Transient hyperphosphatasemia in an infant with bronchiolitis and pneumonia.

We present a case of benign transient hyperphosphatasemia in a 4-month-old infant with acute bronchiolitis and pneumonia. During hospitalization the infant had an increased catalytic activity of alkaline phosphatase (ALP): day 2, 5074 U/L; day 3, 5622-U/L; and day 8, 3129 U/L. The x-ray, leukocytosis, and C-reactive protein findings pointed to bacterial etiology of the respiratory disorder. Electrophoretic separation revealed an atypical isoenzyme profile: fast anodal, near-cathodal and bone fractions. ALP levels normalized within 54 days, and control electrophoresis indicated normal liver, placental/placental-like, intestinal and bone isoenzymes. The appearance of atypical fast anodal and near-cathodal fractions of ALP in this infant during the course of acute lower respiratory tract infection and rapid return to the reference intervals pointed to benign transient hyperphosphatasemia.

Epidemiology of congestive heart failure in three ethnic groups.

Congestive heart failure (CHF) is a leading cause of morbidity, disability, and mortality in old age, but little is known about the epidemiology of this condition in free-living minority populations. To determine the prevalence of CHF and associated risk factors in a multiethnic community, a population sample of 2759 elderly (i.e., 65 years of age and older) African American (AA), Hispanic-Cuban (HC), and white non-Hispanic (WNH) men and women from Miami-Dade County, Florida, were examined. There were 153 (5.6%) cases of self-reported CHF in the sample. The unadjusted prevalence rate of CHF was virtually identical among elderly AA (4.8%) and WNH (4.9%) but was significantly (p=0.04) lower than the rate among HC (6.8%). Sex- and ethnic-specific analyses showed that the highest prevalence rate of CHF was among HC women (8.2%). A multiple logistic analysis was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of CHF in relation to age, sex, ethnicity, medical history, and smoking and alcohol drinking habits. Age (65-74 vs. 75-84; OR 1.7; CI 1.2-2.4; p=0.01), HC ethnic group (OR 1.5; CI 1.0-2.4; p=0.05), history of hypertension (OR 1.5; CI 1.1-2.1; p=0.02), history of myocardial infarction (OR 2.3; CI 1.5-3.5; p=0.0001), and history of diabetes mellitus (OR 1.9; CI 1.3-2.8; p=0.001) were directly, significantly, and independently associated with the prevalence of self-reported CHF. The findings here confirm those of prior studies in elderly white US residents, which indicate that heart attack, hypertension, and diabetes mellitus are major risk factors for CHF. The results also show that elderly AA and WNH have similar CHF prevalence rates. The higher CHF prevalence in elderly HC women found in this study requires further investigation. (c)2001 by CHF, Inc.

Epidemiology of peripheral vascular disease: a predictor of systemic vascular disease.

It is estimated that peripheral vascular disease (PVD) affects 30 percent of the adult population, and two-thirds of all cases are asymptomatic. Detecting PVD can be relatively easy and inexpensive, and based either on subjectively supplied historical information (claudication) or upon physical examination findings [ankle-brachial index (ABI)]. The ABI may serve as a marker for increased risk for systemic vascular disease as an abnormally low ABI has been shown to be associated with systemic vascular disease. Epidemiology of and risk factors for PVD are in similar to coronary heart disease. PVD is uncommon until middle age and then increases dramatically. Prevalence of PVD is slightly higher in men than women, yet this tends to diminish with age. Cigarette smoking is probably the most important risk factor for PVD. Hypertension, hypercholesterolemia, and diabetes are also risk factors for the development of symptomatic PVD. Conversely, the presence of a high degree of physical activity and higher levels of HDL-cholesterol as well as a lower body mass index (BMI) are protective. Patients who have vascular disease in one organ system often exhibit evidence of vascular disease elsewhere. Presence of coronary artery disease among patients with symptomatic PVD is between two and four times higher than those without PVD, and PVD is also associated with cerebrovascular disease.

