Critical appraisal of CRP measurement for the prediction of coronary heart disease events: new data and systematic review of 31 prospective cohorts.

Background: Non-uniform reporting of relevant relationships and metrics hampers critical appraisal of the clinical utility of C-reactive protein (CRP) measurement for prediction of later coronary events.

Methods: We evaluated the predictive performance of CRP in the Northwick Park Heart Study (NPHS-II) and the Edinburgh Artery Study (EAS) comparing discrimination by area under the ROC curve (AUC), calibration and reclassification. We set the findings in the context of a systematic review of published studies comparing different available and imputed measures of prediction.

Telangiectasia in the Edinburgh Vein Study: epidemiology and association with trunk varices and symptoms.

Objective: Little research has been devoted to telangiectasia. The purpose of this study was to analyse the data in the Edinburgh Vein Study to determine the prevalence of telangiectasia in the general population, to analyse the demographic characteristics and association with symptoms and to compare the findings to those relating to varices of the saphenous systems.

Design: Cross-sectional population study.

Metabolic syndrome, haemostatic and inflammatory markers, cerebrovascular and peripheral arterial disease: The Edinburgh Artery Study.

The role of metabolic syndrome and associated haemostatic and inflammatory markers in risk of atherosclerosis in different vascular beds is controversial. We used modified National Cholesterol Education Program criteria to define metabolic syndrome in a population-based cohort of men and women aged 55-74 years with up to 15 years of follow-up to investigate whether metabolic syndrome is associated with risk of cerebrovascular and peripheral arterial disease and the role of inflammatory and haemostatic factors in these relationships. Data were available for 762 participants, of whom 267 (35%) had metabolic syndrome at baseline and 69 (9.

Low dose aspirin and cognitive function in middle aged to elderly adults: randomised controlled trial.

Objective: To determine the effects of low dose aspirin on cognitive function in middle aged to elderly men and women at moderately increased cardiovascular risk.

Design: Randomised double blind placebo controlled trial.

Setting: Central Scotland.

Alpha+ -thalassaemia and malaria in Melanesia: epidemiological perspectives.

In 1948 Haldane first proposed that the high frequencies of thalassaemias in malaria-endemic regions were due to natural selection by malaria. Some of the highest frequencies of alpha+ -thalassaemia are found in the Pacific region of Melanesia. Consequently, Melanesia has provided a unique opportunity for an extensive study of the association between alpha+ -thalassaemia and malaria.

Retinal microvascular abnormalities and cognitive dysfunction: a systematic review.

Objective: To examine the evidence for an association between cognitive impairment or dementia and the presence of retinal microvascular abnormalities.

Methods: A systematic review of observational studies identified through searching five electronic databases and reference lists. Studies were required to have both a recognised cognitive function assessment (either a structured neuropsychological test or a clinical evaluation of dementia), and assessment of the retinal microvasculature (either characteristics associated with generalised retinopathy or changes specific to arterioles or venules).

Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis.

Context: Prediction models to identify healthy individuals at high risk of cardiovascular disease have limited accuracy. A low ankle brachial index (ABI) is an indicator of atherosclerosis and has the potential to improve prediction.

Objective: To determine if the ABI provides information on the risk of cardiovascular events and mortality independently of the Framingham risk score (FRS) and can improve risk prediction.

Epidemiology of chronic venous disease.

Chronic venous disease of the legs occurs commonly in the general population in the Western world. Estimates of the prevalence of varicose veins vary widely from 2-56% in men and from 1-60% in women. These variations reflect differences in variability of study populations including age, race and gender, methods of measurement and disease definition.

Bypass surgery for chronic lower limb ischaemia.

Background: Surgical bypass of an occluded arterial segment is one of the mainstay treatments for patients with critical limb ischaemia (CLI). However, it was introduced without formal evaluation.

Objectives: To determine the effects of bypass surgery in patients with CLI.

Increased microerythrocyte count in homozygous alpha(+)-thalassaemia contributes to protection against severe malarial anaemia.

Background: The heritable haemoglobinopathy alpha(+)-thalassaemia is caused by the reduced synthesis of alpha-globin chains that form part of normal adult haemoglobin (Hb). Individuals homozygous for alpha(+)-thalassaemia have microcytosis and an increased erythrocyte count. Alpha(+)-thalassaemia homozygosity confers considerable protection against severe malaria, including severe malarial anaemia (SMA) (Hb concentration < 50 g/l), but does not influence parasite count.

Host erythrocyte polymorphisms and exposure to Plasmodium falciparum in Papua New Guinea.

Background: The protection afforded by human erythrocyte polymorphisms against the malaria parasite, Plasmodium falciparum, has been proposed to be due to reduced ability of the parasite to invade or develop in erythrocytes. If this were the case, variable levels of parasitaemia and rates of seroconversion to infected-erythrocyte variant surface antigens (VSA) should be seen in different host genotypes.

Methods: To test this hypothesis, P.

