P13
C-reactive protein in prepubertal children with abdominal obesity as a marker of cardiovascular and metabolic risk
S Galcheva, Y Yotov, V Iotova
Medical University, Varna, Bulgaria
Topic: Risk factors and risk prediction
High sensitivity C-reactive protein (hsCRP) is a marker of inflammation and is found to be a significant predictor of cardiovascular diseases (CVD). Metabolic syndrome and abdominal obesity are associated with earlier and more severe presentation of atherosclerosis.
Aim: To evaluate the level of hsCRP in children aged below 10 years according to overweight/obesity status and in relation to cardiovascular parameters and other risk factors.
Participants and methods: We evaluated 168 healthy children (78 boys and 90 girls) at the mean age 8.1±1.2 years divided in three groups normal (NW, 31.5%), overweight (OW, 27.4%) or obese (OB, 41.1%) according to body mass index (BMI) international reference (Cole, 2000) and waist circumference (WC). Their blood pressure (BP) and heart rate (HR) were measured and blood tests for fasting blood glucose (BG), immunoreactive insulin (IRI), lipids, liver enzymes, hsCRP, and other proinflammatory and hormonal markers were drawn. HOMA-IR was calculated according to the standard formula. Log transformation of data for the hsCRP, BMI and other variables was performed where appropriate because of skewed distribution.
Results: The hsCRP was significantly higher in the OB 7.53±0.91 (mean±SE) compared with the OW 4.11±0.9 (p=0.029) and NW 3.17±0.88 mg/l (p=0.001) children, without important gender differences. The inflammation marker displayed significant linear increase with both BMI and WC. The hsCRP was positively correlated with IRI (r=0.237, p=0.004), with HOMA-IR (r=0.279, p=0.001), with systolic BP (r=0.396, p>0.0001) and diastolic BP (r=0.299, p >0.0001), and negatively with HDL-cholesterol (r=-0.202, p=0.013). In multivariable linear regression model, the hsCRP increased with 1.84 mg/l (95%CI=1.50–2.26, p>0.0001) per WC quartile after adjustment for age, gender, BMI, birth weight, BG, HOMA-IR. For BMI, the significance of the relation with hsCRP which was present in the univariate analysis disappeared after adjusting for WC in the multivariate model.
Conclusions: The hsCRP is elevated in healthy overweight and obese children already in prepuberty. It correlates with higher BP and other important risk factors for CVD. At this age, waist circumference is a better predictor of the hsCRP levels than is BMI. The prevention of CVD through weight control has to start early in life.
P23
The association between D-vitamin status and aortic stiffness
O Mayer1, J Filipovsky1, J Seidlerova1, J Vrzalova1, R Cifkova2
1
2nd Department of Internal Medicine, University Hospital, Plzen, Czech Republic, 2Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czech Republic
Topic: Risk factors and risk prediction
Background: Recent studies indicate the possible role of D-vitamin in the etiology of vascular diseases. We aimed to establish the association between mild decrease of serum monohydroxyde D-vitamin concentration (25(OH)-D) and aortic pulse wave velocity (APWV) as a measure of aortic stiffness.
Methods: 576 subjects (mean age 48.03y (SD 14.8)), 41.5% males), a Pilsen sub-sample of postMONICA survey were included into cross-sectional study. APWW was estimated using Sphygmocor device, 25(OH)-D by RIA method.
Results: see table. The significance of association between 25(OH)-D and APWV remained even if adjusted for age, gender and all conventional risk factor as potential confounders (beta=–0,093, p=0.009).
Conclusion: In our sample of general population we found a clear significant and independent negative association between D vitamin and aortic rigidity. Subject with lowest D vitamin status showed the highest aortic stiffness.
mean±SEM; ∗∗∗ p>0.001, ∗∗p>0.01, p>0.05; Mann-Whitney U test, I vs. II, III or IV.
