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BASELINE LDL-CHOLESTEROL LEVELS AND OUTCOME IN PATIENTS WITH SEVERE HEART FAILURE
86 PO22-280
Poster Sessions PO22 Epidemiology of CVD risk factors THE ATHEROGENIC LIPOPROTEIN PHENOTYPE AS PREDICTOR OF CARDIOVASCULAR EVENTS IN PATIENTS WITH NON-CORONARY FORMS OF ATHEROSCLEROSIS
M. Rizzo 1 , V. Pernice 2 , A. Frasheri 2 , G. Rini 1 , K. Berneis 3 . 1 Department of Clinical Medicine and Emerging Diseases, University of Palermo, Italy; 2 Angiographic Unit, Villa Maria Eleonora Hospital, Palermo, Italy; 3 Clinic for Endocrinology, Diabetes & Clinical Nutrition, University Hospital Zurich, Switzerland Recent findings suggest that patients with non-coronary forms of atherosclerosis show elevated triglycerides, reduced HDL-cholesterol and increased atherogenic small, dense low-density-lipoproteins (LDL). These three lipid abnormalities constitute the “atherogenic-lipoprotein-phenotype” (ALP) but its predictive role in these patients still remains to be established. We performed a 2-years follow-up study to assess clinical and biochemical predictors of cardiovascular events in 44 male patients (64±5 years, BMI: 27±3), 26 with peripheral arterial disease and 18 with abdominal aortic aneurysm. Beyond traditional cardiovascular risk factors, we measured LDL size and subclasses by gradient gel electrophoresis and ALP was assessed as the concomitant presence of high triglycerides, low HDL-cholesterol and elevated small, dense LDL. Clinical events were registered in the 43% of patients. At univariate analysis we found that patients with events had increased prevalence of hypertension (p=.0098), diabetes (p=.0089), family history of cardiovascular diseases (p=.0089), of elevated small, dense LDL (p=.0222) and ALP (p=.0224). At multivariate analysis (including all clinical and laboratory variables) we found the following independent predictors of events: hypertension (OR 8.9, p=.0347), diabetes (OR 9.4, p=.0270), elevated small, dense LDL (OR 6.9, p=.0488) and ALP (OR 8.7, p=.0497). This is the first study that evaluated the predictive role of ALP beyond traditional cardiovascular risk factors in patients with non-coronary forms of atherosclerosis. We confirmed that hypertension and diabetes are strong predictors of cardiovascular events in these patients but ALP seems to be a strong predictor too. Yet, these findings need to be confirmed by future prospective studies with larger sample size. PO22-281
PLASMA ADIPONECTIN AND RISK OF CARDIOVASCULAR DISEASE IN WOMEN - DATA FROM THE CORA-STUDY
E. Windler 1 , P. Algenstaedt 2 , U.F. Hess 2 , M. Schoeffauer 3 , C. Bamberger 1 , H. Boeing 4 , B.C. Zyriax 1 . 1 University Hospital Hamburg-Eppendorf, Division of Endocrinology and Metabolism of Aging; Hamburg, Germany; 2 University Hospital Hamburg-Eppendorf, Department of Internal Medicine; Hamburg, Germany; 3 University of Heidelberg, School of Medicine; Heidelberg, Germany; 4 German Institute of Human Nutrition, Department of Epidemiology; Potsdam-Rehbrücke, Germany Background and aims: Adiponectin appears to be inversely associated with obesity and insulin resistance and to have anti-inflammatory and antiatherogenic properties. However, recent studies have generated inconsistent results as to coronary heart disease (CHD). We used data from the CORA study to investigate into the link of plasma concentrations of adiponectin and incident CHD. Methods: The CORA study is a population based case-control study on 200 women with incident CHD and 255 age-matched controls. Plasma concentrations of adiponectin were available for 181 cases and 231 controls. Results: Plasma concentrations of adiponectin were significantly lower in women with CHD (p<0.0001), and in women with BMI ≥25 kg/m2 (p <0.02), even more so with central obesity (WHR ≥0.85), prevalent diabetes or insulin resistance (HOMA-IR ≥3.8), or low HDL-cholesterol (<50 mg/dl), and in smokers (each p <0.0001), but not in hypertensive women. Adiponectin correlated with these risk factors, and with intake of fruit and vegetables, meat and sausage and alcohol as dietary markers of cardiovascular risk. In a logistic regression model the odds ratio of adiponectin of 0.943 per µg/ml (CI 0.92-0.97, p <0.0001) for risk of CHD was progressively reduced by elevated WHR, obesity-related risk factors, smoking, and dietary parameters. Conclusions: Plasma adiponectin indicates protection from CHD in women that is attenuated by combined effects of central obesity and dependent risk factors, parameters of nutrition and smoking. Thus, the impact of adiponectin goes beyond its relation to adiposity, but may also reflect independent effects of nutrition.
