Major Cardiovascular Disease Risk Research Articles

Baseline comparison of three health utility measures and the feeling thermometer among participants in the action to control cardiovascular risk in diabetes trial

BackgroundHealth utility (HU) measures are used as overall measures of quality of life and to determine quality adjusted life years (QALYs) in economic analyses. We compared baseline values of three HUs including Short Form 6 Dimensions (SF-6D), and Health Utilities Index, Mark II and Mark III (HUI2 and HUI3) and the feeling thermometer (FT) among type 2 diabetes participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. We assessed relationships between HU and FT values and patient demographics and clinical variables.MethodsACCORD was a randomized clinical trial to test if intensive controls of glucose, blood pressure and lipids can reduce the risk of major cardiovascular disease (CVD) events in type 2 diabetes patients with high risk of CVD. The health-related quality of life (HRQOL) sub-study includes 2,053 randomly selected participants. Interclass correlations (ICCs) and agreement between measures by quartile were used to evaluate relationships between HU’s and the FT. Multivariable regression models specified relationships between patient variables and each HU and the FT.ResultsThe ICCs were 0.245 for FT/SF-6D, 0.313 for HUI3/SF-6D, 0.437 for HUI2/SF-6D, 0.338 for FT/HUI2, 0.337 for FT/HUI3 and 0.751 for HUI2/HUI3 (P < 0.001 for all). Common classification by quartile was found for the majority (62%) of values between HUI2 and HUI3, which was significantly (P < 0.001) higher than between other HUs and the FT: SF-6D/HUI3 = 40.8%, SF-6D/HUI2 = 40.9%, FT/HUI3 = 35.0%, FT/HUI2 = 34.9%, and FT/SF-6D = 31.9%. Common classification was higher between SF-6D/HUI2 and SF-6D/HUI3 (P < 0.001) than between FT/SF-6D, FT/HUI2, and FT/HUI3. The mean difference in HU values per patient ranged from −0.024 ± 0.225 for SF-6D/ HUI3 to −0.124 ± 0.133 for SF-6D/HUI2. Regression models were significant; clinical and demographic variables explained 6.1% (SF-6D) to 7.7% (HUI3) of the variance in HUs.ConclusionsThe agreements between the different HUs were poor except for the two HUI measures; therefore HU values derived different measures may not be comparable. The FT had low agreement with HUs. The relationships between HUs and demographic and clinical measures demonstrate how severity of diabetes and other clinical and demographic factors are associated with HUs and FT measures.Trial registrationClinicalTrials.gov Identifier: NCT00000620

Plasma fibrinogen as a biomarker in gynecologic cancers.

