289 Retinal vascular caliber and the prevalence of obesity in children: baseline results of a comprehensive school-based Intervention Study (JuvenTUM III)
H Hanssen1, M Neidig2, ACB Renner2, K Blume2, A Schmidt-Trucksaess1, M Halle2, M Siegrist2
1
Division of Sports Medicine, Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland, 2Technical University of Munich, Department of Prevention & Sports Medicine, Munich, Germany
Topic: Obesity
Purpose: the prevalence of childhood obesity is high and its association with future cardiovascular disease in adulthood is well established. Primary prevention strategies beginning in childhood are promising means to reduce risk of coronary heart disease. the cross-sectional data presented analyze the prevalence of obesity and its correlation to early retinal vascular changes in young children.
Methods: the baseline examination included 592 school children aged 9–13 years from secondary schools. Anthropometric measurements and blood collections were conducted using standard protocols for children. Retinal microvascular diameters and the arteriolar to venular ratio (AVR) were assessed with a non-mydriatic vessel analyser using a computer-based program. Augmentation index (Aix@HR75) and mean central blood pressure were analyzed by use of a sphygmograph.
Results: In this population with an average age of 11.1±0.6 years, 23 % of the children were overweight or obese. the mean retinal arteriolar and venular calibres were 208.0 ±15.6 cm and 236.2 ±16.2 cm, respectively, with a mean AVR of 0.88±0.1. Girls had significantly larger retinal vessel diameters than boys (p>0.001). Larger venular diameters were significantly associated with higher BMI, percentage body fat and serum levels of triglycerides (TGA) as well as hs-CRP. Neither HDL or LDL cholesterol nor fasting blood glucose were related to retinal microvascular diameters. Arteriolar calibers correlated inversely with central and peripheral blood pressure but not with Aix@HR75. In addition, higher BMI was significantly associated with higher mean central blood pressure (p>0.001).
Conclusions: Changes of the retinal microcirculation have been shown to be associated with cardiovascular disease in adults. Similar to findings in adults, childhood obesity is associated with retinal venular dilatation and higher blood pressure. Early retinal microvascular changes are already existent in school children in the presence of cardiovascular risk factors.
290: Risk factor and therapeutic management in people at high cardiovascular risk: Results from EUROASPIRE III survey in 12 European countries
K Kotseva1, C Jennings1, G De Backer2, D De Bacquer2, D Gaita3, A Pajak4, U Keil5, D Wood1
1
National Heart and Lung Institute, Imperial College London, London, United Kingdom, 2Ghent University, Ghent, Belgium, 3Institute of Cardiovascular Disease, Timisoara, Romania, 4Institute of Clinical Epidemiology and Population Studies, Institute of Public Health, Krakow, Poland, 5Institute of Epidemiology und Social Medicine, University of Muenster, Munster, Germany
Topic: Prevention of CVD
EUROASPIRE III Study Group
Purpose: the third EUROASPIRE survey was carried out in 2006/2007 under the auspices of European Society of Cardiology, Euro Heart Survey programme. the aim was to determine whether the 2003 Joint European Societies guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been followed in clinical practice.
Methods: EUROASPIRE III survey was undertaken in selected geographical areas and 66 general practices in 12 European countries: Belgium, Bulgaria, Croatia, Finland, Germany, Italy, Latvia, Poland, Romania, Slovenia, Spain and the UK. Consecutive patients, men and women >80 years of age, without a history of coronary or other atherosclerotic disease, either started on antihypertensive and/or lipid lowering and/or anti-diabetes treatments, at least 6 months but not more than 3 years prior to the study, were identified retrospectively. Data collection was based on a review of patient s medical notes and a prospective interview and examination by trained technicians using standardised methods and instruments.
Results: A total of 5687 medical notes were reviewed and 4366 high risk individuals (57.7% females) were interviewed (participation rate 76.7%). the mean (SD) age was 60.0 (10.3) years. Overall, 70.8% had blood pressure = 140/90 mmHg (= 130/80 in people with diabetes mellitus), 78.9% had total cholesterol = 4.5 mmol/l and 30.2% reported a history of diabetes. the prevalence of undetected diabetes (fasting glucose = 7.0 mmol/l among patients with no history of diabetes) was 12.7%. the risk factor control was very poor, with only 26.3% of patients using antihypertensive medication achieving the blood pressure goal and 30.6% of patients on lipid-lowering medication achieving the total cholesterol goal. 39.9% of patients with self-reported diabetes had HbA1c = 6.1% and 7.4% had fasting plasma glucose = 6.0 mmol/l. the use of cardioprotective medication was: aspirin or other anti-platelets 22.0%; beta-blockers 31.2%; ACE inhibitors/ARB 55.7%; calcium channel blockers 24.0%; and statins 39.9%.
Conclusions: the EUROASPIRE III survey shows that risk factor management in patients at high cardiovascular risk in Europe is a major cause for concern. Blood pressure, lipid and glucose control are completely inadequate with most patients not achieving the targets defined in the prevention guidelines. Primary prevention needs a systematic, comprehensive, multidisciplinary approach, which addresses lifestyle and risk factor management by general practitioners, nurses and other allied health professionals, and a healthcare system which invests in prevention.
