Salivary IgA to MAA-LDL and Oral Pathogens Are Linked to Coronary Disease.

A large body of literature has established the link between periodontal disease and cardiovascular disease. Oxidized low-density lipoproteins (OxLDLs) have a crucial role in atherosclerosis progression through initiation of immunological response. Monoclonal IgM antibodies to malondialdehyde-modified low-density lipoprotein (MDA-LDL) and to malondialdehyde acetaldehyde-modified low-density lipoprotein (MAA-LDL) have been shown to cross-react with the key virulence factors of periodontal pathogens Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. We have previously shown that salivary IgA antibodies to MAA-LDL cross-react with P. gingivalis in healthy humans. In this study, we aim to assess whether oral mucosal immune response represented by salivary IgA to MAA-LDL and oral pathogens is associated with coronary artery disease (CAD). Also, the molecular mimicry through antibody cross-reaction between salivary IgA to MAA-LDL and oral pathogens was evaluated. The study subjects consisted of 451 patients who underwent a coronary angiography with no CAD ( n = 133), stable CAD ( n = 169), and acute coronary syndrome (ACS, n = 149). Elevated salivary IgA antibody levels to MAA-LDL, Rgp44 (gingipain A hemagglutinin domain of P. gingivalis), and Aa-HSP60 (heat shock protein 60 of A. actinomycetemcomitans) were discovered in stable-CAD and ACS patients when compared to no-CAD patients. In a multinomial regression model adjusted for known cardiovascular risk factors, stable CAD and ACS were associated with IgA to MAA-LDL ( P = 0.016, P = 0.043), Rgp44 ( P = 0.012, P = 0.004), Aa-HSP60 ( P = 0.032, P = 0.030), Tannerella forsythia ( P = 0.002, P = 0.004), Porphyromonas endodontalis ( P = 0.016, P = 0.020), Prevotella intermedia ( P = 0.038, P = 0.005), and with total IgA antibody concentration ( P = 0.002, P = 0.016). Salivary IgA to MAA-LDL showed cross-reactivity with the oral pathogens tested in the study patients. The study highlights an association between salivary IgA to MAA-LDL and atherosclerosis. However, whether salivary IgA to MAA-LDL and the related oral humoral responses play a causal role in the development in the CAD should be elucidated in the future.

Interests in health care technology assessment (HCTA) and HCTA training needs in eight European countries: COMETT-ASSESS.

Between mid-1991 and mid-1992, nearly 300 different organisations involved in European health care contributed their views to a survey covering a range of topics relevant to health care technology assessment (HCTA) and economic appraisal of health technologies. Organisations who participated included manufacturers, health care institutions, professional associations, health care reimbursement or funding agencies, academic institutions and policy making agencies in eight European countries. The study was carried out as part of a larger project, COMETT-ASSESS, funded partially by the EC COMETT programme, to design and deliver training in health care technology assessment and socioeconomic evaluation. The survey demonstrates a high level of interest in assessment of health care technologies among European organisations, regardless of the type of organisation. Eight out of ten organisations report high-medium levels of interest in using HCTA in their decision making. A similar proportion report high-medium interest in increasing their general understanding of HCTA, and 2 out of 3 in carrying out assessments. All organisations clearly identify a need to train their staff in HCTA. The two key groups of staff requiring training are managers and clinicians. Manufacturers also report a need to train their marketing staff. The principal reason for training is in order to improve the use staff make of HCTA in their decision-making. This finding indicates that it may not be sufficient for European countries to develop effective HCTA dissemination strategies which improve the flow of information on technology assessment results; decision-makers within the organisations targeted will also need training, if they are to use this information effectively. As well as a need to train decision-makers, organisations also report a need to train their researchers, and to a lesser extent their own trainers. When it comes to the types of technologies which need to be assessed, organisations consistently report that they are interested in assessment of accepted health technologies, as well as new or recently introduced ones. In contrast, to date the major emphasis in many HCTA programmes has been on technologies which are yet to enter the service setting. More thought now needs to be given to developing methodologies for assessing technologies once they have reached the service setting. For this the presence of a skilled and well-trained group of health personnel will also be necessary.(ABSTRACT TRUNCATED AT 400 WORDS)

Comparison of trends in ischaemic heart disease between North Karelia, Finland, and Kaunas, Lithuania, from 1971 to 1987.

