Association of electrocardiogram abnormalities and incident heart failure events

BACKGROUND Unless effective preventive strategies are implemented, aging of the population will result in a significant worsening of the heart failure (HF) epidemic. Few data exist on whether baseline electrocardiographic (ECG) abnormalities can refine risk prediction for HF. METHODS We examined a prospective cohort of 2,915 participants aged 70 to 79 years without preexisting HF, enrolled between April 1997 and June 1998 in the Health, Aging, and Body Composition (Health ABC) study. Minnesota Code was used to define major and minor ECG abnormalities at baseline and at year 4 follow-up. Using Cox models, we assessed (1) the association between ECG abnormalities and incident HF and (2) the incremental value of adding ECG to the Health ABC HF Risk Score using the net reclassification index. RESULTS At baseline, 380 participants (13.0%) had minor, and 620 (21.3%) had major ECG abnormalities. During a median follow-up of 11.4 years, 485 participants (16.6%) developed incident HF. After adjusting for the Health ABC HF Risk Score variables, the hazard ratio (HR) was 1.27 (95% CI 0.96-1.68) for minor and 1.99 (95% CI 1.61-2.44) for major ECG abnormalities. At year 4, 263 participants developed new and 549 had persistent abnormalities; both were associated with increased subsequent HF risk (HR 1.94, 95% CI 1.38-2.72 for new and HR 2.35, 95% CI 1.82-3.02 for persistent ECG abnormalities). Baseline ECG correctly reclassified 10.5% of patients with HF events, 0.8% of those without HF events, and 1.4% of the overall population. The net reclassification index across the Health ABC HF risk categories was 0.11 (95% CI 0.03-0.19). CONCLUSIONS Among older adults, baseline and new ECG abnormalities are independently associated with increased risk of HF. The contribution of ECG screening for targeted prevention of HF should be evaluated in clinical trials.

Prediction of arrhythmic events by Wedensky modulation in patients with coronary artery disease.

PRINCIPLES Prediction of arrhythmic events (AEs) has gained importance with the availability of implantable cardioverter-defibrillators (ICDs), but is still imprecise. This study evaluated the innovative Wedensky modulation index (WMI) as predictor of AEs. METHODS In this prospective cohort, 179 patients with coronary artery disease (CAD) referred for AE risk assessment underwent baseline evaluation including measurement of R-/T-wave WMI (WMI(RT)) and left ventricular ejection fraction (LVEF). Two endpoints were assessed 3 years after the baseline evaluation: sudden cardiac death or appropriate ICD event (EP1) and any cardiac death or appropriate ICD event (EP2). Associations between baseline predictors (WMI(RT) and LVEF) and endpoints were evaluated in regression models. RESULTS Only three patients were lost to follow-up. EP1 and EP2 occurred in 24 and 27 patients, respectively. WMI(RT) (odds ratio [OR] per 1 point increase for EP1 20.1, 95% confidence interval [CI] 1.8-221.4, p = 0.014, and for EP2 73.3, 95% CI 6.6-817.7, p <0.001) and LVEF (OR per 1% increase for EP1 0.94, 95% CI 0.90-0.99, p = 0.013, and for EP2 0.93, 95% CI 0.89-0.97, p = 0.002) were significantly associated with both endpoints. In bivariable regression controlled for LVEF, WMI(RT) was independently associated with EP1 (p = 0.047) and EP2 (p = 0.007). The combination of WMI(RT) ≥0.60 and LVEF ≤30% resulted in a positive predictive value of 36% for EP1 and 50% for EP2. CONCLUSIONS WMI(RT) is a significant predictor of AEs independent of LVEF and has potential to improve AE risk prediction in CAD patients. However, WMI(RT) should be evaluated in larger and independent samples before recommendations for clinical routine can be made.

