Overt Ischemic Heart Disease Research Articles

The effect of intradialytic aerobic training on physical performance and quality of life among hemodialysis patients

Background Patients with chronic kidney disease and end-stage kidney disease have reduced physical performance and impaired quality of life. The aim of this work is to study the effect of intradialytic aerobic training using a pedal on physical performance and quality of life among hemodialysis (HD) patients. Patients and methods This experimental study was conducted on 30 adult patients with end-stage kidney disease on maintenance HD for more than 3 months. Mentally or physically unfit patients, patients with overt ischemic heart disease or cardiac decompensation, severe anemic patients (hemoglobin≤8 g/dl), patients with advanced chronic kidney disease-mineral and bone disorder, patients with advanced lower limbs joints disease, and those with amputation of the lower limb were excluded. Patients were divided into two groups; each group consisted of 15 patients. Group A performed intradialytic aerobic exercise for 30 min three times/week for 8 weeks. Group B was a control group. Results There was significant improvement in the distance walked in 6-min walk test in the exercise group (P=0.04). Moreover, there was significant improvement in the main scales of kidney disease quality-of-life short form, version 1.3, Arabic version (Kidney Disease Component Summary, Physical Composite Scale, and Mental Composite Scale) (P<0.001, P=0.018, and P=0.037, respectively). Conclusion Exercise has a beneficial effect on the physical performance and quality of life in HD patients.

Microbiome and metabolome features of the cardiometabolic disease spectrum

Previous microbiome and metabolome analyses exploring non-communicable diseases have paid scant attention to major confounders of study outcomes, such as common, pre-morbid and co-morbid conditions, or polypharmacy. Here, in the context of ischemic heart disease (IHD), we used a study design that recapitulates disease initiation, escalation and response to treatment over time, mirroring a longitudinal study that would otherwise be difficult to perform given the protracted nature of IHD pathogenesis. We recruited 1,241 middle-aged Europeans, including healthy individuals, individuals with dysmetabolic morbidities (obesity and type 2 diabetes) but lacking overt IHD diagnosis and individuals with IHD at three distinct clinical stages—acute coronary syndrome, chronic IHD and IHD with heart failure—and characterized their phenome, gut metagenome and serum and urine metabolome. We found that about 75% of microbiome and metabolome features that distinguish individuals with IHD from healthy individuals after adjustment for effects of medication and lifestyle are present in individuals exhibiting dysmetabolism, suggesting that major alterations of the gut microbiome and metabolome might begin long before clinical onset of IHD. We further categorized microbiome and metabolome signatures related to prodromal dysmetabolism, specific to IHD in general or to each of its three subtypes or related to escalation or de-escalation of IHD. Discriminant analysis based on specific IHD microbiome and metabolome features could better differentiate individuals with IHD from healthy individuals or metabolically matched individuals as compared to the conventional risk markers, pointing to a pathophysiological relevance of these features.

THE EFFECT OF INTRADIALYTIC AEROBIC TRAINING ON PHYSICAL PERFORMANCE AND QUALITY OF LIFE AMONGHEMODIALYSIS PATIENTS

Chronic kidney disease (CKD) and end stage renal disease (ESRD) are worldwide public health problems.(1)The prevalence of CKD (stages 1-5) in the general United States adult population was 14.8% in 2013-2016, CKD and ESRD patients have increased risk of functional impairment, regardless of their age, gender, associated co-morbidities, and cardiovascular events.(3) This high level of functional limitations in patients with CKD and ESRD is not necessarily improved by dialysis. Rehabilitationprinciples need to be integrated into the routine management of patients. (5)Rehabilitation of CKD and ESRD patients involves many aspects as psychological, nutritional, and exercise training.(6)Various exercise programs, such as aerobic exercise, resistance exercise, combined aerobic and resistance exercise, and passive exercise including electrical stimulation have been developed for hemodialysis patientsThe aim of the current study was to assess the effect of intradialytic aerobic training on physical performance and quality of life in patients maintained on haemodialysis therapy.The study included thirty patients on maintenance hemodialysis therapy for more than three months in Alexandria University Hospitals.Patients were divided into two groups: Group (A): Fifteen patients performed exercise during hemodialysis session.Group (B): Fifteen patients were not assigned to any exercise program (as a control group).Mentally or physically unfit patients,patients with overt ischemic heart disease or cardiac decompensation, severe anaemic patients (Hb ≤ 8 g/dl),patients with advanced chronic kidney disease-mineral and bone disorder (CKD-MBD), patients with advanced lower limbs joints disease or amputation of lower limb were excluded.

