Aging affects the association between endothelial nitric oxide synthase gene polymorphism and acute myocardial infarction in the Korean male population

OBJECTIVES

The aging process affects responsiveness and other functions of endothelium and vascular smooth muscle cells, predisposing the old vessels to the development of atherosclerotic lesions. Endothelial nitric oxide synthase (ecNOS) gene polymorphisms were shown to affect the occurrence of acute myocardial infarction (AMI). We hypothesized that aging may affect the association between the ecNOS gene polymorphism and AMI.

METHODS

We investigated the age-related distribution of the ecNOS gene a/b polymorphism in 121 male AMI patients and 206 age-matched healthy male controls.

RESULTS

The aa, ab and bb genotypes were found in 1, 49 and 156 cases among the control subjects and 5, 23 and 93 cases among the AMI patients, respectively. There was a significant correlation between the ecNOS polymorphism and AMI (p = 0.045). When the correlation was analyzed by age, the significance remained only in the group below the age of 51 (p = 0.009). The proportion of smokers was increased in the young patients when compared to the old patients (p = 0.033), indicating that smoking also has greater effect on the younger population. The incidences of hypertension and diabetes mellitus, however, were similar in both populations.

CONCLUSION

Our work provides the first evidence that links ecNOS polymorphism to the risk of AMI in relation to age. Young persons who smoke or have ecNOSaa genotype may have an increased risk of developing AMI. The functional as well as structural changes associated with aging in the vascular endothelium may mask the effect of the ecNOS polymorphism in the development of AMI in old persons.

Activation of monocytes, T-lymphocytes and plasma inflammatory markers in angina patients

Inflammation and activation of immune cells have important roles in the pathogenesis of atherosclerosis. We analyzed the plasma levels of inflammatory markers and the degree of activation of peripheral blood monocytes and T-lymphocytes isolated from 12 unstable angina, 12 stable angina, and 12 normal subjects. In 20%-33% of patients, monocytes expressed high basal levels of IL-8, tissue factor, IL-1beta, and monocyte chemoattractant protein-1 mRNA. Furthermore, basal mRNA levels of these cytokines showed strong correlation with each other (p < 0.01 in all combination) but not with tumor necrosis factor-alpha or transforming growth factor-beta1. Plasma level of C-reactive protein was highest in the unstable angina patients (1.63+/-0.70 mg/l) and lowest in the control subjects (0.22+/-0.08 mg/l) (P = 0.03). We also observed a high correlation between C-reactive protein level and the occurrence of minor and major coronary events during 6 months of follow-up. Activation status of T-cells, assessed by the percentage of HLA-DR positive cells, was highest in the unstable angina patients (26.8+/-1.4%) compared with that in the control (14.7+/-1.2%) (P = 0.0053). Our data represent the first case showing that the circulating monocytes in angina patients are activated to a state express numerous proatherogenic cytokines. These results may help to diagnose angina patients according to the inflammatory markers and evaluate the prognosis of the disease.

Memories of childhood abuse: dissociation, amnesia, and corroboration

OBJECTIVE

This study investigated the relationship between self-reported childhood abuse and dissociative symptoms and amnesia. The presence or absence of corroboration of recovered memories of childhood abuse was also studied.

METHOD

Participants were 90 female patients admitted to a unit specializing in the treatment of trauma-related disorders. Participants completed instruments that measured dissociative symptoms and elicited details concerning childhood physical abuse, sexual abuse, and witnessing abuse. Participants also underwent a structured interview that asked about amnesia for traumatic experiences, the circumstances of recovered memory, the role of suggestion in recovered memories, and independent corroboration of the memories.

RESULTS

Participants reporting any type of childhood abuse demonstrated elevated levels of dissociative symptoms that were significantly higher than those in subjects not reporting abuse. Higher dissociative symptoms were correlated with early age at onset of physical and sexual abuse and more frequent sexual abuse. A substantial proportion of participants with all types of abuse reported partial or complete amnesia for abuse memories. For physical and sexual abuse, early age at onset was correlated with greater levels of amnesia. Participants who reported recovering memories of abuse generally recalled these experiences while at home, alone, or with family or friends. Although some participants were in treatment at the time, very few were in therapy sessions during their first memory recovery. Suggestion was generally denied as a factor in memory recovery. A majority of participants were able to find strong corroboration of their recovered memories.

CONCLUSIONS

Childhood abuse, particularly chronic abuse beginning at early ages, is related to the development of high levels of dissociative symptoms including amnesia for abuse memories. This study strongly suggests that psychotherapy usually is not associated with memory recovery and that independent corroboration of recovered memories of abuse is often present.

