Monthly haemostatic factor variability in women and men.

BACKGROUND: Hormonal status influences haemostatic factors including fibrinogen, factor VII and plasminogen activator inhibitor (PAI-1), and concentrations differ among men, premenopausal and postmenopausal women. This study examines how phases of the menstrual cycle influence variability of fibrinogen, factor VII and PAI-1. DESIGN: We studied 103 subjects (39 premenopausal women, 18 postmenopausal women and 46 men) during three, randomized, 8-week energy- and nutrient-controlled experimental diets in the Dietary Effects on Lipids and Thrombogenic Activity (DELTA) Study. Fasting blood samples were collected weekly during the last 4 weeks of each diet period, and haemostatic factors were quantified. Two linear mixed-effects models were used for fibrinogen, factor VII and PAI-1: one to estimate and compare group-specific components of variance, and the other to estimate additional fixed effects representing cyclical functions of day of menstrual cycle in premenopausal women. RESULTS: Systematic cyclical variation with day of menstrual cycle was observed for fibrinogen (P < 0.0001), factor VII (P = 0.0012) and PAI-1 (P = 0.0024) in premenopausal women. However, the amplitude of cycling was small relative to the total magnitude of intra-individual variability. In addition, the intra-individual variance and corresponding coefficient of variation observed in premenopausal women did not differ from postmenopausal women and men. CONCLUSIONS: The variability in haemostatic factors in premenopausal women is no greater than for postmenopausal women or men. Consequently, premenopausal women can be included in studies investigating haemostatic factor responses without controlling for stage of menstrual cycle.

Disparity in frequency of normal coronary artery in black and white patients undergoing cardiac catheterization.

BACKGROUND: Normal epicardial coronary arteries (NCA) based on angiography have been reported to occur more frequently in Blacks than in Whites, but these studies have suffered from the limitation of being retrospective, reporting on relatively small numbers of subjects, or lacking a systematic angiogram interpretation. METHODS AND RESULTS: Angiograms of 560 consecutive patients (226 Black and 334 White) enrolled in the Harlem-Bassett Study were reviewed. The presence of coronary artery disease risk factors was documented. A coronary artery was defined as normal if no segment contained a luminal diameter stenosis > 24%. Overall, NCA were found in 39.1% of patients (Blacks 42.9% and Whites 36.5%) and were present most frequently in White women (53.7%). Black men were two times more likely than White men to have NCA (odds ratio [OR] 2.09, P < .002). More Blacks than Whites with NCA were hypertensive (OR 3.30, P < .001) and cigarette smokers (OR 5.18, P < .001), whereas more Whites had hypercholesterolemia (OR .29, P < .001). CONCLUSION: Significant racial differences exist between the Black and White populations in regard to the presence of NCA. The traditional risk factors of age, diabetes, cigarette smoking, and hypercholesterolemia are present in both groups. However, a racial disparity exists in the frequency of some risk factors (hypertension, cigarette smoking, hypercholesterolemia) in patients with NCA.

Prediction of respiratory distress syndrome using the Abbott FLM-II amniotic fluid assay.

BACKGROUND: Most laboratories using the Abbott FLM-II assay for assessing fetal lung maturity follow the manufacturer's recommendations for interpreting the surfactant to albumin ratio (S/A). Thus, values >55 mg/g are considered mature and values <40 mg/g, immature-leaving a wide range of indeterminate values. Little data is available to assist the clinician in interpreting values between 40 and 55 mg/g. The goal of this study was to determine decision levels that would more clearly identify risk for RDS based on S/A results. METHODS: Respiratory distress syndrome was identified based on medical record review in 46 infants (born at six hospitals), who had S/A measurements on amniotic fluid within 72 h of delivery. An additional 257 women, who had had the S/A test requested but had non-RDS infants, were also identified for this study. The probability of RDS was calculated based on S/A values and on gestational age. Odds ratios were computed for different S/A ratios and different gestational ages. RESULTS: Probability of RDS increased with decreasing S/A and decreasing gestational age. At gestational age >36 weeks, the probability of developing RDS ranged from 1% at S/A>44 mg/g to 39% at S/A44 mg/g to 92% at S/A

Efficacy of an intervention to prevent excessive gestational weight gain.

OBJECTIVE: This study was undertaken to evaluate the efficacy of an intervention directed at preventing excessive gestational weight gain. STUDY DESIGN: Healthy pregnant women with normal and overweight early pregnancy body mass index were monitored from early pregnancy until 1-year postpartum. One hundred seventy-nine women in the intervention group had their gestational weight gains monitored by health care providers and also received by-mail patient education. Three hundred eighty-one women formed an historical control group. The proportions in each group gaining more weight in pregnancy than is recommended and retaining more than 2.27 kg at 1-year postpartum were compared using logistic regression analysis. RESULTS: Low-income women who received the intervention had a significantly reduced risk of excessive gestational weight gain (odds ratio [OR]=0.41, 95% CI=0.20-0.81). Overweight women within this income subgroup were at significantly reduced risk of retaining more than 2.27 kg (OR=0.24, 95% CI=0.07-0.89). CONCLUSION: The intervention appeared to reduce the risk of excessive gestational weight gain only in the low-income subgroup.

An evaluation of the atkins' diet.

Low-carbohydrate (LC) weight-reducing diets are popular choices for self-dieters. Eighteen adults (BMI >/= 25 kg/m(2)) were enrolled in this short-term longitudinal study to evaluate dietary intake and weight on their "usual" diets and LC diet. Subjects were instructed to follow the first two phases of the diet described in Dr. Atkins' New Diet Revolution (2 weeks each). Total daily intake of calories and nutrients were calculated from 3-day food diaries. Body weight was measured at the end of each 2-week diet session. All enrolled subjects completed the study (age = 39.8 +/- 8.1 years, BMI = 36.6 +/- 6.6 kg/m(2)). Mean caloric intakes were 1400 +/- 472 kcal/day (Induction diet) and 1558 +/- 490 kcal/day (Ongoing Weight Loss diet) both p

Apolipoprotein [a] genotype influences isoform dominance pattern differently in African Americans and Caucasians.

Plasma lipoprotein [a] (Lp[a]) concentrations are inversely associated with, and largely determined by, apolipoprotein [a] (apo[a]) gene size, a highly polymorphic trait. We studied if, within an individual, the smaller apo[a] isoform always dominated, whether there was interaction between the two alleles, and whether these features differed between Caucasians and African Americans. We determined apo[a] gene sizes, apo[a] protein sizes and relative amounts, and plasma Lp[a] levels in 430 individuals (263 Caucasians and 167 African Americans). Of the 397 heterozygotes with at least one detectable apo[a] isoform (238 Caucasians and 159 African Americans), the larger allele dominated in 28% of Caucasians and 23% of African Americans, while the smaller allele dominated in 56% of Caucasians and 45% of African Americans. In Caucasians, dominance of the smaller allele increased with Lp[a] levels, from 44% at Lp[a] < or = 30 nM to 81% at Lp[a] >100 nM (P < 0.0001). Dominance by the smaller allele increased with increasing size of the larger allele in both groups but with the smaller allele only in African Americans. There was no interaction between apo[a] alleles within genotypes; one apo[a] isoform level was not associated with the other isoform level, and isoform levels were not affected by the difference in size. More of the dominance pattern was explained by Lp[a] level and apo[a] genotype in African Americans than in Caucasians (29% vs. 13%). Thus, genotype influences isoform-specific Lp[a] levels and dominance patterns differently in African Americans and in Caucasians.