- Email: [email protected]
1FS02-4 Diet, physical activity, childhood obesity and risk of cardiovascular disease
6
1FS02
Monday September 29, 2003: Featured Symposium Life Style and Vascular Disease - The West and the East Meet Together -
major environmental account for vascular cell derangement characteristic of diabetes, and the receptor for AGE (RAGE) as the major genic factor that responds to them. AGE fractions that caused the vascular derangement were proven to be RAGE ligands. When made diabetic, RAGE-overexpressing transgenic mice exhibited the exacerbation of the indices of nephropathy, and this was prevented by the inhibition of AGE formation. We also created RAGE-deficient mice. The RAGE-/- animals showed marked amelioration of diabetic nephropathy. Extracellular signals and nuclear factors that induce the transcription of human RAGE gene were also identified, which would be regarded as risk factors of diabetic complications; this included tumor necrosis factor-alpha, estradiol, and transcription factors NF-kappa B and Sp-1. Through an analysis of vascular polysomal poly(A)+RNA, we came across a novel splice variant coding for a soluble RAGE protein, and named it endogenous secretory RAGE (esRAGE). esRAGE was able to capture AGE ligands and to neutralize the AGE action on endothelial cells, suggesting that this variant has a potential to protect blood vessels from diabetes-induced injury. The AGE-RAGE system should thus be regarded as a candidate molecular target for overcoming this life- and QOL-threatening disease.
mass index (BMI) were positively correlated with BP. Magnesium (Mg), 3-methylhistidine (3MH, a marker of animal protein intake) and taurine (a marker of seafood intake) were inversely correlated with BP. (4). Factor analyses using 8 variables (BMI, Na, K, Na/K ratio, Calcium, Mg, 3MH and taurine) yielded three-grouped factors that explained 68% of total variance of BP among the study samples. (5). Urinary 8-hydroxy-2’-deoxyguanosine (a marker of oxidative DNA damage) was positively associated with BP (p<0.05) and serum triglycerides (p=0.063), and negatively associated with serum high-density lipoprotein cholesterol (HDL) (p=0.032) in Han subjects (Chongqing center). Conclusions: (1) Geoethnic sensitive and cross-cultural differences should partly explain the diet – BP association. (2). An increase in animal protein and seafood intake may have benefits in controlling high BP in the Chinese. (3). The relation of oxidative DNA damage to BP and HDL may suggest an important etiological association in studies of cardiovascular diseases. 1FS02-3
Homocysteine and folate: From genes to greens
L. Tokgözoˇglu. Hacettepe University, Dept. of Cardiology, Kavaklidere Ankara, Turkey
1FS02 LIFE STYLE AND VASCULAR DISEASE - THE WEST AND THE EAST MEET TOGETHER 1FS02-1
Optimal diet and lifestyle for prevention of coronary heart disease
F. Hu. Harvard University, Boston, MA, USA Coronary heart disease (CHD) remains the leading cause of mortality in the industrialized countries and is rapidly becoming a primary cause of death worldwide. Thus, identification of dietary and lifestyle changes that will most effectively prevent CHD is critical. Compelling evidence from metabolic studies, prospective cohort studies, and clinical trials in the past several decades converges to indicate that at least three dietary strategies are effective in preventing CHD: substitute nonhydrogenated unsaturated fats for saturated and trans fats; increase consumption of omega-3 fatty acids from fish, fish oil supplements, or plant sources; consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products. However, simply lowering the percentage of energy from total fat in the diet is unlikely to improve lipid profile or reduce CHD incidence. In the Nurses’ Health Study, lack of exercise, a diet high in trans fat and glycemic load and lower in fiber and folic acid, current smoking and abstinence from alcohol were each associated with a significantly increased risk for diabetes, independent of obesity. Women who were not overweight, consumed a diet low in trans fat (found in hydrogenated vegetable oils), high in polyunsaturated fat (found in natural vegetables oils) and cereal fiber, exercised moderately to vigorously for at least 30 minutes a day, had on average at least half an alcoholic drink per day (5 grams of alcohol), and didn’t smoke, reduced the risk of developing CHD by over 80 percent when compared to the rest of the women.
