To evaluate the role of the inflammatory biomarkers C-reactive protein (CRP), myeloperoxidase, paraoxonase, secretory phospholipase A2 group IIA (sPLA2), lipoprotein-associated phospholipase A2, fibrinogen, macrophage chemoattractant protein-1 and adiponectin, in predicting the risk of coronary heart disease (CHD) among people estimated to be at intermediate risk according to the Framingham Risk Score (FRS).
Prospective case-control study nested in EPIC-Norfolk cohort.
Apparently healthy men and women aged 45-79 years.
Risk of future coronary artery disease.
For participants predicted to be at intermediate risk by the FRS, the highest c statistics were observed for FRS plus CRP (0.61, 95% CI 0.57 to 0.65) and for FRS plus sPLA2 (0.56, 95% CI 0.52 to 0.6). Net correct reclassification of cases and controls for each marker was assessed for people across the entire risk spectrum and again for people at intermediate risk only. The largest differences were observed for CRP, 12.0% net reclassification improvement in the entire risk spectrum and 28.4% net reclassification improvement in the intermediate-risk group and for sPLA2, the net reclassification improvement was 6.4% in the entire risk spectrum and 16.3% in the intermediate-risk group.
The discriminatory potential of inflammatory biomarkers was substantially different when analysed across the entire risk spectrum compared with the subgroup of people at intermediate risk.
"Given the conclusion in the Framingham Heart Study that investigated novel biomarkers, including CRP that these added only moderately to standard risk factors for individual risk assessment , no inflammatory marker is yet incorporated in major cardiovascular risk prediction tools. However, several prospective studies  demonstrated in men  and women  that C-reactive protein (CRP) significantly added prognostic information to the Framingham risk score, especially in intermediate risk categories. "
[Show abstract][Hide abstract] ABSTRACT: The article reviews the evidence and extent of the excess cardiovascular risk in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis. RA entails nearly twice as high a standardized mortality ratio and is considered an equivalent of type 2 diabetes with regard to cardiovascular risk. The associated excess cardiovascular risk can only partly be explained by traditional risk factors, and the underlying inflammation is crucially involved in the pathogenesis. Data obtained from patients with early RA suggest that serum triglycerides, a proxy of disease activity as markers of systemic inflammation, impaired function of apolipoprotein A-I and HDL particles, and mediating hypertension are determinants of the excess cardiovascular risk. These changes seem to be preceded by a lowering of total cholesterol and are followed in the course of the disease by immune processes typically illustrated by positivity of rheumatoid factor. Evidence is available to postulate the notion that reduced plasma lipoprotein- associated phospholipaseA2 mass or activity, mediated by diminished hydrolysis of VLDL triglycerides and of Lp(a) phospholipids, may induce reduction or altered composition of HDL particles and apoA-I dysfunction which, along with elevated plasma triglycerides, initiate and contribute to chronic inflammation. Lifestyle modification, traditional non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors, low-dose corticosteroids, statins, tumor-necrosis-α inhibitors and, particularly, the immunosuppressive methotrexate, all have potential beneficial effects in eliciting a reduction in disease activity and cardiovascular risk. Adherence to the recent EULAR recommendations is a key in the prevention and management of cardiovascular risk among patients with rheumatic diseases.
Current pharmaceutical design 02/2012; 18(11):1465-77. DOI:10.2174/138161212799504740 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The command language by which an operator exerts supervisory control over a general purpose remote manipulator should be designed to accommodate certain characteristics of human performance if there is to be effective communication between the operator and the machine. Some of the ways in which people formulate tasks, use language, learn and make errors are discussed and design implications are drawn. A general approach to command language design is suggested, based on the notion matching the operator's current task schema or context by appropriate program structures or 'frames' in the machine.
[Show abstract][Hide abstract] ABSTRACT: LTCC substrate material has been successfully used to fabricate a
4-GHz 20-dB stripline coupler with 20-dB directivity and a low second
harmonic 4-GHz stripline edge coupled filter. These circuits provide
mechanical, size, performance, and cost advantages when compared to
stripline assemblies made from softboard or nonhomogeneous materials.
Measured results for both circuits are presented and design
recommendations are discussed
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