RESUMO
INTRODUCTION: This study aimed to determine whether ethnic differences show different patterns of arterial disease in the lower limb. METHODS: A prospective analysis of 100 consecutive patients with 160 lower limb arteriograms was performed looking at the pattern of disease with relation to ethnicity in Trinidad and Tobago. RESULTS: There were 53 male and 47 female patients with an age range of 43-90 years (mean: 66 years). Of the 100 patients, 45 were of East Indian descent, 36 of Afro-Caribbean descent, 14 of mixed descent and 5 had other backgrounds. There were 32 smokers and 69 diabetics. The most commonly affected artery in East Indians was the anterior tibial artery (ATA, 70%) followed by the peroneal artery (60%), superficial femoral artery (SFA, 60%), posterior tibial artery (PTA, 57%) and tibioperoneal trunk (TPT, 39%). In Afro-Caribbeans, the most commonly affected artery was the ATA (79%) followed by the PTA (74%), peroneal artery (66%) and TPT (55%). The mixed group showed the PTA (85%) to be most diseased followed by the peroneal artery (75%), ATA (70%), SFA (70%), dorsalis pedis artery (DPA, 60%) and TPT (50%). Overall, the most diseased vessel in all groups was the ATA (73%) followed by the PTA (66%), peroneal artery (64%), SFA (59%), TPT (46%), DPA (38%), popliteal artery (31%) and medial plantar artery (MPA, 29%), with the proximal vessels not being affected severely. CONCLUSIONS: Ethnic divisions were only statistically significant (p<0.05) with East Indians showing worse disease in the profunda femoris artery and Afro-Caribbeans showing worse disease in the PTA, DPA and MPA. This suggests that environmental factors may play a significant role in the disease process including smoking and dietary factors rather than purely genetics.
Assuntos
Arteriosclerose/etnologia , Extremidade Inferior/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriosclerose/diagnóstico por imagem , População Negra/etnologia , Feminino , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Trinidad e Tobago/epidemiologiaRESUMO
An association has been reported between cardiovascular disease (CVD) and osteoporosis, perhaps attributable to the presence of common risk factors. To assess this possibility, we measured areal bone mineral density (BMD) and carotid artery intimal medial thickness (IMT), a measure of preclinical atherosclerosis, in 535 women and 335 men from the San Antonio Family Osteoporosis Study. Variance decomposition methods were used to determine whether cross-sectional measures of areal BMD (measured by dual-energy X-ray absorptiometry) of the total hip, spine, and forearm were correlated with IMT, serum lipids, and/or C-reactive protein (CRP), a marker of inflammation, after accounting for known environmental factors. We observed significant inverse correlations of IMT and BMD at all bone sites in women >60 years of age (P < 0.001) and modest positive correlations (not significant) of IMT on hip BMD (P < 0.1) in women <60 years of age. Similarly, we observed negative correlations between IMT and forearm BMD in men >60 years of age (P < 0.001) and positive correlations in men <60 years of age (P = 0.05). Variation in risk factors for CVD, including serum levels of low- and high-density lipoprotein cholesterol, low-density lipoprotein particle size, triglycerides, paraoxonase 1 activity, and CRP did not account for the relationship between BMD and IMT in either older or younger men or women. In summary, our results demonstrate that decreased BMD is correlated with increased IMT in older (but not younger) Mexican American men and women, independent of serum CVD risk factors.
Assuntos
Arteriosclerose/etnologia , Arteriosclerose/etiologia , Densidade Óssea , Osteoporose/complicações , Osteoporose/etnologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artérias Carótidas/diagnóstico por imagem , Feminino , Humanos , Masculino , Americanos Mexicanos , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Radiografia , Fatores de Risco , Texas/epidemiologia , Túnica Íntima/diagnóstico por imagemRESUMO
The powerful relation between atherosclerosis and diabetes may have a common genetic basis. However, few genes predisposing to both have been identified. Calpain-10 (CAPN10) was the first gene for type 2 diabetes identified by positional cloning, wherein a combination of haplotypes conferred increased risk of diabetes. We sought to determine whether CAPN10 influences subclinical atherosclerosis. Among nondiabetic subjects from 85 Mexican-American families with a history of coronary artery disease, subclinical atherosclerosis was assessed by common carotid artery intima-media thickness (IMT), insulin sensitivity was assessed by hyperinsulinemic-euglycemic clamp, and insulin secretion was estimated by the oral glucose tolerance test. These phenotypes were tested for association with CAPN10 haplotypes. Haplotype 1112 (of single nucleotide polymorphisms [SNPs] 44, 43, 56, and 63) was associated with increased IMT, while haplotype 1221 was associated with decreased IMT. The 112/121 haplotype combination (of SNPs 43, 56, and 63), originally found to confer increased risk for diabetes, was associated with the largest IMT in our study population. CAPN10 was also associated with both insulin sensitivity and insulin secretion. Covariate analysis suggested that CAPN10 affects IMT independently of these diabetes-related phenotypes. The fact that the diabetes gene CAPN10 also influences the risk for atherosclerosis shows that inherited factors may underlie the frequent co-occurrence of these two conditions.
