Objective To investigate the effect of calcium supplementation on bone mineral density （BMD） in Chinese women with different Fokl vitamin D receptor （VDR） genotypes （FF, Ff, and ff） after weaning or resumption o...Objective To investigate the effect of calcium supplementation on bone mineral density （BMD） in Chinese women with different Fokl vitamin D receptor （VDR） genotypes （FF, Ff, and ff） after weaning or resumption of menstruation during lactation. Methods A total of 40 subjects with the same Fokl VDR genotype were randomly divided into two groups： one received calcium tablet （600 mg once daily as CaCO3） and the other placebo tablet once daily for 1 year. At baseline, BMD was measured by dual-energy X-ray absorptiometry at lumbar spine （L2-L4） and at left hip whereas serum PICP, serum OC, and urinary CTX, serum 25（OH）VitD3, and serum estradiol were measured at weaning and I year thereafter. Results After the intervention, BMD at lumbar spine and at left hip increased significantly in all these women with a trend among different Fokl VDR genotypes such as FF 〉 Ff 〉 ff （P〈O.05, 〈0.01, and 〈0.001, respectively）. BMD at lumbar spine in women with FF VDR genotype increased much more rapidly than in those with ff VDR genotype （P〈0.05）. Compared with the control group women with the FF genotype regained more BMD after calcium supplementation （P〈0.05）. Conclusion Daily calcium 600 mg supplementation has beneficial effect on the bone health of women with FF VDR genotype.展开更多
Objective To investigate the association of estrogen receptor alpha （ER-c0 PvulI polymorphisms with the effect of calcium supplementation on bone development in Chinese pubertal girls, and to study the importance of ...Objective To investigate the association of estrogen receptor alpha （ER-c0 PvulI polymorphisms with the effect of calcium supplementation on bone development in Chinese pubertal girls, and to study the importance of calcium supplementation by maximizing the peak bone mass at their pubertal stage for bone development and osteoporosis prevention and the role of estrogen in regulating bone mass. Methods Ninety-four pubertal girls were recruited in the study and divided into two groups and three sub-groups according to the ER-α PvulI polymorphisms. One year before and after calcium supplementation, bone mineral density （BMD） was measured by DEXA, while BGP, BAP, TRACP5b, and 25-OH-VitD3, as well as estrogen were detected by ELISA. Analysis of covariance was used to examine the effect of ER-ct polymorphisms on bone development. Results The absolute increase and percentage change of BGP were significantly higher in the supplemented group than in the control group （P〈0.05）. In the intervened group, The increase and percentage change of the total body and radio distal 1/3 BMD were higher in PP than in PP genotype （P〈0.05）, and the increase of BAP in Pp was also higher than PP in the same group （P〈0.05）. Conclusion PP genotype shows a better response to calcium supplementation than the other Pvull polymorphisms.展开更多
Osteoporosis, characterized by loss of bone mass and microarchitectural deterioration of bone tissue, results in enhanced bone fragility and increases risk of fractureIll. In China, the incidence of primary osteoporos...Osteoporosis, characterized by loss of bone mass and microarchitectural deterioration of bone tissue, results in enhanced bone fragility and increases risk of fractureIll. In China, the incidence of primary osteoporosis is as high as 50%-70% in 60-69 years old females and approximately 30% in 60-69 years old males[21, which is closely related with the low intake of calcium. According to the nationwide nutrition and health survey in 2002 in China, the average daily calcium intake of Chinese residents is 391 mg, accounting for 41% of the recommended calcium intake.展开更多
BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without auto-transplantation.AIM To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH oc...BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without auto-transplantation.AIM To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH occurrence after TPTX.METHODS This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship Hospital.From January 2015 to May 2016,conventional CS was performed in patients who underwent TPTX,with calcium amounts adjusted according to postoperative serum calcium levels.From October 2016 to May 2018,preventive CS was performed according to preoperative alkaline phosphatase(ALP)levels.The patients were defined as lowrisk(ALP<500 U/L)and high-risk(ALP>500 U/L)for SH.All preoperative blood samples were collected in the fasting state on the day before surgery.Postoperative blood samples were obtained at 6-7 AM from the first postoperative day.RESULTS A total of 271 patients were included.These patients were 47.7±11.1 years old,and 57.6%were male.Their mean body mass index(BMI)was 22.9±3.8 kg/m^(2).There were no significant differences in sex,age,BMI,preoperative ALP,serum calcium,serum phosphorus,calcium-phosphorus ratio,and intact parathyroid hormone(iPTH)between the two CS groups.Compared with conventional CS,preventive CS led to lower occurrence rates of hypocalcemia within 48 h(46.0%vs 74.5%,P<0.001)and SH(31.7%vs 64.1%,P<0.001).Multivariable analysis showed that preoperative iPTH levelsodds ratio(OR)=1.001,95%confidence interval(CI:1.000-1.001,P=0.009),preoperative ALP amounts(OR=1.002,95%CI:1.001-1.003,P=0.002),preoperative serum phosphorus levels(OR=8.729,95%CI:1.518-50.216,P=0.015)and preventive CS(OR=0.132,95%CI:0.067-0.261,P<0.001)were independently associated with SH.In patients with preoperative ALP≥500 U/L,only preventive CS(OR=0.147,95%CI:0.038-0.562.P=0.005)was independently associated with SH.CONCLUSION This study suggests that preventive CS could reduce the occurrence of SH,indicating its critical value for hypocalcemia after TPTX.展开更多
To prepare calcium-binding peptides, the flesh residue of Mactra Veneriformis was subjected to enzymatic hydrolysis. By comparing the capability of combining calcium of the hydrolyzates, pepsin was confirmed to be the...To prepare calcium-binding peptides, the flesh residue of Mactra Veneriformis was subjected to enzymatic hydrolysis. By comparing the capability of combining calcium of the hydrolyzates, pepsin was confirmed to be the most suitable enzyme for hydrolyzing the flesh residue to release calcium-binding peptides among the seven tested proteases. The pepsin hydrolyzate (PHM) was divided into three fractions according to the molecule weight of its composition, which ranged from 0.5 to 15 kDa. The low-molecule-weight fraction named PHM-3 had the highest capability in combining calcium. The peptides existing in the PHM-3 fraction consisted of higher contents of Glu, Ala and Leu, and could produce one type of calcium-peptide complex by powerfully chelating calcium ions. PHM-3 products could effectively increase calcium absorption and retention while they decreased the calcium excretion in animal tests. Additionally, symptoms caused by low calcium bioavailability in ovariectomized rats, such as bone mineral density reduction and mechanical strength loss could be significantly ameliorated by the hydrolytic products addition in diet.展开更多
Pregnancy induced hypertension (PIH) is a common complication in pregnancy and prenatal stage. Because the direct and indirect relationship between low calcium intake and many diseases, such as rachitis, young age myo...Pregnancy induced hypertension (PIH) is a common complication in pregnancy and prenatal stage. Because the direct and indirect relationship between low calcium intake and many diseases, such as rachitis, young age myopia and hypertension, calcium supplementation has been a hot topic among nutritionists, Randomized trials of calcium supplementation during pregnancy were conducted in 212 healthy primipara. They were divided into 4 groups and pave 120mg, 240mg, Ig or 2g of calcium daily from 20 to 28wks of gestation up to delivery respectively. As a result, the incidence of PIH was 8.9%, 7.5%, 8% and 4% respectively in these groups, The control group (106 pregnant women) who did not receive calcium gave an incidence of 18%. Supplementation of 2g of calcium daily showed significant resutls in lowering the incidence of PM (P<0.05) without any adverse effects. In 1992 calcium supplementation was widely used in antenatal clinic. 200 cases with intake of 2g calcium were compared with corresponding non-calcium supplementation cases, and the incidence of PIH was 7.5% and 16.5% (P< 0.005) respectively. Mediating parathyroid hormone and renin activity are thought to be the effect of calcium on decreasing the incidence of PIH,展开更多
