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231: Antihypertensive treatment with beta-blockers in the metabolic syndrome
Journal of Clinical Lipidology, Vol 2, No 5S, October 2008
was comparable after placebo and telmisartan treatment. However, an increase in plasma AD at 120 min of the clamp following telmisartan faze (p<0.05) was observed. Conclusions: Close relation between expressions of AD and its receptors suggests paracrine functions of AD in SAT. In IGH, R2 is more abundantly expressed in SAT. HI stimulates the expression of R2. Telmisartan does not influence expressions of AD and its receptors in SAT, whereas it enhances plasma AD in response to HI.
treatment in patients with metabolic syndrome decreases significantly weight, fat mass and cardiometabolic risk factors. We found that treatment with orlistat in combination with hypocaloric diet was effective in reducing weight and fat mass and, notably, had further beneficial effects on leptin resistance.
Funding: Grant VZ MZO 00023001
231
230
ANTIHYPERTENSIVE TREATMENT WITH BETA-BLOCKERS IN THE METABOLIC SYNDROME A.M. Carella, G. Antonucci, M. Conte, M. Di Pumpo, E. Antonucci. T. Masselli-Mascia. Hospital, Department of Internal Medicine, San Severo (FG), Italy
CHANGES OF PLASMA LEPTIN LEVELS AND CARDIOMETABOLIC RISK FACTORS DURING THE WEIGHT LOSS WITH ORLISTAT IN COMBINATION WITH HYPOCALORIC DIET E. Stokic. Department of Endocrinology, Novi Sad, Serbia Objective: Evidence has suggested that the adipocyte-derived hormone leptin may be an important factor linking obesity, the metabolic syndrome and cardiovascular disorders. Obese patients have higher leptin levels, suggesting a leptin resistance in obesity. Methods: The aim of the study was to evaluate effects of 24-week hypocaloric diet and orlistat therapy in 38 patients (10 males and 28 females) with a mean age of 36.5±11.3 years, with metabolic syndrome on cardiometabolic risk factors and leptin level. Body weight, height and waist circumference, fat mass, systolic and diastolic pressure, serum lipids, leptin and glycemia were assessed before and after the treatment. Results: There was significant reduction in body weight (115.24 ±21, 83 vs. 96.94 ± 20.99 kg, p<0.01), fat mass and waist (123.59 ± 18.91cm, p<0.001). Significant improvements of lipids were observed for total (p<0.001) and LDL cholesterol (5.05 ± 1.00 vs., 3.68 ± 1.13 mol/l, p<0.001) and triglycerides (2.02 ± 0.69 vs. 1.56 ± 0.60 mol/l, p<0, 05). Glucose decreased significantly. Leptin levels decreased significantly (23, 9±16, 3 vs. 7.3±5, 6 ng/ml, p<0.001) and leptin levels expressed per kilogram of body fat was significantly lower after weight loss than before. Conclusion: There results suggest that orlistat
Funding: none
Objective: the metabolic syndrome (MS) is a cluster of metabolic disorders, including hypertension, and insulin resistance plays a key role in the pathogenesis of this syndrome. Antihypertensive treatment with conventional beta-blockers is underused in the MS because most of these drugs have shown adverse effects on carbohydrate and lipid metabolism, including increased insulin resistance. Aim of this study was to review the evidence supporting the reasons for underusing beta-blockers in treating hypertension in the MS and, in case, for selecting beta-blockers of choice. Methods: a review of Literature, from 1997 to 2007, has been carried out (on PubMed), through these key-words: metabolic syndrome and beta-blockers. Results: 148 items (74 reviews) were obtained; most of conventional beta-blockers have been reported to cause frequently dosedependent adverse effects on glucose and lipid metabolism and are not recommended of choice in the MS, except in selected cases. However, some recent studies have shown a better metabolic profile with newer 3th generation vasodilating beta-blockers, such as Carvedilol and Nebivolol. Conclusions: reduced peripheral blood flow, due to increase in peripheral vascular resistance, play a central role in mediating the metabolic side effects of conventional beta-blockers. The vasodilating action of Carvedilol and Nebivolol, due respectively to alpha1-blocking effect and release of nitric oxide, explain the lack of adverse
S107
Multiple Risk Factors in Cardiovascular Disease—Abstracts
metabolic effects using these beta-blockers that could be a valuable tool for hypertension treatment also in the MS.
patients, the NCEP-ATPIII criteria of the MetS more strongly than the IDF MetS criteria predict the incidence of T2DM.
