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Graham IM, Gillespie D, Gkikopoulou KC, Hastie GD, Thompson PM. Directional hydrophone clusters reveal evasive responses of small cetaceans to disturbance during construction at offshore windfarms. Biol Lett 2023; 19:20220101. [PMID: 36651028 PMCID: PMC9845968 DOI: 10.1098/rsbl.2022.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mitigation measures to disperse marine mammals prior to pile-driving include acoustic deterrent devices and piling soft starts, but their efficacy remains uncertain. We developed a self-contained portable hydrophone cluster to detect small cetacean movements from the distributions of bearings to detections. Using an array of clusters within 10 km of foundation pile installations, we tested the hypothesis that harbour porpoises (Phocoena phocoena) respond to mitigation measures at offshore windfarm sites by moving away. During baseline periods, porpoise movements were evenly distributed in all directions. By contrast, animals showed significant directional movement away from sound sources during acoustic deterrent device use and piling soft starts. We demonstrate that porpoises respond to measures aimed to mitigate the most severe impacts of construction at offshore windfarms by swimming directly away from these sound sources. Portable directional hydrophone clusters now provide opportunities to characterize responses to disturbance sources across a broad suite of habitats and contexts.
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Affiliation(s)
- I. M. Graham
- Lighthouse Field Station, School of Biological Sciences, University of Aberdeen, Cromarty, Ross-shire IV11 8YL, Scotland
| | - D. Gillespie
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, Fife KY16 8LB, Scotland
| | - K. C. Gkikopoulou
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, Fife KY16 8LB, Scotland
| | - G. D. Hastie
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, Fife KY16 8LB, Scotland
| | - P. M. Thompson
- Lighthouse Field Station, School of Biological Sciences, University of Aberdeen, Cromarty, Ross-shire IV11 8YL, Scotland
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Butler JRA, Young JC, McMyn IAG, Leyshon B, Graham IM, Walker I, Baxter JM, Dodd J, Warburton C. Evaluating adaptive co-management as conservation conflict resolution: Learning from seals and salmon. J Environ Manage 2015; 160:212-225. [PMID: 26144563 DOI: 10.1016/j.jenvman.2015.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/12/2015] [Accepted: 06/08/2015] [Indexed: 06/04/2023]
Abstract
By linking iterative learning and knowledge generation with power-sharing, adaptive co-management (ACM) provides a potential solution to resolving complex social-ecological problems. In this paper we evaluate ACM as a mechanism for resolving conservation conflict using a case study in Scotland, where seal and salmon fishery stakeholders have opposing and entrenched objectives. ACM emerged in 2002, successfully resolving this long-standing conflict. Applying evaluation approaches from the literature, in 2011 we interviewed stakeholders to characterise the evolution of ACM, and factors associated with its success over 10 years. In common with other ACM cases, triggers for the process were shifts in slow variables controlling the system (seal and salmon abundance, public perceptions of seal shooting), and exogenous shocks (changes in legal mandates, a seal disease outbreak). Also typical of ACM, three phases of evolution were evident: emerging local leadership preparing the system for change, a policy window of opportunity, and stakeholder partnerships building the resilience of the system. Parameters maintaining ACM were legal mechanisms and structures, legal power held by government, and the willingness of all stakeholders to reach a compromise and experiment with an alternative governance approach. Results highlighted the critical role of government power and support in resolving conservation conflict, which may constrain the extent of local stakeholder-driven ACM. The evaluation also demonstrated how, following perceived success, the trajectory of ACM has shifted to a 'stakeholder apathy' phase, with declining leadership, knowledge exchange, stakeholder engagement, and system resilience. We discuss remedial actions required to revive the process, and the importance of long term government resourcing and alternative financing schemes for successful conflict resolution. Based on the results we present a generic indicator framework and participatory method for the longitudinal evaluation of ACM applied to conservation conflict resolution.
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Affiliation(s)
- J R A Butler
- CSIRO Land and Water Flagship, GPO Box 2583, Brisbane, QLD, 4001, Australia.
| | - J C Young
- NERC Centre for Ecology and Hydrology, Bush Estate, Penicuik, EH26 0QB, UK.
| | - I A G McMyn
- ECUS Ltd., Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, UK.
| | - B Leyshon
- Scottish Natural Heritage, Dingwall Business Park, Dingwall, Ross-shire, IV15 9XB, UK.
| | - I M Graham
- Lighthouse Field Station, Institute of Biological and Environmental Sciences, University of Aberdeen, Cromarty, IV11 8YL, UK.
| | - I Walker
- Scottish Government Wildlife and Habitats Division, Area G-H93, Victoria Quay, Edinburgh, EH6 6QQ, UK.
| | - J M Baxter
- Scottish Natural Heritage, Silvan House, 3rd Floor East, 231 Corstorphine Road, Edinburgh, EH12 7AT, UK.
| | - J Dodd
- Scottish Natural Heritage, Cameron House, Oban, Argyll, PA34 4AE, UK.
| | - C Warburton
- Wild Scotland, Old Town Jail, St. John Street, Stirling, FK8 1EA, UK.
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Elshorbagy AK, Valdivia-Garcia M, Graham IM, Palma Reis R, Sales Luis A, Smith AD, Refsum H. The association of fasting plasma sulfur-containing compounds with BMI, serum lipids and apolipoproteins. Nutr Metab Cardiovasc Dis 2012; 22:1031-1038. [PMID: 21550220 DOI: 10.1016/j.numecd.2011.01.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 11/27/2010] [Accepted: 01/04/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Sulfur amino acids are recognized as potent modulators of lipid metabolism. Plasma total cysteine (tCys) is associated with fat mass, obesity and serum LDL-cholesterol and apolipoprotein (Apo)-B in large population studies. It is not known how fasting plasma concentrations of cysteine precursors and products relate to these associations in humans, given that sulfur-containing compounds (SCC) influence rodent weight gain and serum lipids. METHODS AND RESULTS We investigated the cross-sectional associations of fasting plasma SCC (methionine, total homocysteine, cystathionine, tCys, taurine and total glutathione) with BMI and fasting serum lipids and apolipoproteins in 854 men and women with and without cardiovascular disease (CVD). In multiple linear regression analysis adjusted for age, gender, CVD and other SCC, neither methionine, taurine, nor total glutathione was associated with BMI. Plasma taurine was, however, inversely related to HDL-cholesterol (partial r = -0.12, p = 0.004) and its associated apoA1 (partial r = -0.18, p < 0.001). Plasma cystathionine correlated positively with triglycerides and BMI, while tCys positively correlated with total cholesterol, LDL-cholesterol (partial r = 0.20, p < 0.001) and its associated apoB. The associations of SCC with serum lipids were independent of BMI. tCys was also independently associated with BMI (partial r = 0.20, p < 0.001) after adjustment for other SCC, glucose, lipids and apolipoproteins. CONCLUSIONS Fasting tCys is associated with BMI independently of metabolically related SCC. Elevation of plasma SCC is generally associated with an unfavorable lipid profile. The negative relations of plasma taurine with HDL-C and apoA1 deserve further investigation.
