Association of maternal blood pressure in pregnancy with blood pressure of their offspring through adolescence.

This article looks at the association of maternal blood pressure with the blood pressure of the offspring from birth to childhood. The Barker hypothesis states that maternal and "in utero" attributes during pregnancy affect a child's cardiovascular health throughout life. We present an analysis of a unique dataset that consists of three distinct developmental processes: maternal cardiovascular health during pregnancy; fetal development; and child's cardiovascular health from birth to 14 years. This study explored whether a mother's blood pressure reading in pregnancy predicts fetal development and determines if this in turn is related to the future cardiovascular health of the child. This article uses data that have been collected prospectively from a Jamaican cohort which involves the following three developmental processes: (1) maternal cardiovascular health during pregnancy which is the blood pressure and anthropometric measurements at seven time-points on the mother during pregnancy; (2) fetal development which consists of ultrasound measurements of the fetus taken at six time-points during pregnancy; and (3) child's cardiovascular health which consists of the child's blood pressure measurements at 24 time-points from birth to 14 years. The inter-relationship of these three processes was examined using linear mixed effects models. Our analyses indicated that attributes later in childhood development, such as child's weight, child's baseline systolic blood pressure (SBP), age and sex, predict the future cardiovascular health of children. The results also indicated that maternal attributes in pregnancy, such as mother's baseline SBP and SBP change, predicted significantly child's SBP over time.

Application of the Bayesian dynamic survival model in medicine.

The Bayesian dynamic survival model (BDSM), a time-varying coefficient survival model from the Bayesian prospective, was proposed in early 1990s but has not been widely used or discussed. In this paper, we describe the model structure of the BDSM and introduce two estimation approaches for BDSMs: the Markov Chain Monte Carlo (MCMC) approach and the linear Bayesian (LB) method. The MCMC approach estimates model parameters through sampling and is computationally intensive. With the newly developed geoadditive survival models and software BayesX, the BDSM is available for general applications. The LB approach is easier in terms of computations but it requires the prespecification of some unknown smoothing parameters. In a simulation study, we use the LB approach to show the effects of smoothing parameters on the performance of the BDSM and propose an ad hoc method for identifying appropriate values for those parameters. We also demonstrate the performance of the MCMC approach compared with the LB approach and a penalized partial likelihood method available in software R packages. A gastric cancer trial is utilized to illustrate the application of the BDSM.

Cross-sectional associations of C-reactive protein with vascular risk factors and vascular complications in the DCCT/EDIC cohort.

OBJECTIVE: To determine the relationships between C-reactive protein (CRP) levels and features of Type 1 diabetes. RESEARCH DESIGN AND METHODS: Serum CRP was measured by nephelometry in a cross-sectional study of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort (n=983) and nondiabetic subjects (n=71). RESULTS: CRP levels [geometric mean (95% CI)] were higher in diabetic than in control subjects, 1.6 (1.5-1.7) vs. 1.2 (1.1-1.5) mg/l, P=.019. CRP was higher in diabetic women (n=438) than in men (n=545) [2.0 (1.8-2.3) vs. 1.3 (1.2-1.5), P<.001]. Diabetic subjects formerly in the DCCT intensive treatment group had higher CRP levels than those who were randomized to the conventional treatment group [1.8 (1.6-1.9), n=479 vs. 1.5 (1.3-1.6), n=456, P=.010], attributable to greater BMI in the prior intensive group. In diabetes, CRP correlated with HbA(1c) (r=0.13, P<.0001) and with insulin resistance traits: BMI (r=0.34, P<.0001), waist-to-hip ratio (WHR; males: r=0.35, P<.0001; females: r=0.22, P<.0001), diastolic blood pressure (r=0.07, P=.025), triglycerides (r=0.19, P<.0001), apoB (r=0.22, P<.0001), LDL particle concentration (r=0.26, P<.0001), and LDL particle size (r=-0.22, P<.0001). CRP was not associated with complications. Significant independent predictors of CRP in diabetes were gender, BMI, WHR, concurrent HbA(1c), and oral contraceptive pill use. CONCLUSIONS: CRP was elevated relative to nondiabetic subjects, and in diabetes was higher in females. Elevated CRP in Type 1 diabetes was associated with poor glycemic control, larger body habitus, and other factors that comprise the insulin resistance syndrome. Nevertheless, CRP levels were not associated with complications. Longitudinal studies are warranted.

