Insulin and Non-esterified Fatty Acid Metabolism in Asymptomatic Diabetics and Atherosclerotic Subjects

Glucose, insulin and non-esterified fatty acid (NEFA) metabolism was studied in 18 patients (mean age 49) with ischemic heart disease (IHD) who did not have any concurrent disorder known to affect glucose tolerance.Significant hyperglycemia and hyperinsulinemia were observed in the IHD patients after oral glucose. The serum NEFA declined to a lower level in IHD patients than in normal subjects who received glucose.In response to hypoglycemia following the oral administration of sodium tolbutamide the serum NEFA in IHD patients rose to a higher level in the rebound phase than in normal subjects. This rise was preceded by a sharp decline in the concentration of circulating insulin.In 72% of the patients (IHD sub-group) the blood glucose values after oral glucose satisfied the criteria for the diagnosis of diabetes mellitus. The metabolic changes following oral glucose in the IHD sub-group and in asymptomatic diabetics (AD), free of clinical atherosclerosis and with similar impairment in glucose tolerance, were compared. Despite insignificantly lower insulin concentrations, the AD showed a significantly lesser fall in circulating NEFA than did the patients in the IHD sub-group. After oral sodium tolbutamide the IHD sub-group patients showed a greater insulin response and a greater rebound increase in circulating NEFA than did the AD.These differences in response to oral glucose and to sodium tolbutamide suggest that the pathogenesis of the impaired glucose tolerance in IHD may be different from that responsible for abnormal carbohydrate tolerance in asymptomatic diabetics without evident atherosclerosis. The abnormalities demonstrated in glucose, insulin and NEFA metabolism may play a role in the genesis of the hyperlipoproteinemia and atherosclerosis of IHD. One possible mechanism leading to hyperlipoproteinemia in ischemic heart disease compatible with the data is discussed.     

Fatty acid turnover in the ischaemic compared to the non-ischaemic human heart

Summary Cardiac extraction, oxidation and release of plasma free fatty acids (FFA) was measured by coronary sinus catheterization, utilizing infusions of ³H palmitate and ¹⁴C oleate, in patients with ischaemic heart disease (IHD) at rest and during pacing induced angina pectoris and, for comparison, in healthy men of similar and younger age and men with hypertriglyceridaemia (HTG). At rest IHD patients differed from healthy men only by greater cardiac fatty acid release, which correlated with a significant glycerol release. In IHD patients, unlike in healthy men, myocardial extraction of both palmitate and oleate decreased while fractional oxidation of oleate increased during pacing. Fatty acid release was unaltered. Men with HTG had at rest higher myocardial FFA extraction than IHD patients, which did not decrease during pacing, but like in the patients oleate fractional oxidation increased on pacing. It is concluded that, in the moderately ischaemic human heart, the restricted blood flow may contribute to limit the fatty acid flux into the myocardium. The augmented cardiac fatty acid release in IHD patients is not related to ischaemia perse but may derive from an increased amount of cardiac interstitial fat.     

Concomitant Sleep Disorders Significantly Increase the Risk of Cardiovascular Disease in Patients with Psoriasis

Background

The increased rates of cardiovascular morbidity and mortality in patients with psoriasis are not adequately explained by traditional risk factors. Whether concomitant sleep disorders (SDs) modify the risk of cardiovascular disease (CVD) in patients with psoriasis remains unknown.

Methods

Using the Taiwan National Health Insurance Research Database (NHIRD), we conducted a cohort study to investigate the association between concomitant SDs and CVD risk in patients with psoriasis. Data from 99,628 adults who received a psoriasis diagnosis during the period from 2004 to 2010 were analyzed. Cox proportional hazards regression analysis models were used to compare the risks of ischemic heart disease (IHD) and stroke between patients with and without SDs.

Results

Psoriasis patients with a concomitant SD had significantly higher risks of IHD (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 1.22–1.28) and stroke (aHR, 1.24; 95% CI, 1.16–1.33) as compared with psoriasis patients without SDs. All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased HRs for IHD and stroke. The increases in IHD and stroke risks conferred by SDs were proportional to the dose of hypnotics used. The effect of SDs on the risks of IHD and stroke was greater in young adults than in middle-aged and older adults.

Conclusions

The risks of IHD and stroke were higher for psoriasis patients with SDs than for those without SDs. Clinicians should carefully evaluate CVD risk, particularly in young patients with psoriasis.     

