Dietary sodium intake is associated with long-term risk of new-onset atrial fibrillation.

BACKGROUND: The association between dietary salt intake and hypertension has been well documented. We evaluated the association between dietary sodium intake and the incidence of new-onset atrial fibrillation (AF) during a mean follow-up of 19 years among 716 subjects from the Oulu Project Elucidating Risk of Atherosclerosis (OPERA) cohort. MATERIAL AND METHODS: Dietary sodium intake was evaluated from a seven-day food record. The diagnosis of AF (atrial flutter included) was made if ICD-10 code I48 was listed in the hospital discharge records during follow-up. RESULTS: In the Kaplan-Meier curves, when quartiles of sodium consumption were considered, the cumulative proportional probabilities for AF events were higher in the highest (4th) quartile (16.8%) than in the lower quartiles (1st 6.7%, 2nd 7.3% and 3rd 10.6%) (p = .003). In the Cox regression analysis, sodium consumption (g/1000 kcal) as a continuous variable was independently associated with AF events (Hazard Ratio = 2.1 (95% CI, 1.2 to 3.7) p =.015) when age, body mass index, smoking (pack-years), office systolic blood pressure, left atrium diameter, left ventricular mass index and the use of any antihypertensive therapy were added as covariates. CONCLUSIONS: These findings indicate that sodium intake is associated with the long-term risk of new-onset AF. Further confirmatory studies are needed. Key messages Sodium consumption correlated positively with CV risk factors: age, smoking, SBP, BMI and LDL-cholesterol. When quartiles of sodium consumption were considered, the AF incidence was higher in the highest quartile compared to lower quartiles. Sodium consumption as a continuous variable was independently associated with AF events when age, BMI, smoking, SBP, LAD, LVMI and the use of any antihypertensive therapy were considered.

Trends in long-term prognosis after acute coronary syndrome.

Background Coronary heart disease incidence, mortality and short-term case-fatality have improved substantially during the past decades. Recent changes in the long-term prognosis among survivors of acute coronary syndrome are less well known. Our aim was to investigate the long-term prognosis of acute coronary syndrome. Design An observational myocardial infarction register study. Methods Data was derived from the population based Finnish Myocardial Infarction register. Patients aged 35 or higher, who had their first acute coronary syndrome during 1993-2011 and survived the first 28 days, were included in the analysis ( n = 13,336). Endpoints were fatal and non-fatal cardiovascular disease events and all-cause mortality at one year and three years after the index event. We also compared the prognosis of acute coronary syndrome survivors with the prognosis of an apparently healthy population with the same age, sex and area of residence, derived from the FINRISK study. Results Significant declines over time were observed in the risk of a new cardiovascular disease event. At three year follow-up the age- and study area-adjusted hazard ratio per calendar year was 0.969 (95% confidence interval 0.960-0.977, p = 4.63 × 10-13) among men and 0.969 (95% confidence interval 0.961-0.978, p = 1.01 × 10-11) among women. Despite the improvement in prognosis, the age-standardized three year cardiovascular disease free survival of acute coronary syndrome patients was significantly lower than in the FINRISK control group (for men p = 6.64 × 10-27 and for women p = 2.11 × 10-15). Conclusion The prognosis of acute coronary syndrome survivors has improved during the 18-year period but is still much worse than the prognosis of comparable general population.

Serum ghrelin and prediction of metabolic parameters in over 20-year follow-up.

Ghrelin is a peptide hormone from the stomach, with an ability to release growth-hormone from the pituitary. Numerous cross-sectional studies indicate that ghrelin also has a role in metabolic abnormalities, such as metabolic syndrome and type 2 diabetes, but evidence for long-term effect is scarce. We investigated, whether ghrelin concentration measured in middle age would predict the development or absence of metabolic disturbances subsequently. Study population consisted of 600 middle-aged persons, and the follow-up time was approximately 21 years. Plasma total ghrelin concentration was measured at the baseline, and divided to tertiles. Numerous anthropometric and other clinical measurements (including blood pressure), and laboratory test were made both at the baseline and at the follow-up. After the follow-up the prevalence of high systolic blood pressure according to MetS IDF-criteria was the lowest in the highest ghrelin tertile, and the highest in the first (p<0.03). When only subjects free of hypertension medication at baseline were considered, subjects belonging to the highest ghrelin tertile developed less new hypertension and high blood pressure according to IDF-criteria as well as medication for it during the follow-up (p<0.05). Although serum insulin levels were negatively correlated to ghrelin levels at both points in time (p<0.001 at baseline and p=0.003 at follow-up), plasma ghrelin concentration did not predict the development of abnormalities in glucose tolerance. The association with ghrelin and metabolic syndrome was lost during the follow-up. In conclusion, our results suggest high ghrelin to be protective against the development of hypertension in the long-term follow-up.

