Coronary artery calcification and dietary intake in asymptomatic men.

Dietary factors may influence the process of atherosclerosis and coronary artery calcification (CAC). This study assessed CAC and its association with dietary intake in asymptomatic men. We evaluated 150 asymptomatic men with mean age of 58.2±5.3 years. The dietary intake was assessed by the Food Consumption Register method. CAC was measured through multidetector computed tomography (MDCT) and assessed in accordance with the Agatston score. Modified Poisson regression model was used to estimate the effects of intake of different nutrients that are prevalent in moderate/severe CAC, adjusted for calorie intake and CAC risk factors by means of prevalence ratios and 95% confidence intervals [95%CI]. An association was found between the intake of some nutrients and moderate/severe CAC. Lower carbohydrate intake (P=0.021) and higher lipid intake (P=0.006) were associated with moderate/severe CAC. After adjustment, the nutrients associated with the prevalence of moderate/severe CAC were carbohydrates (P=0.040), lipids (P=0.005), and saturated fatty acids (SFA) (P=0.013). A 1% increase in lipids and SFA intake caused an increase of 4% [95%CI: 1-7%] and 8% [95%CI: 2-14%] in the prevalence of moderate/severe CAC, respectively. A 1% increase of carbohydrate intake led to a 2% decrease in the likelihood of moderate/severe CAC [95%CI: 1-4%]. These conclusions showed that the higher intake of total lipids and SFA was associated with higher CAC scores, whereas higher carbohydrate intake was associated with lower CAC scores in asymptomatic men.

Impact of metabolic syndrome and C-reactive protein on outcome after coronary stenting.

Metabolic syndrome (MS) identifies cardiovascular risk; however, there is little information regarding the evolution of patients with MS after stent implantation. The aim of this single-center study is to evaluate the possible association between MS and clinical restenosis, after adjustment for highsensitivity C-reactive protein (hs-CRP) and angiographic predictors of restenosis. In a longitudinal study, 159 patients (89 with and 70 without MS) were studied. Criteria for MS were: elevated blood pressure (systolic >or=130 mmHg, diastolic >or=85 mmHg or drug treatment for hypertension; elevated fasting glucose (>100 mg/dl) or drug treatment for elevated glucose; reduced HDL-cholesterol (<40 mg/dl in men and <50 mg/dl in women) or drug treatment for reduced HDL-cholesterol; elevated triglycerides (>or=150 mg/dl) or drug treatment for elevated triglycerides; and obesity (body mass index >28.8 kg/m2). The primary end point was the rate of major adverse clinical events (MACE): cardiovascular death, myocardial infarction, or target lesion revascularization (TLR) during the 12-month follow-up period. The secondary end point was the rate of TLR. MS was neither identified as predictor of MACE [hazard ratio (HR): 0.844; 95% CI: 0.41-1.74; p=0.648], nor TLR (HR: 1.05; 95% CI: 0.44-2.50; p=0.91), even when controlled for hs-CRP levels and angiographic predictors of restenosis. Also, no significant interaction between MS and hs-CRP was found (p=0.135 and p=0.194, for MACE and TLR, respectively). This study shows that patients with MS do not have an additional risk of MACE, even when controlled for angiographic predictors of restenosis and hs-CRP.

Nutritional Status and Cognitive Impairment among the Very Old in a Community Sample from Southern Brazil.

