- Email: [email protected]
31 ANKLE-BRACHIAL INDEX PREDICTS AN INCREASED CARDIOVASCULAR RISK
S42
Nutrition, Metabolism & Cardiovascular Diseases (2008) S35–S65
elderly and patients with metabolic syndrome. HCT was not modified by physical training. FBG decreased only in elderly patients after the whole training period. hsCRP improved in women and patients with metabolic syndrome, only. Conclusion: The physical training modulate the prothrombotic and microinflammatory patterns of overweight hypertensive patients, depending on the sex and the condition of metabolic syndrome.
Background: Metalloproteinases are biomarkers of collagen remodelling. Some of them are increased by vascular stress, other ones by muscular-joint stress. Aim: We aimed at evaluating the modification of serum MMP-2, MMP-9 (more vascular-specific) and their active forms during a sequential training program. Methods: We enrolled 40 overweight patients (mean age: 52.9±8.3 yrs; M:F = 22:18) with newly diagnosed hypertension, not treated with antihypertensive nor antihyperlipdaemic drugs or under stabilized treatment since more than 6 months. After 2 months of AHA Step 2 diet, they followed a sequential training program including 28 days of added 4 METs/week and 28 days of 6 METs/week. We monitored at each step dietary habits, anthropometric measurements, blood pressure measurement, MMP-2, MMP-9, MMP-2a and MMP-9a. Results: The plasma level of MMP-2, MMP-9, MMP-2a and MMP-9a improved significantly when compared to the baseline both after the first and the second training period. The difference was also significant when comparing the second period with the first one in both sexes (beyond MMP-2 that further improved only in women), in adult and elderly patients, and in patient with and without metabolic syndrome. Conclusion: Physical training significantly improved the plasma level of some biomarkers of vascular stress. This improvement seems not to be influenced by sex, age and metabolic pattern of the patient at the baseline.
single best initial screening test to perform in syntomatic and asyntomatic patients suspected of PAD is the ankle-brachial index (ABI). An ABI value <0.90 indicates a positive test for the disease. A further elevated ABI (>1.30) in non compressible calcified vessels is often detected in patients with diabetes or end-stage renal disease. Case report: A 64 years old female with a positive history for type 2 diabetes, hypertension, hypercholesterolemia and cigarette smoking, was admitted to the hospital with severe right leg claudication (less than 100 metres). She was asymptomatic for angor and dyspnea. Physical examination was negative except for the absence of popliteal, and pedal pulses. Elettrocardiogram showed aspecific abnormalities. The right leg ABI was 0.41, and left leg ABI was 0.57. Duplex ultrasound, angio-computerized thomography and catheterbased angiography showed an occlusion of the right external iliac artery, a severe stenosis of the left external iliac artery; furthermore, a 60% stenosis of the right superficial femoral artery and a total occlusion of the left superficial femoral artery were detected. The right and left external iliac stenoses were treated with percutaneous transluminal angioplasty (PTA), with significant angiographic result. She also performed a coronary arteriography, showing a 60% stenosis of the anterior descending artery and a total occlusion of the right coronary artery. The patient was treated with oral hypoglycemic agents, ace-inhibitor, statin and clopidogrel; a strong suggestion for stop smoking was also recommended. Conclusions: Peripheral arterial disease is an independent risk factor for coronary artery disease (CAD). The prevalence of CAD in patients with PAD varies in a range from 14% to 90%, which clearly reflects differences in sensitivity of the technique for CAD. CAD is detected in 19% to 47% of patients with PAD using clinical history plus ECG, in 62% to 63% using stress tests and in 90% of subjects performing an angiography. Patients with an ABI <0.9 show a significant increase of cardiovascular death (RR. 1.9), cerebrovascular disease (RR 2.0) and total mortality (RR 1.6), independently of other major risk factors (Circulation 2006;114:688 99.). The ABI has a sensitivity of 95% and a specificity of approximately 100% for the detection of PAD compared to angiography. The ABI may therefore represent an effective marker of high cardiovascular risk in clinical practice. Patients with low ABI should be strongly considered for secondary-prevention strategy based on effective drug therapy combined with stop smoking in order to prevent further ischemic events and reduce mortality.
