- Email: [email protected]
Lipid target achievement among very high and high cardiovascular risk patients in a lipid clinic
Abstracts / Atherosclerosis 235 (2014) e192–e301
Results: 20 males were enrolled in this study. Their mean age was 63.011.1 years. The preoperative LVEF was 24.54.0% and predict EuroSCORE mortality was 17.211.6%. About the response of DSE, there were 10 cases with uniphasic response, 8 cases with biphasic response, and two patients with static response. All cases received coronary bypass grafting surgery. One patient received combined right carotid endarterectomy for his severe carotid stenosis, and six patients received valvular procedures concomitantly. The average number of distal anastomosis was 4.01.0 and mean bypass time was 180.0 69.9 minutes. There was no surgical mortality, hospital mortality, or follow-up mortality. Their mean postoperative LVEF was 36.37.7% and functional class was 1.40.6. Conclusion: The DSE is a useful tool to evaluate patient's myocardial viability and contractile reserve. Through careful patient selection, intraoperative management, and postoperative care, surgical revascularization may offer encouraging survival and improve life quality in patients with ischemic cardiomyopathy. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0543. ALBUMINURIA SIGINIFICANTLY PREDICTS CARDIOVASCULAR EVENTS IN PATIENTS WITH TYPE 2 DIABETES INDEPENDENTLY FROM THE BASELINE CORONARY ARTERY STATE P. Reina, A. Vonbanka, D. Zanolinb, A. Leihererb, C.H. Saelya, H. Drexelb a Academic Teaching Hospital Feldkirch, Department of Internal Medicine & Cardiology, Feldkirch, Austria; b Academic Teaching Hospital Feldkirch, Vivit-Institute, Feldkirch, Austria
Objectives: Albuminuria is an important indicator of cardiovascular risk. We have recently shown that it is also associated with angiographically determined coronary artery disease (CAD). Whether albuminuria predicts cardiovascular events independently of the baseline coronary artery state in patients with type 2 diabetes (T2DM) has not been investigated yet. Methods: We measured urinary albumin and creatinine concentrations in 211 consecutive patients with T2DM undergoing coronary angiography for the evaluation of suspected or established stable CAD. Albuminuria was defined as a urinary albumin to creatinine ratio (ACR) of 30 mg/mg or greater. Prospectively, we recorded vascular events over 3.21.4 years. Results: During follow up, 24.6% of our patients suffered cardiovascular events. The cardiovascular event rate was significantly higher in patients with albuminuria (n¼85) than in those with normoalbuminuria (35.3 vs. 17.5%; p ¼ 0.003). Cox regression analysis adjusting for age, gender, BMI, smoking, systolic and diastolic blood pressure, LDL cholesterol, HDL cholesterol, eGFR, and use of ace inhibitors/angiotensin II antagonists confirmed that albuminuria significantly predicted cardiovascular events independently from conventional risk factors (adjusted HR 1.96 [1.113.46]; p¼0.021). Further adjustment for the angiographically determined presence of CAD at baseline did not significantly attenuate the predictive power of the ACR (HR 1.84 [1.04-3.27]; p¼0.037). Similar results were obtained when the ACR was entered into the final regression model as a continuous variable (standardized adjusted HR 1.30 [1.02-1.65]; p ¼ 0.037). Conclusion: Albuminuria significantly predicts cardiovascular events in patients with T2DM independently of established cardiovascular risk factors and of the baseline coronary artery state. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0555. HBA1C IS A SIGNIFICANTLY STRONGER PREDICTOR OF CARDIOVASCULAR EVENT RISK IN WOMEN THAN IN MEN AMONG PATIENTS UNDERGOING CORONARY ANGIOGRAPHY C.H. Saelya, A. Vonbanka, P. Reina, D. Zanolinb, K. Geigerb, A. Leihererb, H. Drexelb
e277
a
Academic Teaching Hospital Feldkirch, Department of Internal Medicine & Cardiology, Feldkirch, Austria; b Academic Teaching Hospital Feldkirch, Vivit-Institute, Feldkirch, Austria Objectives: The power of HbA1c to predict future cardiovascular events in the clinically important high-risk population of patients undergoing coronary angiography has not been investigated so far. In the present study we therefore addressed this issue and also tested the hypothesis that gender modulates the impact of HbA1c on cardiovascular event risk.
