Zhang Y, Reilly KH, Tong W, Xu T, Chen J, Bazzano LA, Qiao D, Ju Z, Chen C, He J.

Blood pressure and clinical outcome among patients with acute stroke in inner Mongolia, China.

J Hypertens 2008 July; 26(7):1446-1452.

Objectives
The association between blood pressure and short-term clinical outcome of acute stroke is inconclusive. We studied the association between admission blood pressure and in-hospital death or disability among acute stroke patients in Inner Mongolia, China.

Methods
A total of 2178 acute ischemic stroke and 1760 hemorrhagic stroke patients confirmed by a computed tomography scan or magnetic resonance imaging were included in the present study. Blood pressure and other study variables were collected within the first 24 h of hospital admission. Clinical outcomes were evaluated by trained neurologists during hospitalization.

Results
The in-hospital case-fatality rate was higher for acute hemorrhagic stroke (5.9%) than it was for acute ischemic stroke (1.8%), whereas the disability rate was higher for those with acute ischemic stroke (41.3%) than those with acute hemorrhagic stroke (34.4%) at discharge. Blood pressure at admission was not significantly associated with clinical outcome in acute ischemic stroke. On the contrary, systolic and diastolic blood pressures were significantly and positively associated with odds of death or disability in acute hemorrhagic stroke. For example, compared to those with a systolic blood pressure less than 140 mmHg, multiple-adjusted odds ratio (95% confidence interval) of death/disability was 1.38 (0.96, 1.99), 1.42 (1.00, 2.03), 1.84 (1.28, 2.64), and 1.91 (1.35, 2.70) among participants with systolic blood pressure 140-159, 160-179, 180-199, and at least 200 mmHg, respectively (P < 0.0001 for linear trend).

Conclusion
Increased systolic and diastolic blood pressure were significantly and positively associated with death and disability among patients with acute hemorrhagic stroke, but not acute ischemic stroke, in inner Mongolia, China.

Modification of risk factors can reduce the number of deaths due to cardiovascular disease (CVD). Internal medicine (IM) residents devote significant clinical time to help patients modify CVD risk factors but may fail to recognize the presence of such factors in their own lives. The prevalence of major modifiable risk factors was assessed in IM residents. Of 101 eligible residents, 56 completed at least 1 component of the study. None had symptoms or history of CVD, and 11 (20%) had >=2 CVD risk factors. Of 39 subjects who had physical assessment, 3 had systolic hypertension and 13 had a body mass index >=25. Of 38 patients with fasting lipid measurements, 13 had total cholesterol >200 mg/dL; 28 had low-density lipoprotein >=100 mg/dL, with 7 >160 mg/dL; and 7 had high-density lipoprotein <40 mg/dL. Three residents smoked 10 cigarettes per day and 15 were sedentary. Training in IM should include strategies to increase awareness of modifiable personal risk factors for CVD, as well as strategies to reduce or eliminate them.

This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable ([alpha]=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.

Background
Cross-sectional studies indicate metabolic syndrome is a risk factor for elevated serum uric acid. However, longitudinal data on this association are limited.

Methods
Bogalusa Heart Study participants (n = 517) were examined as children, aged 5 to 17 years, and as adults 13 to 21 years later. Childhood metabolic syndrome components included the highest quartile (specific for year of age, race, sex, and study year) of body mass index, insulin resistance, blood pressure, and triglycerides and lowest quartile of HDL cholesterol. Metabolic syndrome was defined as the presence of 3 or more of these components and elevated serum uric acid, in adulthood, as values at or above the 90th percentile (specific for race and sex).

Results
For males, after multivariate adjustment, the odds ratios (95% confidence interval) of elevated serum uric acid associated with high blood pressure, low HDL-cholesterol, high triglycerides, insulin resistance, and high body mass index were 2.61 (1.13, 6.03), 1.47 (0.57, 3.80), 1.30 (0.55, 3.08), 2.87 (1.23, 6.71), and 3.25 (1.36, 7.74), respectively. The analogous odds ratios for females were 2.12 (0.99, 4.54), 0.38 (0.14, 1.04), 1.16 (0.54, 2.46), 1.78 (0.83, 3.79), and 3.55 (1.73, 7.31), respectively. Males and females with the metabolic syndrome in childhood were 2.60 (1.08, 6.27) and 3.01 (1.34, 6.75) times more likely to have elevated serum uric acid as adults, respectively.

