Glutathione S-transferase genotypes in systemic sclerosis and their association with clinical manifestations in early disease

The glutathione S-transferases (GSTs) are a family of enzymes involved in limiting oxidative damage to tissues. Null alleles for one or more of the GST enzymes, especially GSTM1, reportedly occur more frequently in patients with Sjögren's syndrome and systemic lupus erythematosus who possess certain autoantibodies. Because systemic sclerosis (SSc) is a disease in which oxidative damage has been hypothesized to contribute both to immune dysfunction and tissue damage, we sought to determine if patients from a multi-ethnic cohort of SSc patients with early disease (< or =5 years) were more likely than ethnically-matched normal controls to have null alleles for GSTM1 (M1) and/or GSTT1 (T1), and if the null allele status correlated with any major disease features. The data show that while M1 and T1 null genotypes were not significantly increased in SSc compared to ethnically matched controls, their frequencies (especially T1 nulls) were significantly higher among SSc patients with hypertension and pulmonary involvement. This suggests that GST genotype may be a genetic factor that contributes to clinical disease expression in SSc.

Clinical significance of the fractional excretion of anions in metabolic acidosis

The fractional excretion of anions has been proposed as a new index for the differential diagnosis of metabolic acidosis, identifying the properties of the conjugate base by examining the renal handling of the anion. Here, we investigated clinical significance of the fractional excretion of anions in pathophysiologic diagnosis of metabolic acidosis by measuring urine ammonium (NH4+) excretion, the ratio of A plasma anion gap/delta plasma HCO3- concentration (deltaAG/deltaHCO3-), and fractional excretion of anions in three different groups of metabolic acidosis: acid overproduction (8 patients with lactic acidosis, 8 with diabetic ketoacidosis, 3 with hippuric acidosis following glue sniffing), acid underexcretion (10 patients with chronic renal failure) and normal controls (10 normal volunteers who underwent 3-day NH4Cl loading). As expected, urine NH4+ excretion was higher in overproduction acidosis than in acid-loaded normal controls (88.1 +/- 12.3 vs. 54.0 +/- 3.7 mmol/day, p < 0.05), and it was lower in chronic renal failure than in acid-loaded normal controls (12.8 +/- 1.7 vs. 54.0 +/- 3.7 mmol/day, p < 0.05). The fractional excretion of anions had no difference between overproduction acidosis and chronic renal failure (41.2 +/- 42.8% vs. 41.0 +/- 8.1%). However, the fractional excretion of anions showed significant differences between the subgroups in acid overproduction (lactic acidosis, 4.7 +/- 0.3%; diabetic ketoacidosis, 45.8 +/- 3.1%; hippuric acidosis, 126.0 +/- 14.4%; p < 0.05). The ratio of plasma deltaAG/deltaHCO3- also exhibited significant differences between the subgroups in acid overproduction (lactic acidosis, 1.5 +/- 0.1; diabetic ketoacidosis, 1.0 +/- 0.1; hippuric acidosis, 0.3 +/- 0.1; p < 0.05). There was an inverse linear correlation between the fractional excretion of anions and the ratio of plasma deltaAG/deltaHCO3- (r2 =-0.89, p < 0.05). In conclusion, determination of the fractional excretion of anions may provide a useful clue to the differential diagnosis of metabolic acidosis caused by acid overproduction.

The value of cystoscopy as an initial diagnostic modality for asymptomatic microscopic hematuria

For the patients who visit outpatient clinics due to asymptomatic microscopic hematuria, cystoscopy has been looked upon as rather invasive compared to other diagnostic methods. We tried to elucidate the actual diagnostic value of cystoscopy in the initial evaluation of asymptomatic microscopic hematuria. We reviewed the results of cystoscopic examinations in 213 patients who visited our hospital due to asymptomatic microscopic hematuria. No definite lesion that could explain the microscopic hematuria was detected by means of IVP, urine cytology, and other nephrologic evaluations for all the patients. Among the abnormal cystoscopic findings in 55 patients, the lesions suspected to be directly related to microscopic hematuria were classified as 'significant lesions' (31 patients, 17.6%) which include entities such as bladder cancer (1.31%). 27 of 31 patients with significant lesions (85.2%) were over 50 yr old, and furthermore, 3 patients who were diagnosed as bladder tumor by cystoscopy were over 60 yr. Cystoscopy should be utilized as initial diagnostic modality in older patients with asymptomatic microscopic hematuria to rule out any possibility of bladder cancer occurrence. Further studies are needed to justify implementation of cystoscopy as an initial diagnostic modality in younger patients with asymptomatic microscopic hematuria.