P24
Anti-atherosclerotic effects of a nutraceutical treatment
V Mercurio, F Affuso, A Ruvolo, F Micillo, V Fazio, G Garofalo, S Fazio
University of Naple's, Federico II Dpt of Clinical Medicine, Cardiovascular and Immunologic Sciences, Naples, Italy
Topic: Lipids and atherosclerosis
Purpose: The term nutraceutical was coined in the 1990's by Dr. Stephen DeFelice. He defined nutraceutical as: “any substance that is a food or a part of a food and provides medical or health benefits, including the prevention and treatment of disease”. Although many studies have investigated the lipid-lowering properties of some nutraceuticals, there are still many doubts about their efficacy. In this study a combination of three substances, namely berberine 500 mg, red yeast rice 200 mg and policosanols 10 mg have been investigated to assess their effects on cholesterolemia and endothelial function in hypercholesterolemic subjects.
Methods: Fifty hypercholesterolemic patients (26 males and 24 females, mean age 55±7 yrs, total cholesterol 6.55±0.75 mmol/l, BMI 28±3.5) have been enrolled in a randomized, double-blind, placebo-controlled study of 6 week treatment with a daily oral dose of nutraceutical combination (NC) or placebo. In a subsequent open label extension of 4 weeks the whole sample received NC. The primary objective was the decrease of total cholesterol (C) in the NC arm. Secondary endpoints were the decrease of low-density lipoprotein cholesterol (LDL-C), triglycerides, the improvement of endothelial-dependent flow-mediated dilation (FMD) and the effects on insulin sensitivity in relation to NC treatment.
Results: The absolute changes from baseline showed a significant reduction of C and LDL-C (C: –1.14±0.88 vs –0.03 ± 0.78mmol/l, p >0.001; –1.06±0.75 and –0.4±0.54mmol/l, p >0.001), and a significant increase of endothelial-dependent flow-mediated dilation in NC arm vs placebo (3 ± 4% and 0 ± 3% respectively, p < 0.05). At the end of open label extension, there was a significant reduction of triglycerides (from 1.57±0.77 to 1.26±0.63mmol/l, p>0.05). Furthermore, in a subgroup of patients with insulin resistance at baseline, NC treatment produced a significant improvement of insulin sensitivity (HOMA from 3.3±0.4 to 2.5±1.3, p>0.05). No adverse effect was observed throughout the study.
Conclusions: NC treatment produced a significant reduction of cholesterol levels, with an improvement of endothelial function. In addition, these effects were associated with a significant improvement of insulin sensitivity.
P25
Endothelial dysfunction predicts clinical restenosis after percutaneous coronary intervention
N Butt, PS Munk, AI Larsen
Stavanger University Hospital, Department of Medicine, Stavanger, Norway
Topic: Risk factors and risk prediction
Background: Endothelial dysfunction (ED) is associated with increased risk for cardiovascular events in patients with coronary artery disease and may predict in-stent restenosis after percutaneous coronary intervention (PCI). We evaluated if ED could predict clinical restenosis in patients after PCI with stent implantation for angina pectoris or acute coronary syndrome.
Methods: One hundred patients were consecutively included after successful PCI with stenting for angiographic single vessel disease. All patients were evaluated with ultrasound detection of brachial artery reactivity at 4 weeks and with a symptom limited exercise stress test at 6 months.
Results: Twenty patients showed clincial signs of restenosis during follow-up and were referred to re-angiography. Patients with clinical restenosis had impaired flow mediated vasodilation (FMD) compared to patients without clinical restenosis (5.8±3.4 versus 9.0±4.8, p=0.005). In multivariate analysis FMD was the only independent predictor for the risk of clinical restenosis (OR 4.5, 95% CI 1.11 to 17.8).
Conclusions: Impaired FMD 4 weeks after PCI independently may predict the risk of clinical restenosis.
FMD, flow mediated vasodilation; B2/C, B2/C lesion according to classification; AMI, acute myocardial infarction.