Penile rehabilitation after nerve-sparing prostatectomy: Fact or fiction?

A 65-year-old man is seen in the clinic two months after a robot-assisted bilateral nerve-sparing radical prostatectomy. He is completely continent and has been since the catheter was removed. The main reason for his referral is erectile dysfunction. Pre-operatively his SHIM score was 25 (maximum score 25). He currently experiences some thickening with stimulation, and an erection hardness score of 2. He has a pleasurable sensation of orgasm during which he remains dry. His sex drive remains normal. He has a long-standing history of hypertension and raised LDL cholesterol, managed with amlodipine and simvastatin respectively. He has no other overt cardiovascular or ischaemic heart disease, and he is not a diabetic, but has an elevated fasting glucose of 6.0 mmol per litre. He stopped smoking five years ago, is 5 feet 11 inches tall, a weight of 95 kg, has a waist measurement of 44 inches (BMI 29 – upper end of overweight) (range <18.50 underweight; 18.50–24.99 healthy weight; 25.00–29.99 overweight; >30.00 obese). He performs no regular exercise. His wife is 60. He is keen to try to regain his erectile function.

Electrocardiographic precordial ST-segment deviations and the risk of cardiovascular death: results from the Copenhagen ECG Study.

BackgroundWe sought to perform a study assessing the association between electrocardiographic ST‐segment deviations and cardiovascular death (CVD), in relation to sex and age (≥ and <65 years), in a large primary care population without overt ischemic heart disease.Methods and ResultsUsing computerized analysis of ECGs from 285 194 persons, we evaluated the association between precordial ST‐segment deviations and the risk of CVD. All data on medication, comorbidity, and outcomes were retrieved from Danish registries. After a median follow‐up period of 5.8 years, there were 6679 cardiovascular deaths. Increasing ST‐depression was associated with an increased risk of CVD in almost all of the precordial leads, with the most robust association seen in lead V5 to V6. ST‐elevations in lead V2 to V6 were associated with increased risk of CVD in young women, but not in men. However, ST‐elevations in V1 increased the risk for both genders and age groups, exemplified by a HR of 1.80 (95% CI [1.19 to 2.74], P=0.005) for men <65 years with ST‐elevations ≥150 μV versus a nondeviating ST‐segment (−50 μV to +50 μV). In contrast, for men <65 years, ST‐elevations in lead V2 to V3 conferred a decreased risk of CVD with a HR of 0.77 (95% CI [0.62 to 0.96], P<0.001) for ST‐elevations ≥150 μV in V2.ConclusionWe found that ST‐depressions were associated with a dose‐responsive increased risk of CVD in nearly all the precordial leads. ST‐elevations conferred an increased risk of CVD in women and with regard to lead V1 also in men. However, ST‐elevations in V2 to V3 were associated with a decreased risk of CVD in young men.

