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466 IDENTIFICATION OF HAEMATOLOGICAL MARKERS ASSOCIATED WITH POOR OUTCOME IN PATIENTS WITH ACUTE CORONARY SYNDROME
79th EAS Congress
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
HDL-C. In subjects with metabolic syndrome (MetS), a high-risk population, while ADN was lower compared with non-MetS, only A2 (moderate drinker) retained adequate ADN, and the linear increase of HDL-C was blunted in A3 (heavy drinker). Conclusion: These results suggest that U-shaped relationship between alcohol consumption and risk of cardiovascular events is explained in part by change of adiponectin level rather than HDL-C. 462 ERECTILE DYSFUNCTION AS A SUBROGATE MARKER OF CORONARY ARTERY DISEASE 1 A. Hernandez-Mijares ´ , A. Jover2 , E. Sola´ 1 , C. Banuls ˜ 2 , K. Garc´ıa-Malpartida2 , M. Rocha2 , V.M. V´ıctor2 . 1 Endocrinology Unit, Hospital Universitario Dr. Peset, 2 Hospital Doctor Peset Research Foundation, Valencia, Spain Background and Objectives: Erectile dysfunction (ED) is highly prevalent among patients with cardiovascular risk factors (CVRF). As it usually precedes cardiovascular disease, it is considered a subrogate marker of subclinical cardiovascular disease. The aim of this study was to evaluate the presence of ED among type 2 diabetic (DM2) patients without clinical macroangiopathy, and to assess the association between ED and silent myocardial ischaemia (SMI) and other CVRF. Patients and Methods: 154 male patients with DM2 and without clinical evidence of cardiovascular disease were included. The presence of ED, SMI and other CVRF was evaluated. Results: Prevalence of ED was 68.2%. Patients with ED were older (57.7±7.5 vs. 52.1±7.9 years, p < 0.001) and showed a longer duration of DM2 (9.0 vs. 3.0 years, p < 0.001), a poor metabolic control (HbA1c 7.2% vs. 6.3%) and higher systolic blood pressure (127.3 vs. 121.2 mmHg, p = 0.017) than patients without ED. No differences were found in lipid profile, body mass index or smoke habit. Independent factors for ED were age (RR 1.1, p = 0.003) and duration of diabetes (RR 1.1, p = 0.006). SMI was detected in 13.6% of patients (18.1% in patients with ED vs. 4.1% in patients without) and 90.5% of patients with SMI had ED. Conclusions: ED is highly prevalent in DM2, and is associated with the presence of SMI and higher systolic blood pressure. This fact points out the usefulness of ED as a marker of poor vascular prognosis in diabetic patients. 463 CHANGING ROLE OF THE “CARDIOVASCULAR RISK FACTOR PROFILE” IN ACUTE MYOCARDIAL INFARCTION R. Potluri. Imperial College London, Imperial College London, London, UK Introduction: Myocardial Infarction (MI) is the main cause of death in Europe and accounts for over 3 million deaths per year. Cardiovascular risk factors such as age, smoking, hypertension, high cholesterol, diabetes mellitus, and strong family history are used to predict MI. Clinical practice has focused on diagnosis and control of these factors. We hypothesied that increased awareness and government led primary care initiatives targeting cardiovascular risk factors has led to changing spectrum of patients presenting with acute MI. Methods: Anonymous information on acute MI patients attending a large multi-ethnic general hospital in Birmingham, UK in the period 2000–2007 was obtained. We looked at the change in the trends of patients presenting with acute MI according to demographics and co-morbidities. Results: Out of 12464 acute MI patients.71.1% Caucasian; 5.1% of South Asian; 0.7% Afro-Caribbean; In-hospital mortality of 11.5%. Divinding the 8-year period into 4 groups of two years, the prevalence of acute MI has halved in 2006−07 