A comparison of non-HDL and LDL cholesterol goal attainment in a large, multinational patient population: The Lipid Treatment Assessment Project 2

Objective: This study evaluated the success in attaining non-HDL-cholesterol (non-HDL-C) goals in the multinational L-TAP 2 study. Methods: 9955 patients >= 20 years of age with dyslipidemia on stable lipid-lowering therapy were enrolled from nine countries. Results: Success rates for non-HDL-C goals were 86% in low, 70% in moderate, and 52% in high-risk patients (63% overall). In patients with triglycerides of >200 mg/dL success rates for non-HDL-C goals were 35% vs. 69% in those with <= 200 mg/dL (p < 0.0001). Among patients attaining their LDL-C goal, 18% did not attain their non-HDL-C goal. In those with coronary disease and at least two risk factors, only 34% and 30% attained respectively their non-HDL-C and LDL-C goals. Rates of failure in attaining both LDL-C and non-HDL-C goals were highest in Latin America. Conclusions: Non-HDL-C goal attainment lagged behind LDL-C goal attainment; this gap was greatest in higher-risk patients. (c) 2012 Elsevier Ireland Ltd. All rights reserved.

Supervised stationary cycling versus supervised treadmill walking for patients with intermittent claudication: Preliminary results

Introduction: Walking programmes are recommended as part of the initial treatment for intermittent claudication (IC). However, for many patients factors such as frailty, the severe leg discomfort associated with walking and safety concerns about exercising in public areas reduce compliance to such prescription. Thus, there is a need to identify a mode of exercise that provides the same benefits as regular walking while also offering convenience and comfort for these patients. The present study aims to provide evidence for the first time of the efficacy of a supervised cycle training programme compared with a conventional walking programme for the treatment of IC. Methods: Thus far 33 patients have been randomized to: a treadmill-training group (n = 12); a cycle-training group (n = 11); or a control group (n = 10). Training groups participated in three sessions of supervised training per week for a period of 6 weeks. Control patients received no experimental intervention. Maximal incremental treadmill testing was performed at baseline and after the 6 weeks of training. Measures included pain-free (PFWT) and maximal walking time (MWT), continuous heart rate and gas-analysis recording, and ankle-brachial index assessment. Results: In the treadmill trained group MWT increased significantly from 1016.7 523.7 to 1255.2 432.2 s (P < 0.05). MWT tended to increase with cycle training (848.72 333.18 to 939.54 350.35 s, P = 0.14), and remained unchanged in the control group (1555.1 683.23 to 1534.7 689.87 s). For PFWT, there was a non-significant increase in the treadmill-training group from 414.4 262.3 to 592.9 381.9 s, while both the cycle training and control groups displayed no significant change in this time (226.7 147.1 s to 192.3 56.8 and 499.4 503.7 s to 466.0 526.1 s, respectively). Conclusions: These preliminary results might suggest that, unlike treadmill walking, cycling has no clear effect on walking performance in patients with IC. Thus the current recommendations promoting walking based programmes appear appropriate. The present study was funded by the National Heart Foundation of Australia.

With the best of intentions: Is it possible to meet the CARI guidelines?

The CARI1 draft dialysis guidelines propose evidence based targets for biochemical and haematological parameters in ESRF. As part of a prospective randomised trial we investigated our ability to apply the CARI and National Heart Foundation of Australia targets to a representative dialysis population. All patients aged between 18–80 yrs were encouraged to enroll regardless of prior history of non-compliance or co-morbidity. Patients were randomised to either usual care (U;n = 44) or focussed care (F;n = 45). Usual care involved monthly blood tests and pysician review second monthly. In addition focus care patients had a monthly review in a physician supervised trial clinic run by nurses. The groups were comparable at baseline in terms of age, gender, dialysis modality, proportion of diabetics, time on dialysis, haemoglobin, ferritin, % saturation, parathyroid hormone, serum corrected calcium, serum phosphate, total cholesterol and LDL. At 6 months there had been significant improvements in PTH (p < 0.05), total cholesterol (p < 0.05) and LDL (p < 0.001), and a trend to better BP control. The proportion of patients meeting targets at 6 months were as follows: tot chol < 5 mmol/l-U 63%, F 82%; LDL < 3 mmol/l-U 75%, F 91%; phosphate < 1.8 mmol/l- U 42%, F 62%; PTH < 21 pmol/l-U 21%, F 40%; BP sys < 140 mmHg-U 41% F 46%; Hb > 11.5 g/dl U 58% F 64%. In spite of an intensive programme to maximise management of the haematological and biochemical parameters in patients with ESRF it appears that in a significant proportion of patients these targets could not be reached. 1The CARI Guidelines (Caring for Australians with Renal Impairment). Australian Kidney Foundation & Australia New Zealand Society of Nephrology, 2001.

