- Email: [email protected]
Elevation of anti-helicobacter pylori antibody is a predictor of ischemic events in patients with coronary heart disease
Monday June 26, 2000: Poster Abstracts P:W4 Infections, CHD, and Atherosclerosis MOP18:W3 ] Atherosclerotic plaque area by transesophageal echocardiography (TEE) related to coronary artery disease (CAD) and risk factors M. Kinoshita, Y. Iwama, A. Sugo, S. Ohashi, H. Sato, T. Kurata, H. Daida, H. Mokuno, H. Yamaguchi. Department of Cardiology, Juntendo University,
Tokyo, Japan Objective: Previous studies have shown the value of plaque thickness in the thoracic aorta for predicting coronary artery disease by TEE. This study was conducted to examine whether measurements of plaque area by TEE is better predictor for CAD and risk factors compared with plaque thickness. Methods: Sixty-nine consecutive patients (mean aged 58 -4- 8) who underwent coronary angiography for diagnosis of heart disease were evaluated by TEE. CAD(+) (n = 15) was defined as >50% stenosis of >1 major artery and the rest of patients were C A D ( - ) (n = 54). In descending thoracic aorta, we measured the plaque thickness (PT) and the ratio of the plaque area to the cross-sectional area of aorta (%plaque area:%PA) at three predefined portions. Max PT, max %PA and mean %PA were used for analysis. Results: The mean %PA and the max %PA in CAD(+) were significantly higher than in C A D ( - ) (11.6 vs 7.2%, p = 0.04:13.9 vs 8.8%, p = 0.04), although the max PT was not significantly different. Among conventional risk factors, HDL cholesterol showed inverse correlation with mean %PA (p -0.03), but not with max %PA and max FT. Conclusion: These results suggest that measurement of plaque area may be a better predictor for CAD than plaque thickness by TEE
MoP19:W3
]
The relationship of flow-dependent dilatation of the popliteal artery to common carotid artery intima media thickness
J. Spdtil, R. Ce~ka, T. Haas, T. Stulc, B. Ho~ej~f. Dep. of Internal Medicine
IH, General Teaching Hospital, Prague 2, CZ
27
1166 of the AT1R gene were studied. AT1R genotypes were identified after digestion with HaelII. Our groups did not differ as to ACE genotype frequencies (31% II, 51% ID, 18% DD in the study group vs 30% II, 57% ID, 13% DD in the control group) or AT1R genotype distribution (AA 53%, AC 41%, CC 6% in the study group, vs AA 58%, AC 37%, CC 5% in the control group). Neither polymorphism was associated with mean age at incidence of myocardial infarction or with left ventricular mass index. These results seem to rule out an association between DD ACE or CC AT1R genotype and increased risk for myocardial infarction in the local Polish population. I
I
MOP21 : W 3
Influence o f plasmatic lipid levels on coronary atherosclerosis and remodeling as determined by 3 D intravascular imaging
M. Gilard, J. Mansourati, J.M. Larlet, A. Touiza, J.J. Blanc, J. Boschat.
University Hospital of Brest, Brest, France Objective: Atherosclerotic arteries tend to undergo compensatory vascular enlargement (CE) to accommodate increasing plaque burden during the early stages of atherosclerosis leading to an increased proportion of restenosis after angioplasty. In some cases, inadequate compensatory contraction (IC) may occur. The aim of this study is to evaluate the influence of lipid disorders on arterial remodeling. Methods: Volumetric reconstruction was carried out using a computerized intravascular ultrasound (IVUS) analysis in 100 pts undergoing coronary angioplasty. Theoretic average of cross sectional area (CSA) was determined at the site of minimal lumen area using proximal and distal reference CSA. Relative CSA (%) was used to classify pts in 2 groups: CE (53 pts, 60 4- 10 years) and IC (47 pts, 63 4- 9 years). Lipid profile was performed immediately prior to IVUS. Results: Relative CSA was significantly different in both groups: CE 40 -423% and IC 30 4- 11% (p = 0.01). Lipid profile was similar (see table).
Objective: Common carotid artery intima-media thickness and flow-dependent dilatation of peripheral artery has been used to assess preclinical stages of atherosclerosis. We studied their relationship. Methods: High-resolution ultrasound was used to determine flow-mediated dilatation in the popliteal artery after a 5-rain. arterial occlusion and also to assess intima-media thickness of the common carotid artery (IMT CCA) in 20 healthy subjects, in 27 patients with hyperdipidemia and in 10 patients with coronary artery disease (CAD).