Personalized MedicineVol. 8, No. 5 EditorialPlasma fibrinogen as a biomarker in gynecologic cancersClemens B TempferClemens B TempferDepartment of Obstetrics & Gynecology, Marienhospital Herne, Ruhr University Bochum, Bochum, Hölkeskampring 40, D-44625 Herne, Germany. Search for more papers by this authorEmail the corresponding author at clemens.tempfer@marienhospital-herne.dePublished Online:9 Sep 2011https://doi.org/10.2217/pme.11.47AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInRedditEmail View article"Plasma fibrinogen as a biomarker in gynecologic cancers." , 8(5), pp. 501–502Keywords: cancercoagulationfibrinogenhypercoagulabilitymetastasispredictionprognosisBibliography1 Lawrence SO, Simpson-Haidaris PJ. Regulated de novo biosynthesis of fibrinogen in extrahepatic epithelial cells in response to inflammation. Thromb. Haemost.92,234–243 (2004).Crossref, Medline, CAS, Google Scholar2 Sahni A, Francis CW. Vascular endothelial growth factor binds to fibrinogen and fibrin and stimulates endothelial cell proliferation. Blood96,3772–3778 (2000).Crossref, Medline, CAS, Google Scholar3 Sahni A, Khoranaa A, Baggs RB, Peng H, Francis CW. FGF-2 binding to fibrin(ogen) is required for augmented angiogenesis. Blood107,126–131 (2006).Crossref, Medline, CAS, Google Scholar4 Simpson-Haidaris PJ, Rybarczyk B. Tumors and fibrinogen. The role of fibrinogen as an extracellular matrix protein. Ann. NY Acad. Sci.936,406–425 (2001).Crossref, Medline, CAS, Google Scholar5 Palumbo JS, Kombrinck KW, Drew AF et al. Fibrinogen is an important determinant of the metastatic potential of circulating tumor cells. Blood96(10),3302–3309 (2000).Crossref, Medline, CAS, Google Scholar6 Palumbo JS, Potter JM, Kaplan LS, Talmage K, Jackson DG, Degen JL. Spontaneous hematogenous and lymphatic metastasis, but not primary tumor growth or angiogenesis, is diminished in fibrinogen-deficient mice. Cancer Res.62(23),6966–6972 (2002).Medline, CAS, Google Scholar7 Palumbo JS, Talmage KE, Massari JV et al. Tumor cell-associated tissue factor and circulating hemostatic factors cooperate to increase metastatic potential through natural killer cell-dependent and-independent mechanisms. Blood110(1),133–141 (2007).Crossref, Medline, CAS, Google Scholar8 Fibrinogen Studies Collaboration, Danesh J, Lewington S et al. Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis. JAMA294,1799–1809 (2005).Crossref, Medline, CAS, Google Scholar9 Woods A, Brull DJ, Humphries SE et al. Genetics of inflammation and risk of coronary artery disease: the central role of interleukin-6. Eur. Heart J.21,1574–1583 (2000).Crossref, Medline, CAS, Google Scholar10 Takeuchi H, Ikeuchi S, Kitagawa Y et al. Pretreatment plasma fibrinogen level correlates with tumor progression and metastasis in patients with squamous cell carcinoma of the esophagus. J. Gastroenterol. Hepatol.22,2222–2227 (2007).Crossref, Medline, CAS, Google Scholar11 Yamashita H, Kitayama J, Kanno N et al. Hyperfibrinogenemia is associated with lymphatic as well as hematogenous metastasis and worse clinical outcome in T2 gastric cancer. BMC Cancer6,147 (2006).Crossref, Medline, Google Scholar12 Wojtukiewicz MZ, Zacharski LR, Moritz TE et al. Prognostic significance of blood coagulation tests in carcinoma of the lung and colon. Blood Coagul. Fibrinolysis3,429–437 (1992).Crossref, Medline, CAS, Google Scholar13 Polterauer S, Grimm C, Seebacher V et al. Plasma fibrinogen levels and prognosis in patients with ovarian cancer: a multicenter study. Oncologist14(10),979–985 (2009).Crossref, Medline, Google Scholar14 Seebacher V, Polterauer S, Grimm C, Husslein H, Leipold H, Hefler-Frischmuth K. The prognostic value of plasma fibrinogen levels in patients with endometrial cancer: a multi-centre trial. Br. J. Cancer102(6),952–956 (2010).Crossref, Medline, CAS, Google ScholarFiguresReferencesRelatedDetailsCited ByCurrent World LiteratureCurrent Opinion in Obstetrics & Gynecology, Vol. 25, No. 1 Vol. 8, No. 5 Follow us on social media for the latest updates Metrics Downloaded 114 times History Published online 9 September 2011 Published in print September 2011 Information© Future Medicine LtdKeywordscancercoagulationfibrinogenhypercoagulabilitymetastasispredictionprognosisFinancial & competing interests disclosureThe author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.No writing assistance was utilized in the production of this manuscript.PDF download

Pulling down the plug on atherosclerosis: Cooling down the inflammasome

Atherosclerotic lesions can result in fatal cardiovascular disease, but what triggers the formation of the atheroma plaques and their progression still begs further investigation. In 'Bench to Bedside', Goran K Hansson and Lars Klareskog peruse how the NLRP3 inflammasome can be activated by cholesterol crystals and worsen atherosclerosis by triggering inflammation through the release of IL-1β from macrophages. But these cells can also die at the lesion site, forming a necrotic core in the atheroma by building up apoptotic cells and debris. In 'Bedside to Bench', Ira Tabas discusses a human study showing that lesional necrosis along with thinning of the fibrotic cap are predictive of culprit lesions involved in fatal disease. Understanding the molecular underpinnings of these two morphological features may lead to new therapies to prevent or decrease the risk for major cardiovascular disease.

