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799 REGIONAL CORRECTION IN WAIST CIRCUMFERENCE EVALUATION NEEDED IN LATVIA
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Atherosclerosis Supplements 12, no. 1 (2011) 13–184
797 CORRELATION BETWEEN LDL-LOWERING BY STATINS AND HEMORHEOLOGICAL PROFILES: A SUBSTUDY OF THE PATROL TRIAL K. Saku, B. Zhang, Y. Uehara, K. Noda. Department of Cardiology, Fukuoka University, Fukuoka, Japan Background: Atorvastatin, rosuvastatin and pitavastatin are available for intensive, aggressive LDL-C-lowering therapy in clinical practice. The objective of the PATROL: Randomized Head-to-Head Comparison of Pitavastatin, Atorvastatin, and Rosuvastatin for Safety and Efficacy (Quantity and Quality of LDL) trial was to compare the safety and efficacy of atorvastatin, rosuvastatin and pitavastatin head-to-head in patients with hypercholesterolemia. This was a prospective randomized multi-center trial to compare these strong statins (UMIN-Registration No:000000586). Methods and Results: Patients with risk factors for coronary artery disease and elevated LDL-C levels were randomized to receive a low dose of atorvastatin (10 mg/day), rosuvastatin (2.5 mg/day), or pitavastatin (2 mg/day) for 16 weeks. Three hundred two patients (from 51 centers) were enrolled, these three strong statins equally reduced LDL-C and LDL-particles, as well as fast-migrating LDL (modified-LDL) by 40−45%. Newly developed pitavastatin was non-inferior to the other two statins with regard to lowering LDL-C. The changes in LDL-C vs. the changes in laboratory parameters were also assessed, and we found that the overall changes in ALT and gamma-GTP were significantly and positively associated with the reduction in LDL-C (r = 0.130, r = 0.157, p < 0.05). Interestingly, changes in red cell counts, hematocrit, hemoglobin, and platelet counts were all significantly affected by the lowering of LDL-C, and no significant differences were observed among the three groups. Thus, lowering LDL-C may raise an important issue regarding blood cell counts. Although the differences were not clinically significant and the correlation coefficients were quite small (r = 0.209, 0.183, 0.174, and 0.149), these are potentially important findings for future studies. Conclusion: LDL-lowering by statins affected hemorheological profiles. 798 THE EFFECT OF NICOTINIC ACID/LAROPIPRANT ADMINISTRATION ON THE LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 (LP-PLA2) ACTIVITY IN PATIENTS WITH MIXED DYSLIPIDEMIA A. Kei1 , E. Liberopoulos1 , K. Tellis2 , C. Rizos1 , A. Tselepis2 , M. Elisaf1 . Department of Internal Medicine, University of Ioannina Medical School, 2 Department of Biochemistry − Clinical Chemistry, University of Ioannina Chemistry School, Ioannina, Greece 1
Introduction: The majority (70−80%) of lipoprotein-associated phospholipase A2 (Lp-PLA2) is associated with low-density lipoprotein (LDL) comprising the total plasma Lp-PLA2. Total plasma Lp-PLA2 is an independent risk factor for cardiovascular disease. On the other hand, a small proportion of the circulating enzyme is associated with high-density lipoprotein (HDL), which plays an atheroprotective role. Aim: To study the effect of nicotinic acid/laropiprant administration on Lp-PLA2 activity. Patients and Methods: We recruited 30 consecutive patients with mixed dyslipidemia who were treated with a conventional statin dose (10−40 mg simvastatin or 10−20 mg atorvastatin or 5−20 mg rosuvastatin) and had not achieved LDL or non-HDL cholesterol goal. Patients were treated with add-onstatin nicotinic acid/laropiprant (1,000/20 mg/day for the first 4 weeks followed by 2,000/40 mg/day for the next 8 weeks) for 3 months. Lp-PLA2 activity levels were assessed before and 3 months after the initiation of nicotinic acid/laropiprant. Results: Nicotinic acid/laropiprant treatment resulted in a 16% reduction of total plasma Lp-PLA2 activity (from 54±11 to 45±10 nmol/mL/min, p = 0.02), whereas it increased HDL-Lp-PLA2 by 45% (from 2.0±0.7 to 2.9±1.1 nmol/mL/min, p < 0.001) compared with baseline levels. Conclusions: Add-on-statin administration of nicotinic acid/laropiprant results in a reduction of total plasma Lp-PLA2 activity and an increase in HDL associated Lp-PLA2 activity, thereby possibly reducing cardiovascular risk by both actions. 