Proteína C reactiva e hipertensión

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1.	Ther Clin Risk Manag. 2011;7:93-8. Epub 2011 Mar 8. A causative link between periodontal disease and glomerulonephritis: a preliminary study. Ardalan MR, Ghabili K, Pourabbas R, Shoja MM. Department of Nephrology, Dialysis, and Transplantation. Abstract BACKGROUND: Periodontal disease has been associated with a number of systemic diseases. A high prevalence of periodontitis among individuals with chronic kidney diseases and end-stage renal disease has been reported. However, no association between periodontal diseases and glomerulonephritis has previously been investigated. OBJECTIVE: The aim of this study was to assess the severity and possible role of periodontitis in a group of patients with unknown primary glomerulonephritis. METHODS: Ten patients with unknown primary glomerulonephritis, and who had a renal biopsy with stable renal function and serum creatinine <1.6 mg/dL, were recruited. Severity of the periodontal disease was clinically measured with plaque index (PI), gingival index (GI), and periodontal pocket depth (PD). The subjects received appropriate dental treatments where indicated. The patients were also put on angiotensin-converting enzyme inhibitor or angiotensin receptor blockers for controlling blood pressure and proteinuria. Six months following appropriate periodontal treatment, renal function, degree of proteinuria, and level of C-reactive protein (CRP) were measured in each individual. RESULTS: The median age of the patients was 30 (15.8) years. The median urine protein excretion was lower following the periodontal therapy (P=008). Prior to the dental and/or periodontal therapies, the median PI, PD, and GI were 57.5%, 4.3, and 1.1, respectively. The majority of the patients had advanced periodontal disease. In four patients, +2/+3 CRP turned negative after periodontal treatment. CONCLUSIONS: The present study revealed that a causative link might exist between periodontal disease and glomerulonephritis. PMCID: PMC3061848 Free PMC Article
	PMID: 21445283 [PubMed - in process]
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2.	An Pediatr (Barc). 2011 Mar 14. [Epub ahead of print] [Classic and emergent cardiovascular risk factors in schoolchildren in Asturias.] [Article in Spanish] Alvarez Caro F, Díaz Martín JJ, Riaño Galán I, Pérez Solís D, Venta Obaya R, Málaga Guerrero S. Hospital Carmen y Severo Ochoa, Cangas del Narcea, Asturias, España. Abstract INTRODUCTION: Classic cardiovascular risk factors are present in infancy. C-reactive protein, leptin and adiponectin are the most important inflammatory cardiovascular risk markers. PATIENTS AND METHODS: A descriptive, cross-sectional study, including children aged 6-12years old from two local primary schools in the city of Avilés. Body measurements were made to determine the prevalence of obesity and overweight. Systolic and diastolic blood pressure was measured and the presence of metabolic syndrome was determined. Family income, dietary, and life-style habits were collected using the questionnaires GRAFFAR, KIDMED and Self-report instruments for measuring physical activity, respectively. Blood analysis included lipid profile, insulin resistance profile, liver profile, C-reactive protein, leptin and adiponectin. RESULTS: A total of 459 schoolchildren were included of whom 31% were overweight and 10.9% were obese. Obese children were heavier with higher levels of body mass index, waist circumference, blood pressure, C- reactive protein, leptin, and lower levels of HDL-cholesterol and apolipoprotein A than non-obese children. No differences were found in physical and sedentary activities, but obese children had a worse quality diet than non-obese children. CONCLUSIONS: Prevalence of obesity and overweight is reaching worrying levels in school age children. Obesity is associated with other classic and inflammatory cardiovascular risk factors. Obese children have a worse quality diet, although they do not do any less physical activities or any more sedentary than non-obese children. Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved. Free Article
	PMID: 21411387 [PubMed - as supplied by publisher]
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3.	Circ J. 2011 Mar 1. [Epub ahead of print] Pre- and Post-Operative Risk Factors Associated With Cerebrovascular Accidents in Patients Supported by Left Ventricular Assist Device. Nakajima I, Kato TS, Komamura K, Takahashi A, Oda N, Sasaoka T, Asakura M, Hashimura K, Kitakaze M. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center. Abstract Background: Cerebrovascular accident (CVA) is a major adverse event following left ventricular assist device (LVAD) surgery. This study investigates pre- and post-operative factors associated with CVA in this population. Methods and Results: A total of 118 consecutive patients who underwent LVAD surgery at our institution between April 1994 and April 2009 were retrospectively reviewed. Clinical characteristics, hemodynamic data, and laboratory indexes associated with CVA after LVAD surgery were analyzed. In total, 57 (48.3%) patients developed CVA 133.5±184.7 days after surgery. The combination of baseline heart disease, type of LVAD surgery, mean right atrial pressure (mRA), serum total bilirubin and total protein concentration, and right ventricular end-diastolic dimension (RVEDd) was associated with CVA at any time after LVAD surgery, with a discriminant probability of 718%. With regard to CVA development later than 3 months after surgery, the combination of mRA and RVEDd before surgery [odds ratio (OR), 1.24, 1.20; 95% confidential interval (CI), 1.07-1.42, 1.06-1.34; P=0.004, P=0.006, respectively], positive blood culture, and C-reactive protein after surgery (OR, 7.66, 2.19; 95%CI, 1.50-39.0, 1.47-3.25; P=0.015, P<0.0001, respectively) was associated with CVA with a discriminant probability of 85.9%. Conclusions: Patients' general condition including malnutrition, in addition to device selection, contributed to overall CVA development after surgery. In the chronic phase after surgery, pre-LVAD right heart failure and post-LVAD systemic infection were highly associated with CVA development. Free Article
	PMID: 21372403 [PubMed - as supplied by publisher]
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4.	Nutr Hosp. 2010 Oct;25(5):845-51. New factors of cardiometabolic risk in severely obese children: influence of pubertal status. Codoñer-Franch P, Murria-Estal R, Tortajada-Girbés M, del Castillo-Villaescusa C, Valls-Bellés V, Alonso-Iglesias E. Department of Pediatrics, Dr Peset University Hospital, and Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain. pilar.codoner@uv.es Abstract The aim of this prospective study was to evaluate the utility of new biochemical markers to assess cardiometabolic risk in severely obese children and adolescents. A total of 107 subjects aged 7 to 14 years, were clinically assessed and anthropometric measures and percentage of fat mass by single frequency bioimpedance analysis were recorded. Of these, 44 were non-overweight and 63 severely obese (body mass index Z-score>2.5) which were stratified by Tanner stages. To estimate the metabolic risk the following variables were considered for analysis: Waist circumference/height>0.5, fasting glucose>100 mg/dL, triglycerides>110 mg/dL, HDL-C<40 mg/dL, and systolic or diastolic blood pressure>95th percentile for age and gender. Fasting insulinemia, apoprotein A1 and B, high-sensitive C-reactive protein, alanine aminotransferase, homocysteine, and folic and uric acids were determined. In severely obese children, metabolic risk was present more frequently in mid puberty. The normalized anthropometric parameters with respect to 50th percentile for age and gender did not differ in the presence of metabolic risk. Insulin resistance was an independent determinant of metabolic risk, adjusted by Tanner stages. Elevated high-sensitive C-reactive protein was noted without any effect of metabolic risk or pubertal stage. Homocysteine, apoprotein B, and alanine aminotransferase values increased with metabolic risk and were not influenced by puberty. Although insulin resistance remains the main factor influencing metabolic risk, biochemical markers as homocysteine, apoprotein B, and alanine aminotransferase, may be useful for identifying severe obese pubertal subjects particularly prone to comorbidities. Free Article
	PMID: 21336445 [PubMed - in process]
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5.	Int J Hypertens. 2011 Jan 24;2011:931402. Waist Circumference, Body Mass Index, and Other Measures of Adiposity in Predicting Cardiovascular Disease Risk Factors among Peruvian Adults. Knowles KM, Paiva LL, Sanchez SE, Revilla L, Lopez T, Yasuda MB, Yanez ND, Gelaye B, Williams MA. Department of Epidemiology, Multidisciplinary International Research Training Program, School of Public Health, University of Washington, Health Sciences Building F-161E, Seattle, WA 98195, USA. Abstract Objectives. To examine the extent to which measures of adiposity can be used to predict selected components of metabolic syndrome (MetS) and elevated C-reactive protein (CRP). Methods. A total of 1,518 Peruvian adults were included in this study. Waist circumference (WC), body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR), and visceral adiposity index (VAI) were examined. The prevalence of each MetS component was determined according to tertiles of each anthropometric measure. ROC curves were used to evaluate the extent to which measures of adiposity can predict cardiovascular risk. Results. All measures of adiposity had the strongest correlation with triglyceride concentrations (TG). For both genders, as adiposity increased, the prevalence of Mets components increased. Compared to individuals with low-BMI and low-WC, men and women with high-BMI and high- WC had higher odds of elevated fasting glucose, blood pressure, TG, and reduced HDL, while only men in this category had higher odds of elevated CRP. Overall, the ROCs showed VAI, WC, and WHtR to be the best predictors for individual MetS components. Conclusions. The results of our study showed that measures of adiposity are correlated with cardiovascular risk although no single adiposity measure was identified as the best predictor for MetS. PMCID: PMC3034939 Free PMC Article
	PMID: 21331161 [PubMed - in process]
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6.	Endocr Pract. 2011 Feb 16:1-19. [Epub ahead of print] Effects of successful parathyroidectomy on metabolic cardiovascular risk factors in patients with severe primary hyperparathyroidism. Ishay A, Herer P, Luboshitzky R. Endocrine Institute, Haemek Medical Center, 18101 Afula B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Abstract Objective Primary hyperparathyroidism (PHPT) may be associated with increased cardiovascular morbidity. The benefit of surgical treatment in this respect is unclear. This study was performed to evaluate the impact of parathyroidectomy on metabolic abnormalities associated with cardiovascular disease.Methods Thirty-four patients with PHPT (aged 51±11.8 years, mean ±SD), were investigated before and one year after successful parathyroidectomy. A control group of 42 normocalcemic healthy subjects, matched for age and body mass index (BMI) was also examined at baseline. We measured serum lipids, glucose, insulin, uric acid, calcium, PTH, C-reactive protein (CRP) and bone density. Insulin resistance index was evaluated by Homeostatic Model Assessment (HOMA) and the presence of metabolic syndrome was determined.Results After surgery, there was a decrease in diastolic blood pressure (p<0.02), serum concentrations of uric acid (p<0.04) and insulin (p<0.009). No difference was observed in rates of metabolic syndrome in patients before and one year after surgery (23.5% vs. 17.6%, p>0.46). Insulin resistance index values were also unchanged after parathyroidectomy (1.1±0.9 vs. 1.3±0.9 before surgery, p>0.68). Significant increase in spine densitometry was observed after surgery (5%, p<0.05). Multivariate logistic regression analysis, after adjustment for age and BMI, revealed that surgery did not lead to significant decrease in likelihood of cardiovascular risk (OR: 1.82, 95% CI 0.53-6.21, p>0.34, for metabolic syndrome; OR: 0.82, 95% CI 0.17-3.88, p>0.8, for insulin resistance index).Conclusions In this study, surgical treatment had no beneficial effect on cardiovascular risk as assessed by the metabolic syndrome and insulin resistance markers in patients with primary hyperparathyroidism one year after surgery. Free Article
	PMID: 21324826 [PubMed - as supplied by publisher]
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7.	J Obes. 2011;2011:186368. Epub 2011 Jan 13. Rs9939609 variant of the fat mass and obesity-associated gene and trunk obesity in adolescents. Mangge H, Renner W, Almer G, Weghuber D, Möller R, Horejsi R. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria. Abstract A common T/A polymorphism (rs9939609) in the fat mass and obesity associated (FTO) gene was found associated with early-onset and severe obesity in both adults and children. However, recent observations failed to find associations of FTO with obesity. To investigate the genetic background of early obesity, we analysed the single nucleotide polymorphism (SNP) rs9939609 of FTO in 371 styrian adolescents towards degree of obesity, subcutaneous adipose tissue (SAT)-distribution determined by lipometry, early metabolic and preatherosclerotic symptoms. The percentage of AA homozygotes for the rs9939609 SNP of FTO was significantly increased in the obese adolescents. Compared to the TT wildtype, AA homozygotes showed significantly elevated values of SAT thickness at the trunk-located lipometer measure points neck and frontal chest, body weight, body mass index, waist, and hip circumference. No associations were found with carotis communis intima media thickness, systolic, diastolic blood pressure, ultrasensitive C-reactive protein (US-CRP), homocystein, total cholesterol, triglycerides, HDL cholesterol, oxidized LDL, fasted glucose, insulin, HOMA-index, liver transaminases, uric acid, and adipokines like resistin, leptin, and adiponectin. Taken together, to the best of our knowledge we are the first to report that the rs9939609 FTO SNP is associated with trunk weighted obesity as early as in adolescence. PMCID: PMC3026980 Free PMC Article
	PMID: 21318054 [PubMed - in process]
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8.	Cardiovasc J Afr. 2011 Jan-Feb;22(1):18-24. Smoking and vascular dysfunction in Africans and Caucasians from South Africa. Zatu MC, Van Rooyen JM, Schutte AE. Hypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa. Abstract BACKGROUND: Smoking is an important modifiable risk factor for cardiovascular disease, with limited research having been done in Africans. We aimed to determine the association between smoking and measurements of vascular function in Africans and Caucasians. METHODS: We determined anthropometric and cardiovascular variables, serum cotinine and C-reactive protein (CRP) in African and Caucasian participants from South Africa (n = 630). RESULTS: Africans had significantly lower body mass index (BMI), higher blood pressure and lower socio-economic status (SES) than Caucasians. Only African smokers showed increased arterial stiffness and a significant correlation between smoking and arterial stiffness. African smokers had increased and Caucasian smokers decreased high-density lipoprotein cholesterol (HDL-C) than the non-smokers. After adjusting for confounders, smoking showed few correlations, mainly with heart rate and CRP. In Africans, smoking also correlated positively with HDL-C, with the opposite result in Caucasians. CONCLUSION: African smokers had significantly increased arterial stiffness, which was not found in Caucasian smokers. Africans generally demonstrated more associations between smoking and cardiovascular dysfunction than Caucasians. Free Article
	PMID: 21298201 [PubMed - indexed for MEDLINE]
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9.	Intern Med. 2011;50(3):197-204. Epub 2011 Feb 1. Factors associated with functional outcomes of patients with cerebral embolism due to nonvalvular atrial fibrillation. Nakajima T, Nishimura H, Tachibana H. Department of Neurology, Nishinomiya Kyoritsu Neurosurgical Hospital, Japan. Abstract OBJECTIVE: This study aimed to identify factors associated with the functional outcomes of patients with cerebral embolism due to nonvalvular atrial fibrillation. METHODS: We retrospectively investigated the short-term functional outcomes of 134 patients diagnosed with cardiogenic cerebral embolism due to nonvalvular atrial fibrillation during the period of May 2006 to August 2008. Functional state was evaluated using the modified Rankin Scale (mRS) on admission and at discharge. RESULTS: A good functional outcome (mRS ≤2) at discharge was significantly associated with low mRS on admission (OR: 0.07; CI: 0.03-0.18; p<0.001), and a low C-reactive protein (CRP) level (OR: 0.19; CI: 0.04-0.89; p<0.05). Functional improvement during admission was positively associated with the presence of dyslipidemia (OR: 2.74; CI: 1.11-6.76; p<0.05), whereas high diastolic blood pressure (OR: 0.95; CI: 0.90-0.99; p<0.05) and a high blood sugar level (OR: 0.98; CI: 0.97-0.99; p<0.05) on admission were inversely associated with functional improvement. Furthermore, no relationship existed between mRS on admission and functional improvement during hospitalization. CONCLUSION: The results suggest that a good functional state at discharge was associated with a good functional state on admission as well as a low serum CRP level. On the other hand, functional improvement was associated with the presence of dyslipidemia, low diastolic blood pressure, and low blood sugar level on admission. Free Article
	PMID: 21297320 [PubMed - in process]
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10.	Anadolu Kardiyol Derg. 2011 Mar;11(2):114-118. doi: 10.5152/akd.2011.029. Epub 2011 Feb 2. [Relation of asymmetric dimethylarginine levels with conventional risk score systems in the healthy subjects with positive family history for coronary artery disease.] [Article in Turkish] Satılmışoğlu H, Ozhan H, Albayrak S, Kaya A, Erden I, Yazıcı M. Düzce Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Düzce, Türkiye. ozhanhakan@yahoo.com. Abstract OBJECTIVE: Coronary artery disease is the most common cause of death in Turkey and the world. Asymmetric dimethylarginine is the major inhibitor of nitric oxide synthesis in humans. It has been shown that increased levels of asymmetric dimethylarginine is associated with endothelial dysfunction and increased atherogenesis. In this study, we aimed to investigate whether asymmetric dimethylarginine level is related with conventional risk score systems in subjects who had family history of coronary artery disease. METHODS: Fifty two subjects within 20-40 years old of whom first degree relatives had myocardial infarction at young ages and 26 age and sex matched control subjects were included in this cross-sectional observational study. Frequency of diabetes, hyperlipidemia, smoking and serum levels of homocysteine, high-sensitive C-reactive protein (hsCRP) and asymmetric dimethylarginine were compared between risk group and control subjects. Relation of asymmetric dimethylarginine level with Framingham and TEKHARF risk scores was also compared. Chi-square and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively. RESULTS: Fasting serum glucose, triglyceride, high-density lipoprotein, diastolic blood pressure, waist circumference and TEKHARF scores were increased in the subjects who had family history of myocardial infarction. Total cholesterol, low-density lipoprotein, hsCRP, homocysteine, creatinine and Framingham risk score were similar in studied groups . Asymmetric dimethylarginine levels were 0.1µmol/L higher in the risk group; however this difference could not reach significance (0.7±0.1 µmol/l vs 0.8±0.1 µmol/l; p=0.061). CONCLUSION: Measurement of serum asymmetric dimethylarginine levels did not reveal utility in defining conventional coronary artery disease risk score systems in cases that had positive family history. Larger studies including patients with different risk tertiles are needed. Free Article
	PMID: 21285018 [PubMed - as supplied by publisher]
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11.	Rev Med Chil. 2010 Oct;138(10):1226-31. Epub 2011 Jan 10. [Association between a cardiovascular risk score and early markers of atherosclerotic disease in Chilean children]. [Article in Spanish] Arnaiz P, Pino F, Marín A, Barja S, Aglony M, Cassis B, Navarrete C, Acevedo M. División de Pediatría, Pontificia Universidad Católica de Chile, Chile. Abstract BACKGROUND: A cardiovascular risk score for children, that includes traditional risk factors, obesity, sedentary habits and a family history of cardiovascular disease, has been recently proposed by Spanish researchers. Aim: To apply this score in school age children in Santiago de Chile and correlate its results with markers of subclinical atherosclerotic disease. MATERIAL AND METHODS: Retrospective analysis of data obtained from 209 children, aged 11.5 ± 2 years, studied between 2005 and 2006. Weight, height, blood pressure, ultrasound measurement of carotid intimamedia thickness and fow mediated dilatation of brachial artery and ultrasensible C reactive protein (us PCR) were measured. The Spanish cardiovascular risk score was calculated and correlated with ultrasound parameters and C reactive protein. RESULTS: According to the score, 173 children (83%) had a low cardiovascular risk, 28 (13%) an intermediate risk and 8 (4%) a high risk. There was no association between the cardiovascular risk score and carotid intima-media thickness, fow mediated arterial dilatation and us PCR. CONCLUSIONS: No significant association was observed between the proposed cardiovascular risk score and early markers of atherosclerotic disease in this group of children. Free Article
	PMID: 21279267 [PubMed - in process]
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12.	Rev Med Chil. 2010 Nov;138(11):1378-85. Epub 2011 Jan 27. [Waist height ratio, ultrasensitive c reactive protein and metabolic syndrome in children]. [Article in Spanish] Arnaiz P, Marín A, Pino F, Barja S, Aglony M, Navarrete C, Acevedo M. División de Pediatría, Pontificia Universidad católica de Chile, Chile. Abstract BACKGROUND: Waist to height ratio and ultrasensitive C-reactive protein are predictors of the presence of the metabolic syndrome in children. AIM: To determine the proportional risk of metabolic syndrome component clustering in children, using waist to height ratio and ultrasensitive C-reactive protein. MATERIAL AND METHODS: Anthropometric measures, blood pressure, fasting serum lipid profile, blood glucose and ultrasensitive C-reactive protein were determined in 209 children aged 11.5 ± 2 years (50% females). The presence of the metabolic syndrome as a function of waist to height ratio and C-reactive protein was modeled using logistic regression equations. The risk of clustering one, two or more components of the metabolic syndrome was calculated. RESULTS: Metabolic syndrome was present in 5% of all children and 18% of those that were obese. The cut off points for waist to hip ratio and ultrasensitive C-reactive protein were 0.55 and 0.61 mg/L, respectively. For each 0.01 increment in waist to height ratio, the odds ratio of increasing one component of the metabolic syndrome was 1.2 (1.15-1.25) or 15 to 25%. The odds ratio for log-transformed ultrasensitive C-reactive protein was 1.62 (1.26-2.09). Excluding waist circumference, the odds ratio of adding one or more components of the metabolic syndrome was 1.05 (1.01-1.09) per 0.01 increment in waist to height ratio, but the odds ratio for C-reactive protein was no longer significant. CONCLUSIONS: Waist to height ratio and ultrasensitive C-reactive protein predict the risk of clustering components of the metabolic syndrome in these children. Free Article
	PMID: 21279250 [PubMed - in process]
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13.	Kardiol Pol. 2011;69(1):33-9. The significance of anaemia in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Bolińska S, Sobkowicz B, Zaniewska J, Chlebińska I, Boliński J, Milewski R, Tycińska A, Musiał W. Department of Cardiology, Medical University, Bialystok, Poland. Comment in: Kardiol Pol. 2011;69(1):40-1. Abstract BACKGROUND: The effects of pre-existing anaemia on the occurrence and course of an acute coronary syndrome has recently become a topic of extensive research. The data on the significance of anaemia in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) are less abundant and the conclusions equivocal. AIM: To evaluate the incidence of anaemia and its impact on early outcomes in patients undergoing primary PCI for STEMI. METHODS: Based on a retrospective review of the medical records of hospitalised patients we selected a study group comprising 551 consecutive patients with STEMI, including 164 females, mean age 63.4 ± 12 years, undergoing primary PCI within the first 12 hours after the onset of chest pain. Anaemia was diagnosed according to the World Health Organisation criteria based on haemoglobin (Hb) values on admission (〈 12 g/dL for females, 〈 13 g/dL for males). RESULTS: Anaemia was diagnosed in 61 (11%) patients (in 13% of females and 10% of males). The anaemic patients were older (71 vs 63 years, p 〈 0.001), had a lower body mass (70 vs 80 kg, p 〈 0.003) and a higher TIMI risk score for STEMI (5 vs 3, p 〈 0.0001). Their laboratory results showed a greater renal impairment (GFR 66.8 vs 75.8 mL/min, p 〈 0.008) and higher C-reactive protein levels (24.8 vs 14.4 mg/L, p 〈 0.001). There were no significant differences in post-infarction myocardial damage as estimated on the basis of ejection fraction and the baseline and peak CK-MB levels. During treatment, in both groups, there was a significant decrease in Hb levels from 11.9 to 11.0 g/dL in the anaemic patients (p 〈 0.0004) and from 14.3 to 13.3 g/dL in the non-anaemic patients (p 〈 0.001). While GFR did not change significantly in the anaemic patients, there was a significant increase in the non-anaemic patients from 75.8 to 80.9 mL/min (p 〈 0.001). The in-hospital mortality was low with a total of 8 (1.3%) patients dying: 5 (8.2%) in the anaemic group and 3 (0.6%) in the non-anaemic group (p 〈 0.001). The anaemic patients were also characterised by a higher incidence of cardiovascular complications (33% vs 17%, p = 0.003). In the multivariate analysis, older age, systolic blood pressure on admission and elevated white blood count were independently associated with a higher risk of death and cardiovascular complications, whereas baseline Hb level was a significant prognostic factor only in the univariate analysis. CONCLUSIONS: Patients with anaemia who develop STEMI are, right from the admission, a separate, higher-risk population of patients with considerably increased risk of death and in-hospital cardiovascular complications. The unfavourable impact of anaemia on outcomes in patients with acute MI undergoing PCI is complex and cannot be explained by the increased extend of post-infarction myocardial damage. In patients with STEMI, anaemia on admission should be treated as an additional risk factor. Free Article
	PMID: 21267962 [PubMed - in process]
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14.	Korean Circ J. 2010 Dec;40(12):632-8. Epub 2010 Dec 31. Effect of Lacidipine on Blood Pressure and Endothelial Function in Mild-to-Moderate Essential Hypertension Patients With Diabetes in Korea. Kim DH, Oh IY, Lee HY, Kim YJ, Kim HS, Kim CH, Oh BH, Kim KS, Kim DI, Kim YD, Ryu KH, Park SH, Baek SH, Shin DG, Shim WJ, Ahn TH, Oh SK, Lee SH, Lee SY, Jeong MH, Chung WS, Jeong JY, Choi SY, Choi SW, Hyon MS. Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea. Abstract BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the efficacy of lacidipine in reducing blood pressure (BP) and to determine its effect on endothelial function in mild-to-moderate hypertensive patients with type 2 diabetes mellitus (DM). SUBJECTS AND METHODS: This was a prospective, multicenter, open-label, single-arm study, enrolling 290 patients with mild-to-moderate hypertension and type 2 DM. Patients were initially treated with 2 mg lacidipine orally once daily for 4 weeks, which was then increased as necessary every 4 weeks to a maximal dose of 6 mg daily. The primary endpoint was the mean change in systolic blood pressure (SBP) from baseline after 12 weeks of treatment. Secondary endpoints included mean changes in diastolic blood pressure (DBP), flow-mediated vasodilatation (FMD), and serum concentrations of biochemical markers such as high-sensitivity C-reactive protein (hs-CRP), monocyte chemo-attractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), and plasminogen activator inhibitor-1 (PAI-1). RESULTS: Lacidipine treatment significantly reduced SBP by -13.4±13.0 mmHg (p<0.001) and DBP by -6.2±9.3 mmHg (p<0.001). Lacidipine treatment did not improve endothelial-dependent vasodilatation, despite significantly improved nitroglycerin-induced, endothelial-independent vasodilatation. MCP-1 levels significantly decreased from 283.66±110.08 pg/mL to 257.83±100.23 pg/mL (p<0.001); whereas there were no significant changes in the levels of hs-CRP, MMP-9, or PAI-1. CONCLUSION: Twelve weeks of treatment with lacidipine was effective and well tolerated in mild-to-moderate hypertensive patients with type 2 DM. In spite of inducing a significant reduction in MCP-1 levels, lacidipine did not improve endothelial function. PMCID: PMC3025336 Free PMC Article
	PMID: 21267385 [PubMed - in process]
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15.	J Cardiovasc Ultrasound. 2010 Dec;18(4):134-8. Epub 2010 Dec 31. Urine Albumin Creatinine Ratio is Associated with Carotid Atherosclerosis in a Community Based Cohort: Atherosclerosis Risk of Rural Area in Korean General Population Study. Sung JK, Kim JY, Youn YJ, Lee JW, Ahn SG, Yoo BS, Lee SH, Yoon J, Choe KH, Yoon JH, Park JK, Koh SB. Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. Abstract BACKGROUND: Albuminuria is a surrogate marker of endothelial dysfunction and a predictor of cardiovascular events. Data are limited with regard to the relationship between albuminuria and subclinical atherosclerosis in a community-based cohort. We determined the association between albuminuria measured by the urine albumin creatinine ratio (UACR) and carotid intima media thickness (CIMT) in a Korean rural population. METHODS: We enrolled 1,369 healthy subjects older than 40 years (857 males and 518 females) with normal renal function and measured the CIMT. We excluded subjects with overt proteinuria (> 300 mg/day) or with treatment of diabetes mellitus, hypertension, dyslipidemia, and any cardiovascular disease. The subjects were stratified into the quartile value of the UACR (lowest quartile: UACR < 4.8 and highest quartile: UACR > 17.7). And we evaluate the relationship between UACR and CIMT by linear regression and logistic regression analysis. RESULTS: Increasing quartile of the UACR had a stepwise increase in body mass index, blood pressure, cholesterol profile [low density lipoprotein (LDL)-cholesterol and triglyceride], glucose, homeostratic model assessment of insulin resistance (HOMA-IR), and C-reactive protein (all p values < 0.001). Maximal CIMT from the 1(st) to the 4(th) quartile values of the UACR were 0.74 ± 0.17, 0.77 ± 0.18, 0.78 ± 0.18, and 0.82 ± 0.21 mm, respectively (p < 0.001). In a multivariate regression model adjusted for age, sex, systolic blood pressure, triglyceride, LDL-cholesterol, fasting blood sugar, waist circumference, adiponectin, HOMA-IR, high sensitive C-reactive protein, smoking, UACR showed a significant association with maximal CIMT (B = 0.014, R(2) = 0.145, p = 0.002). CONCLUSION: Albuminuria measured by the UACR was significantly associated with both CIMT and traditional risk factors of atherosclerosis except for smoking in healthy Koreans. PMCID: PMC3021891 Free PMC Article
	PMID: 21253362 [PubMed - in process]
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16.	BMC Infect Dis. 2011 Jan 20;11:21. A case of septicaemic anthrax in an intravenous drug user. Powell AG, Crozier JE, Hodgson H, Galloway DJ. Department of Surgical Gastroenterology, Gartnavel General Hospital, Glasgow, UK. arfonpowell@doctors.org.uk Abstract BACKGROUND: In 2000, Ringertz et al described the first case of systemic anthrax caused by injecting heroin contaminated with anthrax. In 2008, there were 574 drug related deaths in Scotland, of which 336 were associated with heroin and or morphine. We report a rare case of septicaemic anthrax caused by injecting heroin contaminated with anthrax in Scotland. CASE PRESENTATION: A 32 year old intravenous drug user (IVDU), presented with a 12 hour history of increasing purulent discharge from a chronic sinus in his left groin. He had a tachycardia, pyrexia, leukocytosis and an elevated C-reactive protein (CRP). He was treated with Vancomycin, Clindamycin, Ciprofloxacin, Gentamicin and Metronidazole. Blood cultures grew Bacillus anthracis within 24 hours of presentation. He had a computed tomography (CT) scan and magnetic resonance imagining (MRI) of his abdomen, pelvis and thighs performed. These showed inflammatory change relating to the iliopsoas and an area of necrosis in the adductor magnus.He underwent an exploration of his left thigh. This revealed chronically indurated subcutaneous tissues with no evidence of a collection or necrotic muscle. Treatment with Vancomycin, Ciprofloxacin and Clindamycin continued for 14 days. Negative Pressure Wound Therapy (NPWT) device was applied utilising the Venturi™ wound sealing kit. Following 4 weeks of treatment, the wound dimensions had reduced by 77%. CONCLUSIONS: Although systemic anthrax infection is rare, it should be considered when faced with severe cutaneous infection in IVDU patients. This case shows that patients with significant bacteraemia may present with no signs of haemodynamic compromise. Prompt recognition and treatment with high dose IV antimicrobial therapy increases the likelihood of survival. The use of simple wound therapy adjuncts such as NPWT can give excellent wound healing results. PMCID: PMC3033829 Free PMC Article
	PMID: 21251266 [PubMed - in process]
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17.	BMC Womens Health. 2011 Jan 19;11:1. Elevated serum neutrophil elastase is related to prehypertension and airflow limitation in obese women. El-Eshmawy MM, El-Adawy EH, Mousa AA, Zeidan AE, El-Baiomy AA, Abdel-Samie ER, Saleh OM. Internal Medicine Department, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt. eman.eladawy@yahoo.com Abstract BACKGROUND: Neutrophil elastase level/activity is elevated in a variety of diseases such as atherosclerosis, systolic hypertension and obstructive pulmonary disease. It is unknown whether obese individuals with prehypertension also have elevated neutrophil elastase, and if so, whether it has a deleterious effect on pulmonary function. Objectives: To determine neutrophil elastase levels in obese prehypertensive women and investigate correlations with pulmonary function tests. METHODS: Thirty obese prehypertensive women were compared with 30 obese normotensive subjects and 30 healthy controls. The study groups were matched for age. Measurements: The following were determined: body mass index, waist circumference, blood pressure, lipid profile, high sensitivity C-reactive protein, serum neutrophil elastase, and pulmonary function tests including forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio. RESULTS: Serum neutrophil elastase concentration was significantly higher in both prehypertensive (405.8 ± 111.6 ng/ml) and normotensive (336.5 ± 81.5 ng/ml) obese women than in control non-obese women (243.9 ± 23.9 ng/ml); the level was significantly higher in the prehypertensive than the normotensive obese women. FEV1, FVC and FEV1/FVC ratio in both prehypertensive and normotensive obese women were significantly lower than in normal controls, but there was no statistically significant difference between the prehypertensive and normotensive obese women. In prehypertensive obese women, there were significant positive correlations between neutrophil elastase and body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, low density lipoprotein cholesterol, high sensitivity C-reactive protein and negative correlations with high density lipoprotein cholesterol, FEV1, FVC and FEV1/FVC. CONCLUSION: Neutrophil elastase concentration is elevated in obese prehypertensive women along with an increase in high sensitivity C-reactive protein which may account for dyslipidemia and airflow dysfunction in the present study population. PMCID: PMC3031240 Free PMC Article
	PMID: 21247478 [PubMed - in process]
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18.	Endocr J. 2011 Jan 13. [Epub ahead of print] Association between bone mineral density and metabolic syndrome in pre- and postmenopausal women. Jeon YK, Lee JG, Kim SS, Kim BH, Kim SJ, Kim YK, Kim IJ. Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. Abstract Metabolic syndrome (MS) has 2 conflicting factors: obesity known to be protective against osteoporosis and an inflammation that activates bone resorption. The aim of this study was to evaluate the difference of bone mineral density (BMD) in women with or without MS according to menopausal state. This is a cross-sectional study of 2,265 women (1,234-premenopausal, 931-postmenopausal) aged over 20 years who visited the Health Promotion Center from January 2006 to December 2009. We measured BMD at the lumbar spine and femoral neck. MS was defined according to the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria. The prevalence of MS was 5.5% in the premenopausal group and 13.5% in the postmenopausal group. In the postmenopausal group, C-reactive protein (CRP) was significantly higher in subjects with MS than those without MS, but it was not in the premenopausal group. In the postmenopausal group, women with MS had a lower BMD at the lumbar spine and femoral neck before or after adjustment. In the premenopausal group, women with MS had a lower BMD at the lumbar spine, but not at the femoral neck. In stepwise linear regression analysis, predictive variables for BMD of the lumbar spine were systolic blood pressure in the premenopausal group and HDL-cholesterol and diastolic blood pressure (DBP) in the postmenopausal group. The predictive variables for BMD of the femoral neck were DBP and waist circumference in the premenopausal group and CRP and DBP in the postmenopausal group. Inflammation might have a more important role in BMD than obesity in the postmenopausal women. Free Article
	PMID: 21242648 [PubMed - as supplied by publisher]
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19.	Endocr J. 2011 Jan 30;58(1):69-73. Epub 2010 Dec 28. Sitagliptin reduces albuminuria in patients with type 2 diabetes. Hattori S. Endocrinology and Metabolism, Tsunemi-cho Clinic, Ashikaga, Tochigi, Japan. sachikohat@hb.tp1.jp Abstract We investigated the inhibitory effect of sitagliptin on albuminuria in patients with type 2 diabetes. Thirty-six patients (19 men and 17 women) whose HbA1c was higher than 6.5% (NGSP) despite receiving education on diet and exercise and medical treatment for at least 6 months at our clinic were enrolled into this study and were successfully followed over 6 months of sitagliptin treatment. Sitagliptin (50 mg/day) treatment significantly lowered both systolic and diastolic blood pressures, fasting blood glucose and postprandial blood glucose, HbA1c, and glycated albumin at 3 months and 6 months. Significant reductions in highly sensitive C-reactive protein and soluble vascular cell adhesion molecule 1 were also observed at 6 months. Urinary albumin excretion (measured as urinary albumin-to-creatinine ratio (ACR: mg/g Cr)) did not change in the 6 months before sitagliptin treatment (ΔACR: 2.3 ± 19.9) and decreased in the 6 months after sitagliptin treatment (ΔACR: -20.6 ± 24.6); these differences were statistically significant. At 6 months, the ACR decreased from 11.6 ± 8.4 to 4.5 ± 5.0 in 13 patients with normoalbuminuria (ACR < 30), from 98.4 ± 79 to 24.9 ± 20 in 15 patients with microalbuminuria (30 < ACR < 300), and from 1263 ± 492 to 561 ± 89 in 8 patients with macroalbuminuria (ACR > 300). Thus, the present findings strongly suggest that sitagliptin reduces albuminuria without lowering the estimated glomerular filtration rate, most likely depending on known factors such as blood sugar reduction, blood pressure reduction, and inflammation reduction, as well as yet undetermined factors caused by an increase in active glucagon-like peptide-1. Free Article
	PMID: 21206136 [PubMed - in process]
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20.	Arq Bras Cardiol. 2011 Jan;96(1):38-46. Epub 2010 Dec 22. Association between inflammatory markers and cardiovascular risk factors in women from Kolkata, W.B, India. [Article in English, Portuguese, Spanish] Ganguli D, Das N, Saha I, Sanapala KR, Chaudhuri D, Ghosh S, Dey S. Department of Physiology, University College of Science and Technology, University of Calcutta, West Bengal, India. Abstract BACKGROUND: Recent research has focused on the use of inflammatory biomarkers in the prediction of cardiovascular risk. However, information is scant regarding the association between these inflammatory markers with other cardiovascular risk factors in Asian Indians, particularly in women. OBJECTIVE: To explore the association between inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) and white blood cell (WBC) count and cardiovascular risk factors such as overall and central adiposity, blood pressure, lipid and lipoprotein variables and fasting glucose. METHODS: We conducted a cross-sectional analysis on 100 women aged 35-80 years. Participants were selected following cluster sampling methodology from 12 different randomly selected urban wards of Kolkata Municipal Corporation. RESULTS: Hs-CRP has a significant association with body mass index (BMI) ( p < 0.001) and waist circumference (WC) (p = 0.002). Significant inverse associations were observed between high-density lipoprotein cholesterol (HDL-C) and both inflammatory markers, hs-CRP (p = 0.031) and WBC count, (p = 0.014). Apolipoprotein A1 (Apo A1) was also negatively associated with hs-CRP. WBC count has significant correlation with fasting glucose and total cholesterol (TC) /HDL-C ratio. Using logistic regression, adjusting for age, BMI (odds ratio/OR, 1.186; confidence interval/CI, 1.046-1.345; p = 0.008) and WC (OR, 1.045; CI, 1.005-1.087; p = 0.027) were the covariates significantly associated with hs-CRP. CONCLUSION: In the present study, risk factors like BMI, WC, and HDL-C and apo A1 show significant association with hs-CRP. WBC count was significantly correlated with HDL-C, fasting glucose, TC/HDL-C ratio in women. Free Article
	PMID: 21180893 [PubMed - in process]
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21.	PLoS One. 2010 Dec 8;5(12):e15186. Changes in ponderal index and body mass index across childhood and their associations with fat mass and cardiovascular risk factors at age 15. Howe LD, Tilling K, Benfield L, Logue J, Sattar N, Ness AR, Smith GD, Lawlor DA. MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, United Kingdom. laura.howe@bristol.ac.uk Abstract BACKGROUND: Little is known about whether associations between childhood adiposity and later adverse cardiovascular health outcomes are driven by tracking of overweight from childhood to adulthood and/or by vascular and metabolic changes from childhood overweight that persist into adulthood. Our objective is to characterise associations between trajectories of adiposity across childhood and a wide range of cardiovascular risk factors measured in adolescence, and explore the extent to which these are mediated by fat mass at age 15. METHODS AND FINDINGS: Using data from the Avon Longitudinal Study of Parents and Children, we estimated individual trajectories of ponderal index (PI) from 0-2 years and BMI from 2-10 years using random-effects linear spline models (N = 4601). We explored associations between PI/BMI trajectories and DXA-determined total-body fat-mass and cardiovascular risk factors at 15 years (systolic and diastolic blood pressure, fasting LDL- and HDL-cholesterol, triglycerides, C-reactive protein, glucose, insulin) with and without adjustment for confounders. Changes in PI/BMI during all periods of infancy and childhood were associated with greater DXA-determined fat-mass at age 15. BMI changes in childhood, but not PI changes from 0-2 years, were associated with most cardiovascular risk factors in adolescence; associations tended to be strongest for BMI changes in later childhood (ages 8.5-10), and were largely mediated by fat mass at age 15. CONCLUSION: Changes in PI/BMI from 0-10 years were associated with greater fat-mass at age 15. Greater increases in BMI from age 8.5-10 years are most strongly associated with cardiovascular risk factors at age 15, with much of these associations mediated by fat-mass at this age. We found little evidence supporting previous reports that rapid PI changes in infancy are associated with future cardiovascular risk. This study suggests that associations between early overweight and subsequent adverse cardiovascular health are largely due to overweight children tending to remain overweight. PMCID: PMC2999567 Free PMC Article
	PMID: 21170348 [PubMed - in process]
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22.	J Korean Med Sci. 2010 Dec;25(12):1766-70. Epub 2010 Nov 24. Association of renal manifestations with serum uric acid in Korean adults with normal uric acid levels. Jung DH, Lee YJ, Lee HR, Lee JH, Shim JY. Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. Abstract Several studies have reported that hyperuricemia is associated with the development of hypertension and cardiovascular disease. Increasing evidences also suggest that hyperuricemia may have a pathogenic role in the progression of renal disease. Paradoxically, uric acid is also widely accepted to have antioxidant activity in experimental studies. We aimed to investigate the association between glomerular filtration rate (GFR) and uric acid in healthy individuals with a normal serum level of uric acid. We examined renal function determined by GFR and uric acid in 3,376 subjects (1,896 men; 1,480 women; aged 20-80 yr) who underwent medical examinations at Gangnam Severance Hospital from November 2006 to June 2007. Determinants for renal function and uric acid levels were also investigated. In both men and women, GFR was negatively correlated with systolic and diastolic blood pressures, fasting plasma glucose, total cholesterol, uric acid, log transformed C reactive protein, and log transformed triglycerides. In multivariate regression analysis, total uric acid was found to be an independent factor associated with estimated GFR in both men and women. This result suggests that uric acid appears to contribute to renal impairment in subjects with normal serum level of uric acid. PMCID: PMC2995231 Free PMC Article
	PMID: 21165292 [PubMed - indexed for MEDLINE]
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23.	Yonsei Med J. 2011 Jan 1;52(1):13-9. Taiwanese female vegetarians have lower lipoprotein-associated phospholipase A2 compared with omnivores. Chen CW, Lin CT, Lin YL, Lin TK, Lin CL. The Division of Cardiology, Department of Internal Medicine, Buddhist Dalin Tzu-Chi General Hospital, Chia-Yi, Taiwan. Abstract PURPOSE: Many studies supported that vegetarians have a lower risk of cardiac diseases and mortality, partly due to better blood pressure and serum cholesterol profiles. However, the inflammatory markers, especially lipoprotein-associated phospholipase A2 (Lp-PLA2), have not been well-studied. This study aimed to compare inflammatory markers and conventional risk factors between vegetarians and omnivores. MATERIALS AND METHODS: One hundred and seventy-three vegetarians and 190 omnivores were studied. Fasting blood samples were obtained to compare levels of glucose, total cholesterol, triacylglycerol, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, homocysteine, Lp-PLA2 activity, and high-sensitivity C-reactive protein (hs-CRP). RESULTS: Vegetarians had higher serum levels of the following markers: hs-CRP (1.8 ± 3.4 vs. 1.2 1.8 mg/L, respectively; p = 0.05), homocysteine (9.39 ± 3.22 vs. 7.62 ± 2.41 μmol/L, respectively; p < 0.01), and triacylglycerol (96.91 ± 59.56 vs. 84.66 ± 43.24 mg/dL, respectively; p < 0.05). Vegetarians also had lower levels of Lp-PLA2 (18.32 ± 7.19 10-3 μmol/min/mL vs. 20.22 8.13 10-3 μmol/min/mL; p < 0.05), total cholesterol (180.62 ± 36.55 mg/dL vs. 192.73 ± 36.57 mg/dL; p < 0.01), LDL cholesterol (118.15 ± 32.8 vs. 126.41 ± 34.28 mg/dL; p < 0.05), and HDL cholesterol (55.59 ± 13.30 vs. 62.09 ± 14.52 mg/dL, p < 0.01). Multivariate analyses demonstrated that a vegetarian diet increases the chances for high serum hs-CRP and low Lp-PLA2 activity. CONCLUSION: In addition to lower total cholesterol, LDL-cholesterol, and HDL-cholesterol, Taiwanese female vegetarians have lower serum Lp-PLA2 activity but higher levels of hs-CRP, homocysteine, and triacylglyerol. It might be due to geographic differences of vegetarian diets, and further studies are needed. PMCID: PMC3017687 Free PMC Article
	PMID: 21155029 [PubMed - in process]
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24.	PLoS Med. 2010 Nov 30;7(11):e1000372. Air Pollution and the microvasculature: a cross-sectional assessment of in vivo retinal images in the population-based multi-ethnic study of atherosclerosis (MESA). Adar SD, Klein R, Klein BE, Szpiro AA, Cotch MF, Wong TY, O'Neill MS, Shrager S, Barr RG, Siscovick DS, Daviglus ML, Sampson PD, Kaufman JD. Department of Epidemiology, University of Washington, Seattle, Washington, United States of America. sadar@umich.edu Abstract BACKGROUND: Long- and short-term exposures to air pollution, especially fine particulate matter (PM(2.5)), have been linked to cardiovascular morbidity and mortality. One hypothesized mechanism for these associations involves microvascular effects. Retinal photography provides a novel, in vivo approach to examine the association of air pollution with changes in the human microvasculature. METHODS AND FINDINGS: Chronic and acute associations between residential air pollution concentrations and retinal vessel diameters, expressed as central retinal arteriolar equivalents (CRAE) and central retinal venular equivalents (CRVE), were examined using digital retinal images taken in Multi-Ethnic Study of Atherosclerosis (MESA) participants between 2002 and 2003. Study participants (46 to 87 years of age) were without clinical cardiovascular disease at the baseline examination (2000-2002). Long-term outdoor concentrations of PM(2.5) were estimated at each participant's home for the 2 years preceding the clinical exam using a spatio-temporal model. Short-term concentrations were assigned using outdoor measurements on the day preceding the clinical exam. Residential proximity to roadways was also used as an indicator of long-term traffic exposures. All associations were examined using linear regression models adjusted for subject-specific age, sex, race/ethnicity, education, income, smoking status, alcohol use, physical activity, body mass index, family history of cardiovascular disease, diabetes status, serum cholesterol, glucose, blood pressure, emphysema, C-reactive protein, medication use, and fellow vessel diameter. Short-term associations were further controlled for weather and seasonality. Among the 4,607 participants with complete data, CRAE were found to be narrower among persons residing in regions with increased long- and short-term levels of PM(2.5). These relationships were observed in a joint exposure model with -0.8 µm (95% confidence interval [CI] -1.1 to -0.5) and -0.4 µm (95% CI -0.8 to 0.1) decreases in CRAE per interquartile increases in long- (3 µg/m(3)) and short-term (9 µg/m(3)) PM(2.5) levels, respectively. These reductions in CRAE are equivalent to 7- and 3-year increases in age in the same cohort. Similarly, living near a major road was also associated with a -0.7 µm decrease (95% CI -1.4 to 0.1) in CRAE. Although the chronic association with CRAE was largely influenced by differences in exposure between cities, this relationship was generally robust to control for city-level covariates and no significant differences were observed between cities. Wider CRVE were associated with living in areas of higher PM(2.5) concentrations, but these findings were less robust and not supported by the presence of consistent acute associations with PM(2.5). CONCLUSIONS: Residing in regions with higher air pollution concentrations and experiencing daily increases in air pollution were each associated with narrower retinal arteriolar diameters in older individuals. These findings support the hypothesis that important vascular phenomena are associated with small increases in short-term or long-term air pollution exposures, even at current exposure levels, and further corroborate reported associations between air pollution and the development and exacerbation of clinical cardiovascular disease. Please see later in the article for the Editors' Summary. PMCID: PMC2994677 Free PMC Article
	PMID: 21152417 [PubMed - indexed for MEDLINE]