OBJECTIVE: To determine which factors, especially those related to nutrition, are associated with cognitive function in the oldest old, here considered those at least 80 years of age. DESIGN: A cross-sectional, population-based study. SETTING: Veranópolis, Rio Grande do Sul, Brazil, and surrounding rural areas. PARTICIPANTS: Individuals aged 80 years and older. MEASUREMENTS: The Mini Nutritional Assessment, anthropometric measurements, and serum levels of albumin and vitamin B12 were associated with cognitive function according to the Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT). Socio-demographic data were obtained through a structured questionnaire. Multivariate analysis was used to determine the associations. RESULTS: According to the MMSE and the CDT, the prevalence of cognitive impairment was 47.7% [95%CI 39.7-55.7] and 58.2% [95%CI 50.3-66.1], respectively. In the adjusted analysis, the only positive linear association with MMSE scores indicating cognitive impairment was age. However, CDT scores indicating cognitive impairment were five times higher among those with low serum vitamin B12 concentrations. For the other variables, there was a positive association between age, being widowed, a low educational level and central nervous system drugs. Being single, living with children and living alone were protective factors for cognitive impairment. CONCLUSIONS: Although cognitive impairment was positively associated with old age, being widowed and low educational level in this population, the only nutritional variable positively associated with cognitive impairment was a low vitamin B12 concentration.

Red wine consumption, coronary calcification, and long-term clinical evolution.

Coronary artery calcification (CAC) is associated with atherosclerotic complications. However, elevated CAC may not always imply a worse prognosis. Herein, we report the clinical evolution of long-term red wine (RW) drinkers in relation to CAC. We followed 200 healthy male habitual RW drinkers and compared them to 154 abstainers for a period of 5.5 years. The initial evaluation included coronary computed tomography angiography (CTA), clinical, demographics, and laboratory data. CAC was quantified by the Agatston score. The follow-up process was conducted by telephone calls and/or hospital record review. The composite end-point of total death, acute myocardial infarction (AMI), or coronary revascularization (or major adverse cardiac event - MACE) was assessed. The RW drinkers ingested 28.9±15 g of alcohol/day for 23.4±12.3 years. They had higher high-density lipoprotein and low-density lipoprotein, but lower C-reactive protein than abstainers. Age, total cholesterol, triglycerides, glucose, and liver enzymes were similar. History of diabetes was lower among drinkers, but other risk factors were similar. However, drinkers had higher CAC than abstainers; the mean value was 131.5±362 in drinkers vs 40.5±320 in abstainers (P<0.001). The median and interquartile range were 15 (0.0-131.5) in RW drinkers and 1 (0.0-40.5) in abstainers (P=0.003). During the follow-up, MACE was significantly lower in drinkers than in abstainers, despite their higher CAC. The difference was driven mainly by AMI (0 vs 6; P<0.03). Greater CAC values in this setting did not predict worse prognosis. A possible underlying mechanism is lesion calcification, which leads to plaque stabilization and less clinical events.

Association of the 894G>T polymorphism of the endothelial constitutive nitric oxide synthase gene with unstable angina.

The 894G>T polymorphism of the endothelial constitutive nitric oxide synthase gene consists of the substitution of a guanine base by a thymine at the 894th nucleotide of the gene. An association of this polymorphism with acute coronary syndromes has been described, only when in combination with other polymorphisms of this gene. The aim of the present study was to search for an association between this polymorphism and unstable angina in a southern Brazilian population. In a case-control study, 156 patients (group 1 (N = 83): unstable angina, group 2 (N = 73): stable angina) were genotyped by PCR and digestion of the product. Univariate analysis demonstrated that the minimal luminal diameter and the degree of stenosis of the culprit lesion differed between groups (P = 0.006 and 0.005, respectively). In addition, the frequencies of the T allele and of the T allele carriers (combined TT and TG genotypes) were significantly higher in the group with unstable angina (41.6 vs 28.8%; P = 0.025, Pearson chi-square test, and 73.5 vs 45.2%; P = 0.001, Pearson chi-square test, respectively). Multivariate logistic regression showed that the frequency of the T allele carriers was the only variable with a predictive value for unstable angina, when controlled for the other variables (6.1 (95% CI = 2.55-14.43); P < 0.001). Thus, in a homogenous group of patients, the endothelial constitutive nitric oxide synthase 894G>T polymorphism was associated with unstable angina. We suggest that this polymorphism may be a genetic risk factor for unstable angina.