P26
Blood pressure indices and cardiovascular risk in high-risk hypertensive patients: a subanalysis of CASE-J trial
S Yasuno1, K Ueshima1, K Oba1, A Fujimoto1, T Ogihara2, T Saruta3, K Nakao4
1
EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan, 2Osaka General Medical Center, Osaka, Japan, 3Keio University School of Medicine, Tokyo, Japan, 4Kyoto University, Graduate School of Medicine, Department of Medicine and Clinical Science, Kyoto, Japan
Topic: Hypertension
CASE-J trial Group
Objective: Recent studies have raised the issue of a predominant role of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) on the risk of cardiovascular (CV) events. In the present study, we examined the relationship between BP indices and the risk of CV events in high-risk Japanese hypertensive patients, as a subanalysis of CASE-J trial.
Methods: The CASE-J trial compared the effects of the angiotensin II receptor blocker candesartan and the calcium channel blocker amlodipine on the incidence of CV events, represented as a composite of sudden death, cerebrovascular, cardiac, renal, and vascular events, in high-risk Japanese hypertensive patients. Subjects were all of 4,703 high-risk hypertensive patients (mean age: 63.8 years) to be analyzed in the trial. We used the multivariate Cox regression analysis to estimate the hazard ratio (HR) and 95% confidential interval (CI) of each BP index at baseline for CV events with adjustment for possible baseline confounders.
Results: BP was strictly controlled to the level as low as less than 140/80 mmHg in the study. During 3.2 ± 0.9 years of follow-up, 268 (5.7%) patients experienced CV events for a rate of 17.7 per 1000 person-years. In the multiple Cox regression analysis, HRs (95%CI) for the risk of CV events were 1.24 (1.09–1.41) for SBP (per 1SD increase), 1.26 (1.09–1.46) for DBP (per 1SD decrease), 1.08 (0.93–1.25) for MAP (per 1SD decrease), and 1.39 (1.21–1.60) for PP (per 1SD increase). With regard to HRs for the risk of each event, SBP and PP were strongly associated with the risk of cerebrovascular event, but DBP and MAP was not (HR (95%CI); 1.27 (1.03–1.57) for SBP, 1.07 (0.85–1.34) for DBP, 1.08 (0.87–1.36) for MAP, and 1.27 (1.47–1.55) for PP). On the other hand, DBP and PP was a significant determinant of the risk of cardiac event (HR (95%CI); 1.27 (0.99–1.61) for SBP, 1.30 (1.02–1.67) for DBP, 1.10 (0.85–1.42) for MAP, and 1.45 (1.16–1.82) for PP), and only PP was significantly associated with the risk of renal event (HR (95%CI); 1.39 (0.97–2.01) for SBP, 1.18 (0.83–1.68) for DBP, 1.03 (0.71–1.49) for MAP, and 1.51 (1.08–2.11) for PP). These results showed that a high PP mainly due to a higher SBP was strongly associated with the onset of cerebrovascular and renal event, and a high PP due to a lower DBP was associated with the onset of cardiac events.
Conclusion: We demonstrated that PP was the most useful predictor of CV events in high-risk Japanese hypertensive patients. However, a significance of PP might differ in the development of each organ damage.
P27
Substantial coronary heart disease mortality reduction associated with changes in risk factors and medical treatments in Ontario 1994–2005
M O'flaherty1, H Wijeysundera2, M Machado2, W Witteman2, F Farahati2, J Tu3, M Khran2, S Capewell2
1
University of Liverpool, Liverpool, United Kingdom, 2University of Toronto, Ontario, Canada, 3Institute for Clinical Evaluative Sciences, 4Ontario, Canada
Topic: Public health
Purpose: Coronary heart disease (CHD) mortality has declined substantially in Canada over recent decades. Our objective was to determine what proportion of this decline was associated with changes in cardiovascular risk factors and medical treatments from 1994 to 2005 in Ontario
Methods: The validated IMPACT model was used in all calculations. We included data on population size, CHD mortality, and risk factor and treatment uptake changes in adults 25 years and older between 1994 and 2005. We considered 8 distinct sub-populations of patients with CHD [acute myocardial infarction (MI), unstable angina, secondary prevention post-MI, chronic angina/CHD, in-hospital and community heart failure, and primary prevention for hyperlipidemia or hypertension], andpopulation changes for six specific cardiovascular risk factors (smoking, diabetes, systolic blood pressure, total cholesterol, exercise, and obesity). The outcome of interest was the number of deaths prevented or postponed associated with specific treatments and risk factor changes.