Assuntos
Arteriosclerose/genética , Calpaína/genética , Adolescente , Adulto , Idoso , Arteriosclerose/enzimologia , Arteriosclerose/etnologia , Doenças das Artérias Carótidas/genética , Doenças das Artérias Carótidas/patologia , Doença das Coronárias , Diabetes Mellitus Tipo 2/genética , Feminino , Predisposição Genética para Doença , Genótipo , Haplótipos , Humanos , Resistência à Insulina/genética , Masculino , Americanos Mexicanos/genética , Pessoa de Meia-Idade , Fenótipo , Túnica Íntima/patologiaRESUMO
Low bone mineral density (BMD) is a predictor of cardiovascular mortality, suggesting that osteoporosis and cardiovascular disease may share common risk factors. We assessed the relationship between BMD and intimal medial thickening (IMT) of the common carotid artery, a marker of sub-clinical atherosclerosis, in 471 women examined as part of the San Antonio Family Osteoporosis Study, a population-based study of osteoporosis risk conducted in Mexican American families. Because of the documented role of vitamin D metabolism in bone metabolism and its possible role in cardiovascular function, we further evaluated whether allelic variation at the vitamin D receptor locus (VDR) influenced joint variation in BMD and IMT. The association of BMD with IMT depended on age, with low BMD being correlated with high IMT in older women, but with low IMT in younger women [age by IMT interaction effects significant at the spine (P = 0.042), radius ultradistal (P = 0.010), and hip (P = 0.006)]. In all women, the VDR BsmI BB genotype was associated with significantly higher forearm BMD (P = 0.005 for both radius ultradistal and midpoint), higher IMT (P = 0.05), and higher spine BMD in older women (P = 0.06), but not with hip BMD. The association of the VDR genotype with IMT was independent of its association with BMD. Although a functional consequence of the BsmI polymorphism on vitamin D metabolism has not been established, these findings support a possible biological relationship among VDR, bone metabolism, and atherosclerosis. We conclude that VDR polymorphisms may be one of multiple factors influencing the joint risk of atherosclerosis and osteoporosis.
Assuntos
Arteriosclerose/genética , Densidade Óssea/genética , Americanos Mexicanos/genética , Osteoporose Pós-Menopausa/genética , Polimorfismo Genético , Receptores de Calcitriol/genética , Adulto , Arteriosclerose/etnologia , Arteriosclerose/patologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/etnologia , Osteoporose Pós-Menopausa/patologia , Pós-Menopausa , Pré-Menopausa , Receptores de Calcitriol/metabolismo , Fatores de Risco , Texas/epidemiologia , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/patologia , Túnica Média/diagnóstico por imagem , Túnica Média/patologia , UltrassonografiaRESUMO
Grande parte da morbidade e mortalidade nos países ocidentais é devido à doença cardiovascular, sendo que se destaca, pela freqüência e gravidade, a doença arterial coronária. Na maioria dos casos, uma ou mais artérias coronárias sofrem processo aterosclerótico, sobre o qual se assesta um trombo, precipitando o evento agudo - daí a denominação aterotrombose para o quadro.Em geral, o desenvolvimento do processo aterotrombótico tem a seguinte seqüência: disfunção endotelial, aderência e infiltração de monócitos à parede arterial, penetração de partículas de LDL (lipoproteínas de baixa densidade), formação da estria gordurosa, lesão gelatinosa, placa fibrosa, ulceração e trombose. Esta última pode obstruir parcial ou totalmente a luz do vaso, levando ou não ao quadro clínico agudo e, eventualmente, ao crescimento da placa aterosclerótica. Há anos foram reconhecidos os denominados fatores de risco, atributos de cada indivíduo que predispõem ao processo aterotrombótico. Seu reconhecimento e controle permite a prevenção do desenvolvimento ou a progressão da doença aterotrombótica. Importante salientar que é comum a presença, no mesmo indivíduo, de mais de um fator de risco, o que traz muitas vezes potencialização de seu efeito deletério. Daí a necessidade da avaliação global de risco...
