Prevalence of asthma and COPD and blood eosinophil count in a middle-aged Belgian population

Various phenotypes exist in asthma and Chronic Obstructive Pulmonary Disease (COPD). These are important to identify in order to guide treatment decisions. We aim to investigate the prevalence and clinical characteristics of obstructive airway diseases in the middle-aged population. We estimated the prevalence of COPD and/or asthma in the Asklepios cohort study (Belgium), using information from the third European Community Respiratory Health Survey (ECRHS3), medical records, and spirometry. Respiratory symptoms, respiratory medication, and current disease status distinguished clinical from sub-clinical cases. In addition, we compared the blood eosinophil count/mu L (median [IQR]) between cases and controls. Of the 2221 participants (mean age 56.1 +/- 5.9 years; 48.7% males), 138 (6.2%) participants had clinical current asthma, 22 (1.0%) participants had sub-clinical ever asthma, 102 (4.6%) had sub-clinical spirometry-defined COPD, 104 (4.6%) participants had clinical spirometry-confirmed COPD, and 11 (0.5%) had asthma and COPD overlap (ACO). Clinical current asthma (160.0 [110.0-250.0]), sub-clinical ever asthma (170.0 [110.0-230.0]), and clinical COPD (160.0 [110.0-220.0])-but less sub-clinical COPD (140.0 [90.0-210.0])-had higher eosinophil counts, compared to controls (130.0 [80.0-200.0]). We conclude that obstructive airway diseases are prevalent in the middle-aged Asklepios cohort. Moreover, the systemic eosinophil count is increased in clinical COPD cases, and in asthma cases regardless of clinical remission

Echocardiography during submaximal isometric exercise in children with repaired coarctation of the aorta compared with controls

Objective Patients with repaired coarctation (RCoA) remain at higher risk of cardiac dysfunction, initially often only detected during exercise. In this study, haemodynamics of isometric handgrip (HG) and bicycle ergometry (BE) were compared in patients with RCoA and matched controls (MCs). Methods Case-control study of 19 children with RCoA (mean age 12.9 +/- 2.3 years; mean age of repair 7 months) compared with 20 MC. HG with echocardiography followed by BE was performed in both groups. Results During HG (blood pressure) BP increased from 114 +/- 11/64 +/- 4 mm Hg to 132 +/- 14/79 +/- 7 mm Hg, without significant differences. During HG as well as BE, HR increased less in patients with RCoA. There were no significant differences in (left ventricle) LV dimensions or LV mass. The RCoA group had diastolic dysfunction: both at rest and during HG they had significantly higher transmitral E and A velocities and lower tissue Doppler E' and A' velocities. E/E' was higher, reaching statistical significance during HG (p<0001). Conventional parameters of systolic function (FS and EF) were similar at rest and HG. More sensitive tissue Doppler S' was significantly lower at rest in CoA subjects (5.1 +/- 1.5 cm/s vs 6.5 +/- 1 +/- 1 cm/s; p<0.01), decreasing further during HG by 5% in the CoA group (NS) while unchanged in controls. Conclusions We provide first evidence that HG with echocardiography is feasible, easy and patient-friendly. A decreased systolic (tissue Doppler) and impaired diastolic LV function was measured in the RCoA group, a difference that tended to increase during HG

Thyroid hormone levels within reference range are associated with heart rate, cardiac structure, and function in middle-aged men and women

Background: Triiodothyronine (T3) has many effects on the heart, and marked changes in cardiac function and structure occur in patients with (subclinical) thyroid disease. We investigated whether between-subject variation in thyroid hormone levels within the euthyroid range is also associated with heart rate and echocardiographic heart function and structure. Methods: Subjects were selected from the Asklepios study (n=2524), a population-representative random sample of patients aged between 35 and 55 years, free from overt cardiovascular disease at baseline. Analyses were restricted to 2078 subjects (1013 women and 1065 men), not using antihypertensive or thyroid medication nor having antithyroperoxidase antibody levels above clinical cut-off or thyrotropin (TSH) levels outside the reference range. All subjects were phenotyped in-depth and underwent comprehensive echocardiography, including diastolic evaluation. Thyroid function parameters were determined by automated electrochemiluminescence. Results: Heart rate was robustly positively associated with (quartiles of) free T3 (FT3) and T3, both in subjects with TSH levels within reference (0.27-4.2 μU/L) and in narrow TSH range (0.5-2.5 μU/L; p<0.0001). FT3 and T3 were negatively associated with left ventricular (LV) end-diastolic volume but positively associated with relative wall thickness. Total T3 (TT3) was associated with enhanced ventricular contraction (as assessed by tissue Doppler imaging). Free thyroxine, FT3, and TT3 were positively associated with late ventricular filling, and TT3 was associated with early ventricular filling. Conclusion: We have demonstrated a strong positive association between thyroid hormone levels within the euthyroid range and heart rate, and more subtle effects on cardiac function and structure. More specifically, we suggest a smaller LV cavity size (with increased relative wall thickness), an enhanced atrial and ventricular contraction, and LV relaxation with higher circulating thyroid hormones. These results illustrate that variation in thyroid hormone levels, even within the reference range, exerts effects on the heart