Several epidemiologic studies have shown correlations between mildly elevated homocysteine levels and cardiovascular disease risk. Hyperhomocysteinemia may be atherogenic or prothrombotic by various mechanisms. Whether mild to moderate hyperhomocysteinemia is a cause, consequence or marker of atherosclerotic vascular disease is still being questioned. The main determinants of plasma homocysteine levels are genetic and nutritional factors. MTHFR 677C>T polymorphism is an important genetic determinant of homocysteine levels. A recent metaanalysis involving more than 23000 subjects has shown that individuals with MTHFR 677 TT genotype have higher risk of coronary disease compared to those with CC genotype. The increase in risk is significant in Europeans but not in North Americans. This discrepancy can be explained by multivitamin intake, ethnic differences and other risk factors. Folate intake is another determinant of plasma homocysteine levels and dietary supplementation with folic acid, vitamin B 12 and B 6 can reduce homocysteine concentrations to different extents. However, evidence linking folate and B vitamin levels to cardiovascular disease is inconclusive. Our studies have revealed that patients with the TT genotype and folate levels below the median of the population have the highest homocysteine levels and more extensive atherosclerosis as judged by the coronary angiogram. The important question of whether lowering homocysteine will decrease cardiovascular risk is being adressed by several randomised trials. Meanwhile, two recent trials questioning the effect of lowering homocysteine on restenosis-the Swiss Heart Study and the FACIT trial have yielded largely discrepant results. Furthermore, a recent trial in patients with stable coronary disease showed that folate supplementation decreased homocysteine levels without having any impact on cardiovascular events. 1FS02-4
1FS02-2
Geoethnic-sensitive and cross-culture differences of dietary patterns and blood pressure in Chinese: Findings from the WHO Cardiovascular Diseases and Alimentary Comparison Study
L. Liu 1 , K. Ikeda 2 , S. Mizushima 3 , L. Mu 4 , Y. Yamori 5 . 1 University of Arkansas for Medical Sciences, Department of Geriatrics, Geriatrics Research, Edu & Clinical Center, VA Hospital, North Little Rock, AR, USA; 2 Mukogawa Women’s University; 3 University of Tokyo, Japan; 4 Chongqing University of Medical Sciences, China; 5 WHO Collaborating Center for Research on Primary Prevention of Cardiovascular Diseases, Kyoto, Japan Objective: To examine relation of dietary patterns and oxidative DNA damage to blood pressure (BP) among five Chinese national ethnic populations (i.e. Han, Uygur, Kazakh, Tibetan and Gouyei). Methods: A random sample of 1,901 middle age Chinese men and women, collected from 11 cooperative study centers in Mainland China, was studied with a standard cross-sectional study design. Results: (1). Significant differences in mean BP and various dietary makers were observed among the five ethnic population samples. Tibetan subjects had the highest prevalence of hypertension, followed by Kazakh, Uygur, Han, and Bouyei (41%, 40%, 24%, 21%, and 16%) (p<0.001). (2). The highest mean 24-hour urinary sodium (Na) excretion, and ratio of Na to potassium (Na/K) were observed in Tibetan subjects, followed by Kazakh, Han, Uygur, and Bouyei subjects (p<0.001). (3) Na, Na/K ratio and body
Diet, physical activity, childhood obesity and risk of cardiovascular disease
Y. Wang. University of Illinois at Chicago, Dept of Human Nutrition, Chicago, IL, USA Eating and physical activity (PA) patterns and obesity in childhood have long-term effects on the risk of cardiovascular disease (CVD). Two-thirds of premature deaths in the US are due to poor nutrition, lack of PA and tobacco use. Obesity, a result of excess energy intake and inadequate PA, has become the second leading cause of preventable disease and death (next to smoking). Currently over 1/3 of American children and adolescents are overweight; 25% have high cholesterol, high blood pressure, or other early warning signs for heart disease. Obesity in childhood increases CVD morbidity and mortality and is associated with increased total serum cholesterol, LDL cholesterol, and triglycerides levels, decreased HDL cholesterol, and elevated blood pressure in later life. Overweight children are 8-10 times more likely to develop hypertension as adults. Healthy eating and PA are essential for good health and for preventing chronic disease. Numerous studies show that dietary intake of fat, cholesterol and sodium, and consumption of vegetable and fruit affects the risk of CVD. Regular PA can substantially reduce the risk of CVD, diabetes and hypertension, in addition to its many other benefits. National representative data show that unhealthy eating and insufficient PA become a serious problem in American children and adolescents. The long-term impact of lifestyles and obesity in childhood on the risk of CVD may be due to: a) Long-lasting effects of early lifestyles on the cardiovascular system; b) Persistence of the risk factors, as dietary and PA habits developed in childhood
XIIIth International Symposium on Atherosclerosis, September 28–October 2, 2003, Kyoto, Japan
1FS03
Monday September 29, 2003: Featured Symposium How Can We Propose Global Guidelines for Prevention of Atherosclerosis?