Low plasma ghrelin concentration is an indicator of the metabolic syndrome.

BACKGROUND: Low ghrelin concentration has been associated with several features of metabolic syndrome (MS), but the relationship between ghrelin concentration and MS as a cluster of metabolic aberrations has not yet been studied. AIMS OF THE STUDY: To analyse whether ghrelin concentration is associated with MS. RESEARCH DESIGN AND METHODS: Fasting plasma ghrelin concentrations of the population-based cohort of 1037 middle-aged men and women were analysed using a commercial radioimmunoassay kit (Phoenix Peptide). MS was determined using the new International Diabetes Federation criteria. RESULTS: The prevalence of MS was 37.2%. The ghrelin concentrations were decreased in subjects with MS (635 pg/mL) compared to those without MS (687 pg/mL) (P=0.001). Ghrelin levels decreased with an increase in the number of metabolic abnormalities. Low ghrelin was a statistically significant predictor of MS in logistic regression analysis (P=0.005) so that the subjects in the 1st ghrelin quartile were at higher risk of having MS compared to the subjects in the 4th quartile (OR=1.82, 95% CI: 1.27-2.60, P=0.001). This association remained statistically significant after adjustment for age and sex (OR=1.76, 95% CI: 1.24-2.55, P=0.002). CONCLUSIONS: Metabolic syndrome is associated with low ghrelin levels suggesting a relationship of ghrelin in the metabolic disturbances of MS.

Gender differences in the treatment and secondary prevention of CHD at population level.

OBJECTIVES: Treatment and secondary prevention measures, received by persons with coronary heart disease (CHD), are insufficiently known at the moment. The aim of this study was to investigate the state of treatment and secondary prevention of CHD in a population-based sample and to analyze possible gender differences in different age groups. DESIGN: 300 men and 300 women with CHD were identified from a nationally representative health examination survey with 88% participation rate, carried out in Finland in 2000-2001. RESULTS: Revascularization had been performed on 34% (95% confidence interval 29, 40%) of men and 13% (8, 18%) of women. Moreover, 76% (71, 81%) of the men and 63% (57, 69%) of the women used antithrombotic medications. Two thirds of both men and women used beta-blockers and one third lipid-lowering medication. Smoking was more common among men, whereas obesity and high total cholesterol concentration were more common among women. CONCLUSIONS: Secondary prevention of CHD is far from optimal and there are gender differences in the care of CHD.

IGF-I concentrations are positively associated with carotid artery atherosclerosis in women.

BACKGROUND: Alterations in the growth hormone (GH)/insulin-like growth factor I (IGF-I) axis are associated with increased cardiovascular morbidity and mortality, but previous studies have yielded conflicting results. In addition, the T1169A polymorphism in the GH1 gene has been associated with IGF-I levels. AIMS: To investigate whether IGF-I concentrations and the T1169A polymorphism of the GH1 gene are associated with cardiovascular risk factors and the intima media thickness (IMT) of the carotid artery. METHODS: Fasting plasma IGF-I concentrations (n=1008) were measured in a large population-based OPERA (Oulu Project Elucidating Risk of Atherosclerosis) cohort. Genotype variants were determined by the restriction fragment length polymorphism method. RESULTS: Low IGF-I concentrations associated with several cardiovascular risk factors including age, adiposity, and high triglyceride, fasting insulin and C-reactive protein concentrations in the analysis of all subjects. In the multivariate models, however, IGF-I concentrations were positively associated with the mean IMT of women (ss=0.127, P=0.009) whereas the association in men was weaker and negative (ss=-0.088, P=0.034). The 1169A allele was associated with low low-density lipoprotein cholesterol in both sexes and with low systolic blood pressure levels in women. CONCLUSIONS: IGF-I concentrations were associated with several traditional cardiovascular risk factors. The observed gender difference in the association between IGF-I concentrations and carotid artery atherosclerosis warrants further study. The GH1 1169A allele may be associated with a favourable metabolic profile.

