Background

Using both estimated glomerular filtration rate (eGFR) and proteinuria to classify the severity of chronic kidney disease (CKD) has been proposed. The utility of a staging system incorporating both eGFR and proteinuria for guiding evaluation of concurrent CKD complications is not known.

Study design

Cross-sectional analysis

Setting & participants

30,528 participants in the US National Health and Nutrition Examination Survey conducted in 1988–1994 and 1999–2006 (n=8,242 for hyperparathyroidism).

Predictors

Classification system that uses both eGFR and proteinuria (alternative) and a system that primarily uses eGFR (NKF-KDOQI; the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative)

Outcomes

Prevalence of anemia, acidosis, hyperphosphatemia, hypoalbuminemia, hyperparathyroidism and hypertension

Measurements

GFR estimated from the CKD-Epidemiology Collaboration (CKD-EPI) equation and proteinuria assessed using urine albumin-creatinine ratio (ACR)

Results

The prevalence of hypoalbuminemia, hypertension and hyperparathyroidism increased with more severe CKD using the NKF-KDOQI system. For example, the prevalence of hyperparathyroidism was 9.1%, 11.1%, 28.2% and 72.5% for Stages 1, 2, 3 and 4, respectively. Similarly the prevalence of anemia, acidosis and hyperphosphatemia increased progressively from Stage 2 through 4. With the alternative system, the prevalence of anemia, hyperphosphatemia, hypertension and hyperparathyroidism was lower in Stage 3 compared to Stage 2. For example, the prevalence of hyperparathyroidism was 13.5%, 40.3%, 22.2%, and 63.4% for stages 1, 2, 3 and 4, respectively. Applying the alternative system, participants without each complication were more likely to be appropriately reclassified to lower stages (for example, overall net reclassification index of −6.5% for hyperparathyroidism). However, participants with complications (except for hypoalbuminemia) were more likely to be inappropriately reclassified to lower stages.

Limitations

Use of single creatinine to estimate GFR and single measure to assess ACR. Small number of participants with CKD Stage 4.

Conclusions

The NKF-KDOQI system may better identify patients with certain concurrent CKD complications compared to systems using eGFR and proteinuria.

Background

Individuals with unrecognized myocardial infarction (UMI) have similar risks for cardiovascular events and mortality as those with recognized myocardial infarction (RMI). The prevalence of cardioprotective medication use and blood pressure and low-density lipoprotein cholesterol control among individuals with UMI is unknown.

Methods

Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who were recruited between May 2004 and October 2007 received baseline twelve-lead electrocardiograms (n = 21,036). Myocardial infarction (MI) status was characterized as no MI, UMI (electrocardiogram abnormalities consistent with MI without self-reported history; n = 949; 4.5%), and RMI (self-reported history of MI; n = 1574; 7.5%).

Results

For participants with no MI, UMI, and RMI, prevalence of use was 38.4%, 44.4%, and 75.7% for aspirin; 18.0%, 25.8%, and 57.2% for beta blockers; 31.7%, 38.7%, and 55.0% for angiotensin converting enzyme inhibitors or angiotensin receptor blockers; and 28.1%, 33.9%, and 64.1% for statins, respectively. Participants with RMI were 35% more likely to have low-density lipoprotein cholesterol < 100 mg/dL than participants with UMI (prevalence ratio = 1.35, 95% confidence interval 1.19–1.52). Blood pressure control (,140/90 mmHg) was similar between RMI and UMI groups (prevalence ratio = 1.03, 95% confidence interval 0.93–1.13).

Conclusion

Although participants with UMI were somewhat more likely to use cardioprotective medications than those with no MI, they were less likely to use cardioprotective medications and to have controlled low-density lipoprotein cholesterol than participants with RMI. Increasing appropriate treatment and risk factor control among individuals with UMI may reduce risk of mortality and future cardiovascular events.

Objective

Dietary glycemic index (GI) and glycemic load (GL), measures of the propensity of dietary carbohydrate to increase blood glucose, have been associated with risk of coronary heart disease, but their association with incidence of heart failure (HF) is unknown. We therefore assessed whether dietary GI and GL were associated with rates of HF events.