are likely to become lifelong habits, causing obese children to become obese adults; and c) Clustering of risk factors as young people with these unfavorable factors may also have other risk factors such as smoking and social, economic, and environmental stresses. Efforts should be made to help young people to develop healthy lifestyles at early age. 1FS02-5
The impact of lifestyle on coronary heart disease risk in different cultural settings: The PRIME Study
P. Ducimetiere. INSERM Unit 258, Villejuif, France
1FS02-6
The impact of westernization on the risk of atherosclerotic vascular disease among Japanese-American men in Hawaii
K. Yano, B. Willcox, R. Chen, B. Rodriguez, J.D. Curb. PHRI, USA Objective: To investigate the impact of Westernization on the risk of coronary heart disease (CHD) and stroke among Japanese-American men in Hawaii. Methods: The length of time lived in Japan during childhood was used as an indicator of Westernization. A total of 7,479 men aged 45-68 and free of CHD, stroke, and cancer were classified to three groups by the number of childhood years in Japan: <1 (most Westernized), 1-9 (intermediate), and 10+ (least Westernized). Incident cases of CHD and stroke during 33 years of follow-up were identified through surveillance of death and hospitalization. Age-adjusted incidence rates of all CHD, definite CHD (CHD death and MI), all stroke, and thromboembolic (TE) stroke were computed for each group of the years in Japan. The relative risk (RR) for each endpoint was estimated using Cox regression models adjusted for age, usual CVD risk factors, and other confounding factors. Results: Significant trends of decreasing age-adjusted rate (per 1000 person-years) with increasing years in Japan were noted for all CHD (11.0, 10.1, 8.0) and definite CHD (7.5, 6.9, 5.5). In contrast, there was no significant or consistent trend for either all stroke (5.5, 4.9, 5.1) or TE stroke (3.7, 2.7, 3.5). In multivariate analyses, the RR for all CHD and definite CHD with the 10+ years group compared to the <1 year group remained significant. Conclusions: Longer exposure to Japanese traditional culture and lifestyle during childhood reduced the risk of CHD (but not stroke) later in life among the first and second generation Japanese-American men in Hawaii. This protective effect could not be fully explained by diet or usual CVD risk factors.
