- Email: [email protected]
M.499 Risk predicting scores and subclinical atherosclerosis in type 2 diabetics
Miscellaneous Spanish Instituta Nacianal de Estad stica data an nanCHD-related martality. Dfl'ect costs of CHD events in Spain, Spanish prices for atorvastatin and EZ price (based on German EZ price) were used to project lifetime costs. The model was run for a population of all patients in an observational lipid lowel: ing treatment study in Spain who stm'ted treatment with atorvastatin and had not reached goal at the first LDL-C measurement after 60 days of treatment. Results: EZ10 co-administered with atorvastatin compaa'ed to atorvastatin titration is projected to increase discounted life expectancy by 0.20 yeat's with a C/LY of 24,828 EURO. Incremental cost per additional patient to goal in the first yeat" was 1,819 EURO per yem'. Conclusion: Based on the model, treatment with ezetimibe coadministered with atorvastatin for CHD and CHD equivalent patients not at goal is a cost-effective alternative to statin titration, well under the limit C/LY of 30,000 EURO considered acceptable in Spain.
•]
PLANT STEROL OR STANOL CONSUMPTION DOES NOT CHANGE OSMOTIC FRAGILITY OF THE ERYTHROCYTE
A. de Jang, J. Plat, R. Mensink. University of Maastricht, Department of
Human Biology, Maastricht, The Netherlands Absarptian af plant sterals and stanals, which ale added ta functianal foods ta decrease serum chalesteral cancenta'atians, is law. Still, a small partian is absarbed and incarparated into red blood cells, which - at least in rats unfavarably increases the asmatic fi'agility af erythracytes. Ta examine this patentially unwanted side effect in humans, 45 subjects an cun'ent statin ~eatrnent were studied. Subjects an cun'ent statin-~eatrnent were chasen, because they ale patential cansumers af these functianal faads, and in additian, intake af statins may increase lipid-standat'dized cancenta'atians af plasma plant sterals and stanals. Valunteers first received a canta'al mat'garine far faur weeks. Far the fallawing 16 weeks, 15 subjects were given the canta'al mat'garine, 15 subjects a margat'ine enriched with plant steral esters, and 15 subjects a margat'ine with plant stanal esters. Daily intake af plant sterals ar stanals was 2.5 g. As a marker af asmatic fi'agility, hemalysis af red blood cells at 5 different saline salutians was measured specta'aphatameta'ically at the end af the run-in (week 4) and experimental periad (week 20). Campared with the canta'al graup, LDL chalesteral was significantly lawered by 5.5 and 10.1% in the plant steral and stanal graups respectively. The saline cancenta'atians ta cause 50% af hemalysis were nan-significantly (p=0.757) increased by 0.9% in the plant steral graup and by 1.6% in the plant stanal graup. In canclusian, plant steral and stanal cansumptian far 16 weeks does nat change asmatic fi'agility af the red blood cell in subjects an cun'ent statin treatment.
•]
i0-years Risk Scores Framingham* PROCAM**
C. de la Vega, Y. Ruiz, J. Riaja, F. Escalana, T. Ganzalez, M. Ariza, P. Valdivielsa, P. Ganzalez-Santas. Centro de Salud Palma-Palmilla, Centro
de Salud San Andres-Torcal, Centro de Investigaciones Medicas, Departamento de Medicina, Universidad de M lag, Centro de Salud Puerta Blanca, M laga, Spain Framingham and PROCAM risk scares are useful tools in clinical practice in arder ta identify peaple at high risk af atherasclerasis in the primary preventian setting. In Spain and ather Eurapean caunta'ies, they are still used assesing cat'diavasculat" risk in diabetics. The aim af this cammunicatian is ta evaluate the assaciatian af risk scares and subclinical atherasclerasis. Patients and Methods: Type 2 diabetic fulfilled the fallawing criteria: autpatient, non-insulin and nan-lipid-lawering drug ~eatrnent, < 70 yearsald, fasting Tg < 400 mg/dL and na priar episade af lipemic pancreatitis. Plasma lipids and lipapratein were measured after 12 haurs fasting. We measured in every patient the ankle-brachial index. Clinical atherasclerasis was identify fi'am medical recards. Framingham and PROCAM risk scares were calculated using the Cal"dyaRiskTM saftwat'e. Patients were categarized as AT pasitive (clinical disease in any vascular ~ee), subclinical AT (ABI < 0.9) and AT negative (ha symptams and ABI > 0.9) patients. Results: 70 patients (39 men), 58 -4- 9 yeat's-ald, were included. Nine (13%) were AT pas, 13 (18%) were subAT and 48 (68%) were AT neg. Risk scales in this graups ale shown in the table. In addition, 43% of patients with SubAT had a 10-yeat" Framinghan risk score < 10% and just 28% had a risk between 10 to 20%. Although women had lower risk than men, they showed the same prevalence of clinical and subclinical atherosclerosis.
