Objectives: To determine concentrations of adiponectin and its predictive value on outcome in a cohort of patients with congestive heart failure (CHF). Methods: Serum and clinical data were obtained for outpatients with clinically controlled CHF (n = 175). Serum concentrations of adiponectin, C reactive protein, N-terminal pro-brain natriuretic peptide (NTproBNP), interleukin (IL) -1b, IL-6, IL-8, IL-10, IL-12, tumour necrosis factor a and CD-40 ligand were determined. The association of adiponectin with the clinical severity of CHF was sought as well as the predictive value of this adipokine on mortality, CHF hospitalisations or the occurrence of each of these end points.Results: Concentrations of adiponectin were significantly increased in patients with CHF. Patients with higher New York Heart Association class had significantly higher serum concentrations of adiponectin. Adiponectin serum concentrations were lower in patients with diabetes and CHF as well as in patients with ischaemic cardiomyopathy. Serum adiponectin concentration was positively associated with age and NTproBNP but was negatively correlated with C reactive protein concentrations. Serum adiponectin above the 75th centile was found to be an independent predictor of total mortality, CHF hospitalisations or a composite of these end points over a two-year prospective follow up. Conclusion: Adiponectin is increased in CHF patients and predicts mortality and morbidity.

Low socioeconomic status is associated with higher blood pressure. There is a need to develop and test culturally appropriate interventions to reduce the prevalence of hypertension among these populations to minimize the resultant cardiovascular morbidity and mortality.

LF power reflects baroreflex function, not cardiac sympathetic innervation.

Abstract-Supine hypertension occurs commonly in primary chronic autonomic failure. This study explored whether supine hypertension in this setting is associated with orthostatic hypotension (OH), and if so, what mechanisms might underlie this association. Supine and upright blood pressures, hemodynamic responses to the Valsalva maneuver, baroreflex-cardiovagal gain, and plasma norepinephrine (NE) levels were measured in pure autonomic failure (PAF), multiple-system atrophy (MSA) with or without OH, and Parkinson's disease (PD) with or without OH. Controls included age-matched, healthy volunteers and patients with essential hypertension or those referred for dysautonomia. Baroreflex-cardiovagal gain was calculated from the relation between the interbeat interval and systolic pressure during the Valsalva maneuver. PAF, MSA with OH, and PD with OH all featured supine hypertension, which was equivalent in severity to that in essential hypertension, regardless of fludrocortisone treatment. Among patients with PD or MSA, those with OH had higher mean arterial pressure during supine rest (109Ϯ3 mm Hg) than did those lacking OH (96Ϯ3 mm Hg, Pϭ0.002). Baroreflex-cardiovagal gain and orthostatic increments in plasma NE levels were markedly decreased in all 3 groups with OH. Among patients with PD or MSA, those with OH had much lower mean baroreflex-cardiovagal gain (0.74Ϯ0.10 ms/mm Hg) than did those lacking OH (3.13Ϯ0.72 ms/mm Hg, Pϭ0.0002). In PAF, supine hypertension is linked to both OH and low baroreflex-cardiovagal gain. The finding of lower plasma NE levels in patients with than without supine hypertension suggests involvement of pressor mechanisms independent of the sympathetic nervous system. Key Words: hypertension, essential Ⅲ hypotension Ⅲ Parkinson's disease Ⅲ autonomic nervous system Ⅲ sympathetic nervous system Ⅲ norepinephrine P rimary chronic autonomic failure has been classified clinically into 3 forms: pure autonomic failure (PAF), multiple-system atrophy (MSA), and autonomic failure in the setting of Parkinson's disease (PD). 1 All 3 forms typically include orthostatic hypotension (OH), wherein reflexive increases in sympathetic neurocirculatory tone fail to compensate adequately for decreased venous return to the heart.Patients with primary chronic autonomic failure also often have supine hypertension. 2 Because of widespread use of the salt-retaining steroid fludrocortisone to treat OH and literature documenting increases in blood pressure secondary to mineralocorticoid administration, 3,4 supine hypertension in primary chronic autonomic failure might be a side effect of treating the OH and not part of the disease; however, supine hypertension has been reported in a substantial proportion of untreated patients. 5 Analogously, levodopa is a mainstay in the treatment of PD, and based on literature that levodopa produces OH, 6 OH in PD might be a side effect of treating the movement disorder and not part of the disease; however, OH occurs in at least some patients with PD who are off or have never been ...

