Depressive symptoms and the metabolic syndrome in childhood and adulthood: a prospective cohort study

OBJECTIVE

To examine the reciprocal associations between depressive symptoms and clinical definitions of the metabolic syndrome in childhood and adulthood.

DESIGN

Population-based prospective cohort study of 921 participants (538 women and 383 men) in Finland. The components of the metabolic syndrome were measured in childhood (mean age 12 years) and again in adulthood (mean age 33 years). A revised version of the Beck Depression Inventory was used to assess depressive symptoms at the mean ages of 24 and 33.

MAIN OUTCOME MEASURES

Metabolic syndrome defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP), the European Group for the Study of Insulin Resistance, and the International Diabetes Federation criteria.

RESULTS

In women, depressive symptoms were associated with increased risk of the metabolic syndrome in adulthood (odds ratio for NCEP metabolic syndrome per 1 SD increase in depressive symptoms 1.40, 95% confidence interval 1.05-1.85). The metabolic syndrome in childhood, in turn, predicted higher levels of depressive symptoms in adulthood (p = .03). In men, no associations were found between depressive symptoms and the clinical definitions of the metabolic syndrome.

CONCLUSION

The process linking depressive symptoms with the metabolic syndrome may go into both directions and may begin early in life.

Alcohol consumption is directly associated with carotid intima-media thickness in Finnish young adults: the Cardiovascular Risk in Young Finns Study

OBJECTIVES

There is substantial epidemiological data suggesting a J- or U-shaped association between alcohol consumption and coronary events. However, some studies in experimental animals suggest that alcohol may increase atherosclerosis. Therefore, our aim was to study whether alcohol consumption is associated with carotid intima-media thickness (IMT), marker of subclinical atherosclerosis, in young, healthy adults.

METHODS

Alcohol consumption, carotid IMT and conventional cardiovascular risk factors were investigated in 2074 subjects, aged 24-39 years.

RESULTS

In subjects consuming none, >0 to <2, 2 to <4 or >or=4 units of alcohol per day, the respective carotid IMT values were 0.57+/-0.004, 0.59+/-0.003, 0.59+/-0.006, and 0.60+/-0.012 mm (mean+/-S.E.M., P<0.0001 for increasing IMT trend across alcohol consumption categories). This direct association between alcohol consumption and IMT was independent of age, sex and several cardiovascular risk factors, e.g. blood pressure, LDL-cholesterol, HDL-cholesterol, BMI, smoking, CRP and insulin (P=0.008 in multivariable regression model). The frequencies of drinking wine or strong alcohol beverages (respective P-values 0.03 and 0.01 for increasing IMT trend across beverage consuming frequency) were directly correlated with carotid IMT in models adjusted for age, sex and risk factors.

CONCLUSIONS

We found a direct relationship between alcohol consumption and carotid IMT in young adults. This association was independent of cardiovascular risk factors suggesting that in young healthy adults alcohol consumption may have pro-atherogenic effects.

Allelic variants of upstream transcription factor 1 associate with carotid artery intima-media thickness: the Cardiovascular Risk in Young Finns study

BACKGROUND

Polymorphisms of the upstream transcription factor 1 (USF1) have been associated with familial combined hyperlipidemia and coronary heart disease. The impact of this gene on subclinical atherosclerosis is unknown. Associations of 3 allelic variants of the USF1 gene and their haplotypes with carotid artery intima - media thickness (IMT), carotid artery compliance (CAC) and brachial artery flow mediated dilatation (FMD) were studied in a population of Finnish healthy young adults.

METHODS AND RESULTS

The study population comprised 2,281 individuals participating in the Cardiovascular Risk in Young Finns study. IMT, CAC and FMD values were measured by ultrasound examination. Genotypes were analysed using the 5' nuclease assay. A significant difference in IMT was found for usf1s1 (rs3737787) and usf1s8 (rs2516838) genotypes (p-values 0.046 and 0.021, respectively). Moreover, there was a significant difference between groups in haplotype 1 and haplotype 2 for IMT (p-values 0.011 and 0.028 respectively). In multivariate stepwise linear regression models adjusted by age, sex, body mass index, systolic and diastolic blood pressures, smoking, C-reactive protein, glucose, high- and low-density lipoprotein-cholesterols and triglycerides there were significant associations for the usf1s1 minor genotype AA to predict low IMT (p=0.038) and usf1s8 minor genotype GG to predict high IMT (p=0.003). There was also a significant association for haplotype 2 to predict low IMT in the otherwise similar multivariate model (p=0.006). No associations were found for polymorphisms and CAC, FMD or serum lipids.

