P13
The effects of atorvastatin and micronized fenofibrate on endothelial functions in metabolic syndrome patients: comparative study
MD Demir Hakan, MD Ural Dilek, MD Kozdag Guliz, MD Ertas Gokhan, MD Tayfun Sahin, MD Oner Gokhan, MD Ulas Bildirici
Department of Cardiology, Kocaeli, Turkey
Topic: Obesity
Objective: To compare the effects of atorvastatin 10 mg/day and micronized fenofibrate 200 mg/day on traditional and non-traditional risk and endothelial functions in patients with metabolic syndrome.
Materials and Methods: Sixty-five consecutive patients who were free of coronary artery were studied. Patients were randomized to atorvastatin 10 mg/da yor micronized fenofibrate 200 mg/day. At entry and end of the study; blood and urine samples were collected fort he biochemical analyses and brachial artery reactivity and carotis intima-media thicknes were measured using high resolution ultrasonography.
Results: A total of 52 patients completed the study. With both drugs; treatment goals of total cholesterol, LDL cholesterol, HDL cholesterol and non HDL cholesterol was reached similarly. CRP reductions were significant in both groups (p=0.041 vs p=0.003) By fenofibrate; while levels of fibrinogen, uric acid and inslin were significantly declined and HOMA index was reduced (p= 0.003, p>0,001,; p=0.001, p= 0.002 respectively), a significant rise in the homocystein levels was observed (p=0.015). In each groups; significant (p=0,002 for atorvastatin and p=0.022 for fenofibrate) and similar improvements occured on flow-mediated dilation of the brachial artery.
Conclusion: Treatment with atorvastatin 10 mg/day or micronized fenofibrate 200 mg/day during six months have similar benefical effects on endothelial vasomotor functions in metabolic syndrome with desirable side effects. Both reduce CRP levels significantly and similarly. While atorvastatin is more effective on LDL cholesterol and total cholesterol, fenofibrate is more effective on inslin resistance and the serum markers of endothelial dysfunction. Both drugs are good treatment options in metabolic syndrome, however lipid status of the patient and the other markers of atherosclerosis should also be considered while selecting the more suitable agent. Combination therapy must be kept in mind with close monitoring of the side effects.
P116
Objectively measured physical activity in association with serum apolipoproteins and apoB/apoA-I ratio in elderly
K Ahmed1, P Rask2, M Dreifaldt3, A Hurtig-Wennlof1
1
Orebro University, School of Health and Medical Sciences/Clinical Medicine., Orebro, Sweden, 2Department of Clinical Physiology, Orebro University Hospital, Orebro, Sweden, 3Department of Cardio-thoracic Surgery, Orebro University Hospital, Orebro, Sweden
Topic: Physical activity
Purpose: Several studies have suggested that subjectively reported physical activity (PA) is associated with favorable apolipoproteins and their ratio but this association has not been much studied in elderly, and seldom with objective methods. the specific aim of the current study was to increase our understanding of the association between objectively measured physical activity, and serum apolipoproteins and apoB/apoA-I ratio in elderly subjects.
Methods: In a long term follow-up of coronary artery bypass graft surgery patient, a total of 89 subjects (55–88 years old) volunteered. Peak oxygen uptake was measured by ergospirometry and PA by accelerometry. Subjects were divided into two groups based on PA recommendations for older adults: More physically active (who achieved 30 minutes of moderate PA/day); and Less physically active, who did not.
Result: Only 26% (23/89) of participants achieved the recommended 30 min/day of moderate intensity activity. Objectively measured PA was associated with higher apolipoprotein A-I and lower apoB/apoAI ratio and BMI in the more physically active group, whereas no significant association with apolipoprotein B was observed.
Conclusion: the significant association of objectively measured PA with favorable apolipoprotein A-I and apoB/apoA-I ratio stresses the importance of being physically active despite of functional limitations.
∗Mann Whitney's U test for differences between less physically active and more physically active groups.
