Natural postmenopause is associated with an increase in combined cardiovascular risk factors.

Cardiovascular disease, while rare in women of reproductive age, is the main cause of mortality in menopause. The purpose of our study was to determine the association of natural menopause with cardiovascular risk factors, including their clustering into metabolic syndrome (MS). A random 5 % representative population sample of women aged 45-54 years was examined. In 575 women, we were able to determine their natural reproductive aging status. Multiple regression analysis was used to calculate the association between age, menopausal status, and risk factors under study. After adjustment for age, there was an increase in the odds ratio of developing MS, as defined by NCEP (OR=2.0; 95 % CI [1.1; 3.7]), and an increase in plasma lipid ratios (total cholesterol/HDL-C, LDL-C/HDL-C, apolipoprotein-B/apolipoprotein-A1; p<0.05 for all) in postmenopausal women. Age, but not menopausal status, was associated with some single components of MS; only waist circumference significantly increased after menopause, independently of age. Clustering of risk factors in MS and lipid ratios (combined factors) was strongly associated with menopause whereas worsening of single components of MS was strongly associated with age. In conclusion, based on our results, the menopause may pose a risk to women through clustering of cardiovascular risk factors beyond simple aging.

[Quality of life of Crohn's disease patients]. / Kvalita zivota u Crohnovy nemoci.

BACKGROUND: The assessment of the quality of life in chronic diseases has started to move from clinical studies to practice. The main goal of the project was to assess the quality of life of Crohn's disease patients from two Czech centres by means of Czech versions of the general World Health Organization Quality of Life--BREF and specific Inflammatory Bowel Disease Questionnaire, to compare the quality of life of patients with an active disease and those in remission and to compare the quality of life with the general Czech population. METHODS AND RESULTS: 103 patients with Crohn's disease underwent a survey performed by means of two Czech versions of quality of life questionnaire. The dataset consisted of 53 men and 50 women; the average age of patients was 42 years. Increased activity was observed in 45 patients; 58 patients were in remission. By means of WHOQOL-BREF, we found the average global score of quality of life and satisfaction with health in our group to be 3.5 (Czech standard 3.8) and 2.8 (Czech standard 3.7), respectively. The results were compared to the Czech standards. A negative influence of disease activity was statistically significant (p < 0.001) in all domains using either of the two questionnaires. Clinical factors such as the use of corticosteroids or immunosuppressives, and the history of surgery influenced some domains. CONCLUSIONS: The results from our study indicate that the disease activity may have a significant impact on the quality of life in Crohn's disease patients. A combination of the general and specific questionnaire may identify factors that would otherwise remain unappreciated properly. The quality of life of patients in remission was comparable to that of the general Czech population.

[Toxoplasmic encephalitis in an HIV patient]. / Toxoplazmová encefalitida u pacienta s HIV infekcí.

Toxoplasmic encephalitis is considered one of the most frequent causes of death in HIV-positive patients. The article presents a case of a 40-year-old HIV-positive male hospitalized for surgical treatment of localized brain tumour verified by CT and MRI. Histopathologically, toxoplasmic aetiology was confirmed. Briefly, tissue toxoplasmosis represents a high risk among HIV-positive patients. Therefore, this disease must be considered in differential diagnosis of localized brain masses in HIV-positive patients.

Proinflammatory status, genetics and atherosclerosis.

Over the last decade, C-reactive protein concentration analyzed by the high sensitivity method (hsCRP) has been proven as a marker of premature atherosclerosis. Concentration exceeding 2 mg/l represents an increased individual risk of myocardial infarction and stroke but strict application of this borderline is complicated by relations of CRP concentrations to other risk factors of cardiovascular diseases. In a large 1 % representative sample of the Czech population, a positive relation of hsCRP to BMI, a waist circumference and triglyceride concentration was documented. Substantial sex differences were found in its relationship to age. Whereas it is continuously increasing in men, this increase appears in women only after menopause. A substantial decrease of body weight and visceral fat volume by increased physical activity is accompanied by significant decrease of hsCRP in young obese women. This decrease was not related to a change of interleukin-6 concentration, although it is supposed to regulate CRP production. CRP concentration is partly under genetic control as a higher concentration in young siblings of probands with proved coronary atherosclerosis was documented. The participation of genes related to lipoprotein metabolism (genes for apolipoprotein CI and apolipoprotein E) influence hsCRP concentrations. We hypothesized that an increased concentration of hsCRP represents a certain marker of proinflammatory status related to central obesity and triglyceride metabolism and it might be related to individual properties of monocytes in atherogenesis.