1FS03 HOW CAN WE PROPOSE GLOBAL GUIDELINES FOR PREVENTION OF ATHEROSCLEROSIS? 1FS03-1
International Atherosclerosis Society harmonized guidelines for prevention of atherosclerotic cardiovascular disease (CVD)
S. Grundy. Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX, USA In 2002, the International Atherosclerosis Society (IAS) released HARMONIZED GUIDELINES ON PREVENTION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE. These are directed primarily to health professionals to provide guidelines on clinical management of risk factors to reduce risk for CVD. A large number of guidelines for CVD prevention have been developed by professional organizations and national societies. They offer “evidence-based” recommendations and go beyond “consensus” recommendations. The evidence mounted in guidelines has been enriched by many powerful randomized controlled trials. The IAS guidelines aim to harmonize and integrate existing guidelines for the clinical management to prevent of atherosclerotic CVD. IAS guidelines abstract the evidence reviewed by several expert panels. They incorporate concepts and information from many existing guidelines for the individual risk factors and for overall CVD prevention. Close attention was paid to the European cardiovascular guidelines, the International Task Force guidelines, WHO guidelines, Asian Pacific and Japanese guidelines on obesity, and country-specific guidelines from the USA, Canada, UK, and Australia. To harmonize existing guidelines, an element of judgment was required to link the different guidelines into a coherent whole. In this harmonization process, useful information was obtained from guidelines that focus on particular CVD risk factors, e.g. major risk factors, such as cigarette smoking, high blood pressure, high blood cholesterol, and diabetes, and/or underlying risk factors, such as overweight/obesity, physical inactivity, and atherogenic diets. In addition, recent guidelines were also surveyed that offer recommendations on global risk factor management in higher risk patients or for primary prevention. 1FS03-2
The International Task Force for Prevention of Coronary Heart Disease - Guidelines for prevention of atherosclerotic cardiovascular diseases
G. Assmann. Institut für Klinische Chemie und Laboratoriumsmedizin, University of Münster, Germany The International Task Force for Prevention of Coronary Heart Disease, in cooperation with the International Atherosclerosis Society, has recently published a new document on prevention of coronary heart disease. This document includes 56 tables and 19 figures designed to teach primary care physicians essential features of preventing coronary heart disease. It is the first document which summarises all the important American and European tools for estimating risk of CHD. Emphasis is given to the identification of high risk individuals by recently developed algorithms as well as risk charts. The pros and cons of various risk estimates are outlined and it is suggested that pharmaceutical treatment should be based upon at least one measurement of global risk by algorithms. These algorithms need geographical adjustment and detailed information is given about the appropriate adjustment factors needed in various geographical areas. The management of high risk individuals as well as considerations for special patient groups are outlined in detail. 1FS03-3
Global guidelines: National issues
P. Barter. The Heart Research Institute, Camperdown, Sydney, Australia There are many sets of guidelines for risk assessment and for the prevention and treatment of atherosclerotic vascular disease. Most recognize that global risk is a function of the interaction between a number of known risk factors. Most also agree on which risk factors are important but differ widely in how they are used to define global risk. Some employ algorithms based on large data sets collected in both the US and Europe. However, there is variation in the weighting given to individual risk factors and also in the recommendations for both initiation triggers and therapeutic targets. In many cases the differences between guidelines reflect a recognition of regional factors and are appropriate. But too often, guidelines established on the basis of information gathered in one population are adopted without consideration of local factors. Consider two examples. In the case of plasma lipids, it may be appropriate to focus primarily on the LDL-cholesterol component of the
XIIIth International Symposium on Atherosclerosis, September 28–October 2, 2003, Kyoto, Japan
MONDAY
Since the 1950s, a small number of epidemiological studies of coronary heart disease (CHD) have adopted the Seven Countries approach in focusing on lifestyle characteristics in different populations, trying to define the betweenand within-country impact of risk factors. Between country differences exist even within Europe, particularly in terms of the well-known North-South gradient. The PRIME Study is an integrated multicentre cohort study in two countries at contrasting CHD risk: Belfast (Northern Ireland) and France (Lille, Strasbourg, Toulouse). The total population consisted of over 10 000 men aged 50-59 years, recruited equally in each region. All procedures used in the initial clinical examination, questionnaires, blood processing, follow-up methods, validation of events were standardized and a centralized biobank was set up. Whereas years of schooling were a clear protective factor in both countries, hostility, depression, social support and type A scores were not; and surprisingly, population differences went in the opposite direction to what was hypothesized. Leisure time activity energy expenditure was negatively associated with risk in both countries and might explain part of the risk gradient. Alcohol intake was more clearly associated with a lower CHD event rate in France than in Belfast and different drinking patterns may be involved. Some biological markers were measured in order to gain a deeper understanding of some dietheart relationships. For instance, whereas a much lower level of carotenoids was observed in Belfast than in France, related to a much lower intake of fruit and vegetables, no association with CHD was shown in either country. It is concluded that many discrepancies between psychosocial and cultural CHD risk factors are present, both across and within European populations, and that biological explanations remain to be identified for most of these.
