- Email: [email protected]
2.P.238 Moderate hyperhomocysteinemia and early myocardial infarction: Relation with vitamins B6, B12 and folate
Tuesday 7 October 1997: Posters Riskfactors (for cardiovascular diseases)
subjects, patients with stable angina pectoris, cerebral atherosclerosis and leg obliterative atheromatosis or Leriche’s syndrome. The level of superoxide anion radical generation was determined by Bellavite et al. method. In all the groups of patients, statistically significantly increased level of superoxide anion radical generation both, by resting granulocytes and those stimulated by opsonized zymosan was in patients with cerebral atherosclerosis, the lowest in those stable angina pectoris. These studies have not solved the problem whether the increased activity of granulocytes manifesting itself by increased superoxide anion radical generation is the primary cause of atherosclerotic changes or whether it is the result of long-lasting contact of cells with atheroscleroticaly changed blood vessels walls. Nevertheless, the obtained results may suggest that oxygen free radicals take part in the process of atherogenesis. Risk factors for thoracic aortic atherosclerosis. A prospective study using multiplane transoesophageal echocardiography M. Peltier, C. Tribouilloy, J.F? Lesbre. South Hospital, Amiens, France
D2 P.234
Detection of atherosclerotic process before the onset of clinical symptoms could help to prevent the development of cardiovascular disease in high-risk subjects. Thoracic aortic atherosclerosis has been recognized as an important source systemic embolism and stroke and a marker of coronary artery disease (CAD). However, the relation between risk factors (RF) and thoracic aortic atherosclerosis has not been well established. In the present study, we examine prospectively using multiplane transoesophageal echocardiography (TEE) the relation between age, sex, hypercholesterolemia, hypertension, smoking, diabetes, family history of CAD and thoracic and coronary aortic atherosclerosis. Methods: 313 consecutive pts with valvular disease who underwent TEE and coronary angiography were included (65 f 11 years, 65% males). Each TEE study was independently reviewed by two experienced echocardiographers without any knowledge of clinical and catheterization findings. Aortic intimal changes were detected in a cross-sectional view and classified in 4 grades (Gr. 0, 1, 2 and 3). Grades 2 and 3 lesions were considered thoracic aortic plaque (TAP). Results: 133 (45%) pts had TAP on TEE and 180 had one or more RF. Smoking were present in 29%, hypercholesterolemia in 24%, diabetes in 12%, hypertension in 39%, and family history of CAD in 15% (1.1 RF per pt). Pts with TAP were older (p c: 0.0001) and more frequent males (p = 0.0003), had more CAD (p < 0.0001) and more RF: hypercholesterolemia (p < O.OOOl), smoking (p < O.OOOl),diabetes (p = 0.002), hypertension (p = O.OOl), and family history of CAD (p = 0.006). By multivariate logistic regression analysis, male gender, age, smoking, diabetes were significant independent predictors (IP) of TAP and age, smoking, hypercholesterolemia, male gender, diabetes were.IP of CAD. Conclusiw: This large prospective study indicates that age, smoking, male gender, diabetes were IP of TAP on TEE in a French population. Because our pts were selected from a group with valvular heart disease, our findings could reflect the situation in a general population. Serum paraoxonase activity and early atherosclerosis in hypertensive and hypercholesterolemic patients G -9 Perani G. Palladini, T. Resasco,A. Frattoni, B. Traversa, G. Bellomo’ 2.P.235
1st
Medical Clinic, University of Pavia and IRCCS Policlinico “San Matteo”, Pavia; ‘Department of Medical Sciences, University of Turin, Novara, Italy
Serum pruaoxonase (sP) is a HDL-associated hydrolase that has been recently claimed to play a role in preventing arterial wall damage induced by oxidized LDL. We studied the relationship between sP activity and the prevalence and progression of early atherosclerosis, evaluated by high resolution (7.5 MHz probe) ultrasonography (US) in a cohort of patients with either hypertension (HT, n = 62) or hypercholestemlemia (HC, n = 73). sP activity was measured spectrophotometrically and the individual phenotype was inferred from the ratio between P and arylesterase activities. In both group no significant correlation was observed between sP activity and either US score (r = -.106 in HT and r = .OlO in HC group) or mean intima-media thickness (mIMT) of the far wall of the common carotid artery (r = -.095 in HT and r = -.019 in HC group). Within HT group, patients with 2-year mIMT increase on antihypertensive therapy had a significantly lower sP activity (1.45 f 1.15 vs 2.65 rt 1.59 U/mL) and a higher prevalence of low activity P phenotypes (61% vs 27%, x2 = 2.999, p = .08) in comparison with patients with mIMT 2-year decrease. Such differences were not observed in simvastin-treated HC patients. However, no significant correlation was 11th International
Symposium
165
detected in either group between the individual sP activity and the 32-year changes in mIMT and US score. Thus, sP may play a role in early atherosclerosis progression in drug treated hypertensive (but not hypercholesterolemic) patients.