Travel distance and mass gain in wintering blackbirds

Birds that range over a large area will have a greater mass-dependent risk of predation than more sedentary birds. Birds that travel more may then reduce winter mass gain to compensate for the increased predation risk that greater travelling entails. I tested whether European blackbirds, Turdus merula, that travelled more in winter had a lower mass than more sedentary birds, independently of any confounding effects of food supply on both ranging behaviour and mass gain. I measured change in winter mass and amount of food eaten in conjunction with the distance that blackbirds travelled to a randomly sited mobile feeder. Blackbirds that travelled shorter distances (per trip and in total) and less often to the feeder had the highest mass midwinter relative to their spring mass. Blackbirds with a higher mean mass midwinter also travelled, on average, shorter distances to the feeder. The distance an individual blackbird travelled to the feeder at any one time was probably independent of the state of its daily energy reserves (how much of its daily total mass gain it had achieved at that point). The relationship between distance travelled and mass was probably independent of food supply because distances actually increased at the end of the winter and the amount of food eaten per individual changed little. More mobile blackbirds were therefore likely to have compensated for any increases in predation risk associated with their greater ranges by decreasing winter mass gain, but will have had an increased risk of starvation because of their lower mass. Copyright 1999 The Association for the Study of Animal Behaviour.     

Delivery of a small for gestational age infant and greater maternal risk of ischemic heart disease

Background

Delivery of a small for gestational age (SGA) infant has been associated with increased maternal risk of ischemic heart disease (IHD). It is uncertain whether giving birth to SGA infant is a specific determinant of later IHD, independent of other risk factors, or a marker of general poor health. The purpose of this study was to investigate the association between delivery of a SGA infant and maternal risk for IHD in relation to traditional IHD risk factors.

Methods and Findings

Risk of maternal IHD was evaluated in a population based cross-sectional study of 6,608 women with a prior live term birth who participated in the National Health and Nutrition Examination Survey (1999–2006), a probability sample of the U.S. population. Sequence of events was determined from age at last live birth and at diagnosis of IHD. Delivery of a SGA infant is strongly associated with greater maternal risk for IHD (age adjusted OR; 95% CI: 1.8; 1.2, 2.9; p = 0.012). The association was independent of the family history of IHD, stroke, hypertension and diabetes (family history-adjusted OR; 95% CI: 1.9; 1.2, 3.0; p = 0.011) as well as other risk factors for IHD (risk factor-adjusted OR; 95% CI: 1.7; 1.1, 2.7; p = 0.025). Delivery of a SGA infant was associated with earlier onset of IHD and preceded it by a median of 30 (interquartile range: 20, 36) years.

Conclusions

Giving birth to a SGA infant is strongly and independently associated with IHD and a potential risk factor that precedes IHD by decades. A pregnancy that produces a SGA infant may induce long-term cardiovascular changes that increase risk for IHD.     

Risk of Ischaemic Heart Disease in Patients with Inflammatory Bowel Disease: Cohort Study Using the General Practice Research Database

ObjectivePatients with inflammatory bowel disease (IBD) demonstrate an inflammatory response which bears some similarities to that seen in ischaemic heart disease (IHD). The nature of the association of IBD with IHD is uncertain. We aimed to define the extent and direction of that association.DesignThis retrospective cohort study examined records from patients aged ≥ 15 years with IBD from 1987–2009 (n = 19163) who were age and gender matched with patients without IBD (n = 75735) using the General Practice Research Database. The primary outcome was the hazard ratio for IHD.ResultsA higher proportion of IBD patients had a recorded diagnosis of IHD ever, 2220 (11.6%) compared with 6504 (8.6%) of controls. However, the majority (4494, 51.5%) developed IHD prior to IBD diagnosis (1404 (63.2%) of IBD cases and 3090 (47.5%) of controls). There was increased IHD incidence in the first year after IBD diagnosis. Mean age at IHD diagnosis was statistically similar across all IBD groups apart from for those with Ulcerative Colitis (UC) who were slightly younger at diagnosis of angina compared to controls (64.5y vs. 67.0y, p = 0.008) and coronary heart disease (65.7y vs.67.9y, p = 0.015). Of those developing IHD following IBD diagnosis, UC patients were at higher risk of IHD (unadjusted HR 1.3 (95% CI 1.1–1.5), p<0.001) or MI (unadjusted HR 1.4 (95% CI 1.1–1.6), p = 0.004).ConclusionAlthough IHD prevalence was higher in IBD patients, most IHD diagnoses predated the diagnosis of IBD. This implies a more complex relationship than previously proposed between the inflammatory responses associated with IHD and IBD, and alternative models should be considered.     

