Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmö Preventive Project)

Aims Orthostatic hypotension (OH) has been linked to increased mortality and incidence of cardiovascular disease in various risk groups, but determinants and consequences of OH in the general population are poorly studied. Methods and results Prospective data of the Swedish 'Malmö Preventive Project' (n = 33 346, 67.3% men, mean age 45.7 +/- 7.4 years, mean follow-up 22.7 +/- 6.0 years) were analysed. Orthostatic hypotension was found in 6.2% of study participants and was associated with age, female gender, hypertension, antihypertensive treatment, increased heart rate, diabetes, low BMI, and current smoking. In Cox regression analysis, individuals with OH had significantly increased all-cause mortality (in particular those aged less than 42 years) and coronary event (CE) risk. Mortality and CE risk were distinctly higher in those with systolic blood pressure (BP) fall >/=30 mmHg [hazard ratio (HR): 1.6, 95% CI 1.3-1.9, P /=15 mmHg (HR: 1.4, 95% CI 1.1-1.9, P = 0.024 and 1.7, 95% CI 1.1-2.5, P = 0.01). In addition, impaired diastolic BP response had relatively greater impact (per mmHg) on CE incidence than systolic reaction. Conclusion Orthostatic hypotension can be detected in approximately 6% of middle-aged individuals and is often associated with such comorbidities as hypertension or diabetes. Presence of OH increases mortality and CE risk, independently of traditional risk factors. Although both impaired systolic and diastolic responses predict adverse events, the diastolic impairment shows stronger association with coronary disease

A Common Missense Variant in the ATP Receptor P2X7 Is Associated with Reduced Risk of Cardiovascular Events

BACKGROUND AND PURPOSE: Extracellular adenosine triphosphate (ATP) regulates inflammatory cells by activation of the P2X(7) receptor. We hypothesized that polymorphisms in P2RX7 influence the risk of ischemic heart disease (IHD), ischemic stroke (IS) and cardiovascular risk factors and tested this hypothesis using genetic association studies. METHODS: Two loss-of-function SNPs in P2RX7 were genotyped in 1244 IHD cases and 2488 controls as well as 5969 individuals with cardiovascular risk factors. Eleven SNPs in a 250 kb region on chromosome 12 spanning P2RX7 as well as neighboring genes OASL, P2RX4 and CAMKK2 were genotyped in 4138 individuals with IS and 2528 controls. Association was examined using linear and logistic regression models with an additive genetic model. RESULTS: The common loss-of-function variant rs3751143 was significantly associated with a decreased risk of IHD in smokers (P = 0.03) as well as decreased risk of IS (OR 0.89; 95% CI = 0.81-0.97; P = 0.012). In addition, an intronic SNP in CAMKK2, rs2686342, were associated with a decreased risk of IS (OR 0.89; 95% CI = 0.82-0.97; P = 0.011). In subgroup analyses, both SNPs were associated with decreased risk of IS in individuals with hypertension (P = 0.045 and 0.015, respectively). CONCLUSIONS: A common loss-of-function missense variant in the gene encoding the P2X(7) receptor is associated with reduced risk of IS and with IHD in smokers. These findings might implicate a role of purinergic signaling in atherogenesis or atherothrombosis

Dietary Fiber and Saturated Fat Intake Associations with Cardiovascular Disease Differ by Sex in the Malmö Diet and Cancer Cohort: A Prospective Study

BACKGROUND: The aim of the study was to examine associations between intake of macronutrients and dietary fiber and incident ischemic cardiovascular disease (iCVD) in men and women. METHODS: We used data from 8,139 male and 12,535 female participants (aged 44-73 y) of the Swedish population-based Malmö Diet and Cancer cohort. The participants were without history of CVD and diabetes mellitus, and had reported stable dietary habits in the study questionnaire. Diet was assessed by a validated modified diet history method, combining a 7-d registration of cooked meals and cold beverages, a 168-item food questionnaire (covering other foods and meal patterns), and a 1-hour diet interview. Sociodemographic and lifestyle data were collected by questionnaire. iCVD cases, which included coronary events (myocardial infarctions or deaths from chronic ischemic heart disease) and ischemic strokes, were ascertained via national and local registries. Nutrient-disease associations were examined by multivariate Cox regressions. RESULTS: During a mean follow-up of 13.5 years, we identified 1,089 male and 687 female iCVD cases. High fiber intakes were associated with lower incidence rates of iCVD in women and of ischemic stroke in men. In post-hoc analysis, we discovered statistically significant interactions between intake of fiber and saturated fat; these interactions also differed between men and women (p<0.001). CONCLUSIONS: In this well-defined population, a high fiber intake was associated with lower risk of iCVD, but there were no robust associations between other macronutrients and iCVD risk. Judging from this study, gender-specific nutrient analysis may be preferable in epidemiology

