Investindo em educaão e saúde
Caros amigos,
Desejo-lhes um Feliz ano novo, com muita esperança, amor e sucesso.
Abiaxo vai artigo meu que Zero Hora publicou no dia de hoje.
A inspiração veio da Dra. Valderês e do livro do Vinod Thomas, ex diretor do Banco Mundial no Brasil, cuja referência está na materia postada imediatamente antes. "O Brasil Visto por Dentro"
Um abraço a todos.
ALOYZIO ACHUTTI: Membro da Academia Sul-Rio-Grandense de Medicina
Superávit primário, dívida externa, dívida social, cotação do dólar, risco Brasil, salário mínimo, bolsa de valores, produto interno bruto, ajuste fiscal, reforma da previdência...
Estes e outros temas são assunto de todo o dia, de manchetes, de discussões acaloradas e objeto de propaganda política, nem sempre bem intencionada.
Tudo isso, e muito mais, diz respeito à gente que vive neste país, corresponde aos nossos 185 milhões de concidadãos. Tem a ver com o que produzimos, consumimos, gastamos, exportamos, desperdiçamos e investimos, dentro desta enorme e rica propriedade natural nem sempre bem conservada e gerida.
Proponho medir parte de nossa riqueza, com unidades não convencionais e monetárias, mas aproximando-nos um pouco mais do valor potencial vivo de nosso capital humano. Pelos padrões atualmente existentes poderíamos estimá-lo em cerca de 13.210.436.478 anos potenciais de vida.
Quantidades, entretanto, não expressam toda a realidade; ou melhor, muitas vezes escondem parte importante e inconveniente dela. Nos adaptamos a manipulações deste tipo, especialmente quando querem nos mostrar que a economia vai bem, apesar de toda a corrupção, desperdício e malversação de recursos. Os números, especialmente quando mostrados setorialmente, são facilmente manipuláveis, e servem também para ocultar graves defeitos de qualidade.
Do conceito de saúde, entretanto, a qualidade de vida é parte indissociável. Não nos conformamos com somente maior número de anos vividos. Trata-se de capitalizar anos de vida saudáveis.
Estudando informações relativas à saúde de nossa população com dados de 1998 foi possível estimar em 37.518.239 o número de anos de vida saudáveis perdidos a cada ano no Brasil, por todas as causas de doença, violências, incapacidade ou morte precoce. Estendendo este cálculo para nosso capital humano global, chega-se a um desperdício – por problemas em grande parte evitáveis - de 20% a 30% dos anos potenciais de vida saudável responsáveis pela produção e conservação de nossas riquezas.
Avaliando a saúde de nossa sociedade, através da equidade na distribuição das riquezas, também se chega a uma proporção semelhante (dependendo do critério utilizado) de pessoas socialmente excluídas que poderiam estar contribuindo para o processo produtivo, aumentando nossa riqueza, aliviando a carga das doenças, participando no controle social e reduzindo conflitos oriundos da desigualdade exagerada.
Marcos de mudança nos ciclos temporais, são ocasiões para reflexão, balanço e bons propósitos. Redefinições políticas são essenciais, mas a incorporação das mudanças na cultura, e na consciência de cada cidadão, implica num processo educacional sério e sustentado.
A fórmula mais eficaz para sanar nossa economia global - deixando ela a desejar quantitativa e qualitativamente - está na participação efetiva na administração de nossos recursos, e na mobilização de nosso capital físico, nosso capital humano e no trabalho produtivo. Assim, somente como ganho em anos potenciais de vida saudáveis de nossa população, podemos esperar rendimentos em torno de 30%.
Pode haver melhor investimento do que em educação e saúde?
Friday, December 30, 2005
O Brasil Visto por Dentro
Grupo Banco Mundial: "Foi lançado neste mês o livro O Brasil visto por dentro " O desenvolvimento em uma terra de contrastes, do ex-diretor do Banco Mundial para o Brasil, Vinod Thomas. Os eventos ocorreram no Rio de Janeiro, São Paulo e Brasília, com a participação de autoridades, pesquisadores e outros interessados..
O Brasil tem um dos maiores potenciais do mundo em desenvolvimento para atingir o progresso sustentado, mas esta realização depende de ações incisivas e urgentes. Esta é a perspectiva do livro, que já está à venda nas melhores livrarias."
O Brasil tem um dos maiores potenciais do mundo em desenvolvimento para atingir o progresso sustentado, mas esta realização depende de ações incisivas e urgentes. Esta é a perspectiva do livro, que já está à venda nas melhores livrarias."
Thursday, December 29, 2005
The Pandemic of Lifestyle Diseases
The Pandemic of Lifestyle Diseases
The WHO estimates that atherosclerosis and diabetes (90% of the Type 2 variety) kill about 16 million people every year, more than are killed by war, famine and malaria combined, and more than might concievably be killed in a single pandemic of bird flu. Half of these deaths occur in people under 70 years old and at least 80% are preventable with simple lifestyle changes.
The ancient Greeks were very perceptive. They gave their god of medicine, Asclepius, two daughters, Panaceia, the goddess of the quick fix and Hygeia, the goddess of prevention and treatment of disease by healthy lifestyle. We have developed this site will prove to you that lifestyle change, Hygeia, is the only way to prevent and treat these diseases. The classic description of the principles of Hygeia was given by Hippocrates about 430 BC.
Drugs and procedures, Panaceia, only treat symptoms and will not decrease total mortality. There is increasing evidence that Panaceia will actually kill more people than it could possibly save.
The bas-relief in the header of Hygeia with her sacred snake was done in 1955 by Armand Filion. It can be seen above the Cedar Avenue entrance to Livingstone Hall, the former nurses' residence at the Montreal General Hospital in Montr�al, Qu�bec, Canada
The WHO estimates that atherosclerosis and diabetes (90% of the Type 2 variety) kill about 16 million people every year, more than are killed by war, famine and malaria combined, and more than might concievably be killed in a single pandemic of bird flu. Half of these deaths occur in people under 70 years old and at least 80% are preventable with simple lifestyle changes.
The ancient Greeks were very perceptive. They gave their god of medicine, Asclepius, two daughters, Panaceia, the goddess of the quick fix and Hygeia, the goddess of prevention and treatment of disease by healthy lifestyle. We have developed this site will prove to you that lifestyle change, Hygeia, is the only way to prevent and treat these diseases. The classic description of the principles of Hygeia was given by Hippocrates about 430 BC.
