Angiotensin receptor blockers in patients with hypertrophic cardiomyopathy: A comparison of VANISH and INHERIT randomized trials

PURPOSE

To identify the cause of discrepancy between the INHERIT trial and VANISH trial in regards to disease modification of angiotensin receptor II blockers in hypertrophic cardiomyopathy (HCM).

METHODS

We replicated the data analysis used in VANISH, converting individual change in each component of the composite endpoint into a z-score and applying this z-score to the INHERIT results.

RESULTS

No significant improvement was identified in the composite z-score between the 2 groups at 12-month follow-up (P = .4). With the exception of tissue Doppler systolic (s') velocity, we found no significant benefit or harm from losartan compared to placebo for any of the individual components of the composite score at 12-month follow-up. Results were similar in analyses without imputed data or when restricted to patients with sarcomeric HCM.

CONCLUSION

Despite applying the potentially more sensitive composite z-score endpoint as in the VANISH trial, no statistically significant benefits from the use of losartan compared to placebo could be detected at 12-month follow-up in patients with overt HCM participating in the INHERIT trial.

Total blubber burden of organochlorine pollutants in phocid seals; methods and suggested standardization

The purpose of the present paper was to investigate methods for calculating the total blubber burden of organochlorine pollutants (OCs) in phocid seals. Harp seals (Phoca groenlandica) were used as the model species. A sample of fat pre-breeding adult females (N = 9) and a sample of thin moulting adult females (N = 7) were collected. From each animal blubber samples from five different body sites (complete blubber columns and samples from different blubber layers), in addition to a sample from a homogenate derived from the entire blubber mass, were analyzed for selected OCs. Significant differences in the concentrations of major OC contaminants were found between inner and outer blubber layer. Within each seal group, no significant difference in OC concentrations was found between homogenates from whole blubber columns from the five different sites of the animals or when comparing these with the OC concentrations found in the blubber sample deriving from a homogenate of the entire blubber mass. When comparing the two seal groups, the mean OC concentrations were significantly higher in the thin seals. However, blubber burden of OCs measured directly and calculated indirectly were not significantly different, and did not vary between the two groups of seals. Since these seals are of the same age and sex group and from the same population, this is not an unexpected result. The present results suggest that comparison of blubber concentrations of OCs in phocid seals should be avoided, especially when comparing differences between geographical areas or for time-trend analyses. For this type of study, we suggest that the blubber burden of OCs is applied as standard in the future. Furthermore, since blubber depth at a specific sampling site is required when using the estimator for calculation of the percent blubber content in phocid seals (the LMD-index), we suggest that this sampling site (central dorsally) is introduced as a standard when sampling blubber for OC analyses in phocid seals.

Determination of toxaphenes in fish and marine mammals

An analytical method for the determination of toxaphene in biological materials using gas chromatography with an electron capture detector (GC-ECD) has been established and validated for three single congeners (chlorinated bornanes (CHB) 26, 50 and 62). The analytical method was based on a method for determination of PCB, DDT and other chlorinated pesticides. To include toxaphene congeners an extra step, adsorption chromatography on silica columns, was introduced to separate the pesticides from PCB. The recovery of CHB-26, 50 and 62 were 97+/-11%, 94+/-10% and 99+/-12%, respectively. Samples from cod, ringed seal and polar bear from the Norwegian arctic environment have been analysed. The levels of CHB-26 and 50 found were 13-55 ng/g fat in cod, 1.3-7.7 ng/g fat in ringed seal and 0.4-119 ng/g fat in polar bear. The levels of CHB-62 were 2.0-13, 0.8-3.4, 0.2-11 ng/g fat in cod, ringed seal and polar bear, respectively.