Methods

We conducted a prospective, observational study of 36,019 women 48-83 years old without baseline HF, diabetes, or myocardial infarction who were participants in the Swedish Mammography Cohort, a prospective cohort study. Diet was measured using food-frequency questionnaires. Women were followed from January 1, 1998 through December 31, 2006 for HF hospitalization or death through the Swedish inpatient and cause-of-death registers. Cox proportional hazards models adjusted for age and other risk factors were used to estimate incidence rate ratios (RR) and 95% confidence intervals (CI).

Results

Over 9 years of follow-up, 639 of 36,019 women died of HF (n = 54) or were hospitalized for HF for the first time (n = 585). We did not find statistically significant associations between dietary GI and HF events (RR comparing highest to lowest quartile = 1.12, 95% CI 0.87-1.45, p for trend = 0.31) or between dietary GL and HF events (RR comparing highest to lowest quartile = 1.30, 95% CI 0.87-1.93, p for trend = 0.16). Results were not significantly different in normal weight and overweight women.

Conclusions

In this population, dietary GI did not appear to be associated with incident HF events. There was a suggestion of an association between dietary GL and HF which did not reach statistical significance.

Background

Obesity is associated with heart failure (HF) incidence. We examined the strength of the association of body mass index (BMI) with HF by age and joint associations of BMI and waist circumference (WC).

Methods and Results

Women aged 48–83 (n = 36,873) and men aged 45–79 (n = 43,487) self-reported height, weight, and WC. HF hospitalization or death (n = 382 women, 718 men) between January 1, 1998 and December 31, 2004 was determined through administrative registers. Hazard ratios (HR), from Cox proportional-hazards models, for an interquartile range higher BMI were 1.39 (95% confidence interval [CI] 1.15–1.68) at age 60 and 1.13 (95% CI 1.02–1.27) at 75 in women. In men, HR were 1.54 (95% CI 1.37–1.73) at 60 and 1.25 (95% CI 1.16–1.35) at 75. A 10 cm higher WC was associated with 15% (95% CI 2%–31%) and 18% (95% CI 4%–33%) higher HF rates among women with BMI 25 and 30 kg/m2, respectively; HR for 1 kg/m2 higher BMI were 1.00 (95% CI 0.96–1.04) and 1.01 (95% CI 0.98–1.04) for WC 70 and 100 cm, respectively. In men, a 10 cm higher WC was associated with 16% and 18% higher rates for BMI 25 and 30 kg/m2, respectively; a 1 kg/m2 higher BMI was associated with 4% higher HF rates regardless of WC.

Conclusions

Strength of the association between BMI and HF events declined with age. In women, higher WC was associated with HF at all levels of BMI. Both BMI and WC were predictors among men.

Acute kidney injury (AKI) is common in premature infants and is associated with poor outcomes. Novel biomarkers can detect AKI promptly. Because premature infants are born with underdeveloped kidneys, baseline biomarker values may differ. We describe baseline values of urinary neutrophil gelatinase associated lipocalin, (NGAL), Interleukin - 18 (IL-18), Kidney Injury Molecule -1 (KIM -1), Osteopontin (OPN), beta-2 microglobulin (B2mG) and Cystatin-C (Cys-C). Next, we test the hypothesis that these biomarkers are inversely related to gestational age (GA). Candidate markers were compared according to GA categories in 123 infants. Mixed linear regression models were performed to determine the independent association between demographics/interventions and baseline biomarker values. We found that urine NGAL, KIM-1, Cys-C and B2mG decreased with increasing GA. With correction for urine creatinine (cr), these markers and OPN/cr decreased with increasing GA. IL-18 (with or without correction for urine creatinine) did not differ across GA categories. Controlling for other potential clinical and demographic confounders with regression analysis shows that, NGAL/cr, OPN/cr and B2mG/cr are independently associated with GA. We conclude that urine values of candidate AKI biomarkers are higher in the most premature infants. These findings should be considered when designing neonatal AKI validation studies.

Background

The prevalence of albuminuria in the general population is high, but awareness of it is low. Therefore, we sought to develop and validate a self-assessment tool that allows individuals to estimate their probability of having albuminuria.

Study Design

Cross-sectional study

Setting & Participants

The population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study for model development and the National Health and Nutrition Examination Survey 1999-2004 (NHANES 1999-2004) for model validation. US adults ≥ 45 years of age in the REGARDS study (n=19,697) and NHANES 1999-2004 (n=7,168)

[nijsje 1]Factor

Candidate items for the self-assessment tool were collected using a combination of interviewer- and self-administered questionnaires.

