Depressive symptoms and cardiovascular burden-related mortality among the aged.

BACKGROUND: Depressive symptoms have been linked to increased cardiovascular mortality among the elderly. This study was aimed to test the independent and additive predictive value of depressive symptoms and B-type natriuretic peptide (BNP), a marker of direct cardiovascular stress and a strong predictor of mortality, together with traditional cardiovascular risk markers on total and cardiovascular mortalities in a general elderly population. METHODS: A total of 508 subjects aged 75 or older participated in the study. The prognostic capacity of depressive symptoms and BNP in regard to total and cardiovascular mortalities was assessed with Cox regression analyses. Depressive symptoms were handled as a dichotomous variable based on the Zung self-rated depression scale score with a cut-off point of 40. RESULTS: The median follow-up time was 84 months with an interquartile range of 36-99 months. Depressive symptoms reflected susceptibility to all-cause (HR 1·60; 95% CI 1·26-2·04) and cardiovascular mortalities (HR 1·81; 95% CI 1·30-2·52) only in univariable analyses. When cardiovascular illnesses and risk markers were taken into account, depressive symptoms lost their significance as an independent predictor of mortality. BNP as a continuous variable was a significant predictor of both all-cause (HR 1·44; 95% CI 1·22-1·69) and cardiovascular mortalities (HR 1·79; 95% CI 1·44-2·22) in fully adjusted models including depressive symptoms as a covariate. CONCLUSIONS: The prognostic capacity of depressive symptoms is closely linked to cardiovascular morbidity and has no independent power in an elderly general population. BNP remains a strong harbinger of death regardless of depressive symptoms status.

B-type natriuretic peptide and severity of cognitive disorder.

BACKGROUND: Natriuretic peptides have been linked to cognitive disorder in previous studies. The aim of this study was to examine the association between the severity of cognitive disorder and the levels of B-type natriuretic peptide (BNP) in an older general population. MATERIAL AND METHODS: This study is a part of the larger population-based, multidisciplinary Kuopio 75+ health study. A total of 601 subjects aged 75 or older participated in the study. A subgroup of 126 individuals was diagnosed with cognitive disorder, and the severity of the disease was assessed. The participants were tested for BNP. Analysis of covariance was carried out to study the relationship between BNP and the stage of cognitive disorder. RESULTS: The association between the level of cognitive disorder and BNP resembled an inverse U-shaped curve, with higher levels of BNP observed among participants with mild cognitive disorder when compared to cognitively intact participants or counterparts with more severe cognitive disorder. This effect remained after adjustment for age (P = 0.02). However, association between BNP and level of cognitive disorder was lost in further adjustment with covariates connected to the levels of BNP. CONCLUSION: The previously reported elevation of natriuretic peptides among individuals with diagnosed cognitive disorder was found only in people with milder stages of the disorder.

The prognostic capacity of B-type natriuretic peptide on cognitive disorder varies by age.

INTRODUCTION: It is known that blood levels of natriuretic peptides associate with cognitive disorder among the middle-aged. We aimed to test whether this association is valid in an older population aged 75 years or older. METHODS: A total of 601 older subjects aged 75 or older participated in the study. A subgroup of 137 with a diagnosed cognitive disorder were tested for natriuretic peptides (ANP, NT-proANP, and BNP), and compared with age-matched controls (n = 464). The control group was followed-up for 5 years, and the association of the baseline BNP with the occurrence of cognitive impairment was studied. RESULTS: In the youngest age tertile (75-78 y), BNP was significantly associated with a diagnosed cognitive disorder when other factors with a known effect on natriuretic peptides were taken into account. In the oldest tertile (83-96 y), higher BNP values suggested the absence of cognitive dysfunction. ANP and NT-proANP did not associate with the presence of cognitive impairment. Among the control group, BNP predicted a cognitive disorder at follow-up, but only in the youngest tertile. CONCLUSIONS: The previously found link between a high BNP concentration and cognitive disorder in older people is only valid among those aged less than 79 years.

