419 Have socioeconomic differences in coronary risk factors changed over 20 years? Results from a population-based study of men between 1978–80 and 1998–2000
SE Ramsay1, PH Whincup2, SL Hardoon1, MC thomas1, RW Morris1, SG Wannamethee1
1
University College London, London, United Kingdom, 2St George's, University of London, London, United Kingdom
Topic: Cardiovascular epidemiology
Background: Although CHD mortality has declined in the UK population since the late 1970s, the decline has been particularly marked among more affluent subjects. While the decline substantially reflects improvements in established coronary risk factors, little is known about how these have changed in different socioeconomic groups.
Aim: To examine whether socioeconomic differences in coronary risk factors in Britain have changed over 20 years between 1978–80 and 1998–2000.
Methods: A socioeconomically representative cohort of men aged 40–59 years from 24 British towns was followed-up from 1978–80. Data on blood pressure, cholesterol, body mass index (BMI), cigarette smoking and physical activity were collected at baseline (1978–80) and in 1998–2000. Social class was based on the longest-held occupation in middle-age.
Results: Overall, the prevalence of cigarette smoking declined and mean blood pressure and non-HDL cholesterol levels fell, while mean HDL cholesterol and BMI, and physical activity increased. the higher odds of being a current smoker in manual (lower) compared with non-manual (higher) social classes in 2000 (age-adjusted odds ratio=2.04; 95% CI 1.68, 2.47) had not changed since 1978–80 (p for interaction social class∗time 0.51). Men in manual occupations became less likely to be physically inactive compared with non-manual groups (p for interaction 0.04) and more likely to be moderate-vigorously active (p for interaction 0.005). the 20-year increase in mean BMI was 2.34 kg/m2 in the manual compared with 2.01 kg/m2 in the non-manual group (difference in mean change 0.33 kg/m2; 95% CI 0.14, 0.53; p for interaction 0.001). Mean systolic blood pressure declined more in manual than non-manual groups (difference in mean change 3.6; 95% CI 2.1, 5.3, p for interaction >0.0001). Non-manual groups had a greater mean decline in non-HDL cholesterol (difference in mean change 0.18 mmol/l; 95% CI 0.11, 0.25, p for interaction >0.0001) and a greater mean increase in HDL-cholesterol (difference in mean change 0.04 mmol/l; 95% CI 0.02, 0.06, p for interaction < 0.0001).
Conclusions: Since the 1980s, socioeconomic differences in physical activity and blood pressure may have been reduced, while those in cigarette smoking have persisted. Socioeconomic differences in BMI, non-HDL and HDL-cholesterol levels appeared to have worsened, with more unfavourable changes in lower socioeconomic groups. Continuing priority is needed to improve adverse cardiovascular risk profiles in socially disadvantaged groups in the UK.
420: Is high ankle-brachial index predictor of increased cardiovascular risk? the Czech post-MONICA study
P Wohlfahrt1, D Palous2, M Ingrischova3, A Krajcoviechova1, J Seidlerova4, V Adamkova1, J Filipovsky4, R Cifkova1
1
Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, 2Department of Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, 32nd Medical Department-Clinical Department of Cardiology and Angiology, 1st Medical Faculty, Charles, Prague, Czech Republic, 4Center of Preventive Cardiology, 2nd Department of Internal Medicine, Charles University, Medical Fa, Pilsen, Czech Republic
Topic: Early detection of asymptomatic disease
Ankle brachial index (ABI) has increasingly been used in general practice to identify patients with low ABI at high cardiovascular risk. However there is no consensus on the clinical significance of high ABI. the aim of our study was to compare large artery stiffness as a marker of cardiovascular risk in patients with low (>1.0), normal (1.0–1.4) and high ABI (>1.4).
Methods: We examined 911 patients from the Czech post-MONICA study (a randomly selected 1% representative population sample, mean age 54±13.5 years, 47% of men). ABI was measured using a handheld Doppler and aortic pulse wave velocity (aPWV) using the Sphygmocor device.
Results: Of the 911 patients, 28 (3.1%) had low ABI and 23 (2.5%) high ABI. there was a U-shaped association between aPWV and ABI. aPWV was significantly higher in patients with low and high ABI compared with normal ABI group (11.1±2.8 vs. 8.3±2.3, p>0.001; 10.8±2.5 vs. 8.3±2.3, p>0.001) and it did not differ between patients with high and low ABI (11.1±2.8 vs. 10.8±2.5, p=0.86). In the logistic regression analysis a PWV together with glucose level, male sex and history of deep venous thrombosis were independent predictors of high ABI.
Conclusion: this is the first study showing increased aortic PWV in patients with high ABI pointing to increased cardiovascular risk in this group.
422: Polymorphism of the alpha2a adrenoreceptor gene and aerobic power in coronary artery disease
S Onkelinx, J Defoor, T thomaes, R Fagard, L Vanhees
KU Leuven, Leuven, Belgium
Topic: Exercise physiology, testing and training
Aims: Aerobic power and trainability of aerobic power has proven to be genotype-dependent in several studies in healthy subjects. Activation of the α-2a-adrenoreceptors (α2a-AR) leads to a hypo-adrenergic state and affect exercise performance. the aim of this study was to determine if the DraI polymorphism in the α2a-AR gene influences aerobic power and its response to physical training in coronary artery disease (CAD).