Outcome

Albuminuria was defined as a urinary albumin to urinary creatinine ratio ≥ 30 mg/g in spot samples.

Results

Eight items were included in the self-assessment tool (age, race, gender, current smoking, self-rated health, and self-reported history of diabetes, hypertension, and stroke). These items provided a c-statistic of 0.709 (95% CI, 0.699 – 0.720) and a good model fit (Hosmer-Lemeshow chi-square p-value = 0.49). In the external validation data set, the c-statistic for discriminating individuals with and without albuminuria using the self-assessment tool was 0.714. Using a threshold of ≥ 10% probability of albuminuria from the self-assessment tool, 36% of US adults ≥ 45 years of age in NHANES 1999-2004 would test positive and be recommended screening. The sensitivity, specificity, and positive and negative predictive values for albuminuria associated with a probability ≥ 10% were 66%, 68%, 23% and 93%, respectively.

Limitations

Repeat urine samples were not available to assess the persistency of albuminuria.

Conclusions

Eight self-report items provide good discrimination for the probability of having albuminuria. This tool may encourage individuals with a high probability to request albuminuria screening.

The prevalence of hypertension is higher among African-Americans than whites. However, inconsistent findings have been reported on the incidence of hypertension among middle-aged and older African-Americans and whites and limited data are available on the incidence of hypertension among Hispanics and Asians in the US. Therefore, this study investigated the age-specific incidence of hypertension by ethnicity for 3,146 participants from the Multi-Ethnic Study of Atherosclerosis. Participants, age 45–84 years at baseline, were followed for a median of 4.8 years for incident hypertension, defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or the initiation of antihypertensive medications. The crude incidence rate of hypertension, per 1,000 person-years, was 56.8 for whites, 84.9 for African-Americans, 65.7 for Hispanics, and 52.2 for Chinese. After adjustment for age, gender, and study site, the incidence rate ratio (IRR) for hypertension was increased for African-Americans age 45–54 (IRR=2.05, 95% CI=1.47, 2.85), 55–64 (IRR=1.63, 95% CI=1.20, 2.23), and 65–74 years (IRR=1.67, 95% CI=1.21, 2.30) compared with whites, but not for those 75–84 years of age (IRR=0.97, 95% CI=0.56, 1.66). Additional adjustment for health characteristics attenuated these associations. Hispanic participants also had a higher incidence of hypertension compared with whites; however, hypertension incidence did not differ for Chinese and white participants. In summary, hypertension incidence was higher for African-Americans compared with whites between 45 and 74 years of age but not after age 75 years. Public health prevention programs tailored to middle-age and older adults are needed to eliminate ethnic disparities in incident hypertension.

Background

HIV-1-positive patients clear the human papillomavirus (HPV) infection less frequently than HIV-1-negative. Datasets for estimating HPV clearance probability often have irregular measurements of HPV status and risk factors. A new transitional probability-based model for estimation of probability of HPV clearance was developed to fully incorporate information on HIV-1-related clinical data, such as CD4 counts, HIV-1 viral load (VL), highly active antiretroviral therapy (HAART), and risk factors (measured quarterly), and HPV infection status (measured at 6-month intervals).

Methodology and Findings

Data from 266 HIV-1-positive and 134 at-risk HIV-1-negative adolescent females from the Reaching for Excellence in Adolescent Care and Health (REACH) cohort were used in this study. First, the associations were evaluated using the Cox proportional hazard model, and the variables that demonstrated significant effects on HPV clearance were included in transitional probability models. The new model established the efficacy of CD4 cell counts as a main clearance predictor for all type-specific HPV phylogenetic groups. The 3-month probability of HPV clearance in HIV-1-infected patients significantly increased with increasing CD4 counts for HPV16/16-like (p<0.001), HPV18/18-like (p<0.001), HPV56/56-like (p = 0.05), and low-risk HPV (p<0.001) phylogenetic groups, with the lowest probability found for HPV16/16-like infections (21.60±1.81% at CD4 level 200 cells/mm3, p<0.05; and 28.03±1.47% at CD4 level 500 cells/mm3). HIV-1 VL was a significant predictor for clearance of low-risk HPV infections (p<0.05). HAART (with protease inhibitor) was significant predictor of probability of HPV16 clearance (p<0.05). HPV16/16-like and HPV18/18-like groups showed heterogeneity (p<0.05) in terms of how CD4 counts, HIV VL, and HAART affected probability of clearance of each HPV infection.

