CVD in a large rural population: The Brisighella Study

Tuesday June 27, 2000: Poster Abstracts P:W9 Geographic Epidemiology of Atherosclerosis controlling for age, smoking, alcohol consumption, total serum cholesterol, fasting blood sugar and body mass index. Results: The Cox proportional hazards models revealed significant hazards ratios (HR) for each 10 mm Hg increment of PP (1.69; 95% CI, 1.60--1.78). Stroke incidence was nearly four-fold greater in the highest level of PP (>55 nun Hg) than in the lowest (<40 mm Hg). This significant association between PP and stroke was shown both in hypertensives and normotensives. The HRs for each 10 mm Hg increment of PP for hypertensives and normotensives were 1.46 (95% CI, 1.37-1.56) and 1.37 (95% CI, 1.18-1.58), respectively Conclusions: In a large population of Korean men, a wide pulse pressure was a significant independent predictor for the incidence of stroke and the association was not modified according to BP level.

TuP6:W9 1 Apolipoprotein E concentration and polymorphism in relation with triglycerides in six European countries: The ApoEurope Project G. Siest 1, F. Schiele I , D. De Bacquer2, M. Vincent-ViryI , U. Beisiegel3 , C. Ehnholm4, A. Evans5, A. Kafatos6, M.C. Martins7 , S. Sans 8, C. Sass I , G. De Backer2, S. Visvikis 1. The ApoEurope Group; lLaboratoire du Centre

de Mddecine Preventive, Vandoeuvre-lbs-Nancy; 9Universitd Henri Poincard (Nancy 1), Nancy, France; 2University of Gent, Belgium; 3 Universitiits-Krankenhaus Eppendo~ Hamburg, Germany; 4National Public Health Institute, Helsinki, Finland; SQueen's Un&ersity, Belfast, Northern Ireland, UK; 6Faculty of Medicine, Heraklion, (Crete), Greece; 71nstituto Nacional de Saude, Lisbon, Portugal; 8Institute of Health Studies, Barcelona, Spain The apolipoprotein E (apt E) serum concentration and polymorphism were determined in addition to triglycerides in 6934 healthy subjects aged 25 to 64 years recruited in six European countries: Finland, France, Greece, Northern Ireland, Portugal and Spain. Age and sex influenced apt E concentration with concentrations being significantly higher in men than in women for those aged between 25 and 44 years. The age effect differed between the sexes after the age of 44, displaying a linear increase in women and a plateau in men. As expected, the serum apt E concentration was highest in e2 carders and lowest in e4 carders in each country with a significantly higher frequency of the e4 allele in the northern regions. The main finding of this study was a clear increasing North-South gradient in serum apt E concentration independent of age, sex and apt E genotype, In subjects aged less than 45 years and with the e3/e3 genotype, apt E concentration was higher in the South-East (Greece) as compared to the North by 20% for men and 32% for women. In addition to the genetic polymorphism, the geographical area is an important factor to take into account when studying serum apt E concentration in multicentre studies and defining reference values.

105

Conclusions: In Poland high 14 day case fatality is due to higher death rates for patients who have suffered a mild stroke. It may be caused by high prevalence of prestroke cardiac diseases and insufficient care in the early stages of stroke.

TuP8:W9 ] Epidemiolel~ of high density Hpoprotein levels in pre- and post-menopause: The BrisigheHa Heart Study A. ReF_~iani,A.EG. Cicero, C. Martini, EO. Odoo, A. Dormi, A. Gaddi. Atherosclerosis Centre "G.C. Descovich", University of Bologna, Italy Objective: To evaluate the trend of HDL-C in a large free-living female population in perimenopausal age. Methods: The Brisighella Heart Study (BHS) is a longitudinal study (1972-stilt in progress) on the major cardiovascular risk factors in a NorthItalian rural population. For this retrospective analysis of the BHS data, we considered only the population surveys carded out before the intervention phase (1976-1986). The metabolic and anthropometric parameters of 141 females in perimenopausal age (mean age = 47.75 4- 1.75 years) were analysed in premenopausal phase and, after four years, in postmeanopausal phase. The Student's t-test for paired samples was carded out to determine when the variation of the metabolic and anthropometric parameters was significant (p < 0.01). Results: Mean (+SD) lipoprotein plasmatic levels, glycemia and BMI in pre- and post-menopausal age are reported in the table. Parameter

Premenopause

Postmanopause

TC LDL-C

234.92 4- 14.98 155.32 4- 11.21 51.89 4- 7.12 132.82 4- 13.78 75.01 4- 8.65 25.04 4- 4.15

