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Cause of early stroke fatality in Poland
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
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