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25.	BMC Immunol. 2010 Dec 2;11:59. Circulating cytokines, chemokines and adhesion molecules in normal pregnancy and preeclampsia determined by multiplex suspension array. Szarka A, Rigó J Jr, Lázár L, Beko G, Molvarec A. First Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary. molvarec@freemail.hu Abstract BACKGROUND: Preeclampsia is a severe complication of pregnancy characterized by an excessive maternal systemic inflammatory response with activation of both the innate and adaptive arms of the immune system. Cytokines, chemokines and adhesion molecules are central to innate and adaptive immune processes. The purpose of this study was to determine circulating levels of cytokines, chemokines and adhesion molecules in normal pregnancy and preeclampsia in a comprehensive manner, and to investigate their relationship to the clinical features and laboratory parameters of the study participants, including markers of overall inflammation (C-reactive protein), endothelial activation (von Willebrand factor antigen) and endothelial injury (fibronectin), oxidative stress (malondialdehyde) and trophoblast debris (cell-free fetal DNA). RESULTS: Serum levels of interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra), IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p40, IL-12p70, IL-18, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, transforming growth factor (TGF)-beta1, interferon-gamma-inducible protein (IP)-10, monocyte chemotactic protein (MCP)-1, intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 were measured in 60 preeclamptic patients, 60 healthy pregnant women and 59 healthy non-pregnant women by multiplex suspension array and ELISA. In normal pregnancy, the relative abundance of circulating IL-18 over IL-12p70 and the relative deficiency of the bioactive IL-12p70 in relation to IL-12p40 might favour Th2-type immunity. Although decreased IL-1ra, TNF-alpha and MCP-1 concentrations of healthy pregnant relative to non-pregnant women reflect anti-inflammatory changes in circulating cytokine profile, their decreased serum IL-10 and increased IP-10 levels might drive pro-inflammatory responses. In addition to a shift towards Th1-type immunity (expressed by the increased IL-2/IL-4 and IFN-gamma/IL-4 ratios), circulating levels of the pro-inflammatory cytokines IL-6 and TNF-alpha, the chemokines IL-8, IP-10 and MCP-1, as well as the adhesion molecules ICAM-1 and VCAM-1, were raised in preeclampsia compared with healthy pregnancy, resulting in an overall pro-inflammatory systemic environment. Increased IP-10, MCP-1, ICAM-1 and VCAM-1 concentrations of preeclamptic patients showed significant correlations with blood pressure values, renal and liver function parameters, as well as with CRP, malondialdehyde, von Willebrand factor antigen and fibronectin levels. CONCLUSIONS: According to our findings, preeclampsia was associated with an overall pro-inflammatory systemic environment. Elevated amounts of pro-inflammatory cytokines, chemokines and adhesion molecules in the maternal circulation might play a central role in the excessive systemic inflammatory response, as well as in the generalized endothelial dysfunction characteristics of the maternal syndrome of preeclampsia. PMCID: PMC3014878 Free PMC Article
	PMID: 21126355 [PubMed - in process]
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26.	Pharmacol Rep. 2010 Sep-Oct;62(5):883-90. Hypotensive effect of atorvastatin is not related to changes in inflammation and oxidative stress. Kuklińska AM, Mroczko B, Musiał WJ, Sawicki R, Kozieradzka A, Usowicz-Szaryńska M, Kamiński K, Knapp M, Szmitkowski M. Department of Cardiology, Medical University, M. Skłodowskiej-Curie 24A, PL15-276 Białystok, Poland. agnieszka.kuklinska@gmail.com Abstract We sought to determine if atorvastatin lowers blood pressure in patients with previously diagnosed and well-controlled essential arterial hypertension and if this effect could be related to anti-inflammatory and anti-oxidative effects. Among 92 patients with essential arterial hypertension, we studied 56 non-smoking and normolipemic: 39 were randomized to receive 80 mg atorvastatin daily for 3 months (statin-treated patients, ST), and the rest continued a previous hypotensive therapy (statin-free patients, SF). Blood pressure was measured using a 24-h ambulatory blood pressure measurement device. Serum levels of high-sensitivity C-reactive protein (hs-CRP), total antioxidant status (TAS) and plasma peroxides (assessed by Oxystat) were measured in both groups. The mean change in systolic BP (SBP) for atorvastatin was -5.7 mmHg (95% confidence interval CI, -4.1 to -7.2 mmHg), and the mean change in diastolic BP (DBP) was -3.9 mmHg (95% CI, -2.7 to -5.0 mmHg). No change in BP in SF patients was observed. In the ST group, hs-CRP and peroxides did not significantly decrease. In the SF group, concentrations of hs-CRP proceeded to decrease while peroxides increased. In the ST group, changes in hs-CRP correlated with changes in total cholesterol and low-density lipoprotein cholesterol (r = 0.41, p = 0.013 and r = 0.35, p = 0.04, respectively) but did not correlate with changes in BP. The hypotensive statin effect was independent of the hypolipemic effect. During three months of observation, TAS concentrations in both groups remained stable. In this randomized study, additionally administered atorvastatin to non-smoking and normolipemic patients with well-controlled essential arterial hypertension resulted in reduction of BP. This effect was not followed by significant changes in hs-CRP, TAS or Oxystat concentrations. The hypotensive effect of atorvastatin did not depend on anti-inflammatory, anti-oxidative or hypolipemic actions. Free Article
	PMID: 21098871 [PubMed - in process]
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27.	BMC Public Health. 2010 Nov 15;10:700. Abdominal obesity and other risk factors largely explain the high CRP in indigenous Australians relative to the general population, but not gender differences: a cross-sectional study. Hodge AM, Maple-Brown L, Cunningham J, Boyle J, Dunbar T, Weeramanthri T, Shaw J, O'Dea K. University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia. hodgea@unimelb.edu.au Abstract BACKGROUND: Previous studies reported high C-reactive protein (CRP) levels in Indigenous Australians, which may contribute to their high risk of cardiovascular disease. We compared CRP levels in Indigenous Australians and the general population, accounting for obesity and other risk factors. METHODS: Cross-sectional study of CRP and risk factors (weight, height, waist and hip circumferences, blood pressure, lipids, blood glucose, and smoking status) in population-based samples from the Diabetes and Related conditions in Urban Indigenous people in the Darwin region (DRUID) study, and the Australian Diabetes, Obesity and Lifestyle study (AusDiab) follow-up. RESULTS: CRP concentrations were higher in women than men and in DRUID than AusDiab. After multivariate adjustment, including waist circumference, the odds of high CRP (>3.0 mg/L) in DRUID relative to AusDiab were no longer statistically significant, but elevated CRP was still more likely in women than men. After adjusting for BMI (instead of waist circumference) the odds for elevated CRP in DRUID participants were still higher relative to AusDiab participants among women, but not men. Lower HDL cholesterol, impaired glucose tolerance (IGT), and higher diastolic blood pressure were associated with having a high CRP in both men and women, while current smoking was associated with high CRP in men but not women. CONCLUSIONS: High concentrations of CRP in Indigenous participants were largely explained by other risk factors, in particular abdominal obesity. Irrespective of its independence as a risk factor, or its aetiological association with coronary heart disease (CHD), the high CRP levels in urban Indigenous women are likely to reflect increased vascular and metabolic risk. The significance of elevated CRP in Indigenous Australians should be investigated in future longitudinal studies. PMCID: PMC2998493 Free PMC Article
	PMID: 21078191 [PubMed - indexed for MEDLINE]
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28.	Cardiovasc Diabetol. 2010 Oct 29;9:69. Fibrinogen and associated risk factors in a high-risk population: urban Indigenous Australians, the DRUID Study. Maple-Brown LJ, Cunningham J, Nandi N, Hodge A, O'Dea K. Menzies School of Health Research, Charles Darwin University, Darwin, Australia. louise.maple-brown@menzies.edu.au Abstract BACKGROUND: Epidemiological evidence suggests that fibrinogen and CRP are associated with coronary heart disease risk. High CRP in Indigenous Australians has been reported in previous studies including our 'Diabetes and Related diseases in Urban Indigenous population in Darwin region' (DRUID) Study. We studied levels of fibrinogen and its cross-sectional relationship with traditional and non-traditional cardiovascular risk factors in an urban Indigenous Australian cohort. METHODS: Fibrinogen data were available from 287 males and 628 females (aged ≥ 15 years) from the DRUID study. Analysis was performed for associations with the following risk factors: diabetes, HbA1c, age, BMI, waist circumference, waist-hip ratio, total cholesterol, triglyceride, HDL cholesterol, C-reactive protein, homocysteine, blood pressure, heart rate, urine ACR, smoking status, alcohol abstinence. RESULTS: Fibrinogen generally increased with age in both genders; levels by age group were higher than those previously reported in other populations, including Native Americans. Fibrinogen was higher in those with than without diabetes (4.24 vs 3.56 g/L, p < 0.001). After adjusting for age and sex, the following were significantly associated with fibrinogen: BMI, waist, waist-hip ratio, systolic blood pressure, heart rate, fasting triglycerides, HDL cholesterol, HbA1c, CRP, ACR and alcohol abstinence. On multivariate regression (age and sex-adjusted) CRP and HbA1c were significant independent predictors of fibrinogen, explaining 27% of its variance; CRP alone explained 25% of fibrinogen variance. On factor analysis, both CRP and fibrinogen clustered with obesity in women (this factor explained 20% of variance); but in men, CRP clustered with obesity (factor explained 18% of variance) whilst fibrinogen clustered with HbA1c and urine ACR (factor explained 13% of variance). CONCLUSIONS: Fibrinogen is associated with traditional and non-traditional cardiovascular risk factors in this urban Indigenous cohort and may be a useful biomarker of CVD in this high-risk population. The apparent different associations of fibrinogen with cardiovascular disease risk markers in men and women should be explored further. PMCID: PMC2988000 Free PMC Article
	PMID: 21029470 [PubMed - indexed for MEDLINE]
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29.	Hippokratia. 2010 Jul;14(3):193-7. Nutrition parameters as hemodialysis adequacy markers. Stolic R, Trajkovic G, Stolic D, Peric V, Subaric-Gorgieva G. Abstract Background and aim: The nutritive status has significant role in improving the quality of life of dialysis' patients. The aim of this study was to find out if there is any correlation of the anthropometric parameters and markers of nutrition with the adequacy of HD.Methods: The investigation was organized as a clinical, cross sectional study. Demographic characteristics, co-morbid conditions, smoking, dialysis duration and blood pressure were recorded. Serum total protein, albumin, ferritin and blood-lipids were measured as biochemical markers of nutritional status.One hundred and forty patients, 82 (58.6%) male, and 58 (41.4%) female, 55±12.59 years, were dividied into two groups. Group A consisted of 44 patients (14 women and 30 men) received the recommended hemodialysis dose (Kt/V ≥ 1.2), while the Group B consisted of 96 patients (69 males and 27 females) received non-adequate hemodialysis dose (Kt/V < 1.2).Results: Patients with adequate hemodialysis had been longer on dialysis in correlation with the group of patients with non-adequate hemodialysis (73 ± 56.4 vs. 44 ± 50.1 months; p: 0.004). Group A and group B presented significant differences in the number of leukocytes (p: 0.027), and hemoglobin (p: 0.047), potassium (p: 0.038) and C-reactive protein level (p: 0.048) as well as in serum total protein (69 ± 4.63 vs. 65 ± 5.74 g/L; p < 0.0001) and albumin (38 ± 2.99 vs. 29 ± 4.4 g/L; p: 0.047). Pearsons correlation of factors that may have impact on hemodialysis adequacy indicated a significant relation between serum total protein and the index of hemodialysis adequacy (r: 0.21; p: 0.0446).Conclusions: All investigated anthropometric parameters and protein status showed significantly higher values in patients with adequate hemodialysis quality (Group A). The Group B showed higher levels of CRP and lower values of hemoglobin. PMCID: PMC2943358 Free PMC Article
	PMID: 20981169 [PubMed - in process]
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30.	Int Heart J. 2010;51(5):312-8. Impact of statin therapy on renal function and long-term prognosis in acute coronary syndrome patients with chronic kidney disease. Shibui T, Nakagomi A, Kusama Y, Atarashi H, Mizuno K. Department of Internal Medicine and Cardiology, Tama-Nagayama Hospital, Nippon Medical School, Tokyo, Japan. Abstract A recent study showed that statins reduce cardiovascular events in stable coronary artery disease patients with chronic kidney disease (CKD). However, it remains unclear whether acute coronary syndrome (ACS) patients with CKD benefit from statins. A total of 501 patients with ACS who underwent successful percutaneous coronary intervention were investigated and CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/minute/1.73 m(2) at discharge. Three hundred and twenty-four of 501 patients (64.7%) had CKD and 173 patients (34.5%) received statins. The patients with CKD were older and had higher blood pressure than those without CKD. With a mean follow-up of 5.2 years, irrespective of treatment assignment, 74 patients with CKD experienced cardiac events (22.8%) in comparison to 25 without CKD (14.1%, HR 1.81; 95% CI 1.15-2.84, P = 0.0095). Cardiac events occurred in only 18 of the patients with CKD treated with statins (16.2%) and in 56 of those treated with CKD without statins (26.3%, HR 0.58; 95% CI 0.34-0.98, P = 0.039), whereas, no significant reduction of the events was observed in the patients without CKD treated with statins versus without having statins (P = 0.130). These data indicate that statin therapy reduces cardiac events in ACS patients with CKD. Free Article
	PMID: 20966602 [PubMed - indexed for MEDLINE]
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31.	Hepatobiliary Pancreat Dis Int. 2010 Oct;9(5):482-6. Advances in prognostic factors in acute pancreatitis: a mini-review. Pavlidis TE, Pavlidis ET, Sakantamis AK. Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 54642 Thessaloniki, Greece. pavlidth@otenet.gr Abstract BACKGROUND: Early assessment of the severity of acute pancreatitis is essential to the proper management of the disease. It is dependent on the criteria of the Atlanta classification system. DATA SOURCES: PubMed search of recent relevant articles was performed to identify information about the severity and prognosis of acute pancreatitis. RESULTS: The scoring systems included the Ranson's or Glasgow's criteria ≥3, the APACHE II classification system ≥8, and the Balthazar's criteria ≥4 according to the computed tomography enhanced scanning findings. The single factors on admission included age >65 years, obesity, hemoconcentration (>44%), abnormal chest X-ray, creatinine >2 mg/dl, C-reactive protein >150 mg/dl, procalcitonin >1.8 ng/ml, albumin <2.5 mg/dl, calcium <8.5 mg/dl, early hyperglycemia, increased intra-abdominal pressure, macrophage migration inhibitory factor, or a combination of IL-10 >50 pg/ml with calcium <6.6 mg/dl. CONCLUSION: The prediction of the severity of acute pancreatitis is largely based on well defined multiple factor scoring systems as well as several single risk factors. Free Article
	PMID: 20943456 [PubMed - indexed for MEDLINE]
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32.	J Nutr Sci Vitaminol (Tokyo). 2010;56(4):222-6. Serum retinol, alpha-tocopherol and systemic inflammatory response in metastatic colorectal carcinoma patients treated with combination chemotherapy and cetuximab. Melichar B, Krcmová L, Kalábová H, Holecková P, Kasparová M, Plísek J, Hyspler R, Studentová H, Solichová D. Department of Oncology, Palacký University Medical School and Teaching Hospital, I.P. Pavlova, Olomouc, Czech Republic. bohuslav.melichar@fnol.cz Abstract Cetuximab is a chimeric antibody registered for the therapy of advanced colorectal carcinoma. Cancer and anticancer therapy are associated with oxidative stress, and disorders of antioxidant balance may be involved in the toxicity associated with anticancer treatment. The aim of the present study was to investigate the changes of serum retinol, alpha-tocopherol and C-reactive protein during the first month of treatment with cetuximab and chemotherapy. Twenty-five consecutive patients with metastatic colorectal carcinoma treated with a combination of chemotherapy and cetuximab were included in the present study. Serum retinol and alpha-tocopherol were determined by high-performance liquid chromatography and serum C-reactive protein was determined using commercial kits. Significant correlation was observed between baseline concentrations of retinol and C-reactive protein (r(s)=-0.54, p<0.01). Median survival of patients who had baseline serum retinol below 1.25 µmol/L was 10 mo compared to 18 mo for patients who had serum retinol equal or above 1.25 µmol/L (p<0.05); median survival of patients who had serum C-reactive protein below 24 mg/L was significantly longer compared to patients with C-reactive protein levels equal or above 24 mg/L (18 vs. 7 mo, p<0.05), but no difference in survival was observed based on alpha-tocopherol levels. Twenty-two patients had evaluation of retinol, alpha-tocopherol and C-reactive protein at least once during the follow up. Serum concentration of alpha-tocopherol decreased significantly during the therapy, but retinol and C-reactive protein concentrations remained unchanged. In conclusion, a significant correlation was observed between serum retinol and C-reactive protein. Serum alpha-tocopherol decreased significantly during the first month of combination therapy with cetuximab. Low retinol and high C-reactive protein concentrations were predictive of poor prognosis in this patient population. Free Article
	PMID: 20924143 [PubMed - indexed for MEDLINE]
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33.	Part Fibre Toxicol. 2010 Sep 29;7:27. Cardiovascular and inflammatory effects of intratracheally instilled ambient dust from Augsburg, Germany, in spontaneously hypertensive rats (SHRs). Upadhyay S, Ganguly K, Stoeger T, Semmler-Bhenke M, Takenaka S, Kreyling WG, Pitz M, Reitmeir P, Peters A, Eickelberg O, Wichmann HE, Schulz H. Institute of Lung Biology and Disease, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg/Munich, Germany. Abstract RATIONALE: Several epidemiological studies associated exposure to increased levels of particulate matter in Augsburg, Germany with cardiovascular mortality and morbidity. To elucidate the mechanisms of cardiovascular impairments we investigated the cardiopulmonary responses in spontaneously hypertensive rats (SHR), a model for human cardiovascular diseases, following intratracheal instillation of dust samples from Augsburg. METHODS: 250 μg, 500 μg and 1000 μg of fine ambient particles (aerodynamic diameter <2.5 μm, PM₂(.)₅-AB) collected from an urban background site in Augsburg during September and October 2006 (PM₂(.)₅ 18.2 μg/m³, 10,802 particles/cm3) were instilled in 12 months old SHRs to assess the inflammatory response in bronchoalveolar lavage fluid (BALF), blood, lung and heart tissues 1 and 3 days post instillation. Radio-telemetric analysis was performed to investigate the cardiovascular responses following instillation of particles at the highest dosage based on the inflammatory response observed. RESULTS: Exposure to 1000 μg of PM₂(.)₅-AB was associated with a delayed increase in delta mean blood pressure (ΔmBP) during 2(nd)-4(th) day after instillation (10.0 ± 4.0 vs. -3.9 ± 2.6 mmHg) and reduced heart rate (HR) on the 3rd day post instillation (325.1 ± 8.8 vs. 348.9 ± 12.5 bpm). BALF cell differential and inflammatory markers (osteopontin, interleukin-6, C-reactive protein, and macrophage inflammatory protein-2) from pulmonary and systemic level were significantly induced, mostly in a dose-dependent way. Protein analysis of various markers indicate that PM₂(.)₅-AB instillation results in an activation of endothelin system (endothelin1), renin-angiotensin system (angiotensin converting enzyme) and also coagulation system (tissue factor, plasminogen activator inhibitor-1) in pulmonary and cardiac tissues during the same time period when alternation in ΔmBP and HR have been detected. CONCLUSIONS: Our data suggests that high concentrations of PM₂(.)₅-AB exposure triggers low grade PM mediated inflammatory effects in the lungs but disturbs vascular homeostasis in pulmonary tissues and on a systemic level by affecting the renin angiotensin system, the endothelin system and the coagulation cascade. These findings are indicative for promotion of endothelial dysfunction, atherosclerotic lesions, and thrombogeneis and, thus, provide plausible evidence that susceptible-predisposed individuals may develop acute cardiac events like myocardial infarction when repeatedly exposed to high pollution episodes as observed in epidemiological studies in Augsburg, Germany. PMCID: PMC2956709 Free PMC Article
	PMID: 20920269 [PubMed - indexed for MEDLINE]
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34.	J Korean Med Sci. 2010 Oct;25(10):1487-91. Epub 2010 Sep 17. Plasma C-reactive protein and endothelin-1 level in patients with chronic obstructive pulmonary disease and pulmonary hypertension. Kwon YS, Chi SY, Shin HJ, Kim EY, Yoon BK, Ban HJ, Oh IJ, Kim KS, Kim YC, Lim SC. Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea. Abstract Pulmonary hypertension is a frequent complication of chronic obstructive pulmonary disease (COPD) and associated with a worse survival and increased risk of hospitalization for exacerbation of COPD. However, little information exists regarding the potential role of systemic inflammation in pulmonary hypertension of COPD. The purpose of the present study was to investigate the degree of C-reactive protein (CRP) and endothelin-1 (ET-1) levels in COPD patient with and without pulmonary hypertension. The levels of CRP and ET-1 were investigated in 58 COPD patient with pulmonary hypertension and 50 patients without pulmonary hypertension. Pulmonary hypertension was defined as a systolic pulmonary artery pressure (Ppa) ≥35 mmHg assessed by Doppler echocardiography. Plasma CRP and ET-1 levels were significantly higher in patients with pulmonary hypertension than in patients without hypertension. There were significant positive correlations between the plasma ET-1 level and CRP level in the whole study groups. For COPD patients, systolic Ppa correlated significantly with plasma CRP levels and plasma ET-1 levels. These findings support a possibility that CRP and ET-1 correlate to pulmonary hypertension in COPD patients. PMCID: PMC2946660 Free PMC Article
	PMID: 20890431 [PubMed - indexed for MEDLINE]
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35.	Diabetologia. 2011 Jan;54(1):69-72. Epub 2010 Oct 1. HbA₁(c) and mean blood glucose show stronger associations with cardiovascular disease risk factors than do postprandial glycaemia or glucose variability in persons with diabetes: the A1C-Derived Average Glucose (ADAG) study. Borg R, Kuenen JC, Carstensen B, Zheng H, Nathan DM, Heine RJ, Nerup J, Borch-Johnsen K, Witte DR; ADAG Study Group. Steno Diabetes Center A/S, Gentofte, Denmark. RBrg@steno.dk Abstract AIMS: Increased glucose excursions and postprandial hyperglycaemia have been suggested as unique risk factors for cardiovascular disease (CVD) and mortality in patients with diabetes mellitus. Much of the evidence is based on a single 2 h glucose value after oral glucose tolerance testing in epidemiological studies. We examined the association between various indices of glycaemia measured during everyday activities and metabolic CVD risk factors in the A1C-Derived Average Glucose (ADAG) study. METHODS: Participants (268 with type 1 diabetes, 159 with type 2 diabetes) completed 16 weeks of intensive continuous glucose monitoring (CGM) and self-monitoring of blood glucose (SMBG). From these data, common indices of postprandial glycaemia, overall hyperglycaemia, glucose variability and HbA₁(c) were derived. The associations between glycaemic indices and known CVD risk factors (lipids, high-sensitivity C-reactive protein and blood pressure) were explored in linear regression models. RESULTS: For both diabetes types, the overall strongest associations with CVD risk factors were seen for the measures of average glycaemia (mean blood glucose and HbA₁(c)). Associations between self-monitored postprandial and fasting glucose and CVD risk factors were weaker, but significant. Measurements of blood glucose variability showed non-significant associations. Overall, calculations based on CGM were not more informative than those based on frequent SMBG. CONCLUSIONS/INTERPRETATION: Mean glycaemia and HbA₁(c) show consistent and stronger associations with CVD risk factors than fasting glucose or postprandial glucose levels or measures of glucose variability in patients with diabetes. PMCID: PMC2995856 Free PMC Article
	PMID: 20886203 [PubMed - in process]
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36.	Diabetes. 2010 Dec;59(12):3017-22. Epub 2010 Sep 28. First-trimester prediction of gestational diabetes mellitus: examining the potential of combining maternal characteristics and laboratory measures. Savvidou M, Nelson SM, Makgoba M, Messow CM, Sattar N, Nicolaides K. Department of Maternal Fetal Medicine, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK. msavvidou2005@yahoo.co.uk Abstract OBJECTIVE: Predictors of gestational diabetes mellitus (GDM) have been widely studied, but few studies have considered multiple measures. Our objective was to integrate several potential GDM predictors with consideration to both simple and novel measures and to determine the extent to which GDM can be predicted in the first trimester. RESEARCH DESIGN AND METHODS: We identified first-trimester maternal samples from 124 women who developed GDM and 248 control subjects who did not. We gathered data on age, BMI, parity, race, smoking, prior GDM, family history of diabetes, and blood pressure. Using retrieved samples, we measured routine (lipids, high-sensitivity C-reactive protein, and γ-glutamyltransferase) and novel (adiponectin, E-selectin, and tissue plasminogen activator [t-PA]) parameters. We determined independent predictors from stepwise regression analyses, calculated areas under the receiver-operating characteristic curves (AUC-ROC), and integrated discrimination improvement (IDI) for relevant models. RESULTS: Compared with control subjects, women who subsequently developed GDM were older, had higher BMIs, were more likely to be of Asian origin, had a history of GDM or family history of type 2 diabetes, and had higher systolic blood pressure (P < 0.05 for all). With regard biochemical measures, stepwise analyses identified only elevated t-PA and low HDL cholesterol levels as significant (P ≤ 0.015) independent predictors of GDM beyond simple non-laboratory-based maternal measures. Their inclusion improved the AUC-ROC from 0.824 to 0.861 and IDI by 0.052 (0.017-0.115). CONCLUSIONS: GDM can be usefully estimated from a mix of simple questions with potential for further improvement by specific blood measures (lipids and t-PA). PMCID: PMC2992761 [Available on 2011/12/1] Free Article
	PMID: 20876721 [PubMed - indexed for MEDLINE]
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37.	J Adolesc Health. 2010 Oct;47(4):346-51. Epub 2010 May 20. Inflammation markers are associated with cardiovascular diseases risk in adolescents: the Young Hearts project 2000. Wijnstok NJ, Twisk JW, Young IS, Woodside JV, McFarlane C, McEneny J, Hoekstra T, Murray L, Boreham CA. Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands. nienke.wijnstok@falw.vu.nl Comment in: J Adolesc Health. 2010 Oct;47(4):319-21. Abstract PURPOSE: The traditional approach for identifying subjects at risk from cardiovascular diseases (CVD) is to determine the extent of clustering of biological risk factors adjusted for lifestyle. Recently, markers of endothelial dysfunction and low grade inflammation, including high sensitivity C-reactive protein (hsCRP), soluble intercellular adhesion molecules (sICAM), and soluble vascular adhesion molecules (sVCAM), have been included in the detection for high risk individuals. However, the relationship of these novel biomarkers with CVD risk in adolescents remains unclear. The purpose of this study, therefore, was to establish the association of hsCRP, sICAM, and sVCAM with CVD risk in an adolescent population. METHODS: Data from the Young Hearts 2000 cross-sectional cohort study, carried out in 1999-2001, were used. From a total of 2,017 male and female participants, 95 obese subjects were identified and matched according to age, sex, and cigarette smoking, with 95 overweight and 95 normal-weight adolescents. Clustered CVD risk was computed using a sum of Z-scores of biological risk factors. The relationship was described using multiple linear regression analyses. RESULTS: hsCRP, sICAM, and sVCAM showed significant associations with CVD risk. hsCRP and sICAM had a positive relation with CVD risk, whereas sVCAM showed an inverse relationship. In this study, lifestyle factors showed no relation with CVD risk. CONCLUSION: The results fit the hypothesized role of low grade inflammation and endothelial dysfunction in CVD risk in asymptomatic adolescents. The inverse relationship of VCAM, however, is hard to explain and indicates the complex mechanisms underlying CVD. Further research is needed to draw firm conclusions on the biomarkers used. Copyright © 2010 Society for Adolescent Health and Medicine. All rights reserved. PMCID: PMC2958312 Free PMC Article
	PMID: 20864003 [PubMed - indexed for MEDLINE]
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38.	Nan Fang Yi Ke Da Xue Xue Bao. 2010 Sep;30(9):2171-4. [Response to metoprolol succinate sustained-release tablets in correlation to pulse pressure, serum vascular endothelial growth factor and C-reactive protein in elderly hypertensive patients with chronic heart failure]. [Article in Chinese] Zhang ZW, Lin ZP. Department of Cardiology, Sun Yat-sen Cardiovascular Hospital, Shenzhen 518020, China. xiaosi1210000@ 163.com Abstract OBJECTIVE: To investigate the effect of metoprolol succinate sustained-release tablets on cardiac function, serum vascular endothelial growth factor (VEGF) and C-reactive protein (CRP) in elderly hypertensive patients and its relation with pulse pressure (PP). METHODS: A total of 330 elderly hypertensive patients with chronic heart failure receiving basic therapy were included. Before initiation and 3 months after the maximal tolerated dose of metoprolol succinate sustained-release tablets, the parameters of blood pressure, clinical features, radionuclide ventriculographic and laboratory findings of the patients were analyzed. RESULTS: As the PP was elevated, the serum levels of VEGF, hs-CRP and BNP increased and the cardiac systolic and diastolic functions decreased. In patients with PP of 59-68 mmHg and > 68 mmHg, 3 months of treatment with the tablets caused significantly increased LVEF by (3.32 ± 2.35)% and (4.12 ± 3.05)% and LVPER by 0.37 ± 0.26 and 0.53 ± 0.37, respectively; PP were decreased by 8.2 ± 3.1 mmHg and 9.4 ± 4.3 mmHg and VEGF by 18.39 ± 8.43 pg/ml and 26.79 ± 14.32 pg/ml, respectively. The treatment also resulted in lowered hs-CRP and BNP in these patients by 0.26 ± 0.13 mg/L and 0.33 ± 0.16 mg/L and by 140.36 ± 68.62 ng/L and 155.39 ± 73.58 ng/L, respectively. CONCLUSION: Obvious elevation of PP is associated with a better response to metoprolol succinate sustained-release tablets in elderly hypertensive patients with chronic heart failure, and 3 months of treatment with the tablets can significantly improve the cardiac function and lower the levels of VEGF, hs-CRP and BNP in these patients. Free Article
	PMID: 20855282 [PubMed - in process]
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39.	Clin Interv Aging. 2010 Sep 7;5:239-51. Risk of "silent stroke" in patients older than 60 years: risk assessment and clinical perspectives. Lim JS, Kwon HM. Department of Neurology, Armed Forces Seoul Hospital, Seoul, Republic of Korea. Abstract With the increasing size of the elderly population and evolving imaging technology, silent brain infarction (SBI) has garnered attention from both the public and the physicians. Over 20% of the elderly exhibit SBI, and the prevalence of SBI increases steadily with age, ie, 30%-40% in those older than 70 years. Well-known cardiovascular risk factors such as hypertension has been identified as a risk factor of SBI (odds ratio [OR] = 3.47) Besides this, blood pressure (BP) reactivity to mental stress, morning BP surges, and orthostatic BP changes have been demonstrated to contribute to the presence of SBI. Further, a metabolic syndrome not only as a whole syndrome (OR =2.18) but also as individual components could have an influence on SBI. Increased C-reactive protein and interleukin-6, coronary artery disease, body mass index, and alcohol consumption have also been associated with SBI. The ORs and possible mechanisms have been discussed in this article. Overt stroke, dementia, depression, and aspiration pneumonia were all associated with SBI. (overt stroke: hazard ratio [HR] =1.9, 95% confidence interval [CI]: 1.2-2.8; dementia: HR =2.26, 95% CI: 1.09-4.70). We also looked into their close relationship with SBI in this review. PMCID: PMC2938031 Free PMC Article
	PMID: 20852671 [PubMed - indexed for MEDLINE]
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40.	Endocr Pract. 2011 Mar-Apr;17(2):192-200. Durability of effects of exenatide treatment on glycemic control, body weight, systolic blood pressure, C-reactive protein, and triglyceride concentrations. Varanasi A, Chaudhuri A, Dhindsa S, Arora A, Lohano T, Vora MR, Dandona P. Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo and Kaleida Health, Buffalo, New York. Abstract Objective: To determine (1) whether long-term treatment with exenatide is associated with reductions in C-reactive protein (CRP), systolic blood pressure (BP), and triglyceride concentrations in addition to reductions in body weight and hemoglobin A1c (A1C) levels and (2) whether these beneficial results persist without any loss of effect while exenatide is being used, and whether they reverse after its cessation.Methods: We conducted a retrospective review of 141 patients with type 2 diabetes mellitus treated with exenatide at a tertiary clinic.Results: Exenatide (mean duration of treatment, 1.4 years) decreased A1C (0.7%), weight (5 kg), systolic BP (8 mm Hg), and triglyceride concentrations (46 mg/dL) (P<.05 for all). Sixty-one patients continued exenatide therapy throughout the study (mean duration of use, 2.4 years). Exenatide treatment reduced their mean weight by 7 kg, systolic BP by 8 mm Hg, triglycerides by 52 mg/dL, A1C by 1.3%, and CRP by 2.4 mg/L (P<.05 for all). Reductions in systolic BP and CRP were not related to weight loss. The reduction in CRP concentration was significantly related to the baseline CRP concentration (r = 0.78; P<.001) and to change in A1C (r = 0.68; P = .02). Patients who stopped taking exenatide had a reversal of the benefits within 6 months after cessation of treatment.Conclusion: Exenatide treatment in patients with type 2 diabetes has durable and persistent beneficial effects on A1C, weight, CRP, systolic BP, and triglyceride concentrations. Cessation of treatment reverses all these beneficial effects within 6 months. There was no evidence of loss of its effects while exenatide treatment was continued. Free Article
	PMID: 20841306 [PubMed - in process]
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41.	Lipids Health Dis. 2010 Sep 3;9:94. Effect of a 21 day Daniel Fast on metabolic and cardiovascular disease risk factors in men and women. Bloomer RJ, Kabir MM, Canale RE, Trepanowski JF, Marshall KE, Farney TM, Hammond KG. Cardiorespiratory/Metabolic Laboratory, The University of Memphis, Memphis, TN 38152, USA. rbloomer@memphis.edu Abstract BACKGROUND: Dietary modification via caloric restriction is associated with multiple effects related to improved metabolic and cardiovascular health. However, a mandated reduction in kilocalories is not well-tolerated by many individuals, limiting the long-term application of such a plan. The Daniel Fast is a widely utilized fast based on the Biblical book of Daniel. It involves a 21 day ad libitum food intake period, devoid of animal products and preservatives, and inclusive of fruits, vegetables, whole grains, legumes, nuts, and seeds. The purpose of the present study was to determine the efficacy of the Daniel Fast to improve markers of metabolic and cardiovascular disease risk. METHODS: 43 subjects (13 men; 30 women; 35 ± 1 yrs; range: 20-62 yrs) completed a 21 day period of modified food intake in accordance with detailed guidelines provided by investigators. All subjects purchased and prepared their own food. Following initial screening, subjects were given one week to prepare for the fast, after which time they reported to the lab for their pre-intervention assessment (day 1). After the 21 day fast, subjects reported to the lab for their post-intervention assessment (day 22). For both visits, subjects reported in a 12 hr fasted state, performing no strenuous physical activity during the preceding 24-48 hrs. At each visit, mental and physical health (SF-12 form), resting heart rate and blood pressure, and anthropometric variables were measured. Blood was collected for determination of complete blood count, metabolic panel, lipid panel, insulin, HOMA-IR, and C-reactive protein (CRP). Subjects' self-reported compliance, mood, and satiety in relation to the fast were also recorded. Diet records were maintained by all subjects during the 7 day period immediately prior to the fast (usual intake) and during the final 7 days of the fast. RESULTS: Subjects' compliance to the fast was 98.7 ± 0.2% (mean ± SEM). Using a 10 point scale, subjects' mood and satiety were both 7.9 ± 0.2. The following variables were significantly (p < 0.05) lower following the fast as compared to before the fast: white blood cell count (5.68 ± 0.24 vs. 4.99 ± 0.19 103.μL-1), blood urea nitrogen (13.07 ± 0.58 vs. 10.14 ± 0.59 mg.dL-1), blood urea nitrogen/creatinine (14.74 ± 0.59 vs. 11.67 ± 0.68), protein (6.95 ± 0.07 vs. 6.77 ± 0.06 g.dL-1), total cholesterol (171.07 ± 4.57 vs. 138.69 ± 4.39 mg.dL-1), LDL-C (98.38 ± 3.89 vs. 76.07 ± 3.53 mg.dL-1), HDL-C (55.65 ± 2.50 vs. 47.58 ± 2.19 mg.dL-1), SBP (114.65 ± 2.34 vs. 105.93 ± 2.12 mmHg), and DBP (72.23 ± 1.59 vs. 67.00 ± 1.43 mmHg). Insulin (4.42 ± 0.52 vs. 3.37 ± 0.35 μU.mL-1; p = 0.10), HOMA-IR (0.97 ± 0.13 vs.0.72 ± 0.08; p = 0.10), and CRP (3.15 ± 0.91 vs. 1.60 ± 0.42 mg.L-1; p = 0.13), were lowered to a clinically meaningful, albeit statistically insignificant extent. No significant difference was noted for any anthropometric variable (p > 0.05). As expected, multiple differences in dietary intake were noted (p < 0.05), including a reduction in total kilocalorie intake (2185 ± 94 vs. 1722 ± 85). CONCLUSION: A 21 day period of modified dietary intake in accordance with the Daniel Fast is 1) well-tolerated by men and women and 2) improves several risk factors for metabolic and cardiovascular disease. Larger scale, randomized studies, inclusive of a longer time period and possibly a slight modification in food choice in an attempt to maintain HDL cholesterol, are needed to extend these findings. PMCID: PMC2941756 Free PMC Article
	PMID: 20815907 [PubMed - indexed for MEDLINE]
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42.	J Rehabil Med. 2010 Sep;42(8):765-72. Evidence of reduced sympatho-adrenal and hypothalamic-pituitary activity during static muscular work in patients with fibromyalgia. Kadetoff D, Kosek E. Osher Center For Integrative Medicine, Stockholm Brain Institute, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. Abstract OBJECTIVE: To assess activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenocortical axis during static exercise in patients with fibromyalgia. PATIENTS AND METHODS: Sixteen patients with fibromyalgia and 16 healthy controls performed a static knee extension until exhaustion. Plasma catecholamines, adrenocorticotropic hormone and cortisol, as well as blood pressure and heart rate, were assessed before, during and following contraction. Plasma C reactive protein was analysed at baseline. RESULTS: Blood pressure and heart rate increased during contraction (p < 0.001) and decreased following contraction (p < 0.001) in both groups alike. Compared with baseline, plasma catecholamines increased during contraction in both groups (p < 0.001), but patients with fibromyalgia had lower levels of plasma adrenaline (p < 0.04) and noradrenaline (p < 0.08) at all times. Adrenocorticotropic hormone increased at exhaustion in controls (p < 0.001), but not in patients with fibromyalgia, who also had lower adrenocorticotropic hormone at exhaustion (p < 0.02) compared with controls. There were no group differences, or changes over time in plasma cortisol. High sensitivity C reactive protein was higher in patients with fibromyalgia compared with controls (p < 0.02). CONCLUSION: Patients with fibromyalgia exhibited a hypoactive sympatho-adrenal system as well as a hypo-reactive hypothalamic-pituitary axis during static exercise. Free Article
	PMID: 20809059 [PubMed - indexed for MEDLINE]
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43.	Diabetes Care. 2010 Sep;33(9):2084-9. Diabetes, glycemic control, and new-onset heart failure in patients with stable coronary artery disease: data from the heart and soul study. van Melle JP, Bot M, de Jonge P, de Boer RA, van Veldhuisen DJ, Whooley MA. Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. j.p.van.melle@thorax.umcg.nl Comment in: Diabetes Care. 2010 Sep;33(9):2120-2. Abstract OBJECTIVE: Diabetes is a predictor of both coronary artery disease (CAD) and heart failure. It is unknown to what extent the association between diabetes and heart failure is influenced by other risk factors for heart failure. RESEARCH DESIGN AND METHODS: We evaluated the association of diabetes and A1C with incident heart failure in outpatients with stable CAD and no history of heart failure (average follow-up 4.1 years). RESULTS: Of 839 participants, 200 had diabetes (23.8%). Compared with patients who did not have diabetes, those with diabetes had an increased risk of heart failure (hazard ratio [HR] 2.17 [95% CI 1.37-3.44]). Adjustment for risk factors for CAD (age, sex, race, smoking, physical inactivity, obesity, blood pressure, and LDL cholesterol), interim myocardial infarction, and myocardial ischemia did not alter the strength of the association between diabetes and heart failure. After inclusion also of other risk factors for heart failure (left ventricular ejection fraction, diastolic dysfunction, and C-reactive protein) and medication use, diabetes remained an independent predictor of heart failure (HR 3.34 [95% CI 1.65-6.76]; P = 0.001). Each 1% increase in A1C concentration was associated with a 36% increased HR of heart failure hospitalization (HR 1.36 [95% CI 1.17-1.58]). CONCLUSIONS: In patients with stable CAD who are free from heart failure at baseline, diabetes and glycemic control are independent risk factors for new-onset heart failure. The mechanisms by which diabetes and hyperglycemia lead to heart failure deserve further study, as the association is independent of baseline functional assessment of ischemia, systolic and diastolic function, and interim myocardial infarction. PMCID: PMC2928369 [Available on 2011/9/1] Free Article
	PMID: 20805280 [PubMed - indexed for MEDLINE]
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44.	Endocr J. 2010 Sep 29;57(9):811-7. Epub 2010 Aug 24. Associations of metabolic factors, especially serum retinol-binding protein 4 (RBP4), with blood pressure in Japanese--the Tanno and Sobetsu study. Chiba M, Saitoh S, Ohnishi H, Akasaka H, Mitsumata K, Furukawa T, Shimamoto K. Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan. okami@sapmed.ac.jp Abstract Excess secretion of various adipocyte-derived molecules has been linked with insulin resistance, obesity, diabetes, inflammation, atherosclerosis, and cardiovascular disease. Retinol-binding protein 4 (RBP4), one of the new adipocytokine, is recently reported to provide a link between insulin resistance and features of metabolic factors. Hypertension is one of the most influential risk factors among cardiovascular disease. We examined the relationship between systolic blood pressure (BP) levels and metabolic factors including homeostasis model assessment of insulin resistance (HOMA-R), high sensitivity c-reactive protein (hs-CRP), adiponectin, and RBP4. The subjects were 153 men aged 59 ± 14 years and 224 women aged 57 ± 14 years who had undergone medical check-ups in rural communities in 2007. Systolic BP was positively correlated with HOMA-R, hs-CRP and RBP4 but not with adiponectin in women. There was a positive significant relationship between serum RBP4 levels and blood pressure in women, but such a relationship was not found in men. Serum RBP4 levels were not correlated with HOMA-R in either men or women. Serum RBP4 levels negatively were correlated with estimated glomerular filtration rate (eGFR) in women but not in men. Multiple regression analysis revealed that serum RBP4 levels significantly were related to systolic BP independently of age, sex, body mass index (BMI), total cholesterol levels and eGFR. Our study showed that increased levels of RBP4 as well as HOMA-R and hs-CRP in women were significantly associated with increased levels of systolic BP. Free Article
	PMID: 20798476 [PubMed - indexed for MEDLINE]
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45.	Arq Bras Cardiol. 2010 Oct;95(4):464-72. Epub 2010 Aug 13. [Body composition, biochemical and clinical changes of adolescents with excessive adiposity]. [Article in Multiple languages] Serrano HM, Carvalho GQ, Pereira PF, Peluzio Mdo C, Franceschini Sdo C, Priore SE. Universidade Federal de Viçosa, Viçosa, MG, Brasil. hiaranut@yahoo.com.br Abstract BACKGROUND: adolescents with excess body fat and eutrophic had the same metabolic changes expected in obese individuals. OBJECTIVE: to evaluate body composition, anthropometric changes, biochemical and clinical characteristics of female adolescents. METHODS: a total of 113 adolescents from public schools in Viçosa, MG, divided into three groups: group 1 - consisting of eutrophic adolescents with excess body fat; group 2 - eutrophic with body fat within normal limits; and group 3 - with excess weight and body fat. Weight, height, waist and hip circumference, blood pressure were measured. The body mass index (BMI) and waist-hip ratio were calculated. The percentage of body fat was obtained by bioelectrical impedance horizontally, following its own protocol for this evaluation. The assessment of the percentage of body fat and biochemistry was performed after 12 hours of fasting, and analyzed the lipid profile, blood glucose and insulin, homocysteine, leptin and C-reactive protein. Insulin resistance was calculated by HOMA index. RESULTS: the group of eutrophic adolescents, with higher adiposity, behaved in relation to blood pressure, HDL and glucose levels, similarly to adolescents who are overweight. It can be seen that the HOMA index, insulin and leptin increased with increasing body fat. More than half of adolescents had total cholesterol and CRP levels above recommended levels. The most obvious metabolic disorder related to the lipid profile for both groups studied. CONCLUSION: excess adiposity in normal weight adolescents may be related to clinical and biochemical changes similar to those found in adolescents who are overweight. Free Article
	PMID: 20721518 [PubMed - in process]
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46.	PLoS One. 2010 Aug 11;5(8):e12065. The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome. Drager LF, Lopes HF, Maki-Nunes C, Trombetta IC, Toschi-Dias E, Alves MJ, Fraga RF, Jun JC, Negrão CE, Krieger EM, Polotsky VY, Lorenzi-Filho G. Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. luciano.drager@incor.usp.br Abstract BACKGROUND: Obstructive Sleep Apnea (OSA) is tightly linked to some components of Metabolic Syndrome (MetS). However, most of the evidence evaluated individual components of the MetS or patients with a diagnosis of OSA that were referred for sleep studies due to sleep complaints. Therefore, it is not clear whether OSA exacerbates the metabolic abnormalities in a representative sample of patients with MetS. METHODOLOGY/PRINCIPAL FINDINGS: We studied 152 consecutive patients (age 48+/-9 years, body mass index 32.3+/-3.4 Kg/m2) newly diagnosed with MetS (Adult Treatment Panel III). All participants underwent standard polysomnography irrespective of sleep complaints, and laboratory measurements (glucose, lipid profile, uric acid and C-reactive protein). The prevalence of OSA (apnea-hypopnea index>or=15 events per hour of sleep) was 60.5%. Patients with OSA exhibited significantly higher levels of blood pressure, glucose, triglycerides, cholesterol, LDL, cholesterol/HDL ratio, triglycerides/HDL ratio, uric acid and C-reactive protein than patients without OSA. OSA was independently associated with 2 MetS criteria: triglycerides: OR: 3.26 (1.47-7.21) and glucose: OR: 2.31 (1.12-4.80). OSA was also independently associated with increased cholesterol/HDL ratio: OR: 2.38 (1.08-5.24), uric acid: OR: 4.19 (1.70-10.35) and C-reactive protein: OR: 6.10 (2.64-14.11). Indices of sleep apnea severity, apnea-hypopnea index and minimum oxygen saturation, were independently associated with increased levels of triglycerides, glucose as well as cholesterol/HDL ratio, uric acid and C-reactive protein. Excessive daytime sleepiness had no effect on the metabolic and inflammatory parameters. CONCLUSIONS/SIGNIFICANCE: Unrecognized OSA is common in consecutive patients with MetS. OSA may contribute to metabolic dysregulation and systemic inflammation in patients with MetS, regardless of symptoms of daytime sleepiness. PMCID: PMC2920316 Free PMC Article
	PMID: 20711453 [PubMed - indexed for MEDLINE]
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47.	Circ J. 2010 Oct;74(10):2066-73. Epub 2010 Aug 6. Reduction of the PaO2/FiO2 ratio in acute aortic dissection – relationship between the extent of dissection and inflammation –. Kurabayashi M, Okishige K, Azegami K, Ueshima D, Sugiyama K, Shimura T, Maeda M, Aoyagi H, Isobe M. Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan. kurabayashi.card@yokohama.jrc.or.jp Abstract BACKGROUND: Acute aortic dissection (AAD) often accompanies acute respiratory failure. The aim of this study was to clarify the relationship between the incidence of oxygenation impairment and the extent of distal type AAD. METHODS AND RESULTS: A total of 49 patients with medically treated distal type AAD were retrospectively examined. AAD% was defined as the percentage of the volume of false lumen to that of aorta in the descending aorta. AAD% was measured by computed tomography. C-reactive protein (CRP) levels, white blood cell (WBC) counts, body temperature and arterial partial pressure of oxygen/fraction of inspired oxygen (PaO(2)/FiO(2)) ratio were measured serially. Oxygenation impairment was defined as a PaO(2)/FiO(2) ratio ≤ 200. This occurred in 19 patients (39%). In patients with oxygenation impairment, AAD% (50.8 ± 10.9% vs 28.0 ± 11.9%, P<0.001), peak CRP levels (15.2 ± 6.5 mg/dl vs 9.6 ± 4.6 mg/dl, P<0.001), peak WBC counts (13,600 ± 3,700/µl vs 10,400 ± 2,800 /µl, P=0.001) and body temperature (38.1 ± 0.5°C vs 37.8 ± 0.4°C, P=0.045) were higher than those without oxygenation impairment. It was found that there were inverse correlations between the PaO(2)/FiO(2) ratio and AAD% (r=-0.604, P<0.001), and between peak CRP levels and the PaO(2)/FiO(2) ratio (r=-0.635, P<0.001). Multivariate analysis demonstrated that the only independent predictor of oxygenation impairment was AAD% (odds ratio, 1.323; 95% confidence interval, 1.035-1.691, P=0.026). CONCLUSIONS: Respiratory failure in AAD appears to be closely correlated with the amount of aortic injury, possibly mediated by the magnitude of the systemic inflammatory reaction to the aortic injury. Free Article
	PMID: 20697178 [PubMed - indexed for MEDLINE]
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48.	Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2010 Jul;35(7):699-704. [Change of serum soluble CD14 level in newly diagnosed type 2 diabetes and its significance]. [Article in Chinese] Mo H, Liu S, Zhou Z, Tang W, Yan X, Huang G, Li J, Feng Q. Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha 410011, China. Abstract OBJECTIVE: To determine the correlation of serum soluble CD14 (sCD14) level with the injury of vascular endothelial cells and chronic low grade inflammation in newly diagnosed Type 2 diabetes (T2DM). METHODS: ELISA was used to examine serum sCD14 and serum soluble E-selectin (sE-selectin) level, while immunoturbidimetric assay was used to detect serum high sensitivity C reactive protein (hsCRP). RESULTS: The levels of serum sCD14, sE-selectin, and hsCRP in newly diagnosed T2DM group were higher than those in the euglycemic group [sCD14: (300.7+/-136.6) ng/mL vs. (273.3+/-86.0) ng/mL); sE-selectin: (21.3+/-7.7) ng/mL vs. (32.9+/-11.4) ng/mL; hsCRP: (1.45+/-1.21) mg/L vs. (2.37+/-1.45)mg/L], and there was a significant difference in the latter two parameters between the 2 groups(P<0.01). In the patients with newly diagnosed T2DM, after matching blood pressure, blood sugar, and blood lipid, the levels of serum sCD14, sE-selectin, and hsCRP in the obese group were higher than those in the non-obese group. There was no significant difference in the former 2 parameters between the 2 groups. The serum sE-selectin was correlated with fasting blood sugar (r=0.369, P<0.001), 2-hour postprandial blood sugar (r=0.421, P<0.001), glycosylated hemoglobin (r=0.291, P=0.005), sCD14(r=0.312, P=0.002), and homeostasis model assessment-insulin resistance(r=0.247, P=0.018) in the newly diagnosed T2DM group. Stepwise regression ana-lysis showed that the serum sCD14 was one of the chief influencing factors on serum sE-selectin. CONCLUSION: Serum sCD14 levels tend to increase in newly diagnosed T2DM patients, especially in the obese diabetic patients, which is one of the chief influencing factors to induce the injury of vascular endothelial cells. The innate immunity mediated by Toll-like receptor 4 may take part in the injury of vascular endothelial cells in newly diagnosed T2DM patients. Free Article
