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2.P.222 Coronary heart disease risk factors and carotid atherosclerosis in a high risk Hungarian population
Tuesday 7 October I997: Risk factors (for cardiovascular
162
The study population included 91 patients (61% males, mean age 64 f 10 yrs, 57% history of hypertension) and 100 controls without evidence of CA (36% males, mean age 52 f 10 yrs, 27% history of hypertension). Body mass index, dyslipidemia, smoking, diabetes, serum creatinine, plasmatic folic acid and vitamin B12 were not significantly different in the two groups. Total homocysteine (tHcy) levels (Nmol/L), determined by HPLC with a fluorescent detector, were significantly (p < O.ooOl) lower in in controls (8.1 & 4.4 wmol/l, 95% C.I. 7.2-8.9) than in patients with CA (11.7 f 6.5, 95% C.I. 10.3-13.0). By multiple regression,. independent significant determinants of tHcv were gender (o = 0.02), aEe. (I, = 0.002). and folic acid (P < 0.0001). By iogistic-regress&n, the &de&nient predi&ors of CA were-male gender (p < O.OOOl), hypertension (p < O.OOOl), age (p i 0.01) and tHcy levels (p < 0.01). This study has confirmed homocysteine as a risk factor for carotid atherosclerosis and consequently we recommend tHcy levels to be screened in all patients at risk for or with atherosclerosis.
12.P.220
1 Serum fibrinogen population
I. Mannas, P. Palma, R. Carvalho, H. Ramos, J.L. Silva. Department Porto, Portugal
and lipoprotein(a)
in a Portuguese
F. Pichel, M.J. Santos, of Endocrinology-Hospital
NIDDM
C. Bacelar, St. Antdnio,
Introductioo: Non Insulin Dependent Diabetes Mellitus (NIDDM) is a disorder that carries an increased risk for atherosclerotic cardiovascular disease, but the high prevalence of classic risk factors does not explain the increased cardiovascular-related morbidity and mortality in these patients. Among other factors, serum Fibrinogen and Lipoprotein(a) (Lp(a)) have been implicated in this process, as shown by many reports describing elevated levels of those parameters in NIDDM patients. Objective: The objective of this work was to compare serum fibrinogen and Lp(a) in patients with high risk for atherosclerotic disease with and without NIDDM. Material and Methods: We have studied 20 randomised patients with NIDDM and compared them with a control group (n = 34). The groups were matched for age, sex, BMI, hypertension, smoking habits, serum levels of total cholesterol, HDL-Cholesterol, LDL-Cholesterol, Apo B, and Apo Al. Results: Mean levels of serum fibrinogen were significantly higher in the NIDDM group compared with the controls (403.5 f 102.3 mg/dl vs 332.4 f 98.7 mg/dl, p < 0.05). There was no statistical difference in the levels of Lp(a) between groups. Conclusions: Fibrinogen is elevated in NIDDM and may contribute to the increased risk for cardiovascular disease in these patients. In this study, we have not found increased levels of Lp(a) in patients with NIDDM.
2.P.221
Genetic susceptibility of a polymorphism
to coronary artery disease: of the PAI-1 gene locus
Maurizio Margaglione, Giuseppe Cappucci, Donatella Nicola Giuliani, Gennaro Vecchione, Elvira Grandone, Unita’ di Atewxclenxi e Tnxnbosi, I.R.C.C.S. CSS, S. Istituto di Medicina Interna e Geriatria, Universitri di
Involvement
Colaizzo, Giovanni Di Minno. Giovanni Rotondo, and Palermo, Italy
A family history of ischemic events is a major determinant of coronary artery disease. PAI-1 plasma levels modulate the ischemic risk and a deletion/insertion polymorphism within the plasminogen activator inhibitor-l (PAI-I 4G/5G) locus affect the expression of this gene. In 1179 healthy employees of our Institution, we have investigated the relationship between the distribution of the 4G/5G polymorphism and the presence of coronary events in first-degree relatives. A family history of documented ischemic coronary disease was assessed by a questionnaire. The PAI4G/5G polymorphism was evaluated by polymerase chain reaction and endonuclease digestion. The group with a first-degree relative who suffered from a coronary ischemic episode had a higher number of homozygotes for the deleted allele (4G/4G) oi the PAIgene as compared to subj& without such family history (OR = 1.62: 95% CI = 1.17-2.25: D = 0.005). The freauencv of the 4G allele was abnormally high as well (OR = 1.29; 95% CI = 1.04-1.60; p = 0.025). The individuals with, were older (p 4 O.OOl), and exhibited higher BMI (p = 0.033) and total cholesterol levels (p < O.OOl), than those without family history. In a multiple logistic regression analysis, only age (p < 0.02) and PAI- polymorphism (p 4 0.03) independently contributed to family history of coronary heart disease, 4G/4G carriers exhibiting a higher family history of coronary artery disease (OR: 1.59). We conclude that PAI- 4G/5G polymorphism, to some extent, accounts for I lth International
Symposium
Posters diseases)
the risk of coronary artery disease related to a family history for such event. These findings support the hypothesis that the 4G variant is a transmissible coronary risk factor.