Drugs and procedures, Panaceia, only treat symptoms and will not decrease total mortality. There is increasing evidence that Panaceia will actually kill more people than it could possibly save.
The bas-relief in the header of Hygeia with her sacred snake was done in 1955 by Armand Filion. It can be seen above the Cedar Avenue entrance to Livingstone Hall, the former nurses' residence at the Montreal General Hospital in Montr�al, Qu�bec, Canada
NHLBI, DASH Eating Plan
NHLBI, DASH Eating Plan: "I give a copy of this to all my hypertensive patients, and have received good feedback. They have found it informative and easy to understand.' -M. Keen, MD Toledo, OH
Get with the plan that is clinically proven to significantly reduce blood pressure. It's not enough to tell hypertensive and prehypertensive patients to, 'Watch your diet.' Give them a week's worth of sample menus, recipes, heart healthy dishes, and an easy-to-read summary of the findings from the 'Dietary Approaches to Stop Hypertension' clinical study that showed how elevated blood pressure levels can be reduced with an eating plan low in total fat, saturated fat, and cholesterol, and rich in fruits, vegetables, and lowfat dairy products. It even has a form to track food habits before starting the plan and a chart to help with meal planning and food shopping. Facts About the DASH Eating Plan 24 pages. NIH Publication No. 03-4082."
Get with the plan that is clinically proven to significantly reduce blood pressure. It's not enough to tell hypertensive and prehypertensive patients to, 'Watch your diet.' Give them a week's worth of sample menus, recipes, heart healthy dishes, and an easy-to-read summary of the findings from the 'Dietary Approaches to Stop Hypertension' clinical study that showed how elevated blood pressure levels can be reduced with an eating plan low in total fat, saturated fat, and cholesterol, and rich in fruits, vegetables, and lowfat dairy products. It even has a form to track food habits before starting the plan and a chart to help with meal planning and food shopping. Facts About the DASH Eating Plan 24 pages. NIH Publication No. 03-4082."
Fundação do Incor deve R$ 200 milhões
De: Isaac roitman [mailto:iroitman@imagelink.com.br]
Enviada em: quarta-feira, 28 de dezembro de 2005 23:46
Assunto: Fw: incor
Publicado na Folha de SP
Demorou p/ aparecer as evidências.
Fundação do Incor deve R$ 200 milhões
FABIANE LEITE
da Folha de S.Paulo
A dívida da Fundação Zerbini, entidade privada que administra o maior instituto público de cardiologia da América Latina, o Incor de São Paulo, chega hoje a R$ 200 milhões, diante de um orçamento de R$ 230 milhões anuais.
O quadro foi apresentado ontem pelo conselho deliberativo do Hospital das Clínicas da USP, ao qual o Incor está ligado, e pela própria fundação. As duas instituições estão em guerra por causa do endividamento, mas ambas cobraram ações do governo Geraldo Alckmin (PSDB) para a solução do problema.
O hospital quer um auxílio financeiro para o pagamento. Já a fundação cobra verbas que não teriam sido repassadas pelo governador. O instituto faz hoje um total de 250 mil consultas por ano, em média, 13 mil internações, 5.000 cirurgias e 2 milhões de exames diagnósticos. Problemas no atendimento não estão descartados, a longo prazo, caso a situação não se resolva.
A Zerbini foi criada com anuência do HC para melhorar a estrutura do Incor, como acelerar as contratações e viabilizar mais rapidamente os investimentos, justamente por não ter as amarras de um órgão estatal.
O conselho do hospital atribui o endividamento a uma má gestão de verbas pelo hoje presidente do Incor e do conselho curador da fundação, José Ramires, e tentou afastá-lo do cargo.
"A fundação está tecnicamente falida, pois não tem patrimônio para pagar a dívida", afirma Marcos Boulos, integrante do conselho deliberativo do hospital.
Ontem, o HC apresentou resultados de uma auditoria independente que aponta controles inadequados das compras e estoques da fundação.
Segundo o órgão, a situação "é grave".
Já Paulo Bonadies, advogado de José Ramires, acusou ontem o governo Alckmin de "tungar", nos últimos cinco anos, R$ 100 milhões destinados à entidade que defende, isso principalmente em razão de repasses não realizados pelo governador e aportes feitos pelo governo federal, mas não direcionados pelo Estado à Zerbini, de acordo com sua versão.
Ainda segundo Bonadies, Alckmin não teria honrado compromisso do ex-governador Mário Covas de pagar empréstimo de R$ 40 milhões do BNDES (Banco Nacional de Desenvolvimento Econômico e Social), dívida de longo prazo assumida pela fundação e que chega a R$ 120 milhões.
"A fundação arca com dois terços do custeio do Incor, hoje de R$ 230 milhões", afirmou o advogado da Zerbini. "Há um clima de beligerância, disputa de egos. Eles [o conselho] estão matando a galinha dos ovos de ouro do hospital, do Incor [a fundação], e diminuindo a oportunidade de se tratar em um centro de excelência",
continuou, classificando em seguida o conselho do hospital como "uma turba", que estaria causando, com as acusações, dificuldades para a fundação obter novos empréstimos no sistema financeiro e recursos de doações. Bonadies nega a falência.
Segundo o advogado, a fundação vem pagando 1.600 funcionários que deveriam estar sob responsabilidade do governo do Estado. O hospital informou que recentemente Alckmin assumiu os salários de mais de 900 funcionários, o que melhorará a situação financeira da Fundação Zerbini.
Alckmin trata a polêmica como um desentendimento entre as duas instituições e informou que vem destinando adequadamente recursos ao Incor.
A Fundação Zerbini também está em pé de guerra com o Ministério Público do Estado de São Paulo, que acompanha o desempenho da instituição.
Ontem o advogado da entidade chamou o promotor que cuida do setor, Paulo José de Palma, de "pústula", em razão de Palma, supostamente, não ter apresentado provas de que a entidade está sob investigação do órgão público.
"Vou levar o caso à Corregedoria [do Ministério Público]", ameaçou. O promotor afirma não ter dado acesso às investigações porque o advogado não teria procuração da Zerbini para trabalhar em nome da instituição. Ele não quis comentar o xingamento do advogado e destacou que seu trabalho é técnico. Segundo Palma, há seis investigações sigilosas na Promotoria sobre a fundação.
Outro lado
Nota emitida ontem pela Secretaria de Estado da Saúde diz que as afirmações do cardiologista José Ramires, hoje presidente do Incor de São Paulo, "são inverídicas".