P117
Leptin/adiponectin ratio is better at estimating the insulin resistance than leptin concentration
M Pytliak1, V Vargova1, V Mechirova1, M Felsoci2
1
Safarik University Medical School, Kosice, Slovak Republic, 2Louis Pasteur University Hospital, Kosice, Slovak Republic
Topic: Biomarkers
Objectives: Adiponectin expression is reduced in obesity, insulin resistance and type 2 diabetes mellitus (T2DM) and its plasma concentrations are inversely related to body weight and insulin levels. Recently, low plasma adiponectin levels have been shown to predict the risk of developing T2DM. On the other hand, leptin concentration rises with BMI. However, leptin resistance occurs frequently in morbid obese patients, which means, that leptin levels do not reflect the condition of the insulin resistance. the aim of this study was to compare correlation of leptin levels and leptin/adiponectin ratio with BMI and HOMA index in patients with 2.nd grade of obesity (BMI > 35 kg.m-2). Furthermore, we assessed endothelial function (measured with flow mediated dilation method on the forearm).
Methods: We examined 47 patients with BMI 38.45 ± 2.85 kg.m-2 21 of which were with overt T2DM, 15 with impaired glucose tolerance confirmed with oGTT and 11 without any changes in the glucose metabolism. Fasting glucose was measured with standard biochemical method. Fasting insulin (IRMA), adiponectin (ELISA) and leptin (IRMA) levels were also examined under standard conditions early in the morning. HOMA index was calculated as G0xI0/22.5 (G0 fasting glucose, I0 fasting insulin). Endothelial function was estimated with flow mediated dilation method as postischemic dilatation of brachial artery; endothelial dysfunction was characterized as postischemic dilatation > 7% from the baseline.
Results: there was no significant difference in the leptin and adiponectin levels in patients with T2DM, IGT and obese patients without glucose homeostasis impairment. We found only weak positive correlation between the leptin levels and BMI (r=0.47581, p=0.045) and HOMA index (r=0.57584, p=0.04) in patients with obesity over 35 kg.m-2. On the other hand, we found strong positive correlation between the leptin/adiponectin ratio and BMI (r=0.86241, p>0.001) and HOMA index (r=0.78965, p>0.01). Leptin/adiponectin ratio correlated negatively with endothelial function (r= –0.6858, p=0.01). No correlation between leptin levels and endothelial function was proven in the group of extreme obese patients.
Conclusions: Based on our data, we assume higher prevalence of leptin resistance in/with higher grades of obesity, what diminish the diagnostic value of leptin in insulin resistance assessment especially in extreme obese subjects. However, adiponectin levels decrease with BMI and rising insulin levels more consistently, suggesting that leptin/adiponectin ratio might be better for the estimation of insulin resistance than leptin levels alone.
P118
the relationship between mild aortic valve sclerosis and carotid disease
B Parfrey, M Nault, D Brouillard, D Armstrong, M Matangi
Kingston Heart Clinic, Kingston, Canada
Topic: Imaging in atherosclerosis
Purpose: Echocardiography (ECHO) is the most commonly performed cardiac imaging investigation. Common carotid artery (CCA) intimal medial thickness (IMT) is a useful screening test for the detection of atherosclerosis. Recent evidence has suggested an association between degenerative aortic valve disease and the presence of atherosclerosis. the purpose of our investigation was to determine the sensitivity, specificity and predictive values of the ECHO finding of mild aortic valve sclerosis for the detection of carotid atherosclerosis.
Methods: Over the past4 years993 patients (P) have had both carotid duplex imaging and ECHO performed within 1 year of each other. P with mild aortic valve sclerosis were included. A CCA IMT of > 1.0mm was considered abnormal, as was any degree of internal carotid artery stenosis (ICA) using ICAVL imaging and velocity criteria. A CCA IMT of < 1.00mm and no ICA stenosis was considered normal. Statistics were based on the carotid being the gold standard for the presence or absence of atherosclerosis. Calculations were made for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. the calculations were performed for men =40 years (M) and women =50 years (W).
Results: See Table 1.
Conclusions: the presence of mild aortic valvesclerosis has a high PPV of 93.3%in M and 84.4% in W for the presence of carotidatherosclerosis. the NPV of 24.1% in M and 30.4% in W for a morphologically normal aortic valve is not clinically useful. the presence of mildaortic valve sclerosis on anECHO report in M or F should lead one to check for other vascular risk factors. these finding suggest that such patients could benefit from vascular preventative therapies such as Aspirin and Statins.