Introduction: Optimal calcium and vitamin D intake is important components of the treatment of osteoporosis. The national average calcium and vitamin D intake for women over age 50 is below the recommended levels for ...Introduction: Optimal calcium and vitamin D intake is important components of the treatment of osteoporosis. The national average calcium and vitamin D intake for women over age 50 is below the recommended levels for optimal bone health. The aim of this study was to assess whether deficiencies in calcium and vitamin D intake exist in women with osteoporosis in a general medicine practice, as well as evaluate whether physicians accurately document calcium and vitamin D supplementation in the health record. Methods: Using the Electronic Health Record (EHR), we identified all female patients age 50 and older with the diagnosis of osteoporosis who were seen at the study site clinic, an urban academic general medicine practice, between January 1st, 2010 and December 1st, 2010. Women were randomly selected to receive an invitation to participate in a telephone survey on osteoporosis treatment. Results: One hundred and sixteen women completed the telephone survey. The mean calcium intake was 1524 mg per day. Forty-nine percent of women surveyed reported taking less than 1200 mg/day of supplemental calcium. When considering reported calcium intake from diet, 33% percent consumed less than 1200 mg/day and 52% percent consumed more than 1500 mg/day. Twenty eight percent of patients were taking less than 800 IU/day of vitamin D;only four percent were taking more than 4000 IU/day. Agreement between patients’ self-reported intake of calcium, vitamin D and multivitamin supplements and physicians’ documentation of these supplements was 52% for calcium, 53% for vitamin D and 61% for multivitamin. Conclusion: Among women with osteoporosis getting regular care in a general medicine practice, approximately a third are getting less than the recommended daily amount of calcium and a quarter less than the recommended amount of vitamin D. In addition, a significant proportion of women are getting excessive daily amounts of calcium, which may also be a quality concern. Rates of agreement between self-reported calcium and vitamin D supplements and chart documentation of these supplements were low.展开更多
Adequate calcium and vitamin D intake is advocated in guidelines of osteoporosis. However, the dosage needed to achieve an optimal calcium intake and vitamin D status is still a point of debate. Of 902 consecutive pat...Adequate calcium and vitamin D intake is advocated in guidelines of osteoporosis. However, the dosage needed to achieve an optimal calcium intake and vitamin D status is still a point of debate. Of 902 consecutive patients older than 50 years presenting at the time of fracture, 502 were evaluable for measurement of calcium intake and serum 25(OH)D concentration. We calculated the percentage of patients who needed calcium supplements to achieve intake of ?1000 mg/d and who needed cholecalciferol supplementation to achieve serum levels of ?50 nmol/l. Calcium intake ranged between 250 and 2050 mg/d and serum 25(OH)D between <10 and 130 nmol/l. A combination of calcium intake of ≥1000 mg/d and serum 25(OH)D concentration of ?50 nmol/l was present in 11% of patients. To achieve 1000 mg/d of calcium, 57% of patients needed supplementation of 500 mg/d and 12% needed 1000 mg/d. Systematic calcium supplements of 500 mg/d would achieve an intake of 1000 mg/d in 88%. To achieve serum 25(OH)D concentrations of 50 nmol/l, 41% of patients needed a supplement of 800 IU D3/d and 25% needed higher doses. Systematic supplementation of 800 IU/d would achieve 50 nmol/l in 75% of patients. Calcium intake and vitamin D status vary considerably between fracture patients. Conclusion: calcium supplements need to be titrated individually to achieve desirable levels. Most patients achieved 50 nmol/l of 25(OH)D with 800 IU D3/d. Prospective studies are needed to study how to achieve and maintain optimal serum vitamin D levels and adequate calcium intake.展开更多
Purpose The goal of this study was to examine the association of calcium supplements with coronary artery disease and survival. Our initial hypothesis was that when adjusted for risk factors, calcium supplements would...Purpose The goal of this study was to examine the association of calcium supplements with coronary artery disease and survival. Our initial hypothesis was that when adjusted for risk factors, calcium supplements would not affect overall survival outcomes or coronary artery disease prevalence in a community population followed by a large cardiovascular practice. Methods Data was retrospectively collected for 5 years and 8 months (1/1/2004to 10/8/2009) from the electronic