Soluble CXCL16 and long-term outcome in acute ischemic stroke

ObjectiveCXCL16 is a chemokine involved in atherosclerosis by promoting inflammation, lipid accumulation and matrix degradation. The level of circulating CXCL16 has been proposed as a predictor of long-term mortality in acute coronary syndromes. We studied plasma CXCL16 in acute ischemic stroke and examined associations with long-term mortality following the acute event. MethodsCXCL16 samples were obtained from 244 patients with acute ischemic stroke (age: 69±13 years) daily from presentation to day 5 and at half a year after the stroke. Patients with overt ischemic heart disease and atrial fibrillation were excluded. The patients were followed for 47 months, with all-cause and cardiovascular (CV) mortality as end-points. ResultsAt follow-up, 72 patients had died with 43 due to CV causes. Plasma CXCL16 was stably elevated in the first days after the acute event followed by a marked decrease after 6 months. In patients who subsequently suffered an adverse outcome, CXCL16 levels at 4 days after the initial event were elevated and were moderately associated with mortality. The increase in CXCL16 from day 1 to 4 was a predictor for all-cause and, in particular, CV mortality even after adjustment in the multivariate analysis for established risk factors such as age, the presence of heart/renal failure, troponin, C-reactive protein and stroke severity. ConclusionsAn increase in plasma CXCL16 during the first days after the initial event is associated with an adverse outcome in patients with acute ischemic stroke, supporting the potential pathogenic role of CXCL16 in atherosclerosis and vascular remodelling as well as their major clinical consequences.

Soluble CD40 ligand, interleukin (IL)-6, and hemostatic parameters in metabolic syndrome patients with and without overt ischemic heart disease

Soluble CD40 ligand (sCD40L, also known as CD154) is a marker for platelet activation which could increase coagulation and inflammation. In this case-control study, we aimed to assess the levels of plasma sCD40L, IL-6, and some hemostatic parameters in patients with metabolic syndrome (MetS) whether or not associated with overt ischemic heart disease (IHD). We measured plasma sCD40L (an index of platelet activation), interleukin (IL)-6 (a proinflammatory cytokine), and some hemostatic parameters (tissue factor [TF], thrombin–antithrombin [TAT] and D-dimer) in 47 patients with metabolic syndrome (21 with and 26 without overt IHD) versus 25 comparable healthy control subjects. Significantly higher levels of sCD40L, IL-6, and thrombotic markers (TF, D-dimer and TAT) were found in patients with metabolic syndrome compared to healthy controls. The levels of IL-6 and sCD40 were highest in patients with overt IHD. Strong positive correlations existed between sCD40L and IL-6 ( r = 0.67, p = 0.003), TF ( r = 0.59, p = 0.008), and platelets count ( r = 0.64, p = 0.005). Higher levels of sCD40L, IL-6, and thrombotic markers exist in MetS patients, particularly those with IHD. The strong positive correlations between sCD40L and IL-6, TF, and platelets count support a link between the CD40–CD40L system and the underlying inflammatory and hypercoagulable state in MetS patients.

Activated Leukocyte Cell Adhesion Molecule and Prognosis in Acute Ischemic Stroke

Biomarkers predicting mortality and functional outcome in stroke may be clinically helpful in identification of patients likely to benefit from intervention. Activated leukocyte cell adhesion molecule (ALCAM) is upregulated during neuroinflammation; we investigated whether ALCAM concentrations are associated with long-term mortality after ischemic stroke. In 244 patients with acute ischemic stroke (age 69±13 years), samples of ALCAM were obtained serially from presentation to Day 5 and after 6 months. Patients with overt ischemic heart disease and atrial fibrillation were excluded. The patients were followed for 47 months with all-cause and cardiovascular mortality as end points. At follow-up, 72 patients (29%) had died, 43 due to cardiovascular causes. Patients with ALCAM in the fourth quartile (>46.8 ng/mL) at admission had a significantly poorer survival rate on univariate analysis (P<0.001); other time points did not add further but provided similar prognostic information. In multivariate analysis, after adjustment for age, stroke severity, C-reactive protein levels, troponin T levels, and heart and/or renal failure, ALCAM levels above the fourth quartile remained an independent predictor of long-term mortality (adjusted hazard ratio, 2.05; 95% CI, 1.11 to 3.76; P=0.021) and cardiovascular mortality (adjusted hazard ratio, 2.54; 95% CI, 1.06 to 6.07; P=0.028). ALCAM levels measured at admission of acute ischemic stroke are associated with long-term mortality.