Peroxide modification of low density lipoproteins in ischemic heart disease

It is shown that the LDL peroxide lipid products level is 1.6-4 times higher in patients with the ischemic heart diseases (IHD) than in normal subjects. At the same time the LDL uptake by macrophages was identical in case of normal subjects and of IHD patients. It is suggested that the LDL premodification in the blood flow in the IHD patients promotes the further modification of LDL particles after their penetration into the vessel wall.     

The effect of changes in the lipid composition of membranes on the functional activity of platelets

The phospholipid and fatty acid composition as well as the effect of platelet lipid composition modifications on the functional parameters of platelets were studied in blood sera from healthy donors and from patients with ischemic heart disease (IHD). It was found that the content of cholesterol and phospholipid hydrolysis products in IHD patients was increased. Reconstitution of the lipid composition of donor platelets by lysophosphatidylcholines, phosphatidic acid, fatty acids and cholesterol led to the increase of the platelet functional activity. It is suggested that the increased adsorption of Ca2+ on platelet surface is due to alterations in the platelet lipid composition in IHD and after modifications.     

Adaptive changes in the myocardium of patients with ischemic heart disease

Changes in the human heart muscle resulting from chronic coronary insufficiency have been analyzed using biopsies taken during surgery from nine patients with ischemic heart disease (IHD) and six patients with the WPW syndrome (without IHD). Histochemical analysis have shown that the atrial myocardium in IHD patients is characterized by an increased density of the microvascular network, increased phosphorylase activity, and decreased succinate dehydrogenase activity. Virtually the same changes have proved to occur in the myocardium of rats adapted to hypoxia by means of repeated exposure in a low-pressure chamber. According to the results of two-dimensional electrophoresis and immunoblotting, acid (but not alkaline) isoforms of inducible HSP70 proteins appear in the myocardium of IHD patients. It is concluded that the myocardium of IHD patients undergoes adaptive changes at the tissue level in response to repeated exposure to ischemia in the course of development of this disease. It is proposed that activation of the synthesis of alkaline HSP70 isoforms in the myocardium of cardiological patients may provide the possibility of improving its resistance to the impact of ischemia and reperfusion (this possibility is not realized under conditions of IHD).     

Changing patterns in drug therapy for ischemic heart disease

To determine the possible influence of studies on β-blocker therapy following myocardial infarction and the introduction of calcium-channel blockers on the prescribing habits of physicians in a large urban centre, the drug therapy received by 100 patients with ischemic heart disease (IHD) (50 with myocardial infarction and 50 with unstable angina) admitted to a university teaching hospital in 1980 was compared with that received by another such group of 100 patients admitted in 1983-84. The proportion of patients with myocardial infarction receiving drug therapy was significantly higher in 1983-84, at the time of both admission (p < 0.01) and discharge (p < 0.001). Much of the increase was due to greater use of β-blockers. Of the 50 patients with unstable angina in 1983-84, 20 were taking calcium-channel blockers when admitted, and 29 were taking them when discharged. In both 1980 and 1983-84 unstable angina was treated more vigorously than myocardial infarction. The results suggest that physicians have developed a more aggressive approach to drug therapy for IHD since the publication of the β-blocker studies and the introduction of calcium-channel blockers.     

Plasma platelet factor 4: a potentially useful predictor of ischaemic heart disease?

The aim was to investigate whether plasma platelet factor 4 (PF-4) in suspected acute myocardial infarction (AMI) patients could serve as a prognostic tool and identify patients at risk for future death from AMI or ischaemic heart disease (IHD). Therefore, upon admission to our coronary care unit plasma PF-4 was measured on 109 consecutive patients. 53 of them proved to have AMI, and 50 IHD but no AMI; the remaining 6 had no evidence of IHD. 24 patients died in hospital or during the follow-up period which was an average of 16.7 +/- 2.4 months. The decreased were subgrouped into those dying of AMI (n = 16), and those dying of IHD but with no AMI (n = 8). No deaths from other causes were recorded. As compared with survivors there was a tendency towards higher PF-4 values among those who died of AMI. However, patients who during follow-up suffered death from IHD proved to have significantly (p less than 0.05) higher PF-4 levels than survivors.     

The Plasma B-Type Natriuretic Peptide Levels Are Low in Males with Stable Ischemic Heart Disease (IHD) Compared to Those Observed in Patients with Non-IHD: A Retrospective Study

Objective

Although the plasma B-type natriuretic peptide (BNP) level is a marker of heart failure, it is unclear whether BNP per se plays a pivotal role for pathogenic mechanisms underlying the development of ischemic heart disease (IHD). In this study, we retrospectively examined the plasma BNP levels in stable patients with IHD and compared to stable patients with cardiovascular diseases other than IHD.

