OBJECTIVES To study the value of a number of proposed prognostic factors in prediction of the risk of perioperative cardiac events after vascular surgery. DESIGN AND METHODS Two hundred and ninety-seven patients undergoing peripheral vascular surgery were prospectively studied. Patients underwent preoperative 24 h ambulatory electrocardiography, measurement of haemostatic variables, myocardial assessment of perfusion by dipyridamole-thallium scintigraphy and radionuclide ventriculography. The primary endpoint was cardiac death or nonfatal myocardial infarction within 30 days of surgery. A combined endpoint included the primary endpoint plus occurrence of cardiac failure, unstable angina or serious arrhythmias. RESULTS The primary endpoint occurred in 21 (7%), and the combined endpoint in 41 (14%) of patients. On multivariate analysis, increased age, previous myocardial infarction, aortic surgery, impaired heart rate variability and a positive thallium scan were independent predictors of primary end-points. Preoperative atrial fibrillation and increased fibrin D-dimer were additional predictors of the combined endpoint. Construction of receiver-operator characteristic curves to examine the incremental value of predictive models showed that sensitivity and specificity of clinical data alone for primary endpoints was 71% and 72% respectively, while for the full model (incorporating heart rate variability and thallium data) this rose to 84% and 80% (p=0.0001). CONCLUSIONS Preliminary screening using clinical data has limited value in risk assessment prior to vascular surgery but preoperative heart rate variability, D-dimers and thallium scanning provide modest incremental predictive value.

The clinical utility of a new assay for plasma lipoprotein(a)-cholesterol (Lp(a)-C) was assessed in parallel with our routine Lp(a) mass measurements in a nested-case control study of subjects within the placebo arm of the West of Scotland Coronary Prevention Study (WOSCOPS). A total of 238 control patients and 108 patients who had suffered a serious vascular event during the course of the WOSCOPS were examined. Lp(a) mass was assessed within 2 years of sampling by an ELISA method on baseline EDTA plasma samples which had been stored at -70 degrees C. Subsequently, the Lp(a) mass was re-measured by an immunoturbidimetric assay approximately 8 years after sampling. On the same stored aliquot the Lp(a)-C was measured. These analyses allowed us to assess whether the Lp(a)-C assay could provide any additional information over and above that which would be obtained from our Lp(a) mass assays. In addition the apo(a) isoform sizes of these subjects were measured using a high resolution immunoblotting system. The Lp(a)-C and Lp(a) mass measurements provided exactly the same information in the study, as they were equally non-discriminatory between cases and controls. The only difference between the two patient groups was the percentage of 'null' apo(a) alleles (control: 25.6% versus cases: 19.4%). We conclude that these results reinforce the concordance of the two assay systems and confirm that the Lp(a)-C assay provides no added information over and above that gained from traditional Lp(a) mass assays, which may be faster and less expensive.

Conference Article| August 01 1999 Use of the West of Scotland Coronary Prevention Study bio-bank to provide new insights into the control of plasma lipoprotein(a) concentrations A. Gaw; A. Gaw 1 *Department of Pathological Biochemistry, 4th Floor Queen Elizabeth Building, Royal Infirmary, University/NHS Trust, Glasgow G31 2ER, U.K. 1To whom conespondence should be addressed Search for other works by this author on: This Site PubMed Google Scholar E. A. Brown; E. A. Brown *Department of Pathological Biochemistry, 4th Floor Queen Elizabeth Building, Royal Infirmary, University/NHS Trust, Glasgow G31 2ER, U.K. Search for other works by this author on: This Site PubMed Google Scholar G. Docherty; G. Docherty †Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, Glasgow G12 8QQ, U.K. Search for other works by this author on: This Site PubMed Google Scholar I. Ford; I. Ford †Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, Glasgow G12 8QQ, U.K. Search for other works by this author on: This Site PubMed Google Scholar West of Scotland Coronary Prevention Study Group West of Scotland Coronary Prevention Study Group Search for other works by this author on: This Site PubMed Google Scholar Biochem Soc Trans (1999) 27 (4): 459–463. https://doi.org/10.1042/bst0270459 Article history Received: March 22 1999 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Citation A. Gaw, E. A. Brown, G. Docherty, I. Ford, West of Scotland Coronary Prevention Study Group; Use of the West of Scotland Coronary Prevention Study bio-bank to provide new insights into the control of plasma lipoprotein(a) concentrations. Biochem Soc Trans 1 August 1999; 27 (4): 459–463. doi: https://doi.org/10.1042/bst0270459 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsBiochemical Society Transactions Search Advanced Search Keywords: apo(a), apolipoprotein(a), CHD, coronary, heart disease, Lp(a). lipoprotein(a), WOSCOPS, Wed of Scotland, Coronary Prevention Study © 1999 Biochemical Society1999 Article PDF first page preview Close Modal You do not currently have access to this content.