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Abstract
Homocysteine is an amino acid that appears to damage the vascular endothelium and promote thrombosis. The most frequent causes of hyperhomocyst(e)inemia are the inherited defect of the enzyme cystathinonine B-synthase and nutritional deficiency of vitamin B(12) or folate. Hyperhomocyst(e)inemia is associated, perhaps causally, with atherosclerotic vascular disease. Interactions with risk factors such as cigarette smoking, hyperlipidemia, and hypertension are possible, but not yet defined. Dietary supplementation with vitamin B(12), folate, and other substances can reduce homocysteine levels. Such simple measures may reduce the risk of vascular disease in hyperhomocyst(e)inemic subjects.
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Affiliation(s)
- I M Graham
- Department of Cardiology, Adelaide Hospital, Dublin, Ireland
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Affiliation(s)
| | - R. N. Harris
- Sea Mammal Research Unit; Scottish Oceans Institute; University of St Andrews; St Andrews; UK
| | - S. J. Middlemas
- Marine Scotland Freshwater Laboratory; Faskally; Pitlochry; UK
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Moore DM, Nadarajan P, Hawksworth R, Lane SJ, Graham IM. Exercise induced fatigue: unfit or unwell? Ir Med J 2011; 104:151. [PMID: 21736093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This case report outlines the diagnoses of a rare myophosphorylase deficiency (McArdle Syndrome) in a unique way. A set of characteristic values from a Cardiopulmonary Exercise Test (CPET) combined with a typical patient history pointed to a failure of the glycolytic pathway in the skeletal muscle. McArdle Syndrome was confirmed with a skeletal muscle biopsy. There is no evidence of such a diagnostic method in the literature.
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Tobin AM, Hughes R, Hand EB, Leong T, Graham IM, Kirby B. Homocysteine status and cardiovascular risk factors in patients with psoriasis: a case-control study. Clin Exp Dermatol 2010; 36:19-23. [DOI: 10.1111/j.1365-2230.2010.03877.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Newey S, Allison P, Thirgood S, Smith AA, Graham IM. Population and individual level effects of over-winter supplementary feeding mountain hares. J Zool (1987) 2010. [DOI: 10.1111/j.1469-7998.2010.00728.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dudina AL, Moore DP, Keogh B, Foley D, Graham IM. Chest pain and hypertension in an 18 year old girl. Ir Med J 2008; 101:285-286. [PMID: 19051620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We describe the case of an 18 year old lady who presented with chest pain, breathlessness and hypertension. The initial diagnosis of renal artery stenosis, while correct, was incomplete. The finding of a reduced right radial pulse suggested the possibility of a large vessel vasculitis. She was also found to have critical coronary artery disease that required stenting and aortic incompetence. Renal artery stenting was also performed. Additional investigations confirmed Takayasu's arteritis. With immunosuppressive therapy and stenting she is now well and normotensive but may require aortic valve replacement in the future.
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Grimes T, Delaney T, Duggan C, Kelly JG, Graham IM. Survey of medication documentation at hospital discharge: implications for patient safety and continuity of care. Ir J Med Sci 2008; 177:93-7. [PMID: 18414970 DOI: 10.1007/s11845-008-0142-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 02/15/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medication discrepancies at the time of hospital discharge are common and can result in error, patient/carer inconvenience or patient harm. Providing accurate medication information to the next care provider is necessary to prevent adverse events. AIMS To investigate the quality and consistency of medication details generated for such transfer from an Irish teaching hospital. METHODS This was an observational study of 139 cardiology patients admitted over a 3 month period during which a pharmacist prospectively recorded details of medication inconsistencies. RESULTS A discrepancy in medication documentation at discharge occurred in 10.8% of medication orders, affecting 65.5% of patients. While patient harm was assessed, it was only felt necessary to contact three (2%) patients. The most common inconsistency was drug omission (20.9%). CONCLUSIONS Inaccuracy of medication information at hospital discharge is common and compromises quality of care.
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Affiliation(s)
- T Grimes
- School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
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Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, De Bacquer D, Ducimetière P, Jousilahti P, Keil U, Njølstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24:987-1003. [PMID: 12788299 DOI: 10.1016/s0195-668x(03)00114-3] [Citation(s) in RCA: 3417] [Impact Index Per Article: 162.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIMS The SCORE project was initiated to develop a risk scoring system for use in the clinical management of cardiovascular risk in European clinical practice. METHODS AND RESULTS The project assembled a pool of datasets from 12 European cohort studies, mainly carried out in general population settings. There were 20,5178 persons (88,080 women and 11,7098 men) representing 2.7 million person years of follow-up. There were 7934 cardiovascular deaths, of which 5652 were deaths from coronary heart disease. Ten-year risk of fatal cardiovascular disease was calculated using a Weibull model in which age was used as a measure of exposure time to risk rather than as a risk factor. Separate estimation equations were calculated for coronary heart disease and for non-coronary cardiovascular disease. These were calculated for high-risk and low-risk regions of Europe. Two parallel estimation models were developed, one based on total cholesterol and the other on total cholesterol/HDL cholesterol ratio. The risk estimations are displayed graphically in simple risk charts. Predictive value of the risk charts was examined by applying them to persons aged 45-64; areas under ROC curves ranged from 0.71 to 0.84. CONCLUSIONS The SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.
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Affiliation(s)
- R M Conroy
- Department of Epidemiology & Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Abstract
BACKGROUND Elevated plasma total homocysteine (tHcy) is a risk factor for cardiovascular disease. Although cysteine is structurally similar and metabolically linked to tHcy, its relation to the risk of cardiovascular disease has received little attention. We studied the relation between plasma total cysteine (tCys) levels and the risk of vascular disease in the coronary, cerebral, and peripheral vessels. METHODS AND RESULTS This case-control study included 750 patients with vascular disease and 800 age- and sex-matched control subjects recruited from 19 centers in 9 European countries. Conventional risk factors for cardiovascular disease were recorded. In addition, plasma levels of tCys, tHcy, folate, B(6), B(12), and creatinine were measured. Overall, a U-shaped relationship was observed between tCys and risk of vascular disease. With the middle range of 250 to 275 micromol/L tCys used as the reference category, the adjusted risk of vascular disease at low (</=225 micromol/L) tCys levels was 2.1 (95% CI 1.2 to 3.6), and the risk at high (>300 micromol/L) tCys levels was 1.6 (95% CI 1.1 to 2.3). Different shapes of the dose-response relationship were seen for the 3 vascular disease categories. The relation with peripheral vascular and cerebrovascular disease was U-shaped, whereas a weak positive relation was observed with coronary heart disease. CONCLUSIONS Our data show a significant U-shaped relationship between tCys and cardiovascular disease after adjustment for tHcy, creatinine, and other cardiovascular disease risk factors.
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Affiliation(s)
- L El-Khairy
- LOCUS for Homocysteine and Related Vitamins, University of Bergen, Bergen, Norway.