South Florida Program on Aging and Health. Assessing the prevalence of Alzheimer's disease in three ethnic groups.

The South Florida Program on Aging and Health was initiated in 1992 with the aim to assess physical and mental health of the elderly in Dade County and provide a basis for public health policy. This report describes the methodology applied in the study and preliminary screening results in a probability sample of 2,400 African American, Cuban American and white non-Hispanic American elderly men and women. Of 2,013 participants screened by May 1995, 11.5% had cognitive impairment. An increase in prevalence from 4-7% to 25-36% with advancing age was found among men and women of each group, from the youngest (65-74) to the oldest (85+ years). Male and female prevalences were similar but vary by ethnic group and age.

Sex differences in early mortality after acute myocardial infarction (the Minnesota Heart Survey).

Although numerous studies indicate that women have a higher early mortality from acute myocardial infarction (AMI) than men, reasons for the difference are largely unexplained. We studied the role of sex in the prognosis of 1,600 patients with AMI aged 30 to 74 years in the population-based Minnesota Heart Survey. A 50% random sample was taken of all AMI patients hospitalized in 1980 and 1985 in the Twin Cities of Minnesota (Minneapolis-St. Paul) (1,168 men, 432 women). A multiple logistic regression model was used for predicting early death (within 28 days) and included baseline characteristics: sex, age, chest pain on admission, history of previous AMI, angina pectoris, coronary artery bypass surgery or hypertension, presence of heart failure, cardiac arrhythmias requiring direct-current shock, diabetes mellitus, valvular disease, cardiomyopathy, and levels of serum enzymes and blood urea nitrogen. Age-adjusted early mortality rate was significantly higher in women than men, but only in those aged < 65 years (12.5% of women vs 6.5% of men, p < 0.01) versus those aged > or = 65 years (19.5% vs 21.6%, p > 0.05). Multivariate analysis also showed that among those < 65 years, female sex was a strong and independent predictor of early death (odds ratio 2.0, 95% confidence interval 1.2 to 3.5, p < 0.01). Rates of coronary angiography, coronary artery bypass surgery, percutaneous transluminal coronary angioplasty, and thrombolysis performed during hospital stay were higher in men, but after adjustment for age, congestive heart failure, and diabetes mellitus, a statistically significant difference persisted only in the frequency of coronary angiography (26% in men vs 17% in women, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol consumption and ultrasonographically assessed carotid artery wall thickness and distensibility. The Atherosclerosis Risk in Communities (ARIC) Study Investigators.

BACKGROUND: Although much has been written in recent years about the relation between alcohol and atherosclerotic disease, controversy exists as to whether and how alcohol exerts an effect on atherosclerosis in different sites. METHODS AND RESULTS: We tested the hypothesis that alcohol consumption is associated inversely with carotid atherosclerosis in a population sample of 45- to 64-year-old men and women who participated in the Atherosclerosis Risk in Communities (ARIC) Study and were free of cardiovascular disease at a baseline examination in 1987 to 1989. B-mode ultrasonography was used to determine carotid artery intimal-medial wall thickness and distensibility as indices of the degree of atherosclerosis. The level of alcohol consumption in the ARIC sample was generally low. Age-adjusted mean values of alcohol consumed (grams per week) were 72.0 for white and 74.3 for nonwhite men and 24.8 for white and 11.2 for nonwhite women. After adjustments for age, artery depth, education, body mass index, sport index, cigarette-years of smoking, low-density lipoprotein cholesterol, and diabetes mellitus, there was no significant cross-sectional association of reported current alcohol intake with either carotid artery wall thickness (among white and nonwhite men and nonwhite women) or distensibility (in any of the four sex-race groups). Among white women, the adjusted mean value of carotid artery wall thickness tended to be higher in light to moderate drinkers than in never or rare drinkers, but the difference across drinking status categories was of borderline statistical significance (P = .04) and may be of little biological importance. CONCLUSIONS: The ARIC Study found no material cross-sectional association between current alcohol intake and carotid atherosclerosis but provides an opportunity in the future to study atherosclerosis progression and incident events in relation to alcohol consumption in a large population sample of men and women.