High blood hemoglobin concentration as risk factor of major atherosclerotic cardiovascular events in 114,159 healthy men and women in the Apolipoprotein MOrtality RISk study (AMORIS)

Background. Few studies have tested differences in relationships between hemoglobin (Hb) and long-term risk of major cardiovascular diseases according to age and gender in healthy subjects as opposed to anemia.Aims. Such relationships were examined and risk-tested in relation to Hb values in the Apolipoprotein MOrtality RISk (AMORIS) Study.Methods. Using data from AMORIS and the Swedish hospital discharge and mortality registers, a prospective cohort study of 114,159 subjects with mean follow-up of 11.8 years, the association between Hb and risk of acute myocardial infarction (AMI), ischemic stroke (IS), and congestive heart failure (CHF) by Cox regression analysis according to age and gender was studied.Results. Elevated Hb levels were associated to acute myocardial infarction (AMI) (HR 1.10 (1.06–1.13) per SD change), mostly confined to men and younger subjects but with greater sex similarity trends for CHF. Slightly increased risks were seen for the lowest Hb levels in the elderly and in females. IS risk was positively and more linearly associated to Hb.Interpretation. In AMORIS the highest AMI and CHF risks were found in the upper region of the distribution, but different shapes of relationships according to age and gender were found. IS associated positively with Hb. Key words:

Masked Hypertension: Evaluation, Prognosis, and Treatment

Blood pressure (BP) may be high during usual daily life in one out of 7-8 individuals with normal BP in the clinic or doctor's office. This condition is usually defined as masked hypertension (MH). Prevalence of MH varied across different studies depending on patient characteristics, populations studied, and different definitions of MH. Self-measured BP and ambulatory BP (ABP) have been widely used to identify subjects with MH. Various factors have been identified as possible determinants of MH. Cigarette smoking, alcohol, physical activity, job, and psychological stress may increase BP out of the clinical environment in otherwise normotensive individuals, leading to MH. In most studies, target organ damage was comparable in subjects with MH and those with sustained hypertension, and greater than in those with true normotension. Subjects with MH showed a 1.5- to 3-fold higher risk of major cardiovascular (CV) disease than those with normotension, and their risk was not different from that of patients with sustained hypertension. In an overview of literature, we found that the risk of major CV disease was higher in subjects with MH than in the normotensive subjects regardless of the definition of MH based on self-measured BP (hazard ratio (HR) 2.13; 95% confidence interval (CI): 1.35-3.35; P = 0.001) or 24-h ABP (HR 2.00; 95% CI: 1.54-2.60; P < 0.001). MH is an insidious and prognostically adverse condition that can be reliably diagnosed by self-measured BP and ABP. MH should be searched for in subjects who appear to be more likely to have this condition. Antihypertensive treatment is envisaged in these subjects, although the associated outcome benefits are still undetermined.

Tolerability of antiretroviral therapy (HAART) in elderly age

Background The median age of people living with HIV/AIDS is increasing: while efficacy of HAART has reduced mortality and prolonged the life of patients, low perception of risk and new late diagnosis are related to infection in an elderly age. Most new late diagnosis are performed in older hardly immuno-compromised subjects; the development of opportunistic diseases complicates management of therapeutic strategies (drugs interactions, cumulative toxicities, hypersensitivity reaction), mainly in presence of comorbities. Most randomized clinical trials with new drugs tend to avoid the enrolment of >50 years patients with proper comorbities of old age. So the few data we can analyze come from observational cohorts. While it is well defined that older people are more adherent to treatment and achieved an adequate control of HIV-RNA viremia more frequently than younger although an incomplete immuno-reconstitution, the development of drug toxicity with higher frequency is controversial. Elderly people are more frequent to show reduced hepatic and kidney function, frequently have comorbities requesting new therapies with a higher pill burden and higher risk of drug interactions. Most antiretroviral drugs are metabolized by cytochrome system. Treatment may accelerate mitochondrial dysfunction, nucleoside reverse transcriptase inhibitors may contribute to muscle wasting. Some typical side effects of HAART such as body change and facial lypoatrophy could be more evident when associated with natural facial changes occurring with aging and modify negatively self perceived body image and relationship capacity. Age was also shown to increase the risk of renal tubular disease in association with tenofovir. Age is one of the major cardio-vascular disease (CVD) risk factors and the inflammatory component may contribute to this increased risk despite HAART efficacy. The risk of myocardial infarctions is increased in older treated HIV+ patients: metabolic abnormalities are more frequent at baseline and the treatment could increase the cumulative risk of CVD.