compared to 2000−01. The decrease was uniform amongst all ethnic groups except Afro-Caribbeans. Moreover, cardiovascular risk factor diagnosis has improved across all ethnic groups. Interestingly, 33% of these MI patients in the 2006−07 group compared to 17% in the 2000−01 group did not have any cardiovascular risk factor apart from age. Conclusion: Whilst clinical practice focusing on risk factor prevention seems to have resulted in halving the cases of MI, the risk factor spectrum of patients has changed and increasing proportions do not have traditional cardiovascular risk factors. 464 VARYING PROPORTIONS OF PERIPHERAL VASCULAR DISEASE INTERVENTIONS COMPARED WITH CORONARY VASCULAR DISEASE IN ENGLAND.IMPLICATIONS FOR THE AETIOPATHOLOGY OF ATHEROSCLEROSIS? N. Ahmad, C. Chan. Vascular Surgery, Wirral University NHS Foundation Trust, Wirral, UK Introduction: Lower limb peripheral vascular disease has the same underlying pathology and treatment modalities as coronary heart disease. There are no UK data describing the surgical interventions for atherosclerosis in the different arterial territories of ethnic groups. Aim: To describe the ratio of intervention for peripheral vascular disease (PVD) in relation to coronary heart disease (CHD) in different ethnic groups aged 50−84 living in England.
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Method: The combined rates of endovascular and elective surgical revascularisation for PVD and CHD were calculated using Hospital Episode Statistics (2003–2009) and the 2006 census estimate. The proportion of PVD interventions to CHD were calculated for the White British, South Asian and Black populations. Results: There were a total of 165 703 combined PVD treatments (133 632 endovascular 32 071 surgical) and 134 312 (29 465 endovascular 104 847 surgical) combined CHD interventions over the 6 year period (ratio of 1.2). White British females had nearly double the proportion of PVD intervention than their male counterparts (m=1.3 f=2.3). The proportion of PVD interventions was much lower in South Asians (m=0.3 f=0.2) compared with Blacks (m=0.9 f=1.2). Conclusion: The burden of atherosclerosis in different ethnic groups is resulting in an unequal distribution of intervention by arterial territory. The implication of these findings on the aetiopathology of atherosclerosis warrants further investigation. 465 ASSOCIATION OF THROMBOMODULIN GENE VARIANTS IN INDIAN PATIENTS WITH CORONARY ARTERY DISEASE (CAD) T. Ashavaid1 , S. Shah2 , C. Ponde3 , R. Rajani3 , R. Mankeshwar4 . 1 Biochemistry, 2 Research Laboratories, 3 Cardiology, 4 Research Department, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India Introduction: Coronary artery disease (CAD) is a major cause of mortality worldwide and is also a growing public health burden in India. The clinical complication of CAD is the rupture of atherosclerotic plaque followed by thrombosis, which leads to myocardial infarction. Thrombomodulin (TM), a membrane glycoprotein is an effective natural anticoagulant present on the endothelium. TM maintains a thromboresistant state by effectively regulating thrombin production which if unregulated can participate in progression of atherothrombosis. Further the TM genetic variants affect the thrombomodulin function and the thrombomodulin plasma levels. Objective: To study the association of Thrombomodulin gene variants in Indian patients with CAD. Material and Method: Blood samples were collected from 133 CAD cases and 133 age and gender matched controls. Genotyping of TM gene was carried out by PCR-SSCP technique. Results were validated by DNA sequencing. Plasma levels of TM were estimated by enzyme immunoassay. Results: