Body adiposity in later life and the incidence of dementia: the health in men study

Objective

To determine if adiposity in later life increases dementia hazard.

Methods

Cohort study of 12,047 men aged 65–84 years living in Perth, Australia. Adiposity exposures were baseline body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR). We used the Western Australian Data Linkage System (WADLS) to establish the presence of new cases of dementia between 1996 and 2009 according to the International Classification of Diseases (ICD). Crude and adjusted hazard ratio (HR, 95% confidence interval, 95%CI) of dementia for each adiposity marker was calculated using Cox regression models. Other measured factors included age, marital status, education, alcohol use, smoking, diet, physical activity, and prevalent hypertension, diabetes, dyslipidaemia and cardiovascular disease.

Results

Compared with men with BMI<25, participants with BMI between 25–30 had lower adjusted HR of dementia (HR = 0.82, 95% CI = 0.70–0.95). The HR of dementia for men with BMI≥30 was comparable to men with BMI<25 (HR = 0.82, 95%CI = 0.67–1.01). Waist circumference showed no obvious association with dementia hazard. Men with WHR≥0.9 had lower adjusted HR of dementia than men with WHR <0.9 (HR = 0.82, 95%CI = 0.69–0.98). We found a “J” shape association between measures of obesity and the hazard of dementia, with the nadir of risk being in the overweight range of BMI and about 1 for WHR.

Conclusions

Higher adiposity is not associated with incident dementia in this Australian cohort of older men. Overweight men and those with WHR≥0.9 have lower hazard of dementia than men with normal weight and with WHR<0.9.

Serum secreted phospholipase A2 is associated with abdominal aortic aneurysm presence but not progression

OBJECTIVE

Secretory phospholipase A(2) (sPLA(2)) has been implicated in rodent models of abdominal aortic aneurysm (AAA). The aim of this study was to assess whether serum sPLA(2) activity was associated with AAA presence and progression.

METHODS

Serum sPLA(2) activity was measured using a fluorometric assay in 1002 men of whom 310 had an AAA. 272 of the men had repeat ultrasound surveillance of their AAA for a median of 5.5 years. The association of sPLA(2) activity with AAA was assessed using multiple regression analysis to adjust for other risk factors.

RESULTS

Median serum sPLA(2) activity was 21.67 in men with AAA and 18.32 U/ml in men without AAA, p<0.001. Men with sPLA(2) activity ≥ median (19.20 U/ml) had a 1.40-fold (95% CI 1.04-1.87, p=0.027) increased prevalence of AAA independent of other risk factors. Serum sPLA(2) activity was not associated with AAA growth.

CONCLUSION

Serum sPLA(2) activity is elevated in men with small AAAs but is not associated with AAA progression.

The effect of having a partner on activities of daily living in men and women aged 82-87 years

BACKGROUND

Physical functioning is an important determinant of mortality and morbidity in older adults and there may be differences by gender and marital status. This study compared disability, measured by the ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs), between older men and women who are either partnered or not partnered.

METHODS

Participants included 5497 women and 1072 men aged 82-87 years from cross sectional surveys conducted in 2008 (the Health in Men Study and the Australian Longitudinal Study on Women's Health). Ordinal logistic regression was used to examine the relationship between disability and gender by marital status, adjusting for self-reported chronic conditions.

RESULTS

Women reported a higher prevalence of most chronic conditions than men. Unpartnered men had significantly higher odds of reporting difficulty in dressing the lower body and doing heavy housework, and significantly lower odds of reporting difficulty managing money and preparing meals than partnered men. Unpartnered and partnered women had significantly lower odds of reporting difficulty in dressing the lower body, walking inside the house, using the toilet, preparing meals, taking medications, using the telephone and performing leisure activities than partnered men. However, unpartnered and partnered women had significantly higher odds of reporting difficulty with eating, shopping, and doing light or heavy housework than did partnered men.

CONCLUSIONS

Differences between partnered and unpartnered older men and women in difficulty with ADLs and IADLs were identified, with women reporting less difficulty overall, regardless of partner status.

Association of single-nucleotide polymorphisms in HLA class II/III region with knee osteoarthritis

OBJECTIVE

A genome-wide association study and a replication using Japanese, Spanish and Greek Caucasian populations have recently indicated two single-nucleotide polymorphisms (SNPs) (rs7775228 and rs10947262) associated with knee Osteoarthritis (OA) susceptibility. We have further evaluated the association in knee OA subjects from Han Chinese and Australian Caucasian origin.