I2
A gas chromatography/mass spectrometry method for the quantitation of total homocysteine in humau plasma J. Pietzsch, U. Julius, M. Hanefeld. Inst. & Policlin. Clin. Metab. Res., Medical Faculty ‘Carl Gustav Carus’, Dresden, Germany The diagnosis of hyperhomocysteinemia, a recently established independent risk factor for the development of coronary and peripheral atherosclerosis, is by detection of total homocysteine (tHcy) in human serum or plasma. We present a rapid methodology suitable for sensitive tHcy determination in plasma using a simple aqu&ms, room temperature one&p derivatization protocol with ethyl chloroformate (ECF) that nrovides volatile N(O.SJ-ethoxvcarbonvl . amino acid ethyl esters, and stable isotope dilution @Z/MS analy&. Under the chromato&laphic conditions employed, the homocysteine derivative and its [3,3,4,4,- 2‘&]-labelled counterpart are well separated with a retention time of 5.59 min. Cjc spectra were scanned for the m/z 234/238 (quantitation ion) and m/z 307/3 11 (confirmation ion) ion pairs. The lower limit of detection was 0.2 WmoUl tHcy with a working range of 0.2 to 300 hmol/l tHcy. The recovery of homocystein&omocystine added to control plasma was 45.8 to 103.7%. The levels of @ICY have been determined bv this method in 50 healthy volunteers (30 males/20 females; mean f SD: ?.SO f 3.18 ymol/L; range: 2.13 to 14.20 @mol/l) with good quality (within-day precision <3.2%, between-day precision ~4.5%). The reference range was derived as s: 14.04 prnolll tHcy (Ithe 95 percentile). In conclusion, the rapid derivatization (total run time including sample preparation is 60 minutes), selective and accurate quantitation of tHcy without serious interference from plasma by using isotope dilution and selected ion monitoring, and the possibility of using the electron impact ionization mode render this method pruticulary appropriate for the evaluation of total homocysteine levels in clinical studies dealing with a large number of samples daily. P.236
This study was supported
in part by the DFG
grant No. Ju 343/1-l.
J Chrdiovoscular risk factors in peripheral or&&al disease patients with and without previous history of coronary artery disease X. Pint& J.M. Escribl, R. Vila, E. Barjau, M. Vela, F. Meco, M.J. Castitieiras, J.M. Capdevila, R. Pujol. Hospital de Bellvitge, Barcelona, Spain We studied the prevalence of cardiovascular risk factors in 438 men who were consecutively admitted at our hospital because of peripheral arterial disease (PAD), who ‘were divided in two groups according if they had or not previous history of coronary artery disease (CAD). Among 438 men, there were 98 (22%) with previous CAD (CAD+) and 340 (78%) without this antecedent (CAD-). Mean age was 67.7 & 8 in CAD+ patients and 64.9 Z!Z11 in CAIpatients (p = 0.001). Diabetes mellitus was present in 38 CAD+ patients (39%) and 101 CAD- patients (30%) (p = 0.028). and hypertension in 54 (55%) and 123 (36%) r:spectively (p = 0.00055). At the time of admission, 31 CAD+ patients (32%) were smokers despite having been diagnosed of this disease. Among CAD- patients, 158 (46%) were smokers. Fifty six CAD+ (57%) and 152 CAD- patients (45%) were former smokers respectively (p = 0.05). Mean HDLc/total cholesterol index was 0.187 f 0.06 in CAD+ patients compared with 0.203 :t 0.09 in CAD- patients (p = 0.05). There were no significant differences in plasma levels of LDLc, HDLc and triglycerides between the two groups. Patients with PAD and CAD are older, have a higher prevalence of hypertension and diabetes and lower values of HDLc/total cholesterol index than PAD patients without previous CAD. A multifactorial secondary prevention strategy is needed to control the high prevalence of cardiovascular risk factors in PAD patients, with more emphasis in those with previous history of CAD. 12.P.237
FJ 2 P 238 ._ Moderate
hyperhomocysteinemia and early myocardial infarction: Relation with vitamins B6, B12 and folate X b) Pint6 C. Mainou, M.A. Vilaseca, I. Ferrer, M. Pal& J.F. Meco, J. Pou, R. Puiol. Baix Llobrenat Homocvsteine Study Group: San Juan de Dies. Bellvt’tge, Creu Roja d’Hospita& care centers Just Oliveres, La Barcelona, Spain