Multi-Model Data Fusion to Improve an Early Warning System for Hypo-/Hyperglycemic Events

Correct predictions of future blood glucose levels in individuals with Type 1 Diabetes (T1D) can be used to provide early warning of upcoming hypo-/hyperglycemic events and thus to improve the patient's safety. To increase prediction accuracy and efficiency, various approaches have been proposed which combine multiple predictors to produce superior results compared to single predictors. Three methods for model fusion are presented and comparatively assessed. Data from 23 T1D subjects under sensor-augmented pump (SAP) therapy were used in two adaptive data-driven models (an autoregressive model with output correction - cARX, and a recurrent neural network - RNN). Data fusion techniques based on i) Dempster-Shafer Evidential Theory (DST), ii) Genetic Algorithms (GA), and iii) Genetic Programming (GP) were used to merge the complimentary performances of the prediction models. The fused output is used in a warning algorithm to issue alarms of upcoming hypo-/hyperglycemic events. The fusion schemes showed improved performance with lower root mean square errors, lower time lags, and higher correlation. In the warning algorithm, median daily false alarms (DFA) of 0.25%, and 100% correct alarms (CA) were obtained for both event types. The detection times (DT) before occurrence of events were 13.0 and 12.1 min respectively for hypo-/hyperglycemic events. Compared to the cARX and RNN models, and a linear fusion of the two, the proposed fusion schemes represents a significant improvement.

Search for new particles in events with one lepton and missing transverse momentum in pp collisions at √s = 8 TeV with the ATLAS detector

This paper presents a search for new particles in events with one lepton (electron or muon) and missing transverse momentum using 20.3 fb−1 of proton-proton collision data at TeX = 8 TeV recorded by the ATLAS experiment at the Large Hadron Collider. No significant excess beyond Standard Model expectations is observed. A W ′ with Sequential Standard Model couplings is excluded at the 95% confidence level for masses up to 3.24 TeV. Excited chiral bosons (W *) with equivalent coupling strengths are excluded for masses up to 3.21 TeV. In the framework of an effective field theory limits are also set on the dark matter-nucleon scattering cross-section as well as the mass scale M * of the unknown mediating interaction for dark matter pair production in association with a leptonically decaying W.

Search for supersymmetry in events with four or more leptons in √s = 8 TeV pp collisions with the ATLAS detector

Results from a search for supersymmetry in events with four or more leptons including electrons, muons and taus are presented. The analysis uses a data sample corresponding to 20.3  fb −1 of proton-proton collisions delivered by the Large Hadron Collider at s √ =8  TeV and recorded by the ATLAS detector. Signal regions are designed to target supersymmetric scenarios that can be either enriched in or depleted of events involving the production of a Z boson. No significant deviations are observed in data from standard model predictions and results are used to set upper limits on the event yields from processes beyond the standard model. Exclusion limits at the 95% confidence level on the masses of relevant supersymmetric particles are obtained. In R -parity-violating simplified models with decays of the lightest supersymmetric particle to electrons and muons, limits of 1350 and 750 GeV are placed on gluino and chargino masses, respectively. In R -parity-conserving simplified models with heavy neutralinos decaying to a massless lightest supersymmetric particle, heavy neutralino masses up to 620 GeV are excluded. Limits are also placed on other supersymmetric scenarios.

The J-curve in HIV: low and moderate alcohol intake predicts mortality but not the occurrence of major cardiovascular events.

OBJECTIVES In HIV-negative populations light to moderate alcohol consumption is associated with a lower cardiovascular morbidity and mortality than alcohol abstention. Whether the same holds true for HIV-infected individuals has not been evaluated in detail. DESIGN Cohort study METHODS:: Adults on antiretroviral therapy in the Swiss HIV Cohort Study with follow-up after August 2005 were included. We categorized alcohol consumption into: abstention, low (1-9 g/d), moderate (10-29 g/d in females and 10-39g/d in men) and high alcohol intake. Cox proportional hazards models were used to describe the association between alcohol consumption and cardiovascular disease free survival (combined endpoint) as well as cardiovascular disease events (CADE) and overall survival. Baseline and time-updated risk factors for CADE were included in the models. RESULTS Among 9,741 individuals included, there were 788 events of major CADE or death during 46,719 years of follow-up, corresponding to an incidence of 1.69 events/100 person-years. Follow-up according to alcohol consumption level was 51% abstention, 20% low, 23% moderate and 6% high intake. As compared to abstention, low (hazard ratio 0.79, 95% confidence interval 0.63-0.98) and moderate alcohol intake (0.78, 0.64-0.95) were associated with a lower incidence of the combined endpoint. There was no significant association between alcohol consumption and CADE. CONCLUSIONS Compared to abstention, low and moderate alcohol intake were associated with a better CADE-free survival. However, this result was mainly driven by mortality and the specific impact of drinking patterns and type of alcoholic beverage on this outcome remains to be determined.

