Objective: Left ventricular hypertrophy (LVH) is a significant predictor of adverse cardiovascular events. Experimental studies suggest a pathophysiological role of magnesium (Mg(2+)) in the development of arterial hypertension and LVH.Methods: In subjects with complete echocardiographic data from the population-based longitudinal "Study of Health in Pomerania" (n = 1 348), the difference in left ventricular mass (LVM) over 5 years (echocardiography) was analyzed in relationship to serum Mg2+ at baseline.Results: Mg(2+) at baseline (0.790 perpendicular to 0.003 mmol/l, mean perpendicular to SEM) inversely correlated with the difference in LVM over 5 years (p < 0.0001, females: p < 0.002, males: p < 0.024). In the lowest Mg(2+)-quintile (Mg(2+) < = 0.73 mmol/l), LVM (187.4 +/- 3.1 g at baseline) increased by 14.9 +/- 1.2 g, while in the highest Mg(2+)-quintile (Mg(2+) > = 0.85 mmol/l) LVM (186.7 +/- 3.4 g at baseline) decreased by -0.5 +/- 2.8 g (p < 0.0001 between quintiles). By multivariable analysis including several cardiovascular risk factors and antihypertensive treatment, serum Mg(2+) was associated with the increase in LVM at a statistically high significant level (p < 0.0001). LVM after 5 years was significantly higher in subjects within the lower Mg(2+)-quintiles. This association remained highly significant after adjustment for several cardiovascular risk factors including arterial hypertension and diabetes mellitus.Conclusions: Hypomagnesemia is one of the strongest predictors of gain in LVM over the following 5 years. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

OBJECTIVE:IGF1 mediates multiple physiological and pathophysiological responses in the cardiovascular system. The aim of this study was to analyze the association between serum IGF1 as well as IGF-binding protein 3 (IGFBP3) levels and endothelial function measured by flow-mediated dilation (FMD).DESIGN:Cross-sectional population-based observational study.METHODS:The study population comprised 1482 subjects (736 women) aged 25-85 years from the Study of Health in Pomerania. Serum IGF1 and IGFBP3 levels were determined by chemiluminescence immunoassays. FMD measurements were performed using standardized ultrasound techniques. FMD values below the sex-specific median were considered low.RESULTS:In males, logistic regression analyses revealed an odds ratio (OR) of 1.27 (95% confidence interval (CI) 1.07-1.51; P=0.008) for decreased FMD for each decrement of IGF1 s.d. after adjustment for major cardiovascular confounders. In females, no significant relationship between serum IGF1 and FMD was found (OR 0.88, CI 0.74-1.05; P=0.147). After exclusion of subjects with the current use of antihypertensive medication, these findings were similar (males: OR 1.40, CI 1.12-1.75; P=0.003; females: OR 0.95, CI 0.77-1.16; P=0.595). There was no association between serum IGFBP3 levels and FMD in both sexes.CONCLUSIONS:Low serum IGF1 levels are associated with impaired endothelial function in males. In women, serum IGF1 is not associated with endothelial function.

Objective We assessed whether the relationship between electrocardiographic and echocardiographic information on left ventricular hypertrophy predicts the development of left ventricular mass over 5 years.Methods Linear regression analyses between various electrocardiographic indices of left ventricular hypertrophy and left ventricular mass (echocardiography) indexed to height(2.7) (LVMIht) was performed in 1488 individuals in each gender subgroup (45-79 years, 841 female, exclusion of intraventricular conduction defects) from the population-based, longitudinal 'Study of Health in Pomerania'. A parameter expressing the difference between observed ECG indices of left ventricular hypertrophy and ECG indices predicted on the basis of echocardiographic readings was calculated in each individual at the baseline visit.Results In individuals with complete echocardiographic data at baseline and 5-year-follow-up (n = 1031, exclusion of aortic valve disease), LVMIht at 5-year-follow-up was significantly correlated with the parameter derived from the Cornell product (P<0.001), the Cornell voltage (P<0.001), the Gubner-Ungerleider-product (P<0.001), the Gubner-Ungerleider-voltage (P<0.001), Lewis voltage (P<0.001) and aVL voltage (P<0.001), but not with Sokolow-Lyon-index-derived parameters. LVMIht at baseline did not significantly correlate with any of these ECG-derived parameters. In female individuals with Cornell products higher than expected based on echocardiographic readings, left ventricular mass increased from 162.3 +/- 2.6 g to 180.5 +/- 2.8 g (males: 213.1 +/- 3.7 g to 236.3 +/- 4.2 g), whereas left ventricular mass increased only from 161.8 +/- 2.5 g to 173.5 +/- 2.8 g (males: 209.7 +/- 3.7g to 215.8 +/- 3.7 g) in individuals with lower than expected Cornell products (P<0.001).Conclusion The relationship of electrocardiographic and echocardiographic information on left ventricular mass may identify individuals at risk for developing progressive increase in left ventricular mass. J Hypertens 27:861-868 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