	PMID: 20693711 [PubMed - in process]
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49.	Intern Med. 2010;49(15):1477-82. Epub 2010 Aug 2. Comparison among body mass index (BMI), waist circumference (WC), and percent body fat (%BF) as anthropometric markers for the clustering of metabolic risk factors in Japanese. Oda E, Kawai R. Medical Check-up Center, Tachikawa Medical Center, Nagaoka. ijie@venus.sannet.ne.jp Abstract OBJECTIVE: To compare body mass index (BMI), waist circumference (WC), and percent body fat (%BF) as markers for the clustering of metabolic risk factors in Japanese. METHODS: Age-adjusted correlation coefficients (Rs) were calculated between the three anthropometric markers of obesity and metabolic risk factors in 2,444 men and 1,442 women among Japanese. Areas under receiver operating characteristic curves (AUCs) of BMI, WC, and %BF were calculated for diagnosing the clustering of 1 or more, 2 or more, 3 or more, and 4 risk factors among increased blood pressure, impaired fasting glucose, increased triglycerides, and decreased HDL cholesterol and for the clustering of 1 or more, 2 or more, 3 or more, 4 or more, 5 or more, and 6 risk factors among the upper four risk factors as well as increased high-sensitivity C-reactive protein and increased LDL cholesterol. RESULTS: The Rs were not significantly different among BMI, WC, and %BF except for the difference between the R of BMI (0.217) and that of %BF (0.283) with LDL cholesterol in men (p=0.014). The AUCs of BMI, WC, and %BF for diagnosing any of the risk factor clustering patterns defined above were not significantly different in both men and women. CONCLUSION: The AUCs for diagnosing the clustering of metabolic risk factors were not significantly different among BMI, WC, and %BF. Free Article
	PMID: 20686277 [PubMed - in process]
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50.	Clin Med Res. 2011 Mar;9(1):17-25. Epub 2010 Aug 3. A pilot study of gene/gene and gene/environment interactions in Alzheimer disease. Ghebranious N, Mukesh B, Giampietro PF, Glurich I, Mickel SF, Waring SC, McCarty CA. Corresponding Author: Catherine A. McCarty, MPH; Marshfield Clinic Research Foundation; 1000 North Oak Avenue, Marshfield, WI 54449; . mccarty.catherine@mcrf.mfldclin.edu. Abstract Background: Although some genes associated with increased risk of Alzheimer Disease (AD) have been identified, few data exist related to gene/gene and gene/environment risk of AD. The purpose of this pilot study was to explore gene/gene and gene/environment associations in AD and to obtain data for sample size estimates for larger, more definitive studies of AD. Methods: The effect of gene/gene and gene/environment interaction related to late onset Alzheimer Disease (LOAD) was investigated in 153 subjects with LOAD and 302 gender matched controls enrolled in the Personalized Medicine Research Project, a population-based bio-repository. Genetic risk factors examined included APOE, ACE, OLR1,and CYP46 genes, and environmental factors included smoking, total cholesterol, LDL, HDL, triglycerides, C-reactive protein, blood pressure, statin use, and body mass index. Results: The mean age of the cases was 78.2 years and the mean age of the controls was 87.2 years. APOE4 was significantly associated with LOAD (OR=3.55, 95%CL=1.70, 7.45). Cases were significantly more likely to have ever smoked cigarettes during their life (49.3% versus 38.4%, p=0.03). The highest recorded blood pressure and pulse pressure measurements were significantly higher in the controls than the cases (all P<0.005). Although not statistically significant in this pilot study, the relationship of the following factors was associated in opposite directions with LOAD based on the presence of an APOE4 allele: obesity at the age of 50, ACE, OLR1, and CYP46. Conclusions: These pilot data suggest that gene/gene and gene/environment interactions may be important in LOAD, with APOE, a known risk factor for LOAD, affecting the relationship of ACE and OLR1 to LOAD. Replication with a larger sample size and in other racial/ethnic groups is warranted and the allele and risk factor frequencies will assist in choosing an appropriate sample size for a definitive study. PMCID: PMC3064752 Free PMC Article
	PMID: 20682755 [PubMed - in process]
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51.	Circ J. 2010 Oct;74(10):2118-24. Epub 2010 Jul 29. Beneficial effects of adaptive servo ventilation in patients with chronic heart failure. Koyama T, Watanabe H, Kobukai Y, Makabe S, Munehisa Y, Iino K, Kosaka T, Ito H. Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine, Akita, Japan. Comment in: Circ J. 2010 Oct;74(10):2056-7. Abstract BACKGROUND: Sleep-disordered breathing (SDB) is thought to be a state of inflammation caused by hypoxic stress. Whether adaptive servo ventilation (ASV) attenuates the inflammatory response and improves the cardiac function of patients with congestive heart failure (CHF) accompanied by SDB was not been investigated. METHODS AND RESULTS: Seventeen inpatients with New York Heart Association (NYHA) II or III underwent polysomnography. There was a positive correlation between the apnea hypopnea index and high-sensitivity C-reactive protein (hs-CRP) level (r=0.753, P=0.016). The patients were divided into ASV (n=10) and non-ASV groups (n=7), and CHF-parameters were measured before and after ASV treatment. Improvement was noted for the NYHA class in the ASV group but not in the non-ASV group. In contrast to the non-ASV group, the level of brain natriuretic peptide (BNP), ejection fraction, and hs-CRP levels in the ASV group significantly improved (BNP, 212.1 ± 181.2 to 77.3 ± 54.0 pg/ml [P<0.05]; ejection fraction, 43.5 ± 6.4 to 53.3 ± 6.1% [P=0.002]; hs-CRP, 0.85 ± 0.58 to 0.21 ± 0.19 mg/dl, [P=0.008]). The increase in ejection fraction was correlated with a decrease in the hs-CRP level (r=-0.753, P=0.001). CONCLUSIONS: Anti-inflammatory effects of ASV are important contributors for improving cardiac function in patients with CHF accompanied by SDB.  Free Article
	PMID: 20679736 [PubMed - indexed for MEDLINE]
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52.	Eur J Endocrinol. 2010 Oct;163(4):601-7. Epub 2010 Aug 2. Adiposity and insulin resistance correlate with telomere length in middle-aged Arabs: the influence of circulating adiponectin. Al-Attas OS, Al-Daghri NM, Alokail MS, Alfadda A, Bamakhramah A, Sabico S, Pritlove D, Harte A, Tripathi G, McTernan PG, Kumar S, Chrousos G. Department of Biochemistry, Obesity Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia. Abstract OBJECTIVE: Studies in obesity have implicated adipocytokines in the development of insulin resistance, which in turn may lead to accelerated aging. In this study, we determined associations of chromosomal telomere length (TL) to markers of obesity and insulin resistance in middle-aged adult male and female Arabs with and without diabetes mellitus type 2 (DMT2). DESIGN AND METHODS: One hundred and ninety-three non-diabetic and DMT2 subjects without complications (97 males and 96 females) participated in this cross-sectional study. Clinical data, as well as fasting blood samples, were collected. Serum glucose and lipid profile were determined using routine laboratory methods. Serum insulin, leptin, adiponectin, resistin, tumor necrosis factor-α, and PAI-1 were quantified using customized multiplex assay kits. High sensitive C-reactive protein (hsCRP) and angiotensin II (ANG II) were measured using ELISAs. Circulating leukocyte TL was examined by quantitative real-time PCR. RESULTS: Circulating chromosomal leukocyte TL had significant inverse associations with body mass index (BMI), systolic blood pressure, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), low-density lipoprotein (LDL)- and total cholesterol, ANG II and hsCRP levels. Adiponectin, BMI, systolic blood pressure, and LDL cholesterol predicted 47% of the variance in TL (P<0.0001). HOMA-IR was the most significant predictor for TL in males, explaining 35% of the variance (P=0.01). In females, adiponectin accounted for 28% of the variance in TL (P=0.01). CONCLUSION: Obesity and insulin resistance are associated with chromosomal TL among adult Arabs. Evidence of causal relations needs further investigation. The positive association of adiponectin to TL has clinical implications as to the possible protective effects of this hormone from accelerated aging. PMCID: PMC2938925 Free PMC Article
	PMID: 20679357 [PubMed - indexed for MEDLINE]
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53.	Pneumonol Alergol Pol. 2010;78(4):271-8. [The influence of inflammatory process on the ventilatory impairment in patients with stable chronic obstructive pulmonary disease]. [Article in Polish] Komnata K. II Oddział Chorób Płuc, Krakowski Szpital Specjalistyczny im. Jana Pawła II, ul. Pradnicka 80, 31-202 Kraków. kkomnata@szpitaljp2.krakow.pl Abstract INTRODUCTION: At present, COPD is known to be a systemic disease resulting from generalized inflammation which affects the function of many organs. Generalized inflammation is recognized from increased serum concentration of inflammatory cytokines. The aim of the present study was to investigate the influence of inflammatory process on the respiratory impairment in patients with stable chronic obstructive pulmonary disease. MATERIAL AND METHODS: A group of 60 stable COPD patients (GOLD stages I-IV) participated in the study. Inclusion criteria were: confirmed diagnosis of chronic obstructive pulmonary disease, clinical stable state, established treatment which had not been changed for at least 3 months prior to the study or in the course of the study. Exclusion criteria included coexistence of other diseases and/or medication causing an increase of markers of inflammation. In all patients inflammatory markers (serum concentration of fibrinogen, hs-CRP, IL-6, TNF-alpha) were determined. In order to assess the stage of COPD, bodyplethysmography with bronchodilating test was conducted and lung hyperinflation parameters were assessed. RESULTS: Analysis of relationship between markers of systemic inflammation and spirometry variables revealed a significant negative correlation between the level of hs-CRP and signs of hyperinflation; IC% of predicted value (r(s) = -0.29; p = 0.023) and IC/TLC (r(s) = -0.32; p = 0.014). The IC/TLC index also tended to be related to the concentration of fibrinogen. Higher fibrinogen concentrations were associated with lower IC/TLC values, albeit without statistical significance (r(s) = -0.23; p = 0.074). There was a positive relationship between serum concentration of TNF-alpha and arterial blood carbon dioxide pressure PaCO(2) (r = 0.281; p = 0.03) as well as right ventricle systolic pressure RVSP in echocardiography (r = 0.332; p = 0.01). CONCLUSIONS: Severity of hyperinflation progression may be associated with the increase of inflammatory process in patients with stable COPD. Inflammatory process may have an adverse affect on the respiratory system increasing significantly static lung hyperinflation. Free Article
	PMID: 20665447 [PubMed - indexed for MEDLINE]
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54.	Lipids Health Dis. 2010 Jul 22;9:76. Effects of aerobic and strength-based training on metabolic health indicators in older adults. Martins RA, Veríssimo MT, Coelho e Silva MJ, Cumming SP, Teixeira AM. Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal. raulmartins@fcdef.uc.pt Abstract BACKGROUND: The weakening of the cardiovascular system associated with aging could be countered by increasing levels of physical activity and functional fitness. However, inconsistent findings have been found, and the variety of characteristics of exercise used in previous studies may partly explain that inconsistent results. OBJECTIVE: To investigate the training effect of sixteen weeks of moderate intensity, progressive aerobic and strength-based training on metabolic health of older women and men. METHODS: Sixty three sedentary individuals (mean (SD) age 76 (8) years) were randomly assigned to control (n = 31) or exercising (n = 32) groups. The training group was separated to aerobic (n = 18) or strength-based (n = 14). Training took place three times a week. Subjects agreed not to change their diet or lifestyle over the experimental period. RESULTS: Exercising group attained after treatment significant differences on body weight, waist circumference, body mass index, diastolic blood pressure, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, total cholesterol/HDL-cholesterol relationship, high sensitivity C-reactive protein, and 6-minute walk distance. The control group only had significant differences on waist circumference. CONCLUSION: The training programs produced significant benefits on metabolic health indicators of sedentary older women and men. PMCID: PMC2912308 Free PMC Article
	PMID: 20663148 [PubMed - indexed for MEDLINE]
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55.	Clin Med Res. 2010 Jul;8(2):89-95. The levels of soluble CD40 ligand and C-reactive protein in normal weight, overweight and obese people. Unek IT, Bayraktar F, Solmaz D, Ellidokuz H, Sisman AR, Yuksel F, Yesil S. Dokuz Eylul University School of Medicine, Department of Internal Medicine, 35340, Inciralti, Izmir, Turkey. tugba.gun@deu.edu.tr Abstract OBJECTIVE: Obesity has been suggested as an independent risk factor for cardiovascular disease. Increasing evidence shows that engagement of soluble CD40 ligand (sCD40L) with its receptor plays a crucial role in the pathogenesis of atherosclerosis. The aim of the present study was to test whether obesity is associated with low-grade systemic inflammation as measured by serum high-sensitive C-reactive protein (hsCRP) and sCD40L concentration. METHODS: Serum hsCRP and sCD40L concentrations were measured in 148 nondiabetic people. The participants were divided into three groups depending upon their body mass index (BMI) levels: Group 1 (normal weight), BMI<25 kg/m(2); Group 2 (overweight), BMI 25 kg/m(2) to 29.9 kg/m(2); and Group 3 (obese), BMI>or=30 kg/m(2). RESULTS: Obese people had more elevated hsCRP levels than both their normal weight and overweight counterparts (P=0.000 and P=0.000, respectively). Similarly, serum concentrations of sCD40L were significantly higher, statistically, in obese subjects compared with normal weight subjects (P=0.003). In addition, obese subjects had higher values of sCD40L than overweight subjects, but the difference did not reach statistical significance (P=0.063). The levels of high-density lipoprotein cholesterol were significantly lower in obese subjects compared to normal weight subjects (P=0.048). The analysis of platelet count disclosed a statistically significant difference between obese subjects and normal weight subjects (P=0.028). The levels of BMI were positively correlated with the serum levels of hsCRP and sCD40L in all subjects (r=0.514, P=0.000 and r=0.283, P=0.000, respectively). Levels of hsCRP were positively correlated with waist circumference, fasting glucose, total cholesterol, triglyceride, low-density lipoprotein cholesterol, leukocytes, platelets, systolic and diastolic blood pressure. Similarly, soluble CD40L levels were positively correlated with waist circumference, fasting glucose and leukocytes. CONCLUSION: Obese patients showed a significant increase of hsCRP and sCD40L levels compared with normal weight subjects, which might contribute to the known proinflammatory milieu found in these patients. PMCID: PMC2910107 Free PMC Article
	PMID: 20660932 [PubMed - indexed for MEDLINE]
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56.	J Inflamm (Lond). 2010 Jul 26;7:36. Prediabetes and prehypertension in disease free obese adults correlate with an exacerbated systemic proinflammatory milieu. Gupta AK, Johnson WD. Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA. alok.gupta@pbrc.edu. Abstract ABSTRACT: BACKGROUND: Obesity is a pro-inflammatory state frequently associated with widespread metabolic alterations that include insulin resistance and deregulation of blood pressure (BP). This cascade of events in some measure explains the susceptibility of obese adults for co-morbid conditions like diabetes mellitus and hypertension. HYPOTHESIS: We hypothesized that an elevated systemic proinflammatory burden correlates with dysglycemia and deregulated blood pressure. METHODS: We analyzed the screening anthropometric and laboratory measures from healthy disease free obese adults (n = 35; women (W) 27, men (M) 8) in a weight loss study. RESULTS: Healthy obese normoglycemic (fasting serum glucose: FSG <100 mg/dL) women and men compared with healthy obese with prediabetes (FSG 100-125 mg/dL) had no significant differences for age (Mean +/- SD: 52 +/- 12 vs. 56 +/- 9 y), weight (95 +/- 11 vs. 99 +/- 13 kg), or waist circumference (108 +/- 10 vs. 108 +/- 11 cm). Normoglycemic group (n = 24; W = 19, M = 5) had normal FSG 92 +/- 4 mg/dL, HbA1c 5.4 +/- 0.3%, BP 118/75 mm Hg, but had elevated high sensitivity C-reactive protein (hs CRP) 3.7 +/- 3 mg/L and fibrinogen 472 +/- 76 mg/dL. The group with prediabetes (n = 11; W = 8, M = 3) with significantly higher FSG (106 +/- 3 mg/dL; p < 0.0001), HbA1c (5.9 +/- 0.5%; p < 0.002), had prehypertension (BP: 127/80 mm Hg) and significantly higher hs CRP (16.9 +/- 9 mg/; p < 0.0001) and fibrinogen (599 +/- 95 mg/dL; p < 0.0002). CONCLUSIONS: In otherwise healthy disease free obese adults, a higher degree of systemic inflammation is associated with prediabetes and prehypertension. PMCID: PMC2920244 Free PMC Article
	PMID: 20659335 [PubMed - in process]
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57.	Mediators Inflamm. 2010;2010:592760. Epub 2010 Jun 21. Effects of sitagliptin treatment on dysmetabolism, inflammation, and oxidative stress in an animal model of type 2 diabetes (ZDF rat). Ferreira L, Teixeira-de-Lemos E, Pinto F, Parada B, Mega C, Vala H, Pinto R, Garrido P, Sereno J, Fernandes R, Santos P, Velada I, Melo A, Nunes S, Teixeira F, Reis F. Institute of Pharmacology & Experimental Therapeutics, IBILI, Medicine Faculty, University of Coimbra, 3000-354 Coimbra, Portugal. Abstract The purpose of this paper is to evaluate the chronic effect of sitagliptin on metabolic profile, inflammation, and redox status in the Zucker Diabetic Fatty (ZDF) rat, an animal model of obese type 2 diabetes. Diabetic and obese ZDF (fa/fa) rats and their controls (ZDF +/+) were treated during 6 weeks with vehicle (control) and sitagliptin (10 mg/kg/bw). Glucose, HbA1c, insulin, Total-c, TGs, IL-1beta, TNF-alpha, CRPhs, and adiponectin were assessed in serum and MDA and TAS in serum, pancreas, and heart. Pancreatic histology was also evaluated. Sitagliptin in diabetic rats promoted a decrease in glucose, HbA1c, Total-c, and TGs accompanied by a partial prevention of insulinopenia, together, with a decrease in CRPhs and IL-1beta. Sitagliptin also showed a positive impact on lipid peroxidation and hypertension prevention. In conclusion, chronic sitagliptin treatment corrected the glycaemic dysmetabolism, hypertriglyceridaemia, inflammation, and hypertension, reduced the severity of the histopathological lesions of pancreatic endocrine and exocrine tissues, together with a favourable redox status, which might be a further advantage in the management of diabetes and its proatherogenic comorbidities. PMCID: PMC2905949 Free PMC Article
	PMID: 20652060 [PubMed - indexed for MEDLINE]
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58.	Int J Environ Res Public Health. 2010 Jun;7(6):2452-9. Epub 2010 May 28. Living with companion animals, physical activity and mortality in a U.S. national cohort. Gillum RF, Obisesan TO. Department of Medicine, College of Medicine, Howard University, 2041 Georgia Avenue, Washington, DC 20060, USA. rfg2.howard.edu@gmail.com Abstract Living with a canine companion is postulated to increase physical activity. We test the hypotheses that adults living with a canine companion have a higher level of physical activity and reduced mortality risk compared to those not living with a companion animal. A U.S. national health survey with longitudinal mortality follow-up studied 11,394 American men and women aged 40 years and over examined in 1988-1994 followed an average 8.5 years. Measurements at baseline included self-reported companion animals in the household, socio-demographics, health status, physical and biochemical measurements. Outcome measures were leisure-time physical activity (LTPA), and death from all causes. Death during follow-up occurred in 3,187 persons. In bivariate cross-sectional analyses living with a dog was associated with more frequent LTPA and higher survival. In proportional hazards regression analysis, no significant interaction of age, gender or ethnicity with animals was found. After adjusting for confounding by baseline socio-demographics and health status at ages 40+, the hazards ratio (95% confidence limits) for living with a canine companion compared to no animals was 1.21(1.04-1.41, p < 0.001). After also controlling for health behaviors, blood pressure and body mass, C-reactive protein and HDL-cholesterol, the HR was 1.19 (0.97-1.47, NS). In a nationwide cohort of American adults, analyses demonstrated no lower risk of death independent of confounders among those living with canine or feline companions, despite positive association of canine companions with LTPA. PMCID: PMC2905559 Free PMC Article
	PMID: 20644682 [PubMed - in process]
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59.	CMAJ. 2010 Sep 21;182(13):1427-32. Epub 2010 Jul 19. The hypertriglyceridemic-waist phenotype and the risk of coronary artery disease: results from the EPIC-Norfolk prospective population study. Arsenault BJ, Lemieux I, Després JP, Wareham NJ, Kastelein JJ, Khaw KT, Boekholdt SM. Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec. Abstract BACKGROUND: Screening for increased waist circumference and hypertriglyceridemia (the hypertriglyceridemic-waist phenotype) has been proposed as an inexpensive approach to identify patients with excess intra-abdominal adiposity and associated metabolic abnormalities. We examined the relationship between the hypertriglyceridemic-waist phenotype to the risk of coronary artery disease in apparently healthy individuals. METHODS: A total of 21,787 participants aged 45-79 years were followed for a mean of 9.8 (standard deviation 1.7) years. Coronary artery disease developed in 2109 of them during follow-up. The hypertriglyceridemic-waist phenotype was defined as a waist circumference of 90 cm or more and a triglyceride level of 2.0 mmol/L or more in men, and a waist circumference of 85 cm or more and a triglyceride level of 1.5 mmol/L or more in women. RESULTS: Compared with participants who had a waist circumference and triglyceride level below the threshold, those with the hypertriglyceridemic-waist phenotype had higher blood pressure indices, higher levels of apolipoprotein B and C-reactive protein, lower levels of high-density lipoprotein cholesterol and apolipoprotein A-I, and smaller low-density lipoprotein particles. Among men, those with the hypertriglyceridemic-waist phenotype had an unadjusted hazard ratio for future coronary artery disease of 2.40 (95% confidence interval [CI] 2.02-2.87) compared with men who did not have the phenotype. Women with the phenotype had an unadjusted hazard ratio of 3.84 (95% CI 3.20-4.62) compared with women who did not have the phenotype. INTERPRETATION: Among participants from a European cohort representative of a contemporary Western population, the hypertriglyceridemic-waist phenotype was associated with a deteriorated cardiometabolic risk profile and an increased risk for coronary artery disease. PMCID: PMC2942915 Free PMC Article
	PMID: 20643837 [PubMed - indexed for MEDLINE]
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60.	Eur J Epidemiol. 2010 Sep;25(9):643-9. Epub 2010 Jul 18. HFE gene mutations increase the risk of coronary heart disease in women. Pardo Silva MC, Njajou OT, Alizadeh BZ, Hofman A, Witteman JC, van Duijn CM, Janssens AC. Department of Epidemiology, Erasmus University Medical Center Rotterdam, The Netherlands. Abstract The purpose of the present study is to examine HFE gene mutations in relation to newly diagnosed (incident) coronary heart disease (CHD). In a population-based follow-up study of 7,983 individuals aged 55 years and older, we compared the risk of incident CHD between HFE carriers and non-carriers, overall and stratified by sex and smoking status. HFE mutations were significantly associated with an increased risk of incident CHD in women but not in men (hazard ratio [HR] for women = 1.7, 95% confidence interval [CI] 1.2-2.4 versus HR for men = 0.9, 95% CI 0.7-1.2). This increased CHD risk associated with HFE mutations in women was statistically significant in never smokers (HR = 1.8, 95% CI 1.1-2.8) and current smokers (HR = 3.1, 95% CI 1.4-7.1), but not in former smokers (HR = 1.3, 95% CI 0.7-2.4). HFE mutations are associated with increased risk of incident CHD in women. PMCID: PMC2931632 Free PMC Article
	PMID: 20640879 [PubMed - indexed for MEDLINE]
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61.	Korean Diabetes J. 2010 Jun;34(3):182-90. Epub 2010 Jun 30. Association between Obesity and Physical Fitness, and Hemoglobin A1c Level and Metabolic Syndrome in Korean Adults. Jekal Y, Lee MK, Park S, Lee SH, Kim JY, Kang JU, Naruse M, Kim SH, Kim SH, Chu SH, Suh SH, Jeon JY. Department of Sport and Leisure Studies, Yonsei University College of Education, Seoul, Korea. Abstract BACKGROUND: The purpose of the current study was to investigate the association of obesity level, physical fitness level, hemoglobin A1c (HbA1c) level and metabolic syndrome (MetS) risk factors among Korean adults. METHODS: A total of 557 adults (272 males and 285 females) who underwent medical check-up at local hospital were recruited. In addition to regular health check-up, cardiopulmonary fitness, muscular endurance were measured and their association were analyzed. RESULTS: The prevalence of MetS was 31.7% for males and 23.7% for females. Females with the higher muscular endurance had lower waist circumference, triglyceride level, and HbA1c level than those with the lower muscular endurance. Males with the higher level of cardiopulmonary fitness had lower diastolic blood pressure, lower high-sensitivity C-reactive protein level and higher high density lipoprotein cholesterol level than males with the lower level of cardiopulmonary fitness. Females with the higher level of cardiopulmonary fitness had lower body weight, body mass index, systolic blood pressure, and fasting blood glucose level than females with the lower level of cardiopulmonary fitness. Participants with the higher level of adiposity and the lower level of physical fitness were 5.26 times (95% confidence interval [CI], 2.19 to 12.62), 5.71 times (95% CI, 2.23 to 14.60) more likely to have MetS, respectively, in male and female compared to participants who were neither obese nor have the lower level of fitness. CONCLUSION: This study suggests that maintaining a healthy body weight as well as a certain level of fitness is important for the prevention of MetS. PMCID: PMC2898932 Free PMC Article
	PMID: 20617079 [PubMed - in process]
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62.	Diabetes Care. 2010 Jul;33(7):1413-8. Potential additional effect of omentectomy on metabolic syndrome, acute-phase reactants, and inflammatory mediators in grade III obese patients undergoing laparoscopic Roux-en-Y gastric bypass: a randomized trial. Herrera MF, Pantoja JP, Velázquez-Fernández D, Cabiedes J, Aguilar-Salinas C, García-García E, Rivas A, Villeda C, Hernández-Ramírez DF, Dávila A, Zaraín A. Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Tlalpan, Mexico. herreram@quetzal.innsz.mx Comment in: Diabetes Care. 2010 Jul;33(7):1693-4. Abstract OBJECTIVE: To assess the additional effect of sudden visceral fat reduction by omentectomy on metabolic syndrome, acute-phase reactants, and inflammatory mediators in patients with grade III obesity (G-III O) undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB). RESEARCH DESIGN AND METHODS: Twenty-two patients were randomized into two groups, LRYGB alone or with omentectomy. Levels of interleukin-6, C-reactive protein, tumor necrosis factor-alpha, leptin, adiponectin, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides, as well as clinical characteristics, were evaluated before surgery and at 1, 3, 6, and 12 months after surgery. Results were compared between groups. RESULTS: Baseline characteristics were comparable in both groups. Mean operative time was significantly higher in the group of patients who underwent omentectomy (P < 0.001). Median weight of the omentum was 795 +/- 341 g. In one patient, a duodenal perforation occurred at the time of omentectomy. BMI, blood pressure, glucose, total cholesterol, LDL, and triglycerides significantly improved in both groups at 1, 3, 6, and 12 months of follow-up when compared with basal values. However, there were no consistent statistically significant differences among the groups in terms of metabolic syndrome components, acute-phase reactants, and inflammatory mediators. CONCLUSIONS: Omentectomy does not have an ancillary short-term significant impact on the components of metabolic syndrome and does not induce important changes in the inflammatory mediators in patients undergoing LRYGB. Operative time is more prolonged when omentectomy is performed. PMCID: PMC2890331 [Available on 2011/7/1] Free Article
	PMID: 20587720 [PubMed - indexed for MEDLINE]
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63.	J Clin Sleep Med. 2010 Jun 15;6(3):251-5. Endothelial function in patients with post-CPAP residual sleepiness. El-Solh AA, Akinnusi ME, Moitheennazima B, Ayyar L, Relia S. The Veterans Affairs Western New York Healthcare System, Buffalo, NY 14215-1199, USA. solh@buffalo.edu Abstract STUDY OBJECTIVES: The significance of residual excessive daytime sleepiness (EDS) on cardiovascular markers in patients with adequately treated obstructive sleep apnea (OSA) remains unclear. The objective of this study was to investigate flow-mediated dilatation (FMD) and inflammatory markers (C-reactive protein [CRP], tumor necrosis factor [TNF]-alpha, and interleukin [IL]-6) in continuous positive airway pressure (CPAP)-compliant patients with residual EDS compared with CPAP-compliant patients without residual EDS. METHODS: FMD of the brachial artery was measured by ultrasound in 12 CPAP-compliant patients with OSA who had residual EDS and 12 age-, sex-, and body mass index-matched CPAP-compliant patients with OSA who did not have residual EDS on week 8 after initiation of CPAP. Twelve otherwise-healthy subjects without sleep disordered breathing were used as control subjects. Serum concentrations of CRP, TNF-alpha, and IL-6 were quantified by enzyme-linked immunosorbent assays. RESULTS: Baseline FMD was comparable among CPAP-compliant patients with residual EDS (7.2 +/- 2.3), CPAP-compliant patients without residual EDS (8.6 +/- 2.1), and control subjects (7.7 +/- 1.4) (p = 0.37). The concentrations of CRP, TNF-alpha, and IL-6 were also not significantly different between subjects with CPAP-compliant residual EDS and those without residual EDS (p = 0.44, p = 0.37, and p = 0.42; respectively). CONCLUSIONS: Residual EDS in patients with adequately treated OSA may not represent a risk factor for cardiovascular diseases. PMCID: PMC2883036 Free PMC Article
	PMID: 20572418 [PubMed - indexed for MEDLINE]
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64.	J Atheroscler Thromb. 2010 Oct 27;17(10):1003-8. Epub 2010 Jun 12. Fibrinogen promotes early atherosclerotic changes of the carotid artery in young, healthy adults. Grebe MT, Luu B, Sedding D, Heidt MC, Kemkes-Matthes B, Schaefer CA, Tillmanns HH, Gündüz D. Department of Cardiology and Angiology, Medical Clinic, University Clinic Giessen and Marburg, Klinikstrasse 36, Giessen, Germany. Mathias.Grebe@innere.med.uni-giessen.de Abstract AIM: To determine whether high plasma levels or activities of different hemostatic proteins contribute to the development of early atherosclerotic vessel wall changes. Elevated levels of various hemostatic proteins and markers of inflammation have been linked to an increased risk of ischemic cardiovascular events; however, the mechanisms by which these molecules might contribute to this increased risk is not clear. METHODS: The intima-media thickness of the common carotid arteries (CCA-IMT) of 125 healthy young volunteers without known cardiovascular risk factors was measured by high-resolution ultrasound. Plasma concentrations of fibrinogen, thrombomodulin, protein Z and CRP were quantified, and the plasma activities of protein C, plasminogen and factor VIII were measured. Other established risk factors, such as body mass index (BMI) and plasma levels of cholesterol, triglycerides and homocysteine, were also determined. Furthermore, the carotid arteries were examined for the presence of plaques and stenoses. RESULTS: Univariate analysis showed a significant negative correlation between CCA-IMT and HDL cholesterol, and positive correlations with age, BMI, LDL cholesterol, triglycerides, homocysteine, fibrinogen and thrombomodulin, but not with total cholesterol, lipoprotein(a) and hsCRP. CCA-IMT was also statistically independent of the activities of protein C, factor VIII and plasminogen. Multivariate analysis revealed a significant correlation of CCA-IMT with age, BMI and fibrinogen. CONCLUSION: Our data suggest that fibrinogen levels correlate with early atherosclerotic changes of the carotid artery in a population with very low cardiovascular risk. Free Article
	PMID: 20551578 [PubMed - indexed for MEDLINE]
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65.	Korean Diabetes J. 2010 Apr;34(2):111-8. Epub 2010 Apr 30. The Association between Serum GGT Concentration and Diabetic Peripheral Polyneuropathy in Type 2 Diabetic Patients. Cho HC. Department of Internal Medicine, Daegu Medical Center, Daegu, Korea. Abstract BACKGROUND: Diabetic peripheral polyneuropathy (DPP) is one of the common complications of diabetes mellitus (DM) and can lead to foot ulcers or amputation. The pathophysiology of DPP includes several factors such as metabolic, vascular, autoimmune, oxidative stress and neurohormonal growth-factor deficiency and recent studies have suggested the use of serum gamma-glutamyl transferase (GGT) as an early marker of oxidative stress. Therefore, we investigated whether serum GGT may be useful in predicting DPP. METHODS: We assessed 90 patients with type 2 DM who were evaluated for the presence of DPP using clnical neurologic examinations including nerve conduction velocity studies. We evaluated the association between serum GGT and the presence of DPP. RESULTS: The prevalence of DPP was 40% (36 cases) according to clinical neurological examinations. The serum GGT concentration was significantly elevated in type 2 diabetic patients with DPP compared to patients without DPP (P < 0.01). There were other factors significantly associated with DPP including smoking (P = 0.019), retinopathy (P = 0.014), blood pressure (P < 0.05), aspartate aminotransferase (P = 0.022), C-reactive protein (P = 0.036) and urine microalbumin/creatinine ratio (P = 0.004). Serum GGT was independently related with DPP according to multiple logistic analysis (P < 0.01). CONCLUSION: This study shows that increased levels of serum GGT may have important clinical implications in the presence of DPP in patients with type 2 diabetes. PMCID: PMC2883349 Free PMC Article
	PMID: 20548843 [PubMed - in process]
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66.	PLoS One. 2010 Jun 9;5(6):e11026. Association of carotid plaque Lp-PLA(2) with macrophages and Chlamydia pneumoniae infection among patients at risk for stroke. Atik B, Johnston SC, Dean D. Center for Immunobiology and Vaccine Development, Children's Hospital Oakland Research Institute, Oakland, California, USA. Abstract BACKGROUND: We previously showed that the burden of Chlamydia pneumoniae in carotid plaques was significantly associated with plaque interleukin (IL)-6, and serum IL-6 and C-reactive protein (CRP), suggesting that infected plaques contribute to systemic inflammatory markers in patients with stroke risk. Since lipoprotein-associated phospholipase A2 (Lp-PLA(2)) mediates inflammation in atherosclerosis, we hypothesized that serum Lp-PLA(2) mass and activity levels and plaque Lp-PLA(2) may be influenced by plaque C. pneumoniae infection. METHODOLOGY/PRINCIPAL FINDINGS: Forty-two patients underwent elective carotid endarterectomy. Tissue obtained at surgery was stained by immunohistochemistry for Lp-PLA(2) grade, macrophages, IL-6, C. pneumoniae and CD4+ and CD8+ cells. Serum Lp-PLA(2) activity and mass were measured using the colorimetric activity method (CAM) and ELISA, respectively. Serum homocysteine levels were measured by HPLC. Eleven (26.2%) patients were symptomatic with transient ischemic attacks. There was no correlation between patient risk factors (smoking, coronary artery disease, elevated cholesterol, diabetes, obesity, hypertension and family history of genetic disorders) for atherosclerosis and serum levels or plaque grade for Lp-PLA(2). Plaque Lp-PLA(2) correlated with serum homocysteine levels (p = 0.013), plaque macrophages (p<0.01), and plaque C. pneumoniae (p<0.001), which predominantly infected macrophages, co-localizing with Lp-PLA(2). CONCLUSIONS: The significant association of plaque Lp-PLA(2) with plaque macrophages and C. pneumoniae suggests an interactive role in accelerating inflammation in atherosclerosis. A possible mechanism for C. pneumoniae in the atherogenic process may involve infection of macrophages that induce Lp-PLA(2) production leading to upregulation of inflammatory mediators in plaque tissue. Additional in vitro and in vivo research will be needed to advance our understanding of specific C. pneumoniae and Lp-PLA(2) interactions in atherosclerosis. PMCID: PMC2882946 Free PMC Article
	PMID: 20543948 [PubMed - indexed for MEDLINE]
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67.	Lancet. 2010 Jun 19;375(9732):2161-7. Epub 2010 Jun 9. Effect of high-dose allopurinol on exercise in patients with chronic stable angina: a randomised, placebo controlled crossover trial. Noman A, Ang DS, Ogston S, Lang CC, Struthers AD. Division of Medical Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK. Comment in: Lancet. 2010 Oct 16;376(9749):1298; author reply 1299-300. Lancet. 2010 Jun 19;375(9732):2126-7. Future Cardiol. 2010 Sep;6(5):575-7. Lancet. 2010 Oct 16;376(9749):1298-9; author reply 1299-300. Lancet. 2010 Oct 16;376(9749):1299; author reply 1299-300. Abstract BACKGROUND: Experimental evidence suggests that xanthine oxidase inhibitors can reduce myocardial oxygen consumption for a particular stroke volume. If such an effect also occurs in man, this class of inhibitors could become a new treatment for ischaemia in patients with angina pectoris. We ascertained whether high-dose allopurinol prolongs exercise capability in patients with chronic stable angina. METHODS: 65 patients (aged 18-85 years) with angiographically documented coronary artery disease, a positive exercise tolerance test, and stable chronic angina pectoris (for at least 2 months) were recruited into a double-blind, randomised, placebo-controlled, crossover study in a hospital and two infirmaries in the UK. We used computer-generated randomisation to assign patients to allopurinol (600 mg per day) or placebo for 6 weeks before crossover. Our primary endpoint was the time to ST depression, and the secondary endpoints were total exercise time and time to chest pain. We did a completed case analysis. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN 82040078. FINDINGS: In the first treatment period, 31 patients were allocated to allopurinol and 28 were analysed, and 34 were allocated to placebo and 32 were analysed. In the second period, all 60 patients were analysed. Allopurinol increased the median time to ST depression to 298 s (IQR 211-408) from a baseline of 232 s (182-380), and placebo increased it to 249 s (200-375; p=0.0002). The point estimate (absolute difference between allopurinol and placebo) was 43 s (95% CI 31-58). Allopurinol increased median total exercise time to 393 s (IQR 280-519) from a baseline of 301 s (251-447), and placebo increased it to 307 s (232-430; p=0.0003); the point estimate was 58 s (95% CI 45-77). Allopurinol increased the time to chest pain from a baseline of 234 s (IQR 189-382) to 304 s (222-421), and placebo increased it to 272 s (200-380; p=0.001); the point estimate was 38 s (95% CI 17-55). No adverse effects of treatment were reported. INTERPRETATION: Allopurinol seems to be a useful, inexpensive, well tolerated, and safe anti-ischaemic drug for patients with angina. FUNDING: British Heart Foundation. Copyright 2010 Elsevier Ltd. All rights reserved. PMCID: PMC2890860 Free PMC Article
	PMID: 20542554 [PubMed - indexed for MEDLINE]
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68.	Diabetol Metab Syndr. 2010 Jun 10;2(1):40. Obesity and metabolic syndrome in 7-9 years-old Portuguese schoolchildren. Pedrosa C, Oliveira BM, Albuquerque I, Simões-Pereira C, Vaz-de-Almeida MD, Correia F. Faculty of Nutrition and Food Sciences of University of Porto, Rua Dr, Roberto Frias, 4200-465 Porto, Portugal. capedrosa@gmail.com. Abstract ABSTRACT: BACKGROUND: Body fat is related to changes in lipid profile, blood pressure and metabolism of insulin and glucose, known as the metabolic syndrome (MS). The aim of this study was to estimate the prevalence of metabolic syndrome (MS) and its components among overweight and obese Portuguese schoolchildren, and to identify associated clinical and biochemical characteristics. METHODS: A total of 82 children (14 overweight and 68 obese; 40 boys and 42 girls) aged 7-9 years, underwent anthropometric measurements. A blood sample was obtained to assess biochemical parameters. Insulin resistance (IR) was determined by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). MS was defined by the National Cholesterol Education Program Adult Treatment Panel III criteria modified by Cook. RESULTS: The prevalence of MS was 15.8%. Abdominal obesity was present in all children. Frequency of elevated blood pressure, low HDL-cholesterol and elevated triglyceride concentrations were 62.6%, 13.4% and 11.0%, respectively. None of the children presented impaired fasting glucose, however hyperinsulinemia (7.3%) and IR (8.5%) were observed. The number of components of MS was higher in children with higher z-BMI (rho = 0.411; p < 0.001). MS was associated with higher leptin concentrations. No association was found with adiponectin or ghrelin levels. Leptin correlated positively with obesity, glucose metabolism, lipid profile, hepatic function and C-reactive protein, and negatively with HDL and Apolipoprotein A-I/B ratio. CONCLUSIONS: This study shows a significant prevalence of MS among obese schoolchildren. Abdominal obesity and elevated blood pressure were the most frequent components of this syndrome. Dyslipidemia, IR and high levels of leptin were also associated with MS in this young group. PMCID: PMC2901245 Free PMC Article
	PMID: 20537155 [PubMed - in process]
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69.	Nefrologia. 2010;30(3):342-8. doi: 10.3265/Nefrologia.pre2010.Apr.10410. [Prevalence of cardiovascular disease in uraemia and relevance of cardiovascular risk factors]. [Article in Spanish] Collado S, Coll E, Deulofeu R, Guerrero L, Pons M, Cruzado JM, de la Torre B, Vera M, Azqueta M, Nicolau C, Cases A. Servicio de Nefrología, Hospital del Mar, Barcelona. scolladonieto@yahoo.es Abstract AIM: To evaluate the prevalence of cardiovascular disease (CVD) and its association with cardiovascular risk factors, as well as their control in end-stage renal disease (ESRD) patients under maintenance hemodialysis (HD). PATIENTS AND METHODS: A total of 265 patients with ESRD on maintenance HD from a University Hospital and 4 dialysis units were included in this multicenter and cross-sectional study that analyzed the prevalence of CVD and the possible association with classic and new cardiovascular risk factors. Usual biochemical and haemathological parameters were analyzed, as well as plasma levels of homocysteine, troponin-I, BNP, lipoprotein(a), C reactive protein, IL-6, fibrinogen, asymmetrical dimethylarginine (ADMA), advanced oxidation protein products (AOPP), malondialdehyde, adiponectin, osteoprotegerin, and fetuin. In a subset of patients an echocardiography and carotid artery Doppler echography were also performed. RESULTS: The prevalence of CVD was 52.8%. Factors positively associated with prevalent CVD were age, BMI, left ventricular hypertrophy, hypertension, dyslipidemia and diabetes mellitus, dialysis vintage, Charlson s comorbility index, levels of fibrinogen, osteoprotegerin, BNP and CRP, as well as carotid intima-media thickness, left ventricular mass and pulse pressure. Factors negatively associated with prevalent CVD were: previous renal transplant, ejection fraction or levels of LDL-c and phosphorous. In the multivariate analysis dyslipidemia, left ventricular hypertrophy, age and LDL-c (negatively) were associated with CVD. CONCLUSIONS: In HD patients the prevalence of CVD is high and is associated with the presence of cardiovascular risk factors and subclinical CVD. Free Article
	PMID: 20514101 [PubMed - indexed for MEDLINE]
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70.	AAOHN J. 2010 May;58(5):185-96. doi: 10.3928/08910162-20100428-01. Stressors among Latino day laborers. A pilot study examining allostatic load. de Castro AB, Voss JG, Ruppin A, Dominguez CF, Seixas NS. University of Washington School of Nursing, Seattle, WA, USA. butchdec@u.washington.edu Abstract This pilot study evaluated the feasibility of conducting a research project focused on stressors and allostatic load (AL) among day laborers. A total of 30 Latino men were recruited from CASA Latina, a worker center in Seattle. Participants completed an interview and researchers measured six indicators of AL (body mass index, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, C-reactive protein, and cortisol). Percentages and mean scores were calculated for several self-reported stressors in work, economic, and social contexts and were compared between low and high AL groups. Overall, participants with high AL reported experiencing more stressors than those with low AL. Additionally, those with high AL generally reported being less healthy both physically and mentally. Findings suggest that Latino day laborers experience stressors that place them at risk for high AL. Also, a study of this nature is possible, but must be conducted with trust and collaboration between researchers and community partners. Copyright 2010, SLACK Incorporated. PMCID: PMC2964275 Free PMC Article
	PMID: 20507008 [PubMed - indexed for MEDLINE]
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71.	Nan Fang Yi Ke Da Xue Xue Bao. 2010 May;30(5):1002-4. [Low serum fetuin A is a risk factor of coronary artery calcification in patients starting hemodialysis]. [Article in Chinese] Zhang B, Shi W, He CS, Liang XL, Liu SX, Liang YZ. Department of Nephrology, Guangdong General Hospital, Guangzhou 510080, China. zhangbinyes@yahoo.com.cn Abstract OBJECTIVE: To examine the relationship between reduction of serum fetuin A and coronary artery calcification (CAC) in patients starting hemodialysis. METHODS: Twenty-nine patients on chronic hemodialysis (duration of hemodialysis less than 6 months) were enrolled in this study. Serum fetuin A and such potential CAC-related risk factors as C-reactive protein (CRP), Ca, P, iPTH, body mass index (BMI) were examined. CAC was detected by multislice spiral CT scan (MSCT) and quantified by the modified Agaston's scoring system. All the 29 patients were followed up for 18 months to appraise the cardiovascular events defined as cardiac failure, angina pectoris or myocardial infarction. RESULTS: Eleven patients (78.57%) were found to have CAC as detected by MSCT in low serum fetuin A (below the average serum concentration of 0.71 g/L) group, a rate significantly higher than that in high serum fetuin A group (7 patients, 46.67%, P<0.05). Serum fetuin A in these 29 patients was related with CAC score (Pearson correlation coefficient of -0.734, P=0.001) and stepwise regression analysis indicated that serum fetuin A (standardized beta=-0.568, P=0.003) and age (standardized beta=0.416, P=0.019) were independently correlated to CAC. Such factors as CRP, Ca, P, iPTH, Chol, TG, HDL-C, LDL-C, BMI and blood pressure were excluded from the regression equation. Reduction of serum fetuin A was associated with cardiovascular events (Spearman's rho -0.758, P<0.01). No significant difference was found between low and high serum fetuin A groups by Kaplan-Meier survival analysis (P=0.065). CONCLUSION: Reduced serum fetuin A may be a potential risk factor of coronary artery calcification, and can contribute to cardiovascular events in patients starting hemodialysis. Free Article
	PMID: 20501379 [PubMed - in process]
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72.	Diabetes Care. 2010 Aug;33(8):1853-5. Epub 2010 May 18. Roles of the metabolic syndrome, HDL cholesterol, and coronary atherosclerosis in subclinical inflammation. Rein P, Saely CH, Beer S, Vonbank A, Drexel H. Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria. Abstract OBJECTIVE: The metabolic syndrome (MetS) and coronary artery disease (CAD) frequently coincide; their individual contribution to inflammation is unknown. RESEARCH DESIGN AND METHODS: We enrolled 1,010 patients undergoing coronary angiography. Coronary stenoses >or=50% were considered significant. The MetS was defined according to American Heart Association-revised National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: C-reactive protein (CRP) did not differ between patients with significant CAD and subjects without significant CAD (P = 0.706) but was significantly higher in MetS patients than in those without MetS (P < 0.001). The MetS criteria low HDL cholesterol (P < 0.001), large waist (P < 0.001), high glucose (P < 0.001), and high blood pressure (P = 0.016), but not high triglycerides (P = 0.352), proved associated with CRP. When all MetS traits were considered simultaneously, only low HDL cholesterol proved independently associated with CRP (F = 44.19; P < 0.001). CONCLUSIONS: CRP is strongly associated with the MetS but not with coronary atherosclerosis. The association of the MetS with subclinical inflammation is driven by the low HDL cholesterol feature. PMCID: PMC2909077 [Available on 2011/8/1] Free Article
	PMID: 20484132 [PubMed - in process]
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73.	J Atheroscler Thromb. 2010 Jul 30;17(7):771-5. Epub 2010 May 13. Successful treatment of a mycotic aortic pseudoaneurysm in a patient with type 2 diabetes mellitus while treating primary aldosteronism with spironolactone. Ito Y, Yoshimura K, Matsuzawa Y, Saito J, Ito H, Furukawa H, Okura K, Fukata M, Konishi T, Nishikawa T. Division of Endocrinology & Metabolism. Department of Medicine, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoko-ku, Yokohama City, Japan. Abstract We describe a diabetic patient successfully treated for an acute mycotic aortic arch pseudoaneurysm with primary aldosteronism. The patient first complained of severe pain in the left upper extremity and left back with high C reactive protein (CRP) and high-grade fever. It was suspected that acute aortic dissection had developed in association with mycotic pseudoaneurysm of the aortic arch because of chest X-ray findings of enlargement of the aortic arch. Computed tomography (CT) of the aortic arch revealed an aortic aneurysm protruding in the superior direction. Staphylococcus aureus was detected in blood culture, suggesting a mycotic aortic aneurysm, and artificial blood vessel replacement of the aortic arch was performed. Intraoperative findings suggested aortic pseudoaneurysm, which consisted of mediastinal rupture of the aorta at the distal arch. Our patient had a 2-year history of type 2 diabetes mellitus and poor blood sugar control, even with twice-daily injection of insulin. Blood pressure was not always well controlled because of primary aldosteronism. Thus, it was speculated that hyperaldosteronism, as well as diabetes-associated atherosclerosis, had persisted for a long time. No reports have described mycotic pseudoaneurysm in the aortic arch in a diabetic patient associated with primary aldosteronism. It is necessary to note that serious vascular complications are possible if aldosteronism is left untreated or is treated insufficiently as essential hypertension. Free Article
	PMID: 20467187 [PubMed - indexed for MEDLINE]