30 ERECTILE DYSFUNCTION AS ADDITIONAL CRITERIUM TO IMPROVE GUIDELINES FOR SCREENING SILENT MYOCARDIAL ISCHEMIA IN DIABETES A. Coppola, A. Pujia, C. Valenti, A. Giustina, A. Garzaniti, C. Gazzaruso. Cardiometabolic Unit, Clinical Institute Beato Matteo Vigevano, Italy E-mail: [email protected]
32 BORDERLINE METABOLIC SYNDROME: NEW RISK FACTORS LEVELS TO KEEP AN EYE ON S. D’Addato, E. Tartagni, A. Dormi, M. Rosticci, M. Pombeni, F. Imola, E. Kajo, E. Andrenacci, C. Borghi. Dip. Medicina Interna, Invecchiamento e Malattie Nefrologiche, Universit` a degli Studi di Bologna, Italy E-mail: [email protected]
In diabetic patients coronary artery disease (CAD) often is silent and represents a negative prognostic factor for cardiovascular morbidity and mortality. At the moment, screening for silent CAD in diabetes is based on guidelines of ADA; nevertheless, recent studies suggest that >40% of patients with silent CAD might be missed on the basis of these guidelines. Erectile Dysfunction (ED) is a powerful marker of silent CAD in diabetes. Aim of the present study was to evacuate whether it is possible to decrease the percentage of patients with silent CAD missed by adding ED to criteria of current ADA guidelines. We have consecutively recruited 293 type 2 diabetic (mean age 55.40±7.03 years) without any apparent vascular complication. Among them, 219 did not have myocardial ischemia on stressing ECG (group SMI ). Seventy four men had a positive stressing ECG; in these subjects an angiographic stenosis >50% in at least one coronary vessel was shown, after a positive scintigraphy or dypiridamole myocardial contrast echocardiography (group SMI+). The two study groups were comparable for age, diabetes duration and degree of glycemic control. In all the patients five risk factors of the current ADA guidelines for the screening of CAD (hypertension, dyslipidemia, family history for CAD, smoking e micro/macroalbuminuria) and the presence of ED by the IIEF-5 questionnaire were evaluated. According to the current guidelines the screening for CAD should be performed in 62.16% of the subjects of the group SMI+. If we add ED to the list of the criteria of the current ADA guidelines, the screening should be performed in 89.19% of subjects of group SMI+. Anyway, the percentage of patients to screen in the group SMI increases slightly, from 39.2% to 42.0%. This implies that if we add ED to the list of risk factors of the current ADA guidelines, the percentage of patients with silent CAD missed decreases from 37.84 to 10.81%. In other words, ED seems to increase sensibility of the current ADA guidelines from 62% to 89%, without a significant variation of specificity. Our data suggest that ED should be added to the list of risk factors to be considered in order to discriminate type 2 diabetic patients to screen for silent CAD.