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Cahill M, Karabatzaki M, Donoghue C, Meleady R, Mynett-Johnson LA, Mooney D, Graham IM, Whitehead AS, Shields DC. Thermolabile MTHFR genotype and retinal vascular occlusive disease. Br J Ophthalmol 2001; 85:88-90. [PMID: 11133719 PMCID: PMC1723690 DOI: 10.1136/bjo.85.1.88] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Raised levels of total plasma homocysteine (tHcy) are associated with an increased risk of retinal vascular occlusive disease. A thermolabile form of a pivotal enzyme in homocysteine metabolism, methylenetetrahydrofolate reductase (MTHFR), has been associated with vascular occlusive disease and raised tHcy levels. The relation between thermolabile MTHFR genotype, tHcy, and retinal vascular occlusive disease has not been determined. METHODS A retrospective case-control study involving hospital based controls and cases with retinal vascular occlusions in whom tHcy levels had been determined was undertaken. Genotyping for the MTHFR 677 C-T mutation that specifies the thermolabile form of the enzyme was performed by established methods in all subjects. The relation between homozygosity for thermolabile MTHFR genotype (TT), raised tHcy levels, and risk of retinal vascular occlusive disease was examined. RESULTS 87 cases of retinal vascular occlusive disease (mean age 68.7 years) comprising 26 cases of retinal artery occlusion and 61 of retinal vein occlusion were compared with 87 controls (mean age 70.2 years). The TT genotype did not confer a significantly increased risk of retinal vascular occlusive disease. The mean tHcy level was significantly higher in the cases than in the controls (p<0.0001). Overall, and in both the cases and controls, the frequency of the TT genotype was higher in those with normal tHcy levels than in those with increased levels of tHcy. However, the TT genotype did not significantly alter the risk of increased tHcy levels in these patients. CONCLUSIONS The TT genotype is not associated with an increased risk of retinal vascular occlusive disease or increased tHcy levels in this group of elderly patients. In older patients, nutritional rather than genetic factors may be more important in increasing tHcy levels, a known risk factor for retinal vascular occlusive disease.
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Affiliation(s)
- M Cahill
- The Research Foundation, The Royal Victoria Eye and Ear Hospital, Dublin 2, Ireland. mark.cahill@joslin,harvard.edu
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Graham IM, Lambin X. Testing the specialist predator hypothesis. Mamm Rev 2000. [DOI: 10.1046/j.1365-2907.2000.0075b.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Coronary heart disease is the leading cause of death in the developed world. Current surgical and pharmacological interventions are essentially palliative and interest in preventive strategies, particularly through nutrition and avoidance of tobacco has increased in recent years. Basic scientific, clinical and epidemiological evidence indicates a positive association between the plasma level of the amino acid homocysteine and vascular disease. Homocysteine levels are inversely related to both intake and plasma levels of folate. Less strong evidence indicates an inverse relationship between folate intake and coronary heart disease risk. It is likely that current estimates of dietary folate requirements are lower than optimal. Folic acid supplementation reliably reduces homocysteine levels, and may also modify endothelial function independent of this effect on homocysteine. Such treatment is cheap and appears to be essentially free of risk. However, until present randomised control trials are complete, it will not be known definitively whether or not increasing folate intake reduces cardiovascular risk.
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Affiliation(s)
- I M Graham
- Trinity College, and Adelaide & Meath Hospital, Incorporating the National Children's Hospital, Dublin, Ireland.
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Stubbs PJ, Al-Obaidi MK, Conroy RM, Collinson PO, Graham IM, Noble IM. Effect of plasma homocysteine concentration on early and late events in patients with acute coronary syndromes. Circulation 2000; 102:605-10. [PMID: 10931798 DOI: 10.1161/01.cir.102.6.605] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although a raised plasma homocysteine is a risk factor for vascular disease, it is not known whether it is associated with an adverse cardiac outcome in patients admitted with acute coronary syndromes. We evaluated the relationship between plasma homocysteine and short-term (28 days) and long-term (median 2.5 years) prognosis in acute coronary syndromes. METHODS AND RESULTS We evaluated the relationship of quintiles of homocysteine to fatal and nonfatal coronary disease early (28 days) and late (29 days to a median of 2. 5 years) after admission to a single unit of patients with unstable angina (n=204) and myocardial infarction (n=236). The end points studied were cardiac death (n=67) and/or myocardial (re)infarction (n=30). Cox regression and logistic regression were used to estimate the relationship of homocysteine to coronary events. The event rate within the first 28 days (22 cardiac deaths and 5 nonfatal infarctions) was not related to the admission homocysteine level. In the 203 unstable angina and 214 myocardial infarction survivors, an apparent threshold effect was seen on long-term follow-up, with a significant step-up in the frequency of events between the lowest 3 quintiles (14 cardiac deaths and 11 nonfatal infarctions) and the upper 2 quintiles (31 fatal and 12 nonfatal events). Patients in the upper 2 quintiles (>12.2 micromol/L) had a 2.6-fold increase in the risk of a cardiac event (95% CI, 1.5 to 4.3, P<0.001). CONCLUSIONS Elevated total homocysteine levels on admission strongly predict late cardiac events in acute coronary syndromes.
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Affiliation(s)
- P J Stubbs
- Department of Cardiology, Watford General Hospital, Watford, UK
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Verhoef P, Meleady R, Daly LE, Graham IM, Robinson K, Boers GH. Homocysteine, vitamin status and risk of vascular disease; effects of gender and menopausal status. European COMAC Group. Eur Heart J 1999; 20:1234-44. [PMID: 10454975 DOI: 10.1053/euhj.1999.1522] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Elevated plasma total homocysteine (tHcy) is a known risk factor for vascular disease. Gender, age, and circulating levels of folate, vitamins B(6)and B(12)affect tHcy levels. Objectives To study associations of gender and age with levels of plasma tHcy, and to examine the relationships of tHcy and circulating levels of folate, vitamins B(6)and B(12)with risk of vascular disease in men and women (pre- and post-menopausal). MATERIAL AND METHODS In a multicentre case-control study in Europe, 750 patients (544 men, 206 women) with documented vascular disease of the coronary, cerebral, or peripheral vessels and 800 control subjects (570 men, 230 women) were enrolled. Plasma tHcy levels (fasting and after methionine loading) and circulating levels of the vitamins were measured. Adjustment for age and centre was carried out for all statistical analyses, with additional adjustment for serum creatinine and vitamins for the tHcy comparisons between the sexes and between cases and controls. Risk analyses included adjustment for creatinine and traditional risk factors. Relationships between age, gender and tHcy were studied among control subjects only. RESULTS Fasting tHcy levels were lower in women than in men. Levels of tHcy showed a positive association with age, for both sexes. In the post-menopausal age category, female post-methionine load tHcy levels surpassed levels of men. Elevation of tHcy (defined as >80th percentile of controls) appeared to be at least as strong a risk factor for vascular disease in women as in men, even before the menopause. For post-methionine load tHcy, there was a 40% stronger association with vascular disease in women than in men. In both sexes, but especially in pre-menopausal women, low circulating levels of vitamin B(6)conferred a two- to threefold increased risk of vascular disease, independent of tHcy. In men, but not in women, low (defined as <20th percentile of controls) circulating folate levels were associated with a 50% increased risk of vascular disease. CONCLUSIONS Elevation of tHcy appears to be at least as strong a risk for vascular disease in women as men, even before the menopause. Our data indicate that associations of the various tHcy measurements (and the vitamins that determine them), with risks of vascular disease may differ between the sexes. The tHcy-independent relationship of vitamin B(6)with vascular disease indicates that it will be advisable to test the effects of vitamin B(6)in clinical trials.