Building Community Coalitions for the Promotion of Physical Activity: 10,000 Steps Rockhampton

The 10,000 Steps Rockhampton project is a multi-strategy community-wide, physical activity intervention based on the simultaneous implementation of five strategies, each identified as 'best practice' for the promotion of physical activity. Several community partners were engaged to develop and implement the strategies during the first eighteen months of the project. These included: the local media (TV, newspaper and radio); the local Division of General Practice and other health professional groups; the Heart Foundation and ‘Just Walk It’; the local council; and several large worksites. A local physical activity task force was also formed to administer a 'micro-grants' scheme, and to guide the development of community based strategies. The presentation will focus on the critical elements involved in developing and maintaining relationships with community partners. These include identification and ‘courting’ of potential partners, strategies for keeping them engaged, and the challenges of maintaining the balance between ‘top-down’ (evidence-based) and ‘bottom-up’ (community-driven) strategies. Data on implementation and uptake of the key strategies will also be presented. These include: 1) process data on the number of health

Genome-wide association of multiple complex traits in outbred mice by ultra low-coverage sequencing

We thank the High-Throughput Genomics Group at the Wellcome Trust Centre for Human Genetics and the Wellcome Trust Sanger Institute for the generation of the sequencing data. This work was funded by Wellcome Trust grant 090532/Z/09/Z (J.F.). Primary phenotyping of the mice was supported by the Mary Lyon Centre and Mammalian Genetics Unit (Medical Research Council, UK Hub grant G0900747 91070 and Medical Research Council, UK grant MC U142684172). D.A.B acknowledges support from NIH R01AR056280. The sleep work was supported by the state of Vaud (Switzerland) and the Swiss National Science Foundation (SNF 14694 and 136201 to P.F.). The ECG work was supported by the Netherlands CardioVascular Research Initiative (Dutch Heart Foundation, Dutch Federation of University Medical Centres, the Netherlands Organization for Health Research and Development, and the Royal Netherlands Academy of Sciences) PREDICT project, InterUniversity Cardiology Institute of the Netherlands (ICIN; 061.02; C.A.R., C.R.B). Na Cai is supported by the Agency of Science, Technology and Research (A*STAR) Graduate Academy. The authors wish to acknowledge excellent technical assistance from: Ayako Kurioka, Leo Swadling, Catherine de Lara, James Ussher, Rachel Townsend, Sima Lionikaite, Ausra S. Lionikiene, Rianne Wolswinkel and Inge van der Made. We would like to thank Thomas M Keane and Anthony G Doran for their help in annotating variants and adding the FVB/NJ strain to the Mouse Genomes Project.