medical record at a large cardiovascular practice at a university. Only patients ≥ age 50 were included in our analysis Results The baseline characteristics of the 8060 study subjects. For the entire study population the mean age was 65 +/– 10 years, 71% were women. On multivariable logistic regression analysis, calcium supplementation was not an independent predictor of all-cause death, nor was calcium supplementation an independent predictor of the diagnosis of coronary artery disease. Survival analysis showed no survival differences for patients on calcium supplements (p = NS). Hazard ratios using the Cox proportional hazards model were calculated, showing that calcium supplementation was not an independent predictor of reduced survival. Conclusion This study suggests that there was no association between calcium supplementation and coronary artery disease as well as overall survival in a large retrospective cohort of patients greater than 50 with high rates of significant cardiovascular risk factors.展开更多
基金supported by the Ministry of Health and Ministry of Science and Technology (2008BAI58B02)National Nature Science Foundation (30571573)
文摘Objective To investigate the effect of calcium supplementation on bone mineral density （BMD） in Chinese women with different Fokl vitamin D receptor （VDR） genotypes （FF, Ff, and ff） after weaning or resumption of menstruation during lactation. Methods A total of 40 subjects with the same Fokl VDR genotype were randomly divided into two groups： one received calcium tablet （600 mg once daily as CaCO3） and the other placebo tablet once daily for 1 year. At baseline, BMD was measured by dual-energy X-ray absorptiometry at lumbar spine （L2-L4） and at left hip whereas serum PICP, serum OC, and urinary CTX, serum 25（OH）VitD3, and serum estradiol were measured at weaning and I year thereafter. Results After the intervention, BMD at lumbar spine and at left hip increased significantly in all these women with a trend among different Fokl VDR genotypes such as FF 〉 Ff 〉 ff （P〈O.05, 〈0.01, and 〈0.001, respectively）. BMD at lumbar spine in women with FF VDR genotype increased much more rapidly than in those with ff VDR genotype （P〈0.05）. Compared with the control group women with the FF genotype regained more BMD after calcium supplementation （P〈0.05）. Conclusion Daily calcium 600 mg supplementation has beneficial effect on the bone health of women with FF VDR genotype.
基金supported by the Nutrition Research Funding of the Chinese Nutrition Society 2004
文摘Objective To investigate the association of estrogen receptor alpha （ER-c0 PvulI polymorphisms with the effect of calcium supplementation on bone development in Chinese pubertal girls, and to study the importance of calcium supplementation by maximizing the peak bone mass at their pubertal stage for bone development and osteoporosis prevention and the role of estrogen in regulating bone mass. Methods Ninety-four pubertal girls were recruited in the study and divided into two groups and three sub-groups according to the ER-α PvulI polymorphisms. One year before and after calcium supplementation, bone mineral density （BMD） was measured by DEXA, while BGP, BAP, TRACP5b, and 25-OH-VitD3, as well as estrogen were detected by ELISA. Analysis of covariance was used to examine the effect of ER-ct polymorphisms on bone development. Results The absolute increase and percentage change of BGP were significantly higher in the supplemented group than in the control group （P〈0.05）. In the intervened group, The increase and percentage change of the total body and radio distal 1/3 BMD were higher in PP than in PP genotype （P〈0.05）, and the increase of BAP in Pp was also higher than PP in the same group （P〈0.05）. Conclusion PP genotype shows a better response to calcium supplementation than the other Pvull polymorphisms.
文摘Osteoporosis, characterized by loss of bone mass and microarchitectural deterioration of bone tissue, results in enhanced bone fragility and increases risk of fractureIll. In China, the incidence of primary osteoporosis is as high as 50%-70% in 60-69 years old females and approximately 30% in 60-69 years old males[21, which is closely related with the low intake of calcium. According to the nationwide nutrition and health survey in 2002 in China, the average daily calcium intake of Chinese residents is 391 mg, accounting for 41% of the recommended calcium intake.
基金Supported by the Subject of Beijing Science and Technology Plan,No.Z191100006619014.