Methods and Results: From 1990 till 2001, nine hundred and thirty-five biologically unrelated Caucasian patients with CAD underwent, before and after a 3 months training programme, a graded bicycle test until exhaustion and were eligible for inclusion in the CAREGENE (CArdiac REhabilitation and GENetics of Exercise performance) study. Polymorphisms were detected using the invader assay. Analyses of variance were performed using ANOVA. Wild-type patients had a significantly higher aerobic power at baseline and after training as compared with carriers of the DraI polymorphism (P>0.05). the response to exercise training was also higher in wild-type patients than in carriers.
Conclusions: Patients with CAD included in the CAREGENE study show that the DraI polymorphism in the α2a-AR gene impairs aerobic power at baseline and after training. this polymorphism also has an adverse influence on the response in aerobic power to physical training.
Data are presented as means ± SE. Comparisons between groups were made by means of ANOVA. a: Adjusted for age, sex and height. b: Adjusted for angina or dyspnoea in daily life activities, previous smoking habit, intake of ACE-inhibitors, myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty and claudication. c: Adjusted for training intensity and frequency and for exercise performance at baseline
423: Minor symptoms of depression in patients with congenital heart disease have a larger impact on quality of life than severely limited exercise capacity
J Mueller, A Hager, J Hess
German Heart Center, Clinic at the Technical University of Munich, Munich, Germany
Topic: Quality of life
Objective: In patients with congenital heart disease quality of life is only marginally associated with exercise capacity. the aim of this study was now to determine the prevalence of depression and its impact on quality of life and exercise capacity.
Patients and methods: From November 2007 to October 2009 a total of 767 patients (352 female, 14–67 years) with various congenital heart diseases (37 palliated/native cyanotic, 58 Fontan, 78 TGA after atrial switch, 52 other Transposition of the Great Arteries, 137 Tetralogy of Fallot, 40 Ebstein s anomaly, 50 Pulmonic Stenosis or Pulmonic Regurge, 70 aortic coarctation, 104 aortic stenosis, 92 isolated shunts, 69 other) completed the health-related quality of life questionnaire SF-36 and the depression scaling instrument ADS to assess depressive symptoms. Afterwards a cardiopulmonary exercise test was performed.
Results: Only 66 patients (8.6%) showed depressive symptoms fulfilling the ADS definition for depression. the total prevalence of depression was lower than in the general population (Wilcoxon test, p>0.001) and did not differ substantially in between the diagnostic subgroups (Kruskal-Wallis test, p=0.195). ADS score was correlated to all of the nine dimensions of quality of life (r=-0.170 to –0.740, p>0.001) and was less pronounced to exercise capacity (r=-.164, p>0.001). Correlation of peak oxygen uptake to quality of life was weaker than the ADS scores to all subscales of quality of life.
Conclusions: Patients with congenital heart disease are rarely depressive. However, even minor depressive symptoms have a stronger impact on quality of life than severely limited exercise capacity as seen in many patients.
424: Ethnic differences in the electrocardiographic repolarisation patterns in elite male athletes and short-term outcomes
M Papadakis1, F Carre2, G Kervio2, J Rawlins1, L Carby3, V Panoulas3, N Chandra1, S Sharma1
1
King's College Hospital, University Hospital Lewisham, London, United Kingdom, 2University of Rennes 1, Rennes, France, 3University Hospital Lewisham, London, United Kingdom
Topic: Sports cardiology
Background: Physical training can provoke electrocardiographic changes and echocardiographic left ventricular hypertrophy in a considerable proportion of Black athletes (BA) but only a minority of White athletes (WA). Consequently, differentiating “BA heart” and hypertrophic cardiomyopathy (HCM) may be challenging. We evaluated the prevalence and significance of electrocardiographic repolarisation anomalies in highly trained BA and compared them to WA and HCM patients in an attempt to differentiate physiology versus pathology.
Methods: We analysed the electrocardiograms of 1,759 male athletes (910 BA; 849 WA) who underwent preparticipation cardiovascular screening. Further cardiac evaluation was performed, where appropriate. Results were compared with those of 150 HCM patients.
Results: T-wave inversions were present in 76%, 25% and 7% of HCM patients, BA and WA, respectively (p>0.001). the majority of HCM patients (60%), a significant proportion of BA (12%) but only a minority of WA (0.7%) exhibited distinctly abnormal electrocardiograms, with deep T-wave inversions (=0.2mV), raising strong clinical suspicion of an underlying cardiomyopathy (p>0.001). Deep T-wave inversions in BA were primarily (65%) identified in contiguous anterior precordial leads (V1-V4) and were associated with convex ST-segment elevation. In contrast, 88% of deep T-wave inversions in HCM were present in contiguous inferior and/or lateral leads and were associated with ST-segment depression. During follow-up (3±2years, range: 1–8), 1 BA was diagnosed with HCM and 1 survived a cardiac arrest. Both athletes exhibited deep T-wave inversions in contiguous inferior and/or lateral leads.
Conclusions: Deep T-wave inversions with associated convex ST-segment elevation in leads V1-V4 appear to represent an ethnic variant of “athlete s heart”, while deep T-wave inversions in inferior and/or lateral leads merit further cardiovascular investigations and regular follow-up.