Ankle brachial index and intima media thickness predict cardiovascular events similarly and increased prediction when combined.

Objective: To compare the predictive value of the ankle brachial index (ABI) and carotid intima media thickness (IMT) for cardiovascular events.

Study Design And Setting: Population-based cohort study. New cardiovascular events (myocardial infarction [MI], stroke, angina, and intermittent claudication) were ascertained over a 12-year period in 1,007 men and women aged 60-79 and free of MI or stroke.

The Emerging Risk Factors Collaboration: analysis of individual data on lipid, inflammatory and other markers in over 1.1 million participants in 104 prospective studies of cardiovascular diseases.

Many long-term prospective studies have reported on associations of cardiovascular diseases with circulating lipid markers and/or inflammatory markers. Studies have not, however, generally been designed to provide reliable estimates under different circumstances and to correct for within-person variability. The Emerging Risk Factors Collaboration has established a central database on over 1.

Cardiovascular diseases and decline in cognitive function in an elderly community population: the Edinburgh Artery Study.

Objective: To investigate cognitive performance and 4-year change in cognitive function in relation to different clinical manifestations of atherosclerotic disease in an elderly community population.

Methods: The Edinburgh Artery Study is a population cohort study of men and women who were recruited to a baseline survey in 1987 and 1988. From the time of study entry, the participants have been invited to two follow-up clinical examinations and continuously monitored for major fatal and nonfatal vascular events.

Final 12-year follow-up of surgery versus surveillance in the UK Small Aneurysm Trial.

Background: The aim was to determine whether early open surgical repair would benefit patients with small abdominal aortic aneurysm compared with surveillance on long-term follow-up.

Methods: The 1090 patients who were enrolled into the UK Small Aneurysm Trial between 1991 and 1995 were followed up for aneurysm repair and mortality until November 2005.

Results: By November 2005, 714 patients (65.

Cognitive decline and markers of inflammation and hemostasis: the Edinburgh Artery Study.

Objectives: To determine whether circulating markers of activated inflammation and hemostasis are associated with cognitive decline in older people.

Design: Prospective cohort study (Edinburgh Artery Study).

Setting: Eleven general practices in Edinburgh, Scotland.

Relative value of inflammatory, hemostatic, and rheological factors for incident myocardial infarction and stroke: the Edinburgh Artery Study.

Background: The aim of our present study was to compare the association of a wide range of 17 biomarkers of inflammation, hemostasis, and blood rheology with incident heart disease and stroke after accounting for an indicator of subclinical atherosclerotic disease and traditional risk factors and also to determine their incremental predictive ability.

Methods And Results: We used data from the Edinburgh Artery Study, a population cohort study started in 1987 that comprised 1592 men and women aged 55 to 74 years. Subjects were followed for a mean of 17 years, and 416 of them suffered at least 1 cardiovascular event.

Low prevalence of an acute phase response in asymptomatic children from a malaria-endemic area of Papua New Guinea.

Levels of C-reactive protein (CRP), a classic marker for the acute phase response (APR), were measured in children with asymptomatic malaria infection in the Amele region of Papua New Guinea (PNG). Despite the presence of parasitemia, the prevalence of CRP levels consistent with an APR (CRP > 10 microg/mL) was very low (< 10%). Splenomegaly was significantly associated with increased parasitemia (P < 0.

Inflammatory, haemostatic, and rheological markers for incident peripheral arterial disease: Edinburgh Artery Study.

Aims: Recently, markers of inflammation, haemostasis, and blood rheology have received much attention as risk factors for coronary heart disease and stroke. However, their role in peripheral arterial disease (PAD) is not well established and some of them, including the pro-inflammatory cytokine interleukin-6 (IL-6), have not been examined before in prospective epidemiological studies.

Methods And Results: In the Edinburgh Artery Study, we studied the development of PAD in the general population and evaluated 17 potential blood markers as predictors of incident PAD.

Distribution of a subclinical marker of cardiovascular risk, the ankle brachial index, in a rural African population: SASPI study.

Background: In sub-Saharan Africa, hypertension and stroke are emerging as an important cause of death and disability, whereas coronary heart disease appears still to be uncommon. The aim of our study was to measure for the first time in an African population the ankle brachial index (ABI), which is known to be a good marker of subclinical atheroma and of the risk of future cardiovascular events.

Methods: The study was part of the Southern African Stroke Prevention Initiative (SASPI).

Ankle-brachial index and extent of atherothrombosis in 8891 patients with or at risk of vascular disease: results of the international AGATHA study.

Aims: AGATHA (a Global Atherothrombosis Assessment) was designed to assess the extent of atherothrombosis and the use of the ankle-brachial index (ABI) in vascular patients. The principal hypotheses were that (1) in diseased patients, a low ABI was related to the number and site of vascular beds affected and (2) in at-risk patients without disease, a low ABI was related to the number of risk factors present.

Methods And Results: Patients were recruited consecutively by 482 clinicians in 24 countries and the ABI measurement was performed at a single visit.