Subclinical perfusion deficits in patients with Type 2 diabetes detectable with Cardiovascular Magnetic Resonance Imaging

Background An estimated 200 million people worldwide have type 2 diabetes. Type 2 diabetes is recognized as an independent risk factor for adverse cardiac events, such as myocardial infarction. Cardiovascular disease is the leading cause of death amongst diabetic patients. The subclinical pathophysiology of diabetic heart disease predicts global microvascular disease, prior to the onset of overt ischemic heart disease. Non-invasive screening methods are therefore important for risk stratification of asymptomatic patients. Cardiovascular Magnetic Resonance Imaging (CMR) is a valuable tool for the assessment of subclinical microvascular function in this high-risk population.

Osteoprotegerin concentrations and prognosis in acute ischaemic stroke

Concentrations of osteoprotegerin (OPG) have been associated with the presence of vascular and cardiovascular diseases, but the knowledge of this marker in the setting of ischaemic stroke is limited. In 244 patients with acute ischaemic stroke (age: 69 +/- 13 years), samples of OPG were obtained serially from presentation to day 5. Patients with overt ischaemic heart disease and atrial fibrillation were excluded. The patients were followed for 47 months, with all-cause mortality as the sole end-point. Multivariable predictors of OPG values at presentation included haemoglobin (T = -2.82; P = 0.005), creatinine (T = 4.56; P < 0.001), age (T = 9.66; P < 0.001), active smoking (T = 2.25; P = 0.025) and pulse rate (T = 3.23; P = 0.001). At follow-up 72 patients (29%) had died. Patients with OPG < or =2945 pg mL(-1) at baseline had a significantly improved survival rate on univariate analysis (P < 0.0001); other time-points did not add further prognostic information. In multivariate analysis, after adjustment for age, stroke severity, C-reactive protein levels, troponin T levels, heart and renal failure concentrations of OPG independently predicted long-term mortality after stroke (adjusted hazard ratio, 2.3; 95% CI: 1.1 to 4.9; P = 0.024). Osteoprotegerin concentrations measured at admission of acute ischaemic stroke are associated with long-term mortality.

Increased morbidity from ischemic heart disease in patients with Wegener's granulomatosis

Experimental studies indicate that patients with Wegener's granulomatosis (WG) experience accelerated atherosclerosis. The purpose of this study was to investigate whether the occurrence of overt ischemic heart disease (IHD) is increased in WG. A total of 293 WG patients were included in the study. Information on all hospitalizations for IHD in Denmark from 1977 to 2006 was obtained from the Danish National Hospital Register. The WG patients were compared with the Danish background population with respect to rates of hospitalization for clinical manifestations of IHD after the date of vasculitis diagnosis by calculating standardized ratios of observed to expected (O:E) events. Sixty-three first IHD events were registered in the WG group during the 2,482 patient-years of followup, corresponding to a significantly increased O:E ratio for IHD of 1.9 (95% confidence interval [95% CI] 1.4-2.4). A significantly increased risk was found for acute myocardial infarction (MI) (O:E ratio 2.5 [95% CI 1.6-3.7]), but not for angina pectoris (O:E ratio 1.3 [95% CI 0.7-2.1]). In analyses stratified according to the time between the diagnosis of vasculitis and the cardiovascular event, increased O:E ratios were found for IHD and acute MI occurring <5.0 years after WG diagnosis (2.1 [95% CI 1.4-3.0] for IHD and 3.6 [95% CI 2.0-5.9] for acute MI) and for IHD occurring > or =10.0 years after WG diagnosis (2.2 [95% CI 1.3-3.4]). Significantly increased O:E ratios for IHD and acute MI were found in patients who were > or =50.0 years of age at the time of diagnosis of WG, in male patients, and in patients who received high cumulative doses of cyclophosphamide. Compared with the background population, WG patients seem to experience an increased number of both early and late cardiovascular events due to IHD.