Methods: We prospectively recorded cardiovascular events over a mean follow-up period of 4.4 years in a large consecutive series of 1449 patients, including 484 women and 965 men who did not have previously known diabetes and who underwent coronary angiography for the evaluation of stable coronary artery disease. Results: During follow-up, the incidence of cardiovascular events was 19.5% in women and 25.6% in men, corresponding to annual event rates of 4.4% and 5.8%; p ¼ 0.001. Among women, HbA1c strongly and significantly predicted cardiovascular events (adjusted OR for a 1% increase in HbA1c ¼ 1.69 [1.16-2.45]; p ¼ 0.006), whereas the association between HbA1c and cardiovascular events was weaker and statistically non-significant in men (OR ¼ 1.15 [0.95-1.39]; p ¼ 0.147. An interaction term gender x HbA1c was significant (p ¼ 0.024), indicating that HbA1c was a significantly stronger predictor of cardiovascular events among women than among men. Conclusion: We conclude that HbA1c is a significantly stronger predictor of cardiovascular event risk in women than in men among patients undergoing coronary angiography.
71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0212. LIPID TARGET ACHIEVEMENT AMONG VERY HIGH CARDIOVASCULAR RISK PATIENTS IN A LIPID CLINIC
AND
HIGH
F. Barkasa, E. Liberopoulosa, M. Kostapanosa, G. Liamisa, D. Tzialasa, M. Elisafa a Department of Internal Medicine, School of Medicine University of Ioannina, Ioannina, Greece
Objectives: To examine the proportion of 'very high' and 'high' CV risk patients achieving treatment targets for dyslipidemia in a University Hospital Lipid Clinic, since data are lacking regarding LDL-C goal attainment according to the latest ESC/EAS guidelines. Methods: This was an observational study. Patients with age 18 years, dyslipidemia, follow-up duration for 3 years and an available posttreatment serum lipid profile were included. The proportion of patients achieving LDL-C targets was recorded. Patients were defined as 'very high' or 'high' CV risk according to NCEP-ATPIII and 2011 ESC/EAS guidelines. The first suggest lowering LDL-C <100 and <130 mg/dL in 'very high' and 'high' CV risk patients respectively, while the latter <70 and <100 mg/dL. Results: One thousand eligible patients were finally enrolled. Of those, 477 (48%) were considered 'very high' and 408 (41%) 'high' risk according to the ESC/EAS guidelines. In terms of the NCEP-ATP III guidelines LDL-C targets were attained by 66% and 86% of patients, respectively. Interestingly, much fewer patients were within LDL-C goals according to the ESC/EAS guidelines: 25% and 42%, respectively. Overall, 92% of these patients were on statins. Of those, 67% were on statin monotherapy, while 33% on statin combinations with ezetimibe (25%), omega-3 fatty acids (5%), fibrates (4%) or coleveselam (2%). Statin of choice was atorvastatin (mean dose 26 mg), rosuvastatin (mean dose 22 mg), simvastatin (mean dose 30 mg) and fluvastatin (mean dose 80 mg) in 43%, 32%, 21% and 3% respectively.