Conclusions
Metabolic syndrome and high body mass index in childhood were predictors of elevated uric acid in adulthood.

Transposable elements (TEs) have shared an exceptionally long coexistence with their host organisms and have come to occupy a significant fraction of eukaryotic genomes. The bulk of the expansion occurring within mammalian genomes has arisen from the activity of type I retrotransposons, which amplify in a "copy-and-paste" fashion through an RNA intermediate. For better or worse, the sequences of these retrotransposons are now wedded to the genomes of their mammalian hosts. Although there are several reported instances of the positive contribution of mobile elements to their host genomes, these discoveries have occurred alongside growing evidence of the role of TEs in human disease and genetic instability. Here we examine, with a particular emphasis on human retrotransposon activity, several newly discovered aspects of mammalian retrotransposon biology. We consider their potential impact on host biology as well as their ultimate implications for the nature of the TE-host relationship.

Purpose
Examine the complex relationships among metabolic syndrome components in black and white individuals by growth periods.

Methods
Path analyses of metabolic syndrome components were performed on 8203 black and white healthy subjects (64.3% white and 47.9% male) comprising children (4-11 years), adolescents (12-18 years), and adults (19-44 years).

Results
The direct effect of body mass index (BMI) on fasting insulin levels was greatest among all the paths for each age group in both races.

In general, path coefficients were greater in whites than in blacks except for the age-mean arterial pressure (MAP) path and greater in children and adults than in adolescents. The direct age effect on MAP was greater in black versus white adults (p = 0.010 for race difference). Whites showed greater direct effects of BMI on MAP in children (p = 0.007), adolescents (p = 0.090), and adults (p = 0.022); BMI on insulin in adolescents (p < 0.001); BMI on triglycerides in children (p = 0.003); and insulin on triglycerides in adults (p < 0.001). A race difference in the effect of BMI on fasting glucose was noted among adolescents (p = 0.048).

Conclusions
The black-white differences in the relationships of obesity and insulin resistance measures to other components may account for the lower prevalence of metabolic syndrome in the black population.

Setting
Data from the medical birth registry of Norway linked with clinical data on virtually all cleft patients treated in Norway over a 35 year period.

Participants
2.1 million children born in Norway between 1967 and 2001, 4138 of whom were treated for an oral cleft.

Main outcome measure
Relative risk of recurrence of isolated clefts from parent to child and between full siblings, for anatomic subgroups of clefts.

Results
Among first degree relatives, the relative risk of recurrence of cleft was 32 (95% confidence interval 24.6 to 40.3) for any cleft lip and 56 (37.2 to 84.8) for cleft palate only (P difference=0.02). The risk of clefts among children of affected mothers and affected fathers was similar. Risks of recurrence were also similar for parent-offspring and sibling-sibling pairs. The "crossover" risk between any cleft lip and cleft palate only was 3.0 (1.3 to 6.7). The severity of the primary case was unrelated to the risk of recurrence.

Conclusions
The stronger family recurrence of cleft palate only suggests a larger genetic component for cleft palate only than for any cleft lip. The weaker risk of crossover between the two types of cleft indicates relatively distinct causes. The similarity of mother-offspring, father-offspring, and sibling-sibling risks is consistent with genetic risk that works chiefly through fetal genes. Anatomical severity does not affect the recurrence risk in first degree relatives, which argues against a multifactorial threshold model of causation.

Background
New age- and sex-specific lipoprotein cut points developed from National Health and Nutrition Examination Survey (NHANES) data are considered to be a more accurate classification of a high-risk lipoprotein level in adolescents compared with existing cut points established by the National Cholesterol Education Program (NCEP). The aim of this study was  to determine which of the NHANES or NCEP adolescent lipoprotein classifications was most effective for predicting abnormal levels in adulthood.