The Framingham and UK Prospective Diabetes Study (UKPDS) risk equations do not reliably estimate the probability of cardiovascular events in a large ethnically diverse sample of patients with diabetes: the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) Study

Available multivariable equations for cardiovascular risk assessment in people with diabetes have been derived either from the general population or from populations with diabetes. Their utility and comparative performance in a contemporary group of patients with type 2 diabetes are not well established. The aim of this study was to evaluate the performance of the Framingham and UK Prospective Diabetes Study (UKPDS) risk equations in participants who took part in the Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) trial. The 4-year risks of cardiovascular disease (CVD) and its constituents were estimated using two published Framingham and the UKPDS risk equations in 7,502 individuals with type 2 diabetes without prior known CVD at their enrolment in the trial. The risk of major CVD was overestimated by 170% (95% CI 146-195%) and 202% (176-231%) using the two Framingham equations. The risk of major coronary heart disease was overestimated by 198% (162-238%) with the UKPDS, and by 146% (117-179%) and 289% (243-341%) with the two different Framingham equations, respectively. The risks of stroke events were also overestimated with the UKPDS and one of the Framingham equations. The ability of these equations to rank risk among ADVANCE participants was modest, with c-statistics ranging from 0.57 to 0.71. Results stratified by sex, treatment allocation and ethnicity were broadly similar. Application of the Framingham and UKPDS risk equations to a contemporary treated group of patients with established type 2 diabetes is likely to substantially overestimate cardiovascular risk.

Relationship between Adherence Level to Statins, Clinical Issues and Health-Care Costs in Real-Life Clinical Setting

Objective Statins have been shown to reduce the risk of major cardiovascular disease. We recognize that there is a major gap between the use of statins in actual practice and treatment guidelines for dyslipidemia. Low adherence to statins may have a significant impact on clinical issues and health-care costs. The objective is to evaluate the impact of low adherence to statins on clinical issues and direct health-care costs. Methods A cohort of 55,134 patients newly treated with statins was reconstructed from the Régie de l'Assurance Maladie du Québec and Med-Echo databases. Subjects included were aged between 45 and 85, initially free of cardiovascular disease, newly treated with statins between 1999 and 2002, and followed-up for a minimum of 3 years. Adherence to statins was measured in terms of the proportion of days' supply of medication dispensed over a defined period, and categorized as ≥80% or <80%. The adjusted odds ratio (OR) of cardiovascular events between the two adherence groups was estimated using a polytomous logistic analysis. The mean costs of direct health-care services were evaluated. A two-part model was applied for hospitalization costs. Results The mean high adherence level to statins was around to 96% during follow-up; and this value was at 42% for the low adherence level. The patients with low adherence to statins were more likely to have coronary artery disease (OR 1.07; 95% confidence interval [CI], 1.01–1.13), cerebrovascular disease (OR 1.13; 95% CI 1.03–1.25), and chronic heart failure within 3-year period of follow-up (OR 1.13; 95% CI 1.01–1.26). Low adherence to statins was also associated with an increased risk of hospitalization by 4% (OR 1.04; 95% CI 1.01–1.09). Among patients who were hospitalized, low adherence to statins was significantly associated with increase of hospitalization costs by approximately $1060/patient for a 3-year period. Conclusion Low adherence to statins was correlated with a higher risk of cardiovascular disease, hospitalization rate, and hospitalization costs. An increased level of adherence to statins agents should provide a better health status for individuals and a net economic gain.

Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort study

Objective To quantify associations of chronic kidney disease stages with major cardiovascular disease and non-vascular mortality in the general adult population.Design Prospective population based cohort study.Setting Reykjavik, Iceland.Participants 16 958...