Patterns of dissociation in clinical and nonclinical samples

Research has consistently found elevated mean dissociation scores in particular diagnostic groups. In this study, we explored whether mean dissociation scores for different diagnostic groups resulted from uniform distributions of scores within the group or were a function of the proportion of highly dissociative patients that the diagnostic group contained. A total of 1566 subjects who were psychiatric patients, neurological patients, normal adolescents, or normal adult subjects completed the Dissociative Experience Scale (DES). An analysis of the percentage of subjects with high DES scores in each diagnostic group indicated that the diagnostic group's mean DES scores were a function of the proportion of subjects within the group who were high dissociators. The results contradict a continuum model of dissociation but are consistent with the existence of distinct dissociative types.

Treatment implications of past trauma in borderline personality disorder

Recent research and clinical experience have shown childhood trauma to be common in the histories of patients with borderline personality disorder. This article reviews the association between borderline personality disorder and early trauma, and how an awareness of the role of trauma may improve the treatment of patients with this disorder. Particularly when early trauma is in the form of childhood abuse, clinicians may be better able to understand the difficulties these patients experience in relational skills, affect tolerance, behavioral control, self-identity, and self-worth. Clinicians may be able to facilitate a stronger therapeutic alliance through acknowledgement of the patient's victimization and empathy with the effects of early trauma on the patient's life. Reframing the patient's experience as a consequence of childhood trauma is essential, especially when making traditional interventions such as interpretation and confrontation. The role of trauma in the development of borderline personality disorder suggests the need for modification of models of individual, family, and group psychotherapies that may allow more productive and successful treatment.

Correlates of dissociative symptomatology in patients with physical and sexual abuse histories

Recent studies have demonstrated a high prevalence of sexual and physical abuse histories and high levels of dissociative symptoms in psychiatric inpatients. We examined whether severity, frequency, and age of onset of abuse correlated with subjects' levels of dissociative symptoms. Sixty-four women reporting a lifetime history of physical and/or sexual abuse were recruited from consecutive admissions to three wards of a psychiatric hospital. Subjects completed the Life Experiences Questionnaire (LEQ) and the Dissociative Experiences Scale (DES). Subjects' self-reports of severity, frequency, and age of onset of abuse were analyzed for correlations with DES score. More invasive sexual abuse was associated with more dissociation. Higher-frequency physical abuse was associated with more dissociation, but no conclusion could be drawn about the impact of frequent sexual abuse due to missing data. An inverse correlation was found between age of onset of abuse and degree of dissociative symptomatology. These preliminary findings are consistent with hypotheses linking more severe, more chronic, and earlier abuse to the greater development of dissociative symptoms. The findings further emphasize the importance of recognizing dissociative symptoms in the clinical setting, and of continued study into the effects of childhood trauma.

The therapeutic roller coaster : dilemmas in the treatment of childhood abuse survivors

Survivors of severe childhood abuse often encounter profound difficulties. In addition to posttraumatic and dissociative symptomatology, abuse survivors frequently have characterologic problems, particularly regarding self-care and maintaining relationships. Backgrounds of abuse, abandonment, and betrayal are often recapitulated and reenacted in therapy, making the therapeutic experience arduous and confusing for therapists and patients. Efforts must be directed at building an adequate psychotherapeutic foundation before undertaking exploration and abreaction of past traumatic experiences. This discussion sets out a model for treatment of childhood abuse survivors, describing stages of treatment and suggesting interventions. Common treatment dilemmas or "traps" are discussed, with recommendations for their resolution.

The revictimization of adult women with histories of childhood abuse

Both clinical experience and recent research statistics support the observation that childhood abuse survivors are vulnerable to revictimization as adults. The responsibility for revictimization, such as physical or sexual assault, belongs to the perpetrators. However, the factors that make abuse survivors more vulnerable to exploitation need to be examined and understood in order to provide adequate treatment and protection. This discussion integrates an understanding of three powerful forces-the repetition compulsion, post-traumatic syndromes, and profound relational disturbances-that permit the process of revictimization to occur.

The reliability of abuse history reports: a comparison of two inquiry formats

We compared patients' reports about histories of physical or sexual abuse in two independent formats: the standard psychiatric intake interview at admission for inpatient treatment, and a subsequent confidential self-report survey about various forms of early childhood trauma. For 92 consecutively admitted female patients, nearly all reports of abuse histories obtained in the intake interview were consistent with later reports obtained in the survey. However, findings of no abuse history obtained in the intake format were frequently inconsistent with reports obtained in the survey, which were twice as frequent as intake reports. Gender of the intake interviewer was not related to reporting. These data suggest caution in accepting at face value initial denials of abuse histories.

Dissociative symptoms in relation to childhood physical and sexual abuse

Studies have reported high rates of childhood abuse in people with psychiatric illness. This study examined whether dissociative symptoms are specific to patients with histories of abuse. Ninety-eight female psychiatric inpatients completed self-report instruments that focused on childhood history of trauma, dissociative symptoms, and psychiatric symptoms in general. Sixty-three percent of the subjects reported physical and/or sexual abuse. Eighty-three percent had dissociative symptom scores above the median score of normal adults, and 24% had scores at or above the median score of patients with posttraumatic stress disorder. Subjects with a history of childhood abuse reported higher levels of dissociative symptoms than those who did not.