Conclusions

This new model predicts the 3-month probability of HPV infection clearance based on CD4 cell counts and other HIV-1-related clinical measurements.

Background

Randomized clinical trials have shown that chocolate intake reduces systolic and diastolic blood pressure and observational studies have found an inverse association between chocolate intake and cardiovascular disease. The aim of this study was to investigate the association between chocolate intake and incidence of heart failure (HF).

Methods and Results

We conducted a prospective cohort study of 31,823 women 48–83 years old without baseline diabetes or a history of HF or myocardial infarction who were participants in the Swedish Mammography Cohort. In addition to health and lifestyle questions, participants completed a food-frequency questionnaire. Women were followed from January 1, 1998 through December 31, 2006 for HF hospitalization or death through the Swedish inpatient and cause-of-death registers. Over 9 years of follow-up, 419 women were hospitalized for incident HF (n =379) or died of HF (n = 40). Compared to no regular chocolate intake, the multivariate-adjusted rate ratio of HF was 0.74 (95%CI 0.58–0.95) for those consuming 1–3 servings of chocolate per month, 0.68 (95%CI 0.50–0.93) for those consuming 1–2 servings per week, 1.09 (95%CI .74–1.62) for those consuming 3–6 servings per week and 1.23 (95%CI 0.73–2.08) for those consuming one or more servings per day (p for quadratic trend = 0.0005).

Conclusions

In this population, moderate habitual chocolate intake was associated with a lower rate of HF hospitalization or death but the protective association was not observed with intake of one or more servings per day.

The association of dietary glycaemic index (GI) and glycaemic load (GL) with cardiovascular diseases has been examined in several populations with varying results. We tested the hypothesis that women with diets high in GI or GL would have higher rates of myocardial infarction (MI) and the associations would be stronger in overweight women. We measured dietary GI and GL in 36,234 Swedish Mammography Cohort participants aged 48–83 using food-frequency questionnaires (FFQ). Cox models were used to calculate incidence rate ratios (RR) and 95% CI for hospitalization or death due to MI assessed using the Swedish inpatient and cause-of-death registers from January 1, 1998 until December 31, 2006. Over 9 years of follow-up, 1,138 women were hospitalized or died due to a first MI. In multivariable-adjusted models, the RR comparing top to bottom quartile of dietary GI was 1.12 (95% CI 0.92–1.35, P-trend = 0.24), and the RR comparing top to bottom quartile of dietary GL was 1.22 (95% CI 0.90–1.65, P-trend = 0.23). Among overweight women, the RR comparing top to bottom quartile of dietary GI was 1.20 (95% CI 0.91–1.58, P-trend = 0.22), and the RR comparing top to bottom quartile of dietary GL was 1.45 (95% CI 0.93–2.25, P-trend = 0.16). There were no statistically significant associations of dietary GI or GL with MI in this population.

Background

Marine omega-3 fatty acids have beneficial effects on cardiovascular risk factors. Consumption of fatty fish and marine omega-3 has been associated with lower rates of cardiovascular diseases.

Objective

We examined the association of fatty fish and marine omega-3 with heart failure (HF) in a population of middle-age and older women.

Methods

Participants in the Swedish Mammography Cohort aged 48–83 years completed 96-item food-frequency questionnaires. Women without history of HF, myocardial infarction, or diabetes at baseline (n= 36 234) were followed from January 1, 1998 until December 31, 2006 for HF hospitalization or mortality through Swedish inpatient and cause-of-death registers; 651 women experienced HF events. Cox proportional hazards models accounting for age and other confounders were used to calculate incidence rate ratios (RR) and 95% confidence intervals (CI).