CONCLUSIONS

The rs2516838 and rs3737787 polymorphisms of USF1 influence the carotid artery IMT, which is a new finding.

Arterial intima-media thickness in 13-year-old adolescents and previous antichlamydial antimicrobial use: a retrospective follow-up study

BACKGROUND

Children with persistent Chlamydia pneumoniae infection may be at increased risk for atherosclerosis. The impact of antimicrobial therapy for primary prevention of atherosclerotic cardiovascular disease is unsolved.

OBJECTIVE

The purpose of this study was to determine whether treatment with antimicrobial agents effective against C pneumoniae during childhood, regardless of indication, has a favorable influence on the arterial wall-thickness in children by the time they reach adolescence.

SUBJECTS AND METHODS

The association of macrolide, tetracycline, quinolone, and rifamycin use (number of exposure events) between ages 5 and 13 years with carotid and aortic intima-media thickness at age 13 years was investigated among 508 healthy children. Information about the use of medications was obtained from the Finnish prescription register. Arterial intima-media thickness was measured with a high-resolution ultrasound.

RESULTS

Mean aortic intima-media thickness showed a significant direct association with the number of antichlamydial antimicrobial exposure events also after controlling for established atherosclerotic risk factors. Elevated C-reactive protein level had an additional effect on aortic intima-media thickness in a multivariable model. Carotid intima-media thickness was not associated with the number of preceding antichlamydial treatments.

CONCLUSIONS

Recurrent antichlamydial treatments in childhood have no favorable influence on early vascular changes but are associated with increased intima-media thickness in the abdominal aorta. These findings suggest that the use of antimicrobial agents does not offer protection against the potential atherogenicity of repeated infectious insults.

Polymorphism in the IL6 promoter region is associated with the risk factors and markers of subclinical atherosclerosis in men: The Cardiovascular Risk in Young Finns Study

OBJECTIVE

Inflammatory factors modify the risk of coronary heart disease. Promoter region genetic polymorphism of inflammatory cytokine interleukin-6 (IL6 -174 G>C) is associated with the variation of IL-6 production. We investigated whether IL6 -174 G>C associates with the risk factors of atherosclerosis and carotid artery compliance (CAC) in young subjects.

METHODS AND RESULTS

As part of the Cardiovascular Risk in Young Finns Study, we performed carotid artery ultrasound examinations, IL6 -174 G>C genotyping and coronary heart disease risk factor determination for 2228 subjects aged 24-39 years. In men CAC was higher for IL6 -174 GG (2.10+/-0.65) than for GC (2.00+/-0.68) or CC (1.95+/-0.63, %/10mmHg, mean+/-S.D., p=0.0221). A similar association was observed for HDL cholesterol (GG 1.22+/-0.29, GC 1.15+/-0.27 and CC 1.14+/-0.28mmol/L, p=0.0015) and apolipoprotein A1 (apoA1) (GG 1.44+/-0.21, GC 1.40+/-0.20, CC 1.38+/-0.21mmol/L, p=0.0118). The opposite genotype effect was present in systolic (GG 127+/-13.1, GC 129+/-13.1, CC 130+/-14.3mmHg, p=0.0382) and diastolic blood pressure (GG 73.8+/-9.14, GC 75.1+/-8.68, CC 75.9+/-9.70mmHg, p=0.0374). The genetic effect size for these parameters was not significant in women.

CONCLUSIONS

IL6 -174 allele G homozygozity associates with beneficial profile of early predictors of atherosclerosis such as high CAC, HDL-C and apoA1 as well as low systolic and diastolic blood pressure in men.

Mortality in a cohort with high fish consumption

BACKGROUND

Our aim was to assess the mortality of fishermen and fishermen's wives in Finland, presuming that the mortality reflects their high consumption of contaminated fish.