Results: Change in diameter of popliteal artery (%) IMT CCA (ram)
Healthy
Hyperlipidemia
CAD
6.6 ± 3.5
0.4 :t= 2*
- 1.6 :t= 3*
0.57 4- 0.12
0.79 -4- 0.17"
1.05 4- 0.26*
CE Total cholesterol (mmol/L) LDL-cholesterol (mmol/L) HDL-cholesterol (mmol/L) LDL/HDL Triglycerides (mmol/L)
By multiple and stepwise regression analysis we found a significant negative correlation of the change in diameter of popliteal artery and IMT CCA (in all subjects r = -0.57, p < 0.001, in subgroup of healthy subjects r = - 0 . 5 2 p = 0.03). There was no correlation in patients with hyperlipidemia and in small subgroup of patients with CAD. Conclusions: In patients with hyperlipidemia and with CAD we demonstrated impaired vasodilatation of popliteal artery during reactive hyperemia. In all subjects we found significant negative correlation between flow-mediated changes in popliteal artery and intima-media thickness of common carotid artery. 7
I MoP20:W3 J ACE and AT1R gene polymorphism in patients with ischaemic heart disease I. Gor~cy, J. Gor~cy, G. Adler, A. Ciechanowicz, M. Naruszewicz.
Pomeranian Medical University, Szczecin, Poland Polymorphism of ACE [I/D] and AT1R [A1166C] genes has been implicated in genetic risk for ischaemic heart disease (IHD) and myocardial infarction (MI). We determined genotype and allele frequencies for ACE and AT1R genes and searched for an association between ACE gene polymorphism and ACE activity and between ACE and AT1R gene polymorphism and left ventricular mass index as assessed by ecbocardiography in 100 patients (mean age 54.2 4- 9.2 y) with a history of myocardial infarction (MI) and in 100 healthy controls (mean age 52.3 4- 10 y). Genomic DNA was PCR amplified using two pairs of primers flanking the polymorphic regions. Subsequently, I/D ACE gene polymorphism and A to C transition at nucleotide position
IC 5.6 3.7 1.3 3,1 1.3
± 1.1 ± 1. ! 5:0.3 5: 1.2 5:0.8
p 0.30 0.32 0.56 0.42 0.35
Conclusion: Our findings suggest that coronary remodeling is not affected by lipid profile. Further sequential IVUS imaging studies are required to elucidate the mechanism of differential coronary remodeling.
P:W4
* = significant change against healthy
5.8 :[: 1,1 3.9 :k 1.1 1.3 4- 0.3 3.3 4- 1.7 1.5 4- 0.8
INFECTIONS, CHD, AND ATHEROSCLEROSIS I
MOP1 " W 4 ] Elevation of anti-helicohacter pylori antibody is a predictor of ischemic events in patients with coronary heart disease W.-C. Tsai, ¥.-H. Li, B.-S. Sheu, L.-M. Tsai, L.-J. Lin, J.-H. Cben.
Department of lnternal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan Objective: Helicobacter pylori (HP) infection was reported to be associated with coronary heart disease (CHD). We studied the anti-HP IgG antibody titers in patients with CHD and evaluated whether this titer can serve as a risk factor of subsequent ischemic events. Methods: Eighty-six consecutive patients (mean age 62 i 10 years, 64 males) who were admitted for coronary angiography were enrolled in this study. All the patients had significant stenosis in at least one coronary vessel and they were followed up in our clinic after appropriate treatments (angioplasty, bypass graft surgery, or medication only). Titers of anti-HP IgG antibody were measured using enzyme-linked immunosorbent assay method. The study end points of ischemic events were unstable angina, acute myocardial infarction, or any new revascularization procedures. Results: After 24 4- 12 months, 30 patients developed ischemic events. Risk factors, lipid profiles, medications, left ventricular ejection fraction, incidence of previous myocardial infarction, numbers of coronary vessels involved were similar between patients with or without ischemic events. Titers of anti-HP IgG antibody were significantly higher among patients with ischemic events (371.1 4- 441.5 vs. 153.0 4- 228.0 U/mL; p = 0.003). Univariate Cox regression analysis identified titers of anti-HP IgG antibody (hazard ratio 2.68; 95% CI 1.37-5.23; p = 0.004) and coronary artery bypass graft surgery (hazard ratio
Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000
Monday June 26, 2000: Poster Abstracts P: W4 Infections, CHD, and Atherosclerosis
28
0.39; 95% CI 0.16--0.95; p = 0.039) as significant factors associated with ischemic events. In multivariate analysis, only titers of anti-HP IgG antibody (hazard ratio 3.36; 95% CI 1.41-8.01; p = 0.006) were independent predictor of future ischemic events. Condnsions: Elevation of anti-HP IgG antibody titers is a predictor for subsequent ischemic events in CHD patients.