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Affiliation(s)
- P Verhoef
- Division of Human Nutrition and Epidemiology, Wageningen Centre for Food Sciences and Wageningen University, Wageningen, The Netherlands
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Harmon DL, Doyle RM, Meleady R, Doyle M, Shields DC, Barry R, Coakley D, Graham IM, Whitehead AS. Genetic analysis of the thermolabile variant of 5, 10-methylenetetrahydrofolate reductase as a risk factor for ischemic stroke. Arterioscler Thromb Vasc Biol 1999; 19:208-11. [PMID: 9974399 DOI: 10.1161/01.atv.19.2.208] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mild hyperhomocysteinemia is a risk factor for atherosclerotic vascular disease. Homozygosity for the C677T mutation in the gene for 5,10-methylenetetrahydrofolate reductase (MTHFR) is frequently associated with hyperhomocysteinemia, particularly in individuals with low levels of serum folate, and has been directly associated with cardiovascular disease in certain populations. The purpose of this study was to establish whether the C677T mutation, which causes thermolabile MTHFR, is a risk factor for ischemic stroke in the Irish population. The homozygous C677T genotype has previously been associated with coronary heart disease in Ireland. We collected blood from 174 individuals (minimum age 60 years) who had suffered an ischemic stroke that was confirmed by computed tomography brain scan. Control subjects (n=183) aged >/=60 years, who had never suffered a stroke or transient ischemic attack, were recruited from hospitals and active retirement groups in the same geographical area. MTHFR genotypes were determined and other known risk factors for stroke were documented. In the control group, the frequency of subjects with the homozygous C677T genotype was 10.4%. In patients who had suffered ischemic stroke, the frequency was 15.5%. This difference was not statistically significant. The odds ratio of stroke for C677T homozygotes, with other genotypes as a reference group, was 1.59, 95% CI=0.85, 2.97. The data indicate that the homozygous C677T MTHFR genotype is at most a moderate risk factor for ischemic stroke.
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Campbell H, O’Gorman V, Stout RW, Hunter W, Herity B, Graham IM, Scott JM. Medical research cooperation in Ireland north and south. Ir J Med Sci 1998. [DOI: 10.1007/bf02937975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meleady RA, Graham IM. Homocysteine and vascular disease: nature or nurture? J Cardiovasc Risk 1998; 5:233-7. [PMID: 9919471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
There is now abundant evidence that elevated plasma total homocysteine is a risk factor for vascular disease in general and for cardiovascular disease in particular. Plasma concentrations of homocysteine are modulated by both genetic and environmental factors, among which inherited enzymatic defects and nutritional deficiencies respectively, are probably the most important. Other environmental factors such as smoking, also influence plasma homocysteine concentrations. The role of nutritional and other environmental factors had been underestimated until recently, when a final examination of the contribution of inherited defects became possible with the advent of DNA isolation and sequencing of large population samples. There is now consistent evidence from many studies that plasma homocysteine levels are inversely correlated with plasma folate, pyridoxal 5'-phosphate and cobalamin levels. This finding, together with that of significant lowering of homocysteine levels achieved with folate supplementation, constitutes a basis for optimism in reducing cardiovascular risk. As yet, no randomised control trial has been carried out to test this hypothesis.
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Affiliation(s)
- R A Meleady
- Department of Cardiology, Adelaide-Meath Hospital, Incorporating the National Children's Hospital, Tallaght, Dublin, Ireland
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Sullivan PA, Murphy D, Sullivan PA, Keogh S, Sullivan PA, Nash P, Kaarisalo MM, Marttila J, Immonen-Raiha P, Salomaa V, Torppa J, Tuomilehto J, Siani A, Racone R, Ragone E, Stinga F, Strazzullol P, Cappuccio FP, Trevisan M, Farinaro E, Mellone C, Fox KF, Cowie MR, Wood DA, Coats AJ, Poole Wilson PA, Sutton GC, Yarnell J, Sweetnam P, Thomas H, Piwonski J, Piotrowski W, Pytlak A, Wannamethee SG, Shaper AG, Walker M, Sharpe PC, Young IS, Hasselwander O, McMaster D, Mercer C, McGrath LT, Evans AE, Thomas F, Guize L, Ducimetiere P, Benetos A, Rosolova H, Simon J, Mayer O, Sefrna F, Mayer O, Šimon J, Rosolova H, Racek J, Trefil L, Marin-Tarlea M, Carp C, Apetrei E, Ginghina C, Serban I, Florica N, Ceck C, Patrascoiu M, Ginghina C, Carp C, Apetrei E, Tarlea M, Cioranu R, Florica N, Ceck C, Vaduva M, Mihaescu D, Lapadat M, Ashton WD, Wood D, Nanchahahal K, Kelleher CC, Brennan PJ, Howarth D, Meade TW, Kelleher CC, Fallon UB, McCarthy U, O’Donnell MMK, Dineen B, Jousilahti P, Vartiainen E, Tuomilehto J, Puska P, Kastarinen M, Nissinen A, Salomaa V, Vartiainen E, Jousilahti P, Tuomilehto J, Puska P, Rosengren A, Wedel H, Wilhelmsen L, Liese AD, Hense HW, Keil U, Keil U, Liese AD, Hense HW, Filipiak B, Döring A, Stieber J, Lowel H, De Laet C, Brasseur D, Kahn A, Wautrecht JC, Decuyper J, Boeynaems JM, Jousilahti P, Vartiainen E, Tuomilehto J, Sundvall J, Puska P, Marques-Vidal P, Ferrières J, Haas B, Evans A, Amouyel P, Luc G, Ducimetiere P, Marques-Vidal P, Ferrieres J, Arveiler D, Montaye M, Evans A, Ducimetiere P, Fuentes R, Notkola IL, Shemeikka S, Tuomilehto J, Nissinen A, Mak R, De BacquerBacquer D, De Backer G, Stam M, Koyuncu R, de Smet P, Kornitzer M, Braeckman L, De Backer G, De Bacquer D, Claeys L, Delanghe J, De Bacquer D, Kornitzer