and Gram&errs
Gavarra, Florida
hospitals, and primary Nerd i Sud i Prat Centre,
We have measured plasma homocysteine concentrations in a group of pa-
on Athemsclerosis,
Paris,
October
1997
Tuesday 7 October 1997: Posters Risk factors Cfor cardiovasculardiseases)
166
tients with premature coronary artery disease and in a healthy control group. The correlation between plasma concentrations of homocysteine and folate, vitamin B6 and B12 was also studied in both groups. Sixty three patients with early myocardial infarction (age ~55 years) and 67 age and sex-matched healthy control subjects were included in the study. Basal plasma total-homocysteine and vitamin B6 were measured by HPLC with fluorescence detection, and vitamins B12 and folate by radioimmunoassay. Mean plasma total-homocysteine levels were 12.4 f 4.1 and 10.9 * 2.3 pmol/l in patients and control subjects respectively (p = NS). In fourteen patients (22.2%) basal plasma homocysteine was over 95 percentile (15.9 pmol/l) of the healthy control group (p < 0.05). A negative correlation was observed between homocysteine and folate plasma concentrations (p < 0.002, r = 0.38), whereas there was no significative correlation between homocysteine and vitamins B12 and B6. We conclude that moderate hyperhomocysteinemia is associated with premature coronary artery disease and that total-plasma homocysteine levels are intluenced by the serum concentration of folate in these patients. This study was supported by a grant from Bristol-Meyers Squibb Company.
lence of CHD in the Polish population. The aim of the study was to assess the risk of CHD in the randomly selected cohort of 263 men and 237 women aged 35-64 years CHD free at baseline, screened in 1984 and rescreened in 1988 and 1993 in the frame of the Warsaw Pol-MONICA Project. During 10 years of follow-up 67 men (25.5%) and 73 women (30.8%) developed symptoms of CHD (diagnosed on the basis of CHD changes assessed by Minnesota code and/or Rose questionnaire). Multivariate logistic regression analysis revealed that in men among 5 analysed conventional risk factors (age, smoking, diastolic blood pressure, cholesterol) only age, DBP and smoking were significantly related to CHD incidence (the relative risk were respectively 1.01, 1.05, and 1.95). In women none of analysed factors occurred significant. The global risk of developing CHD within 10 years in the examined sample of men increased from 8.5% (none of the risk factor, age = 40) up to 46.8% (age = 60, DBP = 100 mmHg, chol = 8 mmol/l, smoking = yes). In women this association was not observed.
2.P 24 lIllYI 1
m2 P239
Lp(a) as a possible biochemical marker for vein graft stenosis after coronary artery bypass surgery
S.N. Pokrovsky, E. Ye. Vlasova, L.N. Il’ina, 0.1. Afanasieva, A.A. Shiryaev, A.A. Agapov, R.S. Akchurin. Cardiology Research Center, Moscow, Russia High Lp(a) level is considered to be a severe independent risk factor for the development of coronary heart disease (CHD) for many of CHD patients with multiple vessel disease. Coronary artery bypass grafting (CABG) with saphenous veins is the widely used operation for myocardial revascularization. But in many cases during the first year after CABG degree of stenosis is high and creates high level of events after bypass surgery. Lipids profile abnormalities could be one of the major reason for restenosis formation. 178 CHD patients (men mean age 50.6 f 5.7) were examined after CABG. TC, TG, LDL-C, HDL-C, apo B; apo AI and Lp(a) was measured. Repeat coronary angiography was performed at 12 months after CABG for the testing of grafts occlusions. In 269 grafts v. saphena magna and in 58 grafts a. mammaria int. or the right gastroepiploic artery were used as bypasses. Levels of TG, HDL-C, apo AI and apo B do not have any significant correlation between restenosis formation in the studied group. Correlation between percent of occlusions of autovenous (white bars) and autoarterial (black bars) bypass grafts with TC (left part) and Lp(a) (right part) 12 months after CABG are shown in figure.