MoP2:W4 ] Association of chlalnydia pneumoniae infection with diabetes mellitus in patients with coronary artery disease Y. Momiyama, R. Hirano, K. Miyazaki, M. Kitagaki, T. Miyagawa, T. Hisada, S. Sawada, A. Yonemura, K. Higashi, T. Shibuya, H. Nakamura, E Ohsuzu. National Defense Medical College, Saitama, Japan
Objective: To elucidate clinical and angiographic characteristics of patients (pts) with coronary artery disease (CAD) who had Chlamydia pneumoniae (CP) infection. Methods: We evaluated clinical and angiographic characteristics and serum IgG antibody to CP in 131 consecutive pts who had cardiac catheterization. The cut off index of IgG titer was measured by enzyme-linked immunosorbent assay, the index > 1.10 being considered positive. Results: Of the 131 pts, 95 had significant CAD (>50% stenosis). The prevalence of CP IgG seropositivity was higher in pts with CAD (46%) than in those without CAD (28%), and CP IgG titer was higher in pts with CAD (1.23 4- 0.76) than in those without CAD (0.86 4- 0.52) (p < 0.01). Of the 95 pts with CAD, 44 were positive for CE Compared between CAD pts positive and those negative for CE we did not find any difference in the prevalence of myocardial infarction and those of eccentric and calcified lesions on coronary arteriograms. Of note was that diabetes mellitus was more prevalent in CAD pts positive for CP than in those negative (50% vs 18%, p < 0.005). Multivariate analysis revealed that CP IgG seropositivity was significantly associated with diabetes in CAD pts, but it was not an independent risk factor for CAD. Conclusion: CP infection was prevalent in pts with CAD, but it was not independently associated with CAD. CP infection was associated with diabetes mellitus which is one of classical risk factors for CAD.
MoP3:W4 [ Chlamydia pneumoniae seropositivity and Carotid Atherosclerosis - A Japanese population-based study N. Maeda, J. Hayashi, Y. Sawayama, C. Shimizu, K. Kashiwagi, H. Nakashima, S. Kashiwagi. Department of General Medicine, Kyushu
University Hospital Fukuoka, Japan Objective: The purpose of this study was to determine the association between Chlamydia pneumoniae (C. pneumoniae) infection and carotid atherosclerosis in a Japanese population-based sample. Methods: In 560 Japanese individuals aged 25 to 85 years (177 men and 383 women, mean age 56.6 4- 13.1 years), we investigated the association between seropositivity to C. pneumoniae infection and carotid atherosclerosis. We measured intima-media thickness (IMT) of the common carotid artery and the presence of carotid plaque by carotid B-mode ultrasound. Plaque was defined as a clearly identified area of focal increased IMT (>1.3 mm). Anti-C. pneumoniae IgA and IgG antibodies were measured by ELISA (HITAZYME C. pneumoniae). Results: The seroprevalence of anti-C, pneumoniae IgG was detected in 43.9%, whereas the seroprevalence of anti-C, pneumoniae IgA was detected in 52.3% of the population. The seroprevalence of anti-C, pneumoniae IgA increased with age, but not anti-C, pneumoniae IgG. There was no difference in seroprevalence levels between men and women. Seropositivity to anti-C. pneumoniae IgA was associated with mean maximum IMT and the presence of carotid plaques, but there were no such associations with anti-C, pneumoniae IgG, by univariate comparison. There was an association between increased carotid plaque and hypertension, diabetes mellitus, smoking, and hyperlipidemia. Conclusions: Seropositivity to anti-C, pneumoniae IgA was associated with carotid atherosclerosis.