Fiber, a component for health gastrointestinal endocrine system

Dietary fiber was classified according to its solubility in an attempt to relate physiological effects to chemical types of fiber. Soluble fibers (B-glucans, gums, wheat dextrin, psyllium, pectin, inulin) were considered to have benefits on serum lipids, while insoluble fibers (cellulose, lignin, pectins, hemicelluloses) were linked with laxation benefits. More important characteristics of fiber in terms of physiological benefits are viscosity and fermentability. Viscous fibers (pectins, B-glucans, gums, psyllium) are those that have gel-forming properties in the intestinal tract, and fermentable fibers (wheat dextrin, pectins, B-glucans, gum, inulin) are those that can be metabolized by colonic bacteria. Objective: To summarize the beneficial effects of dietary fiber, as nutraceuticals, in order to maintain a healthy gastrointestinal system. Methods: Our study is a systematic review. Electronic databases, including PubMed, Medline, with supplement of relevant websites, were searched. We included randomized and non-randomized clinical trials, epidemiological studies (cohort and case-control). We excluded case series, case reports, in vitro and animal studies. Results: The WHO, the U.S. Food and Drug Administration (FDA), the Heart Foundation and the Romanian Dietary Guidelines recommends that adults should aim to consume approximately 25–30 g fiber daily. Dietary fiber is found in the indigestible parts of cereals, fruits and vegetables. There are countries where people don’t eat enough food fibers, these people need to take some kind of fiber supplement. Evidence has been found that dietary fiber from whole foods or supplements may (1) reduce the risk of cardiovascular disease by improving serum lipids and reducing serum total and low-density lipoprotein (LDL) cholesterol concentrations, (2) decreases the glycaemic index of foods, which leads to an improvement in glycemic response, positive impact on diabetes, (3) protect against development of obesity by increasing satiety hormone leptin concentrations, (4) reduced risk of developing colorectal cancer by normalizes bowel movements, improve the integrity of the epithelial layer of the intestines, increase the resistance against pathogenic colonization, have favorable effects on the gut microbiome, wich is the second genomes of the microorganisms, (5) have a positive impact on the endocrine system by gastrointestinal polypeptide hormonal regulation of digestion, (6) have prebiotic effect by short-chain fatty acids (SCFA) production; butyrate acid is the preferred energy source for colonic epithelial cells, promotes normal cell differentiation and proliferation, and also help regulate sodium and water absorption, and can enhance absorption of calcium and other minerals. Although all prebiotics are fiber, not all fiber is prebiotic. This generally refers to the ability of a fiber to increase the growth of bifidobacteria and lactobacilli, which are beneficial to human health, and (7) play a role in improving immune function via production of SCFAs by increases T helper cells, macrophages, neutrophils, and increased cytotoxic activity of natural killer cells. Conclusion: Fiber consumption is associated with high nutritional value and antioxidant status of the diet, enhancing the effects on human health. Fibers with prebiotic properties can also be recommended as part of fiber intake. Due to the variability of fiber’s effects in the body, it is important to consume fiber from a variety of sources. Increasing fiber consumption for health promotion and disease prevention is a critical public health goal.

Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles

OBJECTIVE: Despite rapid declines over the last two decades, coronary heart disease (CHD) mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI), Republic of Ireland (RoI) and Scotland.

METHODS: CHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year) to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i) smoking prevalence and (ii) physical inactivity rates of up to 15% by 2030; relative decreases in (iii) dietary salt intake of up to 30% by 2030 and (iv) dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted.

RESULTS: Projected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25-84). In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8-7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1-3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2-5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8-9.0%. These projections remained stable under a wide range of sensitivity analyses.

CONCLUSIONS: Feasible reductions in four cardiovascular risk factors (already achieved elsewhere) could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity.

The church history of England, from the year 1500, to the year 1688. Chiefly with regard to the Catholicks ... with ... the lives of the most eminent Catholicks ... also, a distinct ... account of the works of the learned ... with the foundation of all the English colleges and monasteries abroad ... To which is prefixed, A general history of ecclesiastical affairs under the British, Saxon, and Norman periods ...

Probably printed in England. of. Halkett & Laing, Brit. mus. Catalogue.

Heart of oak, the British bulwark : shewing, I. reasons for paying greater attention to the propagation of oak timber ... II. the insufficiency of the present laws ... III. the testimony of some of the most eminent timber merchants, shipwrights, &c. ... IV. that the neglect of planting ... V. the author's opinion what methods would be most effectual ... humbly offered to His Majesty and the Parliament, as well as to all proprietors of land in Great-Britain /

Goldsmiths'-Kress no. 09842.

Heart of oak, the British bulwark; shewing reasons for paying greater attention to the propagation of oak timber than has hitherto been manifested, etc.

Mode of access: Internet.

Telemonitoring or Structured Telephone Support Programmes for Patients with Chronic Heart Failure: Systematic Review and Meta-Analysis

Objective: To determine whether remote monitoring (structured telephone support or telemonitoring) without regular clinic or home visits improves outcomes for patients with chronic heart failure. Data sources: 15 electronic databases, hand searches of previous studies, and contact with authors and experts. Data extraction: Two investigators independently screened the results. Review methods: Published randomised controlled trials comparing remote monitoring programmes with usual care in patients with chronic heart failure managed within the community. Results: 14 randomised controlled trials (4264 patients) of remote monitoring met the inclusion criteria: four evaluated telemonitoring, nine evaluated structured telephone support, and one evaluated both. Remote monitoring programmes reduced the rates of admission to hospital for chronic heart failure by 21% (95% confidence interval 11% to 31%) and all cause mortality by 20% (8% to 31%); of the six trials evaluating health related quality of life three reported significant benefits with remote monitoring, and of the four studies examining healthcare costs with structured telephone support three reported reduced cost and one no effect. Conclusion: Programmes for chronic heart failure that include remote monitoring have a positive effect on clinical outcomes in community dwelling patients with chronic heart failure.