291: Trends in coronary heart disease mortality in England by socioeconomic circumstances, 1982–2006
M Bajekal1, S Scholes1, M O'flaherty2, R Raine1, P Norman3, S Capewell2
1
University College London, London, United Kingdom, 2University of Liverpool, Liverpool, United Kingdom, 3University of Leeds, Leeds, United Kingdom
Topic: Socio-demographic factors
IMPACTsec Research Group
Understanding the scale of social inequalities in coronary heart disease (CHD) mortality and differential trends in these by age, gender and social position is crucial for assessing the impact of concomitant changes in risk factors, healthcare, legislation and policy on health inequities. Previous analyses of trends in Scotland suggest that falling CHD mortality rates may have recently begun to level in younger age-groups. Furthermore, the flattening of rates was confined to the most socially deprived groups where large improvements are still possible [BMJ 2009 339 b27613]. Given the uncertainty attached to the estimates, the authors advised caution and suggested confirmatory research of these potentially important findings.
We therefore update previous analyses, overcoming the technical limitation of small counts by using data for England (population 50 million) and examining socio-economic trends over a longer time-span (1982–2006).
Small areas (c.1500 people) in England were aggregated into equal quintiles by ascending scores on an index of multiple deprivation (with quintile 1 the most affluent and 5 the most deprived). CHD deaths and populations from 1981–2007 for each quintile group were used to calculate three-year moving averages of age-standardised and age-specific mortality rates for each social group, separately by gender.
Trends by quintiles were analysed using Joinpoint regression modelling to calculate annual percentage change (APC) estimates and to identify turning points in each series.
there was a clear social gradient in the rate of decline in age-standardised CHD mortality with the steepest fall in the most affluent quintile. thus, while absolute inequalities narrowed, relative inequalities increased slightly. For similar age and social groups, rates fell faster for men than women, particularly in those aged over 85. From 2000, rates levelled off in the most affluent groups (q1 and q2) for women aged 45–54 and in both the affluent (q1) and more deprived (q4) groups in men aged 25–44.
Comparisons across and within countries provide valuable insights into potential drivers of inequality for a leading cause of death worldwide. the differing results for England and Scotland are intriguing. these differences may be real or may reflect data artefact arising from uncertainties in accurately estimating denominator populations, particularly among young, mobile populations in deprived areas with high levels of immigration. these important issues will be further discussed in the presentation.
292: Chronic heart failure and aging: effects of exercise training on left ventricular diastolic dysfunction and MMP-9
M Sandri, N Mangner, V Adams, R Hoellriegel, R Hambrecht, G Schuler, S Gielen
University of Leipzig, Heart Center, Leipzig, Germany
Topic: Cardiovascular rehabilitation
Background: Diastolic dysfunction (DD) may occur in both physiologic aging and chronic heart failure (CHF) and is accompanied by an increased level of MMP-9 as indicator of myocardial fibrosis. It has, however, never been assessed, whether the degree of DD in CHF patients is age dependent and if potential beneficial effects of exercise training (ET) on diastolic function are diminished in old age.
Methods: We randomized 60 pts. with stable CHF (age 62.4±1.7 yrs, EF 28.3±1.7%, VO2max 13.6±2.0ml/kg∗min) and 60 healthy subjects (HS) (age 60.5±2.4 yrs, EF 60±1%, VO2max 21.1 ±3.1 ml/kg∗min) to a training (T) or a control group (C). To detect possible aging effects we included subjects below 55 (y) and above 65 yrs. (o). Subjects in the T-group exercised 4 times daily at 60 to 70% of VO2max for 4 weeks under supervision. At baseline and after the intervention lateral E/è ratio was determined by echocardiography. MMP-9 was measured by ELISA.
Results: As compared to young HS, old HS showed at baseline an increased E/à ratio and increased MMP-9 levels (y: E/à 7.2±0.1 MMP-9 23.8±11pg/ml; o: E/à 13.8±0.2; MMP-9 76.5±16pg/ml; p>0.05). In CHF pts. diastolic function was impaired and MMP-9 levels were increased (y: E/à 14.9±0.5; MMP-9 276±39pg/ml; o: E/à 14.3±0.2; MMP-9 283±79pg/ml) with no observable difference between y and o (p=0.72). As a result of ET, E/à was reduced by 34% and MMP-9 levels were reduced by 23% in old HS (p>0.05), while both remained unchanged in young training HS and C respectively. In y and o pts. with CHF four wks. of ET resulted in a significant change in E/à (y: 33.5±2%; p>0,05; o: 35.2±3%; p>0.05) and in MMP-9 levels (y: 29%; p>0.05; o: 35% p>0.05). In C no effect was detectable.
Conclusions: the present trial provides new insight into the age-dependency of cardiovascular ET effects: Among HS aging is associated with the development of diastolic dysfunction and increased MMP-9 levels. In CHF both young and old pts. exhibit a similar degree of diastolic dysfunction and MMP-9 amount. Four weeks of ET are effective in improving diastolic function and MMP-9 levels in old HS and in all age groups of CHF pts. this lusitropic ET effects were not significantly diminished among older pts. underlining the potentials of rehabilitation interventions in an age-group with a high prevalence of CHF.
