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Cardiovascular (CV) diseases are still the most frequent cause of death in industrial nations. Employer-initiated screening of the CV risk could make an early contribution to optimization of the prevention strategies.In a cross-sectional study the CV risk profile (e.g., dyslipidemia, hypertension, smoking, diabetes mellitus and familial disposition) of 1436 employees at the industrial park in Frankfurt Höchst was analyzed. The total risk was estimated using the PROCAM score.A hypercholesterolemia (low-density lipoprotein, LDL130 mg/dl) was detected in 36% of the participants. Of the high-risk participants (myocardial infarct, apoplexy and/or diabetes) 23.7% (n = 9/38) were in the target range for LDL as defined by the European Society of Cardiology (ESC) of below 70 mg/dl, 18.4% (n = 7) had levels between 70 and 100 mg/dl and 57.9% (n = 22) had levels of more than 100 mg/dl. In addition, more than half of the subjects (53.2%) had increased blood pressure values (defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg). The prevalence of diabetes (blood sugar126 mg/dl) was very low (1.3%) as was the frequency of manifest CV diseases (1.4% myocardial infarct or apoplexy, 2.9% stabile angina pectoris or peripheral arterial occlusive disease, PAOD).The data confirm that the risk factors high blood pressure and dyslipidemia are widespread and the achievement of target values is insufficient, particularly with a high risk of CV. Behavioral therapeutic and/or pharmaceutical measures should be instigated in order to better exploit the high preventive potential for carriers of these risk factors.

Severe hypertriglyceridemia is defined at a plasma triglyceride (TG) concentration of885 mg/dl and may result - in particular when clinical symptoms appear before the age of 40 - from "large variant" mutations in genes which influence the function of the lipoprotein lipase (LPL). For diagnosis, secondary factors have to be excluded and treated before further genetic tests are considered. Typical symptoms in almost all patients are recurrent, sometimes severe abdominal pain attacks, which can result in acute pancreatitis, the most important, sometimes life-threatening complication. To minimize the risk of severe pancreatitis, the aim is to maintain the plasma TG concentration1000 mg/dl. Other clinical manifestations which can occur and are reversible are eruptive xanthomas, lipemia retinalis, hepatosplenomegaly, dyspnea syndrome, and impaired neurocognitive function. The hyperviscosity syndrome caused by chylomicronemia is seen as the underlying reason for some of the symptoms. Patients with mild-to-moderate hypertriglyceridemia have an increased cardiovascular risk. To lower this is the primary treatment goal here. Treatment mainly consists of a life-long, strict fat- and carbohydrate-restricted diet and the abstention from alcohol. Omega‑3-Fatty acids and fibrates can be used to lower plasma TG levels. Recently, new gene therapy approaches for LPL-deficient patients have become available in Germany.

Inverse relationships have been described between the largely genetically determined levels of serum/plasma lipoprotein(a) [Lp(a)], type 2 diabetes (T2D) and fasting insulin. Here, we aimed to evaluate the nature of these relationships with respect to causality. We tested whether we could replicate the recent negative findings on causality between Lp(a) and T2D by employing the Mendelian randomization (MR) approach using cross-sectional data from three independent cohorts, Berlin Aging Study II (BASE-II; n = 2012), LIFE-Adult (n = 3281) and LIFE-Heart (n = 2816). Next, we explored another frequently discussed hypothesis in this context: Increasing insulin levels during the course of T2D disease development inhibits hepatic Lp(a) synthesis and thereby might explain the inverse Lp(a)–T2D association. We used two fasting insulin-associated variants, rs780094 and rs10195252, as instrumental variables in MR analysis of n = 4937 individuals from BASE-II and LIFE-Adult. We further investigated causality of the association between fasting insulin and Lp(a) by combined MR analysis of 12 additional SNPs in LIFE-Adult. While an Lp(a)–T2D association was observed in the combined analysis (meta-effect of OR [95% CI] = 0.91 [0.87–0.96] per quintile, p = 1.3x10-4), we found no evidence of causality in the Lp(a)–T2D association (p = 0.29, fixed effect model) when using the variant rs10455872 as the instrumental variable in the MR analyses. Likewise, no evidence of a causal effect of insulin on Lp(a) levels was found. While these results await confirmation in larger cohorts, the nature of the inverse Lp(a)–T2D association remains to be elucidated.