The Need for Uniform Definitions in the Regionalized Care of ST‐segment Elevation Myocardial Infarction

The Need for Uniform Definitions in the Regionalized Care of ST‐segment Elevation Myocardial Infarction

Atypical presentation of a middle age male with severe hypertriglyceridaemia: a case report

BackgroundSevere hypertriglyceridaemia (HTG) is uncommon but most prevalent in subjects with type 2 diabetes mellitus (T2DM) and excess ethanol intake.Case presentationWe describe a case of a middle age male (53 y) presenting to the emergency room with acute atypical central chest pain and severe HTG in the absence of evidence of overt ischaemic heart disease (IHD). Admission ECG and EET (exercise tolerance test) were negative for reversible ischaemic changes. His admission glucose was 12.2 mmol/l, triglycerides (TG) were 103 mmol/l, total cholesterol 37 mmol/l. Cardiac Troponin T could not be measured on three occasions but CK MB mass was normal at 3 μg/l. The patient was started on Bezafibrate 400 mg OD, Simvastatin 20 mg nocte, Omacor (Omega-3 fish oil) 1 gm bd and Metformin 500 mg tds. Four weeks after admission, lipid and liver profiles showed remarkable improvement, TG 2.9 mmol/l, Tchol 6.3 mmol/l and HDLc 1.5 mmol/l, ALAT and GGT were normal.ConclusionA case report of severe hypertriglyceridaemia with atypical presentation demonstrate the role of combined lipid modifying agents in lowering triglycerides and cholesterol as well as improving liver enzymes.

Cardiac troponin I concentrations in people presenting with diabetic ketoacidosis

Elevated troponin concentrations may be observed in a wide spectrum of medical disorders in people without evidence of overt ischaemic heart disease. The prospective relationship between serum cardiac troponin I (cTnI) and diabetic ketoacidosis (DKA) has not been examined in adults. Forty patients (14 male and 26 female) with type 1 diabetes were recruited. cTnI, creatine kinase (CK), cystatin C and beta-hydroxybutyrate were measured on admission and at 24, 48 and 72 h post-admission. Daily electrocardiographs were also performed. Four out of forty subjects presenting with DKA had an increase in cTnI (median (SD) 0.06 (0.31) microg/L). One of the subjects had multiple possible reasons for the elevated cTnI concentration. However, the other three subjects had no obvious precipitating factors. This cohort underwent echocardiography and thallium-201 scintigraphy, which revealed no abnormalities. Minor troponin elevations appear to occur in a small number of subjects with type 1 diabetes presenting with DKA. The clinical relevance of this at this stage remains unknown and further large-scale studies are suggested.

Frequency and Significance of Troponin T Elevation in Acute Ischemic Stroke

Elevated levels of troponin have been reported in patients with acute ischemic stroke. In this prospective study, the prevalence and characteristics of troponin elevation were examined in 244 patients with acute ischemic stroke but without overt ischemic heart disease. Troponin T (TnT) and creatine kinase-MB (CK-MB) concentrations were measured and 12-lead electrocardiograms obtained daily during the first 5 days of admission. Myocardial perfusion scintigraphy was performed in patients with TnT levels of 0.10 micro g/L and in comparable controls without elevation of TnT. Patients were followed for a mean of 19 +/- 7 months, with all-cause mortality as the clinical end point. Elevated levels of TnT (>0.03 micro g/L) and creatine kinase-MB (> or =10 micro g/L) were observed in 10% and 9% of patients, respectively. Patients with elevated TnT had higher frequencies of heart and/or renal failure. Perfusion abnormalities on myocardial perfusion scintigraphy at rest were not more frequent or pronounced in patients with TnT levels of > or =0.10 micro g/L than in the control group. Only 7 patients (3%) had elevations of TnT or creatine kinase-MB and electrocardiographic changes suggesting acute myocardial infarctions. According to univariate and multivariate analyses, elevation of TnT was significantly associated with mortality. In conclusion, elevated levels of TnT are rare in patients presenting with ischemic stroke but without overt ischemic heart disease. Heart and renal failure rather than myocardial infarction are the most likely causes. When present, elevation of TnT seems to be useful in identifying patients who are at increased risk of dying within the following 2 years.

