Background and Purpose-A J-shaped relationship has been demonstrated between alcohol and both clinical cardiovascular events and carotid atherosclerosis. A similar J-shaped relationship has been found between alcohol intake and inflammatory markers. If inflammation were on the intermediate causal pathway between alcohol intake and atherosclerosis, then genetic determinants of enhanced inflammation would be expected to modify this relationship. Methods-In a large community population (nϭ1000; age, 50 to 65 years), we studied the effects of the interleukin-6 (IL-6)-174 polymorphism and gene-alcohol interactions on common carotid artery intima-media thickness (CCA-IMT) and carotid plaque. Results-The CC genotype was associated with significantly higher IL-6 levels; the odds ratio (OR) for IL-6 in the top quartile was 2.07 (95% CI, 1.16 to 3.72; Pϭ0.014). Interactions were seen between genotype and alcohol consumption for both IL-6 levels and CCA-IMT. In individuals who drank Ͼ30 g/d of alcohol, the CC genotype was associated with higher IL-6 levels, elevated CCA-IMT (Pϭ0.001), and increased risk of carotid plaque (OR, 3.64; 95% CI, 1.15 to 11.54; Pϭ0.028). The J-shaped relationship between alcohol intake and IMT was seen only for the CC genotype. Conclusions-These data suggest that the IL-6-174 promotor polymorphism may modulate the effects of alcohol on carotid atherosclerosis. These data support the hypothesis that inflammation forms part of the intermediate causal pathway between alcohol intake and atherosclerosis.

Background and Purpose-Established "systemic" vascular risk factors do not fully explain the occurrence of atherosclerosis at the carotid bifurcation. Local anatomic and hemodynamic factors may also influence the initiation of the atherosclerotic process. We determined whether the angle of internal carotid artery (ICA) origin is a risk factor for early atherosclerosis. Methods-In 1300 individuals from a normal population aged 40 to 70 years, we measured both carotid intima-media thickness (IMT) at 3 arterial sites (common carotid artery; carotid bifurcation; ICA bulb) and the presence of any atherosclerotic plaque within the ICA bulb bilaterally by means of high-resolution ultrasound. A standardized transverse insonation was used to determine the angle of ICA origin, expressed as the angle of rotation relative to the external carotid artery. Results-This

Objectives: Mortality is high and functional outcome poor in mechanically ventilated stroke patients. In addition, age .65 years is an independent predictor of death at 2 months among these patients. Our objective was to determine survival rates, functional outcome, and quality of life (QoL) in stroke patients older than 65 years requiring mechanical ventilation. Methods: A prospective cohort study with an additional cross-sectional survey in 65 patients aged 65 years and older (mean age (SD): 75.6 (6.0) years) with ischaemic or haemorrhagic stroke who underwent mechanical ventilation. Main outcome measures were survival rate at 6 months, and Barthel Index (BI), modified Rankin Scale, and QoL at 15.8 (SD 8.0) months. Results: Survival rate at 6 months was 40%. Elective intubation (odds ratio (OR) 13.6; p = 0.002) was the only independent positive predictor for survival, while age .77.5 years (OR 0.1; p = 0.004) and white blood count .10/nl at admission (OR 0.31; p = 0.032) were independent negative predictors for survival at 6 months. At the time of the cross-sectional survey, BI was .70 in five out of 22 patients, 35-70 in three and ,35 in the remaining 14 patients. QoL was impaired primarily in the physical domain, whereas the psychosocial domain was less affected. Conclusions: Although only 40% of elderly patients intubated in the acute phase of stroke survived at least 6 months, one in four survivors recovered to a good functional outcome with a reasonable QoL. Elderly stroke patients need to be selected carefully for intensive care treatment, but elective intubation to allow diagnostic procedures should not be withheld primarily based on their age. P revious studies showed that severe ischaemic or haemorrhagic stroke requiring intensive care therapy and mechanical ventilation (MV) is associated with a poor prognosis. Approximately 60% of the patients die within the first 2 months and the majority of the survivors remain severely disabled.1-4 Age .65 years was identified as an independent predictor of death at 2 months in mechanically ventilated stroke patients, 4 and according to recent population based data, 75-85% of stroke patients fall within this age range.5 6 The overall 28 day mortality of stroke is approximately 25%, and 10% of all stroke patients require MV during the acute phase of stroke therapy. 7 8 Thus, the question of whether intensive care therapy should be minimised in elderly stroke patients is highly relevant for stroke neurologists and intensivists considering the limited intensive care capacities.The principal dilemma is that withholding MV will lead to a higher early mortality, whereas intensive care therapy probably improves survival at the cost of severe neurological deficits; reliable early predictors of functional outcome are lacking. On the other hand, new diagnostic and therapeutic strategies (for example, acute stroke MRI, thrombolysis, or mild hypothermia) may improve prognosis and outcome, but often require at least temporary airway protection and mechanical ventilation.This p...