Heart 2006 May 22; (Read article online)

Huerta C, Varas-Lorenzo C, Castellsague J, García Rodríguez LA

Objetives To estimate the risk of first hospital admission for heart failure (HF) associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Background Observational studies have shown that NSAID use increased the risk of incident HF and hospitalization for HF, mostly among patients with previous heart disease, as well as the risk of a HF relapse. Methods We conducted a cohort study with a nested case-control analysis using the U.K General Practice Research Database. Overall, 1,396 cases of first hospital admission for non fatal HF were identified (January 1997 to December 2000) and compared with a random sample of 5,000 controls. Results The incidence rate was 2.7 per 1,000 person-years. Prior clinical diagnosis of HF was the main independent risk factor triggering a first HF hospitalization (Relative Risk(RR)7.3;95%CI 6.3-8.8). The risk of a first hospital admission for HF associated with current use of NSAIDs was 1.3(95%CI 1.1-1.6) after controlling for major confounding factors. No effects of dose and duration were found. The RR in current users of NSAIDs with prior HF was 8.6(95%CI 5.3-13.8) compared to patients who did not use NSAIDs and without prior clinical diagnosis of HF. Conclusion Use of NSAIDs was associated with a small risk increase of first hospitalization for HF. In patients with prior clinical diagnosis of HF, the use of NSAIDs might lead to worsening of pre-existing HF that triggers their hospital admission. This increased risk, although small, may result in considerable public health impact, particularly among the elderly.

Cytogenet Genome Res 2006; 114(1): 24-9 (Read article online)

Pérez-Mancera PA, González-Herrero I, Maclean K, Turner AM, Yip MY, Sánchez-Martín M, García JL, Robledo C, Flores T, Gutiérrez-Adán A, Pintado B, Sánchez-García I

The Snail-related zinc-finger transcription factor, SLUG (SNAI2), is critical for the normal development of neural crest-derived cells and loss-of-function SLUG mutations have been proven to cause piebaldism and Waardenburg syndrome type 2 in a dose-dependent fashion. However, little is known about the consequences of SLUG overexpression in embryonic development. We report SLUG duplication in a child with a unique de novo 8q11.2-->q13.3 duplication associated with tetralogy of Fallot, submucous cleft palate, renal anomalies, hypotonia and developmental delay. To investigate the effects of Slug overexpression on development, we analyzed mice carrying a Slug transgene. These mice were morphologically normal at birth, inferring that Slug overexpression is not sufficient to cause overt morphogenetic defects. In the adult mice, there was a 20% incidence of sudden death, cardiomegaly and cardiac failure associated with incipient mesenchymal tumorigenesis. These findings, while not directly implicating Slug in congenital and acquired heart disease, raise the possibility that Slug overexpression may contribute to specific cardiac phenotypes and cancer development.

Int J Obes (Lond) 2006 May 23; (Read article online)

Huang RC, Burke V, Newnham JP, Stanley FJ, Kendall GE, Landau LI, Oddy WH, Blake KV, Palmer LJ, Beilin LJ

