The toenail mercury level was directly associated with the risk of myocardial infarction, and the adipose-tissue DHA level was inversely associated with the risk. High mercury content may diminish the cardioprotective effect of fish intake.

Our findings are compatible with the view that persons with NIDDM or borderline glucose intolerance have stiffer arteries than their counterparts with normal glucose tolerance and that the decreased elasticity is independent of artery wall thickness. The joint effect of elevated glucose, insulin, and triglycerides can have a considerable impact on arterial stiffness and play an important role in the early pathophysiology of macrovascular disease in NIDDM.

Abstract-The prognostic value of sleep blood pressure reported by recent studies is variable. Our aim was to examine the relationship of sleep blood pressure, measured by 24-hour ambulatory blood pressure monitoring, with all-cause mortality. We studied a cohort of 3957 patients aged 55Ϯ16 (58% treated) referred for ambulatory monitoring (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005) Key Words: ambulatory blood pressure monitoring Ⅲ dipping Ⅲ mortality Ⅲ cohort Ⅲ sleep blood pressure D ata generated by 24-hour ambulatory blood pressure monitoring (ABPM) have been used to predict cardiovascular morbidity, as well as cardiovascular and all-cause mortality. [1][2][3][4][5][6][7][8][9] There is mounting evidence that this predictive ability is in part unrelated to clinic blood pressure (BP) measurements. Conceivably, ABPM reflects physiological states that are not captured by resting clinic measurements. 9 Moreover, ABPM reduces the influence of the measurement itself on BP values, namely the white-coat effect. In addition, ambulatory monitoring may unmask abnormal BP values that were not detected in the office. Thus, it is expected that ABPM would predict mortality above and beyond clinic measurements. There is still debate, however, whether in reality this is indeed the case and whether the use of this burdensome technique in clinical care is justified and contributes to patient management. 5 Another issue under debate concerns which component of the 24-hour ambulatory monitoring incorporates the most valuable prognostic information. Measurements taken during the waking state reflect, in part, physical activity, which may differ within and between patients. Thus, we hypothesized that, compared with awake BP, sleep measurements would relate to prognosis in a more profound way. Indeed, some 1,3,5,7,10,11 but not all 2 of the outcome studies have suggested this previously.In this study, we investigated all-cause mortality among patients who underwent ambulatory monitoring in a single center since 1991. We highlight sleep BP data identified by recorded sleeping periods, including afternoon naps. 12 We show that sleep BP, as well as nocturnal BP reduction (dipping, a somewhat controversial and infrequently studied topic 7,9,10,13 ) have independent predictive power. Methods Study PopulationData were extracted from our entire ABPM service database, from 1991 through 2005. All of the patients were included, except those Ͻ16 years old, pregnant women, and subjects with poor-quality ABPM (Ͻ50 valid measurements). Patients were referred for standard clinical indications at the discretion of the referring physician (mainly primary care practitioners, who have been shown to use ABPM for appropriate indications 14 ). We were not involved in the clinical care of these patients. Baseline data collected included demographic characteristics (age: 55 years [range: 16 to 93 years], sex (53% female), ethnicity (94% Jewish and 6% non-Jewish, predominantly Moslem Arabs), height (1.67 m; range...

Objective-To evaluate the stability of short recordings of heart rate variability (HRV) with time, and the association of HRV with age and sex. Design-Five minute Holter recordings were made twice over a two month interval (tracking study). In addition, HRV was measured in a cross sectional study. Setting-Residents of 11 Israeli kibbutzim were examined in their settlements. Subjects-32 men and 38 women (aged 31-67) participated in the tracking study and 294 (aged 35-65) were involved in the cross sectional study. Main outcome measures-Time and frequency domain analyses on Holter recordings were undertaken in two breathing conditions: spontaneous and controlled breathing (15 respirations per minute). Regression was used to assess the relations of sex, age, heart rate, and logarithmically transformed HRV indices. Results-HRV measures were highly consistent with time with correlations of 0.76-0.80 for high frequency and total power. Geometric mean total power declined with age by 45% in men and 32% in women, and was lower by 24% among women than among men (all p < 0.005). Men had a 34% higher very low and low frequency power and a higher ratio of low to high frequency power (p < 0.001). Conversely, high frequency power in women represents a greater proportion of total power than in men. Conclusion-Short recordings of HRV in a non-laboratory setting are stable over months and therefore characteristic of an individual. Strong age and sex eVects were evident. HRV derived from short recordings can be informative in population based studies. (Heart 1998;80:156-162) Keywords: heart rate variability; parasympathetic activity; reliability; sex diVerences Heart rate variability (HRV) measures can provide non-invasive information on the autonomic nervous system, including its vagal and sympathetic components. [1][2][3][4] Interest in these measures has increased recently in light of predictive associations between reduced HRV and increased mortality after an acute myocardial infarction (MI), 5-8 and between HRV and the incidence of coronary heart disease and mortality in a community based population. 9 10 These associations were independent of the eVect of conventional risk factors. 9 10 Most studies of HRV have used 24 hour Holter recorded electrocardiograms (ECGs). Such measurement is often not feasible for widescale epidemiological studies, and may be unnecessary. In men after an acute MI, HRV measures calculated from 2-15 minute segments were remarkably similar to those calculated over 24 hours, and provided predictive information similar in strength to the entire record. 8 A recently published report of a European and North American task force on measurement of HRV for clinical use indicated sparse availability of information on the reliability of short segment recordings. 11 We undertook two studies in an unselected free living population sample to determine the feasibility and potential usefulness of five minute recordings in men and women aged 35-65 years. Recordings were made under conditions of free and ...