METHODS

All Finnish fishermen, registered since 1980, were identified from the Professional Fishermen Register (N = 6410), and the fishermen's wives from the national population register (N = 4260). The cohorts were individually linked with cause-of-death data until 2005 at Statistics Finland. The follow-up started in the year after the first registration as a fisherman and at marriage (if later) for the wives. The standardized mortality ratios (SMRs) were calculated based on the national mortality rates. In addition, blood samples and food frequency questionnaire data were collected from a volunteer sample.

RESULTS

The average fish consumption and serum concentrations of fish-derived fatty acids and environmental contaminants were higher among the fishermen and their wives than among the general population from the same region. The fishermen and their wives had lower mortality from all causes (SMR 0.78, 95% confidence interval (CI) 0.73-0.82, and 0.84, 0.76-0.93, respectively), and ischaemic heart diseases (0.73, 0.65-0.81, and 0.65, 0.50-0.83) than the general population. Mortality from cerebrovascular diseases and malignant neoplasms was decreased among the fishermen (0.67, 0.52-0.85, and 0.90, 0.80-1.01), but not among the wives. In addition, the fishermen's mortality from water transport accidents was extremely high (8.31, 5.65-11.79).

CONCLUSIONS

The fishermen and their wives had lower mortality from many natural causes. The high intakes of environmental contaminants in fish were not seen as excess mortality.

Association of high sensitive C-reactive protein with apolipoprotein E polymorphism in children and young adults: the Cardiovascular Risk in Young Finns Study

BACKGROUND

A relation between apolipoprotein E (APOE) genotypes and high sensitive C-reactive protein (hsCRP) has been observed in some studies with elderly subjects and different patient groups. We studied whether serum hsCRP levels are linked with common APOE (epsilon 2, epsilon 3, epsilon 4) polymorphism already in children and young adults.

METHODS

The study cohort included 1221 subjects participating in the Cardiovascular Risk in Young Finns Study at age 3-18 years at baseline in 1980. These subjects were reexamined at the 21-year follow-up at age 24-39 years in 2001. APOE phenotypes were examined in 1986, serum hsCRP was measured from fresh samples in 2001 and baseline hsCRP (in 1980) was measured from frozen samples in 2005.

RESULTS

Serum hsCRP was significantly associated with APOE phenotypes in children and young adults using multivariate analysis adjusted for age, body mass index, smoking, total cholesterol and low-density lipoprotein cholesterol. Male epsilon 4 carriers had significantly lower hsCRP levels both in childhood (p=0.003) and in adulthood (p=0.013). hsCRP increased in both phenotype classes (epsilon 4+ and epsilon 4-) during the 21-year follow-up. Female epsilon 4 carriers had lower hsCRP levels in childhood (p=0.032) but not in adulthood (p=0.995). An interaction effect between time and APOE phenotype (p=0.045) in relation to hsCRP was observed in females during the 21-year follow-up.

CONCLUSIONS

Common APOE polymorphism affects the level of circulating hsCRP already in children and young adults. Male APOE epsilon 4 carriers have consistently lower hsCRP levels. In females, APOE epsilon 4 carriers had lower hsCRP levels in childhood but not in adulthood.

Exercise training with dietary counselling increases mitochondrial chaperone expression in middle-aged subjects with impaired glucose tolerance

BACKGROUND

Insulin resistance and diabetes are associated with increased oxidative stress and impairment of cellular defence systems. Our purpose was to investigate the interaction between glucose metabolism, antioxidative capacity and heat shock protein (HSP) defence in different skeletal muscle phenotypes among middle-aged obese subjects during a long-term exercise and dietary intervention. As a sub-study of the Finnish Diabetes Prevention Study (DPS), 22 persons with impaired glucose tolerance (IGT) taking part in the intervention volunteered to give samples from the vastus lateralis muscle. Subjects were divided into two sub-groups (IGTslow and IGTfast) on the basis of their baseline myosin heavy chain profile. Glucose metabolism, oxidative stress and HSP expressions were measured before and after the 2-year intervention.

RESULTS

Exercise training, combined with dietary counselling, increased the expression of mitochondrial chaperones HSP60 and glucose-regulated protein 75 (GRP75) in the vastus lateralis muscle in the IGTslow group and that of HSP60 in the IGTfast group. In cytoplasmic chaperones HSP72 or HSP90 no changes took place. In the IGTslow group, a significant positive correlation between the increased muscle content of HSP60 and the oxygen radical absorbing capacity values and, in the IGTfast group, between the improved VO2max value and the increased protein expression of GRP75 were found. Serum uric acid concentrations decreased in both sub-groups and serum protein carbonyl concentrations decreased in the IGTfast group.

