Risk of End-stage Renal Disease Associated with Alcohol Consumption

Alcohol consumption has been linked to kidney disorders in selected patient groups, but whether it contributes to the burden of end-stage renal disease (ESRD) in the general population is unknown. The authors conducted population-based case-control study to asess the realation between alcohol consumption and risk of ESRD. The study took place in Maryland, Virginia, West Virginia, and Washington, DC, in 1991. Participants were 716 patients who had started treatment for ESRD and 361 control subjects of similar age (20-64 years) selected by random digit dialing. The main risk factor of interest was self-reported consumption of alcoholic beverages (frequency of drinking days and number of drinks consumed per drinking day). In univariate analysis, consumption of alcohol exhibited a J-shaped association with risk of ESRD. The J shape disappeared after exclusion of persons who had ever consumed home-distilled whiskey ("moonshine”) and adjustment for age, race, sex, income, history of hypertension, history of diabetes mellitus, use of acetaminophen, use of opiates, and cigarette smoking; however, the odds ratio for ESRD remained significantly increased (odds ratio = 4.0; 95% confidence interval: 1.2, 13.0) among persons who consumed an average of >2 alcoholic drinks per day. The corresponding population attributable risk was 9 percent. Thus, consumption of more than two alcoholic drinks per day, on average, was associated with an increased risk of kidney failure In the general population. A lower intake of alcohol did not appear to be harmful. Because these results are based on self-reports in a case-control study, they should be seen as preliminary. Am J Epidemiol 1999; 150:1275-8

Dissociation of the diurnal variation of aldosterone and cortisol in anephric subjects

Dissociation of the diurnal variation of aldosterone and cortisol in anephric subjects. Diurnal variation of plasma aldosterone and cortisol concentration in man was studied in 13 anephric subjects and 7 normal subjects. All subjects were ambulatory and active throughout the study except during an 8-hour sleep period. Six anephric subjects received Kayexalate® (sodium polystyrene sulfonate) during the studies to prevent potassium accumulation and increase in plasma potassium concentration. Diurnal variation of plasma aldosterone concentration with peak and nadir concentrations at 12:00 noon and 12:00 midnight respectively was demonstrated in the studies on normal subjects. Changes in plasma aldosterone concentration were not significantly correlated with changes in plasma cortisol concentration but were highly correlated with changes in PRA (P < 0.001). There was a highly significant correlation between plasma aldosterone and potassium concentration in the anephric subjects studied without Kayexalate® administration (P < 0.001). In the anephric subjects who received Kayexalate®, plasma aldosterone and potassium concentration remained stable, and no correlation could be demonstrated. No diurnal variation of plasma aldosterone concentration could be demonstrated in either group of anephric subjects, whereas plasma cortisol concentration varied as in the studies on normal subjects. Conclusion. Diurnal variation of plasma aldosterone concentration is dependent on continued stimulation by the renin-angiotensin system. Loss of this stimulation has no demonstrable effect on the diurnal variation of plasma cortisol concentration.Dissociation des variations nycthémérales de l'aldostérone et du cortisol chez les sujets anéphriques. Les variations nycthémérales de l'aldostérone et du cortisol plasmatiques chez l'homme ont été étudiées chez 13 sujets anéphriques et 7 sujets normaux. Tous les sujets étaient ambulatoires excepté pendant une période de sommeil de 8 heures. Six sujets anéphriques receivaient du Kayexalate® (sodium polystyrene sulfonate) afin d'empêcher une accumulation de potassium et une augmentation de la kaliémie. Des variations nycthémérales de l'aldostéronémie avec un pic et un nadir à midi et minuit, respectivement, ont été observées chez les sujets normaux. Les modifications de l'aldostéronémie ne sont pas significativement corrélées avec les modifications du cortisol plasmatique mais très corrélées avec celles de PRA (P < 0,001). Il existe une corrélation très significative entre l'aldostéronémie et la kaliémie chez les sujets anéphriques étudiés en dehors de l'administration de Kayexalate (P < 0,001). Chez les sujets anéphriques recevant du Kayexalate l'aldostéronémie et la kaliémie sont stables et aucune corrélation n'est obtenue. Aucune variation nycthémérale de l'aldostéronémie n'a été observé dans les groupes de sujets anéphriques alors que la concentration de cortisol plasmatique varie comme chez les sujets normaux. Il peut être conclu de ces études que les variations nycthémérales de l'aldostéronémie dépendent de la stimulation par le système rénine-angiotensine. La perte de cette stimulation n'a pas d'effet sur la cortisolémie

