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848 RELATION BETWEEN SUBCLINICAL ATHEROSCLEROSIS AND COMPONENTS OF THE METABOLIC SYNDROME IN HYPERTENSIVE PATIENTS
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Atherosclerosis Supplements 12, no. 1 (2011) 13–184
847 COMPARISON OF EFFECTS OF EZETIMIBE ON CAROTID ARTERIAL ELASTIC MODULUS AND C-REACTIVE PROTEIN WITH FLUVASTATIN IN PATIENTS WITH HYPERCHOLESTEROLEMIA T. Yamagishi1,2 , M. Kato3 , K. Omata4 , H. Hasegawa2,5 , H. Kanai2,5 . 1 Department of Internal Medicine, Tohoku Kosai Hospital, 2 Department of Biomedical Engineering, Graduate School of Biomedical Engineering, Tohoku University, Sendai, 3 R&D Center, Panasonic Shikoku Electronics Co., Ltd, Yokohama, 4 Health Administration Center, Miyagi University of Education, 5 Department of Electronic Engineering, Graduate School of Engineering, Tohoku University, Sendai, Japan Objective: Carotid arterial wall elastic modulus (Eq) is an early indicator of atherosclerosis as reported previously. Effects of ezetimibe on brachioancle pulse wave velocity (baPWV), high sensitivity C-reactive protein (hsCRP), carotid IMT and Eq were compared with fluvastatin in patients with hypercholesterolemia. Methods: Forty patients with hypercholesterolemia (mean age 52) were randomly assigned to receive either 10 mg ezetimibe (n = 20) or 30 mg fluvastatin (n = 20) daily. Eq was obtained by the phased-tracking method (Kanai, Circulation 2003). At four locations of bilateral common carotid arteries, IMT and Eq were measured simultaneously. BaPWV and hsCRP were examined. Sequential data were normalized and fitted to a simple exponential function. Results: The LDL cholesterol (LDL-C), baPWV, hsCRP, mean IMT and mean Eq at baseline were 155.5±28.8 mg/dL, 1511.4±233.8 cm/s, 622.7±462.7 ng/mL, 0.67±0.11 mm, 175.8±59.6 kPa, respectively. After 6 months of administration, ezetimibe and fluvastatin significantly (p < 0.05, ANOVA) reduced LDL-C (−23% vs −33%), hsCRP (−45% vs −57%) and Eq (−50% vs −18%) but not baPWV and IMT. By an exponential decay curve analysis, the time-constants for LDL-C and Eq of ezetimibe were similar to those of fluvastatin (1.2±0.4 vs 1.5±0.3 and 3.0±0.6 vs 3.8±1.1 months). On the other hand, the time-constant for hsCRP of ezetimibe was significantly smaller than that of fluvastatin (1.3±0.6 vs 4.4±1.0 months). Conclusions: In patients with hypercholesterolemia, ezetimibe as well as fluvastatin decreased Eq in the carotid artery and hsCRP, being considered as good surrogate markers for the early detection of vascular remodeling such as improvement of endothelial dysfunction prior to changes in baPWV and IMT. 848 RELATION BETWEEN SUBCLINICAL ATHEROSCLEROSIS AND COMPONENTS OF THE METABOLIC SYNDROME IN HYPERTENSIVE PATIENTS C. Serban1 , S. Dragan2 , I. Mozos1 , L. Susan3 , R. Christodorescu4 , L. Noveanu5 , A. Pacurari3 , A. Caraba3 , R. Mateescu5 , I. Romosan3 . 1 Pathophysiology, 2 Preventive Cardiology and Cardiovascular Rehabilitation Clinic, 3 Internal Medicine, 4 Department of Cardiology, Ascar, 5 Physiology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania Objective: The purpose of this study was to compare the values of anthropometric parameters and the values of carotid intima-media thickness in hypertensive patients with metabolic syndrome considering the number of NCEP ATP III criteria present. Material and Method: 48 hypertensive patients with metabolic syndrome (mean age 57±3.67 years) were studied. The patients were divided in four groups depending on the number of NCEP criteria present: 12 patients with 2, 11 patients with 3, 13 patients with 4, and 12 patients with 5 criteria of NCEP accomplished. Anthropometric parameters were determined for all participants. Results: A significant direct graded relationship was observed between the values of anthropometric parameters and the number of NCEP present criteria. Mean BMI values for the patients with 2, 3, 4, and 5 criteria were: 23.24±0.93, 27.90±2.38, 27.06±2.11, 27.83±2.10, kg/m2 , p < 0.001. Mean WC values for those with 2, 3, 4, and 5 criteria were: 76±2.08, 96±9.03, 98±11.39, 99±9.04, cm, p < 0.001. Mean WHR values for those with 2, 3, 4, and 5 criteria were: 0.77±0.13, 0.99±0.10, 1.03±0.12, 1.05±0.11, cm, p < 0.001. The study revealed a significant directly graded relationship between the values of carotid IMT and the number of NCEP criteria present (mean IMT for those with 2, 3, 4, and 5 criteria: 0.84±0.03 mm, 1.22±0.11 mm, 1.29±0.04 mm, 1.30±0.94 mm, p < 0.001). Conclusion: In conclusion, carotid IMT increased according to the number of MS components in hypertensive patients with metabolic syndrome.