Lean body mass, consisting mostly of skeletal muscle, is important for healthy aging. We performed a genome-wide association study for whole body (20 cohorts of European ancestry with n = 38,292) and appendicular (arms and legs) lean body mass (n = 28,330) measured using dual energy X-ray absorptiometry or bioelectrical impedance analysis, adjusted for sex, age, height, and fat mass. Twenty-one single-nucleotide polymorphisms were significantly associated with lean body mass either genome wide (p, We acknowledge the essential role of the Cohorts for Heart and Aging Research in Genome Epidemiology (CHARGE) Consortium in development and support of this manuscript. CHARGE members include the Netherland’s Rotterdam Study (RS), Framingham Heart Study (FHS), Cardiovascular Health Study (CHS), the NHLBI’s Atherosclerosis Risk in Communities (ARIC) Study, and Iceland’s Age, Gene/Environment Susceptibility (AGES) Reykjavik Study. Age, Gene/Environment Susceptibility Reykjavik Study (AGES-Reykjavik): has been funded by NIH contract N01-AG-12100, the NIA Intramural Research Program, Hjartavernd (the Icelandic Heart Association), and the Althingi (the Icelandic Parliament). The study is approved by the Icelandic National Bioethics Committee, (VSN: 00-063) and the Data Protection Authority. The researchers are indebted to the participants for their willingness to participate in the study. Old Order Amish (OOA): this work was supported by NIH research grants U01 HL72515, U01 GM074518, R01 HL088119, R01 AR046838, and U01 HL084756. Partial funding was also provided by the Mid-Atlantic Nutrition and Obesity Research Center of Maryland (P30 DK072488).). L.M.Y.-A. was supported by F32AR059469 from NIH/NIAMS. M.F. was supported by American Heart Association grant 10SDG2690004. Cardiovascular Health Study (CHS): This CHS research was supported by NHLBI contracts N01-HC- 85079, N01-HC-85080, N01-HC-85081, N01-HC-85082, N01-HC-85083, N01-HC-85084, N01-HC-85085, N01-HC-85086; N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, N01-HC-45133, N01-HC-85239, and by HHSN268201200036C and NHLBI grants HL080295, HL087652, HL105756, HL103612, HL120393, and HL130114 with additional contribution from NINDS. Additional support was provided through AG-023629, AG-15928, AG-20098, and AG-027058 from the NIA. See also http://www.chs-nhlbi.org/pi.htm. DNA handling and genotyping at Cedars-Sinai Medical Center was supported in part by the National Center for Research Resources, grant UL1RR033176, and is now at the National Center for Advancing Translational Sciences, CTSI grant UL1TR000124; in addition to the National Institute of Diabetes and Digestive and Kidney Disease grant DK063491 to the Southern California Diabetes Endocrinology Research Center. CoLaus: The CoLaus study received financial contributions from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne, and the Swiss National Science Foundation (grants 33CSCO-122661, 33CS30-139468, and 33CS30-148401). We thank Vincent Mooser and Gérard Waeber, Co-PIs of the CoLaus study. Special thanks to Yolande Barreau, Mathieu Firmann, Vladimir Mayor, Anne-Lise Bastian, Binasa Ramic, Martine Moranville, Martine Baumer, Marcy Sagette, Jeanne Ecoffey, and Sylvie Mermoud for data collection. Data analysis was supervised by Sven Bergmann and Jacques S. Beckmann. The computations for this paper were performed in part at the Vital-IT Center for high-performance computing of the Swiss Institute of Bioinformatics. deCODE Study: The study was funded by deCODE Genetics, ehf. We thank all the participants of this study, the staff of deCODE Genetics core facilities and recruitment center and the densitometry clinic at the University Hospital for their important contributions to this work. The EPIC Study: The EPIC Obesity study is funded by Cancer Research United Kingdom and the Medical Research Council. I.B. acknowledges support from EU FP6 funding (contract no. LSHM-CT-2003-503041) and by the Wellcome Trust (WT098051). Erasmus Rucphen Family (ERF) Study: The study was supported by grants from The Netherlands Organisation for Scientific Research (NWO), Erasmus MC, the Centre for Medical Systems Biology (CMSB), and the European Community’s Seventh Framework Programme (FP7/2007-2013), ENGAGE Consortium, grant agreement HEALTH-F4-2007-201413. We are grateful to all general practitioners for their contributions, to Petra Veraart for her help in genealogy, Jeannette Vergeer for the supervision of the laboratory work and Peter Snijders for his help in data collection. Fenland: The Fenland Study is funded by the Wellcome Trust and the Medical Research Council, as well as by the Support for Science Funding programme and CamStrad. We are grateful to all the volunteers for their time and help, and to the General Practitioners and practice staff for help with recruitment. We thank the Fenland Study co-ordination team and the Field Epidemiology team of the MRC Epidemiology Unit for recruitment and clinical testing. Tuomas O. Kilpeläinen was supported by the Danish Council for Independent Research (DFF—1333-00124 and Sapere Aude program grant DFF—1331-00730B). Framingham Osteoporosis Study (FOS)/Framingham Heart Study (FHS): The study was funded by grants from the US National Institute for Arthritis, Musculoskeletal and Skin Diseases and National Institute on Aging (R01 AR 41398 and U24AG051129; D.P.K. and R01AR057118; D.K. D.K. was also supported by FP7-PEOPLE-2012-Marie Curie Career Integration Grants (CIG)). The Framingham Heart Study of the National Heart, Lung, and Blood Institute of the National Institutes of Health and Boston University School of Medicine were supported by the National Heart, Lung, and Blood Institute’s Framingham Heart Study (N01-HC-25195) and its contract with Affymetrix, Inc. for genotyping services (N02-HL-6-4278). Analyses reflect intellectual input and resource development from the Framingham Heart Study investigators participating in the SNP Health Association Resource (SHARe) project. A portion of this research was conducted using the Linux Cluster for Genetic Analysis (LinGA-II) funded by the Robert Dawson Evans Endowment of the Department of Medicine at Boston University School of Medicine and Boston Medical Center. eQTL HOb Study: The study was supported by Genome Quebec, Genome Canada and the Canadian Institutes of Health Research (CIHR). Gothenburg Osteoporosis and Obesity Determinants Study (GOOD): The study was funded by the Swedish Research Council, the Swedish Foundation for Strategic Research, The ALF/LUA research grant in Gothenburg, the Lundberg Foundation, the Emil and Vera Cornell Foundation, the Torsten and Ragnar Söderberg’s Foundation, Petrus and Augusta Hedlunds Foundation, the Västra Götaland Foundation, and the Göteborg Medical Society. We would like to thank Dr Tobias A. Knoch, Luc V. de Zeeuw, Anis Abuseiris, and Rob de Graaf as well as their institutions the Erasmus Computing Grid, Rotterdam, The Netherlands, and especially the national German MediGRID and Services@MediGRID part of the German D-Grid, both funded by the German Bundesministerium fuer Forschung und Technology under grants #01 AK 803 A-H and # 01 IG 07015G for access to their grid resources. We also thank Karol Estrada, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands for advice regarding the grid resources. Health Aging and Body Composition Study (Health ABC): This study was funded by the National Institutes of Aging. This research was supported by NIA contracts N01AG62101, N01AG62103, and N01AG62106. The genome-wide association study was funded by NIA grant 1R01AG032098-01A1 to Wake Forest University Health Sciences and genotyping services were provided by the Center for Inherited Disease Research (CIDR). CIDR is fully funded through a federal contract from the National Institutes of Health to The Johns Hopkins University, contract number HHSN268200782096C. Indiana: We thank the individuals who participated in this study, as well as the study coordinators, without whom this work would not have been possible. This work was supported by National Institutes of Health grants R01 AG 041517 and M01 RR-00750. Genotyping services were provided by CIDR. CIDR is fully funded through a federal contract from the National Institutes of Health to The Johns Hopkins University, contract number HHSN268200782096C. This research was supported in part by the Intramural Research Program of the NIH, National Library of Medicine. Kora (KORA F3 and KORA F4): The KORA research platform was initiated and financed by the Helmholtz Center Munich, German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. Part of this work was financed by the German National Genome Research Network (NGFN-2 and NGFNPlus: 01GS0823). Our research was supported within the Munich Center of Health Sciences (MC Health) as part of LMUinnovativ. The London Life Sciences Population (LOLIPOP): The study was funded by the British Heart Foundation, Wellcome Trust, the Medical Research Council, and Kidney Research UK. The study also receives support from a National Institute for Health Research (NIHR) programme grant. Rotterdam Study (RSI, RSII & RSIII): The generation and management of GWAS genotype data for the Rotterdam Study (RS I, RS II, RS III) was executed by the Human Genotyping Facility of the Genetic Laboratory of the Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands. The GWAS datasets are supported by the Netherlands Organisation of Scientific Research NWO Investments (no. 175.010.2005.011, 911-03-012), the Genetic Laboratory of the Department of Internal Medicine, Erasmus MC, the Research Institute for Diseases in the Elderly (014-93-015; RIDE2), the Netherlands Genomics Initiative (NGI)/Netherlands Organisation for Scientific Research (NWO) Netherlands Consortium for Healthy Aging (NCHA), project no. 050-060-810. We thank Pascal Arp, Mila Jhamai, Marijn Verkerk, Lizbeth Herrera, Marjolein Peters, MSc, and Carolina Medina-Gomez, MSc, for their help in creating the GWAS database, and Karol Estrada, PhD, Yurii Aulchenko, PhD, and Carolina Medina-Gomez, PhD, for the creation and analysis of imputed data. The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. We are grateful to the study participants, the staff from the Rotterdam Study and the participating general practitioners and pharmacists. We thank Dr Karol Estrada, Dr Fernando Rivadeneira, Dr Tobias A. Knoch, Anis Abuseiris, and Rob de Graaf (Erasmus MC Rotterdam, The Netherlands) for their help in creating GRIMP, and we thank BigGRID, MediGRID, and Services@MediGRID/D-Grid (funded by the German Bundesministerium fuer Forschung und Technology; grants 01 AK 803 A-H, 01 IG 07015G) for access to their grid computing resources. Rush Memory and Aging Project (MAP): The Memory and Aging Project was supported by National Institute on Aging grants R01AG17917, R01AG15819, and R01AG24480, the Illinois Department of Public Health, the Rush Clinical Translational Science Consortium, and a gift from Ms Marsha Dowd. TwinsUK (TUK): The study was funded by the Wellcome Trust, Arthritis Research UK, and the Chronic Disease Research Foundation. The study also received support from a National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London. We thank the staff and volunteers of the TwinsUK study. The study was also supported by Israel Science Foundation, grant number 994/10. Age, Gene/Environment Susceptibility Reykjavik Study (AGES-Reykjavik) has been funded by NIH contract N01-AG-12100, the NIA Intramural Research Program, Hjartavernd (the Icelandic Heart Association), and the Althingi (the Icelandic Parliament). The study is approved by the Icelandic National Bioethics Committee (VSN: 00-063) and the Data Protection Authority. The researchers are indebted to the participants for their willingness to participate in the study. Berlin Aging Study