Assuntos
Masculino , Feminino , Criança , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Arteriosclerose/dietoterapia , Arteriosclerose/etnologia , Arteriosclerose/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Fatores de Risco , TromboseRESUMO
Trinidadians of South Asian origin have a high prevalence of cardiovascular disease and diabetes compared to Trinidadians of African origin. The degree to which these differences are related to genetic and/or environmental factors is unclear. To determine whether there might be a genetic basis for this difference in prevalence of deleterious phenotypes we examined allele frequencies for candidate genes in atherosclerosis and diabetes. We genotyped 81 consecutive neonates of African origin and 103 consecutive neonates of South Asian origin. We evaluated common polymorphisms in 11 candidate genes for atherosclerosis and diabetes. We found differences between the two subpopulations in the allele frequencies of several candidate genes, including APOE, LIPC, APOC3, PON1, PON2, and PPP1R3. However, the differences in the allele frequencies were not all consistent with the pattern of CHD expression between these two ethnic groups in adulthood. Thus, differences in genetic architecture alone may not explain the wide disparities in disease prevalence between these two subpopulations. It is very likely that environmental factors, or unmeasured genetic factors, influence the genetic susceptibility to disease in these subpopulations.
Assuntos
Arteriosclerose/etnologia , Arteriosclerose/genética , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/genética , Frequência do Gene/genética , Polimorfismo Genético/genética , África/etnologia , Sudeste Asiático/etnologia , Sangue Fetal , Marcadores Genéticos/genética , Predisposição Genética para Doença/genética , Humanos , Recém-Nascido , Fenótipo , Prevalência , Fatores de Risco , Trinidad e Tobago/epidemiologiaRESUMO
We investigated the effects of apolipoprotein (apo) B signal peptide length polymorphisms on low density lipoprotein cholesterol (LDL-C), apo B, and post-challenge (2 h) glucose levels in 686 Mexican Americans from 34 families. The most common allele encoded an apo B signal peptide of 27 amino acids (ins; SP-27), the next most frequent allele encoded a 24 amino acid signal peptide (del; SP-24), and the rarest allele encoded a 29 amino acid signal peptide (ins; SP-29) that has been found only in Mexican Americans. Homozygotes for the SP-24 allele had significantly higher mean levels of apo B. LDL-C, and 2-h glucose than SP-27 homozygotes, and SP-27/SP-24 heterozygotes had intermediate levels (P = 0.01 for apo B, P < 0.001 for LDL-C, and P = 0.04 for 2-h glucose). Heterozygotes for the SP-29 allele had higher apo B and LDL-C levels compared to homozygotes for the SP-27 or SP-24 alleles. Apo B signal peptide length polymorphism accounted for 4.2%, 3.5%, and 3.0% of the residual variation in LDL-C, apo B, and 2-h glucose levels, respectively, among the Mexican American families.
Assuntos
Apolipoproteínas B/genética , Glicemia/análise , LDL-Colesterol/sangue , Americanos Mexicanos/genética , Polimorfismo Genético , Sinais Direcionadores de Proteínas/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Alelos , Apolipoproteínas B/sangue , Arteriosclerose/epidemiologia , Arteriosclerose/etnologia , Sequência de Bases , Gorduras na Dieta , Suscetibilidade a Doenças/etnologia , Ingestão de Energia , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Esforço Físico , Pobreza , Fatores de Risco , Texas/epidemiologiaRESUMO
Comparison of aortic and coronary atherosclerosis in the United States, Jamaica, Japan and India demonstrates that after the first two decades of life, there is a greater severity of intimal alteration in the United States than in the other population groups. The 3 foreign populations exhibited much less coronary atherosclerosis and a lower incidence of myocardial infarction. Their diets, too, were of lower caloric content and contained less than half the fat found in the United States diet. In Japan and Jamaica, atherosclerosis proved to be disproportionately more severe in the aorta than in the coronary arteries. Accordingly, appraisals of atherosclerosis limited to the aorta do no provide adequate indexes of geographical variations. A much lower proportion of complicated atheromatous lesions (ulcerated or calcified plaques) accounted for most of the differences observed. While there was a general parallelism between the severity of coronary atherosclerosis and the frequency of myocardial infarction, there were instances of cardiac infarction associated with relatively minor degrees of coronary intimal alteration. These situations indicate that virtually all grossly recognizable intimal lesions may be complicated by thrombosis (Summary)