Self-esteem, narcissism, and stressful life events: Testing for selection and socialization

We examined whether self-esteem and narcissism predict the occurrence of stressful life events (i.e., selection) and whether stressful life events predict change in self-esteem and narcissism (i.e., socialization). The analyses were based on longitudinal data from 2 studies, including samples of 328 young adults (Study 1) and 371 adults (Study 2). The effects of self-esteem and narcissism were mutually controlled for each other and, moreover, controlled for effects of depression. After conducting the study-level analyses, we meta-analytically aggregated the findings. Self-esteem had a selection effect, suggesting that low self-esteem led to the occurrence of stressful life events; however, this effect became nonsignificant when depression was controlled for. Regardless of whether depression was controlled for or not, narcissism had a selection effect, suggesting that high narcissism led to the occurrence of stressful life events. Moreover, stressful life events had a socialization effect on self-esteem, but not on narcissism, suggesting that the occurrence of stressful life events decreased self-esteem. Analyses of trait–state models indicated that narcissism consisted almost exclusively of perfectly stable trait variance, providing a possible explanation for the absence of socialization effects on narcissism. The findings have significant implications because they suggest that a person’s level of narcissism influences whether stressful life events occur, and that self-esteem is shaped by the occurrence of stressful life events. Moreover, we discuss the possibility that depression mediates the selection effect of low self-esteem on stressful life events.

Uric Acid and Cardiovascular Events: A Mendelian Randomization Study

Obesity and diets rich in uric acid-raising components appear to account for the increased prevalence of hyperuricemia in Westernized populations. Prevalence rates of hypertension, diabetes mellitus, CKD, and cardiovascular disease are also increasing. We used Mendelian randomization to examine whether uric acid is an independent and causal cardiovascular risk factor. Serum uric acid was measured in 3315 patients of the Ludwigshafen Risk and Cardiovascular Health Study. We calculated a weighted genetic risk score (GRS) for uric acid concentration based on eight uric acid-regulating single nucleotide polymorphisms. Causal odds ratios and causal hazard ratios (HRs) were calculated using a two-stage regression estimate with the GRS as the instrumental variable to examine associations with cardiometabolic phenotypes (cross-sectional) and mortality (prospectively) by logistic regression and Cox regression, respectively. Our GRS was not consistently associated with any biochemical marker except for uric acid, arguing against pleiotropy. Uric acid was associated with a range of prevalent diseases, including coronary artery disease. Uric acid and the GRS were both associated with cardiovascular death and sudden cardiac death. In a multivariate model adjusted for factors including medication, causal HRs corresponding to each 1-mg/dl increase in genetically predicted uric acid concentration were significant for cardiovascular death (HR, 1.77; 95% confidence interval, 1.12 to 2.81) and sudden cardiac death (HR, 2.41; 95% confidence interval, 1.16 to 5.00). These results suggest that high uric acid is causally related to adverse cardiovascular outcomes, especially sudden cardiac death.