4 20%22% 4% . dC(.t S.W.4
hs-I.,
K. Przvbvcien, B. Torbus-Lisiecka, Cardiology, Pomeranian Medical Szczecin, Poland
I2 P 240
we can say that Lp(a) and TC concentrations for the restenosis formation during 12 months
can be used as after CABG.
Coronary heart dii risk in middle aged population 10 year Warsaw Pol-MONICA follow-up project
M. Polakowska, G. Broda, W. Piotrowski, Cardiology, Warsaw, Poland
A. Pytlak.
In contrast to western populations, Poland countries with still increasing CHD mortality level of conventional CHD risk factors plays
National
Institate
of
belongs to only few European trends. It is postulated that high an important role in high prevaI I th International
Symposium
of 72, 70-I Ii
antitbrombm III a risk factor for ischaemic heart disease (HID) in Warsaw Pol-Monica population?
Is
A. Pvtlak, W. Piotrowski, Warsaw: Poland
24-w
2. Komacewicz-Jach. Institute Academy, ul. Powstaricow Wlkp.
The aim of this work is a verification if there is a relationship between the level of particular HDL cholesterol subfraction and the advancement grade of the ischemic heart disease (BID). The examination has been carried out an 111 persons divided into 4 groups. At 64 patients having the total cholesterol level ~250 mg% and triglyceride level < 200 mg% the coronarography was made because of clinical suspicion of the IHD. According to the result of this examination two groups have been built up. Group I comprised 20 patients without atheromatosis changes in the coronary vessels, while group II comprised 40 patients with changes >70% vessel diameter. The number of occupated vessel was a criterion for dividing group II into subgroups. Subgroup IIa was composed of 12 patient having 1 coronary vessel narrowed. Subgroup IIb had 18 patients with atheromatosis changer, in 2 vessels. Subgroup IIc was composed of 10 patients having 3 general coronary vessels occupated by atheromatous changes. Besides that 20 spouses (group III) and 31 children (group IV) of the group II patient were examined. The family members had no coronary disease symptoms. At every examined person the full lipid profile was determined (in that HDL2 and HDLS). The HDLs/HDLz ratio in the groups without IHD symptoms was following: in group I: 1.72 f 0.75, in group III: 1.60 f 0.58 and in group IV: 1.69 f 0.55. The differences between these groups were statistically inessential. In group Ii the HDLs/HDLz ratio had the value of 2.38 f 0.80, being essentially different from group I on the level p < 0.005, as well as from groups III and IV on the level p < 0.0005. In the subgroups of group II the HDL3/HDL2 ratio was 2.16 & 0.59 at the patients with changes in I coronary vessels, while 2.59 f 0.83 with changes in 2 vessels and 2.22 f 0.85 at the persons with essential changes in 3 vessels. The differences between the subgroups were not sigrificant. These results show that the elevated HDLs/HDLz ratio is significantly higher in the persons with the coronary disease when compared with healthy people. Yet its value does not depend upon the advancement grade of the atheromatous changes. 2.P.242 17
In conclusion good predictors
Dependence between the advancement of the ischemic heart disease and the HDL cholesterol subfraction