Results: From 1994–2005, the overall CHD mortality rate in Ontario fell 35% from 190.9 to 124.8 deaths per 100,000 inhabitants, resulting in an estimated 7585 fewer CHD deaths in 2005. Medical treatments accounted for approximately 48% of the total mortality decrease. Treatments for chronic angina and chronic CHD accounted for the largest benefits (approximately 26% of the fall), followed by community heart failure (9%), and initial AMI treatments (7%). Other medical treatments for hyperlipidemia, hypertension, heart failure, post MI, and unstable angina together explained approximately 6% of total CHD mortality decrease.
Changes in cardiovascular risk factors explained approximately 40% of the total mortality decrease. The largest contributing risk factors were reductions in total plasma cholesterol (explaining approximately 20% of the mortality fall), and systolic blood pressure (19%), followed by smoking cessation (4%), and an increase in physical activity (4%). Increasing diabetes prevalence and body mass index had increased CHD mortality by approximately 6% and 2%, respectively.
Conclusions: Approximately half the substantial CHD mortality decrease between 1994 and 2005 was attributable to medical treatments, slightly less than half to improvements in major risk factors, offset by adverse trends in obesity and diabetes. The data suggest that future CHD strategies should maximise evidence-based therapies and also support more aggressive policies to control tobacco and promote healthy diets.
P29
Using the Health Survey for England to monitor the effect on non-smokers and on inequalities of smokefree legislation
JS Mindell1, H Wardle2
1
University College London, London, United Kingdom, 2National Centre for Social Research, London, United Kingdom
Topic: Public health
Purpose: On 1st July 2007, England implemented smokefree legislation to protect non-smokers from tobacco smoke. We used data from the Health Survey for England (HSE) to assess whether concerns about impacts on health inequalities were justified.
Method: The HSE is an annual survey of a nationally-representative random sample of the general population. An interviewer visits the selected households, followed by a nurse. Questions ask about smoking habits and exposure to others smoke; a saliva sample in some years provides cotinine levels, a nicotine metabolite indicating exposure to tobacco.
Results: Subjective and objective measures of tobacco smoke exposure were static 1998–2003. Self-reported exposure fell in 2006 but fell more in 2007 from 53% (95% CI 49–57%) of men before to 24% (20–28%) after 1st July and from 39% (35–42%) to 20% (17–23%) in women. Mean reported weekly exposure to tobacco smoke in 2007 fell from 4.2hr before to 2.0hr after 1st July among men (3.4hr to 1.4hr among women, both p>0.001). Geometric mean cotinine fell from 0.20ng/ml before to 0.14ng/ml after in men and 0.19ng/ml to 0.12ng/ml in women (both p>0.001). The largest fall occurred in the youngest adults (0.24ng/ml to 0.15ng/ml, p>0.001). Similar reductions occurred across all socio-economic groups eg 0.16ng/ml to 0.12ng/ml least deprived quintile (p>0.001) and the middle quintile (p=0.008); 0.29ng/ml to 0.19ng/ml in the most deprived quintile (p=0.014). The proportion with undetectable cotinine increased in each group, regardless of age, sex, socio-economic group, education, employment status, income, area deprivation, reported exposure, or whether smoking occurred in the home most days. The increase was very significant in almost all cases.
Conclusions: Reductions in exposure began during publicity around the need for smoke free legislation but the largest fall occurred on implementation. The legislation has protected non-smokers without increasing inequalities.