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74.	Nutr Metab (Lond). 2010 May 13;7:42. Fruit and vegetable consumption and proinflammatory gene expression from peripheral blood mononuclear cells in young adults: a translational study. Hermsdorff HH, Zulet MA, Puchau B, Martínez JA. Department of Nutrition, Food Science, Physiology and Toxicology, University of Navarra, Pamplona, Spain. jalfmtz@unav.es. Abstract ABSTRACT: BACKGROUND: Fruits and vegetables are important sources of fiber and nutrients with a recognized antioxidant capacity, which could have beneficial effects on the proinflammatory status as well as some metabolic syndrome and cardiovascular disease features. The current study assessed the potential relationships of fruit and vegetable consumption with the plasma concentrations and mRNA expression values of some proinflammatory markers in young adults. METHODS: One-hundred and twenty healthy subjects (50 men/70 women; 20.8 +/- 2.6 y; 22.3 +/- 2.8 kg/m2) were enrolled. Experimental determinations included anthropometry, blood pressure and lifestyle features as well as blood biochemical and inflammatory measurements. The mRNA was isolated from peripheral blood mononuclear cells (PBMC) and the gene expression concerning selected inflammatory markers was assessed by quantitative real-time PCR. Nutritional intakes were estimated by a validated semi-quantitative food-frequency questionnaire. RESULTS: The highest tertile of energy-adjusted fruit and vegetable consumption (>660 g/d) was associated with lower plasma concentrations of C-reactive protein (CRP) and homocysteine and with lower ICAM1, IL1R1, IL6, TNFalpha and NFkappaB1 gene expression in PBMC (P for trend < 0.05), independently of gender, age, energy intake, physical activity, smoking, body mass index, systolic blood pressure and circulating non-esterified fatty acids. In addition, plasma CRP, homocysteine and TNFalpha concentrations and ICAM1, TNFalpha and NFkappaB1 gene expression in PBMC showed a descending trend as increased fiber intake (>19.5 g/d) from fruits and vegetables (P for trend < 0.05). Furthermore, the participants within the higher tertile (>11.8 mmol/d) of dietary total antioxidant capacity showed lower plasma CRP and mRNA values of ICAM1, IL1R1, IL6, TNFalpha and NFkappaB1 genes (P for trend < 0.05). The inverse association between fruit and vegetable consumption and study proinflammatory markers followed the same trend and remained statistically significant, after the inclusion of other foods/nutrients in the linear regression models. CONCLUSION: A higher fruit and vegetable consumption was independently associated not only with reduced CRP and homocysteine concentrations but also with a lower mRNA expression in PBMC of some relevant proinflammatory markers in healthy young adults. PMCID: PMC2882916 Free PMC Article
	PMID: 20465828 [PubMed - in process]
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75.	Endokrynol Pol. 2010 Mar-Apr;61(2):160-8. Adipose tissue activity in relation to overweight or obesity. Gnacińska M, Małgorzewicz S, Guzek M, Lysiak-Szydłowska W, Sworczak K. Department of Endocrinology and Internal Medicine, Medical University, Gdańsk. Abstract INTRODUCTION: Obesity is associated with a number of diseases resulting from the excessive amount of adipose tissue. The aim of this study was to investigate the correlation between the quantity of adipose tissue and the prevalence of metabolic disturbances, and the concentration of adipokines and proinflammatory cytokines in obese or overweight patients. MATERIAL AND METHODS: Fifty-five middle-aged subjects with body mass index (BMI) > 25 kg/m(2) took part in this study. Twenty-three healthy people with normal BMI formed the control group. Twenty-one people from the study group were on a low-calorie diet. All subjects underwent anthropometric assessment, laboratory investigations, and blood-pressure examination. RESULTS: Patients with obesity or overweight, in comparison to those with normal BMI, showed insulin resistance and a higher concentration of high sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor 1 (PAI-1), and interleukin 6 (Il-6). The concentration of adiponectin was significantly lower in this group. The patients on the low-calorie diet had significantly lower concentrations of leptin when compared to other obese people; moreover, a trend towards decreased hs-CRP concentration was seen. A significant positive correlation between leptin and hs-CRP was observed. The serum concentration of adiponectin was inversely correlated with that of TNF-alpha, IL-6, hs-CRP, and PAI-1. CONCLUSIONS: The results of this study may suggest the beneficial impact of a low-calorie diet on the slowing down of inflammatory processes. The observed negative correlation between the concentrations of adiponectin and inflammatory cytokines may confirm the anti-inflammatory activity of this adipokine. Free Article
	PMID: 20464701 [PubMed - indexed for MEDLINE]
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76.	Diabetologia. 2010 Aug;53(8):1620-30. Epub 2010 May 9. Physical activity, obesity and cardiometabolic risk factors in 9- to 10-year-old UK children of white European, South Asian and black African-Caribbean origin: the Child Heart And health Study in England (CHASE). Owen CG, Nightingale CM, Rudnicka AR, Sattar N, Cook DG, Ekelund U, Whincup PH. Division of Community Health Sciences, St George's University of London, Cranmer Terrace, London SW17 ORE, UK. cowen@sgul.ac.uk Abstract AIMS/HYPOTHESIS: Physical inactivity is implicated in unfavourable patterns of obesity and cardiometabolic risk in childhood. However, few studies have quantified these associations using objective physical activity measurements in children from different ethnic groups. We examined these associations in UK children of South Asian, black African-Caribbean and white European origin. METHODS: This was a cross-sectional study of 2,049 primary school children in three UK cities, who had standardised anthropometric measurements, provided fasting blood samples and wore activity monitors for up to 7 days. Data were analysed using multilevel linear regression and allowing for measurement error. RESULTS: Overall physical activity levels showed strong inverse graded associations with adiposity markers (particularly sum of skinfold thicknesses), fasting insulin, HOMA insulin resistance, triacylglycerol and C-reactive protein; for an increase of 100 counts of physical activity per min of registered time, levels of these factors were 12.2% (95% CI 10.2-14.1%), 10.2% (95% CI 7.5-12.8%), 10.2% (95% CI 7.5-12.8%), 5.8% (95% CI 4.0-7.5%) and 19.2% (95% CI 13.9-24.2%) lower, respectively. Similar increments in physical activity levels were associated with lower diastolic blood pressure (1.0 mmHg, 95% CI 0.6-1.5 mmHg) and LDL-cholesterol (0.04 mmol/l, 95% CI 0.01-0.07 mmol/l), and higher HDL-cholesterol (0.02 mmol/l, 95% CI 0.01-0.04 mmol/l). Moreover, associations were broadly similar in strength in all ethnic groups. All associations between physical activity and cardiometabolic risk factors were reduced (albeit variably) after adjustment for adiposity. CONCLUSIONS/INTERPRETATION: Objectively measured physical activity correlates at least as well with obesity and cardiometabolic risk factors in South Asian and African-Caribbean children as in white European children, suggesting that efforts to increase activity levels in such groups would have equally beneficial effects. PMCID: PMC2892063 Free PMC Article
	PMID: 20454952 [PubMed - indexed for MEDLINE]
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77.	Int J Stroke. 2010 Apr;5(2):117-25. The Levels of Inflammatory Markers in the Treatment of Stroke study (LIMITS): inflammatory biomarkers as risk predictors after lacunar stroke. Elkind MS, Luna JM, Coffey CS, McClure LA, Liu KM, Spitalnik S, Paik MC, Roldan A, White C, Hart R, Benavente O. Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA. mse13@columbia.edu Abstract BACKGROUND: Inflammation is increasingly recognised as playing a central role in atherosclerosis, and peripheral blood markers of inflammation have been associated with incident and recurrent cardiac events. The relationship of these potentially modifiable risk markers to prognosis after ischaemic stroke is less clear. The Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) study will address hypotheses related to the role of inflammatory markers in secondary stroke prevention in an efficient manner using the well-established framework of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (NCT00059306). METHODS: SPS3 is an ongoing Phase III multicentre secondary prevention trial focused on preventing recurrent stroke in patients with small vessel ischaemic stroke, or lacunes. In SPS3, patients are assigned in a factorial design to aspirin vs. aspirin plus clopidogrel, and to usual vs. aggressive blood pressure targets. The purpose of LIMITS is to determine whether serum levels of inflammatory markers - including high-sensitivity C-reactive protein, serum amyloid A, CD40 ligand, and monocyte chemoattractant protein-1 - predict recurrent stroke and other vascular events among lacunar stroke patients. The project will also determine whether these markers predict which people will respond best to dual antiplatelet therapy with clopidogrel and aspirin, as well the relationship to cognitive function. ANALYSIS: plan Multivariable Cox proportional hazard regression modeling will be used to estimate hazard ratios for the effect of marker levels on risk of recurrent stroke and other outcomes after adjusting for additional potential risk factors, including age, gender, ethnicity, treatment arm, and traditional stroke risk factors. Interactions between marker levels and treatment assignment for both arms of the SPS3 study will be assessed. Observations will be censored at the time of last follow-up visit. CONCLUSIONS: LIMITS represents an efficient approach to the identification of novel inflammatory biomarkers for use in risk prediction and treatment selection in patients with small vessel disease. PMCID: PMC2918656 Free PMC Article
	PMID: 20446946 [PubMed - indexed for MEDLINE]
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78.	Arq Bras Cardiol. 2010 Feb;94(2):255-61, 273-9, 260-6. [Obesity and coronary artery disease: role of vascular inflammation]. [Article in English, Portuguese, Spanish] Gomes F, Telo DF, Souza HP, Nicolau JC, Halpern A, Serrano CV Jr. Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. Abstract Obesity is becoming a global epidemic. Around 1.1 billion adults and 10% of the world's children are currently overweight or considered obese. Generally associated with risk factors for cardiovascular disease, such as Diabetes Mellitus and systemic arterial high blood pressure, the obesity has been more and more seen as an independent risk factor for Coronary Artery Disease (CAD). Coronary arteriosclerosis comprises a series of inflammatory responses at cellular and molecular level, whose reactions are stronger in obese patients. In the past, the adipose tissue was regarded as a mere fat deposition. Now it is seen from a totally different standpoint, as an active endocrine and paracrine organ that produces several inflammatory cytokines, such as the adipokines. This article aims to raise awareness about obesity as an increasingly significant public health issue over the past decades, as well as to relate the intense inflammatory process in obese individuals with an increased tendency for this group of individuals to develop CAD. Free Article
	PMID: 20428625 [PubMed - indexed for MEDLINE]
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79.	BMC Nephrol. 2010 Apr 27;11:7. Serum C-reactive protein and thioredoxin levels in subjects with mildly reduced glomerular filtration rate. Tsuchikura S, Shoji T, Shimomura N, Kakiya R, Emoto M, Koyama H, Ishimura E, Inaba M, Nishizawa Y. Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan. Abstract BACKGROUND: Chronic kidney disease (CKD) is a newly recognized high-risk condition for cardiovascular disease (CVD), and previous studies reported the changes in inflammation and oxidative stress in advanced stages of CKD. We compared the levels of serum biomarkers for inflammation and oxidative stress between subjects with normal and mildly reduced glomerular filtration rate (GFR). METHODS: The subjects were 182 participants of a health check-up program including those with normal (>or= 90 mL/min/1.73 m2, N = 79) and mildly reduced eGFR (60-89 mL/min/1.73 m2, N = 103) which was calculated based on serum creatinine, age and sex. We excluded those with reduced eGFR < 60 mL/min/1.73 m2. No one had proteinuria. We measured serum levels of C-reactive protein (CRP) and thioredoxin (TRX) as the markers of inflammation and oxidative stress, respectively. RESULTS: As compared with subjects with normal eGFR, those with mildly reduced eGFR had increased levels of both CRP and TRX. Also, eGFR was inversely correlated with these biomarkers. The associations of eGFR with these biomarkers remained significant after adjustment for age and sex. When adjustment was done for eight possible confounders, CRP showed significant association with systolic blood pressure, high density lipoprotein cholesterol (HDL-C) and non-HDL-C, whereas TRX was associated with sex significantly, and with eGFR and systolic blood pressure at borderline significance. CONCLUSIONS: We showed the increased levels of CRP and TRX in subjects with mildly reduced eGFR. The eGFR-CRP link and the eGFR-TRX link appeared to be mediated, at least partly, by the alterations in blood pressure and plasma lipids in these subjects. PMCID: PMC2868841 Free PMC Article
	PMID: 20423474 [PubMed - indexed for MEDLINE]
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80.	Diabetes Care. 2010 Jul;33(7):1635-9. Epub 2010 Apr 22. Pericardial adipose tissue, atherosclerosis, and cardiovascular disease risk factors: the Jackson heart study. Liu J, Fox CS, Hickson D, Sarpong D, Ekunwe L, May WD, Hundley GW, Carr JJ, Taylor HA. 1Jackson Heart Study, University of Mississippi Medical Center, Jackson State University, Jackson,Mississippi, USA. jliu@medicine.umsmed.edu Comment in: Diabetes Care. 2010 Sep;33(9):e127; author reply e128. Abstract OBJECTIVE: Pericardial adipose tissue (PAT), a regional fat depot that surrounds the heart, is associated with an unfavorable cardiometabolic risk factor profile. The associations among PAT, cardiometabolic risk factors, and coronary artery calcification (CAC) and abdominal aortic artery calcification (AAC) in African American populations have not been explored. RESEARCH DESIGN AND METHODS: A total of 1,414 African Americans (35% men; mean +/- SD age 58 +/- 11 years) drawn from the Jackson Heart Study (JHS) underwent multidetector computed tomography assessment of abdominal visceral adipose tissue (VAT) and PAT between 2007 and 2009. Cardiometabolic risk factors, CAC, and AAC were examined in relation to increments of PAT and VAT. RESULTS: PAT was significantly correlated with BMI, waist circumference, and VAT (r = 0.35, 0.46, and 0.69; all P < 0.0001). PAT (per 1-SD increase) was associated with elevated levels of systolic blood pressure (P < 0.04), fasting glucose, triglycerides, and C-reactive protein and lower levels of HDL (all P values<0.0001). PAT was also associated with metabolic syndrome (odds ratio [OR] 1.89; P < 0.0001), hypertension (1.48; P < 0.0006), and diabetes (1.40; P < 0.04); all associations were diminished after further adjustment for VAT (most P > 0.05). However, the association of PAT with CAC but not with AAC remained significant (OR 1.34 [95% CI 1.10-1.64]; P < 0.004) after multivariable and VAT adjustment. CONCLUSIONS: PAT is significantly correlated with most cardiometabolic risk factors and CAC in the JHS cohort. The results suggest that PAT is an important VAT depot that may exert a local effect on the coronary vasculature. PMCID: PMC2890373 [Available on 2011/7/1] Free Article
	PMID: 20413524 [PubMed - indexed for MEDLINE]
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81.	J Atheroscler Thromb. 2010 Apr 30;17(4):342-9. Epub 2010 Apr 7. Plasma level of platelet-derived microparticles is associated with coronary heart disease risk score in healthy men. Ueba T, Nomura S, Inami N, Nishikawa T, Kajiwara M, Iwata R, Yamashita K. Department of Neurosurgery, Kishiwada City Hospital, Osaka, Japan. a.fenton@liverpool.ac.uk Abstract AIM: The aim of this study was to clarify the relationship between platelet-derived microparticles (PDMPs) and the Framingham 10-yr coronary heart disease (CHD) risk score. METHODS: A cross-sectional study of healthy volunteers free of medication, and cardiovascular or cerebrovascular disease was conducted. The subjects were 190 Japanese men (median age 41). An ELISA kit and monoclonal antibodies against CD42b and CD42a (glycoprotein Ib and IX) were used. RESULTS: PDMPs are correlated with platelet count, high sensitivity C-reactive protein (hsCRP), and diastolic blood pressure by multivariate analysis (R(2)=0.316, p <0.001). Quartile range of PDMPs is significantly associated with the 10-yr CHD risk score after adjusting for age, platelet count, hsCRP, and hypertension (p=0.033) and for age, platelet count, hsCRP, and presence of metabolic syndrome (MS) (p=0.020). In individuals with a predicted 10-yr risk for CHD >or=8% (corresponding with the highest quartile), compared to those with a predicted 10-yr risk <8%, the odds ratio (OR), adjusted for age, platelet count, hsCRP, and hypertension, was 3.3 (1.2-8.9) and adjusted for age, platelet count, hsCRP, and MS, was 4.5 (1.6-11.8). The age-, platelet count-, hsCRP- and hypertension-adjusted OR for a 10-yr CHD risk score >or=8% was 0.8 (0.5-1.3) for hsCRP and 3.9 (1.6-9.4) for hypertension. The age-, platelet count-, hsCRP- and MS -adjusted OR for a 10-yr CHD risk score >or=8% was 0.7 (0.4-1.2) for hsCRP and 7.9 (2.6-24.5) for MS. CONCLUSION: Elevated PDMPs are associated with the 10-yr CHD risk score in healthy men. Free Article
	PMID: 20379056 [PubMed - indexed for MEDLINE]
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82.	Acad Emerg Med. 2010 Apr;17(4):353-9. Complement activation in emergency department patients with severe sepsis. Younger JG, Bracho DO, Chung-Esaki HM, Lee M, Rana GK, Sen A, Jones AE. Department of Emergency Medicine, Center for Computational Medicine and Biology, University of Michigan, Ann Arbor, MI, USA. jyounger@umich.edu Abstract OBJECTIVES: This study assessed the extent and mechanism of complement activation in community-acquired sepsis at presentation to the emergency department (ED) and following 24 hours of quantitative resuscitation. METHODS: A prospective pilot study of patients with severe sepsis and healthy controls was conducted among individuals presenting to a tertiary care ED. Resuscitation, including antibiotics and therapies to normalize central venous and mean arterial pressure (MAP) and central venous oxygenation, was performed on all patients. Serum levels of Factor Bb (alternative pathway), C4d (classical and mannose-binding lectin [MBL] pathway), C3, C3a, and C5a were determined at presentation and 24 hours later among patients. RESULTS: Twenty patients and 10 healthy volunteer controls were enrolled. Compared to volunteers, all proteins measured were abnormally higher among septic patients (C4d 3.5-fold; Factor Bb 6.1-fold; C3 0.8-fold; C3a 11.6-fold; C5a 1.8-fold). Elevations in C5a were most strongly correlated with alternative pathway activation. Surprisingly, a slight but significant inverse relationship between illness severity (by sequential organ failure assessment [SOFA] score) and C5a levels at presentation was noted. Twenty-four hours of structured resuscitation did not, on average, affect any of the mediators studied. CONCLUSIONS: Patients with community-acquired sepsis have extensive complement activation, particularly of the alternative pathway, at the time of presentation that was not significantly reversed by 24 hours of aggressive resuscitation. PMCID: PMC2918899 Free PMC Article
	PMID: 20370773 [PubMed - indexed for MEDLINE]
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83.	Turk Kardiyol Dern Ars. 2009 Apr;37 Suppl 4:18-26. [The JUPITER trial: a new approach in primary prevention]. [Article in Turkish] Güleç S. Ankara Universitesi Tip Fakültesi Kardiyoloji Anabilim Dali, Ankara, Turkey. gulec99@yahoo.com Abstract Current practice guidelines recommend that, when determining target LDL-cholesterol levels in individuals without cardiovascular disease and diabetes, global risk estimation be made taking into account age, sex, total cholesterol level, HDL-cholesterol level, smoking status, and systolic blood pressure. Based on this assessment, target LDL-cholesterol levels have been set as <100 mg/dL, <130 mg/dL, and <160 mg/dL for high-, intermediate-, and low-risk individuals, respectively. The most important rationale for this approach is to implement a cost-effective treatment strategy, giving special attention to high-risk individuals when allocating available sources. Recent data suggest that increased levels of high sensitive C-reactive protein (hs-CRP) are associated with increased risk for cardiovascular events, independent of other risk parameters. Most recently, the JUPITER trial demonstrated that rosuvastatin 20 mg/day significantly lowered cardiovascular mortality and all-cause mortality in low- or intermediate-risk patients whose LDL-cholesterol levels were <130 mg/dL (median 108 mg/dL) and hs-CRP levels were =/>2 mg/L. As the current guidelines do not recommend statin therapy for this patient group, these results have caused a widespread interest, giving rise to arguments about the effectiveness of primary prevention recommendations of the guidelines. This review aims to discuss the results and implications of the JUPITER trial. Free Article
	PMID: 19553758 [PubMed - indexed for MEDLINE]
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84.	Am J Hypertens. 2010 Jul;23(7):767-74. Epub 2010 Mar 25. Association of serum osteoprotegerin with left ventricular mass in African American adults with hypertension. Noheria A, Mosley TH Jr, Kullo IJ. Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA. Abstract BACKGROUND: African-Americans with hypertension are susceptible to left ventricular hypertrophy (LVH). Serum osteoprotegerin level has been reported to be associated with LVH. We investigated the association of osteoprotegerin with LV mass (LVM) in 898 African-Americans with hypertension (mean age 65 years, 71% women). METHODS: Osteoprotegerin levels were measured in serum by an immunoassay and log-transformed for analyses. LVM index (LVMi; LVM/height(2.7)) was estimated using M-mode echocardiography. Linear regression analyses using generalized estimating equations were used to assess the association of osteoprotegerin with LVMi. RESULTS: Serum osteoprotegerin was correlated with LVMi (r = 0.21; P < 0.0001), an estimated increase in LVMi of 5.05 (95% confidence interval 2.93, 7.17) g/m(2.7) in the highest compared to the lowest osteoprotegerin quartile. This association remained statistically significant after adjustment for conventional cardiovascular risk factors (age, sex, body mass index (BMI), history of smoking, diabetes, systolic blood pressure (BP), total and high-density lipoprotein cholesterol), estimated renal function, history of myocardial infarction and stroke, lifestyle factors (physical activity score, years of education, amount of alcohol consumption), medications (aspirin, antihypertensives, statins, estrogens), and C-reactive protein (CRP) (P = 0.02). Additionally, osteoprotegerin was correlated with early/atrial (E/A) ratio (r = -0.16; P < 0.0001), LV mean wall thickness (r = 0.17; P < 0.0001) and relative wall thickness (r = 0.14; P < 0.0001) but not ejection fraction (r = 0.04; P = 0.24) or internal end-diastolic dimension (r = 0.02; P = 0.60). CONCLUSION: In African-Americans with hypertension, a higher serum osteoprotegerin level is weakly but independently associated with a higher LVM. PMCID: PMC2901868 Free PMC Article
	PMID: 20339356 [PubMed - indexed for MEDLINE]
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85.	Rev Esp Cardiol. 2010 Apr;63(4):415-22. [Cystatin C and cardiovascular risk in the general population]. [Article in Spanish] Cepeda J, Tranche-Iparraguirre S, Marín-Iranzo R, Fernández-Rodríguez E, Riesgo-García A, García-Casas J, Hevia-Rodríguez E. Servicio de Análisis Clínicos. Hospital Santos Reyes. Sanidad de Castilla y León (SACYL). Aranda de Duero. Burgos. España. j_cepeda_p@hotmail.com Abstract INTRODUCTION AND OBJECTIVES: Cystatin C has been proposed as a novel marker of renal function and as a predictor of cardiovascular risk in the elderly. The aim of this study was to determine the prevalence of an elevated cystatin C level in the general population and its relationship with cardiovascular risk factors and disease. METHODS: This descriptive epidemiologic cross-sectional study involved a simple randomized sample of individuals aged >49 years from the general population, and was based on personal health records. From the final selection of 415 individuals, 359 underwent cystatin C measurement using a immunonephelometric assay. The cut-point used was that recommended for the method in adults. RESULTS: Of the 359 individuals (mean+/-standard deviation age, 64+/-10 years, 63.5% female) studied, 17.3% (95% confidence interval [CI] 13.4%-21.2%) had an elevated cystatin C level. The mean level was 0.81+/-0.21 mg/L, and increased with age. Elevation of the cystatin C level was associated with: older age (P< .0001); high measures of systolic blood pressure (P< .0001), hemoglobin A1c (P=.031), triglycerides (P=.019), homocysteine (P< .0001), C-reactive protein (P=.015), fibrinogen (P=.006) and microalbuminuria (P=.001); and a low high-density lipoprotein cholesterol level (P=.021) and estimated glomerular filtration rate (P< .0001). Associated cardiovascular diseases included coronary heart disease (P=.013) and heart failure (P=.038). The main factors independently associated with an elevated cystatin C level were diabetes (odds ratio [OR]=5.37), male sex (OR=4.91) and decreased glomerular filtration (OR=0.83). CONCLUSIONS: The prevalence of an elevated cystatin C level in the general population was found to be high and was associated with the presence of classical cardiovascular risk factors such as diabetes, hypertension and chronic renal disease, along with higher levels of C-reactive protein, homocysteine and fibrinogen. Free Article
	PMID: 20334807 [PubMed - indexed for MEDLINE]
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86.	J Int AIDS Soc. 2010 Mar 22;13:12. Elevated osteoprotegerin is associated with abnormal ankle brachial indices in patients infected with HIV: a cross-sectional study. Jang JJ, Schwarcz AI, Amaez DA, Woodward M, Olin JW, Keller MJ, Schecter AD. Zena and Michael A Wiener Cardiovascular Institute and Marie-Joseìe and Henry R Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York, USA. james.j.jang@kp.org Abstract BACKGROUND: Patients infected with HIV have an increased risk for accelerated atherosclerosis. Elevated levels of osteoprotegerin, an inflammatory cytokine receptor, have been associated with a high incidence of cardiovascular disease (including peripheral arterial disease, or PAD), acute coronary syndrome, and cardiovascular mortality. The objective of this study was to determine whether PAD is prevalent in an HIV-infected population, and to identify an association with HIV-specific and traditional cardiovascular risk factors, as well as levels of osteoprotegerin. METHODS: One hundred and two patients infected with HIV were recruited in a cross-sectional study. To identify the prevalence of PAD, ankle-brachial indices (ABIs) were measured. Four standard ABI categories were utilized: < or = 0.90 (definite PAD); 0.91-0.99 (borderline); 1.00-1.30 (normal); and >1.30 (high). Medical history and laboratory measurements were obtained to determine possible risk factors associated with PAD in HIV-infected patients. RESULTS: The prevalence of PAD (ABI < or = 0.90) in a young HIV-infected population (mean age: 48 years) was 11%. Traditional cardiovascular risk factors, including advanced age and previous cardiovascular history, as well as elevated C-reactive protein levels, were associated with PAD. Compared with patients with normal ABIs, patients with high ABIs had significantly elevated levels of osteoprotegerin [1428.9 (713.1) pg/ml vs. 3088.6 (3565.9) pg/ml, respectively, p = 0.03]. CONCLUSIONS: There is a high prevalence of PAD in young HIV-infected patients. A number of traditional cardiovascular risk factors and increased osteoprotegerin concentrations are associated with abnormal ABIs. Thus, early screening and aggressive medical management for PAD may be warranted in HIV-infected patients. PMCID: PMC2859852 Free PMC Article
	PMID: 20307322 [PubMed - indexed for MEDLINE]
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87.	Diabetol Metab Syndr. 2010 Mar 18;2:16. Assessment of efficacy and tolerability of once-daily extended release metformin in patients with type 2 diabetes mellitus. Levy J, Cobas RA, Gomes MB. Department of Medicine, Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil. julevy@ig.com.br Abstract AIMS: To determine prospectively the efficacy, tolerability and patient satisfaction of an extended release formulation of metformin (metformin XR) in hospital based outpatients with type 2 diabetes mellitus currently treated with standard metformin. METHODS: Patients on immediate release standard metformin either alone or combined with other oral agents were switched to extended release metformin XR 500 mg tablets and titrated to a maximum dose of 2000 mg/day Measurements to include glucose and lipid control, blood pressure, body weight, waist circumference, C-reactive protein, adverse events and patient satisfaction were recorded at baseline, three and six months. RESULTS: Complete data were obtained for 35 of the 61 patients enrolled to the study. At three and six months no changes were reported for any of the cardiovascular risk factors except for lipids where there was a modest rise in plasma triglycerides. These effects were achieved with a reduced dose of metformin XR compared to pre-study dosing with standard metformin (1500 mg +/- 402 vs 1861 +/- 711 p = 0.004). A total of 77% of patients were free of gastrointestinal side effects and 83% of patients stated a preference for metformin XR at the end of the study. Ghost tablets were reported in the faeces by the majority of the patients (54.1%). CONCLUSIONS: Patients switched to extended release metformin XR derived the same clinical and metabolic benefits as for standard metformin but with reduced dosage, fewer gastrointestinal side effects and a greater sense of well being and satisfaction on medication. PMCID: PMC2847989 Free PMC Article
	PMID: 20298568 [PubMed]
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88.	BMC Public Health. 2010 Mar 18;10:143. Central blood pressure and pulse wave velocity: relationship to target organ damage and cardiovascular morbidity-mortality in diabetic patients or metabolic syndrome. An observational prospective study. LOD-DIABETES study protocol. Gómez-Marcos MA, Recio-Rodríguez JI, Rodríguez-Sánchez E, Castaño-Sánchez Y, de Cabo-Laso A, Sánchez-Salgado B, Rodríguez-Martín C, Castaño-Sánchez C, Gómez-Sánchez L, García-Ortiz L. La Alamedilla Health Centre, Primary Care Research Unit, Castilla y León Health Service - SACYL, Salamanca, Spain. Abstract BACKGROUND: Diabetic patients show an increased prevalence of non-dipping arterial pressure pattern, target organ damage and elevated arterial stiffness. These alterations are associated with increased cardiovascular risk.The objectives of this study are the following: to evaluate the prognostic value of central arterial pressure and pulse wave velocity in relation to the incidence and outcome of target organ damage and the appearance of cardiovascular episodes (cardiovascular mortality, myocardial infarction, chest pain and stroke) in patients with type 2 diabetes mellitus or metabolic syndrome. METHODS/DESIGN: Design: This is an observational prospective study with 5 years duration, of which the first year corresponds to patient inclusion and initial evaluation, and the remaining four years to follow-up. SETTING: The study will be carried out in the urban primary care setting. STUDY POPULATION: Consecutive sampling will be used to include patients diagnosed with type 2 diabetes between 20-80 years of age. A total of 110 patients meeting all the inclusion criteria and none of the exclusion criteria will be included. MEASUREMENTS: Patient age and sex, family and personal history of cardiovascular disease, and cardiovascular risk factors. Height, weight, heart rate and abdominal circumference. Laboratory tests: hemoglobin, lipid profile, creatinine, microalbuminuria, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood insulin, fibrinogen and high sensitivity C-reactive protein. Clinical and 24-hour ambulatory (home) blood pressure monitoring and self-measured blood pressure. Common carotid artery ultrasound for the determination of mean carotid intima-media thickness. Electrocardiogram for assessing left ventricular hypertrophy. Ankle-brachial index. Retinal vascular study based on funduscopy with non-mydriatic retinography and evaluation of pulse wave morphology and pulse wave velocity using the SphygmoCor system. The medication used for diabetes, arterial hypertension and hyperlipidemia will be registered, together with antiplatelet drugs. DISCUSSION: The results of this study will help to know and quantify the prognostic value of central arterial pressure and pulse wave velocity in relation to the evolution of the subclinical target organ damage markers and the possible incidence of cardiovascular events in patients with type 2 diabetes mellitus. PMCID: PMC2858115 Free PMC Article
	PMID: 20298558 [PubMed - in process]
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89.	Turk Kardiyol Dern Ars. 2010 Jan;38(1):14-9. [Aortic strain and distensibility in patients with metabolic syndrome]. [Article in Turkish] Güray Y, Refiker M, Demirkan B, Güray U, Boyaci A, Korkmaz S. Department of Cardiology, Türkiye Yüksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey. yesimguray@gmail.com Abstract OBJECTIVES: Metabolic syndrome (MetS) is associated with increased risk for cardiovascular disease. We evaluated aortic stiffness and factors affecting aortic stiffness by echocardiography in patients with MetS. STUDY DESIGN: The study included 27 patients (18 men, 9 women; mean age 56+/-7.5 years) and 33 patients (20 men, 13 women; mean age 54.3+/-5.5 years) with and without MetS, respectively, according to the ATP-III criteria. Blood pressure, pulse pressure, waist circumference, and levels of total cholesterol, HDL and LDL cholesterol, triglyceride, and high-sensitivity C-reactive protein (hs-CRP) were measured. Systolic and diastolic diameters of the ascending aorta were measured by M-mode echocardiography from the parasternal long-axis views, and parameters of aortic stiffness (aortic strain and distensibility) were calculated. RESULTS: Compared to the control group, patients with MetS had significantly higher values of blood pressure, pulse pressure, waist circumference, and higher triglyceride, glucose, and hs-CRP levels and lower HDL cholesterol level (p<0.05). In the MetS group, aortic strain (9.0+/-3.5% vs. 6.3+/-3.8%; p=0.007) was significantly increased and aortic distensibility (2.7+/-1.9 cm(2)/dyn/10(3) vs. 4.8+/-1.9 cm(2)/dyn/10(3) p=0.001) was significantly decreased. Aortic distensibility was negatively correlated with age (r=-0.269, p=0.03), hs-CRP (r=-0.287, p=0.002), systolic blood pressure (r=-0.533, p<0.001), and diastolic blood pressure (r=-0.275, p=0.03). In age-adjusted multiple regression analysis, systolic blood pressure (beta=0.8, p<0.001), waist circumference (beta=0.5, p=0.02), and hs-CRP (beta=0.6, p=0.002) were independent predictors of aortic distensibility. CONCLUSION: Aortic stiffness is increased in patients with MetS. Using a noninvasive and readily available tool, transthoracic echocardiography, arterial stiffness can easily be assessed, so that the incidence of cardiovascular diseases and associated mortality can be decreased through appropriate treatment for risk factors. Free Article
	PMID: 20215837 [PubMed - indexed for MEDLINE]
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90.	Med Intensiva. 2010 Aug-Sep;34(6):363-9. Epub 2010 Mar 6. [Effects of induced hypothermia in critically ill children]. [Article in Spanish] Mencía S, Berroya A, López-Herce J, Botrán M, Urbano J, Carrillo A. Sección de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España. santiagomencia@yahoo.es Abstract OBJECTIVE: To study the efficacy of induced hypothermia (IH) in children, its effect on hemodynamic, hematological, and biochemical parameters and its side effects. DESIGN: Retrospective, observational study. SETTING: Pediatric intensive care unit. PATIENTS: Pediatric patients requiring induced hypothermia. INTERVENTIONS: None. DATA COLLECTED: The following variables were recorded prior to the initiation of IH and after 4, 24, 48, 72, and 120 hours: heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), diuresis, dose of inotropic, sedative, and muscle relaxant drugs, fluid balance, hematocrit, white cell count, white cell differential percentages, platelet count, blood levels of glucose, sodium, and potassium, C reactive protein, lactate, coagulation times, pressure ulcers, shivering, infections and death. RESULTS: Thirty-one patients with a mean age of 20 months (SD: 39.8) were included in the study. The mean duration of IH was 3.97 days (range: 1 to 11 days). Among the IH effects, there was a significant fall in heart rate, with no changes in SBP, DBP, or diuresis. The blood tests revealed a progressive and significant fall in platelet count and an increase in C reactive protein levels. The fall in hematocrit and glucose and lactate levels was not significant. Positive cultures were detected in 25.8% of the patients during IH, most commonly from the bronchial aspirate (65%). CONCLUSIONS: Induced hypothermia can be useful in some critically ill children. Tolerance is generally good and there are usually few side effects, which can be controlled through appropriate monitoring. Copyright © 2009 Elsevier España, S.L. y SEMICYUC. All rights reserved. Free Article
	PMID: 20207445 [PubMed - indexed for MEDLINE]
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91.	Diabetes Care. 2010 Jun;33(6):1179-85. Epub 2010 Mar 3. Insulin resistance predicts mortality in nondiabetic individuals in the U.S. Ausk KJ, Boyko EJ, Ioannou GN. Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle Washington, USA. Abstract OBJECTIVE: Insulin resistance is a suspected causative factor in a wide variety of diseases. We aimed to determine whether insulin resistance, estimated by the homeostasis model assessment for insulin resistance (HOMA-IR), is associated with all-cause or disease-specific mortality among nondiabetic persons in the U.S. RESEARCH DESIGN AND METHODS: We determined the association between HOMA-IR and death certificate-based mortality among 5,511 nondiabetic, adult participants of the third U.S. National Health and Nutrition Examination Survey (1988-1994) during up to 12 years of follow-up, after adjustment for potential confounders (age, sex, BMI, waist-to-hip ratio, alcohol consumption, race/ethnicity, educational attainment, smoking status, physical activity, C-reactive protein, systolic and diastolic blood pressure, plasma total and HDL cholesterol, and triglycerides). RESULTS: HOMA-IR was significantly associated with all-cause mortality (adjusted hazard ratio 1.16 [95% CI 1.01-1.3], comparing successive quartiles of HOMA-IR in a linear model and 1.64 [1.1-2.5], comparing the top [HOMA-IR >2.8] to the bottom [HOMA-IR <or=1.4] quartile). HOMA-IR was significantly associated with all-cause mortality only in subjects with BMI <25.2 kg/m(2) (the median value) but not in subjects with BMI >or=25.2 kg/m(2). Subjects in the second, third, and fourth quartile of HOMA-IR appeared to have higher cardiovascular mortality than subjects in the lowest quartile of HOMA-IR. HOMA-IR was not associated with cancer-related mortality. CONCLUSIONS: HOMA-IR is associated with all-cause mortality in the nondiabetic U.S. population but only among persons with normal BMI. HOMA-IR is a readily available measure that can be used in the future to predict mortality in clinical or epidemiological settings. PMCID: PMC2875420 [Available on 2011/6/1] Free Article
	PMID: 20200308 [PubMed - indexed for MEDLINE]
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92.	J Atheroscler Thromb. 2010 Apr 30;17(4):410-5. Epub 2010 Mar 3. Small, dense LDL and high-sensitivity C-reactive protein (hs-CRP) in metabolic syndrome with type 2 diabetes mellitus. Nakano S, Kuboki K, Matsumoto T, Nishimura C, Yoshino G. Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan. Abstract AIM: To clarify the clinical significance of small,dense LDL (sLDL) in the metabolic syndrome associated with type 2 diabetes. METHODS: One hundred and ten healthy non-diabetic and non-metabolic syndrome subjects (58 male/52 female), 77 non-metabolic diabetic subjects (62/15), 58 non-diabetic metabolic subjects (25/33), and 46 metabolic diabetic subjects (29/17) were enrolled in this study. RESULTS: The subjects with metabolic syndrome (both with and without type 2 diabetes) had significantly higher fasting blood glucose, total-cholesterol (C), LDL-C, triglyceride, sLDL-C and hs-CRP levels than non-metabolic and non-diabetic subjects. HDL-C levels were significantly decreased in the former compared to the latter. Among the metabolic syndrome subjects, those with type 2 diabetes had significantly higher fasting blood glucose, systolic blood pressure and hs-CRP values than those without diabetes. sLDL-C, LDL-C and hs-CRP were the highest and HDL-C was lowest in the metabolic syndrome with diabetes group. A multiple regression analysis revealed the most significant determinant of sLDL-C to be LDL-C, followed by HDL-C, total-C, metabolic syndrome, type 2 diabetes mellitus, and triglyceride. CONCLUSION: Metabolic syndrome is a significant determinant of the plasma sLDL-C level. Hs-CRP was the highest in the metabolic syndrome patients with type 2 diabetes. Therefore, type 2 diabetes may further increase the risk of coronary artery disease in the metabolic syndrome subjects through cardiovascular inflammation. Free Article
	PMID: 20197633 [PubMed - indexed for MEDLINE]
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93.	Diabetes. 2010 May;59(5):1153-60. Epub 2010 Feb 25. Lipoprotein particle size and concentration by nuclear magnetic resonance and incident type 2 diabetes in women. Mora S, Otvos JD, Rosenson RS, Pradhan A, Buring JE, Ridker PM. Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusett, USA. smora@partners.org Abstract OBJECTIVE: Diabetic dyslipoproteinemia is characterized by low HDL cholesterol and high triglycerides. We examined the association of lipoprotein particle size and concentration measured by nuclear magnetic resonance (NMR) spectroscopy with clinical type 2 diabetes. RESEARCH DESIGN AND METHODS: This was a prospective study of 26,836 initially healthy women followed for 13 years for incident type 2 diabetes (n = 1,687). Baseline lipids were measured directly and lipoprotein size and concentration by NMR. Cox regression models included nonlipid risk factors (age, race, smoking, exercise, education, menopause, blood pressure, BMI, family history, A1C, and C-reactive protein). NMR lipoproteins were also examined after further adjusting for standard lipids. RESULTS: Incident diabetes was significantly associated with baseline HDL cholesterol, triglycerides, and NMR-measured size and concentration of LDL, IDL, HDL, and VLDL particles. The associations of these particles differed substantially by size. Small LDL(NMR) and small HDL(NMR) were positively associated with diabetes (quintile 5 vs. 1 [adjusted hazard ratios and 95% CIs], 4.04 [3.21-5.09] and 1.84 [1.54-2.19], respectively). By contrast, large LDL(NMR) and large HDL(NMR) were inversely associated (quintile 1 vs. 5, 2.50 [2.12-2.95] and 4.51 [3.68-5.52], respectively). For VLDL(NMR), large particles imparted higher risk than small particles (quintile 5 vs. 1, 3.11 [2.35-4.11] and 1.31 [1.10-1.55], respectively). Lipoprotein particle size remained significant after adjusting for standard lipids and nonlipid factors. CONCLUSIONS: In this prospective study of women, NMR lipoprotein size and concentrations were associated with incident type 2 diabetes and remained significant after adjustment for established risk factors, including HDL cholesterol and triglycerides. PMCID: PMC2857895 [Available on 2011/5/1] Free Article
	PMID: 20185808 [PubMed - indexed for MEDLINE]
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94.	J Am Soc Hypertens. 2009 Jul-Aug;3(4):260-6. C-reactive Protein among Community-Dwelling Hypertensives on Single-agent Antihypertensive Treatment. Fulop T, Rule AD, Schmidt DW, Wiste HJ, Bailey KR, Kullo IJ, Schwartz GL, Mosley TH, Boerwinkle E, Turner ST. Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States. Abstract BACKGROUND: C-reactive protein is a predictor of adverse cardiovascular outcomes. The effect of antihypertensive therapy on C-reactive protein levels is largely unknown. METHOD: We undertook a cross-sectional study of CRP levels among participants with primary hypertension on single-agent anti-hypertensive therapy in the community-based biracial Genetic Epidemiology Network of Arteriopathy cohort. Linear regression models were used to assess the association of anti-hypertensive medication class with log-transformed C-reactive protein after adjustment for age, gender, ethnicity, body mass index, smoking, diabetes, HMG-Co-A reductase inhibitor use, achieved blood pressure control (<140/90 mmHg), serum creatinine and urine albumin-to-creatinine ratios. RESULTS: There were 662 participants in the cohort taking single-agent therapy for hypertension. Median C-reactive protein levels differed across participants: 0.40 mg/dL for those on diuretics, 0.34 mg/dL on calcium channel blockers, 0.25 mg/dL on beta blockers and 0.27 mg/dL on renin-angiotensin-aldosterone system inhibitors (p<0.001). With multivariable adjustment, the group on renin-angiotensin-aldosterone system inhibitors had a 20% lower mean CRP on average than the group on diuretics (p=0.044), differences between other medication classes were not apparent. Heart rate had a strong association with C-reactive protein (p < 0.001). CONCLUSIONS: Antihypertensive medication class may influence inflammation, particularly in patients on RAAS inhibitors. PMCID: PMC2739300 Free PMC Article
	PMID: 20161163 [PubMed]
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95.	J Am Soc Hypertens. 2009 May-Jun;3(3):184-91. Aldosterone Receptor Antagonism Reduces Urinary C-Reactive Protein Excretion in Angiotensin II-Infused, Hypertensive Rats. Ortiz RM, Mamalis A, Navar LG. Division of Natural Sciences, University of California, Merced CA. Abstract BACKGROUND: Elevated C-reactive protein (CRP) may contribute to elevated arterial pressure in Ang II-dependent hypertension. However, the in vivo effects of Ang II and of mineralocorticoid receptor (MR) antagonism on CRP during Ang II-dependent hypertension have not been examined. In addition, urinary CRP excretion as a method to monitor the progression of Ang II-induced inflammation has not been evaluated. METHODS: Urine samples were collected from three groups (n = 10/group) of rats: 1) normotensive control, 2) angiotensin II infused (Ang II; 60 ng/min), and 3) Ang II + eplerenone (epl; 25 mg/d). A diet containing epl (0.1 %) was provided after 1 week of Ang II infusion. RESULTS: After 28 d, Ang II increased SBP from 136 +/- 5 to 207 +/- 8 mmHg; this response in SBP was not altered following MR antagonism (215 +/- 6 mmHg). Ang II-infusion increased plasma CRP from 14 +/- 2 to 26 +/- 3 mug/mL and increased urinary CRP excretion nearly 8-fold (143 +/- 26 vs 1102 +/- 115 ng/d). Treatment with eplerenone reduced plasma CRP by 25 % and urinary immunoreactive CRP (irCRP) by 34 % in Ang II-infused rats suggesting that aldosterone contributes to the CRP-associated inflammatory response in Ang II-dependent hypertension. CONCLUSIONS: The increase in SBP preceded the increase in irCRP excretion by at least 4 days suggesting that CRP does not significantly contribute to increased arterial blood pressure in Ang II-dependent hypertension. The blockade of MR reduced plasma CRP and urinary irCRP excretion demonstrating the contribution of aldosterone to the Ang II-induced generation of CRP. Furthermore, urinary CRP may serve as a non-invasive index for monitoring cardiovascular inflammation during hypertension. PMCID: PMC2740916 Free PMC Article
	PMID: 20161115 [PubMed]
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96.	Hypertension. 2010 Apr;55(4):953-60. Epub 2010 Feb 15. C-reactive protein promotes cardiac fibrosis and inflammation in angiotensin II-induced hypertensive cardiac disease. Zhang R, Zhang YY, Huang XR, Wu Y, Chung AC, Wu EX, Szalai AJ, Wong BC, Lau CP, Lan HY. Department of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China. Comment in: Hypertension. 2010 Jul;56(1):e15; author reply e16. Abstract C-reactive protein (CRP) is a risk factor or biomarker for cardiovascular diseases, including hypertension. The present study investigated the functional importance of human CRP in hypertensive cardiac remodeling by a chronic infusion of angiotensin II (Ang II) into mice that express human CRP. Compared with the wild-type mice, although Ang II infusion caused an equally high systolic blood pressure, levels of human CRP were further elevated, and cardiac remodeling was markedly exacerbated in mice that express human CRP, resulting in a significant reduction in the left ventricular ejection fraction and fractional shortening and an increase in cardiac fibrosis (collagen I and III and alpha-smooth muscle actin) and inflammation (interleukin 1beta and tumor necrosis factor-alpha). The enhancement in cardiac remodeling in mice that express human CRP was associated with further upregulation of the Ang II type I receptor and transforming growth factor-beta1 and overactivation of both transforming growth factor-beta/Smad and nuclear factor-kappaB signaling pathways. Furthermore, in vitro studies in cardiac fibroblasts revealed that CRP alone was able to significantly induce expression of the Ang II type I receptor, collagen I/III, and alpha-smooth muscle actin, as well as proinflammation cytokines (interleukin 1beta and tumor necrosis factor-alpha), which was further enhanced by addition of Ang II. In conclusion, CRP is not only a biomarker but also a mediator in Ang II-mediated cardiac remodeling. Enhanced upregulation of the Ang II type I receptor and activation of the transforming growth factor-beta/Smad and nuclear factor-kappaB signaling pathways may be the mechanisms by which CRP promotes cardiac fibrosis and inflammation under high Ang II conditions. Free Article
	PMID: 20157054 [PubMed - indexed for MEDLINE]
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97.	BMC Pediatr. 2010 Feb 15;10:8. Endothelial dysfunction in obese non-hypertensive children without evidence of sleep disordered breathing. Bhattacharjee R, Alotaibi WH, Kheirandish-Gozal L, Capdevila OS, Gozal D. Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Kentucky, USA. Abstract BACKGROUND: Endothelial dysfunction is a complication of both obesity and obstructive sleep apnea syndrome (OSAS), the latter being highly prevalent among obese children. It is unknown whether obesity causes endothelial dysfunction in children in the absence of OSAS. This study examines endothelial function in obese and non-obese children without OSAS. METHODS: Pre-pubertal non-hypertensive children were recruited. Endothelial function was assessed in a morning fasted state, using a modified hyperemic test involving cuff-induced occlusion of the radial and ulnar arteries. The absence of OSAS was confirmed by overnight polysomnography. Anthropometry was also performed. RESULTS: 55 obese children (mean age 8.6 +/- 1.4 years, mean BMI z-score: 2.3 +/- 0.3) were compared to 50 non-obese children (mean age 8.0 +/- 1.6 years, mean BMI z-score 0.3 +/- 0.9). Significant delays to peak capillary reperfusion after occlusion release occurred in obese compared to non-obese children (45.3 +/- 21.9 sec vs. 31.5 +/- 14.1 sec, p < 0.01), but no differences in the magnitude of hyperemia emerged. Time to peak reperfusion and percentage of body fat were positively correlated (r = 0.365, p < 0.01). CONCLUSIONS: Our findings confirm that endothelial dysfunction occurs early in life in obese children, even in the absence of OSAS. Thus, mechanisms underlying endothelial dysfunction in pediatric obesity are operational in the absence of sleep-disordered breathing. PMCID: PMC2829007 Free PMC Article
	PMID: 20156343 [PubMed - indexed for MEDLINE]
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98.	J Atheroscler Thromb. 2010 Feb 26;17(2):173-80. Epub 2010 Feb 12. Ezetimibe ameliorates metabolic disorders and microalbuminuria in patients with hypercholesterolemia. Yagi S, Akaike M, Aihara K, Iwase T, Ishikawa K, Yoshida S, Sumitomo-Ueda Y, Kusunose K, Niki T, Yamaguchi K, Koshiba K, Hirata Y, Dagvasumberel M, Taketani Y, Tomita N, Yamada H, Soeki T, Wakatsuki T, Matsumoto T, Sata M. Department of Cardiovascular Medicine, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan. syagi@clin.med.tokushima-u.ac.jp Abstract AIM: Ezetimibe, an inhibitor of Niemann-Pick C1-like 1 protein, has been shown to reduce the intestinal absorption of cholesterol. We investigated whether it also has beneficial effects on metabolic disorder and/or renal insufficiency in patients with hypercholesterolemia. METHODS: Ezetimibe was administered to 38 Japanese patients with hypercholesterolemia to obtain appropriate low-density lipoprotein cholesterol (LDL-chol) levels. Age- and sex-matched patients with hypercholesterolemia (n=38) were the controls. We evaluated the effects of ezetimibe before and 4 to 8 weeks after ezetimibe treatment. RESULTS: Ezetimibe significantly decreased LDL-chol levels and metabolic syndrome-related factors, including body weight, waist circumference, blood pressure; homeostasis model assessment insulin resistance (HOMA-IR), and urinary albumin excretion, were significantly reduced. In addition, it decreased the level of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-alpha, the urinary excretion of 8-hydroxy-2'-deoxyguanosine, a parameter of oxidative stress, and increased the urinary excretion of nitrate and nitrite (NOx). In the controls we observed no such changes. Excepting the decrease in the serum TNF-alpha level, the effects of ezetimibe were not correlated with decreased LDL-chol levels. CONCLUSION: Ezetimibe ameliorated the status of metabolic syndrome and microalbuminuria, reduced inflammation and oxidative stress, and increased nitric oxide bioavailability in a LDL-chol reduction-dependent and -independent manner. Free Article
	PMID: 20150722 [PubMed - indexed for MEDLINE]