Methods

The study population was 2088 patients (1698 males and 390 females) who were admitted to our hospital due to IHD (n = 1,661) and non-IHD (n = 427) and underwent cardiac catheterization. Measurements of the hemodynamic parameters and blood sampling were performed.

Results

The plasma BNP levels were significantly lower in the IHD group than in the non-IHD group (p<0.001). The multiple regression analysis examining the logBNP values showed that age, a male gender, low left ventricular ejection fraction, low body mass index, serum creatinine, atrial fibrillation and IHD per se were significant explanatory variables. When the total study population was divided according to gender, the plasma BNP levels were found to be significantly lower in the IHD group than in the non-IHD group among males (p<0.001), but not females (p = NS). Furthermore, a multiple logistic regression analysis of IHD showed the logBNP value to be a significant explanatory variable in males (regression coefficient: −0.669, p<0.001), but not females (p = NS).

Conclusions

The plasma BNP levels were relatively low in stable patients with IHD compared with those observed in stable patients with non-IHD; this tendency was evident in males. Perhaps, the low reactivity of BNP is causally associated with IHD in males. We hope that this study will serve as a test of future prospective studies.     

Adrenomedullin as a sensitive marker for coronary and peripheral arterial complications in patients with atherosclerotic risks

Plasma adrenomedullin (AM) levels are elevated in various pathological states including cardiovascular and inflammatory diseases. The present study investigated whether an increased AM level is a marker of vascular complications in patients with atherosclerotic risks. In 114 patients with cardiovascular risks and/or diseases including ischemic heart disease (IHD) and peripheral arterial disease (PAD), plasma AM concentration and other inflammatory markers such as high sensitive C-reactive protein (CRP) and interleukin (IL)-6 were examined. The plasma AM level was not altered by the absence or presence of each of four major risk factors, i.e., hypertension, diabetes mellitus, hyperlipidemia, and smoking and its level was not significantly correlated with blood pressure, plasma glucose, or serum lipid levels. The patients with IHD had a significantly higher concentration of plasma AM than those without IHD. The AM level in subjects with PAD was also increased significantly compared with those without PAD. The plasma AM was strongly correlated with inflammatory parameters such as CRP and IL-6. Among AM, CRP, and IL-6, however, only AM was an independent predictor for both IHD and PAD by multiple logistic regression analysis. Our findings suggest the possibility that plasma AM is a novel sensitive marker for the presence of vascular lesions in patients with atherosclerotic risks.     

Increased myeloperoxidase activity is a risk factor for ischemic heart disease in patients with diabetes mellitus

Using a previously developed spectrophotometric method (Bioorg. Khim. 2009, vol. 35, pp. 629–639) a significant increase of myeloperoxidase (MPO) activity (versus healthy control) was found in blood plasma of patients with type 2 diabetes mellitus (DM2) without cardiovascular complications, and also in patients with ischemic heart disease (IHD). The plasma MPO concentration measured by an enzyme-linked immunosorbent assay was significantly higher only in blood plasma of patients with DM2 and IHD. A significant positive correlation between blood MPO activity and blood MPO content was observed only in blood plasma samples from healthy donors. Increased MPO activity did not correlate with MPO concentration in blood plasma of patients with DM2 and DM2 with IHD. Taken together, these results indicate that studies on the MPO role in the development of pathological processes should include simultaneous determination of both the amount of enzyme and its peroxidase activity in blood of patients. The proposed approach gives comprehensive information about the relationship between MPO activity and MPO concentration in patient’s blood. Since the high concentration of MPO is a diagnostically important parameter for the prediction of development of endothelial dysfunction and cardiovascular diseases, the obtained results point to the contribution of MPO-dependent reactions in cardiovascular complications associated with diabetes mellitus. MPO activity may serve as an additional diagnostic criterion for determination of risk of IHD in DM patients.     

Movement patterns and gallery use by the sexually dimorphic Wellington tree weta

The Wellington tree weta, Hemideina crassidens, is a harem-polygynous nocturnal insect whose males defend and mate groups of females residing in cavities in trees. In this study I examined sexual differences in gallery use (number of galleries occupied per unit time), distance travelled per night and activity patterns after sunset. In addition, I investigated how gallery size affected each of these variables. On average, males and females did not differ in the number of galleries visited per night, or in the distance they travelled per night; however, adult males were more likely to be seen earlier in the night than later. Although males and females did not differ in their gallery use or distance travelled, adult males occupied a significantly greater number of galleries and travelled greater distances per night at sites with small galleries than did males at sites with large galleries. These results suggest that habitat structure of a forest patch influences intrasexual tree weta behaviour.     

