Subsequent Coronary Heart Disease Research Articles

Relationship Between Physical Activity, Fitness, and CHD Risk Factors in Middle-Age Chinese

Background:The impact of physical activity, aerobic fitness, and body composition on coronary heart disease (CHD) risk factors in Hong Kong Chinese adults has not been previously investigated.Methods:The study surveyed 707 randomly selected middle-age Hong Kong Chinese by telephone for Physical Activity Rating (PAR). Three hundred and sixteen respondents (age: 45.1 ± 8.1 y) participated in subsequent aerobic fitness testing (VO2max) and CHD risk factor screening.Results:More than 70% of respondents did not have sufficient levels of physical activity. Fifty percent of the men and 19.5% of the women had two or more CHD risk factors. PAR correlated poorly with VO2max and CHD risk factors. VO2max showed significant associations with CHD risk factors. The adjusted odds ratios of having CHD risk factors for unfit participants ranged from 1.11 to 6.61 as compared to fit participants. Obese but fit individuals demonstrated lower odds of CHD risk factors than the obese and unfit individuals. WC was found to be a stronger predictor for CHD risk factors than BMI.Conclusions:The prevalence of CHD risk factors in middle-age Chinese in Hong Kong was high and was related to levels of aerobic fitness and obesity.

Depression and Coronary Heart Disease

Beyond depression's impact on life quality, it is associated with both the incidence of coronary heart disease (CHD) and its prognosis. Depression is three times more common in CHD patients than in the general community. It is independently associated with at least a doubling in risk of subsequent cardiac events. Studies also show that it may precede the development of clinically evident CHD by many years. The mechanisms linking depression and CHD are currently unknown and likely to be complex. In addition to behavioral factors, changes in autonomic regulation, vascular disease of the brain, subchronic inflammation, reduced omega-3 free fatty acid levels, and enhanced platelet responsiveness may all be involved. Only one large clinical trial has attempted to alter CHD prognosis by treating depression. It succeeded in producing a small, but significant reduction in depression symptoms, but had no impact on subsequent CHD events. While debate continues about the causal relationship between CHD and depression, the best treatment strategy to improve prognosis in depressed CHD patients remains intensive modification of standard CHD risk factors in combination with treatment of depression to improve life quality.

Tissue plasminogen activator antigen and D-dimer as markers for atherothrombotic risk among healthy postmenopausal women.

Plasma markers of fibrinolytic function are associated with incident coronary events among several, but not all, prospective epidemiologic investigations of healthy individuals. Few studies have evaluated this relationship in women. In addition, although menopausal hormone therapy (HT) may alter markers of fibrinolytic function, the relevance of this effect for coronary risk assessment has not been studied. In a prospective, nested case-control study among 75 343 postmenopausal women without prior cardiovascular disease or cancer, we evaluated the relationships of elevated tissue plasminogen activator (tPA) antigen and D-dimer with subsequent first coronary heart disease events over a median period of 2.9 years. Baseline levels of both biomarkers were higher among 304 cases compared with 304 controls matched on age, smoking status, ethnicity, and length of follow-up; median values were 9.0 versus 7.4 ng/mL (P<0.001) for tPA antigen and 27.6 versus 23.4 ng/mL (P=0.001) for D-dimer. In matched-pairs analyses, the odds ratio in the highest versus lowest quartile of tPA antigen was 3.5 (95% CI, 2.1 to 5.8; P trend <0.001) and for D-dimer was 2.0 (95% CI, 1.2 to 3.2; P trend=0.005). After adjustment for lipid and nonlipid risk factors, including C-reactive protein, tPA antigen remained a significant predictor. Multivariable-adjusted associations for D-dimer, although attenuated, largely remained statistically significant. When stratified by HT, the relationship between tPA antigen and incident coronary heart disease was similar among nonusers, estrogen-only users, and current users of any HT. Elevated tPA antigen and, to a lesser extent, D-dimer are independently associated with incident coronary events among postmenopausal women. In analyses stratified by HT, tPA antigen remained a consistent marker of increased coronary risk.

Plasma fibrinogen and its association with cardiovascular risk factors in apparently healthy Japanese subjects.