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99.	Diabetes Metab. 2010 Apr;36(2):144-51. Epub 2010 Feb 9. Exercise ameliorates serum MMP-9 and TIMP-2 levels in patients with type 2 diabetes. Kadoglou NP, Vrabas IS, Sailer N, Kapelouzou A, Fotiadis G, Noussios G, Karayannacos PE, Angelopoulou N. 1st Department of Internal Medicine, Hippokratio General Hospital of Thessaloniki, Thessaloniki, Greece. nikoskad@yahoo.com Abstract AIM: This study assessed the impact of regular exercise on inflammatory markers (high-sensitivity C-reactive protein [hsCRP], fibrinogen), and matrix metalloproteinases (MMPs) and their inhibitors (TIMPs), in patients with type 2 diabetes mellitus (T2DM). PATIENTS: Fifty overweight patients with T2DM were randomly assigned to two groups: (A) an exercise group (EXG, n=25), with self-controlled exercise for at least 150 min/week and one additional supervised exercise session/week; and (B) a control group (COG, n=25), with no exercise instructions. All participants were taking oral antidiabetic drugs, and none had diabetic complications. Clinical parameters, exercise capacity (VO(2 peak)), ventilatory threshold (VT), insulin resistance indices (fasting insulin, HOMA-IR, HOMA%S), hsCRP, fibrinogen, MMP-2, MMP-9, TIMP-1 and TIMP-2 were assessed at baseline and after 16 weeks. RESULTS: No significant changes were found in body mass index, waist/hip ratio, insulin-resistance indices, MMP-2 and TIMP-1 throughout the study in either group (P>0.05). Compared with controls, the EXG showed a significant decrease in systolic and mean blood pressure, total and LDL cholesterol, and HbA(1c) (P<0.05). Also, exercise significantly suppressed levels of fibrinogen (P=0.047), hsCRP (P=0.041) and MMP-9 (P=0.028), and the MMP-9-to-TIMP-1 ratio (P=0.038), whereas VO(2 peak) (P=0.011), VT (P=0.008) and plasma TIMP-2 levels (P=0.022) were considerably upregulated in the EXG vs. COG. Standard multiple-regression analyses revealed that MMP-9 changes were independently associated with fibrinogen and HbA(1c) changes, while fibrinogen changes independently predicted TIMP-2 alterations with exercise. CONCLUSION: Mostly self-controlled exercise of moderate intensity ameliorated serum levels of pro- and anti-atherogenic markers in patients with T2DM, with no effects on body weight. These data offer further insight into the cardioprotective mechanisms of exercise in patients with T2DM. (c) 2010 Elsevier Masson SAS. All rights reserved. Free Article
	PMID: 20149706 [PubMed - indexed for MEDLINE]
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100.	Reumatismo. 2009 Oct-Dec;61(4):298-305. [Subclinical atherosclerosis in patients with psoriatic arthritis: a case-control study. Preliminary data]. [Article in Italian] Contessa C, Ramonda R, Lo Nigro A, Modesti V, Lorenzin M, Puato M, Zanon M, Balbi G, Doria A, Punzi L. Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, Italia. Abstract OBJECTIVE: The aim of this study was to evaluate the prevalence of subclinical atherosclerosis in patients with psoriatic arthritis (PsA), correlated with some traditional risk factors of atherosclerosis and with PsA-related disease factors. METHODS: Forty-one patients and 41 healthy subjects were evaluated for intima-media thickness (IMT) and flow-mediated dilation (FMD), using carotid duplex scanning. IMT values were expressed like IMT mean (cumulative mean of all the IMT mean) and M-MAX (cumulative mean of all the higher IMT). Subclinical atherosclerosis markers were correlated with age, body mass index (BMI) and blood pressure in both groups, with duration of arthritis, duration of psoriasis, tender and swollen joints, BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in patients. RESULTS: IMT mean and M-MAX were both higher in PsA patients compared with controls (0.7+/-0.15 vs 0.62+/-0.09 mm; p<0.01 and 0.86+/-0.21 vs. 0.74+/-0.13 mm; p<0.01 respectively). FMD was smaller in patients than in controls (5.9+/-2 vs 7.5+/-2.8%; p<0.01). Univariate analysis showed a correlation between IMT mean and SBP (r=0.217; p=0.05) and a correlation between M-MAX and age (r=0.392; p<0.001), BMI (r=0.252; p<0.05), SBP (r=0.446; p<0.001) in both groups. In PsA patients M-MAX resulted correlated with ESR (r=0.338; p<0.05) and BASDAI (r=0.322; p<0.05). CONCLUSIONS: PsA patients exhibited endothelial dysfunctions which is an early marker of subclinical atherosclerosis, as well as an higher IMT. An interesting correlation between M-MAX and PsA activity index (ESR and BASDAI) was found. Free Article
	PMID: 20143006 [PubMed - indexed for MEDLINE]
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101.	J Atheroscler Thromb. 2010 Mar 31;17(3):278-84. Epub 2010 Feb 5. Is pentraxin 3 involved in obesity-induced decrease in arterial distensibility? Miyaki A, Maeda S, Yoshizawa M, Misono M, Sasai H, Shimojo N, Tanaka K, Ajisaka R. Division of Sports Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan. Abstract AIM: Obesity is a strong risk factor for cardiovascular morbidity and mortality. In addition, decreased central arterial distensibility is recognized as an independent risk factor for cardiovascular disease (CVD). Obese subjects exhibit low arterial distensibillity; however, the mechanism responsible for the decrease in arterial distensibility in obese subjects has not yet been elucidated. Pentraxin 3 (PTX3), a recently identified member of the pentraxin family of proteins, is produced in areas of atherosclerosis. A recent study has revealed that the PTX3 level may indicate the vascular inflammatory status. The aim of this study was to investigate plasma PTX3 concentrations and arterial distensibility in obese subjects. METHODS: Eleven obese men (age: 44+/-2 years, body mass index [BMI]: 32+/-1 kg/m(2)) and 14 nonobese men (age: 42+/-2 years, BMI: 26+/-1 kg/m(2)) participated in this study. We measured arterial compliance (using simultaneous B-mode ultrasound and arterial applanation tonometry of the common carotid artery); beta-stiffness index, an index of arterial compliance adjusted for distending pressure; and plasma PTX3 concentrations. RESULTS: Arterial compliance was significantly lower and the beta-stiffness index was significantly higher in obese men than in non-obese men. Plasma PTX3 concentration was markedly higher in obese than non-obese men. CONCLUSIONS: Obese men have lower arterial distensibility and higher circulating PTX3 levels than non-obese men; therefore, higher PTX3 levels and decreased arterial distensibility coexist in obese men. The high PTX3 concentrations in obese men may be involved in the mechanism underlying the obesity-induced decrease in arterial distensibility. Free Article
	PMID: 20134101 [PubMed - indexed for MEDLINE]
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102.	Chest. 2010 Feb;137(2):496-7; author reply 497-8. The effect of continuous positive airway pressure on C-reactive protein levels in patients with obstructive sleep apnea syndrome. Ryan S, McNicholas W. Comment on: Chest. 2009 Jul;136(1):125-9. Free Article
	PMID: 20133306 [PubMed - indexed for MEDLINE]
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103.	J Atheroscler Thromb. 2010 Feb 26;17(2):181-8. Epub 2010 Feb 3. Comparative study of atherosclerotic parameters in Mongolian and Japanese patients with hypertension and diabetes mellitus. Uurtuya S, Kotani K, Taniguchi N, Yoshioka H, Kario K, Ishibashi S, Yamada T, Kawano M, Khurelbaatar N, Itoh K, Lkhagvasuren T. Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan. Abstract AIM: Cardiovascular disease is becoming increasingly more problematic in Mongolia. The cardioankle vascular index (CAVI) and circulating C-reactive protein (CRP) are new atherosclerosis-related parameters, but no comparative studies of atherosclerotic parameters including CAVI and CRP are available between Mongolian and Japanese populations, such as disease populations of hypertension (HT) and diabetes mellitus (DM). Our study objective was to examine atherosclerotic profiles in HT and DM patients in both countries. METHODS: From a hospital-based population, 156 Mongolian outpatients with HT and DM (men: 46%, mean age: 57.1 years) and 156 age- and sex-matched Japanese outpatients with HT and DM (men: 46%, age: 57.7) were recruited. Body mass index (BMI), heart rate (HR), blood pressure (BP), pulse pressure (PP), ankle-brachial index (ABI), ultrasonographic carotid intima-media thickness (IMT), blood total cholesterol (T-Cho), glucose, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were measured, in addition to CAVI and CRP. RESULTS: The levels of BMI, HR, BP, PP, insulin and IMT were significantly higher and T-Cho and glucose were significantly lower in the Mongolian patients in comparison to the Japanese patients. Particularly, the levels of CAVI (mean+/-SD) (8.1+/-1.1 vs. 8.8+/-1.2) and CRP(median[interquartile range])(0.05[0.03-0.12]vs. 0.19[0.09-0.42]mg/dL)were significantly higher in Mongolian than Japanese patients. These significant differences remained unchanged, even after taking into account multiple variables, including BP and HOMA-IR. In addition, except for CAVI in the subgroup of DM, generally similar trends regarding atherosclerotic parameters were seen in the subgroup by sex and disease (HT, DM and HT plus DM). CONCLUSION: These findings suggest that Mongolian patients with HT and DM may be at higher risk for cardiovascular disease than Japanese patients. Free Article
	PMID: 20124737 [PubMed - indexed for MEDLINE]
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104.	Environ Health Perspect. 2010 Jun;118(6):803-11. Epub 2010 Feb 2. Residential traffic exposure, pulse pressure, and C-reactive protein: consistency and contrast among exposure characterization methods. Rioux CL, Tucker KL, Mwamburi M, Gute DM, Cohen SA, Brugge D. Department of Public Health and Community Medicine, Tufts University, Boston, Massachusetts 02155 , USA. christine.rioux@tufts.edu Abstract BACKGROUND: Traffic exposure may increase cardiovascular disease (CVD) risk via systemic inflammation and elevated blood pressure, two important clinical markers for managing disease progression. OBJECTIVES: We assessed degree and consistency of association between traffic exposure indicators as predictors of C-reactive protein (CRP) and pulse pressure (PP) in an adult U.S. Puerto Rican population (n = 1,017). METHODS: Cross-sectional information on health and demographics and blood data was collected. Using multiple linear regression, we tested for associations between CRP, PP, and six traffic exposure indicators including residential proximity to roads with > 20,000 vehicles/day and traffic density [vehicle miles traveled per square mile (VMT/mi2)]. Diabetes and obesity [body mass index (BMI) >or= 30 kg/m2] were tested as effect modifiers. RESULTS: CRP was positively associated with traffic density in the total population [36% CRP difference with 95% confidence interval (CI) 2.5-81%] for residence within the highest versus lowest VMT/mi2 level. With BMI >or= 30, CRP showed significant positive associations with five of six traffic indices including residence <or= 200 m versus > 200 m of a roadway [22.7% CRP difference (95% CI, 3.15-46.1)] and traffic density in the third highest versus lowest VMT/mi2 level [28.1% difference (95% CI, 1.0-62.6)]. PP was positively associated with residence within <or= 100 m of a roadway for the total population [2.2 mmHg (95% CI, 0.13-4.3 mmHg)] and persons with BMI >or= 30 [3.8 mmHg (95% CI, 0.88-6.8)]. Effect estimates approximately doubled for residence within <or= 200 m of two or more roadways, particularly in persons with diabetes [8.1 mmHg (95% CI, 2.2-14.1)]. CONCLUSIONS: Traffic exposure at roadway volumes as low as 20,000-40,000 vehicles/day may increase CVD risk through adverse effects on blood pressure and inflammation. Individuals with elevated inflammation profiles, that is, BMI >or= 30, may be more susceptible to the effects of traffic exposure. PMCID: PMC2898857 Free PMC Article
	PMID: 20123638 [PubMed - indexed for MEDLINE]
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105.	J Nephrol. 2010 Mar-Apr;23(2):175-80. Renal resistance index is a marker of future renal dysfunction in patients with essential hypertension. Okura T, Kurata M, Irita J, Enomoto D, Jotoku M, Nagao T, Koresawa M, Kojima S, Hamano Y, Mashiba S, Miyoshi K, Higaki J. Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Toon City, Ehime - Japan. okura@m.ehime-u.ac.jp Abstract AIM: In patients with essential hypertension (EHT), the intrarenal resistance index (RI) has been shown to be related to the severity of target organ damage (TOD). Cystatin C is has been reported to be related to TOD in EHT. The aim of the present study was to clarify whether the RI predicts future renal function assessed by cystatin C levels in EHT. METHODS: One-hundred and twelve patients participated. RI and cystatin C were measured at baseline, and 12 months later, cystatin C was measured again. RESULTS: The patients were divided into 2 groups according to RI value: the low RI group (RI<0.7) and the high RI group (RI> or =0.7). After 12 months, cystatin C levels were significantly elevated in the high RI group, whereas the levels remained unchanged in the low RI group. Stepwise regression analysis using the baseline values of RI, age, pulse pressure, HbA1c, cystatin C, log-transformed (ln) C-reactive protein and ln urinary albumin/creatinine as covariates, showed baseline RI was the only independent determinant of the time-related changes in cystatin C levels. CONCLUSION: This finding suggests that the renal RI may be a marker of future renal dysfunction in EHT. Free Article
	PMID: 20119927 [PubMed - indexed for MEDLINE]
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106.	J Am Coll Cardiol. 2010 Jan 26;55(4):342-9. A high ankle brachial index is associated with greater left ventricular mass MESA (Multi-Ethnic Study of Atherosclerosis). Ix JH, Katz R, Peralta CA, de Boer IH, Allison MA, Bluemke DA, Siscovick DS, Lima JA, Criqui MH. Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California 92161, USA. joeix@ucsd.edu Abstract OBJECTIVES: This study sought to determine the association of high ankle brachial index (ABI) measurements with left ventricular (LV) mass, and to compare its strength with that of low ABI with LV mass. BACKGROUND: Arterial stiffness leads to LV mass through nonatherosclerotic pathways in mice. In humans, a high ABI indicates stiff peripheral arteries and is associated with cardiovascular disease (CVD) events. Whether high ABI is associated with LV mass in humans and whether this might reflect consequences of arterial stiffness, atherosclerosis, or both is unknown. METHODS: Among 4,972 MESA (Multi-Ethnic Study of Atherosclerosis) participants without clinical CVD, we used linear regression to evaluate the association of low (<0.90) and high (>1.40 or incompressible) ABI with LV mass by cardiac magnetic resonance imaging (MRI). Intermediate ABIs served as the reference category. To determine the effect of subclinical atherosclerosis, models were adjusted for common and internal carotid intima media thickness (cIMT) and natural log-transformed coronary artery calcification. RESULTS: Compared with subjects with intermediate ABI, LV mass was higher with either low (2.70 g/m(2) higher, 95% confidence interval: 0.65 to 4.75) or high ABI (6.84 g/m(2) higher, 95% confidence interval: 3.2 to 10.47) after adjustment for traditional CVD risk factors, kidney function, and C-reactive protein. However, further adjustment for cIMT and CAC substantially attenuated the association of low ABI with LV mass index (1.24 g/m(2) higher, 95% confidence interval: -0.84 to 3.33), whereas the association of high ABI was minimally altered (6.01 g/m(2) higher, 95% confidence interval: 2.36 to 9.67). CONCLUSIONS: High ABI is associated with greater LV mass; an association that is not attenuated with adjustment for subclinical atherosclerosis in nonperipheral arterial beds. High ABI might lead to greater LV mass through nonatherosclerotic pathways. Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. PMCID: PMC2837506 Free PMC Article
	PMID: 20117440 [PubMed - indexed for MEDLINE]
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107.	Turk Kardiyol Dern Ars. 2009 Oct;37(7):461-6. The prevalence of aspirin resistance in patients with metabolic syndrome. Cağirci G, Ozdemir O, Geyik B, Cay S, Oztürk S, Aras D, Topaloğlu S. Department of Cardiology, Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. Abstract OBJECTIVES: Aspirin is recommended for primary prevention in patients with metabolic syndrome (MetS). In this study, we evaluated aspirin resistance in MetS patients. STUDY DESIGN: The study included 32 patients (23 males, 9 females; mean age 60.7+/-11.4 years) with the diagnosis of MetS, according to the criteria of the International Diabetes Federation. Aspirin resistance was determined by the PFA-100 analysis (Platelet Function Analyzer). The results were compared with a control group of 30 patients (16 males, 14 females; mean age 61.6+/-7.3 years) without MetS. All the patients were taking aspirin at the time of the PFA-100 analysis. RESULTS: Overall, 21 patients (33.9%) were aspirin nonresponders. The prevalence of aspirin resistance was 46.9% in the MetS group, and 20% in the control group. The difference between the two groups was statistically significant (p=0.033). Compared to aspirin responders, fasting blood glucose level was higher (102.0+/-14.6 mg/dl vs. 95.3+/-9.9 mg/dl; p=0.036) and waist circumference tended to be greater in nonresponders (97.4+/-14.1 cm vs. 89.7+/-15.0 cm; p=0.053). Multivariate logistic regression analysis showed that MetS (OR 0.28, 95% CI 0.09-0.88; p=0.029), fasting blood glucose (OR 0.95, 95% CI 0.91-0.99; p=0.045), uric acid (OR 0.46, 95% CI 0.28-0.76; p=0.002), gamma-glutamyl transferase (OR 1.04, 95% CI 1.00-1.08; p=0.043), high-sensitivity C-reactive protein (OR 1.07, 95% CI 1.01-1.12; p=0.015) levels and platelet count (OR 0.99, 95% CI 0.98-0.99; p=0.034) significantly affected aspirin resistance. CONCLUSION: Our results show that a significant proportion of MetS patients will not benefit from aspirin use due to high aspirin resistance. Free Article
	PMID: 20098039 [PubMed - indexed for MEDLINE]
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108.	Turk Kardiyol Dern Ars. 2009 Oct;37(7):447-53. Evaluation of atrial electromechanical delay and left atrial mechanical functions in patients with rheumatoid arthritis. Acar G, Sayarlioğlu M, Akçay A, Sökmen A, Sökmen G, Yalçintaş S, Nacar AB, Gündüz M, Tuncer C. Department of Cardiology, Medicine Faculty of Kahramanmaraş Sütçü Imam University, Kahramanmaraş, Turkey. gurkandracar@hotmail.com Abstract OBJECTIVES: The aim of this study was to evaluate atrial electromechanical delay measured by tissue Doppler imaging (TDI) and left atrial (LA) mechanical functions in patients with rheumatoid arthritis (RA). STUDY DESIGN: The study included 68 patients (53 females, 15 males; mean age 43.7 years) with RA. Using TDI, atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), and right ventricular tricuspid annulus (PA tricuspid). Left atrial volumes (maximal, minimal, and pre-systolic) were measured by the method of discs in the apical four-chamber view and were indexed to body surface area. Mechanical function parameters of the LA were calculated. The results were compared with those of 41 age- and gender-matched healthy volunteers (32 females, 9 males; mean age 41.9 years). RESULTS: Patients with RA had significantly prolonged PA lateral, PA septum, and intra- (PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical delays compared to controls (p<0.0001, p=0.05, p<0.0001, and p<0.0001, respectively). Left atrial volumes were similar in the two groups (p>0.05). Left atrial passive emptying fraction was significantly decreased, LA active emptying volume and active emptying fraction were increased in RA patients (p=0.05, p=0.01, and p<0.0001; respectively). Interatrial electromechanical delay was correlated with systolic blood pressure (r=0.20, p=0.04), left ventricular mass index (r=0.22, p=0.02), C-reactive protein (CRP) (r=0.27, p=0.005), and LA active emptying fraction (r=0.29, p=0.002). In linear regression analysis, LA active emptying fraction and CRP were independent variables of interatrial electromechanical delay (beta=0.28, p=0.002 and beta=0.25, p=0.006, respectively). CONCLUSION: Prolonged electromechanical delays and impaired LA mechanical functions may be an early manifestation of subclinical cardiac involvement in RA patients. Free Article
	PMID: 20098037 [PubMed - indexed for MEDLINE]
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109.	Diabetes Care. 2010 Apr;33(4):804-10. Epub 2010 Jan 22. Inflammation and the incidence of type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis (MESA). Bertoni AG, Burke GL, Owusu JA, Carnethon MR, Vaidya D, Barr RG, Jenny NS, Ouyang P, Rotter JI. Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA. abertoni@wfubmc.edu Abstract OBJECTIVE: Many studies have documented associations between inflammation and type 2 diabetes incidence. We assessed potential variability in this association in the major U.S. racial/ethnic groups. RESEARCH DESIGN AND METHODS: Incident type 2 diabetes was assessed among men and women aged 45-84 years without prior clinical cardiovascular disease or diabetes in the prospective Multi-Ethnic Study of Atherosclerosis. Interleukin (IL)-6, fibrinogen, and C-reactive protein (CRP) were measured at baseline (2000-2002); fasting glucose and diabetes medication use was assessed at baseline and three subsequent in-person exams through 2007. Type 2 diabetes was defined as use of diabetes drugs or glucose > or =126 mg/dl. Covariates included baseline demographics, clinic, smoking, alcohol, exercise, hypertension medication, systolic blood pressure, insulin resistance, and BMI. Cox proportional hazards regression was used to calculate hazard ratios (HRs) by quartiles of CRP, IL-6, and fibrinogen. RESULTS: Among 5,571 participants (mean age 61.6 years, 53% female, 42.1% white, 11.5% Chinese, 25.7% black, and 20.7% Hispanic), 410 developed incident diabetes during a median follow-up time of 4.7 years (incidence 16.8 per 1,000 person-years). CRP, IL-6, and fibrinogen levels were associated with incident diabetes in the entire sample. After adjustment, the associations were attenuated; however, quartile 4 (versus quartile 1) of IL-6 (HR 1.5 [95% CI 1.1-2.2]) and CRP (1.7 [1.3-2.4]) remained associated with incident diabetes. In stratified analyses, similar associations were observed among white, black, and Hispanic participants. CONCLUSIONS: Higher levels of inflammation predict short-term incidence of type 2 diabetes in a multiethnic American sample. PMCID: PMC2845031 Free PMC Article
	PMID: 20097779 [PubMed - indexed for MEDLINE]
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110.	Hypertension. 2010 Mar;55(3):806-11. Epub 2010 Jan 18. Lifetime risk factors and arterial pulse wave velocity in adulthood: the cardiovascular risk in young Finns study. Aatola H, Hutri-Kähönen N, Juonala M, Viikari JS, Hulkkonen J, Laitinen T, Taittonen L, Lehtimäki T, Raitakari OT, Kähönen M. Department of Clinical Physiology, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland. Abstract Limited and partly controversial data are available regarding the relationship of arterial pulse wave velocity and childhood cardiovascular risk factors. We studied how risk factors identified in childhood and adulthood predict pulse wave velocity assessed in adulthood. The study cohort consisted of 1691 white adults aged 30 to 45 years who had risk factor data available since childhood. Pulse wave velocity was assessed noninvasively by whole-body impedance cardiography. The number of conventional childhood and adulthood risk factors (extreme quintiles for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, body mass index, and smoking) was directly associated with pulse wave velocity in adulthood (P=0.005 and P<0.0001, respectively). In multivariable regression analysis, independent predictors of pulse wave velocity were sex (P<0.0001), age (P<0.0001), childhood systolic blood pressure (P=0.002) and glucose (P=0.02), and adulthood systolic blood pressure (P<0.0001), insulin (P=0.0009), and triglycerides (P=0.003). Reduction in the number of risk factors (P<0.0001) and a favorable change in obesity status (P=0.0002) from childhood to adulthood were associated with lower pulse wave velocity in adulthood. Conventional risk factors in childhood and adulthood predict pulse wave velocity in adulthood. Favorable changes in risk factor and obesity status from childhood to adulthood are associated with lower pulse wave velocity in adulthood. These results support efforts for a reduction of conventional risk factors both in childhood and adulthood in the primary prevention of atherosclerosis. Free Article
	PMID: 20083727 [PubMed - indexed for MEDLINE]
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111.	J Am Coll Cardiol. 2009 Dec 15;54(25):2366-73. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? Matthews KA, Crawford SL, Chae CU, Everson-Rose SA, Sowers MF, Sternfeld B, Sutton-Tyrrell K. Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15213, USA. matthewska@upmc.edu Comment in: J Am Coll Cardiol. 2009 Dec 15;54(25):2374-5. Abstract OBJECTIVES: This prospective study examined whether changes in traditional and novel coronary heart disease (CHD) risk factors are greater within a year of the final menstrual period (FMP), relative to changes that occur before or after that interval, in a multiethnic cohort. BACKGROUND: Understanding the influence of menopause on CHD risk remains elusive and has been evaluated primarily in Caucasian samples. METHODS: SWAN (Study of Women's Health Across the Nation) is a prospective study of the menopausal transition in 3,302 minority (African American, Hispanic, Japanese, or Chinese) and Caucasian women. After 10 annual examinations, 1,054 women had achieved an FMP not due to surgery and without hormone therapy use before FMP. Measured CHD risk factors included lipids and lipoproteins, glucose, insulin, blood pressure, fibrinogen, and C-reactive protein. We assessed which of 2 models provided a better fit with the observed risk factor changes over time in relation to the FMP: a linear model, consistent with chronological aging, or a piecewise linear model, consistent with ovarian aging. RESULTS: Only total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B demonstrated substantial increases within the 1-year interval before and after the FMP, consistent with menopause-induced changes. This pattern was similar across ethnic groups. The other risk factors were consistent with a linear model, indicative of chronological aging. CONCLUSIONS: Women experience a unique increase in lipids at the time of the FMP. Monitoring lipids in perimenopausal women should enhance primary prevention of CHD. PMCID: PMC2856606 Free PMC Article
	PMID: 20082925 [PubMed - indexed for MEDLINE]
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112.	J Clin Endocrinol Metab. 2010 Mar;95(3):1386-94. Epub 2010 Jan 15. Additive effect of polymorphisms in the IL-6, LTA, and TNF-{alpha} genes and plasma fatty acid level modulate risk for the metabolic syndrome and its components. Phillips CM, Goumidi L, Bertrais S, Ferguson JF, Field MR, Kelly ED, Mehegan J, Peloso GM, Cupples LA, Shen J, Ordovas JM, McManus R, Hercberg S, Portugal H, Lairon D, Planells R, Roche HM. Nutrigenomics Research Group, University College Dublin School of Public Health and Population Science, University College Dublin Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland. Abstract Context: Cytokine polymorphisms and dietary fat composition may influence the risk of the metabolic syndrome (MetS). Objective: The objective of the study was to determine the relationship between lymphotoxin-alpha (LTA), TNF-alpha, and IL-6 gene polymorphisms with MetS risk and investigate whether plasma fatty acid composition, a biomarker of dietary fat intake, modulated these associations. Design: Polymorphisms (LTA rs915654, TNF-alpha rs1800629, IL-6 rs1800797), biochemical measurements, and plasma fatty acids were determined in the LIPGENE-SU.VI.MAX study of MetS cases and matched controls (n = 1754). Results: LTA rs915654 minor A allele carriers and TNF-alpha rs1800629 major G allele homozygotes had increased MetS risk [odds ratio (OR) 1.37 (confidence interval [CI] 1.12-1.66), P = 0.002 and OR 1.35 (CI 1.08-1.70), P = 0.009] compared with their TT homozygotes and A allele carriers. Possession of the IL-6 rs1800797 GG genotype by the LTA and TNF-alpha risk genotype carriers further increased risk of the MetS [OR 2.10 (CI 1.19-3.71) P = 0.009], fasting hyperglycemia [OR 2.65 (CI 1.12-6.28), P = 0.027], high systolic blood pressure [OR 1.99 (CI 1.07-3.72), P = 0.03], and abdominal obesity [OR 1.52 (CI 1.01-2.28), P = 0.04]. Plasma polyunsaturated to saturated fat ratio exacerbated these effects; subjects in the lowest 50th percentile had even greater risk of the MetS [OR 4.40 (CI 1.55-12.45), P = 0.005], fasting hyperglycemia, high systolic blood pressure, and abdominal obesity (P < 0.05). Conclusions: LTA, TNF-alpha, and IL-6 genotype interactions increased MetS risk, which was further exacerbated by a low plasma polyunsaturated to saturated fat exposure, indicating important modulation of genetic risk by dietary fat exposure. Free Article
	PMID: 20080841 [PubMed - indexed for MEDLINE]
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113.	BMC Nephrol. 2010 Jan 15;11:1. The relation of C--reactive protein to chronic kidney disease in African Americans: the Jackson Heart Study. Fox ER, Benjamin EJ, Sarpong DF, Nagarajarao H, Taylor JK, Steffes MW, Salahudeen AK, Flessner MF, Akylbekova EL, Fox CS, Garrison RJ, Taylor HA Jr. Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA. efox@medicine.umsmed.edu Abstract BACKGROUND: African Americans have an increased incidence and worse prognosis with chronic kidney disease (CKD--estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m2) than their counterparts of European-descent. Inflammation has been related to renal disease in non-Hispanic whites, but there are limited data on the role of inflammation in renal dysfunction in African Americans in the community. METHODS: We examined the cross-sectional relation of log transformed C-reactive protein (CRP) to renal function (eGFR by Modification of Diet and Renal Disease equation) in African American participants of the community-based Jackson Heart Study's first examination (2000 to 2004). We conducted multivariable linear regression relating CRP to eGFR adjusting for age, sex, body mass index, systolic and diastolic blood pressure, diabetes, total/HDL cholesterol, triglycerides, smoking, antihypertensive therapy, lipid lowering therapy, hormone replacement therapy, and prevalent cardiovascular disease events. In a secondary analysis we assessed the association of CRP with albuminuria (defined as albumin-to-creatinine ratio > 30 mg/g). RESULTS: Participants (n = 4320, 63.2% women) had a mean age +/- SD of 54.0 +/- 12.8 years. The prevalence of CKD was 5.2% (n = 228 cases). In multivariable regression, CRP concentrations were higher in those with CKD compared to those without CKD (mean CRP 3.2 +/- 1.1 mg/L vs. 2.4 +/- 1.0 mg/L, respectively p < 0.0001). CRP was significantly associated with albuminuria in sex and age adjusted model however not in the multivariable adjusted model (p > 0.05). CONCLUSION: CRP was associated with CKD however not albuminuria in multivariable-adjusted analyses. The study of inflammation in the progression of renal disease in African Americans merits further investigation. PMCID: PMC2826325 Free PMC Article
	PMID: 20078870 [PubMed - indexed for MEDLINE]
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114.	Intern Med. 2010;49(2):117-24. Epub 2010 Jan 15. Comparison between high-sensitivity C-reactive protein (hs-CRP) and white blood cell count (WBC) as an inflammatory component of metabolic syndrome in Japanese. Oda E, Kawai R. Medical Check-up Center, Tachikawa Medical Center, Nagaoka. ijie@venus.sannet.ne.jp Abstract OBJECTIVE: To compare two systemic inflammatory markers, high-sensitivity C-reactive protein (hs-CRP) and white blood cell count (WBC), as a component of metabolic syndrome (MetS). METHODS: Data of hs-CRP and WBC from 2,185 Japanese men and 1,383 Japanese women were examined using receiver operating characteristic (ROC) curve for diagnosing MetS and Spearman's correlation coefficients. RESULTS: The area under ROC curve (AUC) of hs-CRP was 0.71 in men and 0.74 in women. The AUC of WBC was 0.65 in men and 0.69 in women. The optimal cutoff point (sensitivity; specificity) of hs-CRP was 0.40 mg/L (0.69; 0.65) in men and 0.35 mg/L (0.67; 0.72) in women. The optimal cutoff point (sensitivity; specificity) of WBC was 5,600/L(-6) (0.61; 0.61) in men and 5,000/L(-6) (0.65; 0.63) in women. Correlations between obesity parameters, blood pressure, and liver function tests were stronger with hs-CRP than with WBC. But, no correlation between MetS-related risk factors was stronger with WBC than with hs-CRP. CONCLUSION: Hs-CRP is superior to WBC as an inflammatory component of MetS in Japanese. However, WBC may be useful when hs-CRP is not available because WBC is routinely measured in clinical practice. Free Article
	PMID: 20075574 [PubMed - indexed for MEDLINE]
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115.	Malar J. 2010 Jan 13;9:14. Shift in epitope dominance of IgM and IgG responses to Plasmodium falciparum MSP1 block 4. Chang SP, Kayatani AK, Terrientes ZI, Herrera S, Leke RG, Taylor DW. John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, Honolulu, HI 96813, USA. sandrac@hawaii.edu Abstract BACKGROUND: Plasmodium falciparum merozoite surface protein-1 (MSP1) has been extensively studied as a blood-stage malaria vaccine candidate, with most work focused on the conserved 19 kDa and semi-conserved 42 kDa C-terminal regions (blocks 16-17) and the hypervariable N-terminal repeat region (block 2). However, recent genotyping studies suggest that additional regions of MSP1 may be under selective pressure, including a locus of intragenic recombination designated as block 4 within the 3' region of the gene. METHODS: The current study examined the antibody response to the two parental and two recombinant forms of block 4 and to blocks 16-17 (3D7) in study populations from Colombia, Papua New Guinea and Cameroon that differ in malaria transmission intensity and ethnic composition. RESULTS: IgM and IgG antibodies were detected against parental and recombinant MSP1 block 4 peptides in all three populations. Overall, 32-44% of the individuals produced IgM to one or more of the peptides, with most individuals having IgM antibodies reactive with both parental and recombinant forms. In contrast, IgG seropositivity to block 4 varied among populations (range 15-65%), with the majority of antibodies showing specificity for one or a pair of block 4 peptides. The IgG response to block 4 was significantly lower than that to blocks 16-17, indicating block 4 is subdominant. Antibodies to block 4 and blocks 16-17 displayed distinct IgG subclass biases, with block 4 responses biased toward IgG3 and blocks 16-17 toward IgG1. These patterns of responsiveness were consistently observed in the three study populations. CONCLUSIONS: Production of antibodies specific for each parental and recombinant MSP1 block 4 allele in different populations exposed to P. falciparum is consistent with balancing selection of the MSP1 block 4 region by the immune response of individuals in areas of both low and high malaria transmission. MSP1 block 4 determinants may be important in isolate-specific immunity to P. falciparum. PMCID: PMC2837054 Free PMC Article
	PMID: 20070906 [PubMed - indexed for MEDLINE]
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116.	Diabetes Care. 2010 Apr;33(4):908-13. Epub 2010 Jan 12. Genetic architecture of plasma adiponectin overlaps with the genetics of metabolic syndrome-related traits. Henneman P, Aulchenko YS, Frants RR, Zorkoltseva IV, Zillikens MC, Frolich M, Oostra BA, van Dijk KW, van Duijn CM. Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands. c.vanduijn@erasmusmc.nl Abstract OBJECTIVE: Adiponectin, a hormone secreted by adipose tissue, is of particular interest in metabolic syndrome, because it is inversely correlated with obesity and insulin sensitivity. However, it is not known to what extent the genetics of plasma adiponectin and the genetics of obesity and insulin sensitivity are interrelated. We aimed to evaluate the heritability of plasma adiponectin and its genetic correlation with the metabolic syndrome and metabolic syndrome-related traits and the association between these traits and 10 ADIPOQ single nucleotide polymorphisms (SNPs). RESEARCH DESIGN AND METHODS: We made use of a family-based population, the Erasmus Rucphen Family study (1,258 women and 967 men). Heritability analysis was performed using a polygenic model. Genetic correlations were estimated using bivariate heritability analyses. Genetic association analysis was performed using a mixed model. RESULTS: Plasma adiponectin showed a heritability of 55.1%. Genetic correlations between plasma adiponectin HDL cholesterol and plasma insulin ranged from 15 to 24% but were not significant for fasting glucose, triglycerides, blood pressure, homeostasis model assessment of insulin resistance (HOMA-IR), and C-reactive protein. A significant association with plasma adiponectin was found for ADIPOQ variants rs17300539 and rs182052. A nominally significant association was found with plasma insulin and HOMA-IR and ADIPOQ variant rs17300539 after adjustment for plasma adiponectin. CONCLUSIONS: The significant genetic correlation between plasma adiponectin and HDL cholesterol and plasma insulin should be taken into account in the interpretation of genome-wide association studies. Association of ADIPOQ SNPs with plasma adiponectin was replicated, and we showed association between one ADIPOQ SNP and plasma insulin and HOMA-IR. PMCID: PMC2845050 Free PMC Article
	PMID: 20067957 [PubMed - indexed for MEDLINE]
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117.	J Atheroscler Thromb. 2010 Jul 30;17(7):705-11. Epub 2010 Jan 12. Switching to aggressive statin improves vascular endothelial function in patients with stable coronary artery disease. Hoshiga M, Arishiro K, Nakakoji T, Miyazaki N, Negoro N, Okabe T, Kohbayashi E, Ishihara T, Hanafusa T. First Department of Internal Medicine, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, Japan. in1026@poh.osaka-med.ac.jp Abstract AIM: The clinical relevance of the suggested pleiotropic effects of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) is controversial. Aggressive statins effectively reduce lipid levels, but whether their other effects are more powerful than those of regular statins is unknown. METHODS: We enrolled 32 patients (mean age, 65 y; male, 23) who had undergone coronary revascularization over 6 months previously and whose serum LDL cholesterol levels persisted at >100 mg/dL, regardless of pravastatin (10 mg/day). Before and 1 and 6 months after switching to atorvastatin (10 mg/day), we evaluated lipid profiles, including RLP-C (remnant-like particle cholesterol), high sensitive CRP (hsCRP), soluble CD40 ligand (sCD40L), TBARS (thiobarbituric acid reactive substances), and endothelial function determined from flow-mediated dilation (FMD) of the brachial artery. RESULTS: One month on atorvastatin lowered LDL cholesterol by 24% (131 to 100 mg/dL, p<0.001). In addition, RLP-C, sCD40L and hsCRP significantly decreased, whereas FMD did not change. After 6 months of this therapy, FMD significantly improved compared to baseline values (5.1 vs 3.6%, p=0.04). Changes in FMD and in total and RLP cholesterol significantly correlated. Moreover, FMD was remarkably improved in patients who achieved target LDL levels (<100 mg/dL). CONCLUSIONS: Switching from a regular to an aggressive statin can improve endothelial function at 6 months in patients with previous coronary artery disease. This effect is suggested to be mainly due to the lipid-lowering effect. Achievement and maintenance of the target LDL level by switching statins is beneficial in the clinical setting. Free Article
	PMID: 20065610 [PubMed - indexed for MEDLINE]
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118.	BMC Public Health. 2010 Jan 8;10:8. The influence of a high intensity physical activity intervention on a selection of health related outcomes: an ecological approach. Buchan DS, Ollis S, Thomas NE, Baker JS. Health and Exercise Sciences, School of Science and Technology, University of the West of Scotland, Hamilton, UK. duncan.buchan@uws.ac.uk Abstract BACKGROUND: Cardiovascular disease (CVD) is the main cause of mortality throughout the world. With accumulating evidence suggesting that CVD has its origins in childhood, it is unsurprising that research into obesity prevalence within school aged youth is burgeoning. Within this study our primary objective will be to examine whether high intensity interval training (HIT) improves the CVD risk profile of secondary school aged adolescents. Our secondary objective will be to identify the prevalence of CVD risk factors and examine factors associated with these in adolescents aged 15-18 years. METHOD/DESIGN: A South Lanarkshire school of low socioeconomic status (SES) was selected to participate in the study intervention. Participants from secondary 5 (15-17 years) and 6 (16-18 years) will be recruited for this study. Participants from secondary 6 will be randomly assigned to Group A (HIT) or Group B (moderate-vigorous) and will perform each protocol three times weekly. The secondary 5 participants will act as the control group. Data collection will take place during the Physical Education (PE) lessons and on school premises and will include: anthropometrical variables (height, weight, waist and hip circumferences, skinfold thickness at two sites), physiological responses (blood pressure, aerobic fitness, heart rate (HR) response, vertical jump performance, 10-metre (m) sprint, 50-m sprint and 505-agility test), diet (self-reported seven-day food diary), physical activity (Physical Activity Questionnaire for Adolescents (PAQ-A)) and blood tests (fasting glucose, insulin, total cholesterol (TC), high-density lipoprotein (HDL), high-sensitivity C-reactive protein (hs-CRP), fibrinogen (Fg), interleukin-6 (IL-6), adiponectin (high molecular weight), triglyceride and plasminogen activator inhibitor-1 (PAI-1). An environmental audit of the secondary school and the health related quality of life (HRQOL) of the participants will also be measured. Finally, all exercise sessions will be video recorded and rate of perceived exertion (RPE) and mood states will also be taken after each exercise session. DISCUSSION: Our study may be able to demonstrate a time efficient means of reducing CVD risk factors in adolescents. TRIAL REGISTRATION: NCT01027156. PMCID: PMC2830172 Free PMC Article
	PMID: 20064208 [PubMed - in process]
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119.	Am J Physiol Heart Circ Physiol. 2010 Mar;298(3):H1103-13. Epub 2010 Jan 8. Preoxygenated hemoglobin-based oxygen carrier HBOC-201 annihilates myocardial ischemia during brief coronary artery occlusion in pigs. Te Lintel Hekkert M, Dubé GP, Regar E, de Boer M, Vranckx P, van der Giessen WJ, Serruys PW, Duncker DJ. Dept. of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus Univ. Medical Center Rotterdam, The Netherlands. Abstract Because of their ability to perfuse remote regions and deliver oxygen, hemoglobin-based oxygen carriers (HBOCs) may be considered in the treatment of several ischemic conditions such as acute coronary syndromes or high-risk percutaneous intervention. Here we studied the effects of intracoronary infusion of ex vivo preoxygenated HBOC-201 during brief total coronary artery occlusion (CAOs) on myocardial oxygenation and left ventricular (LV) function in a large animal model and investigated the influence of HBOC-201 temperature and infusion rate on these effects. Thirteen open-chest anesthetized swine were instrumented for measurement of global and regional LV function and metabolism. CAOs were induced by inflating an intracoronary balloon catheter; preoxygenated HBOC-201 (12 g/dL) was infused distally through the central lumen of the balloon catheter. Animals underwent consecutive 3-min CAOs interspersed by 30 min of reperfusion, accompanied by different HBOC-201 infusion rates (0, 15, 23, 30, 40, and 50 ml/min) and/or two infusion temperatures (18 degrees C or 37 degrees C) in random order. CAO elicited immediate loss of systolic shortening (SS) in the ischemic region (19 +/- 1% at baseline vs. -3 +/- 2% at end of CAO), resulting in decreases in maximum rate of rise in LV pressure (15 +/- 5%) and stroke volume (12 +/- 4%; all P < 0.05). Balloon deflation resulted in marked coronary reactive hyperemia (to 472 +/- 74% of baseline), increases in coronary venous concentrations of adenosine + inosine (to 218 +/- 26% of baseline; both P < 0.05) and rapid restoration of SS toward baseline. HBOC-201 ameliorated the CAO-induced changes in SS, stroke volume, reactive hyperemia, and coronary venous adenosine + inosine. The effects were temperature and flow dependent with full preservation of SS at 50 ml/min HBOC-201 of 37 degrees C. In conclusion, intracoronary preoxygenated HBOC-201 preserved myocardial oxygenation and LV function in swine during CAO in a dose- and temperature-dependent manner. In our study setting, preoxygenated HBOC-201 can match the oxygen delivery role of endogenous blood in the heart on an almost equivalent-volume basis. Free Article
	PMID: 20061545 [PubMed - indexed for MEDLINE]
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120.	J Clin Endocrinol Metab. 2010 Mar;95(3):1060-8. Epub 2010 Jan 8. Obesity without established comorbidities of the metabolic syndrome is associated with a proinflammatory and prothrombotic state, even before the onset of puberty in children. Mauras N, Delgiorno C, Kollman C, Bird K, Morgan M, Sweeten S, Balagopal P, Damaso L. Nemours Children's Clinic, 807 Children's Way, Jacksonville, Florida 32207, USA. nmauras@nemours.org Abstract Background: Metabolic syndrome (MS)-related comorbidities in obesity, such as hypertension, dyslipidemia, and glucose intolerance, are increasingly recognized in children, predisposing them to early cardiovascular disease. Objective: The objective of the study was to investigate whether markers of inflammation and prothrombosis are abnormal in obese children without established MS comorbidities across puberty, as compared with lean, age-matched controls. Subjects and Methods: Obese children (body mass index >95%) with normal fasting glucose, blood pressure, cholesterol and triglycerides were recruited; lean controls (body mass index 10-75%) had no first-degree relatives with MS. High-sensitivity C-reactive protein (hsCRP), IL-6, plasminogen activator inhibitor 1, and fibrinogen concentrations were measured. Body composition was assessed by waist circumference and dual-energy x-ray absorptiometry. Results: Of 623 children screened, 203 enrolled (106 males, 97 females), aged 7-18 yr, 115 obese, 88 lean (balanced for age and gender), 99 prepubertal, and 104 pubertal. Many screen failures were due to silent comorbidities. Obese subjects with insulin resistance but without MS comorbidities had about 10 times higher hsCRP concentrations than controls and higher fibrinogen, IL-6, and plasminogen activator inhibitor-1 (P < 0.01 all). Differences were significant, even in the prepubertal cohort. hsCRP and fibrinogen correlated with waist circumference (r = 0.73 and 0.40, respectively) and percent fat mass (r = 0.76 and 0.47) (P < 0.0001). Conclusion: Childhood obesity per se is associated with a proinflammatory and prothrombotic state before other comorbidities of the MS are present and even before the onset of puberty. Whether biomarkers like hsCRP and fibrinogen are useful in assessing cardiovascular risk and whether these abnormalities are reversible with earlier therapeutic interventions in very young obese children requires further study. Free Article
	PMID: 20061420 [PubMed - indexed for MEDLINE]
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121.	Nutr Hosp. 2009 Nov-Dec;24(6):688-92. [G1359A polymorphism of the cannabinoid receptor gene (CNR1) on anthropometric parameters and cardiovascular risk factors in patients with morbid obesity]. [Article in Spanish] Luis DA, González Sagrado M, Aller R, Izaola O, Conde R, Pérez Castrillón JL, Romero E. Instituto de Endocrinología y Nutrición, Facultad de Medicina, Universidad de Valladolid, Valladolid, España. dadluis@yahoo.es Abstract BACKGROUND: A polymorphism (1359 G/A) of the CB1 gene has been described, it was reported as a common polymorphism in European populations. The aim of our study was to investigate the influence of this polymorphism of CB1 receptor gene on obesity anthropometric parameters, cardiovascular risk factors and adipocytokines in morbid obese patients. DESIGN: A population of 66 morbid obese patients was analyzed. An indirect calorimetry, tetrapolar electrical bioimpedance, blood pressure, a serial assessment of nutritional intake with 3 days written food records and biochemical analysis (lipid profile, adipocytokines, insulin, CRP and lipoprotein-a) were performed. The statistical analysis was performed for the combined G1359A and A1359A as a group and wild type G1359G as second group, with a dominant model. RESULTS: Thirty eight patients (57.6%) had the genotype G1359G (wild type group) and 28 (42.4%) patients G1359A (40.0%) (mutant type group). Weight (117.4 +/- 17.4 kg vs 109.4 +/- 13.8 kg: p < 0.05), BMI (45.4 +/- 4.7 vs 43.3 +/- 3.4: p < 0.05), fat mass (60.1 +/- 13.4 kg vs 53,6 +/- 12.8 kg: p < 0.05), waist circumference (126.3 +/- 10.8 cm vs 122.9 +/- 12.6 cm: p < 0.05), C reactive protein (11.2 +/- 8.8 mg/dl vs 7.8 +/- 4.6 mg/dl: p < 0.05), insulin (23.5 +/- 19.8 mUI/L vs 18.4 +/- 17.1 mUI/L: p < 0.05) and HOMA (6.46 +/- 6.2 vs 4.70 +/- 4.6: p < 0.05) were lowers in patients with G1359A genotype. No differences were detected between groups in other parameters. CONCLUSION: The mutant genotype G1359A is associated with a better cardiovascular profile (weight, BMI, fat mass, waist circumference, insulin, HOMA and c reactive protein) than wild type group. Free Article
	PMID: 20049372 [PubMed - indexed for MEDLINE]
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122.	J Womens Health (Larchmt). 2009 Dec;18(12):2041-7. Metabolic syndrome and elevated C-reactive protein in breast cancer survivors on adjuvant hormone therapy. Thomson CA, Thompson PA, Wright-Bea J, Nardi E, Frey GR, Stopeck A. Department of Nutritional Sciences, University of Arizona, Tucson, Arizona 85724, USA. cthomson@u.arizona.edu Abstract AIMS: As the efficacy of treatment for breast cancer has improved, particularly with the use of antiestrogenic therapies, there is an increasing population of long-term breast cancer survivors who seeks care with unique health issues. These patients may be at increased risk for cardiovascular disease (CVD) resulting from excess adiposity and treatment effects. Metabolic syndrome (MetS) and elevated C-reactive protein (CRP), two predictors of CVD, have not been fully evaluated in overweight breast cancer survivors on hormone-modulating agents. METHODS: Anthropometric measures, including weight, height, waist and hip circumferences; clinical laboratory assessments, including lipids, glucose, glycoslyated hemoglobin (HbA1c), insulin, and high sensitivity CRP; and body composition and blood pressure (BP) were collected from overweight breast cancer survivors (n=42). Select measures were used to derive MetS using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) diagnostic criteria. RESULTS: Participants had a mean body weight of 83.8 kg and body mass index (BMI) of 31.4 kg/m2. Mean fasting glucose (98+/-12.9 mg/dL), HbA1c (6.0+/-0.5 mg/dL), cholesterol (199+/-33.7 mg/dL), and insulin (16+/-3.2 mg/dL) were all at the upper end of the normal range. MetS was diagnosed in 54.8% of overweight postmenopausal breast cancer survivors. CRP was moderately or severely elevated in 90.5% of the population (mean of 5.1+/-5.3 mg/dL). CONCLUSIONS: In our sample, overweight breast cancer survivors commonly have MetS and elevated CRP that place them at increased risk for cardiovascular and other metabolic diseases. If replicated in a larger sample, this warrants close medical monitoring to prevent and reduce morbidity and mortality unrelated to breast cancer. PMCID: PMC2828195 Free PMC Article
	PMID: 20044868 [PubMed - indexed for MEDLINE]
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123.	Diabetes Metab Syndr Obes. 2010 Jun 22;3:187-95. High-sensitivity C-reactive protein concentrations among patients with and without diabetes in a multiethnic population of Singapore: CREDENCE Study. Dalan R, Jong M, Chan SP, Hawkins R, Choo R, Lim B, Tan ML, Leow MK. Department of Endocrinology, Tan Tock Seng Hospital, Singapore. Abstract OBJECTIVES: To determine whether high-sensitivity C-reactive protein (hs-CRP) concentrations differ between Chinese, Malays, and Indians with and without type 2 diabetes mellitus and to look for an association with demographic, metabolic and therapeutic variables. METHODS: Phase 1: We retrieved records of 50 Chinese, 51 Malay, and 67 Indian individuals who had routine health screening blood tests. Phase 2: We recruited 111 Chinese, 68 Malays, and 67 Indians with type 2 diabetes mellitus and measured their hs-CRP in addition to standard laboratory tests. RESULTS: Phase 1: The median hs-CRP was 0.6 mg/L (0.2-6.2) in Chinese, 1.2 mg/L (0.2-7.9) in Malays, and 1.9 mg/L (0.2-10.0) in Indians. The Indians had higher hs-CRP compared to Chinese (P < 0.05) when adjusted for age, sex, body mass index (BMI), lipids, blood pressure, and smoking, and a significant correlation was seen between female sex, smoking status, fasting glucose and triglyceride concentration, and hs-CRP in all three ethnicities. Phase 2: The median hs-CRP was 1.2 mg/L (0.2-9.9) in Chinese, 2.2 mg/L (0.2-9.0) in Malays, and 2.3 mg/L (0.2-9.8) in Indians. Indians had higher hs-CRP when compared to Chinese (P < 0.05) and a significant correlation was seen between BMI, female gender, diabetes, and the use of metformin and hs-CRP in all three ethnicities (P < 0.05) when adjusted for the above variables and use of aspirin, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACE-I/ARB), statin, metformin, rosiglitazone, sulfonylurea, glinides, acarbose, and insulin. CONCLUSION: hs-CRP concentrations are significantly higher in Indians compared to the Chinese (in both the diabetic and nondiabetic individuals) after adjustment for the various demographic, metabolic, and therapeutic variables. PMCID: PMC3047995 Free PMC Article