Sex differences in coronary heart disease mortality trends: the Minnesota Heart Survey, 1970-1988.

Recent U.S. national statistics indicate a slowing of the rate of decline in coronary heart disease (CHD) deaths among women. To examine recent sex-specific rates of mortality decline in the Minnesota Heart Survey, we computed the average annual percentage change in age-adjusted CHD death rate for the periods 1970-1978 and 1979-1988. We fit a log-linear regression model to the yearly CHD death rates, with separate sex-specific slopes estimated simultaneously for the two calendar periods. The average annual percentage decline in age-adjusted CHD death rate among men was slightly greater in the period 1979-1988 [4.8%; 95% confidence interval (CI) = 5.2-4.3] than in the period 1970-1978 (3.9%; 95% CI = 4.6-3.1). In contrast, among women, the rate of decline was less in the period 1979-1988 (3.6%; 95% CI = 4.8-2.3) than in 1970-1978 (4.8%; 95% CI = 5.6-4.0). We found a slowing of the rate of decline in out-of-hospital CHD deaths in both men and women. We observed a large increase in the rate of decline in the CHD death rate in hospital among men in the period 1979-1988 (8.3%; 95% CI = 9.3-7.2), compared with the period 1970-1978 (2.4%; 95% CI = 3.2-1.7). This increase did not occur among women (4.1%; 95% CI = 5.7-2.5 in 1970-1980 vs 3.8%; 95% CI = 4.9-2.7 in 1970-1978); this difference is a major factor in the steeper recent decline in overall CHD mortality among men compared with women.

Menopause and serum cholesterol: differences between blacks and whites. The Minnesota Heart Survey.

The relation between menopause and serum total and high-density-lipoprotein cholesterol was examined by the Minnesota Heart Survey in a cross-sectional, population-based study of 344 black women and 474 white women aged 35-54 years from the Twin Cities metropolitan area in 1985-1986. Analysis of covariance was used to examine differences in serum total and high-density-lipoprotein cholesterol in black women and white women by menopausal status, adjusting for the effects of age, educational level, cigarette smoking, body mass index, exercise, alcohol consumption, diabetes mellitus, sex hormone, beta blocker, and diuretic use. Among whites, adjusted serum total cholesterol was 13 mg/dl higher in postmenopausal than in premenopausal women (p less than 0.002). Black postmenopausal women had slightly higher serum total cholesterol than did their premenopausal counterparts (5.4 mg/dl). However, this was not statistically significant. An interaction term in a linear regression model confirmed a racial difference in the total cholesterol association with menopause (p less than 0.02). The higher total cholesterol levels observed in white postmenopausal women were mainly among those with natural menopause (20.7 mg/dl higher than premenopausal, p less than 0.0003) and those with a hysterectomy and at least one intact ovary (11.0 mg/dl higher, p = 0.05). Among black women, only the subgroup with a hysterectomy and a bilateral oophorectomy had a significantly higher serum total cholesterol (19.9 mg/dl higher than premenopausal, p less than 0.05). There was no significant association between high-density-lipoprotein cholesterol and any type of menopause in either black women or white women. Our findings may reflect a true physiologic difference in the relation between menopause and serum total cholesterol between American blacks and whites. The lack of a significant association between menopause and high-density-lipoprotein cholesterol in either race raises the possibility that menopause may not affect atherosclerosis risk via reduced high-density-lipoprotein cholesterol.

Trends in survival of hospitalized myocardial infarction patients between 1970 and 1985. The Minnesota Heart Survey.