Methods and Results
Adolescent and adult measures of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were collected in 365 Australian, 1185 Finnish, and 273 US subjects participating in 3 population-based prospective cohort  studies. Lipoprotein variables in adolescence were classified according to NCEP and NHANES cut points and compared for their ability to predict abnormal levels in adulthood. With the use of diagnostic performance statistics (sensitivity, specificity, positive predictive value, negative predictive value, area under receiver operating characteristic curve) in pooled and cohort-stratified data, the NHANES cut points (compared with 
NCEP cut points) were more strongly predictive of low high-density lipoprotein cholesterol in adults but less predictive of high total cholesterol, high low-density lipoprotein cholesterol, and high triglyceride levels in adults. We identified heterogeneity in the relative 
usefulness of each classification between cohorts.

Conclusions
The separate use of NHANES cut points for high-density lipoprotein cholesterol and NCEP cut points for total cholesterol, low-density lipoprotein cholesterol, and triglycerides yielded the most accurate classification of adolescents who developed dyslipidemia in adulthood.

Studies of inner-city asthmatic children have shown significant regional variation in dust allergen exposures. The home environment of asthmatic children in the Gulf South region of the USA has not been characterized.

This study describes indoor dust allergen levels in the homes of 86 asthmatic children in New Orleans and explores regional variability in dust allergen exposure. Data were used from baseline home visits of children in the New Orleans Healthy Homes Initiative. Interview, visual observation, and environmental dust sampling data of 86 children between 4 and 17 years of age were analyzed. Seventy-seven percent of households had moderate (>2.0-9.9 microg/g) or high (> or =10.0 microg/g) levels of either Der p 1 or Der f 1 dust mite allergen and 56.6% had moderate (>2.0-8.0 U/g) or high (>8.0 U/g) levels of cockroach allergen (Bla g 1).

The prevalence of high (>10 microg/g) levels of dog (Can f 1) allergen was 26.5%, and few households (6.0%) had high cat allergen (Fel d 1) levels (>8.0 microg/g). Households with average humidity levels >50% were three times more likely to have elevated dust mite levels (odds ratio = 3.2; 95% confidence interval = 1.1, 9.3; p = 0.03). Home ownership and education level were inversely associated with cockroach and dust mite allergen levels, respectively. Our findings reinforce the evidence of regional variability in dust allergen exposure levels. Asthmatic children living in the Gulf South are exposed to multiple indoor allergen exposures and live in a highly allergenic environment.

Objective
To determine the 8-year incidence of hypertension and its risk factors among Chinese adults
Methods
A population-based sample of 10,525 Chinese adults aged >=40 years and free from hypertension at baseline was followed up from 1991 to 1999-2000. Incident hypertension was defined as systolic pressure >=140 mmHg, diastolic pressure >=90 mmHg, or current use of antihypertensive medication.
Results
Over a mean of 8.2 years of follow-up, 28.9% of men and 26.9% of women developed hypertension. Among men, independent predictors of incident hypertension were baseline age [relative risk (RR) per 5 years: 1.10; 95% confidence interval (CI): 1.07, 1.13], living in urban regions versus rural regions (RR: 0.74; 95% CI: 0.64, 0.85), alcohol drinking versus non-drinking (RR: 1.13; 95% CI: 1.02, 1.24), prehypertension versus normotension (RR: 1.70; 95% CI: 1.53, 1.88), heart rate (RR of third versus first tertile: 1.27; 95% CI: 1.13, 1.44), body mass index (RR of third versus first tertile: 1.28; 95% CI: 1.12, 1.46), and low versus high physical activity (RR: 1.27; 95% CI: 1.10, 1.47). Results were similar for women, with current smoking in place of alcohol drinking and opposite results for region. The population-attributable risk of modifiable risk factors was between 25 and 50%.
Conclusions
These data indicate that the incidence of hypertension is high among these Chinese adults, and suggest that 25-50% of new hypertension cases could be prevented with risk factor modification. Given the excess cardiovascular mortality associated with hypertension, these data call for urgent improvements in hypertension prevention and control programs in China.