	PMID: 21437088 [PubMed - in process]
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124.	J Nutr. 2010 Feb;140(2):278-84. Epub 2009 Dec 23. Serum lipid and blood pressure responses to quercetin vary in overweight patients by apolipoprotein E genotype. Egert S, Boesch-Saadatmandi C, Wolffram S, Rimbach G, Müller MJ. Institute of Nutrition and Food Science, Nutritional Physiology, University of Bonn, 53115 Bonn, Germany. Abstract Our objective was to examine the effect of a quercetin supplementation on blood pressure, lipid metabolism, markers of oxidative stress, inflammation, and body composition in an at-risk population of 93 overweight-obese volunteers aged 25-65 y with metabolic syndrome traits in relation to apolipoprotein (apo) E genotype. Participants were randomized to receive 150 mg/d quercetin in a double-blinded, placebo-controlled, crossover trial with 6-wk treatment periods separated by a 5-wk washout period. Retrospectively, 5 apoE genotype variants were found (epsilon2/epsilon3, n = 3; epsilon3/epsilon3, n = 60; epsilon3/epsilon4, n = 23; epsilon2/epsilon4, n = 4; and epsilon4/epsilon4, n = 3). Participants were classified into the following 3 apoE phenotypes: apoE2 (n = 3), apoE3 (n = 60), and apoE4 (n = 26). Data were analyzed for apoE3 and apoE4 subgroups. Quercetin decreased systolic blood pressure by 3.4 mm Hg (P < 0.01) in the apoE3 group, whereas no significant effect was observed in the apoE4 group. Quercetin decreased serum HDL cholesterol (P < 0.01) and apoA1 (P < 0.01) and increased the LDL:HDL cholesterol ratio (P < 0.05) in the apoE4 subgroup, whereas the apoE3 subgroup had no significant changes in these variables. Quercetin significantly decreased plasma oxidized LDL and tumor necrosis factor-alpha in the apoE3 and apoE4 groups, whereas no significant inter-group differences were found. Serum C-reactive protein and nutritional status (body weight, waist circumference, fat mass, fat-free mass) were unaffected compared with placebo. In conclusion, quercetin exhibited blood pressure-lowering effects in overweight-obese carriers of the apo epsilon3/epsilon3 genotype but not in carriers of the epsilon4 allele. Furthermore, quercetin supplementation resulted in a reduction in HDL cholesterol and apoA1 in apo epsilon4 carriers. Free Article
	PMID: 20032478 [PubMed - indexed for MEDLINE]
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125.	Circ Cardiovasc Qual Outcomes. 2008 Nov;1(2):92-7. Epub 2008 Nov 9. C-reactive protein and reclassification of cardiovascular risk in the Framingham Heart Study. Wilson PW, Pencina M, Jacques P, Selhub J, D'Agostino R Sr, O'Donnell CJ. EPICORE, Emory University School of Medicine, and the Atlanta VAMC Epidemiology and Genetics Section, Atlanta, GA 30306, USA. peter.wf.wilson@emory.edu Abstract BACKGROUND: The relationship of circulating levels of high-sensitivity C-reactive protein (CRP) with cardiovascular disease (CVD) risk, particularly with consideration of effects at intermediate levels of risk, has not been fully assessed. METHODS AND RESULTS: Among 3006 offspring participants in the Framingham Heart Study free of CVD (mean age, 46 years at baseline), there were 129 hard coronary heart disease (CHD) events and 286 total CVD events during 12 years of follow-up. Cox regression, discrimination with area under the receiver operating characteristic curve, and net reclassification improvement were used to assess the role of CRP on vascular risk. In an age-adjusted model that included both sexes, the hazard ratios for new hard CHD and total CVD were significantly associated with higher CRP levels. Similar analyses according to increasing homocysteine level showed significant protective associations for hard CHD but not for total CVD. In multivariable analyses that included age, sex, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, diabetes mellitus, current smoking, hypertension treatment, and homocysteine, the log CRP level remained significantly related to development of hard CHD and total CVD and provided moderate improvement in the discrimination of events. The net reclassification improvement when CRP was added to traditional factors was 5.6% for total CVD (P=0.014) and 11.8% for hard CHD (P=0.009). CONCLUSIONS: Circulating levels of CRP help to estimate risk for initial cardiovascular events and may be used most effectively in persons at intermediate risk for vascular events, offering moderate improvement in reclassification of risk. PMCID: PMC3033831 Free PMC Article
	PMID: 20031795 [PubMed - indexed for MEDLINE]
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126.	Eur J Endocrinol. 2010 Mar;162(3):535-41. Epub 2009 Dec 18. Non-diabetic metabolic syndrome and obesity do not affect serum paraoxonase and arylesterase activities but do affect oxidative stress and inflammation. Tabur S, Torun AN, Sabuncu T, Turan MN, Celik H, Ocak AR, Aksoy N. Department of Endocrinology and Metabolic Diseases, Harran University School of Medicine, 63300 Sanliurfa, Turkey. Abstract OBJECTIVE: Paraoxonase-1 (PON-1), which has PON and arylesterase activities, is a high-density lipoprotein (HDL)-bound antioxidant enzyme that inhibits atherosclerosis. Diabetes has been shown to have an impact on oxidative stress. The effect of metabolic syndrome (MetS) on oxidative stress and PON-1 has been shown before, and PON-1 has been found to be related with accelerated atherogenesis. This study aimed to determine the oxidative state and PON and arylesterase activities in non-diabetic MetS and non-MetS obese patients. DESIGN: Thirty obese patients (3 M and 27 F) without MetS, 40 non-diabetic obese patients (3 M and 37 F) with MetS, and 30 controls (2 M and 28 F) were enrolled. METHODS: A 75 g glucose tolerance test was performed. PON-1, PON, arylesterase, total antioxidant status (TAS), high-sensitive C-reactive protein (hsCRP), and metabolic parameters were analyzed. RESULTS: PON and arylesterase activities were similar between the groups, while TAS was low in both MetS and obese groups compared to controls (P<0.01 and P<0.05 respectively). CRP was higher in the MetS group compared with the obese and control groups (P<0.01 and P<0.001 respectively). In both the obese and MetS groups, CRP showed a positive correlation with body mass index (BMI). TAS was negatively correlated with BMI, waist circumference, triglyceride levels, and systolic and diastolic blood pressures (P<0.001). CONCLUSIONS: Oxidative stress is altered in non-diabetic MetS and non-MetS obese patients, but PON and arylesterase activities seem not to be affected. This result may be due to the absence of diabetes, the most severe form of altered carbohydrate metabolism. Free Article
	PMID: 20022940 [PubMed - indexed for MEDLINE]
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127.	Turk Kardiyol Dern Ars. 2009 Sep;37(6):391-6. Decreased coronary flow reserve in obese women. Eroğlu S, Sade LE, Bozbaş H, Müderrisoğlu H. Department of Cardiology, Medicine Faculty of Başkent University, Ankara, Turkey. serpileroglu@gmail.com Abstract OBJECTIVES: Obesity is associated with an increased rate of cardiovascular disease and risk factors. It is a common problem in apparently healthy women. We aimed to investigate the association between obesity and coronary flow reserve (CFR) in obese women. STUDY DESIGN: The study included 80 consecutive women (mean age 55.6+/-10.2 years) without diabetes mellitus and clinical coronary artery disease. Body mass index (BMI) was calculated and obesity was defined as BMI = or >30 kg/m(2). Based on BMI, the patients were grouped as normal weight (n=13; 18.5-24.9 kg/m(2)), overweight (n=32; 25-29.9 kg/m(2)), obese (n=32; = or >30-39.9 kg/m(2)), and morbid obese (n=3; = or > 40 kg/m(2)). Peak diastolic coronary flow velocities were measured in the distal left anterior descending artery by transthoracic pulsed wave Doppler echocardiography at baseline and after dipyridamole infusion and CFR was calculated as the ratio of hyperemic to baseline peak diastolic velocities. RESULTS: There were 35 obese women (43.8%). Coronary flow reserve was significantly lower in obese women than in nonobese subjects (2.2+/-0.5 vs. 2.5+/-0.4; p=0.022). The lowest CFR was seen in patients with a BMI of = or > 40 kg/m(2); overweight women did not differ significantly from women of normal weight. Coronary flow reserve was correlated with BMI (r=-0.314, p=0.005), waist circumference (r=-0.316, p=0.005), C-reactive protein (CRP) (r=-0.342, p=0.011), and adiponectin level (r=0.410, p=0.011). In regression analysis, BMI (p=0.017), waist circumference (p=0.048), systolic blood pressure (p=0.025), fasting glucose (p=0.035), and adiponectin level (p=0.037) were found to be independent predictors for impaired CFR. In ROC analysis, the cut-off value for BMI to predict impaired CFR was = or > 30 kg/m(2), with 76% sensitivity and 72% specificity (ROC area 0.805, p<0.001, 95% CI 0.669-0.96). CONCLUSION: Impaired CFR in obese women suggests the presence of microvascular dysfunction. Treatment of obesity is important for the prevention of atherosclerosis. Free Article
	PMID: 20019452 [PubMed - indexed for MEDLINE]
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128.	J Clin Endocrinol Metab. 2010 Feb;95(2):693-8. Epub 2009 Dec 16. Adipokine profile and urinary albumin excretion in isolated growth hormone deficiency. Oliveira CR, Salvatori R, Meneguz-Moreno RA, Aguiar-Oliveira MH, Pereira RM, Valença EH, Araujo VP, Farias NT, Silveira DC, Vieira JG, Barreto-Filho JA. Division of Endocrinology, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, Maryland 21287, USA. Abstract Background: GH deficiency (GHD) is often associated with cardiovascular risk factors, including abdominal fat accumulation, hypercholesterolemia, and increased C-reactive protein. Despite the presence of these risk factors, adults with congenital lifetime isolated GHD (IGHD) due to an inactivating mutation in the GHRH receptor gene do not have premature atherosclerosis. Objective: The aim was to study the serum levels of adiponectin and leptin (antiatherogenic and atherogenic adipokine, respectively), and the urinary albumin excretion (UAE) in these IGHD individuals. Design and Patients: We conducted a cross-sectional study of 20 IGHD individuals (seven males; age, 50.8 +/- 14.6 yr) and 22 control subjects (eight males; age, 49.9 +/- 11.5 yr). Main Outcome Measures: Anthropometric factors, body composition, blood pressure, serum adiponectin, leptin, and UAE were measured. Results: Adiponectin was higher [12.8 (7.1) vs. 9.7 (5) ng/ml; P = 0.041] in IGHD subjects, whereas no difference was observed in leptin [7.3 (6.3) vs. 9.3 (18.7 ng/ml] and UAE [8.6 (13.8) vs. 8.5 (11.1) microg/min]. Conclusions: Subjects with lifetime untreated IGHD have an adipokine profile with high adiponectin and normal leptin levels that may delay vascular damage and lesions of the renal endothelium. PMCID: PMC2840862 Free PMC Article
	PMID: 20016047 [PubMed - indexed for MEDLINE]
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129.	J Thromb Haemost. 2009 Nov;7(11):1779-86. Socioeconomic inequalities in coronary heart disease risk in older age: contribution of established and novel coronary risk factors. Ramsay SE, Morris RW, Whincup PH, Papacosta O, Rumley A, Lennon L, Lowe G, Wannamethee SG. Division of Population Health, UCL, London, UK. s.ramsay@pcps.ucl.ac.uk Abstract BACKGROUND: Evidence on socioeconomic inequalities in coronary heart disease (CHD) and their pathways in the elderly is limited. Little is also known about the contributions that novel coronary risk factors (particularly inflammatory/hemostatic markers) make to socioeconomic inequalities in CHD. OBJECTIVES: To examine the extent of socioeconomic inequalities in CHD in older age, and the contributions (relative and absolute) of established and novel coronary risk factors. METHODS: A population-based cohort of 3761 British men aged 60-79 years was followed up for 6.5 years for CHD mortality and incidence (fatal and non-fatal). Social class was based on longest-held occupation recorded at 40-59 years. RESULTS: There was a graded relationship between social class and CHD incidence. The hazard ratio for CHD incidence comparing social class V (unskilled workers) with social class I (professionals) was 2.70 [95% confidence interval (CI) 1.37-5.35; P-value for trend = 0.008]. This was reduced to 2.14 (95% CI 1.06-4.33; P-value for trend = 0.11) after adjustment for behavioral factors (cigarette smoking, physical activity, body mass index, and alcohol consumption), which explained 38% of the relative risk gradient (41% of absolute risk). Additional adjustment for inflammatory markers (C-reactive protein, interleukin-6, and von Willebrand factor) explained 55% of the relative risk gradient (59% of absolute risk). Blood pressure and lipids made little difference to these estimates; results were similar for CHD mortality. CONCLUSIONS: Socioeconomic inequalities in CHD persist in the elderly and are at least partly explained by behavioral risk factors; novel (inflammatory) coronary risk markers made some further contribution. Reducing inequalities in behavioral factors (especially cigarette smoking) could reduce these social inequalities by at least one-third. PMCID: PMC2810435 Free PMC Article
	PMID: 20015318 [PubMed - indexed for MEDLINE]
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130.	Clin J Am Soc Nephrol. 2010 Feb;5(2):173-81. Epub 2009 Dec 10. Prevalence of atrial fibrillation and its predictors in nondialysis patients with chronic kidney disease. Ananthapanyasut W, Napan S, Rudolph EH, Harindhanavudhi T, Ayash H, Guglielmi KE, Lerma EV. Department of Medicine, University of Illinois at Chicago, Advocate Christ Medical Center, Oak Lawn, Illinois 60453, USA. Abstract BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) increases systemic inflammation, which is implicated in development and maintenance of atrial fibrillation (AF); therefore, we hypothesized that the prevalence of AF would be increased among nondialysis patients with CKD. This study also reports independent predictors of the presence of AF in this population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective, cross-sectional analysis of 1010 consecutive nondialysis patients with CKD from two community-based hospitals was conducted. Estimated GFRs (eGFRs) were calculated using the Modification of Diet in Renal Disease (MDRD) equation. Multivariate logistic regression was used to determine independent predictors. RESULTS: Of 1010 nondialysis patients with CKD, 214 (21.2%) had AF. Patients with AF were older than patients without AF (76 +/- 11 versus 63 +/- 15 yr). The prevalence of AF among white patients (42.7%) was higher than among black patients (12.7%) or other races (5.7%). In multivariate analyses, age, white race, increasing left atrial diameter, lower systolic BP, and congestive heart failure were identified as independent predictors of the presence of AF. Although serum high-sensitivity C-reactive protein levels were elevated in our population (5.2 +/- 7.4 mg/L), levels did not correlate with the presence of AF or with eGFR. Finally, eGFR did not correlate with the presence of AF in our population. CONCLUSIONS: The prevalence of AF was increased in our population, and independent predictors were age, white race, increasing left atrial diameter, lower systolic BP, and congestive heart failure. PMCID: PMC2827597 Free PMC Article
	PMID: 20007681 [PubMed - indexed for MEDLINE]
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131.	BMC Public Health. 2009 Dec 15;9:466. A cross-curricular physical activity intervention to combat cardiovascular disease risk factors in 11-14 year olds: 'activity knowledge circuit'. Knox G, Baker JS, Davies B, Faulkner S, Rance J, Rees A, Morgan K, Thomas N. Cardiff School of Sport, University of Wales Institute Cardiff, Cardiff, UK. gaknox@uwic.ac.uk Abstract BACKGROUND: Cardiovascular disease is the leading cause of mortality worldwide. Risk factors associated with cardiovascular disease have been shown to track from childhood through to adulthood. Previous school-based physical activity interventions have demonstrated modest improvements to cardiovascular disease risk factors by implementing extra-curricular activities or improving current physical education curriculum. Few have attempted to increase physical activity in class-room taught curriculum subjects. This study will outline a school-based cross-curricular physical activity intervention to combat cardiovascular disease risk factors in 11-14 year old children. METHOD/DESIGN: A South Wales Valley school of low socio-economic status has been selected to take part. Participants from year eight (12-13 years) are to be assigned to an intervention group, with maturation-matched participants from years seven (11-12 years) and nine (13-14 years) assigned to a control group. A cross-curricular physical activity intervention will be implemented to increase activity by two hours a week for 18 weeks. Participants will briskly walk 3200 m twice weekly during curriculum lessons (60 minutes duration). With the exception of physical education, all curriculum subjects will participate, with each subject delivering four intervention lessons. The intervention will be performed outdoors and on school premises. An indoor course of equal distance will be used during adverse weather conditions. Cardiovascular disease risk factors will be measured pre- and post-intervention for intervention and control groups. These will take place during physical education lessons and will include measures of stature, mass, waist, hip, and neck circumferences, together with skinfold measure's taken at four sites. Blood pressure will be measured, and fitness status assessed via the 20 m multi-stage fitness test. Questionnaires will be used to determine activity behaviour (physical activity questionnaire for adolescence), diet (seven day food diary) and maturation status. Fasting blood variables will include total cholesterol, low-density lipoprotein cholesterol, high density lipoprotein cholesterol, triglycerides, insulin, glucose, high-sensitivity C-reactive protein, interleukin-6, adiponectin, and fibrinogen. Motivational variables and psychological well-being will be assessed by questionnaire. DISCUSSION: Our study may prove to be a cost effective strategy to increase school time physical activity to combat cardiovascular disease risk factors in children. TRIAL REGISTRATION: [NCT00998478]. PMCID: PMC2803189 Free PMC Article
	PMID: 20003492 [PubMed - indexed for MEDLINE]
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132.	Cardiovasc Diabetol. 2009 Dec 9;8:62. Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study. Leehey DJ, Moinuddin I, Bast JP, Qureshi S, Jelinek CS, Cooper C, Edwards LC, Smith BM, Collins EG. Veterans Affairs Hospital, Hines, IL, USA. david.leehey@va.gov Abstract BACKGROUND: Patients with obesity, diabetes, and chronic kidney disease (CKD) are generally physically inactive, have a high mortality rate, and may benefit from an exercise program. METHODS: We performed a 24-week randomized controlled feasibility study comparing aerobic exercise plus optimal medical management to medical management alone in patients with type 2 diabetes, obesity (body mass index [BMI] > 30 kg/m2), and stage 2-4 CKD (estimated glomerular filtration rate [eGFR] 15-90 mL/min/1.73 m2 with persistent proteinuria). Subjects randomized to exercise underwent thrice weekly aerobic training for 6 followed by 18 weeks of supervised home exercise. The primary outcome variable was change in proteinuria. RESULTS: Seven subjects randomized to exercise and 4 control subjects completed the study. Exercise training resulted in an increase in exercise duration during treadmill testing, which was accompanied by slight but insignificant decreases in resting systolic blood pressure and 24-hour proteinuria. Exercise did not alter GFR, hemoglobin, glycated hemoglobin, serum lipids, or C-reactive protein (CRP). Caloric intake and body weight and composition also did not change with exercise training. CONCLUSION: Exercise training in obese diabetic patients with CKD is feasible and may have clinical benefits. A large-scale randomized controlled trial to determine the effects of exercise on renal functions, cardiovascular fitness, inflammation, and oxidative stress in diabetic patients with CKD is planned. PMCID: PMC2796994 Free PMC Article
	PMID: 20003224 [PubMed - indexed for MEDLINE]
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133.	J Clin Endocrinol Metab. 2010 Feb;95(2):722-30. Epub 2009 Dec 8. Metformin reduces arterial stiffness and improves endothelial function in young women with polycystic ovary syndrome: a randomized, placebo-controlled, crossover trial. Agarwal N, Rice SP, Bolusani H, Luzio SD, Dunseath G, Ludgate M, Rees DA. Centre for Endocrine and Diabetes Sciences, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, United Kingdom. Abstract Context: Patients with polycystic ovary syndrome (PCOS) have an increased prevalence of insulin resistance and display subclinical evidence of early cardiovascular disease. Metformin improves insulin sensitivity and circulating markers of cardiovascular risk in patients with PCOS, but it is unclear whether this translates into improvements in vascular function. Objective: Our objective was to evaluate the effects of metformin on arterial stiffness and endothelial function in women with PCOS. Design and Intervention: Thirty women with PCOS were assigned to consecutive 12-wk treatment periods of metformin or placebo in a randomized, double-blind, crossover design separated by an 8-wk washout. Main Outcome Measures: The primary outcome measures were assessments of arterial stiffness [augmentation index (AIx), central blood pressure, and brachial and aortic pulse wave velocity (PWV)] and endothelial function. Anthropometry, testosterone, and metabolic biochemistry (lipids, homeostasis model of assessment for insulin resistance, high-sensitivity C-reactive protein, adiponectin, and plasminogen activator inhibitor-1) were also assessed. Results: Metformin improved AIx [-6.1%; 95% confidence interval (CI) for the difference -8.5 to -3.5%; P < 0.001], aortic PWV (-0.76 m/sec; 95% CI for the difference -1.12 to -0.4 m/sec; P < 0.001), brachial PWV (-0.73 m/sec; 95% CI for the difference -1.09 to -0.38; P < 0.001), central blood pressure (P < 0.001), and endothelium-dependent (AIx after albuterol; P = 0.003) and endothelium-independent (AIx after nitroglycerin; P < 0.001) vascular responses. Metformin also reduced weight (P < 0.001), waist circumference (P < 0.001), and triglycerides (P = 0.004) and increased adiponectin (P = 0.001) but did not affect testosterone or other metabolic measures. Conclusions: Short-term metformin therapy improves arterial stiffness and endothelial function in young women with PCOS. Free Article
	PMID: 19996308 [PubMed - indexed for MEDLINE]
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134.	Arch Pediatr Adolesc Med. 2009 Dec;163(12):1135-43. Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, Pariante CM, Poulton R, Caspi A. Social, Genetic, and Developmental Psychiatry Centre, Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA. Abstract OBJECTIVE: To understand why children exposed to adverse psychosocial experiences are at elevated risk for age-related disease, such as cardiovascular disease, by testing whether adverse childhood experiences predict enduring abnormalities in stress-sensitive biological systems, namely, the nervous, immune, and endocrine/metabolic systems. DESIGN: A 32-year prospective longitudinal study of a representative birth cohort. SETTING: New Zealand. PARTICIPANTS: A total of 1037 members of the Dunedin Multidisciplinary Health and Development Study. Main Exposures During their first decade of life, study members were assessed for exposure to 3 adverse psychosocial experiences: socioeconomic disadvantage, maltreatment, and social isolation. MAIN OUTCOME MEASURES: At age 32 years, study members were assessed for the presence of 3 age-related-disease risks: major depression, high inflammation levels (high-sensitivity C-reactive protein level >3 mg/L), and the clustering of metabolic risk biomarkers (overweight, high blood pressure, high total cholesterol, low high-density lipoprotein cholesterol, high glycated hemoglobin, and low maximum oxygen consumption levels. RESULTS: Children exposed to adverse psychosocial experiences were at elevated risk of depression, high inflammation levels, and clustering of metabolic risk markers. Children who had experienced socioeconomic disadvantage (incidence rate ratio, 1.89; 95% confidence interval, 1.36-2.62), maltreatment (1.81; 1.38-2.38), or social isolation (1.87; 1.38-2.51) had elevated age-related-disease risks in adulthood. The effects of adverse childhood experiences on age-related-disease risks in adulthood were nonredundant, cumulative, and independent of the influence of established developmental and concurrent risk factors. CONCLUSIONS: Children exposed to adverse psychosocial experiences have enduring emotional, immune, and metabolic abnormalities that contribute to explaining their elevated risk for age-related disease. The promotion of healthy psychosocial experiences for children is a necessary and potentially cost-effective target for the prevention of age-related disease. Free Article
	PMID: 19996051 [PubMed - indexed for MEDLINE]
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135.	Med Sci Sports Exerc. 2010 Apr;42(4):701-7. Effects of different doses of physical activity on C-reactive protein among women. Stewart LK, Earnest CP, Blair SN, Church TS. The Cooper Institute. Abstract Elevated C-reactive protein (CRP) is associated with an increased risk of cardiovascular disease. Physical activity has been inversely associated with CRP. However, the clinical trials examining the effect of exercise training have produced conflicting results. PURPOSE: The purpose of this study was to examine the influence an exercise training program on CRP in postmenopausal women. METHODS: Sedentary, overweight, or obese postmenopausal women with elevated systolic blood pressure (120-160 mm Hg; n = 464) were randomized into one of four groups: a nonexercise control or one of three aerobic exercise groups; exercise energy expenditure of 4, 8, or 12 kcal·kg(-1)·wk(-1) (KKW) for 6 months at a training intensity of 50% of peak VO2. RESULTS: Complete data for 421 participants were available, and mean (SD) baseline CRP was 5.7 (5.5) mg·L(-1), with no significant differences across groups. Although VO2 increased in a dose-response manner, there were no significant changes in CRP in any of the exercise intervention groups compared with the control group. Change in fitness was not associated with change in CRP, whereas change in weight was significantly associated with change in CRP. CONCLUSIONS: Despite increasing fitness, 6 months of aerobic exercise training did not improve CRP. However, improvements in CRP were associated with reductions in weight. PMCID: PMC2891301 Free PMC Article
	PMID: 19952829 [PubMed - indexed for MEDLINE]
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136.	Chin Med J (Engl). 2009 Nov 5;122(21):2560-6. Effects of five-year intensive multifactorial intervention on the serum amyloid A and macroangiopathy in patients with short-duration type 2 diabetes mellitus. Du JL, Liu JF, Men LL, Yao JJ, Sun LP, Sun GH, Song GR, Yang Y, Bai R, Xing Q, Li CC, Sun CK. Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China. Abstract BACKGROUND: A five-year follow-up study of intensive multifactorial intervention was undertaken to assess the changes of circulating serum amyloid A (SAA) levels and the incidence of atherosclerosis (AS) in patients with short-duration type 2 diabetes mellitus (T2DM) without macroangiopathy, and whether intensive multifactorial intervention could prevent or at least postpone the occurrence of macroangiopathy. METHODS: Among 150 patients with short-duration T2DM, 75 were assigned to receive conventional outpatient treatment (conventional group) and the others underwent intensive multifactorial integrated therapy targeting hyperglycemia, hypertension, dyslipidemia and received aspirin simultaneously (intensive group). RESULTS: Plasma SAA levels were higher in diabetic patients than those in healthy control subjects, and decreased obviously after intensive multifactorial intervention. The levels of SAA were positively correlated with body mass index (BMI), waist hip ratio (WHR), triglyceride (TG), high sensitive C-reactive protein (hs-CRP) and common carotid intima-media thickness (CC-IMT). The standard-reaching rates of glycemia, blood pressure and lipidemia were significantly higher in intensive group than those of conventional group. The incidence of macroangiopathy decreased by 58.96% in intensive group compared with conventional group. CONCLUSIONS: Intensive multifactorial intervention may significantly reduce the SAA levels and prevent the occurrence of AS in short-duration patients with T2DM. SAA might be one of the risk factors of T2DM combined with AS. Free Article
	PMID: 19951570 [PubMed - indexed for MEDLINE]
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137.	Korean J Intern Med. 2009 Dec;24(4):350-5. Epub 2009 Nov 27. Serum C-reactive protein levels in normal-weight polycystic ovary syndrome. Oh JY, Lee JA, Lee H, Oh JY, Sung YA, Chung H. Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea. Abstract BACKGROUND/AIMS: Serum levels of highly sensitive C-reactive protein (hsCRP), a vascular inflammatory marker, may predict the development of cardiovascular disease (CVD) and type 2 diabetes. Women with polycystic ovary syndrome (PCOS) are at greater risk for type 2 diabetes and CVD. The aim of this study was to compare hsCRP levels between normal weight women with PCOS and controls with a normal menstrual cycle and to determine the factors associated with serum hsCRP levels. METHODS: Thirty-nine lean PCOS patients and 24 healthy, regular cycling women were enrolled in this study. We performed anthropometric measurements, fat computed tomography (CT), and blood sampling to determine blood chemistry and levels of hsCRP, gonadotropins, testosterone, and sex-hormone binding globulin. We also conducted 75-g oral glucose-tolerance test and euglycemic hyperinsulinemic clamp to assess insulin sensitivity. RESULTS: Serum hsCRP concentrations were higher in women with PCOS than in women with regular mensturation. However, this difference was no longer significant after adjusting for body mass index (BMI). hsCRP levels were correlated with waist circumference (r=0.46, p<0.01), BMI (r=0.46, p<0.01), visceral fat area (r=0.45, p<0.01), and systolic (r=0.42, p<0.05) and diastolic blood pressure (r=0.39, p<0.05). hsCRP also tended to be negatively associated with insulin-mediated glucose uptake (IMGU) (r=-0.31, p=0.07). A multiple regression analysis revealed that BMI (beta=0.29, p<0.05), systolic blood pressure (beta=0.39, p<0.01), and IMGU (beta=-0.31, p<0.05) predicted serum hsCRP levels in women with PCOS. CONCLUSIONS: PCOS by itself does not seem to be associated with increased hsCRP levels, whereas known CVD risk factors affect serum hsCRP levels in PCOS. PMCID: PMC2784979 Free PMC Article
	PMID: 19949734 [PubMed - indexed for MEDLINE]
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138.	Crit Care. 2009;13(6):R191. Epub 2009 Nov 30. Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding. Schick KS, Fertmann JM, Jauch KW, Hoffmann JN. Department of Surgery, University of Munich - Grosshadern, Marchioninistrasse 15 81377 Munich, Germany. kerstin.schick@med-uni-muenchen.de Abstract INTRODUCTION: Prothrombin complex concentrates are recommended for rapid reversal of vitamin K anticoagulants. As they normalize levels of vitamin K dependent clotting factors and re-establish hemostasis, they may also be used as adjunctive therapy in patients with major bleeding. The aim of this study was to retrospectively evaluate the efficacy of prothrombin complex concentrates in the surgical setting. METHODS: The case notes of 50 patients requiring urgent oral anticoagulation reversal (n = 12) or with severe perioperative coagulopathic bleeding (n = 38) who received an infusion of prothrombin complex concentrate (Beriplex P/N(R) 500) at the surgical department of the University of Munich Hospital, Germany were retrospectively reviewed. Efficacy of prothrombin complex concentrate application was evaluated using the Quick test, reported as an international normalized ratio, hemodynamic measurements and requirement for blood products. Safety assessments included whole blood hemoglobin levels and specific parameters of organ dysfunction. RESULTS: Baseline characteristics were comparable, except that mean baseline international normalized ratio and hemoglobin levels were significantly higher (P < 0.01) in anticoagulation reversal than in bleeding patients. In anticoagulation reversal, the international normalized ratio was significantly reduced (from 2.8 +/- 0.2 at baseline to 1.5 +/- 0.1, P < 0.001) after one prothrombin complex concentrate infusion (median dose 1500 IU; lower quartile 1,000, upper quartile 2,000). No major bleeding was observed during surgery after prothrombin complex concentrate administration. Only one patient received platelets and red blood cell transfusion after prothrombin complex concentrate administration. In bleeding patients, infusion of prothrombin complex concentrate (median dose 2,000 IU; lower quartile 2,000, upper quartile 3,000) significantly reduced the INR from 1.7 +/- 0.1 at baseline to 1.4 +/- 0.1 (P < 0.001). This decrease was unrelated to fresh frozen plasma or vitamin K administration. Bleeding stopped after prothrombin complex concentrate administration in 4/11 (36%) patients with surgical bleeding and 26/27 (96%) patients with diffuse bleeding. Hemoglobin levels increased significantly from baseline in bleeding patients (P < 0.05) and mean arterial pressure stabilized (P < 0.05). No thrombotic events or changes in organ function were reported in any patient. CONCLUSIONS: Prothrombin complex concentrate application effectively reduced international normalized ratios in anticoagulation reversal, allowing surgical procedures and interventions without major bleeding. In bleeding patients, the improvement in coagulation after prothrombin complex concentrate administration was judged to be clinically significant. PMCID: PMC2811941 Free PMC Article
	PMID: 19948037 [PubMed - indexed for MEDLINE]
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139.	World J Gastroenterol. 2009 Nov 28;15(44):5586-91. Unsedated transnasal small-caliber esophagogastroduodenoscopy in elderly and bedridden patients. Yuki M, Amano Y, Komazawa Y, Fukuhara H, Shizuku T, Yamamoto S, Kinoshita Y. Division of Internal Medicine, Izumo-City General Medical Center, Izumo-shi, Shimane, Japan. Abstract AIM: To evaluate the safety of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) for elderly and critically ill bedridden patients. METHODS: One prospective randomized comparative study and one crossover comparative study between transnasal small-caliber EGD and transoral conventional EGD was done (Study 1). For the comparative study, we enrolled 240 elderly patients aged > 65 years old. For the crossover analysis, we enrolled 30 bedridden patients with percutaneous endoscopic gastrostomy (PEG) (Study 2). We evaluated cardiopulmonary effects by measuring arterial oxygen saturation (SpO(2)) and calculating the rate-pressure product (RPP) (pulse rate x systolic blood pressure/100) at baseline, 2 and 5 min after endoscopic intubation in Study 1. To assess the risk for endoscopy-related aspiration pneumonia during EGD, we also measured blood leukocyte counts and serum C-reactive protein (CRP) levels before and 3 d after EGD in Study 2. RESULTS: In Study 1, we observed significant decreases in SpO(2) during conventional transoral EGD, but not during transnasal small-caliber EGD (0.24% vs -0.24% after 2 min, and 0.18% vs -0.29% after 5 min, P = 0.034, P = 0.044). Significant differences of the RPP were not found between conventional transoral and transnasal small-caliber EGD. In Study 2, crossover analysis showed statistically significant increases of the RPP at 2 min after intubation and the end of endoscopy (26.8 and 34.6 vs 3.1 and 15.2, P = 0.044, P = 0.046), and decreases of SpO(2) (-0.8% vs -0.1%, P = 0.042) during EGD with transoral conventional in comparison with transnasal small-caliber endoscopy. Thus, for bedridden patients with PEG feeding, who were examined in the supine position, transoral conventional EGD more severely suppressed cardiopulmonary function than transnasal small-caliber EGD. There were also significant increases in the markers of inflammation, blood leukocyte counts and serum CRP values, in bedridden patients after transoral conventional EGD, but not after transnasal small-caliber EGD performed with the patient in the supine position. Leukocyte count increased from 6053 +/- 1975/L to 6900 +/- 3392/L (P = 0.0008) and CRP values increased from 0.93 +/- 0.24 to 2.49 +/- 0.91 mg/dL (P = 0.0005) at 3 d after transoral conventional EGD. Aspiration pneumonia, possibly caused by the endoscopic examination, was found subsequently in two of 30 patients after transoral conventional EGD. CONCLUSION: Transnasal small-caliber EGD is a safer method than transoral conventional EGD in critically ill, bedridden patients who are undergoing PEG feeding. PMCID: PMC2785063 Free PMC Article
	PMID: 19938199 [PubMed - indexed for MEDLINE]
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140.	Arq Bras Cardiol. 2009 Oct;93(4):360-6, 353-9. Evaluation of the degree of vascular inflammation in patients with metabolic syndrome. [Article in English, Portuguese, Spanish] Junqueira AS, Romêo Filho LJ, Junqueira Cde L. Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil. asmjunqueira@uol.com.br Abstract BACKGROUND: Metabolic Syndrome (MS) is defined as a set of cardiovascular risk factors related to visceral obesity and insulin resistance that lead to an increase in general mortality, especially cardiovascular. The inflammatory markers are considered emergent risk factors and can be potentially used in the clinical stratification of cardiovascular diseases, establishing prognostic values. OBJECTIVE: This study aims at evaluating which components of the MS present an increase of IL-6 and hs-CRP, identifying the marker that better expresses the degree of inflammation and which isolate component presents a higher degree of interference on the studied inflammatory markers, in order to identify other important risk factors when determining arterial inflammation. METHODS: A total of 87 hypertensive, diabetic and dyslipidemic patients were selected, aged 26 to 85 years, who met the necessary criteria for the positive diagnosis of MS. The patients were assessed through 24-hour ambulatory blood pressure monitoring (ABPM) and underwent hs-CRP and IL-6 measurements, among other metabolic variables. RESULTS: The patients that presented CRP > 0.3mg/dl showed a significant correlation (p<0.05) with abdominal perimeter >102/88 cm in 83.7%, glycemia > 110mg/dl in 88% and BMI > 30kg/m(2) in 60.5% of the studied individuals. CONCLUSION: We concluded that the CRP was the inflammatory marker with the highest expression regarding the studied variables, with smoking, albuminuria, previous personal history of cardiopathy, BMI, abdominal perimeter and hyperglycemia being the ones with the highest statistical significance. Interleukin-6 did not present a correlation with any of the studied variables. Free Article
	PMID: 19936455 [PubMed - indexed for MEDLINE]
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141.	J Cardiovasc Nurs. 2010 Jan-Feb;25(1):52-60. The influence of cardiac rehabilitation on inflammation and metabolic syndrome in women with coronary heart disease. Beckie TM, Beckstead JW, Groer MW. College of Nursing, University of South Florida, Tampa, FL 33612-4766, USA. tbeckie@health.usf.edu Abstract BACKGROUND: Metabolic syndrome (MetS) and increased inflammatory markers, both predictors of future cardiovascular events, are more prevalent in women with coronary heart disease (CHD). The influence of cardiac rehabilitation (CR) on MetS and inflammatory biomarkers is not well characterized for women. PURPOSE: : The purpose of this article was to examine the effects of a 12-week behaviorally enhanced CR exclusively for women compared with traditional CR on components of the MetS and inflammatory markers in women with CHD. METHODS: The randomized clinical trial used 2 treatment groups, both receiving a comprehensive 12-week CR program, with 1 group receiving a motivationally enhanced intervention exclusively for women. A subset of 91 women (mean age, 61.6 years) from the parent study provided serum samples to examine the effects of CR on high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), and intercellular adhesion molecule-1 (ICAM-1). RESULTS: After CR, the total sample of women demonstrated significant reductions in hsCRP (P =.002), IL-6 (P <.001), TNF-alpha (P =.010), and ICAM-1 (P =.016). Women in the gender-tailored CR program significantly improved all biomarker levels compared with baseline (P <.05 for all), whereas those in the traditional group improved only hsCRP (P <.05) and IL-6 (P <.05) levels. The combined study group demonstrated improvements in several components of MetS (triglycerides, waist circumference, and systolic blood pressure) but not in others (high-density lipoprotein cholesterol, fasting glucose, and diastolic blood pressure). CONCLUSION: Cardiac rehabilitation promotes greater improvements in inflammatory biomarkers than in components of MetS for women with CHD. Improvements in body composition or weight may not be a precondition for the benefits of exercise because of loss of abdominal fat. Examining components of MetS as continuous variables is recommended to prevent lost information inherent in dichotomization. PMCID: PMC2913415 Free PMC Article
	PMID: 19935427 [PubMed - indexed for MEDLINE]
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142.	Am J Clin Nutr. 2010 Jan;91(1):175-83. Epub 2009 Nov 18. Dietary supplementation with cis-9,trans-11 conjugated linoleic acid and aortic stiffness in overweight and obese adults. Sluijs I, Plantinga Y, de Roos B, Mennen LI, Bots ML. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. i.sluijs-2@umcutrecht.nl Abstract BACKGROUND: Animal studies suggest that dietary cis-9,trans-11 (c9,t11) conjugated linoleic acid (CLA) may inhibit or regress the development of atherosclerosis. The effect of CLA on atherosclerosis has not been assessed in humans. OBJECTIVE: We investigated the effect of c9,t11 CLA supplementation on aortic pulse wave velocity (a marker of atherosclerosis) and on cardiovascular risk factors in overweight and obese but otherwise apparently healthy subjects. DESIGN: In a double-blind, randomized, placebo-controlled, parallel-group trial, we randomly assigned 401 subjects, aged 40-70 y and with a body mass index (in kg/m(2)) > or = 25, to receive either 4 g CLA/d (2.5 g c9,t11 CLA/d and 0.6 g trans-10,cis-12 CLA/d) or placebo supplements for 6 mo. Aortic pulse wave velocity, blood pressure, anthropometric characteristics, and concentrations of fasting lipid, glucose, insulin, and C-reactive protein were measured before and after supplementation. RESULTS: During the intervention, mean (+/-SE) pulse wave velocity did not change in the c9,t11 CLA group (Delta0.00 +/- 0.07) compared with the placebo group (Delta0.09 +/- 0.06). There was no effect of c9,t11 CLA supplementation on blood pressure, body composition, insulin resistance, or concentrations of lipid, glucose, and C-reactive protein. CONCLUSION: This study does not support an antiatherosclerotic effect or an effect on cardiovascular risk factors of c9,t11 CLA. This trial was registered at www.clinicaltrials.gov as NCT00706745. Free Article
	PMID: 19923377 [PubMed - indexed for MEDLINE]
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143.	Diabetologia. 2010 Feb;53(2):263-7. Epub 2009 Nov 18. Lipid and inflammatory biomarkers and kidney function decline in type 2 diabetes. Lin J, Hu FB, Mantzoros C, Curhan GC. Renal Division, MRB-4, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. jlin11@partners.org Abstract AIMS/HYPOTHESIS: Potentially modifiable biomarkers may influence the decline in estimated GFR (eGFR), but few data are currently available in type 2 diabetic adults. METHODS: We studied 516 women with type 2 diabetes in the Nurses' Health Study with data on lipid and inflammatory biomarkers from plasma collected in 1989 and plasma creatinine in samples collected in 1989 and 2000. An estimated GFR decline of >or=25% over 11 years was the outcome of interest. RESULTS: Comparing the highest with the lowest quartile, soluble tumour necrosis factor receptor 2 (sTNFR-2) was independently associated with an eGFR decline of >or=25% (multivariate OR 5.81; 95% CI 2.90-11.65); this association was stronger in obese women (OR 16.76; 95% CI 4.69-59.90 for BMI >or=30 kg/m(2); OR 2.78, 95% CI 1.12-6.89 for BMI <30 kg/m(2); p for interaction = 0.02). No lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol, non-HDL-cholesterol, triacylglycerols, lipoprotein(a), or apolipoprotein B) or other markers of inflammation (C-reactive protein, fibrinogen, E-selectin, intracellular cell adhesion molecule 1, leptin or adiponectin) were significantly associated with eGFR decline after multivariable adjustment. CONCLUSIONS/INTERPRETATION: Elevated sTNFR-2 levels may be an important and potentially modifiable risk factor for eGFR decline in type 2 diabetes, especially in those with a BMI of >or=30 kg/m(2). PMCID: PMC2809803 Free PMC Article
	PMID: 19921505 [PubMed - indexed for MEDLINE]
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144.	Circ Heart Fail. 2009 Nov;2(6):692-9. Epub 2009 Sep 22. Chronic vagus nerve stimulation improves autonomic control and attenuates systemic inflammation and heart failure progression in a canine high-rate pacing model. Zhang Y, Popovic ZB, Bibevski S, Fakhry I, Sica DA, Van Wagoner DR, Mazgalev TN. Department of Molecular Cardiology and Cardiovascular Medicine, Cleveland Clinic, USA. zhangy2@ccf.org Abstract BACKGROUND: Autonomic dysfunction, characterized by sympathetic activation and vagal withdrawal, contributes to the progression of heart failure (HF). Although the therapeutic benefits of sympathetic inhibition with beta-blockers in HF are clear, the role of increased vagal tone in this setting has been less studied. We have investigated the impact of enhancing vagal tone (achieved through chronic cervical vagus nerve stimulation, [VNS]) on HF development in a canine high-rate ventricular pacing model. METHODS AND RESULTS: Fifteen dogs were randomized into control (n=7) and VNS (n=8) groups. All dogs underwent 8 weeks of high-rate ventricular pacing (at 220 bpm for the first 4 weeks to develop HF and another 4 weeks at 180 bpm to maintain HF). Concomitant VNS, at an intensity reducing sinus rate approximately 20 bpm, was delivered together with the ventricular pacing in the VNS group. At 4 and 8 weeks of ventricular pacing, both left ventricular end-diastolic and -systolic volumes were lower and left ventricular ejection fraction was higher in the VNS group than in the control group. Heart rate variability and baroreflex sensitivity improved in the VNS dogs. Rises in plasma norepinephrine, angiotensin II, and C-reactive protein levels, ordinarily expected in this model, were markedly attenuated with VNS treatment. CONCLUSIONS: Chronic VNS improves cardiac autonomic control and significantly attenuates HF development in the canine high-rate ventricular pacing model. The therapeutic benefit of VNS is associated with pronounced anti-inflammatory effects. VNS is a novel and potentially useful therapy for treating HF. Free Article
	PMID: 19919995 [PubMed - indexed for MEDLINE]
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145.	Intern Med. 2009;48(21):1855-62. Epub 2009 Nov 2. Association of metabolic syndrome with urinary albumin excretion, low-grade inflammation, and low glomerular filtration rate among non-diabetic Japanese subjects. Abe R, Minami J, Ohrui M, Ishimitsu T. Department of Hypertension and Cardiorenal Medicine, Dokkyo Medical University, Mibu, Japan. Abstract OBJECTIVE: Several studies have reported a significant association of metabolic syndrome with urinary albumin excretion, high-sensitivity C-reactive protein, or chronic kidney disease; however, no study has investigated the association of metabolic syndrome with these 3 factors together in the same individual. Therefore, we conducted the present study to obtain more information on this association. METHODS: We enrolled 712 Japanese subjects without diabetes, macroalbuminuria, or medications, who entered our hospitalized health check-up program (180 women and 532 men; mean age, 53.2 years; mean body mass index, 24.1 kg/m(2)). Metabolic syndrome was diagnosed by 4 major definitions. Low glomerular filtration rate was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m(2). RESULTS: Both urinary albumin excretion and high-sensitivity C-reactive protein were significantly higher in those with metabolic syndrome than without, and metabolic syndrome was an independent determinant of both. In contrast, estimated glomerular filtration rate and the prevalence of low glomerular filtration rate did not differ significantly between those with and without metabolic syndrome. Among the 5 components of metabolic syndrome and other clinical variables, systolic blood pressure was an independent determinant of urinary albumin excretion; the 5 components and low-density lipoprotein cholesterol were all independent determinants of high-sensitivity C-reactive protein; systolic blood pressure was an independent determinant of low glomerular filtration rate. CONCLUSION: Metabolic syndrome is associated with vascular dysfunction and low-grade inflammation and the latter association is strong, whereas the association of metabolic syndrome with low glomerular filtration rate may be less apparent among those without diabetes, macroalbuminuria, and medications. Free Article
	PMID: 19881234 [PubMed - indexed for MEDLINE]
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146.	Diabetes Care. 2009 Nov;32(11):e136. Lower vital capacity is associated with diabetes but not with metabolic syndrome in nonobese Japanese men: Response to Nakajima and Saito. Oda E, Kawai R. Comment on: Diabetes Care. 2009 Nov;32(11):e135. Free Article
	PMID: 19875599 [PubMed - indexed for MEDLINE]
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147.	Arthritis Res Ther. 2009;11(5):R160. Epub 2009 Oct 29. The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study. Lee YC, Chibnik LB, Lu B, Wasan AD, Edwards RR, Fossel AH, Helfgott SM, Solomon DH, Clauw DJ, Karlson EW. Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA. ylee9@partners.org Abstract INTRODUCTION: Despite recent advances in anti-inflammatory therapy, rheumatoid arthritis (RA) patients continue to rate pain as a priority. The etiology of RA pain is likely multifactorial, including both inflammatory and non-inflammatory components. In this study, we examine the association between disease activity, sleep, psychiatric distress and pain sensitivity in RA. METHODS: Fifty-nine female RA patients completed questionnaires and underwent pressure pain threshold testing to assess hyperalgesia/allodynia at joint and non-joint sites. Blood samples were taken to measure C-reactive protein (CRP). The association between disease activity, sleep problems, psychiatric distress and pain threshold was assessed using Pearson/Spearman correlations and multivariable linear regression. Disease activity levels, sleep problems and psychiatric distress were compared between RA patients with fibromyalgia and RA patients without fibromyalgia. RESULTS: In unadjusted analyses, CRP was not correlated with pain threshold, but tender joint count was inversely correlated with pain threshold at all sites (P < or = 0.004). Sleep problems were associated with low pain threshold at all sites (P < or = 0.0008). Psychiatric distress was associated with low pain threshold at the wrist and thumbnail (P < or = 0.006). In multivariable linear regression models, CRP was inversely associated with wrist pain threshold (P = 0.003). Sleep problems were inversely associated with pain threshold at all sites (P < or = 0.01), but psychiatric distress was not. Despite differences in pain threshold, CRP levels and sleep problems between RA patients with fibromyalgia and those without fibromyalgia, associations between these variables did not change when patients with fibromyalgia were excluded. CONCLUSIONS: Multivariable models are essential in analyses of pain. Among RA patients, inflammation is associated with heightened pain sensitivity at joints. In contrast, poor sleep is associated with diffuse pain sensitivity, as noted in central pain conditions such as fibromyalgia. Future studies examining pain sensitivity at joint and non-joint sites may identify patients with different underlying pain mechanisms and suggest alternative approaches to treating RA pain. PMCID: PMC2787262 Free PMC Article
	PMID: 19874580 [PubMed - indexed for MEDLINE]
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148.	Tohoku J Exp Med. 2009 Nov;219(3):201-6. Chronic carbon monoxide exposure is associated with the increases in carotid intima-media thickness and C-reactive protein level. Davutoglu V, Zengin S, Sari I, Yildirim C, Al B, Yuce M, Ercan S. Department of Cardiology, Gaziantep University, School of Medicine, Gaziantep, Turkey. Abstract Being the most common cause of death from poisoning worldwide, cardiovascular manifestations of acute carbon monoxide (CO) poisoning have been subject of various studies but current evidence about effects of chronic CO exposure on atherosclerosis is limited which is very common. We aimed to investigate association of chronic CO exposure with atherosclerosis by measuring carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (hs-CRP). Forty healthy male non-smoker indoor barbecue workers (mean age; 33.0 +/- 9.0 years) working in different restaurants for at least three years and 48 age-matched healthy men (mean age; 34.3 +/- 6.6 years) enrolled in the study. Clinical characteristics of indoor barbecue workers and control group were comparable in terms of body mass index, blood pressure, and lipid profile. However, carboxyhemoglobin (COHb) (6.4 +/- 1.5% vs. 2.0 +/- 1.1%), hs-CRP (2.7 +/- 2.0 mg/L vs. 1.1 +/- 0.8 mg/L) and CIMT (1.1 +/- 0.3 mm vs. 0.9 +/- 0.1 mm) were higher in indoor barbecue workers (p < 0.001 for each). In Pearson correlation analysis, CIMT was correlated with COHb concentration (r = 0.635, p < 0.001) and hs-CRP level (r = 0.466, p < 0.001). Among indoor barbecue workers, the years worked (years exposed to CO) are correlated with COHb, hs-CRP and CIMT. In multivariate analysis, COHb concentration is the only independent predictor of CIMT (beta = 0.571, p < 0.001). The increased CIMT and hs-CRP in indoor barbecue workers suggest that chronic CO exposure may increase the risk of atherosclerotic cardiovascular events. Free Article