Diffuse alveolar hemorrhage in lupus nephritis

AIM

Diffuse alveolar hemorrhage (DAH) is a rare and catastrophic event in systemic lupus erythematosus (SLE) with a high mortality rate, and little information is available about the degree of renal involvement in this condition.

PATIENTS AND METHODS

To evaluate the effects of renal impairment on the course of DAH, the hospital records of 7 patients (9 episodes) with DAH and SLE between 1988 and 1998 at Seoul National University Hospital were reviewed. A diagnosis of DAH was established when the patient had an acute pulmonary syndrome including either hemoptysis, new alveolar infiltrates on the chest radiograph, the presence of a falling hematocrit or hemorrhagic BAL. All patients were women and their median age was 26 years ranging between 23 and 39. All patients had concurrent lupus nephritis and 4 of them were classified as WHO class IV with renal pathology.

RESULTS

Their median serum creatinine level at the time of DAH was 4.6 mg/dl (0.8 - 13.6), and the median daily proteinuria amount was 778 mg (436 - 6200). All of the patients received corticosteroid therapy, and intravenous cyclophosphamide was given to 3 cases. Hemodialysis was done in 3 cases, and 4 of the 7 patients died during an acute event. We reviewed five series about the clinical parameters, including the serum creatinine level, treatment and hospital outcome. From the results of the analysis, it was determined that concomitant infection (RR 4.2) and the use of mechanical ventilation (RR 6.1) were associated with the increased risk of mortality, but azotemia (sCr > 3.0 mg/dl) (RR 1.5) or hemodialysis therapy (RR 1.3) was not shown to have a significant association.

CONCLUSION

It could be suggested that even though renal failure is combined with DAH in SLE patients, the same aggressive treatment results in a comparable outcome as patients with normal renal function.

Beta-fibrinogen gene -455G/A polymorphism and coronary heart disease incidence: the Atherosclerosis Risk in Communities (ARIC) Study

PURPOSE

The -455G/A (HaeIII) polymorphism of the beta-fibrinogen gene influences levels of plasma fibrinogen. We determined whether it influences risk of coronary heart disease.

METHODS

We conducted a case-cohort study nested within a prospective investigation, the Atherosclerosis Risk in Communities Study. We accumulated 398 incident coronary heart disease cases over a median of 5.3 years of follow-up and compared their -455G/A status with a random sample of the cohort (n = 498).

RESULTS

Plasma fibrinogen was higher (p = 0.04) in AA homozygous participants (341 mg/dL) than in persons carrying the G allele: GA (290 mg/dL), GG (298 mg/dL). However, there was no significant association between -455G/A and incident CHD.

CONCLUSIONS

Although a small effect cannot be excluded, -455G/A does not appear to be an important genetic determinant of CHD.

Systemic sclerosis in 3 US ethnic groups: a comparison of clinical, sociodemographic, serologic, and immunogenetic determinants

OBJECTIVE

To determine whether ethnic factors influence the presentation, serologic expression and immunogenetics of systemic sclerosis (SSc), patients from 3 ethnic groups were compared for clinical features, SSc-associated autoantibodies, and human leukocyte antigen (HLA) class II alleles.

METHODS

Fifty-four Hispanics, 28 African Americans, and 79 whites from Texas with recent-onset (less than 5 years) SSc enrolled in a prospective longitudinal study were assessed for sociodemographic, clinical, immunologic, immunogenetic, behavioral, and psychologic parameters using validated instruments and standard laboratory techniques. Serologic and immunogenetic characteristics from these patients and larger retrospective SSc cohorts of the same ethnic groups also were examined.

RESULTS

Hispanics and African Americans in the prospective cohort were more likely to have diffuse skin involvement, skin pigmentary changes, digital ulcers, pulmonary hypertension (African Americans), and an overall lower sociodemographic status than whites, who had more facial telangiectasia and hypothyroidism. In the larger combined prospective and retrospective groups of SSc patients, whites were likely to have more anticentromere antibodies (ACA) and African Americans more anti-U1-ribonucleoprotein (RNP) and anti-U3-RNP (fibrillarin) autoantibodies. HLA-DQB1*0301 was significantly associated with SSc per se in all 3 ethnic groups; HLA-DRB1*11 correlated with the anti-topoisomerase I antibody response, and HLA-DRB1*01, DRB1*04, and DQB1*0501 with ACA.