"De maneira nenhuma há dívida entre a Fundação Zerbini e a Secretaria de Estado da Saúde", diz o texto, ao comentar a informação dos advogados do médico de que o governo não teria feito os repasses para a fundação.
"Como afirmou o conselho deliberativo do Hospital das Clínicas, ao qual o Incor é subordinado, a secretaria repassou R$ 600 milhões ao Incor em dez anos, ou seja, R$ 60 milhões por ano", destaca o texto da pasta.
A secretaria também negou que tenha existido um compromisso do ex-governador Mário Covas de pagar um empréstimo assumido pela Fundação Zerbini com o BNDES.
No texto, o governo destaca ainda que o atendimento não será afetado. "Vale ressaltar que a secretaria acredita que as divergências entre HC e Incor serão resolvidas o mais breve possível. A pasta acompanha o caso [...] e confia nas informações do HC de que não há a menor possibilidade do atendimento à população ser prejudicado", diz a nota.
Em entrevista ontem, o HC informou que o governo autorizou a criação de mais de 900 cargos públicos no Incor, em substituição às vagas privadas, que entravam nos gastos da Zerbini. Assim, diz acreditar o conselho deliberativo, a fundação terá folga para saldar a dívida com o BNDES.
O advogado da fundação, Paulo Bonadies, diz que hoje um total de 3.000 funcionários do Incor têm salários pagos pela fundação.
Enviada em: quarta-feira, 28 de dezembro de 2005 23:46
Assunto: Fw: incor
Publicado na Folha de SP
Demorou p/ aparecer as evidências.
Fundação do Incor deve R$ 200 milhões
FABIANE LEITE
da Folha de S.Paulo
A dívida da Fundação Zerbini, entidade privada que administra o maior instituto público de cardiologia da América Latina, o Incor de São Paulo, chega hoje a R$ 200 milhões, diante de um orçamento de R$ 230 milhões anuais.
O quadro foi apresentado ontem pelo conselho deliberativo do Hospital das Clínicas da USP, ao qual o Incor está ligado, e pela própria fundação. As duas instituições estão em guerra por causa do endividamento, mas ambas cobraram ações do governo Geraldo Alckmin (PSDB) para a solução do problema.
O hospital quer um auxílio financeiro para o pagamento. Já a fundação cobra verbas que não teriam sido repassadas pelo governador. O instituto faz hoje um total de 250 mil consultas por ano, em média, 13 mil internações, 5.000 cirurgias e 2 milhões de exames diagnósticos. Problemas no atendimento não estão descartados, a longo prazo, caso a situação não se resolva.
A Zerbini foi criada com anuência do HC para melhorar a estrutura do Incor, como acelerar as contratações e viabilizar mais rapidamente os investimentos, justamente por não ter as amarras de um órgão estatal.
O conselho do hospital atribui o endividamento a uma má gestão de verbas pelo hoje presidente do Incor e do conselho curador da fundação, José Ramires, e tentou afastá-lo do cargo.
"A fundação está tecnicamente falida, pois não tem patrimônio para pagar a dívida", afirma Marcos Boulos, integrante do conselho deliberativo do hospital.
Ontem, o HC apresentou resultados de uma auditoria independente que aponta controles inadequados das compras e estoques da fundação.
Segundo o órgão, a situação "é grave".
Já Paulo Bonadies, advogado de José Ramires, acusou ontem o governo Alckmin de "tungar", nos últimos cinco anos, R$ 100 milhões destinados à entidade que defende, isso principalmente em razão de repasses não realizados pelo governador e aportes feitos pelo governo federal, mas não direcionados pelo Estado à Zerbini, de acordo com sua versão.
Ainda segundo Bonadies, Alckmin não teria honrado compromisso do ex-governador Mário Covas de pagar empréstimo de R$ 40 milhões do BNDES (Banco Nacional de Desenvolvimento Econômico e Social), dívida de longo prazo assumida pela fundação e que chega a R$ 120 milhões.
"A fundação arca com dois terços do custeio do Incor, hoje de R$ 230 milhões", afirmou o advogado da Zerbini. "Há um clima de beligerância, disputa de egos. Eles [o conselho] estão matando a galinha dos ovos de ouro do hospital, do Incor [a fundação], e diminuindo a oportunidade de se tratar em um centro de excelência",
continuou, classificando em seguida o conselho do hospital como "uma turba", que estaria causando, com as acusações, dificuldades para a fundação obter novos empréstimos no sistema financeiro e recursos de doações. Bonadies nega a falência.
Segundo o advogado, a fundação vem pagando 1.600 funcionários que deveriam estar sob responsabilidade do governo do Estado. O hospital informou que recentemente Alckmin assumiu os salários de mais de 900 funcionários, o que melhorará a situação financeira da Fundação Zerbini.
Alckmin trata a polêmica como um desentendimento entre as duas instituições e informou que vem destinando adequadamente recursos ao Incor.
A Fundação Zerbini também está em pé de guerra com o Ministério Público do Estado de São Paulo, que acompanha o desempenho da instituição.
Ontem o advogado da entidade chamou o promotor que cuida do setor, Paulo José de Palma, de "pústula", em razão de Palma, supostamente, não ter apresentado provas de que a entidade está sob investigação do órgão público.
"Vou levar o caso à Corregedoria [do Ministério Público]", ameaçou. O promotor afirma não ter dado acesso às investigações porque o advogado não teria procuração da Zerbini para trabalhar em nome da instituição. Ele não quis comentar o xingamento do advogado e destacou que seu trabalho é técnico. Segundo Palma, há seis investigações sigilosas na Promotoria sobre a fundação.
Outro lado
Nota emitida ontem pela Secretaria de Estado da Saúde diz que as afirmações do cardiologista José Ramires, hoje presidente do Incor de São Paulo, "são inverídicas".
"De maneira nenhuma há dívida entre a Fundação Zerbini e a Secretaria de Estado da Saúde", diz o texto, ao comentar a informação dos advogados do médico de que o governo não teria feito os repasses para a fundação.
"Como afirmou o conselho deliberativo do Hospital das Clínicas, ao qual o Incor é subordinado, a secretaria repassou R$ 600 milhões ao Incor em dez anos, ou seja, R$ 60 milhões por ano", destaca o texto da pasta.
A secretaria também negou que tenha existido um compromisso do ex-governador Mário Covas de pagar um empréstimo assumido pela Fundação Zerbini com o BNDES.