7
1FS02
Monday September 29, 2003: Featured Symposium Life Style and Vascular Disease - The West and the East Meet Together -
major environmental account for vascular cell derangement characteristic of diabetes, and the receptor for AGE (RAGE) as the major genic factor that responds to them. AGE fractions that caused the vascular derangement were proven to be RAGE ligands. When made diabetic, RAGE-overexpressing transgenic mice exhibited the exacerbation of the indices of nephropathy, and this was prevented by the inhibition of AGE formation. We also created RAGE-deficient mice. The RAGE-/- animals showed marked amelioration of diabetic nephropathy. Extracellular signals and nuclear factors that induce the transcription of human RAGE gene were also identified, which would be regarded as risk factors of diabetic complications; this included tumor necrosis factor-alpha, estradiol, and transcription factors NF-kappa B and Sp-1. Through an analysis of vascular polysomal poly(A)+RNA, we came across a novel splice variant coding for a soluble RAGE protein, and named it endogenous secretory RAGE (esRAGE). esRAGE was able to capture AGE ligands and to neutralize the AGE action on endothelial cells, suggesting that this variant has a potential to protect blood vessels from diabetes-induced injury. The AGE-RAGE system should thus be regarded as a candidate molecular target for overcoming this life- and QOL-threatening disease.
mass index (BMI) were positively correlated with BP. Magnesium (Mg), 3-methylhistidine (3MH, a marker of animal protein intake) and taurine (a marker of seafood intake) were inversely correlated with BP. (4). Factor analyses using 8 variables (BMI, Na, K, Na/K ratio, Calcium, Mg, 3MH and taurine) yielded three-grouped factors that explained 68% of total variance of BP among the study samples. (5). Urinary 8-hydroxy-2’-deoxyguanosine (a marker of oxidative DNA damage) was positively associated with BP (p<0.05) and serum triglycerides (p=0.063), and negatively associated with serum high-density lipoprotein cholesterol (HDL) (p=0.032) in Han subjects (Chongqing center). Conclusions: (1) Geoethnic sensitive and cross-cultural differences should partly explain the diet – BP association. (2). An increase in animal protein and seafood intake may have benefits in controlling high BP in the Chinese. (3). The relation of oxidative DNA damage to BP and HDL may suggest an important etiological association in studies of cardiovascular diseases. 1FS02-3
Homocysteine and folate: From genes to greens
L. Tokgözoˇglu. Hacettepe University, Dept. of Cardiology, Kavaklidere Ankara, Turkey
1FS02 LIFE STYLE AND VASCULAR DISEASE - THE WEST AND THE EAST MEET TOGETHER 1FS02-1
Optimal diet and lifestyle for prevention of coronary heart disease
F. Hu. Harvard University, Boston, MA, USA Coronary heart disease (CHD) remains the leading cause of mortality in the industrialized countries and is rapidly becoming a primary cause of death worldwide. Thus, identification of dietary and lifestyle changes that will most effectively prevent CHD is critical. Compelling evidence from metabolic studies, prospective cohort studies, and clinical trials in the past several decades converges to indicate that at least three dietary strategies are effective in preventing CHD: substitute nonhydrogenated unsaturated fats for saturated and trans fats; increase consumption of omega-3 fatty acids from fish, fish oil supplements, or plant sources; consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products. However, simply lowering the percentage of energy from total fat in the diet is unlikely to improve lipid profile or reduce CHD incidence. In the Nurses’ Health Study, lack of exercise, a diet high in trans fat and glycemic load and lower in fiber and folic acid, current smoking and abstinence from alcohol were each associated with a significantly increased risk for diabetes, independent of obesity. Women who were not overweight, consumed a diet low in trans fat (found in hydrogenated vegetable oils), high in polyunsaturated fat (found in natural vegetables oils) and cereal fiber, exercised moderately to vigorously for at least 30 minutes a day, had on average at least half an alcoholic drink per day (5 grams of alcohol), and didn’t smoke, reduced the risk of developing CHD by over 80 percent when compared to the rest of the women.
