- Email: [email protected]
P-436 Prevention, Physical Exercise
S174
Abstracts of the 17th Asian Pacific Congress of Cardiology
P-433 Abnormal Blood Rheology in Patients with Cardiac Syndrome X Byoung Kwon Lee1 , Azhil Durairaj2 , Anilkumar Mehra2 , Herbert J. Meiselman3 , Tamas Alexy3 . 1 Department of Internal Medicine, Cardiology Division, Inje University, Sanggye Paik Hospital, Korea, Republic of (South Korea), 2 Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA, 3 Department of Physiology and Biophysics, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA Background: Cardiac syndrome X (CSX) continues to be of clinical interest, yet the underlying pathophysiological mechanisms have not been fully elucidated. It is well known that elevated blood viscosity and RBC aggregation can adversely affect microcirculatory blood flow. The present study was designed to explore whether CSX is associated with abnormalities of blood rheology. Methods: Blood samples were obtained from 152 adult angina patients undergoing diagnostic coronary angiography; geometric and flow velocity data were obtained. Rheological measurements were performed in a blinded manner; 21 subjects were later identified with CSX. Hemorheological and clinical laboratory data were compared to 21 age- and gender-matched healthy controls. Results: CSX patients had markedly abnormal blood rheology: (1) Higher RBC aggregation and aggregability as judged by ESR and Myrenne indices at stasis and low shear (p < 0.001); (2) Elevated hematocrit-corrected blood viscosity (p < 0.001), plasma viscosity (p < 0.001), and yield stress (p < 0.01). WBC counts and hs CRP levels were significantly elevated in CSX; coronary flow velocities were below normal. Conclusions: Abnormal hemorheological parameters exist in subjects with CSX and may contribute to the pathophysiology of the disease, presumably via adversely affecting blood flow in the coronary microcirculation. Therapeutic measures aimed at normalizing blood rheology and hence microcirculatory flow should be explored. P-434 Abnormal Sympathetic Nerve Activities Provoked in Central Sleep Apnea Syndrome Mana Hiraishi, Yasuyo Taniguchi, Takatoshi Hayashi, Shinichiro Yamada, Kazuo Mizutani, Sachiyo Iwata, Akira Shimane, Katsunori Okajima, Masahiro Kumada, Gaku Kanda, Yasue Tsukishiro, Kensuke Matsumoto, Takumi Inoue, Kimitake Imamura, Toru Tagashira, Masahiro Tashiro, Hiroyuki Shibata, Teishi Kajiya. Department of Cardiology, Himeji Cardiovascular Center, Japan Sleep disturbance sometimes attribute to the worsening of heart failure. This study was retrospectively investigated the effect of abnormal respiratory pattern, especially chain stokes respiration (CSR) on heart rate viability in sleep apnea syndrome (SAS). We characterized sympatho-vagal power balance autonomic responsiveness from the power spectrum analysis of heart rate variability (HRV) in each 23 patients of CSR (male 91.3%, mean age 61.4±10.1) during January to October, 2008. 6 patients of obstructive SAS and 11 patients without SAS (control) were also analyzed. Low frequency (LF), high frequency (HF), and low frequency-tohigh frequency ratio (LF/HF), as well as CVR-R intervals of HRV (CVLF, CVHF, CVLF/CVHF) were compared during the abnormal and normal respiration in both groups. LF/HF and CVLF/CVHF values during the CSR were significantly higher compare to those during the normal respiration (3.16±0.86
and 1.17±0.55, p < 0.05). During normal respiration, there weren’t significant disparity in each HRV values between SAS (CSR and obstructive SAS) and control. These results suggest that sympathetic nerve power activated in CSR may be taken a turn for the worse in heart faiure. P-435 Possible Interaction Between Gender and Cardiovascular Risk Factors in First- and Second-Generation Turkish Migrant Women Margarethe Hochleitner, Angelika Bader, Doris Musshauser, Alice Chwosta. Department of Internal Medicine, Innsbruck Medical University, Austria In the third year of a CVD prevention program aimed at both second- and first-generation Turkish migrant women in rural Austria 910 participants completed a questionnaire on self-assessed CVD risk factors. Second generation was defined as having gone to school in Austria. More than half of the participants (477) were young adult women between 20 and 40 years of age. As expected, results varied widely between first and second generation. The greatest differences were found in gender- and lifestyle-related risk