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553 EFFECTS OF TREADMILL TRAINING ON WALKING DISTANCE AND ENDOTHELIAL FUNCTION IN PATIENTS WITH INTERMITTENT CLAUDICATION
79th EAS Congress
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
status (Young Finns: 9.2% vs.8.6%, P = 0.003; CDAH: 7.2% vs.3.8%, P = 0.02), but not mother’s smoking status (Young Finns: 9.0% vs.8.7%, P = 0.34; CDAH: 7.2% vs.5.4%, P = 0.44) was associated with adult FMD. Conclusions: Parental smoking in youth is associated with reduced FMD in young adulthood measured over 20-years later. Our data lend support toward initiatives to reduce youth’s exposure to second-hand tobacco smoke. 550 ECCENTRIC ENDURANCE EXERCISE ECONOMICALLY IMPROVES GLUCOSE TOLERANCE M. Zeppetzauer1 , C.H. Saely1,2,3 , P. Rein1,2,3 , A. Vonbank1,2,3 , H. Drexel1,2,3,4 . 1 VIVIT Institute, 2 Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria, 3 Private University of the Principality of Liechtenstein, Triesen, Liechtenstein, 4 Drexel University College of Medicine, Philadelphia, PA, USA Background: The interplay of muscle contraction with an external force can result in one of three types of muscle activity: shortening or “concentric” when muscle contraction is stronger than the external force; lengthening or “eccentric” when the external force is stronger; and isometric when both forces are equal. Effects od eccentric exercise on glucose metabolism are unclear. Methods: We randomly allocated 45 healthy sedentary individuals (16 men and 29 women, mean age 48 years) to one of two groups, one beginning with two months of hiking upwards, the other with two months of hiking downwards the same route, with a crossover for two months. For the opposite way, a cable car was used; the distance was covered three to five times a week. Standard oral glucose tolerance tests were performed at baseline and after the two months periods of eccentric and concentric exercise, respectively; the area under the glucose curve was used as a measure of glucose tolerance. Results: Both eccentric and concentric endurance exercise significantly improved glucose tolerance versus baseline (by 4.1%;p = 0.136 and 6.2%;p = 0.023, respectively). Of note, adjustment for energy expenditure per exercise unit (127±22 kcal/unit with eccentric and 442±78 kcal/unit with concentric exercise) revealed a significantly greater improvement of glucose tolerance per kcal spent with eccentric than with concentric exercise (0.1123 mg.h.dl-1 .kcal-1 versus 0.0245 mg.h.dl-1 .kcal-1 ; p = 0.038). Conclusion: We conclude that eccentric endurance exercise economically improves glucose tolerance. It therefore is a promising new exercise modality for individuals who are not able to participate in more strenuous exercise regimens. 551 EFFECT OF BODY MASS INDEX ON ISCHAEMIC HEART DISEASE RISK: OBSERVATIONAL AND CAUSAL ESTIMATES ON 76000 INDIVIDUALS B.G. Nordestgard1 , T.M. Palmer2 , M. Benn1 , J. Zacho1 , A. Tybjærg-Hansen3 , G. Davey Smith2 , N.J. Timpson2 . 1 University of Copenhagen, Herlev, Denmark, 2 University of Bristol, Bristol, UK, 3 University of Copenhagen, Copenhagen, Denmark Background: We tested the hypothesis that known positive observational relationships between body mass index (BMI) and ischaemic heart disease (IHD) are causal. Methods: In two general population studies (the Copenhagen General Population Study (CGPS; n = 54613 [3780 IHD]) and the Copenhagen City Heart Study (CCHS; n = 10474 [2006 IHD]) we measured BMI and genotyped FTO (rs9939609), MC4R (rs17782313), and TMEM18 (rs6548238). We also genotyped the Copenhagen Ischaemic Heart Disease Study (CIHDS; n = 10540 [5270 IHD]). An allele score across the three genotypes was an instrumental variable for BMI. In all studies, IHD was diagnosed from 1976 though 2009, and follow-up was 100% complete. Results: In the general population, for a 4kg/m2 increase in BMI the observational odds ratios for IHD were 1.23 (95% CI: 1.19, 1.28) for the CGPS, 1.31 (95% CI: 1.23, 1.39) for the CCHS, and 1.26 (95% CI: 1.19, 1.34) for these studies combined. Each additional adiposity related allele from the allele score was associated with a 0.07 (95% CI: 0.05, 0.09) increase in standardised BMI and an odds ratio for IHD of 1.03 (95% CI: 1.01, 1.05). Instrumental variable analysis using the allele score estimated causal IHD odds ratios for a 4kg/m2 increase in BMI of 1.31 (95% CI: 0.76, 2.26) in the CGPS, 2.11 (95% CI: 1.05, 4.24) in the CCHS, 1.46 (95% CI: 0.96, 2.24) in the CIHDS, and 1.52 (95% CI: 1.12, 2.05) for these studies combined. Conclusions: For every 4kg/m2 increase in BMI, observational estimates suggested a 26% increase in risk of IHD. Causal estimates derived using genotypes reliably associated with BMI are largely free of confounding and reverse causation. These suggest that a 4kg/m2 BMI increase confers a 52% increase in risk of IHD.
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552 EFFECT OF AN ADHERENCE PROGRAMME ON CARDIOVASCULAR EVENTS IN HIGH-RISK PATIENTS WITH HYPERCHOLESTEROLEMIA 1,2 Ja. Muller-Nordhorn ¨ , H. Englert3 , K. Wegscheider4 , H. Voller ¨ 5 , F. Sonntag6 , W. Meyer-Sabellek1 , E. Windler7 , H.A. Katus8 , S.N. Willich1 . 1 Institute for Social Medicine, Epidemiology and Health Economics, 2 Berlin School of 4 Public Health, Berlin, 3 University of Applied Sciences, Munster, ¨ Department of Medical Biometry and Epidemiology, Hamburg, 5 Klinik am See, Rudersdorf, ¨ 6 Cardiology Practice, Henstedt-Ulzburg, 7 University Medical Center Hamburg-Eppendorf, Hamburg, 8 Department of Cardiology, Heidelberg, Germany Objective: Adherence to statin therapy is insufficient in patients with hypercholesterolemia. The objective of the study was to assess the effect of an adherence programme on cardiovascular events. Methods: In the ORBITAL (Open-label primary care study: Rosuvastatin-Based compliance Initiatives linked To Achievement of LDL goals) Study, patients were included with an indication for statin therapy according to the Joint European Guidelines. Patients were enrolled consecutively in 1961 primary care practices. The adherence programme included health education material and telephone calls in regular intervals. Cardiovascular events were defined as myocardial infarction, stroke, or revascularisation during the 3-year follow-up. Health-related quality of life was assessed with the visual analogue scale (VAS). Results: A total of 7640 patients were included, with 6.4% having at least one cardiovascular event during follow-up. There was no significant difference in events between intervention and control group (relative risk [RR] 1.1, 95% confidence interval [CI] 0.9−1.3). After adjustment for age, sex and baseline cardiovascular risk, risk of event was significantly and inversely associated with VAS scores (RR per unit increase 0.99; 95% CI 0.98–0.99) and smoking status (never vs. yes) (RR 0.73; 95% CI 0.53–0.98). Conclusion: The adherence programme did not have an effect on cardiovascular events in patients with hypercholesterolemia. Health-related quality of life was a major predictor for recurrent clinical events event after adjustment for baseline risk. The importance of smoking prevention needs to be emphasized. 