Determinants of persistence in hypertensive patients treated with irbesartan: results of a postmarketing survey.

BACKGROUND: Persistence is a key factor for long-term blood pressure control, which is of high prognostic importance for patients at increased cardiovascular risk. Here we present the results of a post-marketing survey including 4769 hypertensive patients treated with irbesartan in 886 general practices in Switzerland. The goal of this survey was to evaluate the tolerance and the blood pressure lowering effect of irbesartan as well as the factors affecting persistence in a large unselected population. METHODS: Prospective observational survey conducted in general practices in all regions of Switzerland. Previously untreated and uncontrolled pre-treated patients were started with a daily dose of 150 mg irbesartan and followed up to 6 months. RESULTS: After an observation time slightly exceeding 4 months, the average reduction in systolic and diastolic blood pressure was 20 (95% confidence interval (CI) -19.6 to -20.7 mmHg) and 12 mmHg (95% CI -11.4 to -12.1 mmHg), respectively. At this time, 26% of patients had a blood pressure < 140/90 mmHg and 60% had a diastolic blood pressure < 90 mmHg. The drug was well tolerated with an incidence of adverse events (dizziness, headaches,...) of 8.0%. In this survey more than 80% of patients were still on irbesartan at 4 month. The most important factors predictive of persistence were the tolerability profile and the ability to achieve a blood pressure target < or = 140/90 mmHg before visit 2. Patients who switched from a fixed combination treatment tended to discontinue irbesartan more often whereas those who abandoned the previous treatment because of cough (a class side effect of ACE-Inhibitors) were more persistent with irbesartan. CONCLUSION: The results of this survey confirm that irbesartan is effective, well tolerated and well accepted by patients, as indicated by the good persistence. This post-marketing survey also emphasizes the importance of the tolerability profile and of achieving an early control of blood pressure as positive predictors of persistence.

The association between cigarettes smoking, cannabis use and alcohol consumption in a population of young men: results of a population-based survey.

BACKGROUND: Cigarette smoking is often initiated at a young age as well as other risky behaviors such as alcohol drinking, cannabis and other illicit drugs use. Some studies suggest that cigarette smoking may have an influence on other risky behaviors but little is known about the chronology of occurrence of those different habits. The aim of this study was to assess, by young men, what were the other risky behaviors associated with cigarette smoking and the joint prevalence and chronology of occurrence of those risky behaviors. METHODS: Cross-sectional analyses of a population-based census of 3526 young men attending the recruitment for the Swiss army, aged between 17 and 25 years old (mean age: 19 years old), who filled a self reported questionnaire about their alcohol, cigarettes, cannabis and other illicit drugs habits. Actual smoking was defined as either regular smoking (¡Ý1 cigarette/day, on every day) or occasional smoking, binge drinking as six or more drinks at least twice a month, at risk drinking as 21 drinks or more per week, recent cannabis use as cannabis consumption at least once during the last month, and use of illicit drugs as consumption once or more of illicit drugs other than cannabis. Age at begin was defined as age at first use of cannabis or cigarette smoking. RESULTS: In this population of young men, the prevalence of actual smoking was 51.2% (36.5% regular smoking, 14.6% occasionnal smoking). Two third of participamnts (60.1%) declared that they ever used cannabis, 25.2% reported a recent use of cannabis. 53.8% of participants had a risky alcohol consumption considered as either binge or at risk drinking. Cigarette smoking was significantly associated with recent cannabis use (Odds Ratio (OR): 3.85, 95% Confidence Interval (CI): 3.10- 4.77), binge drinking (OR: 3.48, 95% CI: 3.03-4.00), at risk alcohol drinking (OR: 4.04, 95% CI: 3.12-5.24), and ever use of illicit drugs (OR: 4.34, 95% CI: 3.54-5.31). In a multivariate logistic regression, odds ratios for smoking were increased for cannabis users (OR 3.10,, 95% CI: 2.48-3.88), binge drinkers (OR: 1.77, 95% CI: 1.44-2.17), at risk alcohol drinkers (OR 2.26, 95% CI: 1.52-3.36) and ever users of illicit drugs (OR: 1.56, 95% CI: 1.20-2.03). The majority of young men (57.3%) initiated smoking before cannabis and mean age at onset was 13.4 years old, whereas only 11.1% began to use cannabis before smoking cigarettes and mean age at onset was slightly older (14.4 years old). 31.6% started both cannabis and tobacco at the same age (15 years old). About a third of participants (30.5%) did have a cluster of risky behaviours (smoking, at risk drinking, cannabis use) and 11.0% did cumulate smoking, drinking, cannabis and ever use of illegal drugs. More than half of the smokers (59.6%) did cumulate cannabis use and at risk alcohol drinking whereas only 18.5% of non-smokers did. CONCLUSIONS: The majority of young smokers initiated their risky behaviors by first smoking and then by other psychoactive drugs. Smokers have an increased risk to present other risky behaviors such as cannabis use, at risk alcohol consumtion and illicit drug use compared to nonsmokers. Prevention by young male adults should focus on smoking and also integrate interventions on other risky behaviors.

