Abstract
The News and notices section is published in every issue of the European Journal of Cardiovascular Prevention and Rehabilitation. It provides readers with details of current affairs, the best of what is being published in other journals and upcoming events for your diaries. Readers are invited to submit material, upcoming events and training opportunities to the News Editors.
Professor Pantaleo Giannuzzi Salvatore Maugeri Foundation IRCCS, Cardiology Department Medical Centre of Veruno Via Revislate 13 I–28010 Veruno, Italy Tel: + 39 0322 884711 Fax: 32 0322 884816 E-mail:
Professor Annika Rosengren The Cardiovascular Institute Gr för kardiovascular forskn Medicin, plan 2 CK SU/Östra 416 85 Göteborg, Austria Tel: +46 31 343 4086 Fax: + 46 31 259 254 E-mail:
Newsworthy
Bigger mothers—bigger babies
In Sweden, a national birth registry exits, which has documented facts about mothers and their newborns since 1973. Children born in Sweden today weigh between 50 and 75 grams more than 20 years ago. High birth weight is associated with more complications for both mothers and babies. The data in the registry were used to investigate in more detail to what extent changes in maternal factors could account for the heavier, or large-for-gestational age (LGA) babies. They found that between 1992 and 2001, the proportion of LGA babies increased from 3.32% to 3.86% and the proportion of babies weighing at least 4.5 kg increased from 3.71% to 4.60%. During the same period, the prevalence of overweight and obesity (body mass index of 25 or greater) in the mothers increased from 25% to 36%, and the prevalence of smoking decreased from 23% to 11%. After adjusting trends in all covariates simultaneously, the association between risk of LGA birth and calendar year disappeared. The authors concluded that the increasing proportions of LGA births over time were explained by increasing maternal body mass index and decreases in maternal smoking. With the increasing prevalence of overweight among adolescents and young women, the prevalence of LGA infants and associated risks will probably increase over time.
Surkan PJ, et al. Reasons for increasing trends in large for gestational age births. Obstet Gynecol 2004; 104:720–726.
Lifestyle factors in the elderly
The proportion of older people is increasing steadily worldwide—in the year 2020 the number of men and women older than 60 years is projected to increase to 1000 million. Cardiovascular diseases cause a large proportion of the morbidity and mortality in the elderly. Cardiovascular disease is dependent on dietary and lifestyle factors and is preventable to a large extent. However, the combined effect of lifestyle and dietary factors in the elderly has not received a lot of attention. A team of European researchers pooled studies from several cohorts into the HALE project (Healthy Ageing: a Longitudinal study in Europe) comprising 1507 men and 832 women aged 70–90 years from 11 European countries. During a 10-year follow-up, 935 participants died. Of these 371, or 40%, died from cardiovascular causes. Adhering to a Mediterranean diet, moderate alcohol use, regular physical activity and nonsmoking were all associated with lower risk of CHD and CVD deaths, and of all-cause mortality. The relative risk associated with these four factors in combination was 0.27 (95% confidence interval, 0.14–0.53) for CHD death, 0.33 (0.22–0.47) for CVD death and 0.35 (0.28–0.44) for death from all causes. Lack of adherence to this low-risk pattern was associated with a population attributable risk of 60% or more for CHD, CVD and all-cause mortality. To a large extent, this lifestyle will probably have been adopted at an earlier age. Notwithstanding, this paper indicates that cardiovascular disease is avoidable to a large extent also among the elderly.
Knoops KT, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 2004; 292:1433–1439.
Dysglycaemia and cardiovascular disease—not only diabetics have increased risk
Diabetes is associated with increased risk of cardiovascular disease but overall, comparatively few cases are attributable to diabetes, because diagnosed diabetes affects only a limited proportion in the population, compared to smoking, hypercholesterolaemia, or hypertension. However, recent evidence suggests that there is a continuous relationship between blood glucose levels and macrovascular disease, with no obvious threshold. Haemoglobin A1c concentration is an indicator of average blood glucose concentrations over the preceding three months. In the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk), with 10,232 male and female participants aged 45–79 years, there was a significant and continuous increase in risk of cardiovascular disease throughout the whole distribution of HbA1c. Persons with HbA1c concentrations less than 5% had the lowest rates of cardiovascular disease and mortality. When persons with known diabetes, HbA1c concentrations of 7% or greater, or a history of cardiovascular disease were excluded, the adjusted relative risk for one percentage point increase in HbA1c, was 1.26 (CI, 1.04–1.52); P = 0.02 for total mortality and 1.40 (CI, 1.14–1.73); P = 0.002 for coronary heart disease. Fifteen percent (68 of 521) of the deaths in the sample occurred in persons with diabetes (4% of the sample), but 72% (375 of 521) occurred in persons with moderately elevated HbA1c concentrations (between 5% and 6.9%), highlighting the role of glucometabolic disturbances as a link in the causal chain in the development of cardiovascular disease.
Khaw KT, et al. Association of haemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 2004; 141:413–420.