factors. BMI > 30 (first 26.3%/second 6.2%), exercise 3 times a week (36.3%/71.3%) and healthy diet (61.7%/83.6%) showed significantly better results among second-generation women. Smoking (16.7%/38.5%) showed significantly worse results in second-generation women. Having fewer language barriers, twice as many second- as first-generation migrants consume German-language media. Even though fewer language barriers led better awareness of health risk factors to be expected in second-generation migrants, they were less informed about their clinically measured risk factors like blood pressure, cholesterol and blood glucose levels than was the first migrant generation in the same age group. Thus, culturally coded gender expectations might be a stronger impetus for health behavior than health information for second-generation migrant women. Healthcare providers should strengthen positive health behavior of the culture of origin and the host culture to support good CVD health of women whose gender roles are in transition. P-436 Prevention, Physical Exercise Margarethe Hochleitner, Angelika Bader. Department of Internal Medicine, Innsbruck Medical University, Austria Objective: The Women’s Health Center for Tyrol focuses on cardiac prevention. Numerous information events and diagnosis campaigns are offered, where heart risk profiles are drawn up. In self-assessment by our patients, on average 90% reply that they get ample physical exercise, even though we on average don’t believe it. Our out-patient clinic for Turkish women shows that physical exercise entails special problems. This fact is known in this group and from the literature, and the patients also admit it. Methods: At two prevention campaigns in 2000 and 2001 we surveyed 1,536 women. Results: Physical exercise at least three times a week for thirty minutes received a positive reply from only 1/4 (403; 26.2%) of the women, while 3/4 (1,126; 73.3%) denied it and 7 (0.5%) gave no answer. Conclusions: Since compliance is particularly questionable in this area, we decided to make an initiative through the Turkish women’s out-patient clinic. First was a “Walk” campaign. Once a week a one-hour accompanied walk through town was made, starting from the hospital. The women were examined before and after the program for heart risk factors, and incentives were offered for them get
Poster Sessions 15: Others more exercise in the hope that networks for group walking would develop. Thereafter, an “Exercise Group” was started with healthy Turkish women who promised to exercise at the hospital for one hour once a week and to also do exercises at home. Compliance is very good with regard to attendance, which is certainly due in part to the excellent networking that already exists in this ethnic group. P-437 Do We Need Special Prevention Programs also in a General Health-System? Margarethe Hochleitner, Angelika Bader. Department of Internal Medicine, Innsbruck Medical University, Austria Objective: In Austria, we do have a lot of prevention programs mainly focusing on heart risk factors. But we see a lot of patients not knowing their heart risk parameters at our hospital. So we developed a low-threshold prevention program. Methods: We organised a shop-in at one of our annual fairs where we provided blood pressure, cholesterol and glucose measurement for free. Results: During four days 860 people attended our program, of whom 533 (62.0%) were female and 327 (38.0%) were male. Hypertension (blood pressure higher than 160/90) was measured in 73 (13.7%) women and 70 (21.4%) men; cholesterol higher than 200 was measured in 200 (37.5%) women and 116 (35.5%) men; glucose higher than 126 was measured in 28 (5.3%) women and 34 (10.4%) men. Only 446 people (289 women = 54.2% of the women, 157 men = 48.0% of the men) showed no risk factors at all. 414 people (244 women = 45.8% of the women, 170 men = 52.0% of the men) had at least one risk factor; 30 people (14 women = 2.6% of the women, 16 men = 4.9% of the men) had two risk factors; 7 people (4 women = 0.8% of the women, 3 men = 0.9% of the men) had even three risk factors. Conclusions: Although Austria offers blood pressure, cholesterol and glucose measurement at the family doctors, at hospital ambulances and even at pharmacies there is a lack of awareness on risk factors. So we need to improve our prevention programs to provide low-threshold measurement. P-438 Improvement of Quality of Treatment in the Management of Hypercholesterolemia in Asian Patients with Coronary Artery Disease Sang Hyun Kim1 , Ji-Dong Sung2 , Sung-Chul Chae3 , Do-Sun Lim4 , Sang-Hong Baek5 , Ki-Hoon Han6 , DongHoon Choi7 , Young-Keun Ahn8 , Young-Dae Kim9 , Hyo-Soo Kim10 . 