S. Rywik.
National
Institute
of Cardiology,
Antithrombin III (AT III) is the most important physiologic inhibitor of circulating thrombin, however there is a lot of controversies if it is the independent IHD risk factor. Aim: To assess the relation of AT III with symptoms of IHD. Methods: Data from a second Warsaw Pol-Monica population screening was used (1433 persons: 710 men and 723 women, aged 35-64). For the analysis we used data on AT III (by chromogenic method), coagulation activity of factor VII and VIII, acute partial thrombin time (APTT), fibrinogen (Fibr.), total cholesterol (TCh) and triglycerides (TG) and number of cigarettes smoked daily. Persons with II-ID were identified on the basis of ECG changes and/or hospitalisation due to heart attack. All analyses were done separately for men and women. T-test procedure was used for comparison mean values
on Atherosclerosis,
Paris,
October
1997
subjects, patients with stable angina pectoris, cerebral atherosclerosis and leg obliterative atheromatosis or Leriche’s syndrome. The level of superoxide anion radical generation was determined by Bellavite et al. method. In all the groups of patients, statistically significantly increased level of superoxide anion radical generation both, by resting granulocytes and those stimulated by opsonized zymosan was in patients with cerebral atherosclerosis, the lowest in those stable angina pectoris. These studies have not solved the problem whether the increased activity of granulocytes manifesting itself by increased superoxide anion radical generation is the primary cause of atherosclerotic changes or whether it is the result of long-lasting contact of cells with atheroscleroticaly changed blood vessels walls. Nevertheless, the obtained results may suggest that oxygen free radicals take part in the process of atherogenesis. Risk factors for thoracic aortic atherosclerosis. A prospective study using multiplane transoesophageal echocardiography M. Peltier, C. Tribouilloy, J.F? Lesbre. South Hospital, Amiens, France
D2 P.234
Detection of atherosclerotic process before the onset of clinical symptoms could help to prevent the development of cardiovascular disease in high-risk subjects. Thoracic aortic atherosclerosis has been recognized as an important source systemic embolism and stroke and a marker of coronary artery disease (CAD). However, the relation between risk factors (RF) and thoracic aortic atherosclerosis has not been well established. In the present study, we examine prospectively using multiplane transoesophageal echocardiography (TEE) the relation between age, sex, hypercholesterolemia, hypertension, smoking, diabetes, family history of CAD and thoracic and coronary aortic atherosclerosis. Methods: 313 consecutive pts with valvular disease who underwent TEE and coronary angiography were included (65 f 11 years, 65% males). Each TEE study was independently reviewed by two experienced echocardiographers without any knowledge of clinical and catheterization findings. Aortic intimal changes were detected in a cross-sectional view and classified in 4 grades (Gr. 0, 1, 2 and 3). Grades 2 and 3 lesions were considered thoracic aortic plaque (TAP). Results: 133 (45%) pts had TAP on TEE and 180 had one or more RF. Smoking were present in 29%, hypercholesterolemia in 24%, diabetes in 12%, hypertension in 39%, and family history of CAD in 15% (1.1 RF per pt). Pts with TAP were older (p c: 0.0001) and more frequent males (p = 0.0003), had more CAD (p < 0.0001) and more RF: hypercholesterolemia (p < O.OOOl), smoking (p < O.OOOl),diabetes (p = 0.002), hypertension (p = O.OOl), and family history of CAD (p = 0.006). By multivariate logistic regression analysis, male gender, age, smoking, diabetes were significant independent predictors (IP) of TAP and age, smoking, hypercholesterolemia, male gender, diabetes were.IP of CAD. Conclusiw: This large prospective study indicates that age, smoking, male gender, diabetes were IP of TAP on TEE in a French population. Because our pts were selected from a group with valvular heart disease, our findings could reflect the situation in a general population. Serum paraoxonase activity and early atherosclerosis in hypertensive and hypercholesterolemic patients G -9 Perani G. Palladini, T. Resasco,A. Frattoni, B. Traversa, G. Bellomo’ 2.P.235
1st
Medical Clinic, University of Pavia and IRCCS Policlinico “San Matteo”, Pavia; ‘Department of Medical Sciences, University of Turin, Novara, Italy
Serum pruaoxonase (sP) is a HDL-associated hydrolase that has been recently claimed to play a role in preventing arterial wall damage induced by oxidized LDL. We studied the relationship between sP activity and the prevalence and progression of early atherosclerosis, evaluated by high resolution (7.5 MHz probe) ultrasonography (US) in a cohort of patients with either hypertension (HT, n = 62) or hypercholestemlemia (HC, n = 73). sP activity was measured spectrophotometrically and the individual phenotype was inferred from the ratio between P and arylesterase activities. In both group no significant correlation was observed between sP activity and either US score (r = -.106 in HT and r = .OlO in HC group) or mean intima-media thickness (mIMT) of the far wall of the common carotid artery (r = -.095 in HT and r = -.019 in HC group). Within HT group, patients with 2-year mIMT increase on antihypertensive therapy had a significantly lower sP activity (1.45 f 1.15 vs 2.65 rt 1.59 U/mL) and a higher prevalence of low activity P phenotypes (61% vs 27%, x2 = 2.999, p = .08) in comparison with patients with mIMT 2-year decrease. Such differences were not observed in simvastin-treated HC patients. However, no significant correlation was 11th International
Symposium
165
detected in either group between the individual sP activity and the 32-year changes in mIMT and US score. Thus, sP may play a role in early atherosclerosis progression in drug treated hypertensive (but not hypercholesterolemic) patients.
