Letters to the Editor
data of Movsesian et al, D'Agnolo et al, and Lederer et al are not in disagreement with our results. Dirk J. Beuckelmann, MD Michael Nibauer, MD Erland Erdmann, MD Department of Medicine I University of Munich Klinikum Grosshadern Munich, FRG
cardiovascular death. Sixty pairs could be matched for conventional cardiovascular risk factors whereby one subject had and the other had not suffered an end point within the follow-up period. The relative odds of those with a second event compared with event-free controls was 2.86 (95% CI, 1.06-8.43) for plasma viscosity (cut-off point, 1.31 mPa sec). These data add to the growing body of evidence suggesting that rheological parameters, in particular plasma viscosity, which, of course, is strongly related to fibrinogen, may contribute to the atherothrombotic risk.
References
Wolfgang Koenig, MD Vinzenz Hombach, MD Department of Internal Medicine IV Ulm University Medical Center Ulm, FRG Edzard Ernst, MD Institute of Physical Medicine and Rehabilitation University of Vienna Vienna, Austria Malte Sund, MS GSF Research Center for Environment and Health Medis Institute Neuherberg, Germany Wilfried Mraz, PhD Department of Clinical Chemistry Klinikum Grofihadern University of Munich Munich, FRG Ulrich Keil, MD, PhD Department of Social Medicine and Epidemiology Ruhr University and GSF Research Center for Environment and Health Institute of Epidemiology Bochum and Neuherberg, FRG
1. Fabiato A: Time and calcium dependence of activation and inactivation of calcium-induced release of calcium from the sarcoplasmic reticulum of a skinned canine cardiac purkinje cell. J Gen Physiol 1985;85:247-289 2. Movsesian MA, Bristow MR, Krall J: Ca 2+ uptake by cardiac sarcoplasmic reticulum from patients with idiopathic dilated cardiomyopathy. Circ Res 1989;65:1141-1144 3. Movsesian MA, Colyer J, Wang JH, Krall J: Phospholambanmediated stimulation of Ca2l uptake in sarcoplasmic reticulum from normal and failing hearts. J Clin Invest 1990;85:1698-1702 4. D'Agnolo A, Luciani GB, Mazzucco A, Gallucci V, Salviati G: Contractive properties and Ca 2+ release activity of the sarcoplasmic reticulum in dilated cardiomyopathy. Circulation 1992;85:518-525 5. Lederer WJ, Berlin JR, Cohen NM, Hadley RW, Bers DM, Cannell MB: Excitation-contraction coupling in heart cells. Role of the sodium-calcium exchange, the calcium current, and the sarcoplasmic reticulum. Ann N YAcad Sci 1990;588:190-206
Plasma Viscosity as a Cardiovascular Risk Factor We appreciate the extensive editorial comment on our recent article' and fully underscore the statements made, particularly the need for longitudinal data from diverse populations. We now have evidence from two different data sets that supports the prognostic importance of plasma viscosity for cardiovascular events as suggested by Yarnell et a12 and Lowe.3 First, in the MONICA-Project Augsburg, 941 initially healthy men 45-64 years old were followed for 6 years. These subjects were part of a random sample of the general population (age, 25-64 years). During the follow-up period, 33 ischemic heart disease events (fatal and nonfatal myocardial infarction, cardiac death) occurred in this group. The age-adjusted relative risk of a major event in the top quintile of the plasma viscosity distribution compared with the bottom quintile was 3.65 (95% CI, 1.02-13.12). These data are remarkably consistent with those reported by Yarnell et al.2 The second data set derives from a case-control study among a cohort of survivors of a first stroke followed for an average of 2 years. End points were second stroke, myocardial infarction, and
1045
References 1. Koenig W, Sund M, Ernst E, Mraz W, Hombach V, Keil U: Association between rheology and components of lipoproteins in human blood: Results from the MONICA-Project Augsburg. Circulation 1992;85 (in press) 2. Yarnell JWG, Baker IA, Sweetnam PM, Bainton D, O'Brian JR, Whitehead PJ, Elwood PC: Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease: The Caerphilly and Speedwell Collaborative Heart Disease Studies. Circulation 1991;83:836-844 3. Lowe GDO: Blood viscosity, lipoproteins and cardiovascular risk. (editorial) Circulation 1992;85 (in press)
Downloaded from http://circ.ahajournals.org/ at SUNY Health Science Center on April 18, 2015
Plasma viscosity as a cardiovascular risk factor. W Koenig, V Hombach, E Ernst, M Sund, W Mraz and U Keil Circulation. 1992;86:1045 doi: 10.1161/01.CIR.86.3.1045 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 1992 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/86/3/1045.citation
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/
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data of Movsesian et al, D'Agnolo et al, and Lederer et al are not in disagreement with our results. Dirk J. Beuckelmann, MD Michael Nibauer, MD Erland Erdmann, MD Department of Medicine I University of Munich Klinikum Grosshadern Munich, FRG
cardiovascular death. Sixty pairs could be matched for conventional cardiovascular risk factors whereby one subject had and the other had not suffered an end point within the follow-up period. The relative odds of those with a second event compared with event-free controls was 2.86 (95% CI, 1.06-8.43) for plasma viscosity (cut-off point, 1.31 mPa sec). These data add to the growing body of evidence suggesting that rheological parameters, in particular plasma viscosity, which, of course, is strongly related to fibrinogen, may contribute to the atherothrombotic risk.
