Subjects with asymptomatic peripheral arterial disease appear to have the same increased risk of cardiovascular events and death found in claudicants.

Objective-To determine whether a low ankle brachial pressure index is associated with an increased risk of cardiovascular events and death, and whether the prediction of such events could be improved by including this index.Design-Cohort study. Setting-11 practices in Edinburgh, Scotland. Subjects-1592 men and women aged 55-74 years selected at random from the age-sex registers of 11 general practices and followed up for 5 years.Main outcome measures-Incidence of fatal and non-fatal cardiovascular events and all cause mortality.Results-At baseline 90 (5.7%) of subjects had an ankle brachial pressure index <0.7, 288 (18.2%) had an index 's0.9, and 566 (35.6%) < 1.0. After five years subjects with an index <0.9 at baseline had an increased risk of non-fatal myocardial infarction (relative risk 1.38, 95% confidence interval 0.88 to 2.16), stroke (1.98, 1.05 to 3.77), cardiovascular death (1.85, 1.15 to 2.97), and all cause mortality (1.58, 1.14 to 2.18) after adjustment for age, sex, coronary disease, and diabetes at baseline. The ability to predict subsequent events was greatly increased by combining the index with other risk factors-for example, hypertensive smokers with normal cholesterol concentrations had a positive predictive value of 25.0%, increasing to 43.8% in subjects with a low index and decreasing to 15.6% in those with a normal index.Conclusion-The ankle brachial pressure index is a good predictor of subsequent cardiovascular events, and improves on predictions by conventional risk factors alone. It is simple and accurate and could be included in routine screening of cardiovascular status. IntroductionCoronary heart disease is the main cause of death and disability in elderly people,' and numerous primary and secondary prevention trials have attempted to reduce its impact.2 Important risk factors include hypercholesterolaemia, hypertension, and cigarette smoking,3 and attempts have been made to target those at greatest risk by using scoring systems such as the Dundee method4 or by identifying subjects with early

Land loss mapping and rate curve development for 62 quadrangles in the Louisiana Coastal Plain show that land loss rates vary significantly throughout coastal Louisiana. Differences in land loss rates among individual quadrangles are a function of the geologic setting, and the factors that contribute to land loss. Of the 62 quadrangles mapped, 16 show an increase in the land loss rate, 36 show a decrease, and 10 remained approximately the same. On a regional scale, the land loss rate for the entire Louisiana Coastal Plain has decreased from an average yearly rate of 41.88 square miles for the 1956-58 to 1974 period to 30.71 square miles for the 1974 to 1983 period. The data generated during the land loss study is being combined with engineering geology, geomorphic, and subsidence data to determine the causes for land loss in site specific areas of the Louisiana coast. It will also be used to identify areas of maximum and minimum land loss so that mitigation efforts can be planned in areas where the potential for significant reduction in land loss is greatest.

BackgroundProlonged exercise, such as marathon running, has been associated with an increase in respiratory mucosal inflammation. The aim of this pilot study was to examine the effects of Montmorency cherry juice on markers of stress, immunity and inflammation following a Marathon.MethodsTwenty recreational Marathon runners consumed either cherry juice (CJ) or placebo (PL) before and after a Marathon race. Markers of mucosal immunity secretory immunoglobulin A (sIgA), immunoglobulin G (IgG), salivary cortisol, inflammation (CRP) and self-reported incidence and severity of upper respiratory tract symptoms (URTS) were measured before and following the race.ResultsAll variables except secretory IgA and IgG concentrations in saliva showed a significant time effect (P <0.01). Serum CRP showed a significant interaction and treatment effect (P < 0.01). The CRP increase at 24 and 48 h post-Marathon was lower (P < 0.01) in the CJ group compared to PL group. Mucosal immunity and salivary cortisol showed no interaction effect or treatment effect. The incidence and severity of URTS was significantly greater than baseline at 24 h and 48 h following the race in the PL group and was also greater than the CJ group (P < 0.05). No URTS were reported in the CJ group whereas 50 % of runners in the PL group reported URTS at 24 h and 48 h post-Marathon.ConclusionsThis is the first study that provides encouraging evidence of the potential role of Montmorency cherries in reducing the development of URTS post-Marathon possibly caused by exercise-induced hyperventilation trauma, and/or other infectious and non-infectious factors.

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