Funding: No funding for the work done in the abstract
Funding: none
232 ADULT TREATMENT PANEL III METABOLIC SYNDROME CRITERIA MORE STRONGLY THAN INTERNATIONAL DIABETES FEDERATION CRITERIA PREDICT THE INCIDENCE OF TYPE 2 DIABETES IN ANGIOGRAPHIED CORONARY PATIENTS C.H. Saely1,2,3, A. Vonbank1,3, P. Rein1,2,3, S. Beer1,2,3, S. Aczel1,2, T. Marte1,2, H. Drexel1,2,3. 1 VIVIT-Institute, Feldkirch, Austria, 2Academic Teaching Hospital Feldkirch, Feldkirch Austria, 3 Private University in the Principality of Liechtenstein Triesen, Liechtenstein
Background: It is unclear whether the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) or the International Diabetes Federation (IDF) criteria of the metabolic syndrome (MetS) more strongly predict the incidence of type 2 diabetes (T2DM). Methods: We recorded the incidence of T2DM over 6 years in a population of 503 consecutive non-diabetic patients undergoing coronary angiography for the evaluation of stable coronary artery disease. Results: At baseline, 144 (28.6%) of our patients had the MetS according to NCEP-ATPIII criteria, and 204 (40.6%) had the MetS according to IDF criteria. During the follow-up period, T2DM was newly diagnosed in 86 (17.1%) patients. Both definitions of the MetS significantly predicted incident diabetes; however, the adjusted odds ratio was higher for the NCEP-ATPIII MetS (3.55 [2.16-5.86]; p <0.001) than for the IDF MetS (2.13 [1.32-3.43]; p = 0.002). Among the 120 patients (23.9%) in whom the two definitions of the MetS led to discordant diagnoses, the incidence of T2DM was significantly higher in patients who fulfilled the NCEP-ATPIII MetS criteria, but not the IDF criteria than in those who conversely fulfilled the IDF but not the NCEP-ATPIII criteria (33.3% vs. 15.6%; p = 0.035). Conclusions: We conclude that among angiographied coronary
S108
233 METABOLIC SYNDROME AND CORONARY HEART DISEASE RISK CHARACTERISTICS IN SEVERE AND PERSISTENTLY MENTALLY ILL S. Kaushik1, R. Shrivastava2, A. Khan3, S. Kaushik4, J.P. Lindenmayer5. 1Nathan Kline Institute for Psychiatric Research, New York, NY, USA, 2LSU Health Sciences Center, Shreveport, LA, USA, 3Fordham University, New York, NY, USA, 4Manhattan Psychiatric Center, New York, NY, USA, 5NYU School of Medicine, New York, NY, USA Background: Data is limited on coronary heart disease (CHD) risk in severe and persistently mentally ill (SPMI). In this population early identification of high risk patients and targeted treatment is required. We assessed the prevalence of metabolic syndrome (MetS) and 10 year CHD risk in SPMI in a long term psychiatric facility. Method: In this cross-sectional study of SPMI patients during 2006-2007, International Diabetes Federation definition of MetS and NCEP-ATP III version of Framingham Risk Scoring (FRS) system for 10 year CHD risk (low risk <10%, significant risk >10%) were used. Body mass index (BMI >30) was used instead of abdominal girth. Results: 274 adults were included [85% male, mean age 44±12.3 years, 93.4 % on atypical antipsychotic (ATP), 24.1% had MetS, mostly exsmokers (20% current smokers)]. CHD risk was significantly higher in those with MetS (32% vs. 14%, p=0.005). In the MetS group, 53% had BMI > 30, 44% had hypertension (HTN), 57.6% had fasting glucose > 100 mg/dl, and 100% had dyslipidemia. 21% patients with HTN and 38% with dyslipidemia were not on treatment. Mean CHD risk of this subgroup was 4.2% (total sample CHD risk mean of 4.62%). Fasting triglycerides levels (p=.005) and BMI (p=.003) were significantly correlated with CHD risk on univariate ANOVA of MetS. 95.5% patients with MetS were on ATP but antipsychotic regimen did not affect the CHD risk or incidence of MetS.
