Circulating plasma cortisol concentrations are not associated with coronary artery disease or peripheral vascular disease.

BACKGROUND: Although the prevalence of cardiovascular disease is declining, the obesity epidemic with associated metabolic syndrome may reverse this trend. Hypothalamic-pituitary-adrenal (HPA) axis activation may underlie the metabolic syndrome, but whether circulating cortisol levels predict vascular disease is less clear. A recent study reported a positive correlation between cortisol levels measured prior to coronary angiography and disease severity, but others have not demonstrated such a relationship. This may be due to different sampling conditions, reflecting basal cortisol levels, vs. responsiveness of HPA axis activity, which may have diverse influences on the pathogenesis of atherosclerosis. AIMS: To determine whether basal circulating cortisol levels predict coronary artery (CAD) or peripheral vascular disease. METHODS: Basal plasma cortisol levels were measured in 278 subjects with suspected CAD, who had undergone elective coronary angiography and in 76 cases and 85 controls with and without peripheral vascular disease, respectively. RESULTS: After adjustment for potential confounding factors, circulating cortisol levels tended to be lower in those with confirmed coronary vessel disease at angiography (P = 0.10), and in those requiring intervention following angiography (P = 0.07). Lower cortisol levels also predicted those with more symptoms of angina (P = 0.01). Cortisol levels were no different in those with or without peripheral vascular disease. CONCLUSION: A single measurement of circulating cortisol is a poor predictor of vascular disease. More detailed characterization of the HPA axis is necessary to determine the role of circulating endogenous glucocorticoids and their responsiveness to stress in atherosclerosis.

Renal function is associated with arterial stiffness and predicts outcome in patients with coronary artery disease.

BACKGROUND: Arterial stiffness (AS) is associated, and a predictor of, outcome in patients with cardiovascular and renal disease. AIM: In this study, we estimated glomerular filtration rate (eGFR) and measured indices of AS in patients with suspected coronary artery disease (CAD), and assessed their predictive value on outcome. DESIGN: Prospective cohort study. METHODS: AS was measured using pulse wave velocity (PWV) and pulse wave analysis in patients with no known renal disease who had recently undergone coronary angiography. Renal function was assessed using serum creatinine concentration [creat](sr) and eGFR (Cockcroft & Gault, C&G). The primary endpoint was a combination of hospitalization due to cardiovascular disease and all-cause mortality. RESULTS: Two hundred eighty-four subjects (210 men, 74 women, mean age 62 years) were followed-up for a mean of 1.5 years. PWV was negatively associated with eGFR (r(2) = 0.09, P < 0.001), even in patients with an eGFR > or =60 ml/min/m(2) (r(2) = 0.04, P < 0.01). PWV was determined by age, heart rate, systolic blood pressure, body mass index and [creat](sr) (r(2) = 0.38, P < 0.001). A lower eGFR (P < 0.01), PWV above the median (P < 0.05) and degree of CAD (P < 0.001) predicted a shorter time to the primary endpoint. eGFR and degree of CAD remained independent determinants of outcomes (P < 0.01), even in patients with normal renal function (P < 0.01). CONCLUSION: This study suggests that even minor reductions in eGFR, within the normal range, are an additional independent risk marker in patients with CAD.

[The study of social economic factors which influence the fertility of the eligible couples for population policy implementation: a case study in Ujung Pandang]. / Kajian faktor-faktor sosial ekonomi yang mempengaruhi fertilitas pasangan usia subur dalam rangka pengelolaan kependudukan, suatu studi kasus di kotamadya Ujung Pandang.

PIP: This study of socioeconomic factors influencing fertility was carried out in Ujung Pandang, the capital of Sulawesi province, Indonesia. 3 regencies were chosen according to their level of economic growth, and a district was selected from each regency. Through simple random sampling, 60-65 couples were selected from each district for a total of 185 respondents. A multivariate linear regression model was applied to find correlations between several socioeconomic variables and fertility. Based on the results of statistical analysis, 5 variables have a strong correlation with fertility: 1) female participation in economic activities, 2) age at 1st marriage, 3) infant and child mortality, 4) education, and 5) maternal age. Education, age at 1st marriage, and female participation in economic activities have a negative correlation, while infant and child mortality and maternal age have a positive correlation. An earlier study found that education has a positive correlation with age at 1st marriage, which means that more educated women postpone marriage while they are in school. Education also has a positive correlation with the use of contraception, which means that well-educated women tend to accept several innovations, including family planning programs and contraception.^ieng