Association of arterial stiffness with single nucleotide polymorphism rs1333049 and metabolic risk factors

The electronic version of this article is the complete one and can be found online at: http://www.cardiab.com/content/12/1/93. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.BACKGROUND: Increased arterial stiffness is a cardiovascular outcome of metabolic syndrome (MetS). The chromosome 9p21 locus has been identified as a major locus for risk of coronary artery disease (CAD). The single nucleotide polymorphism (SNP), rs1333049 on chromosome 9p21.3 has been strongly associated with CAD and myocardial infarction. Increased arterial stiffness could be the link between the 9p21 polymorphism and increased cardiovascular risk. Since the impact of a genetic polymorphism on arterial stiffness especially in Asian populations has not been well defined, we aimed to investigate the association of arterial stiffness with rs 1333049 variant on chromosome 9p21.3 in Thai subjects with and without MetS risk factors. METHODS: A total of 208 Thai subjects, aged 35-75 years, 135 with and 73 without MetS, according to IDF and NCEP-ATPIII criteria, were included in this study. Aortic-femoral pulse wave velocity (afPWV), brachial-ankle pulse wave velocity (baPWV) and aortic ankle pulse wave velocity (aaPWV) were measured and used as markers of arterial stiffness. The chromosome 9p21.3 locus, represented by the rs 1333049 variant and blood biochemistry were evaluated. RESULTS: Arterial stiffness was elevated in subjects with MetS when compared with nonMetS subjects. PWV, especially afPWV increased progressively with increasing number of MetS risk factors (r = 0.322, P <0.001). We also found that the frequency distribution of the rs1333049 genotypes is significantly associated with the afPWV (P <0.05). In multivariate analyses, there was an association between homozygous C allele and afPWV (Odds ratio (OR), 8.16; 95% confidence interval (CI), 1.91 to 34.90; P = 0.005), while the GC genotype was not related to afPWV (OR, 1.79; 95% CI, 0.84 to 3.77; P = 0.129) when compared with the GG genotype. CONCLUSIONS: Our findings demonstrate for the first time that arterial stiffness is associated with genetic polymorphism in 9p21 and metabolic risk factors in a Thai population

Clusters of Sudden Unexplained Death Associated with the Mushroom, Trogia venenata, in Rural Yunnan Province, China

INTRODUCTION: Since the late 1970's, time-space clusters of sudden unexplained death (SUD) in northwest Yunnan, China have alarmed the public and health authorities. From 2006-2009, we initiated enhanced surveillance for SUD to identify a cause, and we warned villagers to avoid eating unfamiliar mushrooms. METHODS: We established surveillance for SUD, defined as follows: sudden onset of serious, unexplained physical impairment followed by death in <24 hours. A mild case was onset of any illness in a member of the family or close socially related group of a SUD victim within 1 week of a SUD. We interviewed witnesses of SUD and mild case-persons to identify exposures to potentially toxic substances. We tested blood from mild cases, villagers, and for standard biochemical, enzyme, and electrolyte markers of disease. RESULTS: We identified 33 SUD, a 73% decline from 2002-2005, distributed among 21 villages of 11 counties. We found a previously undescribed mushroom, Trogia venenata, was eaten by 5 of 7 families with SUD clusters compared to 0 of 31 other control-families from the same villages. In T. venenata-exposed persons SUD was characterized by sudden loss of consciousness during normal activities. This mushroom grew nearby 75% of 61 villages that had time-space SUD clusters from 1975 to 2009 compared to 17% of 18 villages with only single SUD (p<0.001, Fisher's exact test). DISCUSSION: Epidemiologic data has implicated T. venenata as a probable cause of clusters of SUD in northwestern Yunnan Province. Warnings to villagers about eating this mushroom should continue

Safety and Reactogenicity of Canarypox ALVAC-HIV (vCP1521) and HIV-1 gp120 AIDSVAX B/E Vaccination in an Efficacy Trial in Thailand