Frequency of Migraine and the Risk of Cardiovascular Disease for Women: Limited Evidence of an Association

Evaluation of: Kurth T, Schurks M, Logroscino G et al. Migraine frequency and risk of cardiovascular disease in women. Neurology 73, 581-588 (2009). There is substantial evidence that migraine with aura (MA) is associated with ischemic stroke and myocardial infarction in women. The mechanisms of this association are poorly understood. Analysis of data from the Women's Health Study, from 27,798 women over 45 years of age who were initially free of cardiovascular disease, found that women with baseline MA at a frequency of less than monthly had increased risk of major cardiovascular disease (HR: 2.28; 95% CI: 1.70-3.07) relative to women without migraine, and those who reported MA with a frequency of more than weekly had more than four-times the risk of ischemic stroke (HR: 4.25; 95% CI: 1.36-13.29) compared with those without migraine. Low numbers of outcome events in each of the frequency categories and lack of information on migraine frequency during follow-up limit the interpretation of these findings, but they suggest that frequency of migraine may be a moderating factor in the link between MA and cardiovascular disease.

Overexpression of Catalase Targeted to Mitochondria Attenuates Murine Cardiac Aging

Age is a major risk for cardiovascular diseases. Although mitochondrial reactive oxygen species have been proposed as one of the causes of aging, their role in cardiac aging remains unclear. We have previously shown that overexpression of catalase targeted to mitochondria (mCAT) prolongs murine median lifespan by 17% to 21%. We used echocardiography to study cardiac function in aging cohorts of wild-type and mCAT mice. Changes found in wild-type mice recapitulate human aging: age-dependent increases in left ventricular mass index and left atrial dimension, worsening of the myocardial performance index, and a decline in diastolic function. Cardiac aging in mice is accompanied by accumulation of mitochondrial protein oxidation, increased mitochondrial DNA mutations and deletions and mitochondrial biogenesis, increased ventricular fibrosis, enlarged myocardial fiber size, decreased cardiac SERCA2 protein, and activation of the calcineurin-nuclear factor of activated T-cell pathway. All of these age-related changes were significantly attenuated in mCAT mice. Analysis of survival of 130 mice demonstrated that echocardiographic cardiac aging risk scores were significant predictors of mortality. The estimated attributable risk to mortality for these 2 parameters was 55%. This study shows that cardiac aging in the mouse closely recapitulates human aging and demonstrates the critical role of mitochondrial reactive oxygen species in cardiac aging and the impact of cardiac aging on survival. These findings also support the potential application of mitochondrial antioxidants in reactive oxygen species-related cardiovascular diseases.

Coagulation factors, activation markers and risk of coronary heart disease: the Northwick Park Heart Studies.

Coagulation factors, activation markers and risk of coronary heart disease: the Northwick Park Heart Studies.

Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study

Objective To investigate the influence of increasing age on the incidence and remaining lifetime risk of cardiovascular disease and cancer in a cohort of older men.Design Prospective cohort study.Setting United...

Cannabinoid-1 receptor antagonists in type-2 diabetes

Type-2 diabetes is closely related to abdominal obesity and is generally associated with other cardiometabolic risk factors, resulting in a risk of major cardiovascular disease. Several animal and human observations suggest that the endocannabinoid system is over-active in the presence of abdominal obesity and/or diabetes. Both central and peripheral endocannabinoid actions, via the activation of CB1 receptors, promote weight gain and associated metabolic changes. Rimonabant, the first selective CB(1) receptor blocker in clinical use, has been shown to reduce body weight, waist circumference, triglycerides, blood pressure, insulin resistance index and C-reactive protein levels, and to increase high-density lipoprotein (HDL) cholesterol and adiponectin concentrations in both non-diabetic and diabetic overweight/obese patients. In addition, a 0.5-0.7% reduction in HbA1c levels was observed in metformin- or sulphonylurea-treated patients with type-2 diabetes and in drug-naïve diabetic patients. Almost half of the metabolic changes, including HbA1c reduction, could not be explained by weight loss, suggesting that there are direct peripheral effects. Rimonabant was generally well-tolerated, and the safety profile was similar in diabetic and non-diabetic patients, with a higher incidence of depressed mood disorders, nausea and dizziness. In conclusion, the potential role of rimonabant in overweight/obese patients with type-2 diabetes and at high risk of cardiovascular disease deserves much consideration.