Results

Compared to women who did not eat fatty fish, RR were 0.86 (95% CI: 0.67, 1.10) for <1 serving/week, 0.80 (95% CI: 0.63, 1.01) for 1 serving/week, 0.70 (95% CI: 0.53, 0.94) for 2 servings/week, and 0.91 (95% CI: 0.59, 1.40) for ≥3 servings/week (Ptrend = 0.049). RR across quintiles of marine omega-3 fatty acids were 1 (reference), 0.85 (95% CI: 0.67, 1.07), 0.79 (95% CI: 0.61, 1.02), 0.83 (95% CI 0.65, 1.06), and 0.75 (95% CI: 0.58, 0.96) (Ptrend = 0.04).

Conclusion

Moderate consumption of fatty fish (one to two servings per week) and marine omega-3 fatty acids were associated with a lower rate of first HF hospitalization or death in this population.

The Dietary Approaches to Stop Hypertension (DASH) diet reduces blood pressure, and consistency with the DASH diet has been associated with lower rates of heart failure (HF) in women. The authors examined the association between consistency with DASH and rates of HF hospitalization or mortality in 38,987 participants in the Cohort of Swedish Men aged 45 to 79 years. Diet was measured using food-frequency questionnaires, and scores were created to assess consistency with DASH by ranking intake of DASH diet components. Cox models were used to calculate rate ratios of HF (807 incident cases) determined through the Swedish inpatient and cause-of-death registers between January 1, 1998 and December 31, 2006. In multivariable-adjusted analyses, men in the highest quartile of the DASH component score had a 22% lower rate of HF events then those in the lowest quartile (95% confidence interval: 5%, 35%, p for trend = 0.006). In conclusion, greater consistency with the DASH diet was associated with lower rates HF events in men aged 45 to 79 years.

Background

A previous study found that consuming 5 or more cups of coffee per day was associated with increased incidence of heart failure (HF). We sought to evaluate this association in a larger population.

Methods

We measured coffee consumption using food-frequency questionnaires among 37,315 men without history of myocardial infarction, diabetes, or HF. They were followed for HF hospitalization or mortality from January 1, 1998 until December 31, 2006 using record linkage to the Swedish inpatient and cause-of-death registries. Cox proportional hazards models adjusted for age, dietary, and demographic factors were used to calculate incidence rate ratios (RR) and 95% confidence intervals (CI).

Results

Over 9 years of follow-up, 784 men experienced a HF event. Compared to men who drank ≤ 1 cup of coffee per day (unadjusted rate 29.9 HF events/10,000 person-years), RR were 0.87 (95% CI 0.69–1.11, unadjusted rate 29.2/10,000 person-years,) for 2 cups/day, 0.89 (95% CI 0.70–1.14, unadjusted rate 25.1/10,000 person-years) for 3 cups/day, 0.89 (95% CI 0.69–1.15, unadjusted rate 25.0/10,000 person-years) for 4 cups/day, and 0.89 (95% CI 0.69–1.15, unadjusted rate 18.1/10,000 person-years) for ≥ 5 cups/day (p for trend in RR = 0.61).

Conclusions

This study did not support the hypothesis that high coffee consumption is associated with increased rates of HF hospitalization or mortality.

Introduction

Left ventricular ejection fraction (LVEF) is a predictor of incident heart failure (HF). However, baseline LVEF is often unavailable in population studies of HF.

Meterial and methods

Of the 5324 Cardiovascular Health Study (CHS) participants free of baseline HF, 143 (3%) had LVEF < 45% and 1091 (21%) developed HF during 13 years of follow-up. Using public-use copies of the CHS data, we compared two predictor models of incident HF, with and without adjustment for baseline LVEF.

Results

Baseline impaired LVEF was a strong independent predictor of incident HF (adjusted hazard ratio, 2.78; P < 0.001) but had no impact on the direction, magnitude or significance of independent associations of the other predictors of incident HF such as age, sex, race, coronary artery disease, hypertension and diabetes.

Conclusion

Baseline LVEF is an important predictor for incident HF but is not essential in population studies of risk factors for incident HF.