12.p.224
Coronaryheartdiseaseriskfactorsandcarotid atherosclerosis in a hi risk Hungarian
population
L. M&k,, Z. Szolnoki, Gy. Simon&, A. Kondacs, I. Wolf, T. Fazekas. Kdlmdn B&t% County Hospital and Health Service of Almdskamards, H-5701 GYUU, PO. Box 46, Hungary
Pdndy
Hungary occupies a “distinguished” place of cardiovascular mortality statistics which is in close connection with the atherosclerosis of coronary and carotid arteries. In order to determine the relationship between the classical coronary heart disease (CHD) risk factors and carotid atherosclerosis, based on the screening performed in 1994 in the village of Almkkamar&, Hungary, 121 subjects having the highest risk were investigated. Plasma lipid levels were measured and the presence of other risk factors was evaluated. Echo-Doppler examination of carotid arteries was performed and a 7-grade classification system of the atherosclerotic process was applied. There was a trend of a more pronounced atherosclerotic process on the right carotid artery but the difference between the two sides proved to be non-significant (P > 0.05). In contrary, there was a significant difference between the risk factor number of subjects with versus without carotid atherosclerosis (P < 0.05). An association was found between the presence of carotid atherosclerotic process and age >60 years (Odds ratio and 95% confidence intervals 4.84; 1.81-12.92, P < 0.05), cholesterol level more than 5.2 mmol/l (2.80; 1.11-7.08, P < 0.05), hypertension (5.97; 1.93-18.50, P -Z O.Ol), diabetes mellitus (5.97; 1.09-44.34, P < 0.5) and the presence of symptoms suggesting stenosis of the lower limbs’ arteries (4.2; 1.18-15.0, P < 0.05). It is concluded that the marked presence of CHD risk factors promotes the atherosclerosis of carotid arteries and the echo-Doppler examination of these vessels along with the investigation of classical CHD risk factors may be a useful method of cardiovascular risk assessment.
lIIII1 2 P 22.3
Hyperfibrhmgenemia and hypertriglyceridemia histocytologic cornposItIon of atherosclerotic
influence the carotid plaques
A. G. Sangiorgi, G. Palmieri, R. Pistolese’ , A. Ippoliti’ , --, Mauiello L.G. Spagnoli. Cattedra di Anatomia Patologica, Universita’ di Roma “Tor Vergata “, Rome; I Cattedra di Chirurgia Vascolare, Universita ’ di Roma “Tar Vergata “, Rome, Italy Our previous works demonstrated that the structural variability of the symptomatic carotid plaques is not a haphazard phenomenon, but is significantly correlated with the presence of several risk factors (Spagnoli et al 1994 Atherosclerosis 108: 39-60). The purpose of this study was to examine if the presence of high level of fibrinogen and/or triglycerides, which recently have been demonstrated to play an independent role in the development of cerebrovascular atherosclerosis, could be related with specific morphologic patterns of symptomatic carotid atherosclerotic plaques, and to evaluate which role those patterns may play in the natural history of cerebrovascular disease (CVD). Seventy-one carotid plaques from patients affected by transient ischemic attacks were studied after endoarterectomy. Clinical and morphological data were quantified and correlated, using multivariate logistic regression, with presence of hypetibrinogenemia and hypertriglyceridemia. Multivariate logistic regression indicates that the presence of thrombosis was strongly correlated with high fibrinogen levels. This correlation is so strong that the increase of tbrombogenic risk in plaques from hyperfibrinogenemic patients is 4.26 times greater as compared with that of patients without any risk facl.or. Plaques from patients with hyperhiglyceridemia were, on the contrary, character&d by the presence of a large atheroma. Our results show remarkable correlation between hyperlibrinogenemia, hypertriglyceridemia and specific morphologic patterns of atherosclerotic plaques, and also outline the relevant pathophysiologic mechanisms through which these risk factors may influence the natural history of CVD, since either mural thrombosis or expansion atheronecrotic mass which increases the risk of plaque rupture, may be source of embolic material.
