Own education, current conditions, parental material circumstances, and risk of myocardial infarction in a former communist country

OBJECTIVE—To study the association between own education, adult and parental circumstances and the risk of myocardial infarction in a former communist country.
DESIGN—Population based case-control study.
SETTING—General population of five districts of the Czech Republic in the age group 25-64 years.
PARTICIPANTS—Random sample of population (938 men and 1048 women, response rate 77%) served as controls to 282 male and 80 female cases of non-fatal first myocardial infarctions.
MAIN OUTCOME MEASURES—Myocardial infarction was defined by the WHO MONICA criteria based on ECG, enzymes and symptoms. The following socioeconomic indicators were studied: own education, crowded housing conditions (more than one person per room), car ownership, and education and occupation of mother and father.
RESULTS—There was a weak correlation between education and car ownership, and a strong association between own education and parental education and occupation. Crowding was not related to other socioeconomic factors. The risk of myocardial infarction was inversely related to education, and was unrelated to material conditions and parental education and occupation. The age-sex-district adjusted odds ratios for apprenticeship, secondary, and university education, compared with primary education, were 0.87, 0.74 and 0.46, respectively (p for trend 0.009); odds ratios for car ownership and crowding were 1.01 (95% confidence intervals 0.77, 1.34) and 0.92 (0.76,( )1.12), respectively. Further adjustment for parental circumstances and adult height did not change these estimates but adjustment for coronary risk factors reduced the gradient. Increased height seemed, anomalously, to confer a small increased risk.
CONCLUSIONS—In this population, the social gradient in non-fatal myocardial infarction is only apparent for own education. Materialist explanations for this gradient seem unlikely but behaviours seem responsible for a part of the gradient.


Keywords: myocardial infarction; ischaemic heart disease; socioeconomic factors; epidemiology; Eastern Europ

Bridging the Gap Between Biofuels and Biodiversity Through Monetizing Environmental Services of Miscanthus Cultivation

Carbon neutrality in the transport sector is a key challenge for the growing bioeconomy as the share of biofuels has stagnated over the past decade. This can be attributed to basic economics and a lack of a robust market for these technologies. Consequently, more sustainable biomass supply concepts are required that reduce negative impacts on the environment and at the same time promote environmental services for sustainable agricultural cropping systems including erosion prevention, soil fertility improvement, greenhouse gas mitigation, and carbon sequestration. One promising concept is the cultivation of perennial biomass crops such as Miscanthus (Miscanthus Andersson) as biofuel feedstock. In this study, the multiple environmental services provided by Miscanthus are first explored and subsequently monetized. Then the integration of Miscanthus cultivation for biomass production into European agricultural systems is assessed. One hectare of Miscanthus provides society with environmental services to a value of 1,200 to 4,183 € a−1. These services are even more pronounced when cultivation takes place on marginal agricultural land. The integration of Miscanthus into existing agricultural practices aids both conservation and further optimization of socio-economic welfare and landscape diversification. As these environmental services are more beneficial to the public than the Miscanthus farmers, subsidies are required to close the gap between biofuels and biodiversity that are calculated based on the provision of environmental services. Similar approaches to that developed in this study may be suitable for the implementation of other biomass cropping systems and therefore help foster the transition to a bioeconomy

Evaluation of lipoprotein(a) in the prevention and management of atherosclerotic cardiovascular disease: A survey among the Lipid Clinics Network

Background and aims: The European Atherosclerosis Society (EAS) Lipid Clinics Network promoted a survey in order to identify and understand how and when lipoprotein(a) [Lp(a)] is tested and clinically evaluated in lipid clinics throughout Europe, and the challenges that may prevent evaluation from being carried out. Methods: This survey was divided into three areas of inquiry: background and clinical setting information of clinicians, questions for doctors who claimed not to measure Lp(a), in order to understand what were the reasons for not ordering the test, and questions for doctors who measure Lp(a), to investigate the use of this value in the management of patients.Results: A total of 151 centres clinicians filled in the survey, out of 226 invited. The proportion of clinicians who declare to routinely measure Lp(a) in clinical practice was 75.5%. The most common reasons for not ordering the Lp(a) test were the lack of reimbursement or of treatment options, the non-availability of Lp(a) test, and the high cost of performing the laboratory test. The availability of therapies targeting this lipoprotein would result in a greater propensity of clinicians to start testing Lp(a). Among those who declared to routinely measure Lp(a), the Lp(a) measurement is mostly requested to further stratify patients' cardiovascular risk, and half of them recognized 50 mg/dL (approx. 110 nmol/L) as the threshold for increased cardiovascular risk due.Conclusions: These results warrant for a great deal of effort from scientific societies to address the barriers that limit the routine use of the measurement of Lp(a) concentration and to recognise the importance of Lp(a) as a risk factor