	PMID: 19851048 [PubMed - indexed for MEDLINE]
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149.	J Clin Endocrinol Metab. 2009 Dec;94(12):5131-8. Epub 2009 Oct 16. Reduced growth hormone secretion is associated with increased carotid intima-media thickness in obesity. Makimura H, Stanley T, Mun D, Chen C, Wei J, Connelly JM, Hemphill LC, Grinspoon SK. Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, LON 211, Boston, Massachusetts 02114, USA. hmakimura@partners.org Abstract CONTEXT: Obesity is associated with reduced GH. OBJECTIVE: The aim of the study was to determine whether reduced GH is associated with increased carotid intima-media thickness (cIMT) in obesity. DESIGN: A total of 102 normal-weight and obese men and women without known hypopituitarism were studied. Subjects underwent GH stimulation testing with GHRH-arginine. Lipid profile, inflammatory markers, oral glucose tolerance test, abdominal computed tomography, dual-energy x-ray absorptiometry, and cIMT were measured. Relative GH deficiency was defined as peak GH of 4.2 microg/liter or less. Subjects were separated based on BMI and GH testing into three groups: normal weight, obese GH sufficient (GHS), and obese relative GH deficient (GHD). Age, gender, and race were similar between the groups. BMI, percentage body fat, and visceral adiposity did not differ between obese GHS and relative GHD. RESULTS: Peak GH was associated with cIMT, IGF-I, high-density lipoprotein, low-density lipoprotein, triglycerides, adiponectin, C-reactive protein, and TNF-alpha (all P < 0.05). Obese GHS subjects had similar cIMT compared to normal-weight subjects (P = not significant), whereas obese GHD subjects had higher cIMT compared to normal-weight subjects (P < 0.05) (normal weight, 0.645 +/- 0.023, vs. obese GHS, 0.719 +/- 0.021, vs. obese GHD, 0.795 +/- 0.063 mm; P = 0.01 by ANOVA). Similar results were seen in sensitivity analyses with less stringent cutoffs (< 5, < or = 8, < 9 microg/liter) to define GHD. In multivariate modeling, peak GH remained significantly associated with cIMT after controlling for age, gender, race, tobacco, blood pressure, cholesterol, and fasting glucose (R(2) for model, 0.35; P < 0.0001). CONCLUSIONS: These results suggest that reduced GH secretion is associated with a more abnormal metabolic phenotype in obesity, characterized by increased cIMT, dyslipidemia, insulin resistance, and inflammation. PMCID: PMC2795664 Free PMC Article
	PMID: 19837914 [PubMed - indexed for MEDLINE]
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150.	J Nutr. 2009 Dec;139(12):2322-8. Epub 2009 Oct 14. Dietary patterns are linked to cardiovascular risk factors but not to inflammatory markers in Alaska Eskimos. Eilat-Adar S, Mete M, Nobmann ED, Xu J, Fabsitz RR, Ebbesson SO, Howard BV. MedStar Research Institute, Hyattsville, MD 20783, USA. eilatsi@017.net.il Abstract Despite the tradition of a diet high in fish oils and abundant physical activity, coronary artery disease is increasing among Alaska Eskimos. Explanations for this observation include lifestyle changes. In this cross-sectional analysis, we evaluated dietary patterns of Alaska Eskimos and investigated the relations between these dietary patterns and known cardiovascular risk factors, including inflammatory markers. We used a principal component analysis with data from FFQ collected in 2000-2004 to determine dietary patterns of Alaska Eskimos. Four dietary patterns were identified: a traditional pattern, plus 3 patterns based on purchased food, one of which reflected healthy food choices. The traditional dietary pattern was associated with lower triglycerides (P < 0.001) and blood pressure (P = 0.04) and slightly higher LDL cholesterol (LDL-C) (P = 0.05). Whereas the healthy purchased diet was associated with a trend toward lower LDL-C (P = 0.09), the beverages and sweets diet was positively associated with LDL-C (P = 0.02). Diet pattern was not associated with inflammatory markers or pathogen burden. Our data show that the traditional diet is related to a better profile of cardiovascular disease risk factors and should be encouraged. Programs are needed to encourage the availability of healthy food choices for those not able to obtain traditional foods. PMCID: PMC2777478 Free PMC Article
	PMID: 19828690 [PubMed - indexed for MEDLINE]
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151.	J Epidemiol Community Health. 2010 Sep;64(9):821-8. Epub 2009 Oct 12. Differences in the association of cardiovascular risk factors with education: a comparison of Costa Rica (CRELES) and the USA (NHANES). Rehkopf DH, Dow WH, Rosero-Bixby L. Department of Epidemiology & Biostatistics, University of California, San Francisco 185 Berry Street, Lobby 3, Suite 6600, San Francisco, CA 94107, USA. drehkopf@gmail.com Abstract BACKGROUND: Despite different levels of economic development, Costa Rica and the USA have similar mortalities among adults. However, in the USA there are substantial differences in mortality by educational attainment, and in Costa Rica there are only minor differences. This contrast motivates an examination of behavioural and biological correlates underlying this difference. METHODS: The authors used data on adults aged 60 and above from the Costa Rican Longevity and Healthy Ageing Study (CRELES) (n=2827) and from the US National Health and Nutrition Examination Survey (NHANES) (n=5607) to analyse the cross-sectional association between educational level and the following risk factors for cardiovascular disease (CVD): ever smoked, current smoker, sedentary, high saturated fat, high carbohydrates, high calorie diet, obesity, severe obesity, large waist circumference, HDL cholesterol, LDL cholesterol, triglycerides, hemoglobin A1c, fasting glucose, C-reactive protein, systolic blood pressure and BMI. RESULTS: There were significantly fewer hazardous levels of risk biomarkers at higher levels of education for more than half (10 out of 17) of the risk factors in the USA, but for less than a third of the outcomes in Costa Rica (five out of 17). CONCLUSIONS: These results are consistent with the context-specific nature of educational differences in risk factors for CVD and with a non-uniform nature of association of CVD risk factors with education within countries. Our results also demonstrate that social equity in mortality is achieved without uniform equity in all risk factors. PMCID: PMC2976055 Free PMC Article
	PMID: 19822554 [PubMed - in process]
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152.	Circ Heart Fail. 2009 Sep;2(5):429-36. Epub 2009 Jun 19. Lipoprotein-associated phospholipase A(2) and risk of congestive heart failure in older adults: the Cardiovascular Health Study. Suzuki T, Solomon C, Jenny NS, Tracy R, Nelson JJ, Psaty BM, Furberg C, Cushman M. Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA. Abstract BACKGROUND: Inflammation may be a causative factor in congestive heart failure (CHF). Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is an inflammation marker associated with vascular risk. One previous study showed an association of Lp-PLA(2) activity with CHF risk, but there were only 94 CHF cases and Lp-PLA(2) antigen, which is available clinically in the United States, was not measured. METHODS AND RESULTS: We measured baseline Lp-PLA(2) antigen and activity in 3991 men and women without baseline CHF or cardiovascular disease who were participating in the Cardiovascular Health Study, a prospective observational study of adults 65 years or older. Cox proportional hazards models adjusted for age, sex, clinic site, race, low-density and high-density lipoprotein cholesterol, body mass index, systolic and diastolic blood pressure, hypertension, smoking status, pack-years, and diabetes were used to calculate hazard ratios and 95% CIs for incident CHF. Further models adjusted for coronary disease events during follow-up and C-reactive protein. Eight hundred twenty-nine participants developed CHF during 12.1 years. Adjusted hazard ratios for CHF with Lp-PLA(2) in the fourth compared with the first quartile were 1.44 (95% CI, 1.16 to 1.79) for Lp-PLA(2) antigen and 1.06 (95% CI, 0.84 to 1.32) for activity. Adjustment for incident coronary disease attenuated the hazard ratio for Lp-PLA(2) antigen to 1.26 (95% CI, 1.02 to 1.57), adjustment for C-reactive protein had minimal impact. CONCLUSIONS: Lp-PLA(2) antigen was associated with risk of future CHF in older people, independent of CHF and coronary risk factors, and partly mediated by coronary disease events. Further clinical and basic research is needed to better understand the role of Lp-PLA(2) in CHF. PMCID: PMC2756764 Free PMC Article
	PMID: 19808373 [PubMed - indexed for MEDLINE]
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153.	Hypertension. 2009 Nov;54(5):1143-50. Epub 2009 Oct 5. Mediterranean-style diet effect on the structural properties of the erythrocyte cell membrane of hypertensive patients: the Prevencion con Dieta Mediterranea Study. Barceló F, Perona JS, Prades J, Funari SS, Gomez-Gracia E, Conde M, Estruch R, Ruiz-Gutiérrez V. Departamento de Biología Fundamental y Ciencias de la Salut, University of the Balearic Islands, Palma de Mallorca, Spain. francisca.barcelo@uib.es Abstract A currently ongoing randomized trial has revealed that the Mediterranean diet, rich in virgin olive oil or nuts, reduces systolic blood pressure in high-risk cardiovascular patients. Here, we present a structural substudy to assess the effect of a Mediterranean-style diet supplemented with nuts or virgin olive oil on erythrocyte membrane properties in 36 hypertensive participants after 1 year of intervention. Erythrocyte membrane lipid composition, structural properties of reconstituted erythrocyte membranes, and serum concentrations of inflammatory markers are reported. After the intervention, the membrane cholesterol content decreased, whereas that of phospholipids increased in all of the dietary groups; the diminishing cholesterol:phospholipid ratio could be associated with an increase in the membrane fluidity. Moreover, reconstituted membranes from the nuts and virgin olive oil groups showed a higher propensity to form a nonlamellar inverted hexagonal phase structure that was related to an increase in phosphatidylethanolamine lipid class. These data suggest that the Mediterranean-style diet affects the lipid metabolism that is altered in hypertensive patients, influencing the structural membrane properties. The erythrocyte membrane modulation described provides insight in the structural bases underlying the beneficial effect of a Mediterranean-style diet in hypertensive subjects. Free Article
	PMID: 19805640 [PubMed - indexed for MEDLINE]
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154.	Cardiovasc Diabetol. 2009 Oct 6;8:54. Network of vascular diseases, death and biochemical characteristics in a set of 4,197 patients with type 1 diabetes (the FinnDiane Study). Mäkinen VP, Forsblom C, Thorn LM, Wadén J, Kaski K, Ala-Korpela M, Groop PH. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland. ville-petteri.makinen@finndiane.fi Abstract BACKGROUND: Cardiovascular disease is the main cause of premature death in patients with type 1 diabetes. Patients with diabetic kidney disease have an increased risk of heart attack or stroke. Accurate knowledge of the complex inter-dependencies between the risk factors is critical for pinpointing the best targets for research and treatment. Therefore, the aim of this study was to describe the association patterns between clinical and biochemical features of diabetic complications. METHODS: Medical records and serum and urine samples of 4,197 patients with type 1 diabetes were collected from health care centers in Finland. At baseline, the mean diabetes duration was 22 years, 52% were male, 23% had kidney disease (urine albumin excretion over 300 mg/24 h or end-stage renal disease) and 8% had a history of macrovascular events. All-cause mortality was evaluated after an average of 6.5 years of follow-up (25,714 patient years). The dataset comprised 28 clinical and 25 biochemical variables that were regarded as the nodes of a network to assess their mutual relationships. RESULTS: The networks contained cliques that were densely inter-connected (r > 0.6), including cliques for high-density lipoprotein (HDL) markers, for triglycerides and cholesterol, for urinary excretion and for indices of body mass. The links between the cliques showed biologically relevant interactions: an inverse relationship between HDL cholesterol and the triglyceride clique (r < -0.3, P < 10(-16)), a connection between triglycerides and body mass via C-reactive protein (r > 0.3, P < 10(-16)) and intermediate-density cholesterol as the connector between lipoprotein metabolism and albuminuria (r > 0.3, P < 10(-16)). Aging and macrovascular disease were linked to death via working ability and retinopathy. Diabetic kidney disease, serum creatinine and potassium, retinopathy and blood pressure were inter-connected. Blood pressure correlations indicated accelerated vascular aging in individuals with kidney disease (P < 0.001). CONCLUSION: The complex pattern of links between diverse characteristics and the lack of a single dominant factor suggests a need for multifactorial and multidisciplinary paradigms for the research, treatment and prevention of diabetic complications. PMCID: PMC2763862 Free PMC Article
	PMID: 19804653 [PubMed - indexed for MEDLINE]
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155.	J Korean Med Sci. 2009 Oct;24(5):831-6. Epub 2009 Sep 23. The relationship between brachial ankle pulse wave velocity and complement 1 inhibitor. Chae YM, Park JK. Department of Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea. Abstract Complement 1 (C1) inhibitor is an acute phase protein with anti-inflammatory properties. The aim of the present study was to elucidate the relationship between brachial ankle pulse wave velocity (baPWV), the parameter of arterial stiffness, and C1 inhibitor. One hundred subjects were randomly enrolled in this study. Data about baPWV, age, gender, hypertension, smoking, and body mass index (BMI) were measured. Blood tests for total cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, hemoglobin A1c, erythrocyte sedimentation rate, C-reactive protein, complement 3, and C1 inhibitor were performed. Based on the Pearson correlation, the C1 inhibitor showed a positive relation to the baPWV (P<0.001). Multiple regression analysis revealed the significant predictors of baPWV were not only the conventional risk factors of arteriosclerosis and/or atherosclerosis, such as age (P<0.001), gender (P<0.001), hypertension (P<0.001), and BMI (P=0.006), but also the acute phase protein, C1 inhibitor (P=0.025). In conclusion, C1 inhibitor is associated with arterial stiffness through its association with increased inflammation. PMCID: PMC2752764 Free PMC Article
	PMID: 19794979 [PubMed - indexed for MEDLINE]
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156.	Korean J Ophthalmol. 2009 Sep;23(3):193-7. Epub 2009 Sep 8. C-reactive protein and lipid profiles in Korean patients with normal tension glaucoma. Choi J, Joe SG, Seong M, Choi JY, Sung KR, Kook MS. HanGil Eye Hospital, Incheon, Korea. Abstract PURPOSE: To compare high-sensitivity C-reactive protein (hsCRP) levels and lipid profiles between Korean normal tension glaucoma (NTG) patients and healthy controls. METHODS: This cross-sectional study included 38 Korean patients with NTG and 38 age- and sex-matched healthy control subjects. We excluded the patients with cardiovascular risk factors and other systemic diseases that might affect CRP levels and lipid profiles. Each patient underwent a Humphrey visual field examination and blood sampling for hsCRP and lipid profile analyses. Subsequently, the NTG patients were classified into two groups based on their untreated intraocular pressure (IOP) level: low NTG (LNTG) with IOP < or = 13 mmHg (13 subjects) and high NTG (HNTG) with relatively high IOP (>13 and < or = 21 mmHg, 25 subjects). The hsCRP levels and lipid profiles were compared between NTG patients and healthy controls, and between LNTG, HNTG, and healthy controls. RESULTS: There were no significant differences in hsCRP and lipid profiles between either the NTG patients and healthy controls, or between the LNTG, HNTG, and controls (p>0.05) after exclusion of Korean patients with cardiovascular risk factors. There was no significant association between hsCRP and visual field indices (p>0.05). CONCLUSIONS: High-sensitivity C-reactive protein-related vascular inflammatory conditions may not be directly associated with the development of NTG, regardless of the untreated IOP level. PMCID: PMC2739962 Free PMC Article
	PMID: 19794947 [PubMed - indexed for MEDLINE]
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157.	J Nutr. 2009 Dec;139(12):2266-71. Epub 2009 Sep 30. Cardiovascular disease risk biomarkers and liver and kidney function are not altered in postmenopausal women after ingesting an elderberry extract rich in anthocyanins for 12 weeks. Curtis PJ, Kroon PA, Hollands WJ, Walls R, Jenkins G, Kay CD, Cassidy A. School of Medicine, University of East Anglia, Norwich, Norfolk, UK. Abstract Growing evidence supports a cardio-protective role for anthocyanins; however, there is limited evidence on their efficacy and safety following the consumption of relatively high but dietarily achievable doses in humans. We conducted a parallel-designed, randomized, placebo-controlled study to examine the effect of chronic consumption of anthocyanins on biomarkers of cardiovascular disease (CVD) risk and liver and kidney function in 52 healthy postmenopausal women (n = 26 in treatment and placebo groups). Volunteers (BMI, 24.7 +/- 3.6 kg/m(2); age, 58.2 +/- 5.6 y) consumed 500 mg/d anthocyanins as cyanidin glycosides (from elderberry) or placebo for 12 wk (2 capsules twice/d). At the beginning (wk 0) and end of the 12-wk intervention, levels of anthocyanins and biomarkers of CVD (inflammatory biomarkers, platelet reactivity, lipids, and glucose) and liver and kidney function (total bilirubin, albumin, urea, creatinine, alkaline phosphatase, alanine aminotransferase, and gamma-glutyl transferase) were assessed in fasted blood. Anthropometric, blood pressure, and pulse measurements were also taken. In addition, postprandial plasma anthocyanins were measured (t = 1, 2, 3 h) following a 500-mg oral bolus dose. After 12 wk of chronic exposure to anthocyanins, there was no significant change in biomarkers of CVD risk and liver and kidney function remained within clinically acceptable ranges. We observed no plasma accumulation of anthocyanins; however, postprandial metabolism increased (P = 0.02). In conclusion, these data suggest that chronic consumption of 500 mg/d of elderberry extract for 12 wk is apparently safe, but ineffective in altering biomarkers of CVD risk in healthy postmenopausal women. Free Article
	PMID: 19793846 [PubMed - indexed for MEDLINE]
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158.	Arthritis Rheum. 2009 Oct 15;61(10):1328-36. Knee osteoarthritis in obese women with cardiometabolic clustering. Sowers M, Karvonen-Gutierrez CA, Palmieri-Smith R, Jacobson JA, Jiang Y, Ashton-Miller JA. Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA. mfsowers@umich.edu Abstract OBJECTIVE: To assess the role of obesity and metabolic dysfunctionality with knee osteoarthritis (OA), knee joint pain, and physical functioning performance, adjusted for joint space width (JSW) asymmetry. METHODS: Knee OA was defined as a Kellgren/Lawrence score > or =2 on weight-bearing radiographs. Obesity was defined as a body mass index > or =30 kg/m2. Cardiometabolic clustering classification was based on having > or =2 of the following factors: low levels of high-density lipoprotein cholesterol; elevated levels of low-density lipoprotein cholesterol, triglycerides, blood pressure, C-reactive protein, waist:hip ratio, or glucose; or diabetes mellitus. The difference between lateral and medial knee JSW was used to determine joint space asymmetry. RESULTS: In a sample of women (n = 482, mean age 47 years), prevalences of knee OA and persistent knee pain were 11% and 30%, respectively. The knee OA prevalence in nonobese women without cardiometabolic clustering was 4.7%, compared with 12.8% in obese women without cardiometabolic clustering and 23.2% in obese women with cardiometabolic clustering. Nonobese women without cardiometabolic clustering were less likely to perceive themselves as limited compared with women in all other obesity/cardiometabolic groups (P < 0.05). Similar associations were seen with knee pain and physical functioning measures. The inclusion of a joint space asymmetry measure was associated with knee OA but not with knee pain or physical functioning. CONCLUSION: Knee OA was twice as frequent in obese women with cardiometabolic clustering compared with those without, even when considering age and joint asymmetry. Obesity/cardiometabolic clustering was also associated with persistent knee pain and impaired physical functioning. PMCID: PMC2776774 Free PMC Article
	PMID: 19790111 [PubMed - indexed for MEDLINE]
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159.	Nutr J. 2009 Sep 28;8:43. Freeze-dried strawberry powder improves lipid profile and lipid peroxidation in women with metabolic syndrome: baseline and post intervention effects. Basu A, Wilkinson M, Penugonda K, Simmons B, Betts NM, Lyons TJ. Department of Nutritional Sciences, 301 Human Environmental Sciences, Oklahoma State University, Stillwater, OK 74078, USA. arpita.basu@okstate.edu Abstract BACKGROUND: Strawberry flavonoids are potent antioxidants and anti-inflammatory agents that have been shown to reduce cardiovascular disease risk factors in prospective cohort studies. Effects of strawberry supplementation on metabolic risk factors have not been studied in obese populations. We tested the hypothesis that freeze-dried strawberry powder (FSP) will lower fasting lipids and biomarkers of oxidative stress and inflammation at four weeks compared to baseline. We also tested the tolerability and safety of FSP in subjects with metabolic syndrome. FSP is a concentrated source of polyphenolic flavonoids, fiber and phytosterols. METHODS: Females (n = 16) with 3 features of metabolic syndrome (waist circumference >35 inches, triglycerides > 150 mg/dL, fasting glucose > 100 mg/dL and < 126 mg/dL, HDL <50 mg/dL, or blood pressure >130/85 mm Hg) were enrolled in the study. Subjects consumed two cups of the strawberry drink daily for four weeks. Each cup had 25 g FSP blended in water. Fasting blood draws, anthropometrics, dietary analyses, and blood pressure measurements were done at baseline and 4 weeks. Biomarkers of oxidative stress and inflammation were measured using ELISA techniques. Plasma ellagic acid was measured using HPLC-UV techniques. RESULTS: Total cholesterol and LDL-cholesterol levels were significantly lower at 4 weeks versus baseline (-5% and -6%, respectively, p < 0.05), as was lipid peroxidation in the form of malondialdehyde and hydroxynonenal (-14%, p < 0.01). Oxidized-LDL showed a decreasing trend at 4 weeks (p = 0.123). No effects were noted on markers of inflammation including C-reactive protein and adiponectin. A significant number of subjects (13/16) showed an increase in plasma ellagic acid at four weeks versus baseline, while no significant differences were noted in dietary intakes at four weeks versus baseline. Thus, short-term supplementation of freeze-dried strawberries appeared to exert hypocholesterolemic effects and decrease lipid peroxidation in women with metabolic syndrome. PMCID: PMC2761419 Free PMC Article
	PMID: 19785767 [PubMed - indexed for MEDLINE]
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160.	J Clin Endocrinol Metab. 2009 Oct;94(10):3872-81. Epub 2009 Sep 22. Gender-specific prevalences of fatty liver in obese children and adolescents: roles of body fat distribution, sex steroids, and insulin resistance. Denzer C, Thiere D, Muche R, Koenig W, Mayer H, Kratzer W, Wabitsch M. Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Hospital of Ulm, D-89075 Ulm, Germany. Abstract CONTEXT: Nonalcoholic fatty liver disease (NAFLD) is known to have a gender-dimorphic prevalence in obese children. Less information is available on predictive factors for NAFLD in obese youths. OBJECTIVE: The aim of the study was to examine the prevalence pattern and to identify clinical and laboratory markers associated with the risk for NAFLD. DESIGN: This was a cross-sectional study. Setting: The study setting was a rehabilitation clinic. STUDY PARTICIPANTS: A total of 532 obese subjects (291 girls) aged 8-19 yr participated in the study. MAIN MEASUREMENTS: Steatosis hepatis and visceral fat mass were determined by ultrasound. Laboratory tests included serum lipids, adiponectin, high-sensitivity C-reactive protein, sex steroids, and an oral glucose tolerance test. RESULTS: Prevalence of hepatic steatosis was significantly higher in boys (41.1%) than in girls (17.2%) and was highest in postpubertal boys (51.2%) and lowest in postpubertal girls (12.2%). Severity of steatosis was associated with increased visceral fat mass, insulin resistance, lower adiponectin levels, and higher blood pressure. Three factors were extracted from the panel of investigated parameters by principal component analysis. Logistic regression analysis revealed significant associations of simple steatosis with the "insulin resistance and visceral fat" factor and the "body fat distribution and inflammation" factor in both genders and additionally with the "steroid hormones" factor in girls. Risk for steatosis hepatis with concomitantly elevated ALT was associated only with "insulin resistance and visceral fat" in girls and with all three factors in boys. CONCLUSION: Our results suggest significant associations of NAFLD with markers of visceral obesity and insulin resistance in both genders and gender-specific associations with parameters of body fat distribution and sex steroids. Free Article
	PMID: 19773396 [PubMed - indexed for MEDLINE]
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161.	Am J Physiol Heart Circ Physiol. 2009 Nov;297(5):H1585-93. Epub 2009 Sep 18. A high-fat diet increases adiposity but maintains mitochondrial oxidative enzymes without affecting development of heart failure with pressure overload. Chess DJ, Khairallah RJ, O'Shea KM, Xu W, Stanley WC. Division of Cardiology, Department of Medicine, University of Maryland, Baltimore, Maryland, USA. Abstract A high-fat diet can increase adiposity, leptin secretion, and plasma fatty acid concentration. In hypertension, this scenario may accelerate cardiac hypertrophy and development of heart failure but could be protective by activating peroxisome proliferator-activated receptors and expression of mitochondrial oxidative enzymes. We assessed the effects of a high-fat diet on the development of left ventricular hypertrophy, remodeling, contractile dysfunction, and the activity of mitochondrial oxidative enzymes. Mice (n = 10-12/group) underwent transverse aortic constriction (TAC) or sham surgery and were fed either a low-fat diet (10% of energy intake as fat) or a high-fat diet (45% fat) for 6 wk. The high-fat diet increased adipose tissue mass and plasma leptin and insulin. Left ventricular mass and chamber size were unaffected by diet in sham animals. TAC increased left ventricular mass (approximately 70%) and end-systolic and end-diastolic areas (approximately 100% and approximately 45%, respectively) to the same extent in both dietary groups. The high-fat diet increased plasma free fatty acid concentration and prevented the decline in the activity of the mitochondrial enzymes medium chain acyl-coenzyme A dehydrogenase (MCAD) and citrate synthase that was observed with TAC animals on a low-fat diet. In conclusion, a high-fat diet did not worsen cardiac hypertrophy or left ventricular chamber enlargement despite increases in fat mass and insulin and leptin concentrations. Furthermore, a high-fat diet preserved MCAD and citrate synthase activities during pressure overload, suggesting that it may help maintain mitochondrial oxidative capacity in failing myocardium. PMCID: PMC2781358 Free PMC Article
	PMID: 19767529 [PubMed - indexed for MEDLINE]
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162.	Atherosclerosis. 2010 Mar;209(1):226-9. Epub 2009 Aug 28. Associations of inflammatory markers with coronary artery calcification: results from the Multi-Ethnic Study of Atherosclerosis. Jenny NS, Brown ER, Detrano R, Folsom AR, Saad MF, Shea S, Szklo M, Herrington DM, Jacobs DR Jr. Department of Pathology, University of Vermont College of Medicine, Burlington, VT 05446, USA. Nancy.Jenny@uvm.edu Abstract OBJECTIVE: Inflammatory markers predict coronary heart disease (CHD). However, associations with coronary artery calcium (CAC), a marker of subclinical CHD, are not established. METHODS: We examined cross-sectional associations of C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen with CAC presence (Agatston score>0 by computed tomography) in 6783 Multi-Ethnic Study of Atherosclerosis (MESA) participants. RESULTS: In all participants, those in the highest, compared to lowest, quartile of CRP had a relative risk (RR, 95% confidence interval) of 1.13 (1.06-1.19; p<0.01) for CAC in age, sex and ethnicity adjusted models. For highest versus lowest quartiles, relative risks were 1.22 (1.15-1.30; p<0.01) for IL-6 and 1.18 (1.11-1.24; p<0.01) for fibrinogen. Adjusting for CHD risk factors (smoking, diabetes, blood pressure, obesity and dyslipidemia) attenuated RRs. RRs for CAC were 1.05 (0.99-1.12; p=0.63) for CRP, 1.12 (1.06-1.20; p<0.01) for IL-6 and 1.09 (1.02-1.16; p=0.01) for fibrinogen in multivariable adjusted models. Results were similar for men and women and across ethnic groups. CONCLUSION: Inflammatory markers were weakly associated with CAC presence and burden in MESA. Our data support the hypothesis that inflammatory biomarkers and CAC reflect distinct pathophysiology. PMCID: PMC2830357 Free PMC Article
	PMID: 19766217 [PubMed - indexed for MEDLINE]
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163.	J Am Coll Cardiol. 2009 Sep 22;54(13):1176-84. Association of chronic kidney disease with the spectrum of ankle brachial index the CHS (Cardiovascular Health Study). Ix JH, Katz R, De Boer IH, Kestenbaum BR, Allison MA, Siscovick DS, Newman AB, Sarnak MJ, Shlipak MG, Criqui MH. Department of Medicine, University of California San Diego, USA. joeix@ucsd.edu Abstract OBJECTIVES: This study sought to determine the association of chronic kidney disease (CKD) with high ankle brachial index (ABI) measurement and to compare its strength with that of CKD with a low ABI. BACKGROUND: CKD is an important risk factor for cardiovascular disease (CVD) events. A high ABI, a marker of lower extremity arterial stiffness, is associated with CVD events and mortality. The association between CKD and high ABI is unknown. METHODS: The CHS (Cardiovascular Health Study) enrolled community-living people >65 years of age and measured kidney function and ABI. Glomerular filtration rate (GFR) was estimated using equations that incorporated either cystatin C or creatinine, and CKD was defined by estimated GFR <60 ml/min/1.73 m(2). The ABI was categorized as low (<0.90), low-normal (0.90 to 1.09), normal (1.10 to 1.40), and high (>1.40 or incompressible). Multinomial logistic regression was used to evaluate the associations of CKD with ABI categories. RESULTS: Among 4,513 participants, 23% had CKD, 13% had a low ABI, and 3% had a high ABI. In models adjusted for age, sex, race, hypertension, diabetes, smoking, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and C-reactive protein, cystatin C-based CKD was associated with both low ABI (relative risk [RR]: 2.0; 95% confidence interval [CI]: 1.6 to 2.5; p <0.001) and high ABI (RR: 1.6; 95% CI: 1.0 to 2.3; p = 0.03). Results were similar when CKD was defined by creatinine. CONCLUSIONS: CKD is associated with both the high and the low extremes of ABI in community-living older people. Future studies should evaluate whether arterial stiffness is an important mechanism leading to CVD in people with CKD. PMCID: PMC2799242 Free PMC Article
	PMID: 19761940 [PubMed - indexed for MEDLINE]
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164.	Mol Biol Cell. 2009 Nov;20(22):4845-55. Epub 2009 Sep 16. Glucose promotes stress resistance in the fungal pathogen Candida albicans. Rodaki A, Bohovych IM, Enjalbert B, Young T, Odds FC, Gow NA, Brown AJ. Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, United Kingdom. Abstract Metabolic adaptation, and in particular the modulation of carbon assimilatory pathways during disease progression, is thought to contribute to the pathogenicity of Candida albicans. Therefore, we have examined the global impact of glucose upon the C. albicans transcriptome, testing the sensitivity of this pathogen to wide-ranging glucose levels (0.01, 0.1, and 1.0%). We show that, like Saccharomyces cerevisiae, C. albicans is exquisitely sensitive to glucose, regulating central metabolic genes even in response to 0.01% glucose. This indicates that glucose concentrations in the bloodstream (approximate range 0.05-0.1%) have a significant impact upon C. albicans gene regulation. However, in contrast to S. cerevisiae where glucose down-regulates stress responses, some stress genes were induced by glucose in C. albicans. This was reflected in elevated resistance to oxidative and cationic stresses and resistance to an azole antifungal agent. Cap1 and Hog1 probably mediate glucose-enhanced resistance to oxidative stress, but neither is essential for this effect. However, Hog1 is phosphorylated in response to glucose and is essential for glucose-enhanced resistance to cationic stress. The data suggest that, upon entering the bloodstream, C. albicans cells respond to glucose increasing their resistance to the oxidative and cationic stresses central to the armory of immunoprotective phagocytic cells. PMCID: PMC2777113 Free PMC Article
	PMID: 19759180 [PubMed - indexed for MEDLINE]
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165.	Intern Med. 2009;48(18):1595-9. Epub 2009 Sep 15. Relationship between serum bilirubin and carotid atherosclerosis in hypertensive patients. Yang XF, Chen YZ, Su JL, Wang FY, Wang LX. Department of Neurology, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Shandong, People's Republic of China. Abstract OBJECTIVE: To investigate the relationship between serum bilirubin and carotid atherosclerosis in patients with hypertension. PATIENTS AND METHODS: Carotid artery ultrasonography was performed in 198 patients (104 males, average age of 65.6+/-7.1 years) with hypertension. Serum levels of bilirubin and C-reactive proteins (CRP) were measured at the same time. RESULTS: Carotid atherosclerosis was detected in 133 patients, 87 of them had carotid artery plaque. The prevalence of stroke (20.3%) and myocardial infarction (13.5%) in the atherosclerosis group was higher than in the non-atherosclerosis group (9.2% and 6.2%, respectively, p<0.05). The average total serum bilirubin in the atherosclerosis group was lower than in the non-atherosclerosis group (12.8+/-1.3 vs 16.8+/-1.5 micromol/L, p<0.01), whereas the average serum of CRP was higher (4.1+/-1.1 vs 2.3+/-0.7 mg/L, p<0.01). After adjusting other factors such as age, total cholesterol, diabetes and systolic blood pressure, total serum bilirubin was negatively associated with carotid atherosclerosis in women and men, with odds ratios of 0.49 (95% CI, 0.28 to 0.71; p<0.01) and 0.66 (95% CI, 0.46 to 0.80; p<0.01). Serum CRP was positively correlated to carotid atherosclerosis, with odds ratios of 1.76 (95% CI, 1.36 to 2.04; p<0.01) in women and 1.95 (95% CI, 1.46 to 2.82; p<0.01) in men. CONCLUSION: Carotid atherosclerosis was associated with a high prevalence of stroke or myocardial infarction in hypertensive patients. Serum bilirubin was negatively associated with carotid atherosclerosis. Free Article
	PMID: 19755760 [PubMed - indexed for MEDLINE]
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166.	Arch Ophthalmol. 2009 Sep;127(9):1175-82. The relation of markers of inflammation and endothelial dysfunction to the prevalence and progression of diabetic retinopathy: Wisconsin epidemiologic study of diabetic retinopathy. Klein BE, Knudtson MD, Tsai MY, Klein R. Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Wisconsin Alumni Research Foundation, Madison, WI 53726, USA. kleinb@epi.ophth.wisc.edu Abstract OBJECTIVE: To determine the relation of glycemia, blood pressure, and serum total cholesterol level as systemic markers of inflammation and endothelial dysfunction to the prevalence and incidence of diabetic retinal outcomes in persons with long-duration type 1 diabetes mellitus. METHODS: Longitudinal population-based study of persons with type 1 diabetes mellitus who received care for their diabetes in south central Wisconsin from July 1, 1979, to June 30, 1980. Data for this investigation were obtained from the 1990-1992 through the 2005-2007 follow-up examinations. Main outcome measures included the severity of diabetic retinopathy (DR) and macular edema (ME). RESULTS: In the 1990-1992 prevalence data, soluble vascular cell adhesion molecule, tumor necrosis factor, and homocysteine levels were associated with increased odds of more severe DR (odds ratios [highest vs lowest quartile], 3.95 [95% confidence interval, 1.66-9.39], 5.46 [2.38-12.52], and 7.46 [2.91-19.16], respectively) in those with kidney disease while controlling for relevant confounders. Similar odds were found for proliferative DR. Only total homocysteine level was associated with increased odds of ME (3.80 [95% confidence interval, 1.91-7.54]), irrespective of kidney disease. None of the markers were associated with incidence of proliferative DR, ME, or progression of DR 15 years later. CONCLUSIONS: A limited number of markers are associated with increased odds of prevalent retinal outcomes in persons with type 1 diabetes mellitus and kidney disease. Only homocysteine level is associated with ME in those with and without kidney disease. In the absence of kidney disease, the markers do not add to the more conventional descriptors and predictors of DR in persons with type 1 diabetes mellitus. This may reflect the close association of DR and kidney disease in diabetic persons. PMCID: PMC2746055 Free PMC Article
	PMID: 19752427 [PubMed - indexed for MEDLINE]
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167.	Rev Med Chil. 2009 Jun;137(6):737-45. Epub 2009 Sep 4. [Association between cardiorespiratory fitness and cardiovascular risk factors in healthy individuals]. [Article in Spanish] Krämer V, Acevedo M, Orellana L, Chamorro G, Corbalán R, Bustamante MJ, Marqués F, Fernández M, Navarrete C. Unidad de Cardiología Preventiva y Rehabilitación Cardiovascular, Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile. vero.kramer@gmail.com Abstract BACKGROUND: Cardio respiratory fitness (FIT) is associated with a better profile in most modifiable cardiovascular risk factors (RF). In Chile, sedentary lifestyle is highly prevalent, reaching almost 90%. AIM: To determine the association between FIT and traditional and emergent RF in a primary prevention population. MATERIAL AND METHODS: We prospectively studied 1973 subjects (36% women, mean age 56+/- 13 years) without history of cardiovascular disease and absence of ischemic changes on exercise testing. We assessed cardiovascular RF and determined body mass index (BMI), waist circumference, systolic and diastolic blood pressure, fasting blood lipids, glucose, C-reactive protein (CRP) and fibrinogen. FIT was measured by a Sci f-reported physical activity questionnaire and by a maximal treadmill exercise test, expressed in metabolic equivalents (METs). RESULTS: Subjects in the highest FIT according to the treadmill test had significantly lower BMI, waist circumference, systolic and diastolic blood pressure, total cholesterol, triglycerides, glucose, CRP and fibrinogen, and higher HDL cholesterol (adjusted by age and gender). LDL cholesterol did not show significant changes. The same pattern of RF (including LDL cholesterol) and CRP was observed when using Sci f-reported physical activity as a FIT parameter There was a significant association between both methods to measure FIT (p <0.0001, Chi-square Mantel-Haenszel). CONCLUSIONS: Our findings show that a better level off IT, assessed by exercise testing or through Sci f report is associated with improved levels of traditional and emergent RF. Free Article
	PMID: 19746274 [PubMed - indexed for MEDLINE]
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168.	Am J Physiol Heart Circ Physiol. 2009 Nov;297(5):H1567-75. Epub 2009 Sep 4. Angiotensin II, mechanotransduction, and pulsatile arterial hemodynamics in hypertension. Lacolley P, Safar ME, Regnault V, Frohlich ED. Université Henri Poincaré, Institut National de la Santé et de la Recherche Médicale U961, Nancy, France. Abstract The aortic blood pressure curve involves two components: a steady component, the mean arterial pressure (MAP), which is dependent on cardiac output and vascular resistance, and a pulsatile component pulse pressure (PP), which is dependent on arterial stiffness and pulse wave reflections. The transduction mechanisms of MAP and PP differ markedly, involving focal adhesion kinase for MAP and oxygen free radicals for PP. Angiotensin II (ANG II) and its blockade are associated with changed vascular resistance and MAP; however, their effects on PP (peripheral and mostly central PP) have been inadequately investigated. In hypertensive rats, when compared with their normotensive controls, ANG II blockade normalizes central PP (<50 mmHg) but not MAP when the same drug dosage is used for each. In hypertensive patients, ANG II blockade reduces arterial stiffness and pulse wave reflections, but with the same reduction in MAP, there is a greater reduction in central than peripheral PP, thereby increasing carotid-brachial PP amplification. With long-term ANG II blockade, the hypertensive arteriolar hypertrophy observed at baseline is corrected in association with reduced arteriolar reflection coefficients, reduced carotid arterial attachments linking alpha(5)-integrin to its ligand fibronectin, and decreased circulating C-reactive protein. When given a normal salt diet, each of these factors contributes separately in reducing arterial stiffness and wave reflections. These responses disappear with a high-salt diet, a condition that usually involves the activation of the local vascular renin-angiotensin-aldosterone system and can be prevented by its selective blockade. Thus ANG II inhibition seems to contribute independently in reducing central PP and aortic stiffness. Free Article
	PMID: 19734358 [PubMed - indexed for MEDLINE]
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169.	Age Ageing. 2009 Nov;38(6):693-7. Epub 2009 Sep 3. C-reactive protein, severity of pneumonia and mortality in elderly, hospitalised patients with community-acquired pneumonia. Thiem U, Niklaus D, Sehlhoff B, Stückle C, Heppner HJ, Endres HG, Pientka L. Department of Geriatrics, Marienhospital Herne, University of Bochum, Widumer Str. 8, D-44627 Herne, Germany. ulrich.thiem@rub.de Abstract BACKGROUND: increasingly, markers of systemic inflammation like C-reactive protein (CRP) levels and white blood count (WBC) are being used for assessing the prognosis of patients with community-acquired pneumonia (CAP). However, their predictive value has not been validated in populations of elderly patients. OBJECTIVE: to evaluate the prognostic value of CRP and WBC in comparison with the CURB score and the pneumonia severity index (PSI) in elderly, hospitalised patients with CAP. METHODS: the charts of all patients, aged 65 years and older, who were consecutively admitted to the Department of Geriatrics, Marienhospital Herne, Germany, for treatment of CAP between January 2001 and September 2005, were reviewed. CRP, WBC, CURB and PSI were analysed in relation to 30-day mortality. RESULTS: in a total of 391 patients, median age 80 years, no association was found between CRP or WBC and mortality. In contrast, the CURB score and PSI were significantly associated with mortality and treatment in the intensive care unit (ICU). CONCLUSION: in elderly, hospitalised patients with CAP, admission CRP and WBC are not predictors of the prognosis. Free Article
	PMID: 19729453 [PubMed - indexed for MEDLINE]
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170.	Korean J Lab Med. 2009 Aug;29(4):286-92. [The relationship between thyroid function and the risk factors of cardiovascular disease at female medical checkups]. [Article in Korean] Nah EH, Lee JG. Korea Association of Health Promotion, Seoul, Korea. cellonah@hanmail.net Abstract BACKGROUND: Thyroid hormones play an important role in regulating lipid and glucose metabolism. Thus this study was conducted to investigate the relationship between the thyroid hormone (FT4) or thyroid stimulating hormone (TSH) and the cardiovascular risk factors and metabolic syndrome in the individuals with subclinical thyroid dysfunction. METHODS: The female health examinee with normal range of FT4 were classified into three groups according to the level of TSH; euthyroid group (n=4,410), subclinical hypothyroidism group (n=438) and subclinical hyperthyroidism group (n=66). Age, blood pressure, BMI, fasting glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, lipoprotein(a), and high-sensitivity C-reactive protein (hsCRP) levels of serum specimens were compared among the groups and association of FT4 or TSH with these parameters. RESULTS: Fasting glucose was significantly higher in subclinical hyperthyroidism than in euthyroid and subclinical hypothyroidism groups (P=0.031), and total cholesterol was higher in subclinical hypothyroidism than in subclinical hyperthyroidism (P=0.011). But the other factors showed no difference among the groups. The level of TSH increased as triglyceride increased, while FT4 decreased as BMI or triglyceride increased. The FT4 also lowered when fasting glucose was above 126 mg/dL. TSH was not related with the metabolic syndrome, but the possibility of the syndrome was 1.3 times higher in the lowest quartile of the normal range of FT4 than in its highest quartile. CONCLUSIONS: For the interpretation of FT4, its reference interval needs to be divided into 4 quartiles, which can be used as one of the predicting factors of the metabolic syndrome. Free Article
	PMID: 19726889 [PubMed - indexed for MEDLINE]
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171.	Hypertension. 2009 Nov;54(5):974-80. Epub 2009 Aug 31. Cardiovascular and metabolic predictors of progression of prehypertension into hypertension: the Strong Heart Study. De Marco M, de Simone G, Roman MJ, Chinali M, Lee ET, Russell M, Howard BV, Devereux RB. Department of Medicine, Weill Cornell Medical College, New York, NY, USA. marinademarco2000@yahoo.it Comment in: Hypertension. 2009 Nov;54(5):954-5. Abstract Prehypertension (defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) frequently evolves to hypertension (HTN) and increases cardiovascular risk. It is unclear whether metabolic and/or cardiac characteristics favor development of HTN in prehypertensive subjects. We evaluated baseline anthropometric, laboratory, and echocardiographic characteristics of 625 untreated prehypertensive participants in the Strong Heart Study, without prevalent cardiovascular disease (63% women; 22% with diabetes mellitus; mean age: 59+/-7 years) to identify predictors of the 4-year incidence of HTN. Diabetes mellitus was assessed by American Diabetic Association criteria, and a diabetes-specific definition of HTN was used. Four-year incidence of HTN was 38%. Incident HTN was independently predicted by baseline systolic blood pressure (odds ratio [OR]: 1.60 per 10 mm Hg; 95% CI: 1.30 to 2.00; P<0.0001), waist circumference (OR: 1.10 per 10 cm; 95% CI: 1.01 to 1.30; P=0.04), and diabetes mellitus (OR: 2.73; 95% CI=1.77 to 4.21; P<0.0001), with no significant effect for age, sex, hemoglobin A1c, homeostatic model assessment index, C-reactive protein, fibrinogen, low-density lipoprotein and high-density lipoprotein cholesterol, triglycerides, plasma creatinine, or urine albumin:creatinine ratio. Higher left ventricular mass index (OR: 1.15 per 5 g/m(2.7); 95% CI: 1.01 to 1.25; P=0.03) or stroke volume index (OR: 1.25 per 5 mL/m(2.04); 95% CI: 1.10 to 1.50; P=0.03) was also identified, together with baseline systolic blood pressure and the presence of diabetes mellitus, as an independent predictor of incident HTN, without an additional predictive contribution from other anthropometric, metabolic, or echocardiographic parameters (all P>0.10). Thus, progression to HTN in 38% of Strong Heart Study prehypertensive participants could be predicted by higher left ventricular mass and stroke volume in addition to baseline systolic blood pressure and prevalent diabetes mellitus. PMCID: PMC2776057 Free PMC Article
	PMID: 19720957 [PubMed - indexed for MEDLINE]
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172.	Turk Kardiyol Dern Ars. 2009 Jun;37(4):234-40. Mentholated cigarette smoking and brachial artery, carotid artery, and aortic vascular function. Ciftçi O, Güllü H, Calişkan M, Topçu S, Erdoğan D, Yildirir A, Yildirim E, Müderrisoğlu H. Department of Cardiology, Medicine Faculty of Başkent University, Ankara, Turkey. ozgurciftci@baskent-kon.edu.tr Abstract OBJECTIVES: We investigated possible acute effects of mentholated versus nonmentholated cigarette smoking on vascular functions and left ventricular diastolic functions in otherwise healthy young smokers. STUDY DESIGN: The study included 20 otherwise healthy smokers (6 women, 14 men; mean age 25.6 years) and 22 healthy nonsmokers (12 women, 10 men; mean age 25.1 years). Ultrasound and echocardiographic examinations were performed to determine baseline characteristics for the brachial artery, aorta, and carotid artery, including brachial flow-mediated dilation (FMD), aortic and carotid stiffness index (SI), distensibility, and elastic modulus (EM). On day 2, each subject smoked either two mentholated or nonmentholated cigarettes and ultrasound and echocardiographic examinations were repeated. The procedure was repeated 15 days later with each subject smoking the other type of cigarette. RESULTS: From the baseline level of 14.0+/-9.0%, FMD decreased significantly to 8.3+/-3.2% (p=0.012) and to 9.8+/-5.5% (p=0.025) after smoking mentholated and nonmentholated cigarettes, respectively. Increase in systolic blood pressure was significant only with mentholated cigarettes (p=0.003). Increases in heart rate and rate-pressure product were significant in both groups, being more prominent with mentholated cigarettes. Both types of cigarettes resulted in significant prolongation of mitral E deceleration time and decrease in mitral E/A ratio. Changes in aortic SI and EM were significant only with mentholated cigarettes, while changes in carotid SI and EM were significant in both groups. Menthol-associated changes in systolic blood pressure, heart rate, rate-pressure product, carotid strain, and carotid SI parameters differed significantly from those seen after nonmentholated cigarette smoking (p=0.027, p<0.001, p<0.001, p=0.037, and p<0.001, respectively). CONCLUSION: Our findings show that mentholated cigarettes are not safer than nonmentholated cigarettes and that menthol-associated acute impairment is more severe in many parameters of elasticity and stiffness. Free Article
	PMID: 19717955 [PubMed - indexed for MEDLINE]
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173.	Haematologica. 2010 Jan;95(1):119-25. Epub 2009 Aug 27. Arterial cardiovascular risk factors and venous thrombosis: results from a population-based, prospective study (the HUNT 2). Quist-Paulsen P, Naess IA, Cannegieter SC, Romundstad PR, Christiansen SC, Rosendaal FR, Hammerstrøm J. Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. petter.quist-paulsen@stolav.no Abstract BACKGROUND: An explanation for the increased risk of myocardial infarction and stroke in patients with venous thrombosis is lacking. The objective of this study was to investigate whether risk factors for arterial cardiovascular disease also increase the risk of venous thrombosis. DESIGN AND METHODS: Cases who had a first venous thrombosis (n=515) and matched controls (n=1,505) were identified from a population-based, nested, case-cohort study (the HUNT 2 study) comprising 71% (n=66,140) of the adult residents of Nord-Trøndelag County in Norway. RESULTS: The age- and sex-adjusted odds ratio of venous thrombosis for subjects with concentrations of C-reactive protein in the highest quintile was 1.6 (95% confidence interval: 1.2-2.2) compared to subjects with C-reactive protein in the lowest quintile. This association was strongest in subjects who experienced venous thrombosis within a year after blood sampling with a three-fold increased risk of participants in the highest versus the lowest quintile. Having first degree relatives who had a myocardial infarction before the age of 60 years was positively associated with venous thrombosis compared to not having a positive family history [odds ratio 1.3 (95% confidence interval: 1.1-1.6)]. Subjects with blood pressure in the highest quintile had half the risk of developing venous thrombosis compared to subjects whose blood pressure was in the lowest quintile. There were no associations between the risk of venous thrombosis and total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, triglycerides, glucose or smoking. We confirmed the positive association between obesity and venous thrombosis. CONCLUSIONS: C-reactive protein and a family history of myocardial infarction were positively associated with subsequent venous thrombosis. Blood pressure was inversely correlated to venous thrombosis. These findings should be confirmed by further investigations. PMCID: PMC2805742 Free PMC Article