was comparable after placebo and telmisartan treatment. However, an increase in plasma AD at 120 min of the clamp following telmisartan faze (p<0.05) was observed. Conclusions: Close relation between expressions of AD and its receptors suggests paracrine functions of AD in SAT. In IGH, R2 is more abundantly expressed in SAT. HI stimulates the expression of R2. Telmisartan does not influence expressions of AD and its receptors in SAT, whereas it enhances plasma AD in response to HI.
treatment in patients with metabolic syndrome decreases significantly weight, fat mass and cardiometabolic risk factors. We found that treatment with orlistat in combination with hypocaloric diet was effective in reducing weight and fat mass and, notably, had further beneficial effects on leptin resistance.
Funding: Grant VZ MZO 00023001
231
230
ANTIHYPERTENSIVE TREATMENT WITH BETA-BLOCKERS IN THE METABOLIC SYNDROME A.M. Carella, G. Antonucci, M. Conte, M. Di Pumpo, E. Antonucci. T. Masselli-Mascia. Hospital, Department of Internal Medicine, San Severo (FG), Italy
CHANGES OF PLASMA LEPTIN LEVELS AND CARDIOMETABOLIC RISK FACTORS DURING THE WEIGHT LOSS WITH ORLISTAT IN COMBINATION WITH HYPOCALORIC DIET E. Stokic. Department of Endocrinology, Novi Sad, Serbia Objective: Evidence has suggested that the adipocyte-derived hormone leptin may be an important factor linking obesity, the metabolic syndrome and cardiovascular disorders. Obese patients have higher leptin levels, suggesting a leptin resistance in obesity. Methods: The aim of the study was to evaluate effects of 24-week hypocaloric diet and orlistat therapy in 38 patients (10 males and 28 females) with a mean age of 36.5±11.3 years, with metabolic syndrome on cardiometabolic risk factors and leptin level. Body weight, height and waist circumference, fat mass, systolic and diastolic pressure, serum lipids, leptin and glycemia were assessed before and after the treatment. Results: There was significant reduction in body weight (115.24 ±21, 83 vs. 96.94 ± 20.99 kg, p<0.01), fat mass and waist (123.59 ± 18.91cm, p<0.001). Significant improvements of lipids were observed for total (p<0.001) and LDL cholesterol (5.05 ± 1.00 vs., 3.68 ± 1.13 mol/l, p<0.001) and triglycerides (2.02 ± 0.69 vs. 1.56 ± 0.60 mol/l, p<0, 05). Glucose decreased significantly. Leptin levels decreased significantly (23, 9±16, 3 vs. 7.3±5, 6 ng/ml, p<0.001) and leptin levels expressed per kilogram of body fat was significantly lower after weight loss than before. Conclusion: There results suggest that orlistat
Funding: none
Objective: the metabolic syndrome (MS) is a cluster of metabolic disorders, including hypertension, and insulin resistance plays a key role in the pathogenesis of this syndrome. Antihypertensive treatment with conventional beta-blockers is underused in the MS because most of these drugs have shown adverse effects on carbohydrate and lipid metabolism, including increased insulin resistance. Aim of this study was to review the evidence supporting the reasons for underusing beta-blockers in treating hypertension in the MS and, in case, for selecting beta-blockers of choice. Methods: a review of Literature, from 1997 to 2007, has been carried out (on PubMed), through these key-words: metabolic syndrome and beta-blockers. Results: 148 items (74 reviews) were obtained; most of conventional beta-blockers have been reported to cause frequently dosedependent adverse effects on glucose and lipid metabolism and are not recommended of choice in the MS, except in selected cases. However, some recent studies have shown a better metabolic profile with newer 3th generation vasodilating beta-blockers, such as Carvedilol and Nebivolol. Conclusions: reduced peripheral blood flow, due to increase in peripheral vascular resistance, play a central role in mediating the metabolic side effects of conventional beta-blockers. The vasodilating action of Carvedilol and Nebivolol, due respectively to alpha1-blocking effect and release of nitric oxide, explain the lack of adverse
S107
Multiple Risk Factors in Cardiovascular Disease—Abstracts
metabolic effects using these beta-blockers that could be a valuable tool for hypertension treatment also in the MS.
patients, the NCEP-ATPIII criteria of the MetS more strongly than the IDF MetS criteria predict the incidence of T2DM.