A history of heart interventions moderates the relationship between psychological variables and the presence of chest pain in older women with self-reported coronary heart disease

Objectives: This study examines the hypothesis that a past history of heart interventions will moderate the relationship between psychosocial factors (stressful life events, social support, perceived stress, having a current partner, having a past diagnosis of depression or anxiety over the past 3 years, time pressure, education level, and the mental health index) and the presence of chest pain in a sample of older women. Design: Longitudinal survey over a 3-year period. Methods: The sample was taken from a prospective cohort study of 10,432 women initially aged between 70 and 75 years, who were surveyed in 1996 and then again in 1999. Two groups of women were identified: those reporting to have heart disease but no past history of heart interventions (i.e., coronary artery bypass graft/angioplasty) and those reporting to have heart disease with a past history of heart interventions. Results: Binary logistic regression analysis was used to show that for the women with self-reported coronary heart disease but without a past history of heart intervention, feelings of time pressure as well as the number of stressful life events experienced in the 12 months prior to 1996 were independent risk factors for the presence of chest pain, even after accounting for a range of traditional risk factors. In comparison, for the women with self-reported coronary heart disease who did report a past history of heart interventions, a diagnosis of depression in the previous 3 years was the significant independent risk factor for chest pain even after accounting for traditional risk factors. Conclusion: The results indicate that it is important to consider a history of heart interventions as a moderator of the associations between psychosocial variables and the frequency of chest pain in older women. Statement of Contribution: What is already known on this subject? Psychological factors have been shown to be independent predictors of a range of health outcomes in individuals with coronary heart disease, including the presence of chest pain. Most research has been conducted with men or with small samples of women; however, the evidence does suggest that these relationships exist in women as well as in men. What does this study add? Most studies have looked at overall relationships between psychological variables and health outcomes. The few studies that have looked at moderators have mainly examined gender as a moderator. To our knowledge, this is the first published study to examine a history of heart interventions as a moderator of the relationship between psychological variables and the presence of chest pain.

Comparing population attributable risks for heart disease across the adult lifespan in women

Background Recent estimates suggest that high body mass index (BMI), smoking, high blood pressure (BP) and physical inactivity are leading risk factors for the overall burden of disease in Australia. The aim was to examine the population attributable risk (PAR) of heart disease for each of these risk factors, across the adult lifespan in Australian women. Methods PARs were estimated using relative risks (RRs) for each of the four risk factors, as used in the Global Burden of Disease Study, and prevalence estimates from the Australian Longitudinal Study on Women's Health, in 15 age groups from 22–27 (N=9608) to 85–90 (N=3901). Results RRs and prevalence estimates varied across the lifespan. RRs ranged from 6.15 for smoking in the younger women to 1.20 for high BMI and high BP in the older women. Prevalence of risk exposure ranged from 2% for high BP in the younger women to 79% for high BMI in mid-age women. In young adult women up to age 30, the highest population risk was attributed to smoking. From age 31 to 90, PARs were highest for physical inactivity. Conclusions From about age 30, the population risk of heart disease attributable to inactivity outweighs that of other risk factors, including high BMI. Programmes for the promotion and maintenance of physical activity deserve to be a much higher public health priority for women than they are now, across the adult lifespan.

Proceedings fo the Seventeenth Annual Sea Turtle Symposium, 4-8 March 1997, Orlando, Florida, U.S.A.