293: Randomized controlled trial of long-term use of yoga and progressive relaxation in cardiovascular rehabilitation
W J Wolfgang JosefMayer-Berger1, C Kettner1, C Pieper2, A Marr2, U Braeutigam3, A Michalsen4, S Moebus2
1
Klinik Roderbirken, 42799, Leichlingen, Germany, 2University Hospital of Essen, Essen, Germany, 3Yoga Schule, Dusseldorf, Germany, 4Clinic of Naturopathy, Immanuel Diakonie Group, Berlin, Germany
Topic: Cardiovascular rehabilitation
Purpose: For Yoga as well as for progressive muscle relaxation (PMR) a blood pressure lowering effect is well established. Relaxation techniques are established in cardiac rehabilitation; however less is known about pattern of practice and effects of Yoga. Purpose of our study was (1) to test if male cardiac rehabilitation patients with a low socio-economic status are motivated to sustainably exercise Viniyoga post-hospital and (2) to determine the effect of Yoga on blood pressure.
Methods: Cardiac rehabilitation male patients (aged 27–63 years) with a diagnosis of hypertension were randomized to a standard cardiac rehabilitation program either with PMR (control, n=167) or Viniyoga (intervention, n=173). the highly structured inpatient training program for Viniyoga and PMR consisted of 3 weeks, 5 times/week of supervised sessions. Blood pressure, heart rate frequency, and medication use were collected at the beginning (t1) and end (t2) of inpatient rehabilitation. As follow-up a 6-month post-hospital self-administered questionnaire was sent to the participants (t3, response=85%).
Results: We noticed more drop-outs in the Yoga group (16%, PMR: 5%) during the inpatient training period, furthermore only 14% of the patients were still exercising Viniyoga at home after 6 months compared to 28% in the PMR group. A slightly higher decrease of the systolic blood pressure (SBP) could be observed in the Viniyoga group att2 (mean at t1 131 mmHg, SD ±18.2, mean difference t1-t2: –8 mmHg, SD ±15.4; PMR: mean at t1 133 mmHg, SD ±18.1, mean difference t1-t2: –6 mmHg, SD ±13.1). However, striking SBP lowering effects could be observed in the Yoga group with respect to the extent of hypertension. In those patients with a SBP>140 mmgH at t1 the decline of SBP was more pronounced in the Yoga group (mean at t1 153 mmHg, SD ±14.9, mean difference t1-t2: –21.2 mmHg, SD ±16.5; PMR: mean at t1 153 mmHg, SD ±11.5, mean difference t1-t2: –12.6 mmHg, SD ±13.7; explorative p=0.008, t-test).
Conclusions: To our knowledge this is the first randomized controlled trial testing the long-term use and blood lowering effect of Viniyoga in cardiac rehabilitation. Our results show that Viniyoga is less well accepted then PMR in cardiac rehabilitation men with low socioeconomic status. However, since Yoga seems to have a more positive effect on blood pressure compared to PMR, special programs should be developed that better suit cardiac patients needs and that enhance the application of Yoga in daily life for encouraging patients to exercise Viniyoga on a long-term regular base.
294: Close relationships and the risk of death in patients with cardiovascular disease: findings from the DANREHAB trial
H Petersen1, A Zwisler2, E Prescott1
1
Bispebjerg Hospital of the Copenhagen, University Hospital, Copenhagen, Denmark, 2Rigshospitalet – Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
Topic: Psychosocial factors and stress
Purpose: Social isolation has previously been found to predict death in patients with myocardial infarction. the aim of the present study was to describe whether a social network, measured as types and diversity of close relationships, predicts mortality in patients with congestive heart failure, ischemic heart disease or a high risk for ischemic heart disease.
Methods: the study population consisted of 770 patients from the DANREHAB trial, randomised into hospital-based comprehensive cardiac rehabilitation versus usual care. Patients social networks were measured using questionnaires that related to types of close relationships (spouse, parents, children, family members, friends, colleagues, neighbours) and diversity was obtained by summarising the different types of relationships. Endpoint was death registered within 5 years. the hazard ratio (HR) for incidence of death was calculated using the Cox proportional hazards model. Few patients with close relationships with parents, colleagues and neighbours actually died, for which reason no HR was calculated.
Results: One hundred and forty deaths occurred. Patients with a spouse had a decreased mortality risk (HR=0.38; 95% CI: 0.26–0.57), whilst no association was found with respect to other close relationships. An association between diversity measured by the sum of the different types of close relationships and death was also found with a HR of 0.47 (95% CI: 0.30–0.74) for patients with = 2 types of relationships (test for trend p>0.001).
the effect of close relationships did not differ by gender, treatment group or type of CVD. Conclusions: Presence of a spouse reduces the mortality risk of patients with CVD. Furthermore, a wide social network seems to decrease the risk of death.