Poster presentations
849 AN ASSOCIATION OF INTIMA-MEDIA THICKENING OF COMMON CAROTID ARTERIES WITH SUBCLINICAL SIGNS OF INSUFFICIENCY OF CEREBRAL BLOOD FLOW T.V. Kirichenko1,2 , V.A. Myasoedova1,2 , D.M. Mironova1 , I.A. Sobenin1,2,3 . 1 Institute of General Pathology and Pathophysiology, 2 Institute for Atherosclerosis Research, 3 Russian Cardiology Research-and-Production Complex, Moscow, Russia Background and Aims: Localization of atherosclerotic lesions in extracranial parts of the brachiocephalic arterial bed accounts for up to 75% of atherosclerotic changes that lead to the development of cerebral ischemia. An increased carotid intima-medial thickness (cIMT) elevates the risk of stroke significantly and is an independent risk factor regardless of the presence of atherosclerotic plaques in carotid arteries. However, there is no evidence of diagnostic significance of cIMT at subclinical cerebrovascular disease. The aim of this study was to examine the association between neurological status and the presence of atherosclerotic lesions in the carotid arteries (especially diffuse thickening of the intima-medial complex), as well as traditional risk factors for cardiovascular disease in apparently healthy individuals. Patients and Methods: The study involved 225 participants (83 men and 142 women) aged 44−75 (mean 63.8±7.1), free of clinical manifestations of atherosclerotic disease, in whom ultrasound B-mode examination of carotid arteries was performed. Integral assessment of neurological status (INS) was performed using specially developed 4-point scale. Results: In men INS correlated with mean and maximum cIMT (r = 0.291, p = 0.008 and r = 0.254, p = 0.021, respectively), but not with the presence of atherosclerotic plaques in carotid basin. In women INS correlated as with mean and maximum cIMT (r = 0.251, p = 0.003 and r = 0.261, p = 0.002, respectively), as with the extent of carotid plaques (r = 0.316, p < 0.001). Conclusion: Diffuse intima-media thickening of carotid arteries determines even minimally expressed, subclinical neurological changes at the earliest stages of cerebrovascular disease. Acknowledgement: This study was supported by Russian Ministry of Education and Science. 850 RISK FACTORS OF CORONARY ARTERY CALCIFICATION IN PATIENTS WITH UNCOMPLICATED ARTERIAL HYPERTENSION SHOWING HIGH COMPLIANCE WITH TREATMENT I. Shatunova1 , N.A. Koziolova2 , I. Lazarev1 . 1 OJSC ‘Gazprom’ Outpatient Clinic, Moscow, 2 Perm State Medical Academy, Perm, Russia Objective: To evaluate coronary artery calcification score (CAC score) in patients with uncomplicated arterial hypertension (AH) showing high compliance with treatment. Methods: 68 patients with uncomplicated AH were examined. Average age was 54.9±6.3 years. Baseline systolic blood pressure (SBP) was 166.2±13.8 mm Hg; baseline diastolic blood pressure (DBP) was 100.3±6.1 mm Hg. Observation period made up 8.8±2.6 years. Spectral computed tomography of coronary arteries was performed in all the patients at the end of the observation period. Compliance level was evaluated as to achievement of target office BP and according to average score of the Morisky–Green test. Results: 57 patients (77.9%) achieved the target office BP. Average score of the Morisky–Green test was 3.69±0.28. 