I2
A gas chromatography/mass spectrometry method for the quantitation of total homocysteine in humau plasma J. Pietzsch, U. Julius, M. Hanefeld. Inst. & Policlin. Clin. Metab. Res., Medical Faculty ‘Carl Gustav Carus’, Dresden, Germany The diagnosis of hyperhomocysteinemia, a recently established independent risk factor for the development of coronary and peripheral atherosclerosis, is by detection of total homocysteine (tHcy) in human serum or plasma. We present a rapid methodology suitable for sensitive tHcy determination in plasma using a simple aqu&ms, room temperature one&p derivatization protocol with ethyl chloroformate (ECF) that nrovides volatile N(O.SJ-ethoxvcarbonvl . amino acid ethyl esters, and stable isotope dilution @Z/MS analy&. Under the chromato&laphic conditions employed, the homocysteine derivative and its [3,3,4,4,- 2‘&]-labelled counterpart are well separated with a retention time of 5.59 min. Cjc spectra were scanned for the m/z 234/238 (quantitation ion) and m/z 307/3 11 (confirmation ion) ion pairs. The lower limit of detection was 0.2 WmoUl tHcy with a working range of 0.2 to 300 hmol/l tHcy. The recovery of homocystein&omocystine added to control plasma was 45.8 to 103.7%. The levels of @ICY have been determined bv this method in 50 healthy volunteers (30 males/20 females; mean f SD: ?.SO f 3.18 ymol/L; range: 2.13 to 14.20 @mol/l) with good quality (within-day precision <3.2%, between-day precision ~4.5%). The reference range was derived as s: 14.04 prnolll tHcy (Ithe 95 percentile). In conclusion, the rapid derivatization (total run time including sample preparation is 60 minutes), selective and accurate quantitation of tHcy without serious interference from plasma by using isotope dilution and selected ion monitoring, and the possibility of using the electron impact ionization mode render this method pruticulary appropriate for the evaluation of total homocysteine levels in clinical studies dealing with a large number of samples daily. P.236
This study was supported
in part by the DFG
grant No. Ju 343/1-l.
J Chrdiovoscular risk factors in peripheral or&&al disease patients with and without previous history of coronary artery disease X. Pint& J.M. Escribl, R. Vila, E. Barjau, M. Vela, F. Meco, M.J. Castitieiras, J.M. Capdevila, R. Pujol. Hospital de Bellvitge, Barcelona, Spain We studied the prevalence of cardiovascular risk factors in 438 men who were consecutively admitted at our hospital because of peripheral arterial disease (PAD), who ‘were divided in two groups according if they had or not previous history of coronary artery disease (CAD). Among 438 men, there were 98 (22%) with previous CAD (CAD+) and 340 (78%) without this antecedent (CAD-). Mean age was 67.7 & 8 in CAD+ patients and 64.9 Z!Z11 in CAIpatients (p = 0.001). Diabetes mellitus was present in 38 CAD+ patients (39%) and 101 CAD- patients (30%) (p = 0.028). and hypertension in 54 (55%) and 123 (36%) r:spectively (p = 0.00055). At the time of admission, 31 CAD+ patients (32%) were smokers despite having been diagnosed of this disease. Among CAD- patients, 158 (46%) were smokers. Fifty six CAD+ (57%) and 152 CAD- patients (45%) were former smokers respectively (p = 0.05). Mean HDLc/total cholesterol index was 0.187 f 0.06 in CAD+ patients compared with 0.203 :t 0.09 in CAD- patients (p = 0.05). There were no significant differences in plasma levels of LDLc, HDLc and triglycerides between the two groups. Patients with PAD and CAD are older, have a higher prevalence of hypertension and diabetes and lower values of HDLc/total cholesterol index than PAD patients without previous CAD. A multifactorial secondary prevention strategy is needed to control the high prevalence of cardiovascular risk factors in PAD patients, with more emphasis in those with previous history of CAD. 12.P.237
FJ 2 P 238 ._ Moderate
hyperhomocysteinemia and early myocardial infarction: Relation with vitamins B6, B12 and folate X b) Pint6 C. Mainou, M.A. Vilaseca, I. Ferrer, M. Pal& J.F. Meco, J. Pou, R. Puiol. Baix Llobrenat Homocvsteine Study Group: San Juan de Dies. Bellvt’tge, Creu Roja d’Hospita& care centers Just Oliveres, La Barcelona, Spain
