The optimal range of sodium intake for cardiovascular health is controversial.
We obtained morning fasting urine samples from 101,945 persons in 17 countries and estimated 24-hour sodium and ...potassium excretion (used as a surrogate for intake). We examined the association between estimated urinary sodium and potassium excretion and the composite outcome of death and major cardiovascular events.
The mean estimated sodium and potassium excretion was 4.93 g per day and 2.12 g per day, respectively. With a mean follow-up of 3.7 years, the composite outcome occurred in 3317 participants (3.3%). As compared with an estimated sodium excretion of 4.00 to 5.99 g per day (reference range), a higher estimated sodium excretion (≥ 7.00 g per day) was associated with an increased risk of the composite outcome (odds ratio, 1.15; 95% confidence interval CI, 1.02 to 1.30), as well as increased risks of death and major cardiovascular events considered separately. The association between a high estimated sodium excretion and the composite outcome was strongest among participants with hypertension (P=0.02 for interaction), with an increased risk at an estimated sodium excretion of 6.00 g or more per day. As compared with the reference range, an estimated sodium excretion that was below 3.00 g per day was also associated with an increased risk of the composite outcome (odds ratio, 1.27; 95% CI, 1.12 to 1.44). As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a reduced risk of the composite outcome.
In this study in which sodium intake was estimated on the basis of measured urinary excretion, an estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake. As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a lower risk of death and cardiovascular events. (Funded by the Population Health Research Institute and others.).
OBJECTIVEMetabolic syndrome (MetS) includes several cardiovascular (CV) risk factors. This study aimed to assess CV risk of MetS, contribution of its components to the risk, and whether MetS provides ...additional risk beyond its components. METHODSThe Prospective Urban Rural Epidemiology (PURE) Turkey cohort included 3933 individuals aged between 35 and 70 years, with a median follow-up of 8.9 years. MetS was diagnosed as the presence of any of the following criteria: high blood pressure, high fasting plasma glucose, abdominal obesity, low HDL-cholesterol, or high triglycerides. The primary outcome was the composite of fatal CV events, non-fatal myocardial infarction, stroke or heart failure, adjusted for age, sex, smoking, family history of CV diseases, and LDL-cholesterol. RESULTSThe primary outcome was more common in the MetS group 178 (9.2%) vs. 70 (3.5%); corresponding incidence rate of 11.3 vs. 4.2 per 1000 person-years; log-rank p<0.001. Each component was significantly associated with the primary outcome; however, when the components were sequentially included in the model, abdominal obesity and high triglycerides did not provide additional risk on top of the other three components. The hazard ratio for MetS for the primary outcome was 2.12 (95% confidence interval 1.59-2.81, p<0.001), and the discriminative ability (c-statistics) of the models with MetS and the components was similar. CONCLUSIONMetS increases the risk of CV events more than two-fold. High blood pressure, high fasting plasma glucose, and low HDL-cholesterol are the top three components of MetS for CV risk. MetS and its components have a similar discriminative ability for CV events.
Abstract Increased plasma levels of neuron specific enolase (NSE) is related to damage of neurons and neuroendocrine cells. We aimed to investigate elevation of NSE after elective percutaneous ...coronary intervention (PCI) on the prediction of silent cerebral infarct (SCIs). Study population consisted of two groups of patients. Group 1 included 92 consecutive patients with normal coronary angiograms, whereas Group 2 consisted of 89 patients who underwent elective coronary stenting. NSE levels were studied before and 12 hour after the procedure. Elevation of greater than 0.12μg/l was considered as SCI.Fourty-seven of 181 study patients (26%) had SCI after the procedure. NSE elevation was significantly more prevalant among patients with PCI than that of controls. Elevation of NSE was observed in 42% of elective PCI patients (n=37) and 11% of the normal coronary artery group (n=10)(p < 0.001).The incidence of SCI was higher in active smokers and patients who had history of myocardial infarction (MI) (55% versus 10%, p<0.001 for active smokers and 40% versus 8%, p<0.001 for history of MI, respectively). Multivariate analysis demonstrated history of smoking (OR: 9.9; 95% CI:3.7-26.9; p<0.001) and prior MI (OR:4.4; 95% CI: 1.7-11.4; p = 0.01) as independent predictors of SCI. For patients undergoing elective PCI, NSE levels after procedure increases. Invasive coronary procedures have risk of SCIs, even in patients with normal coronary arteries. In conclusion, increased diagnosis of SCIs might improve understanding of their relationship with invasive cardiac procedures, facilitate to prevent occurrence of silent microemboli and decrease the risk of adverse neurological events.
Abstract Suppression of the hypothalamic-pituitary-adrenal axis due to chronic exogenous steroid use is the most common cause of secondary adrenal insufficiency. Most kidney transplant recipients ...receive steroid therapy for immunosuppression; they are also at high risk for acute coronary events which can increase their physiological stress. Use of steroids early in the course of acute myocardial infarction (MI) raises concerns about the possibility of an increased risk of aneurysm formation and myocardial rupture. We present six case reports of kidney transplant recipients. Two of these recipients developed adrenal insufficiency after acute anterior MI; the life-threatening situation was successfully managed with corticosteroid administration. Four of these kidney transplant recipients presented with acute anterior MI; in these patients prophylactic steroid therapy prevented adrenal insufficiency, without any complication of the MI. We recommend the use of prophylactic corticosteroids for kidney transplant recipients to prevent adrenal insufficiency in the early course of acute MI.
It is estimated that one out of three adults has hypertension and that more than 50% of them are unaware of this condition. Blood pressure screening can facilitate early diagnosis and reduce the risk ...of further complications associated with hypertension. However, disagreement between credible guidelines on major topics like diagnosis of hypertension and the threshold blood pressure values for treatment initiations caused confusion and inaction among physicians.
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