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Differences in cardiovascular risk factors between men and women in the Acute Coronary Syndromes
e38 acids which may affect vessel walls. Several studies have demonstrated that LpPlA2 is an independent risk marker for cardiovascular disease. However, few data about the relationship between LpPlA2, lipoprotein(a) [Lp(a)] and calcium score exist in the general population. Methods: LpPlA2 activity levels were measured by immunoturbidimetry, lipoprotein(a) by using an immunoturbidimetric assay and calcium score as CACS Agaston score in 307 subjects of Montignoso Study. Results: LpPlA2 activity levels were significantly (p 187 nmoL/min/mL), subjects with CACSAg>¼ 10 had significantly (p< 10 (31%). No association between CVS > 1, hsCRP>3mg/L and LpPlA2 tertiles. Discussion: Our data suggest that LpPlA2 may contribute to the pathophysiological mechanism in the early phase of atherosclerotic plaque formation, suggesting that a vascular inflammation may have a detrimental role. DIFFERENCES IN CARDIOVASCULAR RISK FACTORS BETWEEN MEN AND WOMEN IN THE ACUTE CORONARY SYNDROMES F. Simonelli, S. Abbolito, C. Miotti, E. Mencarelli, S. Burocchi, V. Presta, G. Gallo, G. Salerno, M. Volpe, L. De Biase. Chair of Cardiology, Dept. Clinical and Molecular Medicine, Sapienza University of Rome, Italy E-mail address: [email protected] (L. De Biase).
We investigated the different control of cardiovascular risk factors such as total cholesterol, LDL, HDL, apolipoprotein A, apolipoprotein B, apolipoprotein B/A1 ratio and Lp (a) at the onset of atherosclerotic disease in male and females. We consecutively enrolled 539 patients admitted to our Coronary Care Unit (CCU) with diagnosis of Acute Coronary Syndrome (ACS) (STEMI, NSTEMI, Unstable Angina) confirmed by a coronary angiography showing obstructive lesions (> 75%). We then divided this population into two groups: 1 (men) and 2 (women). In the sample analyzed, 77% of patients are men and 23% women. Women are older than men at the onset of ischemic heart disease or during relapse. Probably because older, women are more often hypertensive (83% vs 63%), diabetics and with an impaired renal function. There were no significant differences in the values of total cholesterol, LDL and apolipoprotein B. In women, triglyceride values are lower than men (133 mg / dl vs. 151 mg / dl), while those of HDL are generally higher (46 mg / dl vs. 39 mg / dl). In women, the levels of apoA1 are higher (125 mg / dl vs. 111 mg / dl) and consequently the ratio apolipoprotein B / apolipoprotein A1 (0.81 vs 0.97) appears to be lower. The plasma levels of Lp (a) were elevated in 37% of the total population and especially in women, in which the average concentration is about 40 mg / dl: the difference between the genders was not statistically significant. From our data it appears that the distribution of risk factors for ACS is dependent on sex and that, in light of the different post ACS prognosis, in certain subpopulations of patients, can be taken in consideration different treatment strategies. INVESTIGATION OF BARRIERS TO AND FACILITATORS OF PHYSICAL ACTIVITY IN PRIMARY CARDIOVASCULAR PREVENTION N. Simonelli 1, A. Gorini 2, M. Giroli 1, M. Amato 1, L. Vigo 1, E. Tremoli 1, J.P. Werba 1. 1 Centro Cardiologico Monzino, IRCCS, Milan, degli Studi di Milano, DIPO, Milan, Italy Italy; 2 Universita E-mail address: [email protected] (J.P. Werba).