16 (23.5%) patients had a CAC score of 0, and 33 (48.5%) patients had a CAC score between 1 and 100, 10 (14.7%) patients had a CAC score between 101 and 400, 7 patients (10.3%) had a CAC score >400. The groups of patients were compared in terms of CAC score and as a result significant differences in terms of AH duration (p < 0.001), baseline DBP and DPB at the end of the observation (p = 0.008 and p = 0.013 respectively), baseline fasting plasma glucose >5.6 mmol/L (p < 0.001), high density lipoproteins in serum (HDL) (p = 0.019), left ventricle myocardium mass index (LVMMI) (p = 0.048) were revealed. Conclusions: AH duration, high DBP level, fasting plasma glucose >5.6 mmol/L, low level of HDL, LVMMI appeared to be predictors of coronary artery calcification development 851 AORTIC STIFFNESS IS A DETERMINANT OF CAROTID INTIMA MEDIA THICKNESS IN PATIENTS AT INTERMEDIATE CARDIOVASCULAR RISK R. Ferre, ´ J. Merino, N. Plana, M. Heras, C. Buixadera, L. Masana. Vascular Medicine and Metabolism Unit, Sant Joan University Hospital. Rovira & Virgili University. CIBERDEM, Reus, Spain Background: Aortic stiffness measured by the Augmentation Index (AIx) and carotid intima media thickness (cIMT) are related to cardiovascular events. The association with these surrogate markers is not well understood. Objective: To determine AIx and cIMT relationship in patients at intermediate CV risk. Methods: eight-hundred and sixteen volunteers were included from an outpatient vascular medicine clinic. AIx was determined by peripheral artery tonometry (EndoPAT-2000) and the cIMT was measured by ultrasonography. Results: The mean age was 52.9 years (12.2), 57.4% men. Mean cIMT was 0.79 mm(0.16), 0.76 in women and 0.80 in men (P = 0.001). The mean AIx was
Atherosclerosis Supplements 12, no. 1 (2011) 13–184
847 COMPARISON OF EFFECTS OF EZETIMIBE ON CAROTID ARTERIAL ELASTIC MODULUS AND C-REACTIVE PROTEIN WITH FLUVASTATIN IN PATIENTS WITH HYPERCHOLESTEROLEMIA T. Yamagishi1,2 , M. Kato3 , K. Omata4 , H. Hasegawa2,5 , H. Kanai2,5 . 1 Department of Internal Medicine, Tohoku Kosai Hospital, 2 Department of Biomedical Engineering, Graduate School of Biomedical Engineering, Tohoku University, Sendai, 3 R&D Center, Panasonic Shikoku Electronics Co., Ltd, Yokohama, 4 Health Administration Center, Miyagi University of Education, 5 Department of Electronic Engineering, Graduate School of Engineering, Tohoku University, Sendai, Japan Objective: Carotid arterial wall elastic modulus (Eq) is an early indicator of atherosclerosis as reported previously. Effects of ezetimibe on brachioancle pulse wave velocity (baPWV), high sensitivity C-reactive protein (hsCRP), carotid IMT and Eq were compared with fluvastatin in patients with hypercholesterolemia. Methods: Forty patients with hypercholesterolemia (mean age 52) were randomly assigned to receive either 10 mg ezetimibe (n = 20) or 30 mg fluvastatin (n = 20) daily. Eq was obtained by the phased-tracking method (Kanai, Circulation 2003). At four locations of bilateral common carotid