METHODS

Two independent case-control association studies were performed using Han Chinese and Australian Caucasian populations. The two SNPs were genotyped in patients who had primary symptomatic knee OA with radiographic confirmation and/or received total knee replacement surgery as well as in matched controls. They were subjected to statistic analyses.

RESULTS

A total of 991 OA patients and 1536 controls were genotyped. No significant difference was detected in genotype or allele frequencies of the two SNPs between knee OA and control groups in the two populations (all P>0.05). The association was also negative even after stratification by sex, body mass index (BMI) and Kellgren/Lawrence scores. The significant heterogeneity was detected between Chinese and Japanese (both P<0.05). In the Caucasian samples, no significant heterogeneity was detected (both P>0.05). The result of meta-analysis showed significant association between knee OA and rs10947262 in total subjects [summary OR=1.26, 95%confidence intervals (CI)=1.07-1.27, P=3 × 10(-8)] and in Caucasian samples (summary OR=1.28, 95%CI=1.04-1.57, P=0.02).

CONCLUSION

We demonstrated no association between the two SNPs in human leukocyte antigen (HLA) class II/III region and knee OA in Han Chinese population. A significant association was detected between SNP rs10947262 and knee OA in Caucasian subjects. Further replication studies are required to identify the impact of controversial association.

Population-based observational study of claudication in older men: the Health in Men Study

OBJECTIVES

To assess the prevalence of and risk factors for claudication and its association with subsequent cardiovascular events.

DESIGN, SETTING AND PARTICIPANTS

Observational cohort study of 12 203 Western Australian men aged 65 years and over, recruited from 1996 to 1999, and followed up from 2001 to 2004.

MAIN OUTCOME MEASURES

Prevalence of claudication and incidence of peripheral arterial disease (PAD); risk factors for claudication and its association with subsequent cardiovascular events.

RESULTS

The prevalence of claudication was 5.3% (638 of 11 970 men). At follow-up, after exclusion of 148 men with claudication at baseline and 76 with missing data at follow-up, the crude average annual incidence of new PAD (claudication or procedure for PAD) was 0.85% (95% CI, 0.72%-0.96%). The risk factors for prevalent claudication and incident PAD were similar, with age, smoking, hypertension, diabetes and history of cardiovascular disease dominating. Of the men with claudication at baseline, nearly half (47.5%; 303 of 638) were not taking aspirin. At follow-up, 42.5% (82 of 193) of the men with incident PAD were not taking aspirin. Claudication at baseline was associated with twice the risk of cardiovascular death (hazard ratio, 2.00; 95% CI, 1.52-2.64). There was a J-shaped relationship between aortic diameter, and both prevalent claudication and subsequent cardiovascular events.

CONCLUSIONS

Among older men, claudication is prevalent and is associated with factors that can still be modified in older age, including smoking, exercise and diet. Relatively few men with claudication or at risk of PAD use aspirin. Claudication is a significant predictor of cardiovascular outcome.

Alcohol use and mortality in older men and women

AIMS

To compare the effect of alcohol intake on 10-year mortality for men and women over the age of 65 years.

DESIGN, SETTING AND PARTICIPANTS

Two prospective cohorts of community-dwelling men aged 65-79 years at baseline in 1996 (n = 11 727) and women aged 70-75 years in 1996 (n = 12 432).

MEASUREMENTS

Alcohol was assessed according to frequency of use (number of days alcohol was consumed per week) and quantity consumed per day. Cox proportional hazards models were compared for men and women for all-cause and cause-specific mortality.

FINDINGS

Compared with older adults who did not consume alcohol every week, the risk of all-cause mortality was reduced in men reporting up to four standard drinks per day and in women who consumed one or two drinks per day. One or two alcohol-free days per week reduced this risk further in men, but not in women. Similar results were observed for deaths due to cardiovascular disease.

CONCLUSIONS

In people over the age of 65 years, alcohol intake of four standard drinks per day for men and two standard drinks per day for women was associated with lower mortality risk. For men, the risk was reduced further if accompanied with 1 or 2 alcohol-free days per week.

Low free testosterone predicts frailty in older men: the health in men study

CONTEXT

The prevalence of frailty increases, whereas testosterone decreases, as men age. Low testosterone may be a risk factor for development of this syndrome.

OBJECTIVE

Our objective was to determine whether testosterone levels are associated with frailty.

