001) and age and diabetes and weakly with smoking. Differences in dose, relative efficacy or relative lipophilicity of statin prescribed showed no correlation with change in IIEF score. This study suggests ED following statin therapy is more likely in patients with severe endothelial dysfunction due to established cardiovascular risk factors including age, smoking and diabetes.