553 EFFECTS OF TREADMILL TRAINING ON WALKING DISTANCE AND ENDOTHELIAL FUNCTION IN PATIENTS WITH INTERMITTENT CLAUDICATION R.A. Januszek1 , P. Mika2 , A. Konik2 , R. Nowobilski2 , R. Ni˙zankowski1 , A. Szczeklik1 . 1 Internal Medicine, Jagiellonian University School of Medicine, 2 Departament of Clinical Rehabilitation, University School of Physical ´ Poland Education, Krakow, Introduction: Regular treadmill training reduces ischemic symptoms and improves walking ability in patients with claudication. While benefits of an exercise training are recognized, the mechanisms involved are not completely appreciated. The improvement in endothelial function may be one of the mechanisms leading to increase in walking abilities. The aim of this study was to assess the effect of treadmill training on endothelial function and walking abilities in patients with claudication. Methods: Thirty five patients aged 55−75 yrs with stable intermittent claudication participated for 3 months, 3 times a week in supervised treadmill training. Changes in FMD (flow mediated dilatation) and treadmill walking performance (pain-free walking time, maximal walking time) were assessed before the study and after 12 weeks. Each time FMD was assessed at rest and after treadmill test to maximal claudication pain. Results: After 12 weeks of treadmill training, FMD significantly increased at rest (53.7%), (p < 0.001) and after treadmill test (47.7%), (p < 0.001). Pain-free walking time was prolonged by 93% (p < 0.001) and maximal walking time by 97% (p < 0.001). No changes in FMD were seen after treadmill test both at the beginning and after 12 weeks. Conclusion: A significant improvement of walking ability over 12 weeks of treadmill training parallels with significant improvement of endothelial function in patients with claudication. 554 WAIST CIRCUNFERENCE AND VASCULAR ALTERATIONS IN YOUNG MEN R. Toro1 , D. Biedma1 , P. Gomez1 , I. Tinoco1 , C. Rodriguez1 , M. Virseda1 , A. Mangas1,2 . 1 Medicine, 2 Cadiz University, Cadiz, Spain Waist circumference (WC) is a measure of upper body fat and should be useful for identifying overweight and obese men at risk of developing metabolic complications. Radial artery applanation tonometry (AT) is a non invasive, reproducible and affordable technology that can be used in conjunction with peripheral obtained blood pressure (BP) to guide patients management. A trove of information can be gleamed from the shape, amplitude and duration of the waveform tha provides insights into the diagnosis and management of many diseases states. Objective: To determinate the possible association between early vascular abnormalities and the WC.
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
status (Young Finns: 9.2% vs.8.6%, P = 0.003; CDAH: 7.2% vs.3.8%, P = 0.02), but not mother’s smoking status (Young Finns: 9.0% vs.8.7%, P = 0.34; CDAH: 7.2% vs.5.4%, P = 0.44) was associated with adult FMD. Conclusions: Parental smoking in youth is associated with reduced FMD in young adulthood measured over 20-years later. Our data lend support toward initiatives to reduce youth’s exposure to second-hand tobacco smoke. 550 ECCENTRIC ENDURANCE EXERCISE ECONOMICALLY IMPROVES GLUCOSE TOLERANCE M. Zeppetzauer1 , C.H. Saely1,2,3 , P. Rein1,2,3 , A. Vonbank1,2,3 , H. Drexel1,2,3,4 . 