Two Markers Complement Each Other in Identifying Risk
Two inflammatory markers—C-reactive protein and lipoprotein-associated phospholipase A2 (Lp-PLA2)—appear to be complementary identifiers of people with a high risk for coronary heart disease who have low levels of low-density lipoprotein cholesterol, said researchers in a report in this week’s issue of the journal Circulation (Circulation. 2004;109:837–842OpenUrl).
In this study, led by Christie Ballantyne, MD, of Baylor College of Medicine in Houston, the 12 819 members of the Atherosclerosis Risk in Communities (ARIC) Study were followed up for 6 years to determine the relation between Lp-PLA2, C-reactive protein, traditional risk factors, and the risk for coronary heart disease events. The researchers found that Lp-PLA2 and C-reactive protein levels were higher in 608 cases than in 704 noncases in this prospective, case–cohort study. In patients with levels of low-density lipoprotein cholesterol below 130 mg/dL, those with Lp-PLA2 and C-reactive protein levels in the highest tertile were at the greatest risk for a coronary heart disease event.
Risk Factors for Heart Disease May Predict Kidney Disease
Risk factors for heart disease—including high blood pressure, smoking, diabetes, and obesity—are also associated with risk of kidney disease, said researchers in a report in the February 18, 2004, issue of The Journal of the American Medical Association (JAMA. 2004;291:844–850OpenUrlCrossRefPubMed).
The study, led by Caroline S. Fox, MD, MPH, from the National Heart, Lung and Blood Institute’s Framingham Heart Study in Massachusetts, analyzed data from 1223 men and 1362 women enrolled in the Framingham Offspring Study who had had a baseline examination between 1978 and 1982 and a follow-up exam between 1998 and 2001. None had kidney disease at baseline, but after an average of 18.5 years, 244 (or 9.4%) had developed kidney disease.
The researchers noted that known cardiovascular risk factors predicted the development of kidney disease.
“In addition, a mildly reduced GFR [glomerular filtration rate] at baseline increased the odds of developing kidney disease. Our data indicate that among unselected participants, diabetes, hypertension, obesity, smoking, low HDL-C [high-density lipoprotein cholesterol] level, and a mild reduction in GFR are important risk factors for the development of new-onset kidney disease,” the authors write. “Patients with mildly reduced GFR should be monitored for progression to kidney disease.”
Preventing Bone Loss After Heart Transplantation
Alendronate may be a more attractive treatment for prevention of bone loss than calcitriol because of monitoring requirements, said researchers in a report in the February 19, 2004, issue of The New England Journal of Medicine (N Engl J Med. 2004;350:767–776OpenUrlCrossRefPubMed). In a head-to-head comparison of the two, the amount of bone loss and fracture rates in the two groups did not differ significantly.
One hundred forty-nine patients were randomly assigned to receive alendronate or calcitriol an average of 21 days after transplantation. Researchers, led by Elizabeth Shane, MD, of the College of Physicians and Surgeons at Columbia University in New York City, estimated bone loss and incidence of bone breaks in untreated patients by referring to a group of 27 heart transplantation patients recruited at the same time as the patients in the study groups.
At 1 year, bone mineral density was 0.7% lower in the group receiving alendronate and 1.6% lower in the calcitriol group. Bone mineral density at the femoral neck decreased 1.7% in the alendronate group and 2.1% in the calcitriol group. Hypercalciuria developed in 27% of the patients in the calcitriol group and 7% of the alendronate group. Both groups suffered less bone loss in the hip than did those in the reference group.