Background:Features of the metabolic syndrome comprise a major risk for cardiovascular disease and will increase in prevalence with rising childhood obesity. We sought to identify early life influences on development of obesity, hypertension and dyslipidemia in children.Methods and results:Cluster analysis was used on a subset of a longitudinal Australian birth cohort who had blood samples at age 8 (n=406). A quarter of these 8-year-olds fell into a cluster with higher body mass index, blood pressure (BP), more adverse lipid profile and a trend to higher serum glucose resembling adult metabolic syndrome. There was a U-shaped relationship between percentage of expected birth weight (PEBW) and likelihood of being in the high-risk cluster. The high-risk cluster had elevated BP and weight as early as 1 and 3 years old. Increased likelihood of the high-risk cluster group occurred with greatest weight gain from 1 to 8 years old (odds ratio (OR)=1.4, 95% confidence interval (CI)=1.3-1.5/kg) and if mothers smoked during pregnancy (OR=1.82, CI=1.05-3.2). Risk was lower if children were breast fed for >/=4 months (OR=0.6, 95% CI=0.37-0.97). Newborns in the upper two quintiles for PEBW born to mothers who smoked throughout pregnancy were at greatest risk (OR=14.0, 95% CI=3.8-51.1) compared to the nadir PEBW quintile of non-smokers.Conclusion:A U-shaped relationship between birth weight and several components of the metabolic syndrome was confirmed in a contemporary, well-nourished Western population of full-term newborns, but post-natal weight gain was the dominant factor associated with the high-risk cluster. There was a prominence of higher as well as lowest birth weights in those at risk. Future health programs should focus on both pre- and post-natal factors (reducing excess childhood weight gain and smoking during pregnancy), and possibly the greatest benefits may arise from targeting the heaviest, as well as lightest newborns, especially with a history of maternal smoking during pregnancy.International Journal of Obesity advance online publication, 23 May 2006; doi:10.1038/sj.ijo.0803394.

Arch Dis Child 2006 May 22; (Read article online)

Pushparajah K, Garvie D, Hickey A, Qureshi S

AIM: To assess a model for cardiology assessments in children with suspected heart disease by a general paediatrician with special expertise in paediatric cardiology (PsePC) in the setting of a district general hospital. METHODS: A new monthly 'screening' clinic was established in May 2004 by the PsePC to reduce the burden of new referrals on outreach tertiary paediatric cardiology services. All patients were to have echocardiograms as part of their referral for cardiac assessment. Over a 1 year period (May 2004-April 2005), through audit, we recorded details of referrers, indications for referral, echocardiography assessments along with subsequent management. This was compared with the pattern of patients seen in the joint paediatric cardiology outreach clinics over a 2-year period between May 2003 - April 2005. RESULTS: In the 'screening' clinic, there were 75 appointments for 65 patients seen in 12 months. Fifty- five of these patients had normal echocardiographic studies. Of the 47 referrals with heart murmurs in asymptomatic children, 4 (8.5%) had structurally abnormal hearts on echocardiographic assessment. All echocardiograms were reviewed by the visiting paediatric cardiologist. Between the 6-month periods of May 2003 - Oct 2003, and November 2003 - April 2004, the number of new patients with normal echocardiographic studies seen in the paediatric cardiology outreach clinic was 33/106(31%) and 28/110(25.4%) respectively. Following the introduction of the 'screening' clinic in May 2004, the number decreased to 21/99(21%) during the 6 months between May 2004 - October 2004, and 10/102 (9.8%) between November 2004 - April 2005. CONCLUSION: The provision of paediatric cardiology services in a hub and spoke configuration is widely accepted, but there is no established ideal model of care. We propose that our model can work effectively in order to identify pathology requiring input of a paediatric cardiologist more appropriately. Paediatricians with specific training in paediatric cardiology are potentially well equipped to provide this basic screening service, combining clinical assessment with echocardiography.

Arch Intern Med 2006 May 22; 166(10): 1134-42 (Read article online)