on Atherosclerosis,
Paris,
October
1997
162
The study population included 91 patients (61% males, mean age 64 f 10 yrs, 57% history of hypertension) and 100 controls without evidence of CA (36% males, mean age 52 f 10 yrs, 27% history of hypertension). Body mass index, dyslipidemia, smoking, diabetes, serum creatinine, plasmatic folic acid and vitamin B12 were not significantly different in the two groups. Total homocysteine (tHcy) levels (Nmol/L), determined by HPLC with a fluorescent detector, were significantly (p < O.ooOl) lower in in controls (8.1 & 4.4 wmol/l, 95% C.I. 7.2-8.9) than in patients with CA (11.7 f 6.5, 95% C.I. 10.3-13.0). By multiple regression,. independent significant determinants of tHcv were gender (o = 0.02), aEe. (I, = 0.002). and folic acid (P < 0.0001). By iogistic-regress&n, the &de&nient predi&ors of CA were-male gender (p < O.OOOl), hypertension (p < O.OOOl), age (p i 0.01) and tHcy levels (p < 0.01). This study has confirmed homocysteine as a risk factor for carotid atherosclerosis and consequently we recommend tHcy levels to be screened in all patients at risk for or with atherosclerosis.
12.P.220
1 Serum fibrinogen population
I. Mannas, P. Palma, R. Carvalho, H. Ramos, J.L. Silva. Department Porto, Portugal
and lipoprotein(a)
in a Portuguese
F. Pichel, M.J. Santos, of Endocrinology-Hospital
NIDDM
C. Bacelar, St. Antdnio,
Introductioo: Non Insulin Dependent Diabetes Mellitus (NIDDM) is a disorder that carries an increased risk for atherosclerotic cardiovascular disease, but the high prevalence of classic risk factors does not explain the increased cardiovascular-related morbidity and mortality in these patients. Among other factors, serum Fibrinogen and Lipoprotein(a) (Lp(a)) have been implicated in this process, as shown by many reports describing elevated levels of those parameters in NIDDM patients. Objective: The objective of this work was to compare serum fibrinogen and Lp(a) in patients with high risk for atherosclerotic disease with and without NIDDM. Material and Methods: We have studied 20 randomised patients with NIDDM and compared them with a control group (n = 34). The groups were matched for age, sex, BMI, hypertension, smoking habits, serum levels of total cholesterol, HDL-Cholesterol, LDL-Cholesterol, Apo B, and Apo Al. Results: Mean levels of serum fibrinogen were significantly higher in the NIDDM group compared with the controls (403.5 f 102.3 mg/dl vs 332.4 f 98.7 mg/dl, p < 0.05). There was no statistical difference in the levels of Lp(a) between groups. Conclusions: Fibrinogen is elevated in NIDDM and may contribute to the increased risk for cardiovascular disease in these patients. In this study, we have not found increased levels of Lp(a) in patients with NIDDM.
2.P.221
Genetic susceptibility of a polymorphism
to coronary artery disease: of the PAI-1 gene locus
Maurizio Margaglione, Giuseppe Cappucci, Donatella Nicola Giuliani, Gennaro Vecchione, Elvira Grandone, Unita’ di Atewxclenxi e Tnxnbosi, I.R.C.C.S. CSS, S. Istituto di Medicina Interna e Geriatria, Universitri di
Involvement
Colaizzo, Giovanni Di Minno. Giovanni Rotondo, and Palermo, Italy
A family history of ischemic events is a major determinant of coronary artery disease. PAI-1 plasma levels modulate the ischemic risk and a deletion/insertion polymorphism within the plasminogen activator inhibitor-l (PAI-I 4G/5G) locus affect the expression of this gene. In 1179 healthy employees of our Institution, we have investigated the relationship between the distribution of the 4G/5G polymorphism and the presence of coronary events in first-degree relatives. A family history of documented ischemic coronary disease was assessed by a questionnaire. The PAI4G/5G polymorphism was evaluated by polymerase chain reaction and endonuclease digestion. The group with a first-degree relative who suffered from a coronary ischemic episode had a higher number of homozygotes for the deleted allele (4G/4G) oi the PAIgene as compared to subj& without such family history (OR = 1.62: 95% CI = 1.17-2.25: D = 0.005). The freauencv of the 4G allele was abnormally high as well (OR = 1.29; 95% CI = 1.04-1.60; p = 0.025). The individuals with, were older (p 4 O.OOl), and exhibited higher BMI (p = 0.033) and total cholesterol levels (p < O.OOl), than those without family history. In a multiple logistic regression analysis, only age (p < 0.02) and PAI- polymorphism (p 4 0.03) independently contributed to family history of coronary heart disease, 4G/4G carriers exhibiting a higher family history of coronary artery disease (OR: 1.59). We conclude that PAI- 4G/5G polymorphism, to some extent, accounts for I lth International
Symposium
Posters diseases)
the risk of coronary artery disease related to a family history for such event. These findings support the hypothesis that the 4G variant is a transmissible coronary risk factor.