Inhibitors of myostatin, a negative regulator of skeletal muscle mass, are being developed to mitigate aging-related muscle loss. Knockout mouse studies suggest myostatin also affects adiposity, glucose handling, and cardiac growth. However, the cardiac consequences of inhibiting myostatin remain unclear. Myostatin inhibition can potentiate cardiac growth in specific settings (Morissette et al. 2006), a concern since cardiac hypertrophy is associated with adverse clinical outcomes. Therefore we examined the systemic and cardiac effects of myostatin deletion in aged mice (27-30 months old). Heart mass increased comparably in both wildtype (WT) and knockout (KO) mice. Aged KO mice maintained twice as much quadriceps mass as aged WT, however both groups lost the same percentage (36%) of adult muscle mass. Dual-energy x-ray absorptiometry (DEXA) revealed increased bone density, mineral content, and area in aged KO versus aged WT mice. Serum insulin and glucose levels were lower in KO mice. Echocardiography showed preserved cardiac function with better fractional shortening (58.1 vs 49.4%, p=0.002) and smaller LV diastolic diameters (3.41 vs 2.71, p=0.012) in KO versus WT mice. Phospholamban phosphorylation was increased 3.3-fold in KO hearts (p<0.05), without changes in total phospholamban, SERCA2a, or calsequestrin. Aged KO hearts showed less fibrosis by Masson's Trichrome staining. Thus myostatin deletion does not affect aging-related increases in cardiac mass and appears beneficial for bone density, insulin sensitivity, and heart function in senescent mice. These results suggest that clinical interventions designed to inhibit skeletal muscle mass loss with aging could have beneficial effects on other organ systems as well.

Background

Among patients with acute ischemic stroke, impaired kidney function has been shown to increase the mortality risk, but the shape of this relationship has not been evaluated in detail.

Methods

We estimated the glomerular filtration rate (eGFR) at the time of hospitalization in 1,175 consecutive patients hospitalized with acute ischemic stroke at the Beth Israel Deaconess Medical Center and examined the shape of the association between eGFR and all-cause mortality.

Results

There were 508 deaths during a median follow-up of 40.3 months, resulting in a ‘U’-shaped relationship between eGFR and all-cause mortality. The curve was relatively flat between 75 and 110 ml/min/1.73 m2 but increased sharply at lower and higher levels of eGFR (test for nonlinearity: p < 0.0001).

Conclusions

Among patients with acute ischemic stroke, a reduced or highly elevated eGFR at hospital admission is associated with a higher mortality rate compared to patients with moderate levels of eGFR.

Aims

Fatty fish and marine omega-3 fatty acids were associated with lower rates of heart failure (HF) among US elderly, but this has not been confirmed in broader age ranges or other populations where source and type of fish may differ. We therefore conducted a population-based, prospective study of 39 367 middle-aged and older Swedish men.

Methods and results

Diet was measured using food-frequency questionnaires. Men were followed for HF through Swedish inpatient and cause-of-death registers from 1 January 1998 to 31 December 2004. We used proportional hazards models adjusted for age and other covariates to estimate hazard ratios (HR). Compared with no consumption, men who ate fatty fish once per week had an HR of 0.88 (95% CI 0.68–1.13). Hazard ratios for consumption two times per week and ≥3 times per week were 0.99 and 0.97, respectively. Hazard ratios across quintiles of marine omega-3 were 1, 0.94 (95% CI 0.74–1.20), 0.67 (95% CI 0.50–0.90), 0.89 (95% CI 0.68–1.16), 1.00 (95% CI 0.77–1.29).

Conclusion

In this population, moderate intake of fatty fish and marine omega-3 fatty acids was associated with lower rates of HF, though the association for fish intake was not statistically significant; higher intake was not associated with additional benefit.

Background:

The DASH diet effectively reduces blood pressure. In observational studies, the association between diets consistent with DASH and risk of coronary heart disease and stroke has been examined with varying results. We hypothesized that diets consistent with the DASH diet would be associated with lower incidence of heart failure (HF).

Methods:

We conducted a prospective, observational study of 36,019 participants in the Swedish Mammography Cohort who were 48-83 years old without baseline HF, diabetes, or myocardial infarction. Diet was measured using food-frequency questionnaires. We created a score to assess consistency with DASH by ranking the intake of DASH diet components and 3 additional scores based on food and nutrient guidelines. Cox models were used to calculate rate ratios of HF hospitalization or death determined through the Swedish inpatient and cause-of-death registers between January 1, 1998 and December 31, 2004.

