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Mo-P1:26 The association of cardiovascular disease risk factors with pulse pressure among white and black men and women
P1
Mon&ty, June 19, 2006: Poster Session Epidemiology of cardiovascular disease
is 8.4% in males and 6% in females. The most representative assodation of borderline metabolic abnormalities is hypertension and decreased HDL-C levels in 14% of males and hypertension and hyperglycaemia in 8% of females. So it is clear the importance of make a diagnosis in these subjects, with a significant, but ignored cardiovascular risk.
IMo-P1:251NC OH RA MN GOIGNLGY CT EHME IDAE: FIIMN IPTAICOTN OFNO RD I S E A S E PREVALENCE AND ASSOCIATED CARDIOVASCULAR RISK M. Masulli, P. Di Bonito, R. Galasso, G. Donnarumma, E. Lapice, G. Riccardi, O. Vaccaro. Department of Clinical attcl Eaperimental Medicine, Federico H Medical School, Naples, Italy Introduction: In 2003 the ADA proposed to lower the diagnostic threshold for impaired fasting glucose (IFG) from 6.1 to 5.6 mmol/l. The cost/benefit balance of this change is controversial. The study aims axe 1) to evaluate the consequences of lowering diagnostic criteria for IFG on prevalence of disease across sex, age, and BMI strata 2) to compare estimated CV risk accross varying values of fasting plasma glucose (FPG). Methods: 43114 non diabetic telephone company employees, aged 35-65 years, were studied. Measurements include: antropometry, B E FPG and lipids. Normoglycemia is defined by A D A 2003 as FPG <5.6 mmol/l. Paxticipants were grouped according to FPG: <5.3 (quartile 1-3 of the normoglycemic range); 5.3-5.5 (quartile 4 of the normoglycemic range); 5.6-6.1 (new IFG cases according to 2003 criteria); 6.1-6.9 (IFG according to 1997 criteria mmol/l). Results: with the 2003 criteria prevalence of IFG increases from 11.6% to 40.5% (i.e by 350%). The largest increase is observed in females with age<45 years (4.0 vs 22.0%), the smallest in males with BMI >35 kg/m 2 (24.0 vs 55.4%). Mean values of CV risk increased with increasing FPG (p<0.001 for linear trend). Age and sex adjusted OR for estimated high CV risk (i.e.coexistence of three or more among LDL cholesterol >3.4, triglycerides >1.69, HDL cholesterol <1.04 retool/l, BP>140/90 m m H g ) were 1.06;1.09;1.15. Conclusions: With the use of the new diagnostic crieria IFG prevalence increases from 200 to 500%, gender, age and adiposity are major influences on prevalence of disease. CV risk increases continually with FPG, with no evidence for a threshold effect.
I
I M o - P 1 : 2 6 Ii T H E A S S O C I A T I O N OF C A R D I O V A S C U L A R D I S E A S E RISK FACTORS WITH PULSE PRESSURE A M O N G WHITE AND BLACK MEN AND WOMEN D. Lacldand, G. Gilbert, W. Mountford, J. AbelL P. Gazes. Medical Universi~ of South Carolina, Charleston, USA Objective: To assess the attributable risks of cholesterol, obesity, smoking, diabetes, gender and race on pulse pressure. Methods: The study population was identified through the Black Pooling Project (11=26083; white males 9586; white females 12058; black males 1829; white females 2610) and included four follow-up cohort studies including the Charleston Heart Study, Evans County Heart Study, NHANES I Follow-up Study and the NHANES II Follow-up Study. Pulse pressure was determined for the all participants and analyzed with smoking, cholesterol, obesity and diabetes using multiple linear regression. Results: Pulse pressure varied significantly by race-sex groups with the proportions in the highest category of pulse pressure (_>60 nun Hg) as follows: white males 24.6%; white females 26.6%; black males 34.4%; and black females 40.0%. Multiple regression analyses identified race, gender, age, cholesterol, diabetes, and body mass index as significant predictors of pulse pressure. While smoking showed a negative trend with pulse pressure in all four race-sex groups, this association was diminished after consideration of age and different effects of smoking on systolic and diastolic blood pressure levels. Conclusions: These findings confirm the association of the traditional cardiovascular risk facts with pulse pressure in all four race-sex groups. The racial disparity in higher pressures among black men and women identifies the increased cardiovascular disease risk for this segment of the population. Funding: These analyses were supported by the Black Pooling Project funded by the National Heart, Lung and Blood Institute.
Mo-P1:27
51
T R O P O N I N T IN H O S P I T A L I Z E D P A T I E N T S - IS I T REALY A SPECIFIC MARKER FOR THE DIAGNOSIS OF ACS?