The aim of the present study was to analyze the relation of low or high serum thyrotropin (TSH) with mortality in patients with invasively treated coronary artery disease. We followed-up 942 patients who underwent coronary angioplasties or coronary artery bypass graft surgery over a mean follow-up period of 6.4 +/- 1.6 years. The study population was divided into three groups using the reference limits of serum TSH (0.25-2.12 mIU/l) as cut-offs. There were 118 patients (12.5%) with low and 125 patients (13.3%) with high serum TSH. One hundred and seventy-four subjects (18.5%) deceased during follow-up. Multivariable analyses revealed that both subjects with low and high serum TSH had a lower all-cause and circulatory mortality than subjects with serum TSH within the reference range. We conclude that low and high serum TSH levels are associated with a reduced all-cause and circulatory mortality in patients with coronary artery disease. (c) 2008 Elsevier Ireland Ltd. All rights reserved.

Hintergrund: Insuline-like growth factor-1 (IGF-1) vermittelt zahlreiche physiologische und pathophysiologische Mechanismen im kardiovaskulären System. So wurden Zusammenhänge zwischen IGF-1-Spiegeln und kardiovaskulärer Morbidität bzw. Mortalität nachgewiesen. Ob die Serumspiegel von IGF-1 oder seines Bindungsproteins IGFBP3 mit der Endothelfunktion assoziiert sind, wurde bislang in keiner populationsbasierten Studie systematisch untersucht.

AIMS:High serum thyrotropin (TSH) levels within the reference range might be associated with an increased cardiovascular risk. In the present study, we investigated the association between serum TSH levels and flow-mediated dilation (FMD) as a measure of endothelial dysfunction. METHODS AND RESULTS:The study population comprised 1364 subjects (670 women) aged 25-85 years with serum TSH levels between 0.25 and 2.12 mIU/L recruited from 5-year follow-up of the Study of Health in Pomerania. No interventions were performed. Measurements of FMD and nitrate-mediated dilation (NMD) were performed in the supine position using standardized ultrasound techniques. FMD and NMD values below the median of each distribution were considered decreased. Analyses adjusted for age, sex, smoking, and systolic and diastolic blood pressure revealed a non-significant inverse trend between serum TSH levels and FMD (P = 0.130). Subjects with serum TSH levels above the highest quartile had lower median FMD values relative to subjects with serum TSH levels below the lowest quartile (4.86 vs. 5.43%, P < 0.05). A linear inverse trend between serum TSH levels and decreased FMD barely missed statistical significance (P = 0.138). Subjects with high serum TSH levels had higher odds of decreased FMD relative to subjects with low serum TSH levels (odds ratio 1.42; 95% confidence interval 1.02; 1.96; P < 0.05). These associations were more pronounced in men than in women. There were no such associations for NMD. CONCLUSION:Serum TSH levels within the upper reference range are associated with impaired endothelial function. Our findings contribute to the discussion on whether the upper TSH reference limit should be redefined.