Aim: To evaluate the incidence of Metabolic Syndrome (MS) in a group of subjects, living in a rural environment, with borderline values in MS risk factors studied for 4 years. Materials and Methods: Brisighella Heart Study, started in 1972 by Prof. Giancarlo Descovich, is an observational longitudinal study with a 4-year follow-up which aims to evaluate the spontaneous trend of major cardiovascular risk factors in a population living in Emilia-Romagna. In this work, we analyzed data belonging to those subjects that presented both to 1992 and 1996 controls and whose age kept under 65 years (<60 years old in 1992): 420 men and 452 women. We referred to Metabolic Syndrome diagnostic criteria from the International Task Force, so we excluded subjects with diabetes and considered only subjects with fasting glucose values between 110 and 125 mg/dl. As for borderline Syndrome (BMS), we redefined the risk factors levels as follows: BMI 25.0 29.0 kg/m2 (males), 25 27.5 kg/m2 (females); Triglycerides 150 179 mg/dl, HDL cholesterol 35 40 mg/dl (males), 45 50 mg/dl (females); Systolic blood pressure 130 139 mmHg and Diastolic blood pressure 85 89 mmHg; Fasting glucose 110 125 mg/dl. Results: The prevalence of subjects with MS in 1992 was 8.5%, 7.4% males and 9.5% females. In 1996 it increased to 15.6%, 14.5% males and 16.6% females. The incidence of MS in 1996 resulted 10.9%, 11.1% in men and 10.8% in women. Subjects with borderline values in 1992 represented 1% of the whole population, 1.3% of males and 0.7% of females. We observed that 25% of these subjects developed MS in 1996 compared to 10.8% in subjects without BMS. This was true in both sexes (men: 20% vs 11%; women: 33.3% vs 10.6%). Conclusions: Our data show that subjects with BMS have a higher probability of developing MS over a 4-year period than subjects without alterations in risk factors levels. Therefore a more intensive control of subjects with borderline values would be recommended and, together with a greater attention to lifestyle changes, it could decrease the incidence of MS as well as that of related cardiovascular events.
29 EFFECT OF PHYSICAL ACTIVITY ON VASCULAR REMODELLING BIOMARKERS IN HYPERTENSIVE OVERWEIGHT PATIENTS A.F.G. Cicero1 , G. Derosa2 , M. Bove1 , M. Manca1 , A.V. Gaddi1 , C. Borghi1 . 1 Internal medicine, Aging and Kidney disease Dept, University of Bologna; 2 Internal Medicine and Therapeutics Dept., University of Pavia, Italy E-mail: [email protected]
31 ANKLE-BRACHIAL INDEX PREDICTS AN INCREASED CARDIOVASCULAR RISK M.G. Coppola, M. Nunziata, A. Baiano, M. Sodano, E. La Fata, F. Jossa, G. Marotta. University “Federico II” Medical School Naples, Department of Clinical and Experimental Medicine, Naples, Italy E-mail: [email protected] Introduction: Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis, which reduces the quality of life in millions of patients. The
Nutrition, Metabolism & Cardiovascular Diseases (2008) S35–S65
elderly and patients with metabolic syndrome. HCT was not modified by physical training. FBG decreased only in elderly patients after the whole training period. hsCRP improved in women and patients with metabolic syndrome, only. Conclusion: The physical training modulate the prothrombotic and microinflammatory patterns of overweight hypertensive patients, depending on the sex and the condition of metabolic syndrome.
Background: Metalloproteinases are biomarkers of collagen remodelling. Some of them are increased by vascular stress, other ones by muscular-joint stress. Aim: We aimed at evaluating the modification of serum MMP-2, MMP-9 (more vascular-specific) and their active forms during a sequential training program. Methods: We enrolled 40 overweight patients (mean age: 52.9±8.3 yrs; M:F = 22:18) with newly diagnosed hypertension, not treated with antihypertensive nor antihyperlipdaemic drugs or under stabilized treatment since more than 6 months. After 2 months of AHA Step 2 diet, they followed a sequential training program including 28 days of added 4 METs/week and 28 days of 6 METs/week. We monitored at each step dietary habits, anthropometric measurements, blood pressure measurement, MMP-2, MMP-9, MMP-2a and MMP-9a. Results: The plasma level of MMP-2, MMP-9, MMP-2a and MMP-9a improved significantly when compared to the baseline both after the first and the second training period. The difference was also significant when comparing the second period with the first one in both sexes (beyond MMP-2 that further improved only in women), in adult and elderly patients, and in patient with and without metabolic syndrome. Conclusion: Physical training significantly improved the plasma level of some biomarkers of vascular stress. This improvement seems not to be influenced by sex, age and metabolic pattern of the patient at the baseline.
