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      The Significance of Atherogenic Indices in Patients on Hemodialysis

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          Atherosclerotic diseases (ASD) are the major cause of mortality and morbidity in patients on hemodialysis (HD). To evaluate the significance and usefulness of atherogenic indices, we examined lipoprotein(a) (Lp(a)), remnant-like particles cholesterol (RLP.C), homocysteine (Hcy), cardiac troponin T (TnT), and ankle-arm blood pressure index (AABI) in 114 patients on HD (male 79, female 35; age 62.1 ± 1.3 years). As a result, serum cardiac TnT and AABI levels in patients with diabetes mellitus (DM) (n = 33) were significantly higher than those in patients without DM (n = 81). In patients with cerebrovascular diseases (CVD), serum levels of both RLP.C and Hcy, and AABI levels were significantly higher than those in patients without CVD. In patients with coronary artery diseases (CAD), serum cardiac TnT and AABI levels were significantly higher than those in patients without CAD. In patients with peripheral vascular diseases (PVD), serum levels of both Hcy and cardiac TnT were significantly higher than those in patients without PVD. Multiple regression analysis did show that the presence of DM, serum Hcy levels and age were independent factors as- sociated with ASD: ASD = –0.348 + 0.426 × DM (scored: 0, absence; 1, presence) + 0.005 × Hcy (nmol/ml) + 0.010 × Age (years) (p < 0.001). In conclusion, the presence of DM and advanced age are major determinants for atherosclerosis. In addition, serum Hcy levels are independent risk factors for atherosclerosis irrespective of the absence of DM.

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          Decreased ankle/arm blood pressure index and mortality in elderly women.

          To evaluate the relationship of the ankle/arm blood pressure index to short-term mortality in women 65 years of age or older. Prospective cohort study with average follow-up of 4.3 years. Rural community near Pittsburgh, Pa. A total of 1492 white women 65 years of age or older, living in the community and ambulatory without the help of another person. All-cause and cause-specific mortality. The ankle/arm index (the systolic pressure in the posterior tibial artery divided by that in the brachial artery) was measured in 1986 through 1988 and found to be 0.9 or less in 82 (5.5%) of the women, 67 of whom reported no symptoms of claudication. Comparing women with an index of 0.9 or less with those with an index greater than 0.9, the relative risk for all-cause mortality 4 years later (after adjustment for age, smoking, and other risk factors) was 3.1 (95% confidence interval [Cl], 1.7 to 5.5); for heart disease, 3.7 (95% Cl, 1.2 to 11.6); for cardiovascular diseases, 4.0 (95% Cl, 1.3 to 8.5); for cancer, 3.3 (95% Cl, 1.3 to 8.5); and for all other causes, 1.1 (95% Cl, 0.1 to 9.2). Similar levels of risk were found after excluding women with symptoms of claudication and/or a history of cardiovascular disease at baseline. Healthy, older women with an ankle/arm index of 0.9 or less are at high risk of death and therefore may be considered for aggressive therapy to modify cardiovascular risk factors.
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            Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index.

            To evaluate the relationship between the ankle/arm blood pressure index (AAI, the ratio of ankle to arm systolic blood pressure, a measure of peripheral arterial disease) and short-term cardiovascular morbidity and mortality in older adults with systolic hypertension. Prospective cohort study, 1- to 2-year follow-up (mean, 16 months). Eleven of 16 field centers from the Systolic Hypertension in the Elderly Program. 1537 older men and women with systolic hypertension. All-cause mortality, coronary heart disease (CHD) mortality, cardiovascular disease (CVD) mortality, and CHD and CVD morbidity and mortality. The AAI was measured at the 1989-1990 clinic examination and was 0.9 or less in 25.5% of 1537 participants. A low AAI was associated with most major CHD and CVD risk factors. In those with a low AAI (< or = 0.9) compared with those with an AAI of more than 0.9, age- and sex-adjusted relative risks for mortality end points at follow-up were as follows: total mortality, 3.8 (95% confidence interval [CI], 2.1 to 6.9); CHD mortality, 3.24 (95% CI, 1.4 to 7.5); and CVD mortality, 3.7 (95% CI, 1.8 to 7.7). For CVD morbidity and mortality, the age- and sex-adjusted relative risk was 2.5 (95% CI, 1.5 to 4.3). After adjustment for baseline CVD and other cardiovascular risk factors, the relative risk for total mortality was 4.1 (95% CI, 2.0 to 8.3) and for CVD morbidity and mortality, 2.4 (95% CI, 1.3 to 4.4). Results were similar when participants with clinical CVD at baseline were excluded. A low AAI appears to be an important predictor of morbidity and mortality among older adults with systolic hypertension.
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              Cholesterol in remnant-like lipoproteins in human serum using monoclonal anti apo B-100 and anti apo A-I immunoaffinity mixed gels


                Author and article information

                Am J Nephrol
                American Journal of Nephrology
                S. Karger AG
                April 2000
                19 April 2000
                : 20
                : 2
                : 107-115
                Department of Medicine III, Okayama University Medical School, Okayama, Japan
                13566 Am J Nephrol 2000;20:107–115
                © 2000 S. Karger AG, Basel

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                Figures: 7, Tables: 2, References: 55, Pages: 9
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