e278
Abstracts / Atherosclerosis 235 (2014) e192–e301
Conclusion: Even in a tertiary referral centre for lipid abnormalities a significant proportion of patients at 'very high' and 'high' CV risk are not at goal according to the recent European lipid guidelines. Using higher doses of potent statins or drug combinations could help fill this gap in clinical practice. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0138. MISSING TEETH PREDICT DIABETES AND DEATH
FUTURE
CARDIOVASCULAR
EVENTS,
J.M. Liljestranda, V. Salomaab, A.S. Havulinnab, S. Pajua, P.J. Pussinena a Institute of Dentistry, University of Helsinki, Helsinki, Finland; b Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
Objectives: Periodontitis, the main cause of tooth loss in the middle-aged and elderly, associates with the risk of atherosclerotic vascular disease. The objective was to study the capability of missing teeth in predicting incident cardiovascular diseases (CVD), diabetes and death. Methods: The FINRISK97 is a Finnish population based survey with 13 years of follow up (n¼8446). Dental status was recorded at baseline by a trained nurse and information on incident CVD-events, diabetes and death was obtained via national registers. The registered CVD events included coronary heart disease (CHD) events, acute myocardial infarction (AMI) and stroke. The population (N¼8446) was divided into following categories depending on the amount of missing teeth; 0-1, 2-4, 5-8, 9-31 and 32 (all) missing. Correlations between missing teeth group and incidence rates for the above-mentioned diseases were analyzed and comprehensively adjusted for confounders. Results: Number of missing teeth was directly associated with age, BMI, systolic blood pressure, cholesterol, triglycerides, CRP, and G-GT, and inversely with years of education and HDL cholesterol. A linear association was found between the number of missing teeth and the odds of having prevalent CVD, CHD, AMI or diabetes at baseline. In the Cox regression analyses, having 5 teeth missing associated with 40-140% increased risk for incident CHD events (p<0.020), AMI (p<0.010), and diabetes (p<0.046). Incident CVD (p<0.042) and death of any cause (p<0.017) associated with 9 missing teeth with an increased risk of 40 – 70%. No association with stroke risk was observed. Having 9 – 31 missing teeth provided higher hazard ratios for incident CVD and CHD events than being fully edentulous. Conclusion: Even a few missing teeth indicate an increased risk of CVD or diabetes. When mapping individual risk factors for chronic diseases, the number of teeth could be a useful additional indicator for general practitioners. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0629. GENETIC FACTORS IN 15-YEAR SURVIVAL OF THE PATIENTS WITH CHRONIC THREE VESSEL DISEASE J. Machala, O. Hlinomazb, M. Pavkova Goldbergovac, A. Vaskuc, L. Grochb a
Pathophysiology, Faculty of Medicine Masaryk University and International Clinical Research Center, Brno, Czech Republic; b Cardioangiology, St. Anne's Faculty Hospital and International Clinical Research Center, Brno, Czech Republic; c Pathophysiology, Faculty of Medicine Masaryk University, Brno, Czech Republic Objectives: Coronary artery disease is the leading cause of death throughout the world. The aim of our study was to assess the role of 23 candidate genetic risk factors and several clinical characteristics in overall survival of the patients suffering of chronic three vessel disease (3VD).
Methods: Coronary angiography was performed in 810 consecutive subjects presenting with the symptoms of stable ischemic heart disease in the year 1998. Out of this number, 196 suffered of 3VD (>50% stenosis of LAD, LCx and RCA). These patients were genotypized for 23 polymorphisms covering PPAR-RXR pathway, renin-angiotensin-aldosteron system, endothelin pathway, cytokine genes, MMP-2, MTHFR and APO E variants. 15-year survival data were obtained from national insurance registry. All the data were available for 150 patients. Statistical analysis used stepwise construction of Cox regression model (a¼0.05), assuming dominant, recessive or additive mode of gene expression. Variables involved in each model construction included age, sex, BMI, diabetes, blood pressure, previously diagnosed coronary stenosis and left main involvement, together with polymorphisms pre-selected by log-rank tests. Results: Out of 23 polymorphisms, four have been selected in the final model construction. SNP in IL-6 gene rs1800795 (-174 G/C) was a significant factor of survival in dominant and additive model, C allele associated with worse prognosis. This SNP was in total linkage disequlibrium with rs1800797 (-597 G/A) in the same gene (D'¼1.0), which was also a significant predictor of survival when rs1800795 was not included in model construction. From other factors, age, BMI, diabetes and left main stenosis were significant in any of the models. After adjusting for all clinical covariates and compared to GG carriers of rs1800795, CG carrirers had HR 2.08 (95%CI¼1.07–4.03) and CC carriers had HR 3.23 (95%CI¼1.57–6.66). Conclusion: Together with other risk factors, polymorphisms in IL-6 gene contributed to 15-year survival of the patients with chronic 3VD. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0466. COMPARISON OF PATIENTS’ ADHERENCE AND LDL-CHOLESTEROL GOAL ATTAINMENT IN 2010 AND 2013 IN THE HUNGARIAN MULTI GAP 2012 STUDY L. Marka, I. Reiberb, G. Paraghc, I. Karadid, G. Padose, R.G. Kissf, Z. Kissg a 2nd Department of Medicine - Cardiology, Pandy Kalman Bekes County Hospital, Gyula, Hungary; b 4th Department of Medicine, St. George Fejer County Hospital, Szekesfehervar, Hungary; c 1st Department of Medicine, Medical and Health Science Centre University of Debrecen, Debrecen, Hungary; d 3rd Department of Medicine, Semmelweis University, Budapest, Hungary; e Independent Department of Lipidology, St. Imre Hospital, Budapest, Hungary; f Department of Cardiology, Military Hospital, Budapest, Hungary; g Research Group, MULTI GAP, Budapest, Hungary
Objectives: The benefit of lipid lowering in secondary prevention of cardiovascular diseases is well documented. Nevertheless there is a large proportion of patients who don't achieve target values. One of the major causes is unsatisfactory patients’ compliance. In this study the change and the correlation of lipid levels and patients’ adherence in 2010 and 2013 was evaluated. Methods: In the Hungarian MULTI-GAP (MULTI Goal Attainment Problem) surveys conducted annually since 2007 the effectiveness of lipid lowering therapies among high-risk patients was monitored by retrospective data analysis using structured questionnaires. Besides the LDL-cholesterol levels and target value achievement since 2010 the patients’ treatment adherence was estimated by the physicians through patient interviews and reviewing the frequency of drug prescriptions. The results were given in percentages. Results: In 2010 the mean LDL-cholesterol level was 2.83 mmol/l, the 2,5 mmol/l goal attainment rate was 41% the 1,8 mmol/l goal achievement rate was 15%. In 2013 these values were 2.64 mmol/l, 50% and 21%, respectively. The adherence data of 1508 patients were evaluated in 2010 and of 1301 patients in 2013. 5 age-groups were formed: 60 or below, 61-70%, 71-80%, 81-90%, and 91-100%. The mean LDL-cholesterol levels in 2010 were 3.31, 3.23, 2.90, 2.92 and 2.77 mmol/l, in 2013 3.32, 3.10, 2.72, 2.70 and 2.43, respectively. A positive linear correlation was found between LDLcholesterol levels and adherence. The difference between the lowest and highest quintile in the rate of patients achieving 1.8 mmol/l goal in 2010 was 14%, and 18% in 2013.
Results: 20 males were enrolled in this study. Their mean age was 63.011.1 years. The preoperative LVEF was 24.54.0% and predict EuroSCORE mortality was 17.211.6%. About the response of DSE, there were 10 cases with uniphasic response, 8 cases with biphasic response, and two patients with static response. All cases received coronary bypass grafting surgery. One patient received combined right carotid endarterectomy for his severe carotid stenosis, and six patients received valvular procedures concomitantly. The average number of distal anastomosis was 4.01.0 and mean bypass time was 180.0 69.9 minutes. There was no surgical mortality, hospital mortality, or follow-up mortality. Their mean postoperative LVEF was 36.37.7% and functional class was 1.40.6. Conclusion: The DSE is a useful tool to evaluate patient's myocardial viability and contractile reserve. Through careful patient selection, intraoperative management, and postoperative care, surgical revascularization may offer encouraging survival and improve life quality in patients with ischemic cardiomyopathy. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0543. ALBUMINURIA SIGINIFICANTLY PREDICTS CARDIOVASCULAR EVENTS IN PATIENTS WITH TYPE 2 DIABETES INDEPENDENTLY FROM THE BASELINE CORONARY ARTERY STATE P. Reina, A. Vonbanka, D. Zanolinb, A. Leihererb, C.H. Saelya, H. Drexelb a Academic Teaching Hospital Feldkirch, Department of Internal Medicine & Cardiology, Feldkirch, Austria; b Academic Teaching Hospital Feldkirch, Vivit-Institute, Feldkirch, Austria