single best initial screening test to perform in syntomatic and asyntomatic patients suspected of PAD is the ankle-brachial index (ABI). An ABI value <0.90 indicates a positive test for the disease. A further elevated ABI (>1.30) in non compressible calcified vessels is often detected in patients with diabetes or end-stage renal disease. Case report: A 64 years old female with a positive history for type 2 diabetes, hypertension, hypercholesterolemia and cigarette smoking, was admitted to the hospital with severe right leg claudication (less than 100 metres). She was asymptomatic for angor and dyspnea. Physical examination was negative except for the absence of popliteal, and pedal pulses. Elettrocardiogram showed aspecific abnormalities. The right leg ABI was 0.41, and left leg ABI was 0.57. Duplex ultrasound, angio-computerized thomography and catheterbased angiography showed an occlusion of the right external iliac artery, a severe stenosis of the left external iliac artery; furthermore, a 60% stenosis of the right superficial femoral artery and a total occlusion of the left superficial femoral artery were detected. The right and left external iliac stenoses were treated with percutaneous transluminal angioplasty (PTA), with significant angiographic result. She also performed a coronary arteriography, showing a 60% stenosis of the anterior descending artery and a total occlusion of the right coronary artery. The patient was treated with oral hypoglycemic agents, ace-inhibitor, statin and clopidogrel; a strong suggestion for stop smoking was also recommended. Conclusions: Peripheral arterial disease is an independent risk factor for coronary artery disease (CAD). The prevalence of CAD in patients with PAD varies in a range from 14% to 90%, which clearly reflects differences in sensitivity of the technique for CAD. CAD is detected in 19% to 47% of patients with PAD using clinical history plus ECG, in 62% to 63% using stress tests and in 90% of subjects performing an angiography. Patients with an ABI <0.9 show a significant increase of cardiovascular death (RR. 1.9), cerebrovascular disease (RR 2.0) and total mortality (RR 1.6), independently of other major risk factors (Circulation 2006;114:688 99.). The ABI has a sensitivity of 95% and a specificity of approximately 100% for the detection of PAD compared to angiography. The ABI may therefore represent an effective marker of high cardiovascular risk in clinical practice. Patients with low ABI should be strongly considered for secondary-prevention strategy based on effective drug therapy combined with stop smoking in order to prevent further ischemic events and reduce mortality.
30 ERECTILE DYSFUNCTION AS ADDITIONAL CRITERIUM TO IMPROVE GUIDELINES FOR SCREENING SILENT MYOCARDIAL ISCHEMIA IN DIABETES A. Coppola, A. Pujia, C. Valenti, A. Giustina, A. Garzaniti, C. Gazzaruso. Cardiometabolic Unit, Clinical Institute Beato Matteo Vigevano, Italy E-mail: [email protected]
32 BORDERLINE METABOLIC SYNDROME: NEW RISK FACTORS LEVELS TO KEEP AN EYE ON S. D’Addato, E. Tartagni, A. Dormi, M. Rosticci, M. Pombeni, F. Imola, E. Kajo, E. Andrenacci, C. Borghi. Dip. Medicina Interna, Invecchiamento e Malattie Nefrologiche, Universit` a degli Studi di Bologna, Italy E-mail: [email protected]
In diabetic patients coronary artery disease (CAD) often is silent and represents a negative prognostic factor for cardiovascular morbidity and mortality. At the moment, screening for silent CAD in diabetes is based on guidelines of ADA; nevertheless, recent studies suggest that >40% of patients with silent CAD might be missed on the basis of these guidelines. Erectile Dysfunction (ED) is a powerful marker of silent CAD in diabetes. Aim of the present study was to evacuate whether it is possible to decrease the percentage of patients with silent CAD missed by adding ED to criteria of current ADA guidelines. We have consecutively recruited 293 type 2 diabetic (mean age 55.40±7.03 years) without any apparent vascular complication. Among them, 219 did not have myocardial ischemia on stressing ECG (group SMI ). Seventy four men had a positive stressing ECG; in these subjects an angiographic stenosis >50% in at least one coronary vessel was shown, after a positive scintigraphy or dypiridamole myocardial contrast echocardiography (group SMI+). The two study groups were comparable for age, diabetes duration and degree of glycemic control. In all the patients five risk factors of the current ADA guidelines for the screening of CAD (hypertension, dyslipidemia, family history for CAD, smoking e micro/macroalbuminuria) and the presence of ED by the IIEF-5 questionnaire were evaluated. According to the current guidelines the screening for CAD should be performed in 62.16% of the subjects of the group SMI+. If we add ED to the list of the criteria of the current ADA guidelines, the screening should be performed in 89.19% of subjects of group SMI+. Anyway, the percentage of patients to screen in the group SMI increases slightly, from 39.2% to 42.0%. This implies that if we add ED to the list of risk factors of the current ADA guidelines, the percentage of patients with silent CAD missed decreases from 37.84 to 10.81%. In other words, ED seems to increase sensibility of the current ADA guidelines from 62% to 89%, without a significant variation of specificity. Our data suggest that ED should be added to the list of risk factors to be considered in order to discriminate type 2 diabetic patients to screen for silent CAD.