II (BASE-II) was supported by the German Federal Ministry of Education and Research (BMBF (grants #16SV5536K, #16SV5537, #16SV5538, and #16SV5837; previously #01UW0808)). Additional contributions (e.g., financial, equipment, logistics, personnel) are made from each of the other participating sites, i.e., the Max Planck Institute for Human Development (MPIB), Max Planck Institute for Molecular Genetics (MPIMG), Charite University Medicine, German Institute for Economic Research (DIW), all located in Berlin, Germany, and University of Lübeck in Lübeck, Germany. B-vitamins in the prevention of osteoporotic fractures (B-PROOF): B-PROOF is supported and funded by The Netherlands Organization for Health Research and Development (ZonMw, grant 6130.0031), the Hague; unrestricted grant from NZO (Dutch Dairy Association), Zoetermeer; Orthica, Almere; NCHA (Netherlands Consortium Healthy Ageing) Leiden/Rotterdam; Ministry of Economic Affairs, Agriculture and Innovation (project KB-15-004-003), the Hague; Wageningen University, Wageningen; VU University Medical Center, Amsterdam; Erasmus Medical Center, Rotterdam. All organizations are based in the Netherlands. We thank Dr Tobias A. Knoch, Anis Abuseiris, Karol Estrada, and Rob de Graaf as well as their institutions the Erasmus Grid Office, Erasmus MC Rotterdam, The Netherlands, and especially the national German MediGRID and Services@MediGRID part of the German D-Grid, both funded by the German Bundesministerium fuer Forschung und Technology (grants #01 AK 803 A-H and #01 IG 07015G) for access to their gird resources. Further, we gratefully thank all participants. Calcium Intake Fracture Outcome Study (CAIFOS): This study was funded by Healthway Health Promotion Foundation of Western Australia, Australasian Menopause Society and the Australian National Health and Medical Research Council Project Grants (254627, 303169, and 572604). We are grateful to the participants of the CAIFOS Study. The salary of Dr Lewis is supported by a National Health and Medical Research Council of Australia Career Development Fellowship. Danish Osteoporosis Study (DOPS): The study was supported by Karen Elise Jensen foundation. Family Heart Study (FamHS): The study was supported by NIH grants R01-HL-117078, R01-HL-087700, and R01-HL-088215 from NHLBI; and R01-DK-089256 and R01-DK-075681 from NIDDK. GenMets (Health 2000): S.R. was supported by the Academy of Finland Center of Excellence in Complex Disease Genetics (213506 and 129680), Academy of Finland (251217), the Finnish foundation for Cardiovascular Research and the Sigrid Juselius Foundation. S.M. was supported by grants #136895 and #141005, V.S. by grants #139635 and 129494, and M.P. by grant #269517 from the Academy of Finland and a grant from the Finnish Foundation for Cardiovascular Research. M.P. was supported by the Yrjö Jahnsson Foundation. Helsinki Birth Cohort Study (HBCS): We thank all study participants as well as everybody involved in the HBCS. HBCS has been supported by grants from the Academy of Finland, the Finnish Diabetes Research Society, Samfundet Folkhälsann, Novo Nordisk Foundation, Liv och Hälsa, Finska Läkaresällskapet, Signe and Ane Gyllenberg Foundation, University of Helsinki, European Science Foundation (EUROSTRESS), Ministry of Education, Ahokas Foundation, Emil Aaltonen Foundation, Juho Vainio Foundation, and Wellcome Trust (grant number WT089062). Johnston County Study: The Johnston County Osteoarthritis Project is supported in part by cooperative agreements S043, S1734, and S3486 from the Centers for Disease Control and Prevention/Association of Schools of Public Health; the NIAMS Multipurpose Arthritis and Musculoskeletal Disease Center grant 5-P60-AR30701; and the NIAMS Multidisciplinary Clinical Research Center grant 5 P60 AR49465-03. Genotyping services were provided by Algynomics company. Korean Genome Epidemiology Study (KoGES): Korean Genome Epidemiology Study (KoGES): This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (found 2001-347-6111-221, 2002-347-6111-221, 2009-E71007-00, 2010-E71004-00). Kora F3 and Kora F4: The KORA research platform was initiated and financed by the Helmholtz Center Munich, German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. Part of this work was financed by the German National Genome Research Network (NGFN-2 and NGFNPlus: 01GS0823). Our research was supported within the Munich Center of Health Sciences (MC Health) as part of LMUinnovativ. LOLIP-REP-IA610: The study was supported by the Wellcome Trust. We thank the participants and research teams involved in LOLIPOP. LOLIP-REP-IA_I: The study was supported by the British Heart Foundation Grant SP/04/002. LOLIP-REP-IA_P: The study was supported by the British Heart Foundation Grant SP/04/002. METSIM: The study was supported by the Academy of Finland, the Finnish Diabetes Research Foundation, the Finnish Cardiovascular Research Foundation, the Strategic Research Funding from the University of Eastern Finland, Kuopio, and the EVO grant 5263 from the Kuopio University Hospital. MrOS Sweden: Financial support was received from the Swedish Research Council (2006-3832), the Swedish Foundation for Strategic Research, the ALF/LUA research grant in Gothenburg, the Lundberg Foundation, the Torsten and Ragnar Söderberg’s Foundation, Petrus and Augusta Hedlunds Foundation, the Västra Götaland Foundation, the Göteborg Medical Society, and the Novo Nordisk foundation. Greta and Johan Kock Foundation, A. Påhlsson Foundation, A. Osterlund Foundation, Malmö University Hospital Research Foundation, Research and Development Council of Region Skåne, Sweden, the Swedish Medical Society. MrOS US: The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) provided funding for the MrOS ancillary study “GWAS in MrOS and SOF” under the grant number RC2ARO58973. Osteoporosis Prospective Risk Assessment study (OPRA): This work was supported by grants from the Swedish Research Council (K2009-53X-14691-07-3, K2010-77PK-21362-01-2), FAS (grant 2007-2125), Greta and Johan Kock Foundation, A. Påhlsson Foundation, A. Osterlund Foundation, Malmö University Hospital Research Foundation, Research and Development Council of Region Skåne, Sweden, the Swedish Medical Society. We are thankful to all the women who kindly participated in the study and to the staff at the Clinical and Molecular Osteoporosis Research Unit for helping in recruitment of study individuals. Orkney Complex Disease Study (ORCADES): ORCADES was supported by the Chief Scientist Office of the Scottish Government (CZB/4/276, CZB/4/710), the Royal Society, the MRC Human Genetics Unit, Arthritis Research UK (17539) and the European Union framework program 6 EUROSPAN project (contract no. LSHG-CT-2006-018947). DNA extractions were performed at the Wellcome Trust Clinical Research Facility in Edinburgh. We acknowledge the invaluable contributions of Lorraine Anderson and the research nurses in Orkney, the administrative team in Edinburgh and the people of Orkney. PEAK 25: This work was supported by grants from the Swedish Research Council (K2009-53X-14691-07-3, K2010-77PK-21362-01-2), FAS (grant 2007-2125), Greta and Johan Kock Foundation, A. Påhlsson Foundation, A. Osterlund Foundation, Malmö University Hospital Research Foundation, Research and Development Council of Region Skåne, Sweden, the Swedish Medical Society. We are thankful to all the women who kindly participated in the study and to the staff at the Clinical and Molecular Osteoporosis Research Unit for helping in recruitment of study individuals. Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS): The study was supported by grants from the Swedish research council (projects 2008-2202 and 2005-8214) and ALF/LUA research grants from Uppsala university hospital, Uppsala, Sweden. Relationship between Insulin Sensitivity and Cardiovascular Disease (RISC): The RISC study is supported by European Union Grant QLG1-CT-2001-01252 and AstraZeneca. We thank Merck Research Labs for conducting DNA genotyping on RISC samples.Rotterdam III: Rotterdam Study (RS): See discovery. SHIP and SHIP TREND: This work was supported by SHIP, which is part of the Community Medicine Research Network of the University of Greifswald, Germany, by the Federal Ministry of Education and Research (01ZZ9603, 01ZZ0103, and 01ZZ0403), the Ministry of Cultural Affairs as well as the Social Ministry of the Federal State of Mecklenburg-West Pomerania and the network “Greifswald Approach to Individualized Medicine (GANI_MED)” funded by the Federal Ministry of Education and Research (03IS2061A). Genome-wide data have been supported by the Federal Ministry of Education and Research (03ZIK012) and a joint grant from Siemens Healthcare, Erlangen, Germany, and the Federal State of Mecklenburg-West Pomerania. The University of Greifswald is a member of the “Center of Knowledge Interchange” program of the Siemens. A.G. and the Cache´ Campus program of the InterSystems GmbH. The SHIP authors are grateful to the contribution of Florian Ernst, Anja Wiechert, and Astrid Petersmann in generating the SNP data and to Mario Stanke for the opportunity to use his Server Cluster for SNP Imputation. Data analyses were further supported by the German Research Foundation (DFG Vo 955/10-1) and the Federal Ministry of Nutrition, Agriculture and Consumer’s Safety. SOF: The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) provided funding for the SOF ancillary study “GWAS in MrOS and SOF” under the grant number RC2ARO58973. Uppsala Longitudinal Study of Adult Men (ULSAM): The study was funded by grants from the Swedish research council (projects 2008-2202 and 2005-8214), the Wallenberg foundation, and ALF/LUA research grants from Uppsala university hospital, Uppsala, Sweden. Andrew P. Morris is a Wellcome Trust Senior Fellow in Basic Biomedical Science, grant number WT098017. CROATIA-VIS (VIS): The CROATIA-Vis study was funded by grants from the Medical Research Council (UK) and Republic of Croatia Ministry of Science, Education and Sports research grants to I.R. (108-1080315-0302). We acknowledge the staff of several institutions in Croatia that supported the field work, including but not limited to The University of Split and Zagreb Medical Schools, the Institute for Anthropological Research in Zagreb and Croatian Institute for Public Health. The SNP genotyping for the CROATIA-Vis cohort was performed in the core genotyping laboratory of the Wellcome Trust Clinical Research Facility at the Western General Hospital, Edinburgh, Scotland. Women’s Health Initiative (WHI): The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts N01WH22110, 24152, 32100–2, 32105–6, 32108–9, 32111–13, 32115, 32118–32119, 32122, 42107–26, 42129–32, and 44221. We thank the WHI investigators and staff for their dedication, and the study participants for making the program possible. A listing of WHI investigators can be found at https://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Short%20List.pdf. FUSION: This research was supported in part by US National Institutes of Health grants 1-ZIA-HG000024 (to F.S.C.), U01DK062370 (to M.B.), R00DK099240 (to S.C.J.P.), the American Diabetes Association Pathway to Stop Diabetes Grant 1-14-INI-07 (to S.C.J.P.), and Academy of Finland Grants 271961 and 272741 (to M.L.) and 258753 (to H.A.K.). We thank all the subjects for participation and the study personnel for excellent technical assistance. The Pima Indian Study: This study was supported by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases, NIH, USA. Studies of a Targeted Risk Reduction Intervention with Defined Exercise (STRRIDE): This study was supported by the National Heart Lung and Blood Institute of the National Institutes of Health, HL57453 (WEK). Gene expression in old and young muscle biopsies: S.M. and T.G. were supported in part by NIH U24AG051129.