799 REGIONAL CORRECTION IN WAIST CIRCUMFERENCE EVALUATION NEEDED IN LATVIA I. Stukena1 , A. Kalvelis1 , G. Bahs1 , I. Skuja2 , A. Lejnieks1 . 1 Riga Stradins University, 2 General Practitioner’s Ilze Skuja Practice, Riga, Latvia Introduction: In prophylaxis of cardiovascular disease (CVD) evaluation of central adiposity with waist circumference (WC) measurements is very important. In different recommendations (e.g. ATP III, IDF) WC border values for men exceed those for women by 14 cm. Aim: To evaluate suitability of WC norms recommend in Europe for Latvian population depending on sex. Materials and Methods: BMI and WC were assessed in 28836 inhabitants of different regions of Latvia. Subjects were subdivided into 4 groups: BMI < 30 kg/m2 and BMI 30 kg/m2 and WC < 102 cm (for men) or <88 cm (for women) and WC 102 cm (for men) or 88 cm (for women). Interrelation between BMI and WC, and their dependence on sex were evaluated.
Poster presentations
Results: Mean WC in men exceeded mean WC in women (97.4±12.3 cm vs. 92.1±13.2 cm, p < 0.001), while men had smaller BMI (27.5±4.5 vs. 28.6±5.7 kg/m2 , p < 0.001). This difference in mean WC between sexes was considerably smaller (5.3 cm) than in European guidelines. Bigger WC in women was detected nearly twice as often as in men (62.2% vs.33.1%). Elevated BMI (30 kg/m2 ) was detected in 25.8% of men and 32.2% of women. In cases BMI <30kg/m2 elevated WC was more frequently detected in women than in men (41.0% vs. 32.1%, respectively). Conclusions: Following WC standards recommended in Europe, enlarged WC is diagnosed in women more frequently than in men. Normal WC value must be increased by 8 cm for women in Latvia in order to decrease the difference in WC of both sexes from 14 cm to 6 cm. 800 BONE MARROW-DERIVED MESENCHYMAL STEM CELL TRANSPLANTATION FOR THE TREATMENT OF CRITICAL LIMB ISCHEMIA E. Shlyakhto1,2 , V. Vavilov1,2 , A. Zaritskey1,2 , D. Polyntsev3 , P. Kruglyakov3 , A. Krylov3 , I. Senchik2 , A. Krutikov1 . 1 Almazov Heart, Blood and Endocrinology Centre, 2 Saint-Petersburg Pavlov State Medical University, 3 “Trans-Technology” Company, Saint Petersburg, Russia Purpose: The purpose of this study was to determine the feasibility and safety of injecting bone marrow mesenchymal stem cells (BM-MSC) into the leg muscles of patients with severe peripheral arterial disease (PAD), in an attempt to improve blood flow and symptoms. Methods: Seventeen patients with end-stage critical limb ischemia (CLI) due to PAD and after failed or impossible operative or interventional revascularization were treated using BM-MSC transplantation. Bone marrow aspirates were collected from iliac, mononuclear cells separated and cultured in vitro in defined conditions until the BM-MSC achieved required numbers. BM-MSC were injected into the gastrocnemius muscle of the affected leg (total cell number 100×106 –130×106 ). Efficacy was assessed following 6, 12 months, 1 and 1.5 year (limb salvage, pain-free walking distance, ulcer size). Perfusion was measured with ankle pressure and transcutaneous oxygen tension (TcpO2)). Results: There were none complications from the procedures. Limb salvage was 65% at follow-up. Six of 17 patients underwent major amputation. The rest of patients had clinical improvement: no rest pain, diminished ulcer size, in several patients increased pain-free walking distance. TcpO2 increased from 17±10 mmHg at baseline to 30±6 mmHg (p = 0.05) at 1 year. Ankle pressure increased from 45±9 mmHg to 60±12 mmHg at 1 year, but decreased to near baseline level at 1.5 year. Conclusions: These results show that cell therapy BM-MSC is safe, feasible, and appears being effective therapeutic strategy in patients with PAD and CLI. It can induce a long-term clinical improvement. 