Pain has been reported to be a common problem in the general population and end-stage renal disease (ESRD) patients. Although similar data for pre-ESRD patients are lacking, we recently reported that the prevalence of pain is also very high (>70%) among pre-ESRD patients at a Los Angeles County tertiary referral centre. The high prevalence of pain in the CKD population is particularly concerning because pain has been shown to be associated with poor quality of life. Of greater concern, poor quality of life, at least in dialysis patients, has been shown to be associated with poor survival. We herein discuss the pathophysiology of common pain conditions, review a commonly accepted approach to the management of pain in the general population, and discuss analgesic-induced renal complications and therapeutic issues specific for patients with reduced renal function.
Our results demonstrate that a major gene determining fasting insulin is located on chromosome 7q. Linkage of BP, HOMA, and leptin levels to the same region suggests this locus may broadly influence traits associated with IR and supports a genetic basis for phenotypic associations in IR syndrome.
Abstract-Although clinical coronary heart disease and many cardiovascular risk factors are well known to aggregate within families, the heritability of carotid artery intima-media thickness (IMT) is less well documented. We report IMT heritability estimates in Mexican American, Salvadoran American, or Guatemalan American (all referred to as Latino) families ascertained through a hypertensive proband. IMT and cardiovascular risk factors (age, sex, blood pressure, body mass index, lipids, fasting glucose, and insulin sensitivity) were measured in 204 adult offspring of 69 hypertensive probands, along with 82 parents (54 probands and 28 spouses). In the offspring, variance component analysis revealed a heritability for IMT of 64% (PϽ0.0001) after adjustment for significant cardiovascular risk factors. Genetic factors accounted for 50% of the total variation in IMT, whereas significant cardiovascular risk factors explained 22% (14% were due to age). For offspring and parents combined, adjusted IMT heritability was less, 34% (Pϭ0.0005), with genetic factors accounting for 18% of the total IMT variation, whereas significant cardiovascular risk factors explained 46% (38% were due to age). We conclude that variation in common carotid artery IMT is heritable in Latino families with a hypertensive proband. Heritability is particularly evident in younger family members, suggesting that acquired factors contribute progressively to IMT variability with aging. Key Words: intima-media thickness Ⅲ coronary heart disease Ⅲ heritability Ⅲ genetic effects I n cross-sectional studies, carotid artery intima-media thickness (IMT) measured by B-mode ultrasonography has been shown to be directly correlated with the same thickness in histological specimens, 1 with traditional cardiovascular risk factors (such as age, smoking, lipids, and hypertension), 2,3 with the angiographic presence of coronary artery disease, 4,5 and with a confirmed family history of coronary artery disease. 6,7 Longitudinal studies have shown that the progression of carotid artery IMT is significantly related to the risk of subsequent clinical coronary events 8 and to the progression of anatomic coronary artery disease. 9 There is a growing number of reports indicating that the absolute magnitude of carotid artery IMT is related to the risk of clinical coronary events. 10 -14 These data suggest that the association between carotid artery IMT and coronary artery disease depends, in part, on the exposure of both arterial beds to the same genetic and environmental risk factors.Although coronary heart disease 15-18 and many of the cardiovascular risk factors 19 -22 are known to aggregate within families, the heritability of carotid IMT has been less well documented. Duggirala et al 23 reported IMT heritability of 92% in Mexico City by using sibship data (mean age 46 years) after adjusting for the effects of traditional cardiovascular risk factors on IMT. Zannad et al 24 reported that genetic factors accounted for 30% of IMT variation in east France by using data fo...
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