DESIGN

We conducted a prospective cohort study.

SETTING AND PARTICIPANTS

Between 2001 and 2004, frailty was assessed in 3616 community-dwelling men aged 70-88 yr. Frailty was reassessed in 1586 men aged 76-93 yr in 2008-2009.

MAIN OUTCOME MEASURES

Frailty was assessed with the FRAIL scale, comprising five domains: fatigue, difficulty climbing a flight of stairs, difficulty walking more than 100 m, more than five illnesses present, or weight loss greater than 5%. Testosterone, SHBG, and LH were assayed at baseline. Free testosterone was calculated using mass action equations.

RESULTS

At baseline, 15.2% of men (n = 548) were frail (at least three deficits), increasing to 23.0% (n = 364) at follow-up. At baseline, each 1 sd decrease in total or free testosterone level was associated with increased odds of frailty [odds ratio (OR) = 1.23; 95% confidence interval (CI) = 1.11-1.38, and OR = 1.29; 95% CI = 1.15-1.44 for total and free testosterone, respectively]. Lower LH was associated with reduced odds of frailty (OR = 0.88; 95% CI = 0.81-0.95). Adjustments were made for age, body mass index, smoking, diabetes, social support, and other covariates. At follow-up, only lower free testosterone levels (OR = 1.22; 95% CI = 1.05-1.42) predicted frailty.

CONCLUSIONS

Lower free testosterone was independently associated with frailty at baseline and follow-up. Randomized trials should explore whether testosterone therapy can prevent the development of frailty.

Depression, antidepressant use and mortality in later life: the Health In Men Study

Context

Depression is associated with increased mortality, but it is unclear if this relationship is dose-dependent and if it can be modified by treatment with antidepressants.

Objective

To determine if (1) the association between depression and mortality is independent of other common potential causes of death in later life, (2) there is a dose-response relationship between increasing severity of depression and mortality rates, and (3) the use of antidepressant drugs reduces mortality rates.

Methods

Cohort study of 5,276 community-dwelling men aged 68–88 years living in Perth, Australia. We used the Geriatric Depression Scale 15-items (GDS-15) to ascertain the presence and severity of depression. GDS-15≥7 indicates the presence of clinically significant depression. Men were also grouped according to the severity of symptoms: “no symptoms” (GDS-15 = 0), “questionable” (1≤GDS-15≤4), “mild to moderate” (5≤GDS-15≤9), and “severe” (GDS-15≥10). Participants listed all medications used regularly. We used the Western Australian Data Linkage System to monitor mortality.

Results

There were 883 deaths between the study assessment and the 30th June 2008 (mean follow-up of participants: 6.0±1.1 years). The adjusted mortality hazard (MH) of men with clinically significant depression was 1.98 (95%CI = 1.61–2.43), and increased with the severity of symptoms: 1.39 (95%CI = 1.13–1.71) for questionable, 2.71 (95%CI = 2.13–3.46) for mild/moderate, and 3.32 (95%CI: 2.31–4.78) for severe depression. The use of antidepressants increased MH (HR = 1.31, 95%CI = 1.02–1.68). Compared with men who were not depressed and were not taking antidepressants, MH increased from 1.22 (95%CI = 0.91–1.63) for men with no depression who were using antidepressants to 1.85 (95%CI = 1.47–2.32) for participants who were depressed but were not using antidepressants, and 2.97 (95%CI = 1.94–4.54) for those who were depressed and were using antidepressants. All analyses were adjusted for age, educational attainment, migrant status, physical activity, smoking and alcohol use and the Charlson comorbidity index.

Conclusions

The mortality associated with depression increases with the severity of depressive symptoms and is largely independent of comorbid conditions. The use of antidepressants does not reduce the mortality rates of older men with persistent symptoms of depression.