Physicochemical and functional properties of the peripheral blood lymphocytes in ischemic heart disease

Electron spin resonance techniques was used for the investigation of the structural organization of lymphocyte plasma membranes of healthy donors and IHD patients. We found the increased fluidity of peripheral blood lymphocyte membranes of patients with IHD using 5 doxyl stearic acid spin label. The ordering of the membrane lipids increased proportionally to the increase of cholesterol cell content. This is the important reason for the inhibition of mitogenic cell activity during IHD. Measured by the chlortetracycline-fluorescence alterations in the processes of mitogen-induced Ca+2 redistribution might be one of the mechanisms which mediates the influence of membrane structure changes on the lymphocyte functions.     

I/D polymorphism in the angiotensin-converting enzyme gene in men with myocardial infarction at young age]

The rate of D allele did not differ between patients with ischemic heart disease (IHD) who had myocardial infarction before the age 45, and healthy males. The DD genotype of the ACE gene was much more frequently encountered in the patients than in healthy males. The findings suggest that the DD genotype is an independent risk factor of the IHD and myocardial infarction in young patients.     

The study of markers of herpes virus infections in myocardial ischemia

A group of patients with ischemic heart disease (IHD), who underwent surgical aorta-coronary vascular shunting, was examined in this investigation. Low titers of HSV-1 specific IgG were detected in all patients, the obtained values being consistent with similar data obtained in healthy subjects of the same age. Negative PCR of HSV-I DNA in blood and biopsy results were obtained. None of the patients demonstrated typical clinical pattern of infectious disease caused by herpes simplex virus. These data are evidence of the absence of the HSV-1 correlation with coronary atherosclerosis in patients with the IHD diagnosis. The significance of HCMV specific IgG titers and HCMV DNA detected in blood plasma in 87.7% cases is probably attributed to existence of connection of HCMV infection markers revealing in patient' blood with IHD diagnosis and coronary atherosclerosis. Besides, the HCMV DNA presence in biopsy taken from myocardium or vascular wall with lesion is revealed in 100% cases. The cytomegalovirus markers in tissue lesions with the help of specific antiserums marked to HSMV recombinant proteins are also revealed in 100% cases. This fact indicates the connection between pathological atherosclerotical process in IHD and cytomegalovirus infection.     

Age-Period-Cohort Projections of Ischaemic Heart Disease Mortality by Socio-Economic Position in a Rapidly Transitioning Chinese Population

Background

With economic development and population aging, ischaemic heart disease (IHD) is becoming a leading cause of mortality with widening inequalities in China. To forewarn the trends in China we projected IHD trends in the most economically developed part of China, i.e., Hong Kong.

Methods

Based on sex-specific IHD mortality rates from 1976 to 2005, we projected mortality rates by neighborhood-level socio-economic position (i.e., low- or high-income groups) to 2020 in Hong Kong using Poisson age-period-cohort models with autoregressive priors.

Results

In the low-income group, age-standardized IHD mortality rates among women declined from 33.3 deaths in 1976–1980 to 19.7 per 100,000 in 2016–2020 (from 55.5 deaths to 34.2 per 100,000 among men). The rates in the high-income group were initially higher in both sexes, particularly among men, but this had reversed by the end of the study periods. The rates declined faster for the high-income group than for the low-income group in both sexes. The rates were projected to decline faster in the high-income group, such that by the end of the projection period the high-income group would have lower IHD mortality rates, particularly for women. Birth cohort effects varied with sex, with a marked upturn in IHD mortality around 1945, i.e., for the first generation of men to grow up in a more economically developed environment. There was no such upturn in women. Birth cohort effects were the main drivers of change in IHD mortality rates.

Conclusion

IHD mortality rates are declining in Hong Kong and are projected to continue to do so, even taking into account greater vulnerability for the first generation of men born into a more developed environment. At the same time social disparities in IHD have reversed and are widening, partly as a result of a cohort effect, with corresponding implications for prevention.     

Movements of salmon Salmo salar (L.) to and from Irish waters

Fish tagged as kelts at a number of Irish stations have been recaptured outside Irish waters along the coasts of Great Britain, Norway and West Greenland. Salmon tagged as smolts in three Irish rivers have been recaptured off the coast of West Greenland and one off the Faroes. Sixteen fish tagged as smolts in Denmark, Great Britain and Sweden were recaptured in Irish rivers or on the coastline of Ireland. Clean salmon tagged in the open sea have travelled to the coasts of Great Britain and a single fish travelled to southern Sweden. Feeding salmon tagged off West Greenland, in the Labrador sea and off the Faroes have been recaptured in Irish waters.