Comparison of the Prevalence of Metabolic Syndrome Between the Criteria for Taiwanese and Japanese and the Projected Probability of Stroke in Elderly Hypertensive Taiwanese

SummaryBackgroundThe cutoff of abdominal circumference for metabolic syndrome (MS) defined by the Bureau of Health Promotion (BHP) of Taiwan for Taiwanese (men, 90cm; women, 80cm) and by the International Diabetes Federation (IDF) for Japanese (men, 85cm; women, 90cm) differs. This study aimed to examine the impact of this difference on the prevalence of MS and the impact of an MS diagnosis on the projected risk of stroke in hypertensive Taiwanese.MethodsMS was examined in a sample of 3,472 hypertensive patients (aged 55–80 years; 1,709 women) across Taiwan. The 10-year probability of stroke estimated from the Framingham equation was compared between MS and non-MS patients.ResultsThe prevalence of MS using the BHP criteria was 59.2% using the BHP criteria (95% confidence interval, CI, 57.6–60.8%; men, 52.5%; women, 66.1%) and 48.9% by the IDF criteria (95% CI, 47.2–50.5%; men, 61.3%; women, 36.1%). Both criteria showed that, compared with non-MS, MS has higher predicted 10-year probability of stroke (BHP, 0.153 ± 0.115 vs. 0.133 ± 0.105; IDF, 0.159 ± 0.109 vs. 0.132 ± 0.112; both p < 0.001) because of the difference in women (BHP, 0.143 ± 0.124 vs. 0.102 ± 0.091; IDF, 0.147 ± 0.121 vs. 0.118 ± 0.110; both p < 0.001) rather than men (BHP, p = 0.21; IDF, p = 0.29).ConclusionBoth criteria demonstrate that MS is highly prevalent in elderly hypertensive patients in Taiwan. Additionally in women, but not men, the predicted probability of stroke is higher in MS than in non-MS patients. The diagnosis of MS is potentially useful for identifying elderly hypertensive females with an elevated risk of stroke in Taiwan

AGE-BSA down-regulates endothelial connexin43 gap junctions

<p>Abstract</p> <p>Background</p> <p>Advanced glycation end products generated in the circulation of diabetic patients were reported to affect the function of vascular wall. We examined the effects of advanced glycation end products-bovine serum albumin (AGE-BSA) on endothelial connexin43 (Cx43) expression and gap-junction communication.</p> <p>Results</p> <p>In human aortic endothelial cells (HAEC) treated with a series concentrations of AGE-BSA (0-500 μg/ml) for 24 and 48 hours, Cx43 transcript and Cx43 protein were reduced in a dose dependent manner. In addition, gap-junction communication was reduced. To clarify the mechanisms underlying the down-regulation, MAPKs pathways in HAEC were examined. Both a MEK1 inhibitor (PD98059) and a p38 MAPK inhibitor (SB203580) significantly reversed the reductions of Cx43 mRNA and protein induced by AGE-BSA. Consistently, phosphorylation of ERK and p38 MAPK was enhanced in response to exposure to AGE-BSA. However, all reversions of down-regulated Cx43 by inhibitors did not restore the functional gap-junction communication.</p> <p>Conclusions</p> <p>AGE-BSA down-regulated Cx43 expression in HAEC, mainly through reduced Cx43 transcription, and the process involved activation of ERK and p38 MAPK.</p

Slow conduction and gap junction remodeling in murine ventricle after chronic alcohol ingestion

<p>Abstract</p> <p>Background</p> <p>Long-term heavy alcohol drinkers are prone to the development of cardiac arrhythmia. To understand the mechanisms, we evaluated the cardiac structural and electrophysiological changes in mice chronically drinking excessive alcohol.</p> <p>Results</p> <p>Male C57BL/6J mice were given 36% alcohol in the drinking water. Those given blank water were used as control. Twelve weeks later, the phenotypic characteristics of the heart, including gap junctions and electrical properties were examined. In the alcohol group the ventricles contained a smaller size of cardiomyocytes and a higher density of capillary networks, compared to the control. Western blots showed that, after drinking alcohol, the content of connexin43 (Cx43) protein in the left ventricle was increased by 18% (p < 0.05). Consistently, immunoconfocal microscopy demonstrated that Cx43 gap junctions were up-regulated in the alcohol group with a disorganized distribution, compared to the control. Optical mapping showed that the alcohol group had a reduced conduction velocity (40 ± 18 vs 60 ± 7 cm/sec, p < 0.05) and a higher incidence of ventricular tachyarrhythmia (62% vs 30%, p < 0.05).</p> <p>Conclusion</p> <p>Long-term excessive alcohol intake resulted in extensive cardiac remodeling, including changes in expression and distribution of gap junctions, growth of capillary network, reduction of cardiomyocyte size, and decrease of myocardial conduction.</p

Thrombolysis in Myocardial Infarction Frame Count in Single-Vessel Disease After Angioplasty