Association between serum lipoproteins and abdominal aortic aneurysm

The importance of dyslipidemia in the etiology of abdominal aortic aneurysm (AAA) is poorly defined, in part because previous association analyses have often not considered the use of current lipid-modifying medications. Medications targeted at altering the concentrations of circulating lipids have an established role in occlusive atherosclerosis but are of unknown value in the primary prevention of AAA. We examined the association between fasting serum levels of triglycerides low- and high-density lipoprotein and the presence of an AAA in a cohort of 3,327 men aged 65 to 83 years. The analyses were adjusted for established risk factors of AAA and the prescription of lipid-modifying agents using multiple logistic regression analysis. Of the 3,327 men, 1,043 (31%) were receiving lipid-modifying therapy at the fasting lipid measurement. The lipid-modifying therapy was statins in most cases (n = 1,023). The serum high-density lipoprotein concentrations were lower in patients with AAAs. The serum high-density lipoprotein concentration was independently associated with a reduced risk of having an AAA in men not receiving current lipid-modifying therapy (odds ratio 0.72, 95% confidence interval 0.56 to 0.93 per 0.4-mM increase) and in the total cohort (odds ratio 0.76, 95% confidence interval 0.63 to 0.91 per 0.4-mM increase, adjusted for lipid-modifying therapy). The concentrations of low-density lipoprotein and triglycerides were not associated with the presence of AAAs. In conclusion, high-density lipoprotein appeared to be the most important lipid in predicting the risk of AAA development, with potential value as a therapeutic target. Current cardiovascular strategies aimed at lowering low-density lipoprotein might not have any effect on the prevention of AAAs.

The novel association of the chemokine CCL22 with abdominal aortic aneurysm

The aim of this study was to examine aortic biopsies with a cytokine array to identify new cytokines associated with abdominal aortic aneurysm (AAA). We assessed the relative expression of 79 cytokines using antibody-based cytokine arrays in a total of 12 AAA and 12 control aortic biopsies. Based on these findings we validated the findings for one cytokine by examining a further 11 AAA and 11 atherothrombosis biopsies and serum from 1028 men, 315 of whom had an AAA. Three cytokines (interleukins 1B and 8, and Chemokine CC motif ligand 22 [CCL22]) were consistently up-regulated in AAA biopsies. Since CCL22 had not previously been associated with aortic dilatation, we confirmed the upregulation of this cytokine in further tissue biopsies and serum using enzyme-linked immunosorbent assay. Median serum concentrations of CCL22 were greater in men with AAA (0.69 ng/ml) than controls (0.56 ng/ml, P < 0.01). Serum CCL22 was independently associated with both small (OR 1.51, 95% CI 1.21-1.88) and large AAA (OR 1.33, 95% CI 1.08-1.62) after adjusting for other risk factors. The association between CCL22 and AAA was also confirmed using immunohistochemistry. The results presented in this study demonstrate a novel association between CCL22 and AAA as well as illustrate how a protein array can be used to identify novel markers of potential pathogenic and diagnostic significance for AAA.

The B-VITAGE trial: a randomized trial of homocysteine lowering treatment of depression in later life

Background

Depression is a leading cause of disability worldwide and depressive symptoms are common in later life. Observational evidence suggests that depression is more prevalent among people with high plasma homocysteine (tHcy), but the results of randomized trials to date have been unable to show that lowering tHcy through the supplementation of vitamins B₆, B₁₂ and folate benefits depressive symptoms. We designed the B-VITAGE trial to determine whether adjunctive treatment with vitamins B₆, B₁₂ and folate increases the efficacy of standard antidepressant treatment.

Methods/Design

The B-VITAGE trial is a 12-month randomized, double-blind, placebo-controlled trial of daily citalopram (20 to 40 mg) plus B₁₂(0.4 mg), B₆ (25 mg) and folic acid (2 mg) or citalopram (20 to 40 mg) plus placebo for the treatment of depression in later life. The trial aims to recruit over 300 older adults with major depression (DSM-IV) and has been powered to detect the impact of an intervention associated with moderate effect size. Depressive symptoms will be rated with the Montgomery-Åsberg Depression Rating Scale (MADRS). The trial has two main outcomes of interest: a reduction of 50% or more in the MADRS total score between baseline and week 12 and the remission of the depressive episode at weeks 12, 26 and 52 according to DSM-IV criteria. We hypothesize that subjects randomly allocated to the vitamin arm of the study will be more likely to show a clinically significant improvement and achieve and maintain remission of symptoms at 12, 26 and 52 weeks. Secondary outcomes of interest include compliance with treatment, reduction in the severity of depressive symptoms, switching to different antidepressants, the use of non-pharmacological antidepressant treatments, response to treatment according to MTHFRC677T genotype, and changes in cognitive function over 52 weeks.

Conclusions

The results of this trial will clarify whether the systematic use of B-vitamins improves the response of older adults to standard antidepressant treatment. We anticipate that our findings will have implications for clinical practice and health policy development.