No texto, o governo destaca ainda que o atendimento não será afetado. "Vale ressaltar que a secretaria acredita que as divergências entre HC e Incor serão resolvidas o mais breve possível. A pasta acompanha o caso [...] e confia nas informações do HC de que não há a menor possibilidade do atendimento à população ser prejudicado", diz a nota.
Em entrevista ontem, o HC informou que o governo autorizou a criação de mais de 900 cargos públicos no Incor, em substituição às vagas privadas, que entravam nos gastos da Zerbini. Assim, diz acreditar o conselho deliberativo, a fundação terá folga para saldar a dívida com o BNDES.
O advogado da fundação, Paulo Bonadies, diz que hoje um total de 3.000 funcionários do Incor têm salários pagos pela fundação.
Saturday, December 24, 2005
American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke
American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke: "AHA News
12/21/2005
American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke
American Heart Association 2005 year-end report:
DALLAS, Dec. 21 - Cell recycling - using a person's own bone marrow - to repair the heart; a gene that may make it possible to predict which patients may benefit from a particular therapy, and a drug that may help smokers reduce their cravings for nicotine, are among the American Heart Association's top 10 research advances in heart disease and stroke for 2005, said Robert Eckel, M.D., president of the American Heart Association.
Other major milestones include hot and cold therapy for stroke rehabilitation, and a study that extended the range of patients that might benefit from prophylactic implantable defibrillators.
The American Heart Association's Top 10 list was created in 1996. Each year's list highlights major gains in heart disease and stroke research.
This year's achievements include:
1. Cell recycling regenerates ailing hearts. Heart attack survivors infused with stem-like cells from their own bone marrow had nearly twice the improvement in their heart's pumping ability as patients given a placebo. Reporting on the 'Intracoronary Infusion of Bone Marrow-Derived Progenitor Cells in Acute Myocardial Infarction: A Randomized, Double-Blind, Placebo Controlled Multicenter Trial (REPAIR),' German researchers said the study is a landmark trial that demonstrates the potential of progenitor therapy for restoring heart function. A second study by another group of German researchers showed that implanting bone marrow cells into blood-starved legs can help people with peripheral "/.../
12/21/2005
American Heart Association's top 10 research advances for 2005 include cell recycling and hot and cold therapy for stroke
American Heart Association 2005 year-end report:
DALLAS, Dec. 21 - Cell recycling - using a person's own bone marrow - to repair the heart; a gene that may make it possible to predict which patients may benefit from a particular therapy, and a drug that may help smokers reduce their cravings for nicotine, are among the American Heart Association's top 10 research advances in heart disease and stroke for 2005, said Robert Eckel, M.D., president of the American Heart Association.
Other major milestones include hot and cold therapy for stroke rehabilitation, and a study that extended the range of patients that might benefit from prophylactic implantable defibrillators.
The American Heart Association's Top 10 list was created in 1996. Each year's list highlights major gains in heart disease and stroke research.
This year's achievements include:
1. Cell recycling regenerates ailing hearts. Heart attack survivors infused with stem-like cells from their own bone marrow had nearly twice the improvement in their heart's pumping ability as patients given a placebo. Reporting on the 'Intracoronary Infusion of Bone Marrow-Derived Progenitor Cells in Acute Myocardial Infarction: A Randomized, Double-Blind, Placebo Controlled Multicenter Trial (REPAIR),' German researchers said the study is a landmark trial that demonstrates the potential of progenitor therapy for restoring heart function. A second study by another group of German researchers showed that implanting bone marrow cells into blood-starved legs can help people with peripheral "/.../
Friday, December 23, 2005
Painting the history of cardiology -- Lomas 331 (7531): 1533 -- BMJ
Painting the history of cardiology -- Lomas 331 (7531): 1533 -- BMJ: "The panels that the Mexican muralist Diego Rivera created for the Mexican National Institute of Cardiology in the 1940s evince a populist concern and celebrate medical technology
The murals Diego Rivera executed for the National Institute of Cardiology in Mexico City (figures 1 and 2) are a testament to his talents as a painter as well as to his prodigious energy. The History of Cardiology consists of two panels of 6 m by 4 m and were completed in time for the inauguration of the new institute building on 18 April 1944. "
The murals Diego Rivera executed for the National Institute of Cardiology in Mexico City (figures 1 and 2) are a testament to his talents as a painter as well as to his prodigious energy. The History of Cardiology consists of two panels of 6 m by 4 m and were completed in time for the inauguration of the new institute building on 18 April 1944. "
Wednesday, December 21, 2005
Erectile Dysfunction a Sign of Looming Heart Risks -
Erectile Dysfunction a Sign of Looming Heart Risks - CME Teaching Brief - MedPage Today: "When patients present with erectile dysfunction, even if no cardiac symptoms are currently present, be aware of the increased risk of future cardiovascular disease, assess risk factors, and intervene as appropriate. "
Tuesday, December 20, 2005
Standards for Statistical Models Used for Public Reporting of Health Outcomes. An American Heart Association Scientific Statement From the Quality of
Standards for Statistical Models Used for Public Reporting of Health Outcomes. An American Heart Association Scientific Statement From the Quality of Care and Outcomes Research Interdisciplinary Writing Group. Cosponsored by the Council on Epidemiology and Prevention and the Stroke Council Endorsed by the American College of Cardiology Foundation
Abstract--With the proliferation of efforts to report publicly the outcomes of healthcare providers and institutions, there is a growing need to define standards for the methods that are being employed. An interdisciplinary writing group identified 7 preferred attributes of statistical models used for publicly reported outcomes. These attributes include (1) clear and explicit definition of an appropriate patient sample, (2) clinical coherence of model variables, (3) sufficiently high-quality and timely data, (4) designation of an appropriate reference time before which covariates are derived and after which outcomes are measured, (5) use of an appropriate outcome and a standardized period of outcome assessment, (6) application of an analytical approach that takes into account the multilevel organization of data, and (7) disclosure of the methods used to compare outcomes, including disclosure of performance of risk-adjustment methodology in derivation and validation samples.
Abstract--With the proliferation of efforts to report publicly the outcomes of healthcare providers and institutions, there is a growing need to define standards for the methods that are being employed. An interdisciplinary writing group identified 7 preferred attributes of statistical models used for publicly reported outcomes. These attributes include (1) clear and explicit definition of an appropriate patient sample, (2) clinical coherence of model variables, (3) sufficiently high-quality and timely data, (4) designation of an appropriate reference time before which covariates are derived and after which outcomes are measured, (5) use of an appropriate outcome and a standardized period of outcome assessment, (6) application of an analytical approach that takes into account the multilevel organization of data, and (7) disclosure of the methods used to compare outcomes, including disclosure of performance of risk-adjustment methodology in derivation and validation samples.