Methods: We examined acute phase response markers (C-reactive proteins, blood sedimentation rate [BSR], fibrinogen, interleukin-6 [IL-6], serum amyloid A and P) as well as the LPS (4 #g/ml)-induced monocyte expression of TNFct and interleukin-1/3 (IL-1/~) in 57 patients suffering from severe familial heterozygous hypercholesterolemia (FH) and 42 patients suffering from familial combined hyperlipidemia (FCH). Values were obtained before and 4 weeks after dietary councelling, after 1 month simvastatin (S) therapy, as well as after 3 and 6 months (either 20 or 40 mg S as necessary to achieve the consensus goals). Results: S-tberapy but not dietary intervention reduced monocyte TNFa and IL-1/3 significantly, the decrease being more pronounced in FCH as compared to FH. CRP, BSR and IL-6 were significantly decreased (FCH > FH), fibrinogen only borderline (-11%). No change in SAA and SAP was detected. No difference between patients on 20 or 40 mg S was seen. Conclusions: This study demonstrates that S dose-independently shows an antiinflammatory effect via reduction of proinflammatory cytokines expressed by monocytes and acute phase response markers, being apparently more pronounced in FCH.
I MoP5:W4 ] The association between antibody titers to helicobacter I
pylori, chronic coronary heart disease and acute myocardial infarction
N. Sarraf-Zadegan, M. Amid, S. Magsoodloo. Isfahan Cardiovascular
Research Center, lsfahan, Iran Objectives: To study the possible relation between Helicobacter pylori (H. pylori) that may act either acutely (eg. Precipitating plaque rupture) or chronically (eg, promoting plaque growth) and acute myocardial infarction (AMI) or chronic coronary heart disease (CHD). Methods: Two groups of patients and a control group were investigated between May, 1997 to Feb, 1999 at Isfahan Cardiovascular Research Center. The AMI group consisted of 52 consecutive patients (mean age 54.8 -4- 8 years) admitted because of an AMI with a diagnosis based on WHO Criteria. The CHD group consisted of 51 consecutive patients (mean age 52.8 -4- 11 years) admitted for coronary angiography because of chronic symptoms of angina pectoris and had at least single vessel significant lesion > 70% lumen narrowing in the coronary angiography report. The controls were random sample of 55 men and women from the same area as the patients, matched for sex, age and time. The controls underwent diagnostic coronary angiography and none had any lesion to be reported in each of coronary vessels. Serum samples were drawn for measurement of H. Pylori antibodies using Eliza method and fibrinogen using fibrinometric method. Results: AMI patients had significantly higher H. Pylori Ab levels compared to control group with an odds ratio of 4 (95% CI, 1.7 to 7.4; P -- 0.004), The CHD group showed similar findings with adjusted odds Ratio of 3.3 (95% CI, 1.1 to 6; P -- 0.01) while The comparison between AMI and CHD groups showed no significant difference with adjusted OR of 1.1 (95% CI 0.3 to 4 p = 0.08). The prevalence rates for H. Pylori Ab among cases and controls is shown in the following table: Caseand ControlGroups
No.
No, Positive Samplesfor H. Pylori
CrudDate %
(95%CI)
AMIGroup CHDor Coronary Anglo(+)Group Controlor Coronary Anglo(-) Group X2 P=
52 51
15 8
27.5 9.8
(25.5-29.5) (7.8-11.8)
26.8 10.3
(24.8-28.7) (8.3-12.3)
55
3
5.5
(3.5-7.4)
5.1
(3.1-7.1)
2.43 0.08
Adjustedfor SocioeconomicClass % (95%CI)
2.48 0.06
Conclusion: These results do not support the hypothesis that H. Pylori may induce the acute coronary events.
I MoP6:W4 I Randomized double-blind, placebo-controlled study of azithromycin in C. Pneumoniae Positive Postmyocardial Infarction Patients (CROAATS)
I MoP4:W4 ] Simvastatin reduces acute phase response markers H. Sinzinger 1, F. Cbehne I , A. Oguoghol , P. Schmid2. l Wilhelm Auerswald
Atherosclerosis Research Group (ASF) Vienna; 2Rehabilitation Center, Bad Schallerbach, Austria Objective: Inflammation recently gains increasing interest in the process of atherogenesis. The influence of statins on this mechanism is widely unknown.