Trial Registration

The trial is registered with the Australian Clinical Trials Registry, trial number (())ACTRN12609000256279.

Association of PPARgamma allelic variation, osteoprotegerin and abdominal aortic aneurysm

OBJECTIVE

We have previously demonstrated high concentrations of the glycoprotein osteoprotegerin (OPG) in biopsies of abdominal aortic aneurysm (AAA), and demonstrated that ligation of the nuclear receptor peroxisome proliferator-activated receptor gamma (PPARgamma) downregulates OPG in vitro and within a mouse model. The aims of this study were to assess the associations between circulating concentrations of OPG, polymorphisms of the gene encoding PPARgamma (PPARG), AAA presence and growth.

DESIGN, PATIENTS AND MEASUREMENTS

Two genetic polymorphisms in PPARG were assessed in 4227 men, 699 of whom had an AAA. For 631 men, who had AAAs, maximum aortic diameter was monitored by yearly ultrasound for a median of 5 years. Plasma OPG was measured in 838 men, 318 of whom had an AAA.

RESULTS

Plasma concentrations of OPG were independently associated with AAA (adjusted odds ratio 1.38, 95% CI 1.10-1.72). The PPARG c.1347C > T polymorphism was associated with plasma concentrations of OPG (beta 0.12, P < 0.01). The PPARG c.34G > C polymorphism was weakly associated with AAA (adjusted odds ratio 1.28, 95% CI 1.01-1.61). PPARG c.1347C > T was associated with increased AAA growth (recessive model, P = 0.03).

CONCLUSIONS

Circulating concentrations of osteoprotegerin are associated with abdominal aortic aneurysm and with one peroxisome proliferator-activated receptor gamma gene polymorphism. Peroxisome proliferator-activated receptor gamma gene polymorphisms are weakly associated with abdominal aortic aneurysm presence and growth. Confirmation of these findings is required in other cohorts.

Obesity and metabolic syndrome increase the risk of incident depression in older men: the health in men study

BACKGROUND

Obesity has been associated with increased risk of prevalent depression among young and middle-aged adults, but the association between obesity (and its various measures, including the metabolic syndrome [MetS]) and incident depression has not been examined adequately in the elderly.

OBJECTIVES

This study evaluated the association between various measures of obesity and incident depression over a 10-year period in a large cohort of community-based older men.

METHODS

The authors recruited 12,216 men aged 65-84 years living in Perth, Australia, between 1996 and 1998, and measured their height, weight, waist and hip circumference, and blood pressure. Participants also completed a questionnaire that included information about the clinical diagnosis and treatment for diabetes, hypertension, and high cholesterol or triglycerides. The authors then used the Western Australian Linked Data System to retrieve information about the following ICD-10 diagnoses between January 1, 1966, and December 31, 2006: depressive episode, recurrent depressive disorder, and dysthymia.

RESULTS

The authors excluded 150 men from these analyses because of prior history of depression or missing data. The mean age of our 12,066 participants was 72 +/- 4 years at the time of recruitment, and they were followed up for an average of 8 +/- 2 years. There were 3,623 deaths during follow-up, and 481 men received the diagnosis of depression. The incidence of depression was 5 per 1,000 person-years. Adjusted Cox proportional hazard models showed that men with body mass index (BMI) > or =30 had a 31% (95% confidence interval [CI] = 5%-64%) increase in the risk of depression compared with that of nonobese men (BMI <30). The association between depression and waist circumference > or =102 cm and waist/hip > or =1 did not reach statistical significance. Men with MetS at the time of recruitment had a 137% (95% CI = 60%-251%) increase in the adjusted risk of incident depression.

CONCLUSIONS

Our results indicate that obesity and MetS are associated with an increase in the risk of incident depression among older men. If this association is truly causal, reducing the prevalence of obesity and MetS could potentially lead to a decline in the prevalence and incidence of depression in later life.

Apolipoprotein E genotype is associated with serum C-reactive protein but not abdominal aortic aneurysm

OBJECTIVE

Apolipoprotein E (ApoE) genotype has been associated with systemic inflammation and athero-thrombosis however the association with abdominal aortic aneurysm (AAA) has not been previously examined. We assessed the association between ApoE genotype with AAA presence and growth, and serum C-reactive protein (CRP).

METHODS

Serum concentrations of CRP (in 1358 men) and 6 single nucleotide polymorphisms (SNPs) for ApoE (in 1711 men) were examined in subjects from the Health In Men Study. 640 men with small AAAs were followed by ultrasound surveillance for a mean of 4.1 years.