SSCP analysis revealed the identification of 6 genetic variants in the samples screened. In younger subjects (49 yrs), the Ala455Val polymorphism was significantly (p-0.006) associated with CAD, increasing the risk of CAD by 3-fold. Furthermore in presence of smoking and alcohol consumption, the risk increases by 4.4-fold & 3.7-fold respectively. TM levels were found to be marginally higher in controls than cases. Conclusions: TM genetic variant Ala455Val predicts the risk of CAD in subjects 49 yrs thus it can be used as a potential candidate marker of CAD by cardiologist for the early screening of young asymptomatic Indian subjects. 466 IDENTIFICATION OF HAEMATOLOGICAL MARKERS ASSOCIATED WITH POOR OUTCOME IN PATIENTS WITH ACUTE CORONARY SYNDROME O. Merono, C. Garcia, M. Cladellas, L. Recasens, V. Bazan, N. Ribas, G. Rivas, A. Sainz, E. Valles, J. Bruguera. Hospital del Mar, Barcelona, Spain Introduction: Anemia is an independent predictor of poor outcome in the setting of an acute coronary syndrome (ACS). We aimed to identify other haematological markers of unfavorable prognosis in patients presenting with ACS. Methods: We prospectively included 174 ACS patients admitted during 2009 in our Coronary Care Unit. Hemoglobin (Hb) levels and other haematological parameters were assessed. We further compared the clinical outcome of patients presenting with anemia (Hb <13 or 12 g/dL in men or women, respectively) at admission as opposed to those who developed anemia during hospitalization. Results: A >5 mg/dl value of C-reactive Protein (CRP) was highly predictive of developing anemia during hospitalization (67% of cases without anemia and CRP >5 mg/dl developed it, p < 0.05). If anemia was identified at admission, a higher incidence of bleeding (21% vs. 4%) and in-hospital mortality (11.9% vs. 1%) was noted as compared to those patients who persisted without anemia throughout hospitalization; p < 0.05. During a median follow-up period of 3.15 months (0.26–6.72), anemia at admission was the only haematological parameter of higher cardiovascular morbidity and total mortality (RR 3; CI 95%: 1.1−8.0, p < 0.05). Developing anemia during hospitalization or >5 mg/dl value of CRP were associated with a non-significant trend toward presenting higher cardiovascular morbidity and total mortality (p = 0.13 and 0.14, respectively). Conclusions: Anemia at admission remains as the strongest haematological predictor of in- and out-hospital morbidity and mortality after an ACS. A >5 mg/dl value for CRP predicts the development anemia during hospitalization.
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
HDL-C. In subjects with metabolic syndrome (MetS), a high-risk population, while ADN was lower compared with non-MetS, only A2 (moderate drinker) retained adequate ADN, and the linear increase of HDL-C was blunted in A3 (heavy drinker). Conclusion: These results suggest that U-shaped relationship between alcohol consumption and risk of cardiovascular events is explained in part by change of adiponectin level rather than HDL-C. 462 ERECTILE DYSFUNCTION AS A SUBROGATE MARKER OF CORONARY ARTERY DISEASE 1 A. Hernandez-Mijares ´ , A. Jover2 , E. Sola´ 1 , C. Banuls ˜ 2 , K. Garc´ıa-Malpartida2 , M. Rocha2 , V.M. V´ıctor2 . 