文摘BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without auto-transplantation.AIM To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH occurrence after TPTX.METHODS This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship Hospital.From January 2015 to May 2016,conventional CS was performed in patients who underwent TPTX,with calcium amounts adjusted according to postoperative serum calcium levels.From October 2016 to May 2018,preventive CS was performed according to preoperative alkaline phosphatase(ALP)levels.The patients were defined as lowrisk(ALP<500 U/L)and high-risk(ALP>500 U/L)for SH.All preoperative blood samples were collected in the fasting state on the day before surgery.Postoperative blood samples were obtained at 6-7 AM from the first postoperative day.RESULTS A total of 271 patients were included.These patients were 47.7±11.1 years old,and 57.6%were male.Their mean body mass index(BMI)was 22.9±3.8 kg/m^(2).There were no significant differences in sex,age,BMI,preoperative ALP,serum calcium,serum phosphorus,calcium-phosphorus ratio,and intact parathyroid hormone(iPTH)between the two CS groups.Compared with conventional CS,preventive CS led to lower occurrence rates of hypocalcemia within 48 h(46.0%vs 74.5%,P<0.001)and SH(31.7%vs 64.1%,P<0.001).Multivariable analysis showed that preoperative iPTH levelsodds ratio(OR)=1.001,95%confidence interval(CI:1.000-1.001,P=0.009),preoperative ALP amounts(OR=1.002,95%CI:1.001-1.003,P=0.002),preoperative serum phosphorus levels(OR=8.729,95%CI:1.518-50.216,P=0.015)and preventive CS(OR=0.132,95%CI:0.067-0.261,P<0.001)were independently associated with SH.In patients with preoperative ALP≥500 U/L,only preventive CS(OR=0.147,95%CI:0.038-0.562.P=0.005)was independently associated with SH.CONCLUSION This study suggests that preventive CS could reduce the occurrence of SH,indicating its critical value for hypocalcemia after TPTX.
基金supported by the National Natural Science Foundation of China (No.30900293)the Open Project Program of National First-Class Key Discipline for Traditional Chinese Medicine of Nanjing University of Chinese Medicine (No.2011ZYX5-004),which is a project funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions,PAPD(ysxk-2010)
文摘To prepare calcium-binding peptides, the flesh residue of Mactra Veneriformis was subjected to enzymatic hydrolysis. By comparing the capability of combining calcium of the hydrolyzates, pepsin was confirmed to be the most suitable enzyme for hydrolyzing the flesh residue to release calcium-binding peptides among the seven tested proteases. The pepsin hydrolyzate (PHM) was divided into three fractions according to the molecule weight of its composition, which ranged from 0.5 to 15 kDa. The low-molecule-weight fraction named PHM-3 had the highest capability in combining calcium. The peptides existing in the PHM-3 fraction consisted of higher contents of Glu, Ala and Leu, and could produce one type of calcium-peptide complex by powerfully chelating calcium ions. PHM-3 products could effectively increase calcium absorption and retention while they decreased the calcium excretion in animal tests. Additionally, symptoms caused by low calcium bioavailability in ovariectomized rats, such as bone mineral density reduction and mechanical strength loss could be significantly ameliorated by the hydrolytic products addition in diet.
文摘Pregnancy induced hypertension (PIH) is a common complication in pregnancy and prenatal stage. Because the direct and indirect relationship between low calcium intake and many diseases, such as rachitis, young age myopia and hypertension, calcium supplementation has been a hot topic among nutritionists, Randomized trials of calcium supplementation during pregnancy were conducted in 212 healthy primipara. They were divided into 4 groups and pave 120mg, 240mg, Ig or 2g of calcium daily from 20 to 28wks of gestation up to delivery respectively. As a result, the incidence of PIH was 8.9%, 7.5%, 8% and 4% respectively in these groups, The control group (106 pregnant women) who did not receive calcium gave an incidence of 18%. Supplementation of 2g of calcium daily showed significant resutls in lowering the incidence of PM (P<0.05) without any adverse effects. In 1992 calcium supplementation was widely used in antenatal clinic. 200 cases with intake of 2g calcium were compared with corresponding non-calcium supplementation cases, and the incidence of PIH was 7.5% and 16.5% (P< 0.005) respectively. Mediating parathyroid hormone and renin activity are thought to be the effect of calcium on decreasing the incidence of PIH,