CONCLUSION

The 2-year intervention up-regulated mitochondrial HSP expressions in middle-aged subjects with impaired glucose tolerance. These improvements, however, were not correlated directly with enhanced glucose tolerance.

Relation of apolipoprotein E polymorphism to markers of early atherosclerotic changes in young adults--the Cardiovascular Risk in Young Finns Study

BACKGROUND

Carotid artery intima-media thickness (IMT), which is measured by ultrasound, is used in the assessment of early atherosclerotic changes, and has been associated with apolipoprotein E (APOE) polymorphism in many studies comprising elderly subjects. However, results are still inconclusive and data relating to young adults are missing. Whether common APOE polymorphism is related to carotid IMT was studied in a population of young adults. Also brachial flow-mediated dilatation (FMD) and carotid artery compliance (CAC) were determined to clarify their relation to this genetic factor.

METHODS AND RESULTS

A total of 1,188 young adults (aged 24-39 years) participating in the Cardiovascular Risk in Young Finns Study with complete data of common APOE polymorphism underwent a carotid and brachial ultrasound. Patients' lipid levels and blood pressure were also examined. There was no significant association between the APOE phenotypes and carotid IMT, brachial FMD or CAC either in young men or in young women. The results were similar for systolic and diastolic blood pressure. In the same population, the well-known association between APOE phenotypes and lipids was seen.

CONCLUSIONS

Common APOE polymorphism does not seem to be an independent genetic determinant of carotid IMT, brachial FMD or CAC.

Associations of dyslipidemias from childhood to adulthood with carotid intima-media thickness, elasticity, and brachial flow-mediated dilatation in adulthood: the Cardiovascular Risk in Young Finns Study

BACKGROUND

Dyslipidemias are the major cause for atherosclerosis. They may act synergistically with nonlipid risk factors to increase atherogenesis. In the present study, we examined the effects of dyslipidemias from childhood to adulthood and their interaction with nonlipid risk factors on markers of subclinical atherosclerosis.

METHODS AND RESULTS

Study subjects were participants of the longitudinal Cardiovascular Risk in Young Finns Study started in 1980 (n=2265, age 3 to 18 years). To phenotype type IIa, IIb, and IV dyslipidemias and hypoHDL-cholesterolemia, we calculated age and sex-specific z scores for lipid values for each subject in 1980, 1983, 1986, and 2001. Subjects with mean z score over 90th percentile for LDL-cholesterol or triglycerides were considered having type IIa or IV dyslipidemia. Subjects with mean z score over 90th percentile for LDL-cholesterol and triglycerides had type IIb dyslipidemia, and those with mean z score below 10th percentile for HDL-cholesterol had hypoHDL-cholesterolemia. Compared to controls, subjects with type IIb dyslipidemia had increased carotid IMT (P<0.01). This difference remained significant when adjusted with other risk factors (P<0.05). Carotid IMT also increased significantly more with increasing number of nonlipid risk factors (P<0.001) or presence of the metabolic syndrome (P<0.05) in subjects with type IIb than in controls. Subjects with type IIb or type IV dyslipidemia had decreased carotid elasticity (P<0.05), but these differences became nonsignificant (P>0.3) when adjusted with blood pressure.

CONCLUSIONS

Our findings suggest that type IIb dyslipidemia has deleterious effects on vasculature already since childhood. Subjects with type IIb dyslipidemia are more vulnerable to the effects of cardiovascular risk factors and metabolic syndrome.

Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol

BACKGROUND

Berries are a particularly rich source of polyphenols. They also contain other bioactive substances, such as vitamin C. Previous studies indicated that the consumption of polyphenol-rich foods (eg, cocoa, tea, and red wine) may induce beneficial changes in pathways related to cardiovascular health. Whether the consumption of berries has similar effects is unknown.

OBJECTIVE

We aimed to investigate the effects of berry consumption on hemostatic function, serum lipids, and blood pressure (BP).

DESIGN

Middle-aged unmedicated subjects (n = 72) with cardiovascular risk factors consumed moderate amounts of berry or control products for 8 wk in a single-blind, randomized, placebo-controlled intervention trial.