Association between level of frailty and bone mineral density in community-dwelling men.

The goal of this study is to determine the associations between the components of a frailty definition and bone mineral density (BMD) in older men. A total of 392 community dwelling men (age range: 58-95 yr) with a mean age of 73+/-8 yr were evaluated. Femoral neck BMD T-scores ranged from -5.78 to +2.50, with 48.7% who had T-scores between -1 and -2.5 (low bone mass) and 8.7% who had T scores < or = -2.5 (osteoporosis). Participants were characterized as normal (39%), intermediate (55%), or frail (6%). Hand grip strength was 31.5+/-9.1 kg in those with normal BMD compared with 26.5+/-7.9 kg in those with osteoporotic BMD (p=0.0026). Walk speed (8 ft) was 2.32+/-0.49 s in those with normal BMD compared with 2.87+/-1.30 s with osteoporotic BMD (p=0.0015). Femoral neck T-score declined significantly with increasing level of frailty (p=0.014), but significance of decline was lost when corrected for age. Increasing frailty was associated with lower femoral neck BMD, although the association was not independent of age. Two components of the frailty model (i.e., hand grip strength and walking speed) were independently associated with lower femoral neck BMD, a finding that has not previously been reported in men.

Sex differences in the effect of diabetes duration on coronary heart disease mortality.

BACKGROUND: It is not known whether the coronary heart disease (CHD) mortality risk associated with recent (RDM; <10 years) or long-standing diabetes mellitus (LDM; > or =10 years) varies by sex. METHODS: The relationship between diabetes duration and CHD mortality was evaluated among 10 871 adults (aged 35-74 years at baseline) using the 1971-1992 National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. RESULTS: The CHD mortality rates per 1000 person-years in men with no myocardial infarction (MI) or diabetes, MI only, RDM only, LDM only, MI and RDM, and MI and LDM were 5.5 (95% confidence interval, 4.8-6.2), 15.2 (11.6-20.0), 13.2 (7.9-22.1), 11.4 (6.4-20.3), 36.0 (16.7-77.7), and 35.4 (14.0-89.7), respectively. The corresponding rates in women were 2.9 (2.5-3.3), 7.3 (5.0-10.8), 5.2 (3.5-7.7), 10.7 (7.5-15.5), 9.3 (4.3-19.9), and 21.6 (6.1-76.0), respectively. Compared with MI, the multivariate hazard ratios and their 95% confidence intervals (adjusted for age, race, smoking, hypertension, total cholesterol level, and body mass index) for fatal CHD in men with RDM, LDM, MI and RDM, and MI and LDM were 0.7 (0.3-1.3), 0.8 (0.4-1.4), 3.2 (1.4-7.4), and 2.4 (0.8-6.7), respectively. The corresponding ratios in women were 0.9 (0.6-1.3), 1.8 (1.1-3.2), 1.3 (0.5-3.5), and 1.6 (0.2-10.9), respectively. CONCLUSIONS: In men, RDM and LDM were associated with as high a risk for CHD death as MI. In women, although RDM had a CHD mortality risk similar to MI, LDM had an even greater risk. Because women with LDM are at very high risk for CHD mortality, current guidelines may need to be further refined to match intensity of treatment to risk in these women.

Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies.

