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564 LOW BONE MINERAL DENSITY IS NOT ASSOCIATED WITH CORONARY ATHEROSCLEROSIS IN PATIENTS WITH TYPE 2 DIABETES
79th EAS Congress
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
Conclusion: A home-based walking intervention may improve onset to pain distance and may be more relevant for patients with diabetes mellitus and PAD who are limited by deconditioning. 560 OBJECTIVELY MEASURED DAILY PHYSICAL ACTIVITY RELATED TO BODY FAT IN YOUNG CHILDREN M. Dencker1 , O. Thorsson1 , M.K. Karlsson2 , C. Linden ´ 2 , L.B. Andersen3 . 1 Unit of Clinical Physiology and Nuclear Medicin, 2 Clinical and Molecular ˚ Osteoporosis Research Unit, Skane University Hospital, Lund University, ¨ Sweden, 3 Center for Research in Childhood Health, Institute of Sport Malmo, Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Introduction: Lack of physical activity has been hypothesised to be a factor for childhood obesity. We assessed if different measures of physical activity is related to body fat in children aged 8 to 11 years. Methods: Cross-sectional study of 226 children (125 boys and 101 girls), recruited from a population-based cohort. Accelerometer measured minutes of light physical activity (LPA), moderate and vigorous physical activity (MVPA) and vigorous physical activity (VPA) per day were assessed. Total body fat mass was measured by a DXA scan, and expressed as percentage of body mass (BF%). Skewed distributions were normalised by natural logarithm. Results: Boys performed significantly more minutes of LPA, MVPA and VPA per day compared to girls (LPA; 165±36 vs. 156±30, MVPA; 46±20 vs. 35±13 and VPA; 15±10 vs. 11±7, all P < 0.05). Girls had higher BF% than boys (22±9 vs. 16±9, P < 0.05). Pearson correlation indicated a significant association between MVPA and VPA versus BF%. In boys r = −0.29 and −0.32, and in girls r = −0.38 and −0.47, all P < 0.05. LPA was not related to BF%, all NS. Conclusions: In this population-based cohort of children minutes of MVPA and VPA per day were related to amount of body fat in both boys and girls, whereas minutes of LPA was not. Longitudinal studies are warranted to establish cause and effect. 561 THE EFFECT OF AEROBIC EXERCISE TRAINING ON ENDOTHELIN-1 CONCENTRATION IN OLD WOMEN V. Boghrabadi, S. Nejatpour, A. Baghi. Islamic Azad University, Shirvan Branch, Shirvan, Iran Endothelial function deteriorates with aging. On the other hand, exercise training improves the function of vascular endothelial cells. Endothelin-1 (ET-1), which is produced by vascular endothelial cells, is a potent constrictor and therefore, has been implicated in regulation of vascular tonus and progression of atherosclerosis. hypothesized that plasma ET-1 concentration increases with age, even in healthy adults, and that lifestyle modification (i.e., exercise) can reduce plasma ET-1 concentration in previously sedentary old adults. measured plasma ET-1 concentration in healthy young (21−28 yr old), healthy middleaged (31−47 yr old), and healthy old (61−69 yr old) women. The plasma level of ET-1 increased significantly with aging (1.02±0.08, 1.33±0.11, and 2.90±0.20 pg/ml in young, middle-aged, and old women, respectively). Thus plasma ET-1 concentration was markedly higher in healthy old women than in healthy young or middle-aged women (by 3- and 2-fold, respectively). In healthy old women, we also measured plasma ET-1 concentration after 3 month of aerobic exercise (cycling on a leg ergometer at 80% of HRR for 30 min, 5 days/wk). Regular exercise significantly decreased plasma ET-1 concentration in the healthy old women (2.22±0.16 pg/ml, P < 0.01) and also significantly reduced their blood pressure. The present study suggests that regular aerobic-endurance exercise reduces plasma ET-1 concentration in old humans, and this reduction in plasma ET-1 concentration may have beneficial effects on the cardiovascular system (i.e., prevention of progression of hypertension and/or atherosclerosis by endogenous ET-1). 562 DEMANDS AND HEART RATE VARIABILITY IN DANISH WHITE-COLLAR WORKERS N. Eller1 , M. Blønd2 , M. Nielsen1 , J. Kristiansen3 , B. Netterstrøm1 . 1 Bispebjerg Hospital, Copenhagen, 2 Nykøbing Falster Hospital, Nykøbing Falster, 3 National Reserach Centre of the Working Environment, Copenhagen, Denmark Introduction: Changes in the autonomous nervous system might be a part of the pathophysiological pathway leading from psychosocial stress to ischemic heart disease (IHD). The current study analyzed the relationship between demands measured in different manners and heart rate variability (HRV) measured at baseline and again, two years later. Demands were measured as quantitative demands, cognitive demands, tempo demands, and weekly working hours. Methods: In 2006 and 2008, measurements of HRV during rest were obtained from 231 participants. The associations between the various demands variables, and HRV were examined using a series of mixed effects models. The dependent variables were the logarithmically transformed levels total power (lnTP), high frequency power (lnHF), and the ratio between low and high frequency power (lnLF/HF). Gender and year of measurement was included as factors, whereas age, time of measurement and physical activity (measured