RESULTS

There was no association between ApoE genotype and AAA presence. Men heterozygote for the ApoE p.Arg176Cys polymorphism had slower AAA growth, odds ratio for AAA progression> or =median 0.41, 95% confidence intervals 0.21-0.80, p=0.01. Men heterozygote for the ApoE g.50093756A>G polymorphism had slightly more rapid AAA growth, odds ratio for AAA progression> or =median 1.48, 95% confidence intervals 1.02-2.14, p=0.04. None of the ApoE SNPs were associated with AAA growth however taking into account multiple testing. Two SNPs in ApoE were associated with serum CRP under a co-dominant model, ApoE p.Cys130Arg (SNP ID rs429358), p=0.00003 and ApoE g.50114786A>G (SNP ID rs4420638), p=0.00013. Adjusting for other risk factors plus serum creatinine the varepsilon4 allele was associated with lower serum CRP under a dominant model, coefficient 0.089, p=0.002.

CONCLUSION

We found no consistent association between ApoE genotype and AAA. We confirmed an association between ApoE genotype and serum CRP.

Lower testosterone levels predict incident stroke and transient ischemic attack in older men

CONTEXT

Lower circulating testosterone concentrations are associated with metabolic syndrome, type 2 diabetes, carotid intima-media thickness, and aortic and lower limb arterial disease in men. However, it is unclear whether lower testosterone levels predict major cardiovascular events.

OBJECTIVE

We examined whether lower serum testosterone was an independently significant risk factor for symptomatic cerebrovascular events in older men.

DESIGN

This was a prospective observational study with median follow-up of 3.5 yr.

SETTING

Community-dwelling, stroke-free older men were studied.

PARTICIPANTS

A total of 3443 men at least 70 yr of age participated in the study.

MAIN OUTCOME MEASURES

Baseline serum total testosterone, SHBG, and LH were assayed. Free testosterone was calculated using mass action equations. Incident stroke or transient ischemic attack (TIA) was recorded.

RESULTS

A first stroke or TIA occurred in 119 men (3.5%). Total and free testosterone concentrations in the lowest quartiles (<11.7 nmol/liter and <222 pmol/liter) were associated with reduced event-free survival (P = 0.014 and P = 0.01, respectively). After adjustment including age, waist-hip ratio, waist circumference, smoking, hypertension, dyslipidemia, and medical comorbidity, lower total testosterone predicted increased incidence of stroke or TIA (hazard ratio = 1.99; 95% confidence interval, 1.33-2.99). Lower free testosterone was also associated (hazard ratio = 1.69; 95% confidence interval, 1.15-2.48), whereas SHBG and LH were not independently associated with incident stroke or TIA.

CONCLUSIONS

In older men, lower total testosterone levels predict increased incidence of stroke or TIA after adjusting for conventional risk factors for cardiovascular disease. Men with low-normal testosterone levels had increased risk. Further studies are warranted to determine whether interventions that raise circulating testosterone levels might prevent cerebrovascular disease in men.

Possible association between genetic polymorphisms in transforming growth factor beta receptors, serum transforming growth factor beta1 concentration and abdominal aortic aneurysm

BACKGROUND

Previous studies have suggested a role for transforming growth factor (TGF) beta and its receptor in thoracic aortic aneurysm, but their role in abdominal aortic aneurysm (AAA) is unknown. This study examined the possible association between TGF-beta receptor 1 and 2 (TGFBR-1 and -2) single nucleotide polymorphisms (SNPs) and serum TGF-beta1 with AAA.

METHODS

Serum concentrations of TGF-beta1 and 58 SNPs for TGFBR-1 and -2 were examined in 1003 and 1711 men respectively from the Health In Men Study. Validation of SNPs was examined in a second referral cohort of 1043 subjects from New Zealand, of whom 654 had an AAA.

RESULTS

Serum TGF-beta1 was not associated with AAA. Only one SNP in TGFBR-2 was weakly associated with AAA; TGFBR2 g.42917C > T, SNP ID rs1078985CC; odds ratio 0.64 (95 per cent confidence interval (c.i.) 0.45 to 0.93); P = 0.020 uncorrected; but this association did not hold after adjusting for multiple testing and was not validated in the New Zealand cohort: odds ratio 0.98 (95 per cent c.i. 0.50 to 1.94); P = 0.960.