Objectives: We tested the hypothesis that working shifts is related to atherosclerosis and myocardial infarction.Background: The number of shift workers is continuously increasing. Shift work is discussed to be related with cardiovascular heart disease.Methods: A total of 25 10 Subjects recruited for the population-based Study of Health in Pomerania were tested, 698 of whom were former shift workers. A general population sample was examined to reach generalizibility and to produce results independent from the effects of the personal shift schedule and from the specific working conditions. Carotid ultrasound was performed to evaluate carotid intima-media thickness. We used multivariable analyses to estimate the coronary heart disease risk, adjusted for age, sex and atherosclerotic risk factors, stratified by exposure to shift work and its duration.Results: Atherosclerotic risk factors differed in part between shift workers and non-shift workers. Shift work was associated with atherosclerosis and myocardial infarction, depending on the duration of the exposure and the age of the participants. Multivariable Cox regression analysis identified shift work as a risk factor for myocardial infarction to be manifest at younger ages (adjusted hazard ratio 1.53, 95% CI 1.06-2.22).Conclusions: Exposure to shift work is a risk factor for atherosclerosis and myocardial infarction. Special prevention programs for shift workers should be provided. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

Increased cardiac left ventricular mass (LVM) is a significant predictor of adverse cardiovascular events. Experimental studies suggest a pathophysiological role of magnesium (Mg ++ ) in the development of arterial hypertension and left ventricular hypertrophy (LVH). Subjects, aged 45 – 79 years, from the population-based, epidemiological, longitudinal “Study of Health in Pomerania” with complete echocardiographic data (n = 1 348 after exclusion of aortic valve disease) were grouped into five quintiles according to serum Mg ++ at baseline (0.790±0.003 mmol/l, mean±SEM). In the lowest Mg ++ -quintile (Mg ++ <<26>0.73 mmol/l), LVM (187.4±3.1 g at baseline) increased by 14.9±1.2 g over the following five years, while in the highest Mg ++ -quintile (Mg ++ <<0.85 mmol/l) LVM (186.7±3.4 g at baseline) decreased by −0.5±2.8 g (p<0.0001 between quintiles). After five years, LVM was significantly higher in the lowest Mg ++ -quintile (LVM: 202.2±3.4 g) in comparison to the highest Mg ++ -quintile (187.2±3.5 g, p<0.003 between quintiles). Mg ++ inversely correlated with the difference in LVM over five years (p<0.0001, females: p<0.002, males: p<0.024) and also with differences in Sokolow-Lyon-index over five years (p<0.01). Unlike age, gender, presence of hypertension or diabetes mellitus, body mass index, smoking status, renal function, high-sensitive C-reactive protein and use of various antihypertensive drugs including diuretics, only Mg ++ (p<0.0001), pulse pressure (p<0.002) and use of β-blockers (p<0.04) were identified as independent predictors of difference in LVM over five years. Hypomagnesemia is one of the strongest predictors of increase in LVM over the following five years. It should initiate decisive preventive measures in subjects prone to developing LVH.

Two patients with dissecting (n = 1) and saccular (n = 1) aneurysms of the infrarenal abdominal aorta with very narrow proximal and distal aortic necks underwent treatment with percutaneous implantation of self-expandable polytetrafluoroethylene (PTFE)-covered nitinol stent-grafts on an off-label basis. The stent-grafts had maximum diameters of 13.5 mm and were deployed via 10-F introducer sheaths. Complete coverage of both aneurysms was achieved without evidence of endoleaks. The only complication observed was a pseudoaneurysm of the femoral access site in one patient, which was treated conservatively. Based on the experience described in this report, an aortic aneurysm with a narrow aortic neck can be safely treated with a PTFE-covered nitinol stent-graft.