12.p.224
Coronaryheartdiseaseriskfactorsandcarotid atherosclerosis in a hi risk Hungarian
population
L. M&k,, Z. Szolnoki, Gy. Simon&, A. Kondacs, I. Wolf, T. Fazekas. Kdlmdn B&t% County Hospital and Health Service of Almdskamards, H-5701 GYUU, PO. Box 46, Hungary
Pdndy
Hungary occupies a “distinguished” place of cardiovascular mortality statistics which is in close connection with the atherosclerosis of coronary and carotid arteries. In order to determine the relationship between the classical coronary heart disease (CHD) risk factors and carotid atherosclerosis, based on the screening performed in 1994 in the village of Almkkamar&, Hungary, 121 subjects having the highest risk were investigated. Plasma lipid levels were measured and the presence of other risk factors was evaluated. Echo-Doppler examination of carotid arteries was performed and a 7-grade classification system of the atherosclerotic process was applied. There was a trend of a more pronounced atherosclerotic process on the right carotid artery but the difference between the two sides proved to be non-significant (P > 0.05). In contrary, there was a significant difference between the risk factor number of subjects with versus without carotid atherosclerosis (P < 0.05). An association was found between the presence of carotid atherosclerotic process and age >60 years (Odds ratio and 95% confidence intervals 4.84; 1.81-12.92, P < 0.05), cholesterol level more than 5.2 mmol/l (2.80; 1.11-7.08, P < 0.05), hypertension (5.97; 1.93-18.50, P -Z O.Ol), diabetes mellitus (5.97; 1.09-44.34, P < 0.5) and the presence of symptoms suggesting stenosis of the lower limbs’ arteries (4.2; 1.18-15.0, P < 0.05). It is concluded that the marked presence of CHD risk factors promotes the atherosclerosis of carotid arteries and the echo-Doppler examination of these vessels along with the investigation of classical CHD risk factors may be a useful method of cardiovascular risk assessment.
lIIII1 2 P 22.3
Hyperfibrhmgenemia and hypertriglyceridemia histocytologic cornposItIon of atherosclerotic
influence the carotid plaques
A. G. Sangiorgi, G. Palmieri, R. Pistolese’ , A. Ippoliti’ , --, Mauiello L.G. Spagnoli. Cattedra di Anatomia Patologica, Universita’ di Roma “Tor Vergata “, Rome; I Cattedra di Chirurgia Vascolare, Universita ’ di Roma “Tar Vergata “, Rome, Italy Our previous works demonstrated that the structural variability of the symptomatic carotid plaques is not a haphazard phenomenon, but is significantly correlated with the presence of several risk factors (Spagnoli et al 1994 Atherosclerosis 108: 39-60). The purpose of this study was to examine if the presence of high level of fibrinogen and/or triglycerides, which recently have been demonstrated to play an independent role in the development of cerebrovascular atherosclerosis, could be related with specific morphologic patterns of symptomatic carotid atherosclerotic plaques, and to evaluate which role those patterns may play in the natural history of cerebrovascular disease (CVD). Seventy-one carotid plaques from patients affected by transient ischemic attacks were studied after endoarterectomy. Clinical and morphological data were quantified and correlated, using multivariate logistic regression, with presence of hypetibrinogenemia and hypertriglyceridemia. Multivariate logistic regression indicates that the presence of thrombosis was strongly correlated with high fibrinogen levels. This correlation is so strong that the increase of tbrombogenic risk in plaques from hyperfibrinogenemic patients is 4.26 times greater as compared with that of patients without any risk facl.or. Plaques from patients with hyperhiglyceridemia were, on the contrary, character&d by the presence of a large atheroma. Our results show remarkable correlation between hyperlibrinogenemia, hypertriglyceridemia and specific morphologic patterns of atherosclerotic plaques, and also outline the relevant pathophysiologic mechanisms through which these risk factors may influence the natural history of CVD, since either mural thrombosis or expansion atheronecrotic mass which increases the risk of plaque rupture, may be source of embolic material.
on Atherosclerosis,
Paris,
October
1997