A prime-boost vaccination regimen with ALVAC-HIV (vCP1521) administered intramuscularly at 0, 4, 12, and 24 weeks and gp120 AIDSVAX B/E at 12 and 24 weeks demonstrated modest efficacy of 31.2% for prevention of HIV acquisition in HIV-uninfected adults participating in a community-based efficacy trial in Thailand.Reactogenicity was recorded for 3 days following vaccination. Adverse events were monitored every 6 months for 3.5 years, during which pregnancy outcomes were recorded. Of the 16,402 volunteers, 69% of the participants reported an adverse event any time after the first dose. Only 32.9% experienced an AE within 30 days following any vaccination. Overall adverse event rates and attribution of relatedness did not differ between groups. The frequency of serious adverse events was similar in vaccine (14.3%) and placebo (14.9%) recipients (p = 0.33). None of the 160 deaths (85 in vaccine and 75 in placebo recipients, p = 0.43) was assessed as related to vaccine. The most common cause of death was trauma or traffic accident. Approximately 30% of female participants reported a pregnancy during the study. Abnormal pregnancy outcomes were experienced in 17.1% of vaccine and 14.6% (p = 0.13) of placebo recipients. When the conception occurred within 3 months (estimated) of a vaccination, the majority of these abnormal outcomes were spontaneous or elective abortions among 22.2% and 15.3% of vaccine and placebo pregnant recipients, respectively (p = 0.08). Local reactions occurred in 88.0% of vaccine and 61.0% of placebo recipients (p<0.001) and were more frequent after ALVAC-HIV than AIDSVAX B/E vaccination. Systemic reactions were more frequent in vaccine than placebo recipients (77.2% vs. 59.8%, p<0.001). Local and systemic reactions were mostly mild to moderate, resolving within 3 days.The ALVAC-HIV and AIDSVAX B/E vaccine regimen was found to be safe, well tolerated and suitable for potential large-scale use in Thailand.ClinicalTrials.govNCT00223080

Outcome of Infective Endocarditis: Improved Results over 18 Years (1990-2007)

Background High morbidity and mortality characterize patients suffering infective endocarditis (IE). The treatment of IE has undergone significant changes within ten years but it is not known whether mortality has decreased and which factors are determinant of the outcome. Objectives Our aim was to evaluate the prognostic significance of clinical characteristics and outcomes of IE. Methods and Results 312 definite cases of IE diagnosed using the Duke criteria were evaluated. Overall in-hospital mortality was 28%. Independent predictors of death, determined by a Weibull regression model, in medically-treated patients were (1) treatment era 1990-1995 vs. 2005-2007 (hazard ratio 3.14; 95% CI 1.37-7.21); (2) aging for each year (hazard ratio 1.02; 95% CI 1.004-1.03); (3) cardiac complications (hazard ratio 1.91; 95% CI 1.06-3.43); and (4) heart failure (hazard ratio 2.27; 95% CI 1.34-3.85). Independent predictors of the death in surgically-treated patients were (1) treatment era 2001-2004 vs. 2005-2007 (hazard ratio: 0.31; 95% CI 0.10-0.97), (2) aging for each year (hazard ratio: 0.96; 95% CI 0.94-0.99), and (3) cardiac complications (hazard ratio: 1.91; 95% CI 1.01-3.63). Conclusions Some of the predictive factors for a poor prognosis were the same as those observed in previous studies. These factors could be used to identify those patients for more aggressive treatment. A new finding was the hazard function for mortality being highest at enrollment and declining rapidly in both medically and surgically treated patients, especially during the first 12 months