Objectives: Albuminuria is an important indicator of cardiovascular risk. We have recently shown that it is also associated with angiographically determined coronary artery disease (CAD). Whether albuminuria predicts cardiovascular events independently of the baseline coronary artery state in patients with type 2 diabetes (T2DM) has not been investigated yet. Methods: We measured urinary albumin and creatinine concentrations in 211 consecutive patients with T2DM undergoing coronary angiography for the evaluation of suspected or established stable CAD. Albuminuria was defined as a urinary albumin to creatinine ratio (ACR) of 30 mg/mg or greater. Prospectively, we recorded vascular events over 3.21.4 years. Results: During follow up, 24.6% of our patients suffered cardiovascular events. The cardiovascular event rate was significantly higher in patients with albuminuria (n¼85) than in those with normoalbuminuria (35.3 vs. 17.5%; p ¼ 0.003). Cox regression analysis adjusting for age, gender, BMI, smoking, systolic and diastolic blood pressure, LDL cholesterol, HDL cholesterol, eGFR, and use of ace inhibitors/angiotensin II antagonists confirmed that albuminuria significantly predicted cardiovascular events independently from conventional risk factors (adjusted HR 1.96 [1.113.46]; p¼0.021). Further adjustment for the angiographically determined presence of CAD at baseline did not significantly attenuate the predictive power of the ACR (HR 1.84 [1.04-3.27]; p¼0.037). Similar results were obtained when the ACR was entered into the final regression model as a continuous variable (standardized adjusted HR 1.30 [1.02-1.65]; p ¼ 0.037). Conclusion: Albuminuria significantly predicts cardiovascular events in patients with T2DM independently of established cardiovascular risk factors and of the baseline coronary artery state. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0555. HBA1C IS A SIGNIFICANTLY STRONGER PREDICTOR OF CARDIOVASCULAR EVENT RISK IN WOMEN THAN IN MEN AMONG PATIENTS UNDERGOING CORONARY ANGIOGRAPHY C.H. Saelya, A. Vonbanka, P. Reina, D. Zanolinb, K. Geigerb, A. Leihererb, H. Drexelb
e277
a
Academic Teaching Hospital Feldkirch, Department of Internal Medicine & Cardiology, Feldkirch, Austria; b Academic Teaching Hospital Feldkirch, Vivit-Institute, Feldkirch, Austria Objectives: The power of HbA1c to predict future cardiovascular events in the clinically important high-risk population of patients undergoing coronary angiography has not been investigated so far. In the present study we therefore addressed this issue and also tested the hypothesis that gender modulates the impact of HbA1c on cardiovascular event risk.
Methods: We prospectively recorded cardiovascular events over a mean follow-up period of 4.4 years in a large consecutive series of 1449 patients, including 484 women and 965 men who did not have previously known diabetes and who underwent coronary angiography for the evaluation of stable coronary artery disease. Results: During follow-up, the incidence of cardiovascular events was 19.5% in women and 25.6% in men, corresponding to annual event rates of 4.4% and 5.8%; p ¼ 0.001. Among women, HbA1c strongly and significantly predicted cardiovascular events (adjusted OR for a 1% increase in HbA1c ¼ 1.69 [1.16-2.45]; p ¼ 0.006), whereas the association between HbA1c and cardiovascular events was weaker and statistically non-significant in men (OR ¼ 1.15 [0.95-1.39]; p ¼ 0.147. An interaction term gender x HbA1c was significant (p ¼ 0.024), indicating that HbA1c was a significantly stronger predictor of cardiovascular events among women than among men. Conclusion: We conclude that HbA1c is a significantly stronger predictor of cardiovascular event risk in women than in men among patients undergoing coronary angiography.
71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0212. LIPID TARGET ACHIEVEMENT AMONG VERY HIGH CARDIOVASCULAR RISK PATIENTS IN A LIPID CLINIC
AND
HIGH
F. Barkasa, E. Liberopoulosa, M. Kostapanosa, G. Liamisa, D. Tzialasa, M. Elisafa a Department of Internal Medicine, School of Medicine University of Ioannina, Ioannina, Greece
Objectives: To examine the proportion of 'very high' and 'high' CV risk patients achieving treatment targets for dyslipidemia in a University Hospital Lipid Clinic, since data are lacking regarding LDL-C goal attainment according to the latest ESC/EAS guidelines. Methods: This was an observational study. Patients with age 18 years, dyslipidemia, follow-up duration for 3 years and an available posttreatment serum lipid profile were included. The proportion of patients achieving LDL-C targets was recorded. Patients were defined as 'very high' or 'high' CV risk according to NCEP-ATPIII and 2011 ESC/EAS guidelines. The first suggest lowering LDL-C <100 and <130 mg/dL in 'very high' and 'high' CV risk patients respectively, while the latter <70 and <100 mg/dL. Results: One thousand eligible patients were finally enrolled. Of those, 477 (48%) were considered 'very high' and 408 (41%) 'high' risk according to the ESC/EAS guidelines. In terms of the NCEP-ATP III guidelines LDL-C targets were attained by 66% and 86% of patients, respectively. Interestingly, much fewer patients were within LDL-C goals according to the ESC/EAS guidelines: 25% and 42%, respectively. Overall, 92% of these patients were on statins. Of those, 67% were on statin monotherapy, while 33% on statin combinations with ezetimibe (25%), omega-3 fatty acids (5%), fibrates (4%) or coleveselam (2%). Statin of choice was atorvastatin (mean dose 26 mg), rosuvastatin (mean dose 22 mg), simvastatin (mean dose 30 mg) and fluvastatin (mean dose 80 mg) in 43%, 32%, 21% and 3% respectively.