M, De Backer G, Cífkova R, Pit’ha J, Červenka L, Šejda T, Lanska V, Škodová Z, Stavek P, Poledne R, Cífková R, Duskova A, Hauserová G, Hejl Z, Lánská V, Škodova Z, Pistulková H, Poledne R, Hubáček J, Pit’ha J, Stávek P, Lánská V, Cífková R, Faleiro LL, Rodrigues D, Fonseca A, Martins MC, Norris RM, Nyyssönen K, Seppänen K, Salonen R, Kantola M, Salonen JT, Parviainen MT, De Henauw S, Myny K, Doyen Z, Van Oyen H, Tafforeau J, Kornitzer M, De Backer G, Benetos A, Thomas F, Guize L, Immonen-Räihä P, Kaarisalo M, Marttila RJ, Torppa J, Tuomilehto J, Houterman S, Hofman B, Witteman JCM, Verschuren WMM, van de Vijver LPL, Kardinaal AFM, Grobbee DE, van Poppel G, Princen HMG, Kornitzer M, Doven M, Koyuncu R, De Bacquer D, Myny K, De Backer G, Tafforeau J, Van Oven H, Doyen M, Koyuncu R, Kornitzer M, De Bacquer D, Myny K, De Backer G, Tafforeau J, Van Oyen H, de Bree A, Verschuren WMM, Blom HJ, Mulder I, Smit HA, Menotti A, Kromhout D, Van den Hoogen PCW, Hofman A, Witteman JCM, Feskens EJM, Štika L, Bruthans J, Wierzbicka M, Bolinska H, Voutilainen S, Nyyssönen K, Salonen R, Lakka TA, Salonen JT, Lakka HM, Lakka TA, Salonen JT, Tuomainen TP, Nyyssonen K, Salonen JT, Punnonen K, Yarnell J, Patterson C, Thomas H, Sweetnam P, Smith WCS, Campbell SE, Cardy A, Phillips DO, Helms PJ, Squair J, Smith WCS, Cardy A, Phillips DO, Helms PJ, Squair J, Smith WCS, Cardy A, Phillips DO, Helms PJ, Squair J, Pytlak A, Piotrowski W, Rywik S, Waskiewicz A, Sygnowska E, Szczesniewska D, Sygnowska E, Waskiewicz A, Wagrowska H, Polakowska M, Rywik S, Broda G, Jasinski B, Piotrowski W, Elandt-Johnson RC, Wagrowska H, Kupsé W, Szczesniewska D, Platonov DY, Haapanen N, Miilunpalo S, Vuori I, Pasanen M, Oja P, Urponen H, Kopp MS, Skrabski A, Szedmák S, Boaz M, Biro A, Katzir Z, Matas T, Smetana S, Green M, Whincup PH, Morris R, Walker M, Lennon L, Thomson A, Ebrahim SJB, Refsum H, Ueland PM, Perry IJ, Boer JMA, Kuivenhoven JA, Feskens EJM, Schouten EG, Havekes LM, Seidell JC, Kastelein JJP, Kromhout D, Oomen CM, Feskens EJM, Rasanen L, Nissinen A, Fidanza F, Menotti A, Kok FJ, Kromhout D, Sileikiene L, Klambienne J, Milasauskiene Z, Cappuccio FP, Siani A, Barba G, Russo L, Ragone E, Strazzullo P, Farinaro E, Trevisan M, Schnohr P, Parner J, Lange P, Meleady R, Graham IM, Ueland PM, Refsum H, Blom H, Whitehead AS, Daly LE, Stefanovic B, Boskovic D, Mitrovic P, Perunicic J, Vukcevic V, Radovanovic N, Terzic B, Mrdovic I, Orilc D, Matic G, Vasiljevic Z, Mitrovic P, Boskovic D, Stefanovic B, Perunicic J, Vukcevic V, Mrdovic I, Radovanovic N, Orlic D, Matic G, Milentijevic B, Rajic D, Mitrovic N, Boskovic S, Vasiljevic Z, Marin-Tarlea M, Carp C, Apetrei E, Serban I, Ceck C, Patrascsoiu M, Florica N, Mihaescu D, Murphy C, Meleady R, Ingram S, Love J, Graham I, Graham IM, Meleady R, van Berkel TFM, Deckers JW, De Bacquer D. Working Group on Epidemiology and Prevention of the European Society of Cardiology. Shannon, May 14-17, 1998. Abstracts. Ir J Med Sci 1998; 167 Suppl 7:1-35. [PMID: 9827492 DOI: 10.1007/bf02937278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Meleady R, Graham IM. The benefit of lowering cholesterol: relative risk can be absolutely misleading! Ir J Med Sci 1998; 167:92-3. [PMID: 9638023 DOI: 10.1007/bf02937945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R Meleady
- Department of Cardiology, Adelaide-Meath Hospital, Dublin
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Seifer C, McNeill B, O’Donnell M, Daly K, Kellett J, McGee HM, Montogomery AJ, O’Callaghan D, Horgan JH, Mahon NG, Codd M, Brennan J, Egan B, McCann HA, Sugrue DD, Menown IBA, Patterson RSHW, McMechan SR, Hameed S, Adgey AAJ, Baird SH, McBride SJ, Trouton TG, Wilson C, McRedmond JP, Fitzgerald DJ, Crowley JJ, Tanguay JF, Santos RM, Stack RS, Mahon NG, Keelan P, McCann HA, Sugrue DD, McKenna CJ, AuBuchon R, Camrud AR, Holmes DR, Schwartz RS, McKenna CJ, Camrud AR, Wolff R, Edwards WD, Holmes DR, Schwartz RS, Hanratty C, McAuley D, Young I, Murtagh G, O’Keeffe B, Richardson G, Scott M, Chew EW, Bailie NA, Graham AMJ, O’Kane H, McKenna CJ, Kwon HM, Ellis L, Holmes DR, Virmani R, Schwartz RS, Noelke L, Wood AE, Javadpour H, Veerasingham D, Wood AE, O’Kane D, Allen JD, Adgey AAJ, Hennessy T, Johnson P, Hildick-Smith D, Winter E, Shapiro L, McKenna CJ, Edwards WD, Lerman A, Holmes DR, Schwartz RS, McGrath LT, Passmore P, Silke B, McAuley D, Nugent AG, McGurk C, Hanratty C, Maguire S, Johnston GD, McAuley D, Nugent AG, McGurk C, Hanratty C, Maguire S, Johnston GD, Lovell SL, McDowell G, McEneany D, Riley MS, Nicholls DP, Gilligan D, Sargent D, Dan D, Gilligan D, Elam G, Rhee B, Keane D, Zhou L, McGovern B, Garan H, Ruskin J, O’Shea JC, Tan HC, Zidar JP, Stack RS, Crowley JJ, O’Keeffe DB, Graffin S, Fitzsimmons D, Brown S, Duff D, Denham B, Woods F, Neligan M, Oslizlok P, Connolly CK, Danton MHD, O’Kane H, Danton M, Gladstone DJ, Craig B, Mulholland HC, Casey F, Chaudhuri S, Hinchion J, Wood AE, Hinchion J, Wood AE, Menown IBA, Patterson RHSW, MacKenzie G, Adgey AAJ, Harbinson MT, Burgess LM, Moohan V, McEneaney DJ, Adgey AAJ, Menown IBA, MacKenzie G, Patterson RSHW, Adgey AAJ, Finnegan OC, Doherty L, Silke B, Riddell JG, Meleady R, Daly L, Graham I, Quinn M, Foley B, Lee J, Mulvihill N, Crean P, Walsh M, O’Morain C, Quinn M, Crean P, Foley B, Walsh M, Hynes C, King SM, David S, Newton H, Maguire M, Rafferty F, Horgan JH, Sullivan PA, Murphy D, Gallagher S, Menown IBA, Allen J, Anderson JM, Adgey AAJ, Dan D, Hoag J, Eckberg D, Gilligan D, Galvin J, Garan H, McGovern B, Ruskin J, Mahon NG, Diamond P, Neilan T, Keelan E, H. A., McCarthy C, Sugrue DD, Harbinson MT, Moohan VP, McEneaney DJ, Burgess LM, Anderson JM, Ayers GM, Adgey AAJ, Roberts M, Burgess L, Anderson C, Wilson C, Khan M, Clements IP, Miller WL, Seifer C, O’Donnell M, McNeill B, Daly K, Turtle F, McDowell