Monday, December 19, 2005
Diesel Exhaust Inhalation Causes Vascular Dysfunction and Impaired Endogenous Fibrinolysis -- Mills et al. 112 (25): 3930 -- Circulation
Diesel Exhaust Inhalation Causes Vascular Dysfunction and Impaired Endogenous Fibrinolysis -- Mills et al. 112 (25): 3930 -- Circulation:
"Background? Although the mechanisms are unknown, it has been suggested that transient exposure to traffic-derived air pollution may be a trigger for acute myocardial infarction. The study aim was to investigate the effects of diesel exhaust inhalation on vascular and endothelial function in humans.
Methods and Results? In a double-blind, randomized, cross-over study, 30 healthy men were exposed to diluted diesel exhaust (300 ?g/m3 particulate concentration) or air for 1 hour during intermittent exercise. Bilateral forearm blood flow and inflammatory factors were measured before and during unilateral intrabrachial bradykinin (100 to 1000 pmol/min), acetylcholine (5 to 20 ?g/min), sodium nitroprusside (2 to 8 ?g/min), and verapamil (10 to 100 ?g/min) infusions 2 and 6 hours after exposure. There were no differences in resting forearm blood flow or inflammatory markers after exposure to diesel exhaust or air. Although there was a dose-dependent increase in blood flow with each vasodilator (P<0.0001 for all), this response was attenuated with bradykinin (P<0.05), acetylcholine (P<0.05), and sodium nitroprusside (P<0.001) infusions 2 hours after exposure to diesel exhaust, which persisted at 6 hours. Bradykinin caused a dose-dependent increase in plasma tissue plasminogen activator (P<0.0001) that was suppressed 6 hours after exposure to diesel (P<0.001; area under the curve decreased by 34%).
Conclusions? At levels encountered in an urban environment, inhalation of dilute diesel exhaust impairs 2 important and complementary aspects of vascular function in humans: the regulation of vascular tone and endogenous fibrinolysis. Thes"
"Background? Although the mechanisms are unknown, it has been suggested that transient exposure to traffic-derived air pollution may be a trigger for acute myocardial infarction. The study aim was to investigate the effects of diesel exhaust inhalation on vascular and endothelial function in humans.
Methods and Results? In a double-blind, randomized, cross-over study, 30 healthy men were exposed to diluted diesel exhaust (300 ?g/m3 particulate concentration) or air for 1 hour during intermittent exercise. Bilateral forearm blood flow and inflammatory factors were measured before and during unilateral intrabrachial bradykinin (100 to 1000 pmol/min), acetylcholine (5 to 20 ?g/min), sodium nitroprusside (2 to 8 ?g/min), and verapamil (10 to 100 ?g/min) infusions 2 and 6 hours after exposure. There were no differences in resting forearm blood flow or inflammatory markers after exposure to diesel exhaust or air. Although there was a dose-dependent increase in blood flow with each vasodilator (P<0.0001 for all), this response was attenuated with bradykinin (P<0.05), acetylcholine (P<0.05), and sodium nitroprusside (P<0.001) infusions 2 hours after exposure to diesel exhaust, which persisted at 6 hours. Bradykinin caused a dose-dependent increase in plasma tissue plasminogen activator (P<0.0001) that was suppressed 6 hours after exposure to diesel (P<0.001; area under the curve decreased by 34%).
Conclusions? At levels encountered in an urban environment, inhalation of dilute diesel exhaust impairs 2 important and complementary aspects of vascular function in humans: the regulation of vascular tone and endogenous fibrinolysis. Thes"
Year Trends in Serum Cholesterol, Hypercholesterolemia, and Cholesterol Medication Use:
Twenty-Year Trends in Serum Cholesterol, Hypercholesterolemia, and Cholesterol Medication Use: The Minnesota Heart Survey, 1980-1982 to 2000-2002 -- Arnett et al. 112 (25): 3884 -- Circulation: "Background� Although US cholesterol concentrations have dropped, &50% of adults have total cholesterol concentrations 5.18 mmol/L, putting them at 'borderline-high risk' for heart disease. Whether the decline has continued into the 21st century is unknown. We assessed 20-year trends in cholesterol, hypercholesterolemia, lipid-lowering drug use, and cholesterol awareness, treatment, and control from Minnesota Heart Survey (MHS) data.
Methods and Results� Five independent, cross-sectional, population-based surveys of 2500 to 5000 adults were conducted in the Minneapolis�St. Paul, Minn, area from 1980 to 2002. Mean (nonfasting) total cholesterol concentrations have continued a 20-year decline, punctuated by an intervening lull. Age-adjusted mean total cholesterol concentrations in 2000 to 2002 were 5.16 and 5.09 mmol/L for men and women, respectively (in 1980 to 1982, 5.49 and 5.38 mmol/L for men and women, respectively) However, the decline has not been uniform across all age groups. Middle-aged to older people have shown substantial decreases, but younger people have shown little overall change and recently had increased total cholesterol values. The mean prevalence of hypercholesterolemia in 2000 to 2002 was 54.9% for men and 46.5% for women and has decreased significantly for both during the study. Age-adjusted mean high-density lipoprotein cholesterol concentrations in 2000 to 2002 were 1.09 and 1.40 mmol/L for men and women, respectively, and were not different from the prior survey. Lipid-lowering drug use rose significantly for both sexes aged 35 to 74 years. Awareness, treatment, and contro"
Methods and Results� Five independent, cross-sectional, population-based surveys of 2500 to 5000 adults were conducted in the Minneapolis�St. Paul, Minn, area from 1980 to 2002. Mean (nonfasting) total cholesterol concentrations have continued a 20-year decline, punctuated by an intervening lull. Age-adjusted mean total cholesterol concentrations in 2000 to 2002 were 5.16 and 5.09 mmol/L for men and women, respectively (in 1980 to 1982, 5.49 and 5.38 mmol/L for men and women, respectively) However, the decline has not been uniform across all age groups. Middle-aged to older people have shown substantial decreases, but younger people have shown little overall change and recently had increased total cholesterol values. The mean prevalence of hypercholesterolemia in 2000 to 2002 was 54.9% for men and 46.5% for women and has decreased significantly for both during the study. Age-adjusted mean high-density lipoprotein cholesterol concentrations in 2000 to 2002 were 1.09 and 1.40 mmol/L for men and women, respectively, and were not different from the prior survey. Lipid-lowering drug use rose significantly for both sexes aged 35 to 74 years. Awareness, treatment, and contro"
Friday, December 16, 2005
Standardized Cardiovascular Disease Mortality from 1980 to 1999 - Brazil
Balanced Cardiovascular Disease Mortality from 1980 to 1999 - Brazil
Gl�ucia Maria Moraes Oliveira, Nelson Albuquerque Souza e Silva, Carlos Henrique Klein Universidade Federal do Rio de Janeiro, Escola Nacional de Sa�de P�blica e Secretaria de Estado de Sa�de do Rio de Janeiro - Rio de Janeiro, RJ - BrazilOBJECTIVE
To compare trends in mortality rates from cardiovascular diseases (CVD), ischemic heart diseases (IHD) and cerebrovascular diseases (CBVD) in the States of Rio de Janeiro (RJ), S�o Paulo (SP) and Rio Grande do Sul (RS) and respective capitals, from 1980 to 1999.