Recent evidence has shown the association of increased plasma fibrinogen levels with subsequent coronary heart disease or stroke. Fibrinogen is an acute-phase inflammatory reactant as well as a clotting factor. The authors investigated an association between fibrinogen levels and cardiovascular risk factors in apparently healthy Japanese subjects, while considering C-reactive protein (CRP) levels, a marker of the inflammatory status. Plasma fibrinogen and serum CRP from 2 706 participants in an annual mass screening examination, held in Matsukawa, Nagano, Japan were measured. A total of 2 355 subjects (816 men and 1 539 women) were analyzed after excluding individuals with a history of diabetes mellitus, heart disease, or stroke. Plasma fibrinogen was strongly correlated with CRP levels. After adjusting the CRP levels, fibrinogen was positively associated with age, smoking status, total cholesterol, and hemoglobin A(1c) (HbA(1c)) in men, and with age, total cholesterol, and HbA(1c) in women. On the other hand, high-density lipoprotein (HDL) cholesterol was a strong negative correlate of fibrinogen in both genders. Fibrinogen levels also tended to be associated positively with body mass index in both genders and negatively with exercise habits in men. The present multiple regression analysis has shown that plasma fibrinogen levels are correlated with conventional cardiovascular risk factors even after adjusting for the CRP levels. Persons with cardiovascular risk factors tended to have higher fibrinogen levels, suggesting that all elevated plasma fibrinogen concentration in those with risk factors may further increase the risk of the development of atherothrombosis and subsequent cardiovascular disease through the blood coagulation system.

Enhanced expression of cytokines and chemokines by blood monocytes to in vitro lipopolysaccharide stimulation are associated with hostility and severity of depressive symptoms in healthy women

The current study investigated the relation of hostility and severity of depressive symptoms, separately and jointly, to the capacity of blood monocytes to secrete an array of cytokines when stimulated by bacterial lipopolysaccharide (LPS). Subjects were 44 healthy, non-smoking, premenopausal women (aged 23–49 years) not currently taking oral contraceptives. Data were collected during the follicular phase of the menstrual cycle. The Cook–Medley Hostility (Ho) scale and the Beck Depression Inventory (BDI) were used to assess hostility and severity of depressive symptoms, respectively. Dual-color flow cytometry was used to measure the total expression of interleukin (IL)-1α, IL-1β, IL-8, tumor necrosis factor (TNF)-α, monocyte chemotactic protein (MCP)-1 and monocyte inflammatory protein (MIP)-1α in blood monocytes following 4 h in vitro LPS stimulation of whole blood. In analyses adjusting for age, body mass index (BMI), fasting cholesterol, alcohol use, race and 17β-estradiol (E 2), higher Ho scores were associated with greater LPS-stimulated expression of IL-1α ( β=0.033, p=0.02), IL-8 ( β=0.046, p=0.01) and IL-1β ( β=0.024, p=0.06). Higher BDI scores were associated with greater expression of TNF-α ( β=0.042, p=0.02) and IL-8 ( β=0.045 p=0.04). The linear combination of Ho and BDI scores was significantly associated with IL-1β ( β=0.18 p=0.057), IL-8 ( β=0.36, p=0.01), TNF-α ( β=0.25, p=0.03), and IL-1α ( β=0.18, p<0.07). Thus, in healthy women, these psychological risk factors, alone and in combination, induce a proinflammatory phenotype in circulating monocytes characterized by the up-regulation of proinflammatory cytokines, supporting the hypothesis that inflammation may be a key pathway whereby hostility and depressive symptoms contribute to atherosclerosis and subsequent coronary heart disease (CHD).

Tissue plasminogen activator antigen and coronary heart disease. Prospective study and meta-analysis.

To determine whether circulating tissue plasminogen activator (t-PA) antigen concentrations are prospectively related to risk of coronary heart disease (CHD) in the general population. We measured baseline concentrations of t-PA antigen in the stored serum samples of 606 CHD cases and 1227 controls 'nested' in a prospective cohort of 5661 men monitored for 16 years, and conducted a meta-analysis of previous relevant studies to place our findings in context. Tissue plasminogen activator antigen values were strongly correlated with several vascular risk factors, including serum lipids, body mass index, alcohol consumption, and markers of systemic inflammation. In a comparison of men in the top third compared with those in the bottom third of baseline t-PA antigen values, the odds ratio for CHD was 2.20 (95% confidence interval (CI) 1.70-2.85) after adjustment for age and town only, but this fell to 1.48 (1.09-2.01) after further adjustment. Analysis of t-PA as a continuous variable gave similar results. Similarly, when published information on all seven available prospective cohort studies in general populations (2119 cases and 8832 controls in total) was synthesized, the combined odds ratio was 2.18 (1.77-2.69) after adjustment for age and sex only, and this fell to 1.47 (1.19-1.81) after further adjustment. Although there is a statistically significant association between circulating concentrations of t-PA antigen and subsequent CHD, additional studies are needed to determine to what extent this is independent from more established risk factors.