Overdenture - implants versus teeth - quality of life and objective therapy evaluation.

An overdenture is a complete or removable partial denture that has one or more tooth roots or implants to provide a support. The study compares two types of prosthodontic treatment - overdenture supported by remained own teeth with ball attachments and that held by implants. The cohort of 35 patients (recall from 1 to 5 years) was evaluated. When subjectively and objectively assessed no significant difference between both groups was observed.

[CRP--a marker of a pro-inflammatory state and cardiovascular risk]. / CRP--marker proinflamacního stavu a kardiovaskulárního rizika.

The importance of elevated basal levels C-reactive protein (CRP) measured by a highly sensitive test has been known for over 10 years. Increased hsCRP concentration correlates with most of the classical risk factors in cardiovascular disease, however. This seriously complicates the interpretation of the elevated concentration. Concentrations of hsCRP are partly genetically determined and can easily be affected positively by lifestyle changes. These two factors lead us to conclude that the setting of hsCRP should not be used routinely at present in assessing the individual risk of complications for atherosclerosis.

Comparison of FK 506, mycophenolate mofetil, and aminoguanidine effects on delay of corneal allograft rejection in an experimental model of low-risk and high-risk keratoplasty.

The purpose of our study was to compare the effectiveness of immunosuppressive drugs on the prevention of allograft rejection in a murine model of low-risk and high-risk keratoplasty. The therapy included FK 506 (tacrolimus; 0.2 mg/kg), mycophenolate mofetil (30 mg/kg), aminoguanidine (0.1 g/kg), and combination of FK506 + mycophenolate mofetil or FK506 + aminoguanidine. The results obtained from the Gray's survival model stratified according to the type of subjects suggest that a major rejection risk reduction was achieved using FK506; good results also were obtained for mycophenolate mofetil. Although the point estimates of both the survival and relative risk of rejection suggest a deferred effect of the combination FK506 + mycophenolate mofetil, this finding did not prove statistically significant.

The significance of carotid artery plaques in the detection of coronary artery disease in asymptomatic type 2 diabetic patients.

This study aimed to evaluate whether there was any association between carotid artery ultrasound parameters and the results of stress myocardial single photon emission computed tomography (SPECT) and coronarography in 126 asymptomatic type 2 diabetic patients. Thirty-three (26%) patients had an abnormal SPECT result, 33 (26%) had an intermediate result and 60 (48%) had a normal result. Carotid ultrasound demonstrated a significant association between an abnormal SPECT result and the presence of atheroma plaques and reduced distensibility of the common carotid artery, but there was no association with intima-media thickness (IMT). In 38 diabetic patients who agreed to be examined with selective coronarography, significant coronary stenosis (at least one stenosis > or = 70%) was diagnosed in 22 (58%) patients. A significant association was demonstrated between significant coronary stenosis and the presence of atheroma plaques; however, there was no association between stenosis and reduced distensibility of the common carotid artery or IMT.

Gaining insight from flexible models--assessment of the secondary prevention trial of CHD in the Czech male population with MI history.

OBJECTIVES: We present results from a secondary prevention trial of coronary heart disease (CHD) in the Czech male population from northern Bohemia with the history of myocardial infarction (MI) and high prevalence of metabolic syndrome. We compare several approaches to analyzing survival data from our study in terms of respective model assumptions. METHODS: While both the Cox and Weibull survival regression models assume proportionality of the hazard functions over time, in many instances this assumption appears incompatible with the data at hand. Gray's implementation of flexible models using penalized splines allows for a more realistic assessment of the covariate effects which may vary over time. RESULTS: Gray's model results revealed a steady decline in the age-adjusted intervention effect over time, which remained significant until about 2.7 years of follow-up. This was in contrast with the results obtained from the Cox and Weibull models which suggested an overall risk reduction due to intervention during the total follow-up of 6.7 years. Survival estimates based on the Cox and Gray models are shown for the two treatment groups and selected sample quantiles of the age distribution for illustration. CONCLUSIONS: Gray's time-varying coefficients model facilitated a more realistic assessment of the intervention effect. Using suitable historical controls with MI history the effect of intervention was found to gradully diminish over time.

The association between left ventricle diastolic dysfunction and endothelial dysfunction and the results of stress myocardial SPECT in asymptomatic patients with type 2 diabetes.