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in four categories) were included as covariates. Subject was included as a random effect. Results: Weekly working hours and quantitative demands were significantly associated with decreased TP, and cognitive demands was nearly significantly associated with decreased TP. Neither HF nor LF/HF were associated with the psychosocial factors. In all models, age was significantly and negatively associated with TP, whereas physical activity was significantly and positively associated with TP. Conclusion: HRV, especially in the form of TP, was associated with age and physical activity but also with various estimates of workload (weekly working hours and quantitative demands). 563 COST EFFICACY IN HOSPITALIZED PATIENTS WITH DIABETES IS RELATIVE TO TREATMENT DECISION MAKING AND CLINICAL OUTCOME C. Voulgari, S. Paximadas, N. Tentolouris. First Department of Propaedeutic Internal Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece Introduction: Changes in medical practice have intensified efforts for clinical efficacy and one of the tools to achieve this is near-patient testing. The fragile equilibrium between technological capabilities and cost-efficacy is often underestimated. The aim of this study was to determine the reliability of pointof-care testing glucose meters among hospitalized diabetic patients. This study compared the accuracy and precision of point-of-care blood glucose (BG) meters. Methods: Diabetic patients undergoing venipuncture for glucose testing were randomized to one of the following BG meters: Accu-Chek Aviva (Roche/Diagnostics), Precision (Abbott/Diagnostics) and Glucotech (Menarini/Diagnostics). Within 5-min following venipuncture, duplicate ipsilateral finger measurements were taken. Finger BG values were compared with laboratory reference values. Meter precision was determined by calculating the absolute mean differences in BG between duplicate samples. Results: Finger sticks were obtained from 600 patients. Mean (±SD) venipuncture BGM was 148±64 mg/dL. Meter accuracy using the 10% criteria was demonstrated in 70%, 58%, and 46% of the samples, respectively. When compared with laboratory reference BGM values, Accu-chek-Aviva scored the highest coefficient correlation (r = 0.75, P = 0.01); no significant correlations were observed between laboratory BG values and those obtained with Glucotech or Precision devices. Using laboratory reference values hyperglycemia (>250 mg/dL) was incorrectly diagnosed in 11% of patients, whereas hypoglycemia (<50 mg/dL) in 25%. Conclusions: In hospitalized diabetic patients, BGM measurements obtained with different glucose meters are often unreliable and higher than the actual glucose values. This results in over diagnosed hyperglycemia and the incorrect administration of insulin or underdiagnosed hypoglycemia in everyday clinical practice. 564 LOW BONE MINERAL DENSITY IS NOT ASSOCIATED WITH CORONARY ATHEROSCLEROSIS IN PATIENTS WITH TYPE 2 DIABETES S. Beer1,2,3 , C.H. Saely1,2,3 , G. Hoefle4 , A. Vonbank1,2,3 , P. Rein1,2,3 , A. Muendlein1,3 , H. Drexel1,2,3,5 . 1 VIVIT Institute, 2 Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria, 3 Private University of the Principality of Liechtenstein, Triesen, Liechtenstein, 4 Internal Medicine, Hospital Hohenems, Hohenems, Austria, 5 Drexel University College of Medicine, Philadelphia, PA, USA Background: The association between low bone mass and angiographically determined coronary atherosclerosis is unclear, this especially holds true for patients with type 2 diabetes (T2DM). Methods: We enrolled 978 consecutive patients, 254 (26.0%) with T2DM and 724 (74.0%) nondiabetic subjects who were undergoing coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD). Bone mineral density (BMD) was assessed by dual X-ray absorptiometry; significant CAD was diagnosed in the presence of coronary stenoses with lumen narrowing 70%. Results: Of the total study cohort (63.7% men; mean age 65±11 years) 35.7% (n = 349) had osteopenia and 14.0% (n = 137) had osteoporosis. Significant CAD was present in 44.5% (n = 435) of our patients. In patients with T2DM the prevalence of significant CAD did not differ significantly between patients with normal BMD, osteopenia or osteoporosis (42.9%, 37.4% and 45.4%; ptrend =0.251). Concordantly, neither osteopenia nor osteoporosis were significantly associated with the presence of significant CAD after multivariate adjustment (adjusted ORs 1.09 [95% CI 0.62–1.92], p = 0.118 and 1.05 [0.45– 2.46], p = 0.913, respectively). In non-diabetic subjects results were similar: The prevalence of significant CAD did not differ significantly between patients with normal BMD, osteopenia or osteoporosis (42.9%, 37.4% and 45.4%; ptrend =0.251) and no association between the presence of osteopenia or osteoporosis and significant CAD was observed after multivariate adjustment