P119
QIMT by radio frequency (examination of tracking). Method of evaluation thickness of the intima media among patients having cardio vascular risk factors. Clinical implication: about 150 cases
XC Castellon, VB Bogdanova
Private Hospital Athis Mons, Department of Cardiology, Athis Mons - Paris, France
Topic: Early detection of asymptomatic disease
the main aim of this study is to reveal an early diagnosis of a pre clinical evolution atheroma plaque, in the patients with cardiovascular risk factors. the intima media thickness is an independent cardiovascular risk factor. the measurement of the intima media is increasingly part of clinical evaluation of patients with risk factors. Mass or individual screening of this marker has high cardiovascular risk should be done at present in all patients with Cardio Vascular risk factors. QIMT is a promising method that allows us to calculate the intima media radio in real time on a reliable and reproducible.
Method: QIMT by Radio frequency. Method of the examination used is in conformity with the IMT protocol of Mannheim standarts of normal values according to age, measurements of IMT based on the radio frequency. this study has been done with 150 patients (100 men and 50 women), aged between 45 and 60 years, having cardiovascular risk factors (Dyslipidemy, standard diabetes II no complicated, hypertension and tobacco). All patients having atheroma plaque located in the carotids have been excluded from the study.
Results: 3% of the group of men and 2% women had resulted pathological (= with 900 micrometers).
Conclusion: the QIMT technique of exploration of an early detection pre clinic evolution of atheroma plaque is easy, specicific, chip, and reproducible to use a routine of preventive cardiology. It enables us to calculate in real- time the thickness intima media in a few minutes, making the results reliable with a sensitivity of 95% and a specificity of 94%.
Comments: the QIMT can be used as a method of exploration complementary to the endothelial function, associates to others high-risk markers (biological: Homocysteine, Willebrand, Micro albuminuria and Markers of Oxidative Stress: plasmatic rates of the vitamins C, α- Tocopherol, ?- Tocopherol, ã- carotene, Lipidic peroxides, oxidized LDL, oxidized Antibodies LDL, OLIGO- ELEMENTS: Selenium, Copper, Zinc, Cu/Zn report/ratio) rate of plasmatic proteins: Proteins thiols) and with VIF (vasodilatation by intermediary of flow) on located in the brachial artery.
P120
the difference in left and right common carotid artery intimal medial thickness may be explained by the velocities
B Parfrey, D Armstrong, M Nault, D Brouillard, M Matangi
Kingston Heart Clinic, Kingston, Canada
Topic: Imaging in atherosclerosis
Purpose: It is well documented that L) common carotid artery (CCA) intimal medial thickness (IMT) is mildly thicker than R) CCA IMT, even in individuals with completely normal carotid studies. We believe there may be an anatomical explanation. the purpose of our investigation was to determine whether or not there was a difference in CCA velocities between L) and R) CCA that may account for the difference in CCA IMT between the two sides.
Methods: CAROTIDfile the carotid duplex imaging module of CARDIOfile, our cardiology database was searched for all patients who had carotid studies with all the necessary data points. All carotid studies were interpreted using Intersocietal Commission for Accredited Vascular Laboratory (ICAVL) imaging and velocity criteria. Patients were separated into those with an ICA stenosis as defined by ICAVL criteria, those without ICA stenosis but who have an abnormal IMT >1.00mm and those without an ICA stenosis who had a normal IMT =1.0mm.
Results: the results are shown in Table 1.
Conclusions: Irrespective of the degree (if any) of ICA stenosis, the L) CCA IMT is consistently thicker than the R) CCA. this difference is highly statistically significant. Similarly there is a highly statistically significant difference in the distal CCA peak systolic velocity (PSV). the difference in velocity most likely has an anatomical explanation. the lower PSV in the R) CCA is most likely due to a fall in CCA velocity after the origin of the R) subclavian. We postulate that the statistically significant higher velocity in the L) CCA leads to increased sheer forces and increased risk of L) CCA intimal damage over time. the end result being slightly thicker L) CCA IMT.
CCA = common carotid artery. PSV = peak systolic velocity in cm/sec. IMT = intimal medial thickness in mm.