PURPOSE: For this report, we examined the relationships between the conditions of being overweight and obese and mortality from all causes, heart disease, cardiovascular disease, and cancer. METHODS: We defined the categories of body weight according to level of body mass index, BMI=wt(kg)/ht(m)2, using classifications suggested by the National Institutes of Health and the World Health Organization. These classifications are as follows: "normal weight" is defined as BMI > or = 18.5, but less than 25; "overweight" equals BMI > or = 25, but less than 30; and "obese" individuals have BMIs > or = 30. Our investigation is based on person-level data from 26 observational studies that include both genders, several racial and ethnic groups, and samples from the US and other countries. The database consists of 74 analytic cohorts, arranged according to natural strata including gender, race, and area of residence. It includes 388,622 individuals, with 60,374 deaths during follow-up. We use proportional hazards models to examine the relationships between the BMI categories and mortality, controlling for age and smoking status. We use random-effects models to assess summary relative risks associated with the overweight and obesity conditions across cohorts. RESULTS: The relative risks among the heaviest individuals for overall death, death caused by coronary heart disease (CHD), and death caused by cardiovascular disease (CVD) are 1.22, 1.57, and 1.48, respectively, when compared with the those within the lowest BMI category. The summary relative risk among the heaviest participants for death from cancer is 1.07. CONCLUSIONS: We document once again, excess mortality associated with obesity. Our results do, however, question whether the current classification of individuals as "overweight" is optimal in the sense, since there is little evidence of increased risk of mortality in this group.

Sex differences in risk for coronary heart disease mortality associated with diabetes and established coronary heart disease.

BACKGROUND: The sex-specific independent effect of diabetes mellitus and established coronary heart disease (CHD) on subsequent CHD mortality is not known. METHODS: This is an analysis of pooled data (n = 5243) from the Framingham Heart Study and the Framingham Offspring Study with follow-up of 20 years. At baseline (1971-1975), 134 men and 95 women had diabetes, while 222 men and 129 women had CHD. Risk for CHD death was analyzed by proportional hazards models, adjusting for age, hypertension, serum cholesterol levels, smoking, and body mass index. The comparative effect of established CHD vs diabetes on the risk of CHD mortality was tested by testing the difference in log hazards. RESULTS: The adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for death from CHD were 2.1 (95% CI, 1.3-3.3) in men with diabetes only, and 4.2 (95% CI, 3.2-5.6) in men with CHD only compared with men without diabetes or CHD. The HR for CHD death was 3.8 (95% CI, 2.2-6.6) in women with diabetes, and 1.9 (95% CI, 1.1-3.4) in women with CHD. The difference between the CHD and the diabetes log hazards was +0.73 (95% CI, 0.72-0.75) in men and -0.65 (95% CI, -0.68 to -0.63) in women. CONCLUSIONS: In men, established CHD signifies a higher risk for CHD mortality than diabetes. This is reversed in women, with diabetes being associated with greater risk for CHD mortality. Current treatment recommendations for women with diabetes may need to be more aggressive to match CHD mortality risk.

Serum lipoproteins in the diabetes control and complications trial/epidemiology of diabetes intervention and complications cohort: associations with gender and glycemia.

OBJECTIVE: To relate the nuclear magnetic resonance (NMR)-determined lipoprotein profile, conventional lipid and apolipoprotein measures, and in vitro oxidizibility of LDL with gender and glycemia in type 1 diabetes. RESEARCH DESIGN AND METHODS: In the 1997-1999 Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications (DCCT/EDIC) cohort, serum from 428 women and 540 men were characterized by conventional lipids, NMR, apolipoprotein levels, and LDL susceptibility to in vitro oxidation. Simple and partial correlation coefficients were calculated for each lipoprotein-related parameter versus gender, with and without covariates (age, diabetes duration, concurrent HbA(1c), DCCT randomization, hypertension, BMI, waist-to-hip ratio, and albuminuria). For concurrent HbA(1c), data were analyzed as above, exchanging gender for HbA(1c). Associations were significant if P < 0.05. RESULTS: Although men and women had similar total and LDL cholesterol and triglycerides, men exhibited the following significant percent differences in NMR profiles versus women: small VLDL 41; IDL -30; medium LDL 39; small LDL 21; large HDL -32; small HDL 35; LDL particle concentration 4; VLDL and HDL diameters -8 and -4, respectively. Small VLDL, small HDL, medium LDL (women only), small LDL (men only), and LDL particle concentration were positively correlated, and HDL size was inversely correlated, with concurrent HbA(1c). NMR profile was unrelated to prior DCCT randomization. Susceptibility of LDL to oxidation was unrelated to gender and glycemia. CONCLUSIONS: Male gender and poor glycemia are associated with a potentially more atherogenic NMR lipoprotein profile. Neither gender nor glycemia influence LDL oxidation in vitro.