Several epidemiologic studies have shown correlations between mildly elevated homocysteine levels and cardiovascular disease risk. Hyperhomocysteinemia may be atherogenic or prothrombotic by various mechanisms. Whether mild to moderate hyperhomocysteinemia is a cause, consequence or marker of atherosclerotic vascular disease is still being questioned. The main determinants of plasma homocysteine levels are genetic and nutritional factors. MTHFR 677C>T polymorphism is an important genetic determinant of homocysteine levels. A recent metaanalysis involving more than 23000 subjects has shown that individuals with MTHFR 677 TT genotype have higher risk of coronary disease compared to those with CC genotype. The increase in risk is significant in Europeans but not in North Americans. This discrepancy can be explained by multivitamin intake, ethnic differences and other risk factors. Folate intake is another determinant of plasma homocysteine levels and dietary supplementation with folic acid, vitamin B 12 and B 6 can reduce homocysteine concentrations to different extents. However, evidence linking folate and B vitamin levels to cardiovascular disease is inconclusive. Our studies have revealed that patients with the TT genotype and folate levels below the median of the population have the highest homocysteine levels and more extensive atherosclerosis as judged by the coronary angiogram. The important question of whether lowering homocysteine will decrease cardiovascular risk is being adressed by several randomised trials. Meanwhile, two recent trials questioning the effect of lowering homocysteine on restenosis-the Swiss Heart Study and the FACIT trial have yielded largely discrepant results. Furthermore, a recent trial in patients with stable coronary disease showed that folate supplementation decreased homocysteine levels without having any impact on cardiovascular events. 1FS02-4
1FS02-2
Geoethnic-sensitive and cross-culture differences of dietary patterns and blood pressure in Chinese: Findings from the WHO Cardiovascular Diseases and Alimentary Comparison Study
L. Liu 1 , K. Ikeda 2 , S. Mizushima 3 , L. Mu 4 , Y. Yamori 5 . 1 University of Arkansas for Medical Sciences, Department of Geriatrics, Geriatrics Research, Edu & Clinical Center, VA Hospital, North Little Rock, AR, USA; 2 Mukogawa Women’s University; 3 University of Tokyo, Japan; 4 Chongqing University of Medical Sciences, China; 5 WHO Collaborating Center for Research on Primary Prevention of Cardiovascular Diseases, Kyoto, Japan Objective: To examine relation of dietary patterns and oxidative DNA damage to blood pressure (BP) among five Chinese national ethnic populations (i.e. Han, Uygur, Kazakh, Tibetan and Gouyei). Methods: A random sample of 1,901 middle age Chinese men and women, collected from 11 cooperative study centers in Mainland China, was studied with a standard cross-sectional study design. Results: (1). Significant differences in mean BP and various dietary makers were observed among the five ethnic population samples. Tibetan subjects had the highest prevalence of hypertension, followed by Kazakh, Uygur, Han, and Bouyei (41%, 40%, 24%, 21%, and 16%) (p<0.001). (2). The highest mean 24-hour urinary sodium (Na) excretion, and ratio of Na to potassium (Na/K) were observed in Tibetan subjects, followed by Kazakh, Han, Uygur, and Bouyei subjects (p<0.001). (3) Na, Na/K ratio and body
Diet, physical activity, childhood obesity and risk of cardiovascular disease
Y. Wang. University of Illinois at Chicago, Dept of Human Nutrition, Chicago, IL, USA Eating and physical activity (PA) patterns and obesity in childhood have long-term effects on the risk of cardiovascular disease (CVD). Two-thirds of premature deaths in the US are due to poor nutrition, lack of PA and tobacco use. Obesity, a result of excess energy intake and inadequate PA, has become the second leading cause of preventable disease and death (next to smoking). Currently over 1/3 of American children and adolescents are overweight; 25% have high cholesterol, high blood pressure, or other early warning signs for heart disease. Obesity in childhood increases CVD morbidity and mortality and is associated with increased total serum cholesterol, LDL cholesterol, and triglycerides levels, decreased HDL cholesterol, and elevated blood pressure in later life. Overweight children are 8-10 times more likely to develop hypertension as adults. Healthy eating and PA are essential for good health and for preventing chronic disease. Numerous studies show that dietary intake of fat, cholesterol and sodium, and consumption of vegetable and fruit affects the risk of CVD. Regular PA can substantially reduce the risk of CVD, diabetes and hypertension, in addition to its many other benefits. National representative data show that unhealthy eating and insufficient PA become a serious problem in American children and adolescents. The long-term impact of lifestyles and obesity in childhood on the risk of CVD may be due to: a) Long-lasting effects of early lifestyles on the cardiovascular system; b) Persistence of the risk factors, as dietary and PA habits developed in childhood
XIIIth International Symposium on Atherosclerosis, September 28–October 2, 2003, Kyoto, Japan
1FS03
Monday September 29, 2003: Featured Symposium How Can We Propose Global Guidelines for Prevention of Atherosclerosis?