Smith GL, Shlipak MG, Havranek EP, Foody JM, Masoudi FA, Rathore SS, Krumholz HM

BACKGROUND: Renal dysfunction predicts increased mortality in cardiovascular patients, but the best renal estimator for quantifying risks is uncertain. We compared admission serum urea nitrogen (SUN) level, creatinine level, Modification of Diet in Renal Disease (MDRD) rate, and Mayo estimated glomerular filtration rate (eGFR) for predicting mortality. METHODS: In a retrospective cohort of Medicare patients (aged >/=65 years) hospitalized for myocardial infarction (n = 44 437) and heart failure (n = 56 652), renal estimators were compared for linearity with 1-year mortality risk, magnitude of risk, and relative importance for predicting risk (percentage variance explained) in proportional hazards models. RESULTS: The SUN level, creatinine level, and Mayo eGFR had linear associations with mortality. These measures predicted steadily increased risk in patients who experienced a myocardial infarction with a SUN level greater than 17 mg/dL (>6.1 mmol/L), a creatinine level greater than 1.0 mg/dL (>88.4 mumol/L), and a Mayo eGFR of less than 100 mL/min per 1.73 m(2); and in patients who experienced heart failure with a SUN level greater than 16 mg/dL (>5.7 mmol/L), a creatinine level greater than 1.1 mg/dL (>97.2 mumol/L), and a Mayo eGFR of 90 mL/min per 1.73 m(2) or less. In contrast, the MDRD eGFR had a J-shaped association and failed to identify increased risks in 50.0% of patients who experienced a myocardial infarction (with an MDRD eGFR >55 mL/min per 1.73 m(2)) and 60.0% of patients who experienced heart failure (with an MDRD eGFR >44 mL/min per 1.73 m(2)). The SUN level and Mayo eGFR had the greatest magnitude of risks. In myocardial infarction and heart failure patients, adjusted mortality increased by 3% and 7%, respectively, per 5-U increase in SUN, and by 3% and 9%, respectively, per 10-U decrease in Mayo eGFR (P<.001), based on models including both renal measures. Of all the measures, SUN had the greatest magnitude of relative importance for predicting mortality. CONCLUSIONS: In older cardiovascular patients, SUN- and creatinine-based measures were powerful predictors of postdischarge mortality. Only MDRD eGFR was less adequate in quantifying risks for patients with mild impairment. Novel estimators, such as the Mayo eGFR, may play an important role in outcomes' prognostication for these patients.

Arch Intern Med 2006 May 22; 166(10): 1115-20 (Read article online)

Wang L, Larson EB, Bowen JD, van Belle G

BACKGROUND: The association of physical function with progression to dementia has not been well investigated. We aimed to determine whether physical function is associated with incident dementia and Alzheimer disease (AD). METHODS: We performed a prospective cohort study of 2288 persons 65 years and older without dementia. Patients were enrolled from 1994 to 1996 and followed up through October 2003. Main outcome measures included incident dementia and AD. RESULTS: During follow-up 319 participants developed dementia (221 had AD). The age-specific incidence rate of dementia was 53.1 per 1000 person-years for participants who scored lower on a performance-based physical function test at baseline (10 points). A 1-point lower performance-based physical function score was associated with an increased risk of dementia (hazard ratio, 1.08; 95% confidence interval, 1.03-1.13; P<.001), an increased risk of AD (hazard ratio, 1.06; 95% confidence interval, 1.01-1.12; P = .01), and an increased rate of decline in the Cognitive Ability Screening Instrument scores (0.11 point per year; 95% confidence interval, 0.08-0.14; P<.001) after adjusting for age, sex, years of education, baseline cognitive function, APOE epsilon4 allele, family history of AD, depression, coronary heart disease, and cerebrovascular disease. CONCLUSIONS: Lower levels of physical performance were associated with an increased risk of dementia and AD. The study suggests that poor physical function may precede the onset of dementia and AD and higher levels of physical function may be associated with a delayed onset.

Eur Heart J 2006 May 22; (Read article online)

Graham MM, Norris CM, Diane Galbraith P, Knudtson ML, Ghali WA

AIMS: To describe health status outcomes at 4 years for a cohort of elderly patients with cardiac disease. METHODS AND RESULTS: Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, an outcomes initiative capturing all patients undergoing cardiac catheterization in Alberta, Canada, health status was measured using the Seattle Angina Questionnaire (SAQ) and crude and risk-adjusted outcomes were determined and compared for patients treated with percutaneous coronary intervention or coronary artery bypass surgery (CABG) vs. medical therapy. Response rates among surviving, consenting patients were 64.8% for patients <70 years (n=7883), 77.3% for patients aged 70-79 years (n=2940), and 77.7% for patients >/=80 years of age (n=439). For patients aged <70 years, and those aged 70-79 years, for all dimensions of the SAQ, scores were significantly better for patients treated with revascularization procedures than with medical therapy. For patients over the age of 80 years, scores for patients treated with CABG in particular were significantly better, with the exception of exertional capacity. At 3 years, all scores remained stable or improved, and continued to favour revascularization. CONCLUSION: Elderly patients undergoing revascularization have better health status at 4 years than do those in the same age group who do not undergo revascularization. These findings suggest that age should not deter against revascularization given the combined survival and quality-of-life benefits.