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(OR 0.83 [95% CI 0.59–1.17], p = 0.292 and 1.27 [0.79–2.04], p = 0.319, respectively). Conclusion: We conclude that BMD neither among patients with T2DM nor among non-diabetic subjects is associated with angiographically determined coronary atherosclerosis. 565 IMPACT OF ACCULTURATION ON CORONARY ARTERY DISEASE IN THE SOUTH ASIAN IMMIGRANTS − UNIQUE POPULATION WITH INCREASED RISK S. Dodani1 , L. Dong2 . 1 Internal Medicine, University of Kansas, Leawood, 2 University of Kansas Medical Center, Kansas City, KS, USA Although differences in coronary artery disease (CAD) risk factors between immigrants and non-immigrants have been examined previously; the effect of acculturation on CAD risk factors in immigrants has not been fully studied less well studied. This study aim is to measure the level of acculturation and its association with CAD and other factors, including Type 2 Diabetes (T2D) in South Asian immigrants (SAIs). Methods: Using an epidemiologic study design, 161 SAIs between the ages of 35−65 years were randomly recruited from the States of Georgia, Kansas and Missouri. CAD markers and common carotid artery intima media thickness (CCA-IMT) were assessed. Scaled (The Suinn-Lew Asian SelfIdentity Acculturation scale-SL-ASIA Scale) and non-scaled (10 years stay in the US) methods were used to measure the acculturation status. Results: Of the total sample, 67.7% were identified to have high acculturation. On the logistic regression model, 10 years stay in the US (p = 0.0068), cholesterol level 200 mg/dl (p = 0.0002), BMI 23 (p = 0.0044) and family history of CAD (p = 0.0078) were found to be independent predictors of CAD. Similar results were seen with T2D as an outcome. Those with high CAD had 2.11 (CI: 1.32, 6.68) odds of having total cholesterol 200 mg/dl compared to those without CAD. Conclusions: Acculturation plays a major role in predisposing immigrant population to CAD. There is need for developing tools that consider acculturation as a predictor for CAD. Further studies that test tailored strategies to improve lifestyle behaviors across diverse racial/ethnic groups are needed. 566 LIVING ALONE AND PERMANENT DISABILITY ARE ASSOCIATED WITH POOR PROGNOSIS AFTER ELECTIVE PCI O. Shakhmatova, A. Komarov, E. Panchenko. Russian Cardiology Research-and-Production Complex, Moscow, Russia Although the incidence and mortality of CAD are known to be related to socioeconomic factors, the relationship between socioeconomic factors and prognosis after elective PCI has been little-studied. Objective: To examine associations between basic socioeconomic factors (education level, employment, living alone) and prognosis after elective PCI. Methods: A total of 264 (213 male, age 58.8±1.0 years) patients with stable CAD who had undergone elective PCI were studied. Socioeconomic data were collected by medical chart review. An 18-months follow-up evaluation was conducted by office visit and telephone interview. Composite end point consists of death, nonfatal MI, unstable angina, stroke, TIA and need for coronary revascularization. Hazard ratios (HRs) were estimated from Cox proportional hazard models. Results: The composite endpoint was observed in 18.2% of patients. Living alone and any reason permanent disability were significantly associated with incidence of the composite endpoint. After adjustment for age, sex, conventional risk factors and main coronary morphologic factors, the risk of developing composite endpoint for those who lived alone at baseline compared with those who did not live alone was 8.4 (95% confidence interval (CI), 3.4–20.5), p = 0.0001; permanent disability also had impact on composite endpoint rate (HR 14.2 (95% CI 4.4–45.8), p = 0.0001). Education level had no affects on prognosis after PCI. Conclusion: Living alone and permanent disability are independent predictors of prognosis after elective PCI. 567 TOTAL BODY FAT AND ABDOMINAL FAT RELATED TO COMPOSITE RISK FACTOR SCORE FOR CVD IN YOUNGER CHILDREN M. Dencker1 , O. Thorsson1 , M.K. Karlsson2 , C. Linden ´ 2 , P. Wollmer1 , L.B. Andersen3 . 1 Unit of Clinical Physiology and Nuclear Medicin, 2 Clinical ˚ and Molecular Osteoporosis Research Unit, Skane University Hospital, Lund ¨ Sweden, 3 Center for Research in Childhood Health, University, Malmo, Institute of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Introduction: Obesity is associated with increased risk of cardiovascular disease (CVD) in adults. We analysed if total body fat and abdominal fat are related to composite risk factor score for CVD in younger children. Methods: Cross-sectional study of 243 (136 boys and 107 girls) children aged 8−11 years, recruited from a population-based cohort. Total fat and abdominal fat mass (AFM) were measured by DXA, total body fat was expressed as percentage of body weight (BF%). Maximal oxygen uptake (VO2PEAK ) was