CONCLUSIONS

Important sociodemographic, clinical, and serologic differences exist between whites, African Americans, and Hispanics, despite shared genetic (HLA class II) predisposing factors. The impact of these differences on prognosis remain to be determined.

Nudf, a fungal homolog of the human LIS1 protein, functions as a dimer in vivo

The NUDF protein is required for nuclear migration through the mycelium of the filamentous fungus Aspergillus nidulans. It is of particular interest, because it closely resembles a human protein, LIS1, that is required for development of the cerebral cortex. Both are approximately 50-kDa proteins with a short N-terminal predicted coiled coil and seven WD-40 domains in the C-terminal half of the molecule. They also interact with homologous proteins, suggesting that they may have similar biochemical functions. Here we describe the purification to homogeneity of NUDF protein in a single step from a cell-free extract of A. nidulans. We demonstrate that NUDF is a homodimer, that its dimerization occurs via the N-terminal coiled coil region of the molecule, and that it must be a dimer to support the growth of A. nidulans.

Cisplatin and infusional cytosine arabinoside for the treatment of colorectal adenocarcinoma: a phase II trial

Based on the in vitro and in vivo synergy between cytosine arabinoside (Ara-C) and cis-diamminedichloroplatinum (cisplatin), we designed a phase II trial of Ara-C with cisplatin for patients with colorectal adenocarcinoma. Forty-eight eligible patients received continuous infusion Ara-C, 30 mg/m2/day over 72 hr, plus cisplatin, 30 mg/m2 for three doses at hours 12, 36, and 60 of the Ara-C infusion. The objective partial response rate for patients with colon carcinoma was 3% (1/32 patients; 95% CI, 0-16%) with a median response duration of 2.8 months. None of the 16 patients treated for rectal carcinoma responded. Myelosuppression was the most severe toxicity. Significant gastrointestinal and hepatic toxicities occurred in a small number of patients. Nephrotoxicity and neurotoxicity were mild. We conclude that the prolonged infusion of Ara-C in combination with divided doses of cisplatin offers no significant therapeutic advantage.

Effect of beta blockers on incidence of new coronary events in older persons with prior myocardial infarction and diabetes mellitus

Of 613 persons, mean age 79 +/- 9 years, with prior myocardial infarction and diabetes mellitus, 68 (11%) had contraindications to beta blockers; 289 of 545 persons (53%) without contraindications to beta blockers were treated with beta blockers. The Cox regression model showed that significant independent predictors of new coronary events were age (risk ratio 1.02 for an increment of 1 year of age), systemic hypertension (risk ratio 2.0), serum low-density lipoprotein cholesterol > or =125 mg/dl (risk ratio 1.4), serum high-density lipoprotein cholesterol < or =35 mg/dl (risk ratio 1.6), and use of beta blockers (risk ratio 0.73).

Rate of progression of valvular aortic stenosis in patients > or = 60 years of age

A retrospective analysis of 171 women and 119 men, mean age 76 +/- 9 years, with aortic stenosis diagnosed by Doppler echocardiography, who had follow-up Doppler echocardiograms, showed that the reduction in aortic valve area per year was not significantly different in older persons with mild, moderate, and severe aortic stenosis. The decrease in aortic valve area per year was significantly greater in men 60 to 74 years old than in women 60 to 74 years old (p = 0.025), in women > or =75 years old than in women 60 to 74 years old (p = 0.006), and in persons with mitral annular calcium than in persons without mitral annular calcium (p = 0.046).

Thrombomodulin Ala455Val polymorphism and risk of coronary heart disease

BACKGROUND

Thrombomodulin (TM) is expressed on the endothelial surface and plays an important role in vasoprotection. A common polymorphism of TM at amino acid position 455 with an alanine (A) to valine (V) transition was previously reported to be associated cross-sectionally with acute myocardial infarction. Whether this single nucleotide polymorphism predicts risk of developing coronary heart disease (CHD) is unclear.

METHODS AND RESULTS

Within a large cohort study, we identified 467 incident CHD cases during an average of 5 years of follow-up. We determined TM-455 genotypes on 376 CHD cases (23% black, 77% white) and a reference sample of 461. The AA genotype was significantly more prevalent in noncases than in cases (P:=0.016). The prevalences of the AA genotype in noncase blacks and whites were 93% and 67%, respectively. The AA genotype frequency was significantly reduced in black cases versus noncases (P:=0.018). It was also lower in white cases than in noncases, but the difference was not statistically significant (P:=0.066). Weighted proportional hazards regression analysis after adjustment for age, sex, and other CHD risk factors showed that having the V allele increased risk of CHD by 6.1-fold (risk ratio 6.1, 95% CI 1.7 to 22.9) in blacks but did not significantly increase the risk in whites.