Repercussion of a deficiency in mitochondrial ß-oxidation on the carbon flux of short-chain fatty acids to the peroxisomal ß-oxidation cycle in Aspergillus nidulans.

The fungus Aspergillus nidulans contains both a mitochondrial and peroxisomal ß-oxidation pathway. This work was aimed at studying the influence of mutations in the foxA gene, encoding a peroxisomal multifunctional protein, or in the scdA/echA genes, encoding a mitochondrial short-chain dehydrogenase and an enoyl-CoA hydratase, respectively, on the carbon flux to the peroxisomal ß-oxidation pathway. A. nidulans transformed with a peroxisomal polyhydroxyalkanoate (PHA) synthase produced PHA from the polymerization of 3-hydroxyacyl-CoA intermediates derived from the peroxisomal ß-oxidation of external fatty acids. PHA produced from erucic acid or heptadecanoic acid contained a broad spectrum of monomers, ranging from 5 to 14 carbons, revealing that the peroxisomal ß-oxidation cycle can handle both long and short-chain intermediates. While the ∆foxA mutant grown on erucic acid or oleic acid synthesized 10-fold less PHA compared to wild type, the same mutant grown on octanoic acid or heptanoic acid produced 3- to 6-fold more PHA. Thus, while FoxA has an important contribution to the degradation of long-chain fatty acids, the flux of short-chain fatty acids to peroxisomal ß-oxidation is actually enhanced in its absence. While no change in PHA was observed in the ∆scdA∆echA mutant grown on erucic acid or oleic acid compared to wild type, there was a 2- to 4-fold increased synthesis of PHA in ∆scdA∆echA cells grown in octanoic acid or heptanoic acid. These results reveal that a compensatory mechanism exists in A. nidulans that increases the flux of short-chain fatty acids towards the peroxisomal ß-oxidation cycle when the mitochondrial ß-oxidation pathway is defective.

Islands of euchromatin-like sequence and expressed polymorphic sequences within the short arm of human chromosome 21

The goals of the human genome project did not include sequencing of the heterochromatic regions. We describe here an initial sequence of 1.1 Mb of the short arm of human chromosome 21 (HSA21p), estimated to be 10% of 21p. This region contains extensive euchromatic-like sequence and includes on average one transcript every 100 kb. These transcripts show multiple inter- and intrachromosomal copies, and extensive copy number and sequence variability. The sequencing of the "heterochromatic" regions of the human genome is likely to reveal many additional functional elements and provide important evolutionary information.

A short motif in Drosophila SECIS Binding Protein 2 provides differential binding affinity to SECIS RNA hairpins

Selenoproteins contain the amino acid selenocysteine which is encoded by a UGA Sec codon. Recoding UGA Sec requires a complex mechanism, comprising the cis-acting SECIS RNA hairpin in the 3′UTR of selenoprotein mRNAs, and trans-acting factors. Among these, the SECIS Binding Protein 2 (SBP2) is central to the mechanism. SBP2 has been so far functionally characterized only in rats and humans. In this work, we report the characterization of the Drosophila melanogaster SBP2 (dSBP2). Despite its shorter length, it retained the same selenoprotein synthesis-promoting capabilities as the mammalian counterpart. However, a major difference resides in the SECIS recognition pattern: while human SBP2 (hSBP2) binds the distinct form 1 and 2 SECIS RNAs with similar affinities, dSBP2 exhibits high affinity toward form 2 only. In addition, we report the identification of a K (lysine)-rich domain in all SBP2s, essential for SECIS and 60S ribosomal subunit binding, differing from the well-characterized L7Ae RNA-binding domain. Swapping only five amino acids between dSBP2 and hSBP2 in the K-rich domain conferred reversed SECIS-binding properties to the proteins, thus unveiling an important sequence for form 1 binding.

Increasing the carbon flux toward synthesis of short-chain-length--medium-chain-length polyhydroxyalkanoate in the peroxisome of Saccharomyces cerevisiae through modification of the beta-oxidation cycle.

Short-chain-length-medium-chain-length polyhydroxyalkanoates were synthesized in Saccharomyces cerevisiae from intermediates of the beta-oxidation cycle by expressing the polyhydroxyalkanoate synthases from Aeromonas caviae and Ralstonia eutropha in the peroxisomes. The quantity of polymer produced was increased by using a mutant of the beta-oxidation-associated multifunctional enzyme with low dehydrogenase activity toward R-3-hydroxybutyryl coenzyme A.