7.. Reiner 1, M. Bergovec 2 , M. Gjura~in 1, V. Goldner I , J. Halle 3, S. Kranj~evi64 , S. Mihatov5 , T. Zrui6 6, J. Culig6, E. Tedeschi-Reiner5 . For
the CROAATS Study Group; /Univ. Hosp. Rebro," 2Univ. Hosp. Dubrava; 3Gen. Hosp. Sv. Duh; 4Univ. Hosp. Merkur; 5Univ. Hosp. S. Milosrdnice; 6pliva Pharmac. Company, Zagreb, Croatia There is a mounting evidence for an association between Chlamydia pneumo-
Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000
Tokyo, Japan Objective: Previous studies have shown the value of plaque thickness in the thoracic aorta for predicting coronary artery disease by TEE. This study was conducted to examine whether measurements of plaque area by TEE is better predictor for CAD and risk factors compared with plaque thickness. Methods: Sixty-nine consecutive patients (mean aged 58 -4- 8) who underwent coronary angiography for diagnosis of heart disease were evaluated by TEE. CAD(+) (n = 15) was defined as >50% stenosis of >1 major artery and the rest of patients were C A D ( - ) (n = 54). In descending thoracic aorta, we measured the plaque thickness (PT) and the ratio of the plaque area to the cross-sectional area of aorta (%plaque area:%PA) at three predefined portions. Max PT, max %PA and mean %PA were used for analysis. Results: The mean %PA and the max %PA in CAD(+) were significantly higher than in C A D ( - ) (11.6 vs 7.2%, p = 0.04:13.9 vs 8.8%, p = 0.04), although the max PT was not significantly different. Among conventional risk factors, HDL cholesterol showed inverse correlation with mean %PA (p -0.03), but not with max %PA and max FT. Conclusion: These results suggest that measurement of plaque area may be a better predictor for CAD than plaque thickness by TEE
MoP19:W3
]
The relationship of flow-dependent dilatation of the popliteal artery to common carotid artery intima media thickness
J. Spdtil, R. Ce~ka, T. Haas, T. Stulc, B. Ho~ej~f. Dep. of Internal Medicine
IH, General Teaching Hospital, Prague 2, CZ
27
1166 of the AT1R gene were studied. AT1R genotypes were identified after digestion with HaelII. Our groups did not differ as to ACE genotype frequencies (31% II, 51% ID, 18% DD in the study group vs 30% II, 57% ID, 13% DD in the control group) or AT1R genotype distribution (AA 53%, AC 41%, CC 6% in the study group, vs AA 58%, AC 37%, CC 5% in the control group). Neither polymorphism was associated with mean age at incidence of myocardial infarction or with left ventricular mass index. These results seem to rule out an association between DD ACE or CC AT1R genotype and increased risk for myocardial infarction in the local Polish population. I
I
MOP21 : W 3
Influence o f plasmatic lipid levels on coronary atherosclerosis and remodeling as determined by 3 D intravascular imaging
M. Gilard, J. Mansourati, J.M. Larlet, A. Touiza, J.J. Blanc, J. Boschat.
University Hospital of Brest, Brest, France Objective: Atherosclerotic arteries tend to undergo compensatory vascular enlargement (CE) to accommodate increasing plaque burden during the early stages of atherosclerosis leading to an increased proportion of restenosis after angioplasty. In some cases, inadequate compensatory contraction (IC) may occur. The aim of this study is to evaluate the influence of lipid disorders on arterial remodeling. Methods: Volumetric reconstruction was carried out using a computerized intravascular ultrasound (IVUS) analysis in 100 pts undergoing coronary angioplasty. Theoretic average of cross sectional area (CSA) was determined at the site of minimal lumen area using proximal and distal reference CSA. Relative CSA (%) was used to classify pts in 2 groups: CE (53 pts, 60 4- 10 years) and IC (47 pts, 63 4- 9 years). Lipid profile was performed immediately prior to IVUS. Results: Relative CSA was significantly different in both groups: CE 40 -423% and IC 30 4- 11% (p = 0.01). Lipid profile was similar (see table).
Objective: Common carotid artery intima-media thickness and flow-dependent dilatation of peripheral artery has been used to assess preclinical stages of atherosclerosis. We studied their relationship. Methods: High-resolution ultrasound was used to determine flow-mediated dilatation in the popliteal artery after a 5-rain. arterial occlusion and also to assess intima-media thickness of the common carotid artery (IMT CCA) in 20 healthy subjects, in 27 patients with hyperdipidemia and in 10 patients with coronary artery disease (CAD).