SUMMARYBackgroundWe compared the thrombolysis in myocardial infarction (TIMI) frame count and examined the impact of angioplasty on the count between patients with normal coronary angiograms and those with single-vessel disease (SVD).MethodsIn 780 consecutive patients referred for coronary angiography, TIMI frame count was measured for 149 patients who had SVD and 32 patients with normal angiograms who underwent the procedure for electro-physiologic study or valvular heart disease survey.ResultsComparison of each of the three vessels in the normal vessel group with the corresponding non-stenotic vessels in the SVD group showed similar counts in each of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). For the stenotic vessels, after successful angioplasty, the counts were all reduced (LAD, 54.5 ±28.8 vs. 34.0 ±19.3; LCX, 67.3 ±31.1 vs. 34.1 ±19.0; RCA, 33.2 ±28.1 vs. 19.3 ±7.9; all p <0.05). In addition, the count in the RCA after angioplasty was lower, compared with the RCA of the normal group (19.3 ±7.9 vs. 29.1 ±14.6, p = 0.001). Multivariate analysis showed that the use of oral calcium channel blockers was the only independent predictor for the reduction in RCA after angioplasty.ConclusionIn patients with SVD, the data of TIMI frame count in the nonstenotic vessels were similar to those without the disease, suggesting that the count in the normal artery is not affected by the adjacent stenotic artery. For the stenotic vessels, angioplasty had differential effects on each of the three arteries, indicating the existence of distinct properties, which is affected by calcium channel blockers, for individual coronary arteries in response to atherosclerosis and/or angioplasty

Chinese Herbal Medicine Therapy and the Risk of Mortality for Chronic Hepatitis B Patients with Concurrent Liver Cirrhosis: a Nationwide Population-Based Cohort Study

Chronic hepatitis B (CHB) is increasingly recognized as a public health problem in Taiwan. After affected patients are diagnosed with contaminant liver cirrhosis (LC), adverse clinical outcomes, especially death, are common. This study aimed to investigate the effect of Chinese herbal medicine (CHM), an essential branch of Traditional Chinese medicine (TCM), on the mortality risk among CHB patients with contaminant LC. This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 1522 patients 20–70 years of age with newly diagnosed CHB with LC during 1998–2007. Among them, 508 (33.37%) had received CHM products after the onset of CHB (CHM users), and the remaining 1014 patients (66.63%) were designated as a control group (non-CHM users). All enrollees were followed until the end of 2012 to determine deaths during the study period. We applied the Cox proportional hazards regression model to compute the hazard ratio for the association of CHM use and the subsequent risk of death. During the follow-up period, 156 CHM users and 493 non-CHM users died. After controlling for potential confounders, CHM users were found to have a significantly reduced risk of death compared with non-CHM users by 56%, and the effect was predominantly observed among those treated with CHM for \u3e 180 days. CHM therapy lowered the risk of death among CHB patients with contaminant LC, which supported CHM might provide further treatment options for those with chronic liver diseases

The Severity of Fatty Liver Disease Relating to Metabolic Abnormalities Independently Predicts Coronary Calcification

Background. Nonalcoholic fatty liver disease (NAFLD) is one of the metabolic disorders presented in liver. The relationship between severity of NAFLD and coronary atherosclerotic burden remains largely unknown. Methods and Materials. We analyzed subjects undergoing coronary calcium score evaluation by computed tomography (MDCT) and fatty liver assessment using abdominal ultrasonography. Framingham risk score (FRS) and metabolic risk score (MRS) were obtained in all subjects. A graded, semiquantitative score was established to quantify the severity of NAFLD. Multivariate logistic regression analysis was used to depict the association between NAFLD and calcium score. Results. Of all, 342 participants (female: 22.5%, mean age: 48.7 ± 7.0 years) met the sufficient information rendering detailed analysis. The severity of NAFLD was positively associated with MRS (X2 = 6.12, trend P < 0.001) and FRS (X2 = 5.88, trend P < 0.001). After multivariable adjustment for clinical variables and life styles, the existence of moderate to severe NAFLD was independently associated with abnormal calcium score (P < 0.05). Conclusion. The severity of NAFLD correlated well with metabolic abnormality and was independently predict coronary calcification beyond clinical factors. Our data suggests that NAFLD based on ultrasonogram could positively reflect the burden of coronary calcification

Factors Associated With Leisure Participation Among the Elderly Living in Long-term Care Facilities

SummaryBackgroundA lack of participation in leisure activities often leads to depression in the elderly. This study investigated the factors impacting leisure participation among the elderly living in long-term care facilities.MethodsThis cross-sectional study recruited 309 individuals older than 65 years from six long-term care facilities located in the Taipei area. Structured in-person questionnaires were administered to assess their demographic characteristics, general self-rated health status, leisure constraints, and leisure participation.ResultsThe average frequency of leisure participation was 27.20 ± 12.48 points. The top five most popular leisure activities were watching television, walking, chatting, reading, and participating in religious activities. Elderly subjects who tended to be female, have religious beliefs, have a high school education level, be married, perceive themselves in better health, demonstrate better cognitive function and have higher scores on activities of daily living and instrumental activities of daily living scales were more likely to participate in leisure activities (p < 0.05). In contrast, those who were older, had stayed in the facility for a longer time period and had more leisure constraints were less likely to participate in leisure activities (p < 0.05). Overall, the predictive factors for leisure participation included religious beliefs, educational level, cognitive skill, instrumental activities of daily living score, depression, personal inner constraints, and structural constraints. The entire model was significant (F = 11.03, p < 0.001).ConclusionBased on the self-reported interests, health status and level of cognitive skill of elderly residents, long-term care facilities should arrange appropriate leisure activities to prevent depression and to improve quality of life