Risk profiles and prognosis of treated and untreated hypertensive men and women in a population-based longitudinal study: the Reykjavik Study

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldThe aim was to examine the risk profiles and prognosis of treated and untreated hypertensive subjects and examine to what degree confounding by indication was present in a population-based cohort study with up to 30-year follow-up. The study population consisted of 9328 men and 10 062 women, aged 33-87 years at the time of attendance from 1967 to 1996. The main outcome measures were myocardial infarction (MI), cardiovascular disease (CVD) mortality and all-cause mortality. Comparing the risk profiles between treated and untreated subjects entering the study showed significantly higher values for some risk factors for treated subjects. During the first 10 years, hypertensive men without treatment, compared with those treated, had a significantly lower risk of suffering MI, CVD and all-cause mortality, hazard ratio (HR) 0.72 (95% CI; 0.57, 0.90), 0.75 (95% CI; 0.59, 0.95) and 0.81 (95% CI; 0.61, 0.98), respectively. No significant differences in outcome were seen during the following 20 years. In identically defined groups of women, no significant differences in mortality were seen between groups. Subgroup analysis, at two stages of the study 5 years apart, revealed that some cardiovascular risk factors had a higher prevalence in hypertensive men who were treated at the later stage, compared with those who remained untreated (P=0.004). In conclusion, hypertensive treated men had a worse prognosis during the first 10 years of follow-up than untreated ones, which is most likely due to worse baseline risk profile. Hypertensive men that were treated at a later stage had a worse risk profile than those not treated at a later stage

Study of the Hydrogen-Metal Systems

Hydrogen accumulation in samples of a palladium and 12Kh18N10T steel at the hydrogen charging by the electrolytic method and hydrogen release from these samples at its electron and X-ray irradiation are studied. Palladium was used as a comparison material (as most efficiently solvent hydrogen known among the simple materials). It is established that a capture effectiveness of hydrogen from an electrolyte (1 M H 2 SO 4 at current density is 0.5 A cm −2 ) for palladium is 3-4 orders more than for steel. The hydrogen yield nonlinearly increases with growing of electron current density and electron energy is more than 40 keV under electron irradiation of saturated palladium and 12Kh18N10T steel samples. About 90% of the hydrogen had removed from hydrogen saturated palladium samples and only 60% from steel under electron beam with energy 40 keV and current density ≈ 20 µA cm −2 for 1 h of irradiation. It is necessary to increase the energy of electrons from 40 to 100 keV for the more effective removal of hydrogen

Analysing the Large Decline in Coronary Heart Disease Mortality in the Icelandic Population Aged 25-74 between the Years 1981 and 2006

BACKGROUND: Coronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s. We examined how much of the decrease between 1981 and 2006 could be attributed to medical and surgical treatments and how much to changes in cardiovascular risk factors. METHODOLOGY: The previously validated IMPACT CHD mortality model was applied to the Icelandic population. The data sources were official statistics, national quality registers, published trials and meta-analyses, clinical audits and a series of national population surveys. PRINCIPAL FINDINGS: Between 1981 and 2006, CHD mortality rates in Iceland decreased by 80% in men and women aged 25 to 74 years, which resulted in 295 fewer deaths in 2006 than if the 1981 rates had persisted. Incidence of myocardial infarction (MI) decreased by 66% and resulted in some 500 fewer incident MI cases per year, which is a major determinant of possible deaths from MI. Based on the IMPACT model approximately 73% (lower and upper bound estimates: 54%-93%) of the mortality decrease was attributable to risk factor reductions: cholesterol 32%; smoking 22%; systolic blood pressure 22%, and physical inactivity 5% with adverse trends for diabetes (-5%), and obesity (-4%). Approximately 25% (lower and upper bound estimates: 8%-40%) of the mortality decrease was attributable to treatments in individuals: secondary prevention 8%; heart failure treatments 6%; acute coronary syndrome treatments 5%; revascularisation 3%; hypertension treatments 2%, and statins 0.5%. CONCLUSIONS: Almost three quarters of the large CHD mortality decrease in Iceland between 1981 and 2006 was attributable to reductions in major cardiovascular risk factors in the population. These findings emphasize the value of a comprehensive prevention strategy that promotes tobacco control and a healthier diet to reduce incidence of MI and highlights the potential importance of effective, evidence based medical treatments

Chronic kidney disease after liver, cardiac, lung, heart–lung, and hematopoietic stem cell transplant