Results: Change in diameter of popliteal artery (%) IMT CCA (ram)
Healthy
Hyperlipidemia
CAD
6.6 ± 3.5
0.4 :t= 2*
- 1.6 :t= 3*
0.57 4- 0.12
0.79 -4- 0.17"
1.05 4- 0.26*
CE Total cholesterol (mmol/L) LDL-cholesterol (mmol/L) HDL-cholesterol (mmol/L) LDL/HDL Triglycerides (mmol/L)
By multiple and stepwise regression analysis we found a significant negative correlation of the change in diameter of popliteal artery and IMT CCA (in all subjects r = -0.57, p < 0.001, in subgroup of healthy subjects r = - 0 . 5 2 p = 0.03). There was no correlation in patients with hyperlipidemia and in small subgroup of patients with CAD. Conclusions: In patients with hyperlipidemia and with CAD we demonstrated impaired vasodilatation of popliteal artery during reactive hyperemia. In all subjects we found significant negative correlation between flow-mediated changes in popliteal artery and intima-media thickness of common carotid artery. 7
I MoP20:W3 J ACE and AT1R gene polymorphism in patients with ischaemic heart disease I. Gor~cy, J. Gor~cy, G. Adler, A. Ciechanowicz, M. Naruszewicz.
Pomeranian Medical University, Szczecin, Poland Polymorphism of ACE [I/D] and AT1R [A1166C] genes has been implicated in genetic risk for ischaemic heart disease (IHD) and myocardial infarction (MI). We determined genotype and allele frequencies for ACE and AT1R genes and searched for an association between ACE gene polymorphism and ACE activity and between ACE and AT1R gene polymorphism and left ventricular mass index as assessed by ecbocardiography in 100 patients (mean age 54.2 4- 9.2 y) with a history of myocardial infarction (MI) and in 100 healthy controls (mean age 52.3 4- 10 y). Genomic DNA was PCR amplified using two pairs of primers flanking the polymorphic regions. Subsequently, I/D ACE gene polymorphism and A to C transition at nucleotide position
IC 5.6 3.7 1.3 3,1 1.3
± 1.1 ± 1. ! 5:0.3 5: 1.2 5:0.8
p 0.30 0.32 0.56 0.42 0.35
Conclusion: Our findings suggest that coronary remodeling is not affected by lipid profile. Further sequential IVUS imaging studies are required to elucidate the mechanism of differential coronary remodeling.
P:W4
* = significant change against healthy
5.8 :[: 1,1 3.9 :k 1.1 1.3 4- 0.3 3.3 4- 1.7 1.5 4- 0.8
INFECTIONS, CHD, AND ATHEROSCLEROSIS I
MOP1 " W 4 ] Elevation of anti-helicohacter pylori antibody is a predictor of ischemic events in patients with coronary heart disease W.-C. Tsai, ¥.-H. Li, B.-S. Sheu, L.-M. Tsai, L.-J. Lin, J.-H. Cben.
Department of lnternal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan Objective: Helicobacter pylori (HP) infection was reported to be associated with coronary heart disease (CHD). We studied the anti-HP IgG antibody titers in patients with CHD and evaluated whether this titer can serve as a risk factor of subsequent ischemic events. Methods: Eighty-six consecutive patients (mean age 62 i 10 years, 64 males) who were admitted for coronary angiography were enrolled in this study. All the patients had significant stenosis in at least one coronary vessel and they were followed up in our clinic after appropriate treatments (angioplasty, bypass graft surgery, or medication only). Titers of anti-HP IgG antibody were measured using enzyme-linked immunosorbent assay method. The study end points of ischemic events were unstable angina, acute myocardial infarction, or any new revascularization procedures. Results: After 24 4- 12 months, 30 patients developed ischemic events. Risk factors, lipid profiles, medications, left ventricular ejection fraction, incidence of previous myocardial infarction, numbers of coronary vessels involved were similar between patients with or without ischemic events. Titers of anti-HP IgG antibody were significantly higher among patients with ischemic events (371.1 4- 441.5 vs. 153.0 4- 228.0 U/mL; p = 0.003). Univariate Cox regression analysis identified titers of anti-HP IgG antibody (hazard ratio 2.68; 95% CI 1.37-5.23; p = 0.004) and coronary artery bypass graft surgery (hazard ratio
Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000
Monday June 26, 2000: Poster Abstracts P: W4 Infections, CHD, and Atherosclerosis
28
0.39; 95% CI 0.16--0.95; p = 0.039) as significant factors associated with ischemic events. In multivariate analysis, only titers of anti-HP IgG antibody (hazard ratio 3.36; 95% CI 1.41-8.01; p = 0.006) were independent predictor of future ischemic events. Condnsions: Elevation of anti-HP IgG antibody titers is a predictor for subsequent ischemic events in CHD patients.