Objectives: An association of sleep with cardiovascular disease has been suggested. We analyzed the association of sleep duration with carotid intima-media thickness (IMT) as measure of generalized atherosclerosis.Methods: IMT of the common carotid arteries was measured in 2437 participants of the Study of Health in Pomerania (SHIP). Participants indicated their daily sleep duration as sum of night and afternoon sleep.Results: There was a J-shaped association of sleep duration (5 to 11/12 h) with IMT. In this association, IMT values were lowest among subjects with an average sleep duration of 7 - 8 h (0.76 +/- 0.15 and 0.79 +/- 0.16 mm, respectively) but increased with shorter and, still more so, with longer sleep duration. Subjects with only 5 h sleep showed age- and sex-adjusted differences of 0.042 mm IMT (95% confidence interval 0.008 - 0.076 versus 8 h sleep). IMT values were still greater among subjects with 11 - 12 h sleep (adjusted differences versus 8 h sleep 0.084 mm [0.040 - 0.128] IMT). Further adjustment for lifestyle indicators, socioeconomic determinants, and biological variables attenuated these differences, but they remained significant.Conclusions: Both longer and shorter sleep duration is associated with an increased risk of atherosclerosis. These findings support the hypothesis that sleep is related to cardiovascular disease. (c) 2007 Elsevier Ireland Ltd. All rights reserved.

Aims: We undertook this prospective observational study to investigate the long-term prognosis after balloon angioplasty (PTCA), coronary stenting (CS) and coronary artery bypass grafting (CABG).Methods and results: A total number of 1038 patients with PTCA (n=499), CS (n=294) or CABG (n=245) were followed-up over a mean time of 6.4 +/- 1.8 years. Forty-two patients (4.0%) were lost to follow-up, leaving a study population of 996 subjects who were available for analyses. The primary and secondary endpoints were mortality and major adverse cardiac events (MACE), respectively. Overall death rate was 19.3%. Age, pulse pressure, smoking, diabetes, serum LDL cholesterol levels and left ventricular ejection fraction rather than the intervention type independently predicted mortality. The incidence rate of MACE was 53.7%. Compared to PTCA patients, CS patients had lower (hazard ratio 0.693; 95% confidence interval 0.514-0.793) and CABG patients the lowest risk of MACE (hazard ratio 0.343; 95% confidence interval 0.261-0.450). Further risk factors for MACE were serum LDL cholesterol levels, three-vessel coronary artery disease and left ventricular ejection fraction of < 30%.Conclusion: Long-term mortality does not differ among patients who received percutaneous interventions or CABG. Major adverse cardiac events occur more often in patients with previous percutaneous interventions, whereby CS has advantage over PTCA. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

BACKGROUND:Thyroid dysfunction is associated with detrimental cardiovascular effects. We analyzed whether thyroid status is related to carotid artery plaques and prevalent strokes. DESIGN, PATIENTS AND MEASUREMENTS:Data from 2128 subjects (1157 men and 971 women) aged > or =45 years without thyroid diseases participating in the Study of Health in Pomerania were analyzed. The presence of carotid plaques was assessed by B-mode ultrasound and prevalent stroke was assessed by interview. The sample was divided according to the reference range of serum TSH levels into decreased (<0.25 mIU/l), normal (0.25-2.12 mIU/l), and elevated (>2.12 mIU/l). Logistic regression models were adjusted for common confounders including age, sex, BMI, hypertension, diabetes mellitus, smoking, school education, plasma fibrinogen and serum cholesterol levels, and statins. RESULTS:The prevalence of carotid plaques at any site was higher in subjects with decreased serum TSH levels (81.7%) compared with normal serum TSH levels (70.2%) and elevated serum TSH levels (65.6%; P<0.001). Fully adjusted logistic regression models revealed increased odds for carotid plaques (odds ratio (OR) 1.67; 95% confidence interval (CI) 1.11-2.51; P<0.05) as well as for prevalent strokes (OR 1.98; 95% CI 1.05-3.73; P<0.05) in subjects with decreased serum TSH levels, while there was no association between elevated serum TSH levels and carotid plaques or stroke respectively. CONCLUSIONS:Thyroid function was associated with the presence of carotid artery plaques and prevalent strokes in this population-based sample. Periodical screening and early treatment of atherosclerotic risk factors should be performed in subjects with decreased serum TSH levels.