Biological transport and mammal to mammal transfer of organochlorines in Arctic fauna

Ringed seal (Phoca hispida) is assumed to be the most important and common prey of polar bears (Ursus maritimus). However, during a scientific survey in the ice area of the northern Barents Sea east of Svalbard in June 1995, an unexpectedly high number of polar bears were observed feeding on harp seal (Phoca groenlandica) carcasses. Samples of both harp and ringed seals were obtained and organochlorine (OC) occurrence and pattern in these two potential polar bear prey species were determined. Significantly higher OC concentrations were found in harp seals, as compared to the ringed seals. All animals in the northern harp seal group were lean specimens in late moult. The industrial chemicals, polychlorinated biphenyls (PCBs) and hexachlorobenzene (HCB), and the OC pesticides bis-2,2,(chlorophenyl)-1,1,1-trichloroethanes (DDTs), hexachlorocyclohexanes (HCHs), and chlordanes (CHLORs) were analysed in blubber. The concentrations of sigma PCB (sum of concentrations of 16 PCB congeners) and sigma DDT (sum of concentrations of p,p'-DDT and p,p'-DDE) in the northern harp seal group ranged from 2093 to 20,382 and 1460 to 10,381 ng g-1 lipid weight, with mean concentrations of 11,133 and 6847 ng g-1 lipid weight, respectively. The mean concentrations of the CHLORs, oxychlordane and trans-nonachlor, were 1311 and 3743 ng g-1 lipid weight, respectively, while the mean concentrations of HCB and HCH isomers (alpha-, beta- and gamma-HCH) were all < 500 ng g-1 lipid weight. No significant difference was found in the mean total blubber mass between the two seal species when collected in June. This indicates that polar bears preying on harp seals instead of ringed seals at this time of the year could accumulate significantly higher PCB concentrations. We suggest that polar bears feeding along the ice-edge east of Svalbard in May and June preferentially prey on harp seals instead of ringed seals, and that this may partly explain the variation in PCB concentrations among polar bears from the Norwegian Arctic. An hypothesis is that the harp seal may function as a transport vector of OCs into the high Arctic environment.

Spatial distribution of persistent organochlorines in ringed seal (Phoca hispida) blubber

Blubber samples, taken through the entire blubber column, were collected from three different anatomical locations on ringed seals (Phoca hispida). The outer and inner layers of these samples were analysed for concentrations of sigma PCBs (sum of the analysed congeners, polychlorinated biphenyls) and p,p'-DDE (4,4'-dichlorodiphenyldichloroethylene). No significant differences were found in blubber thickness or in per cent extractable lipid when comparing age- and sex-groups, or in extractable lipid content when comparing anatomical locations of the blubber or blubber depth. No significant differences were found between the three different anatomical locations with respect to the concentrations of sigma PCBs or p,p'-DDE. However, the concentrations of both sigma PCB and p,p'-DDE were significantly higher in the outer blubber layer compared to the inner. Higher levels of both sigma PCB and p,p'-DDE were found in males compared to females and juveniles in both the inner and outer parts of the blubber column. The most commonly used blubber sampling devices are biopsy tools that penetrate only the outer layer of the blubber. Analyses of such samples will not reflect the real body burden of organochlorines. Standard methods for sampling blubber of marine mammals should be developed so that comparative studies and longitudinal monitoring programs of pollutants in marine mammals can be conducted in a meaningful way.

Body core temperature during food restriction in rats

Deep body temperature and locomotor activity of rats fed a reduced food amount (n = 9) and of starved rats (n = 9), were measured by implanted transmitters. Both groups were then refed ad libitum. The reduction in body temperature was significant for both groups, but larger in the starved rats than in the food restricted rats. There was a displacement of the circadian temperature rhythm in the starved rats. There were no significant differences in locomotor activity between groups until the start of refeeding. Rats fed reduced food amounts rapidly increased their activity, while the starved group retained a low activity for several days. Thermal conductance was reduced by 30% in both groups. This reduction in thermal conductance may explain how starving and semistarving rats are able to maintain core temperatures close to normal, even if resting metabolic rates are drastically reduced. The measured reduction in body core temperature signifies a change in the thermoregulatory 'set-point' during starvation.