arteries, IMT and Eq were measured simultaneously. BaPWV and hsCRP were examined. Sequential data were normalized and fitted to a simple exponential function. Results: The LDL cholesterol (LDL-C), baPWV, hsCRP, mean IMT and mean Eq at baseline were 155.5±28.8 mg/dL, 1511.4±233.8 cm/s, 622.7±462.7 ng/mL, 0.67±0.11 mm, 175.8±59.6 kPa, respectively. After 6 months of administration, ezetimibe and fluvastatin significantly (p < 0.05, ANOVA) reduced LDL-C (−23% vs −33%), hsCRP (−45% vs −57%) and Eq (−50% vs −18%) but not baPWV and IMT. By an exponential decay curve analysis, the time-constants for LDL-C and Eq of ezetimibe were similar to those of fluvastatin (1.2±0.4 vs 1.5±0.3 and 3.0±0.6 vs 3.8±1.1 months). On the other hand, the time-constant for hsCRP of ezetimibe was significantly smaller than that of fluvastatin (1.3±0.6 vs 4.4±1.0 months). Conclusions: In patients with hypercholesterolemia, ezetimibe as well as fluvastatin decreased Eq in the carotid artery and hsCRP, being considered as good surrogate markers for the early detection of vascular remodeling such as improvement of endothelial dysfunction prior to changes in baPWV and IMT. 848 RELATION BETWEEN SUBCLINICAL ATHEROSCLEROSIS AND COMPONENTS OF THE METABOLIC SYNDROME IN HYPERTENSIVE PATIENTS C. Serban1 , S. Dragan2 , I. Mozos1 , L. Susan3 , R. Christodorescu4 , L. Noveanu5 , A. Pacurari3 , A. Caraba3 , R. Mateescu5 , I. Romosan3 . 1 Pathophysiology, 2 Preventive Cardiology and Cardiovascular Rehabilitation Clinic, 3 Internal Medicine, 4 Department of Cardiology, Ascar, 5 Physiology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania Objective: The purpose of this study was to compare the values of anthropometric parameters and the values of carotid intima-media thickness in hypertensive patients with metabolic syndrome considering the number of NCEP ATP III criteria present. Material and Method: 48 hypertensive patients with metabolic syndrome (mean age 57±3.67 years) were studied. The patients were divided in four groups depending on the number of NCEP criteria present: 12 patients with 2, 11 patients with 3, 13 patients with 4, and 12 patients with 5 criteria of NCEP accomplished. Anthropometric parameters were determined for all participants. Results: A significant direct graded relationship was observed between the values of anthropometric parameters and the number of NCEP present criteria. Mean BMI values for the patients with 2, 3, 4, and 5 criteria were: 23.24±0.93, 27.90±2.38, 27.06±2.11, 27.83±2.10, kg/m2 , p < 0.001. Mean WC values for those with 2, 3, 4, and 5 criteria were: 76±2.08, 96±9.03, 98±11.39, 99±9.04, cm, p < 0.001. Mean WHR values for those with 2, 3, 4, and 5 criteria were: 0.77±0.13, 0.99±0.10, 1.03±0.12, 1.05±0.11, cm, p < 0.001. The study revealed a significant directly graded relationship between the values of carotid IMT and the number of NCEP criteria present (mean IMT for those with 2, 3, 4, and 5 criteria: 0.84±0.03 mm, 1.22±0.11 mm, 1.29±0.04 mm, 1.30±0.94 mm, p < 0.001). Conclusion: In conclusion, carotid IMT increased according to the number of MS components in hypertensive patients with metabolic syndrome.