Objective
To explore the accuracy of various body mass index (BMI) cutpoints in identifying children who have excess adiposity (based on skin fold thicknesses), adverse levels of lipids, insulin, and blood pressures and a high risk for severe adult obesity.
Study Design
Cross-sectional (n=10,099) and longitudinal (n=2392) analyses were performed among subjects who participated in the Bogalusa Heart Study.
Results
Of children with a BMI <=95th percentile (P) of the Centers for Disease Control (CDC) growth charts, 39% had at least two risk factors, 65% had excess adiposity, and 65% had an adult BMI of <=35 kg/m2. Of those with a BMI <=99th P, 59% had at least two risk factors, 94% had excess adiposity, and 88% had an adult BMI of <=35 kg/m2. About 4% of children in the US now have a BMI <=99th P.
Conclusions
The 99th P of BMI-for-age may be appropriate for identifying children who are at very high risk for biochemical abnormalities and severe adult obesity. More aggressive weight control strategies may be warranted for this subgroup.

Context
Epidemiologic studies have suggested that folate intake decreases risk of cardiovascular diseases. However, the results of randomized controlled trials on dietary supplementation with folic acid to date have been inconsistent.
Objective
To evaluate the effects of folic acid supplementation on risk of cardiovascular diseases and all-cause mortality in randomized controlled trials among persons with preexisting cardiovascular or renal disease.
Data Sources
Studies were retrieved by searching MEDLINE (January 1966-July 2006) using the Medical Subject Headings cardiovascular disease, coronary disease, coronary thrombosis, myocardial ischemia, coronary stenosis, coronary restenosis, cerebrovascular accident, randomized controlled trial, clinical trials, homofolic acid, and folic acid, and the text words folic acid and folate. Bibliographies of all retrieved articles were also searched, and experts in the field were contacted.
Study Selection
From 165 relevant retrieved reports, 12 randomized controlled trials compared folic acid supplementation with either placebo or usual care for a minimum duration of 6 months and with clinical cardiovascular disease events reported as an end point.
Data Extraction
Data on study design, characteristics of participants, changes in homocysteine levels, and cardiovascular disease outcomes were independently abstracted by 2 investigators using a standardized protocol.
Data Synthesis
Studies including data from 16, 958 participants with preexisting vascular disease were analyzed using a random-effects model. The overall relative risks (95% confidence intervals) of outcomes for patients treated with folic acid supplementation compared with controls were 0.95 (0.88-1.03) for cardiovascular diseases, 1.04 (0.92-1.17) for coronary heart disease, 0.86 (0.71-1.04) for stroke, and 0.96 (0.88-1.04) for all-cause mortality. The relative risk was consistent among participants with preexisting cardiovascular or renal disease.
Conclusions
Folic acid supplementation has not been shown to reduce risk of cardiovascular diseases or all-cause mortality among participants with prior history of vascular disease. Several ongoing trials with large sample sizes might provide a definitive answer to this important clinical and public health question.

Purpose
The use of different definitions of the metabolic syndrome has led to inconsistent results on the association between the metabolic syndrome and risk of cardiovascular disease. We examined the association between the metabolic syndrome and risk of cardiovascular disease.
Methods
A MEDLINE search (1966-April 2005) was conducted to identify prospective studies that examined the association between the metabolic syndrome and risk of cardiovascular disease. Information on sample size, participant characteristics, metabolic syndrome definition, follow-up duration, and endpoint assessment was abstracted.
Results
Data from 21 studies met the inclusion criteria and were included. Individuals with the metabolic syndrome, compared to those without, had an increased mortality from all causes (relative risk [RR] 1.35; 95% confidence interval [CI], 1.17-1.56) and cardiovascular disease (RR 1.74; 95% CI, 1.29-2.35); as well as an increased incidence of cardiovascular disease (RR 1.53; 95% CI, 1.26-1.87), coronary heart disease (RR 1.52; 95% CI, 1.37-1.69) and stroke (RR 1.76; 95% CI, 1.37-2.25). The relative risk of cardiovascular disease associated with the metabolic syndrome was higher in women compared with men and higher in studies that used the World Health Organization definition compared with studies that used the Adult Treatment Panel III definition.
Conclusion
This analysis strongly suggests that the metabolic syndrome is an important risk factor for cardiovascular disease incidence and mortality, as well as all-cause mortality. The detection, prevention, and treatment of the underlying risk factors of the metabolic syndrome should become an important approach for the reduction of the cardiovascular disease burden in the general population.

