Women with PCOS have an increased risk for cardiovascular disease regardless of diagnostic criteria - a prospective population-based cohort study

OBJECTIVE

Polycystic ovary syndrome (PCOS) is associated with many cardiovascular disease (CVD) risk factors, such as obesity, type 2 diabetes mellitus and hypertension. However, it remains debatable whether the presence of multiple CVD risk factors translates to increased CVD events.

DESIGN

A prospective, population-based Northern Finland Birth Cohort 1966.

METHODS

Individuals with an expected date of birth in 1966 in Northern Finland have been followed from birth. Women in the cohort were classified as having PCOS according to either the National Institute of Health (NIH) criteria (n=144) or the Rotterdam criteria (n=386) at age 31, and they were compared to women without any PCOS features. The study population was re-examined at age 46, and the incidence of major adverse cardiovascular events (MACE), including myocardial infarction (MI), stroke, heart failure and cardiovascular mortality, was recorded up to age 53.

RESULTS

During the 22-year follow-up, both women with NIH-PCOS and women with Rotterdam-PCOS had a significantly higher risk for cardiovascular events than control women. The BMI-adjusted hazard ratio (HR) for MACE in the Rotterdam-PCOS group and the NIH-PCOS group was 2.33 (1.26-4.30) and 2.47 (1.18-5.17), respectively. The cumulative hazard curves in both diagnostic categories began to diverge at age 35. Regarding the individual CVD endpoints, MI was significantly more prevalent in both women with NIH-PCOS (p=0.010) and women with Rotterdam-PCOS (p=0.019), when compared to control women.

CONCLUSIONS

PCOS should be considered a significant risk factor for CVD. Future follow-up will show how the risk of CVD events develops after menopausal age.

QRS duration as an independent risk factor for appropriate shocks and mortality in patients with prophylactic implantable cardioverter-defibrillator

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Community’s 7th Framework Programme FP7/2007-2013

Background

The implantable cardioverter defibrillator (ICD) is an established therapy for the prevention of sudden cardiac death (SCD) in high-risk heart failure patients. However, improvements in risk stratification are necessary to increase the efficiency of ICD use. We performed an analysis of the retrospective EU-CERT-ICD registry with respect to QRS duration and effects of cardiac resynchronisation therapy (CRT) on outcomes.

Methods/Results

A total of 5033 patients (81% males) from 14 European centres had an ICD implanted for primary prophylaxis. Mean age at the time of ICD implantation was 64±11 years and ischemic cardiomyopathy was the underlying pathology in 65% of patients. CRT was used in 43% of the patients. The median follow-up was 2.7 years (IQR 1.4-4.6 years). Predefined primary endpoints were all-cause mortality, first appropriate and first inappropriate shocks. The effect of covariates on the cumulative primary endpoints were assessed through hazard ratios in the Fine and Gray subdistributional hazard models (accounting for the competing risks) stratified by centres.

Because of resynchronization by the device, the analysis considered a different influence of QRS on outcomes in the CRT-D and the ICD groups. We observed an increase in the cumulative incidence of the first appropriate shock with increasing QRS values for patients implanted with only an ICD (HR 1.12 per 10ms increase, p<0.001). In patients with CRT-D, increasing QRS values related to a (statistically non-significant) decrease in the cumulative incidence of the first appropriate shocks (HR 0.96 per 10ms, p=0.299).

Since a wide QRS is an indication for CRT-D therapy, high QRS values cluster among those patients with implanted CRT-D, while among patients with QRS under 130ms standard ICD implantations are more frequent. This can explain the observed increase in the cumulative incidence of the first appropriate shocks for increasing QRS values up to 130ms in the ICD-group and its decrease for increasing QRS values over 130ms in the CRT-D group.

Regarding all-cause mortality, hazard ratios for age, LVEF, NYHA, ICM, AF, diabetes and sex category agreed with the results obtained in previously published meta-analyses.

Increased QRS values are associated with higher mortality in the ICD group (HR 1.09 per 10ms increase, p<0.001), but not in the CRT-D group (HR 0.99 per 10ms increase, p=0.695).

Conclusion

In our study, we confirmed QRS duration as an independent risk factor for appropriate ICD shocks and all-cause mortality in patients with ICD for primary prophylaxis. However, this was only observed in patients with single- or dual-chamber ICD, while there was no correlation in CRT-D patients. The findings suggest that CRT-D exerts a protective effect regarding the occurrence of first appropriate shock and all-cause mortality for patients with QRS values higher than 130 ms and indication for resynchronization.