Hintergrund und Zielsetzung Sensible Defizite nach einem Schlaganfall sind haufig, sie beeinflussen in negativer Weise die Regeneration motorischer Funktionen, die Unabhangigkeit in den Aktivitaten des taglichen Lebens (ADL), die Lange des stationaren Aufenthaltes und letztlich die Lebensqualitat. Im deutschen Sprachraum existiert bisher kein reliables, standardisiertes Untersuchungsinstrument. Ziel der Arbeit war die standardisierte Ubersetzung und Validierung des Sensibilitatsassessments „Rivermead Assessment of Somatosensory Performance“ (RASP).

Ziel der RAN-Studie (Ruckenschmerzen, Adipositas und Nikotinkonsum) war es, den Nutzen von Masnahmen zur betrieblichen Gesundheitsforderung und Pravention darzustellen. Dabei sollte gezeigt werden, dass durch betriebliche Praventionsstrategien lebensstilbedingter Risikofaktoren wie z. B. Rauchen und Ubergewicht die Gesundheit und Arbeitsfahigkeit der Mitarbeiter moglichst lange erhalten werden kann. Der Beitrag stellt Studiendesign und erste Ergebnisse hinsichtlich Nikotinkonsum und „Body Mass Index“ (BMI) vor. Die Studie wurde in einem Berliner Betrieb der Siemens AG zwischen 2006–2009 durchgefuhrt. Als Grundgesamtheit wurden 875 Mitarbeiter eingeschlossen. Die Studienteilnehmer wurden einmal jahrlich bezuglich ihres Gesundheitszustands und -verhaltens beraten und verschiedenen Interventionskursen mit den Schwerpunkten „Ruckenschmerzen“, „Gewichtsreduktion“ oder „Rauchentwohnung“ zugeteilt. Die Methode der RAN-Studie beruhte auf einer Verknupfung von subjektiven Daten zu den Risikofaktoren chronischer Krankheiten, die in Anlehnung an den Bundesgesundheitssurvey 1998 erhoben wurden, mit den objektiven Daten aus medizinischen Untersuchungen sowie den Krankenkassendaten der Studienteilnehmer. Die Teilnahmerate an der RAN-Studie konnte trotz Konzernumbau bei ca. 46% stabil gehalten werden. Hierzu durften auch die eingesetzten Methoden des sozialen Marketings beigetragen haben. Die Raucherpravalenz unter den Studienteilnehmern konnte von 21,2% im Jahr 2006 auf 14,2% im Jahr 2009 (−33%) gesenkt werden. Bezuglich des BMI ergaben sich im Studienverlauf keine signifikanten Veranderungen. Die Ergebnisse weiterer Datenanalysen sollen zeigen, inwieweit die eingesetzten Methoden der RAN-Studie zu einer kardiovaskularen Risikoreduktion beitragen, die Pravalenz von Folgekrankheiten und deren Kosten vermindert oder deren Eintritt verzogert sowie die Arbeitsfahigkeit der Mitarbeiter nachhaltig verlangert werden kann. Die Koppelung von Surveydaten, arztlichen Untersuchungsdaten und Krankenkassendaten in einer Langsschnittstudie darf als innovativer Ansatz der RAN-Studie angesehen werden.