Variation in stated management of acute myocardial infarction in five countries

We examined the variation in stated practice in the management of acute myocardial infarction (AMI) among doctors in Australia, Brazil, Chile, India and Thailand. Hospitals were identified as primary, secondary or tertiary by investigators from around their own region. All doctors within each hospital who would be expected to treat patients with AMI were asked to indicate which investigations and treatments they would offer to a patient with an AMI who develops angina on Day 3 after admission. the numbers of hospitals ranged from 5 to 26 per country, and doctor response rates varied from 70 to 100%. Within-country variation was large, and statistically significant variations were seen between countries in the use of most interventions. the large variation both between and within a range of countries across the economic spectrum suggests a widespread need for agreement about what constitutes appropriate management after AMI. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.Univ Newcastle, Fac Med & Hlth Sci, Ctr Clin Epidemiol & Biostat, Newcastle, NSW 2300, AustraliaEscola Paulista Med, Clin Epidemiol Unit, São Paulo, BrazilUniv La Frontera, Clin Epidemiol Unit, Fac Med, Sch Med, Temuco, ChileGovt Med Coll, Clin Epidemiol Unit, Nagpur, Maharashtra, IndiaKhon Kaen Univ, Clin Epidemiol Unit, Fac Med, Khon Kaen, ThailandEscola Paulista Med, Clin Epidemiol Unit, São Paulo, BrazilWeb of Scienc

Risk factors for cardiovascular disease in the developing world. A multicentre collaborative study in the International Clinical Epidemiology Network (INCLEN)

Twelve centres in 7 countries in the Developing World (China, Thailand, the Philippines, Indonesia, Chile, Colombia and Brazil) connected with the International Clinical Epidemiology Network (INCLEN) each measured cardiovascular disease (CVD) risk factors in random samples of approx. 200 men aged between 35 and 65 years. Samples of men aimed to be representative of the population from which they were drawn, but the population in each centre was not designed to be representative of the whole country. Cigarette smoking rates varied from 16 to 78% and mean cholesterol levels varied from 3.8 to 6.4 mmol/l. In Bogota, Colombia, 46% of the men had a cholesterol level > 6.5mmol/l and in another 5 communities 19% or more of the population had these levels. A body mass index (BMI) of > 25 was seen in more than 50% of 4 communities and a blood pressure ? 160mmHg systolic and/or 95 mmHg diastolic was found in more than 20% of 6 countries. BMI was strongly correlated with blood cholesterol and blood pressure levels in almost all population groups. It would appear that many communities in the Developing World have high levels of risk factors for CVD and that steps could well start to be taken now to prevent the emergence of CVD epidemics in the future

Socio-economic status and risk factors for cardiovascular disease: A multicentre collaborative study in the International Clinical Epidemiology Network (INCLEN)

As part of a multicentre collaborative study of risk factors for cardiovascular disease (CVD) in the International Clinical Epidemiology Network (INCLEN), each of 12 Centres in 7 countries examined the relationship between CVD risk factors and socio-economic variables. Each Centre (three in Thailand, two each in China, Chile and Brazil and one each in the Philippines, Indonesia and Colombia) examined approx. 200 men aged 35-65 drawn at random from a population within their locality (not designed to be necessarily representative of the general population). Standardized measures of CVD risk factors included body mass index (BMI), blood pressure, blood cholesterol and cigarette smoking habits. Education, occupation and current income were grouped into ordinal categories of socio-economic status according to standard protocol guidelines, and comparisons were made between risk factor levels within each of these categories. Many of these populations had higher levels of education (as a marker of socio-economic status) than would the general population of their country. For both BMI and blood cholesterol there were a number of centres which showed positive associations with socio-economic status. These were predominately in China or urban or rural South East Asia. For blood pressure and cigarette smoking the associations with socio-economic status tended to be negative, more in line with the direction of association seen in the 'Developed' World. The high risk factor levels found in these populations, particularly the alarming prevalence of cigarette smoking in Asia and the high cholesterol levels in Latin America and Urban S.E. Asia suggest that CVD will emerge as a major public health problem in the Developing World. As this happens, knowledge of the patterns of association between risk and socio-economic status is likely to be important in both understanding the reasons for the patterns of disease and directing efforts at prevention