G, Long H, McNair W, Campbell NPS, Mathew TP, Turtle F, Smye M, Nesbitt GS, Young IS, Adgey AAJ, Meleady R, Mulcahy D, Graham IM, Moore D, Menown IBA, McMechan SR, MacKenzie G, Adgey AAJ, Diamond P, Sugrue D, Codd MB, Galvin J, Zimmerman P, Winget J, Capeless M, Galvin J, Garan H, McGovern B, Ruskin J, McKelvey TA, Danton MHD, Sarsam MIA, McEneaney D, Roberts M, Burgess L, Anderson C, Wilson C, Khan M. Irish cardiac society. Ir J Med Sci 1998. [DOI: 10.1007/bf02937898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Graham IM, Daly LE, Refsum HM, Robinson K, Brattström LE, Ueland PM, Palma-Reis RJ, Boers GH, Sheahan RG, Israelsson B, Uiterwaal CS, Meleady R, McMaster D, Verhoef P, Witteman J, Rubba P, Bellet H, Wautrecht JC, de Valk HW, Sales Lúis AC, Parrot-Rouland FM, Tan KS, Higgins I, Garcon D, Andria G. Plasma homocysteine as a risk factor for vascular disease. The European Concerted Action Project. JAMA 1997; 277:1775-81. [PMID: 9178790 DOI: 10.1001/jama.1997.03540460039030] [Citation(s) in RCA: 960] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Elevated plasma homocysteine is a known risk factor for atherosclerotic vascular disease, but the strength of the relationship and the interaction of plasma homocysteine with other risk factors are unclear. OBJECTIVE To establish the magnitude of the vascular disease risk associated with an increased plasma homocysteine level and to examine interaction effects between elevated plasma homocysteine level and conventional risk factors. DESIGN Case-control study. SETTING Nineteen centers in 9 European countries. PATIENTS A total of 750 cases of atherosclerotic vascular disease (cardiac, cerebral, and peripheral) and 800 controls of both sexes younger than 60 years. MEASUREMENTS Plasma total homocysteine was measured while subjects were fasting and after a standardized methionine-loading test, which involves the administration of 100 mg of methionine per kilogram and stresses the metabolic pathway responsible for the irreversible degradation of homocysteine. Plasma cobalamin, pyridoxal 5'-phosphate, red blood cell folate, serum cholesterol, smoking, and blood pressure were also measured. RESULTS The relative risk for vascular disease in the top fifth compared with the bottom four fifths of the control fasting total homocysteine distribution was 2.2 (95% confidence interval, 1.6-2.9). Methionine loading identified an additional 27% of at-risk cases. A dose-response effect was noted between total homocysteine level and risk. The risk was similar to and independent of that of other risk factors, but interaction effects were noted between homocysteine and these risk factors; for both sexes combined, an increased fasting homocysteine level showed a more than multiplicative effect on risk in smokers and in hypertensive subjects. Red blood cell folate, cobalamin, and pyridoxal phosphate, all of which modulate homocysteine metabolism, were inversely related to total homocysteine levels. Compared with nonusers of vitamin supplements, the small number of subjects taking such vitamins appeared to have a substantially lower risk of vascular disease, a proportion of which was attributable to lower plasma homocysteine levels. CONCLUSIONS An increased plasma total homocysteine level confers an independent risk of vascular disease similar to that of smoking or hyperlipidemia. It powerfully increases the risk associated with smoking and hypertension. It is time to undertake randomized controlled trials of the effect of vitamins that reduce plasma homocysteine levels on vascular disease risk.
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Affiliation(s)
- I M Graham
- Department of Cardiology, Adelaide Hospital, Trinity College, Dublin, Ireland
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Gallagher PM, Meleady R, Shields DC, Tan KS, McMaster D, Rozen R, Evans A, Graham IM, Whitehead AS. Homocysteine and risk of premature coronary heart disease. Evidence for a common gene mutation. Circulation 1996; 94:2154-8. [PMID: 8901666 DOI: 10.1161/01.cir.94.9.2154] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Plasma homocysteine levels are modulated by nutritional and genetic factors, among which is the enzyme methylenetetrahydrofolate reductase (MTHFR). A common defective (thermolabile) variant of this enzyme is causally associated with elevated plasma homocysteine, itself an independent risk factor for coronary heart disease. METHODS AND RESULTS To examine the hypothesis that the allele (T) that codes for the thermolabile defect increases the risk of coronary heart disease, we studied 111 patients with clinical and objective investigational evidence of coronary heart disease and 105 control subjects. The frequencies of the thermolabile defect (T) in patients and control subjects were measured, and the prevalence of elevated plasma total homocysteine according to genotype was assessed. The frequency of the defective allele was higher in patients than in control subjects with an OR of 1.6 (95% CI, 1.1 to 2.4; P = .02). The OR in the coronary heart disease group for the homozygous TT genotype was 2.9 (95% CI, 1.2 to 7.2; P = .02); 17% of patients and 7% of control subjects had the TT genotype. Plasma total homocysteine levels were significantly associated with disease status, a relationship that matched the strength of the association between disease and homozygous inheritance of the defective enzyme. CONCLUSIONS Homozygotes for the defective allele (T) are at increased risk of premature coronary heart disease. MTHFR, which modulates basal plasma homocysteine concentration, is folate dependent, and dietary supplementation or fortification with folic acid may reduce plasma homocysteine levels and consequent coronary risk in a significant proportion of the general population.