文摘Introduction: Optimal calcium and vitamin D intake is important components of the treatment of osteoporosis. The national average calcium and vitamin D intake for women over age 50 is below the recommended levels for optimal bone health. The aim of this study was to assess whether deficiencies in calcium and vitamin D intake exist in women with osteoporosis in a general medicine practice, as well as evaluate whether physicians accurately document calcium and vitamin D supplementation in the health record. Methods: Using the Electronic Health Record (EHR), we identified all female patients age 50 and older with the diagnosis of osteoporosis who were seen at the study site clinic, an urban academic general medicine practice, between January 1st, 2010 and December 1st, 2010. Women were randomly selected to receive an invitation to participate in a telephone survey on osteoporosis treatment. Results: One hundred and sixteen women completed the telephone survey. The mean calcium intake was 1524 mg per day. Forty-nine percent of women surveyed reported taking less than 1200 mg/day of supplemental calcium. When considering reported calcium intake from diet, 33% percent consumed less than 1200 mg/day and 52% percent consumed more than 1500 mg/day. Twenty eight percent of patients were taking less than 800 IU/day of vitamin D;only four percent were taking more than 4000 IU/day. Agreement between patients’ self-reported intake of calcium, vitamin D and multivitamin supplements and physicians’ documentation of these supplements was 52% for calcium, 53% for vitamin D and 61% for multivitamin. Conclusion: Among women with osteoporosis getting regular care in a general medicine practice, approximately a third are getting less than the recommended daily amount of calcium and a quarter less than the recommended amount of vitamin D. In addition, a significant proportion of women are getting excessive daily amounts of calcium, which may also be a quality concern. Rates of agreement between self-reported calcium and vitamin D supplements and chart documentation of these supplements were low.
文摘Adequate calcium and vitamin D intake is advocated in guidelines of osteoporosis. However, the dosage needed to achieve an optimal calcium intake and vitamin D status is still a point of debate. Of 902 consecutive patients older than 50 years presenting at the time of fracture, 502 were evaluable for measurement of calcium intake and serum 25(OH)D concentration. We calculated the percentage of patients who needed calcium supplements to achieve intake of ?1000 mg/d and who needed cholecalciferol supplementation to achieve serum levels of ?50 nmol/l. Calcium intake ranged between 250 and 2050 mg/d and serum 25(OH)D between <10 and 130 nmol/l. A combination of calcium intake of ≥1000 mg/d and serum 25(OH)D concentration of ?50 nmol/l was present in 11% of patients. To achieve 1000 mg/d of calcium, 57% of patients needed supplementation of 500 mg/d and 12% needed 1000 mg/d. Systematic calcium supplements of 500 mg/d would achieve an intake of 1000 mg/d in 88%. To achieve serum 25(OH)D concentrations of 50 nmol/l, 41% of patients needed a supplement of 800 IU D3/d and 25% needed higher doses. Systematic supplementation of 800 IU/d would achieve 50 nmol/l in 75% of patients. Calcium intake and vitamin D status vary considerably between fracture patients. Conclusion: calcium supplements need to be titrated individually to achieve desirable levels. Most patients achieved 50 nmol/l of 25(OH)D with 800 IU D3/d. Prospective studies are needed to study how to achieve and maintain optimal serum vitamin D levels and adequate calcium intake.
文摘Purpose The goal of this study was to examine the association of calcium supplements with coronary artery disease and survival. Our initial hypothesis was that when adjusted for risk factors, calcium supplements would not affect overall survival outcomes or coronary artery disease prevalence in a community population followed by a large cardiovascular practice. Methods Data was retrospectively collected for 5 years and 8 months (1/1/2004to 10/8/2009) from the electronic medical record at a large cardiovascular practice at a university. Only patients ≥ age 50 were included in our analysis Results The baseline characteristics of the 8060 study subjects. For the entire study population the mean age was 65 +/– 10 years, 71% were women. On multivariable logistic regression analysis, calcium supplementation was not an independent predictor of all-cause death, nor was calcium supplementation an independent predictor of the diagnosis of coronary artery disease. Survival analysis showed no survival differences for patients on calcium supplements (p = NS). Hazard ratios using the Cox proportional hazards model were calculated, showing that calcium supplementation was not an independent predictor of reduced survival. Conclusion This study suggests that there was no association between calcium supplementation and coronary artery disease as well as overall survival in a large retrospective cohort of patients greater than 50 with high rates of significant cardiovascular risk factors.