Poster presentations
measured during maximal exercise test. Systolic and diastolic blood pressure (SBP, DBP), and resting heart rate (HR) were measured. Mean artery pressure (MAP) and pulse pressure (PP) were calculated. Echocardiography was performed and left ventricular mass (LVM) was calculated. Z-scores (Value for the individual-mean value for group)/SD were calculated. Sum of z-scores for SBP, DBP, MAP, PP, HR, LVM, and -VO2PEAK were calculated in boys and girls, separately, and used as composite risk factor score. Results: Mean BF% was 18.8±9.2% and mean AFM 2.8±2.3 kg. Pearson correlations between ln BF% and ln AFM versus composite risk factor score were for boys (r = 0.52, and r = 0.55, both P < 0.05), for girls (r = 0.36 and 0.43, both P < 0.05). Boys and girls were divided according to quartiles of BF% and AFM. One-way ANOVA analysis indicated significant differences in composite risk factor score between the different quartiles of BF% or AFM (all, P= < 0.001). Conclusion: Total body fat and abdominal fat are associated with elevated composite risk factor score for CVD in younger children. 568 BODY MASS INDEX AND WAIST CIRCUMFERENCE AS PREDICTORS OF THE INCIDENCE OF TYPE 2 DIABETES AMONG ANGIOGRAPHIED CORONARY PATIENTS C.H. Saely1,2,3 , P. Rein1,2,3 , A. Vonbank1,2,3 , S. Beer1,2,3 , C. Boehnel1,2,3 , S. Greber1 , 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 prevalence of diabetes among angiographied coronary patients is high, but no data are available on the incidence of diabetes in this clinically important patient population. In this prospective cohort study we therefore aimed at investigating the incidence of diabetes among angiographied coronary patients and in particular at evaluating the impact of body mass index (BMI) and of waist circumference on diabetes risk. Methods: The incidence of T2DM was recorded over 8 years in a population of 506 consecutive non-diabetic patients undergoing coronary angiography for the evaluation of stable coronary artery disease. Results: During follow-up, T2DM was newly diagnosed in 107 (21.1%) of our patients. In logistic regression analysis both baseline BMI (standardized adjusted odds ratio (OR) = 1.34 [1.08–1.66]; p = 0.007) and baseline waist circumference (OR = 1.49 [1.18–1.88]; p = 0.001) significantly predicted the incidence of type 2 diabetes after multivariate adjustment when entered separately into the regression models. When BMI and waist circumference were entered simultaneously into a logistic regression model, waist circumference after adjustment for BMI remained significantly predictive of T2DM (OR = 1.44 [1.02–2.03]; p = 0.039), whereas the association of BMI with incident T2DM after adjustment for the waist circumference was no longer significant (p = 0.788). Conclusion: We conclude that the incidence of diabetes is high among angiographied coronary patients. A large waist circumference predicts the incidence of diabetes independently from BMI, whereas BMI does not predict diabetes independently from waist circumference. 569 SYMPATHETIC OUTFLOW TO BONE MARROW MEGAKARYOCYTES STIMULATES NEOINTIMA FORMATION VIA PLATELET-DERIVED NEUROPEPTIDE Y K. Abe1,2 , S. Saadat1 , J. Fennessy1 , S. Dandamudi1 , J. Kitlinska1 , J. Tilan1 , C. Lu1 , M.K. Hellerstein3 , Z. Zukowska4 . 1 Physiology, Georgetown University, Washington, DC, 2 Cell Biology, National Institutes of Health, Bethesda, MD, 3 Nutritional Sciences, University of California at Berkeley, Berkeley, CA, 4 Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA Although the association between stress and the development of cardiovascular disease has been supported by numerous studies, a mechanism linking these events has yet to be described. Here we propose a novel mechanism by which stress induces post-angioplasty vascular remodeling by activating a neural-bone marrow-vascular axis. This process is initiated by stressinduced sympathetic input into hematopoietic bone marrow, triggering increased turnover of megakaryocytes (MKs) and production of nascent platelets rich in neuropeptide Y (NPY), a sympathetic neurotransmitter with potent mitogenic in vitro and in vivo activity on smooth muscle cells through the NPY Y1 receptor (Y1R). Using an arterial guide-wire injury model in mice either genetically deficient in platelet NPY, systemic NPY, or hybrids generated by platelet transfer between Sv129/Npy+/+ and Sv129/Npy−/− mice, we found platelet-derived NPY to be essential for neointimal hyperplasia and the mobilization of immune cells into these vascular lesions. The anatomical basis of this axis is demonstrated by close proximity of NPY+/tyrosine hydroxylase+/synapsin+ -sympathetic nerves with MKs in the bone marrow. Stress activated MK turnover, endomitosis, and synthesis of platelet NPY, and when combined with guide-wire angioplasty, amplified neointimal hyperplasia. Conversely, sympathectomy impaired these proliferative and endomitotic processes on MKs while also decreasing vascular remodeling following arterial injury. These data indicate that either genetically