Overweight and Abdominal Obesity Association with All-Cause and Cardiovascular Mortality in the Elderly Aged 80 and Over: A Cohort Study.

OBJECTIVE: To evaluate the association between overweight and abdominal obesity with all-cause and cardiovascular mortality in the elderly aged 80 and over. DESIGN: A prospective cohort study. SETTING: A population-based study of community-dwelling very elderly adults in a city in southern Brazil. PARTICIPANTS: 236 very elderly adults, number that represents 85% of the population aged 80 and over living in the city in the period (mean age 83.4 ± 3.2). MEASUREMENTS: Overweight and abdominal obesity were assessed using recommended cut-off points for body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). The association between these anthropometric measurements and all-cause and cardiovascular mortality were independently estimated by Cox proportional hazards model. Kaplan-Meier was used to assess survival time. RESULTS: Increased WC (>80cm F and >94cm M) and WHtR (>0.53 F and >0.52 M) were associated with lower all-cause mortality, but only WHtR remained associated even after controlling for residual confounding (HR 0.55 CI95% 0.36-0.84; p<0.001). Additionally increased WC was independently associated with lower mortality from cardiovascular diseases (HR 0.57 CI95% 0.34-0.95; p<0.030). BMI and WHR did not show significant independent association with mortality in the main analysis. CONCLUSION: Greater abdominal fat accumulation, as estimated by WC and WHtR, presented an association with lower allcause and cardiovascular mortality in the elderly aged 80 and over, but not by BMI and WHR.

Coronary artery calcification and dietary intake in asymptomatic men

Dietary factors may influence the process of atherosclerosis and coronary artery calcification (CAC). This study assessed CAC and its association with dietary intake in asymptomatic men. We evaluated 150 asymptomatic men with mean age of 58.2±5.3 years. The dietary intake was assessed by the Food Consumption Register method. CAC was measured through multidetector computed tomography (MDCT) and assessed in accordance with the Agatston score. Modified Poisson regression model was used to estimate the effects of intake of different nutrients that are prevalent in moderate/severe CAC, adjusted for calorie intake and CAC risk factors by means of prevalence ratios and 95% confidence intervals [95%CI]. An association was found between the intake of some nutrients and moderate/severe CAC. Lower carbohydrate intake (P=0.021) and higher lipid intake (P=0.006) were associated with moderate/severe CAC. After adjustment, the nutrients associated with the prevalence of moderate/severe CAC were carbohydrates (P=0.040), lipids (P=0.005), and saturated fatty acids (SFA) (P=0.013). A 1% increase in lipids and SFA intake caused an increase of 4% [95%CI: 1-7%] and 8% [95%CI: 2-14%] in the prevalence of moderate/severe CAC, respectively. A 1% increase of carbohydrate intake led to a 2% decrease in the likelihood of moderate/severe CAC [95%CI: 1-4%]. These conclusions showed that the higher intake of total lipids and SFA was associated with higher CAC scores, whereas higher carbohydrate intake was associated with lower CAC scores in asymptomatic men.

Effects of probucol on plasma lipoprotein subfractions and activities of lipoprotein lipase and hepatic triglyceride lipase.

The effects of 12 weeks treatment with probucol on plasma lipoprotein subfraction levels and on LPL and HTGL activities were investigated. Plasma VLDL-C, VLDL-TG, VLDL-apo B levels were not changed. Probucol significantly reduced plasma IDL-C and IDL-apo B levels by 26.7% and 23.8%, respectively. Plasma cholesterol and apo B levels of large light LDL (LDL1) were decreased significantly by 27.8% and 23.2% by probucol treatment. Plasma cholesterol and apo B levels of small heavy LDL (LDL2) remained unchanged. Probucol markedly reduced plasma HDL2 levels. The reduction rates of plasma TC, TG and apo A-I levels of HDL2 were 43.0%, 43.6% and 47.0%. Probucol significantly decreased HDL3-C and HDL3-apo A-I levels by 18.0% and 19.2%. LPL activities in the post-heparin plasma were decreased significantly from 2.53 +/- 0.71 mumol free fatty acids (FFA)/ml/h to 1.71 +/- 0.71 mumol FFA/ml/h by probucol while HTGL activities remained unchanged. We conclude that probucol suppresses LPL activity and decreases plasma IDL, LDL1 and HDL2 levels due to disturbances of VLDL conversion to LDL1 via IDL and of HDL3 conversion to HDL2.