Im Rahmen eines integrativen Versorgungskonzeptes wurde mit adipösen PatientInnen ein multimodales Programm zur Gewichtsreduktion durchgeführt. Dargestellt werden die institutionellen Rahmenbedingungen des Versorgungsmodells, das Therapiekonzept und Ergebnisse bezogen auf Gewichtsreduktion, Veränderung metabolischer Risikofaktoren, Körperzusammensetzung, Blutdruck und gesundheitsbezogene Lebensqualität nach zwölfmonatiger Therapieteilnahme.Die Literatur zu diesem Artikel finden Sie online unter www.adipositas-online.de

A study of 27 patients (18 males and 9 females; median age 57 [35-70] years) with hypercholesterolaemia examined the lipid-reducing effect, clinical reliability and tolerance of lovastatin, an HMG-CoA-reductase inhibitor, given in a single evening dose. After a four-week period on placebo and a lipid-reducing diet the patients received 20 mg lovastatin for four weeks. If, at the end of this period, total cholesterol levels were still above 200 mg/dl, the dose was increased to 40 mg, after a further four weeks to 80 mg. After a three-month treatment period total cholesterol concentration in lovastatin-treated patients was 28% lower than in the placebo group (289.4 +/- 42.2 vs 208.0 +/- 39.9 mg/dl; P less than 0.0001). LDL-cholesterol concentration had fallen by 40% (215.1 +/- 44.4 vs 130.1 +/- 24.7 mg/dl; P less than 0.0001), while plasma triglyceride concentrations had fallen by 15% (166.3 +/- 71.8 vs 141.8 +/- 69.8 mg/dl; P less than 0.01). At the same time, HDL-cholesterol levels had risen by 12% (42.9 +/- 12.4 vs 47.9 +/- 18.2 mg/dl; P less than 0.01). These results confirm the marked lipid-reducing effect of lovastatin.

Hintergrund: Der altersbedingte progressive Muskelverlust ist ein wachsendes Problem in unserer alternden Gesellschaft. Einhergehend mit der Verminderung der physischen Fahigkeiten, erhohtem Sturzrisiko, Minderung der Lebensqualitat und Selbststandigkeit im Alter fuhrt dieser zu einem erhohten Bedarf an medizinischer Versorgung [1 – 3]. Die Telomerlange wird als Marker fur das biologische Alter und altersassoziierte Erkrankungen vermehrt diskutiert [4]. Die Beziehung zwischen der Abnahme von Muskelmasse und Telomerlange wurde bisher kaum untersucht. Methoden: Hier wurde die Beziehung zwischen der Magermasse anhand verschiedener Parameter und der relativen Telomerlange (rLTL) von 1,398 Teilnehmern der Berliner Altersstudie II (mittleres Alter 68,18 ± 3,66 Jahre, 49,6% Manner) untersucht. Die Bestimmung der Telomerlangen von Leukozyten erfolgte mittels Real Time-PCR. Parameter der Korperzusammensetzung wurden mithilfe der Doppelrontgen-Absorptiometrie (DXA) geschatzt und als Magermasse in den Beinen (LLM), absolute appendikulare Magermasse (ALM), und nach Korrektur von ALM fur die Korpergrose (ALM/ht2) und den Body-Mass-Index (ALMBMI) untersucht. Ergebnisse: Hoch signifikante Korrelationen wurden zwischen rLTL (p < 0,001) und ALM (r = 0,248), ALMBMI (r = 0,251), ALM/ht2 (r = 0,207), und LLM (r = 0,263) gefunden. Assoziationen blieben auch nach stufenweiser Adjustierung fur Alter, Geschlecht, BMI, geringgradige Inflammation, Lebensstilfaktoren und Morbiditatslast fur alle untersuchten Muskelparameter signifikant, mit Ausnahme von ALM/ht2. Schlussfolgerung: Kurze Telomere sind mit einer geringen Magermasse assoziiert. Unsere Ergebnisse zeigen auf, dass rLTL ein potenziell unabhangiger Risikofaktor fur den Verlust der Muskelmasse darstellen konnte. Der Zusammenhang zwischen Telomerverkurzung und progressivem Verlust der Muskelmasse, sollte in Kombination mit der physischen Funktionalitat im longitudinalen Kontext weiter untersucht werden. Der relevante Einfluss des Korpergewichts auf die Muskelmasse sollte hierbei berucksichtigt werden. Sponsoren: Die Studie wurde gefordert von Bundesministerium fur Bildung und Forschung (BMBF). Literatur: [1] Evans, What is sarcopenia? J Gerontol A Biol Sci Med Sci, 1995. [2] Lauretani et al., Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol (1985), 2003. [3] Janssen, et al., Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc, 2002. [4] Muezzinler et al., A systematic review of leukocyte telomere length and age in adults. Ageing Res Rev, 2013.