and Gram&errs
Gavarra, Florida
hospitals, and primary Nerd i Sud i Prat Centre,
We have measured plasma homocysteine concentrations in a group of pa-
on Athemsclerosis,
Paris,
October
1997
Tuesday 7 October 1997: Posters Risk factors Cfor cardiovasculardiseases)
166
tients with premature coronary artery disease and in a healthy control group. The correlation between plasma concentrations of homocysteine and folate, vitamin B6 and B12 was also studied in both groups. Sixty three patients with early myocardial infarction (age ~55 years) and 67 age and sex-matched healthy control subjects were included in the study. Basal plasma total-homocysteine and vitamin B6 were measured by HPLC with fluorescence detection, and vitamins B12 and folate by radioimmunoassay. Mean plasma total-homocysteine levels were 12.4 f 4.1 and 10.9 * 2.3 pmol/l in patients and control subjects respectively (p = NS). In fourteen patients (22.2%) basal plasma homocysteine was over 95 percentile (15.9 pmol/l) of the healthy control group (p < 0.05). A negative correlation was observed between homocysteine and folate plasma concentrations (p < 0.002, r = 0.38), whereas there was no significative correlation between homocysteine and vitamins B12 and B6. We conclude that moderate hyperhomocysteinemia is associated with premature coronary artery disease and that total-plasma homocysteine levels are intluenced by the serum concentration of folate in these patients. This study was supported by a grant from Bristol-Meyers Squibb Company.
lence of CHD in the Polish population. The aim of the study was to assess the risk of CHD in the randomly selected cohort of 263 men and 237 women aged 35-64 years CHD free at baseline, screened in 1984 and rescreened in 1988 and 1993 in the frame of the Warsaw Pol-MONICA Project. During 10 years of follow-up 67 men (25.5%) and 73 women (30.8%) developed symptoms of CHD (diagnosed on the basis of CHD changes assessed by Minnesota code and/or Rose questionnaire). Multivariate logistic regression analysis revealed that in men among 5 analysed conventional risk factors (age, smoking, diastolic blood pressure, cholesterol) only age, DBP and smoking were significantly related to CHD incidence (the relative risk were respectively 1.01, 1.05, and 1.95). In women none of analysed factors occurred significant. The global risk of developing CHD within 10 years in the examined sample of men increased from 8.5% (none of the risk factor, age = 40) up to 46.8% (age = 60, DBP = 100 mmHg, chol = 8 mmol/l, smoking = yes). In women this association was not observed.
2.P 24 lIllYI 1
m2 P239
Lp(a) as a possible biochemical marker for vein graft stenosis after coronary artery bypass surgery
S.N. Pokrovsky, E. Ye. Vlasova, L.N. Il’ina, 0.1. Afanasieva, A.A. Shiryaev, A.A. Agapov, R.S. Akchurin. Cardiology Research Center, Moscow, Russia High Lp(a) level is considered to be a severe independent risk factor for the development of coronary heart disease (CHD) for many of CHD patients with multiple vessel disease. Coronary artery bypass grafting (CABG) with saphenous veins is the widely used operation for myocardial revascularization. But in many cases during the first year after CABG degree of stenosis is high and creates high level of events after bypass surgery. Lipids profile abnormalities could be one of the major reason for restenosis formation. 178 CHD patients (men mean age 50.6 f 5.7) were examined after CABG. TC, TG, LDL-C, HDL-C, apo B; apo AI and Lp(a) was measured. Repeat coronary angiography was performed at 12 months after CABG for the testing of grafts occlusions. In 269 grafts v. saphena magna and in 58 grafts a. mammaria int. or the right gastroepiploic artery were used as bypasses. Levels of TG, HDL-C, apo AI and apo B do not have any significant correlation between restenosis formation in the studied group. Correlation between percent of occlusions of autovenous (white bars) and autoarterial (black bars) bypass grafts with TC (left part) and Lp(a) (right part) 12 months after CABG are shown in figure.