Effects of probucol and pravastatin on plasma lipids, activities of postheparin lipoprotein lipase, and lecithin cholesterol acyltransferase and apo A-I containing lipoproteins with and without apo A-II in patients with moderate hypercholesterolemia.

In this study, plasma HDL fractions were separated by ultracentrifugation and apo A-I containing lipoproteins (A-I Lp) were then isolated using anti-apo A-I immunoaffinity chromatography. The A-I Lp were further separated into two fractions with the use of anti-apo A-II immunoaffinity chromatography. One fraction, Lp A-I, contained apo A-I without apo A-II, while the other, Lp A-I/A-II, contained both apo A-I and apo A-II. These techniques were applied to investigate the changes in HDL apoprotein composition in hypercholesterolemic subjects treated with either probucol or pravastatin. Treatment with probucol (500 mg/day) or pravastatin (10 mg/day) reduced mean plasma total cholesterol concentrations by 24% (p < 0.01) and 16% (p < 0.05), respectively. Both drugs caused some reduction in lipoprotein lipase activity, but neither had any influence on the activity of hepatic triglyceride lipase or lecithin cholesterol acyltransferase. Their effects on HDL-cholesterol levels and apoprotein composition differed markedly. Probucol significantly decreased the HDL-cholesterol concentration, the plasma apo A-I/apo A-II ratio, and the number of large particles of diameter greater than 10.4 nm. When the ratios of Lp A-I and Lp A-I/A-II for the probucol-treated subjects were compared with those in the normolipidemic controls, and with the ratios before and after administration of probucol, a remarkable decrease in the level of Lp A-I was apparent. It is presumed that the decrease in HLD-cholesterol by prolonged probucol administration reflects the decrease of Lp A-I more than the decrease of Lp A-I/A-II.(ABSTRACT TRUNCATED AT 250 WORDS)

Impact of diet on the cardiovascular risk profile of Japanese immigrants living in Brazil: contributions of World Health Organization CARDIAC and MONALISA studies.

1. Japanese immigrants from Okinawa living in Brazil have a higher mortality from cardiovascular diseases and have their mean life expectancy shortened compared with their counterparts living in Japan. 2. A cross-sectional study comparing Okinawans living in Okinawa (OO) and Okinawan immigrants living in Brazil (OB) was designed to characterize the dietary factors that could interfere with the profile of cardiovascular risk factors and with this reduction on the life expectancy when Okinawans emigrate to Brazil. 3. In total, 234 OO and 160 OB (aged 45-59 years) were recruited to the present study to undergo medical and dietary history, blood pressure measurement, electrocardiograph (ECG), blood tests and 24 h food/urine collection. 4. In the present study, OO subjects presented with 37% less obesity and 50% less systemic hypertension than OB. The OB subjects used threefold more antihypertensive medication than OO. Meat intake was 34% higher in OB than OO, whereas fish intake was sevenfold higher in OO than OB. Serum potassium levels were 10% higher in OO than OB. Urinary taurine (an index of seafood intake) was 43% higher in OO than OB. Urinary isoflavones (an index of the intake of soy products) were significantly lower in OB than in OO. Of acid (20:5) and docosahexaenoic acid (22:6) were two- and threefold higher in OO than OB, respectively. 5. The rate of ischaemic ECG changes in OO subjects was only 50% of that of OB subjects. 6. There were no differences in the smoking rate between OO and OB subjects. 7. The results of the present study suggest that coronary risk factors and cardiovascular health are not only regulated by genetic factors, but that the impact of lifestyle (mainly diet) can be large enough to modulate the expression of genes.