Funding: No funding for the work done in the abstract
Funding: none
232 ADULT TREATMENT PANEL III METABOLIC SYNDROME CRITERIA MORE STRONGLY THAN INTERNATIONAL DIABETES FEDERATION CRITERIA PREDICT THE INCIDENCE OF TYPE 2 DIABETES IN ANGIOGRAPHIED CORONARY PATIENTS C.H. Saely1,2,3, A. Vonbank1,3, P. Rein1,2,3, S. Beer1,2,3, S. Aczel1,2, T. Marte1,2, H. Drexel1,2,3. 1 VIVIT-Institute, Feldkirch, Austria, 2Academic Teaching Hospital Feldkirch, Feldkirch Austria, 3 Private University in the Principality of Liechtenstein Triesen, Liechtenstein
Background: It is unclear whether the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) or the International Diabetes Federation (IDF) criteria of the metabolic syndrome (MetS) more strongly predict the incidence of type 2 diabetes (T2DM). Methods: We recorded the incidence of T2DM over 6 years in a population of 503 consecutive non-diabetic patients undergoing coronary angiography for the evaluation of stable coronary artery disease. Results: At baseline, 144 (28.6%) of our patients had the MetS according to NCEP-ATPIII criteria, and 204 (40.6%) had the MetS according to IDF criteria. During the follow-up period, T2DM was newly diagnosed in 86 (17.1%) patients. Both definitions of the MetS significantly predicted incident diabetes; however, the adjusted odds ratio was higher for the NCEP-ATPIII MetS (3.55 [2.16-5.86]; p <0.001) than for the IDF MetS (2.13 [1.32-3.43]; p = 0.002). Among the 120 patients (23.9%) in whom the two definitions of the MetS led to discordant diagnoses, the incidence of T2DM was significantly higher in patients who fulfilled the NCEP-ATPIII MetS criteria, but not the IDF criteria than in those who conversely fulfilled the IDF but not the NCEP-ATPIII criteria (33.3% vs. 15.6%; p = 0.035). Conclusions: We conclude that among angiographied coronary
S108
233 METABOLIC SYNDROME AND CORONARY HEART DISEASE RISK CHARACTERISTICS IN SEVERE AND PERSISTENTLY MENTALLY ILL S. Kaushik1, R. Shrivastava2, A. Khan3, S. Kaushik4, J.P. Lindenmayer5. 1Nathan Kline Institute for Psychiatric Research, New York, NY, USA, 2LSU Health Sciences Center, Shreveport, LA, USA, 3Fordham University, New York, NY, USA, 4Manhattan Psychiatric Center, New York, NY, USA, 5NYU School of Medicine, New York, NY, USA Background: Data is limited on coronary heart disease (CHD) risk in severe and persistently mentally ill (SPMI). In this population early identification of high risk patients and targeted treatment is required. We assessed the prevalence of metabolic syndrome (MetS) and 10 year CHD risk in SPMI in a long term psychiatric facility. Method: In this cross-sectional study of SPMI patients during 2006-2007, International Diabetes Federation definition of MetS and NCEP-ATP III version of Framingham Risk Scoring (FRS) system for 10 year CHD risk (low risk <10%, significant risk >10%) were used. Body mass index (BMI >30) was used instead of abdominal girth. Results: 274 adults were included [85% male, mean age 44±12.3 years, 93.4 % on atypical antipsychotic (ATP), 24.1% had MetS, mostly exsmokers (20% current smokers)]. CHD risk was significantly higher in those with MetS (32% vs. 14%, p=0.005). In the MetS group, 53% had BMI > 30, 44% had hypertension (HTN), 57.6% had fasting glucose > 100 mg/dl, and 100% had dyslipidemia. 21% patients with HTN and 38% with dyslipidemia were not on treatment. Mean CHD risk of this subgroup was 4.2% (total sample CHD risk mean of 4.62%). Fasting triglycerides levels (p=.005) and BMI (p=.003) were significantly correlated with CHD risk on univariate ANOVA of MetS. 95.5% patients with MetS were on ATP but antipsychotic regimen did not affect the CHD risk or incidence of MetS.