4 20%22% 4% . dC(.t S.W.4
hs-I.,
K. Przvbvcien, B. Torbus-Lisiecka, Cardiology, Pomeranian Medical Szczecin, Poland
I2 P 240
we can say that Lp(a) and TC concentrations for the restenosis formation during 12 months
can be used as after CABG.
Coronary heart dii risk in middle aged population 10 year Warsaw Pol-MONICA follow-up project
M. Polakowska, G. Broda, W. Piotrowski, Cardiology, Warsaw, Poland
A. Pytlak.
In contrast to western populations, Poland countries with still increasing CHD mortality level of conventional CHD risk factors plays
National
Institate
of
belongs to only few European trends. It is postulated that high an important role in high prevaI I th International
Symposium
of 72, 70-I Ii
antitbrombm III a risk factor for ischaemic heart disease (HID) in Warsaw Pol-Monica population?
Is
A. Pvtlak, W. Piotrowski, Warsaw: Poland
24-w
2. Komacewicz-Jach. Institute Academy, ul. Powstaricow Wlkp.
The aim of this work is a verification if there is a relationship between the level of particular HDL cholesterol subfraction and the advancement grade of the ischemic heart disease (BID). The examination has been carried out an 111 persons divided into 4 groups. At 64 patients having the total cholesterol level ~250 mg% and triglyceride level < 200 mg% the coronarography was made because of clinical suspicion of the IHD. According to the result of this examination two groups have been built up. Group I comprised 20 patients without atheromatosis changes in the coronary vessels, while group II comprised 40 patients with changes >70% vessel diameter. The number of occupated vessel was a criterion for dividing group II into subgroups. Subgroup IIa was composed of 12 patient having 1 coronary vessel narrowed. Subgroup IIb had 18 patients with atheromatosis changer, in 2 vessels. Subgroup IIc was composed of 10 patients having 3 general coronary vessels occupated by atheromatous changes. Besides that 20 spouses (group III) and 31 children (group IV) of the group II patient were examined. The family members had no coronary disease symptoms. At every examined person the full lipid profile was determined (in that HDL2 and HDLS). The HDLs/HDLz ratio in the groups without IHD symptoms was following: in group I: 1.72 f 0.75, in group III: 1.60 f 0.58 and in group IV: 1.69 f 0.55. The differences between these groups were statistically inessential. In group Ii the HDLs/HDLz ratio had the value of 2.38 f 0.80, being essentially different from group I on the level p < 0.005, as well as from groups III and IV on the level p < 0.0005. In the subgroups of group II the HDL3/HDL2 ratio was 2.16 & 0.59 at the patients with changes in I coronary vessels, while 2.59 f 0.83 with changes in 2 vessels and 2.22 f 0.85 at the persons with essential changes in 3 vessels. The differences between the subgroups were not sigrificant. These results show that the elevated HDLs/HDLz ratio is significantly higher in the persons with the coronary disease when compared with healthy people. Yet its value does not depend upon the advancement grade of the atheromatous changes. 2.P.242 17
In conclusion good predictors
Dependence between the advancement of the ischemic heart disease and the HDL cholesterol subfraction
S. Rywik.
National
Institute
of Cardiology,
Antithrombin III (AT III) is the most important physiologic inhibitor of circulating thrombin, however there is a lot of controversies if it is the independent IHD risk factor. Aim: To assess the relation of AT III with symptoms of IHD. Methods: Data from a second Warsaw Pol-Monica population screening was used (1433 persons: 710 men and 723 women, aged 35-64). For the analysis we used data on AT III (by chromogenic method), coagulation activity of factor VII and VIII, acute partial thrombin time (APTT), fibrinogen (Fibr.), total cholesterol (TCh) and triglycerides (TG) and number of cigarettes smoked daily. Persons with II-ID were identified on the basis of ECG changes and/or hospitalisation due to heart attack. All analyses were done separately for men and women. T-test procedure was used for comparison mean values
on Atherosclerosis,
Paris,
October
1997