The -1C to T polymorphism in the annexin A5 gene is not associated with the risk of acute myocardial infarction or sudden cardiac death in middle-aged Finnish males.

OBJECTIVE: A common polymorphism (-1C to T) in the translation initiation sequence of annexin A5 (ANV) gene has recently been associated with a decreased risk of acute myocardial infarction (AMI). The aim of the present study was to analyze the association between the ANV genepolymorphism and the risk of AMI and ischemic sudden cardiac death (SCD) in middle-aged Finnish males. MATERIAL AND METHODS: A case-control study involving three distinct groups of subjects was carried out: (1) victims of SCD (n=98), (2) survivors of AMI (n=212), and (3) randomly selected control subjects without any history of coronary heart disease (n=243). The ANV polymorphism was genotyped in each study group. RESULTS: Among the control group of healthy Finnish males the prevalence rates of the CC, CT, and TT genotypes were 83.1%, 15.2%, and 1.6%, respectively. Among the survivors of AMI, the prevalence rates of CC, CT, and TT were 79.7%, 20.3%, and 0%, respectively, and among the victims of SCD 83.7%, 16.3%, and 0%, respectively. No significant differences in the genotype or allele distributions were observed between the study groups. CONCLUSION: The -1C to T polymorphism in the ANV gene is not associated with the risk of AMI or SCD in middle-aged Finnish males.

Prevalence, characteristics and natural course of inappropriate sinus tachycardia.

AIMS: To study the prevalence, characteristics and natural course of inappropriate sinus tachycardia (IST). METHODS AND RESULTS: The prevalence and characteristics of IST were evaluated in a random sample of 604 middle-aged subjects. Seven of the subjects (1.16%) fulfilled the contemporary diagnostic criteria of IST. The systolic (147+/-11 mmHg vs. 130+/-13 mmHg, P<0.001) and diastolic ambulatory blood pressures (92+/-7 mmHg vs. 81+/-8 mmHg, P<0.001) were higher among the subjects with IST than among the controls. The other laboratory, echocardiographic and personality measurements, with the exception of the hostility score (10+/-2 vs. 8+/-3, P<0.001), revealed no differences between the groups. The natural course and prognosis of the disorder was assessed among the subjects fulfilling the IST criteria and nine previously diagnosed IST patients. During a mean follow-up of 6.0+/-2.4 years, none of the subjects developed any clinical or echocardiographic evidence of structural heart disease despite ongoing palpitations, and there was no significant reduction in the 24-h average HR (9+/-2 bpm vs. 89+/-8 bpm, P=0.204). CONCLUSION: The prevalence of IST in a middle-aged population was higher than previously assumed. Despite the chronic nature of the disorder, the prognosis of IST was benign. The causal relationship between IST and hypertension and/or hostile personality type remains speculative.

Biliary lipid composition in monozygotic and dizygotic pairs of twins.

The relative contribution of genetic factors to biliary and serum lipid composition was studied in 17 monozygotic and 18 dizygotic middle aged male pairs of twins. Cholesterol precursors, squalene and Methylated sterols which reflect the activity of cholesterol synthesis were also measured. Pairwise intraclass correlations were determined for monozygotic and dizygotic twin pairs and heritability estimates were calculated. Molar % of biliary cholesterol and percentage distribution of biliary cholic acid and particularly deoxycholic acid showed significant pairwise correlations within the monozygotic but not the dizygotic pairs. Similar correlations were found for total biliary methylsterols and of the methylsterol subfractions for the two methostenols but not for squalene, lanosterol and dimethylsterols. In serum, the precursor sterols, but not squalene, showed even higher pairwise correlations in the monozygotic twins than the corresponding precursors in bile. Molar per cent of bile acids and phospholipids and cholesterol saturation index were not correlated significantly in either twin pairs, but the pairwise correlations tended to be higher in the monozygotic than in the dizygotic pairs. Gall stones were found in seven monozygotic and three dizygotic subjects. Two monozygotic twin pairs were concordant for gall stones; all the dizygotic pairs were discordant. Overall, these data suggest that molar percentage of biliary cholesterol, bile acid composition, cholesterol synthesis, bile cholesterol saturation, and gall stone formation may be under a significant genetic control.