Abstract Background Microflora-dependent trimethylamine-N-oxide (TMAO) formation, which results from intake of choline and L-carnitine-rich food, shows promise as a predictor of cardiovascular ...disease (CVD) risk, but these associations have not been examined in ethnically diverse populations. In a multiethnic population-based study of adults in Canada, we assessed the stability of TMAO and L-carnitine in stored serum samples and their association with intimal medial thickness, prevalent risk factors, and clinical events. Methods In a randomly sampled cross-sectional study of 1286 Canadians, fasting serum samples were collected and stored. In 292 consecutive individuals (99 CVD cases and 193 unmatched control subjects), L-carnitine and TMAO concentrations were assessed using validated analytical approaches. Results The mean (± SD) TMAO level was 1.998 ± 3.13 μM and L-carnitine was 42.29 ± 11.35 μM. The relative levels of the samples did not appreciably change after 3 freeze-thaw cycles (coefficient of variation, 5.6% and 4.7%, respectively). No significant association between L-carnitine levels and prevalent CVD was found, with adjustment for covariates (odds ratio, 1.57; 95% confidence interval, 0.58-4.26; P trend = 0.65), for highest vs lowest quintile group. TMAO levels showed a significant, graded association with prevalent CVD (odds ratio, 3.17; 95% confidence interval, 1.05-9.51; P trend = 0.02). After further adjustment for diabetes status, meat, fish, and cholesterol intake, the association remained significant. No significant association between carotid intimal medial thickness and L-carnitine ( P = 0.64) or TMAO ( P = 0.18) was found. Conclusions Serum TMAO and L-carnitine analysis on stored samples is reliable. Our findings support an association between TMAO with prevalent CVD in a multiethnic population. This finding requires replication in larger studies in which dietary intake and stored serum samples exist.
Abstract Objective We sought to characterize maternal health profiles and birth outcomes among First Nations people living in Southern Ontario. Methods We performed a retrospective chart review of ...all 453 women from the Six Nations Reserve, Ontario, who were pregnant between 2005 and 2010. Maternal health behaviours, past medical history, physical measurements, birth outcomes, and newborn characteristics were abstracted. Key maternal and newborn characteristics were compared with those of a cohort of non-First Nations women recruited from nearby Hamilton, Ontario. Results The average age of women in the study cohort was 25.1 ± 6.2 (mean ± SD) years, and 75.8% were multiparous. The mean pre-pregnancy BMI was 28.3 ± 6.6 kg/m2 , and the average weight gain in pregnancy was 14.9 ± 8.3 kg. Mean weight gain during pregnancy was inversely associated with pre-pregnancy BMI, and 57.1% of women gained more than the recommended weight. The prevalence of type 2 diabetes or gestational diabetes was 4.7%, hypertension was present before or during pregnancy in 5.6%, and 35% used tobacco during pregnancy. The mean gestational age at delivery was 39.5 ± 1.7 weeks and the mean crude birth weight was 3619 ± 557 g. The main determinants of newborn weight included sex of the newborn, pre-pregnancy BMI, and weight gain during pregnancy. Compared with a contemporary cohort of 622 non-First Nations mothers and newborns, First Nations mothers were, on average, younger (25.1 vs. 32.1 years; P < 0.001), had a higher mean pre-pregnancy BMI (28.3 vs. 26.8 kg/m2 ; P < 0.001), and were more likely to use tobacco during pregnancy (35.0% vs. 14.4%; P < 0.001). First Nations newborns had significantly higher mean birth weight (+176 grams) and length (+2.3 cm) than non-First Nations newborns. Conclusion First Nations mothers from the Six Nations Reserve tended to have a high pre-pregnancy BMI, tended to gain more than the recommended weight during pregnancy, and commonly used tobacco during pregnancy. Programs to prevent overweight/ obesity and excess weight gain during pregnancy and to minimize smoking are required among women of child-bearing age in this community.
To describe the effect of subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD) on health-related quality of life (HRQOL) of patients at enrollment in two ...randomized clinical trials; to examine the relation of visual acuity to HRQOL; to compare HRQOL scores between participants with unilateral and bilateral CNV independent of other characteristics.
Randomized clinical trials.
Two Submacular Surgery Trials (SST) recruited patients with AMD and either new subfoveal CNV (Group N Trial) or predominantly hemorrhagic CNV (Group B Trial). Health-related quality of life interviews included the National Eye Institute Visual Function Questionnaire NEI-VFQ, the SF-36 Health Survey, and the Hospital Anxiety and Depression Scale HADS. Linear correlation and regression analyses were used to relate baseline HRQOL scores to visual acuity and bilateral disease.
Interview data were analyzed for 789 AMD patients: 454 patients in the Group N Trial and 335 patients in the Group B Trial. Participants reported poor vision-related functioning in many domains measured by the NEI-VFQ (mean overall scores of 65 for Group N and 63 for Group B). Visual acuity of the better eye was strongly associated with NEI-VFQ scores but not with SF-36 or HADS scores. After adjusting for visual acuity of the better eye and other factors, bilateral cases had NEI-VFQ overall scores six points lower than unilateral cases in Group N Trial and 10 points lower than unilateral cases in the Group B Trial.
Subfoveal CNV profoundly affects vision-related quality of life. The effect is more pronounced with bilateral disease, even after controlling for visual acuity.
Ischemia can lead to myocardial necrosis, arrhythmias and death. Current practice suggests that asymptomatic or silent myocardial ischemia be treated as though it were symptomatic ischemia. This ...practice is associated with a growing trend of more frequent use of electrocardiographic monitoring, more complex therapeutic drug regimens and more frequent use of revascularization. However, there is no adequate study of the efficacy and safety of alternative therapeutic approaches to the treatment of asymptomatic myocardial ischemia. Therefore, the National Heart, Lung, and Blood Institute has planned the Asymptomatic Cardiac Ischemia Pilot (ACIP) study. The ACIP study is a multicenter international pilot trial to determine the efficacy and safety of angina-directed medical therapy, angina plus ambulatory electrocardiographic-directed medical therapy and revascularization. The treatment of asymptomatic cardiac ischemia is double-blind and placebo-controlled. The primary end point is elimination of ischemia on the 48-hour electrocardiogram at 12 weeks. Patients will be followed-up for at least 1 year. Secondary analyses will include comparisons of the 2 medical regimens, amounts of medicine taken, and exercise versus electrocardiographic results. Eleven clinical units are recruiting 600 patients with coronary anatomy suitable for revascularization, a positive exercise stress test, and 1 or more asymptomatic ischemic episodes on the 48-hours electrocardiogram. Patients are stratified by center, symptom status and previous coronary surgery. If warranted by the pilot study results, a full-scale trial will be considered to determine whether amelioration of asymptomatic ischemia improves survival and reduces cardiovascular morbidity.
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