revious studies have demonstrated that renal insufficiency is an independent risk factor for cardiovascular morbidity and for all-cause as well as cardiovascular death in both the general population and patients with cardiovascular disease. [1][2][3][4] In particular, recent studies have shown that any stage of renal dysfunction (mild to severe) is an independent risk factor for short-and long-term mortality among patients with myocardial infarction (MI), even after administration of fibrinolytics. [5][6][7][8] Moreover, it has been demonstrated that impaired renal function is associated with poorer clinical outcome after either percutaneous coronary intervention or coronary artery bypass graft surgery. [9][10][11][12] Several recently published studies have shown that renal insufficiency is common among patients with a broad spectrum of acute coronary syndromes (ACS) at admission and is associated with higher risk of death as well as major bleeding. [13][14][15][16][17][18][19] However, the effect of renal insufficiency in patients with non-ST-segment elevation MI (NSTEMI) and unstable angina (UA) has been less extensively investigated.The primary objective of this study was to evaluate the characteristics of patients with varying degrees of renal dysfunction among those hospitalized with all clinical presentations of ACS and the impact of renal dysfunction on in-hospital cardiovascular mortality of those patients. Secondarily, we sought to investigate the aforementioned for those with ST-segment elevation MI (STEMI) and those with NSTEMI and UA, separately and to compare the predictive value of these 2 final models in order to conclude in which of these 2 subgroups creatinine clearance is the better predictor. Methods DesignThe design and rationale of this study have been described in detail previously. 20 Briefly, from October 2003 to September 2004 (12 months) we enrolled almost all consecutive patients (participation rate =98%) that entered cardiology clinics or emergency units of 6 major general hospitals in Greece. Finally, the study included only those patients with a discharge diagnosis of ACS; that is, patients STEMI or NSTEMI and UA. The criteria for the diagnosis of STEMI, NSTEMI and UA took into account clinical presentation, ECG findings and the results of serum biochemical markers of necrosis. In particular, acute MI was defined by a typical rise and gradual fall of troponin or a more rapid rise and fall of creatine kinase (CK)-MB, with at least 1 of the following: (a) ischemic symptoms, (b) development of Background The relationship between renal dysfunction and mortality in patients with myocardial infarction (MI) has been extensively investigated, but there are limited data about this relationship in patients presenting with non-ST-segment-elevation MI and unstable angina. Therefore, the aim of the present study was to investigate whether renal insufficiency is an independent predictor for in-hospital mortality among such patients. Methods and ResultsTwo thousand a hundred and seventy-two patie...

No abstract

Objective: The aim of the present study was to examine the independent association between time spent on sedentary activity, either objectively measured or self-reported and IR proxy measures in European adolescents. Methods:A subset (n=1,097) of a large multicentre European study in adolescents (HELENA-CSS study) was used in the present study. Homeostasis model assessment (HOMA)-IR was calculated. Serum concentrations of glucose (GF) and insulin (IF) were measured after an overnight fast. The HOMA-IR was calculated as IF (µlU/mL) × GF (mmol/l)/22.5 (to convert IF values in µlU/mL to pmol/l multiply by 6.945) sedentary time and the time spent on moderate-to-vigorous physical activity (MVPA) was objectively measured by using accelerometers. Moreover, the daily minutes spent on sedentary activities were recorded through a self-report sedentary behaviour questionnaire.Results: Univariate analyses showed that HOMA-IR levels were significantly higher among adolescents watching TV ≥ 2h/day (1.87 (C.I.1.31, 2.66)) compared to the rest of adolescents (2.02 (1.44, 2.82), p=0.011). Moreover, the objectively measured MVPA was inversely correlated to HOMA-IR (rho=-0.117, p=0.023). Multilevel linear regression analysis revealed that adolescents watching TV ≥ 2 h/day had significantly higher HOMA-IR even after controlling for gender, age, total energy intake, total fat intake, simple carbohydrate intake and pubertal stage (p=0.007). Further adjustment for MVPA, showed that TV viewing time remained significantly related to the IR (p=0.002). In this model, MVPA was also inversely associated with HOMA-IR levels (p=0.001). Finally, further controlling for waist circumference showed that adolescents exceeding the limit of 2 h/day watching TV continued to have higher HOMA-IR levels (p=0.002). Stratified analysis by BMI status, revealed that TV viewing time is independently associated with HOMA-IR only among normal weight adolescents, while MVPA was inversely associated with IR in both overweight/ obese and normal weight adolescents. Conclusions:The results of the present study indicate that time spent watching TV and at MVPA is related to IR independent of central fat mass and total energy intake in normal weight European adolescents, while MVPA seems to protect adolescents from developing IR even among overweight/obese adolescents. Therefore, intervention programmes aiming at reducing sedentary behaviours and increasing overall moderate-intensity activities should be implemented.