OBJECTIVE: To compare the long-term trends in mortality and attack rate of ischaemic heart disease in North Karelia, Finland, and in Kaunas, Lithuania, from 1971 to 1987. DESIGN: Data on routine mortality statistics were obtained from the Central Statistical Office of Finland and from the Central City Archives of Kaunas. In addition, data from the community based myocardial infarction registers were used. The registers used similar diagnostic criteria and had operated in both areas during the entire study period. SETTING: The province of North Karelia in Finland and the city of Kaunas in Lithuania. SUBJECTS: The target populations were the people of North Karelia and Kaunas aged 35-64 years. MAIN OUTCOME MEASURES: Mortality from ischaemic heart disease and the attack rate of acute myocardial infarction. RESULTS: In North Karelia mortality from ischaemic heart disease and the attack rate of acute myocardial infarction declined steeply both in men and women. This decline was accompanied by a decrease in total mortality. In Kaunas, both mortality and the attack rate increased in men but remained unchanged in women. In 1985 to 1987, age standardised total mortality per 100,000 inhabitants was similar in the two populations in men (1081 (95% confidence interval (CI) 1013 to 1149), in North Karelia; 1082 (95% CI 1032 to 1132), in Kaunas). The proportional mortality from ischaemic heart disease was considerably higher in North Karelia (40%) than in Kaunas (28%). In women, age standardised total mortality was lower in North Karelia (350 (95% CI 312-388)) than in Kaunas (440 (95% CI 413 to 467)). The proportional mortality from ischaemic heart disease in women was also higher in North Karelia (28%) than in Kaunas (13%). CONCLUSIONS: Despite the remarkable decline in the occurrence of ischaemic heart disease, it still remains the most important cause of premature mortality in North Karelia. In Kaunas ischaemic heart disease mortality and attack rate increased in men. Experiences from successful cardiovascular disease prevention programmes in western countries, such as the North Karelia Project, should be exploited to prevent an increasing epidemic of ischaemic heart disease in eastern Europe.

Acute myocardial infarction (AMI) in Finland--baseline data from the FINMONICA AMI register in 1983-1985.

The acute myocardial infarction (AMI) register of the FINMONICA study, the Finnish part of the WHO-coordinated multinational MONICA project, operates in the provinces of North Karelia and Kuopio in eastern Finland and in Turku, Loimaa and in communities around Loimaa in southwestern Finland. The AMI register serves as an instrument for the assessment of trends in mortality from coronary heart disease (CHD) and of the incidence and attack rates of AMI among 25-64-year-old residents of the study areas. This report describes the methods used in the FINMONICA AMI register and the findings during the first 3 years of the study, in 1983-1985. The criteria of the multinational WHO MONICA project were used in the classification of fatal events and in the diagnosis of non-fatal definite AMI, but based on the experience within the FINMONICA study, stricter diagnostic criteria than those originally described in the WHO MONICA protocol were used for non-fatal possible AMI. This led to a marked improvement in the comparability of the data from the three study areas with regard to the incidence and attack rates of non-fatal AMI. During the 3-year period the total number of registered events was 6266 among men and 2092 among women. Among men the incidence and attack rates of AMI and mortality from CHD were higher in eastern than in southwestern Finland. Also among women the incidence and attack rates of AMI were higher in eastern than in southwestern Finland, whereas there was no regional difference in mortality from CHD among women. The mortality findings of the FINMONICA AMI Register were in good agreement with the official CHD mortality statistics of Finland.

Medical technology assessment in Finland.

We need five kinds of people to guide us further through the integrated process of medical technology assessment: (a) idea generators; (b) entrepreneurs/product, process and practice "champions"; (c) program managers; (d) gatekeepers/communicators; and (e) sponsors/"coaches." If we focus on idea generators, empirical research quickly points out a significant difference between people who create ideas and those who apply the ideas that others have generated. Entrepreneurs and product "champions" promote change and innovation, take ideas, and attempt to move them forward in organizations to gain their adoption. The third necessary contributor to development in medical technology assessment is referred to as the program manager, the person who handles the supportive functions of planning, scheduling, and finance. Communicators are crucial in getting the results of assessment efforts disseminated. The sponsor or the "coach" is a more senior person who does not carry out the research or directly champion change but who provides the encouragement, support, facilitation, and help in "bootlegging activities" that are necessary to aid junior people in their attempts to move research advances forward in an organization. Whether we find these kinds of people in Finland or not--and how long we take to do so--will determine the path of medical technology assessment in Finland toward the year 2000 and beyond.

A cross-sectional ecological analysis of blood pressure and its determinants in eleven Pacific populations.