1 Endocrinology Unit, Hospital Universitario Dr. Peset, 2 Hospital Doctor Peset Research Foundation, Valencia, Spain Background and Objectives: Erectile dysfunction (ED) is highly prevalent among patients with cardiovascular risk factors (CVRF). As it usually precedes cardiovascular disease, it is considered a subrogate marker of subclinical cardiovascular disease. The aim of this study was to evaluate the presence of ED among type 2 diabetic (DM2) patients without clinical macroangiopathy, and to assess the association between ED and silent myocardial ischaemia (SMI) and other CVRF. Patients and Methods: 154 male patients with DM2 and without clinical evidence of cardiovascular disease were included. The presence of ED, SMI and other CVRF was evaluated. Results: Prevalence of ED was 68.2%. Patients with ED were older (57.7±7.5 vs. 52.1±7.9 years, p < 0.001) and showed a longer duration of DM2 (9.0 vs. 3.0 years, p < 0.001), a poor metabolic control (HbA1c 7.2% vs. 6.3%) and higher systolic blood pressure (127.3 vs. 121.2 mmHg, p = 0.017) than patients without ED. No differences were found in lipid profile, body mass index or smoke habit. Independent factors for ED were age (RR 1.1, p = 0.003) and duration of diabetes (RR 1.1, p = 0.006). SMI was detected in 13.6% of patients (18.1% in patients with ED vs. 4.1% in patients without) and 90.5% of patients with SMI had ED. Conclusions: ED is highly prevalent in DM2, and is associated with the presence of SMI and higher systolic blood pressure. This fact points out the usefulness of ED as a marker of poor vascular prognosis in diabetic patients. 463 CHANGING ROLE OF THE “CARDIOVASCULAR RISK FACTOR PROFILE” IN ACUTE MYOCARDIAL INFARCTION R. Potluri. Imperial College London, Imperial College London, London, UK Introduction: Myocardial Infarction (MI) is the main cause of death in Europe and accounts for over 3 million deaths per year. Cardiovascular risk factors such as age, smoking, hypertension, high cholesterol, diabetes mellitus, and strong family history are used to predict MI. Clinical practice has focused on diagnosis and control of these factors. We hypothesied that increased awareness and government led primary care initiatives targeting cardiovascular risk factors has led to changing spectrum of patients presenting with acute MI. Methods: Anonymous information on acute MI patients attending a large multi-ethnic general hospital in Birmingham, UK in the period 2000–2007 was obtained. We looked at the change in the trends of patients presenting with acute MI according to demographics and co-morbidities. Results: Out of 12464 acute MI patients.71.1% Caucasian; 5.1% of South Asian; 0.7% Afro-Caribbean; In-hospital mortality of 11.5%. Divinding the 8-year period into 4 groups of two years, the prevalence of acute MI has halved in 2006−07 compared to 2000−01. The decrease was uniform amongst all ethnic groups except Afro-Caribbeans. Moreover, cardiovascular risk factor diagnosis has improved across all ethnic groups. Interestingly, 33% of these MI patients in the 2006−07 group compared to 17% in the 2000−01 group did not have any cardiovascular risk factor apart from age. Conclusion: Whilst clinical practice focusing on risk factor prevention seems to have resulted in halving the cases of MI, the risk factor spectrum of patients has changed and increasing proportions do not have traditional cardiovascular risk factors. 464 VARYING PROPORTIONS OF PERIPHERAL VASCULAR DISEASE INTERVENTIONS COMPARED WITH CORONARY VASCULAR DISEASE IN ENGLAND.IMPLICATIONS FOR THE AETIOPATHOLOGY OF ATHEROSCLEROSIS? N. Ahmad, C. Chan. Vascular Surgery, Wirral University NHS Foundation Trust, Wirral, UK Introduction: Lower limb peripheral vascular disease has the same underlying pathology and treatment modalities as coronary heart disease. There are no UK data describing the surgical interventions for atherosclerosis in the different arterial territories of ethnic groups. Aim: To describe the ratio of intervention for peripheral vascular disease (PVD) in relation to coronary heart disease (CHD) in different ethnic groups aged 50−84 living in England.