CONCLUSIONS

The TM A455V polymorphism predicts risk of developing CHD in blacks.

Effects of recycled FGD liner material on water quality and macrophytes of constructed wetlands: a mesocosm experiment

We investigated the use of flue-gas-desulfurization (FGD) by-products from electric power plant wet scrubbers as liners in wetlands constructed to improve water quality. Mesocosm experiments were conducted over two consecutive growing seasons with different phosphorus loadings. Wetland mesocosms using FGD liners retained more total and soluble reactive phosphorus, with lower concentrations in the leachate (first year) and higher concentrations in the surface water (second year). Leachate was higher in conductivity (second year) and pH (both years) in lined mesocosms. Surface outflow did not reveal any significant difference in physicochemical characteristics between lined and unlined mesocosms. There was no significant difference in total biomass production of wetland plants between lined and unlined mesocosms although lower average stem lengths and fewer stems bearing flowers were observed in mesocosms with FGD liners. Potentially phytotoxic boron was significantly higher in the belowground biomass of plants grown in lined mesocosms with low phosphorus loading. A larger-scale, long-term wetland experiment close to full scale is recommended from this two-year mesocosm study to better predict the potentially positive and negative effects of using FGD by-products in constructed wetlands.

Three-port microlaparoscopic cholecystectomy in 159 patients

BACKGROUND

Laparoscopic cholecystectomy has undergone many refinements including reductions in port size and number. This study attempts to determine whether further reduction in port size from that previously reported by us can reduce postoperative pain without compromising the efficacy of the surgery.

METHODS

In this study, 159 patients underwent laparoscopic cholecystectomy with three ports: one 5-mm umbilical port, one 3-mm subxiphoid port, and one 3-mm port in the right subcostal position. Data were collected prospectively for each patient on the duration of analgesic use, quantity of analgesic tablets consumed, postoperative pain, most painful incision, and days of recovery required before return to activity and work. These measures were compared with those collected from a group of 100 patients who had undergone laparoscopic cholecystectomy with three 5-mm ports in a previous study.

RESULTS

Patients in the current study group required analgesics for a longer duration (4 vs 2.9 days; p = 0.001), used more analgesic tablets (10.7 vs 8.1; p = 0.007), and reported greater postoperative discomfort (5 vs 4.1; p = 0.016) as compared with all in the 5-mm port group. The 3-mm port group needed more days for recovery before leaving the house (2.9 vs 2.7; p = 0.504), but they returned to work earlier (5.1 vs 5.9; p = 0.065) than the group that had undergone cholecystectomy with three 5-mm ports, although there was not a significant difference between the groups. Operative time increased from 18.5 to 20.9 min (p = 0.054) in the group with two 3-mm ports. Five patients (3.1%) in the current group required enlargement of a port to complete the procedure, as compared with none in the comparison group. There was one complication (0.6%), as compared with two complications (2.0%) in the previous group.

CONCLUSIONS

This study did not demonstrate a reduction in postoperative pain or a consistent improvement in recovery when the port size was reduced at the subcostal and subxiphoid positions. It did, however, show that ports could safely be reduced in size without a negative impact on the surgeon's ability to perform a cholecystectomy. Reducing port size can be a tool in the surgeon's armamentarium for use in the attempt to optimize cosmetic results.

Th1/Th2 predominance and proinflammatory cytokines determine the clinicopathological severity of IgA nephropathy

BACKGROUND

IgA nephropathy is one of the most common forms of primary glomerulonephritis in adults. Its pathogenesis is complex. The nature of infiltrating and proliferating cells and of cellular mediators could contribute to the progression of IgA nephropathy towards end-stage renal failure.

METHODS

To evaluate this hypothesis, we attempted to quantify the magnitude of intrarenal gene expression of various cytokines (IL-1 beta, TNF-alpha, IL-6, IL-15, IL-2, IFN-gamma, IL-10) and chemokines (IL-8, RANTES, MCP-1) in 48 renal core biopsy specimens, diagnosed as IgA nephropathy by immunofluorescence microscopy. Semi-quantitative reverse-transcriptase polymerase chain reaction using internal competitors was used for the quantification of gene transcripts.