115
AT pos
Sub AT
AT neg
i5.4 ± 9.7 35.4 ± 22
i2.9 ± 9 ll ± 9.3
9.6 ± 7.8 7.7 ± 7.i
One-wayAnova. *p= 0.084; **p<0.05 Conclussion: Most diabetics with subclinical disease have low o1"moderate risk profile according to Framingham and PROCAM scores.
~-00]
ACHIEVE CHOLESTEROL TARGETS FAST WITH ATORVASTATIN STRATIFIED TITRATION: THE ACTFAST STUDY
E. de Teresa, C. Fat'sang, A. Gaw, G. Gensini, L. Leiter, P. Martineau, A. Lange. University of Malaga & V. de la Victoria Hospital, M laga,
Spain; 1st Department of Medicine, Semmelweis University, Budapest, Hungary; University of Glasgow, Glasgow, United Kingdom; University of Florence, Florence, Italy. Careggi Hospital; University of Toronto & St-Michael's Hospital & Canadian Heart Research Centre, Toronto; Pfizer, Canada Many high risk patients da nat achieve lipid targets defined in the guidelines. This care gap may be explained by initiatian af statins at insufficient starting dose o1"by the lack af subsequent uptita'atian. An appraach based an matching the starting dose af statin ta the baseline LDL-chalesteral value would facilitate achievement af targets. ACTFAST is a 12-week, parallel arm, apen-label ta'ial which enralled subjects with caranary heat't disease (CHD) ar CHD-equivalent. The abjective is ta campare the efficacy and safety af atarvastatin at starting doses af 10-80 mg/d. Subjects with LDL > 2.6 mmal/L but < 5.7 mmal/L were assigned a starting dose af atarvastatin based an baseline LDL. After 6 weeks, uptita'atian accun'ed in subjects nat reaching LDL target. 2145 subjects wele enralled fi'am 139 sites. The subjects exhibited the fallawing characteristics: CHD (59%), CHD-equivalents (7%), diabetes (39%) ar 10y CV risk > 20% (7%). 64% af subjects were statin-fi'ee and 36% were inadequately canta'alled with usual doses af anather statin. At baseline, 33%, 36%, 12% and 20% af subjects were assigned ta 10, 20, 40 and 80 rag, respectively. The last subject visit will occur in February 2004. This study is expected ta demansta'ate that a flexible stat't dose af atarvastatin 10-80rag/d, matched ta the baseline LDL, allaws the majarity af high risk patients ta safely reach the LDL tat'get af < 2.6 mmal/L at first dose o1" with just a single titratian step. The results would pravide clinicians with a simple algarithm far managing high-risk patients.
• RISK PREDICTING SCORES AND SUBCLINICAL ATHEROSCLEROSIS IN TYPE 2 DIABETICS
de Waal
]
M-MODE ULTRASOUND IMAGING OF ARTERIAL WALL MOVEMENT AND ARTERIAL WALL THICKNESS OF DISTAL CAROTID ARTERIES IN ATHEROSCLEROSIS STUDIES IN HEALTHY ADULTS
