Survival of the fattest: unexpected findings about hyperglycaemia and obesity in a population based study of 75-year-olds

OBJECTIVE: To study the relationship between body mass index (BMI) and mortality among 75-year-olds with and without diabetes mellitus type 2 (DM) or impaired fasting glucose (IFG). DESIGN: Prospective population-based cohort study with a 10-year follow-up. PARTICIPANTS: A random sample of 618 of the 1100 inhabitants born in 1922 and living in the city of Västerås in 1997 were invited to participate in a cardiovascular health survey; 70% of those invited agreed to participate (432 individuals: 210 men, 222 women). OUTCOME MEASURES: All-cause and cardiovascular mortality. RESULTS: 163 of 432 (38%) participants died during the 10-year follow-up period. The prevalence of DM or IFG was 41% (35% among survivors, 48% among non-survivors). The prevalence of obesity/overweight/normal weight/underweight according to WHO definitions was 12/45/42/1% (14/43/42/1% among survivors, 9/47/42/2% among non-survivors). The hazard rate for death decreased by 10% for every kg/m(2) increase in BMI in individuals with DM/IFG (HR 0.91, 95% CI 0.86 to 0.97; p=0.003). After adjustment for sex, current smoking, diagnosed hypertension, diagnosed angina pectoris, previous myocardial infarction and previous stroke/transient ischaemic attack, the corresponding decrease in mortality was 9% (HR 0.92, 95% CI 0.86 to 0.99; p=0.017). These findings remained after exclusion of individuals with BMI<20 or those who died within 2-year follow-up. In individuals without DM/IFG, BMI had no effect on mortality (HR 1.01, 95% CI 0.95 to 1.07; p=0.811). The HR for BMI differed significantly between individuals with and without DM/IFG (p interaction=0.025). The increased all-cause mortality in individuals with DM/IFG in combination with lower BMI was driven by cardiovascular death. CONCLUSION: High all-cause and cardiovascular mortality was associated with lower BMI in 75-year-olds with DM/IFG but not in those without DM/IFG. Further studies on the combined effect of obesity/overweight and DM/IFG are needed in order to assess the appropriateness of current guideline recommendations for weight reduction in older people with DM/IFG

Ten-Year Survival in 75-Year-Old Men and Women: Predictive Ability of Total Cholesterol, HDL-C, and LDL-C

Objective. The purpose of this study was to investigate prognostic impact of cholesterol and its subfractions among 75-year-old people from the general population. Methods and Results. The study comprised a random sample (222 women and 210 men) from the general population (participation rate 70%). During 10-year follow-up, 19% of women and 35% of men experienced a major cardiovascular event (MCVE). The all-cause mortality was 29% for women and 47% for men. After adjustment for cardiovascular risk factors, a low level of high-density lipoprotein cholesterol (HDL-C) was significantly associated with MCVE (P = .006) and mortality (P = .011) in men but not in women. The prognostic sex disparity was nearly significant (P = .051 for MCVE and .067 for mortality). The associations of adjusted HDL-C to MCVE and mortality were unchanged after excluding individuals with prevalent stroke or MI. Total cholesterol and low-density lipoprotein cholesterol (LDL-C) were not significantly related to prognosis in either sex. Main Conclusions. HDL-C was associated with dismal prognosis in men but not in women. Elderly men with HDL-C <40 mg/dL deserve particular attention for cardiovascular prevention

Left Ventricular Systolic Dysfunction in 75-year-old Men and Women : A Community-based Study of Prevalence, Screening and Mitral Annulus Motion for Diagnosis and Prognostics

Reduced performance of the left ventricle to eject blood – left ventricular systolic dysfunction (LVSD) – is a common predecessor of the heart failure syndrome. With or without symptoms, LVSD is associated with a poor prognosis. However, with adequate treatment, the development or progression of symptoms, the need for hospitalisation and mortality can all be reduced. In the present work, the occurrence of LVSD was evaluated by echocardiography in a community-based sample of 75-year-old men and women (n = 433). LVSD was a common condition, with a prevalence rate of 6.8%. In nearly half the participants with LVSD, there was no clinical evidence of heart failure. Community-based screening for asymptomatic LVSD has been proposed as a strategy to reduce the incidence of heart failure. Because of the high costs and low availability, echocardiography is not a suitable screening tool. The plasma concentration of B-type natriuretic peptide (BNP) has been the most advocated screening tool. Another alternative is the standard 12-lead electrocardiogram (ECG). Both the ECG and BNP were effective in excluding LVSD in our 75-year-old community-based sample. However, compared with BNP, the ECG had considerably better specificity. In screening for LVSD, BNP had a diagnostic value in addition to the ECG, but only in individuals with abnormal ECGs. The left ventricular ejection fraction (LVEF) measured by echocardiography is a well-established index for describing left ventricular systolic function. The wall motion index (WMI) and the amplitude of mitral annulus motion (MAM) are suggested as alternative echocardiographic methods. Compared with MAM, the WMI had a more favourable agreement with the LVEF in our 75-year-old participants. Nonetheless, MAM was a strong predictor of mortality. MAM predicted the risk of all-cause and cardiac mortality independently of other risk factors. In addition, when it came to cardiac mortality, the predictive ability of MAM was independent of the LV function measured as the WMI

Åtgärdsprogram för jämtlandsmaskros, 2014–2019 : (Taraxacum crocodes)