The combined effect of pravastatin and aspirin on clinical cardiovascular events

The 3-hydroxy-3methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, can achieve significant reductions in plasma low-density lipoprotein (LDL)-cholesterol levels. Experimental and clinical evidence now shows that some statins interfere with formation of atherosclerotic lesions independent of their hypolipidemic properties. Vulnerable plaque rupture can result in thrombus formation and artery occlusion; this plaque deterioration is responsible for most acute coronary syndromes, including myocardial infarction (MI), unstable angina, and coronary death, as well as coronary heart diseaseequivalent non-hemorrhagic stroke. Inhibition of HMG-CoA reductase has potential pleiotropic effects other than lipid-lowering, as statins block mevalonic acid production, a precursor to cholesterol and numerous other metabolites. Statins' beneficial effects on clinical events may also thus involve nonlipid-related mechanisms that modify endothelial function, inflammatory responses, plaque stability, and thrombus formation. Aspirin, routinely prescribed to post-MI patients as adjunct therapy, may potentiate statins beneficial effects, as aspirin does not compete metabolically with statins but acts similarly on atherosclerotic lesions. Common functions of both medications include inhibition of platelet activity and aggregation, reduction in atherosclerotic plaque macrophage cell count, and prevention of atherosclerotic vessel endothelial dysfunction. The Cholesterol and Recurrent Events (CARE) trial provides an ideal population in which to examine the combined effects of pravastatin and aspirin. Lipid levels, intermediate outcomes, are examined by pravastatin and aspirin status, and differences between the two pravastatin groups are found. A modified Cox proportional-hazards model with aspirin as a time-dependent covariate was used to determine the effect of aspirin and pravastatin on the clinical cardiovascular composite endpoint of coronary heart disease death, recurrent MI or stroke. Among those assigned to pravastatin, use of aspirin reduced the composite primary endpoint by 35%; this result was similar by gender, race, and diabetic status. Older patients demonstrated a nonsignificant 21% reduction in the primary outcome, whereas the younger had a significant reduction of 43% in the composite primary outcome. Secondary outcomes examined include coronary artery bypass graft (38% reduction), nonsurgical bypass, peripheral vascular disease, and unstable angina. Pravastatin and aspirin in a post-MI population was found to be a beneficial combination that seems to work through lipid and nonlipid, anti-inflammatory mechanisms. ^

The effect of life events on blood pressure and body mass index in children

In Conroe, Texas, 492 students ages 5 to 15 participated in a screening examination for cardiovascular risk factor study. Among 492 students, 141 elementary and junior high students participated in the present sub-study to investigate the effect of the number of recent life events on blood pressure and on body mass index. Using the elementary and junior high school Coddington scales, life events occurring in the past 12 months were measured for students ages 9 to 14 years, no significant differences in life events were observed by age and sex. The number of life events was not related to blood pressure but was positively correlated to body mass index in children and adolescents. ^

Longitudinal and logistic analysis of endocrine hormone profiles, physical maturation, and candidate genes related to pubertal events in children

Children who experience early pubertal development have an increased risk of developing cancer (breast, ovarian, and testicular), osteoporosis, insulin resistance, and obesity as adults. Early pubertal development has been associated with depression, aggressiveness, and increased sexual prowess. Possible explanations for the decline in age of pubertal onset include genetics, exposure to environmental toxins, better nutrition, and a reduction in childhood infections. In this study we (1) evaluated the association between 415 single nucleotide polymorphisms (SNPs) from hormonal pathways and early puberty, defined as menarche prior to age 12 in females and Tanner Stage 2 development prior to age 11 in males, and (2) measured endocrine hormone trajectories (estradiol, testosterone, and DHEAS) in relation to age, race, and Tanner Stage in a cohort of children from Project HeartBeat! At the end of the 4-year study, 193 females had onset of menarche and 121 males had pubertal staging at age 11. African American females had a younger mean age at menarche than Non-Hispanic White females. African American females and males had a lower mean age at each pubertal stage (1-5) than Non-Hispanic White females and males. African American females had higher mean BMI measures at each pubertal stage than Non-Hispanic White females. Of the 415 SNPs evaluated in females, 22 SNPs were associated with early menarche, when adjusted for race ( p<0.05), but none remained significant after adjusting for multiple testing by False Discovery Rate (p<0.00017). In males, 17 SNPs were associated with early pubertal development when adjusted for race (p<0.05), but none remained significant when adjusted for multiple testing (p<0.00017). ^ There were 4955 hormone measurements taken during the 4-year study period from 632 African American and Non-Hispanic White males and females. On average, African American females started and ended the pubertal process at a younger age than Non-Hispanic White females. The mean age of Tanner Stage 2 breast development in African American and Non-Hispanic White females was 9.7 (S.D.=0.8) and 10.2 (S.D.=1.1) years, respectively. There was a significant difference by race in mean age for each pubertal stage, except Tanner Stage 1 for pubic hair development. Both Estradiol and DHEAS levels in females varied significantly with age, but not by race. Estradiol and DHEAS levels increased from Tanner Stage 1 to Tanner Stage 5.^ African American males had a lower mean age at each Tanner Stage of development than Non-Hispanic White males. The mean age of Tanner Stage 2 genital development in African American and Non-Hispanic White males was 10.5 (S.D.=1.1) and 10.8 (S.D.=1.1) years, respectively, but this difference was not significant (p=0.11). Testosterone levels varied significantly with age and race. Non-Hispanic White males had higher levels of testosterone than African American males from Tanner Stage 1-4. Testosterone levels increased for both races from Tanner Stage 1 to Tanner Stage 5. Testosterone levels had the steepest increase from ages 11-15 for both races. DHEAS levels in males varied significantly with age, but not by race. DHEAS levels had the steepest increase from ages 14-17. ^ In conclusion, African American males and females experience pubertal onset at a younger age than Non-Hispanic White males and females, but in this study, we could not find a specific gene that explained the observed variation in age of pubertal onset. Future studies with larger study populations may provide a better understanding of the contribution of genes in early pubertal onset.^

