P4660Lipoprotein particle profiles compared with standard lipids in the association with sub-clinical aortic valve calcification in apparently healthy Japanese men

Introduction

Calcific aortic valve disease (CAVD) is one of the most common heart diseases worldwide, and its prevalence has increased in developed countries along with aging populations. Subclinical CAVD is characterized by aortic valve calcification (AVC) that may lead to aortic stenosis. AVC shares the same risk factors with atherosclerotic disease. Recently, nuclear magnetic resonance (NMR)-based lipoprotein particles, low-density and high-density lipoprotein particles (LDL-p, HDL-p) in particular, have emerged as novel markers of atherosclerotic disease. It has been unclear, however, whether NMR-based particles are associated with AVC.

Purpose

To examine cross-sectional association of NMR-based lipoprotein particles, standard lipids with AVC, and compare their strengths of association.

Methods

We studied a community-based random sample of Japanese men aged 40–79 years examined in 2006–08 in Japan. We excluded participants with history of myocardial infarction, stroke, aortic valve surgery, serum triglyceride concentration ≥400 mg/dl, estimated glomerular filtration rate (eGFR) <30 (ml/min/1.73m2), and use of lipid-lowering medication. We scored the degree of AVC according to Agatston's method, and defined prevalent AVC as the score >0. Lipoprotein particles were measured using NMR spectroscopy.

In our main analysis, we obtained multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (95% CI) of prevalent AVC in the top quartile (Q4) for each lipid index in reference to the lowest quartile (Q1). Adjusting covariates include age, smoking, drinking, systolic blood pressure, glycated hemoglobin, medications for hypertension and/or for diabetes, eGFR, C-reactive protein. For sensitivity analysis, we repeated similar analyses presenting ORs per 1 standard deviation (SD) higher NMR-lipoproteins particles or standard lipids.

Results

Of 874 participants we analyzed, 153 (17.5%) men had AVC. The average (SD) age was 63.3 (10.0) years. Those with AVC tended to be older, likely to have clustering of atherosclerotic risk factors. Multivariable-adjusted ORs of prevalent AVC for Q4 versus Q1 were significantly positive for LDL-p [OR, 2.21 (95% CI: 1.24, 3.95] and low-density lipoprotein cholesterol (LDL-c) [2.17 (1.24, 3.80)]. In contrast, neither HDL-p nor high-density lipoprotein cholesterol (HDL-c) was significantly associated with AVC. In sensitivity analyses, however, the corresponding ORs per 1SD higher lipids/lipoprotein particles were smaller in LDL-p [1.33 (1.09, 1.63)] than LDL-c [1.41 (1.15, 1.73)]. The association of HDL-p became significant [1.28 (1.02, 1.61)] (per 1SD decrement) in the sensitivity analysis.

Conclusion

The overall associations of AVC with NMR-based lipoprotein particles (i.e. LDL-p, HDL-p) are comparable to those of standard lipids. This finding is parallel to the association between atherosclerotic cardiovascular diseases with NMR-based lipoproteins.

Association between excessive supraventricular ectopy and subclinical cerebrovascular disease: a population-based study

BACKGROUND AND PURPOSE

The association between an increased supraventricular ectopic beat (SVEB) and subclinical cerebrovascular disease remains unclear. Given the emerging concept that an increased SVEB is a marker of atrial cardiomyopathy or atherosclerosis burden, we sought to determine whether excessive supraventricular ectopic activity (ESVEA) is associated with a higher burden of subclinical cerebrovascular disease in the middle-aged to older cohort with neither apparent stroke nor atrial fibrillation.

METHODS

We conducted a cross-sectional population-based study of 462 men (mean age, 68.1 years) who underwent 24-h Holter electrocardiography and brain magnetic resonance imaging. ESVEA was defined as the presence of >10 SVEBs/h. Subclinical cerebrovascular diseases were defined as silent brain infarct (SBI), white matter hyperintensity (WMH) and intracranial atherosclerotic stenosis (ICAS). The association of ESVEA with the presence of subclinical cerebrovascular diseases was adjusted for potential confounding covariates.

RESULTS

A total of 88 (19.0%) participants had ESVEA and 81 (17.5%), 91 (19.7%) and 109 (23.6%) had SBI, WMH and ICAS, respectively. In multivariable-adjusted Poisson regression with robust error variance, ESVEA was associated with the presence of WMH (relative risk, 1.58; 95% confidence interval, 1.06-2.36) and ICAS (relative risk, 1.49; 95% confidence interval, 1.02-2.18), but not with that of SBI (relative risk, 1.32; 95% confidence interval, 0.86-2.01). These associations were consistent when the graded distributions of subclinical cerebrovascular diseases were applied as outcomes in ordinal logistic regression.

CONCLUSIONS

The ESVEA was independently associated with higher burdens of WMH and ICAS. This suggests that increased SVEBs might improve risk stratification of individuals at high risk of subclinical cerebrovascular disease and consequently apparent ischaemic stroke.