Diabetic retinopathy and serum lipoprotein subclasses in the DCCT/EDIC cohort.

PURPOSE: To determine associations between retinopathy status and detailed serum lipoprotein subclass profiles in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) cohort. METHODS: Persons with type 1 diabetes (440 women, 548 men) from the DCCT/EDIC cohort were studied. Retinopathy was characterized by Early Treatment Diabetic Retinopathy Study (ETDRS) scores, hard exudate scores, and ETDRS scores minus the hard exudate component. Lipoproteins were characterized by conventional lipid profile, nuclear magnetic resonance lipoprotein subclass profile (NMR-LSP), apoA1, apoB, lipoprotein(a), and susceptibility of LDL to oxidation. Data were analyzed with and without the following covariates: age, gender, duration of diabetes, HbA(1c), albumin excretion rate (AER), creatinine clearance, hypertension, body mass index, waist-hip ratio, DCCT treatment group, smoking status. RESULTS: The severity of retinopathy was positively associated with triglycerides (combined cohort) and negatively associated with HDL cholesterol (men, combined cohort). NMR-LSP identified retinopathy as being positively associated with small and medium VLDL and negatively with VLDL size. In men only, retinopathy was positively associated with small LDL, LDL particle concentration, apoB concentration, and small HDL and was negatively associated with large LDL, LDL size, large HDL, and HDL size. No associations were found with apoA1, Lp(a), or susceptibility of LDL to oxidation. All three measures of retinopathy revealed the same associations. CONCLUSIONS: NMR-LSP reveals new associations between serum lipoproteins and severity of retinopathy in type 1 diabetes. The data are consistent with a role for dyslipoproteinemia involving lipoprotein subclasses in the pathogenesis of diabetic retinopathy.

The relationship of physical activity and body weight with all-cause mortality: results from the Puerto Rico Heart Health Program.

PURPOSE: To study the relationship of physical activity and obesity with all-cause mortality in Puerto Rican Men. METHODS: The Puerto Rico Heart Health Program collected physical activity and anthropometric measurements in 9,824 men between 1962 and 1965. After excluding those with known coronary heart disease at baseline, and those who died within the first three years of the study we analyzed the data for the relationship between physical activity and overweight status to all-cause mortality in 9,136 men. We stratified our participants by quartiles of physical activity. Participants were classified into four categories of body weight: underweight (BMI < 18.5), healthy weight (BMI =18.5-24.9), overweight (BMI = 25-29.9), and obese (BMI = 30+). RESULTS: After adjusting for age, education, smoking status, hypertension status, hypercholesterolemic status, urban/rural residence, and overweight status, physical activity was independently related to all-cause mortality. All-cause mortality was lower in those in quartile 2 (OR = 0.68, CI = 0.58-0.79) than quartile 1 (reference, sedentary group). Mortality among those in quartile 3 and 4 (0.63, CI = 0.54-0.75; and 0.55, CI = 0.46-0.65, respectively) were also significantly lower than those observed in quartile 1, but not significantly lower than those observed in quartile 2. Furthermore, within every category of body weight, those who were most active had significantly lower odds ratio of all-cause mortality. CONCLUSION: Our findings support the current recommendation that some physical activity is better than none, in protecting against all-cause mortality. The benefits of an active lifestyle are independent of body weight and that overweight and obese Puerto Rican men who are physically active experienced significant reductions in all-cause mortality compared with their sedentary counterparts.

Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailty.