Durchgefuhrt wurde eine retrospektive Evaluation der diagnostischen Wertigkeit der cCT-Perfusion in der Diagnostik dementer Patienten im Vergleich zum Mini-Mental-State-Test (MMSE). Datensatze von 55 Patienten wurden untersucht. Bei allen Patienten wurden eine native, eine KM-gestutzte und eine Perfusions-CT des Neurokraniums angefertigt. Die klinische Erhebung des Demenzgrades erfolgte mit dem MMSE. In den Datensatzen der cCT-Perfusion wurden 24 ROI markiert. Anschliesend wurden Blutvolumen (BV), Blutfluss (BF) und mittlere Transitzeit (MTZ) berechnet und intra- und interhemisphariell sowie mit dem Demenzgrad verglichen. Mit steigendem Demenzgrad zeigten sich eine signifikante Abnahme des BV in der Okzipital- sowie in der Temporalregion. Der BF verringerte sich signifikant im Frontallappen, in der Basalganglien- und der Okzipitalregion. Gleichzeitig konnte eine signifikante Zunahme der MTZ in der Basalganglienregion gemessen werden. Die Gruppe mit Alzheimer-Demenz zeigte eine signifikante Abnahme des BF im Vergleich zur Gruppe der normalen Kandidaten in der Frontal-, Basalganglien-, Okzipital- und Temporalregion. Es war eine Verminderung der zerebralen Durchblutung mit fortschreitender Demenz zu beobachten. Die kostengunstige und nahezu ubiquitar verfugbare cCT-Perfusion liefert Informationen uber regionale zerebrale Perfusionsunterschiede, die eine Graduierung der Demenz erlauben und bei der Differenzierung der Demenzarten hilfreich sein konnen.

Familial hypercholesterolemia is an autosomal-dominant inherited disorder caused by mutations in the low-density lipoprotein (LDL) receptor gene. The homozygous form is characterized by high-serum LDL cholesterol concentrations, xanthoma formation and premature atherosclerosis. Recently, another molecular defect that also results in severely elevated LDL cholesterol levels was identified: autosomal recessive hypercholesterolemia. This inherited disorder is caused by a mutation in a putative LDL receptor adaptor protein. In our lipid clinic, three sisters with phenotypic homozygous hypercholesterolemia were recently diagnosed as having autosomal recessive hypercholesterolemia. They presented in 1990 with massive tuberous xanthomas at the knees, thighs, elbows and buttocks. LDL receptor and apolipoprotein B gene defects were excluded through mutation analysis. From 1992 onward they underwent LDL-apheresis on a weekly basis. To date the clinical outcome is very satisfying with no evidence of coronary heart disease or aortic valve lesions and almost complete regression of xanthomatosis.

Bei 120 alteren Schlaganfall-Patienten (Durchschnittsalter 78 Jahre) wurde der Zusammenhang zwischen der Fremd- und Selbsteinschatzung von Aktivitatseinschrankungen im Barthel-Index (BI) untersucht. Ferner wurde der Zusammenhang zwischen den beiden Aktivitatsbeurteilungen und ausgewahlten Testergebnissen des Geriatrischen Assessments bestimmt. Die Auswertung der Beurteilungsdaten des BI erfolgte anhand des Rasch-Modells und der Rating-Skalen-Analyse. Es zeigte sich eine sehr gute Ubereinstimmung zwischen der Fremd- und Selbstbeurteilung (r=0,90) mit nur geringen Urteilsabweichungen beim Barthel-Item „Baden”. Die Fremd- und Selbstbeurteilung im BI korrelierte signifikant mit den Ergebnissen der „Tinetti Gait and Balance”-Skala (r=0,72 bzw. r=0,76), aber nur gering mit anderen Verfahren des Geriatrischen Assessments (weniger als 8% gemeinsame Varianz). Insgesamt weisen die Ergebnisse darauf hin, dass die in einem unstrukturierten Interview anhand des BI erhobene Selbsteinschatzung von Aktivitatseinschrankungen ein valides diagnostisches Mas bei Schlaganfall-Patienten darstellen kann. Unklar ist allerdings, inwieweit die in dieser Studie gewahlte Interviewmethodik fur den hohen Zusammenhang zwischen Selbst- und Fremdbeurteilung verantwortlich ist.

Guidelines for the reduction of cholesterol to prevent atherosclerotic vascular events were recently released by the American Heart Association and the American College of Cardiology. The authors claim to refer entirely to evidence from randomized controlled trials, thereby confining their guidelines to statins as the primary therapeutic option. The guidelines derived from these trials do not specify treatment goals, but refer to the percentage of cholesterol reduction by statin medication with low, moderate, and high intensity. However, these targets are just as little tested in randomized trials as are the cholesterol goals derived from clinical experience. The same applies to the guidelines of the four patient groups which are defined by vascular risk. No major statin trial has included patients on the basis of their global risk; thus the allocation criteria are also arbitrarily chosen. These would actually lead to a significant increase in the number of patients to be treated with high or maximum dosages of statins. Also, adhering to dosage regulations instead of cholesterol goals contradicts the principles of individualized patient care. The option of the new risk score to calculate lifetime risk up to the age of 80 years in addition to the 10-year risk can be appreciated. Unfortunately it is not considered in the therapeutic recommendations provided, despite evidence from population and genetic studies showing that even a moderate lifetime reduction of low-density lipoprotein (LDL) cholesterol or non-HDL cholesterol has a much stronger effect than an aggressive treatment at an advanced age. In respect to secondary prevention, the new American guidelines broadly match the European guidelines. Thus, the involved societies from Germany, Austria and Switzerland recommend continuing according to established standards, such as the EAS/ESC guidelines.

When used appropriately, drugs are an effective and efficient intervention in the care of patients. However, elderly, multimorbid patients are especially prone to adverse side effects caused by the simultaneous intake of many drugs--this effect is called polypharmacy. Furthermore, adverse medical effects occur more frequently with elderly people compared to younger patients. This is due to age-specific metabolic changes and issues with compliance and adherence. Therefore, the indication for medication should be taken carefully and individually especially for elderly patients, in order to develop a realistic risk-benefit ratio, taking into consideration questions like quality of life and life expectancy.In this paper, the current medical care situation of elderly people is presented; problems are identified and analyzed.Supported by a selected literature search, recommendations for improving medication safety are summarized.