RESULTS

Berry consumption inhibited platelet function as measured with a platelet function analyzer (using collagen and ADP as platelet activator) [changes: 11% and -1.4% in the berry and control groups, respectively; P = 0.018, analysis of covariance (ANCOVA)]. Plasma biomarkers of platelet activation, coagulation, and fibrinolysis did not change during the intervention. Serum HDL-cholesterol concentrations increased significantly more (P = 0.006, ANCOVA) in the berry than in the control group (5.2% and 0.6%, respectively), but total cholesterol and triacylglycerol remained unchanged. Systolic BP decreased significantly (P = 0.050, ANCOVA); the decrease mostly occurred in subjects with high baseline BP (7.3 mm Hg in highest tertile; P = 0.024, ANCOVA). Polyphenol and vitamin C concentrations in plasma increased, whereas other nutritional biomarkers (ie, folate, tocopherols, sodium, and potassium) were unaffected.

CONCLUSION

The consumption of moderate amounts of berries resulted in favorable changes in platelet function, HDL cholesterol, and BP. The results indicate that regular consumption of berries may play a role in the prevention of cardiovascular disease.

The influence of smoking and homocysteine on subclinical atherosclerosis is modified by the connexin37 C1019T polymorphism - The Cardiovascular Risk in Young Finns Study

BACKGROUND

A polymorphism C1019T on the connexin37 (Cx37) gene has been found to associate with coronary artery disease. There are conflicting results on which allele confers risk, and the possibility of interactions between the polymorphism and risk factors has been raised. In this study, we examined interactions between the Cx37 polymorphism and common risk factors and their associations to early vascular parameters of atherosclerosis: carotid artery intima-media thickness (IMT), and carotid artery compliance (CAC) and brachial artery flow mediated dilatation (FMD).

METHODS

A population of 1440 healthy young adults from the Cardiovascular Risk in Young Finns Study was studied. The subjects were genotyped and their cardiovascular risk factor and ultrasound data gathered in 2001 were used for the statistical analyses.

RESULTS

In the whole population, homocysteine in subjects with the TT genotype was found to be associated with higher FMD values (p for interaction 0.038) and remained so in three different adjusted models (p for interaction 0.022-0.038). In women with the CC genotype, smoking was found to be associated with higher FMD values and the smoking-by-genotype interaction remained significant in three adjusted models (p for interaction 0.001-0.041). In women with TT genotype, the effect of smoking was opposite, i.e., FMD values for smokers were lower compared to non-smokers. In men, physical activity interacted with Cx37 on CAC in the CT and TT genotypes (p for interaction 0.011). No significant interactions were found to predict IMT.

CONCLUSIONS

The effect of smoking and homocysteine levels on arterial endothelial functions and elasticity were modified by the allelic variation of the Cx37 gene. These data suggest that variation in the connexin gene may modify effects risk factors have on vascular function.

When do social inequalities in C-reactive protein start? A life course perspective from conception to adulthood in the Cardiovascular Risk in Young Finns Study

BACKGROUND

It is unclear when in the life course do social inequalities in inflammation emerge. We examined whether the association between socioeconomic position (SEP) and C-reactive protein (CRP) is determined at conception, in childhood, adolescence or adulthood in 1484 participants from the population-based Cardiovascular Risk in Young Finns Study.

METHODS

Five variants of the CRP gene were used to investigate whether SEP differences in CRP levels are determined at conception. SEP and serum CRP were assessed in childhood (age 3-9), adolescence (age 12-18) and in adulthood (age 24-39). SEP was measured using parental education and occupational status in childhood and adolescence, and participants' own education and occupational status in adulthood. Participants with CRP > 10 mg/l were excluded.

RESULTS

All CRP gene variants were associated with circulating CRP concentrations in childhood, but there were no differences in the distribution of these variants by SEP. No strong evidence was found of associations between parental SEP and CRP. A graded association between higher SEP and lower CRP was observed in adulthood for education (P = 0.0005) but not for occupational status. Trajectories that led to high educational achievement both in the participants and their parents were associated with lower (P <or= 0.047) CRP levels in adulthood. Excluding participants with infectious diseases, pregnant or lactating women and women using oral contraceptives did not change the findings.

CONCLUSION

In this cohort, SEP differences in CRP concentrations seen in adulthood appear not to be determined at conception or evident in childhood or adolescence.