Diabetes mellitus is associated with a poor cardiovascular prognosis. Stress myocardial single-photon emission computed tomography (SPECT) reliably detects coronary ischaemia in asymptomatic patients. Our study aimed to evaluate the association between systolic and diastolic left ventricular function, left ventricular hypertrophy, endothelial function and the results of stress myocardial SPECT in 126 patients with type 2 diabetic patients with no cardiovascular symptoms. Thirty-three patients (26%) had abnormal SPECT results, 33 patients (26%) had intermediate (equivocal) results, and 60 patients (48%) had normal results. We found a significant association between an abnormal SPECT result, left ventricular diastolic dysfunction and impaired post-ischaemic dilatation of the brachial artery. No association was found between the SPECT result and systolic function and left ventricular hypertrophy, however. An abnormal SPECT result was significantly associated with left ventricular diastolic dysfunction and the deterioration of post-ischaemic dilatation of the brachial artery in asymptomatic patients with type 2 diabetes.

(TTA)n repeat polymorphism in the HMG-CoA reductase gene and cholesterolaemia.

BACKGROUND: Hypercholesterolaemia is one of the main risk factors of atherosclerosis. Both environmental and genetic factors have been implicated in the development of hypercholesterolaemia. The enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase plays an important role in cholesterol synthesis. Thus we supposed that polymorphisms in this gene could influence cholesterolaemia. PATIENTS AND METHODS: Using PCR, we measured the (TTA)n repeat polymorphism near the Alu sequence of the gene for HMG-CoA reductase in two groups of children selected from opposite ends of the cholesterolaemia distribution curve obtained from measuring cholesterolaemia in 2000 children. Eighty-two children in high- and eighty-six children in low-cholesterolaemic groups participated on the study. RESULTS: A significant difference was found in the frequencies of the genotypes of the 10+ add alleles (43.9% in high-cholesterolaemic children vs 24.4% in low-cholesterolaemic children p < 0.025). No differences were demonstrated in the frequencies of other genotypes (allele 10+ even and without allele 10). No associations between lipid parameters and genotypes or genotype subgroups within the group of high- and low-cholesterolaemic children were found. CONCLUSION: The (TTA)n repeat polymorphism in the gene for HMG-CoA reductase could be another genetic marker that plays a role in the genetic determination of cholesterolaemia.

Lack of an association between apolipoprotein B XbaI polymorphism and blood lipid parameters in childhood.

The frequencies of the alleles of XbaI polymorphism in the apolipoprotein B gene were determined in two groups of children, 82 with high (HCG) and 86 with low (LCG) cholesterol levels. A slightly higher incidence of the X2X2 genotype in HCG was found, but the differences were not statistically significant. No relations were found between the XbaI polymorphic site and the levels of serum lipids and lipoproteins. Common XbaI polymorphism in the apolipoprotein B gene does not determine significantly the plasma cholesterol levels in childhood.

[Is the recent decrease in cholesterolemia in the Czech Republic convincing evidence?]. / Je nedávný pokles cholesterolémie v Ceské republice prukazný?

BACKGROUND: The objective of the study was to evaluate the 8-year trend of serum cholesterol levels in six districts of the Czech Republic, to assess whether the reduction of mean values of total cholesterol recorded during the period between 1985 and 1992 was convincing and to discuss possible causes and consequences of this development. METHODS AND RESULTS: Three cross-sectional surveys of risk factors were implemented in independent random 1% samples of the population aged 25-64 years. In 1985 1256 men (respondence rate 81.5%) and 1317 women (85%) were examined, In 1988 1357 men (85.2%) and 1412 women (88.4%), in 1992 1142 men (73.2%) and 1211 women (76.7%). A detailed check of the deviations in estimations during different time intervals from reference values provided evidence that the analytical method did not have an impact on the revealed changes. In men the mean total cholesterol level was 6.21 (95% confidence limit 6.14-6.28 mmol/l in 1985; 6.29 (6.23-6.35) mmol/l in 1988; 5.99 (5.91-6.06) mmol/l in 1992. In women the mean value of the total cholesterol level was 6.19 (6.12-6.25) mmol/l in 1985; 6.23 (6.17-6.30) mmol/l in 1988; 5.95 (5.88-6.02) mmol/l in 1992. According to variance analysis (ANOVA) the serum cholesterol in 1992 was lower by 0.22 mmol/l (p < 0.0001) than in 1985 and by 0.28 mmol/l (p < 0.0001) lower than in 1988. The drop of cholesterol between 1988-1992 may have been caused by dietary changes recorded in the population. According to nationwide data after 1990 there was a marked drop of the consumption of meat and meat products, milk and dairy products and animal fats, while the consumption of vegetable fats increased. Despite these dietary improvements, in six districts in 1992 fats accounted for 37% of the energy intake, the P/S ratio was only 0.41 in men and 0.46 in women. In these districts in 1992 and 1993 a decline of the standardized mortality rate from IHD in men was recorded. CONCLUSIONS: During an eight-year period the mean serum cholesterol level of men and women decreased significantly in six districts of the Czech Republic. This change was probably associated with a restricted intake of foods which have an impact on the serum cholesterol level.