MoP2:W4 ] Association of chlalnydia pneumoniae infection with diabetes mellitus in patients with coronary artery disease Y. Momiyama, R. Hirano, K. Miyazaki, M. Kitagaki, T. Miyagawa, T. Hisada, S. Sawada, A. Yonemura, K. Higashi, T. Shibuya, H. Nakamura, E Ohsuzu. National Defense Medical College, Saitama, Japan
Objective: To elucidate clinical and angiographic characteristics of patients (pts) with coronary artery disease (CAD) who had Chlamydia pneumoniae (CP) infection. Methods: We evaluated clinical and angiographic characteristics and serum IgG antibody to CP in 131 consecutive pts who had cardiac catheterization. The cut off index of IgG titer was measured by enzyme-linked immunosorbent assay, the index > 1.10 being considered positive. Results: Of the 131 pts, 95 had significant CAD (>50% stenosis). The prevalence of CP IgG seropositivity was higher in pts with CAD (46%) than in those without CAD (28%), and CP IgG titer was higher in pts with CAD (1.23 4- 0.76) than in those without CAD (0.86 4- 0.52) (p < 0.01). Of the 95 pts with CAD, 44 were positive for CE Compared between CAD pts positive and those negative for CE we did not find any difference in the prevalence of myocardial infarction and those of eccentric and calcified lesions on coronary arteriograms. Of note was that diabetes mellitus was more prevalent in CAD pts positive for CP than in those negative (50% vs 18%, p < 0.005). Multivariate analysis revealed that CP IgG seropositivity was significantly associated with diabetes in CAD pts, but it was not an independent risk factor for CAD. Conclusion: CP infection was prevalent in pts with CAD, but it was not independently associated with CAD. CP infection was associated with diabetes mellitus which is one of classical risk factors for CAD.
MoP3:W4 [ Chlamydia pneumoniae seropositivity and Carotid Atherosclerosis - A Japanese population-based study N. Maeda, J. Hayashi, Y. Sawayama, C. Shimizu, K. Kashiwagi, H. Nakashima, S. Kashiwagi. Department of General Medicine, Kyushu
University Hospital Fukuoka, Japan Objective: The purpose of this study was to determine the association between Chlamydia pneumoniae (C. pneumoniae) infection and carotid atherosclerosis in a Japanese population-based sample. Methods: In 560 Japanese individuals aged 25 to 85 years (177 men and 383 women, mean age 56.6 4- 13.1 years), we investigated the association between seropositivity to C. pneumoniae infection and carotid atherosclerosis. We measured intima-media thickness (IMT) of the common carotid artery and the presence of carotid plaque by carotid B-mode ultrasound. Plaque was defined as a clearly identified area of focal increased IMT (>1.3 mm). Anti-C. pneumoniae IgA and IgG antibodies were measured by ELISA (HITAZYME C. pneumoniae). Results: The seroprevalence of anti-C, pneumoniae IgG was detected in 43.9%, whereas the seroprevalence of anti-C, pneumoniae IgA was detected in 52.3% of the population. The seroprevalence of anti-C, pneumoniae IgA increased with age, but not anti-C, pneumoniae IgG. There was no difference in seroprevalence levels between men and women. Seropositivity to anti-C. pneumoniae IgA was associated with mean maximum IMT and the presence of carotid plaques, but there were no such associations with anti-C, pneumoniae IgG, by univariate comparison. There was an association between increased carotid plaque and hypertension, diabetes mellitus, smoking, and hyperlipidemia. Conclusions: Seropositivity to anti-C, pneumoniae IgA was associated with carotid atherosclerosis.