Einleitung: Das richtige Timing der Energie- und Proteinaufnahme gehort zu den praventiven Masnahmen zur Erhaltung der appendikularen Skelettmuskelmasse bei alteren Personen. Hierbei wird eine gleichmasige Verteilung (30 g Protein/Mahlzeit) auf die drei Hauptmahlzeiten empfohlen (Paddon-Jones 2009). Ziele: Ermittlung der zeitlichen Verteilung der Energie- und Proteinaufnahme bei selbststandig zu Hause lebenden Senioren. Daruber hinaus soll der Zusammenhang zwischen Timing und appendikularer Skelettmuskelmasse bestimmt werden. Methoden: Die appendikulare Skelettmuskelmasse wurde mittels Doppelrontgen-Absorptiometrie (DXA) bestimmt. Fur die Ermittlung der zeitlichen Aufnahme von Energie und Protein wurde ein 5-Tage-Ernahrungsprotokoll ausgewertet. Resultate: Es wurde eine Teilstichprobe von 133 Studienteilnehmern (96 Manner; 37 Frauen) im Alter von 60 – 80 Jahren erfasst (MW = 68 Jahre). Die durchschnittliche tagliche Energie- und Proteinaufnahme war bei den Mannern 24.5 kcal/kg bzw. 0,97 g/kg KG und bei den Frauen 28,2 kcal/kg bzw. 1,08 g/kg KG. Der durchschnittliche BMI aller Teilnehmer lag bei 27 kg/m2, wobei 1,5% untergewichtig, 35,3% normalgewichtig, 44,4% ubergewichtig und 18,8% adipos sind. Die zeitliche Energie- und Proteinaufnahme verteilte sich wie folgt: Fruhstuck: 6,2 kcal/kg; 0,24 g/kg, Mittagessen: 11 kcal/kg; 0,44 g/kg, Abendessen: 14 kcal/kg; 0,5 g/kg. Die Energie- und Proteinaufnahme war unter den Hauptmahlzeiten signifikant unterschiedlich (p < 0,001). Die absolute Proteinmenge der einzelnen Mahlzeiten lag bei 20 g (Fruhstuck), 33 g (Mittag), 39 g (Abend). Es gab keinen signifikanten Unterschied zwischen den Geschlechtern. Die appendikulare Skelettmuskelmasse lag im Durchschnitt bei den Mannern bei 23,7 kg (SMI 7,6 kg/m2) und bei den Frauen bei 15,8 kg (SMI 6 kg/m2). Es gab keinen signifikanten Unterschied in Bezug auf die Skelettmuskelmasse bei den Teilnehmern (Manner/Frauen), die mehr oder weniger als 30 g Protein/Mahlzeit aufgenommen haben. Schlussfolgerung: Bei der untersuchten Stichprobe ist die Verteilung der Energie- und Proteinaufnahme unter den einzelnen Hauptmahlzeiten ungleichmasig. Dies deutet darauf hin, dass eine gleichmasige Verteilung von Energie und Protein auf die Hauptmahlzeiten nicht notwendig ist, um die Skelettmuskelmasse bei alteren Personen positiv zu beeinflussen. Referenzen: Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Current Opinion in Clinical Nutrition & Metabolic Care. 2009;12(1): 86 – 90 10.1097/MCO.0b013e32831cef8b. Interessenkonflikte: Keine

Patients with dyslipidaemia or hypercholesterolemia carry a substantially increased cardiovascular risk and need optimal treatment of this key risk factor. We aimed to investigate the utilisation, efficacy and tolerability of the single pill combination extended-release niacin/laropiprant 1000 mg/20 mg or 2000 mg /40 mg under conditions of primary care practice.The present study was a prospective, non-interventional, observational study involving 885 primary care physicians throughout Germany. Data on adult patients treated with niacin/laropiprant one or two tablets daily within the labelled indication were documented for an average of 23 ± 7 weeks. The study was registered in the Association of research-based pharmaceutical companies (VFA) database under no. 354.A total of 2359 patients were analysed in the intent-to-treat population (mean age 61.1 years, 67% males) of whom 1917 could be followed up. Background statin therapy was often discontinued and only about 50% of patients received two tables niacin/laropiprant at the end of the study. Individual goal attainment rates as subjectively determined by the investigator were for LDL-C 59.4%, total cholesterol 59.5%, HDL-C 72.8% and TG 51.5%, respectively. Objective (laboratory) goal attainment rates according to NCEP ATP III criteria were lower: LDL-C100 mg/dl goal was achieved in 17.8%, HDL-C40 in males or50 mg/dl in females in 37.9% and TG150 mg/dl in 18.7%. Totally, 422 adverse events were noted in 231 patients (9.7%), of which 317 were considered drug-related. Flushing occurred in 15%.Niacin/laropiprant resulted in beneficial effects on serum lipids and was generally well tolerated. The full potential of the drug combination was not explored by most physicians due to discontinuation of statins and lack of titration of the combination. Overall, treatment effects were consistent with those seen in controlled trials.

There have only been a few publications focussing on how the curriculum Q7 "medicine of aging and the elderly" is implemented at German medical schools. In order to stimulate discussion about the implementation of Q7 the authors present the results of a survey of medical students of the Charité - Universitätsmedizin Berlin. The aim of the survey was to identify items that contribute to a good course and thus improve the quality of lectures and courses in geriatric medicine with the overall aim to encourage more students to become geriatricians after their studies.Medical students from the fifth clinical semester were interviewed in anonymous form following each course using standardized questionnaires for organizational and didactic topics. Factor analysis, proof of reliability, descriptive statistics and correlation analysis were performed as statistical methods.The proof of reliability of questionnaires showed good internal consistency with Cronbachs alpha values of 0.88 (seminars), 0.91 (lectures) and 0.92 (bedside teaching). The overall response rate was very high (95.3%, n = 803 questionnaires). The ratings for questionnaire items in the three teaching formats (i.e. seminars, lectures, bedside teaching) ranged mostly from good to very good. In the correlation analysis across all three teaching formats clear communication of learning objectives, the treatment of topics according to their own expectations and the learning experience were rated as most relevant overall.The evaluation results indicate a high level of satisfaction with the curriculum of geriatrics at the Charité, which can therefore be recommended across faculties taking into account the criteria named.

The incidence of skin diseases more common in older patients, e.g. inflammatory and autoimmune diseases, benign and malignant tumors and paraneoplastic syndromes, is increasing worldwide rapidly mainly due to early or lifelong UV-overexposure and to an aging population. In order to transform this demographic change into a chance a better understanding of the pathomechanisms of these diseases, an early diagnosis and therapy are essential steps. In addition, a joint effort to raise public awareness, patient education, preventive measures and consistent monitoring of high-risk groups is of great importance. In this article, the relationship between aging and associated skin diseases will be presented with a particular focus on the epidemiology and risk factors.

Sensory deficits after stroke are common and impact motor regeneration and the total length of hospital stay as well as quality of life factors including the independence to conduct daily life activities. There is currently no existing reliable and standardized assessment tool to measure somatosensory performance in the German language. The aim of our study was to translate the original version of the Rivermead assessment for somatosensory performance (RASP) into German and to study its reliability in a German-speaking population sample.The translation of the English original version followed the protocol of the Medical Outcomes Trust. The German version was assessed with 60 patients with first time presentation of subacute stroke and AC1 coefficients were calculated to measure interrater reliability for the different subtests.The mean AC1 value was 0.75 (range 0.58-0.81). The interrater reliability was good to excellent for all subtests.The German version of the RASP (RASP-DT) developed in this study is a reliable assessment instrument for sensory deficits after stroke.