PO22-282
BASELINE LDL-CHOLESTEROL LEVELS AND OUTCOME IN PATIENTS WITH SEVERE HEART FAILURE
G. Charach 1,2 , O. Rogowsky 1 , D. Weksler 1 , D. Sheps 1 , G. Keren 1 , J. George 1 . 1 Cardiology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2 Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Background: The prevalence of HF increases constantly in the US and Europe. Treatment by statins is well established for primary and secondary prevention of coronary events. There are controversial reports concerning low cholesterol as a negative prognostic predictor for patients with advanced HF. However there is no sufficient data to show whether low cholesterol is associated future HF admissions mortality in patients with HF. We evaluated the impact of baseline LDL-cholesterol levels on the clinical outcome in patients with HF Methods and results: We evaluated 297 CHF patients with an average NYHA of 2.8. Mean follow up was 3.7 years. One hundred and seven (37%) of the patients died during follow up and the mean time till first hospital admission due to HF was 25±17 months. Patient cohort was divided into 3 groups (Tertiles) according to LDL levels: Group1- LDL<89 mg/dl values, group 2- 89 mg/dl115mg/dl. The prevalence of diabetes mellitus, HTN, IHD was lower in latter tertile, yet there were more patients with advanced NYHA class (3-4). The best overall outcome was evident in group 3 with the highest LDL (>115 mg/dl). The same trend was observed in groups of patients with only IHD sentence to vague Conclusion: Very low LDL cholesterol levels are associated with a reduced survival in patients with clinically controlled severe HF. PO22-283
DOES SERUM HOMOCYSTEINE LEVELS CORRELATE TO DIFFERENT RISK FACTORS, PRESENTATION OF CORONARY ARTERY DISEASE AND ANGIOGRAPHIC INVOLVEMENT?
T. Akgun, I.H. Tanboga, M.M. Can, E. Turkyilmaz, H.C. Tokgoz, T. Bezgin, C.Y. Karabay, N. Keles, F. Koca, A. Ozkan, K. Sonmez, M. Saglam, B. Yaymaci, N. Ozdemir, C. Kaymaz. Cardiology,Kosuyolu Heart Center,Istanbul,Turkey We aimed to investigate the association between serum homocysteine (Hcy) level and age, gender, clinical characteristics, lipid profile, presentation of coronary artery disease (CAD) and severity of angiographic involvement. The study comprised 800pts (M 514,F 286,age 60.5+12) for whom coronary angiographies were performed for different indications. The younger subset (age <60y) had a lower Hcy level compared to the older subset (age > 60 yrs) (p=0.001). In overall group, male pts (p<0.0001) and smokers (p=0.01) had a higher Hcy compared to female pts and non-smokers, respectively. However, systolic and/or diastolic hypertension or DM were not associated with a difference in Hcy level (p=NS) Linear regression showed close correlation between Hcy and lipoprotein(a) (r=0.82,p<0.0001) and between Hcy and LDL (r=0.79,p<0.001) and HDL cholestrol (r=0.75, p<0.01). In the analysis of the clinical presentation, pts with stable angina had a lower Hcy than NSTEMI/UA and STEMI pts (p=0.02,p<0.0001) whereas latter two subgroups had similar Hcy levels (p=NS). 9µg/ml was found to be the best cut-off limit for clinical significance. Serum Hcy level > 9µg/ml was associated with a significant increase in the angiographically proven CAD risk compared with Hcy < 9µg/ml. However, Hcy was not different between one, two and three vessel CAD (p=NS). Conclusions: Serum Hcy level seems to be associated with older age, male sex, smoking and lipoprotein(a) level but not with hypertension and DM. Moreover, Hcy > 9 µg/ml may discriminate the acute coronary syndrome and angiographically proven CAD PO22-284
LOW HDL CHOLESTEROL IS ASSOCIATED WITH POOR 10-YEARS SURVIVAL IN MEN BUT NOT IN WOMEN AMONG THE ELDERLY
G. Nilsson 1,2 , P. Hedberg 3 , T. Jonason 3 , I. Lonnberg 2 , J. Ohrvik 1,4 . for Clinical Research, Uppsala University, Vasteras, Sweden; 2 Department of Medicine, Central Hospital Vasteras, Vasteras, Sweden; 3 Department of Physiology, Central Hospital Vasteras, Vasteras, Sweden; 4 Department of Medicine, Karolinska Institutet, Stockholm, Sweden 1 Centre
Background: In middle-aged people survival is positively associated with 77th Congress of the European Atherosclerosis Society, April 26–29, 2008, Istanbul, Turkey
Poster Sessions PO22 Epidemiology of CVD risk factors THE ATHEROGENIC LIPOPROTEIN PHENOTYPE AS PREDICTOR OF CARDIOVASCULAR EVENTS IN PATIENTS WITH NON-CORONARY FORMS OF ATHEROSCLEROSIS