Relationship between leptin and C-reactive protein in young Finnish adults

CONTEXT

Leptin and C-reactive protein (CRP) concentrations are increased in inflammation, and both have been linked to increased risk for cardiovascular diseases.

OBJECTIVE

The objective of the study was to explore in a population-based sample whether the relation between leptin and CRP is independent of obesity level and whether genetic causes of CRP elevation contribute to leptin levels.

DESIGN

This was a population-based study including 1862 young adults (971 women; 891 men) aged 24-39 yr.

SETTING

The study was conducted at five centers in Finland.

MAIN OUTCOME MEASURES

Associations between leptin and CRP adjusted for obesity indices, risk factors, genetic variables, and lifestyle variables were measured.

RESULTS

Women had 3.0-fold higher median concentrations of leptin (12.5 vs. 4.1 ng/ml) and 1.3-fold higher median concentrations of CRP (0.75 vs. 0.56 mg/liter) than men (P < 0.0001 in both comparisons). In univariate analyses, CRP and leptin were significantly intercorrelated (r = 0.47, P < 0.0001 for women; r = 0.46, P < 0.0001 for men). In multiple regression analysis including age, body mass index, waist circumference, insulin, lipids, systolic and diastolic blood pressures, smoking status, and use of oral contraceptives in women, leptin was the main determinant of CRP in men (P < 0.0001) and the second most important determinant in women (P < 0.0001). A Mendelian randomization test based on genetic variants in the CRP gene (five single nucleotide polymorphisms) provided no support for CRP as a causal agent for leptin.

CONCLUSIONS

Leptin, obesity, and oral contraceptive use in women were the main factors related to CRP. The relation between leptin and CRP was independent of obesity and cardiovascular risk factors.

Associations between connexin37 gene polymorphism and markers of subclinical atherosclerosis: the Cardiovascular Risk in Young Finns study

OBJECTIVE

Connexin37 (cx37) C1019T polymorphism has been shown to associate with coronary artery disease in different populations. We investigated whether this polymorphism associates with carotid artery intima-media thickness (IMT), carotid artery compliance (CAC) and brachial artery flow mediated dilatation (FMD) - i.e., early ultrasound markers of subclinical atherosclerosis - in a clinically healthy population of young Finnish adults.

METHODS AND RESULTS

1440 individuals from the Cardiovascular Risk in Young Finns study were genotyped and studied using cardiovascular risk factor and ultrasound data obtained in 2001. In linear regression models, no significant association between the cx37 polymorphism and carotid IMT, CAC or brachial artery FMD (ANOVA, p=0.159, 0.151 and 0.547), respectively, was found in the whole population or in women and men separately.

CONCLUSIONS

The connexin37 C1019T polymorphism is not related with markers of subclinical atherosclerosis in young adults.

Associations of methylenetetrahydrofolate reductase C677T polymorphism with markers of subclinical atherosclerosis: the Cardiovascular Risk in Young Finns Study

OBJECTIVE

To study whether the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism or serum homocysteine concentration is associated with carotid artery intima media thickness (IMT), carotid artery compliance (CAC) or brachial artery flow mediated dilatation (FMD) in a healthy Finnish adult population.

METHODS

Cross-sectional data obtained in 2001 for the Cardiovascular Risk in Young Finns Study were used. Carotid artery IMT, CAC and brachial FMD were measured by ultrasound and serum homocysteine concentrations using a commercial immunoassay kit. We studied 1,440 subjects (aged 24-39 years). Genotyping was performed using the 5' nuclease TaqMan assay.

RESULTS

Homocysteine values differed between genotypes in women and men (ANOVA, p<0.001 for both sex groups): the genotype raised values in the order of CC, CT, TT. There was a significant difference in CAC values between the MTHFR genotypes in men (ANOVA, p = 0.008), and the CC genotype had the lowest values. In multivariate linear regression analysis adjusted for other major coronary risk factors (e.g. age, smoking, body mass index, systolic blood pressure, C-reactive protein), the association remained significant (R (2) = 25.8 %, beta = 0.091; p = 0.02). Homocysteine level was directly associated with CAC in the whole population (R (2) = 18.0 %, beta = 0.012; p = 0.014) and in women (R (2) = 9.3%, beta = 0.02; p = 0.013), but not in men (R (2) = 15.2 %, beta = 0.004; p = 0.444). We found no association between homocysteine level or the MTHFR polymorphism and carotid IMT or brachial artery FMD.