	PMID: 19713225 [PubMed - in process]
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174.	Metabolism. 2010 Jan;59(1):54-61. Epub 2009 Aug 26. Changes in C-reactive protein from low-fat diet and/or physical activity in men and women with and without metabolic syndrome. Camhi SM, Stefanick ML, Ridker PM, Young DR. Population Science, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA. sarah.camhi@pbrc.edu Comment in: Metabolism. 2010 Mar;59(3):454-5; author reply 455-6. Abstract Change in high-sensitivity C-reactive protein (CRP) from low-fat diet (diet) and physical activity (PA) interventions is relatively unknown for adults with metabolic syndrome. The objective of the study was to assess CRP change (DeltaCRP) with diet and/or PA in men and women with and without metabolic syndrome. Men (n = 149) and postmenopausal women (n = 125) with elevated low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol were recruited into a 1-year randomized controlled trial. Treatment groups were as follows: control, diet (reduced total fat, saturated fat, and cholesterol intake), PA (45-60 minutes at 60%-85% maximum heart rate), or diet + PA. Weight loss was not an intervention focus. Metabolic syndrome was defined using the American Heart Association/National Heart, Lung, and Blood Institute criteria. Stored plasma samples were analyzed for CRP. Change in CRP was compared between treatments, within sex and metabolic syndrome status, using analysis of covariance, including covariates for baseline CRP and body fat change. For women with metabolic syndrome (n = 39), DeltaCRP was greater in diet vs control (-1.2 +/- 0.4, P = .009), diet + PA vs control (-1.3 +/- 0.4, P = .006), and diet + PA vs PA (-1.1 +/- 0.4, P = .02). Women with metabolic syndrome receiving the diet component (diet or diet + PA) had greater DeltaCRP compared with those who did not (control or PA) (P = .001). Change in CRP was not significantly different between intervention groups in men overall, women overall, men with (n = 47) or without metabolic syndrome (n = 102), or women without metabolic syndrome (n = 86). Low-fat diet may be the most effective treatment for reducing CRP in women with metabolic syndrome. PMCID: PMC2789861 Free PMC Article
	PMID: 19709693 [PubMed - indexed for MEDLINE]
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175.	Mediators Inflamm. 2009;2009:959281. Epub 2009 Aug 20. Gender differences relating to metabolic syndrome and proinflammation in Finnish subjects with elevated blood pressure. Ahonen T, Saltevo J, Laakso M, Kautiainen H, Kumpusalo E, Vanhala M. Palokka Health Center, 40270 Jyväskylä, Finland. tiina.ahonen@fimnet.fi Abstract Fasting insulin, adiponectin, high-sensitivity C-reactive protein (hs-CRP), and interleukin-1 receptor antagonist (IL-1Ra) were determined in 278 men and 273 women with blood pressure > or = 130 and/or > or = 85 mmHg and/or with antihypertensive medication. Metabolic syndrome (MetS) with the National Cholesterol Education Program (NCEP) criteria was observed in 35% of men and 34% of women. Men with MetS had lower hs-CRP and IL-1Ra than women. The absolute gender difference in adiponectin was smaller and those in IL-1Ra and hs-CRP were greater in subjects with MetS compared to those without. After adjustment with body mass index the association between insulin and the odd's ratio (OR) for MetS remained significant in both genders, in females also the association between the OR for MetS and adiponectin. There are gender differences in subjects with elevated blood pressure and MetS with respect to inflammatory markers and the relationship between adiponectin levels and MetS. PMCID: PMC2730476 Free PMC Article
	PMID: 19707530 [PubMed - indexed for MEDLINE]
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176.	Eur Heart J. 2009 Nov;30(22):2733-41. Epub 2009 Aug 21. Effect of irbesartan and enalapril in non-ST elevation acute coronary syndrome: results of the randomized, double-blind ARCHIPELAGO study. Montalescot G, Drexler H, Gallo R, Pearson T, Thoenes M, Bhatt DL. Bureau 2-236, Institut de Cardiologie, Hôpital Pitié-Salpétrière, 47 boulevard de l'hôpital, Paris, France. gilles.montalescot@psl.ap-hop-paris.fr Abstract AIMS: This study investigated the effects of irbesartan vs. enalapril, with early vs. late treatment, on markers of inflammation and ischaemic heart disease in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). METHODS AND RESULTS: Patients hospitalized with ischaemic symptoms and evidence of NSTEACS were randomized to early (at hospitalization) or late (at hospital discharge) treatment with irbesartan 150 mg/day followed by 300 mg/day on day 15 (n = 212) or enalapril 10 mg/day followed by 20 mg/day on day 15 (n = 217) to day 60. The primary endpoint was the change from baseline in high-sensitivity C-reactive protein (hs-C-reactive protein) at day 60; secondary endpoints included changes in troponin I, B-type natriuretic peptide, microalbuminuria, interleukin 6, myeloperoxidase, secretory non-pancreatic type II phospholipase A2, ischaemia-modified albumin, soluble CD40 ligand, matrix metalloproteinase-9, aldosterone, and blood pressure. High-sensitivity C-reactive protein levels were comparable in both the irbesartan and enalapril treatment arms. There were no treatment-related differences in any of the biomarkers measured. Changes in inflammatory markers were unaffected by the timing of treatment initiation. Both treatments were well tolerated, with no differences in major adverse cardiac events. CONCLUSION: In patients with NSTEACS, inflammatory markers decreased over time in both treatment arms, with no differences between irbesartan and enalapril. Free Article
	PMID: 19700470 [PubMed - indexed for MEDLINE]
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177.	Tex Heart Inst J. 2009;36(4):303-8. Progesterone levels and carotid intima-media thickness: a negative association in older northern Chinese men. Ma Q, Sun X, Chen Y, Chen X, Zhi G, Tan G. Institute of Nephrology of PLA, General Hospital of PLA, 28 Fuxing Road, Beijing 100853, People's Republic of China. Abstract In experimental research, progesterone has been found to be beneficial to the central nervous and cardiovascular systems; however, its potential role in preventing atherosclerosis in elderly men remains unclear. In this prospective study, we analyzed data in 385 older men and women from 6 communities in Beijing, China, in order to discover whether progesterone is associated with carotid intima-media thickness and plaque occurrence. Intima-media thickness and atherosclerotic plaques were determined by use of ultrasonography. Sex-hormone levels were measured by immunoassay. The data were analyzed via analysis of covariance and logistic regression analysis; P < 0.05 was considered statistically significant. We found a negative association between mean intima-media thickness and progesterone concentration in men, before and after adjustments for such traditional risk factors of atherosclerosis as age, triglyceride levels, total and low-density lipoprotein cholesterol levels, high-sensitivity C-reactive protein, systolic blood pressure, waist-to-hip ratio, and body mass index (analysis of covariance, P = 0.007 and P = 0.015, respectively). However, no such association was found in women (P = 0.304 and P = 0.247, respectively). In the logistic regression model that was adjusted for the confounding factors of atherosclerosis, men with progesterone levels in the lowest quartile (<1.87 nmol/L) had more risk of higher intima-media thickness (odds ratio, 2.15; P = 0.042). Although further experimental and prospective studies are warranted in order to determine the mechanism of progesterone's function in atherosclerosis prevention, we conclude that progesterone concentrations are negatively associated with carotid artery atherosclerosis in northern Chinese men 60 years of age or older. PMCID: PMC2720297 Free PMC Article
	PMID: 19693303 [PubMed - indexed for MEDLINE]
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178.	Hypertension. 2009 Oct;54(4):763-8. Epub 2009 Aug 17. Arterial destiffening with atorvastatin in overweight and obese middle-aged and older adults. Orr JS, Dengo AL, Rivero JM, Davy KP. Human Integrative Physiology Laboratory, Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA. Abstract We hypothesized that atorvastatin (ATOR) treatment would reduce arterial stiffness in overweight and obese middle-aged and older adults. Twenty-six (11 men and 15 women) overweight or obese (body mass index: 31.6+/-0.7 kg/m(2)) middle-aged and older adults (age: 54+/-2 years) were randomly assigned to receive either ATOR (80 mg/d) or placebo for 12 weeks. Arterial stiffness (beta-stiffness and pulse wave velocity) was measured before and after the intervention. At baseline, the ATOR (n=16) and placebo (n=10) groups did not differ with respect to age, body mass index, blood pressure, serum lipid and lipoprotein concentrations, high-sensitivity C-reactive protein, indices of arterial stiffness, or compliance (all P>0.05). After the 12-week treatment period, the ATOR group experienced a 47% reduction in low-density lipoprotein cholesterol (149+/-6 to 80+/-8 mg/dL) and a 42% reduction in high-sensitivity C-reactive protein (3.6+/-0.8 to 2.1+/-0.5 mg/L; both P<0.05). In addition, beta-stiffness (9.4+/-0.6 to 7.6+/-0.5 U) and aortic pulse wave velocity (1096+/-36 to 932+/-32 cm/s), but not brachial pulse wave velocity, decreased (both P<0.05) with ATOR. In contrast, there were no significant changes in beta-stiffness (9.1+/-0.8 to 9.1+/-0.7 U) or aortic pulse wave velocity (1238+/-89 to 1191+/-90 cm/s; both P>0.05) in the placebo group. There were no relations between the reductions in arterial stiffness indices and any of the baseline cardiometabolic risk factors (all P>0.05). However, the reductions in arterial stiffness were correlated with the reduction in low-density lipoprotein cholesterol but not high-sensitivity C-reactive protein or any other cardiometabolic variables (all P<0.05). Taken together, these findings suggest that ATOR reduces arterial stiffness in overweight and obese middle-aged and older adults, and these favorable changes occur irrespective of baseline cardiometabolic risk factors. Free Article
	PMID: 19687343 [PubMed - indexed for MEDLINE]
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179.	Invest Ophthalmol Vis Sci. 2010 Jan;51(1):272-6. Epub 2009 Aug 13. Peripheral vascular endothelial dysfunction in glaucomatocyclitic crisis: a preliminary study. Shen SC, Ho WJ, Wu SC, Yu KH, Lin HC, Lin YS, Tsay PK, Chu PH. Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan. Abstract PURPOSE: Glaucomatocyclitic crisis (GCC) is a syndrome of recurrent unilateral increased intraocular pressure associated with mild cyclitis and few clinical symptoms. This study was undertaken to assess brachial artery endothelium-dependent flow-mediated vasodilation (FMD) as an indicator of vascular endothelial function, to describe the association between GCC and endothelial dysfunction excluding age effects. METHODS: This prospective study was conducted from January 2007 to April 2009 and included 12 patients with GCC and 15 age-matched normal control subjects. Detailed clinical parameters were reviewed, including highly sensitive C-reactive protein (hs-CRP), homocysteine, anti-SSA, anti-cardiolipin antibodies, and HLA type. Brachial artery FMD and endothelium-independent, nitroglycerin-mediated vasodilation (NMD) were studied by using high-resolution, two-dimensional (2-D) ultrasonic imaging. RESULTS: Twelve patients with GCC were evaluated. The mean age of the patients was 36.3 years including 5 (41.6%) women and 7 (58.4%) men. There were no significant differences between patients with GCC and control subjects with regard to basal data, including body mass index, smoking, blood pressure, complete blood count, and routine blood biochemistries. Homocysteine and hs-CRP were within normal limits. Two (16.7%) patients were positive for HLA-B27, anti-SSA, and anti-cardiolipin antibodies. The nitroglycerin-mediated vasodilation in the patients with GCC was not significantly different from that of the control group. The FMD was much lower in the GCC group than in the control groups (mean 4.81% vs. 7.89%, P < 0.01). CONCLUSIONS: The significantly lower FMD in patients with GCC implies peripheral vascular endothelial dysfunction. However, in the 16.7% positive for the HLA-B27, anti-SSA, and anti-cardiolipin antibodies, these parameters are associated with GCC and abnormal FMD. Free Article
	PMID: 19684007 [PubMed - indexed for MEDLINE]
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180.	J Thromb Haemost. 2009 Oct;7(10):1605-11. Epub 2009 Aug 11. Circulating inflammatory and hemostatic biomarkers are associated with risk of myocardial infarction and coronary death, but not angina pectoris, in older men. Wannamethee SG, Whincup PH, Shaper AG, Rumley A, Lennon L, Lowe GD. Department of Primary Care and Population Health, UCL Medical School, Royal Free Campus, London NW3 2PF, UK. goya@pcps.ucl.ac.uk Abstract AIMS: The extent to which hemostatic and inflammatory biomarkers are related to angina pectoris as compared with myocardial infarction (MI) remains uncertain. We examined the relationship between a wide range of inflammatory and hemostatic biomarkers, including markers of activated coagulation, fibrinolysis and endothelial dysfunction and viscosity, with incident myocardial infarction (MI) or coronary heart disease (CHD) death and incident angina pectoris uncomplicated by MI or CHD death in older men. METHODS: A prospective study of 3217 men aged 60-79 years with no baseline CHD (angina or MI) and who were not on warfarin, followed up for 7 years during which there were 198 MI/CHD death cases and 220 incident uncomplicated angina cases. RESULTS: Inflammatory biomarkers [C-reactive protein (CRP), interleukin-6, fibrinogen], plasma viscosity and hemostatic biomarkers [von Willebrand factor (VWF) and fibrin D-dimer] were associated with a significant increased risk of MI/CHD death but not with uncomplicated angina even after adjustment for age and conventional risk factors. Adjustment for CRP attenuated the relationships between VWF, fibrin D-dimer and plasma viscosity with MI/CHD death. Comparisons of differing associations with risk of MI/CHD deaths and uncomplicated angina were significant for the inflammatory markers (P < 0.05) and marginally significant for fibrin D-dimer (P = 0.05). In contrast, established risk factors including blood pressure and high-density lipoprotein (HDL)-cholesterol were associated with both MI/CHD death and uncomplicated angina. CONCLUSION: Circulating biomarkers of inflammation and hemostasis are associated with incident MI/CHD death but not incident angina uncomplicated by MI or CHD death in older men. PMCID: PMC2810437 Free PMC Article
	PMID: 19682232 [PubMed - indexed for MEDLINE]
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181.	Obesity (Silver Spring). 2010 Feb;18(2):239-46. Epub 2009 Aug 13. Characterization of herpes virus entry mediator as a factor linked to obesity. Bassols J, Moreno JM, Ortega F, Ricart W, Fernandez-Real JM. Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomédica de Girona, CIBEROBN Fisiopatología de la Obesidad y Nutrición, Girona, Spain. Abstract Herpes virus entry mediator (HVEM) is a member of the tumor necrosis factor (TNF) receptor superfamily (TNFRSF14), which serves as a receptor for herpes viruses and cytokines such as lymphotoxin-alpha (LT-alpha) and LIGHT (lymphotoxin-like inducible protein that competes with glycoprotein D for herpes virus entry on T cells). We aimed to explore the associations of HVEM with human obesity. HVEM gene expression and protein levels were studied in total adipose tissue and in their fractions (isolated adipocytes and stromovascular cells (SVCs)) obtained from 81 subjects during elective surgical procedures. HVEM -241GA and -14AG gene polymorphisms were also studied and associated with obesity measures in 840 subjects. Visceral adipose tissue had significantly higher expression of HVEM than subcutaneous adipose tissue (P < 0.0001). Obese patients had significantly higher subcutaneous HVEM gene expression (P = 0.03) and protein levels (P = 0.01) than lean subjects. HVEM gene expression and protein levels were found in both isolated adipocytes and SVCs. These findings were confirmed in primary cultures from human preadipocytes, in which a significant increase in HVEM was observed during the differentiation process. HVEM -241GA and -14AG gene polymorphisms were associated with obesity, diastolic pressure, several inflammatory parameters (C-reactive protein and interleukin 18 (IL-18)), and circulating LIGHT concentrations. A sample of men with the G241A gene polymorphism also showed an increased serum titer of IgG antiherpes virus 1. These results provide evidences of an existing relationship between HVEM and obesity, which suggest that this TNF superfamily receptor could be involved in the pathogenesis of obesity and inflammation-related activity. Free Article
	PMID: 19680232 [PubMed - indexed for MEDLINE]
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182.	Clin Exp Pharmacol Physiol. 2009 May;36(5-6):509-15. Epub 2008 Oct 28. Activation of reactive oxygen species and the renin-angiotensin system in IgA nephropathy model mice. Ohashi N, Katsurada A, Miyata K, Satou R, Saito T, Urushihara M, Kobori H. Department of Physiology and Hypertension and Renal Center of Excellence, Tulane University Health Sciences Center, New Orleans, Louisiana, USA. nohashi@tulane.edu Abstract 1. Although IgA nephropathy is the most common form of primary glomerulopathy, the detailed mechanisms underlying its development remain uncertain. 2. In the present study, we used male high IgA strain of ddY (HIGA) mice as the IgA nephropathy model and age-matched male BALB/c mice as the control. Recent studies have demonstrated that reactive oxygen species (ROS)-dependent enhancement of the renin-angiotensin system (RAS) plays a potential role in the development and progression of renal injury. Therefore, in the present study we periodically measured the systolic blood pressure (SBP) of mice over the period 21-25 weeks of age and estimated markers for ROS, RAS and renal damage after mice had been killed at 25 weeks of age. 3. Markers for ROS (urinary 8-isoprostane excretion and renal 4-hydroxy-2-nonenal accumulation), RAS (renal angiotensinogen protein expression, urinary angiotensinogen excretion and renal angiotensin II) and renal damage (desmin-positive area and urinary protein excretion), as well as SBP, were significantly increased in HIGA mice compared with control BALB/c mice. 4. The data suggest that both ROS and the RAS are activated at an early phase in IgA nephropathy model mice. PMCID: PMC2727608 Free PMC Article
	PMID: 19673933 [PubMed - indexed for MEDLINE]
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183.	PLoS One. 2009 Aug 11;4(8):e6590. Inflammation and infection do not promote arterial aging and cardiovascular disease risk factors among lean horticulturalists. Gurven M, Kaplan H, Winking J, Eid Rodriguez D, Vasunilashorn S, Kim JK, Finch C, Crimmins E. Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA. gurven@anth.ucsb.edu Abstract BACKGROUND: Arterial aging is well characterized in industrial populations, but scantly described in populations with little access to modern medicine. Here we characterize health and aging among the Tsimane, Amazonian forager-horticulturalists with short life expectancy, high infectious loads and inflammation, but low adiposity and robust physical fitness. Inflammation has been implicated in all stages of arterial aging, atherogenesis and hypertension, and so we test whether greater inflammation associates with atherosclerosis and CVD risk. In contrast, moderate to vigorous daily activity, minimal obesity, and low fat intake predict minimal CVD risk among older Tsimane. METHODS AND FINDINGS: Peripheral arterial disease (PAD), based on the Ankle-Brachial Index (ABI), and hypertension were measured in Tsimane adults, and compared with rates from industrialized populations. No cases of PAD were found among Tsimane and hypertension was comparatively low (prevalence: 3.5%, 40+; 23%, 70+). Markers of infection and inflammation were much higher among Tsimane than among U.S. adults, whereas HDL was substantially lower. Regression models examine associations of ABI and BP with biomarkers of energy balance and metabolism and of inflammation and infection. Among Tsimane, obesity, blood lipids, and disease history were not significantly associated with ABI. Unlike the Tsimane case, higher cholesterol, C-reactive protein, leukocytes, cigarette smoking and systolic pressure among North Americans are all significantly associated with lower ABI. CONCLUSIONS: Inflammation may not always be a risk factor for arterial degeneration and CVD, but instead may be offset by other factors: healthy metabolism, active lifestyle, favorable body mass, lean diet, low blood lipids and cardiorespiratory health. Other possibilities, including genetic susceptibility and the role of helminth infections, are discussed. The absence of PAD and CVD among Tsimane parallels anecdotal reports from other small-scale subsistence populations and suggests that chronic vascular disease had little impact on adult mortality throughout most of human evolutionary history. PMCID: PMC2722089 Free PMC Article
	PMID: 19668697 [PubMed - indexed for MEDLINE]
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184.	Diabetes Care. 2009 Nov;32(11):1965-71. Epub 2009 Aug 3. Sleep duration, lifestyle intervention, and incidence of type 2 diabetes in impaired glucose tolerance: The Finnish Diabetes Prevention Study. Tuomilehto H, Peltonen M, Partinen M, Lavigne G, Eriksson JG, Herder C, Aunola S, Keinänen-Kiukaanniemi S, Ilanne-Parikka P, Uusitupa M, Tuomilehto J, Lindström J; Finnish Diabetes Prevention Study Group. Department of Otorhinolaryngology, Kuopio University Hospital, and University of Kuopio, Kuopio, Finland. henri.tuomilehto@kuh.fi Abstract OBJECTIVE: Both short and long sleep duration have frequently been found to be associated with an increased risk for diabetes. The aim of the present exploratory analysis was to examine the association between sleep duration and type 2 diabetes after lifestyle intervention in overweight individuals with impaired glucose tolerance in a 7-year prospective follow-up. RESEARCH DESIGN AND METHODS: A total of 522 individuals (aged 40-64 years) were randomly allocated either to an intensive diet-exercise counseling group or to a control group. Diabetes incidence during follow-up was calculated according to sleep duration at baseline. Sleep duration was obtained for a 24-h period. Physical activity, dietary intakes, body weight, and immune mediators (C-reactive protein and interleukin-6) were measured. RESULTS: Interaction between sleep duration and treatment group was statistically significant (P = 0.003). In the control group, the adjusted hazard ratios (HRs) (95% CI) for diabetes were 2.29 (1.38-3.80) and 2.74 (1.67-4.50) in the sleep duration groups 9-9.5 h and >or=10 h, respectively, compared with for that of the 7-8.5 h group. In contrast, sleep duration did not influence the incidence of diabetes in the intervention group; for sleep duration groups 9-9.5 h and >or=10 h, the adjusted HRs (95% CI) were 1.10 (0.60-2.01) and 0.73 (0.34-1.56), respectively, compared with that in the reference group (7-8.5 h sleep). Lifestyle intervention resulted in similar improvement in body weight, insulin sensitivity, and immune mediator levels regardless of sleep duration. CONCLUSIONS: Long sleep duration is associated with increased type 2 diabetes risk. Lifestyle intervention with the aim of weight reduction, healthy diet, and increased physical activity may ameliorate some of this excess risk. PMCID: PMC2768215 Free PMC Article
	PMID: 19651919 [PubMed - indexed for MEDLINE]
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185.	Arterioscler Thromb Vasc Biol. 2009 Oct;29(10):1691-5. Epub 2009 Jul 30. Carotid intima-media thickness, systemic inflammation, and incidence of heart failure hospitalizations. Engström G, Melander O, Hedblad B. Department of Clinical Sciences in Malmö, Lund University, Malmö University Hospital, Sweden. Gunnar.Engstrom@med.lu.se Abstract OBJECTIVE: This study explored the relationships between carotid intima-media thickness (IMT), plasma levels of C-reactive protein (CRP), and incidence of heart failure hospitalizations. METHODS AND RESULTS: Men and women from the general population (n=4691), without history of myocardial infarction or stroke, were examined. Incidence of hospitalizations attributable to heart failure was studied over a mean follow-up of 13 years. A total of 75 subjects were hospitalized with a primary diagnosis of heart failure. Adjusted for risk factors, the hazards ratios (95% CI) were 1.00, 0.98 (0.36 to 2.7), 1.9 (0.80 to 4.6), and 2.7 (1.1 to 6.2), respectively, for the 1st, 2nd, 3rd, and 4th quartiles of IMT (P for trend=0.003). The HR associated with CRP levels >or=3 mg/L (versus <1 mg/L) was 2.0 (95% CI: 1.06 to 3.9) after adjustments for risk factors. There was a significant interaction between IMT and CRP on heart failure incidence (P=0.028). Subjects with CRP >or=3 mg/L and IMT in the 4th quartile had an adjusted HR of 3.7 (1.9 to 7.1) compared to those with CRP <3 mg/L and IMT in quartile 1 to 3. CONCLUSIONS: High IMT and high CRP are both independent risk factors for incidence of heart failure requiring hospitalization. The joint exposure to both risk factors substantially increases the risk. Free Article
	PMID: 19644052 [PubMed - indexed for MEDLINE]
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186.	Sleep. 2009 Jul 1;32(7):857-64. Gender differences in the cross-sectional relationships between sleep duration and markers of inflammation: Whitehall II study. Miller MA, Kandala NB, Kivimaki M, Kumari M, Brunner EJ, Lowe GD, Marmot MG, Cappuccio FP. The University of Warwick, Clinical Sciences Research Institute, UHCW Campus, Warwick Medical School, Coventry, UK. michelle.miller@warwick.ac.uk Comment in: Sleep. 2009 Jul 1;32(7):841-2. Abstract OBJECTIVE: To examine the relationships between sleep and inflammatory markers because these may be important in the development of cardiovascular disease. METHODS AND RESULTS: The relationship between self-reported sleep duration and interleukin-6 (IL-6) (n = 4642) and high-sensitivity C-reactive protein (hs-CRP) (n = 4677) was examined in individuals from the Whitehall II study. Following multiple adjustments, there were no overall linear or nonlinear trends between sleep duration and IL-6. However, in women but not men (interaction P < 0.05), levels of IL-6 tended to be lower in individuals who slept 8 hours (11% [95% confidence interval 4 to 17]) as compared to 7 hours. With hs-CRP, in the adjusted model, there was no association between hs-CRP and sleep duration in men. However, there was a significant nonlinear association in women, the level of hs-CRP being significantly higher in women short sleepers (5 hours or less) after multiple adjustments (P = 0.04) (interaction P < 0.05). CONCLUSIONS: No significant variation in inflammatory markers with sleep duration was observed in men. By contrast, both IL-6 and hs-CRP levels varied with sleep duration in women. The observed pattern of variation was different according to the inflammatory marker observed. Further longitudinal studies are required to fully investigate possible temporal relationships between short sleep and markers of inflammation. PMCID: PMC2706900 Free PMC Article
	PMID: 19639748 [PubMed - indexed for MEDLINE]
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187.	J Atheroscler Thromb. 2009 Jun;16(3):179-87. Increased plasma urotensin-II and carotid atherosclerosis are associated with vascular dementia. Ban Y, Watanabe T, Suguro T, Matsuyama TA, Iso Y, Sakai T, Sato R, Idei T, Nakano Y, Ota H, Miyazaki A, Kato N, Hirano T, Ban Y, Kobayashi Y. Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo 142-8555, Japan. Abstract AIM: Human urotensin-II (UII) is a cyclic neuropeptide with potent vasoconstrictive activity in the vasculature. The expression of UII and its receptor (UT) mRNA is detected at high levels in the brain. We evaluated the relationship between plasma UII levels and vascular dementia (VaD) caused by stroke or atherosclerotic small vessel disease. METHODS: Carotid artery intima-media thickness (IMT), plaques, plasma levels of immunoreactive UII (IR-UII), and atherosclerotic biomarkers were determined in 42 patients with VaD, 197 with Alzheimer's disease (AD), and 47 non-demented elderly controls. RESULTS: Age, gender, body mass index, systolic blood pressure (SBP), fasting plasma glucose, insulin, triglycerides, high-density lipoprotein cholesterol, leptin, and plasminogen activator inhibitor-1 levels were not significantly different among these groups. IR-UII, low-density lipoprotein (LDL) cholesterol, lipoprotein(a), lipid peroxides, interleukin-6, and high-sensitive C-reactive protein (hs-CRP) levels, and maximum IMT were significantly higher in VaD than in AD patients or controls. IR-UII level showed a significantly positive correlation with SBP or maximum IMT. Multivariate logistic regression analysis revealed a significantly independent association between IR-UII levels or increased maximum IMT (> or =1.1 mm) and VaD as compared with SBP, LDL cholesterol, and interleukin-6 levels. CONCLUSION: Increased plasma IR-UII levels and carotid atherosclerosis may be involved in the pathogenesis and progression of VaD. Free Article
	PMID: 19638714 [PubMed - indexed for MEDLINE]
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188.	BMC Geriatr. 2009 Jul 28;9:33. Cognitive function, social integration and mortality in a U.S. national cohort study of older adults. Obisesan TO, Gillum RF. Department of Medicine, College of Medicine, Howard University, Washington, DC, USA. tobisesan@howard.edu Abstract BACKGROUND: Prior research suggests an interaction between social networks and Alzheimer's disease pathology and cognitive function, all predictors of survival in the elderly. We test the hypotheses that both social integration and cognitive function are independently associated with subsequent mortality and there is an interaction between social integration and cognitive function as related to mortality in a national cohort of older persons. METHODS: Data were analyzed from a longitudinal follow-up study of 5,908 American men and women aged 60 years and over examined in 1988-1994 followed an average 8.5 yr. Measurements at baseline included self-reported social integration, socio-demographics, health, body mass index, C-reactive protein and a short index of cognitive function (SICF). RESULTS: Death during follow-up occurred in 2,431. In bivariate analyses indicators of greater social integration were associated with higher cognitive function. Among persons with SICF score of 17, 22% died compared to 54% of those with SICF score of 0-11 (p < 0.0001). After adjusting for confounding by baseline socio-demographics and health status, the hazards ratio (HR) (95% confidence limits) for low SICF score was 1.43 (1.13-1.80, p < 0.001). After controlling for health behaviors, blood pressure and body mass, C-reactive protein and social integration, the HR was 1.36 (1.06-1.76, p = 0.02). Further low compared to high social integration was also independently associated with increased risk of mortality: HR 1.24 (1.02-1.52, p = 0.02). CONCLUSION: In a cohort of older Americans, analyses demonstrated a higher risk of death independent of confounders among those with low cognitive function and low social integration with no significant interaction between them. PMCID: PMC2724371 Free PMC Article
	PMID: 19638207 [PubMed - indexed for MEDLINE]
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189.	Life Sci. 2009 Aug 26;85(9-10):357-64. Epub 2009 Jul 23. Effects of pyrrolidine dithiocarbamate on high-fat diet-induced metabolic and renal alterations in rats. Ebenezer PJ, Mariappan N, Elks CM, Haque M, Soltani Z, Reisin E, Francis J. Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, LA 70803, USA. Abstract AIMS: We investigated the effects of the nuclear factor kappa B (NFkappaB) blocker pyrrolidine dithiocarbamate (PDTC) on high-fat diet (HFD)-induced metabolic and renal alterations in obese and lean Zucker rats (OZR and LZR, respectively). MAIN METHODS: Rats were fed a HFD resembling the typical "Western" diet or a regular diet (RD) and allowed free access to tap water or tap water containing PDTC (150 mg/kg body weight) for 10 weeks; rats were then sacrificed. Total ROS production rates were measured using electron paramagnetic resonance spectroscopy, and superoxide production was measured with lucigenin assay. Blood, plasma, and urine were analyzed. Semi-quantitative reverse transcriptase-polymerase chain reaction and electrophoretic mobility shift assay were conducted to assess NFkappaB mRNA levels and DNA binding activities, respectively; immunofluorescence was performed to assess protein levels. KEY FINDINGS: OZR-HFD rats exhibited significantly higher levels of total renal cortical reactive oxygen species production, plasma lipids, insulin, C-reactive protein, blood urea nitrogen, creatinine, and urinary albumin excretion than all other groups (p<0.05); these changes were accompanied by a significant decrease in plasma high density lipoprotein levels (p<0.05). Gene expression levels of desmin, cytokine and oxidative stress genes were significantly higher in the renal cortical tissues of OZR-HFD; NFkappaB p65 DNA binding activity was also significantly higher in these animals. PDTC attenuated these changes. SIGNIFICANCE: Our data suggest that NFkappaB blockade may prove beneficial in treating the nephropathy often associated with metabolic syndrome. PMCID: PMC2760250 Free PMC Article
	PMID: 19631668 [PubMed - indexed for MEDLINE]
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190.	Arq Bras Cardiol. 2009 Jun;92(6):437-42, 456-61, 472-8. Metabolic syndrome in patients with high blood pressure in Cuiabá-Mato Grosso State: prevalence and associated factors. [Article in English, Multiple languages] Franco GP, Scala LC, Alves CJ, França GV, Cassanelli T, Jardim PC. Instituto de Saúde Coletiva, Universidade Federal de Mato Grosso, Cuiabá, MT, Brasil. gppf@terra.com.br Abstract BACKGROUND: Metabolic Syndrome (MS) is a cluster of predisposing factors for cardiovascular diseases and diabetes mellitus, whose epidemiological characteristics are poorly known at regional and national levels. OBJECTIVE: To estimate the prevalence of MS and its associated factors in a sample of patients with high blood pressure in the urban area of Cuiabá, Mato Grosso State. METHODS: This was a cross-sectional study (May to November 2007) in a sample of 120 patients with high blood pressure (aged > or = 20 years), paired by gender and selected by the systematic sampling of a source population of 567 patients with high blood pressure in Cuiabá. All patients answered to home inquiries to provide sociodemographic and life habits data. The following measurements were taken: blood pressure; body mass index (BMI); waist and hip circumferences; plasma glucose, insulin, and lipid levels; homeostasis model assessment-estimated insulin resistance (HOMA); C-reactive protein, uric acid and fibrinogen levels. High blood pressure criterion: average systolic blood pressure > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg; and Metabolic Syndrome diagnosis according to the I Brazilian Directive for Metabolic Syndrome and the NCEP-ATP III criteria. RESULTS: 120 patients (60 women), with high blood pressure and an average age of 58.3 +/- 12.6 years, were analyzed. We found a MS prevalence of 70.8% (95%CI 61.8 to 78.8), predominantly among women (81.7% vs. 60.0%; p=0.009), with no difference between adults (71.4%) and elderly patients (70.2%). The multiple regression analysis showed a positive association between MS and BMI > or = 25 kg/m(2), insulin resistance and family history of high blood pressure. CONCLUSION: A high prevalence of MS was observed among patients with high blood pressure living in Cuiabá, with a significant association with BMI > or = 25 kg/m(2), insulin resistance (HOMA index) and, especially, a family history of high blood pressure. These results suggest the need for deeper studies on this subject. Free Article
	PMID: 19629311 [PubMed - indexed for MEDLINE]
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191.	Rev Med Chil. 2009 Mar;137(3):329-36. Epub 2009 Jun 15. Frequency and characteristics of metabolic syndrome in patients with symptomatic carotid atherosclerosis. Maksimovic M, Vlajinac H, Radak D, Maksimovic J, Otasevic P, Marinkovic J, Jorga J. Institute for Hygiene and Medical Ecology, School of Medicine, Belgrade, Serbia. milosmaksimovic71@gmail.com Abstract BACKGROUND: Metabolic syndrome (MetS) is associated with increased risk of carotid atherosclerosis. AIM: To estimate the frequency of MetS in patients with symptomatic carotid atherosclerotic disease, and to compare clinical, biochemical and ultrasonographic characteristics of patients with and without MetS. MATERIAL AND METHODS: Cross-sectional study of 657 consecutive patients (412 males) with symptomatic carotid atherosclerotic disease. Carotid atherosclerosis was estimated by high resolution B-mode ultrasonography. National Cholesterol Education Program (NCEP) M criteria were used for estimation of MetS. RESULTS: Metabolic syndrome was present in 55.6% of studied patients. Among patients with metabolic syndrome there was a significantly higher proportion of women, and mean values of body weight, body mass index, waist circumference, percentage of body fat, systolic and diastolic blood pressure, serum triglycerides, total cholesterol and glucose were significantly higher. Mean values of high density lipoprotein cholesterol and alcohol consumption were significantly lower in patients with MetS. No differences between patients with or without MetS, were observed for age, smoking, mean values of low density lipoprotein cholesterol, high sensitive C-reactive protein and fibrinogen, and for degree of carotidstenosis or severity of clinical manifestations. CONCLUSION: Half of these patients with carotid stenosis have features of the metabolic syndrome. Free Article
	PMID: 19621173 [PubMed - indexed for MEDLINE]
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192.	Cardiovasc Diabetol. 2009 Jul 16;8:35. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. Department of Clinical Sciences, Lund, Lund University, Box 117, 221 00 Lund, Sweden. Tommy.Jonsson@med.lu.se Abstract BACKGROUND: Our aim was to compare the effects of a Paleolithic ('Old Stone Age') diet and a diabetes diet as generally recommended on risk factors for cardiovascular disease in patients with type 2 diabetes not treated with insulin. METHODS: In a randomized cross-over study, 13 patients with type 2 diabetes, 3 women and 10 men, were instructed to eat a Paleolithic diet based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts; and a Diabetes diet designed in accordance with dietary guidelines during two consecutive 3-month periods. Outcome variables included changes in weight, waist circumference, serum lipids, C-reactive protein, blood pressure, glycated haemoglobin (HbA1c), and areas under the curve for plasma glucose and plasma insulin in the 75 g oral glucose tolerance test. Dietary intake was evaluated by use of 4-day weighed food records. RESULTS: Study participants had on average a diabetes duration of 9 years, a mean HbA1c of 6,6% units by Mono-S standard and were usually treated with metformin alone (3 subjects) or metformin in combination with a sulfonylurea (3 subjects) or a thiazolidinedione (3 subjects). Mean average dose of metformin was 1031 mg per day. Compared to the diabetes diet, the Paleolithic diet resulted in lower mean values of HbA1c (-0.4% units, p = 0.01), triacylglycerol (-0.4 mmol/L, p = 0.003), diastolic blood pressure (-4 mmHg, p = 0.03), weight (-3 kg, p = 0.01), BMI (-1 kg/m2, p = 0.04) and waist circumference (-4 cm, p = 0.02), and higher mean values of high density lipoprotein cholesterol (+0.08 mmol/L, p = 0.03). The Paleolithic diet was mainly lower in cereals and dairy products, and higher in fruits, vegetables, meat and eggs, as compared with the Diabetes diet. Further, the Paleolithic diet was lower in total energy, energy density, carbohydrate, dietary glycemic load, saturated fatty acids and calcium, and higher in unsaturated fatty acids, dietary cholesterol and several vitamins. Dietary GI was slightly lower in the Paleolithic diet (GI = 50) than in the Diabetic diet (GI = 55). CONCLUSION: Over a 3-month study period, a Paleolithic diet improved glycemic control and several cardiovascular risk factors compared to a Diabetes diet in patients with type 2 diabetes. PMCID: PMC2724493 Free PMC Article
	PMID: 19604407 [PubMed - indexed for MEDLINE]
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193.	Mol Med. 2009 Sep-Oct;15(9-10):291-6. Epub 2009 Jun 6. The inverse association between cardiorespiratory fitness and C-reactive protein is mediated by autonomic function: a possible role of the cholinergic antiinflammatory pathway. Jae SY, Heffernan KS, Yoon ES, Lee MK, Fernhall B, Park WH. The Health and Integrative Physiology Laboratory, Department of Sports Informatics, University of Seoul, Seoul, South Korea. Abstract Although studies have shown an inverse association between cardiorespiratory fitness (CRF) and C-reactive protein (CRP) levels, the underlying mechanisms are not fully understood. There is emerging evidence that autonomic nervous system function is related to CRP levels. Because high CRF is related to improved autonomic function, we hypothesized that the association between high CRF and low CRP levels would be affected by autonomic nervous system function. Cross-sectional analyses were conducted on 2,456 asymptomatic men who participated in a medical screening program. Fasting blood samples for cardiovascular disease risk factors were analyzed, and CRF was measured by maximal exercise treadmill test with expired gas analysis. We used an index of cardiac autonomic imbalance defined as the ratio of resting heart rate to 1 min of heart rate recovery after exercise (RHR/HRR). CRF was significantly correlated with CRP (r = -0.16, P < 0.05), and RHR/HRR (r = -0.48, P < 0.05), while RHR/HRR was significantly correlated with CRP (r = 0.25, P < 0.05). In multivariable linear regression models that adjusted for age, body mass index, smoking, disease status, medications, lipid profiles, glucose, and systolic blood pressure, CRF was inversely associated with CRP (beta = -0.09, P < 0.05). However, this relationship was no longer significant after adjusting for RHR/HRR in a multivariable linear regression model (beta = -0.03, P = 0.29). These results suggest that autonomic nervous system function significantly affects the relationship between CRF and inflammation in middle-aged men. Thus, physical activity or exercise training may favorably affect the cholinergic antiinflammatory pathway, but additional research is needed to confirm this finding. PMCID: PMC2710293 Free PMC Article
	PMID: 19603105 [PubMed - indexed for MEDLINE]
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194.	Mol Med. 2009 Nov-Dec;15(11-12):402-6. Epub 2009 Jun 18. Osteopontin is associated with increased arterial stiffness in rheumatoid arthritis. Bazzichi L, Ghiadoni L, Rossi A, Bernardini M, Lanza M, De Feo F, Giacomelli C, Mencaroni I, Raimo K, Rossi M, Mazzone AM, Taddei S, Bombardieri S. Department of Internal Medicine, Division of Rheumatology, University of Pisa, Pisa, Italy. L.bazzichi@int.med.unipi.it Abstract Rheumatoid arthritis (RA) patients are characterized by increased arterial stiffness, an independent predictor of cardiovascular risk. It has been suggested that osteopontin (OPN), a cytokine involved in RA pathogenesis, might have vascular effects. To study a possible relationship between OPN and arterial stiffness, aortic pulse wave velocity (PWV) was measured by tonometry in 69 patients (41 with RA, 28 with systemic sclerosis [SSc]) and 18 healthy controls. Plasma OPN levels, oxidative stress markers, and endothelin 1 (ET-1) were assessed. OPN levels were significantly (P < 0.05) higher in RA (median 9.93, range 4.36-47.80 ng/mL) than in SSc (4.3, 2.1-19.7 ng/mL) or controls (5.2, 4.1-9.4 ng/mL). In RA patients, log-OPN was related to log-C-reactive protein (log-CRP) (r = 0.30, P < 0.05), age (r = 0.38, P < 0.01), Health Assessment Questionnaire (HAQ) (r = 0.58, P < 0.0001), and inversely related to total cholesterol (r = -0.33, P < 0.05) and apolipoprotein A (apoA) (r = -0.58, P < 0.001), but not to oxidative stress markers and ET-1. PWV was similar in RA (median 8.1, range 4.7-16.4 m/s) and SSc (median 8.7, range 7.1-13.1 m/s), but significantly greater (P < 0.01) than controls (median 7.5, range 4.1-10.4 m/s). Aortic PWV was related to log-OPN (r = 0.40, P < 0.01) only in RA patients. It also was related to age (r = 0.34, P < 0.05), mean blood pressure (r = 0.44, P < 0.001), and HAQ (r = 0.48, P < 0.001). In multiple regression analysis (r(2) = 0.36), including confounders, log-OPN remained a significant predictor (P < 0.05) of PWV in RA. Elevated plasma OPN levels are associated with increased arterial stiffness in RA patients, suggesting that this protein might represent a bridge protein between inflammation and the consequent joint damage and cardiovascular risk in RA patients. PMCID: PMC2710292 Free PMC Article
	PMID: 19603104 [PubMed - indexed for MEDLINE]
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195.	Am J Epidemiol. 2009 Aug 15;170(4):464-71. Epub 2009 Jul 13. Vitamin C deficiency in a population of young Canadian adults. Cahill L, Corey PN, El-Sohemy A. Department of Nutritional Sciences, University of Toronto, Ontario, Canada. Comment in: Am J Epidemiol. 2010 Feb 1;171(3):387; author reply 387-8. Abstract A cross-sectional study of the 979 nonsmoking women and men aged 20-29 years who participated in the Toronto Nutrigenomics and Health Study from 2004 to 2008 was conducted to determine the prevalence of serum ascorbic acid (vitamin C) deficiency and its association with markers of chronic disease in a population of young Canadian adults. High performance liquid chromatography was used to determine serum ascorbic acid concentrations from overnight fasting blood samples. A 1-month, 196-item food frequency questionnaire was used to assess dietary intakes. Results showed that 53% of subjects had adequate, 33% had suboptimal, and 14% had deficient levels of serum ascorbic acid. Subjects with deficiency had significantly higher measurements of mean C-reactive protein, waist circumference, body mass index, and blood pressure than did subjects with adequate levels of serum ascorbic acid. The odds ratio for serum ascorbic acid deficiency was 3.43 (95% confidence interval: 2.14, 5.50) for subjects who reported not meeting the recommended daily intake of vitamin C compared with those who did. Results suggest that 1 of 7 young adults has serum ascorbic acid deficiency, in part, because of unmet recommended dietary intakes. Furthermore, serum ascorbic acid deficiency is associated with elevated markers of chronic disease in this population of young adults, which may have long-term adverse health consequences. Free Article
	PMID: 19596710 [PubMed - indexed for MEDLINE]
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196.	Stroke. 2009 Sep;40(9):e542. Epub 2009 Jul 9. Placebo-controlled trial of high-dose atorvastatin in patients with severe cerebral small vessel disease. Niruban A, Myint PK, Potter JF. Comment on: Stroke. 2009 May;40(5):1721-8. Free Article
	PMID: 19590053 [PubMed - indexed for MEDLINE]
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197.	Stroke. 2009 Sep;40(9):e543. Epub 2009 Jul 9. Statins and gender-related difference in endothelial function in cerebral small vessel disease. Tsuda K. Comment on: Stroke. 2009 May;40(5):1721-8. Free Article
	PMID: 19590049 [PubMed - indexed for MEDLINE]
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198.	J Clin Endocrinol Metab. 2009 Oct;94(10):3687-95. Epub 2009 Jul 7. Insulin resistance in adolescents with type 2 diabetes is associated with impaired exercise capacity. Nadeau KJ, Zeitler PS, Bauer TA, Brown MS, Dorosz JL, Draznin B, Reusch JE, Regensteiner JG. Division of Pediatric Endocrinology, The Children's Hospital, University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA. kristen.nadeau@ucdenver.edu Abstract CONTEXT: The incidence of pediatric type 2 diabetes (T2D) is rising, with unclear effects on the cardiovascular system. Cardiopulmonary fitness, a marker of morbidity and mortality, is abnormal in adults with T2D, yet the mechanisms are incompletely understood. OBJECTIVE: We hypothesized that cardiopulmonary fitness would be reduced in youth with T2D in association with insulin resistance (IR) and cardiovascular dysfunction. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional study at an academic hospital that included 14 adolescents (age range, 12-19 yr) with T2D, 13 equally obese adolescents and 12 lean adolescents similar in age, pubertal stage, and activity level. MAIN OUTCOME MEASURES: Cardiopulmonary fitness was measured by peak oxygen consumption (VO(2)peak) and oxygen uptake kinetics (VO(2)kinetics), IR by hyperinsulinemic clamp, cardiac function by echocardiography, vascular function by venous occlusion plethysmography, body composition by dual-energy x-ray absorptiometry, intramyocellular lipid by magnetic resonance spectroscopy, and inflammation by serum markers. RESULTS: Adolescents with T2D had significantly decreased VO(2)peak and insulin sensitivity, and increased soleus intramyocellular lipid, C-reactive protein, and IL-6 compared to obese or lean adolescents. Adolescents with T2D also had significantly prolonged VO(2)kinetics, decreased work rate, vascular reactivity, and adiponectin, and increased left ventricular mass and fatty acids compared to lean adolescents. In multivariate linear regression analysis, IR primarily, and fasting free fatty acids and forearm blood flow secondarily, were significant independent predictors of VO(2)peak. CONCLUSIONS: Given the strong relationship between decreased cardiopulmonary fitness and increased mortality, these findings in children are especially concerning and represent early signs of impaired cardiac function. PMCID: PMC2758737 Free PMC Article
	PMID: 19584191 [PubMed - indexed for MEDLINE]
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199.	Arq Bras Endocrinol Metabol. 2009 Apr;53(3):332-9. [Factors associated with insulin resistence in rural populations]. [Article in Portuguese] Mendes LL, Gazzinelli A, Velásquez-Meléndez G. Departamento de Enfermagem Materno-Infantil e Saúde Pública (EMI), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil. Abstract This study explores the relations of anthropometric, body composition assessments, biochemical and hemodynamic parameters with insulin resistance in two rural communities. Sample was composed by adults aged 18 or older, both sexes. Participants were excluded if pregnant and diabetic. Data collection included demographic lifestyle, hemodynamic, anthropometric and biochemical variables. From the 567 subjects, 50.4% were men and 49.6%, women. Most of the sample was non-white (75.7%), lived with partner (69.3%) and had low educational level. Overweight and obesity prevalences were 17.4% and 5.5%, respectively. Multivariate analysis found risk factors associated to insulin resistance for non-diabetic adults with low income and educational level: overweight, obesity, elevated waist-to-hip ratio, C-reactive protein and skin color. Free Article
	PMID: 19578594 [PubMed - indexed for MEDLINE]
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200.	J Psychiatr Res. 2009 Dec;43(16):1246-52. Epub 2009 Jul 4. Does improving mood in depressed patients alter factors that may affect cardiovascular disease risk? Taylor CB, Conrad A, Wilhelm FH, Strachowski D, Khaylis A, Neri E, Giese-Davis J, Roth WT, Cooke JP, Kraemer H, Spiegel D. Department of Psychiatry and Behavioral Sciences, Stanford Medical Center, 401 Quarry Rd, Room 1316, Stanford, CA 94305-5722, USA. btaylor@stanford.edu Abstract To determine if improvement in mood would ameliorate autonomic dysregulation, HPA dysfunction, typical risk factors and C-reactive protein in depressed patients with elevated cardiovascular disease risk (CVD), 48 depressed participants with elevated cardiovascular risk factors were randomized to a cognitive behavioral intervention (CBT) or a waiting list control (WLC) condition. Twenty non-depressed age and risk-matched controls were also recruited. Traditional risk factors (e.g., lipids, blood pressure) and C-reactive protein were assessed pre- and post-treatment six months later. Subjects also underwent a psychophysiological stress test while cardiovascular physiology was measured. Salivary cortisol was measured during the day and during the psychological stress test. At post-treatment, the CBT subjects were significantly less depressed than WLC subjects. There was no significant difference in change scores on any of the traditional risk factors or C-reactive protein, cortisol measures, or cardiovascular physiology, except for triglyceride levels and heart rate, which were significantly lower in treatment compared to control subjects. The normal controls exhibited no change in the variables measured during the same time. A significant improvement in mood may have little impact on most traditional or atypical risk factors, cortisol or cardiophysiology. PMCID: PMC2783820 Free PMC Article
	PMID: 19577757 [PubMed - indexed for MEDLINE]
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