263.63 4- 18.01 175,69 4- 14.32 56.83 4- 8.23 154,06 4- 11.92 84,06 4- 7.09 26,53 4- 4.34

blDL-C TG Glucose BMI

Significance P P P P P P

< < < < < <

0.01 0.01

0.01 0.01 0.01 0.01

Conclusion: In contrast with the results of epidemiological transversal studies (which suggest that the mean plasmatic HDL-C level decrease in postmenopause) and according to the longitudinal Frammingham and Taipei Studies our data confirm that mean HDL-C level significantly raises after menopause in a free-living female population.

I TuP9:W9 I Association between lipidic phenotype variability and CHD/CVD in a large rural population: The Brisigheila Study A.F.G. Cicero, C. Martini, V. Nativio, A. Reggiani, A. Dormi, A. Gaddi.

Atherosclerosis Centre "G.C. Descovich", Bologna, Italy Objective: To evaluate the association between lipidic phenotype variability

I TuP7:W9 1 Causeof early stroke fatality in Poland T. Mendel, I. Baroni, W. Lechowicz, D. Ryglewicz, A. Czlonkowska. Institute of Psychiatry and Neurology, Sobieskiego 1/9, 02-957 Warsaw, Poland Objective: The cause of high early stroke fatality in Poland remains unclear. Multinational, multicentre studies as International Stroke Trial (IST) performed in 1993-1996, may help to explain this phenomenon. The main aim of this study was to find the causes of the high 14-day stroke fatality in Poland. Methods: In the IST 17370 people were confirmed as having had ischemic strokes. Data from the randomisation and 14 day follow-up cards, according to the 14-day IST protocol were entered in the major database (Borland International) in Edinburgh. This database was used for our analysis. The 14-day fatality was compared between Poland (677 randomized patients) and all other centers participating in IST studies (16693). Results: In Poland, the 14 day fatality was higher than in the overall IST study (13.6%; 95%CI 11-16 vs. 9.59%; 95%CI 9.1-10). After adjusting for case mix differences, the risk of death during 14 days in Poland was 57% higher than in all other participating countries. The case fatality in Poland was higher for those who: were younger than 75 (11.3%; 95%CI 8.3-14.1 vs. 6.7%; 95%CI 6.2-7.2), fully alert (9.2%; 95%CI 6.7-12.1 vs.4.6%; 95%CI 4.2-4.9), with mild stroke [partial anterior circulation infarct] (14.9%; 95%CI 11.0-19.0 vs. 7.7%; 95% CI 7.0-8.3) and without atrial fibrillation (11.8%; 95%CI 8.9-14.6 vs. 7.8%; 95%CI 7.4-8.3.). Higher rates of death were also noticed among women (17.4%; 95% CI 13.3-21.5 vs. 10.7%; 95%CI 9.9-11.4). Coronary heart disease was more likely to be the reported cause of death in Poland than in all the IST countries (18.5%; 95% CI 11.0-27.0 vs. 7.5%; 95%CI 6.5-9.1).

(primitive and not) and cardiovascular diseases (CD: 410--414 and 430--438 codes by IX ICD) in a large rural Northern-Italy population. Methods: The Brisighella Study is a longitudinal study (1972-in progress) on the major cardiovascular risk factors in a North-Italian rural population. At 1996's population control, 1303 subjects were tested in 4 or more four-yearly surveys (53.74 + 14.97 years). The individual lipidic phenotype by Fredrickson classification was attributed for each survey on the basis of LDL-C and TG plasmatic levels suggested from De Bruin et al. for Garnilial Combined Hyperiipoproteinemia (FCH) detection. A primitive dyslipoproteinemia presence was suspected on the basis of: CD personal or familial history; No disease nor drugs assumption potentially affecting lipid metabolism; Cholesterol/lipids lowering drugs assumption; BMI < 27 for men and <25 for women; LDL-C plasmatic levels > 200 mg/dL; Correct dietary habit. X 2 test with Yates correction was carded out to test the CD prevalence difference between the whole hyperlipoproteinernic population and the primitive hyperlipoproteinemic subgroup. Results: Obviously, both Ila and variable phenotypes have a much higher CD prevalence in respect to normolipidemic subjects, while in the whole population CD is more frequent among Ila (2.94%) than among variable phenotypes (1.83%) IX2 = 26.39, 1 FD, p < 0.001]. Comparing the same prevalences among the whole dyslipidemic group and the primitive dyslipidemic subgroup it appears that in Ila subjects there is a similar CD prevalence, while in primitive variable phenotypes it is much superior (5.26%) [X2 = 10.05, 1 FD, p < 0.001]. In primitive hyperlipidemics CD prevalence is significantly higher in variable phenotypes than in Ila subjects, too (5.26% Vs 2.90%).

Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000

Tuesday June 27, 2000: Poster Abstracts P:W9 Geographic Epidemiology of Atherosclerosis

106

Conclusion: In our population the CD prevalence is more strongly associated to a primitive variability of the lipidic phenotype (partly related to FCH) than to a constant primitive Ila phenotype.

considered in the preoperative evaluation of the patients, but with different premises.

I TuP12:W9 1 Dramatic increase of premature myocardial infarction in I TuP10:W9 ] Low incidence ofxanthomas in heterozygous familial hypercholesterolemia (FH) in Spain C. Garcts I , F. Rodrfguez Artalejo 2, A. Serrano 3, J. Gonz~ilez Bonillo 4, IF. Almagro 5, J.A. Garrido 6, M. Zufiiga7, M. de Oya I . 1F. Jimdnez Diaz,

Madrid; 2Univ Auttnoma, Madrid; 3C. Salud Portagalete; 4C. Salud Huesca; 5Hosp. Guipdzcoa; 6Hosp. A. Marcide, El Ferrol; 7Hosp. Valdecilla, Santander, Spain The diagnosis of FH is based on identification of high LDL levels, with evidence of an autosomal dominant mode of inheritance, high incidence of ischaemic heart disease (IHD), xanthomas, xanthelasmas and corneal arcus. Xanthomas are present in 54-75% of patients with FH in North-European countries, this incidence seems to be lower in South-European countries. In our study we wanted to characterize clinical manifestations of FH in Spain. Patients and Methods: We studied 301 cases of FH from central and north regions in our country. Inclusion criteria were: total cholesterol over 300 mg/dl and triglyeeride below 250 mg/dl in the proband and in at least one of the first-degree relatives of the proband. Results: Plasma lipids levels (means 4- SD) and clinical manifestation were:

Cholesterol (mg/dl) Triglyceride (mg/dl) LDL-C (rny/dl) HDL-C (my/d) Xanthomas Xanthelasmas Arcus Corneae IHD Familial history of IHD

Total (n = 301)

Men (n = 140)

Women (n = 161)

346 :t: 58 135 5:69 250 5 : 6 4 53 5:13 23 (8%) 18 (6%) 60 (20%) 60 (20%) 153 (51%)

346 5:53 149 5:"/3 249 ± 57 50 -4- 12 13 (9%) 5 (4%) 35 (26%) 42 (29%) 70 (50%)

346 5:62 123 5:62 249 5:70 55 5:14 10 (6%) 13 (8%) 25 (15%) 18 (l 1%) 83 (5 1%)

Isfahan, Iran F.A. Sayed-Tabatabaei, N. Sarraf-Zadegan, M. Boshtam, Sh. Hoseini. Isfahan

Cardiovascular Research Center, lsfahan, lran Objective: Cardiovascular diseases (CVD) are the leading causes of death in US and most of the western countries, as well as developing countries. Increasing incidence of coronary artery disease (CHD) is observed in most of developing countries in recent years. This study was performed to determined the trend of incidence of premature myocardial infarction (MI) (ie. in population less than 60 years old) from 1986 to 1995 according to official statistics on hospital discharges. Methods: As there was no official MI registry unit in our country, a special register has been established in Isfahan Cardiovascular Research Center and data was collected from all hospitals which may admit the CHD patients in CCUs or cardiology wards. MI was considered to have occurred when at least two of the three WHO standard criteria for MI diagnosis were fulfilled. Results: An increase in incidence of MI was seen in both sexes and it was more clear between 1990 to 1995. The absolute increase in men was from 95.9 to 175 per 100,000. It seems to be greater than women which was from 13.2 to 64.7 per 100,000, but the values themselves are greater in men. Indeed, the relative increase (incidence ratio) was more dramatic in women (4.9 fold vs. 1.8 fold). The relative increase in total population was 2.2 fold. Conclusions: Such a huge increase in values suggests the need for large comprehensive preventive campaigns for primary prevention and risk factor control especially in women. To avoid the possible sources of bias, establishing the standard registry units based on MONICA protocol in all developing countries is strongly suggested.

