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Upper Tertile (upper + tertile)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Cardiovascular Disease	28%

Selected Abstracts

Aortic Root Dimension as an Independent Predictor for All-Cause Death in Adults <65 Years of Age (from The Chin-Shan Community Cardiovascular Cohort Study)

ECHOCARDIOGRAPHY, Issue 5 2010
Chao-Lun Lai M.D.
Background: Evidence on aortic root dimension for predicting cardiovascular morbidity and mortality is inconclusive. This cohort study sought to characterize the predictive power of aortic root dimension on cardiovascular morbidity and mortality in an ethnic Chinese population. Methods: We recruited 1,851 participants in the Chin,Shan Community Cardiovascular Cohort (CCCC) study who had received echocardiography without previous cardiovascular events. Aortic root dimension was measured by M-mode echocardiography and indexed by body surface area to obtain aortic root dimension index (AOI). The end points were all-cause death and incident cardiovascular events including coronary heart disease and stroke over a median follow-up of 11.9 years. Results: Although tertiles of AOI was associated with an increased risk of cardiovascular events and all-cause death in univariate analysis, the significance diminished after adjusting for age variable (P for trend = 0.11 for cardiovascular events; P for trend = 0.23 for all-cause death). In subgroup analysis, we found a significant association between tertiles of AOI and risk of all-cause death in the final multivariate Cox regression model in adults <65 years. The adjusted relative risk was 1.88 (95% CI, 1.04 to 3.40) in participants in the upper tertile of AOI compared with participants in the lower tertile (P for trend = 0.037). In adults ,65 years, tertile of AOI was not associated with all-cause death (P for trend = 0.14). Tertiles of AOI was not associated with cardiovascular events throughout this study. Conclusion: Our study showed a significant association between AOI and all-cause death in adults <65 years in an ethnic Chinese population. (Echocardiography 2010;27:487-495) [source]

Diverse Effect of Inflammatory Markers on Insulin Resistance and Insulin-Resistance Syndrome in the Elderly

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2004
Angela M. Abbatecola MD
Objectives: To evaluate the potential association between different inflammatory markers and insulin resistance (IR), as well as insulin-resistance syndrome (IRS) in a large, population-based study of older, nondiabetic persons. Design: Cross-sectional study. Setting: Outpatient clinic in Greve in Chianti and Bagno a Ripoli (Italy). Participants: One thousand one hundred forty-six nondiabetic subjects ranging in age from 22 to 104. Measurements: Anthropometric measurements; plasma fasting levels of glucose, insulin, and cholesterol (total, high-density lipoprotein, low-density lipoprotein); homeostasis model assessment to estimate degree of insulin resistance; tumor necrosis factor , (TNF-,), interleukin 6 (IL-6), soluble IL-6 receptor (sIL-6R), interleukin receptor antagonist (IL-1ra), and C-reactive protein (CRP) plasma concentrations; diastolic, systolic, and mean arterial blood pressure; and echo-color-Doppler duplex scanning examination of carotid arteries. Results: Insulin resistance correlated with age (r=0.102; P<.001) and plasma levels of TNF-, (r=0.082; P=.007), IL-1ra (r=0.147; P<.001), IL-6 (r=0.133; P<.001), sIL-6R (r=,0.156; P<.001), and CRP (r=0.83; P<.001). Subjects in the upper tertile of IR degree were older and had higher serum levels of TNF-,, IL-1ra, and IL-6 and lower levels of sIL-6R than subjects in the lowest tertile. Independent of age, sex, body mass index, waist-to-hip ratio, triglycerides, drug intake, diastolic blood pressure, smoking habit, and carotid atherosclerotic plaques, higher IL-6 (t=2.987; P=.003) serum concentrations were associated with higher IR, whereas sIL-6R levels (t=,5.651; P<.001) were associated with lower IR. Furthermore, IL-1ra concentrations (t=2.448; P=.015) were associated with IRS, and higher sIL-6R plasma levels continued to correlate negatively with IRS. Conclusion: Different inflammatory markers are associated with a diverse effect on IR and IRS in elderly nondiabetic subjects. [source]

The Residual Platelet Aggregation after Deployment of Intracoronary Stent (PREDICT) score

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 1 2008
T. GEISLER
Summary.,Background:,Recent studies suggest a high interindividual variability of response to clopidogrel associated with adverse cardiovascular outcome. Different clinical factors are considered to influence a persistent residual platelet aggregation (RPA) despite conventional antiplatelet therapy. Objectives:,To investigate clinical factors that affect RPA after 600-mg clopidogrel loading in a large unselected cohort of patients with symptomatic CAD. Methods:,The study population included a consecutive cohort of 1092 patients treated with coronary stenting for stable angina and acute coronary syndromes (ACS). Residual platelet activity was assessed by ADP (20 ,mol L,1)-induced platelet aggregation , 6 h after LD. Eleven clinical factors were included in the primary analysis. Results:,In multivariate regression analysis increased RPA was significantly influenced by ACS, reduced LV-function, diabetes mellitus, renal failure (creatinine > 1.5 mg dL,1), and age > 65 years. In a factor-weighed model the risk for high RPA increased with higher score levels (OR for patients with a score of 1,3, 1.21, 95% CI 0.7,2.1; score 4,6, OR 2.0, 95% CI 1.17,3.5; P = 0.01; score 7,9, OR 3.3, 95% CI 1.8,6.0). During a 30-day follow-up the incidence of major adverse events was higher in patients with RPA in the upper tertile (4.8% vs. 2.5% in the 2nd and 1.5% in the 1st tertile; P < 0.05). Conclusions:,The PREDICT score provides a good tool to estimate residual platelet activity after clopidogrel LD by easily available patient details. Additionally, we demonstrate its association with short-term outcome. Thus, patients with a high score may benefit from intensified antiplatelet therapy by improved platelet inhibition and risk reduction for thromboischemic events. [source]