OBJECTIVES: To investigate the effects of testosterone supplementation on bone, body composition, muscle, physical function, and safety in older men. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: A major medical institution. PARTICIPANTS: One hundred thirty-one men (mean age 77.1 +/- 7.6) with low testosterone, history of fracture, or bone mineral density (BMD) T-score less than -2.0 and frailty. INTERVENTION: Participants received 5 mg/d of testosterone or placebo for 12 to 24 months; all received calcium (1500 mg/d diet and supplement) and cholecalciferol (1,000 IU/d). MEASUREMENTS: BMD of hip, lumbar spine, and mid-radius; body composition; sex hormones, calcium-regulating hormones; bone turnover markers; strength; physical performance; and safety parameters. RESULTS: Ninety-nine men (75.6%) completed 12 months, and 62 (47.3%) completed end therapy (mean 23 months; range 16-24 months for 62 who completed therapy). Study adherence was 54%, with 40% of subjects maintaining 70% or greater adherence. Testosterone and bioavailable testosterone levels at 12 months were 583 ng/dL and 157 ng/dL, respectively, in the treatment group. BMD on testosterone increased 1.4% at the femoral neck and 3.2% at the lumbar spine (P=.005) and decreased 1.3% at the mid-radius (P<.001). There was an increase in lean mass and a decrease in fat mass in the testosterone group but no differences in strength or physical performance. There were no differences in safety parameters. CONCLUSION: Older, frail men receiving testosterone replacement increased testosterone levels and had favorable changes in body composition, modest changes in axial BMD, and no substantial changes in physical function.

Examining the dynamic association of BMI and mortality in the Framingham Heart Study.

Based on the 40-year follow-up of the Framingham Heart Study (FHS), we used logistic regression models to demonstrate that different designs of an observational study may lead to different results about the association between BMI and all-cause mortality. We also used dynamic survival models to capture the time-varying relationships between BMI and mortality in FHS. The results consistently show that the association between BMI and mortality is dynamic, especially for men. Our analysis suggests that the dynamic property may explain part of the heterogeneity observed in the literature about the association of BMI and mortality.

Effect of treatment and adherence on ethnic differences in blood pressure control among adults with hypertension.

We evaluated whether hypertension control differs by ethnicity after accounting for patient characteristics, treatment, and adherence to treatment using the third National Health and Nutrition Examination Survey (US population estimate, 42,511,379). Outcome measures were prescribed treatment, treatment adherence, hypertension control (blood pressure [BP]<140/90 mm Hg). Multivariate logistic regression was performed with non-Hispanic whites (NHW) as the comparison group. Non-Hispanic blacks (NHB) were more likely to report medication prescription (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.1-2.5) and being advised to restrict salt (OR 1.5, CI: 1.2-2.0). Among those advised, NHB were more likely to report salt restriction (OR 1.5, CI: 1.1-2.1) and weight-loss attempts (OR 1.7, CI: 1.3-2.3). Among persons advised to follow exercise, alcohol restriction, smoking cessation, tension reduction, or diet modification, NHB (OR 2.2, CI: 1.6-3.0) and Mexican Americans (OR 2.0, CI: 1.1-3.9) were more likely to report adherence. The likelihood of uncontrolled hypertension was higher in NHB (OR 1.4, CI: 1.1-1.7) and Mexican Americans (OR 1.5, CI 1.1-2.0) despite medication adherence. Even after adjustment for treatment and adherence, substantial ethnic differences in hypertension control were found. Initiating treatment, while crucial, is not sufficient and future guidelines should emphasize aggressive treatment escalation to achieve hypertension control.

Thirty-year Survival for Black and White Hypertensive Individuals in the Evans County Heart Study and the Hypertension Detection and Follow-up Program.