1 Cardiology, Seoul National University Boramae Hospital, Korea, Republic of (South Korea), 2 Samsung Medical Center, Korea, Republic of (South Korea), 3 Kyungbook University, Korea, Republic of (South Korea), 4 Korea University, Korea, Republic of (South Korea), 5 Catholic University, Korea, Republic of (South Korea), 6 Ulsan University, Korea, Republic of (South Korea), 7 Yonsei University, Korea, Republic of (South Korea), 8 Chonnam University, Korea, Republic of (South Korea), 9 Donga University, Korea, Republic of (South Korea), 10 Seoul National University, Korea, Republic of (South Korea) Background: Treatment gap in the management of hyperlipidemia, meaning failure to achieve therapeutic goal recommended by treatment guideline, was estimated in several studies. This study was designed to evaluate the change of quality in the treatment of hypercholesterolemia in coronary heart disease (CHD) patients. Methods: The patients with CHD who have received the treatment at ten tertiary cardiac centers of Korea
S175 were enrolled. Patients were enrolled when they were documented as having coronary artery disease by coronary angiography or stress tests or history of myocardial infarction or revascularization. Medical records of more than thirty patients for each physician of 3 or more doctors were reviewed at ten tertiary hospitals. This survey was repeated with four year interval. Results: Findings from the survey of 1,000 patients with coronary heart disease showed the decrease of treatment gap since 2003. The proportion of CHD patients with lipidlowering drugs increased from 57.9% in 2003 to 59.5% in 2007. The proportion of treatment goal achievement after treatment was changed from 51.3% to 76.2%. Mean LDLcholesterol reduction with lipid-lowering drug treatment was 26.5%. Increased prescriptions of high-potency statins, increased proportion of treated patients with drugs and educated patients were significantly associated with the increase of goal achievement rate. Conclusion: Significant treatment gap which had been confirmed in CHD patients of Korea in 2003 has been markedly decreased with treatment effort since that. Systematic, effective treatment approach to reduce this gap is warranted. P-439 Weight Change and Mortality in a Prospective Community Study in Taiwan Pei-Chun Chen1 , Fung-Chang Sung1 , Kuo-Liong Chien2 , Ta-Chen Su3 , Hsiu-Ching Hsu3 , Yuan-Teh Lee4 . 1 Institution of Environmental Health, China Medical University, Taiwan, 2 Institution of Preventive Medicine, National Taiwan University, Taiwan, 3 Department of Internal Medicine, National Taiwan University Hospital, Taiwan, 4 Department of Clinical Medicine, China Medical University, Taiwan Background: The association between weight change and all cause and cause-specific mortality is less well documented among Asian populations. Methods: We evaluated weight changes between the baseline survey in 1990 1991 and examinations in 1992 1993 among 2788 participants aged 35 years or older reporting no cardiovascular disease or cancer in a community cohort study in Taiwan. The influence of the 2-year weight change on subsequent mortality during a median 14-year follow-up period was assessed using Cox proportional hazards models. Results: During the follow up period, the mortality per 1000 person years was 18.3 for all causes, 5.0 for cardiovascular disease and 5.6 for cancer. A U-shape relationship was found between weight change and all-cause mortality (p for nonlinear relation <0.001). The multivariate-adjusted hazard ratios [HR], compared with stable weight (loss or gain < 4%), were 1.35 (95% confidence interval [CI] 1.11 1.65) for weight loss 4%, 0.89 (0.78 1.01) for weight gain 4 10% and 1.16 (1.03 1.30) for weight gain >10%. Weight loss, but not weight gain, increased risk for non-cardiovascular and non-cancer deaths (HR and 95% CI: 1.29, 1.03 1.63 and 1.38, 1.09 1.75, respectively). No appreciable association was observed between weight change and cardiovascular deaths. Conclusions: In the middle-aged and older population in Taiwan, weight loss is associated with stronger risk for the all-cause, non-cardiovascular and non-cancer mortality than is weight gain. The 2-year weight change is not related to the long-term cardiovascular mortality.