The 17th Annual Sea Turtle Symposium was held at the Delta Orlando Resort in Orlando, Florida U.S.A. from March 4-8, 1997. The symposium was hosted by Florida Atlantic University, Mote Marine Laboratory, University of Central Florida, University of Florida, Florida Atlantic University and the Comité Nacional para la Conservación y Protección de las Totugas Marinas. The 17th was the largest symposium to date. A total of 720 participants registered, including sea turtle biologists, students, regulatory personnel, managers, and volunteers representing 38 countries. In addition to the United States, participants represented Australia, Austria, the Bahamas, Bonaire, Bermuda, Brazil, Canada, Colombia, Costa Rica, Croatia, Cuba, Cyprus, Dominican Republic, Ecuador, England, Guatemala, Greece, Honduras, India, Italy, Japan, Madagascar, Malaysia, Mexico, The Netherlands, Nicaragua, Peru, Philippines, Republic of Seychelles, Scotland, Spain, Sri Lanka, Switzerland, Taiwan, Turkey, Uruguay, and Venezuela. In addition to the 79 oral, 2 video, and 120 poster presentations, 3 workshops were offered: Selina Heppell (Duke University Marine Laboratory) provided “Population Modeling,” Mike Walsh and Sam Dover (Sea World-Orlando) conducted “Marine Turtle Veterinary Medicine” and “Conservation on Nesting Beaches” was offered by Blair Witherington and David Arnold (Florida Department of Environmental Protection). On the first evening, P.C.H. Pritchard delivered a thoughtful retrospect on Archie Carr that showed many sides of a complex man who studied and wrote about sea turtles. It was a presentation that none of us will forget. The members considered a number of resolutions at the Thursday business meeting and passed six. Five of these resolutions are presented in the Commentaries and Reviews section of Chelonian Conservation and Biology 2(3):442-444 (1997). The symposium was fortunate to have many fine presentations competing for the Archie Carr Best Student Presentations awards. The best oral presentation award went to Amanda Southwood (University of British Columbia) for “Heart rates and dive behavior of the leatherback sea turtle during the internesting interval.” The two runners-up were Richard Reina (Australian National University) for “Regulation of salt gland activity in Chelonia mydas” and Singo Minamikawa (Kyoto University) for “The influence that artificial specific gravity change gives to diving behavior of loggerhead turtles”. The winner of this year’s best poster competition was Mark Roberts (University of South Florida) for his poster entitled “Global population structure of green sea Turtles (Chelonia mydas) using microsatellite analysis of male mediated gene flow.” The two runners-up were Larisa Avens (University of North Carolina-Chapel Hill) for “Equilibrium responses to rotational displacements by hatchling sea turtles: maintaining a migratory heading in a turbulent ocean” and Annette Broderick (University of Glasgow) for “Female size, not length, is a correlate of reproductive output.” The symposium was very fortunate to receive a matching monetary and subscription gift from Anders J. G. Rhodin of the Chelonian Research Foundation. These enabled us to more adequately reward the fine work of students. The winners of the best paper and best poster awards received $400 plus a subscription to Chelonian Conservation and Biology. Each runner up received $100. The symposium owes a great debt to countless volunteers who helped make the meeting a success. Those volunteers include: Jamie Serino, Alan Bolton, and Karen Bjorndal, along with the UF students provided audio visual help, John Keinath chaired the student awards committee, Mike Salmon chaired the Program Commiteee, Sheryan Epperly and Joanne Braun compiled the Proceedings, Edwin Drane served as treasurer and provided much logistical help, Jane Provancha coordinated volunteers, Thelma Richardson conducted registration, Vicki Wiese coordinated food and beverage services, Jamie Serino and Erik Marin coordinated entertainment, Kenneth Dodd oversaw student travel awards, Traci Guynup, Tina Brown, Jerris Foote, Dan Hamilton, Richie Moretti, and Vicki Wiese served on the time and place committee, Blair Witherington created the trivia quiz, Tom McFarland donated the symposium logo, Deborah Crouse chaired the resolutions committee, Pamela Plotkin chaired the nominations committee, Sally Krebs, Susan Schenk, and Larry Wood conducted the silent auction, and Beverly and Tom McFarland coordinated all 26 vendors. Many individuals from outside the United States were able to attend the 17th Annual Sea Turtle Symposium thanks to the tireless work of Karen Eckert, Marydele Donnelly, and Jack Frazier in soliciting travel assistance for a number of international participants. We are indebted to those donating money to the internationals’ housing fund (Flo Vetter Memorial Fund, Marinelife Center of Juno Beach, Roger Mellgren, and Jane Provancha). We raise much of our money for international travel from the auction; thanks go to auctioneer Bob Shoop, who kept our auction fastpaced and entertaining, and made sure the bidding was high. The Annual Sea Turtle Symposium is unequaled in its emphasis on international participation. Through international participation we all learn a great deal more about the biology of sea turtles and the conservation issues that sea turtles face in distant waters. Additionally, those attending the symposium come away with a tremendous wealth of knowledge, professional contacts, and new friendships. The Annual Sea Turtle Symposium is a meeting in which pretenses are dropped, good science is presented, and friendly, open communication is the rule. The camaraderie that typifies these meetings ultimately translates into understanding and cooperation. These aspects, combined, have gone and will go a long way toward helping to protect marine turtles and toward aiding their recovery on a global scale. (PDF contains 342 pages)