Effects of raloxifene on bone metabolism and serum lipids in postmenopausal women on chronic hemodialysis

Premature amenorrhea and hypoestrogenism and lack of hormone replacement therapy after menopause have been frequently reported in uremic women on dialysis. Therefore, in addition to renal osteodystrophy, postmenopausal women on dialysis could be at risk of osteoporosis. In addition, these patients are at higher risk for hyperlipidemia, arteriosclerosis, and subsequent coronary heart disease and stroke. Recent evidence has suggested that hormone replacement therapy (HRT) in postmenopausal women could have several beneficial effects as well as potentially serious risks. Great efforts have been made to identify therapeutic alternatives that would have the benefits of estrogen on brain and bone without its adverse effects on breast and endometrium. In the present study, we evaluated the effect of raloxifene, a selective estrogen receptor modulator (SERM), on bone metabolism and serum lipids in postmenopausal women on chronic hemodialysis. We performed a prospective, blind, placebo-controlled, and randomized study. Fifty postmenopausal women on chronic hemodialysis with proven severe osteopenia or osteoporosis by bone densitometry were selected. After a written informed consent, patients were randomized into two groups: 25 women on placebo and 25 women on the study drug, raloxifene hydrochloride, at a dose of 60 mg/day. In all patients, we performed a baseline bone mineral density (BMD) analysis and simultaneously evaluated different biochemical parameters, serum lipids (total low-density lipoprotein [LDL] and high-density lipoprotein [HDL] cholesterol and triglycerides) and serum markers of bone resorption (pyridinoline crosslinks). BMD was reassessed after 1 year of therapy. Bone resorption markers were determined every 3 months for 1 year. After 1 year on raloxifene therapy, lumbar spine BMD (trabecular bone) significantly improved, whereas femoral neck BMD (cortical bone) did not change significantly. No changes in BMD were observed at trabecular or cortical sites in the placebo group. Serum pyridinoline levels showed a significant decrease after 6 months on raloxifene that persisted thereafter. Low-density lipoprotein (LDL)-cholesterol decreased significantly in the raloxifene group with no changes in serum triglycerides, total cholesterol, or HDL cholesterol. No significant side effects were observed in the raloxifene group. The study demonstrates that after one year on raloxifene, postmenopausal women on hemodialysis have a significant increase in trabecular BMD, decrease in bone resorption markers and LDL-cholesterol values, suggesting that SERMs could constitute a therapeutic alternative to improve bone metabolism and control of hyperlipidemia in these patients. The possible long-term effects of raloxifene remain to be determined.

Ankle-arm blood pressure index and cardiovascular risk factors in elderly Japanese men.

Low ankle-arm systolic blood pressure index (AAI) correlates with various cardiovascular risk factors and with risk of subsequent coronary heart disease and stroke in Western countries. However, few epidemiological data are available among Japanese, in whom the reported prevalence of peripheral artery disease is low. We examined the relationship between AAI and cardiovascular risk factors among 1,219 men aged 60 to 79 years in two Japanese communities in 1999 and 2000. The prevalence of AAI<0.90 was 5% in both communities. Hypertension, major ECG abnormality, current smoking, and history of stroke were associated with two- to four-fold higher prevalence of AAI<0.90. One-standard deviation increments of body mass index and high density lipoprotein-cholesterol levels were associated with 60% and 40% lower prevalence of AAI<0.90, respectively. Although the prevalence of low AAI in Japanese elderly men is lower than that reported in the Unites States and European studies, similar correlations of low AAI with cardiovascular risk factors were observed among different ethnic groups. Low AAI is suggested to be a predictor for stroke among Japanese men, which should be confirmed by a prospective study.

Women and Coronary Heart Disease Risk Factors

The prevalence of cardiovascular risk factors among women is high and cardiovascular risk factors often occur in clusters. Strong relationships between exposure to cigarette smoke, physical inactivity, hypertension, and abnormal levels of lipoproteins and homocysteine and subsequent coronary heart disease (CHD) in women are evident from many studies, while the impact of menopause, psychosocial factors, and inflammatory markers is less clear and requires further study. Observational studies document that smoking cessation reduces CHD risk among persons with and without existing CHD, and that moderate levels of physical activity are associated with lower CHD risk. Clinical trials over the last decade have convincingly shown that treatment of hypertension and dyslipidemia reduces CHD risk in both genders, but many women (and men) with hypertension and dyslipidemia remain either untreated or under-treated.