Background: The prevalence of sedentarism is increasing in Italy (PASSI data: from 29% in 2008 to 34% in 2015) and is higher in immigrants and in people with low educational level and/or socio-economic status. The identification of barriers to and facilitators of physical activity (PA) could aid to adopt personalized strategies of intervention. This information may be obtained through Motivational Interviewing (MI), a
Abstracts the SISA collaborative style of human interaction aimed to motivate and to elicit commitment toward positive changes in personal behavior. Objective: Identify barriers to and facilitators of PA in a sample of sedentary participants in a program of primary cardiovascular (CV) prevention. Materials and methods: Levels of PA were assessed, using the PASSI score, in the first 260 subjects who adhered to ProSALUTE, a program of primary CV prevention directed to adult residents in a peripheral neighborhood of Milan. Sedentary participants were invited to follow face-to-face MI sessions with a nursing researcher trained in this style of interaction. After obtaining informed consent, discussions were audio recorded and transcribed verbatim. The MI contents were summarized in categories of meaning for both barriers and facilitators. Results: The prevalence of sedentarism was 24% (n¼63). 18 subjects were not invited to perform CM due to psycho-physical or linguistic problems. 21 subjects, mostly immigrants or unemployed, declined CM (chi squared: p¼0.042 and p¼0.006, respectively). 43 MI sessions were carried out with 24 participants. The main categories of facilitators were the good perception of the personal capability to carry out PA (or self-efficacy) and an appropriate social support. Shortages in the same categories were the barriers more often reported. Conclusions: In primary CV prevention, self-efficacy and social support are the predominant barriers to or facilitators of PA and thus represent possible targets for intervention to encourage the adoption of a physically active lifestyle. CAUSATIVE MUTATIONS AND PREMATURE CARDIOVASCULAR DISEASE IN PATIENTS WITH SEVERE HYPERCHOLESTEROLEMIA M. Sodano 1, M. Gentile 1, F. Jossa 1, G. Marotta 1, G. Fortunato 2, 3, M.D. Di Taranto 4, C. Giacobbe 2, 3, A. Iannuzzi 5, G. Covetti 5, G. Chiariello 5, P. Rubba 1. 1 Dipartimento di Medicina Clinica e Chirurgia, Universita degli Studi di Napoli “Federico II”, Napoli, Italy; 2 CEINGE S.C.a r.l. Biotecnologie Avanzate, Napoli, Italy; 3 Dipartimento di Medicina degli Studi di Napoli Molecolare e Biotecnologie Mediche, Universita Federico II, Napoli, Italy; 4 IRCCS Fondazione SDN, Napoli, Italy; 5 UO Medicina Interna, AORN “A. Cardarelli” di Napoli, Italy E-mail address: [email protected] (M. Sodano).
Familial Hypercholesterolemia (FH) is a common lipid disorder, caused by mutations affecting the clearance of LDL cholesterol. FH patients have elevated LDL cholesterol and if untreated develop premature cardiovascular disease (CVD). Young adults, attending our Lipid Clinic, with LDL> 190mg/dL, after excluding Familial Combined Hyperlipidemia, were included in the study. Search for causative mutations, MedPed/WHO score and non-invasive ultrasound examination of carotid arteries were performed. Among the 225 patients there were 179 with LDLR mutations, 2 with apo B gene Mutations, 1 PCSK9 gene mutation, and 43 patients without mutations. Among 171 unrelated index cases there were 129 mutations (75 %). Among patients with LDLR mutations, we found 13 homozygotes or compound heterozygotes, 83 patients with radical mutations and 83 with missense mutations. An increase has been detected in LDL cholesterol, prevalence of xanthoma and of carotid plaques, among different categories of LDLR mutations or increasing MedPed/WHO score (all p< 0.001). History of premature CVD was more prevalent in homozygotes/compound heterozygotes as compared to patients with other mutations (p¼ 0.012) and in patients with MedPed/WHO score > 8 as compared to those with score < 8 (p < 0.001), MedPed/WHO score (p< 0.001), after controlling for age, gender, smoking habits , blood pressure. In all patients, with LDL> 190 mg/dL, after excluding those with Familial Combined Hyperlipidemia, intensive lipid lowering treatment is indicated. Molecular analysis and MedPed/WHO score are helpful in identifying priorities for treatment with PCSK9 inhibitors. Prevalence of plaques is strongly associated with level of LDL cholesterol, even in a cohort of patients who had severe hypercholesterolemia.
We investigated the different control of cardiovascular risk factors such as total cholesterol, LDL, HDL, apolipoprotein A, apolipoprotein B, apolipoprotein B/A1 ratio and Lp (a) at the onset of atherosclerotic disease in male and females. We consecutively enrolled 539 patients admitted to our Coronary Care Unit (CCU) with diagnosis of Acute Coronary Syndrome (ACS) (STEMI, NSTEMI, Unstable Angina) confirmed by a coronary angiography showing obstructive lesions (> 75%). We then divided this population into two groups: 1 (men) and 2 (women). In the sample analyzed, 77% of patients are men and 23% women. Women are older than men at the onset of ischemic heart disease or during relapse. Probably because older, women are more often hypertensive (83% vs 63%), diabetics and with an impaired renal function. There were no significant differences in the values of total cholesterol, LDL and apolipoprotein B. In women, triglyceride values are lower than men (133 mg / dl vs. 151 mg / dl), while those of HDL are generally higher (46 mg / dl vs. 39 mg / dl). In women, the levels of apoA1 are higher (125 mg / dl vs. 111 mg / dl) and consequently the ratio apolipoprotein B / apolipoprotein A1 (0.81 vs 0.97) appears to be lower. The plasma levels of Lp (a) were elevated in 37% of the total population and especially in women, in which the average concentration is about 40 mg / dl: the difference between the genders was not statistically significant. From our data it appears that the distribution of risk factors for ACS is dependent on sex and that, in light of the different post ACS prognosis, in certain subpopulations of patients, can be taken in consideration different treatment strategies. INVESTIGATION OF BARRIERS TO AND FACILITATORS OF PHYSICAL ACTIVITY IN PRIMARY CARDIOVASCULAR PREVENTION N. Simonelli 1, A. Gorini 2, M. Giroli 1, M. Amato 1, L. Vigo 1, E. Tremoli 1, J.P. Werba 1. 1 Centro Cardiologico Monzino, IRCCS, Milan, degli Studi di Milano, DIPO, Milan, Italy Italy; 2 Universita E-mail address: [email protected] (J.P. Werba).