[Changes in the cardiovascular risk profile of the population of the Czech Republic--MONICA 1992]. / Zmeny v kardiovaskulárním rizikovém profilu obyvatelstva Ceské republiky--MONIKA 1992.

BACKGROUND: The cardiovascular risk profile of the population in the Czech Republic is unfavourable, the mortality of the population from cardiovascular diseases is among the highest in the world. The objective of the present work was to compare the prevalence of the most serious risk factors in 1988 and 1992 and to find out whether the change of the political and economic system in 1989 had an impact on the risk profile of the population. Within the framework of the international WHO project MONICA independent 1% random population samples, age bracket 25-64 years, were examined in six districts of the Czech Republic. METHODS AND RESULTS: In 1988 1,357 men (response rate 85.5%) and 1,412 women (88.4%) were examined; in 1992 1,139 men (71.2%) and 1,214 women (75.0%) attended the examination. The prevalence of smokers (regular consumption of more than 1 cigarette per day) did not differ significantly in men: 41.8% in 1988, 40.3% in 1992 nor in women: 25.3%-24.1%. Also the prevalence of elevated blood pressure levels (BPs > 21.3 and/or BPd > 12.7 kPa) did not reveal a significant difference neither in men: 19.1%-20.4% nor in women 14.0%-15.0%. The prevalence of hypercholesterolaemia (total cholesterol > 6.5 mmol/l) was in 1992 significantly lower than in 1988--in men by 9% (39.6%-30.6%, p < 0.001) and in women by 6.3% (36.3%-30.0%, p < 0.001). Also in the prevalence of obesity (BMI men > 30, women > 29) a significant drop was recorded in men by 5.2% (23.8%-18.6%, p < 0.01) in women by 5.1% (33.3%-28.2%, p < 0.01). CONCLUSIONS: The probable reason for this partial improvement of the risk profile in 1992, as compared with data in 1988, are dietary changes which may be the result of the introduced market economy and global transformation of society after the political change in 1989.

Genetic markers in hypercholesterolemic and normocholesterolemic Czech children.

The genetic background of polygenic hypercholesterolemia was studied in hypercholesterolemic children consuming a diet identical to control individuals with low cholesterol concentrations. Significantly higher frequencies of "disadvantage" alleles, usually combined with a higher LDL cholesterol, were found in hypercholesterolemic individuals when polymorphisms in apolipoprotein E, apolipoprotein B--XbaI and LDL receptor--PvuII were studied.

Serum selenium in adult Czechoslovak (central Bohemia) population.

The serum selenium levels in 367 healthy adult (25-64 yr) Central Bohemia residents, 176 men and 191 women, were determined using atomic absorption spectrometry. An extremely wide range of values was found in the whole population sample (< 20-296 micrograms/L) as well as in each sex or age category studied. The mean selenium concentration and 95% confidence interval calculated after logarithmic transformation of the data were 74 micrograms/L (71-77) for the whole population sample, 72 micrograms/L (67-76) for men, and 76 micrograms/L (72-81) for women. About 10% of the residents exhibited serum selenium level below 45 micrograms/L. There was no significant correlation between serum selenium and sex, age, or smoking status of participants. However, the lowest average level was found in the group of heavy smoking women: 66 micrograms/L. The selenium status of the Central Bohemia population seems to be below European average. Groups of residents having a very low nutritional selenium intake may be expected to occur in this population.

Development of the cardiovascular risk in the population of the Czech Republic.

