- Email: [email protected]
Arterial wall elasticity among male and female non-smokers and smokers
160
Marchioli
whether fibrinogen levels may modulate endothelial function, expressed as brachial flow-mediated vasodilation (FMV) in healthy subjects without cardiovascular risk factors diabetes, hypertension, hypercholesterolemia, smoking and infective disease, neoplasia, liver disease or autoimmunity disorders. Here we presented preliminary data relative to a group of 30 women (mean age 35 20 yrs); nobody was taking hormonal replacement therapy or antioxidant drugs. In all subjects it has been evaluated fibrinogen (determined by coagulometer), plasma viscosity (by rotational viscometer), platelets, white cells, haematocrit, lipid parameters and brachial FMV (using a non-invasive ultrasound method). We found that all values were in the normal range; brachial FMV was related to fibrinogen (r--0.462; p-0.01), plasma viscosity (r--0.366; p-0.046) and to white cell levels (r--0.387; p-0.034).These results suggest that in healthy women the behaviour of endothelial reactivity may be dependent to fibrinogen, plasma viscosity and white cell levels so to indicate an involvement of inflammatory state in the modulation of endothelial state. It is necessary clarify which factor may influence inflammation even in absence of evident causal conditions.
[4-•
MEDITERRANEAN DIET AND POST-AMI RISK OF CARDIOVASCULAR MORTALITY
R. Marchioli 1, E Barzi 2, R.M. Marfisi 1, M. Woodward2. J Consorzio Mario Negri Sud, Santa Maria Imabro, Italy; 2Institute for International Health, University of Sydney, Australia
Purpose: To estimate the effect of a Mediterranean Diet on the risk of cardiovascular death (CVD) after myocardial infarction (MI). Methods: The GISSI-Prevenzione trial recruited 11323 subjects in 172 centres across Italy. Subjects surviving recent MI were randomly assigned supplements of n-3 PUFA, vitamin E, both or neither. Dietary habits were assessed with a food-frequency questionnaire at randomisation and were updated at the 6th, 18th and 42nd month follow-up visits. To reduce withinsubject variation and to best represent the long-term dietary pattern, pooled logistic regression models were used to estimate the relative risk of CVD associated with a relatively high food intake compared with a low intake. The foods analysed were fruit, vegetables (fresh and cooked), fish and olive oil. A dietary score was computed from the consumption frequencies of the five foods; patients were categorised into four score-groups ranging from the worst to the best dietary habit. All the models were adjusted for age, sex and experimental treatment received. Results: All foods and the dietary score were associated with a significant reduction in the risk of all-causes mortality; the protective effects increased linearly with increasing intake of each food and increasing score. When compared to people in the worst score quarter, the odds ratio (95% confidence interval) for those in the best score quarter was 0.46 (0.40~).54). Conclusion: A Mediterranean diet, based on a daily intake of fruit, vegetables and olive oil, helps to reduce the risk of CVD for those who have already suffered a heart attack.
[4-•
ARTERIAL WALL ELASTICITY AMONG MALE AND FEMALE NON-SMOKERS AND SMOKERS
H. Marcoyannopoulou-Foias, N. Papageorgakis, G.M. Fojas, G. Jullien.
Evangelismos University Hospital, Athens, Greece Purpose: To compare arterial wall elasticity between non-smokers and smokers of the two sexes. Method: Arterial wall elasticity was determined indirectly by Pulse Wave Velocity (P.W.V) using an original method and device which recorded the left external carotid and left dorsalis pedis pulses simultaneously with a single lead ECG. The time delay between the two pulses is measured automatically. A longer transmission time would indicate decreased arterial wall elasticity. Materials: A total of 108 subjects were studied 59 non-smokers and 49 smokers (one or more packs per day); 38 were males and 70 females. Of the 38 males, 18 were non-smokers and 20 smokers; and of the 70 females, 41 were non-smokers and 29 smokers. Results: The mean time of the PWV (in seconds) were as follows: For all the 108 subjects regardless of sex 59 non-smokers-0.1549 and 49 smokers-0.1581; 18 male non-smokers-0.1622, 20 male smokers-0.1517; 41 female non-smokers-0.1515, 29 female smokers-0.1527. The study shows that smoking alone without considering gender does not significantly affect the PWV (p value-0.117). However when the subjects are separated into two sexes, it is shown that the mean time of the PWV is significantly lower (p value-0.044) among male smokers compared to male non smokers while this mean time is the same among female non-smokers and smokers.