Methods: We examined acute phase response markers (C-reactive proteins, blood sedimentation rate [BSR], fibrinogen, interleukin-6 [IL-6], serum amyloid A and P) as well as the LPS (4 #g/ml)-induced monocyte expression of TNFct and interleukin-1/3 (IL-1/~) in 57 patients suffering from severe familial heterozygous hypercholesterolemia (FH) and 42 patients suffering from familial combined hyperlipidemia (FCH). Values were obtained before and 4 weeks after dietary councelling, after 1 month simvastatin (S) therapy, as well as after 3 and 6 months (either 20 or 40 mg S as necessary to achieve the consensus goals). Results: S-tberapy but not dietary intervention reduced monocyte TNFa and IL-1/3 significantly, the decrease being more pronounced in FCH as compared to FH. CRP, BSR and IL-6 were significantly decreased (FCH > FH), fibrinogen only borderline (-11%). No change in SAA and SAP was detected. No difference between patients on 20 or 40 mg S was seen. Conclusions: This study demonstrates that S dose-independently shows an antiinflammatory effect via reduction of proinflammatory cytokines expressed by monocytes and acute phase response markers, being apparently more pronounced in FCH.
I MoP5:W4 ] The association between antibody titers to helicobacter I
pylori, chronic coronary heart disease and acute myocardial infarction
N. Sarraf-Zadegan, M. Amid, S. Magsoodloo. Isfahan Cardiovascular
Research Center, lsfahan, Iran Objectives: To study the possible relation between Helicobacter pylori (H. pylori) that may act either acutely (eg. Precipitating plaque rupture) or chronically (eg, promoting plaque growth) and acute myocardial infarction (AMI) or chronic coronary heart disease (CHD). Methods: Two groups of patients and a control group were investigated between May, 1997 to Feb, 1999 at Isfahan Cardiovascular Research Center. The AMI group consisted of 52 consecutive patients (mean age 54.8 -4- 8 years) admitted because of an AMI with a diagnosis based on WHO Criteria. The CHD group consisted of 51 consecutive patients (mean age 52.8 -4- 11 years) admitted for coronary angiography because of chronic symptoms of angina pectoris and had at least single vessel significant lesion > 70% lumen narrowing in the coronary angiography report. The controls were random sample of 55 men and women from the same area as the patients, matched for sex, age and time. The controls underwent diagnostic coronary angiography and none had any lesion to be reported in each of coronary vessels. Serum samples were drawn for measurement of H. Pylori antibodies using Eliza method and fibrinogen using fibrinometric method. Results: AMI patients had significantly higher H. Pylori Ab levels compared to control group with an odds ratio of 4 (95% CI, 1.7 to 7.4; P -- 0.004), The CHD group showed similar findings with adjusted odds Ratio of 3.3 (95% CI, 1.1 to 6; P -- 0.01) while The comparison between AMI and CHD groups showed no significant difference with adjusted OR of 1.1 (95% CI 0.3 to 4 p = 0.08). The prevalence rates for H. Pylori Ab among cases and controls is shown in the following table: Caseand ControlGroups
No.
No, Positive Samplesfor H. Pylori
CrudDate %
(95%CI)
AMIGroup CHDor Coronary Anglo(+)Group Controlor Coronary Anglo(-) Group X2 P=
52 51
15 8
27.5 9.8
(25.5-29.5) (7.8-11.8)
26.8 10.3
(24.8-28.7) (8.3-12.3)
55
3
5.5
(3.5-7.4)
5.1
(3.1-7.1)
2.43 0.08
Adjustedfor SocioeconomicClass % (95%CI)
2.48 0.06
Conclusion: These results do not support the hypothesis that H. Pylori may induce the acute coronary events.
I MoP6:W4 I Randomized double-blind, placebo-controlled study of azithromycin in C. Pneumoniae Positive Postmyocardial Infarction Patients (CROAATS)
I MoP4:W4 ] Simvastatin reduces acute phase response markers H. Sinzinger 1, F. Cbehne I , A. Oguoghol , P. Schmid2. l Wilhelm Auerswald
Atherosclerosis Research Group (ASF) Vienna; 2Rehabilitation Center, Bad Schallerbach, Austria Objective: Inflammation recently gains increasing interest in the process of atherogenesis. The influence of statins on this mechanism is widely unknown.
7.. Reiner 1, M. Bergovec 2 , M. Gjura~in 1, V. Goldner I , J. Halle 3, S. Kranj~evi64 , S. Mihatov5 , T. Zrui6 6, J. Culig6, E. Tedeschi-Reiner5 . For
the CROAATS Study Group; /Univ. Hosp. Rebro," 2Univ. Hosp. Dubrava; 3Gen. Hosp. Sv. Duh; 4Univ. Hosp. Merkur; 5Univ. Hosp. S. Milosrdnice; 6pliva Pharmac. Company, Zagreb, Croatia There is a mounting evidence for an association between Chlamydia pneumo-
Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000