METHODS
Data regarding CVD deaths were obtained from Datasus, and those regarding populations were obtained from IBGE. Crude and sex and age-adjusted mortality rates were calculated using the direct method (standard population: State of Rio de Janeiro?s population twenty years of age or older in 2000). Because of the relevant increase in mortality from ill-defined causes in the city and State of RJ as of 1990, the deaths were balanced prior to adjustments. The trends were analyzed using linear regressions.
RESULTS
Annual declines of balanced and adjusted mortality ranged from -11.3 CVD deaths/100,000 inhabitants in the city and State of RJ to -7.4 in the city of SP. IHD mortality rates were similar in the State and city of RJ and in Porto Alegre, and lower in the city of SP (-2.5 deaths/100,000 inhabitants). CBVD mortality rates ranged from -6.0 to -2.8 deaths/100,000 inhabitants in the State of RJ and in Porto Alegre, respectively.
CONCLUSION
A decline in balanced and adjusted CVD, IHD and CBVD mortality rates was observed from 1980 to 1999 in the three States and capitals. In the State and city of RJ declines in IHD were clear as of 1990, whereas declines in CBVD occurred throughout the period studied.
Gl�ucia Maria Moraes Oliveira, Nelson Albuquerque Souza e Silva, Carlos Henrique Klein Universidade Federal do Rio de Janeiro, Escola Nacional de Sa�de P�blica e Secretaria de Estado de Sa�de do Rio de Janeiro - Rio de Janeiro, RJ - BrazilOBJECTIVE
To compare trends in mortality rates from cardiovascular diseases (CVD), ischemic heart diseases (IHD) and cerebrovascular diseases (CBVD) in the States of Rio de Janeiro (RJ), S�o Paulo (SP) and Rio Grande do Sul (RS) and respective capitals, from 1980 to 1999.
METHODS
Data regarding CVD deaths were obtained from Datasus, and those regarding populations were obtained from IBGE. Crude and sex and age-adjusted mortality rates were calculated using the direct method (standard population: State of Rio de Janeiro?s population twenty years of age or older in 2000). Because of the relevant increase in mortality from ill-defined causes in the city and State of RJ as of 1990, the deaths were balanced prior to adjustments. The trends were analyzed using linear regressions.
RESULTS
Annual declines of balanced and adjusted mortality ranged from -11.3 CVD deaths/100,000 inhabitants in the city and State of RJ to -7.4 in the city of SP. IHD mortality rates were similar in the State and city of RJ and in Porto Alegre, and lower in the city of SP (-2.5 deaths/100,000 inhabitants). CBVD mortality rates ranged from -6.0 to -2.8 deaths/100,000 inhabitants in the State of RJ and in Porto Alegre, respectively.
CONCLUSION
A decline in balanced and adjusted CVD, IHD and CBVD mortality rates was observed from 1980 to 1999 in the three States and capitals. In the State and city of RJ declines in IHD were clear as of 1990, whereas declines in CBVD occurred throughout the period studied.
Indicadores de Saúde no Brasil
Indicadores de Saúde no Brasil
Aloyzio Cechella Achutti
Health Indicators in Brazil
In the circulatory diseases chapter of this issue of Arquivos Brasileiros de Cardiologia, Dr. Gláucia M.M.Oliveira analyzes mortality data in the states of Rio de Janeiro, São Paulo, Rio Grande do Sul and their respective capitals, during the period of 1980-19991./.../
Nesta edição dos Arquivos Brasileiros de Cardiologia, a Dra. Gláucia M. M. Oliveira publica uma análise sobre dados de mortalidade, no capítulo das doenças do aparelho circulatório, para os estados do Rio de Janeiro, São Paulo, Rio Grande do Sul e suas capitais, no período de 1980-19991./.../
Aloyzio Cechella Achutti
Health Indicators in Brazil
In the circulatory diseases chapter of this issue of Arquivos Brasileiros de Cardiologia, Dr. Gláucia M.M.Oliveira analyzes mortality data in the states of Rio de Janeiro, São Paulo, Rio Grande do Sul and their respective capitals, during the period of 1980-19991./.../
Nesta edição dos Arquivos Brasileiros de Cardiologia, a Dra. Gláucia M. M. Oliveira publica uma análise sobre dados de mortalidade, no capítulo das doenças do aparelho circulatório, para os estados do Rio de Janeiro, São Paulo, Rio Grande do Sul e suas capitais, no período de 1980-19991./.../
Monday, December 12, 2005
Determinantes Sociais e Econômicos de Saúde e Doença
Caros amigos,
Enviei para toda a lista AMICOR uma mensagem com copia anexa de um documento preliminar sobre uma proposta para formar um grupo virtual de estudos e de trabalho sobre Determinantes Sociais e Econômicos de Saúde e Doença.
Sugestões, críticas e adesões serão sempre benvindas.
A proposta será discutida com quem tiver condições de comparecer na reunião ordinária do Servilo de Cardiologia do Hospital Moinhos de Vento, no próximo dia 15, 5a. feira, das 7:30 às 8:30 da manhã.
Quem não o tiver recebido pode solicitar para meu endereço.
Um abraço a todos
AA
Enviei para toda a lista AMICOR uma mensagem com copia anexa de um documento preliminar sobre uma proposta para formar um grupo virtual de estudos e de trabalho sobre Determinantes Sociais e Econômicos de Saúde e Doença.