A cross-sectional interpopulation analysis of blood pressure and its determinants was conducted with the data collected during epidemiologic surveys in 11 Pacific island populations from 1975 to 1981. In each of these populations, the mean arterial blood pressure increased with age; the overall blood pressure levels differed among the populations. The multivariate analyses suggest that dietary factors that result in differences in body mass, plasma cholesterol, and glucose intolerance contribute considerably to interpopulation differences in blood pressure. The impact of these differences in effects of dietary factors on interpopulation blood pressure seemed to be uniform, even though the overall levels of each of these three variables differed significantly among the populations. This study of blood pressure data, accrued from 6224 men and 7029 women aged 20-79 years, supports the hypothesis that dietary factors strongly contribute to high blood pressure as well as to interpopulation differences in the prevalence of hypertension. We propose using these data in planning programs for prevention and control of hypertension in the Pacific countries.

Prevalence of ischaemic ECG abnormalities according to the diabetes status in the population of Fiji and their associations with other risk factors.

The prevalence of ECG abnormalities indicating the presence of coronary heart disease was examined in the Melanesian (444 men and 457 women) and Asian Indian (408 men and 435 women) population living in Fiji. The aim of the present analysis was to determine the levels of coronary risk factors in people with diabetes, impaired glucose tolerance (IGT) or normal glucose tolerance. The prevalence of ECG abnormalities suggesting coronary heart disease (Q-waves, ST-depression or T-wave changes) was higher among women than men and among Asian Indians than Melanesians. The prevalence of ECG abnormalities was highest in diabetic subjects, intermediate in people with IGT and lowest in people who had normal glucose tolerance. People with IGT were more likely than others to have high risk factor levels. In people with IGT the increased levels of other coronary risk factors might explain a great deal of the increased prevalence of the ECG abnormalities as compared with the prevalence in those with normal glucose tolerance. Also in diabetic subjects, the levels of other coronary risk factors were increased in those who had ECG abnormalities, but not more than was the case with IGT, so that diabetes itself seemed to remain as the major identified risk factor for ECG abnormalities. The prevalence of diabetes in our study populations, especially in Asian Indians, was very high. This suggests that diabetes is the major risk factor for coronary heart disease in such populations.

Smoking rates in Pacific islands.

PIP: This study collected data on rates of cigarette smoking in the following Pacific Islands: Cook Islands, Fiji, Kiribati, Nauru, New Caledonia, Niue, Tuvalu, and Western Samoa. The data were collected in 1975-81 as part of a diabetes-cardiovascular diseases survey. A large variation in the prevalence of smoking was found in the populations surveyed. 90% of men and 74% of women on Kiribati were daily smokers compared with 38% of men and 19% of women on the Cook Islands and only 4% of the female population of Fiji. There was no association between age and the prevalence of smoking. Smoking tended to be more common in rural areas than urban areas and was higher among men than women in all populations studied. For both men and women, the prevalence of smoking was higher among lower income groups and those who reported moderate or heavy alcohol consumption. There was no clear association between smoking and marital status. Overall, the data on the prevalence of cigarette smoking indicate that this has become a significant public health problem in Pacific island communities. The data further suggest that the prevalence of smoking differs markedly in culturally and ethnically different populations. Somewhat unexpected was the greater proportion of smokers among traditional communities in rural areas compared with urban areas. This finding can be explained in part by the widespread practice of cultivating tobacco in many rural areas of the Pacific. It is recommended that a reliable survey of smoking patterns in the Pacific islands and prospective surveys that correlate the results of such a study with the distribution of cardiovascular diseases and cancer be conducted.^ieng

The effect of maternally inhaled styrene on embryonal and foetal development in mice and Chinese hamsters.

Pregnant mice and Chinese hamsters were exposed to styrene 6 hrs daily during the period of major organogenesis via inhalation in concentrations 250 p.p.m., and 300, 500, 750 and 1000 p.p.m., respectively. Both in mice and in Chinese hamsters embryotoxicity was raised. Some minor skeletal malformations (rib fusions, extra ribs) were noted in mice but not in Chinese hamsters.

Embryotoxicity and teratogenicity of styrene and styrene oxide on chick embryos enhanced by trichloropropylene oxide.

The effects of TCPO (trichloropropylene oxide) on the embryotoxicity and teratogenicity of styrene and styrene oxide and chick embryos were investigated. The compounds were injected into the air space of the eggs in a total volume of 25 microliter on the third day of embryogenesis. TCPO increased embryotoxicity and teratogenicity of styrene and styrene oxide. Our results present evidence that the epoxides possess embryotoxic and teratogenic properties in chick embryos.