1 VIVIT Institute, 2 Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria, 3 Private University of the Principality of Liechtenstein, Triesen, Liechtenstein, 4 Drexel University College of Medicine, Philadelphia, PA, USA Background: The interplay of muscle contraction with an external force can result in one of three types of muscle activity: shortening or “concentric” when muscle contraction is stronger than the external force; lengthening or “eccentric” when the external force is stronger; and isometric when both forces are equal. Effects od eccentric exercise on glucose metabolism are unclear. Methods: We randomly allocated 45 healthy sedentary individuals (16 men and 29 women, mean age 48 years) to one of two groups, one beginning with two months of hiking upwards, the other with two months of hiking downwards the same route, with a crossover for two months. For the opposite way, a cable car was used; the distance was covered three to five times a week. Standard oral glucose tolerance tests were performed at baseline and after the two months periods of eccentric and concentric exercise, respectively; the area under the glucose curve was used as a measure of glucose tolerance. Results: Both eccentric and concentric endurance exercise significantly improved glucose tolerance versus baseline (by 4.1%;p = 0.136 and 6.2%;p = 0.023, respectively). Of note, adjustment for energy expenditure per exercise unit (127±22 kcal/unit with eccentric and 442±78 kcal/unit with concentric exercise) revealed a significantly greater improvement of glucose tolerance per kcal spent with eccentric than with concentric exercise (0.1123 mg.h.dl-1 .kcal-1 versus 0.0245 mg.h.dl-1 .kcal-1 ; p = 0.038). Conclusion: We conclude that eccentric endurance exercise economically improves glucose tolerance. It therefore is a promising new exercise modality for individuals who are not able to participate in more strenuous exercise regimens. 551 EFFECT OF BODY MASS INDEX ON ISCHAEMIC HEART DISEASE RISK: OBSERVATIONAL AND CAUSAL ESTIMATES ON 76000 INDIVIDUALS B.G. Nordestgard1 , T.M. Palmer2 , M. Benn1 , J. Zacho1 , A. Tybjærg-Hansen3 , G. Davey Smith2 , N.J. Timpson2 . 1 University of Copenhagen, Herlev, Denmark, 2 University of Bristol, Bristol, UK, 3 University of Copenhagen, Copenhagen, Denmark Background: We tested the hypothesis that known positive observational relationships between body mass index (BMI) and ischaemic heart disease (IHD) are causal. Methods: In two general population studies (the Copenhagen General Population Study (CGPS; n = 54613 [3780 IHD]) and the Copenhagen City Heart Study (CCHS; n = 10474 [2006 IHD]) we measured BMI and genotyped FTO (rs9939609), MC4R (rs17782313), and TMEM18 (rs6548238). We also genotyped the Copenhagen Ischaemic Heart Disease Study (CIHDS; n = 10540 [5270 IHD]). An allele score across the three genotypes was an instrumental variable for BMI. In all studies, IHD was diagnosed from 1976 though 2009, and follow-up was 100% complete. Results: In the general population, for a 4kg/m2 increase in BMI the observational odds ratios for IHD were 1.23 (95% CI: 1.19, 1.28) for the CGPS, 1.31 (95% CI: 1.23, 1.39) for the CCHS, and 1.26 (95% CI: 1.19, 1.34) for these studies combined. Each additional adiposity related allele from the allele score was associated with a 0.07 (95% CI: 0.05, 0.09) increase in standardised BMI and an odds ratio for IHD of 1.03 (95% CI: 1.01, 1.05). Instrumental variable analysis using the allele score estimated causal IHD odds ratios for a 4kg/m2 increase in BMI of 1.31 (95% CI: 0.76, 2.26) in the CGPS, 2.11 (95% CI: 1.05, 4.24) in the CCHS, 1.46 (95% CI: 0.96, 2.24) in the CIHDS, and 1.52 (95% CI: 1.12, 2.05) for these studies combined. Conclusions: For every 4kg/m2 increase in BMI, observational estimates suggested a 26% increase in risk of IHD. Causal estimates derived using genotypes reliably associated with BMI are largely free of confounding and reverse causation. These suggest that a 4kg/m2 BMI increase confers a 52% increase in risk of IHD.