New-Onset Diabetes, Antihypertensive Treatment, and Outcome

New-onset diabetes (NOD) confers increased risk for cardiovascular disease and all-cause mortality in different clinical settings.1,2 In the specific context of hypertensive subjects exposed to the long-term effects of antihypertensive drugs, a study from our group3 and a recent 28-year follow-up study from Sweden4 showed a greater risk of major cardiovascular disease in hypertensive subjects who developed NOD than in those who did not. Notably, the yearly incidence of NOD ranged from 1.0% in the Swedish study4 to 1.9% in our study.3 This issue of Hypertension hosts a posthoc analysis of the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) database, which tested the hypothesis that NOD is a predictor of cardiac morbidity and cardiac and all-cause mortality.5 The hypertensive subjects who developed NOD showed a 43% higher risk of cardiac morbidity (ie, a composite of sudden death, myocardial infarction, death associated with revascularization, and congestive heart failure requiring hospitalization) when compared with those who did not develop diabetes. When the determinants of the composite pool of cardiovascular events were examined separately, NOD was associated with a marginally higher risk of myocardial infarction (hazard ratio [HR]: 1.30; 95% CI: 0.99 to 1.70; P =0.057) and a significantly higher risk of congestive heart failure (HR: 1.41; 95% CI: 1.06 to 1.87; P =0.017). These findings are in full agreement with a recent report from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET), in which NOD was associated with a 74% excess risk …

Estratificación y grado de control del riesgo cardiovascular en la población hipertensa española. Resultados del estudio DICOPRESS

Hypertension, together with other contributing risk factors, is a major risk for cardiovascular disease. The aim of this study was to assess the cardiovascular risk in the Spanish hypertensive population according to the 2003 European Society of Hypertension-European Society of Cardiology (ESH/ESC) guidelines criteria and to determine the control rate of the main cardiovascular risk factors (CVRF). Observational and transversal study including 22,639 patients with essential hypertension, who have been admitted to primary care units and hypertension units in Spain. Dyslipemia (52.1%), diabetes (36.6%) and smoking (22.3%) were the most prevalent CVRF. Cardiovascular risk stratification according to the ESH/ESC guidelines showed that more than 70% patients were considered at high added risk (36.9%) or at very high added risk (35.8%), whereas only 7.6% were classified in the low-risk stratum. Blood pressure was the worst controlled risk factor among hypertensive patients (80.6%). Total cholesterol was also poorly controlled in a high percentage of the analyzed population (66.4%). Diabetes was the best predictor of uncontrolled blood pressure with an odds ratio of 5.25 (99% confidence interval, 4.57-6.06). Coexistence of several cardiovascular risk factors, as well as the presence of target organ damage and associated cardiovascular conditions in the Spanish hypertensive population, increase the vascular risk, complicate the control in the hypertensive population and show the convenience of using ESH/ESC 2003 guidelines to estimate the cardiovascular risk.

Smoking and a complement gene polymorphism interact in promoting cardiovascular disease morbidity and mortality

We have demonstrated previously that carriers of a genotype called C4B*Q0 (silent allele of the C4B gene) have a substantially increased risk to suffer from myocardial infarction or stroke, and are selected out from the healthy elderly population. Because smoking carries a major risk for cardiovascular disease (CVD), it seemed worthwhile to study if these two factors interact. Study 1 involved 74 patients with angina pectoris (AP), 85 patients with recent acute myocardial infarction (AMI) and 112 survivors of a previous AMI and 382 controls from Iceland. Study 2 involved 233 patients with severe CVD and 274 controls from Hungary. Smoking habits were registered for each subject. The number of C4A and C4B genes was determined by phenotyping or genotyping. Compared to controls, C4B*Q0 carrier frequency was significantly higher at diagnosis in Icelandic smokers with AP (P = 0.005) and AMI (P = 0.0003) and Hungarian smokers with severe coronary artery disease (P = 0.023), while no such difference was observed in non-smoking subjects. Age-associated decrease in C4B*Q0 observed previously in two remote Caucasian populations was found, in the present study, to be associated strongly with smoking, and to already occur in smokers after age 50 years both in Iceland and Hungary. Our findings indicate that the C4B*Q0 genotype can be considered as a major covariate of smoking in precipitating the risk for AMI and associated deaths.