Aim: To evaluate the incidence of Metabolic Syndrome (MS) in a group of subjects, living in a rural environment, with borderline values in MS risk factors studied for 4 years. Materials and Methods: Brisighella Heart Study, started in 1972 by Prof. Giancarlo Descovich, is an observational longitudinal study with a 4-year follow-up which aims to evaluate the spontaneous trend of major cardiovascular risk factors in a population living in Emilia-Romagna. In this work, we analyzed data belonging to those subjects that presented both to 1992 and 1996 controls and whose age kept under 65 years (<60 years old in 1992): 420 men and 452 women. We referred to Metabolic Syndrome diagnostic criteria from the International Task Force, so we excluded subjects with diabetes and considered only subjects with fasting glucose values between 110 and 125 mg/dl. As for borderline Syndrome (BMS), we redefined the risk factors levels as follows: BMI 25.0 29.0 kg/m2 (males), 25 27.5 kg/m2 (females); Triglycerides 150 179 mg/dl, HDL cholesterol 35 40 mg/dl (males), 45 50 mg/dl (females); Systolic blood pressure 130 139 mmHg and Diastolic blood pressure 85 89 mmHg; Fasting glucose 110 125 mg/dl. Results: The prevalence of subjects with MS in 1992 was 8.5%, 7.4% males and 9.5% females. In 1996 it increased to 15.6%, 14.5% males and 16.6% females. The incidence of MS in 1996 resulted 10.9%, 11.1% in men and 10.8% in women. Subjects with borderline values in 1992 represented 1% of the whole population, 1.3% of males and 0.7% of females. We observed that 25% of these subjects developed MS in 1996 compared to 10.8% in subjects without BMS. This was true in both sexes (men: 20% vs 11%; women: 33.3% vs 10.6%). Conclusions: Our data show that subjects with BMS have a higher probability of developing MS over a 4-year period than subjects without alterations in risk factors levels. Therefore a more intensive control of subjects with borderline values would be recommended and, together with a greater attention to lifestyle changes, it could decrease the incidence of MS as well as that of related cardiovascular events.
29 EFFECT OF PHYSICAL ACTIVITY ON VASCULAR REMODELLING BIOMARKERS IN HYPERTENSIVE OVERWEIGHT PATIENTS A.F.G. Cicero1 , G. Derosa2 , M. Bove1 , M. Manca1 , A.V. Gaddi1 , C. Borghi1 . 1 Internal medicine, Aging and Kidney disease Dept, University of Bologna; 2 Internal Medicine and Therapeutics Dept., University of Pavia, Italy E-mail: [email protected]
31 ANKLE-BRACHIAL INDEX PREDICTS AN INCREASED CARDIOVASCULAR RISK M.G. Coppola, M. Nunziata, A. Baiano, M. Sodano, E. La Fata, F. Jossa, G. Marotta. University “Federico II” Medical School Naples, Department of Clinical and Experimental Medicine, Naples, Italy E-mail: [email protected] Introduction: Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis, which reduces the quality of life in millions of patients. The