Abstracts of the 17th Asian Pacific Congress of Cardiology
P-433 Abnormal Blood Rheology in Patients with Cardiac Syndrome X Byoung Kwon Lee1 , Azhil Durairaj2 , Anilkumar Mehra2 , Herbert J. Meiselman3 , Tamas Alexy3 . 1 Department of Internal Medicine, Cardiology Division, Inje University, Sanggye Paik Hospital, Korea, Republic of (South Korea), 2 Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA, 3 Department of Physiology and Biophysics, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA Background: Cardiac syndrome X (CSX) continues to be of clinical interest, yet the underlying pathophysiological mechanisms have not been fully elucidated. It is well known that elevated blood viscosity and RBC aggregation can adversely affect microcirculatory blood flow. The present study was designed to explore whether CSX is associated with abnormalities of blood rheology. Methods: Blood samples were obtained from 152 adult angina patients undergoing diagnostic coronary angiography; geometric and flow velocity data were obtained. Rheological measurements were performed in a blinded manner; 21 subjects were later identified with CSX. Hemorheological and clinical laboratory data were compared to 21 age- and gender-matched healthy controls. Results: CSX patients had markedly abnormal blood rheology: (1) Higher RBC aggregation and aggregability as judged by ESR and Myrenne indices at stasis and low shear (p < 0.001); (2) Elevated hematocrit-corrected blood viscosity (p < 0.001), plasma viscosity (p < 0.001), and yield stress (p < 0.01). WBC counts and hs CRP levels were significantly elevated in CSX; coronary flow velocities were below normal. Conclusions: Abnormal hemorheological parameters exist in subjects with CSX and may contribute to the pathophysiology of the disease, presumably via adversely affecting blood flow in the coronary microcirculation. Therapeutic measures aimed at normalizing blood rheology and hence microcirculatory flow should be explored. P-434 Abnormal Sympathetic Nerve Activities Provoked in Central Sleep Apnea Syndrome Mana Hiraishi, Yasuyo Taniguchi, Takatoshi Hayashi, Shinichiro Yamada, Kazuo Mizutani, Sachiyo Iwata, Akira Shimane, Katsunori Okajima, Masahiro Kumada, Gaku Kanda, Yasue Tsukishiro, Kensuke Matsumoto, Takumi Inoue, Kimitake Imamura, Toru Tagashira, Masahiro Tashiro, Hiroyuki Shibata, Teishi Kajiya. Department of Cardiology, Himeji Cardiovascular Center, Japan Sleep disturbance sometimes attribute to the worsening of heart failure. This study was retrospectively investigated the effect of abnormal respiratory pattern, especially chain stokes respiration (CSR) on heart rate viability in sleep apnea syndrome (SAS). We characterized sympatho-vagal power balance autonomic responsiveness from the power spectrum analysis of heart rate variability (HRV) in each 23 patients of CSR (male 91.3%, mean age 61.4±10.1) during January to October, 2008. 6 patients of obstructive SAS and 11 patients without SAS (control) were also analyzed. Low frequency (LF), high frequency (HF), and low frequency-tohigh frequency ratio (LF/HF), as well as CVR-R intervals of HRV (CVLF, CVHF, CVLF/CVHF) were compared during the abnormal and normal respiration in both groups. LF/HF and CVLF/CVHF values during the CSR were significantly higher compare to those during the normal respiration (3.16±0.86
and 1.17±0.55, p < 0.05). During normal respiration, there weren’t significant disparity in each HRV values between SAS (CSR and obstructive SAS) and control. These results suggest that sympathetic nerve power activated in CSR may be taken a turn for the worse in heart faiure. P-435 Possible Interaction Between Gender and Cardiovascular Risk Factors in First- and Second-Generation Turkish Migrant Women Margarethe Hochleitner, Angelika Bader, Doris Musshauser, Alice Chwosta. Department of Internal Medicine, Innsbruck Medical University, Austria In the third year of a CVD prevention program aimed at both second- and first-generation Turkish migrant women in rural Austria 910 participants completed a questionnaire on self-assessed CVD risk factors. Second generation was defined as having gone to school in Austria. More than half of the participants (477) were young adult women between 20 and 40 years of age. As expected, results varied widely between first and second generation. The greatest differences were found in gender- and lifestyle-related risk factors. BMI > 30 (first 26.3%/second 6.2%), exercise 