Dinoflagellate cysts abundance and events of ODP Hole 189-1168A sediments

Palynomorphs were studied in samples from Ocean Drilling Program (ODP) Leg 189, Hole 1168A (slope of the western margin of Tasmania; 2463 m water depth). Besides organic-walled dinoflagellate cysts (dinocysts), broad categories of other palynomorphs were quantified in terms of relative abundance. In this contribution, we provide an overview of the early late Eocene-Quaternary dinocyst distribution and illustrate main trends in palynomorph distribution. Dinocyst species throughout Hole 1168A are largely cosmopolitan with important contributions of typical low-latitude taxa and virtual absence of endemic Antarctic taxa. Dinocyst stratigraphic distribution broadly matches that known from the Northern Hemisphere and equatorial regions, although significant differences are noted. Selected potentially biochronostratigraphically useful events are summarized. The distribution of dinocysts in the middle-upper Miocene interval is rather patchy, probably due to prolonged exposure to oxygen. An important general aspect in the dinocyst assemblages is the near absence of Antarctic endemic species and the apparent influence of relatively warm waters throughout the succession at Site 1168. General palynomorph distribution indicates continued deepening from an initial shallow, even restricted, marine setting from late Eocene-Quaternary times. A curious massive influx of small skolochorate acritarchs is recorded throughout the late early-early middle Miocene; the significance of this signal is not yet understood. A general long-term oligotrophic nature of the surface waters influencing Site 1168 is suggested from the low abundance of (proto) peridinioid, presumably heterotrophic, species. The overall dinocyst distribution pattern corresponds to the long-term existence of a Leeuwin-like current influencing the region, including Site 1168, confirming results of earlier studies on other microfossil groups. The occasional influence of colder surface water conditions is, however, also apparent, notably during the late Pliocene-Quaternary, indicating the potential of high-resolution dinocyst analysis for future paleoceanographic studies.

Calcareous nannofossil stratigraphy, nannofossil events and carbon isotopic ratios of ODP Leg 183 sites