801 CARDIOVASCULAR RISK PROFILE IN NONOBESE AND OBESE HYPERTENSIVE ADOLESCENTS. STUDY BASED ON BIOMARKERS AND ULTRASONOGRAPHIC ASSESSMENT OF EARLY ATHEROSCLEROSIS B. Głowinska-Olszewska, ´ W. Łuczynski, ´ J. Tołwinska, ´ A. Bossowski. Department of Paediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University, Bialystok, Poland Background and Aims: To investigate vascular status, left ventricle mass, as well as plasma biomarkers of endothelial activation and inflammation in hypertensive (HT) adolescents with particular attention to compare nonobese with obese patients in the limelight of increasing knowledge of high cardiovascular risk in these children. Patients and Methods: 79 newly recognized HT adolescents aged 15.1±2.1 yrs were divided according to their diagnosis into: 34 nonobese HT and 45 obese HT adolescents and compared to 35 healthy volunteers. Using ultrasound IMT (intima media thickness), FMD (flow mediated dilation) and LVMi (left ventricle mass index) were assessed. Adhesion molecules and inflammatory interleukins, together with lipids and insulin resistance were also studied. Results: HT obese adolescents had higher triglycerides level, insulin resistance index (HOMA) and elevated levels of IL-6, TNF alfa, sICAM-1 and sEselectin compared to control group and to nonobese HT patients. FMD was lower in both HT groups, IMT was higher in both HT groups as compared to control. LVMi was higher in both HT groups as well, with the highest value in nonobese ones. Nonobese hypertensive adolescents had the same early cardiovascular changes assessed ultrasonographically as their obese hypertensive peers, although metabolic alterations, endothelial activation and inflammation measured as plasma biomarkers were more pronounced in obese ones. Conclusions: Attention should be directed into recognition of hypertension in nonobese children and adolescents and their cardiovascular risk profile. Mechanisms of atherosclerosis in nonobese HT adolescents require further investigation as they seem to be different than in obese HT ones.
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
797 CORRELATION BETWEEN LDL-LOWERING BY STATINS AND HEMORHEOLOGICAL PROFILES: A SUBSTUDY OF THE PATROL TRIAL K. Saku, B. Zhang, Y. Uehara, K. Noda. Department of Cardiology, Fukuoka University, Fukuoka, Japan Background: Atorvastatin, rosuvastatin and pitavastatin are available for intensive, aggressive LDL-C-lowering therapy in clinical practice. The objective of the PATROL: Randomized Head-to-Head Comparison of Pitavastatin, Atorvastatin, and Rosuvastatin for Safety and Efficacy (Quantity and Quality of LDL) trial was to compare the safety and efficacy of atorvastatin, rosuvastatin and pitavastatin head-to-head in patients with hypercholesterolemia. This was a prospective randomized multi-center trial to compare these strong statins (UMIN-Registration No:000000586). Methods and Results: Patients with risk factors for coronary artery disease and elevated LDL-C levels were randomized to receive a low dose of atorvastatin (10 mg/day), rosuvastatin (2.5 mg/day), or pitavastatin (2 mg/day) for 16 weeks. Three hundred two patients (from 51 centers) were enrolled, these three strong statins equally reduced LDL-C and LDL-particles, as well as fast-migrating LDL (modified-LDL) by 40−45%. Newly developed pitavastatin