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
Conclusion: A home-based walking intervention may improve onset to pain distance and may be more relevant for patients with diabetes mellitus and PAD who are limited by deconditioning. 560 OBJECTIVELY MEASURED DAILY PHYSICAL ACTIVITY RELATED TO BODY FAT IN YOUNG CHILDREN M. Dencker1 , O. Thorsson1 , M.K. Karlsson2 , C. Linden ´ 2 , L.B. Andersen3 . 1 Unit of Clinical Physiology and Nuclear Medicin, 2 Clinical and Molecular ˚ Osteoporosis Research Unit, Skane University Hospital, Lund University, ¨ Sweden, 3 Center for Research in Childhood Health, Institute of Sport Malmo, Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Introduction: Lack of physical activity has been hypothesised to be a factor for childhood obesity. We assessed if different measures of physical activity is related to body fat in children aged 8 to 11 years. Methods: Cross-sectional study of 226 children (125 boys and 101 girls), recruited from a population-based cohort. Accelerometer measured minutes of light physical activity (LPA), moderate and vigorous physical activity (MVPA) and vigorous physical activity (VPA) per day were assessed. Total body fat mass was measured by a DXA scan, and expressed as percentage of body mass (BF%). Skewed distributions were normalised by natural logarithm. Results: Boys performed significantly more minutes of LPA, MVPA and VPA per day compared to girls (LPA; 165±36 vs. 156±30, MVPA; 46±20 vs. 35±13 and VPA; 15±10 vs. 11±7, all P < 0.05). Girls had higher BF% than boys (22±9 vs. 16±9, P < 0.05). Pearson correlation indicated a significant association between MVPA and VPA versus BF%. In boys r = −0.29 and −0.32, and in girls r = −0.38 and −0.47, all P < 0.05. LPA was not related to BF%, all NS. Conclusions: In this population-based cohort of children minutes of MVPA and VPA per day were related to amount of body fat in both boys and girls, whereas minutes of LPA was not. Longitudinal studies are warranted to establish cause and effect. 561 THE EFFECT OF AEROBIC EXERCISE TRAINING ON ENDOTHELIN-1 CONCENTRATION IN OLD WOMEN V. Boghrabadi, S. Nejatpour, A. Baghi. Islamic Azad University, Shirvan Branch, Shirvan, Iran Endothelial function deteriorates with aging. On the other hand, exercise training improves the function of vascular endothelial cells. Endothelin-1 (ET-1), which is produced by vascular endothelial cells, is a potent constrictor and therefore, has been implicated in regulation of vascular tonus and progression of atherosclerosis. hypothesized that plasma ET-1 concentration increases with age, even in healthy adults, and that lifestyle modification (i.e., exercise) can reduce plasma ET-1 concentration in previously sedentary old adults. measured plasma ET-1 concentration in healthy young (21−28 yr old), healthy middleaged (31−47 yr old), and healthy old (61−69 yr old) women. The plasma level of ET-1 increased significantly with aging (1.02±0.08, 1.33±0.11, and 2.90±0.20 pg/ml in young, middle-aged, and old women, respectively). Thus plasma ET-1 concentration was markedly higher in healthy old women than in healthy young or middle-aged women (by 3- and 2-fold, respectively). In healthy old women, we also measured plasma ET-1 concentration after 3 month of aerobic exercise (cycling on a leg ergometer at 80% of HRR for 30 min, 5 days/wk). Regular exercise significantly decreased plasma ET-1 concentration in the healthy old women (2.22±0.16 pg/ml, P < 0.01) and also significantly reduced their blood pressure. The present study suggests that regular aerobic-endurance exercise reduces plasma ET-1 concentration in old humans, and this reduction in plasma ET-1 concentration may have beneficial effects on the cardiovascular system (i.e., prevention of progression of hypertension and/or atherosclerosis by endogenous ET-1). 562 DEMANDS AND HEART RATE VARIABILITY IN DANISH WHITE-COLLAR WORKERS N. Eller1 , M. Blønd2 , M. Nielsen1 , J. Kristiansen3 , B. Netterstrøm1 . 1 Bispebjerg Hospital, Copenhagen, 2 Nykøbing Falster Hospital, Nykøbing Falster, 3 National Reserach Centre of the Working Environment, Copenhagen, Denmark Introduction: Changes in the autonomous nervous system might be a part of the pathophysiological pathway leading from psychosocial stress to ischemic heart disease (IHD). The current study analyzed the relationship between demands measured in different manners and heart rate variability (HRV) measured at baseline and again, two years later. Demands were measured as quantitative demands, cognitive demands, tempo demands, and weekly working hours. Methods: In 2006 and 2008, measurements of HRV during rest were obtained from 231 participants. The associations between the various demands variables, and HRV were examined using a series of mixed effects models. The dependent variables were the logarithmically transformed levels total power (lnTP), high frequency power (lnHF), and the ratio between low and high frequency power (lnLF/HF). Gender and year of measurement was included as factors, whereas age, time of measurement and physical activity (measured