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Affiliation(s)
- P M Gallagher
- Department of Genetics, Trinity College, Dublin 2, Ireland
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Meleady RA, Graham IM. Homocysteine as a risk factor for coronary artery disease. J Cardiovasc Risk 1995; 2:216-21. [PMID: 7584796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article reviews the evidence that homocysteine is a risk factor for coronary artery disease. This evidence ranges from that obtained from in-vitro experiments sometimes using non-physiological concentrations of homocysteine to epidemiological studies involving large numbers of subjects. Despite the variety of studies and methodologies employed, the hypothesis that homocysteine is a risk factor remains plausible. The relationship between certain nutrients and serum homocysteine and the therapeutic implications of this relationship are discussed.
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Affiliation(s)
- R A Meleady
- Department of Cardiology, Adelaide Hospital, Dublin, Ireland
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O'Callaghan PA, Comerford DM, Graham IM, Higgins I, Daly LE, Robinson K, McLoughlin M, Kilcoyne D, Hickey N, Walsh MJ. National perspective of acute coronary care in the Republic of Ireland. Heart 1995; 73:576-80. [PMID: 7626360 PMCID: PMC483923 DOI: 10.1136/hrt.73.6.576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To assess the use of acute coronary care facilities in the Republic of Ireland with regard to case mix, patient characteristics, mortality and factors associated with mortality, time intervals to admission, utilisation of thrombolysis, and risk factor profiles. DESIGN A 1 week prospective census of all hospitals admitting acute coronary cases. These comprised 23 coronary care units (CCU) and 17 combined coronary care/intensive care units (CCU/ICU). Data were collected by standardised methods on each new patient "upon whom a cardiac monitor was placed". RESULTS Acute coronary heart disease was confirmed in 185 (44.9%) of 412 patients. Of these 109 (26.4%) had a confirmed myocardial infarction and 76 (18.4%) unstable angina. Women were significantly older than men in all groups. Of those with proven acute coronary heart disease, 42.6% were current smokers, 23.1% were aware of having a raised cholesterol concentration, and 42.3% gave a history of prior hypertension. Only 44% were transported by ambulance. Median delay time from the onset of symptoms to admission was 6 h in Dublin and 4 h elsewhere. 34.9% of patients with a confirmed myocardial infarction received thrombolysis. Mortality of patients with myocardial infarction CCU/ICU at 7 days was 10.9 %. CONCLUSIONS There is potential for considerable improvement in the management of coronary heart disease in the Republic of Ireland through a reduction in delay times to admission to hospital, increased use of thrombolytic treatment, and intensification of advice on primary and secondary risk factors.
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Affiliation(s)
- P A O'Callaghan
- Council on Acute Coronary Care of the Irish Heart Foundation, Ballsbridge, Dublin
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Graham IM. Health promotion or confusion? J R Soc Med 1994; 87:185. [PMID: 20894908 PMCID: PMC1294426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- I M Graham
- Adelaide/Meath Hospitals, Peter Street Dublin 8, Ireland
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Prichard J, Allwright S, NcSweeney M, Macleod D, O’Regan M, Lyons RA, Power CK, Sreenan S, Burke CM, Daly L, Lonergan M, Graham I, Zhang W, Bard JM, McCrum EE, McMaster D, Fruchart JC, Cambien F, Evans AE, Ryan N, Clarke R, Robinson R, Refsum R, Ueland P, Lonergan N, O’Donnell A, McGivern E, Ben-Shlomo Y, Finnan F, Davey Smith G, McArdle M, Kelleher CC, Ward J, Broodle SE, Bleakney GM, Cullen BM, Gavin AT, Hurley M, Fogarty J, Boydell LR, Broddle SE, Scally GJ, Kilcoyne D, Anderson S, Cassidy C, Graham IM, Hickey N, Mulcahy R, Gorman D, Carter H, Collins C, Shelley E, Dean G, Lavelle P, O’Kelly F, Power B, Hillery I, Gaffney B, Darragh P, Thornton L, Clarke AT, Peyton M, Scally G, O’Reilly D, Shelly E, Kirke PN, O’Connell B, Moloney AC, Evans A, Hayes C, Laffoy M, O’Flanagan D, Corcoran R, Devlin J, MacAulay DC, Stott G, Kilbane P. 13th all Ireland social medicine meeting. Ir J Med Sci 1994. [DOI: 10.1007/bf02943011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Daly L, Robinson K, Tan KS, Graham IM. Hyperhomocysteinaemia: a metabolic risk factor for coronary heart disease determined by both genetic and environmental influences? Q J Med 1993; 86:685-9. [PMID: 8255967 DOI: 10.1093/qjmed/86.10.685] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- L Daly
- Department of Public Health Medicine and Epidemiology, University College Dublin, Ireland
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Abstract
Twenty four patients with ankylosing spondylitis of 10 or more years' duration were assessed for evidence of cardiac disease. Seven patients (29%) had evidence of cardiac disease, including one patient with a pericardial effusion, three with conduction abnormalities, and two with aortic incompetence. Aortic incompetence in one patient was clinically silent and was detected only with Doppler echocardiography. This patient had, in addition, thickening of the posterior aortic wall, an echocardiographic feature not previously described in ankylosing spondylitis. There was no evidence of aortic valve disease in a control group matched for age and sex. Patients with ankylosing spondylitis and cardiac abnormalities were older, had a longer disease duration, and more peripheral joint disease than those without cardiac abnormalities. Doppler echocardiography is a useful technique in the assessment of cardiac disease in ankylosing spondylitis and may detect aortic valve disease at an early preclinical stage.
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Affiliation(s)
- T W O'Neill
- Department of Rheumatology, St Vincents Hospital, Dublin, Ireland
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Graham IM, Kilcoyne D, O'Dwyer UY, Reid Y. Irish Heart Foundation nutrition policy. Ir Med J 1991; 84:135-43. [PMID: 1817127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
One hundred and seventy-two consecutive cases of acute myocardial infarction (MI) admitted to a coronary care unit were studied with regard to ventricular arrhythmias--pre-mature ventricular contractions (PVC), ventricular tachycardia (VT) and ventricular fibrillation (VF). Sixty-seven (39%) patients had ventricular arrhythmias (PCC-VT-VF), of whom 17 (9.8%) had VT and 11 (6.4%) VF. VT and VF, but not total arrhythmias, were more common in anterior infarctions. Fifty-six out of 67 (83.5%) of these patients arrived at Accident & Emergency (A&E) within the first six hours of onset of chest pain. Ten out of 11 (91%) patients who had VF did so in the first six hours. PVCs were poor predictors of the occurrence of VF (positive predictive value 5.9%). Forty-three patients (84%) who had PVCs did not develop any further arrhythmias. Spontaneous heart rate had no influence on the occurrence of ventricular arrhythmias. Frequent PVCs were more commonly associated with progression to VT and VF. In 30 cases (88%) lignocaine was effective. There was no death due to VT/VF and all responded to drugs and/or cardioversion.
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Abstract
100 patients were examined without knowledge of other findings to assess the value of apex displacement as a sign of cardiomegaly; 25 had a radiographic cardiothoracic ratio greater than 50%. The apex was located in only half of the patients, palpability being influenced by frame size, percentage ideal body weight, and percentage body fat. By comparison with the cardiothoracic ratio, apex displacement beyond the midclavicular line as the diagnostic test for cardiomegaly had a specificity of 76%, a sensitivity of 59%, a positive predictive value of 59.4%, and a negative predictive value of 76.9%. Another clinical sign of cardiomegaly, apex more than 10 cm from the midsternal line, was more sensitive but even less specific.