Eur Heart J 2006 May 22; (Read article online)

Indermühle A, Vogel R, Meier P, Wirth S, Stoop R, Mohaupt MG, Seiler C

AIMS: The adaptation of the myocardial microcirculation in humans to pathologic and physiologic stress has not been examined in vivo so far. We sought to test whether the relative blood volume (rBV) measured by myocardial contrast echocardiography (MCE) can differentiate between left ventricular (LV) hypertrophy (LVH) in hypertensive heart disease and athlete's heart. METHODS AND RESULTS: Four groups were investigated: hypertensive patients with LVH (n=15), semi-professional triathletes with LVH (n=15), professional football players (n=15), and sedentary control individuals without cardiovascular disease (n=15). MCE was performed at rest and during adenosine-induced hyperaemia. The rBV (mL mL(-1)), its exchange frequency (beta, min(-1)), and myocardial blood flow (mL min(-1) g(-1)) were derived from steady state and refill sequences of ultrasound contrast agent. Hypertensive patients had lower rBV (0.093 +/- 0.013 mL mL(-1)) than triathletes (0.141 +/- 0.012 mL mL(-1), P<0.001), football players (0.129 +/- 0.014 mL mL(-1), P<0.001), and sedentary individuals (0.126 +/- 0.018 mL mL(-1), P<0.001). Conversely, the exchange frequency (beta) was significantly higher in hypertensive patients (11.3 +/- 3.8 min(-1)) than in triathletes (7.4 +/- 1.8 min(-1)), football players (7.7 +/- 2.3 min(-1)), and sedentary individuals (9.0 +/- 2.5 min(-1)). An rBV below 0.114 mL mL(-1) distinguished hypertensive patients and triathletes with a sensitivity of 93% and a specificity of 100%. CONCLUSION: Pathologic and physiologic LVH were differentiated non-invasively and accurately by rBV, a measure of vascularisation assessed by MCE.

Eur J Pediatr 2006 May 23; (Read article online)

Moons P, Barrea C, Suys B, Ovaert C, Boshoff D, Eyskens B, Vandenrijn C, Sluysmans T

INTRODUCTION: Although summer and sports camps for children with congenital heart disease are organized in many countries and regions, empirical data on the effects of such camps is limited. OBJECTIVES: The aim of the present study was to investigate changes in the perceived health status and habitual physical activities in children attending a special sports camp. MATERIALS AND METHODS: In this longitudinal study, 25 children with congenital heart disease who participated in a three-day multi-sports camp were included. The perceived health status was measured using the Child Health Questionnaire-Child Form, CHQ-CF87, completed by the child at the start of the camp (T1), at the end of the camp (T2), and 3 months after the camp concluded (T3). Habitual physical activities were assessed by means of a modified version of the Baecke questionnaire, which was completed by one of the parents at T1 and T3. RESULTS: During the sports camp, we observed significant improvements in the children's perception of their physical functioning, role-physical functioning, general health, role-emotional functioning, self-esteem, mental health, and general behavior. For physical functioning, role-emotional functioning, and family activities, high scores persisted three months after the sports camp concluded. The habitual physical activities (sport and leisure time) of the children remained unchanged. DISCUSSION AND CONCLUSION: In conclusion, we propose that a special sports camp for children with congenital heart disease may improve specific dimensions of subjective health status. Our study confirms a previous report on the benefits of such camps for afflicted children. If these findings can be further corroborated in other settings, participation in sport camps should be advocated as a simple, noninvasive means to promote healthier children.