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552 EFFECT OF AN ADHERENCE PROGRAMME ON CARDIOVASCULAR EVENTS IN HIGH-RISK PATIENTS WITH HYPERCHOLESTEROLEMIA 1,2 Ja. Muller-Nordhorn ¨ , H. Englert3 , K. Wegscheider4 , H. Voller ¨ 5 , F. Sonntag6 , W. Meyer-Sabellek1 , E. Windler7 , H.A. Katus8 , S.N. Willich1 . 1 Institute for Social Medicine, Epidemiology and Health Economics, 2 Berlin School of 4 Public Health, Berlin, 3 University of Applied Sciences, Munster, ¨ Department of Medical Biometry and Epidemiology, Hamburg, 5 Klinik am See, Rudersdorf, ¨ 6 Cardiology Practice, Henstedt-Ulzburg, 7 University Medical Center Hamburg-Eppendorf, Hamburg, 8 Department of Cardiology, Heidelberg, Germany Objective: Adherence to statin therapy is insufficient in patients with hypercholesterolemia. The objective of the study was to assess the effect of an adherence programme on cardiovascular events. Methods: In the ORBITAL (Open-label primary care study: Rosuvastatin-Based compliance Initiatives linked To Achievement of LDL goals) Study, patients were included with an indication for statin therapy according to the Joint European Guidelines. Patients were enrolled consecutively in 1961 primary care practices. The adherence programme included health education material and telephone calls in regular intervals. Cardiovascular events were defined as myocardial infarction, stroke, or revascularisation during the 3-year follow-up. Health-related quality of life was assessed with the visual analogue scale (VAS). Results: A total of 7640 patients were included, with 6.4% having at least one cardiovascular event during follow-up. There was no significant difference in events between intervention and control group (relative risk [RR] 1.1, 95% confidence interval [CI] 0.9−1.3). After adjustment for age, sex and baseline cardiovascular risk, risk of event was significantly and inversely associated with VAS scores (RR per unit increase 0.99; 95% CI 0.98–0.99) and smoking status (never vs. yes) (RR 0.73; 95% CI 0.53–0.98). Conclusion: The adherence programme did not have an effect on cardiovascular events in patients with hypercholesterolemia. Health-related quality of life was a major predictor for recurrent clinical events event after adjustment for baseline risk. The importance of smoking prevention needs to be emphasized. 553 EFFECTS OF TREADMILL TRAINING ON WALKING DISTANCE AND ENDOTHELIAL FUNCTION IN PATIENTS WITH INTERMITTENT CLAUDICATION R.A. Januszek1 , P. Mika2 , A. Konik2 , R. Nowobilski2 , R. Ni˙zankowski1 , A. Szczeklik1 . 1 Internal Medicine, Jagiellonian University School of Medicine, 2 Departament of Clinical Rehabilitation, University School of Physical ´ Poland Education, Krakow, Introduction: Regular treadmill training reduces ischemic symptoms and improves walking ability in patients with claudication. While benefits of an exercise training are recognized, the mechanisms involved are not completely appreciated. The improvement in endothelial function may be one of the mechanisms leading to increase in walking abilities. The aim of this study was to assess the effect of treadmill training on endothelial function and walking abilities in patients with claudication. Methods: Thirty five patients aged 55−75 yrs with stable intermittent claudication participated for 3 months, 3 times a week in supervised treadmill training. Changes in FMD (flow mediated dilatation) and treadmill walking performance (pain-free walking time, maximal walking time) were assessed before the study and after 12 weeks. Each time FMD was assessed at rest and after treadmill test to maximal claudication pain. Results: After 12 weeks of treadmill training, FMD significantly increased at rest (53.7%), (p < 0.001) and after treadmill test (47.7%), (p < 0.001). Pain-free walking time was prolonged by 93% (p < 0.001) and maximal walking time by 97% (p < 0.001). No changes in FMD were seen after treadmill test both at the beginning and after 12 weeks. Conclusion: A significant improvement of walking ability over 12 weeks of treadmill training parallels with significant improvement of endothelial function in patients with claudication. 554 WAIST CIRCUNFERENCE AND VASCULAR ALTERATIONS IN YOUNG MEN R. Toro1 , D. Biedma1 , P. Gomez1 , I. Tinoco1 , C. Rodriguez1 , M. Virseda1 , A. Mangas1,2 . 1 Medicine, 2 Cadiz University, Cadiz, Spain Waist circumference (WC) is a measure of upper body fat and should be useful for identifying overweight and obese men at risk of developing metabolic complications. Radial artery applanation tonometry (AT) is a non invasive, reproducible and affordable technology that can be used in conjunction with peripheral obtained blood pressure (BP) to guide patients management. A trove of information can be gleamed from the shape, amplitude and duration of the waveform tha provides insights into the diagnosis and management of many diseases states. Objective: To determinate the possible association between early vascular abnormalities and the WC.