Women and coronary heart disease risk factors.

The prevalence of cardiovascular risk factors among women is high and cardiovascular risk factors often occur in clusters. Strong relationships between exposure to cigarette smoke, physical inactivity, hypertension, and abnormal levels of lipoproteins and homocysteine and subsequent coronary heart disease (CHD) in women are evident from many studies, while the impact of menopause, psychosocial factors, and inflammatory markers is less clear and requires further study. Observational studies document that smoking cessation reduces CHD risk among persons with and without existing CHD, and that moderate levels of physical activity are associated with lower CHD risk. Clinical trials over the last decade have convincingly shown that treatment of hypertension and dyslipidemia reduces CHD risk in both genders, but many women (and men) with hypertension and dyslipidemia remain either untreated or under-treated.

Migraine and coronary heart disease in women and men.

We evaluated migraine as an independent risk factor for subsequent coronary heart disease (CHD) events among women in the Women's Health Study (WHS) and men in the Physicians' Health Study (PHS). Although several studies have suggested that migraine is associated with increased risk of stroke, there are few and conflicting data on whether migraine predicts risk of future CHD events. The WHS is an ongoing randomized, double-blind, placebo-controlled trial of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer in 39876 women health professionals aged > or =45 years in 1993, and the PHS is a completed randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in the primary prevention of cardiovascular disease and cancer in 22071 men physicians aged 40 to 84 years in 1982. Primary endpoints were defined as major CHD (nonfatal myocardial infarction [MI] or fatal CHD) and total CHD (major CHD plus angina and coronary revascularization). After adjusting for other CHD risk factors, female health professionals and male physicians reporting migraine were not at increased risk for subsequent major CHD (women: relative risk [RR], 0.83; 95% confidence interval [CI], 0.53 to 1.29; men: RR, 1.02; 95% Cl, 0.79 to 1.31) or total CHD (women: RR, 1.01; 95% Cl, 0.76 to 1.34; men: RR, 0.98; 95% Cl, 0.82 to 1.18). When considered separately, there was also no increase in risk of MI or angina. These prospective data suggest that migraine is not associated with increased risk of subsequent CHD events in women or men.

The impact of diabetes mellitus and prior myocardial infarction on mortality from all causes and from coronary heart disease in men

ObjectivesThe goal of this study was to examine the impact of diabetes and prior myocardial infarction (MI) on mortality in men. BackgroundPrevious studies have suggested that a history of diabetes and a prior MI confer similar risk for subsequent fatal coronary heart disease (CHD). Few studies have examined duration of diabetes in relation to mortality. MethodsWe examined type 2 diabetes and prior MI in relation to mortality among 51,316 men aged 40 to 75 years in the Health Professionals Follow-up Study. ResultsDuring 10 years of follow-up, we documented 4,150 deaths from all causes, including 1,124 deaths from CHD. Compared with men without diabetes or prior MI at baseline, the multivariate relative risks (RRs) for fatal CHD were 3.84 (95% confidence interval [CI], 3.12 to 4.71) for those with diabetes only, 7.88 (95% CI, 6.86 to 9.05) for those with MI only, and 13.41 (95% CI, 10.49 to 17.16) for those with both diabetes and MI. The corresponding RRs for total mortality were 1.91 (95% CI, 1.70 to 2.15), 2.23 (95% CI, 2.03 to 2.45), and 3.13 (95% CI, 2.56 to 3.84), respectively. Duration of diabetes was an independent risk factor for total as well as CHD mortality; the multivariate RRs of CHD mortality for increasing duration of diabetes (≤5 years, 6 to 10 years, 11 to 15 years, 16 to 25 years, 26+ years) were 1.63, 1.93, 2.35, 2.31, and 3.87, respectively (p for trend <0.001), compared with nondiabetic participants. ConclusionsThese findings support that both diabetes and MI are associated with elevated total and CHD mortality, and having both conditions is particularly hazardous. Longer duration of diabetes is a strong predictor of death among diabetic men.

A man's heart and a wife's education: a 12-year coronary heart disease mortality follow-up in Norwegian men.

