Objectives-To determine the prevalence of latex sensitisation among a large group of healthcare workers, study the occupational and non-occupational factors associated with latex allergy, and characterise latex exposure in air and by gloves.Methods-All 2062 employees of a general hospital in Hamilton, Ontario, Canada who regularly used latex gloves were invited to participate in a cross sectional survey, representing the baseline phase of a prospective cohort morbidity study. Attempts were made to recruit employees who were diagnosed with latex allergy before the survey. Glove extracts were assayed for antigenic protein, and area and personal air samples were obtained on two occasions (summer and winter) to estimate exposure to airborne latex protein. A questionnaire on medical and occupational information was administered by an interviewer. Skin prick tests were performed with latex reagents, three common inhalants, and six foods. Results-The mean (SD) latex protein concentrations were 324 (227) yg/g in powdered surgical gloves and 198 (104) ug/g in powdered examination gloves. Personal latex aeroallergen concentrations ranged from 5 to 616 nglm3.There was a total of 1351 (66%) participants. The prevalence of positive latex skin tests was 12 1% (95% confidence interval (95% CI) 10-3% to 13.9%). This prevalence did not vary by sex, age, hospital, or smoking status but subjects who were latex positive were significantly more likely to be atopic (P < 0-01). Participants who were latex positive were also significantly more likely to have positive skin tests to one or more foods (Mantel-Haenszel odds ratio (OR) adjusted for atopy 12-1, 95% CI 7-6 to 19-6, P < 10-9). Work related symptoms were more often reported among latex positive people, and included hives (OR 6-3, 95% CI 3-2 to 12.5), eye symptoms (OR 1-9, 95% CI 1-2 to 2.8), and wheezy or whistling chest (OR 4 7, 95% CI 2-8 to 7.9). The prevalence of latex sensitivity was highest among laboratory workers (16.9%), and nurses and physicians (13-3%). When the glove consumption per healthcare worker for each department was grouped into tertiles, the prevalence of latex skin test positivity was greater in the higher tertiles of glove use for sterile (surgical) gloves (P < 0.005) but not for examination gloves. Conclusions-In this large, cross sectional study of healthcare workers, the prevalence of latex sensitisation was 12-1% (9-5% among all those eligible), and there were significant associations with atopy, positive skin tests to certain foods, work related symptoms, and departmental use of gloves per healthcare worker. This cohort is being followed up prospectively and will be retested to determine the incidence of development of latex sensitivity. (Occup Environ Med 1997;54:335-342)

Background Atrial fibrillation (AF) is common and has a substantial genetic basis. Identification of individuals at greatest AF risk could minimize the incidence of cardioembolic stroke. Methods To determine whether genetic data can stratify risk for development of AF, we examined associations between AF genetic risk scores and incident AF in five prospective studies comprising 18,919 individuals of European ancestry. We examined associations between AF genetic risk scores and ischemic stroke in a separate study of 509 ischemic stroke cases (202 cardioembolic [40%]) and 3,028 controls. Scores were based on 11 to 719 common variants (≥5%) associated with AF at P-values ranging from <1×10−3 to <1×10−8 in a prior independent genetic association study. Results Incident AF occurred in 1,032 (5.5%) individuals. AF genetic risk scores were associated with new-onset AF after adjusting for clinical risk factors. The pooled hazard ratio for incident AF for the highest versus lowest quartile of genetic risk scores ranged from 1.28 (719 variants; 95%CI, 1.13–1.46; P=1.5×10−4) to 1.67 (25 variants; 95%CI, 1.47–1.90; P=9.3×10−15). Discrimination of combined clinical and genetic risk scores varied across studies and scores (maximum C statistic, 0.629–0.811; maximum ΔC statistic from clinical score alone, 0.009–0.017). AF genetic risk was associated with stroke in age- and sex-adjusted models. For example, individuals in the highest quartile of a 127-variant score had a 2.49-fold increased odds of cardioembolic stroke, versus those in the lowest quartile (95%CI, 1.39–4.58; P=2.7×10−3). The effect persisted after excluding individuals (n=70) with known AF (odds ratio, 2.25; 95%CI, 1.20–4.40; P=0.01). Conclusions Comprehensive AF genetic risk scores were associated with incident AF beyond clinical AF risk factors, with magnitudes of risk comparable to other clinical risk factors, though offered small improvements in discrimination. AF genetic risk was also associated with cardioembolic stroke in age- and sex-adjusted analyses. Efforts to determine whether AF genetic risk may improve identification of subclinical AF or distinguish stroke mechanisms are warranted.