Rheum Dis Clin North Am 2006 May; 32(2): 275-93 (Read article online)

Becker MA, Jolly M

After introduction of urate-lowering therapy, asympotomatic hyperuricemia was treated with allopurinol or uricosuric agents in the belief that hyperuricemia and/or gout caused chronic kidney disease. Epidemiologic studies in the 1970s, however, failed to confirm the view that hyperuricemia and gout were independent risk factors for chronic kidney disease. As a result, urate-lowering pharmacotherapy is generally not recommended at the present time in the management of asymptomatic hyperuricemia even though recent epidemiological, experimental, and clinical studies have prompted reexamination of a causal role for hyperuricemia (with or without gout) in chronic kidney disease as well as other important disorders including cardiovascular disease, hypertension, and metabolic syndrome. The issue of such a role remains unresolved and this article reviews the current status of the relationship between hyperuricemia and associated disorders.

Eur Heart J 2006 May 22; (Read article online)

Andreassi MG, Ait-Ali L, Botto N, Manfredi S, Mottola G, Picano E

AIMS: Medical radiological exposure is associated with an additional risk of cancer. Children with repaired congenital heart disease (CHD) are theoretically at a relatively greater cancer risk as the radiological exposure can be intensive in these patients. Chromosomal aberrations test (CA) and micronucleus assay (MN) in peripheral blood lymphocytes are biomarkers of chromosomal damage and intermediate endpoints in carcinogenesis. METHODS AND RESULTS: The frequency of CA and MN was assessed in three groups of patients: Group I, 32 exposed patients (17 males, age=15.5 +/- 8.3 years) who underwent cardiac procedures employing ionizing radiation (mostly cardiac catheterization) for CHD between 1965 and 2000; Group II, 32 healthy age- and sex-matched subjects (17 males, age=14.1 +/- 12.3 years), and Group III, 10 newborn non-exposed patients (7 males) with CHD. Exposed patients of Group I had a mean value of 2.9 +/- 1.4 cardiac catheterization (range 1-5) procedures per person. The mean frequency of CA was higher in the exposed patients (Group I = 2.8 +/- 1.9% vs. Group II=0.7 +/- 0.7%; vs. Group III=0.8 +/- 0.8%; P<0.0001). Similarly, the mean values of MN were higher in the exposed patients (Group I = 12.3 +/- 5.1 per thousand vs. Group II=6.0 +/- 3.8 per thousand; vs. Group III=4.4 +/- 1.4 per thousand; P<0.0001). CONCLUSION: Cardiac ionizing procedures are associated with a long-lasting mark in the chromosomal damage of exposed children with CHD.

Pediatr Clin North Am 2006 Jun; 53(3): 493-512 (Read article online)

Mitsnefes MM

Hypertension is one of the most common health problems in the United States and a powerful independent risk factor for cardiovascular and renal disease. Until recently, the incidence of persistent hypertension in children has been low, with a range of 1% to 3%. Recent data indicate that over the last decade, however, average blood pressure levels have risen substantially among American children. Obesity and other lifestyle factors, such as physical inactivity and increased intake of high-calorie, high-salt foods, are thought to be responsible for this trend. Hypertension in children is currently recognized as an important health issue. There is increasing evidence that hypertension has its antecedents during childhood, because adult blood pressure often correlates with childhood blood pressure. Hypertension in children also is viewed as a significant risk factor for the development of cardiovascular disease in adulthood.