Population surveys of the major cardiovascular risk factors were conducted in six districts of the Czech Republic in 1988 and 1992 as part of the WHO MONICA Project. One-percent independent random samples of the population aged 25-64 years were examined and investigated; in 1988, the survey included 1357 men and 1412 women (response rates of 85.5% and 88.4%, respectively); 1139 men and 1214 women with the response rate 71.2% and 75.0%, respectively, were enrolled in 1992. Over the four years, the mean levels of diastolic blood pressure rose from 83.8 mmHg to 85.5 mmHg (p < 0.001) in men; the rise in women from 80.7 mmHg to 81.6 mmHg was non-significant. Systolic blood pressure between the two surveys did not differ significantly. Mean total cholesterol levels declined from 6.24 mmol/l to 5.91 mmol/l (p < 0.001) in men and from 6.16 mmol/l to 5.87 mmol/l (p < 0.001) in women. Mean BMI decreased from 27.5 to 26.9 (p < 0.001) in men and from 27.4 to 26.5 (p < 0.001) in women. The authors assume that the significant decreases in cholesterolaemia and BMI may be caused by changes in the dietary pattern resulting from the market economy principles setting in after the 1989 revolution, and by an increased attention of the population to their health in the new socioeconomic conditions. If the trend continues, one might expect a decrease in mortality from IHD. On the other hand, the rise in diastolic blood pressure may be due to deteriorated control of hypertension.

[Smoking habits of male and female physicians in the Czech Republic]. / Kurácké návyky lékaru a lékarek v Ceské republice.

The results of questionnaires given to 673 male and female physicians, pertaining to smoking habits, were compared with the Czech population with a similar age distribution according to results of the MONICA study. Male doctors smoke less frequently than men of the Czech population (24.2% vs. 44.9%). Female doctors smoke more frequently than male doctors, and what is worse, more frequently than women in the Czech population (27.4% vs. 26.6%). Specialists in internal medicine smoke least frequently (17.4%), surgeons smoke most frequently (32.3%). Partners of male and female smokers smoke more frequently than partners of non-smokers. Husbands more frequently than wives. Smokers are more frequently ignorant of their other risk factors. The authors present also data from some European and overseas countries. In countries where the number of smokers among medical doctors declines, there is also a decline of smoking in the general population. In the USA, Great Britain, Switzerland, Norway and Sweden smoking habits declined among physicians during the past 30 years 3-6x.

[Serum lipid and lipoprotein levels in children in relation to their dietary habits and parental blood cholesterol]. / Hladiny sérových lipidu a lipoproteinu u detí ve vztahu k jejich nutricním návykum a k cholesterolémii rodicu.

In a group of 2000 Prague children aged 11-12 years the distribution of serum cholesterol levels was assessed. For further investigations 100 children with cholesterol levels above the 95th percentile (HYPER) were selected and 100 children with values between the 5th and 10th percentile (HYPO). Children and parents were subjected to detailed clinical and laboratory examination, in children the three-day dietary intake was assessed. Boys of the HYPER group had significantly higher LDL, HDL and VLDL cholesterol levels as well as levels of apolipoprotein B and less favourable values of the atherogenic index (AI). Girls of the HYPER group had significantly higher mean values of LDL-cholesterol and apolipoprotein B and also less favourable values of the AI. In the group HYPER children no abnormalities were detected in the carbohydrate metabolism nor a higher incidence of obesity although they differed significantly from children in the HYPO group as regards parameters of the lipid spectrum. The energy value of the consumed diet of children in the HYPER and HYPO group does not differ significantly. Although in boys of the HYPER group there was a higher ratio of total fat and animal fat (p less than 0.05), neither the percentage ratio of fatty acids nor the P:S ratio differed significantly in children of the HYPER and HYPO group. Parents of children of the HYPER group had significantly higher mean cholesterol, apolipoprotein B, LDL cholesterol values and less favourable values of the atherogenic index than parents of children of the HYPO group. The incidence of hypercholesterolaemia in the families of these children was also significantly higher.

Cholesterolaemia in school-age children and hypercholesterolaemia aggregation in the family.

The distribution of cholesterol values was established in a group of 2,000 Prague children aged 11-12 years. Of these, 100 children with cholesterol values exceeding the 95th percentile (HYPER), and 100 children with values between the 5th and the 10th percentiles (HYPO) were selected for follow-up. In addition to a thorough clinical and laboratory examination in children and parents, three-day food consumption was registered in children. Even though differing significantly from those assigned to the HYPO group in lipid spectrum parameters, HYPER group children did not show any abnormalities in carbohydrate metabolism or increased incidence of obesity. There is no significant difference in the energy values of food consumed by HYPER and HYPO children. Although a significantly higher proportion (in per cent) of total lipids and animal fat consumption was found in HYPER boys (p less than 0.05), the proportions (in per cent) of fatty acids, and the unsaturated/saturated fatty acid ratio in HYPER and HYPO children did no differ significantly. Parents of HYPER children showed significantly higher mean values of cholesterol, apolipoprotein B, LDL cholesterol and more unfavourable atherogenic index values. Hypercholesterolaemia aggregation in both parents was likewise significantly higher in children assigned to the HYPER group.