Conclusion: Male smokers have significantly lower time of PWV compared to male non-smokers while female smokers do not differ from female non-smokers.
~-~
INTERLEUKIN 1 RECEPTOR ANTAGONIST GENOTYPE IS ASSOCIATED W I T H CORONARY ATHEROSCLEROSIS IN PATIENTS W I T H TYPE 2 DIABETES
R. Marculescu 1, G. Endler 1, M. Schillinge~, M. Exner 1, E. Hayden3, K. Huber4, O. Wagner 1, C. Mannhalter 1. JDepartment of Laboratory
Medicine, 2Department of Internal Medicine II, Division of Angiology, University of Vienna, General Hospital," 3Department of Business Administration, University of Vienna, School of Business, Economics and Computer Science," 4Department of Internal Medicine II, Division of Cardiology, University of Vienna, General Hospital, Austria The proinflammatory cytokine IL-1 is thought to play a key role in atherogenesis. The interleukin 1 receptor antagonist (IL-lra) is a major modulator of IL-1 activity. A variable number tandem repeat (VNTR) polymorphism in the IL-lra gene (IL1RN) has been described of which allele 2 (IL1RN*2) is associated with single vessel coronary artery disease (CAD) and diabetic nephropathy. We studied the relationship between the IL1RN genotype and CAD in patients with type 2 diabetes. 787 consecutive patients admitted for suspected CAD were included in the study. According to the current criteria of the American Diabetes Association (ADA) 250 patients suffered from type 2 diabetes mellitus. Among these, the IL1RN*2 carriers (n-108) had a significantly higher prevalence of CAD (85.2%) compared to the noncarriers (73.2%). The difference was statistically significant in a multivariate logistic regression model (odds ratio [OR] 2.2, 95% CI 1.1 - 4.3, p-0.02). In patients without diabetes the prevalence of CAD was similar in IL1RN*2 carriers and non carriers (55.7% versus 55.6%). Our results suggest that IL1RN*2 is associated with CAD in patients with type 2 diabetes.
THE SIMPLIFIED ACUTE PHYSIOLOGY SCORE (SAPS) 11 •4-]] USED IN THE EVALUATION OF OUTCOME IN PATIENTS W I T H ACUTE CORONARY SYNDROME ADMITTED AT THE CORONARY CARE UNIT C.E. Marinas 1, R.E. Ramboyong1, R.T. Tibayan 1, C.S. Oro2, E.S. Caguioa 1, D.R. Flores Jr. 1. JDepartment of Medicine-Cardiology, 2Family Medicine
Department, Santo Tomas University Hospital, Manila, Philippines Background: The critical care management of patient with acute coronary syndrome(ACS) admitted at the coronary care unit(CCU) is a challenging task among clinicians mainly because of a high probability of mortality and morbidity. Objective: This study investigated the possible use of SAPS 11 severity of illness scoring in the evaluation and prognostication of clinical outcomes in patient with ACS at the CCU. Methodology: Patients were initially evaluated at the CCU. Data from the physiologic variables of the SAPS 11 scores were collected with in the first 24 hours of CCU stay. Computation of the worst points and tabulation of standardized scores were assigned. Clinical outcomes upon discharge from the CCU were categorized as 1. Improvement, 2. Morbidity, 3. Mortality. Results: A total of 108 patients were included in the study with a mean age of 63.44 with a male predominance at 61%. The average SAPS 11 scores was 35.07 (range 6 84). Patient who were discharge improved had a mean score of 42 compared to a mean score 65 in those who expired. Patient with scores between 2040, which is not far from the cut off scores of noted mortality, developed high incidence of heart failure, arrhythmia and other cardiovascular complications. The average probability of mortality derived from SAPS 11 score with cut off >50 was 15.87%. The SAPS 11 measured by AUC in the study population was 0.82±0.0194. The relative risk of those who expired with a score >50 to those who survived with a score>50 was 1.14. Age was positively correlated with all the physiologic parameters using multiple linear regression. Conclusion: The SAPS 11 score can be a valuable tool as a prognostic marker of clinical outcome in patients with acute coronary syndrome. The higher the score (more than 50) the higher the probability of mortality.