was non-inferior to the other two statins with regard to lowering LDL-C. The changes in LDL-C vs. the changes in laboratory parameters were also assessed, and we found that the overall changes in ALT and gamma-GTP were significantly and positively associated with the reduction in LDL-C (r = 0.130, r = 0.157, p < 0.05). Interestingly, changes in red cell counts, hematocrit, hemoglobin, and platelet counts were all significantly affected by the lowering of LDL-C, and no significant differences were observed among the three groups. Thus, lowering LDL-C may raise an important issue regarding blood cell counts. Although the differences were not clinically significant and the correlation coefficients were quite small (r = 0.209, 0.183, 0.174, and 0.149), these are potentially important findings for future studies. Conclusion: LDL-lowering by statins affected hemorheological profiles. 798 THE EFFECT OF NICOTINIC ACID/LAROPIPRANT ADMINISTRATION ON THE LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 (LP-PLA2) ACTIVITY IN PATIENTS WITH MIXED DYSLIPIDEMIA A. Kei1 , E. Liberopoulos1 , K. Tellis2 , C. Rizos1 , A. Tselepis2 , M. Elisaf1 . Department of Internal Medicine, University of Ioannina Medical School, 2 Department of Biochemistry − Clinical Chemistry, University of Ioannina Chemistry School, Ioannina, Greece 1
Introduction: The majority (70−80%) of lipoprotein-associated phospholipase A2 (Lp-PLA2) is associated with low-density lipoprotein (LDL) comprising the total plasma Lp-PLA2. Total plasma Lp-PLA2 is an independent risk factor for cardiovascular disease. On the other hand, a small proportion of the circulating enzyme is associated with high-density lipoprotein (HDL), which plays an atheroprotective role. Aim: To study the effect of nicotinic acid/laropiprant administration on Lp-PLA2 activity. Patients and Methods: We recruited 30 consecutive patients with mixed dyslipidemia who were treated with a conventional statin dose (10−40 mg simvastatin or 10−20 mg atorvastatin or 5−20 mg rosuvastatin) and had not achieved LDL or non-HDL cholesterol goal. Patients were treated with add-onstatin nicotinic acid/laropiprant (1,000/20 mg/day for the first 4 weeks followed by 2,000/40 mg/day for the next 8 weeks) for 3 months. Lp-PLA2 activity levels were assessed before and 3 months after the initiation of nicotinic acid/laropiprant. Results: Nicotinic acid/laropiprant treatment resulted in a 16% reduction of total plasma Lp-PLA2 activity (from 54±11 to 45±10 nmol/mL/min, p = 0.02), whereas it increased HDL-Lp-PLA2 by 45% (from 2.0±0.7 to 2.9±1.1 nmol/mL/min, p < 0.001) compared with baseline levels. Conclusions: Add-on-statin administration of nicotinic acid/laropiprant results in a reduction of total plasma Lp-PLA2 activity and an increase in HDL associated Lp-PLA2 activity, thereby possibly reducing cardiovascular risk by both actions. 799 REGIONAL CORRECTION IN WAIST CIRCUMFERENCE EVALUATION NEEDED IN LATVIA I. Stukena1 , A. Kalvelis1 , G. Bahs1 , I. Skuja2 , A. Lejnieks1 . 1 Riga Stradins University, 2 General Practitioner’s Ilze Skuja Practice, Riga, Latvia Introduction: In prophylaxis of cardiovascular disease (CVD) evaluation of central adiposity with waist circumference (WC) measurements is very important. In different recommendations (e.g. ATP III, IDF) WC border values for men exceed those for women by 14 cm. Aim: To evaluate suitability of WC norms recommend in Europe for Latvian population depending on sex. Materials and Methods: BMI and WC were assessed in 28836 inhabitants of different regions of Latvia. Subjects were subdivided into 4 groups: BMI < 30 kg/m2 and BMI 30 kg/m2 and WC < 102 cm (for men) or <88 cm (for women) and WC 102 cm (for men) or 88 cm (for women). Interrelation between BMI and WC, and their dependence on sex were evaluated.