[Generalized anxiety disorder in a population aged 80 years and older]. / Transtorno de ansiedade generalizada em idosos com oitenta anos ou mais.

OBJECTIVE: To describe the prevalence of generalized anxiety disorder (GAD) in a community-dwelling population aged 80 years and older. Also to compare sleep patterns, cognitive function and prevalence of other psychiatric conditions between healthy controls and GAD subjects. METHODS: DSM-IV criteria were used to diagnose GAD. A representative random sample of 77 community-dwelling subjects (35%), aged 80 years or more from the rural southern county of Veranopolis, Brazil, was selected. Sleep patterns were assessed using the Pittsburgh Sleep Quality Index and a 2-week sleep/wake diary. Five neuropsychological tests (Buschke-Fuld Selective Reminding Test, CERAD word list, verbal fluency test and two sub-tests of the Wechsler memory scale) were used for cognitive evaluation. RESULTS: The estimated GAD prevalence was 10.6 percent. GAD was associated with major depression, with a significant greater number of depressive symptoms as measured by the Geriatric Depression Scale and with a significant more frequent occurrence of minor depression. Sleeping patterns and cognition function among GAD subjects were not compromised. The severity of physical diseases was similar in both GAD subjects and healthy controls. GAD was associated with a significantly lower health-related quality of life. CONCLUSIONS: In comparison with previous studies, the prevalence of GAD is higher in the studied population. This disorder is frequently associated with both depressive symptoms and a lower health-related quality of life.

Changes in the profile of lipoprotein subfractions associated with hormone replacement therapy.

OBJECTIVE: To report the effects of 2 regimens of hormone replacement therapy during the postmenopausal period on the profile of the major lipoprotein subfractions (HDL, LDL, and VLDL). METHODS: We carried out a cohort study in 38 postmenopausal patients who were starting their hormone replacement therapy due to gynecological indications, for a period of 12 weeks. Analysis of lipoprotein subclasses was performed through nuclear magnetic resonance spectroscopy. RESULTS: Hormone replacement therapy cause an increase in the proportion of larger subfractions of VLDL and HDL (p=0.008 and 0.03, respectively) and in the proportion of larger particles of VLDL due to a 36% increase in the levels of larger particles (p=0.004), concomitantly with a 15% reduction in the levels of smaller particles (p=0.04). In regard to HDL, the increase occurred only a 17% increase in the levels of larger particles (p=0.002). No significant change occurred in the distribution pattern of LDL subfractions. CONCLUSION: The proportion of larger subfractions of VLDL and HDL increases after hormone replacement therapy. The increase in the proportion of larger particles of VLDL occurs due to an increase in the levels of the larger subclasses concomitantly with a reduction in the smaller particles. However, an increase in the proportion of larger particles of HDL occurs only due to an increase in the levels of the larger subfractions.

PANDORA - Survey of Brazilian cardiologists about cholesterol reduction.

OBJECTIVE: To report about a group of physicians' understanding of the recommendations of the II Brazilian Guidelines Conference on Dyslipidemias, and about the state of the art of primary and secondary prevention of atherosclerosis. METHODS: Through the use of a questionnaire on dyslipidemia, atherosclerosis prevention, and recommendations for lipid targets established by the II Brazilian Guidelines Conference on Dyslipidemias, 746 physicians, 98% cardiologists, were evaluated. RESULTS: Eighty-seven percent of the respondents stated that the treatment of dyslipidemia changes the natural history of coronary disease. Although most of the participants followed the total cholesterol recommendations (<200mg/dL for atherosclerosis prevention), only 55.8% would adopt the target of LDL-C <100 mg/dL for secondary prevention. Between 30.5 and 36.7% answered, in different questions, that the recommended level for HDL-C should be <35mg/dL. Only 32.7% would treat their patients indefinitely with lipid- lowering drugs. If the drug treatment did not reach the proposed target, only 35.5% would increase the dosage, and 29.4% would change the medication. Participants did not know the targets proposed for diabetics. CONCLUSION: Although the participating physicians valued the role played by lipids in the prevention of atherosclerosis, serious deficiencies exist in their knowledge of the recommendations given during the II Brazilian Guidelines Conference on Dyslipidemias.