Summary Background Lipoprotein(a) concentrations in plasma are associated with cardiovascular risk in the general population. Whether lipoprotein(a) concentrations or LPA genetic variants predict long-term mortality in patients with established coronary heart disease remains less clear. Methods We obtained data from 3313 patients with established coronary heart disease in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. We tested associations of tertiles of lipoprotein(a) concentration in plasma and two LPA single-nucleotide polymorphisms ([SNPs] rs10455872 and rs3798220) with all-cause mortality and cardiovascular mortality by Cox regression analysis and with severity of disease by generalised linear modelling, with and without adjustment for age, sex, diabetes diagnosis, systolic blood pressure, BMI, smoking status, estimated glomerular filtration rate, LDL-cholesterol concentration, and use of lipid-lowering therapy. Results for plasma lipoprotein(a) concentrations were validated in five independent studies involving 10 195 patients with established coronary heart disease. Results for genetic associations were replicated through large-scale collaborative analysis in the GENIUS-CHD consortium, comprising 106 353 patients with established coronary heart disease and 19 332 deaths in 22 studies or cohorts. Findings The median follow-up was 9·9 years. Increased severity of coronary heart disease was associated with lipoprotein(a) concentrations in plasma in the highest tertile (adjusted hazard radio [HR] 1·44, 95% CI 1·14–1·83) and the presence of either LPA SNP (1·88, 1·40–2·53). No associations were found in LURIC with all-cause mortality (highest tertile of lipoprotein(a) concentration in plasma 0·95, 0·81–1·11 and either LPA SNP 1·10, 0·92–1·31) or cardiovascular mortality (0·99, 0·81–1·2 and 1·13, 0·90–1·40, respectively) or in the validation studies. Interpretation In patients with prevalent coronary heart disease, lipoprotein(a) concentrations and genetic variants showed no associations with mortality. We conclude that these variables are not useful risk factors to measure to predict progression to death after coronary heart disease is established. Funding Seventh Framework Programme for Research and Technical Development (AtheroRemo and RiskyCAD), INTERREG IV Oberrhein Programme, Deutsche Nierenstiftung, Else-Kroener Fresenius Foundation, Deutsche Stiftung für Herzforschung, Deutsche Forschungsgemeinschaft, Saarland University, German Federal Ministry of Education and Research, Willy Robert Pitzer Foundation, and Waldburg-Zeil Clinics Isny.

Abstract. Fedorowski A, Hedblad B, Engström G, Gustav Smith J, Melander O (Department of Clinical Sciences, Lund University, Malmö; and Skå ne University Hospital, Malmö, Sweden). Orthostatic hypotension and long-term incidence of atrial fibrillation: the Malmö Preventive Project. J Intern Med 2010; 268: 383-389.Objectives. Orthostatic hypotension (OH), a common manifestation of autonomic dysfunction, has been identified as an independent risk factor for all-cause mortality and incident cardiovascular disease. However, the role of OH in the development of atrial fibrillation has not been studied.Design. We investigated the incidence of atrial fibrillation in relation to baseline presence of OH according to international consensus criteria in the Swedish population-based prospective cohort of the Malmö Preventive Project. The study sample consisted of 33 346 individuals (67.3% men; mean age, 45.6 ± 7.4 years; range, 26-61 years). The association between OH and incidence of atrial fibrillation during follow-up was assessed using the Kaplan-Meier method and multivariable Cox proportional hazard models, taking into account conventional risk factors for atrial fibrillation.Results. At baseline, 1987 participants (6.1%) met the diagnostic criteria for OH. Over a follow-up period of approximately 24 years, 2312 individuals (3.0 events ⁄ 1000 person-years) were diagnosed with new-onset atrial fibrillation. Of these, 196 had OH at baseline (4.6 events ⁄ 1000 person-years amongst all OH-positive individuals). In a multivariable Cox regression analysis, OH predicted incidence of atrial fibrillation independently of other risk factors (hazard ratio [HR]: 1.30; 95% confidence interval [CI]: 1.05-1.61; P = 0.016), and this association was significant in hypertensive (HR: 1.44; 95%CI: 1.10-1.88; P = 0.008), but not in normotensive participants (HR: 1.10; 95%CI: 0.77-1.58; P = 0.60).Conclusions. The presence of OH predicts the incidence of atrial fibrillation in middle-aged hypertensive individuals, independently of conventional risk factors. Further studies of the association of autonomic dysfunction and OH with atrial fibrillation are needed.