Association Between Length of Residence and Cardiovascular Disease Risk Factors Among an Ethnically Diverse Group of United States Immigrants

Although differences in cardiovascular disease (CVD) risk factors between immigrants and nonimmigrants have been examined previously, the effect of acculturation on CVD risk factors in immigrants has been less well studied. To determine the association between length of U.S. residence (proxy for acculturation) and major CVD risk factors. Data on 5,230 immigrant adults from the 2002 National Health Interview Survey (NHIS) was analyzed. Primary independent variable was length of U.S. residence < 10, 10 to < 15, and > or = 15 years. Main outcome measures included obesity, hypertension, diabetes, hyperlipidemia, smoking, and physical inactivity. Multiple logistic regression was used to assess the association between length of residence and odds of multiple CVD risk factors adjusting for confounders. SAS-callable SUDAAN was used for statistical analysis. Among the patients, 55.4% were obese, 17.3% had hypertension, 15.9% had hyperlipidemia, 6.6% had diabetes, 79.3% were physically inactive, and 14.3% were smokers. Using < 10 years as reference, those with length of residence > or = 15 years were more likely to be obese (OR 1.31, 95% CI 1.03-1.65), have hyperlipidemia (OR 1.59, 95% CI 1.14-2.22), and be smokers (OR 1.39, 95% CI 1.04-1.85). Length of residence > or = 15 years was associated with decreased odds of sedentary lifestyle (OR 0.63, 95% CI 0.47-0.84). Length of residence > or = 15 years was not associated with odds of having diabetes (OR 1.40, 95% CI 0.78-2.51) or hypertension (OR 1.21, 95% CI 0.86-1.71). Among immigrants from diverse ethnic backgrounds, longer length of residence in the United States is associated with increased odds of obesity, hyperlipidemia, and cigarette smoking even after adjusting for relevant confounding factors.

The Relationship Between Total Cholesterol and the Risk of Major Cardiovascular Diseases is Similar Amongst Individuals With and Without Diabetes Across Populations in the Asia Pacific Region

The Relationship Between Total Cholesterol and the Risk of Major Cardiovascular Diseases is Similar Amongst Individuals With and Without Diabetes Across Populations in the Asia Pacific Region

Diabetes is Associated with Alterations in the Dystrophin Glycoprotein Complex Composition in the Heart Muscle

BACKGROUND: Obesity and diabetes pose a major risk for cardiovascular disease and are associated with an increased incidence of heart failure. Myocardial dystrophin disruption has been shown to be a major cause of advanced heart failure. Whether diabetes is associated with the dystrophin glycoprotein complex (DGC) composition in the myocardium is not known. PURPOSE: We compared the expression of various components of the DGC in hearts of normal lean and obese Zucker rats, an established model of syndrome-X, exhibiting type II diabetes. METHODS: Immunoblotting and immunohistochemical analyses were performed on cell membrane and cytosolic fractions of hearts obtained from normal lean Zucker (LNZ) rats and diabetic obese Zucker (OSXZ) rats to examine the expression and localization of components of the DGC. RESULTS: Immunoblot analysis revealed markedly higher cytoplasmic dystrophin content (39.95 ± 3.7% over control) as compared to control lean hearts, with no significant difference in the membrane dystrophin content. The content of á-dystroglycan was 35.99 ± 2.9% and 34.74 ± 2.5% higher in the membrane and cytosolic fractions of the OSXZ hearts as compared to the LNZ hearts. The cytosolic content of ß-dystroglycan was 49.84 ± 6.4% higher in the OSXZ hearts as compared to LNZ hearts, while the membrane content was 24.82% higher. CONCLUSION: These preliminary data suggest a difference in composition of the DGC between the normal and syndrome-X Zucker rat hearts. (Supported by funds from NSF Grant 0314742).