Low socioeconomic status is an established risk factor for coronary heart disease. Yet relatively few studies have examined whether wives' socioeconomic status may influence men's coronary heart disease (CHD) risk factors and mortality. We examined whether wives' education was associated with men's risk of CHD after taking into account the men's own educational level. Married men were identified in a population-based cohort recruited for a cardiovascular disease screening conducted 1977-1983 in three Norwegian counties. Differences in baseline risk factors and subsequent CHD mortality by men's and their wives' education were examined. The cohort was followed through 1992. Wives' education was inversely related to the prevalence of men's sedentary behaviour, being overweight, having a high diastolic blood pressure, blood pressure treatment, and high total cholesterol and smoking in logistic regression analyses adjusting for men's age and education. For smoking and obesity, we observed a significant men's by wives' education interaction, with stronger inverse trends observed by wives' education among the higher-educated men. In prospective analyses, men's age-adjusted CHD mortality rates decreased with increasing level of wives' education within each stratum of men's education, with the exception of men in the lowest (7 years) education category where no trend by wives' education was observed. In additional multivariate analyses, adjusting for numerous baseline risk factors, the inverse trend in men's CHD mortality by wives' educational level remained significant only among men in the highest education category (>or=11 years of education). The data suggest that a partner's educational level could add valuable information to studies designed to characterize and measure the influence of socioeconomic status. Also, our data do not support other studies reporting that educated wives are hazardous for men's hearts.

Dietary fats and 16-year coronary heart disease mortality in a cohort of men and women in Great Britain.

The paper aims to investigate the relationships of dietary fats to subsequent coronary heart disease (CHD) mortality in men and women while taking account of other CHD-related behaviours. A cohort of randomly selected men and women were interviewed in 1984-85 and monitored subsequently for 16 y for deaths. The interview covered health, health-related behaviours, physical measurements, socio-demographic details and a dietary questionnaire. Appropriate exclusions left 1225 men and 1451 women aged 40-75 with 98 and 57 CHD deaths, respectively. Saturated, polyunsaturated and total fat intakes were estimated. The sample was randomly selected from households in Great Britain. The interviews took place in participants' own homes. Not consuming alcohol, smoking, not exercising and being socially disadvantaged were related to high saturated fat intake and CHD death. Cox survival analyses adjusting for these factors found that a level of saturated fat 100 g per week higher corresponded to a relative risk for CHD death for men of 1.00 (0.86-1.18) and 1.40 (1.09-1.79) for women. This difference between the effects of saturated fat in men and women was statistically significant (P=0.019). Results are also reported for total fat and the relative effects of polyunsaturated and saturated fats. Strong evidence was found for the within cohort relationship of dietary fat and CHD death in women while no evidence was found for a relationship in men. Possible explanations for this are discussed.

Intraindividual variability of children's blood lipid and lipoprotein concentrations: a review.

Of the numerous risk factors that have been associated with atherosclerosis and subsequent coronary heart disease, none have caught the public's attention more than plasma cholesterol. An increasing number of studies are focusing on intervention strategies aimed at "improving" the plasma lipid-lipoprotein profile of children. However, the efficacy of these strategies cannot be ascertained unless the biologic and analytic variability of these metabolites has been determined. From the limited available literature, it would appear that the biologic variability of total cholesterol, high- and low-density lipoprotein cholesterol, and triacylglycerol in children is similar to that reported for adults. Yet studies that have directly focused on this important issue with children are scarce, especially those that have included a representative sample and measurements of lipoprotein subfractions. Further research is warranted with children to better establish the extent of intraindividual variation associated with the lipid-lipoprotein profile.

Relationship between lipid levels and clinical outcomes in the Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Trial: to what extent is the reduction in coronary events with pravastatin explained by on-study lipid levels?