Mini-Mental State Examination score and B-type natriuretic peptide as predictors of cardiovascular and total mortality in an elderly general population.

INTRODUCTION. The aim of the present study was to examine the power of B-type natriuretic peptide (BNP) and mild cognitive impairment as independent predictors of total and cardiovascular mortality in combination with established cardiovascular risk markers in an elderly general population without severe cognitive impairment. METHODS. A total of 499 individuals, aged more than 75 years, were examined and followed up for a median of 7.9 years in a prospective population-based stratified cohort study carried out in eastern Finland. The Cox proportional hazards regression model was used to determine the impact of multiple factors on total and cardiovascular mortality. RESULTS. In a multivariable model including established cardiovascular risk factors and conditions, both continuous BNP (adjusted hazard ratio (HR) 1.44 for a 1-SD change; 95% confidence interval (CI) 1.22-1.77; P < 0.001) and continuous MMSE score (HR 0.81 for a 1-SD change; 95% CI 0.70-0.94; P = 0.007) were independently associated with all-cause mortality. In a multivariable model, BNP remained a significant predictor of cardiovascular mortality, while MMSE score lost its significance. CONCLUSIONS. BNP, a measure of cardiovascular burden, and MMSE score 18-23, an indicator of mild cognitive impairment, are both independent predictors of total mortality. BNP and MMSE score may potentially be useful in screening elderly patients for elevated risk of mortality.

Effects of Protostrongylus sp. and Pneumocystis sp. on the pulmonary tissue and the condition of mountain and brown hares from Finland.

Mountain hares (Lepus timidus) and brown hares (Lepus europaeus) shot by hunters in several game management districts in southern and central Finland during the hunting season from September to the end of February 1998-2001 were examined for Protostrongylus sp. and Pneumocystis sp. Of the mountain hares, 96.5% (194/201) were infected with the lungworm Protostrongylus sp. and 16.9% (32/189) had cyst forms of the fungus Pneumocystis sp. in the lungs. The prevalence of the lungworm and fungus in brown hares was 60% (18/30) and 20.0% (6/30), respectively. The tissue changes associated with the lungworms were macroscopically and microscopically well demarcated. The majority and most severe histopathologic changes were seen at the distal part of the caudal lobes. Inflammatory cells, mainly eosinophils and macrophages, and in lesser degree neutrophils, lymphocytes, and plasma cells were typical findings in the worm-infected tissue. The condition and weight of the hare did not show any significant association with the intensity of the lungworm infection. All Pneumocystis-infected mountain hares were young, and their condition and weight correlated negatively with the intensity of the infection. The intensity of the Pneumocystis infection did not correlate with that of the lungworm infection. Within a tissue section, a slight but significant positive correlation was observed between presence of cysts and inflammatory cells.

Occurrence and destruction of PAHs, PCBs, CIPhs, CIBzs, and PCDD/Fs in ash from gasification of straw.

Two experiments were performed with an atmospheric circulating fluidized bed gasifier (ACFBG), the first with pelletized straw and the second with loose straw, to investigate the occurrence of polycyclic aromatic hydrocarbons (PAHs), chlorophenols (CIPhs), polychlorinated biphenyls (PCBs), polychlorinated benzenes (ClBzs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) in the bottom ash and fly ash formed during gasification. Only PAHs were present in large amounts, and only in the fly ash, ranging from 300 to 555 mg/kg ash in the tests with pelletized straw and from 73 to 118 mg/kg ash in those with loose straw. These amounts are so high that environmentally safe disposal or reuse of the ash would be difficult, so the development of a technique to handle the problem was included in the project. The method investigated was to burn the fly ash in a circulating fluidized bed (CFB) boiler in order to destroy the PAHs. This worked surprisingly well, eliminating 99% of the PAHs, without any further formation of the other harmful organic compounds analyzed. Thus, this method could actually be useful in practice. Especially the fact that the formation of PCDD/Fs was minimal during gasification and further treatment of the ash in the CFB boiler makes the gasification technique highly competitive relative to conventional combustion methods.