e278
Abstracts / Atherosclerosis 235 (2014) e192–e301
Conclusion: Even in a tertiary referral centre for lipid abnormalities a significant proportion of patients at 'very high' and 'high' CV risk are not at goal according to the recent European lipid guidelines. Using higher doses of potent statins or drug combinations could help fill this gap in clinical practice. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0138. MISSING TEETH PREDICT DIABETES AND DEATH
FUTURE
CARDIOVASCULAR
EVENTS,
J.M. Liljestranda, V. Salomaab, A.S. Havulinnab, S. Pajua, P.J. Pussinena a Institute of Dentistry, University of Helsinki, Helsinki, Finland; b Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
Objectives: Periodontitis, the main cause of tooth loss in the middle-aged and elderly, associates with the risk of atherosclerotic vascular disease. The objective was to study the capability of missing teeth in predicting incident cardiovascular diseases (CVD), diabetes and death. Methods: The FINRISK97 is a Finnish population based survey with 13 years of follow up (n¼8446). Dental status was recorded at baseline by a trained nurse and information on incident CVD-events, diabetes and death was obtained via national registers. The registered CVD events included coronary heart disease (CHD) events, acute myocardial infarction (AMI) and stroke. The population (N¼8446) was divided into following categories depending on the amount of missing teeth; 0-1, 2-4, 5-8, 9-31 and 32 (all) missing. Correlations between missing teeth group and incidence rates for the above-mentioned diseases were analyzed and comprehensively adjusted for confounders. Results: Number of missing teeth was directly associated with age, BMI, systolic blood pressure, cholesterol, triglycerides, CRP, and G-GT, and inversely with years of education and HDL cholesterol. A linear association was found between the number of missing teeth and the odds of having prevalent CVD, CHD, AMI or diabetes at baseline. In the Cox regression analyses, having 5 teeth missing associated with 40-140% increased risk for incident CHD events (p<0.020), AMI (p<0.010), and diabetes (p<0.046). Incident CVD (p<0.042) and death of any cause (p<0.017) associated with 9 missing teeth with an increased risk of 40 – 70%. No association with stroke risk was observed. Having 9 – 31 missing teeth provided higher hazard ratios for incident CVD and CHD events than being fully edentulous. Conclusion: Even a few missing teeth indicate an increased risk of CVD or diabetes. When mapping individual risk factors for chronic diseases, the number of teeth could be a useful additional indicator for general practitioners. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0629. GENETIC FACTORS IN 15-YEAR SURVIVAL OF THE PATIENTS WITH CHRONIC THREE VESSEL DISEASE J. Machala, O. Hlinomazb, M. Pavkova Goldbergovac, A. Vaskuc, L. Grochb a
Pathophysiology, Faculty of Medicine Masaryk University and International Clinical Research Center, Brno, Czech Republic; b Cardioangiology, St. Anne's Faculty Hospital and International Clinical Research Center, Brno, Czech Republic; c Pathophysiology, Faculty of Medicine Masaryk University, Brno, Czech Republic Objectives: Coronary artery disease is the leading cause of death throughout the world. The aim of our study was to assess the role of 23 candidate genetic risk factors and several clinical characteristics in overall survival of the patients suffering of chronic three vessel disease (3VD).