I TuP13:W9 I Coronary atherosclerosis in subjects 60-69 years old in I

With a total cholesterol level of 346 4- 58, only 8% of the patients have xanthomas and 20% IHD. 51% have a familial antecedent of IHD. Condnsions: Contrary to that shown in international literature, xanthomas are very infrequent in FH in Spain and the diagnosis should be suspected for other aspects. The high prevalence of familial antecedent of IHD supports the usefulness of this aspect as a marker for diagnosis and prevention.

TuP11 : W 9 ~ Peripheral vascular surgery in women - Trends and

outcome changes in the Stockholm area (Sweden) R. Hultgren, P'~ Olofsson, Eric Wahlberg. Department of Vascular Surgery,

Karolinska Hospital, Stockholm, Sweden Objectives: To investigate possible gender differences over time in; a) the number and type of procedures performed, b) outcome, in patients with PAOD undergoing vascular interventions. Methods: Data from the inpatient-register of the National Board of Health and Welfare and data from the Cause of Death-register for Stockholm County (population 1.7 miljon 1994) have been analyzed for all patients subjected to vascular intervention 1970-1994. Results: The total number of interventions rose from 18 in 1970 to 786 interventions/million inhabitants 1994. While the number of embolectomies has diminished over time, the number of infrainguinai procedures increased. The fraction of female patients also grew significantly (p < 0.001) from 34% to 1970 to 48% 1994. Mean age, increased from 63 to 71 years with a steady five year age difference between women and men. (71 vs. 66 years, p = 0.01). The strongest negative predictor for survival was increasing age (p < 0.001), followed by male sex (p < 0.001). Comparing 30-day survival among the infrainguinal and suprainguinal procedures, shows no significant difference between women and men, although women are older (6 and 3 years older). Conclusions: This study presents a dramatic increase in the number of vascular operations in Stockholm with a parallel expansion of the proportion performed on female patients. It is unknown whether this development is a result of an increased incidence of PAOD in women. It is probable, however, that in 10-15 years most peripheral vascular procedures will be infrainguinal interventions in women over 70 years old. Previous assumptions, that the outcome of vascular surgery is poor in women, with both elevated mortality rates and more complications, are challenged in this study. Male sex was a predictor of poor survival, suggesting that gender aspects still need to be

three European cities and its changes over a 25 year period I V.S. Zhdanov , N.H. Stemb~, 2, A.M. Vikhert 1. 1Russian Cardiology -C-'oomp--~,ex,Moscow, Russia; LMalmo University Hospital, Malmo, Sweden

Objective: To study the evolution of coronary atherosclerosis (Ath) in subjects 60-69 years old over a 25 year period. Methods: We have previously reported the evolution of atherosclerosis in subjects 20-59 years old in different populations. The main coronary arteries were collected at autopsy in subjects 60-69 years old in Malmo, Riga and Yalta and durinlg two periods, the early sixties (the I st study) and the late eighties (the 2 na study). During the 1st study 1536 males and 1114 females were included, during the 2 nd 410 and 319 subjects, resp. Ath was estimated as extent of raised lesions (RL). Results: In Malmo males extent of RL was decreased in the 2 nd study whilst it was significantly increased in males of Riga and Yaita. In Maimo females the extent of RL decreased in the 2 nd study, in Riga and Yalta the extent of RL was the same in 40-59 year old females, but was increased in females 60-69 years old. Conclusions: Extent of Ath in Malmo males and females decreased in the 2 nd study whilst in Riga and Yalta Ath increased in the 2 nd study. This changing pattern was also found for younger age groups.

TuP14:W9 ] Appropriate treatment of dyslipidaemia in angiographtcally defined British Columbians M. Francis. J. Frohlich. Healthy Heart Program, St. Paul's Hospital,

University of British Columbia, Vancouver, Canada Objective: To assess the appropriateness of dyslipideemia treatment in British Columbians with known angiographic, lipid, and risk factor profiles. Methods: Three hundred and fourteen patients were followed up 4 years after having angiography, lipid profile, and risk factor assessment. Positive angiograms were seen in 253 individuals. Through a mailed questionnaire, information was collected on changes in smoking, diet, and other lifestyle risk factors. Availability of diet, exercise, and smoking cessation counselling was assessed. Most recent cholesterol measurement was noted, along with use of lipid-lowering and other medications. Results: The National Cholesterol Education Program (NCEP) guidelines were used to determine appropriateness of treatment for dyslipidaemia. Based on these guidelines, 274 patients should have had annual cholesterol mea-

Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000