Early growth and carotid intima-media thickness at midlife: Northern Finland 1966 Birth Cohort study

Background

Carotid intima-media thickness (CIMT) reflects atherogenesis and is a strong predictor of cardiovascular diseases. Although cardiovascular diseases have been shown to originate in foetal life and childhood, the information on the contribution of early growth to CIMT in adulthood remains limited.

Purpose

To assess the influence of early growth patterns on CIMT in midlife.

Methods

A subpopulation of the Northern Finland Birth Cohort 1966 took part in follow-up, including CIMT evaluation by ultrasound (n=1155) at the age of 46 years. Maternal pre-pregnancy body mass index (BMI) was self-reported and birth weight and gestational age were measured after delivery. BMI growth curves were modelled based on frequent anthropometric measurements in infancy and childhood. Peak weight and height velocity in infancy (0–2 years of age, n=637) as well as age and BMI at adiposity peak (AP, mean age 9 months, n=461) and at adiposity rebound (AR, mean age 5.8 years, n=562) were established. Results are reported as unstandardized beta (β) with 95% confidence intervals for one standard deviation increase in early growth variable. Associations were adjusted for sex, birth weight, maternal pre-pregnancy BMI as well as adult weight, height, systolic blood pressure, low-density lipoprotein cholesterol, physical activity, diabetes, heart diseases and antihypertensive medication.

Results

Infant peak weight velocity (β=0.018 (0.011, 0.025), p<0.001) was associated with a higher CIMT in midlife, independently of adjustments for sex, early life factors and adult cardiometabolic factors (β=0.011 (0.003, 0.019), p=0.010). Infant peak height velocity was also associated with adult CIMT, but only in females (β=0.012 (0.004, 0.021), p=0.004) and the association was attenuated after adjustments (β=0.010 (0.0, 0.021), p=0.055). Birth weight and gestational age were not associated with adult CIMT. BMI at AP (β=0.011 (0.003, 0.019), p=0.007) and BMI at AR (β=0.010 (0.003, 0.018), p=0.005) were directly associated with CIMT in midlife in univariate analysis, but not independently of adult cardiometabolic factors. Timing of AP and AR were not related to adult CIMT. Finally, maternal pre-pregnancy BMI (β=0.005 (0.0, 0.011), p=0.066) also tended to be associated with a higher CIMT in midlife.

Conclusions

Rapid growth in infancy was the most important early growth-related factor associating with CIMT in midlife, and this relationship was not fully mediated by adult anthropometrics, cardiometabolic risk factors and morbidity.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Yrjö Jahnsson Foundation, Aarne Koskelo Foundation

P5316Birthweight, childhood growth patterns and left ventricular structure at midlife: Northern Finland 1966 Birth Cohort Study

Background

Higher cardiac left ventricular (LV) mass (LVM) has independently been associated with cardiovascular risk and mortality. Changes in LV structure have been observed in children with obesity. However, information about the long-term influence of early growth on LV structure is limited.

Purpose

To explore the associations between early growth patterns, specifically birth weight, age and body mass index (BMI) at infant BMI peak and at childhood BMI rebound, and LV structure at midlife.

Methods

At the age of 46, a sample of the participants of the Northern Finland Birth Cohort 1966 took part in follow-up examinations. A randomly selected subpopulation was enrolled to echocardiographic examinations (n=1124). BMI at various ages in childhood was calculated from frequent anthropometric measurements collected from child welfare clinical records. Age and BMI at BMI peak (n=541, mean age 9.0 months) and at BMI rebound (n=657, mean age 5.8 years) were derived from random effect models.

Results

Birth weight (n=1124), BMI at BMI peak and at BMI rebound were directly associated with LVM (beta [standardized]: 0.171, 0.186 and 0.223, respectively, p<0.001 for all) and LVM index (LVMI) (beta: 0.146, 0.120 and 0.120, respectively, p<0.01 for all) at midlife. All the associations, except that between BMI at BMI peak and LVMI, remained significant after adjustments for gender, adult blood pressure, heart rate, antihypertensive medications, heart diseases and diabetes (p<0.05 for all). Significant interaction between gender and age at BMI rebound was observed in LVMI. Age at BMI rebound was inversely associated with LVMI in both genders, the association being stronger in males (beta: −0.212, p<0.001) compared to females (beta: −0.117, p=0.025) and independent of potential confounders. There were direct univariate associations of birth weight and BMI at BMI peak and rebound with LV relative wall thickness (p=0.009–0.019), which were largely explained by potential confounders. However, the association of birth weight with LV relative wall thickness retained its significance even after relevant adjustments (beta: 0.097, p=0.001). After additional adjustments for adult BMI, only associations of birth weight and BMI at BMI peak with LVM remained significant, which, however, did not remain significant after additional adjustment for adult height.