M. Rizzo 1 , V. Pernice 2 , A. Frasheri 2 , G. Rini 1 , K. Berneis 3 . 1 Department of Clinical Medicine and Emerging Diseases, University of Palermo, Italy; 2 Angiographic Unit, Villa Maria Eleonora Hospital, Palermo, Italy; 3 Clinic for Endocrinology, Diabetes & Clinical Nutrition, University Hospital Zurich, Switzerland Recent findings suggest that patients with non-coronary forms of atherosclerosis show elevated triglycerides, reduced HDL-cholesterol and increased atherogenic small, dense low-density-lipoproteins (LDL). These three lipid abnormalities constitute the “atherogenic-lipoprotein-phenotype” (ALP) but its predictive role in these patients still remains to be established. We performed a 2-years follow-up study to assess clinical and biochemical predictors of cardiovascular events in 44 male patients (64±5 years, BMI: 27±3), 26 with peripheral arterial disease and 18 with abdominal aortic aneurysm. Beyond traditional cardiovascular risk factors, we measured LDL size and subclasses by gradient gel electrophoresis and ALP was assessed as the concomitant presence of high triglycerides, low HDL-cholesterol and elevated small, dense LDL. Clinical events were registered in the 43% of patients. At univariate analysis we found that patients with events had increased prevalence of hypertension (p=.0098), diabetes (p=.0089), family history of cardiovascular diseases (p=.0089), of elevated small, dense LDL (p=.0222) and ALP (p=.0224). At multivariate analysis (including all clinical and laboratory variables) we found the following independent predictors of events: hypertension (OR 8.9, p=.0347), diabetes (OR 9.4, p=.0270), elevated small, dense LDL (OR 6.9, p=.0488) and ALP (OR 8.7, p=.0497). This is the first study that evaluated the predictive role of ALP beyond traditional cardiovascular risk factors in patients with non-coronary forms of atherosclerosis. We confirmed that hypertension and diabetes are strong predictors of cardiovascular events in these patients but ALP seems to be a strong predictor too. Yet, these findings need to be confirmed by future prospective studies with larger sample size. PO22-281
PLASMA ADIPONECTIN AND RISK OF CARDIOVASCULAR DISEASE IN WOMEN - DATA FROM THE CORA-STUDY
E. Windler 1 , P. Algenstaedt 2 , U.F. Hess 2 , M. Schoeffauer 3 , C. Bamberger 1 , H. Boeing 4 , B.C. Zyriax 1 . 1 University Hospital Hamburg-Eppendorf, Division of Endocrinology and Metabolism of Aging; Hamburg, Germany; 2 University Hospital Hamburg-Eppendorf, Department of Internal Medicine; Hamburg, Germany; 3 University of Heidelberg, School of Medicine; Heidelberg, Germany; 4 German Institute of Human Nutrition, Department of Epidemiology; Potsdam-Rehbrücke, Germany Background and aims: Adiponectin appears to be inversely associated with obesity and insulin resistance and to have anti-inflammatory and antiatherogenic properties. However, recent studies have generated inconsistent results as to coronary heart disease (CHD). We used data from the CORA study to investigate into the link of plasma concentrations of adiponectin and incident CHD. Methods: The CORA study is a population based case-control study on 200 women with incident CHD and 255 age-matched controls. Plasma concentrations of adiponectin were available for 181 cases and 231 controls. Results: Plasma concentrations of adiponectin were significantly lower in women with CHD (p<0.0001), and in women with BMI ≥25 kg/m2 (p <0.02), even more so with central obesity (WHR ≥0.85), prevalent diabetes or insulin resistance (HOMA-IR ≥3.8), or low HDL-cholesterol (<50 mg/dl), and in smokers (each p <0.0001), but not in hypertensive women. Adiponectin correlated with these risk factors, and with intake of fruit and vegetables, meat and sausage and alcohol as dietary markers of cardiovascular risk. In a logistic regression model the odds ratio of adiponectin of 0.943 per µg/ml (CI 0.92-0.97, p <0.0001) for risk of CHD was progressively reduced by elevated WHR, obesity-related risk factors, smoking, and dietary parameters. Conclusions: Plasma adiponectin indicates protection from CHD in women that is attenuated by combined effects of central obesity and dependent risk factors, parameters of nutrition and smoking. Thus, the impact of adiponectin goes beyond its relation to adiposity, but may also reflect independent effects of nutrition.