BACKGROUND:Results for standard revascularization therapies in acute myocardial infarction (AMI) have been limited in part by distal embolization, a process which might be reduced by the application of ultraviolet laser light. The aim was to assess feasibility and safety of excimer laser coronary angioplasty (ELCA) in a randomized study in AMI. METHODS:Twenty-seven consecutive patients with ST-segment elevation AMI (aged 57.8+/-9.2 years) were randomized either to balloon angioplasty and stent implantation alone (n=13) or adjunct ELCA (n=14). Quantitative coronary angiography was analyzed by an independent core laboratory. RESULTS:ELCA was feasible and safe in all cases. No procedure-associated complications were observed. Similar results were found for main parameters in laser (L) and control (C) patients: diameter stenosis decreased from 94.3+/-9.6 to 20.7+/-10.3% (L) and from 82.7+/-16.8 to 18.9+/-5.5% (C) (p=ns; L vs. C). TIMI flow increased from 0.7+/-1.2 to 2.8+/-0.4 and from 1.7+/-1.5 to 3.0+/-0 (p=ns; L vs. C), respectively. The post-procedural myocardial blush score did not differ between the groups (2.1+/-1.3 and 2.7+/-1.0; p=ns; L vs. C) and the final corrected TIMI frame count (cTFC) was also similar in both groups (23+/-7 and 22+/-4; p=ns; L vs. C), but the cTFC gain was higher in the laser group (53+/-14% and 35+/-20%; p<0.05; L vs. C). CONCLUSIONS:Laser angioplasty is feasible and safe for the treatment of patients with ST elevation AMI. Procedural results were at least on par with conventional treatment. Further randomized controlled trials are needed to assess the benefit of laser angioplasty in AMI.

We have evaluated a portable electrocardiogram (ECG) card in the large population-based epidemiological 'Study of Health in Pomerania' (SHIP). In all, 7008 men and women (20-79 years) were randomly selected from population registries and 4310 subjects participated. Participants used an ECG card for four weeks and recorded two ECGs daily. The participants were also encouraged to record additional ECGs in the case of symptomatic arrhythmias, chest pain or dizziness. The ECGs were sent via telephone. Acrobat (.pdf) files arrived at the study centre via email. Arrhythmias were analysed by visual ECG inspection. Seventy-one per cent of the participants sent at least 80% of the requested ECGs for four weeks. There were few problems (about 70) in the total of 38,162 ECGs transmitted. Overall, 94% of all ECGs were rated as 'good'. Physicians required about 1.5 h to read approximately 100 ECGs daily. The functionality and ergonomics of ECG cards appear to be sufficiently developed for large-scale use in epidemiological studies.

Objectives: The goal of this study was to determinate whether functional thyroid status was associated with rate-adjusted QT intervals (QTc) in a general population.

Decreased serum TSH levels predict cardiovascular mortality, which could be explained by left ventricular hypertrophy (LVH). The aim of this analysis was to investigate the association between thyroid function and LVH. The population-based Study of Health in Pomerania was conducted in a previously iodine-deficient area. Data of 1510 individuals at least 45 yr of age with echocardiography and without thyroid disorders were analyzed. LVH was defined as a left ventricular mass index (LVMI) exceeding 150 g/m(2) (men) or 120 g/m(2) (women). Overt hyperthyroidism was associated with LVMI (P < 0.01), whereas euthyroid subjects and those with elevated TSH levels did not significantly differ with regard to LVMI. LVH was observed in three (15.0%) subjects with elevated serum TSH levels, in 127 (10.5%) euthyroid persons, in 24 (12.5%) individuals with decreased serum TSH levels, and in four (57.1%) subjects with hyperthyroidism (P < 0.01). Logistic regression analysis identified overt hyperthyroidism as an independent risk factor for LVH (odds ratio, 13.65; 95% confidence interval, 2.83-65.75; P < 0.01). There is an association between thyroid function status, cardiac mass, and LVH. Hyperthyroidism is an independent risk factor for LVH.