BACKGROUND: The Minnesota Heart Survey is a population-based study designed to monitor and explain trends in cardiovascular mortality, morbidity, and risk factors. As part of this effort, a 50% sample of patients hospitalized for myocardial infarction (MI) in the seven-county Twin Cities (Minneapolis and St. Paul) metropolitan area was reviewed in 1970, 1980, and 1985. Those with a validated definite MI were followed for 4-year mortality. The purpose was to determine whether the improved survival observed between 1970 and 1980 was extended to the 1980-1985 period. METHODS AND RESULTS: Crude 28-day mortality in men changed from 18% in 1970 to 12% in 1980 to 13% in 1985; in women it changed from 27% in 1970 to 22% in 1980 to 18% in 1985. After adjustment for severity factors (e.g., age, previous MI, and admission heart rate and systolic blood pressure), 28-day mortality was significantly lower in 1980 than in 1970 in men (RR, 0.66; 95% CI, 0.47, 0.92) and in women (RR, 0.69; 95% CI, 0.46, 1.04), but no change occurred from from 1980 to 1985 (p greater than 0.25). After adjustment for severity indicators, 4-year survival was better in 1980 than in 1970 for men (RR, 0.67; 95% CI, 0.54, 0.83) and for women (RR, 0.72; 95% CI, 0.54, 0.98), but there was no significant change from 1980 to 1985 (p greater than 0.25). CONCLUSIONS: These results suggest that improvements in survival among hospitalized MI patients contributed to the overall decline in coronary heart disease mortality in the Twin Cities area between 1970 and 1980 but not between 1980 and 1985.

Predicting death from coronary heart disease using a questionnaire.

The ten-year coronary heart disease (CHD) mortality is reported for 18,322 male civil servants aged 40 to 64 according to questionnaire responses at entry into the Whitehall study. In all 1714 died, 723 from CHD. The predictive power of the questionnaire was examined with a view to its use as a screening tool in population studies. In predicting death from coronary heart disease the greatest specificity (true negative rate) was achieved with men reporting both angina (A) and a history of severe chest pain (possible myocardial infarction, PMI). This strategy (A plus PMI) achieved a specificity of 99% but a sensitivity (true positive rate) of only 7%. In contrast, in men reporting angina and/or PMI, specificity was 90% and sensitivity 29%. If this 'and/or' algorithm was extended to include the report of dyspnoea, diabetes, and/or attending a primary care physician with heart disease or hypertension, then specificity was still 85%, but sensitivity increased to 44%. This combination (11 questions in all) is therefore recommended for screening purposes. Identifying and excluding those who favour positive answers ('yes-set' responders), using questions such as the effect of weather on breathing, led to small increases in specificity but relatively large falls in sensitivity. Among subjects reporting chest pain, those who also complained of non-specific symptoms experienced only half the mortality of those with none of these additional complaints.

Drinking habits and coronary heart disease: the Yugoslavia cardiovascular disease study.

In a prospective study of more than 10,000 Yugoslav men residing in Bosnia and Croatia, who were first examined in 1964--1965, consumption of alcoholic beverages was related inversely to the subsequent appearance of coronary heart disease clinically manifest as myocardial infarction or nonsudden coronary heart disease death. Consumption of alcoholic beverages was not so related to sudden cardiac death. Men who drank most frequently had half the subsequent incidence of overall coronary heart disease as men who seldom or never drank. This finding was true for urban residents only. Serum cholesterol and Quetelet index were also related to coronary heart disease in urban areas but not in rural areas. The inverse relation of alcohol consumption to coronary heart disease incidence was statistically significant even after taking into account differences in blood pressure, serum cholesterol levels, cigarette smoking and other variables. The apparent absence of protection against sudden death may be due to chance or it may reflect the deleterious effects of high alcohol consumption on the myocardial cells and increased vulnerability to lethal arrhythmias in an especially lean population. There is, in fact, a specific association of recent drunkenness with sudden death in this population. Conceivably, the acute effect of heavy drinking may be a dominant factor in the incidence of sudden death for this population.