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Background In heart failure (HF), traditional cardiovascular risk factors (RF) as body mass index (BMI), total cholesterol (TC) and systolic blood pressure (SBP) are associated with better survival. It is unknown at which time point along the disease continuum the adverse impact of these RF ceases and may 'start to reverse'. We analyzed the distribution of RF and their association with survival across HF stages. Methods We pooled data from four cohort studies from the German Competence Network HF. Employing ACC/AHA-criteria, patients were allocated to stage A (n = 218), B (n = 1324), C1 (i.e., New York Heart Association [NYHA] classes I and II; n = 1134), and C2 + D (NYHA III and IV; n = 639). Results With increasing HF severity median age increased (63/67/67/70 years), whereas the proportion of females (56/52/37/35%), median BMI (26.1/28.8/27.7/26.6 kg/m2 ), TC (212/204/191/172 mg/dl), and SBP (140/148/130/120 mm Hg) decreased (P < 0.001 for trend for all). In the total cohort, higher levels of all RF were associated with better survival, even after extensive adjustment for multiple confounders. If analyses were stratified, however, a higher RF burden predicted better survival only in clinically symptomatic patients: hazard ratio (HR) per + 2 kg/m2 BMI 0.91 (95% confidence interval 0.88; 0.95); per + 10 mg/dl TC 0.93 (0.92; 0.95); per + 5 mm Hg SBP 0.94 (0.92; 0.95). Conclusion In this well-characterized sample of patients representing the entire HF continuum, reverse associations were only consistently observed in symptomatic HF stages. Our data indicate that the phenomenon of a "reverse epidemiology" in HF is subject to significant selection bias in less advanced disease. [ABSTRACT FROM AUTHOR]

Focuses on tiling of the Euclidean plane. Description of a method to construct these types of tilings; Visualizing the tiles on a computer screen; Definition of a tiling; Creation of a salamander using tiling; Use of the mathematical property self-similarity to create the salamander.

An abstract of the article "Prevalence and Determinants of Depression in Chronic Systolic Heart Failure," by S. Stork and colleagues is presented.

Aims: Increasing evidence suggests that enhanced aldosterone signalling plays a key role in the onset and progression of diastolic heart failure (DHF). Aldo-DHF will test the hypothesis that aldosterone receptor blockade by spironolactone will improve exercise capacity and diastolic function in patients with DHF. Methods: Aldo-DHF is a randomized, placebo-controlled, double-blinded, two-armed, multicentre, parallel group study. Four hundred and twenty patients with DHF will be randomly assigned to receive spironolactone 25 mg per day or placebo. The main inclusion criteria are: age > or = 50 years, New York Heart Association II/III, preserved left ventricular ejection fraction (> or =50%), and echocardiographic evidence of diastolic dysfunction. The two primary endpoints are changes in exercise capacity (peak VO(2), spiroergometry) and in diastolic function (E/é, echocardiography) after 12 months. Secondary endpoints include effects of spironolactone on additional parameters of exercise performance and diastolic as well as systolic function, neurohumoral activation, and quality of life. Morbidity and mortality as well as safety aspects will also be assessed. Conclusion: Aldo-DHF is the first large-scale clinical trial to evaluate the effects of aldosterone receptor blockade on exercise capacity and diastolic function in patients with DHF. Aldo-DHF will provide important information about the clinical course of this condition and may have significant impact on treatment strategies and future trials in these patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES:: To investigate the relationship between different indices of body fat and blood pressure in children and adolescents. DESIGN:: Cross-sectional cohort study along with regular public health service examinations in school classes two, five and nine. PARTICIPANTS:: A total of 2365 healthy schoolchildren aged 8-16?y. MEASUREMENTS:: Body mass index (BMI), skinfolds, waist-hip ratio, body fat determined by bioelectric impedance analysis and blood pressure. RESULTS:: In comparison with recently published normative data, a significant increase of obesity was found. There is a higher prevalence of obesity in children with lower education. A positive association between body fat and hypertension was observed in children aged above 10?y. The BMI had the strongest association with blood pressure among the indices of body fat considered here. CONCLUSION:: Obesity is an increasing problem even among schoolchildren. This observation should be treated seriously as the relationship of body fat to cardiovascular risk is detectable already at a young age. Attention should be paid to the dependence of obesity on the level of education. The analysis suggests that BMI should be the preferred index to assess body fat.International Journal of Obesity (2003) 27, 1459-1464. doi:10.1038/sj.ijo.0802462 [ABSTRACT FROM AUTHOR]

An abstract of the article "Generic Health-Related Quality of Life in Patients With Chronic Systolic Heart Failure: Impact of Depression," by C. Angermann and colleagues is presented.