Baseline and time-averaged fluid removal affect technique survival in peritoneal dialysis in a non-linear fashion

NEPHROLOGY, Issue 3 2007
KATHRYN J WIGGINS
SUMMARY: Aim: The longevity of peritoneal dialysis (PD) is limited by technique failure and patient mortality. The authors assessed the influence of baseline and time-averaged fluid removal on patient, technique and death-censored technique survival. Methods: Peritoneal and total fluid removal was measured 1 month after commencing PD, then 6 monthly, in 225 incident patients (mean age 55.3 ± 15.8 years, 52% male). A Cox proportional hazards model regression analysis was performed to identify variables independently predictive of technique and patient survival. Results: Seventy (31.9%) patients were transferred to haemodialysis and 39 (17.63%) died. Technique survival was greatest in the middle tertile of baseline total fluid removal (mean survival time 3.5 vs 2.5 and 2.2 years for the lower and upper tertiles, respectively, log rank 6.5, P = 0.039). The middle tertile of both baseline and time-averaged total fluid removal were significant predictors of PD survival (adjusted hazard ratio (HR) 0.476, 95% CI 0.286,0.795, P = 0.005 relative to the upper tertile and HR 0.573, 95% CI 0.350,0.939, P = 0.027 for baseline and time-averaged, respectively). Other significant variables on multivariate analysis were body mass index (HR 1.044 per kg/m2, 95% CI 1.005,1.084, P = 0.028), creatinine (HR 0.999 per ,mol, 95% CI 0.998,1.000, P = 0.048) and residual Kt/V (HR 0.418, 95% CI 0.233,0.747, P = 0.003). Patient survival was not affected by fluid removal. Conclusion: Patients with moderate total fluid removal both at baseline and throughout their PD career have improved technique survival. Attention should be paid to optimizing total fluid removal. [source]

Serum heme oxygenase-1 levels are increased in Parkinson's disease but not in Alzheimer's disease

ACTA NEUROLOGICA SCANDINAVICA, Issue 2 2010
I. Mateo
Mateo I, Infante J, Sánchez-Juan P, García-Gorostiaga I, Rodríguez-Rodríguez E, Vázquez-Higuera JL, Berciano J, Combarros O. Serum heme oxygenase-1 levels are increased in Parkinson's disease but not in Alzheimer's disease. Acta Neurol Scand: 2010: 121: 136,138. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective,,, Oxidative stress is implicated in Parkinson's disease (PD) and Alzheimer's disease (AD), and heme oxygenase-1 (HO-1) is a potent antioxidant overexpressed in PD substantia nigra and AD cerebral cortex and hippocampus, indicating a possible up-regulation of antioxidant defenses in both neurodegenerative diseases. The role of HO-1 in peripheral blood of PD and AD patients remains unresolved. Methods,,, We measured serum HO-1 levels in 107 patients with PD, 105 patients with AD, 104 controls for PD and 120 controls for AD. Results,,, The median serum concentration of HO-1 was significantly higher in PD patients (2.04 ng/ml) compared with that of PD controls (1.69 ng/ml, P = 0.016), with PD patients predominating over controls in the upper tertile of serum HO-1 levels, whereas there was more PD controls than PD patients in the lower tertile (P = 0.006). Median serum levels of HO-1 did not differ significantly between AD patients and AD controls. Conclusion,,, The increase of serum HO-1 levels in PD patients could indicate a systemic antioxidant reaction related to a chronic oxidative stress state in PD brain. [source]

Neutrophil to Lymphocyte Ratio as a Predictor of Long-term Mortality in African Americans Undergoing Percutaneous Coronary Intervention

CLINICAL CARDIOLOGY, Issue 12 2009
Shyam Poludasu MD
Abstract Background Neutrophil to lymphocyte ratio (N/L ratio) has been shown to predict long-term mortality in patients undergoing percutaneous coronary intervention (PCI). African Americans have been shown to have lower mean neutrophil counts compared to whites. The usefulness of the N/L ratio in predicting long-term mortality in African Americans undergoing PCI is unknown. Methods We evaluated a total of 372 African American patients (327 patients with lower N/L ratio [<3.5] and 45 patients with higher N/L ratio [,3.5]) who underwent PCI during January 2003 to August 2005. The primary endpoint was all-cause mortality at a median follow-up to 3.6 years. Results During the median ( ± SD) follow-up period of 3.6 ± 1 years, there were a total of 48 deaths. The mortality rate was 10.4% in the group with a lower N/L ratio and 31.1% in the group with a higher N/L ratio (unadjusted p < 0.001). After adjustment for covariates with significant impact on mortality, N/L ratio was still a strong and independent predictor of long-term mortality with a hazard ratio (HR) of 2.1 (95% confidence interval [CI]: 1.1,4; p = 0.02). N/L ratio was also found to be a strong and independent predictor of long-term mortality even when analyzed as a categorical variable with 3 groups (HR of 0.39 for lower tertile compared to the upper tertile, 95% CI: 0.19,0.81; p = 0.012) and as a continuous variable (p = 0.002). Conclusion N/L ratio is a powerful independent predictor of long-term mortality in African Americans undergoing PCI. Copyright © 2009 Wiley Periodicals, Inc. [source]