Conclusions

This study shows that birth weight and early growth patterns are associated with LV structure at midlife, which is largely explained by adult BMI. Therefore, the relationship between early growth patterns to LV structure in the adulthood may be largely explained by their strong tracking to obesity and related cardiovascular risk factors at midlife and to some extent by normal somatic growth.

Prevalence of Borrelia burgdorferi in Ixodes ricinus ticks in urban recreational areas of Helsinki

Lyme borreliosis, an infection caused by the tick-borne spirochete Borrelia burgdorferi, is a major health problem for populations in areas of endemicity in the Northern Hemisphere. In the present study we assessed the density of ticks and the prevalence of B. burgdorferi sensu lato among ticks in popular urban recreational areas of Helsinki, Finland. Altogether 1,688 Ixodes ricinus ticks were collected from five areas located within 5 km of the downtown section of Helsinki, and 726 of them (303 nymphs, 189 females, and 234 males) were randomly chosen for laboratory analysis. The midguts of the ticks were divided into three pieces, one for dark-field microscopy, one for cultivation in BSK-II medium, and one for PCR analysis. Ticks were found in all the study areas; their densities varied from 1 to 36 per 100 m along which a cloth was dragged. The rate of tick infection with B. burgdorferi sensu lato varied from 19 to 55%, with the average being 32%. Borellia afzelii was the most predominant genospecies in all the areas, and no B. burgdorferi sensu stricto isolates were detected. Only two ticks were concurrently infected with both B. afzelii and Borrelia garinii. Dark-field microscopy gave more positive results for B. burgdorferi than did cultivation or PCR analysis. However, the agreement between all three methods was fairly good. We conclude that Lyme borreliosis can be contracted even in urban environments not populated with large mammals like deer or elk. The disease should be taken into account in the differential diagnosis of certain symptoms of patients from these areas, and the use of measures to improve the awareness of the general population and health care officials of the risk of contracting the disease is warranted.

Bovine mastitis in Finland in 1988 and 1995--changes in prevalence and antimicrobial resistance

Two surveys were carried out (during 1988 and 1995) to estimate the prevalence of bovine mastitis in Finland. In 1988, 17,111 quarter milk samples were obtained from 4495 cows, and in 1995 the corresponding figures were 10,410 and 2648. Antimicrobial susceptibility of mastitis pathogens was studied. Prevalence of mastitis on cow basis decreased from 47.8% in 1988 to 37.8% in 1995. Staphylococci was the largest group of pathogens isolated. The proportion of Staphylococcus aureus decreased and that of coagulase-negative staphylococci (CNS) increased. The proportion of strains resistant to at least one antibacterial drug increased with regard to S. aureus from 36.9% in 1988, to 63.6% in 1995 and with CNS from 26.6% to 49.7%. Most of the increase in antibacterial resistance was due to a higher number of beta-lactamase producing strains. Multiresistance also increased, but it was proportional to the overall increase in resistance. All the predominant mastitis streptococci were susceptible to beta-lactams tested.

Bovine mastitis in Finland in 1988 and 1995--changes in prevalence and antimicrobial resistance

Two surveys were carried out (during 1988 and 1995) to estimate the prevalence of bovine mastitis in Finland. In 1988, 17,111 quarter milk samples were obtained from 4495 cows, and in 1995 the corresponding figures were 10,410 and 2648. Antimicrobial susceptibility of mastitis pathogens was studied. Prevalence of mastitis on cow basis decreased from 47.8% in 1988 to 37.8% in 1995. Staphylococci was the largest group of pathogens isolated. The proportion of Staphylococcus aureus decreased and that of coagulase-negative staphylococci (CNS) increased. The proportion of strains resistant to at least one antibacterial drug increased with regard to S. aureus from 36.9% in 1988, to 63.6% in 1995 and with CNS from 26.6% to 49.7%. Most of the increase in antibacterial resistance was due to a higher number of beta-lactamase producing strains. Multiresistance also increased, but it was proportional to the overall increase in resistance. All the predominant mastitis streptococci were susceptible to beta-lactams tested.