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in four categories) were included as covariates. Subject was included as a random effect. Results: Weekly working hours and quantitative demands were significantly associated with decreased TP, and cognitive demands was nearly significantly associated with decreased TP. Neither HF nor LF/HF were associated with the psychosocial factors. In all models, age was significantly and negatively associated with TP, whereas physical activity was significantly and positively associated with TP. Conclusion: HRV, especially in the form of TP, was associated with age and physical activity but also with various estimates of workload (weekly working hours and quantitative demands). 563 COST EFFICACY IN HOSPITALIZED PATIENTS WITH DIABETES IS RELATIVE TO TREATMENT DECISION MAKING AND CLINICAL OUTCOME C. Voulgari, S. Paximadas, N. Tentolouris. First Department of Propaedeutic Internal Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece Introduction: Changes in medical practice have intensified efforts for clinical efficacy and one of the tools to achieve this is near-patient testing. The fragile equilibrium between technological capabilities and cost-efficacy is often underestimated. The aim of this study was to determine the reliability of pointof-care testing glucose meters among hospitalized diabetic patients. This study compared the accuracy and precision of point-of-care blood glucose (BG) meters. Methods: Diabetic patients undergoing venipuncture for glucose testing were randomized to one of the following BG meters: Accu-Chek Aviva (Roche/Diagnostics), Precision (Abbott/Diagnostics) and Glucotech (Menarini/Diagnostics). Within 5-min following venipuncture, duplicate ipsilateral finger measurements were taken. Finger BG values were compared with laboratory reference values. Meter precision was determined by calculating the absolute mean differences in BG between duplicate samples. Results: Finger sticks were obtained from 600 patients. Mean (±SD) venipuncture BGM was 148±64 mg/dL. Meter accuracy using the 10% criteria was demonstrated in 70%, 58%, and 46% of the samples, respectively. When compared with laboratory reference BGM values, Accu-chek-Aviva scored the highest coefficient correlation (r = 0.75, P = 0.01); no significant correlations were observed between laboratory BG values and those obtained with Glucotech or Precision devices. Using laboratory reference values hyperglycemia (>250 mg/dL) was incorrectly diagnosed in 11% of patients, whereas hypoglycemia (<50 mg/dL) in 25%. Conclusions: In hospitalized diabetic patients, BGM measurements obtained with different glucose meters are often unreliable and higher than the actual glucose values. This results in over diagnosed hyperglycemia and the incorrect administration of insulin or underdiagnosed hypoglycemia in everyday clinical practice. 564 LOW BONE MINERAL DENSITY IS NOT ASSOCIATED WITH CORONARY ATHEROSCLEROSIS IN PATIENTS WITH TYPE 2 DIABETES S. Beer1,2,3 , C.H. Saely1,2,3 , G. Hoefle4 , A. Vonbank1,2,3 , P. Rein1,2,3 , A. Muendlein1,3 , H. Drexel1,2,3,5 . 1 VIVIT Institute, 2 Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria, 3 Private University of the Principality of Liechtenstein, Triesen, Liechtenstein, 4 Internal Medicine, Hospital Hohenems, Hohenems, Austria, 5 Drexel University College of Medicine, Philadelphia, PA, USA Background: The association between low bone mass and angiographically determined coronary atherosclerosis is unclear, this especially holds true for patients with type 2 diabetes (T2DM). Methods: We enrolled 978 consecutive patients, 254 (26.0%) with T2DM and 724 (74.0%) nondiabetic subjects who were undergoing coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD). Bone mineral density (BMD) was assessed by dual X-ray absorptiometry; significant CAD was diagnosed in the presence of coronary stenoses with lumen narrowing 70%. Results: Of the total study cohort (63.7% men; mean age 65±11 years) 35.7% (n = 349) had osteopenia and 14.0% (n = 137) had osteoporosis. Significant CAD was present in 44.5% (n = 435) of our patients. In patients with T2DM the prevalence of significant CAD did not differ significantly between patients with normal BMD, osteopenia or osteoporosis (42.9%, 37.4% and 45.4%; ptrend =0.251). Concordantly, neither osteopenia nor osteoporosis were significantly associated with the presence of significant CAD after multivariate adjustment (adjusted ORs 1.09 [95% CI 0.62–1.92], p = 0.118 and 1.05 [0.45– 2.46], p = 0.913, respectively). In non-diabetic subjects results were similar: The prevalence of significant CAD did not differ significantly between patients with normal BMD, osteopenia or osteoporosis (42.9%, 37.4% and 45.4%; ptrend =0.251) and no association between the presence of osteopenia or osteoporosis and significant CAD was observed after multivariate adjustment