Poster presentations
849 AN ASSOCIATION OF INTIMA-MEDIA THICKENING OF COMMON CAROTID ARTERIES WITH SUBCLINICAL SIGNS OF INSUFFICIENCY OF CEREBRAL BLOOD FLOW T.V. Kirichenko1,2 , V.A. Myasoedova1,2 , D.M. Mironova1 , I.A. Sobenin1,2,3 . 1 Institute of General Pathology and Pathophysiology, 2 Institute for Atherosclerosis Research, 3 Russian Cardiology Research-and-Production Complex, Moscow, Russia Background and Aims: Localization of atherosclerotic lesions in extracranial parts of the brachiocephalic arterial bed accounts for up to 75% of atherosclerotic changes that lead to the development of cerebral ischemia. An increased carotid intima-medial thickness (cIMT) elevates the risk of stroke significantly and is an independent risk factor regardless of the presence of atherosclerotic plaques in carotid arteries. However, there is no evidence of diagnostic significance of cIMT at subclinical cerebrovascular disease. The aim of this study was to examine the association between neurological status and the presence of atherosclerotic lesions in the carotid arteries (especially diffuse thickening of the intima-medial complex), as well as traditional risk factors for cardiovascular disease in apparently healthy individuals. Patients and Methods: The study involved 225 participants (83 men and 142 women) aged 44−75 (mean 63.8±7.1), free of clinical manifestations of atherosclerotic disease, in whom ultrasound B-mode examination of carotid arteries was performed. Integral assessment of neurological status (INS) was performed using specially developed 4-point scale. Results: In men INS correlated with mean and maximum cIMT (r = 0.291, p = 0.008 and r = 0.254, p = 0.021, respectively), but not with the presence of atherosclerotic plaques in carotid basin. In women INS correlated as with mean and maximum cIMT (r = 0.251, p = 0.003 and r = 0.261, p = 0.002, respectively), as with the extent of carotid plaques (r = 0.316, p < 0.001). Conclusion: Diffuse intima-media thickening of carotid arteries determines even minimally expressed, subclinical neurological changes at the earliest stages of cerebrovascular disease. Acknowledgement: This study was supported by Russian Ministry of Education and Science. 850 RISK FACTORS OF CORONARY ARTERY CALCIFICATION IN PATIENTS WITH UNCOMPLICATED ARTERIAL HYPERTENSION SHOWING HIGH COMPLIANCE WITH TREATMENT I. Shatunova1 , N.A. Koziolova2 , I. Lazarev1 . 1 OJSC ‘Gazprom’ Outpatient Clinic, Moscow, 2 Perm State Medical Academy, Perm, Russia Objective: To evaluate coronary artery calcification score (CAC score) in patients with uncomplicated arterial hypertension (AH) showing high compliance with treatment. Methods: 68 patients with uncomplicated AH were examined. Average age was 54.9±6.3 years. Baseline systolic blood pressure (SBP) was 166.2±13.8 mm Hg; baseline diastolic blood pressure (DBP) was 100.3±6.1 mm Hg. Observation period made up 8.8±2.6 years. Spectral computed tomography of coronary arteries was performed in all the patients at the end of the observation period. Compliance level was evaluated as to achievement of target office BP and according to average score of the Morisky–Green test. Results: 57 patients (77.9%) achieved the target office BP. Average score of the Morisky–Green test was 3.69±0.28. 16 (23.5%) patients had a CAC score of 0, and 33 (48.5%) patients had a CAC score between 1 and 100, 10 (14.7%) patients had a CAC score between 101 and 400, 7 patients (10.3%) had a CAC score >400. The groups of patients were compared in terms of CAC score and as a result significant differences in terms of AH duration (p < 0.001), baseline DBP and DPB at the end of the observation (p = 0.008 and p = 0.013 respectively), baseline fasting plasma glucose >5.6 mmol/L (p < 0.001), high density lipoproteins in serum (HDL) (p = 0.019), left ventricle myocardium mass index (LVMMI) (p = 0.048) were revealed. Conclusions: AH duration, high DBP level, fasting plasma glucose >5.6 mmol/L, low level of HDL, LVMMI appeared to be predictors of coronary artery calcification development 851 AORTIC STIFFNESS IS A DETERMINANT OF CAROTID INTIMA MEDIA THICKNESS IN PATIENTS AT INTERMEDIATE CARDIOVASCULAR RISK R. Ferre, ´ J. Merino, N. Plana, M. Heras, C. Buixadera, L. Masana. Vascular Medicine and Metabolism Unit, Sant Joan University Hospital. Rovira & Virgili University. CIBERDEM, Reus, Spain Background: Aortic stiffness measured by the Augmentation Index (AIx) and carotid intima media thickness (cIMT) are related to cardiovascular events. The association with these surrogate markers is not well understood. Objective: To determine AIx and cIMT relationship in patients at intermediate CV risk. Methods: eight-hundred and sixteen volunteers were included from an outpatient vascular medicine clinic. AIx was determined by peripheral artery tonometry (EndoPAT-2000) and the cIMT was measured by ultrasonography. Results: The mean age was 52.9 years (12.2), 57.4% men. Mean cIMT was 0.79 mm(0.16), 0.76 in women and 0.80 in men (P = 0.001). The mean AIx was