Hepatic lipase activity and high density lipoproteins in familial hypercholesterolemia: adaptational mechanisms for LDL-receptor deficient state.

With a view toward elucidating the poorly understood high density lipoprotein (HDL) metabolism in familial hypercholesterolemic (FH) patients, the activities of the plasma enzymes involved in HDL metabolism; hepatic triglyceride lipase (HTGL), lipoprotein lipase (LPL) and lecithin-cholesterol acyltransferase (LCAT) with concomitant determination of HDL particle size, were analyzed in 50 age-matched hypercholesterolemic patients (26 FH and 24 non-FH patients). The activity of HTGL in FH patients was significantly higher (p less than 0.02) than in non-FH patients. The analysis of HDL size by gradient gel electrophoresis showed significantly smaller HDL particles in FH patients. Analysis of the correlation between HTGL activity and HDL particle size confirmed that the variation in HDL particle size was related to HTGL activity. Those results suggest that the differences in HTGL activity and HDL size between the familial and non-familial types of hypercholesterolemia may be due to differences in their pathophysiology. The high HTGL activity and small HDL particles in FH probably are the consequences of an adaptational mechanism used by LDL-receptor-deficient hepatocytes to increase the intracellular pool of cholesterol.

An improved method for removal of antithrombin III from post-heparin plasma lipase fractions with a high recovery rate.

Affinity chromatography on heparin-Sepharose has been widely used for the purification of post-heparin plasma triglyceride lipases, but this procedure alone yields lipase fractions with a high content of antithrombin III (AT), which also binds to heparin and coelutes with the lipases. A rapid procedure in which this major contaminant is reduced by the use of affinity chromatography on heparin-Sepharose with low affinity for AT and further removal by anti-AT IgG Affi-Gel 10 column chromatography is reported and the results are compared with these of the conventional heparin-Sepharose and Concanavalin A-Sepharose column chromatography two step method. While the AT contamination of hepatic lipase eluate from conventional heparin-Sepharose column chromatography was 92 mg/dl in 100 mg/dl protein, heparin-Sepharose with low affinity for AT yielded samples with 55 mg/dl in 100 mg/dl protein. A second passage on concanavalin A-Sepharose of the sample from conventional heparin-Sepharose reduced the AT content from 92 mg/dl to 42 mg/dl in 100 mg/dl protein, but passage of the sample from heparin-Sepharose with low affinity for AT through an anti-AT IgG Affi-Gel 10 column removed almost all of the AT contamination from the lipase sample. This hepatic triglyceride lipase (HTGL) sample had a specific activity 1,963-fold higher than that of post-heparin plasma with a yield of 17% of the starting material, showing an excellent recovery rate compared with similar methods in use.

Effects of pravastatin on lipid transfer protein and lecithin cholesterol acyltransferase in heterozygous familial hypercholesterolemia.

