Identifying the threshold for vitamin D insufficiency in relation to cardiometabolic markers.

BACKGROUND AND AIMS: To determine the association between vitamin D status and cardiometabolic indicators, and to determine the vitamin threshold that affects these parameters. METHODS AND RESULTS: High-tech employees were recruited from a periodic occupational health examination clinic and via the study's website. Diastolic and systolic blood pressure (DBP, SBP), body mass index (BMI), and waist circumference were measured. Serum concentrations of 25(OH)D, fasting plasma insulin (FPI), fasting plasma glucose (FPG), triglycerides (TG), and high sensitive C-Reactive Protein (hs-CRP) were measured in fasting blood samples. Of the 400 men who agreed to participate, 358 (90%) completed the study. Mean age was 48.8 ± 10.2 y, BMI 27.0 ± 3.8 k/m(2), serum 25(OH)D 22.1 ± 7.9 ng/l. Deficiency (defined as serum 25(OH)D < 12 ng/ml) was observed among 10.6%, 29.9% were insufficient (12 < 25(OH)D < 20 ng/ml), and 59.5% had sufficient levels (25(OH)D > 20 ng/ml). BMI, waist circumference, FPI, HOMA-IR, TG, hs-CRP levels, DBP, and SBP were negatively associated with serum 25(OH)D. A curved linear association was found with insulin and HOMA-IR with a significant spline knot at 11 ng/ml. For hs-CRP a spline knot at 14 ng/ml was observed. TG, SBP, and DBP exhibited linear associations with 25(OH)D. CONCLUSIONS: Vitamin D status is related to cardiometabolic indicators in healthy men. We suggest a 25(OH)D threshold of 11-14 ng/ml for these outcomes. Future studies are required to address temporal relationships and the impact of vitamin D supplementation.

Obesity is the major determinant of elevated C-reactive protein in subjects with the metabolic syndrome.

OBJECTIVE: To investigate the relationship between C-reactive protein (CRP) and various characteristics of the metabolic syndrome. DESIGN: Population-based cross-sectional study. SUBJECTS: A total of 1929 subjects undergoing a medical examination in a preventive medicine clinic (age, 50+/-10 y; 63% males). RESULTS: The proportion of subjects with CRP levels above the cut point generally used to indicate an obvious source of infection or inflammation (>10 mg/l) was 3, 7, and 15% in subjects who were normal weight, overweight, and obese, respectively. Subjects with obesity had markedly higher CRP level compared to patients without obesity regardless of whether they had the metabolic syndrome. However, there was no significant difference in CRP levels between nonobese subjects without the metabolic syndrome and subjects in whom the diagnosis of the metabolic syndrome was based on criteria other than obesity (adjusted geometric mean CRP 1.75 vs 2.08 mg/l, P=0.79). Similarly, CRP levels did not differ among obese subjects with and without the metabolic syndrome (adjusted geometric mean CRP 3.22 vs 3.49 mg/l, P=0.99). There was a linear increase in CRP levels with an increase in the number of metabolic disorders (P(trend) <0.0001), which was substantially diminished after controlling for body mass index (BMI) (P(trend)=0.1). Stepwise multivariate linear regression analysis identified BMI, triglyceride levels, HDL cholesterol levels (inversely), and fasting glucose as independently related to CRP levels. However, BMI accounted for 15% of the variability in CRP levels, whereas triglycerides, HDL cholesterol and fasting glucose levels accounted for only approximately 1% of the variability in CRP levels. CONCLUSION: Obesity is the major factor associated with elevated CRP in individuals with the metabolic syndrome. CRP levels in the range suggesting a source of infection or inflammation (>10 mg/l) are more common among obese subjects than in nonobese subjects.

[Thrombolytic treatment for acute myocardial infarction in menstruating women].

A 44-year-old woman was admitted to the intensive cardiac care unit due to an extensive anterior myocardial infarction of acute onset. Because she was menstruating, thrombolytic treatment was relatively contraindicated. On primary coronary angioplasty, an occluding clot was found in her proximal, left anterior coronary artery. Despite menstrual bleeding, 500,000 IU/10 min of urokinase was infused into the artery. After restoration of blood flow, angioplasty was performed and a 90% residual stenosis was found in the artery. She was then fully heparinized for 5 days and concomitantly given aspirin, 100 mg/day. There were no complications, nor was menstrual bleeding excessive. She was discharged in good clinical and hemodynamic status after 10 days of hospitalization. Based on our experience, and reinforced by an additional 23 cases reported by others, we suggest that thrombolytic treatment should not be withheld even in menstruating women, when access to primary, coronary angioplasty is not available.

Transient hepatic dysfunction in two brothers receiving heparin and streptokinase: a genetic predisposition?

Two brothers with acute myocardial infarction are presented. Subsequent to a standard thrombolysis treatment with streptokinase and heparin, both developed abnormal liver tests, with elevated transaminases only. This liver dysfunction resolved promptly. The occurrence of such side-effects in two siblings raises the question of genetic predisposition to the otherwise uncommon hepatic complications of thrombolysis treatment.

[Mediastinal abscess complicating perforated riding gastric ulcer].

Gastric ulcer in a diaphragmatic hernia is a specific clinical entity, different from other gastric ulcerations. A 71-year-old man with a perforated and bleeding gastric ulcer in a diaphragmatic hernia, complicated by a posterior mediastinal abscess, is presented.