The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) trial showed that pravastatin significantly reduced mortality and coronary heart disease (CHD) events in 9014 patients with known CHD and total cholesterol 4.0 to 7.0 mmol/L at baseline. Secondary objectives included assessment of CHD event reduction according to lipid levels. We investigated the relationships of baseline and on-study lipids with subsequent CHD events in separate Cox models. Treatment effect on CHD event reduction was examined by baseline lipids and after adjustment for on-study lipid levels. Baseline lipids were significant predictors of CHD events. The adjusted relative risk per mmol/L (on placebo) was 1.24 (P=0.004) for total cholesterol, 1.28 (P=0.002) for low-density lipoprotein cholesterol, and 0.52 (P=0.004) for high-density lipoprotein cholesterol. Apolipoproteins A1 and B were strong predictors (each P=0.001). Pravastatin reduced the risk of the composite outcome of fatal CHD or nonfatal myocardial infarction by 24% (95% confidence interval [CI], 15% to 32%) and the expanded end point of fatal CHD, nonfatal myocardial infarction, unstable angina, or coronary revascularization by 17% (95% CI, 10% to 24%). Similar relative effects were observed for different categories of baseline lipids. The proportion of treatment effect explained by on-study lipid levels was 67% (95% CI, 27% to 106%) for the composite and 97% (95% CI, 49% to 145%) for the expanded end point. The most important lipids associated with event reduction were apolipoprotein B, low-density lipoprotein cholesterol, and the combination of total and high-density lipoprotein cholesterol. Changes in lipid levels can explain all or most of the observed benefit of pravastatin. Some treatment effect may also be mediated through nonlipid changes.

Serum Triglyceride Concentration and Coronary Heart Disease

To the Editor: The independent prognostic significance of fasting triglyceride concentration is currently debated. The article by Sharrett et al1 reports the impact of several lipid parameters on the subsequent occurrence of coronary heart disease in the Atherosclerosis Risk in Communities Study, in which a large middle-aged population free from coronary heart disease at baseline was followed for 10 years. The authors’ statement that triglycerides provide “substantial” and “independent” coronary heart disease prediction, at least in women, is not fully supported by the study results. The authors affirm that the association between triglycerides and subsequent coronary heart disease they found in women after adjustment for age …

Cardiovascular risk factors in ethnic minority women aged ≤30 years

Men and women of African and South Asian ancestry in the United States are increasingly recognized as being at greater risk for coronary heart disease (CHD) than Caucasians of European ancestry. Relatively little data on the genetic and lifestyle risk factors that predispose women to CHD in these ethnic minorities are available. We compared coronary risk factors in a volunteer sample of African-American, Asian Indian American, and Caucasian American women of college age. Life style, dietary, hemodynamic and anthropometric parameters, and laboratory data were sought from 70 subjects in each ethnic group. African-American women were found to have lower triglyceride levels and higher apolipoproten A-1, high-density lipoprotein (HDL), lipoprotein (a) (Lp(a)), fibrinogen, and fasting insulin levels. They also consumed more fat and cholesterol than their peers, had a higher percentage of body fat, body weight, and body mass indexes, and reported less physical activity than Caucasians. Asian Indian American women had higher Lp(a), HDL, and fibrinogen levels than Caucasian American women, and also reported less physical activity. Thus, young African- American and Asian Indian American women have several modifiable risk factors as well as some nontraditional lipid risk factors that warrant consideration for explaining the increased prevalence of CHD in these ethnic groups. The tendency toward peripheral insulin insensitivity and increased body fat in this age group of African-American women suggests diet and exercise may reduce the risk of subsequent CHD.

Serological markers of Chlamydia pneumoniae infection in men and women and subsequent coronary events; the Scottish Heart Health Study Cohort.

To investigate the relationship between serum markers of Chlamydia pneumoniae infection and subsequent coronary events. In a nested case-control study, based on the Scottish Heart Health Study cohort, we estimated IgG, IgA and IgM antibodies to C. pneumoniae, and circulating immune complexes containing C. pneumoniae antigen in baseline serum samples from 217 cases experiencing a subsequent coronary event during follow-up (mean 7.5 years) and from their matched controls. In men, the proportion of specimens positive for IgG, IgA and IgM antibodies showed no case-control differences (80% vs 80%, 57% vs 53% and 3% vs 3%, respectively). The odds ratio for a coronary event was 1.00 (95% confidence interval 0.59-1.69) for the presence of IgG antibodies to C. pneumoniae; 1.21 (0.76-1.92) for IgA and 0.75 (0.17-3.35) for IgM. Similar results were seen in women. The proportion of specimens with circulating immune complexes with C. pneumoniae antigen also showed no case-control differences (12% vs 12%, both sexes combined) with an odds ratio of 1.00 (0.57-1.76). Prior infection with C. pneumoniae, as estimated by these markers, does not appear to be a risk factor for subsequent coronary heart disease.

Leg length, insulin resistance, and coronary heart disease risk: The Caerphilly Study

BACKGROUNDAdult height has been inversely associated with coronary heart disease risk in several studies. The mechanism for this association is not well understood, however, and this was investigated by examining...