Background and Purpose— Metabolic and hormonal changes associated with pregnancy and childbirth are assumed to contribute to the development of cardiovascular disease among women. We analyzed the association of parity with common carotid intima-media thickness (IMT), which has a predictive value of subsequent myocardial infarction and stroke. Methods— The Study of Health in Pomerania (SHIP), an epidemiological study of the general population in the northeast of Germany, included 1195 women aged 45 to 79 years. Mean and maximum far-wall IMT of the common carotid arteries were assessed by high-resolution ultrasound. All women were comprehensively characterized as to their reproductive history as well as to socioeconomic, behavioral, and biological risk factors. Results— There was a U-shaped association between the number of children (from 0 to ≥4) and mean and maximum IMT. Nulliparous women had the highest age-adjusted mean (0.81 mm [95% CI, 0.78 to 0.84]) and maximum IMT (1.04 mm [95% CI, 1.00 to 1.09]), and women with single parity the lowest (mean IMT, 0.73 [95% CI, 0.72 to 0.74]; maximum IMT, 0.91 mm [95% CI, 0.89 to 0.93]; P<0.001 versus nulliparity for both parameters). Stepwise multivariate adjustment for socioeconomic factors, lifestyle variables, and biological variables attenuated the magnitude of this association yet significance remained. Conclusions— Nulliparity and higher number of children are associated with increased carotid IMT. These findings add support to the hypothesis of a link between the reproductive history of women and cardiovascular disease.

CONTEXT The thyroid gland is a potential target organ for radiation-related damage. OBJECTIVE The aim of the analysis was to investigate the association between occupational exposure to ionizing radiation and autoimmune thyroid disease (AITD). DESIGN Our design was the cross-sectional Study of Health in Pomerania. SETTING The setting was the general community. SUBJECTS Analyses were performed in a population-based sample of 4299 subjects. Among them, 160 persons reported a history of occupational exposure to ionizing radiation. MAIN OUTCOME MEASURE AITD was defined as the combined presence of hypoechogenicity in thyroid ultrasound and antithyroxiperoxidase antibodies greater than 200 IU/ml. RESULTS Females with occupational exposure to ionizing radiation had more often AITD than nonexposed females (10.0 vs. 3.4%; P < 0.05). This association persisted after adjustment for relevant confounders (odds ratio, 3.46; 95% confidence interval, 1.16-10.31; P < 0.05). In males, there were too few subjects who fulfilled the criteria of AITD, but the association between the exposure to radiation and hypoechogenicity of the thyroid gland barely missed statistical significance (odds ratio, 2.20; 95% confidence interval, 0.92-5.26; P = 0.08). In both females and males, subjects who reported a length of exposure of more than 5 yr exhibited the highest risk of the endpoints. CONCLUSIONS We conclude that occupational exposure to ionizing radiation is related to the risk of AITD. The usage of thyroid protection shields by radiation workers is strongly recommended.

The reported mean dose–area product (DAP) received by patients from coronary angiography and percutaneous coronary intervention (PCI) is high and typically varies too greatly in invasive cardiology—that is, within 16–106 Gy × cm2 and 34–109 Gy × cm2, respectively.1 Skin erythema, chronic radiodermatitis, and musculocutaneous deep injury in conjunction with complex coronary interventions may result.1,2 The International Commission on Radiological Protection points out that, unfortunately, “Many interventionists are not aware of the potential for injury from procedures, their occurrence, or the simple methods for decreasing their incidence utilising dose control strategies”.2 Recently in clinical routine and with no negative diagnostic implications, effective dose reduction techniques enabled mean patient DAPs of 4.2 (1.6) and 6.7 (5.2) Gy × cm2 for elective coronary angiography and one vessel PCI, respectively.1,3 In realisation of the European Directive 97/43 that “Member States shall ensure that practitioners … have adequate theoretical and practical training for the purpose of radiological practices”,4 new European guidelines in that field have been established.5 We describe the contents of a training minicourse in less irradiating cardiac interventional techniques and its validation in clinical routine. Before and after the minicourse we analysed the following mean radiation parameters of 10 coronary angiographies, performed by each …