Methods: Coronary angiography was performed in 810 consecutive subjects presenting with the symptoms of stable ischemic heart disease in the year 1998. Out of this number, 196 suffered of 3VD (>50% stenosis of LAD, LCx and RCA). These patients were genotypized for 23 polymorphisms covering PPAR-RXR pathway, renin-angiotensin-aldosteron system, endothelin pathway, cytokine genes, MMP-2, MTHFR and APO E variants. 15-year survival data were obtained from national insurance registry. All the data were available for 150 patients. Statistical analysis used stepwise construction of Cox regression model (a¼0.05), assuming dominant, recessive or additive mode of gene expression. Variables involved in each model construction included age, sex, BMI, diabetes, blood pressure, previously diagnosed coronary stenosis and left main involvement, together with polymorphisms pre-selected by log-rank tests. Results: Out of 23 polymorphisms, four have been selected in the final model construction. SNP in IL-6 gene rs1800795 (-174 G/C) was a significant factor of survival in dominant and additive model, C allele associated with worse prognosis. This SNP was in total linkage disequlibrium with rs1800797 (-597 G/A) in the same gene (D'¼1.0), which was also a significant predictor of survival when rs1800795 was not included in model construction. From other factors, age, BMI, diabetes and left main stenosis were significant in any of the models. After adjusting for all clinical covariates and compared to GG carriers of rs1800795, CG carrirers had HR 2.08 (95%CI¼1.07–4.03) and CC carriers had HR 3.23 (95%CI¼1.57–6.66). Conclusion: Together with other risk factors, polymorphisms in IL-6 gene contributed to 15-year survival of the patients with chronic 3VD. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0466. COMPARISON OF PATIENTS’ ADHERENCE AND LDL-CHOLESTEROL GOAL ATTAINMENT IN 2010 AND 2013 IN THE HUNGARIAN MULTI GAP 2012 STUDY L. Marka, I. Reiberb, G. Paraghc, I. Karadid, G. Padose, R.G. Kissf, Z. Kissg a 2nd Department of Medicine - Cardiology, Pandy Kalman Bekes County Hospital, Gyula, Hungary; b 4th Department of Medicine, St. George Fejer County Hospital, Szekesfehervar, Hungary; c 1st Department of Medicine, Medical and Health Science Centre University of Debrecen, Debrecen, Hungary; d 3rd Department of Medicine, Semmelweis University, Budapest, Hungary; e Independent Department of Lipidology, St. Imre Hospital, Budapest, Hungary; f Department of Cardiology, Military Hospital, Budapest, Hungary; g Research Group, MULTI GAP, Budapest, Hungary
Objectives: The benefit of lipid lowering in secondary prevention of cardiovascular diseases is well documented. Nevertheless there is a large proportion of patients who don't achieve target values. One of the major causes is unsatisfactory patients’ compliance. In this study the change and the correlation of lipid levels and patients’ adherence in 2010 and 2013 was evaluated. Methods: In the Hungarian MULTI-GAP (MULTI Goal Attainment Problem) surveys conducted annually since 2007 the effectiveness of lipid lowering therapies among high-risk patients was monitored by retrospective data analysis using structured questionnaires. Besides the LDL-cholesterol levels and target value achievement since 2010 the patients’ treatment adherence was estimated by the physicians through patient interviews and reviewing the frequency of drug prescriptions. The results were given in percentages. Results: In 2010 the mean LDL-cholesterol level was 2.83 mmol/l, the 2,5 mmol/l goal attainment rate was 41% the 1,8 mmol/l goal achievement rate was 15%. In 2013 these values were 2.64 mmol/l, 50% and 21%, respectively. The adherence data of 1508 patients were evaluated in 2010 and of 1301 patients in 2013. 5 age-groups were formed: 60 or below, 61-70%, 71-80%, 81-90%, and 91-100%. The mean LDL-cholesterol levels in 2010 were 3.31, 3.23, 2.90, 2.92 and 2.77 mmol/l, in 2013 3.32, 3.10, 2.72, 2.70 and 2.43, respectively. A positive linear correlation was found between LDLcholesterol levels and adherence. The difference between the lowest and highest quintile in the rate of patients achieving 1.8 mmol/l goal in 2010 was 14%, and 18% in 2013.