RESULTS

The expression of intrarenal gene transcripts of various cytokines and chemokines was closely interrelated, but not associated with the pathological grading system. The IFN-gamma/IL-10 ratio was higher in patients with renal dysfunction than in those with normal renal function (P=0.0483). Gene transcript levels of proinflammatory cytokines were related to the amount of proteinuria. In patients with severe glomerular sclerosis, the ratio of IFN-gamma/IL-10 gene transcripts was high (P=0.04). IL-10 gene transcript level was related to the severity of tubulointerstitial damage. The levels of gene expression of IL-10 (P=0.009), IFN-gamma (P=0.03), and TNF-alpha (P=0.005) were related to the degree of mesangial matrix expansion and the extent of intrarenal arteriolar changes correlated with the expression of the IL-8 gene transcript (r=0.43, P=0.004).

CONCLUSIONS

We propose that Th1/Th2 predominance and the level of proinflammatory cytokines could determine the pathogenetic processes and the severity of the clinical manifestations of IgA nephropathy.

Sample size and power calculations in repeated measurement analysis

Controlled clinical trials in neuropsychopharmacology, as in numerous other clinical research domains, tend to employ a conventional parallel-groups design with repeated measurements. The hypothesis of primary interest in the relatively short-term, double-blind trials, concerns the difference between patterns or magnitudes of change from baseline. A simple two-stage approach to the analysis of such data involves calculation of an index or coefficient of change in stage 1 and testing the significance of difference between group means on the derived measure of change in stage 2. This article has the aim of introducing formulas and a computer program for sample size and/or power calculations for such two-stage analyses involving each of three definitions of change, with or without baseline scores entered as a covariate, in the presence of homogeneous or heterogeneous (autoregressive) patterns of correlation among the repeated measurements. Empirical adjustments of sample size for the projected dropout rates are also provided in the computer program.

Prognosis of congestive heart failure after prior myocardial infarction in older persons with atrial fibrillation versus sinus rhythm

In a prospective study of 651 older persons with congestive heart failure after prior myocardial infarction, persons with atrial fibrillation had a significantly higher mortality than those with sinus rhythm if they had an abnormal (p = 0.005) or normal (p = 0.0001) left ventricular ejection fraction. The Cox regression model showed that significant independent risk factors for total mortality were age (risk ratio 1.03 for an increment of 1 year of age), hypertension (risk ratio 1.2), diabetes mellitus (risk ratio 1.4), abnormal left ventricular ejection fraction (risk ratio 2.1), and atrial fibrillation (risk ratio 1.5).

Differential effects of adenovirus-p16 on bladder cancer cell lines can be overcome by the addition of butyrate

High frequency of p16 alteration and high local recurrence rate of bladder cancer make this cancer an ideal target for p16 gene therapy. However, a low transduction rate of p16 via adenoviral vector causes an inconsistent result. In this study, we have tested adenovirus-p16 in several bladder cancer cell lines and investigated a way of improving the low transduction rate. Adenovirus-p16 showed a strong antitumor effect on bladder cancer cell lines (253J and T24) with strong Coxackie-adenoviral receptor (CAR) expression but little antitumor effect on bladder cancer cell lines (J82 and HT1376) with little CAR expression. In this study, we suggest a simple way of overcoming the differential effects of the adenovirus. The addition of butyrate to media was found to increase the transduction rate of adenovirus remarkably and increase the antitumor effect of adenovirus-p16 in bladder cancer cell lines with little CAR expression. Butyrate effects were related with increased CAR expression on the cell surface as well as increased transgene expression from adenoviral vector. From these observations, application of adenovirus-p16 gene therapy with butyrate can overcome the obstacle of low gene transfer and enhance the antitumor effect of adenovirus-p16 in bladder cancer.

Verbal and visual memory improve after choline supplementation in long-term total parenteral nutrition: a pilot study

BACKGROUND

Previous investigations have demonstrated that choline deficiency, manifested in low plasma-free choline concentration and hepatic injury, may develop in patients who require long-term total parenteral nutrition (TPN). Preliminary studies have suggested lecithin or choline supplementation might lead to improved visual memory in the elderly and reverse abnormal neuropsychological development in children. We sought to determine if choline-supplemented TPN would lead to improvement in neuropsychological test scores in a group of adult, choline-deficient outpatients receiving TPN.