T. de Waal, F. Zijta, W. Stak, E. de Graat, J. Kastelein, J. Karemaker.
Department of Vascular Medicine, AMC, Department of Physiology, AMC, Amsterdam, The Netherlands Background: Determinants and risk factars far cardiavascular disease ale af influence an arterial wall praperties.These praperties can be madeled accarding ta M-made ulta'asaund data an arterial wall mavement and B-made ultrasaund data an arterial wall thickness. The parameters af the madels can be used far identificatian and specificatian af cat'diavascular risk priar ta the appeat'ance af clinical sequela and ta investigate the effects af drugs an arterial remadeling. We develaped still image analysis saftware ta abtain (stiffness) b and (intima-media thickness) IMT data fi'am M- and B-made digital still fi'ames. The relatianship between ~ with age and IMT with age in subjects withaut symptams af cardiavascular disease was described in healthy adults. Methods: In 51 subjects aged 33,4(range 23.0 ta 61.4)year's M-made mode images including the right and the left distal camman caratid arterial walls were abtained far at least 3 heartbeats with a 5mm/sec sweep. The video still images were stared as JPEG files. B-made images were used far the IMT measurements. Edge detectian saftware was used ta ta'ack the cantaurs af the M-made arterial wall mavement. ~ was calculated accarding ta [ln(SBP/DBP)]/(dD/DD)]; IMT was calculated as the average distance between fat" wall lumen-intima and media-adventitia interfaces. Pearsan cala'elatians between age, IMT and ~ were calculated. Results: Fram age 23 ta 61, ~ and age (1--0.46, p=0.001), and IMT and age (1"=0.63, p=0.001) were cala'elated
74th EAS Congress, 17-20 April 2004, Seville, Spain
•]
PLANT STEROL OR STANOL CONSUMPTION DOES NOT CHANGE OSMOTIC FRAGILITY OF THE ERYTHROCYTE
A. de Jang, J. Plat, R. Mensink. University of Maastricht, Department of
Human Biology, Maastricht, The Netherlands Absarptian af plant sterals and stanals, which ale added ta functianal foods ta decrease serum chalesteral cancenta'atians, is law. Still, a small partian is absarbed and incarparated into red blood cells, which - at least in rats unfavarably increases the asmatic fi'agility af erythracytes. Ta examine this patentially unwanted side effect in humans, 45 subjects an cun'ent statin ~eatrnent were studied. Subjects an cun'ent statin-~eatrnent were chasen, because they ale patential cansumers af these functianal faads, and in additian, intake af statins may increase lipid-standat'dized cancenta'atians af plasma plant sterals and stanals. Valunteers first received a canta'al mat'garine far faur weeks. Far the fallawing 16 weeks, 15 subjects were given the canta'al mat'garine, 15 subjects a margat'ine enriched with plant steral esters, and 15 subjects a margat'ine with plant stanal esters. Daily intake af plant sterals ar stanals was 2.5 g. As a marker af asmatic fi'agility, hemalysis af red blood cells at 5 different saline salutians was measured specta'aphatameta'ically at the end af the run-in (week 4) and experimental periad (week 20). Campared with the canta'al graup, LDL chalesteral was significantly lawered by 5.5 and 10.1% in the plant steral and stanal graups respectively. The saline cancenta'atians ta cause 50% af hemalysis were nan-significantly (p=0.757) increased by 0.9% in the plant steral graup and by 1.6% in the plant stanal graup. In canclusian, plant steral and stanal cansumptian far 16 weeks does nat change asmatic fi'agility af the red blood cell in subjects an cun'ent statin treatment.
•]
i0-years Risk Scores Framingham* PROCAM**
C. de la Vega, Y. Ruiz, J. Riaja, F. Escalana, T. Ganzalez, M. Ariza, P. Valdivielsa, P. Ganzalez-Santas. Centro de Salud Palma-Palmilla, Centro
de Salud San Andres-Torcal, Centro de Investigaciones Medicas, Departamento de Medicina, Universidad de M lag, Centro de Salud Puerta Blanca, M laga, Spain Framingham and PROCAM risk scares are useful tools in clinical practice in arder ta identify peaple at high risk af atherasclerasis in the primary preventian setting. In Spain and ather Eurapean caunta'ies, they are still used assesing cat'diavasculat" risk in diabetics. The aim af this cammunicatian is ta evaluate the assaciatian af risk scares and subclinical atherasclerasis. Patients and Methods: Type 2 diabetic fulfilled the fallawing criteria: autpatient, non-insulin and nan-lipid-lawering drug ~eatrnent, < 70 yearsald, fasting Tg < 400 mg/dL and na priar episade af lipemic pancreatitis. Plasma lipids and lipapratein were measured after 12 haurs fasting. We measured in every patient the ankle-brachial index. Clinical atherasclerasis was identify fi'am medical recards. Framingham and PROCAM risk scares were calculated using the Cal"dyaRiskTM saftwat'e. Patients were categarized as AT pasitive (clinical disease in any vascular ~ee), subclinical AT (ABI < 0.9) and AT negative (ha symptams and ABI > 0.9) patients. Results: 70 patients (39 men), 58 -4- 9 yeat's-ald, were included. Nine (13%) were AT pas, 13 (18%) were subAT and 48 (68%) were AT neg. Risk scales in this graups ale shown in the table. In addition, 43% of patients with SubAT had a 10-yeat" Framinghan risk score < 10% and just 28% had a risk between 10 to 20%. Although women had lower risk than men, they showed the same prevalence of clinical and subclinical atherosclerosis.
115
AT pos
Sub AT
AT neg
i5.4 ± 9.7 35.4 ± 22
i2.9 ± 9 ll ± 9.3
9.6 ± 7.8 7.7 ± 7.i
One-wayAnova. *p= 0.084; **p<0.05 Conclussion: Most diabetics with subclinical disease have low o1"moderate risk profile according to Framingham and PROCAM scores.