Sugestões, críticas e adesões serão sempre benvindas.
A proposta será discutida com quem tiver condições de comparecer na reunião ordinária do Servilo de Cardiologia do Hospital Moinhos de Vento, no próximo dia 15, 5a. feira, das 7:30 às 8:30 da manhã.
Quem não o tiver recebido pode solicitar para meu endereço.
Um abraço a todos
AA
Friday, December 09, 2005
Lown Fellowship in Cardiovascular Disease in the Developing World
ProCOR: "Lown Fellowship in Cardiovascular Disease in the Developing World
The Lown Fellowship in Cardiovascular Disease in the Developing World offers:
- Emphasis on clinical and community research
- One-year training period
- No ECFMG certificate requirement
The Fellowship was developed in 2002 by the Lown Cardiovascular Center (www.lowncenter.org), which promotes a non-invasive, patient-focused model of cardiovascular care that is particularly applicable in low-resource settings as well as in countries like the US. This model of care has been practiced at the Lown Cardiovascular Center for more than 40 years with demonstrated efficacy ('Long-Term Outcomes of Optimized Medical Management of Outpatients With Stable Coronary Artery Disease' Am J Cardiol 2004;93:294-299.)
We invite inquiries and applications from promising candidates who meet the specified criteria outlined below.
Shmuel Ravid, MD, MPH
Director
Lown Fellowship in Cardiovascular Disease in the Developing World
Lown Cardiovascular Research Foundation"
The Lown Fellowship in Cardiovascular Disease in the Developing World offers:
- Emphasis on clinical and community research
- One-year training period
- No ECFMG certificate requirement
The Fellowship was developed in 2002 by the Lown Cardiovascular Center (www.lowncenter.org), which promotes a non-invasive, patient-focused model of cardiovascular care that is particularly applicable in low-resource settings as well as in countries like the US. This model of care has been practiced at the Lown Cardiovascular Center for more than 40 years with demonstrated efficacy ('Long-Term Outcomes of Optimized Medical Management of Outpatients With Stable Coronary Artery Disease' Am J Cardiol 2004;93:294-299.)
We invite inquiries and applications from promising candidates who meet the specified criteria outlined below.
Shmuel Ravid, MD, MPH
Director
Lown Fellowship in Cardiovascular Disease in the Developing World
Lown Cardiovascular Research Foundation"
The ageing population of the United Kingdom and cardiovascular disease -- Majeed and Aylin 331 (7529): 1362 -- BMJ
The ageing population of the United Kingdom and cardiovascular disease -- Majeed and Aylin 331 (7529): 1362 -- BMJ: "The number of people aged 65 and over is predicted to increase by about 53% between 2001 and 2031, but the number of people aged under 65 will change little during this period (table). The increase in the number of older people will likely lead to an increase in the number of people who have chronic diseases, including cardiovascular disease. This will impose further workload and financial pressures on the NHS. We examined the possible impact of the ageing population on the expected number of people with three cardiovascular disorders: coronary heart disease, heart failure, and atrial fibrillation."
Peripheral Arterial Disease Guidelines Push Early Diagnosis -
Peripheral Arterial Disease Guidelines Push Early Diagnosis - CME Teaching Brief - MedPage Today: "Be aware that the new peripheral arterial disease guidelines recommend the use of targeted questions to identify patients.
Explain to patients that the guidelines, issued by the major cardiovascular professional societies, emphasize the relationship between coronary artery disease and peripheral arterial disease. "/.../
Explain to patients that the guidelines, issued by the major cardiovascular professional societies, emphasize the relationship between coronary artery disease and peripheral arterial disease. "/.../
Thursday, December 08, 2005
Avoiding heart attacks and strokes: Don't be a victim, protect yourself
WHO | Avoiding heart attacks and strokes:
Don't be a victim, protect yourself:
"Cardiovascular diseases are killing more and more people around the world, striking rich and poor alike. Those who survive a heart attack or stroke often need to take long-term medical treatment. If you have ever had a heart attack or stroke, or had to care for someone who has, you will know that these diseases can seriously affect the life of both the patient and his or her family. The effects can even reach beyond the family to the community.
Yet so many heart attacks and strokes could be prevented. That is why you should read this booklet. It explains why heart attacks and strokes happen and how you can avoid them. It tells you what you should do to avoid becoming a victim. This publication is available for free download, hard copies can be ordered from WHO Press.
Short summary [pdf 34kb]
Part 1. What you should know [pdf 1.52Mb]
Part 2. What you can do [pdf 776kb]
Full report [pdf 2.16Mb]
Don't be a victim, protect yourself:
"Cardiovascular diseases are killing more and more people around the world, striking rich and poor alike. Those who survive a heart attack or stroke often need to take long-term medical treatment. If you have ever had a heart attack or stroke, or had to care for someone who has, you will know that these diseases can seriously affect the life of both the patient and his or her family. The effects can even reach beyond the family to the community.
Yet so many heart attacks and strokes could be prevented. That is why you should read this booklet. It explains why heart attacks and strokes happen and how you can avoid them. It tells you what you should do to avoid becoming a victim. This publication is available for free download, hard copies can be ordered from WHO Press.
Short summary [pdf 34kb]
Part 1. What you should know [pdf 1.52Mb]
Part 2. What you can do [pdf 776kb]
Full report [pdf 2.16Mb]
guidelines to raise HDL levels
Today in Cardiology: "Cardiologists and other experts at Johns Hopkins University have issued interim guidelines for physicians on how best to treat low levels of HDL cholesterol and help keep arteries clear from LDL buildup.
In an article published online in the New England Journal of Medicine, the researchers reported that existing strategies to prevent heart disease have not addressed the best means to raise HDL cholesterol and instead have focused heavily on lowering LDL cholesterol."
In an article published online in the New England Journal of Medicine, the researchers reported that existing strategies to prevent heart disease have not addressed the best means to raise HDL cholesterol and instead have focused heavily on lowering LDL cholesterol."
Saturday, December 03, 2005
Coffe and hypertension
Caro Prof. Dr AAchutti, sugiro a leitura aos que se dedicam a pesquisa, prevenção e tratamento da hipertensao arterial dos artigos anexos e da Carta Medica - pags 5 e 6- anexos.
Breve esperamos colocar no mercado uma patente resultante de nossas pesquisas - um fitoterapico de cafe - , em parceria com uma industria farmaceutica nacional ( patente mundial obtida).