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(OR 0.83 [95% CI 0.59–1.17], p = 0.292 and 1.27 [0.79–2.04], p = 0.319, respectively). Conclusion: We conclude that BMD neither among patients with T2DM nor among non-diabetic subjects is associated with angiographically determined coronary atherosclerosis. 565 IMPACT OF ACCULTURATION ON CORONARY ARTERY DISEASE IN THE SOUTH ASIAN IMMIGRANTS − UNIQUE POPULATION WITH INCREASED RISK S. Dodani1 , L. Dong2 . 1 Internal Medicine, University of Kansas, Leawood, 2 University of Kansas Medical Center, Kansas City, KS, USA Although differences in coronary artery disease (CAD) risk factors between immigrants and non-immigrants have been examined previously; the effect of acculturation on CAD risk factors in immigrants has not been fully studied less well studied. This study aim is to measure the level of acculturation and its association with CAD and other factors, including Type 2 Diabetes (T2D) in South Asian immigrants (SAIs). Methods: Using an epidemiologic study design, 161 SAIs between the ages of 35−65 years were randomly recruited from the States of Georgia, Kansas and Missouri. CAD markers and common carotid artery intima media thickness (CCA-IMT) were assessed. Scaled (The Suinn-Lew Asian SelfIdentity Acculturation scale-SL-ASIA Scale) and non-scaled (10 years stay in the US) methods were used to measure the acculturation status. Results: Of the total sample, 67.7% were identified to have high acculturation. On the logistic regression model, 10 years stay in the US (p = 0.0068), cholesterol level 200 mg/dl (p = 0.0002), BMI 23 (p = 0.0044) and family history of CAD (p = 0.0078) were found to be independent predictors of CAD. Similar results were seen with T2D as an outcome. Those with high CAD had 2.11 (CI: 1.32, 6.68) odds of having total cholesterol 200 mg/dl compared to those without CAD. Conclusions: Acculturation plays a major role in predisposing immigrant population to CAD. There is need for developing tools that consider acculturation as a predictor for CAD. Further studies that test tailored strategies to improve lifestyle behaviors across diverse racial/ethnic groups are needed. 566 LIVING ALONE AND PERMANENT DISABILITY ARE ASSOCIATED WITH POOR PROGNOSIS AFTER ELECTIVE PCI O. Shakhmatova, A. Komarov, E. Panchenko. Russian Cardiology Research-and-Production Complex, Moscow, Russia Although the incidence and mortality of CAD are known to be related to socioeconomic factors, the relationship between socioeconomic factors and prognosis after elective PCI has been little-studied. Objective: To examine associations between basic socioeconomic factors (education level, employment, living alone) and prognosis after elective PCI. Methods: A total of 264 (213 male, age 58.8±1.0 years) patients with stable CAD who had undergone elective PCI were studied. Socioeconomic data were collected by medical chart review. An 18-months follow-up evaluation was conducted by office visit and telephone interview. Composite end point consists of death, nonfatal MI, unstable angina, stroke, TIA and need for coronary revascularization. Hazard ratios (HRs) were estimated from Cox proportional hazard models. Results: The composite endpoint was observed in 18.2% of patients. Living alone and any reason permanent disability were significantly associated with incidence of the composite endpoint. After adjustment for age, sex, conventional risk factors and main coronary morphologic factors, the risk of developing composite endpoint for those who lived alone at baseline compared with those who did not live alone was 8.4 (95% confidence interval (CI), 3.4–20.5), p = 0.0001; permanent disability also had impact on composite endpoint rate (HR 14.2 (95% CI 4.4–45.8), p = 0.0001). Education level had no affects on prognosis after PCI. Conclusion: Living alone and permanent disability are independent predictors of prognosis after elective PCI. 567 TOTAL BODY FAT AND ABDOMINAL FAT RELATED TO COMPOSITE RISK FACTOR SCORE FOR CVD IN YOUNGER CHILDREN M. Dencker1 , O. Thorsson1 , M.K. Karlsson2 , C. Linden ´ 2 , P. Wollmer1 , L.B. Andersen3 . 1 Unit of Clinical Physiology and Nuclear Medicin, 2 Clinical ˚ and Molecular Osteoporosis Research Unit, Skane University Hospital, Lund ¨ Sweden, 3 Center for Research in Childhood Health, University, Malmo, Institute of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Introduction: Obesity is associated with increased risk of cardiovascular disease (CVD) in adults. We analysed if total body fat and abdominal fat are related to composite risk factor score for CVD in younger children. Methods: Cross-sectional study of 243 (136 boys and 107 girls) children aged 8−11 years, recruited from a population-based cohort. Total fat and abdominal fat mass (AFM) were measured by DXA, total body fat was expressed as percentage of body weight (BF%). Maximal oxygen uptake (VO2PEAK ) was