Predictive Value of Normal Left Atrial Volume in Stress Echocardiography

Our objective was to evaluate whether normal left atrial volume index (LAVI) is a predictor of a normal stress echocardiogram and thus a predictor of low ischemic risk. Left atrial enlargement is closely related to the chronicity and intensity of the burden of increased ventricular filling pressure. Typically ischemic heart disease (IHD) has a long period of subclinical dysfunction. Increased filling pressure, reflected by enlarged LAVI, is hypothesized to mirror the burden of subclinical and overt IHD. We hypothesized that a normal LAVI might also be useful in predicting low IHD risk. One hundred eighty randomly selected patients (mean age, 63 +/- 15 years; 53% men) underwent outpatient exercise or dobutamine stress echocardiography for known or suspected coronary artery disease. Left atrial volume index was measured retrospectively with the biplane area-length method. The stress echocardiogram was interpreted as abnormal if wall motion abnormalities (WMAs) were noted at rest and/or with stress. Left atrial volume index was categorized as < or =28 ml/m2 (normal), 28.1 to 32 ml/m2, 32.1 to 36 ml/m2, and >36 ml/m2. Abnormal stress echocardiography was identified in 57 patients (31.7%). The percentage of abnormal stress echocardiograms in each LAVI category was 5.7%, 21.9%, 38.7%, and 54.7%, respectively. The negative predictive value for LAVI < or =28 ml/m2 was 94.3%. Normal resting LAVI (< or =28 ml/m2) was strongly predictive of a normal stress echocardiogram. Left atrial volume index might be a simple means of identifying patients with low ischemic risk and should be further evaluated as a complement to the assessment of ischemic risk.

High triglycerides/low high-density lipoprotein cholesterol, ischemic electrocardiogram changes, and risk of ischemic heart disease

Background High triglycerides (TG)/low high-density lipoprotein cholesterol (HDL-C)(TG ≥1.60 and HDL-C ≤1.18 mmol/L) and ischemic ST-T changes in the resting electrocardiogram (ECG) are both strong risk factors of ischemic heart disease (IHD) in men without clinical cardiovascular diseases. This study tested the hypothesis that men free of clinical IHD with high TG/low HDL-C and resting ischemic ECG changes would have a particularly poor prognosis with respect to IHD. Methods We conducted a cohort study of 2906 men, aged 53 to 74 years, without overt IHD at baseline. Results During 8 years, IHD developed in 229 men; 61 cases were fatal. Of the risk factors recorded, ischemic ECG changes and high TG/low HDL-C were the strongest risk factors of IHD. Compared with men without high TG/low HDL-C and without ischemic ECG changes, age-adjusted relative risk of total IHD (95% CI) was 3.5 (1.7-7.2) in men with both high TG/low HDL-C and ischemic ECG changes; the corresponding value for fatal IHD was 11.2 (4.9-25.8). Adjusted for conventional risk factors, the interaction term high TG/low HDL-C × ischemic ECG changes was a significant predictor of IHD death, with a relative risk of 2.6 (1.0-6.9). Conclusions In men free of clinical IHD, ischemic ECG changes were significantly more predictive of fatal IHD in men with high TG/low HDL-C, indicating an adverse synergistic effect of these 2 risk factors. (Am Heart J 2003;145:103-8.)

PERCUTANEOUS TRANSLUMINAL RENAL ARTERY ANGIOPLASTY: WHO BENEFITS MOST?