World J Gastroenterol 2006 May 14; 12(18): 2923-7 (Read article online)

Ng W, Wong WM, Chen WH, Tse HF, Lee PY, Lai KC, Li SW, Ng M, Lam KF, Cheng X, Lau CP

AIM: The use of low-dose aspirin to prevent cardiovascular disease events is well established. However, the incidence and predictors of upper gastrointestinal bleeding (UGIB) with its use are unknown. We studied prospectively the incidence and outcome of peptic ulceration in low-dose aspirin users. METHODS: A total of 991 patients with coronary artery disease (CAD) on low-dose aspirin were prospectively followed-up for two years for the occurrence and clinical features of first hospitalized episode of UGIB. RESULTS: UGIB had a bimodal presentation with 45% occurring within four months of aspirin initiation and had an overall prevalence of 1.5% per year. There was no UGIB-related death. Hypertension (OR = 4.6, 95%CI 1.5 - 14.7, P = 0.009), history of peptic ulceration (OR = 3.1, 95%CI 1.1 - 9.0, P = 0.039), tertiary education (OR = 3.08, 95%CI 1.1- 9.0, P = 0.039) and higher lean body mass (P = 0.016) were independent factors associated with UGIB. Use of nitrate did not reduce UGIB. CONCLUSION: The incidence of UGIB in patients with CAD on long-term low-dose aspirin is low, but is accompanied with significant morbidity. With prolonged use of aspirin, UGIB continues to be a problem for those with risk factors and especially in patients with a history of peptic ulcers, in which UGIB tends to occur early after aspirin therapy.

Spinal Cord 2006 May 23; (Read article online)

Stoner L, Sabatier MJ, Mahoney ET, Dudley GA, McCully KK

Study design:Repeated measures training intervention.Objectives:To evaluate the effects of neuromuscular electrical stimulation (NMES)-induced resistance exercise therapy on lower extremity arterial health in individuals with chronic, complete spinal cord injury (SCI). We define 'arterial health' using three surrogate markers: (a) resting diameter, (b) flow-mediated dilation (FMD), and (c) arterial range.Setting:Department of Kinesiology, University of Georgia, USA.Methods:We assessed five 36+/-5-year-old male individuals with chronic, complete SCI before, during, and after 18 weeks of training. The quadriceps femoris muscle group of both legs were trained twice a week with 4 x 10 repetitions of unilateral, dynamic knee extensions. The health of the posterior tibial artery was assessed using a B-mode ultrasound unit equipped with a high-resolution video capture device. Proximal occlusion was used to evoke ischemia for 5 min and then for 10 min. FMD was calculated using the peak diameter change (above rest) following 5 min occlusion. Arterial range was calculated using minimum (during occlusion) and maximum diameters (post 10 min occlusion). Hierarchical linear modeling accounted for the nested (repeated measures) experimental design.Results:FMD improved from 0.08+/-0.11 mm (2.7%) to 0.18+/-0.15 mm (6.6%) (P=0.004), and arterial range improved from 0.36+/-0.28 to 0.94+/-0.40 mm (P=0.001), after 18 weeks of training. Resting diameter did not significantly change.Conclusions:Home-based, self-administered NMES resistance exercise therapy consisting of 80 contractions/week improved FMD and arterial range. This provides evidence that resistance exercise therapy can improve arterial health after SCI, which may reduce the risk of future cardiovascular disease.Spinal Cord advance online publication, 23 May 2006; doi:10.1038/sj.sc.3101940.

Heart 2006 May 22; (Read article online)

McElduff P, Jaefarnezhad M, Durrington PN

Objective To compare national and international recommendations for statin treatment in the primary prevention of cardiovascular disease in middle aged men. Design Application of the current American, British and European recommendations to results of a prospective study. Participants Men aged 49-65 years (n=1653), who participated in the Caerphilly Prospective Study. Main outcome measures Proportion who would receive statin treatment, the number needed to treat (NNT) to prevent one first cardiovascular (CVD) event (myocardial infarction and stroke) over 10 years and the potential number of events prevented over 10 years in the whole population (population impact) by the use of statins in accordance with each set of guidelines, assuming a reduction of risk in the range 10-50% using the observed events and base-line risk factors. Results There were 212 events. For an anticipated reduction in first CVD events of 30% with statin treatment, the NNT was 26.0, if the whole population was treated. The lowest NNT was 12.1 for the National Health Service Framework (NSF), achieved when only 14% of the men received a statin. However, this prevented the lowest number of events (19.2/212) and had the smallest population impact on CVD incidence (-9.1%). The American and earlier Joint British Societies guidelines, although giving NNT's of around 21 prevented more events and had a greater population impact of -21.6 to - 23.3%. They did, however, target some 60% of the male population. The British Hypertension Society guidelines and new Joint British Societies recommendations achieved the greatest population impact of -27% whilst maintaining the NNT at 22.2. They did, however, target three quarters of this population. Conclusion Even effective preventive therapy will have little impact in preventing disease if its deployment does not include those at typical risk. Whether cholesterol-lowering on such a scale should be attempted with medication raises philosophical, psychological and economic considerations, particularly in view of the high likelihood of individual benefit from statin treatment. More effective nutritional policies to reduce serum cholesterol on a population level and reduce the requirement statins in primary prevention should also be considered.