Background: The prevalence of sedentarism is increasing in Italy (PASSI data: from 29% in 2008 to 34% in 2015) and is higher in immigrants and in people with low educational level and/or socio-economic status. The identification of barriers to and facilitators of physical activity (PA) could aid to adopt personalized strategies of intervention. This information may be obtained through Motivational Interviewing (MI), a
Abstracts the SISA collaborative style of human interaction aimed to motivate and to elicit commitment toward positive changes in personal behavior. Objective: Identify barriers to and facilitators of PA in a sample of sedentary participants in a program of primary cardiovascular (CV) prevention. Materials and methods: Levels of PA were assessed, using the PASSI score, in the first 260 subjects who adhered to ProSALUTE, a program of primary CV prevention directed to adult residents in a peripheral neighborhood of Milan. Sedentary participants were invited to follow face-to-face MI sessions with a nursing researcher trained in this style of interaction. After obtaining informed consent, discussions were audio recorded and transcribed verbatim. The MI contents were summarized in categories of meaning for both barriers and facilitators. Results: The prevalence of sedentarism was 24% (n¼63). 18 subjects were not invited to perform CM due to psycho-physical or linguistic problems. 21 subjects, mostly immigrants or unemployed, declined CM (chi squared: p¼0.042 and p¼0.006, respectively). 43 MI sessions were carried out with 24 participants. The main categories of facilitators were the good perception of the personal capability to carry out PA (or self-efficacy) and an appropriate social support. Shortages in the same categories were the barriers more often reported. Conclusions: In primary CV prevention, self-efficacy and social support are the predominant barriers to or facilitators of PA and thus represent possible targets for intervention to encourage the adoption of a physically active lifestyle. CAUSATIVE MUTATIONS AND PREMATURE CARDIOVASCULAR DISEASE IN PATIENTS WITH SEVERE HYPERCHOLESTEROLEMIA M. Sodano 1, M. Gentile 1, F. Jossa 1, G. Marotta 1, G. Fortunato 2, 3, M.D. Di Taranto 4, C. Giacobbe 2, 3, A. Iannuzzi 5, G. Covetti 5, G. Chiariello 5, P. Rubba 1. 1 Dipartimento di Medicina Clinica e Chirurgia, Universita degli Studi di Napoli “Federico II”, Napoli, Italy; 2 CEINGE S.C.a r.l. Biotecnologie Avanzate, Napoli, Italy; 3 Dipartimento di Medicina degli Studi di Napoli Molecolare e Biotecnologie Mediche, Universita Federico II, Napoli, Italy; 4 IRCCS Fondazione SDN, Napoli, Italy; 5 UO Medicina Interna, AORN “A. Cardarelli” di Napoli, Italy E-mail address: [email protected] (M. Sodano).
Familial Hypercholesterolemia (FH) is a common lipid disorder, caused by mutations affecting the clearance of LDL cholesterol. FH patients have elevated LDL cholesterol and if untreated develop premature cardiovascular disease (CVD). Young adults, attending our Lipid Clinic, with LDL> 190mg/dL, after excluding Familial Combined Hyperlipidemia, were included in the study. Search for causative mutations, MedPed/WHO score and non-invasive ultrasound examination of carotid arteries were performed. Among the 225 patients there were 179 with LDLR mutations, 2 with apo B gene Mutations, 1 PCSK9 gene mutation, and 43 patients without mutations. Among 171 unrelated index cases there were 129 mutations (75 %). Among patients with LDLR mutations, we found 13 homozygotes or compound heterozygotes, 83 patients with radical mutations and 83 with missense mutations. An increase has been detected in LDL cholesterol, prevalence of xanthoma and of carotid plaques, among different categories of LDLR mutations or increasing MedPed/WHO score (all p< 0.001). History of premature CVD was more prevalent in homozygotes/compound heterozygotes as compared to patients with other mutations (p¼ 0.012) and in patients with MedPed/WHO score > 8 as compared to those with score < 8 (p < 0.001), MedPed/WHO score (p< 0.001), after controlling for age, gender, smoking habits , blood pressure. In all patients, with LDL> 190 mg/dL, after excluding those with Familial Combined Hyperlipidemia, intensive lipid lowering treatment is indicated. Molecular analysis and MedPed/WHO score are helpful in identifying priorities for treatment with PCSK9 inhibitors. Prevalence of plaques is strongly associated with level of LDL cholesterol, even in a cohort of patients who had severe hypercholesterolemia.