METHODS

Eleven subjects (8 males, 3 females) who received nightly TPN for more than 80% of their nutritional needs for at least 12 weeks before entry in the study were enrolled. Exclusion criteria included active drug abuse, mental retardation, cerebral vascular accident, head trauma, hemodialysis or peritoneal dialysis, (prothrombin time [PT] >2x control), or acquired immune deficiency syndrome (AIDS). Patients were randomly assigned to receive their usual TPN regimen (n = 6, aged 34.0 +/- 12.6 years) over a 12-hour nightly infusion or their usual TPN regimen plus choline chloride (2 g) (n = 5, aged 37.3 +/- 7.3 years). The following neuropsychological tests were administered at baseline and after 24 weeks of choline supplementation (or placebo): Weschler Adult Intelligence Scale-Revised (WAIS-R, intellectual functioning), Weschler Memory Scale-Revised (WMS-R, two subtests, verbal and visual memory), Rey-Osterrieth Complex Figure Test (visuospatial functioning and perceptual organization), Controlled Oral Word Association Test (verbal fluency), Grooved Pegboard (manual dexterity and motor speed), California Verbal Learning Test (CVLT, rote verbal learning ability), and Trail Making Parts A & B (visual scanning, psychomotor speed and set shifting). Scores were reported in terms of standard scores including z scores and percentile ranks. Mean absolute changes in raw scores were compared between groups using the Wilcoxon rank sum test, where p values < .05 constituted statistical significance.

RESULTS

Significant improvements were found in the delayed visual recall of the WMS-R (7.0 +/- 2.7 vs -.33 +/- 5.7, p = .028), and borderline improvements in the List B subset of the CVLT (1.0 +/- 0.8 vs -2.0 +/- 2.4, p = .06) and the Trails A test (-3.8 +/- 8.1 vs 3.7 +/- 4.5 seconds, p = .067). No other statistically significant changes were seen.

CONCLUSIONS

This pilot study indicates both verbal and visual memory may be impaired in patients who require long-term TPN and both may be improved with choline supplementation.

Prevalence of coronary artery disease, complex ventricular arrhythmias, and silent myocardial ischemia and incidence of new coronary events in older persons with chronic renal insufficiency and with normal renal function

In a prospective study of 98 persons > or = 65 years of age with chronic renal insufficiency (serum creatinine > 3.0 mg/dl) for > 1 year and 98 age- and sex-matched persons with normal renal function (serum creatinine < or = 1.2 mg/dl), new coronary events developed at 23-month follow-up in 69 persons (70%) with chronic renal insufficiency and at 48-month follow-up in 24 persons (24%) with normal renal function (p < 0.0001). Significant independent risk factors for new coronary events were age (risk ratio 1.1), prior coronary artery disease (risk ratio 3.5), complex ventricular arrhythmias diagnosed by 24-hour ambulatory electrocardiography (risk ratio 2.5), silent myocardial ischemia diagnosed by 24-hour ambulatory electrocardiography (risk ratio 1.9), and chronic renal insufficiency (risk ratio 3.4).

Seasonal variation of deaths from fatal myocardial infarction, primary cardiac arrest, sudden cardiac death, and refractory congestive heart failure in older persons living in New York City

OBJECTIVE

To investigate if there is seasonal variation in cardiac deaths in older persons living in a nursing home in New York City.

DESIGN

In a prospective study, the major clinical cause of death of all persons aged 60 years and older residing in a nursing home in New York City during a 15-year period was investigated. The author carefully reviewed the major cause of death with the physicians taking care of all persons who died in the nursing home or after transfer to a general hospital. We investigated whether there was seasonal variation in deaths from either fatal myocardial infarction, primary cardiac arrest, sudden cardiac death, or refractory congestive heart failure.

SETTING

A large nursing home in which 1265 older persons died of fatal myocardial infarction, primary cardiac arrest, sudden cardiac death, or refractory congestive heart failure during a 15-year period.

PATIENTS

The 1265 persons who died from cardiac causes included 410 men and 855 women, mean age 83 +/- 8 years at the time of death.

MEASUREMENTS AND MAIN RESULTS

During a 15-year period, 1265 older persons died of fatal myocardial infarction, primary cardiac arrest, sudden cardiac death, or refractory congestive heart failure. Cardiac deaths occurred from December through March in 497 of 1265 persons (39%), from April through July in 378 of 1265 persons (30%), and from August through November in 390 of 1265 persons (31%). The frequency of cardiac deaths was significantly greater between December and March (P < 0.001). The incidence of cardiac deaths between December and March was 1.29 times greater than the average of the incidence of cardiac deaths during the two other 4-month periods.

CONCLUSION

The frequency of cardiac deaths in older persons living in a nursing home in New York City significantly increased 1.29 times during the period December through March compared with the average of the two other 4-month periods (P < 0.001).