Simvastatin and pravastatin, two 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, were compared in a multinational, randomized, double-blind trial. Patients demonstrating moderate hyperchol

The present study investigates the functional skills and capabilities of a sample of 105 patients treated at the Lutheran Geriatric Center Berlin after a hip fracture during a period of two years between 2004 and 2006.Geriatric assessment instruments (Barthel index, Instrumental Activities of Daily Living Scale (IADL), Timed UpGo (TUG), Tinetti, grip strength, Geriatric Depression Scale (GDS)) were implemented to measure the functional capabilities in this prospective study. The subjects were divided into three groups, characterized by the type of mobility device they used: crutches, a four-wheeled walker, or a wheel chair. Furthermore, the data were measured at three test intervals (t(0:): baseline before discharge, t(1): 4 weeks after discharge, t(2): 4 months after discharge).The results of the study differ significantly for each of the three groups at the different test intervals (Barthel index, IADL, TUG, Tinetti, grip strength, all p0.000, ANOVA). The results of our investigation demonstrate a substantial difference in increase, stagnation or deterioration of capabilities for patients in all three groups. However, from t(1) to t(2) only the group using crutches as a mobility device demonstrated the highest increase of their capabilities in this specific areas (Tinetti, grip strength, IADL, TUG, p≤0.05, general linear model). The results of the study differ significantly for each of the three groups at the different test intervals (Barthel index, IADL, TUG, Tinetti, grip strength, all p0.000, ANOVA). The results of our investigation demonstrate substantial differences in all three groups with respect to increase, stagnation, or deterioration of capabilities. However, from t(1) to t(2) only the group using crutches as a mobility device demonstrated the highest increase of their capabilities in these specific areas (Tinetti, grip strength, IADL, TUG, p≤0.001, general linear model)A group-specific approach, based on the mobility devices used, allowed for better differentiation of functional capabilities after femoral hip fracture.

Demographic change is posing an enormous challenge for societies in industrialized countries: the number of elderly and chronically ill is on the rise, whereas the number of people in the work force is declining. Assistive technology can be an important factor in this process and will help to alleviate shortcomings of the present system. The following example of the joint research program "SmartSenior", which began in mid 2009, shows the stakeholders, challenges, and future trends of assistive technology for the elderly. There is potential for the application of modern technology in three areas: in the training of senior citizens' abilities and skills, in supporting the activities of daily life, and in the continuous monitoring of vital functions.

With increasing age a clear increase in drug use exists in parallel with the age-related burden of disease. Elderly subjects have more frequent and more severe adverse drug reactions. Often polypharmacy causes a cascade which leads to the prescription of additional drugs to treat adverse drug reactions. To ensure safe medications, consideration of physiological changes and their relevance for pharmacodynamics and pharmacokinetics is necessary, as are critical prescription decisions with clearly defined individual therapeutic targets. Geriatric assessments should be performed more often. They comprise assessments of activities of daily living, the degree of autonomy and self-sufficiency, cognitive and nutritional status. Chronological age is only a minor criterion for prescription decisions. Practical help (dispensing devices, help when visual, tactile or cognitive impairments are present) will be able to improve adherence and thus safety and efficacy of drugs. Recognizing and preventing adverse drug reactions is probably the single most reversible affliction of geriatric medicine. Lists with potentially inappropriate medications (PIM) in the elderly are rather unsuitable due to their categorical character. Better consideration of patient-related factors and defining "potentially inappropriate patients (PIP)" seems preferable for preventing the prescription of risk-entailing medications.

Our aging society in industrialised countries is not only characterised by higher age and better health in general, but in age related capabilities and handicaps often based on chronic diseases and functional losses. Additionally multimorbidity can lead to functional losses followed by handicaps and disabilities. In consequence the elderly person can suffer from immobility, social isolation and depression. Furthermore it implies a high risk of loosing his or her independence. The main aim for those elderly is to obtain their `every day competence' in spite of lifelong handicap and chronic disease. Cause of new developments in ambient technologies there is a challenge to supplement multi- and interdisciplinary approach to fulfil these aims. Ambient technologies as part of information and communication technologies have a great potential to influence quality of life for elderly people and prolong their independence. We will report about different examples of ambient technologies for this challenge. In `Tele-Reha', a tele-rehabilitation-project, mobility-impaired patients after discharge from hospital, their caregiving relatives, and geriatric professionals were comprised using PC-based videoconferencing systems. Additional they got access to a computer based information service. The objective was to prevent social isolation, more functional disabilities and secondary diseases which may result in the frequent need for outpatient or inpatient treatment. Another project focused on patients after stroke or hip fracture by sensor technology based home rehabilitation. Most of our patients have not reached their full potential of mobility and independence after the hospital. We conduct studies to investigate the feasibility of a sensor based home exercise program for motor learning. The project `nutribook' was developed for patients with severe chronic nutrition deficits who live at home and have ambulant services by nurses and their family doctors.

A computerized image analysis system was used to quantitate age-related changes in the structure of the proximal femur in CW-1 female mice, ranging from 3 to 32 months of age. Morphological findings revealed a progressive thinning of bone trabeculae within the femoral head, accompanied by the development of marrow cavities in the cortical bone of the femoral neck and in the subchondral bone. As a result, the compact bone in senescent mice acquired an appearance similar to trabecular bone. Quantitative image analysis revealed a similarity in the pattern of changes in the three types of bone: cortical, trabecular, and subchondral. Bone density increased from 3 to 12 months of age and subsequently declined. A similar pattern was noted for the changes in the thickness of the cortical and the subchondral bone. Regression analysis revealed that the changes with age fitted a second-order model; thus it was possible to predict the age of maximal values for each parameter. Hence, the age of maximal bone density for cortical, trabecular, and subchondral bone was 12.3, 14.8, and 18.0 months, respectively. The rate of bone loss after 12 months was most prominent for trabecular bone (1.47% per month), so that by 32 months of age its overall mass had declined by 57% in comparison to peak values seen at 12 months of age (p less than 0.001). The density of the subchondral and cortical bones decreased at a slower rate (0.6% to 0.8% per month) and at the age of 32 months their values had decreased by 12% to 18% in comparison to those at 12 months (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Total blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD.According to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 +/- 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B(12), hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional.According to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B(12) levels were within range, though dietary folate intake (97 [80-128] microg/d) was reduced about 75% (recommendation 400 microg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B(12) were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters.We analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B(12) concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.

Substantial residual cardiovascular risk persists despite effective LDL lowering treatment in populations at elevated risk for adverse cardiovascular outcomes. Low HDL cholesterol is an independent cardiovascular risk factor and occurs in about one-third of patients treated for dyslipidaemia in Europe. Moreover, randomised intervention studies have shown that increasing HDL cholesterol improves cardiovascular outcomes. Correcting low HDL cholesterol therefore presents a rational and proven strategy for intervention to produce further reductions in cardiovascular risk beyond those possible with a statin alone. Nicotinic acid (niacin in the USA) is the most effective agent currently available for increasing levels of HDL cholesterol.A once-daily, prolonged-release formulation of nicotinic acid (Niaspan) is as effective on HDL cholesterol as the immediate-release formulation, and is equally effective at increasing HDL cholesterol whether or not patients are already taking a statin. Niaspan also shares the antiatherogenic benefit of nicotinic acid, and induced regression of atherosclerosis in patients with cardiovascular disease during a period of treatment of up to 2 years. The incidence of flushing, the principal side effect of nicotinic acid, is lower with Niaspan than with immediate-release nicotinic acid. Simple practical measures are available to minimise the incidence and impact of flushing, including careful dose titration and avoiding hot or spicy foods near the time of ingestion of Niaspan. The potential for hepatotoxicity, muscle toxicity or marked exacerbation of hyperglycaemia in diabetes with Niaspan is very low, with or without concomitant statin treatment.Niaspan provides a practical means of delivering the cardioprotective benefits associated with correction of low HDL cholesterol.