The Associations of C-Reactive Protein with Serum Levels of Polyunsaturated Fatty Acids and Trans Fatty Acids Among Middle-Aged Men from Three Populations

BACKGROUND

C-reactive protein (CRP) and many fatty acids (FAs) have been linked to cardiovascular disease. Associations of serum CRP with FAs in different populations have not been established.

METHODS

Participants were 926 men aged 40-49 (2002-2006) from a population-based sample; 310 Whites from Pennsylvania, U.S., 313 Japanese from Shiga, Japan, and 303 Japanese Americans from Hawaii, U.S. Serum CRP (mg/L) was measured using immunosorbent assay while serum FAs (%) were measured using capillary-gas-liquid chromatography.

RESULTS

Whites had CRP (mg/L) levels higher than Japanese with Japanese Americans in-between (age-adjusted geometric mean "GM" 0.96, 0.38, 0.66, respectively). Whites had also higher levels of total n-6 FAs (%) and trans fatty acids (TFAs) but lower levels of marine-derived n-3 FAs compared to Japanese (41.78 vs. 35.05, 1.04 vs. 0.58, and 3.85 vs. 9.29, respectively). Japanese Americans had FAs levels in-between the other two populations. Whites had significant inverse trends between CRP and tertiles of total n-6 FAs (GM 1.20, 0.91 and 0.80; p=0.002) and marine-derived n-3 FAs (GM 1.22, 1.00 and 0.72; p<0.001) but a significant positive trend with TFAs (GM 0.80, 0.95 and 1.15; p=0.007). Japanese had a significant inverse trend between CRP and only total n-6 FAs (GM 0.50, 0.35 and 0.31; p<0.001). Japanese Americans had CRP associations with n-3 FAs, n-6 FAs, and TFAs similar to but weaker than Whites.

CONCLUSIONS

With the exception of consistent inverse association of CRP with total n-6 FAs, there are considerable variations across the three populations in the associations of CRP with different FAs.

Four to seven random casual urine specimens are sufficient to estimate 24-h urinary sodium/potassium ratio in individuals with high blood pressure

This study was done to clarify the optimal number and type of casual urine specimens required to estimate urinary sodium/potassium (Na/K) ratio in individuals with high blood pressure. A total of 74 individuals with high blood pressure, 43 treated and 31 untreated, were recruited from the Japanese general population. Urinary sodium, potassium and Na/K ratio were measured in both casual urine samples and 7-day 24-h urine samples and then analyzed by correlation and Bland–Altman analyses. Mean Na/K ratio from random casual urine samples on four or more days strongly correlated with the Na/K ratio of 7-day 24-h urine (r=0.80–0.87), which was similar to the correlation between 1 and 2-day 24-h urine and 7-day 24-h urine (r=0.75–0.89). The agreement quality for Na/K ratio of seven random casual urine for estimating the Na/K ratio of 7-day 24-h urine was good (bias: −0.26, limits of agreements: −1.53–1.01), and it was similar to that of 2-day 24-h urine for estimating 7-day 24-h values (bias: 0.07, limits of agreement: −1.03 to 1.18). Stratified analyses comparing individuals using antihypertensive medication and individuals not using antihypertensive medication showed similar results. Correlations of the means of casual urine sodium or potassium concentrations with 7-day 24-h sodium or potassium excretions were relatively weaker than those for Na/K ratio. The mean Na/K ratio of 4–7 random casual urine specimens on different days provides a good substitute for 1–2-day 24-h urinary Na/K ratio for individuals with high blood pressure.

Factors associated with mortality of myxedema coma: report of eight cases and literature survey

High-dose thyroid hormone replacement has been recommended for treatment of myxedema coma (MC) while questions of safety of the therapy and of efficacy of low-dose thyroid hormone replacement have not been systematically addressed. We treated 8 patients with MC in a period of 18 years, the first 3 with high-dose intravenous injections of levotriiodothyronine (LT3) and the other 5 patients with a smaller amount of either LT3 or levothyroxine (LT4). Two of the first 3 patients died of pneumonia and the other 5 recovered despite pulmonary abnormalities at the outset. To find factors associated with fatal outcome after treatment, the MEDLINE database was searched for MC cases with data of thyroid hormone replacement and outcome within 1 month of therapy. Clinical data for our 5 patients and 82 cases from the MEDLINE search were pooled and factors associated with mortality were sought among age, gender, presence of cardiac or pulmonary complications, and doses of thyroid hormone by multiple logistic regression analysis. It revealed that greater age, cardiac complications, and high-dose thyroid hormone replacement (LT4 > or = 500 microg/d or LT3 > or = 75 microg/d) were significantly associated with a fatal outcome within 1 month of treatment. Elderly MC patients can be treated with low-dose hormone replacement. A bolus of 500 microg LT4, especially by mouth or via nasogastric tube, appears to be tolerated by younger patients (< 55 years) without cardiac complication. The conclusion remains to be confirmed in more patients.