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Affiliation(s)
- T W O'Neill
- Department of Cardiology, Meath Hospital, Dublin, Ireland
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Daly LE, Hickey N, Graham IM, Mulcahy R. Predictors of sudden death up to 18 years after a first attack of unstable angina or myocardial infarction. Br Heart J 1987; 58:567-71. [PMID: 3426893 PMCID: PMC1277307 DOI: 10.1136/hrt.58.6.567] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Factors related to the occurrence of sudden death were examined in 551 men aged less than 60 years who survived a first attack of unstable angina or myocardial infarction by at least 28 days. There were 301 deaths over an average follow up period of 9.4 years and 138 (46%) of these were sudden. Life table techniques permitted the estimation of mortality up to 18 years after the index event. The proportion of sudden deaths showed a decrease with length of follow up. In those who were non-smokers and in those aged less than 45 years on admission sudden deaths in the first two years were very common (80% (95% confidence interval: 69%-91%) and 79% (95% confidence interval: 68%-90%) respectively). The proportion of sudden deaths in the remaining 16 years of follow up was related inversely to age at initial attack. After the first two years of follow up sudden death rates were similar in those who continued to smoke and those who stopped smoking, although those who continued to smoke had a significantly higher overall mortality. The risk of sudden death should be borne in mind when planning the investigation and rehabilitation of young and non-smoking subjects presenting with a first coronary event.
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Affiliation(s)
- L E Daly
- Cardiac Department, St Vincent's Hospital, Dublin, Ireland
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Conroy RM, Cahill S, Mulcahy R, Johnson H, Graham IM, Hickey N. The relation of social class to risk factors, rehabilitation, compliance and mortality in survivors of acute coronary heart disease. Scand J Soc Med 1986; 14:51-6. [PMID: 3704583 DOI: 10.1177/140349488601400202] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We studied 299 consecutive male 28-day survivors of unstable angina or myocardial infarction aged under 60 years to examine the relationship between social class and initial risk factors, change in risk-factors at one year follow-up, return to work, and 3-year mortality. There was a significant correlation between smoking on admission and social class, with 80% of lower and 31% of upper classes being current smokers. Daily cigarette consumption among smokers was significantly higher in lower-class patients. Lower-class patients also had a significantly higher weekly alcohol intake. Although the proportion of hypertensives did not vary with social class, mean in-hospital blood pressure was higher in lower-class patients. Social class bore no relationship to amount of leisure exercise, serum cholesterol or degree of overweight. There was a 90% 1-year return to work overall, and while there was no relationship between social class and eventual re-employment, lower-class patients took significantly longer to return to work. There were highly significant associations between social class and successful smoking cessation, increase in leisure exercise and weight reduction over the first year after discharge. There was no significant association between social class and 3-year mortality.
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Abstract
This study was designed to determine the relation between stopping smoking and angina after infarction in survivors of an acute coronary attack. The study population comprised 408 men aged under 60 who survived a first attack of unstable angina or myocardial infarction by 28 days and were smoking cigarettes at the time of their attack. These patients were followed up for an average of nine years. Three hundred and eighty four were alive at the one year follow up examination, when the presence or absence of angina together with habits of smoking were recorded. The prevalence of angina at one year was 19.5% in the 241 who had stopped smoking cigarettes compared with 32.2% in those who had continued (p less than 0.01). Six years later, however, the prevalence of angina after infarction was the same in the two groups. It is concluded that the onset of angina after infarction can be delayed by stopping smoking cigarettes but that this effect is not maintained in the long term.
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Kay EW, Moore D, Graham IM. The evaluation of trials of medical therapy. A didactic guide to nonsense detection. Ir J Med Sci 1985; 154:71-9. [PMID: 3886591 DOI: 10.1007/bf02937146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Subjects who stop smoking cigarettes after myocardial infarction have an improved rate of survival compared with those who continue, but to date it was not known whether the benefit persisted for more than six years. A total of 498 men aged under 60 years who had survived a first episode of unstable angina or myocardial infarction by two years were followed up by life table methods for a further 13 years. Mortality in those who continued to smoke was significantly higher (82.1%) than in those who stopped smoking (36.9%). These differences increased with time. Mortality in those who were non-smokers initially and who continued not to smoke was intermediate (62.1%). The adverse effect of continued smoking was most pronounced in those with unstable angina. Continuing to smoke increased the rate of sudden death to a greater degree in those with less severe initial attacks, while the effect of smoking on fatal reinfarctions was most apparent in those with a more complicated presentation. These findings suggest that stopping cigarette smoking is the most effective single action in the management of patients with coronary heart disease.
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Graham IM. Modern drug treatment--No. 8. Drugs and the prevention of death from myocardial infarction. Ir Med J 1982; 75:291-6. [PMID: 6127329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
The influence of age, sex, and overt ischaemic heart disease on survival after pacing was studied in a population of 427 patients. The median survival for the whole group was 7.75 years. Women between 55 and 74 years and men between 65 and 74 years enjoyed median survivals in excess of 10 years. Patients over 74 years and men with ischaemic heart disease had median survivals of the order of 5 years and 3 1/2 years, respectively. The findings may help to match generator lifetimes to patient-survival prospects.
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Abstract
Echocardiography detected asymmetric septal hypertrophy (ASH) in five of 200 adults being assessed for aortic valve surgery. Four of these were among 119 patients with dominant aortic stenosis, which was severe in three. ASH was confirmed at the time of aortic valve replacement in two of these patients; the third declined operation. The finding of ASH in only one of 81 patients with free aortic reflux is consistent with chance association. While the same explanation could apply to the higher prevalence in those with aortic stenosis, it may be that a long-standing pressure overload can trigger inappropriate septal hypertrophy in predisposed individuals.
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Abstract
A total of 213 male patients who survived an initial episode of acute coronary inusfficiency or myocardial infarction for 28 days have been followed for 5 years. The effect of age, weight, severity of infarction diastolic blood pressure, serum cholesterol, and cigarette smoking at the time of the initial attack on postinfarction morbidity and death was examined. Only severity of infarction adversely influenced the long-term mortality rate; none of the factors studied was related to subsequent morbidity. The effect of subsequent cigarette smoking on morbidity and death was noted over the 5 year period. Smoking did not affect subsequent morbidity but there was an increased death rate among those who continued to smoke. This effect of smoking was independent of the severity of infarction. Improved long-term survival may be predicted for patients who stop or markedly reduce cigarette smoking.
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Graham IM, Hickey N, Mulcahy R, MacKenzie G. Letter: beta-blockade and myocardial infarction. Br Med J 1975; 2:616. [PMID: 236811 PMCID: PMC1673506 DOI: 10.1136/bmj.2.5971.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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