Characterization of Finnish Borrelia burgdorferi sensu lato isolates by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and with monoclonal antibodies

Thirty-seven Borrelia burgdorferi strains, isolated in 1992 from Ixodes ricinus in Finland, were investigated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and by immunoblotting and indirect immunofluorescence assay (IFA) with five to nine monoclonal antibodies (MAbs). By SDS-PAGE results and reactivities to MAbs H3TS, J 8.3, I 17.3, and D6, the 37 isolates were assigned to the species B. burgdorferi sensu stricto (n = 7), Borrelia afzelii (n = 17), or Borrelia garinii (n = 13). Twenty more isolates examined only by IFA and with part of the MAbs were distributed as follows: 9 B. burgdorferi sensu stricto and 11 other species. Among 16 of 37 isolates displaying a SDS-PAGE patterns considered typical of that of B. garinii, 3 were negative by the test with MAb D6; the rest were positive. The three MAb D6-negative isolates reacted with MAb J 8.3 but not with MAb I 17.3. It is suggested that these isolates of a previously undescribed type represent atypical B. afzelii strains deficient in the expression of OspB proteins. The misleading species designation by the SDS-PAGE result is described. The IFA results were generally consistent with those obtained by immunoblotting. The exception was for 3 of 29 isolates that were positive with MAb H5332 by immunoblotting but that were IFA negative. In the present material of 57 strains, all 16 B. burgdorferi sensu stricto isolates originated from the Aland Islands. B. afzelii and B. garinii were isolated from all three regions where ticks were collected. The distributive difference seems to offer a basis for comparative clinico-epidemiological studies of Lyme borreliosis.

Prevalence of Borrelia burgdorferi in selected tick populations in Finland

The purpose of the studies was to determine the prevalence of Borrelia burgdorferi sensu lato in selected populations of Ixodes ricinus in Finland and to secure strains of the spirochete for further characterization. 1,210 Ixodes ricinus ticks (399 females, 419 males and 392 nymphs) were collected during June to August 1992 by flagging from 8 sites in 3 regions. The frequency of B. burgdorferi infection was determined by isolation in BSK II medium. The species identity of most of the isolates was confirmed with the immunofluorescence method. 67 B. burgdorferi strains were isolated from 8 sites; the prevalence ranged from 2.8% to 7.9%. The overall isolation percentage for adult male ticks was 6.4% (7.5% for females, 5.3% for males); for nymphs, 3.8%. No statistically significant association of the prevalence was observed with either pasture or off-pasture habitats nor with specific geographic region/regions. Prevalence figures were roughly of the same magnitude in areas and parts of the country known to differ in their incidence of human borreliosis. An additional 294 ticks, mainly engorged females, were collected from places outside the main study sites. Of the 7 positive ticks 3 were engorged females, originating from a cow, a dog and a cat, respectively. The results in general demonstrate that tick populations in various parts of Finland quite commonly harbour B. burgdorferi.

The efficacy of tinidazole in naturally occurring periodontitis in dogs: bacteriological and clinical results

The efficacy of tinidazole in addition to a single course of scaling was studied in 14 dogs with periodontitis. Three test teeth, two with periodontitis and one with healthy periodontium, were selected per dog. Subgingival bacterial samples were taken, and clinical examination was carried out at each of four visits (0, 14, 90 and 180 days). The bacterial samples were cultured anaerobically using selective and nonselective media. All teeth in the dentition, except one diseased test tooth with periodontitis were scaled at the first visit and tinidazole or placebo administered twice a day for 7 days. The mean probing depth of the diseased test pockets was significantly more reduced in tinidazole+scaling (T1S1) than scaling alone (T0S1) group at all visits compared to baseline values. The most significant decreases of bacterial counts in T1 or T0 groups were found in agar corroding Gram-negative rods in both diseased and healthy T1S1 pockets and in slimy Gram-negative rods in diseased T1S0 pockets between visits 1 and 2. The intergroup comparisons showed that Gram-positive cocci decreased significantly more in S1 pockets as well as sporeforming Gram-positive rods in diseased S0 pockets of T1 than T0 group. The highest number of isolates was found in the group of pigmented Gram-negative anaerobe rods, mainly Porphyromonas spp. The percentage of Porphyromonas gingivalis-like isolates decreased to zero and Porphyromonas endodontalis-like isolates increased in all test teeth of T1 group at 14 days. It is concluded that tinidazole has good efficacy against P. gingivalis-like bacteria which seem to be periodontal pathogens in dogs.