3 times a week (36.3%/71.3%) and healthy diet (61.7%/83.6%) showed significantly better results among second-generation women. Smoking (16.7%/38.5%) showed significantly worse results in second-generation women. Having fewer language barriers, twice as many second- as first-generation migrants consume German-language media. Even though fewer language barriers led better awareness of health risk factors to be expected in second-generation migrants, they were less informed about their clinically measured risk factors like blood pressure, cholesterol and blood glucose levels than was the first migrant generation in the same age group. Thus, culturally coded gender expectations might be a stronger impetus for health behavior than health information for second-generation migrant women. Healthcare providers should strengthen positive health behavior of the culture of origin and the host culture to support good CVD health of women whose gender roles are in transition. P-436 Prevention, Physical Exercise Margarethe Hochleitner, Angelika Bader. Department of Internal Medicine, Innsbruck Medical University, Austria Objective: The Women’s Health Center for Tyrol focuses on cardiac prevention. Numerous information events and diagnosis campaigns are offered, where heart risk profiles are drawn up. In self-assessment by our patients, on average 90% reply that they get ample physical exercise, even though we on average don’t believe it. Our out-patient clinic for Turkish women shows that physical exercise entails special problems. This fact is known in this group and from the literature, and the patients also admit it. Methods: At two prevention campaigns in 2000 and 2001 we surveyed 1,536 women. Results: Physical exercise at least three times a week for thirty minutes received a positive reply from only 1/4 (403; 26.2%) of the women, while 3/4 (1,126; 73.3%) denied it and 7 (0.5%) gave no answer. Conclusions: Since compliance is particularly questionable in this area, we decided to make an initiative through the Turkish women’s out-patient clinic. First was a “Walk” campaign. Once a week a one-hour accompanied walk through town was made, starting from the hospital. The women were examined before and after the program for heart risk factors, and incentives were offered for them get
Poster Sessions 15: Others more exercise in the hope that networks for group walking would develop. Thereafter, an “Exercise Group” was started with healthy Turkish women who promised to exercise at the hospital for one hour once a week and to also do exercises at home. Compliance is very good with regard to attendance, which is certainly due in part to the excellent networking that already exists in this ethnic group. P-437 Do We Need Special Prevention Programs also in a General Health-System? Margarethe Hochleitner, Angelika Bader. Department of Internal Medicine, Innsbruck Medical University, Austria Objective: In Austria, we do have a lot of prevention programs mainly focusing on heart risk factors. But we see a lot of patients not knowing their heart risk parameters at our hospital. So we developed a low-threshold prevention program. Methods: We organised a shop-in at one of our annual fairs where we provided blood pressure, cholesterol and glucose measurement for free. Results: During four days 860 people attended our program, of whom 533 (62.0%) were female and 327 (38.0%) were male. Hypertension (blood pressure higher than 160/90) was measured in 73 (13.7%) women and 70 (21.4%) men; cholesterol higher than 200 was measured in 200 (37.5%) women and 116 (35.5%) men; glucose higher than 126 was measured in 28 (5.3%) women and 34 (10.4%) men. Only 446 people (289 women = 54.2% of the women, 157 men = 48.0% of the men) showed no risk factors at all. 414 people (244 women = 45.8% of the women, 170 men = 52.0% of the men) had at least one risk factor; 30 people (14 women = 2.6% of the women, 16 men = 4.9% of the men) had two risk factors; 7 people (4 women = 0.8% of the women, 3 men = 0.9% of the men) had even three risk factors. Conclusions: Although Austria offers blood pressure, cholesterol and glucose measurement at the family doctors, at hospital ambulances and even at pharmacies there is a lack of awareness on risk factors. So we need to improve our prevention programs to provide low-threshold measurement. P-438 Improvement of Quality of Treatment in the Management of Hypercholesterolemia in Asian Patients with Coronary Artery Disease Sang Hyun Kim1 , Ji-Dong Sung2 , Sung-Chul Chae3 , Do-Sun Lim4 , Sang-Hong Baek5 , Ki-Hoon Han6 , DongHoon Choi7 , Young-Keun Ahn8 , Young-Dae Kim9 , Hyo-Soo Kim10 . 