CONCLUSION

These findings suggest there is no important role of genetic polymorphisms in the main receptors for TGF-beta and circulating TGF-beta1 in AAA in older individuals. (c) 2009 British Journal of Surgery Society Ltd.

Polymorphisms of the CRP gene inhibit inflammatory response and increase susceptibility to depression: the Health in Men Study

BACKGROUND

Depression has been associated with chronic changes in the serum concentration of C-reactive protein (CRP) in observational studies, but it is unclear if this association is causal or is due to confounding and bias. Genetic studies are less subject to this type of error and offer an opportunity to investigate if CRP is causally linked to depression, particularly because known polymorphisms of the CRP gene have been associated with high- and low-basal serum concentrations of CRP [single nucleotide polymorphisms (SNPs) rs1130864 and rs1205, respectively]. The aim of this study is to determine if polymorphisms of SNPs rs1130864 and rs1205 are associated with prevalent depression.

METHODS

We completed a cross-sectional study of a community sample of 3700 men aged > or = 70 years, and used the 15-item Geriatric Depression Scale (GDS-15) to assess depressive symptoms. A GDS-15 score 7 or more indicates the presence of clinically significant depressive symptoms. Physical morbidity was assessed with the physical component summary score (PCS) of the SF-36 Health Survey. We collected fasting blood samples to measure high sensitivity CRP and to extract DNA for the genotyping of SNPs rs1130864 and rs1205 of the CRP gene.

RESULTS

One hundred and eighty-two men were depressed (4.9%). The odds of depression increased by 2% (95% CI = 1-4%) for every unit (mg/l) increase of CRP and nearly doubled for men with CRP > or = 3 mg/l vs <1 mg/l [odds ratio (OR) = 1.95, 95% confidence interval (CI) = 1.27-2.98]. However, the association between high CRP (> or = 3 mg/l) and depression was no longer significant after the analyses were adjusted for smoking, age, body mass index (BMI) and PCS. Men with the CT and TT genotypes of rs1130864 had 1.36 (95% CI = 1.13-1.63) and 2.31 (95% CI = 1.65-3.24) greater odds of CRP > or = 3 mg/l than CC carriers, but there was no association between this polymorphism and the presence of prevalent depression. The G > A polymorphism of SNP rs1205 was associated with 24% (95% CI = 16-32%) lower concentration of CRP compared with other genotypes. Men with the rs1205 AA genotype had 1.66 (95% CI = 1.07-2.57) and 1.67 (95% CI = 1.08-2.58) greater odds of having clinically significant depression than participants with the GA and GG genotypes, respectively.

CONCLUSION

Our study shows that clinically significant depressive symptoms in later life are unlikely to be caused by an increase in the serum concentration of CRP. Instead, we found that the risk of depression was greater amongst people who carry the rs1205 G > A genetic polymorphism of the CRP gene, which was associated with approximately 20% lower serum concentration of CRP compared with other genotypes. This suggests that CRP may be a compensatory response to external insults that predispose to depression, and that an increase in the concentration of CRP might be adaptive.

Polymorphisms of the matrix metalloproteinase 9 gene and abdominal aortic aneurysm

BACKGROUND

Increased matrix metalloproteinase (MMP) 9 activity has been implicated in the formation of abdominal aortic aneurysm (AAA). The aim was to explore the association between potentially functional variants of the MMP-9 gene and AAA.

METHODS

The -1562C > T and -1811A > T variants of the MMP-9 gene were genotyped in 678 men with an AAA (at least 30 mm in diameter) and 659 control subjects (aortic diameter 19-22 mm) recruited from a population-based trial of screening for AAA. Levels of MMP-9 were measured in a random subset of 300 cases and 84 controls. The association between genetic variants (including haplotypes) and AAA was assessed by multivariable logistic regression.

RESULTS

There was no association between the MMP-9-1562C > T (odds ratio (OR) 0.70 (95 per cent confidence interval (c.i.) 0.27 to 1.82)) or -1811A > T (OR 0.71 (95 per cent c.i. 0.28 to 1.85)) genotypes, or the most common haplotype (OR 0.81 (95 per cent c.i. 0.62 to 1.05)) and AAA. The serum MMP-9 concentration was higher in cases than controls, and in minor allele carriers in cases and controls, although the differences were not statistically significant.

CONCLUSION

In this study, the genetic tendency to higher levels of circulating MMP-9 was not associated with AAA.