Impact of atherosclerotic risk factors on different ankle-brachial-index criteria--results of the Heinz Nixdorf RECALL study.

BACKGROUND: On the basis of the Heinz Nixdorf RECALL Study (HNR) we estimated the impact of classical atherosclerotic risk factors on different ankle-brachial-index (ABI) criteria. PATIENTS AND METHODS: In a subgroup of participants (n = 2586) who had normal ABI at baseline ABI measurement was repeated at a 5 years follow-up and 3 different ABIs were defined: "ABI-high" calculated from the higher pressure, "ABI-low" from the lower pressure of both foot arteries of each leg. "Pure-ABI-low" was defined by exclusion of participants with ABI-high from those with ABI-low. Mönckebergs mediacalcinosis (MC) was accepted in case of ABI-high > 1.4 in one leg. RESULTS: According to ABI-high 2 %, to ABI-low 7.8 % and pure-ABI-low 5.8 % of the participants developed peripheral arterial disease (PAD) (ABI < 0.9) and 3.6 % developed MC within the 5 years. Age did not play any role whereas female gender, diabetes mellitus and smoking were associated with an increased relative risk of pathologic ABI-high and ABI-low. Looking at the pure-ABI-low group only, female gender and smoking showed significant associations. None of the analysed risk factors except gender had an impact on the development of MC. CONCLUSIONS: Classical risk factors have different impact on incidence of PAD as defined by different ABI criteria.

Aquaporin 5 gene promoter--1364A/C polymorphism associated with 30-day survival in severe sepsis.

BACKGROUND: Because the aquaporin (AQP) 5 promoter -1364A/C polymorphism is associated with altered AQP5 expression, this association could have an impact on key mechanisms in sepsis, such as cell migration, activity of the rennin-angiotensin- aldosterone system (RAAS), and water transport across biologic membranes. Therefore, we tested the hypothesis that the AQP5 promoter -1364A/C polymorphism is associated with increased 30-day survival in severe sepsis. METHODS: In a prospective study, adults with severe sepsis (N = 154) were genotyped for the AQP5 promoter -1364A/C polymorphism. The clinical endpoint was 30-day survival. Kaplan-Meier plots and multivariate proportional hazard analyses were used to evaluate the relationship between genotypes and clinical outcomes. RESULTS: Thirty-day survival was significantly associated with AQP5 -1364A/C genotypes (P = 0.001). Survival rates were 57% for AA genotypes (n = 90) but 83% for combined AC/CC genotypes (56 vs. 8, respectively). Multivariate proportional hazard analysis including sex, age, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment score, body mass index, necessity for continuous hemofiltration/dialysis, concentrations of plasma angiotensin II, serum aldosterone, C-reactive protein, and interleukin 6 as covariates revealed the AQP5 -1364A/C polymorphism as a strong and independent prognostic factor for 30-day survival. In this analysis, homozygous AA subjects were at high risk for death within 30 days (hazard ratio, 3.59; 95% CI, 1.47-8.80; P = 0.005) compared with AC/CC genotypes. CONCLUSION: The C-allele of the AQP5 -1364A/C polymorphism is associated with increased 30-day survival in patients with severe sepsis. This finding suggests the importance of variations in expression of AQP5 channels in severe sepsis.

Cardiovascular risk factors in patients with uncontrolled and long-term acromegaly: comparison with matched data from the general population and the effect of disease control.

CONTEXT: Data on cardiovascular risk in acromegaly are scanty and lack a clear correlation to epidemiological data. OBJECTIVE: Our aim was an evaluation of cardiovascular risk factors in patients with active acromegaly, a calculation of the Framingham risk score (FRS) compared with age- and gender-matched controls of the general population, and an evaluation of the effect of IGF-I normalization. DESIGN AND SETTING: We conducted a retrospective, comparative study at a university referral center. PATIENTS: A total of 133 patients with acromegaly (65 men, aged 45-74 yr) from the German Pegvisomant Observational Study were matched to 665 controls from the general population. MAIN OUTCOME MEASURES: Risk factors were measured at baseline and after 12 months of treatment with pegvisomant (n=62). RESULTS: Patients with acromegaly had increased prevalence of hypertension, mean systolic and diastolic blood pressure (BP), history of diabetes mellitus and glycosylated hemoglobin (all P<0.001) and decreased high-density lipoprotein, low-density lipoprotein, and total cholesterol (all P<0.001). FRS was significantly higher in patients with acromegaly compared with controls (P<0.001). At 12 months, systolic BP (P=0.04) and glycosylated hemoglobin (P=0.02) as well as FRS (P=0.005) decreased significantly. IGF-I was normalized in 62% (41 of 62). In these patients, glucose and systolic and diastolic BP was significantly lower than in partially controlled patients. SUMMARY: We found an increased prevalence of cardiovascular risk factors in acromegalic patients compared with controls. Control of acromegaly led to a significant decrease of FRS, implying a reduced risk for coronary heart disease. This was most significant in those patients who completely normalized their IGF-I levels. CONCLUSION: Disease control is important to reduce the likelihood for development of coronary heart disease.