73rd EAS Congress
Marchioli
whether fibrinogen levels may modulate endothelial function, expressed as brachial flow-mediated vasodilation (FMV) in healthy subjects without cardiovascular risk factors diabetes, hypertension, hypercholesterolemia, smoking and infective disease, neoplasia, liver disease or autoimmunity disorders. Here we presented preliminary data relative to a group of 30 women (mean age 35 20 yrs); nobody was taking hormonal replacement therapy or antioxidant drugs. In all subjects it has been evaluated fibrinogen (determined by coagulometer), plasma viscosity (by rotational viscometer), platelets, white cells, haematocrit, lipid parameters and brachial FMV (using a non-invasive ultrasound method). We found that all values were in the normal range; brachial FMV was related to fibrinogen (r--0.462; p-0.01), plasma viscosity (r--0.366; p-0.046) and to white cell levels (r--0.387; p-0.034).These results suggest that in healthy women the behaviour of endothelial reactivity may be dependent to fibrinogen, plasma viscosity and white cell levels so to indicate an involvement of inflammatory state in the modulation of endothelial state. It is necessary clarify which factor may influence inflammation even in absence of evident causal conditions.
[4-•
MEDITERRANEAN DIET AND POST-AMI RISK OF CARDIOVASCULAR MORTALITY
R. Marchioli 1, E Barzi 2, R.M. Marfisi 1, M. Woodward2. J Consorzio Mario Negri Sud, Santa Maria Imabro, Italy; 2Institute for International Health, University of Sydney, Australia
Purpose: To estimate the effect of a Mediterranean Diet on the risk of cardiovascular death (CVD) after myocardial infarction (MI). Methods: The GISSI-Prevenzione trial recruited 11323 subjects in 172 centres across Italy. Subjects surviving recent MI were randomly assigned supplements of n-3 PUFA, vitamin E, both or neither. Dietary habits were assessed with a food-frequency questionnaire at randomisation and were updated at the 6th, 18th and 42nd month follow-up visits. To reduce withinsubject variation and to best represent the long-term dietary pattern, pooled logistic regression models were used to estimate the relative risk of CVD associated with a relatively high food intake compared with a low intake. The foods analysed were fruit, vegetables (fresh and cooked), fish and olive oil. A dietary score was computed from the consumption frequencies of the five foods; patients were categorised into four score-groups ranging from the worst to the best dietary habit. All the models were adjusted for age, sex and experimental treatment received. Results: All foods and the dietary score were associated with a significant reduction in the risk of all-causes mortality; the protective effects increased linearly with increasing intake of each food and increasing score. When compared to people in the worst score quarter, the odds ratio (95% confidence interval) for those in the best score quarter was 0.46 (0.40~).54). Conclusion: A Mediterranean diet, based on a daily intake of fruit, vegetables and olive oil, helps to reduce the risk of CVD for those who have already suffered a heart attack.
[4-•
ARTERIAL WALL ELASTICITY AMONG MALE AND FEMALE NON-SMOKERS AND SMOKERS
H. Marcoyannopoulou-Foias, N. Papageorgakis, G.M. Fojas, G. Jullien.
Evangelismos University Hospital, Athens, Greece Purpose: To compare arterial wall elasticity between non-smokers and smokers of the two sexes. Method: Arterial wall elasticity was determined indirectly by Pulse Wave Velocity (P.W.V) using an original method and device which recorded the left external carotid and left dorsalis pedis pulses simultaneously with a single lead ECG. The time delay between the two pulses is measured automatically. A longer transmission time would indicate decreased arterial wall elasticity. Materials: A total of 108 subjects were studied 59 non-smokers and 49 smokers (one or more packs per day); 38 were males and 70 females. Of the 38 males, 18 were non-smokers and 20 smokers; and of the 70 females, 41 were non-smokers and 29 smokers. Results: The mean time of the PWV (in seconds) were as follows: For all the 108 subjects regardless of sex 59 non-smokers-0.1549 and 49 smokers-0.1581; 18 male non-smokers-0.1622, 20 male smokers-0.1517; 41 female non-smokers-0.1515, 29 female smokers-0.1527. The study shows that smoking alone without considering gender does not significantly affect the PWV (p value-0.117). However when the subjects are separated into two sexes, it is shown that the mean time of the PWV is significantly lower (p value-0.044) among male smokers compared to male non smokers while this mean time is the same among female non-smokers and smokers.