Differences in cardiac disease prevalence and in blood variables between major and minor stroke patients

In 310 patients with carotid territory stroke, we investigated whether a history of cardiac disease was more frequent among those with major stroke (n = 169) than among those with minor stroke (n = 141), and whether the two groups differed in values for blood variables directly or indirectly associated with stroke, each variable being adjusted for age and sex. A history of angina pectoris was more frequent in the major stroke than in the minor stroke group, 16% vs. 9% (p < 0.042; odds ratio, 2.2); and among female patients, a history of atrial fibrillation was more common in those with major stroke than in those with minor stroke, 35% vs. 13% (p < 0.033; odds ratio, 2.8). ESR (erythrocyte sedimentation rate) values were higher in the major than in the minor stroke group, 21 +/- 21 (mean +/- SD) vs. 15 +/- 14 mm/h (p < 0.028), as were WBC (white blood cell) counts, 9.4 +/- 3.2 vs. 7.9 +/- 2.3 x 109/l, p < 0.001. WBC counts were also higher in stroke survivors than in non-survivors, 9.6 +/- 3 vs. 8.3 +/- 3 x 109/l (p < 0.0027), as were serum creatinine values, 115 +/- 59 vs. 95 +/- 21 mumol/l (p < 0.0094). The differences between major and minor stroke patients may reflect differences in the degree of atherosclerosis and thrombogenicity

80-year-old men have elevated plasma concentrations of catecholamines but decreased plasma renin activity and aldosterone as compared to young men

Plasma concentrations of adrenaline, noradrenaline, aldosterone and plasma renin activity were determined in a selected group of 80-year-old men (N = 41) in good health without clinical signs of cardiovascular disease, and were compared to levels in young healthy males (N = 20, 24-28 years). Plasma adrenaline and noradrenaline concentrations were higher (0.24 median; 25th-75th percentiles 0.16-0.34 nmol/L vs 0.15; 0.11-0.18 nmol/L, p < 0.01 and 2.22; 1.58-3.27 nmol/L vs 1.15; 1.00-1.74 nmol/L, p < 0.001), and plasma renin activity and plasma aldosterone concentration were lower in the old than in the young men (0.65; 0.35-1.04 micrograms/L/1h vs 2.09; 1.23-2.41 micrograms/L/1h, p < 0.001 and 0.12; 0.09-0.19 nmol/L vs 0.38; 0.28-0.54 nmol/L, p < 0.001). In conclusion, increased plasma concentrations of catecholamines and decreased plasma concentration of aldosterone and plasma renin activity in old men, as compared to young men, must be considered when interpreting data of these hormones in elderly men

Fyra nya instrument för analys av blodgaser testade: Behändiga kassetter skall ge bättre användarvänlighet

An entirely new type of blood gas analyser has made its way into the marketplace, to be used, for example, in emergency rooms, intensive care units, ambulances, and bedside with quarantined patients in infectious diseases units. The instruments reviewed here employ new miniaturised analysis circuitry, integrated into the cassette on which the blood sample is applied. These instruments are designed for use by care-givers without specific laboratory training. Four point-of-care blood gas analysers are tested: OPTI 1 (AVL), I-STAT (HP), IRMA (Infiniti) och ABL 70 (Radiometer)

Body composition and dietary habits in 80-year-old smoking men without cardiovascular disease

Eighty-year-old male residents in the community of Malmö were questioned about smoking habits and the occurrence of cardiovascular disease (CVD). Of 1,280 subjects, 122 were selected for further studies and allocated into 4 groups: 1) no CVD, non-smokers; 2) no CVD, smokers; 3) CVD, smokers; and 4) CVD, non-smokers. The smokers had consumed on the average 13 g of tobacco daily for 59 years. Lean body mass (LBM), body fat (BF), % body fat (%BF), and total body water (TBW) were estimated by means of bioelectrical impedance analysis. The mean body weight (BW), LBM, and %BF for all subjects were 74.1 +/- 10.2 kg, 58.0 +/- 6.8 kg, and 21.3 +/- 5.9 kg, respectively. There were no significant differences between all subjects with and without CVD. A lower BW among smokers than in non-smokers was explained by lower BF and %BF in the former. Smokers who had lived predominantly in rural areas had lower BW (6.9 kg) and LBM (5.2 kg) than those from an urban area. A positive correlation was noted between the degree of physical activity and LBM and TBW. Seventeen percent of the smokers exercised regularly. The CVD group had higher plasma cholesterol concentrations than the non-CVD group. Plasma triglycerides showed a positive correlation with BF, %BF and BW, whereas HDL cholesterol was negatively correlated with BF, %BF and BW. It is concluded that smoking is one of several important factors related to body composition, and the penetrance of this factor is still apparent in elderly men