References
Wolfgang Koenig, MD Vinzenz Hombach, MD Department of Internal Medicine IV Ulm University Medical Center Ulm, FRG Edzard Ernst, MD Institute of Physical Medicine and Rehabilitation University of Vienna Vienna, Austria Malte Sund, MS GSF Research Center for Environment and Health Medis Institute Neuherberg, Germany Wilfried Mraz, PhD Department of Clinical Chemistry Klinikum Grofihadern University of Munich Munich, FRG Ulrich Keil, MD, PhD Department of Social Medicine and Epidemiology Ruhr University and GSF Research Center for Environment and Health Institute of Epidemiology Bochum and Neuherberg, FRG
1. Fabiato A: Time and calcium dependence of activation and inactivation of calcium-induced release of calcium from the sarcoplasmic reticulum of a skinned canine cardiac purkinje cell. J Gen Physiol 1985;85:247-289 2. Movsesian MA, Bristow MR, Krall J: Ca 2+ uptake by cardiac sarcoplasmic reticulum from patients with idiopathic dilated cardiomyopathy. Circ Res 1989;65:1141-1144 3. Movsesian MA, Colyer J, Wang JH, Krall J: Phospholambanmediated stimulation of Ca2l uptake in sarcoplasmic reticulum from normal and failing hearts. J Clin Invest 1990;85:1698-1702 4. D'Agnolo A, Luciani GB, Mazzucco A, Gallucci V, Salviati G: Contractive properties and Ca 2+ release activity of the sarcoplasmic reticulum in dilated cardiomyopathy. Circulation 1992;85:518-525 5. Lederer WJ, Berlin JR, Cohen NM, Hadley RW, Bers DM, Cannell MB: Excitation-contraction coupling in heart cells. Role of the sodium-calcium exchange, the calcium current, and the sarcoplasmic reticulum. Ann N YAcad Sci 1990;588:190-206
Plasma Viscosity as a Cardiovascular Risk Factor We appreciate the extensive editorial comment on our recent article' and fully underscore the statements made, particularly the need for longitudinal data from diverse populations. We now have evidence from two different data sets that supports the prognostic importance of plasma viscosity for cardiovascular events as suggested by Yarnell et a12 and Lowe.3 First, in the MONICA-Project Augsburg, 941 initially healthy men 45-64 years old were followed for 6 years. These subjects were part of a random sample of the general population (age, 25-64 years). During the follow-up period, 33 ischemic heart disease events (fatal and nonfatal myocardial infarction, cardiac death) occurred in this group. The age-adjusted relative risk of a major event in the top quintile of the plasma viscosity distribution compared with the bottom quintile was 3.65 (95% CI, 1.02-13.12). These data are remarkably consistent with those reported by Yarnell et al.2 The second data set derives from a case-control study among a cohort of survivors of a first stroke followed for an average of 2 years. End points were second stroke, myocardial infarction, and
1045
References 1. Koenig W, Sund M, Ernst E, Mraz W, Hombach V, Keil U: Association between rheology and components of lipoproteins in human blood: Results from the MONICA-Project Augsburg. Circulation 1992;85 (in press) 2. Yarnell JWG, Baker IA, Sweetnam PM, Bainton D, O'Brian JR, Whitehead PJ, Elwood PC: Fibrinogen, viscosity, and white blood cell count are major risk factors for ischemic heart disease: The Caerphilly and Speedwell Collaborative Heart Disease Studies. Circulation 1991;83:836-844 3. Lowe GDO: Blood viscosity, lipoproteins and cardiovascular risk. (editorial) Circulation 1992;85 (in press)
Downloaded from http://circ.ahajournals.org/ at SUNY Health Science Center on April 18, 2015
Plasma viscosity as a cardiovascular risk factor. W Koenig, V Hombach, E Ernst, M Sund, W Mraz and U Keil Circulation. 1992;86:1045 doi: 10.1161/01.CIR.86.3.1045 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 1992 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/86/3/1045.citation
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/
Downloaded from http://circ.ahajournals.org/ at SUNY Health Science Center on April 18, 2015