99
Method: The combined rates of endovascular and elective surgical revascularisation for PVD and CHD were calculated using Hospital Episode Statistics (2003–2009) and the 2006 census estimate. The proportion of PVD interventions to CHD were calculated for the White British, South Asian and Black populations. Results: There were a total of 165 703 combined PVD treatments (133 632 endovascular 32 071 surgical) and 134 312 (29 465 endovascular 104 847 surgical) combined CHD interventions over the 6 year period (ratio of 1.2). White British females had nearly double the proportion of PVD intervention than their male counterparts (m=1.3 f=2.3). The proportion of PVD interventions was much lower in South Asians (m=0.3 f=0.2) compared with Blacks (m=0.9 f=1.2). Conclusion: The burden of atherosclerosis in different ethnic groups is resulting in an unequal distribution of intervention by arterial territory. The implication of these findings on the aetiopathology of atherosclerosis warrants further investigation. 465 ASSOCIATION OF THROMBOMODULIN GENE VARIANTS IN INDIAN PATIENTS WITH CORONARY ARTERY DISEASE (CAD) T. Ashavaid1 , S. Shah2 , C. Ponde3 , R. Rajani3 , R. Mankeshwar4 . 1 Biochemistry, 2 Research Laboratories, 3 Cardiology, 4 Research Department, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India Introduction: Coronary artery disease (CAD) is a major cause of mortality worldwide and is also a growing public health burden in India. The clinical complication of CAD is the rupture of atherosclerotic plaque followed by thrombosis, which leads to myocardial infarction. Thrombomodulin (TM), a membrane glycoprotein is an effective natural anticoagulant present on the endothelium. TM maintains a thromboresistant state by effectively regulating thrombin production which if unregulated can participate in progression of atherothrombosis. Further the TM genetic variants affect the thrombomodulin function and the thrombomodulin plasma levels. Objective: To study the association of Thrombomodulin gene variants in Indian patients with CAD. Material and Method: Blood samples were collected from 133 CAD cases and 133 age and gender matched controls. Genotyping of TM gene was carried out by PCR-SSCP technique. Results were validated by DNA sequencing. Plasma levels of TM were estimated by enzyme immunoassay. Results: SSCP analysis revealed the identification of 6 genetic variants in the samples screened. In younger subjects (49 yrs), the Ala455Val polymorphism was significantly (p-0.006) associated with CAD, increasing the risk of CAD by 3-fold. Furthermore in presence of smoking and alcohol consumption, the risk increases by 4.4-fold & 3.7-fold respectively. TM levels were found to be marginally higher in controls than cases. Conclusions: TM genetic variant Ala455Val predicts the risk of CAD in subjects 49 yrs thus it can be used as a potential candidate marker of CAD by cardiologist for the early screening of young asymptomatic Indian subjects. 466 IDENTIFICATION OF HAEMATOLOGICAL MARKERS ASSOCIATED WITH POOR OUTCOME IN PATIENTS WITH ACUTE CORONARY SYNDROME O. Merono, C. Garcia, M. Cladellas, L. Recasens, V. Bazan, N. Ribas, G. Rivas, A. Sainz, E. Valles, J. Bruguera. Hospital del Mar, Barcelona, Spain Introduction: Anemia is an independent predictor of poor outcome in the setting of an acute coronary syndrome (ACS). We aimed to identify other haematological markers of unfavorable prognosis in patients presenting with ACS. Methods: We prospectively included 174 ACS patients admitted during 2009 in our Coronary Care Unit. Hemoglobin (Hb) levels and other haematological parameters were assessed. We further compared the clinical outcome of patients presenting with anemia (Hb <13 or 12 g/dL in men or women, respectively) at admission as opposed to those who developed anemia during hospitalization. Results: A >5 mg/dl value of C-reactive Protein (CRP) was highly predictive of developing anemia during hospitalization (67% of cases without anemia and CRP >5 mg/dl developed it, p < 0.05). If anemia was identified at admission, a higher incidence of bleeding (21% vs. 4%) and in-hospital mortality (11.9% vs. 1%) was noted as compared to those patients who persisted without anemia throughout hospitalization; p < 0.05. During a median follow-up period of 3.15 months (0.26–6.72), anemia at admission was the only haematological parameter of higher cardiovascular morbidity and total mortality (RR 3; CI 95%: 1.1−8.0, p < 0.05). Developing anemia during hospitalization or >5 mg/dl value of CRP were associated with a non-significant trend toward presenting higher cardiovascular morbidity and total mortality (p = 0.13 and 0.14, respectively). Conclusions: Anemia at admission remains as the strongest haematological predictor of in- and out-hospital morbidity and mortality after an ACS. A >5 mg/dl value for CRP predicts the development anemia during hospitalization.