CONCLUSIONS

The findings suggest that the MTHFR polymorphism does not influence IMT or FMD, but that the T allele may have an effect on CAC in men.

Toll-like receptor 4 gene (Asp299Gly) polymorphism associates with carotid artery elasticity. The cardiovascular risk in young Finns study

OBJECTIVE

Early subclinical markers of atherosclerosis, such as carotid artery intima media thickness (IMT) and elasticity predict future coronary events. The G allele of the Toll-like receptor 4 (TLR-4) gene Asp299Gly polymorphism has been previously associated with decreased development of atherosclerosis and with lower risk of myocardial infractions. We wanted to examine the association of this polymorphism with carotid IMT and compliance in a population of young Finnish Caucasian adults.

METHODS

Carotid artery IMT and elasticity indices of 2201 study subjects who participated in a randomized multicenter study (cardiovascular risk in young Finns study) were measured with ultrasound. The genotyping was performed using the TaqMan 5'-nuclease assay.

RESULTS

According to multivariate linear regression analysis adjusted with potential confounders, the G allele carriers had significantly higher carotid arterial compliance, measured in increase of luminal diameter percentage in response to blood pressure rise of 10 mmHg, than did the AA homozygotes (beta=0.099 with 95% CI 0.029-0.169 and p=0.006). The difference between AA homozygotes and GG homozygotes was even more pronounced (beta=0.382 with 95% CI 0.119-0.644 and p=0.004). Variation in the TLR-4 genotype was not related with IMT. The results of the two independent study cohorts of Eastern and Western Finland were in accordance with the results of the whole combined study population.

CONCLUSION

The G allele of the TLR-4 gene Asp299Gly polymorphism is associated with increased carotid artery compliance in young adults. This beneficial effect of the G allele may reduce the risk of future cardiovascular events.

Influence of apolipoprotein E polymorphism on serum lipid and lipoprotein changes: a 21-year follow-up study from childhood to adulthood. The Cardiovascular Risk in Young Finns Study

BACKGROUND

We examined the influence of apolipoprotein E (apoE) polymorphism on longitudinal changes in serum lipids by following the subjects participating in The Cardiovascular Risk in Young Finns Study over a 21-year period.

METHODS

Serum lipids were determined in randomly selected Finnish children and adolescents in 1980 and the subjects were re-examined in 1983, 1986 and after 21 years in 2001. ApoE polymorphism was determined in 1736 participants, and serum lipid values and apoE phenotypes were available for 1233 subjects.

RESULTS

ApoE phenotype-related differences in serum total and low-density lipoprotein (LDL)-cholesterol were maintained throughout the 21-year follow-up from childhood to adulthood, i.e., the apoE epsilon2 allele was consistently associated with lower and the epsilon4 allele with higher total and LDL-cholesterol (p<0.001 for all). In adulthood, there was also a significant apoE phenotype-related difference in high-density lipoprotein (HDL)-cholesterol (p=0.007), and the epsilon2 allele was associated with higher and the epsilon4 allele with lower apoA-I and HDL-cholesterol. In addition, apoB increased in the phenotype order E3/2<E3/3<E4 (E4/3+E4/4) (p<0.001). The LDL-lowering effect of the epsilon2 allele was greater in adulthood than in childhood, i.e., there was a significant apoE phenotypextime interaction (p=0.039) with longitudinal change in LDL-cholesterol.

CONCLUSIONS

ApoE polymorphism is associated with lipid levels at different ages and affects the longitudinal change in LDL-cholesterol from childhood to adulthood.

Brachial artery flow-mediated dilation and asymmetrical dimethylarginine in the cardiovascular risk in young Finns study

BACKGROUND

Elevated asymmetrical dimethylarginine (ADMA) is a novel risk factor for atherosclerosis that may impair endothelial function by interfering with endothelial nitric oxide synthesis. To gain insight into the effects of ADMA on systemic endothelial function, we examined the association between ADMA and brachial artery flow-mediated dilation (FMD) in a large population of young adults.