Objective
We examined the relationship between periodontal disease and different types of diabetes in pregnant and nonpregnant women.
Study Design
This study was based on the data from the third National Health and Nutrition Examination Survey (NHANES III), including 256 pregnant and 4234 nonpregnant women. Women were classified into those with gestational diabetes mellitus (GDM) in current pregnancy, with GDM in previous pregnancy, and with type 1 or 2 diabetes.
Results
In pregnant women, the prevalence of periodontitis was 44.8% in women with GDM and 13.2% in nondiabetic women, with adjusted odds ratio (aOR) of 9.11 (95% confidence interval [CI] 1.11-74.9). In nonpregnant women, the prevalence of periodontitis was 40.3% in women with type 1 or 2 diabetes, 25.0% in women with previous history of GDM, and 13.9% in nondiabetic women, with aOR of 2.76 (1.03-7.35) for women with type 1 or 2 diabetes.
Conclusion
We found an association between periodontal disease and GDM.

Influence of lipoprotein lipase gene Ser447Stop and [beta]1-adrenergic receptor gene Arg389Gly polymorphisms and their interaction on obesity from childhood to adulthood: the Bogalusa Heart Study

International Journal of Obesity. Aug 2006. 30 (8):1183-1188

Objectives
To investigate the influence of lipoprotein lipase (LPL) Ser447Stop and [beta]1-adrenergic receptor (ADRB1) Arg389Gly gene polymorphisms, individually and in combination, on obesity from childhood to adulthood.
Design and subjects
A community-based cohort of 1331 subjects (30% black and 70% white subjects) was followed over an average period of 23 years from childhood (age range: 4-17 years) to adulthood (age range: 18-44 years).
Measurements
Body mass index (BMI, kg/m2) and LPL Ser447Stop and the ADRB1 Arg389Gly genotypes. 
Results
The frequency of the ADRB1 Gly389 allele was 0.25 in white subjects vs 0.39 in black subjects (P<0.001); 0.08 vs 0.05 (P=0.280) for the LPL Stop447 allele. There was no association between the LPL Stop447 allele and BMI among white and black subjects either in childhood and adulthood levels or annual change from childhood to adulthood. The ADRB1 Gly389 allele was associated with lower BMI only in black adults (P=0.017). Further, the interaction effect of the LPL Stop447 allele and ADRB1 Gly389 allele on adult BMI or its annual change was significant in white subjects and in the total sample (P=0.03-0.006). Childhood values tended to show a similar trend. Having both ADRB1 Gly389 allele and LPL Stop447 allele was associated with 71% (95% confidence interval: 26-89%) less odds for developing obesity from childhood to adulthood after adjusting for age, race, sex, and childhood BMI. Conclusion: While Gly389 allele of the ADRB1 gene lowers obesity in black subjects, this allele in conjunction with Stop447 allele of the LPL gene lowers obesity in adults and attenuates the development of obesity from childhood to adulthood. These findings underscore the importance of gene-gene interaction in the assessment of genetic influences on complex traits such as obesity.

Patient-delivered partner treatment for Trichomonas vaginalis infection: a randomized controlled trial

Sexually Transmitted Diseases. Jul 2006. 33(7):445-50

Objectives
Infections with Trichomonas vaginalis (TV) are common and recurrence rates are high. Better methods of treating partners of women with trichomoniasis are needed. GOAL: To determine if patient-delivered partner treatment (PDPT) is better and more cost-effective than partner referral.
Study Design
Women attending a family planning clinic who were culture-positive and treated for TV (N = 463) were randomized to either standard partner referral (PR), booklet-enhanced partner referral (BEPR), or PDPT. At baseline and 1 month, women were interviewed and cultured for TV. Detailed cost information was also collected.
Results
Most women had 1 partner, were less than 24 years old, and were black. The percentage of women reporting that their partners were treated was similar for PDPT but significantly lower for BEPR compared to PR. TV follow-up rates were similar. PDPT cost less and was cost saving compared to PR and BEPR.
Conclusion
Among women with TV, PDPT did not result in more partners taking the medicine or lower follow-up rates than PR but was less costly.