Prevalence of overweight and obesity on the island of Ireland: results from the North South Survey of Children's Height, Weight and Body Mass Index, 2002

<p>Abstract</p> <p>Background</p> <p>Childhood obesity is emerging as a major public health problem in developed and developing countries worldwide. The aim of this survey was to establish baseline data on the prevalence and correlates of overweight and obesity among children and adolescents in the Republic of Ireland (RoI) and Northern Ireland (NI).</p> <p>Methods</p> <p>The heights and weights of 19,617 school-going children and adolescents aged between 4 and 16 years in NI and RoI were measured using standardised and calibrated scales and measures. The participants were a representative cross-sectional sample of children randomly selected on the basis of age, gender and geographical location of the school attended. Overweight and obesity were classified according to standard IOTF criteria.</p> <p>Results</p> <p>Males were taller than females, children in RoI were taller than those in NI and the more affluent were taller than the less well off. The overall prevalence of overweight and obesity was higher among females than males in both jurisdictions. Overall, almost one in four boys (23% RoI and NI) and over one in four girls (28% RoI, 25% NI) were either overweight or obese. In RoI, the highest prevalence of overweight was among 13 year old girls (32%) and obesity among 7 year old girls (11%). In NI the highest prevalence of overweight and obesity were found among 11 and 8 year old girls respectively (33% and 13%).</p> <p>Conclusion</p> <p>These figures confirm the emergence of the obesity epidemic among children in Ireland, a wealthy country with the European Union. The results serve to underpin the urgency of implementing broad intersectoral measures to reduce calorie intake and increase levels of physical activity, particularly among children.</p

Higher cardiorespiratory fitness predicts long-term survival in patients with heart failure and preserved ejection fraction: the Henry Ford Exercise Testing (FIT) Project

Introduction: Higher cardiorespiratory fitness (CRF) is associated with improved exercise capacity and quality of life in heart failure with preserved ejection fraction (HFpEF), but there are no large studies evaluating the association of HFpEF, CRF, and long-term survival. We therefore aimed to determine the association between CRF and all-cause mortality, in patients with HFpEF. Material and methods: In the Henry Ford Exercise Testing (FIT) Project, 167 patients had baseline HFpEF, defined as a clinical diagnosis of heart failure with ejection fraction ≥ 50% on echocardiogram. The CRF was estimated from the peak workload (in METs) from a clinician-referred treadmill stress test and categorized as poor (1-4 METs), intermediate (5-6 METs), and moderate-high (≥ 7 METs). Additional analyses assessing the effect of HFpEF and CRF on mortality were also conducted, matching HFpEF patients to non-HFpEF patients using propensity scores. Results: Mean age was 64 ±13 years, with 55% women, and 46% Black. Over a median follow-up of 9.7 (5.2-18.9) years, there were 103 deaths. In fully adjusted models, moderate-high CRF was associated with 63% lower mortality risk (HR = 0.37, 95% CI: 0.18-0.73) compared to the poor-CRF group. In the propensity-matched cohort, HFpEF was associated with a HR of 2.3 (95% CI: 1.7-3.2) for mortality compared to non-HFpEF patients, which was attenuated to 1.8 (95% CI: 1.3-2.5) after adjusting for CRF. Conclusions: Moderate-high CRF in patients with HFpEF is associated with improved survival, and differences in CRF partly explain the intrinsic risk of HFpEF. Randomized trials of interventions aimed at improving CRF in HFpEF are needed

Cardiovascular risk stratification among individuals with obesity: The Coronary Artery Calcium Consortium.