Patient survival after cardiac, liver, and hematopoietic stem cell transplant (HSCT) is improving; however, this survival is limited by substantial pretransplant and treatment-related toxicities. A major cause of morbidity and mortality after transplant is chronic kidney disease (CKD). Although the majority of CKD after transplant is attributed to the use of calcineurin inhibitors, various other conditions such as thrombotic microangiopathy, nephrotic syndrome, and focal segmental glomerulosclerosis have been described. Though the immunosuppression used for each of the transplant types, cardiac, liver and HSCT is similar, the risk factors for developing CKD and the CKD severity described in patients after transplant vary. As the indications for transplant and the long-term survival improves for these children, so will the burden of CKD. Nephrologists should be involved early in the pretransplant workup of these patients. Transplant physicians and nephrologists will need to work together to identify those patients at risk of developing CKD early to prevent its development and progression to end-stage renal disease

Prognostic role of cardiovascular risk factors for men with cardiomegaly (the Reykjavik Study)

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldThe Reykjavik Study is a large population-based cohort study, starting in 1967. A total of 9,139 men, born in the years 1907 to 1934, have been followed for 4 to 24 years. Heart size was determined by chest roentgenogram in 2 planes and cardiomegaly, defined as a relative heart size exceeding 550 ml/m2, was detected in 517. Multivariate Cox regression analysis was used to estimate the independent contribution of variables measured at each participant's first visit to the risk of both all-cause and coronary artery disease (CAD) mortality. Cardiomegaly was detected in 3.7% of men aged 75 years. One half of these men had hypertension, one third had manifestations of CAD, and 37% had neither. Among men with cardiomegaly, the presence of CAD had marked deleterious effect on prognosis. Serum total cholesterol and systolic blood pressure were significant independent risk factors of CAD mortality with risk ratio of 1.008 per mg/dl serum cholesterol (95% confidence interval 1.00 to 1.01; p = 0.004) and 1.015/mm Hg (95% confidence interval 1.000 to 1.300; p = 0.043), respectively. Smoking > 25 cigarettes/day carried a 2.3-fold risk (95% confidence interval 1.3 to 4.4; p = 0.008) of all-cause mortality. The traditional risk factors for CAD, serum cholesterol, high blood pressure, and smoking maintain their detrimental effect on prognosis among patients with cardiomegaly. These findings have implications for secondary prevention, signifying that in the presence of cardiomegaly, complacency is not justified in controlling major risk factors for CAD

Prevalence of coronary heart disease in Icelandic men 1968-1986. The Reykjavik Study

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldThe prevalence of coronary heart disease (CHD) was determined in a general population sample of 9141 Icelandic men aged 34-79 years, and the prevalence of four different forms of CHD was estimated separately: symptomatic infarction fulfilling WHO-MONICA criteria for definite myocardial infarction; myocardial infarction detected by ECG changes only (unrecognized, silent infarction); angina pectoris detected by the Rose questionnaire and associated with ECG manifestations of myocardial ischaemia, either at rest or during exercise, but no manifestations of myocardial infarction; angina pectoris without ECG changes indicative of myocardial ischaemia. The study was conducted in five stages allowing evaluation of trends from 1968-1986. Age was a major determinant of the prevalence of all forms of CHD. Thus, the prevalence of myocardial infarction (symptomatic or silent) rose from undetectable levels in the youngest age group (30-34 years) to around 12% (7% symptomatic and 5% silent) in the oldest group (75-79 years) and the prevalence of all forms of CHD rose from 4% in the youngest age group to 23% in the age group 70-74 years. Age-standardized comparison was carried out on the prevalence of the different forms of CHD at different stages of the study in 50-64-year-old men who were represented in all stages of the study. There was a gradual increase in the prevalence of myocardial infarction from 3% (symptomatic and silent combined, CI 1.9-4.8) in 1968 to 4.9% in 1986 (CI 3.9-6.1) (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS

Australian Inland Mission nursing sister standing behind a Volkswagen with a vista of Andamooka in the background, South Australia, 1975? [transparency] /

Title devised from information supplied by donor.; Part of The Reverend Andrew Leslie McKay collection of photographs relating to Inland Australia, 1950-1976.; Andamooka is a town in central east South Australia.; Location identified from PIC/9193/741.; Mould spots. Colour loss top left.; The person in this image also appears in PIC/9193/731.; Also available in an electronic version via the internet at: http://nla.gov.au/nla.pic-vn4181658; Collection donated by Mrs Lyn McKay, widow of Reverend Les McKay, through their daughter Dr. Judith McKay