Objectives
The diagnosis of pulmonary tuberculosis presents challenges in children, because symptoms are nonspecific, sputa are not accessible, and Mycobacterium tuberculosis cultures and smears often are negative. The Microscopic Observation Drug Susceptibility technique is a simple, inexpensive method for Mycobacterium tuberculosis isolation with superior speed and sensitivity over Lowenstein-Jensen culture in studies of adults with pulmonary tuberculosis. The objective of this study was to determine whether Microscopic Observation Drug Susceptibility culture can improve the sensitivity and speed of Mycobacterium tuberculosis recovery among Peruvian children with symptoms suggestive of pulmonary tuberculosis.
Methods
Two specimens of each type (gastric aspirate, nasopharyngeal aspirate, and stool specimens) were collected from each patient, examined by auramine stain, and cultured by Microscopic Observation Drug Susceptibility and Lowenstein-Jensen techniques. Patients (n=165) were enrolled between April 2002 and February 2004 at the Instituto de Salud del Nino, the major pediatric hospital in Lima, Peru. Inclusion criteria were age < or = 12 years, Stegen-Toledo clinical score > or = 5 points, and absence of antituberculous therapy. The main outcome measurements were (1) proportion of specimens that were culture positive by Microscopic Observation Drug Susceptibility versus Lowenstein-Jensen and (2) days required for positive culture result, stratified by specimen type and auramine stain result.
Results
Fifteen (9%) patients had at least 1 positive Mycobacterium tuberculosis culture (from stool in 3 cases, nasopharyngeal aspirate in 8 cases, and gastric aspirate in 15 cases). Thirty-eight culture-positive specimens were obtained (22 gastric aspirate, 12 nasopharyngeal aspirates, and 4 stools). Microscopic Observation Drug Susceptibility provided  significantly more positive cultures than Lowenstein-Jensen (33 of 38 specimens culture positive by Microscopic Observation Drug Susceptibility vs 21 of 38 by Lowenstein-Jensen). This was attributed to enhanced recovery of Mycobacterium tuberculosis from auramine-negative specimens (19 of 23 by Microscopic Observation Drug Susceptibility vs 9 of 23 by Lowenstein-Jensen), in contrast to similar detection rates for the 2 tests with auramine-positive samples. Similar results were found for analyses that were limited to gastric aspirates. Isolation was faster by Microscopic Observation Drug Susceptibility than Lowenstein-Jensen.
Conclusions
Isolation of Mycobacterium tuberculosis from children with suspected pulmonary tuberculosis by Microscopic Observation Drug Susceptibility demonstrated greater yield and faster recovery than by Lowenstein-Jensen method, significantly improving local capabilities to detect pediatric tuberculosis in resource-poor settings.

Objectives
This study sought to examine the usefulness of non-high-density lipoprotein cholesterol levels in predicting future dyslipidemia and other cardiovascular risk in adulthood.
Methods
The study sample consisted of a longitudinal cohort of subjects (n=1163; 30.1% black and 55.4% female) who participated in the Bogalusa Heart Study both as children at 5 to 14 years of age and as adults 27 years later.
Results
The childhood level of non-high-density lipoprotein cholesterol, like low-density lipoprotein cholesterol, was the best predictor of the adulthood level; the next best predictor for both variables was the change in BMI from childhood to adulthood. Furthermore, those in the age-, race-, and gender-specific top quartile, compared with those in the bottom quartile, of non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels in childhood were 4.5 and 3.5 times more likely, respectively, to develop adult dyslipidemia, independent of baseline BMI and BMI change after 27 years. Although, at equivalent cutoff points, childhood high-risk versus acceptable-risk status for both lipid measures was associated significantly with increased prevalence of obesity and adverse levels of low-density lipoprotein cholesterol and triglycerides in adulthood, only childhood non-high-density lipoprotein cholesterol high-risk status was associated with increased prevalence of low-high-density lipoprotein cholesterol levels, hyperinsulinemia, and hyperglycemia (marginal).
Conclusions
Adverse levels of non-high-density lipoprotein cholesterol versus low-density lipoprotein cholesterol in childhood not only equally persist over time and better predict adult dyslipidemia but also are related to nonlipid cardiovascular risk factors in adulthood.

Background
There is growing evidence that symptoms of depression influence the development of cardiovascular disease. The objective of this study was to evaluate the direct and indirect relationship between symptoms of