OBJECTIVE: The effectiveness of coronary artery calcification (CAC) for risk stratification in obesity, in which imaging is often limited because of&nbsp;a reduced signal to noise ratio, has not been well studied. METHODS: Data from 9334 participants (mean age: 53.3 ± 9.7 years; 67.9% men) with BMI ≥ 30 kg/m2 from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior cardiovascular diseases (CVD), were used. The predictive value of CAC for all-cause and cause-specific mortality was evaluated using multivariable-adjusted Cox proportional hazards and competing-risks regression. RESULTS: Mean BMI was 34.5 (SD 4.4) kg/m2 (22.7% Class II and 10.8% Class III obesity), and 5461 (58.5%) had CAC. Compared with CAC = 0, those with CAC = 1-99, 100-299, and ≥300 Agatston units had higher rates (per 1000 person-years) of all-cause (1.97 vs. 3.5 vs. 5.2 vs. 11.3), CVD (0.4 vs. 1.1 vs. 1.5 vs. 4.2), and coronary heart disease (CHD) mortality (0.2 vs. 0.6 vs. 0.6 vs. 2.5), respectively, after mean follow-up of 10.8 ± 3.0 years. After adjusting for traditional cardiovascular risk factors, CAC ≥ 300 was associated with significantly higher risk of all-cause (hazard ratio [HR]: 2.05; 95% CI: 1.49-2.82), CVD (subdistribution HR: 3.48; 95% CI: 1.81-6.70), and CHD mortality (subdistribution HR: 5.44; 95% CI: 2.02-14.66), compared with CAC = 0. When restricting the sample to individuals with BMI ≥ 35 kg/m2 , CAC ≥ 300 remained significantly associated with the highest risk. CONCLUSIONS: Among individuals with obesity, including moderate-severe obesity, CAC strongly predicts all-cause, CVD, and CHD mortality and may serve as an effective cardiovascular risk stratification tool to prioritize the allocation of therapies for weight management

The HEARTS partner forum—supporting implementation of HEARTS to treat and control hypertension

Cardiovascular diseases (CVD), principally ischemic heart disease (IHD) and stroke, are the leading causes of death (18. 6 million deaths annually) and disability (393 million disability-adjusted life-years lost annually), worldwide. High blood pressure is the most important preventable risk factor for CVD and deaths, worldwide (10.8 million deaths annually). In 2016, the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) launched the Global Hearts initiative to support governments in their quest to prevent and control CVD. HEARTS is the core technical package of the initiative and takes a public health approach to treating hypertension and other CVD risk factors at the primary health care level. The HEARTS Partner Forum, led by WHO, brings together the following 11 partner organizations: American Heart Association (AHA), Center for Chronic Disease Control (CCDC), International Society of Hypertension (ISH), International Society of Nephrology (ISN), Pan American Health Organization (PAHO), Resolve to Save Lives (RTSL), US CDC, World Hypertension League (WHL), World Heart Federation (WHF) and World Stroke Organization (WSO). The partners support countries in their implementation of the HEARTS technical package in various ways, including providing technical expertise, catalytic funding, capacity building and evidence generation and dissemination. HEARTS has demonstrated the feasibility and acceptability of a public health approach, with more than seven million people already on treatment for hypertension using a simple, algorithmic HEARTS approach. Additionally, HEARTS has demonstrated the feasibility of using hypertension as a pathfinder to universal health coverage and should be a key intervention of all basic benefit packages. The partner forum continues to find ways to expand support and reinvigorate enthusiasm and attention on preventing CVD. Proposed future HEARTS Partner Forum activities are related to more concrete information sharing between partners and among countries, expanded areas of partner synergy, support for implementation, capacity building, and advocacy with country ministries of health, professional societies, academy and civil societies organizations. Advancing toward the shared goals of the HEARTS partners will require a more formal, structured approach to the forum and include goals, targets and published reports. In this way, the HEARTS Partner Forum will mirror successful global partnerships on communicable diseases and assist countries in reducing CVD mortality and achieving global sustainable development goals (SDGs)

The urgency to regulate validation of automated blood pressure measuring devices: a policy statement and call to action from the world hypertension league

No abstract available