Results:

Over 7 years, 443 women developed HF. Women in the top quartile of the DASH diet score based on ranking DASH diet components had a 37% lower rate of HF after adjustment for age, physical activity, energy intake, education, family history of myocardial infarction, cigarette smoking, postmenopausal hormone use, living alone, hypertension, high cholesterol, body mass index, and incident myocardial infarction. Rate ratios across quartiles were 1.00, 0.85 (95% CI 0.66-1.11), 0.69 (95% CI 0.54-0.88), and 0.63 (95% CI 0.48-0.81), p for trend <0.001. A similar pattern was seen with the guideline-based scores.

Conclusions:

In this population, diets consistent with DASH were associated with lower rates of HF.

Background

Severe, abrupt onset headache raises concern for aneurysmal subarachnoid hemorrhage (SAH). The current standard work-up is brain CT scan followed by LP if the CT is non-diagnostic in patients with a normal neurological exam. Some have suggested that angiography is also indicated in this common clinical situation. Is evaluation with brain CT and LP for thunderclap headache to rule out SAH sufficient and is angiography needed?

Methods

We systematically searched for studies that followed neurologically-intact patients with thunderclap headache and normal CT and LP for at least 1 year. The primary outcome was SAH. We estimated the proportion of patients who developed SAH and the one-sided upper 95% confidence bound.

Results

Seven studies including 813 patients were identified. None of the patients developed SAH during follow-up (pooled proportion = 0, upper 95% confidence bound = 0.004).

Conclusion

Although our methods have important limitations, we believe this analysis will give clinicians better tools to decide whether or not to pursue further work-up with angiography in patients with thunderclap headache and normal neurological exam, CT, and LP.

Studies have reported a possible link between cocaine use and risk of cardiovascular events. We examined the association between self-reported cocaine use and physician diagnosed myocardial infarction (MI) in the Third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988–1994. We estimated odds ratios (OR) using logistic regression models adjusted for age and additionally for sex, race, and other MI risk factors, which accounted for the complex sampling design. In the 18–59 age group, there was no statistically significant association between any exposure to cocaine and MI (age-adjusted OR = 1.56, 95% confidence interval (CI): 0.44– 5.50, p-value= 0.48, multivariate-adjusted OR = 1.06, 95% CI: 0.30– 3.73, p-value= 0.92). Participants who reported using cocaine >10 times had a non-significant higher prevalence of MI (age-adjusted OR = 3.13, 95% CI: 0.80- 12.25, p-value= 0.10, multivariate-adjusted OR = 1.84, 95% CI: 0.46– 7.29, p-value= 0.40). However, participants aged 18–45 who reported >10 occasions of cocaine use had a significantly elevated prevalence of MI in age-adjusted models (OR= 4.60, 95% CI: 1.12– 18.88, p-value= 0.035). The association was attenuated in multivariate-adjusted models (OR = 3.84, 95% CI: 0.98– 15.07, p-value= 0.054). The lifetime prevalence of cocaine use increased from 14% in NHANES III to 19% in NHANES 2005–2006. In conclusion, these data support a substantial association between cocaine use and MI; the temporal trend in cocaine use may increase the occurrence of MI, particularly among younger populations.

Carbohydrate quantity and quality may influence risk of cardiovascular disease through blood lipid concentrations and inflammation. We measured dietary glycemic index (GI) and dietary glycemic load (GL) among 18,137 healthy women ≥ 45 years old without diagnosed diabetes using a food-frequency questionnaire. We assayed fasting total, HDL, and LDL cholesterol, LDL:HDL cholesterol ratio, triacylglycerols (TG), and C-reactive protein (CRP). We evaluated associations with dietary GI and GL using a cross-sectional design, adjusting for age, body mass index, lifestyle factors, and other dietary factors. Dietary GI was significantly associated with HDL and LDL cholesterol, LDL:HDL cholesterol ratio, TG, and CRP (comparing top to bottom quintile difference in HDL cholesterol = -2.6 mg/dL, LDL cholesterol = 2.2 mg/dL, LDL:HDL cholesterol ratio = 0.16, TG = 12 mg/dL, and CRP = 0.21 mg/L). Dietary GL was associated with HDL cholesterol, LDL:HDL cholesterol ratio, and TG (comparing top to bottom quintile HDL cholesterol = -4.9 mg/dL, LDL:HDL cholesterol ratio = 0.24, and TG = 13 mg/dL). Differences in blood lipids and CRP between extreme quintiles of dietary GI and GL were small, but may translate into a clinically meaningful difference in cardiovascular risk.