Conclusion: Male smokers have significantly lower time of PWV compared to male non-smokers while female smokers do not differ from female non-smokers.
~-~
INTERLEUKIN 1 RECEPTOR ANTAGONIST GENOTYPE IS ASSOCIATED W I T H CORONARY ATHEROSCLEROSIS IN PATIENTS W I T H TYPE 2 DIABETES
R. Marculescu 1, G. Endler 1, M. Schillinge~, M. Exner 1, E. Hayden3, K. Huber4, O. Wagner 1, C. Mannhalter 1. JDepartment of Laboratory
Medicine, 2Department of Internal Medicine II, Division of Angiology, University of Vienna, General Hospital," 3Department of Business Administration, University of Vienna, School of Business, Economics and Computer Science," 4Department of Internal Medicine II, Division of Cardiology, University of Vienna, General Hospital, Austria The proinflammatory cytokine IL-1 is thought to play a key role in atherogenesis. The interleukin 1 receptor antagonist (IL-lra) is a major modulator of IL-1 activity. A variable number tandem repeat (VNTR) polymorphism in the IL-lra gene (IL1RN) has been described of which allele 2 (IL1RN*2) is associated with single vessel coronary artery disease (CAD) and diabetic nephropathy. We studied the relationship between the IL1RN genotype and CAD in patients with type 2 diabetes. 787 consecutive patients admitted for suspected CAD were included in the study. According to the current criteria of the American Diabetes Association (ADA) 250 patients suffered from type 2 diabetes mellitus. Among these, the IL1RN*2 carriers (n-108) had a significantly higher prevalence of CAD (85.2%) compared to the noncarriers (73.2%). The difference was statistically significant in a multivariate logistic regression model (odds ratio [OR] 2.2, 95% CI 1.1 - 4.3, p-0.02). In patients without diabetes the prevalence of CAD was similar in IL1RN*2 carriers and non carriers (55.7% versus 55.6%). Our results suggest that IL1RN*2 is associated with CAD in patients with type 2 diabetes.
THE SIMPLIFIED ACUTE PHYSIOLOGY SCORE (SAPS) 11 •4-]] USED IN THE EVALUATION OF OUTCOME IN PATIENTS W I T H ACUTE CORONARY SYNDROME ADMITTED AT THE CORONARY CARE UNIT C.E. Marinas 1, R.E. Ramboyong1, R.T. Tibayan 1, C.S. Oro2, E.S. Caguioa 1, D.R. Flores Jr. 1. JDepartment of Medicine-Cardiology, 2Family Medicine
Department, Santo Tomas University Hospital, Manila, Philippines Background: The critical care management of patient with acute coronary syndrome(ACS) admitted at the coronary care unit(CCU) is a challenging task among clinicians mainly because of a high probability of mortality and morbidity. Objective: This study investigated the possible use of SAPS 11 severity of illness scoring in the evaluation and prognostication of clinical outcomes in patient with ACS at the CCU. Methodology: Patients were initially evaluated at the CCU. Data from the physiologic variables of the SAPS 11 scores were collected with in the first 24 hours of CCU stay. Computation of the worst points and tabulation of standardized scores were assigned. Clinical outcomes upon discharge from the CCU were categorized as 1. Improvement, 2. Morbidity, 3. Mortality. Results: A total of 108 patients were included in the study with a mean age of 63.44 with a male predominance at 61%. The average SAPS 11 scores was 35.07 (range 6 84). Patient who were discharge improved had a mean score of 42 compared to a mean score 65 in those who expired. Patient with scores between 2040, which is not far from the cut off scores of noted mortality, developed high incidence of heart failure, arrhythmia and other cardiovascular complications. The average probability of mortality derived from SAPS 11 score with cut off >50 was 15.87%. The SAPS 11 measured by AUC in the study population was 0.82±0.0194. The relative risk of those who expired with a score >50 to those who survived with a score>50 was 1.14. Age was positively correlated with all the physiologic parameters using multiple linear regression. Conclusion: The SAPS 11 score can be a valuable tool as a prognostic marker of clinical outcome in patients with acute coronary syndrome. The higher the score (more than 50) the higher the probability of mortality.
73rd EAS Congress