are likely to become lifelong habits, causing obese children to become obese adults; and c) Clustering of risk factors as young people with these unfavorable factors may also have other risk factors such as smoking and social, economic, and environmental stresses. Efforts should be made to help young people to develop healthy lifestyles at early age. 1FS02-5
The impact of lifestyle on coronary heart disease risk in different cultural settings: The PRIME Study
P. Ducimetiere. INSERM Unit 258, Villejuif, France
1FS02-6
The impact of westernization on the risk of atherosclerotic vascular disease among Japanese-American men in Hawaii
K. Yano, B. Willcox, R. Chen, B. Rodriguez, J.D. Curb. PHRI, USA Objective: To investigate the impact of Westernization on the risk of coronary heart disease (CHD) and stroke among Japanese-American men in Hawaii. Methods: The length of time lived in Japan during childhood was used as an indicator of Westernization. A total of 7,479 men aged 45-68 and free of CHD, stroke, and cancer were classified to three groups by the number of childhood years in Japan: <1 (most Westernized), 1-9 (intermediate), and 10+ (least Westernized). Incident cases of CHD and stroke during 33 years of follow-up were identified through surveillance of death and hospitalization. Age-adjusted incidence rates of all CHD, definite CHD (CHD death and MI), all stroke, and thromboembolic (TE) stroke were computed for each group of the years in Japan. The relative risk (RR) for each endpoint was estimated using Cox regression models adjusted for age, usual CVD risk factors, and other confounding factors. Results: Significant trends of decreasing age-adjusted rate (per 1000 person-years) with increasing years in Japan were noted for all CHD (11.0, 10.1, 8.0) and definite CHD (7.5, 6.9, 5.5). In contrast, there was no significant or consistent trend for either all stroke (5.5, 4.9, 5.1) or TE stroke (3.7, 2.7, 3.5). In multivariate analyses, the RR for all CHD and definite CHD with the 10+ years group compared to the <1 year group remained significant. Conclusions: Longer exposure to Japanese traditional culture and lifestyle during childhood reduced the risk of CHD (but not stroke) later in life among the first and second generation Japanese-American men in Hawaii. This protective effect could not be fully explained by diet or usual CVD risk factors.