1 Cardiology, Seoul National University Boramae Hospital, Korea, Republic of (South Korea), 2 Samsung Medical Center, Korea, Republic of (South Korea), 3 Kyungbook University, Korea, Republic of (South Korea), 4 Korea University, Korea, Republic of (South Korea), 5 Catholic University, Korea, Republic of (South Korea), 6 Ulsan University, Korea, Republic of (South Korea), 7 Yonsei University, Korea, Republic of (South Korea), 8 Chonnam University, Korea, Republic of (South Korea), 9 Donga University, Korea, Republic of (South Korea), 10 Seoul National University, Korea, Republic of (South Korea) Background: Treatment gap in the management of hyperlipidemia, meaning failure to achieve therapeutic goal recommended by treatment guideline, was estimated in several studies. This study was designed to evaluate the change of quality in the treatment of hypercholesterolemia in coronary heart disease (CHD) patients. Methods: The patients with CHD who have received the treatment at ten tertiary cardiac centers of Korea
S175 were enrolled. Patients were enrolled when they were documented as having coronary artery disease by coronary angiography or stress tests or history of myocardial infarction or revascularization. Medical records of more than thirty patients for each physician of 3 or more doctors were reviewed at ten tertiary hospitals. This survey was repeated with four year interval. Results: Findings from the survey of 1,000 patients with coronary heart disease showed the decrease of treatment gap since 2003. The proportion of CHD patients with lipidlowering drugs increased from 57.9% in 2003 to 59.5% in 2007. The proportion of treatment goal achievement after treatment was changed from 51.3% to 76.2%. Mean LDLcholesterol reduction with lipid-lowering drug treatment was 26.5%. Increased prescriptions of high-potency statins, increased proportion of treated patients with drugs and educated patients were significantly associated with the increase of goal achievement rate. Conclusion: Significant treatment gap which had been confirmed in CHD patients of Korea in 2003 has been markedly decreased with treatment effort since that. Systematic, effective treatment approach to reduce this gap is warranted. P-439 Weight Change and Mortality in a Prospective Community Study in Taiwan Pei-Chun Chen1 , Fung-Chang Sung1 , Kuo-Liong Chien2 , Ta-Chen Su3 , Hsiu-Ching Hsu3 , Yuan-Teh Lee4 . 1 Institution of Environmental Health, China Medical University, Taiwan, 2 Institution of Preventive Medicine, National Taiwan University, Taiwan, 3 Department of Internal Medicine, National Taiwan University Hospital, Taiwan, 4 Department of Clinical Medicine, China Medical University, Taiwan Background: The association between weight change and all cause and cause-specific mortality is less well documented among Asian populations. Methods: We evaluated weight changes between the baseline survey in 1990 1991 and examinations in 1992 1993 among 2788 participants aged 35 years or older reporting no cardiovascular disease or cancer in a community cohort study in Taiwan. The influence of the 2-year weight change on subsequent mortality during a median 14-year follow-up period was assessed using Cox proportional hazards models. Results: During the follow up period, the mortality per 1000 person years was 18.3 for all causes, 5.0 for cardiovascular disease and 5.6 for cancer. A U-shape relationship was found between weight change and all-cause mortality (p for nonlinear relation <0.001). The multivariate-adjusted hazard ratios [HR], compared with stable weight (loss or gain < 4%), were 1.35 (95% confidence interval [CI] 1.11 1.65) for weight loss 4%, 0.89 (0.78 1.01) for weight gain 4 10% and 1.16 (1.03 1.30) for weight gain >10%. Weight loss, but not weight gain, increased risk for non-cardiovascular and non-cancer deaths (HR and 95% CI: 1.29, 1.03 1.63 and 1.38, 1.09 1.75, respectively). No appreciable association was observed between weight change and cardiovascular deaths. Conclusions: In the middle-aged and older population in Taiwan, weight loss is associated with stronger risk for the all-cause, non-cardiovascular and non-cancer mortality than is weight gain. The 2-year weight change is not related to the long-term cardiovascular mortality.