The Evans County Heart Study (ECHS), initiated in 1960, was one of the first major studies to document cardiovascular disease (CVD) risks for African Americans and Caucasians with elevated blood pressures. In the early 1970's, the Hypertension Detection and Follow-up Program (HDFP), with a site in Georgia (HDFP-GA) was one of the first major studies to demonstrate that treating hypertension with stepped care (SC), versus referred care (RC), has better short-term outcomes. With this background, study objectives were to evaluate 30-year survival and cardiovascular outcomes of the HDFP-GA and to compare outcomes of these patients with 1619 hypertensive individuals (30-69 years of age) from the ECHS. HDFP-GA patients included 688 individuals (black [n=267]; white [n=421]) randomized to RC (n=341) and SC (n=347). The ECHS was comprised of 733 black and 886 white hypertensives. All-cause mortality and CVD mortality were assessed in the HDFP-GA and compared to the ECHS hypertensives. After 30-years of follow-up, 65.7% of the HDFP-GA cohort had died compared with a similar 65.8% of the ECHS hypertensives. However, CVD mortality rates, while similar for the SC and RC arms, were lower than in the HDFP-GA total study group than the hypertensive participants of ECHS (32.6% vs. 40.3% p<.001). CVD survival rates for both SC and RC HDFP-GA arms were significantly better than population-based hypertensive individuals in the ECHS, with consistent benefits in all four race-sex groups. These results identify the importance of long-term follow-up of individuals in hypertension studies and trials that include CVD outcomes.

Physical activity and prostate cancer mortality in Puerto Rican men.

Studies on the association between physical activity and fatal prostate cancer have produced inconclusive results. The Puerto Rico Heart Health Program was a cohort study of a randomly selected sample of 9824 men age 35 to 79 years at baseline who were followed for mortality until 2002. Multiple examinations collected information on lifestyle, diet, body composition, exercise, urban-rural residence, and smoking habits. Physical activity status was measured using the Framingham Physical Activity Index, an assessment of occupational, leisure-time, and other physical activities measured as usual activity over the course of a 24-hour day. Physical activity was stratified into quartiles. Multivariate logistic regression analysis was used to assess the association of physical activity with prostate cancer mortality. Other covariates included age, education, urban-rural residence, smoking, and body mass index. Compared with the lowest level of physical activity (Q1), the risk of prostate cancer mortality was OR = 0.99 (95% CI = 0.64-1.55) for Q2, OR = 1.34 (95% CI = 0.88-2.05) for Q3, and OR = 1.19 (95% CI = 0.75-1.90) for Q4. Further analyses by age group, overweight status, or vigorous physical activity also did not show a significant association between physical activity and prostate cancer mortality. Physical activity did not predict prostate cancer mortality in this group of Puerto Rican men.

Protein and legume intake and prostate cancer mortality in Puerto Rican men.

Prostate cancer is the number 1 cancer killer among Puerto Rican (PR) men. Plant foods have been inversely associated with prostate cancer. Legumes play a significant role in the PR diet; consumption of legumes in PR (14 lb/capita) was double that of the United States (7 lb/capita). We examined dietary protein consumption (from baseline 24-h dietary recalls) and prostate cancer mortality in the PR Heart Health Program, a cohort study of 9,824 men aged 35-79 years at baseline (1964) with follow-up until 2005. Total protein intake in the cohort was 85 g/day, and sources of protein were 30% vegetable, 30% dairy, 31% animal, and 8% seafood protein. Legume intake was 2.3 servings/day (1/4 cup each). Legume intake was not associated with prostate cancer mortality [comparing highest quartile to lowest quartile-odds ratio (OR) 1.40 [95% confidence interval (CI) 0.91-2.18], P trend 0.17]-nor were total protein, animal, seafood, dairy, or vegetable protein intakes. Consuming 1-2 servings of fruit was inversely associated (OR 0.50, 95% CI 0.32-0.77), whereas consuming more than 2 servings of fruit was not associated with prostate cancer mortality. Thus, we find no association between legumes or protein intake and prostate cancer mortality in this longitudinal cohort study of PR men.

Effect of cerclage on obstetrical outcome in twin gestations with a shortened cervical length.