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measured during maximal exercise test. Systolic and diastolic blood pressure (SBP, DBP), and resting heart rate (HR) were measured. Mean artery pressure (MAP) and pulse pressure (PP) were calculated. Echocardiography was performed and left ventricular mass (LVM) was calculated. Z-scores (Value for the individual-mean value for group)/SD were calculated. Sum of z-scores for SBP, DBP, MAP, PP, HR, LVM, and -VO2PEAK were calculated in boys and girls, separately, and used as composite risk factor score. Results: Mean BF% was 18.8±9.2% and mean AFM 2.8±2.3 kg. Pearson correlations between ln BF% and ln AFM versus composite risk factor score were for boys (r = 0.52, and r = 0.55, both P < 0.05), for girls (r = 0.36 and 0.43, both P < 0.05). Boys and girls were divided according to quartiles of BF% and AFM. One-way ANOVA analysis indicated significant differences in composite risk factor score between the different quartiles of BF% or AFM (all, P= < 0.001). Conclusion: Total body fat and abdominal fat are associated with elevated composite risk factor score for CVD in younger children. 568 BODY MASS INDEX AND WAIST CIRCUMFERENCE AS PREDICTORS OF THE INCIDENCE OF TYPE 2 DIABETES AMONG ANGIOGRAPHIED CORONARY PATIENTS C.H. Saely1,2,3 , P. Rein1,2,3 , A. Vonbank1,2,3 , S. Beer1,2,3 , C. Boehnel1,2,3 , S. Greber1 , 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 prevalence of diabetes among angiographied coronary patients is high, but no data are available on the incidence of diabetes in this clinically important patient population. In this prospective cohort study we therefore aimed at investigating the incidence of diabetes among angiographied coronary patients and in particular at evaluating the impact of body mass index (BMI) and of waist circumference on diabetes risk. Methods: The incidence of T2DM was recorded over 8 years in a population of 506 consecutive non-diabetic patients undergoing coronary angiography for the evaluation of stable coronary artery disease. Results: During follow-up, T2DM was newly diagnosed in 107 (21.1%) of our patients. In logistic regression analysis both baseline BMI (standardized adjusted odds ratio (OR) = 1.34 [1.08–1.66]; p = 0.007) and baseline waist circumference (OR = 1.49 [1.18–1.88]; p = 0.001) significantly predicted the incidence of type 2 diabetes after multivariate adjustment when entered separately into the regression models. When BMI and waist circumference were entered simultaneously into a logistic regression model, waist circumference after adjustment for BMI remained significantly predictive of T2DM (OR = 1.44 [1.02–2.03]; p = 0.039), whereas the association of BMI with incident T2DM after adjustment for the waist circumference was no longer significant (p = 0.788). Conclusion: We conclude that the incidence of diabetes is high among angiographied coronary patients. A large waist circumference predicts the incidence of diabetes independently from BMI, whereas BMI does not predict diabetes independently from waist circumference. 569 SYMPATHETIC OUTFLOW TO BONE MARROW MEGAKARYOCYTES STIMULATES NEOINTIMA FORMATION VIA PLATELET-DERIVED NEUROPEPTIDE Y K. Abe1,2 , S. Saadat1 , J. Fennessy1 , S. Dandamudi1 , J. Kitlinska1 , J. Tilan1 , C. Lu1 , M.K. Hellerstein3 , Z. Zukowska4 . 1 Physiology, Georgetown University, Washington, DC, 2 Cell Biology, National Institutes of Health, Bethesda, MD, 3 Nutritional Sciences, University of California at Berkeley, Berkeley, CA, 4 Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA Although the association between stress and the development of cardiovascular disease has been supported by numerous studies, a mechanism linking these events has yet to be described. Here we propose a novel mechanism by which stress induces post-angioplasty vascular remodeling by activating a neural-bone marrow-vascular axis. This process is initiated by stressinduced sympathetic input into hematopoietic bone marrow, triggering increased turnover of megakaryocytes (MKs) and production of nascent platelets rich in neuropeptide Y (NPY), a sympathetic neurotransmitter with potent mitogenic in vitro and in vivo activity on smooth muscle cells through the NPY Y1 receptor (Y1R). Using an arterial guide-wire injury model in mice either genetically deficient in platelet NPY, systemic NPY, or hybrids generated by platelet transfer between Sv129/Npy+/+ and Sv129/Npy−/− mice, we found platelet-derived NPY to be essential for neointimal hyperplasia and the mobilization of immune cells into these vascular lesions. The anatomical basis of this axis is demonstrated by close proximity of NPY+/tyrosine hydroxylase+/synapsin+ -sympathetic nerves with MKs in the bone marrow. Stress activated MK turnover, endomitosis, and synthesis of platelet NPY, and when combined with guide-wire angioplasty, amplified neointimal hyperplasia. Conversely, sympathectomy impaired these proliferative and endomitotic processes on MKs while also decreasing vascular remodeling following arterial injury. These data indicate that either genetically