1FS03 HOW CAN WE PROPOSE GLOBAL GUIDELINES FOR PREVENTION OF ATHEROSCLEROSIS? 1FS03-1
International Atherosclerosis Society harmonized guidelines for prevention of atherosclerotic cardiovascular disease (CVD)
S. Grundy. Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX, USA In 2002, the International Atherosclerosis Society (IAS) released HARMONIZED GUIDELINES ON PREVENTION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE. These are directed primarily to health professionals to provide guidelines on clinical management of risk factors to reduce risk for CVD. A large number of guidelines for CVD prevention have been developed by professional organizations and national societies. They offer “evidence-based” recommendations and go beyond “consensus” recommendations. The evidence mounted in guidelines has been enriched by many powerful randomized controlled trials. The IAS guidelines aim to harmonize and integrate existing guidelines for the clinical management to prevent of atherosclerotic CVD. IAS guidelines abstract the evidence reviewed by several expert panels. They incorporate concepts and information from many existing guidelines for the individual risk factors and for overall CVD prevention. Close attention was paid to the European cardiovascular guidelines, the International Task Force guidelines, WHO guidelines, Asian Pacific and Japanese guidelines on obesity, and country-specific guidelines from the USA, Canada, UK, and Australia. To harmonize existing guidelines, an element of judgment was required to link the different guidelines into a coherent whole. In this harmonization process, useful information was obtained from guidelines that focus on particular CVD risk factors, e.g. major risk factors, such as cigarette smoking, high blood pressure, high blood cholesterol, and diabetes, and/or underlying risk factors, such as overweight/obesity, physical inactivity, and atherogenic diets. In addition, recent guidelines were also surveyed that offer recommendations on global risk factor management in higher risk patients or for primary prevention. 1FS03-2
The International Task Force for Prevention of Coronary Heart Disease - Guidelines for prevention of atherosclerotic cardiovascular diseases
G. Assmann. Institut für Klinische Chemie und Laboratoriumsmedizin, University of Münster, Germany The International Task Force for Prevention of Coronary Heart Disease, in cooperation with the International Atherosclerosis Society, has recently published a new document on prevention of coronary heart disease. This document includes 56 tables and 19 figures designed to teach primary care physicians essential features of preventing coronary heart disease. It is the first document which summarises all the important American and European tools for estimating risk of CHD. Emphasis is given to the identification of high risk individuals by recently developed algorithms as well as risk charts. The pros and cons of various risk estimates are outlined and it is suggested that pharmaceutical treatment should be based upon at least one measurement of global risk by algorithms. These algorithms need geographical adjustment and detailed information is given about the appropriate adjustment factors needed in various geographical areas. The management of high risk individuals as well as considerations for special patient groups are outlined in detail. 1FS03-3
Global guidelines: National issues
P. Barter. The Heart Research Institute, Camperdown, Sydney, Australia There are many sets of guidelines for risk assessment and for the prevention and treatment of atherosclerotic vascular disease. Most recognize that global risk is a function of the interaction between a number of known risk factors. Most also agree on which risk factors are important but differ widely in how they are used to define global risk. Some employ algorithms based on large data sets collected in both the US and Europe. However, there is variation in the weighting given to individual risk factors and also in the recommendations for both initiation triggers and therapeutic targets. In many cases the differences between guidelines reflect a recognition of regional factors and are appropriate. But too often, guidelines established on the basis of information gathered in one population are adopted without consideration of local factors. Consider two examples. In the case of plasma lipids, it may be appropriate to focus primarily on the LDL-cholesterol component of the
XIIIth International Symposium on Atherosclerosis, September 28–October 2, 2003, Kyoto, Japan
MONDAY
Since the 1950s, a small number of epidemiological studies of coronary heart disease (CHD) have adopted the Seven Countries approach in focusing on lifestyle characteristics in different populations, trying to define the betweenand within-country impact of risk factors. Between country differences exist even within Europe, particularly in terms of the well-known North-South gradient. The PRIME Study is an integrated multicentre cohort study in two countries at contrasting CHD risk: Belfast (Northern Ireland) and France (Lille, Strasbourg, Toulouse). The total population consisted of over 10 000 men aged 50-59 years, recruited equally in each region. All procedures used in the initial clinical examination, questionnaires, blood processing, follow-up methods, validation of events were standardized and a centralized biobank was set up. Whereas years of schooling were a clear protective factor in both countries, hostility, depression, social support and type A scores were not; and surprisingly, population differences went in the opposite direction to what was hypothesized. Leisure time activity energy expenditure was negatively associated with risk in both countries and might explain part of the risk gradient. Alcohol intake was more clearly associated with a lower CHD event rate in France than in Belfast and different drinking patterns may be involved. Some biological markers were measured in order to gain a deeper understanding of some dietheart relationships. For instance, whereas a much lower level of carotenoids was observed in Belfast than in France, related to a much lower intake of fruit and vegetables, no association with CHD was shown in either country. It is concluded that many discrepancies between psychosocial and cultural CHD risk factors are present, both across and within European populations, and that biological explanations remain to be identified for most of these.
7