J Hum Hypertens 2006 May 18; (Read article online)

Bacon SL, Lavoie KL, Campbell TS, Fleet R, Arsenault A, Ditto B

Silent myocardial ischaemia is a common phenomenon in patients with coronary heart disease. However, very little is known about the underlying mechanisms of silent ischaemia. One potential pathway that may contribute to this absence of pain is increased blood pressure. The main aim of the current study was to assess the associations among blood pressure, pain and ischaemia in patients undergoing a standard exercise stress test. We hypothesized that patients who experienced chest pain during exercise would have lower baseline and peak blood pressures compared to those who did not experience chest pain. A total of 1355 patients (418 women) who underwent a single-photon emission computed tomography treadmill exercise stress test and had not experienced a cardiac event in the past 2 weeks participated in the current study. Myocardial perfusion defects were assessed at rest and during the stress challenge. Systolic blood pressure (SBP), diastolic blood pressure, heart rate (HR) and rate pressure product (RPP) were assessed during rest and at peak exercise. There were no main effects of either pain or ischaemia on the baseline cardiovascular variables. Peak exercise data revealed main effects of pain on SBP, RPP and HR, and main effects of ischaemia on SBP and RPP, controlling for age, sex, baseline level, medication status and cardiac history. These findings suggest that acute rather than chronic increases in blood pressure may be one mechanism to explain the phenomena of silent myocardial ischaemia in cardiac patients, and may potentially provide a target for future treatment strategies.Journal of Human Hypertension advance online publication, 18 May 2006; doi:10.1038/sj.jhh.1002043.

Hum Hered 2006 May 19; 61(2): 87-96 (Read article online)

Hamon SC, Kardia SL, Boerwinkle E, Liu K, Klos KL, Clark AG, Sing CF

Objective: Evaluate the consistency of the contribution of interactions between single nucleotide polymorphism (SNP) genotype effects to variation in measures of lipid metabolism across ethnic strata within gender. Methods and Results: We considered 80 SNPs within the apolipoprotein (APO) A1/C3/A4/A5 gene cluster using an over-parameterized general linear model to identify SNPs whose genotype effects combine non-additively to influence plasma levels of high density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triglycerides (TG) in a consistent manner across ethnic strata. We analyzed population-based samples of unrelated 18 to 30 year old African-Americans (n = 1,858) and European-Americans (n = 1,973) ascertained without regard to health at four field centers (Birmingham, Ala.; Chicago, Ill.; Minneapolis, Minn. and Oakland, Calif., USA) by the Coronary Artery Risk Development in Young Adults (CARDIA) study. To identify which SNP genotype effects combine non-additively we used a two-tier analysis strategy. We first required that pairs of SNPs show statistically significant non-additivity in both ethnic strata within a gender, where experiment-wise significance was evaluated using a permutation test to determine the probability of observing the number of tests significant in both ethnic strata by chance alone. Second, we required no significant evidence of heterogeneity of the relationship between the phenotype and the two SNP genotypes across ethnic strata and across field centers within each ethnic group. From this strategy we identified ten pairs of SNPs, involving thirteen SNPs, that displayed statistically significant non-additivity of SNP genotype effects on TC. Only one of these thirteen SNPs had statistically significant genotype effects that were consistent across samples. Conclusion: Our analyses suggest that ignoring the contribution of interactions between SNP genotype effects when modeling multi-SNP genotype-phenotype relationships may result in an underestimate of the contribution of genetic variation to variation in quantitative cardiovascular disease (CVD) risk factor traits. Copyright (c) 2006 S. Karger AG, Basel.