Triiodothyronine and free thyroxine levels are differentially associated with metabolic profile and adiposity-related cardiovascular risk markers in euthyroid middle-aged subjects

Background: We previously showed that in healthy young men a less favorable body composition is associated with higher FT3 levels within the euthyroid range. Besides, a higher FT3-to-FT4 ratio has been related to a less favorable metabolic phenotype and more placental growth in pregnant women. In the present study, we therefore investigated whether serum TSH, thyroid hormone levels and the FT3-to-FT4 ratio are associated with metabolic and adiposity-related cardiovascular risk markers in a healthy population of middle-aged euthyroid men and women. Methods: Thyroid parameters were measured in 2524 generally healthy subjects from the Asklepios study (35-55yrs, mean age 46 years). Analyses were restricted to 2315 subjects (1138 women and 1177 men), not using thyroid medication, not having anti-TPO levels above clinical cut-off values nor TSH levels outside the reference range (0.27-4.2 mU/L). Twenty-seven percent of the women and 47.5% of the men were overweight, while 13% of women and 17% of men were obese. Twenty percent of the subjects were active smokers. Serum thyroid function parameters were determined by electrochemiluminescence. Results: (F) T3 and the FT3-to-FT4 ratio were positively related to BMI, waist circumference and components of the metabolic syndrome, i.e. triglycerides, systolic and diastolic blood pressure and fasting plasma glucose, and negatively with HDL-cholesterol levels, whereas FT4 was negatively associated to BMI, waist circumference and triglycerides (all p-values <0.001). TSH related positively to total cholesterol levels (p<0.01), triglycerides and to systolic and diastolic blood pressure (all p<0.001). The FT3-to-FT4 ratio was further positively associated to the adiposity-related inflammation markers interleukin-6 (IL6) and high-sensitive CRP (hs-CRP) and to pulse wave velocity. All associations were adjusted for sex, age, height and smoking and most associations persisted after additional adjustment for weight or waist circumference. Conclusion: In healthy euthyroid middle-aged men and women, higher (F) T3 levels, lower FT4 levels and thus a higher FT3-to-FT4 ratio are consistently associated with various markers of unfavorable metabolic profile and cardiovascular risk

A comparison between local wave speed in the carotid and femoral arteries in healthy humans: application of a new method

The wave speed (c) and the arrival time of reflected wave (Trw) in the common left carotid artery and common left femoral artery have been evaluated in 70 healthy subjects, aged 35-55 years with a non-invasive method. Wave speed and the arrival time of reflected waves were determined with InDU-loop and non-invasive wave intensity analysis (ndl) techniques, respectively. Diameter (D) was measured with ultrasound echo wall tracking and velocity (U) was obtained by ultrasonography. A statistical analysis has been carried out in order to establish a potential relation of c and Trw with gender and age in the study population. Subjects have been divided in two classes of age, one from 35 to 45 years and the other from 45 to 55 years. Results show that c and Trw in the femoral artery are higher than those in carotid, in both men and women (P < 0.001). Also, the distance of the reflection (L) site from the point of measurement is higher in the femoral than in the carotid artery. We did not find statistically significant differences between c, age or gender in femoral artery. However, c in the carotid artery increases with age (P < 0.05), but did not change between men and women. In this paper InDU-loop has been used for the first time to determine c and Trw in carotid and femoral arteries in a large population of healthy subjects

Assessment of model based (input) impedance, pulse wave velocity, and wave reflection in the Asklepios Cohort

Objectives : Arterial stiffness and wave reflection parameters assessed from both invasive and non-invasive pressure and flow readings are used as surrogates for ventricular and vascular load. They have been reported to predict adverse cardiovascular events, but clinical assessment is laborious and may limit widespread use. This study aims to investigate measures of arterial stiffness and central hemodynamics provided by arterial tonometry alone and in combination with aortic root flows derived by echocardiography against surrogates derived by a mathematical pressure and flow model in a healthy middle-aged cohort. Methods : Measurements of carotid artery tonometry and echocardiography were performed on 2226 ASKLEPIOS study participants and parameters of systemic hemodynamics, arterial stiffness and wave reflection based on pressure and flow were measured. In a second step, the analysis was repeated but echocardiography derived flows were substituted by flows provided by a novel mathematical model. This was followed by a quantitative method comparison. Results : All investigated parameters showed a significant association between the methods. Overall agreement was acceptable for all parameters (mean differences: -0.0102 (0.033 SD) mmHg*s/ml for characteristic impedance, 0.36 (4.21 SD) mmHg for forward pressure amplitude, 2.26 (3.51 SD) mmHg for backward pressure amplitude and 0.717 (1.25 SD) m/s for pulse wave velocity). Conclusion : The results indicate that the use of model-based surrogates in a healthy middle aged cohort is feasible and deserves further attention