Fabry disease is an X-linked disorder caused by a deficiency of lysosomal alpha-galactosidase A resulting in accumulation of alpha-D-galatosyl conjugated glycosphingolipids. Clinical manifestations include a small-fiber neuropathy associated with debilitating pain and hypohidrosis. We report the effect of a 3-year open-label extension of a previously reported 6-month placebo-controlled enzyme replacement therapy (ERT) trial in which 26 hemizygous patients with Fabry disease received 0.2 mg/kg of alpha-galactosidase A every 2 weeks. The effect of ERT on neuropathic pain scores while off pain medications, quantitative sensory testing, quantitative sudomotor axon reflex test (QSART), and thermoregulatory sweat test (TST) is reported. In the patients who crossed-over from placebo to ERT (n = 10), mean pain-at-its-worst scores on a 0-10 scale decreased (from 6.9 to 4.5). There was a significant reduction in the threshold for cold and warm sensation in the foot. At the 3-year time-point, pre-ERT sweat excretion in 17 Fabry patients was 0.24 +/- 0.33 microl/mm(2) vs. 1.05 +/- 0.81 in concurrent controls (n = 38). Sweat function improved 24-72 h post-enzyme infusion (0.57 +/- 0.71 microl/mm(2)) and normalized in four anhidrotic patients. TST confirmed the QSART results. We conclude that prolonged ERT in Fabry disease leads to a modest but significant improvement in the clinical manifestations of the small-fiber neuropathy associated with this disorder. QSART may be useful to further optimize the dose and frequency of ERT.

PAF involves generalized loss of sympathoadrenomedullary cells, MSA + NOH intact sympathoadrenomedullary cells, and PD + NOH intact adrenomedullary cells but organ-selective sympathetic denervation, especially in the heart.

The generation of higher cholesterol blood levels is proposed as a possible link between chronic periodontal inflammation and atherosclerosis.

Abstract-Recently the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure introduced the term "prehypertension" for systolic blood pressure levels of 120 to 139 mm Hg and diastolic BP levels of 80 to 89 mm Hg. Little is known about the prevalence of this entity and the cardiovascular risk factors associated with it. We aimed to determine the prevalence of prehypertension and the cardiovascular risk factors associated with it in a large population-based sample of young Israeli adults. We studied 36 424 Israel Defense Forces employees during the years 1991 to 1999. Subjects completed a detailed questionnaire and underwent physical examination, and blood samples were drawn after a 14-hour fast. Prehypertension was defined as a systolic blood pressure of 120 to 139 mm Hg, and/or a diastolic blood pressure of 80 to 89 mm Hg. We calculated the age-and sex-specific prevalence of prehypertension and other cardiovascular risk factors associated with this condition. Prehypertension was observed among 50.6% of men and 35.9% of women. The prehypertensive group had higher levels of blood glucose, total cholesterol, low-density lipoprotein cholesterol, and triglycerides, higher body mass index, and lower levels of high-density lipoprotein cholesterol than did the normotensive group. Multivariate logistic regression analysis showed that body mass index was the strongest predictor of prehypertension among both males and females (odds ratio, 1.100; 95% CI, 1.078 to 1.122 and odds ratio, 1.152; 95% CI, 1.097 to 1.21, respectively, for every 1 kg/m 2 increase). Our findings support the recommendation of lifestyle modification for prehypertensive patients. Further prospective studies are required to determine the role of pharmacotherapy in prehypertension. Key Words: cardiovascular diseases Ⅲ young adults Ⅲ hypertension, borderline H ypertension is likely the most common disease on Earth. 1 It is associated with an increased risk of morbidity and mortality from cardiovascular disease (CVD) and represents the single greatest preventable cause of death in humans. The standard definition of hypertension as blood pressure (BP) Ն140/90 mm Hg is based on the observation that the risk of CVD increases sharply above this level. However, recent data have shown that an increased risk of CVD is present in persons with BP levels as low as 115/ 70 mm Hg and that this risk increases steadily with rising BP. 2 The incremental association between BP and CVD risk has been reflected recently in the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). 3 In its report, the JNC7 introduced a new BP category, "prehypertension," defined as a systolic BP (SBP) of 120 to 139 mm Hg and/or a diastolic BP (DBP) of 80 to 89 mm Hg. Since the publication of the JNC7 report, several studies have assessed the prevalence and significance of prehypertension. Still, the importance of this entity in regard to global CVD risk and the pref...