Kardiologiia 2006; 46(3): 25-29 (Read article online)

Berezin MV, Dovgaliuk IV, LutaÄ­ AV, Berezina AM, Kodin AV

AIM: To assess cytoarchitectonics and parameters of aggregation of erythrocytes in patients with acute myocardial infarction, to elucidate their relationships with risk factors of ischemic heart disease. Material and methods. We examined 80 patients with acute myocardial infarction, 20 patients with stable angina pectoris comprised control group. Patients were divided into subgroups according to depth of damage of the myocardium and presence of statins in the treatment scheme. Examination included assessment of cytoarchitectonics and parameters of aggregation of erythrocytes, determination of blood plasma lipid spectrum and concentration of fibrinogen. Results and conclusions. Pronounced pathological changes of cytoarchitectonics of erythrocytes and parameters of their aggregation develop in acute myocardial infarction. These changes increase with increase of depth of myocardial damage. Inclusion of statins in the scheme of treatment leads to significant improvement of the parameters studied. This improvement is more pronounced in patients with non-Q-wave myocardial infarction. Presence of significant interrelationships between cytoarchitectonics of erythrocytes and their aggregation and levels of low density lipoprotein cholesterol, concentration of fibrinogen.

Kardiologiia 2006; 46(4): 81-84 (Read article online)

Sorokin EV

Prognostic advantage of a combination of calcium antagonist and angiotensin converting inhibitor (ACEI) over combination of beta-adrenoblocker with tiazide diuretic was proved in a large randomized study of long term treatment of arterial hypertension. In another randomized study administration of ACEI for 12 months caused substantial retardation of cardiac remodeling in elderly patients with normal left ventricular function in postinfarction period. These results are important for a practical physicians as they concern treatment of wide circle of in- out-patients.

Kardiologiia 2006; 46(4): 4-9 (Read article online)

Belenkov IN, Savchenko AP, Shiriaev AA, Rudenko BA, Vlasova EE

AIM: Investigation of efficacy of endovascular interventions in native vascular bed and grafts, elucidation of factors, affecting immediate and remote prognosis after endovascular treatment. MATERIAL AND METHODS Coronary stenting was carried out in 212 patients who had previously undergone coronary bypass surgery. Stents were implanted into native vessels and grafts in 116 (native vessels group) and 96 (grafts group) patients, respectively. Frequency of angina recurrence and development of complications were assessed during hospitalization and after 1 year. Coronary angiography was repeated after 1 year in 47 and 36 patients in native vessels and grafts groups, respectively. Multifactorial analysis of predictors of complications and angina recurrence was performed with the use of logistic regression. RESULTS AND CONCLUSION: In grafts group signs of distal embolism were observed in 9 patients (9.4%), shunt thrombosis occurred in 2 of these patients. Risk factors of embolism in grafts group were complicated lesions (type C) and length of stenosis >20 mm. There was 1 non-Q wave myocardial infarction after stenting of native vascular bed (0.8%). Angina recurrence was observed after 1 year in 9 (7.8%) and 26 (27.1%), myocardial infarction developed during 1 year in 2 (1.7%) and 3 (3.1%) patients of native vessels and grafts groups, respectively. Risk factors of recurrence of clinic of ischemic heart disease (IHD) after stenting of grafts were time interval between stenting and bypass surgery >5 years and the use of stents without drug coating. More frequent recurrence of clinic of IHD in patients of grafts group was a consequence of higher level of restenosis in stented segments and more frequent progression of atherosclerosis in previously unaffected segments.