Unfavourable effects of resistance training on central arterial compliance
Reductions in the compliance of central arteries exert a number of adverse effects on cardiovascular function and disease risk. Endurance training is efficacious in increasing arterial compliance in healthy adults. The Authors determined the effects of resistance training on carotid arterial compliance using an intervention study design. Twenty-eight healthy men, aged 20–38 years were randomly assigned to the intervention group (n = 14) and the control group (n =14). Control subjects were instructed not to alter their normal activity levels throughout the study period. Intervention subjects underwent three supervised resistance training sessions per week for four months and detraining for a subsequent four months. The resistance training increased maximal strength in all muscle groups tested (P < 0.001). There were no significant differences in baseline arterial compliance and β-stiffness index between the intervention and control groups. In the intervention group, carotid arterial compliance decreased 19% (P < 0.05), and β-stiffness index increased 21% (P < 0.01) after resistance training. These values returned completely to the baseline levels during the detraining period. Arterial compliance did not change in the control group. In both groups, there were no significant changes in brachial and carotid blood pressure, carotid intima-media thickness, lumen diameter, and femoral arterial compliance. Changes in carotid artery compliance were significantly and negatively related to corresponding changes in left ventricular mass index (r = −0.56, P < 0.001) and left ventricular hypertrophy index (r = −0.68, P < 0.001). In conclusion, in marked contrast to the beneficial effect of regular aerobic exercise, several months of resistance training ‘reduces’ central arterial compliance in healthy men.
Miyachi M, et al. Unfavourable effects of resistance training on central arterial compliance. A randomised intervention study. Circulation 2004; 110:2858–2863.
Interrelations between brachial endothelial function and carotid intima-media thickness in young adults
Endothelial vasodilator dysfunction and carotid intimamedia thickening (IMT) are two indicators of sub-clinical cardiovascular disease. The Authors examined their correlation and interaction with risk factors in a large, community-based cohort of young adults. As part of the longitudinal cardiovascular Risk in Young Finns Study, endothelium-dependent brachial artery flow-mediated dilatation (FMD) and carotid artery IMT were measured by ultrasound in 2109 healthy adults aged 24–39 years. Flow-mediated dilatation was inversely associated with IMT (P = 0.001) in a multivariate model adjusted for age, sex, brachial vessel size, and several risk variables. The subjects with age- and sex-specific FMD values in the extreme deciles were classified into groups of impaired (n = 204, FMD = 1.1 ± 1.4%, mean ± SD) and enhanced (n = 204, FMD = 16.3 ± 2.9%) FMD response. The number of risk factors was correlated with increased IMT in subjects with an impaired FMD response (P < 0.05) but not in subjects with an enhanced FMD response (P > 0.2). In conclusion, brachial FMD is inversely associated with carotid IMT. The number of risk factors in young adults is correlated with increased IMT in subjects with evidence of endothelial dysfunction, but not in subjects with preserved endothelial function. These observations suggest that endothelial dysfunction is an early event in atherosclerosis and that the status of systemic endothelial function may modify the association between risk factors and atherosclerosis.
Juonala M, et al. Interrelations between brachial endothelial function and carotid intima-media thickness in young adults. The Cardiovascular Risk in Young Finns Study. Circulation 2004; 110:2774–2777.
Preventing microalbuminuria in type II diabetes
The multicentre double-blind, randomised Bergamo Nephrologic Diabetes Complications Trial (BE NEDICT) was designed to assess whether angiotensin-converting-enzyme inhibitors and non-dihydropiridine calcium-channel blockers, alone or in combination, prevent microalbuminuria in subjects with hypertension, type II diabetes mellitus, and normal urinary albumin excretion. This study enrolled 1204 subjects, who were randomly assigned to receive at least three years of treatment with trandolapril (at a dose of 2 mg per day) plus verapamil (sustained-release formulation, 180 mg per day), trandolapril alone (2 mg per day), verapamil alone (sustained-release formulation, 240 mg per day), or placebo. The target blood pressure was 120/80 mmHg. The urinary end-point was the development of persistent microalbuminuria (overnight albumin excretion, ≥ 20 mg per minute at two consecutive visits). The primary outcome was reached in 5.7% of the subjects receiving trandolapril plus verapamil, 6.0% of the subjects receiving trandolapril, 11.9% of the subjects receiving verapamil, and 10.0% of control subjects receiving placebo. Thus, in subjects with type II diabetes and hypertension but with normoalbuminuria, the use of trandolapril plus verapamil and trandolapril alone decreased the incidence of microalbuminuria to a similar extent. The effect of verapamil alone was similar to that of the placebo.
Ruggenenti P, et al. Preventing microalbuminuria in type II diabetes. N Engl J Med 2004; 351: 1941–1951.
Angiotensin-receptor blockade versus converting-enzyme inhibition in type II diabetes and nephropathy
Few studies have directly compared the renoprotective effects of angiotensin II-receptor blockers and angiotensin-converting-enzyme (ACE) inhibitors in persons with type II diabetes. In this prospective, multicentre, double-blind, five-year study, 250 subjects with type II diabetes and early nephropathy were randomly assigned to receive either the angiotensin II-receptor blocker telmisertan (80 mg daily, in 120 subjects) or the ACE inhibitor enalapril (20 mg daily, in 130 subjects). The primary end-point was the change in the glomerular filtration rate between the baseline value and the last available value during the five-year treatment period. Secondary end-point included the annual changes in the glomerular filtration rate, serum creatinine level, urinary albumin excretion, and blood pressure, the rate of end-stage renal disease and cardiovascular events; and the rate of death from all causes. After five years, the change in the glomerular filtration rate was −17.9 ml per minute per 1.73 m2 of body-surface area with telmisertan, as compared with −14.9 ml per minute per 1.73 m2 with enalapril. The effects of the two agents on the secondary end-point were not significantly different after five years. The Authors concluded that telmisertan is not inferior to enalapril in providing long-term renoprotection in persons with type II diabetes. These findings do not necessarily apply to persons with more advanced nephropathy, but they support the clinical equivalence of angiotensin II-receptor blockers and ACE inhibitors in persons with type II diabetes that place them at high risk for cardiovascular events.
Barnett AH, et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in type II diabetes and nephropathy. N Engl J Med 2004; 351:1952–1961.