PO22-282
BASELINE LDL-CHOLESTEROL LEVELS AND OUTCOME IN PATIENTS WITH SEVERE HEART FAILURE
G. Charach 1,2 , O. Rogowsky 1 , D. Weksler 1 , D. Sheps 1 , G. Keren 1 , J. George 1 . 1 Cardiology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2 Internal Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Background: The prevalence of HF increases constantly in the US and Europe. Treatment by statins is well established for primary and secondary prevention of coronary events. There are controversial reports concerning low cholesterol as a negative prognostic predictor for patients with advanced HF. However there is no sufficient data to show whether low cholesterol is associated future HF admissions mortality in patients with HF. We evaluated the impact of baseline LDL-cholesterol levels on the clinical outcome in patients with HF Methods and results: We evaluated 297 CHF patients with an average NYHA of 2.8. Mean follow up was 3.7 years. One hundred and seven (37%) of the patients died during follow up and the mean time till first hospital admission due to HF was 25±17 months. Patient cohort was divided into 3 groups (Tertiles) according to LDL levels: Group1- LDL<89 mg/dl values, group 2- 89 mg/dl
DOES SERUM HOMOCYSTEINE LEVELS CORRELATE TO DIFFERENT RISK FACTORS, PRESENTATION OF CORONARY ARTERY DISEASE AND ANGIOGRAPHIC INVOLVEMENT?
T. Akgun, I.H. Tanboga, M.M. Can, E. Turkyilmaz, H.C. Tokgoz, T. Bezgin, C.Y. Karabay, N. Keles, F. Koca, A. Ozkan, K. Sonmez, M. Saglam, B. Yaymaci, N. Ozdemir, C. Kaymaz. Cardiology,Kosuyolu Heart Center,Istanbul,Turkey We aimed to investigate the association between serum homocysteine (Hcy) level and age, gender, clinical characteristics, lipid profile, presentation of coronary artery disease (CAD) and severity of angiographic involvement. The study comprised 800pts (M 514,F 286,age 60.5+12) for whom coronary angiographies were performed for different indications. The younger subset (age <60y) had a lower Hcy level compared to the older subset (age > 60 yrs) (p=0.001). In overall group, male pts (p<0.0001) and smokers (p=0.01) had a higher Hcy compared to female pts and non-smokers, respectively. However, systolic and/or diastolic hypertension or DM were not associated with a difference in Hcy level (p=NS) Linear regression showed close correlation between Hcy and lipoprotein(a) (r=0.82,p<0.0001) and between Hcy and LDL (r=0.79,p<0.001) and HDL cholestrol (r=0.75, p<0.01). In the analysis of the clinical presentation, pts with stable angina had a lower Hcy than NSTEMI/UA and STEMI pts (p=0.02,p<0.0001) whereas latter two subgroups had similar Hcy levels (p=NS). 9µg/ml was found to be the best cut-off limit for clinical significance. Serum Hcy level > 9µg/ml was associated with a significant increase in the angiographically proven CAD risk compared with Hcy < 9µg/ml. However, Hcy was not different between one, two and three vessel CAD (p=NS). Conclusions: Serum Hcy level seems to be associated with older age, male sex, smoking and lipoprotein(a) level but not with hypertension and DM. Moreover, Hcy > 9 µg/ml may discriminate the acute coronary syndrome and angiographically proven CAD PO22-284
LOW HDL CHOLESTEROL IS ASSOCIATED WITH POOR 10-YEARS SURVIVAL IN MEN BUT NOT IN WOMEN AMONG THE ELDERLY
G. Nilsson 1,2 , P. Hedberg 3 , T. Jonason 3 , I. Lonnberg 2 , J. Ohrvik 1,4 . for Clinical Research, Uppsala University, Vasteras, Sweden; 2 Department of Medicine, Central Hospital Vasteras, Vasteras, Sweden; 3 Department of Physiology, Central Hospital Vasteras, Vasteras, Sweden; 4 Department of Medicine, Karolinska Institutet, Stockholm, Sweden 1 Centre
Background: In middle-aged people survival is positively associated with 77th Congress of the European Atherosclerosis Society, April 26–29, 2008, Istanbul, Turkey