An elevated plasma lipoprotein(a) (Lp(a)) concentration is an independent risk factor for coronary heart disease (CHD). Plasma Lp(a) levels are believed to be predominantly controlled by the APO(a) gene, which encodes the apo(a) glycoprotein moiety of the Lp(a) particle. However, other parameters in the lipoprotein profile as well as co-existing disease states or personal traits have been proposed as co-varieties. In order to examine these potential controlling factors in greater detail than previously possible, 1760 unrelated Caucasian subjects were studied, from which were identified 907 with a single expressing APO(a) allele. This strategy was followed to obviate the difficulty in dealing with the co-expression of different apo(a) isoforms and the resulting compound plasma Lp(a) level. After cube-root transformation of the plasma Lp(a) levels to normalise their distribution, a series of correlates were computed. There was no good correlation between Lp(a) concentration and any other measured lipid or lipoprotein in the lipid profile or with any other variable examined, with the important exception of the length of the expressed apo(a) isoform (r=−0.491, P=0.0001). We conclude that in this population the plasma Lp(a) concentration is not predicted by the plasma lipid profile, alcohol intake, or smoking status but is predicted, albeit incompletely, by the length polymorphism of the APO(a) gene.

OBJECTIVES:The primary objective of this study was to estimate knowledge about oral contraceptives amongst oral contraceptive users within family planning clinics in Scotland and to ascertain if this was due to clinicians not attempting to convey certain information or to a lack of understanding of teaching.METHOD:This was a criterion-based audit using three separate questionnaires to estimate the agreement of senior staff with criteria set by a multi-disciplinary expert panel, actual routine clinical practice and user knowledge.RESULTS:Senior clinical staff within family planning clinics in Scotland agreed with 12 out of 15 criteria set by a multidisciplinary panel in over 85% of cases. For six out of 15 criteria, there was a discrepancy of more than 30% in what clinicians did in practice compared to what senior staff thought they ought to do. For a further two criteria, there was a deficiency of over 30% between the number of clients who understood the criteria and the number of clients the clinicians thought they had taught. Most importantly, these latter criteria included the rules for safe and effective pill taking.CONCLUSION:An improvement in user knowledge is required to achieve effective and reliable use of oral contraceptives. Methods of doing this, such as staff and client prompts, should be further explored.

OBJECTIVES:The primary objective of this study was to investigate the relationship between various client characteristics and knowledge of oral contraceptives amongst pill users.METHOD:This was a subanalysis of the data from the national audit of Scottish family planning clinics.RESULTS:There were significant differences in knowledge about many different criteria according to the characteristics of the client group. Low educational attainment, unemployment and more rural residence produced greater significant differences in contraception knowledge than social deprivation according to postcode (zipcode). Age and duration of use affected different criteria to varying degrees, but teenagers scored relatively poorly compared to the general population and knowledge did not significantly improve overall with duration of use.CONCLUSION:Client characteristics do affect levels of pill knowledge. Clinicians must reflect on how to communicate more effectively with all types of pill users. They should take the opportunity of clinic visits for repeat pill prescriptions to improve knowledge levels.

A B s T R A C T Objectives The primary objective of this study was to investigate the relationship between various client characteristics and knowledge of oral contraceptives amongst pill users. Method This was a subanalysis of the data from the national audit ofScottish family planning clinics. Results There were significant differences in knowledge about many different criteria according to the characteristics of the client group. Low educational attainment, unemployment and more rural residence produced greater significant differences in contraception knowledge than social deprivation according to postcode (zipcode). Age and duration of use affected different criteria to varying degress, but teenagers scored relatively poorly compared to the general population and knowledge did not significantly improve overall with duration of use. Conclusion Client characteristics do affect levels of pill knowledge. Clinicians must reflect on how to communicate more effectively with all types of pill users. They should take the opportunity of clinic visits for repeat pill prescriptions to improve knowledge levels.

Conference Abstract| August 01 1998 Perioperative Cardiac Risk Stratification, Hypercoaguabhjty and Heart Rate Variability N Mamode; N Mamode 1Peripheral Vascular Unit, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, Scotland Search for other works by this author on: This Site PubMed Google Scholar G Docherty; G Docherty 2Peripheral Vascular Unit, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, Scotland Search for other works by this author on: This Site PubMed Google Scholar PW Macfarlane; PW Macfarlane 3Peripheral Vascular Unit, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, Scotland Search for other works by this author on: This Site PubMed Google Scholar GDO Lowe; GDO Lowe 4Peripheral Vascular Unit, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, Scotland Search for other works by this author on: This Site PubMed Google Scholar SM Cobbe SM Cobbe 5Peripheral Vascular Unit, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, Scotland Search for other works by this author on: This Site PubMed Google Scholar Author and article information Publisher: Portland Press Ltd Online ISSN: 1470-8736 Print ISSN: 0143-5221 © 1988 The Biochemical Society and the Medical Research Society1988 Clin Sci (Lond) (1998) 95 (s39): 9P–10P. https://doi.org/10.1042/cs095009pc Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Citation N Mamode, G Docherty, PW Macfarlane, GDO Lowe, SM Cobbe; Perioperative Cardiac Risk Stratification, Hypercoaguabhjty and Heart Rate Variability. Clin Sci (Lond) 1 August 1998; 95 (s39): 9P–10P. doi: https://doi.org/10.1042/cs095009pc Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1988 The Biochemical Society and the Medical Research Society1988 Article PDF first page preview Close Modal You do not currently have access to this content.