Determinants of inter-individual cholesterol level variation in an unbiased young male sample.

QUESTION UNDER STUDY: Affected by individual life style, the total cholesterol serum level is a major morbidity and mortality risk factor for atherosclerotic cardiovascular disease (CVD). We present total cholesterol values and their possible aetiological factors of young Swiss conscripts. Particularly, we study varying impact of these factors depending on different levels of individual cholesterol. METHODS: Male conscripts (n = 19,272) of the 2005 census of the conscripts have been examined, reflecting ca. 59% of a total Swiss male birth cohort. Quantile regression allows us to analyse responses of arbitrary quantiles with respect to variables of interest. RESULTS: Eleven percent of all conscripts show clinically important increased total cholesterol levels. There is a major association of high individual cholesterol level with French regional language. The largest socio-economic subsample--agricultural and construction workers--show significantly higher individual cholesterol levels than employees in the industry sector and students, respectively. CONCLUSIONS: We were able to find that culture, as indicated by the mother tongue, and socioeconomic status as indicated by profession/vocation, influence individual total cholesterol levels while climate as indicated by altitude does not have an influence on cholesterol levels. Such a broad screening programme offers a unique opportunity to target persons at high-risk for CVD morbidity and mortality already early in life.

Unexpected high prevalence of metabolic disorders and chronic disease among young male draftees--the Swiss Army XXI experience.

QUESTIONS: What are the benefits of laboratory screening examinations entailed in the new army recruitment concept (Swiss Army XXI)? PRINCIPLES/METHODS: Between January 1 and June 30, 2004, a total of 7714 of 11,322 (68%) draftees from 6 Swiss army recruitment centres underwent clinical examination and laboratory testing. RESULTS: In 1.7% of the draftees we found elevated levels of the C-reactive protein (CRP) as evidence of infection or inflammation. Although we found no case of acute hepatitis, 16 draftees had active hepatitis B and 1 patient had active hepatitis C. Diseases, which were found by laboratory screening, and which forbid service in the army, included Crohn's disease, terminal renal insufficiency and essential thrombocytosis. In conditions such as anaemia (0.1%) or latent iron deficiency (7.2%), the cause may have to be elucidated before the start of military training. In other draftees (9.8%), we found elevated alanine-amino-transferase (ALAT) levels as a hint to possible alcohol abuse, which might impair the ability to serve in special units of the army. Finally, elevated levels of ferritin (0.1%), glucose (0.4%), and cholesterol (1.4%) may indicate iron overload/haemochromatosis, impaired glucose tolerance or even overt diabetes mellitus and hypercholesterolaemia. CONCLUSIONS: The results of our studies indicate that laboratory evaluation may confirm findings of the medical examination and may help to explain unspecific symptoms. Draftees with severe diseases and conditions caused by serious underlying disease can be excluded from military services early on the basis of laboratory testing. Future cost benefit analyses will have to show whether laboratory screening and consecutive early preventive measures are also advantageous to society as a whole and will reduce public health costs.

Soluble hemoglobin-haptoglobin scavenger receptor CD163 as a lineage-specific marker in the reactive hemophagocytic syndrome.

Reactive hemophagocytic syndrome (RHS) is a disease of overwhelming macrophage activity triggered by infection, malignancy or autoimmune disorders. Currently used laboratory markers for the quantitative assessment of monocyte/macrophage activation lack lineage-restricted expression patterns and thus specificity. Serum levels of the macrophage specific scavenger receptor CD163 were determined by enzyme-linked immunosorbent assay (ELISA) and were found to be highly increased in patients with RHS (median 39.0 mg/L). Significantly lower levels were determined in patients with sepsis (median 9.1 mg/L), acute mononucleosis (median 8.2 mg/L), Leishmania infection (median 6.7 mg/L) and healthy controls (median 1.8 mg/L). Follow-up of patients with a relapsing course of the disease revealed close correlations of sCD163 with clinical disease activity, serum ferritin and other markers of macrophage activity. Large sinusoidal accumulations of CD163 expressing macrophages actively engaged in phagocytosis of blood cells were detected in spleen sections of RHS patients. Our data suggests sCD163 to be a macrophage-specific marker in patients with disorders of inappropriate macrophage activation.