Saudacoes
Darcy Lima
Darcy Roberto Lima [drlima@cafeesaude.com.br]
Context Caffeine acutely increases blood pressure, but the association between habitual consumption of caffeinated beverages and incident hypertension is uncertain.
Objective To examine the association between caffeine intake and incident hypertension in women.
Design, Setting, and Participants Prospective cohort study conducted in the Nurses’ Health Studies (NHSs) I and II of 155 594 US women free from physician-diagnosed hypertension followed up over 12 years (1990-1991 to 2002-2003 questionnaires). Caffeine intake and possible confounders were ascertained from regularly administered questionnaires.
We also tested the associations with types of caffeinated beverages.
Main Outcome Measure Incident physician-diagnosed hypertension.
Results During follow-up, 19 541 incident cases of physician-diagnosed hypertension
were reported in NHS I and 13 536 in NHS II. In both cohorts, no linear association
between caffeine consumption and risk of incident hypertension was observed after multivariate adjustment (NHS I, P for trend=.29; NHS II, P for trend=.53). Using
categorical analysis, an inverse U-shaped association between caffeine consumption
and incident hypertension was found. Compared with participants in the lowest uintile
of caffeine consumption, those in the third quintile had a 13% and 12% increased risk of hypertension, respectively (95% confidence interval in NHS I,8%-18%;in NHSII, 6%-18%). When studying individual classes of caffeinated beverages, habitual coffee consumption was not associated with increased risk of hypertension. By contrast, consumption of cola beverages was associated with an increased risk of hypertension, independent of whether it was sugared or diet cola (P for trend <.001).
Conclusion No linear association between caffeine consumption and incident hypertension was found. Even though habitual coffee consumption was not associated with an increased risk of hypertension, consumption of sugared or diet cola was associated with it. Further research to elucidate the role of cola beverages in hypertension is warranted.
JAMA. 2005;294:2330-2335 www.jama.com
C-reactive protein and its role in metabolic syndrome
The Lancet 2005; 366:1954-1959
Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com]
DOI:10.1016/S0140-6736(05)67786-0
C-reactive protein and its role in metabolic syndrome: mendelian randomisation study
Nicholas J Timpson a , Debbie A Lawlor a, Roger M Harbord a, Tom R Gaunt b, Ian NM Day a b, Lyle J Palmer a c, Andrew T Hattersley d, Shah Ebrahim a, Gordon DO Lowe e, Ann Rumley e and George Davey Smith a
Summary
Background
Circulating C-reactive protein (CRP) is associated with the metabolic syndrome and might be causally linked to it. Our aim was to generate estimates of the association between plasma CRP and metabolic syndrome phenotypes that were free from confounding and reverse causation, to assess the causal role of this protein.
Methods
We examined associations between serum CRP concentration and metabolic syndrome phenotypes in the British Women's Heart and Health Study. We then compared these estimates with those derived from a mendelian randomised framework with common CRP gene haplotypes to generate unconfounded and unbiased estimates of any causal associations.
Findings
In a sample of British women, body-mass index (BMI), systolic blood pressure, waist-to-hip ratio, serum concentrations of HDL cholesterol and triglycerides, and insulin resistance were all associated with plasma CRP concentration. CRP haplotypes were associated with plasma CRP concentration (p<0·0001). With instrumental variable analyses, there was no association between plasma CRP concentration and any of the metabolic syndrome phenotypes analysed. There was strong evidence that linear regression and mendelian randomisation based estimation gave conflicting results for the CRP–BMI association (p=0·0002), and some evidence of conflicting results for the association of CRP with the score for insulin resistance (p=0·0139), triglycerides (p=0·0313), and HDL cholesterol (p=0·0688).
Interpretation
Disparity between estimates of the association between plasma CRP and phenotypes comprising the metabolic syndrome derived from conventional analyses and those from a mendelian randomisation approach suggests that there is no causal association between CRP and the metabolic syndrome phenotypes.
Affiliations
a Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR, UK
b Human Genetics Division, School of Medicine, University of Southampton, Southampton, UK
c Laboratory for Genetic Epidemiology, Western Australian Institute of Medical Research and University of Western Australia Centre for Medical Research, Perth, Australia
d Peninsular Medical School, University of Exeter, Exeter, UK
e Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com]
DOI:10.1016/S0140-6736(05)67786-0
C-reactive protein and its role in metabolic syndrome: mendelian randomisation study
Nicholas J Timpson a , Debbie A Lawlor a, Roger M Harbord a, Tom R Gaunt b, Ian NM Day a b, Lyle J Palmer a c, Andrew T Hattersley d, Shah Ebrahim a, Gordon DO Lowe e, Ann Rumley e and George Davey Smith a
Summary
Background
Circulating C-reactive protein (CRP) is associated with the metabolic syndrome and might be causally linked to it. Our aim was to generate estimates of the association between plasma CRP and metabolic syndrome phenotypes that were free from confounding and reverse causation, to assess the causal role of this protein.
Methods
We examined associations between serum CRP concentration and metabolic syndrome phenotypes in the British Women's Heart and Health Study. We then compared these estimates with those derived from a mendelian randomised framework with common CRP gene haplotypes to generate unconfounded and unbiased estimates of any causal associations.
Findings
In a sample of British women, body-mass index (BMI), systolic blood pressure, waist-to-hip ratio, serum concentrations of HDL cholesterol and triglycerides, and insulin resistance were all associated with plasma CRP concentration. CRP haplotypes were associated with plasma CRP concentration (p<0·0001). With instrumental variable analyses, there was no association between plasma CRP concentration and any of the metabolic syndrome phenotypes analysed. There was strong evidence that linear regression and mendelian randomisation based estimation gave conflicting results for the CRP–BMI association (p=0·0002), and some evidence of conflicting results for the association of CRP with the score for insulin resistance (p=0·0139), triglycerides (p=0·0313), and HDL cholesterol (p=0·0688).
Interpretation
Disparity between estimates of the association between plasma CRP and phenotypes comprising the metabolic syndrome derived from conventional analyses and those from a mendelian randomisation approach suggests that there is no causal association between CRP and the metabolic syndrome phenotypes.
Affiliations
a Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BS8 2PR, UK
b Human Genetics Division, School of Medicine, University of Southampton, Southampton, UK
c Laboratory for Genetic Epidemiology, Western Australian Institute of Medical Research and University of Western Australia Centre for Medical Research, Perth, Australia
d Peninsular Medical School, University of Exeter, Exeter, UK
e Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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