Poster presentations
Results: Mean WC in men exceeded mean WC in women (97.4±12.3 cm vs. 92.1±13.2 cm, p < 0.001), while men had smaller BMI (27.5±4.5 vs. 28.6±5.7 kg/m2 , p < 0.001). This difference in mean WC between sexes was considerably smaller (5.3 cm) than in European guidelines. Bigger WC in women was detected nearly twice as often as in men (62.2% vs.33.1%). Elevated BMI (30 kg/m2 ) was detected in 25.8% of men and 32.2% of women. In cases BMI <30kg/m2 elevated WC was more frequently detected in women than in men (41.0% vs. 32.1%, respectively). Conclusions: Following WC standards recommended in Europe, enlarged WC is diagnosed in women more frequently than in men. Normal WC value must be increased by 8 cm for women in Latvia in order to decrease the difference in WC of both sexes from 14 cm to 6 cm. 800 BONE MARROW-DERIVED MESENCHYMAL STEM CELL TRANSPLANTATION FOR THE TREATMENT OF CRITICAL LIMB ISCHEMIA E. Shlyakhto1,2 , V. Vavilov1,2 , A. Zaritskey1,2 , D. Polyntsev3 , P. Kruglyakov3 , A. Krylov3 , I. Senchik2 , A. Krutikov1 . 1 Almazov Heart, Blood and Endocrinology Centre, 2 Saint-Petersburg Pavlov State Medical University, 3 “Trans-Technology” Company, Saint Petersburg, Russia Purpose: The purpose of this study was to determine the feasibility and safety of injecting bone marrow mesenchymal stem cells (BM-MSC) into the leg muscles of patients with severe peripheral arterial disease (PAD), in an attempt to improve blood flow and symptoms. Methods: Seventeen patients with end-stage critical limb ischemia (CLI) due to PAD and after failed or impossible operative or interventional revascularization were treated using BM-MSC transplantation. Bone marrow aspirates were collected from iliac, mononuclear cells separated and cultured in vitro in defined conditions until the BM-MSC achieved required numbers. BM-MSC were injected into the gastrocnemius muscle of the affected leg (total cell number 100×106 –130×106 ). Efficacy was assessed following 6, 12 months, 1 and 1.5 year (limb salvage, pain-free walking distance, ulcer size). Perfusion was measured with ankle pressure and transcutaneous oxygen tension (TcpO2)). Results: There were none complications from the procedures. Limb salvage was 65% at follow-up. Six of 17 patients underwent major amputation. The rest of patients had clinical improvement: no rest pain, diminished ulcer size, in several patients increased pain-free walking distance. TcpO2 increased from 17±10 mmHg at baseline to 30±6 mmHg (p = 0.05) at 1 year. Ankle pressure increased from 45±9 mmHg to 60±12 mmHg at 1 year, but decreased to near baseline level at 1.5 year. Conclusions: These results show that cell therapy BM-MSC is safe, feasible, and appears being effective therapeutic strategy in patients with PAD and CLI. It can induce a long-term clinical improvement. 801 CARDIOVASCULAR RISK PROFILE IN NONOBESE AND OBESE HYPERTENSIVE ADOLESCENTS. STUDY BASED ON BIOMARKERS AND ULTRASONOGRAPHIC ASSESSMENT OF EARLY ATHEROSCLEROSIS B. Głowinska-Olszewska, ´ W. Łuczynski, ´ J. Tołwinska, ´ A. Bossowski. Department of Paediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University, Bialystok, Poland Background and Aims: To investigate vascular status, left ventricle mass, as well as plasma biomarkers of endothelial activation and inflammation in hypertensive (HT) adolescents with particular attention to compare nonobese with obese patients in the limelight of increasing knowledge of high cardiovascular risk in these children. Patients and Methods: 79 newly recognized HT adolescents aged 15.1±2.1 yrs were divided according to their diagnosis into: 34 nonobese HT and 45 obese HT adolescents and compared to 35 healthy volunteers. Using ultrasound IMT (intima media thickness), FMD (flow mediated dilation) and LVMi (left ventricle mass index) were assessed. Adhesion molecules and inflammatory interleukins, together with lipids and insulin resistance were also studied. Results: HT obese adolescents had higher triglycerides level, insulin resistance index (HOMA) and elevated levels of IL-6, TNF alfa, sICAM-1 and sEselectin compared to control group and to nonobese HT patients. FMD was lower in both HT groups, IMT was higher in both HT groups as compared to control. LVMi was higher in both HT groups as well, with the highest value in nonobese ones. Nonobese hypertensive adolescents had the same early cardiovascular changes assessed ultrasonographically as their obese hypertensive peers, although metabolic alterations, endothelial activation and inflammation measured as plasma biomarkers were more pronounced in obese ones. Conclusions: Attention should be directed into recognition of hypertension in nonobese children and adolescents and their cardiovascular risk profile. Mechanisms of atherosclerosis in nonobese HT adolescents require further investigation as they seem to be different than in obese HT ones.