SUMMARYWe set out to assess the long‐term benefits of renal percutaneous transluminal angioplasty (PTA) in 107 consecutive hypertensive patients with atheromatous renal artery stenosis. During 12‐month follow‐up, blood pressure fell to normal levels in 10 (8.8%) patients and improved in 76 (67.3%); renal function improved or remained stable in 74% of patients. In patients with atheromatous disease, renal angioplasty was most successful in those with stenosis in a single functioning kidney, and in nine patients who presented with symptoms and signs of heart failure, in the absence of overt ischaemic or valvular heart disease. In the latter group, renal PTA resulted in a large loss of sodium and water, resolution of the ‘apparent’ heart failure, and a marked improvement in blood pressure and renal function. It is suggested that all hypertensive patients with haemodynamically significant renal artery stenosis (and/or mild to moderate impairment in renal function), should be considered for renal PTA. Patients with atheromatous stenosis in a single functioning kidney, and those who present with signs of sodium and water retention, are likely to benefit most.

Socioeconomic status, ABO phenotypes and risk of ischaemic heart disease: an 8-year follow-up in the Copenhagen Male Study.

The association of socioeconomic status with the risk of ischaemic heart disease is only partly explained by the uneven distribution of conventional risk factors. We tested the hypothesis that an uneven socioeconomic distribution of ABO phenotypes could contribute to the explanation. A prospective study controlling for age and other relevant potential confounders: smoking, physical activity, wine consumption, height, weight, serum lipids, blood pressure, hypertension, type II diabetes, serum selenium concentration and soldering fumes exposure. The Copenhagen Male Study, Denmark. Two thousand, nine hundred and ninety-three men aged 53-74 years without overt ischaemic heart disease. Incidence of ischaemic heart disease in an 8-year follow-up. Two hundred and forty-two men (8.1%) had a first ischaemic heart disease event. There was no association between socioeconomic status and the ABO blood group phenotypes and, in accordance with this, ABO phenotype was not a confounder for the association of socioeconomic status with the risk of ischaemic heart disease. However, ABO blood group was a strong risk or effect modifier. Only among men with the O phenotype was socioeconomic status (social classes IV and V versus social classes I, II and III) associated with a significant excess risk (relative risk 1.7, 95% confidence interval 1.1-2.7 and P = 0.02 after adjustment for confounders; the corresponding relative risks among the A and B/AB phenotypes comparing low social classes with the higher social classes were 1.08 (P = 0.77) and 1.08 (P = 0.89), respectively). ABO phenotypes did not contribute directly to the explanation of socioeconomic inequalities in the risk of ischaemic heart disease. However, the finding of ABO phenotypes being effect modifiers for the association of socioeconomic status with the risk of ischaemic heart disease may open up new possibilities of clarifying the roles of socioeconomic status and ABO blood group as cardiovascular disease risk factors.

Heart attacks and lower-limb function in master endurance athletes.

Whether very vigorous physical activity bestows on the participant more health benefits or more adverse effects is unclear: we investigated whether men participating in competitive endurance sports in middle and old age are at increased risk of heart attacks as well as of lower-limb osteoarthritis and disability. In our cohort study with an 11-yr follow-up, we studied 269 male orienteering runners (mean age 48.6 yr at baseline; range 37-61), who in 1984 were placed among the 60 best in their master orienteer age-class in Finland, and 188 male nonsmoking controls (mean age 50.4 yr; range 39-61) classified as healthy at 20 yr of age and without overt ischemic heart disease up until 1985. We followed mortality and studied the prevalence of questionnaire-reported physician-diagnosed diseases and disabilities at the end of the follow-up in late 1995. Two (0.7%) of the 269 runners and 10 (5.3%) of the 188 controls had suffered myocardial infarctions during the follow-up, the age-adjusted odds ratio (95% confidence interval) being 0.15 (0.03-0.67) in runners compared with controls (P = 0.0059). At follow-up, orienteering runners reported knee osteoarthritis and knee pain more often than did the controls, whereas the occurrence of hip osteoarthritis and hip pain did not differ. Disability due to hip or knee pain after the same everyday activities tended to be less in the runners. In top-level master endurance athletes having a long-term training background and participating in competitive endurance sports, the risk both of heart attack and of lower-limb disability is low.