~-00]
ACHIEVE CHOLESTEROL TARGETS FAST WITH ATORVASTATIN STRATIFIED TITRATION: THE ACTFAST STUDY
E. de Teresa, C. Fat'sang, A. Gaw, G. Gensini, L. Leiter, P. Martineau, A. Lange. University of Malaga & V. de la Victoria Hospital, M laga,
Spain; 1st Department of Medicine, Semmelweis University, Budapest, Hungary; University of Glasgow, Glasgow, United Kingdom; University of Florence, Florence, Italy. Careggi Hospital; University of Toronto & St-Michael's Hospital & Canadian Heart Research Centre, Toronto; Pfizer, Canada Many high risk patients da nat achieve lipid targets defined in the guidelines. This care gap may be explained by initiatian af statins at insufficient starting dose o1"by the lack af subsequent uptita'atian. An appraach based an matching the starting dose af statin ta the baseline LDL-chalesteral value would facilitate achievement af targets. ACTFAST is a 12-week, parallel arm, apen-label ta'ial which enralled subjects with caranary heat't disease (CHD) ar CHD-equivalent. The abjective is ta campare the efficacy and safety af atarvastatin at starting doses af 10-80 mg/d. Subjects with LDL > 2.6 mmal/L but < 5.7 mmal/L were assigned a starting dose af atarvastatin based an baseline LDL. After 6 weeks, uptita'atian accun'ed in subjects nat reaching LDL target. 2145 subjects wele enralled fi'am 139 sites. The subjects exhibited the fallawing characteristics: CHD (59%), CHD-equivalents (7%), diabetes (39%) ar 10y CV risk > 20% (7%). 64% af subjects were statin-fi'ee and 36% were inadequately canta'alled with usual doses af anather statin. At baseline, 33%, 36%, 12% and 20% af subjects were assigned ta 10, 20, 40 and 80 rag, respectively. The last subject visit will occur in February 2004. This study is expected ta demansta'ate that a flexible stat't dose af atarvastatin 10-80rag/d, matched ta the baseline LDL, allaws the majarity af high risk patients ta safely reach the LDL tat'get af < 2.6 mmal/L at first dose o1" with just a single titratian step. The results would pravide clinicians with a simple algarithm far managing high-risk patients.
• RISK PREDICTING SCORES AND SUBCLINICAL ATHEROSCLEROSIS IN TYPE 2 DIABETICS
de Waal
]
M-MODE ULTRASOUND IMAGING OF ARTERIAL WALL MOVEMENT AND ARTERIAL WALL THICKNESS OF DISTAL CAROTID ARTERIES IN ATHEROSCLEROSIS STUDIES IN HEALTHY ADULTS
T. de Waal, F. Zijta, W. Stak, E. de Graat, J. Kastelein, J. Karemaker.
Department of Vascular Medicine, AMC, Department of Physiology, AMC, Amsterdam, The Netherlands Background: Determinants and risk factars far cardiavascular disease ale af influence an arterial wall praperties.These praperties can be madeled accarding ta M-made ulta'asaund data an arterial wall mavement and B-made ultrasaund data an arterial wall thickness. The parameters af the madels can be used far identificatian and specificatian af cat'diavascular risk priar ta the appeat'ance af clinical sequela and ta investigate the effects af drugs an arterial remadeling. We develaped still image analysis saftware ta abtain (stiffness) b and (intima-media thickness) IMT data fi'am M- and B-made digital still fi'ames. The relatianship between ~ with age and IMT with age in subjects withaut symptams af cardiavascular disease was described in healthy adults. Methods: In 51 subjects aged 33,4(range 23.0 ta 61.4)year's M-made mode images including the right and the left distal camman caratid arterial walls were abtained far at least 3 heartbeats with a 5mm/sec sweep. The video still images were stared as JPEG files. B-made images were used far the IMT measurements. Edge detectian saftware was used ta ta'ack the cantaurs af the M-made arterial wall mavement. ~ was calculated accarding ta [ln(SBP/DBP)]/(dD/DD)]; IMT was calculated as the average distance between fat" wall lumen-intima and media-adventitia interfaces. Pearsan cala'elatians between age, IMT and ~ were calculated. Results: Fram age 23 ta 61, ~ and age (1--0.46, p=0.001), and IMT and age (1"=0.63, p=0.001) were cala'elated
74th EAS Congress, 17-20 April 2004, Seville, Spain