Association between feline immunodeficiency virus antibodies and host characteristics in Finnish cats

Toward the end of 1989 the largest private veterinary laboratory in Finland (Vet/lab) began using a commercial combined ELISA test for Feline Immunodeficiency Virus (FIV) antibodies and Feline Leukemia Virus (FeLV) antigens (Cite Combo). The overall proportion of FIV seropositive feline samples was 5% during the 22 month study period. The number of tests performed increased slowly while the positive test results decreased with time (7% in 1990 and 4% in 1991). The decrease in prevalence was assumed to reflect a change in the sample population rather than an actual change in the general cat population. There were more symptomatic and domestic cats tested in 1990 than 1991. The lower-risk groups in the second year of the study may simply be an indication that the cat owners became more aware of FIV and the motivation to send samples switched from the veterinarian's interest to diagnose the disease in a symptomatic cat to the owner's interest to survey their cats for possible FIV infection. In a multivariable analysis, breed, symptoms, age and sex were associated with the risk of FIV seropositivity. The risk increased faster with age in males than in females (i.e., the age effect was not constant between sexes). The cats with symptoms had a higher risk than those without symptoms and non-purebred cats were at a higher risk than purebred cats. FeLV infection was not associated with FIV.

Association between feline immunodeficiency virus antibodies and host characteristics in Finnish cats

Toward the end of 1989 the largest private veterinary laboratory in Finland (Vet/lab) began using a commercial combined ELISA test for Feline Immunodeficiency Virus (FIV) antibodies and Feline Leukemia Virus (FeLV) antigens (Cite Combo). The overall proportion of FIV seropositive feline samples was 5% during the 22 month study period. The number of tests performed increased slowly while the positive test results decreased with time (7% in 1990 and 4% in 1991). The decrease in prevalence was assumed to reflect a change in the sample population rather than an actual change in the general cat population. There were more symptomatic and domestic cats tested in 1990 than 1991. The lower-risk groups in the second year of the study may simply be an indication that the cat owners became more aware of FIV and the motivation to send samples switched from the veterinarian's interest to diagnose the disease in a symptomatic cat to the owner's interest to survey their cats for possible FIV infection. In a multivariable analysis, breed, symptoms, age and sex were associated with the risk of FIV seropositivity. The risk increased faster with age in males than in females (i.e., the age effect was not constant between sexes). The cats with symptoms had a higher risk than those without symptoms and non-purebred cats were at a higher risk than purebred cats. FeLV infection was not associated with FIV.

Role of feeding in the treatment of dogs with pancreatic degenerative atrophy

Fourteen dogs with pancreatic degenerative atrophy (PDA) were fed their original diets or a special diet for 2 periods of 4 weeks to compare the severity of clinical signs in relation to different types of diet. During the first period, the dogs were given ordinary food, and in the second period, the dogs were given only the special diet that consisted of a commercial moderate-fat, low-fiber, highly-digestible food. In addition, equal amounts of pancreatic enzymes were added into the food during highly-digestible food. In addition, equal amounts of pancreatic enzymes were added into the food during both periods. The owners were given a questionnaire covering 9 typical signs of PDA. They were asked to assess the severity of signs daily for the 2 periods using a scale provided with the questionnaire. The general well-being of the dogs was significantly (p less than 0.05) better during the period when the dogs were fed a special diet. Of the individual clinical signs associated with PDA the severity of flatulence, borborygmi, volume of faeces and frequency of defecation were significantly (p less than 0.05) decreased on the special diet. There were no significant differences in appetite, drinking, colour and consistency of the faeces or in coprophagy between the 2 feeding periods. The costs of the special diet were almost double compared to the ordinary diets.

Listeria monocytogenes septicemia associated with consumption of salted mushrooms

Listeria monocytogenes septicemia in an 80-year-old man is described. On the day before clinical symptoms appeared the patient had eaten homemade salted mushrooms, rufous milkcap (Lactarius rufus Fr.). L. monocytogenes serotype 4b was isolated in blood cultures. The mushrooms which had been stored in cold for 5 months before consumption contained the same listeria serotype at a level of 10(6) CFU/g. Salt content (NaCl) of the mushrooms was 7.5%. Fever and diarrhea disappeared with penicillin therapy and the patient was discharged after 4 weeks in the hospital.