METHODS AND RESULTS

Plasma ADMA and brachial FMD, as well as conventional cardiovascular risk factors, were measured in 2096 white adults aged 24 to 39 years. In univariate analysis, ADMA was inversely correlated with FMD (r=-0.07, P=0.003). The inverse association between ADMA and FMD remained significant in a multivariable regression model adjusted for age, sex, conventional cardiovascular risk factors, estimated glomerular filtration rate, and brachial artery baseline diameter (beta+/-SE -1.56+/-0.62%, P=0.01).

CONCLUSIONS

We conclude that elevated plasma ADMA concentrations are associated with decreased brachial FMD responses in healthy adults. These data provide evidence at the population level that ADMA levels are associated with endothelial function.

Impact of repeated dietary counseling between infancy and 14 years of age on dietary intakes and serum lipids and lipoproteins: the STRIP study

BACKGROUND

Atherosclerosis development might be delayed or prevented by dietary measures. The aims of the present study were to evaluate the effect of low-saturated-fat, low-cholesterol dietary counseling on fat intakes, growth, serum cholesterol values, and pubertal development in children and adolescents.

METHODS AND RESULTS

In the randomized prospective Special Turku Coronary Risk Factor Intervention Project (STRIP), a low-saturated-fat, low-cholesterol diet was introduced to intervention infants (n=540) at 7 months of age, and control children (n=522) received an unrestricted diet. Dietary intakes, serum cholesterol values, somatic growth, and development were followed up throughout childhood and adolescence. Saturated fat intakes, serum total cholesterol, and low-density lipoprotein cholesterol values were lower (P<0.001) in the intervention than in control children during the 14 years, whereas high-density lipoprotein cholesterol values in the 2 study groups showed no difference. Boys had lower total and low-density lipoprotein cholesterol concentrations than girls throughout childhood (P<0.001), and the intervention effect on serum cholesterol concentration was larger in boys than girls. The 2 study groups showed no difference in growth, body mass index, pubertal development, or age at menarche (median, 13.0 and 12.8 years in the intervention and control girls, respectively; P=0.52). The cholesterol values decreased as puberty progressed. Mean concentrations of total and high-density lipoprotein cholesterol decreased from approximately 4.5 and approximately 1.4 mmol/L, respectively, in Tanner stage 1 (prepubertal) boys to approximately 3.9 and approximately 1.1 mmol/L in Tanner stage 4 (late pubertal) boys.

CONCLUSIONS

Repeated dietary counseling remains effective in decreasing saturated fat and cholesterol intake and serum cholesterol values at least until 14 years of age. Puberty markedly influences serum cholesterol concentrations.

CYBA C242T gene polymorphism and flow-mediated vasodilation in a population of young adults: the Cardiovascular Risk in Young Finns Study

OBJECTIVE

Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase is a major source of the superoxide anion that contributes to decreased nitric oxide bioavailability in the vasculature. The C242T polymorphism of the CYBA gene that encodes p22phox, a component of NADPH oxidase, has been found to modulate superoxide production. We examined the relationship of the C242T polymorphism with endothelial-dependent brachial artery flow-mediated vasodilatation (FMD) in a population-based sample of young healthy adults.

METHODS

FMD, defined as the increased percentage in brachial artery diameter after reactive hyperemia, was assessed by ultrasound and the C242T polymorphism using a 5' nuclease assay in 2058 subjects aged 24-39 years.

RESULTS

The mean values of brachial artery FMD were 8.0 +/- 4.4% in all study subjects (n = 2058), and 7.8 +/- 4.4, 8.2 +/- 4.5, and 8.7 +/- 4.5% in subjects with the CC (n = 1362), CT (n = 616), and TT (n = 80) genotypes of the C242T CYBA polymorphism, respectively (P = 0.02 for trend). The association remained significant (P = 0.019) in multivariate analyses adjusted for age, sex, obesity indices, smoking habits, blood pressure, serum glucose, lipids, and C-reactive protein. The relationship between FMD and the C242T polymorphism was stronger (P = 0.004) in overweight subjects (body mass index > or = 25 kg/m, n = 895) and ever-smokers (P = 0.008, n = 1082), whereas no relationship was found in normal-weight subjects and non-smokers (P = 0.824 and P = 0.438, respectively).

CONCLUSION

The C242T polymorphism of the CYBA gene seems to be related to endothelial function in a population-based sample of young healthy adults. Overweight and smoking status may modify this genetic effect.