Jämtlandsmaskros (Taraxacum crocodes) är en flerårig växt, som endast är känd från Sverige och Norge och därav nordisk endem. Huvuddelen av lokalerna finns i landskapen Medelpad, Härjedalen, Jämtland och Lappland. De viktigaste miljöerna för jämtlandsmaskros utgörs av steniga eller grusiga stränder och strandängar vid oreglerade eller svagt reglerade vattendrag och sjöar. Inom centrala Jämtlands kalkbergrundsområde påträffas jämtlandsmaskrosen även i kalkfuktängar, som sköts med slåtter eller bete samt i kalkblekemiljöer. Den största enskilda faktorn bakom jämtlandsmaskrosens tillbakagång är vattenkraftens exploatering av vattendrag och sjöar. Därnäst i betydelse för jämtlandsmaskrosens tillbakagång kommer upphörd hävd av naturliga fodermarker. Viktiga åtgärder som föreslås är hydrologisk återställning av vattendrag och förbättrade rutiner hos myndigheter avseende artskydd vid tillsyn av pågående vattenreglering samt fortsatt skötsel av lokaler som är hävdberoende

Effects of oral appliance treatment on inflammatory biomarkers in obstructive sleep apnea : A randomised controlled trial

Obstructive sleep apnea (OSA) may lead to increased circulating concentrations of inflammatory biomarkers and treatment may change these. We aimed to assess the effect of oral appliance (OA) therapy on inflammatory biomarkers in a randomised controlled pilot trial. A total of 71 patients with OSA and systemic hypertension were randomly allocated to an active, mandible protruded (OAa) or a passive, mandible non-protruded device (OAp) treatment. Serum concentrations of the inflammatory biomarkers white blood cells, high-sensitivity C-reactive protein, interleukin 6, interleukin 10, and tumour necrosis factor-alpha were measured at baseline and after 3 months of OA treatment. The differences between treatment groups in biomarker concentration change during the treatment were presented as the Vargha and Delaney effect size and evaluated with the Wilcoxon-Mann-Whitney test. This effect size expresses the probability of a higher value in a random participant from one group compared with a random patient from the other group, and a value of 0.5 means stochastically equal groups. After 3 months of treatment, there was a significant reduction of the apnea-hypopnea index in the OAa group compared with the OAp group (effect size 0.258, 95% confidence interval 0.146-0.386, p &lt; .001). There were no significant differences between the groups in any of the inflammatory markers' concentration changes during the treatment period (effect sizes between 0.488 and 0.524; all p values &gt;=.737). Thus, OA treatment for 3 months did not affect circulating concentrations of some common inflammatory markers in patients with OSA and systemic hypertension

White Blood Cell Count in Elderly Is Clinically Useful in Predicting Long-Term Survival

Introduction. White blood cell (WBC) count is often included in routine clinical checkups. We determined the prognostic impact of WBC count on all-cause, cardiovascular, and noncardiovascular mortality during an 11-year followup in a general population of 75-year-olds. Study Population. The study included 207 men and 220 women comprising 69% of the invited 75-year-olds in a defined geographical area. Main Results. The median WBC count (in 109/L) was 6.3 (interquartile range 5.4–7.2) for men and 5.7 (4.9–6.8) for women, P<0.001 for sex difference. The hazard ratio (HR) for all-cause mortality per 109/L increase in WBCs was 1.16 (95% confidence interval, 1.03–1.32; P=0.016) in men and 1.28 (1.10–1.50; P=0.002) in women. These HRs were essentially unchanged by adjustment for established risk factors (current smoking, known hypertension, prior myocardial infarction, known diabetes, total cholesterol, high-density lipoprotein cholesterol, and body mass index). Furthermore, increased WBC count was significantly associated with cardiovascular mortality in both sexes and with noncardiovascular mortality in women. Conclusions. The WBC count deserves attention as a potentially clinical useful predictor of survival in the 75-year-olds, especially among women

Keynote Speech: Civil Liberties in the Age of Forever War

The 2015 LENS Conference, Law in the Age of \u27Forever War\u27, focuses on the legal issues that accompany warfare in a time when technology, relationships between nations, and the abilities of non-state actors to affect the international stage, are all changing rapidly. Speakers address some of the difficult issues that have come to define modern law as it relates to warfare: targeting, surveillance, home-grown terrorism, intelligence gathering in the digital age, ensuring human rights and civil liberties. Introduction: Professor Scott Silliman, Judge, US Court of Military Commission Review; and Director Emeritus, LENS Speaker: Dean Erwin Chemerinsky, Dean and Distinguished Professor of Law, and Raymond Pryke Professor of First Amendment Law, UC Irvine School of La

Interstudy heterogeneity of definitions of diastolic dysfunction severely affects reported prevalence.

AIMS: The aim of this article is to examine how the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE) recommendations on the classification of diastolic dysfunction (DDF) are interpreted in the scientific community and to explore how variations in the DDF definition affect the reported prevalence. METHODS AND RESULTS: A systematic review of studies citing the EACVI/ASE consensus document 'Recommendations for the evaluation of left ventricular diastolic function by echocardiography' was performed. The definition of DDF used in each study was recorded. Subsequently, several possible interpretations of the EACVI/ASE classification scheme were used to obtain DDF prevalence in a community-based sample (n = 714). In the systematic review, 60 studies were included. In 13 studies, no specification of DDF definition was presented, a one-level classification tree was used in 13, a two-level classification tree in 18, and in the remaining 16 studies, a DDF definition was presented but no grading of DDF was performed. In 17 studies, the DDF definition relied solely on early diastolic tissue velocity and/or left atrial size. In eight of these studies, a single parameter was used, in two studies the logical operator AND was used to combine two or more parameters, and the remaining seven studies used the logical operator OR. The resulting prevalence of DDF in the community-based sample varied from 12 to 84%, depending on the DDF definition used. CONCLUSION: A substantial heterogeneity of definitions of DDF was evident among the studies reviewed, and the different definitions had a substantial impact on the reported prevalence of DDF