The effects of HMG CoA reductase inhibitor PRAVASTATIN on plasma lipoprotein levels, lipid transfer protein (LTP) activity and lecithin cholesterol acyltransferase (LCAT) activity were investigated in 20 patients with heterozygous familial hypercholesterolemia. Plasma total cholesterol decreased from 299.2 +/- 45.2 to 245.9 +/- 45.1 (mean +/- SD in mg/dl) (p < 0.0001), low density lipoprotein (LDL) cholesterol from 221.1 +/- 47.6 to 164.9 +/- 48.1 (p < 0.0001) and LDL-triglycerides from 38.0 +/- 10.2 to 30.2 +/- 8.8 (p < 0.0001). High density lipoprotein (HDL) cholesterol increased from 60.1 +/- 13.9 to 63.1 +/- 17.0 (p = 0.0264). The HDL-cholesterol: HDL-triglycerides ratio increased from 3.91 +/- 1.14 to 4.91 +/- 1.65 (p = 0.0029). Lipid transfer protein (LTP) activity (as % of transferred cholesteryl ester (CE)) decreased from 4.68 +/- 2.47 to 3.70 +/- 2.31 (p = 0.0024) and LCAT activity decreased from 113.1 +/- 29.9 (U/L) to 97.0 +/- 22.7. There was a negative correlation between LTP/LCAT ratio and HDL-C levels. These results suggested that the changes in plasma HDL-cholesterol concentrations during treatment with pravastatin may be related to the decreases in LTP and LCAT activity due to this drug.

Interactive effects of ApoE polymorphism, alcohol and smoking on age-related trends of blood pressure levels in elderly men: the Bambuì Cohort Study of Ageing (1997-2008).

Data from a population-based prospective study were used to examine longitudinal changes in blood pressure (BP) and seek interactions between apolipoprotein E (ApoE) genotypes, smoking and alcohol in a cohort of 557 elderly Brazilian men. Repeated BP measurements were obtained in four waves, and multi-level random-effects pattern-mixture models were used to evaluate age-related BP trajectories while accounting for non-ignorable dropouts/deaths and handling heterogeneities as random parameter variations. Alcohol was associated with high systolic BP in ε2 carriers and those with the ε3/3 genotype, but not in ε4 carriers. This was dependent on age and smoking habits: at the age of 60, expected systolic BP in alcohol drinking ε2 carriers was 16.5 mm Hg higher than in the reference group of non-smokers/non-drinkers if they were not smokers (P=0.049), and 28.6 mm Hg higher if they were also smokers (P=0.004). The youngest smoking/non-drinking ε2 carriers had lower systolic BP, but it increased rapidly and led to higher expected levels among older carriers. Alcohol consumption, alone or together with smoking, interacts with the effects of ApoE genotype on systolic BP, probably nullifying the more favourable lipid profile of ε2 carriers. The interactions of gene-modifiable risk factors have major public health implications.

Red wine consumption, coronary calcification, and long-term clinical evolution

Coronary artery calcification (CAC) is associated with atherosclerotic complications. However, elevated CAC may not always imply a worse prognosis. Herein, we report the clinical evolution of long-term red wine (RW) drinkers in relation to CAC. We followed 200 healthy male habitual RW drinkers and compared them to 154 abstainers for a period of 5.5 years. The initial evaluation included coronary computed tomography angiography (CTA), clinical, demographics, and laboratory data. CAC was quantified by the Agatston score. The follow-up process was conducted by telephone calls and/or hospital record review. The composite end-point of total death, acute myocardial infarction (AMI), or coronary revascularization (or major adverse cardiac event - MACE) was assessed. The RW drinkers ingested 28.9±15 g of alcohol/day for 23.4±12.3 years. They had higher high-density lipoprotein and low-density lipoprotein, but lower C-reactive protein than abstainers. Age, total cholesterol, triglycerides, glucose, and liver enzymes were similar. History of diabetes was lower among drinkers, but other risk factors were similar. However, drinkers had higher CAC than abstainers; the mean value was 131.5±362 in drinkers vs 40.5±320 in abstainers (P<0.001). The median and interquartile range were 15 (0.0-131.5) in RW drinkers and 1 (0.0-40.5) in abstainers (P=0.003). During the follow-up, MACE was significantly lower in drinkers than in abstainers, despite their higher CAC. The difference was driven mainly by AMI (0 vs 6; P<0.03). Greater CAC values in this setting did not predict worse prognosis. A possible underlying mechanism is lesion calcification, which leads to plaque stabilization and less clinical events.