Cores from Sites 1135, 1136, and 1138 of Ocean Drilling Program Leg 183 to the Kerguelen Plateau (KP) provide the most complete Paleocene and Eocene sections yet recovered from the southern Indian Ocean. These nannofossil-foraminifer oozes and chalks provide an opportunity to study southern high-latitude biostratigraphic and paleoceanographic events, which is the primary subject of this paper. In addition, a stable isotope profile was established across the Cretaceous/Tertiary (K/T) boundary at Site 1138. An apparently complete K/T boundary was recovered at Site 1138 in terms of assemblage succession, isotopic signature, and reworking of older (Cretaceous) nannofossil taxa. There is a significant color change, a negative carbon isotope shift, and nannofossil turnover. The placement of the boundary based on these criteria, however, is not in agreement with the available shipboard paleomagnetic stratigraphy. We await shore-based paleomagnetic study to confirm or deny those preliminary results. The Paleocene nannofossil assemblage is, in general, characteristic of the high latitudes with abundant Chiasmolithus, Prinsius, and Toweius. Placed in context with other Southern Ocean sites, the biogeography of Hornibrookina indicates the presence of some type of water mass boundary over the KP during the earliest Paleocene. This boundary disappeared by the late Paleocene, however, when there was an influx of warm-water discoasters, sphenoliths, and fasciculiths. This not only indicates that during much of the late Paleocene water temperatures were relatively equable, but preliminary floral and stable isotope analyses also indicate that a relatively complete record of the late Paleocene Thermal Maximum event was recovered at Site 1135. It was only at the beginning of the middle Eocene that water temperatures began to decline and the nannofossil assemblage became dominated by cool-water species while discoaster and sphenolith abundances and diversity were dramatically reduced. One new taxonomic combination is proposed, Heliolithus robustus Arney, Ladner, and Wise.

Bio- and magnetostratigraphic events of ODP holes of the central Kerguelen Plateau

Neogene biostratigraphic and magnetostratigraphic data are compiled from Holes 747A, 748B, and 751A drilled on the Southern Kerguelen Plateau during Ocean Drilling Program Leg 120. Neogene sections have excellent to good magnetostratigraphic signatures in many intervals. This, in addition to minimal coring gaps and the occurrence of mixed assemblages of both calcareous and siliceous microfossil assemblages, makes these valuable biostratigraphic reference sections for intra- and extraregional correlations. This paper combines the sequence of biostratigraphic events reported from diatom, radiolarian, planktonic foraminifer, calcareous nannofossil, and silicoflagellate studies of Leg 120 sediments. It correlates microfossil datums with the geomagnetic polarity time scale to test existing age estimates and to refine biostratigraphic age controls for the southern high latitudes. Significant biostratigraphic datums are presented in a series of age-depth plots. Numerous hiatuses are clearly identified through this approach, and the positions of lesser disconformities are suggested. Most Neogene intervals are represented in at least one site, although "regional" unconformities occur in the upper Pliocene, uppermost Miocene/lowermost Pliocene, middle upper Miocene, middle middle Miocene, and at the lower/middle Miocene boundaries. The longest hiatus spanned 6 m.y., with most other hiatuses representing 1 m.y. or less. This paper compiles Leg 120 biostratigraphic and magnetostratigraphic data for use in future syntheses of southern high latitude biostratigraphy and presents an age model for Leg 120 Neogene sediments.

Calcium isotope composition of Oceanic Anoxic Events 1a and 2 sediments

Calcium-isotope ratios (d44/42Ca) were measured in carbonate-rich sedimentary sections deposited during Oceanic Anoxic Events 1a (Early Aptian) and 2 (Cenomanian-Turonian). In sections from Resolution Guyot, Mid-Pacific Mountains; Coppitella, Italy; and the English Chalk at Eastbourne and South Ferriby, UK, a negative excursion in d44/42Ca of ~0.20 per mil and ~0.10 per mil is observed for the two events. These d44/42Ca excursions occur at the same stratigraphic level as the carbon-isotope excursions that define the events, but do not correlate with evidence for carbonate dissolution or lithological changes. Diagenetic and temperature effects on the calcium-isotope ratios can be discounted, leaving changes in global seawater composition as the most probable explanation for d44/42Ca changes in four different carbonate sections. An oceanic box model with coupled strontium- and calcium-isotope systems indicates that a global weathering increase is likely to be the dominant driver of transient excursions in calcium-isotope ratios. The model suggests that contributions from hydrothermal activity and carbonate dissolution are too small and short-lived to affect the oceanic calcium reservoir measurably. A modelled increase in weathering flux, on the order of three times the modern flux, combined with increased hydrothermal activity due to formation of the Ontong-Java Plateau (OAE1a) and Caribbean Plateau (OAE2), can produce trends in both calcium and strontium isotopes that match the signals recorded in the carbonate sections. This study presents the first major-element record of a weathering response to Oceanic Anoxic Events.