OBJECTIVE: Our purpose was to determine the impact of cerclage placement on obstetric outcome in twin gestations with a shortened cervical length. STUDY DESIGN: A prospective cohort study of 147 consecutive twin pregnancies (July 1994 to March 2001) who underwent transvaginal ultrasonographic cervical length measurement between 18 and 26 weeks' gestation. Cerclage was offered to women with cervical lengths < or = 25 mm. Patients were segregated into quartiles by cervical length. Regression analysis and chi(2) tests were used to determine the effect of cervical length and cerclage on parameters of prematurity. RESULTS: One hundred twenty-eight twin gestations met inclusion criteria, including 21 (16.4%) who underwent cerclage for a cervical length < or = 25 mm. Decreasing cervical length was significantly associated with a shorter length of gestation, lower combined birth weight, delivery at < or = 34 weeks, preterm premature rupture of fetal membranes, and very low birth weight. None of these outcomes was altered by cerclage placement. CONCLUSION: Midtrimester cerclage does not alter the risks of prematurity associated with a shortened cervical length in twin gestations.

Colonoscopy: practice variation among 69 hospital-based endoscopists.

BACKGROUND: The medical profession, payers, and patients are interested increasingly in the quality of endoscopic procedures, including colonoscopy. The American Society for Gastrointestinal Endoscopy has recommended "report cards" by which endoscopists may keep track of certain key elements of their practice including indications, findings, duration, technical end points, complications, and patient satisfaction. METHODS: The GI-Trac endoscopy reporting database includes many of the data points recommended by ASGE for report cards. Seven hospital centers in North America have been collecting data prospectively for varying periods since 1994. These data were aggregated and analyzed by individual endoscopist. A total of 69 endoscopists performed 17,868 colonoscopies. RESULTS: Twelve percent of the endoscopists reported that more than 20% of procedures they performed were completely normal. The average time taken by 27% of endoscopists was more than 40 minutes (without trainees involved), and only 55% achieved a cecal intubation rate of over 90%; for 9% the rate was less than 80%. Complication rates were too low for individual comparisons. CONCLUSION: These data provide an idea of colonoscopy performance by individual endoscopists in mainly academic centers. Incorporating all recommended data elements in future reporting databases will contribute to meaningful bench marking and to quality improvement efforts.

Lipoproteins in the DCCT/EDIC cohort: associations with diabetic nephropathy.

BACKGROUND: Lipoproteins may contribute to diabetic nephropathy. Nuclear magnetic resonance (NMR) can quantify subclasses and mean particle size of very low density lipoprotein (VLDL), low density lipoprotein (LDL), and high density lipoprotein (HDL), and LDL particle concentration. The relationship between detailed lipoprotein analyses and diabetic nephropathy is of interest. METHODS: In a cross-sectional study, lipoproteins from 428 women and 540 men from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort were characterized by conventional lipid enzymology, NMR, apolipoprotein levels, and LDL oxidizibility. Linear regression was performed for each lipoprotein parameter versus log albumin excretion rate (AER), with and without covariates for age, diabetes duration, HbA1c, hypertension, body mass index, waist-hip ratio, and DCCT treatment group. Significance was taken at P < 0.05. RESULTS: By multivariate analysis, conventional profile, total triglycerides, total- and LDL cholesterol, but not HDL cholesterol, were associated with AER. NMR-determined large, medium, and small VLDL were associated with AER in both genders (except large VLDL in women), and intermediate density lipoprotein (IDL) was associated with AER (men only). LDL particle concentration and ApoB were positively associated with AER (in men and in the total cohort), and there was a borderline inverse association between LDL diameter and AER in men. Small HDL was positively associated with AER and a borderline negative association was found for large HDL. No associations were found with ApoA1, Lp(a), or LDL oxidizibility. CONCLUSION: Potentially atherogenic lipoprotein profiles are associated with renal dysfunction in type 1 diabetes and further details are gained from NMR analysis. Longitudinal studies are needed to determine if dyslipoproteinemia can predict patients at risk of nephropathy, or if lipoprotein-related interventions retard nephropathy.