Poor social relations and adverse health behaviour: stronger associations in low socioeconomic groups?

OBJECTIVE: Poor social relations are supposed to contribute to adverse health behaviour. We examined this association and the role of low socio-economic position. METHODS: We regressed health behaviour on composite variables of the two exposures of social relations and socio-economic position (SEP). Social relations included networks and support; health behaviour was analysed in terms of smoking, poor nutrition and physical inactivity; socio-economic position comprised of income and education. Cross sectional data from a population based epidemiological study in German (4,814 men and women aged 45-75) was analysed. RESULTS: Among the indicators for social relations, social isolation was consistently associated with adverse health behaviour; social support showed modest effect. A combination of poor social relations and low SEP displayed stronger (additive) associations with adverse health behaviour than each factor alone. However, superadditivity was excluded. CONCLUSION: Given the important role of health adverse behaviour in chronic disease development, results underline the relevance of social environment and socio-economic structure in Public Health interventions.

Low socio-economic position is associated with poor social networks and social support: results from the Heinz Nixdorf Recall Study.

BACKGROUND: Social networks and social support are supposed to contribute to the development of unequal health within populations. However, little is known about their socio-economic distribution. In this study, we explore this distribution. METHODS: This study analyses the association of two indicators of socio-economic position, education and income, with different measures of social networks and support. Cross-sectional data have been derived from the baseline examination of an epidemiological cohort study of 4.814 middle aged urban inhabitants in Germany (Heinz Nixdorf Recall Study). Bivariate and multivariate logistic regression analysis were carried out to estimate the risk of having poor social networks and support across socio-economic groups. RESULTS: Socially disadvantaged persons more often report poor social networks and social support. In multivariate analyses, based on education, odds ratios range from 1.0 (highest education) to 4.9 (lowest education) in a graded way. Findings based on income show similar effects, ranging from 1.0 to 2.5. There is one exception: no association of SEP with close ties living nearby and regularly seen was observed. CONCLUSION: Poor social networks and low social support are more frequent among socio-economically disadvantaged people. To some extent, this finding varies according to the indicator chosen to measure these social constructs.

Residence close to high traffic and prevalence of coronary heart disease.

AIMS: Long-term exposure to urban air pollution may accelerate atherogenesis and increase cardiopulmonary mortality. We aim to examine the relationship between the long-term residential exposure to traffic and prevalence of coronary heart disease (CHD). METHODS AND RESULTS: We used baseline data from the German Heinz Nixdorf RECALL study, a population-based, prospective cohort study. For 3399 participants from two cities, we assessed the long-term personal traffic exposure and background air pollution, comparing residents living within 150 m of major roads with those living further away. The principal outcome variable was clinically manifest CHD. We evaluated the association with multivariable logistic regression, controlling for background air pollution and individual level risk factors. Of 3399 participants, 242 (7.1%) had CHD. The crude odds ratio (OR) for prevalence of CHD at high traffic exposure was significantly elevated (1.62, 95%CI 1.12-2.34) and rose to 1.85 (95%CI 1.21-2.84) after adjusting for cardiovascular risk factors and background air pollution. Subgroup analysis showed stronger effects for men (OR 2.33, 95%CI 1.44-3.78), participants younger than 60 years (OR 2.67, 95%CI 1.24-5.74) and never-smokers (OR 2.72, 95%CI 1.40-5.29). CONCLUSION: This study provides epidemiological evidence that the long-term exposure to traffic-related emissions may be an important risk factor for CHD.

[Noninvasive plaque imaging using contrast-enhanced cardiac computed tomography]. / Nichtinvasive Darstellung koronarer Plaques mittels kontrastgestützter kardialer Computertomographie.

Recent technical advances in both multislice spiral computed tomography (MSCT) and electron-beam computed tomography (EBT) renewed the clinicians' interest in the potentials of CT-based, contrast-enhanced, noninvasive coronary angiography. Despite the fact that invasive, selective coronary angiography remains the "gold standard", cardiac CT lumenography permits visualization of flow-limiting coronary stenosis with a sensitivity and specificity of about 90%. The method is, nevertheless, limited by imaging artifacts which are due to extensive coronary calcifications, or, especially in the right coronary and circumflex artery, to rapid coronary motion. Moreover, the clinical value for the exclusion of obstructive coronary artery disease is not yet established, and further prospective studies are required. On the other hand, cardiac CT permits reliable estimation of coronary calcification and quantification of overall coronary plaque burden and thereby allows risk assessment to predict the individual cardiovascular risk. Diagnostic accuracy may be enhanced by combining assessment of calcified plaque burden and contrast imaging. The newer MSCT technology also allows for differentiation of coronary lesion configuration, especially of noncalcified plaques. However, very few data are currently available on this aspect, and the future clinical relevance of this promising technique remains to be proven. The purpose of this article is to describe the principles and potentials of contrast-enhanced coronary CT imaging and to summarize the practical limitations with the currently available scanning equipment.