D. Planer, R. Alcalai, C. Afsin, A. Osman, A. Pollak, C. Lotan. Hadassah Tile Hebrew Universi~ Medical Center; Jerusalem, Israel Aims: To characterize the differences between patients with ACS and nonthrombotic troponin elevation in hospitalized patients. Methods: Between 1.1.2003 to 1.10.2003, all patients with elevated troponin levels (cutoff value 0.1 ng/ml) at Hadassah hospital were analyzed. Demographic and clinical data were collected and death date was recorded. The study population was divided according to the principal diagnosis to two subgroups: ACS and non-thrombotic troponin elevation (NTTE). Predictors for the diagnosis of ACS were chaxacterized by multivariate regression analysis. Short and long term adjusted mortality analysis were performed. Results: 615 patients comprised the study group. The mean age was 68-4-15; 398 patients were males (64.7%). Only 326 patients (53%) were diagnosed as ACS while 254 patients (41%) had a wide spectrum of conditions such as sepsis, respiratory failure, CVA, renal failure and surgical emergencies. In the other 35 patients (5.7%), the diagnosis could not be determined. The positive predictors for the diagnosis of ACS were age between 40-70, a history of HTN or IHD, normal renal function and troponin level above lng/ml. Hospitalization in a surgical department was a strong negative predictor for ACS. In hospital as well as long term adjusted mortality rates were significantly lower in the ACS group (P<0.001). C o n d n s i o n s : In hospitalized patients, non-thrombotic troponin elevation is common. These patients axe older, suffer from multiple medical conditions and have a poorer prognosis compared to ACS patients.
IMo-P1:281
I i
E V A L U A T I O N O F M A N D A T O R Y S T U D I E S IN D I S L I P I D E M I C P A T I E N T S AT A L I P I D C L I N I C IN HAVANA
A. Nasiff-Hadad, E. Merino-Ibaxra, A. Herrera-Gonzalez. Herntat~os Ameijeiras Hospital, Ciudad de la Habana, Cuba Introduction: A group of studies considered mandatory (glucose, ASAT, creatinine and amilase in plasma), to rule out some secondary causes of dislipidemies (DL) axe indicated to subjects with abnormal lipids profile. Objective: To evaluate the usefulness of mandatory studies to determine the etiology of DL. Materials and method: Glucose, ASAT, creatinine and amilase in plasma were determined in 1067 subjects with DL. Spearman correlation coefficient was calculated between the lipids variables and the mandatory studies. The results were confirmed through regression analysis lineal/logistic and analysis of receiver operative chaxacteristic curve (ROC). Results: Significant correlation does not exist between the total cholesterol and the cholesterol in LDL with mandatories studies, but we found correlation between the latter and the levels of triglycerides, this correlation gets lost subdividing the levels of triglycerides according to ATP III classification. Lineal/logistic regression analysis did not demonstrate influence of the madatories studies on the levels of cholesterol or triglycerides. On the other hand, in the ROC curve analysis we could not find a clear cut point from which some of the studies have enough sensibility and specificity to make dependent of its elevation the subject hypercholesterolemia or hypertriglyceridemia. Correlation was not demonstrated between serum amilase and the levels of triglycerides. C o n d u s i o n s : Mandatories studies looking for a secondary dislipidemia should be suggested by clinical data and never on routine-basis. It is not necessary plasma amilase in hypertriglyceridemic patients.
IMo-P1:291
P R E V A L E N C E OF D Y S L I P I D E M I A E S T I M A T E D FROM A SELF-REPORTED SURVEY VERSUS CLINICAL AND LABORATORY EVALUATION: C O M P A R I S O N OF S H I E L D A N D N H A N E S D A T A
H.E. Bays 1, R.H. Chapman-, S. Grandy 3 . 1L-Mare Research Center; Louisville, KY USA: "-Vahwmedies Research, Falls Church, VA, USA: 3AstraZeneca, Wihnington, DE, USA Objectives: Optimal treatment of dyslipidemia, hypertension and diabetes requires that patients know they have the diseases. Awareness of these CHD risk factors was assessed by comparing a self-reported survey, Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD), to objective data from National Health and Nutrition Examination Survey (NHANES 1999-2002).
XIV bzterTtational Symposium on Atherosclerosis, Rome, Italy, June 18-22, 2006
Mon&ty, June 19, 2006: Poster Session Epidemiology of cardiovascular disease
is 8.4% in males and 6% in females. The most representative assodation of borderline metabolic abnormalities is hypertension and decreased HDL-C levels in 14% of males and hypertension and hyperglycaemia in 8% of females. So it is clear the importance of make a diagnosis in these subjects, with a significant, but ignored cardiovascular risk.
IMo-P1:251NC OH RA MN GOIGNLGY CT EHME IDAE: FIIMN IPTAICOTN OFNO RD I S E A S E PREVALENCE AND ASSOCIATED CARDIOVASCULAR RISK M. Masulli, P. Di Bonito, R. Galasso, G. Donnarumma, E. Lapice, G. Riccardi, O. Vaccaro. Department of Clinical attcl Eaperimental Medicine, Federico H Medical School, Naples, Italy Introduction: In 2003 the ADA proposed to lower the diagnostic threshold for impaired fasting glucose (IFG) from 6.1 to 5.6 mmol/l. The cost/benefit balance of this change is controversial. The study aims axe 1) to evaluate the consequences of lowering diagnostic criteria for IFG on prevalence of disease across sex, age, and BMI strata 2) to compare estimated CV risk accross varying values of fasting plasma glucose (FPG). Methods: 43114 non diabetic telephone company employees, aged 35-65 years, were studied. Measurements include: antropometry, B E FPG and lipids. Normoglycemia is defined by A D A 2003 as FPG <5.6 mmol/l. Paxticipants were grouped according to FPG: <5.3 (quartile 1-3 of the normoglycemic range); 5.3-5.5 (quartile 4 of the normoglycemic range); 5.6-6.1 (new IFG cases according to 2003 criteria); 6.1-6.9 (IFG according to 1997 criteria mmol/l). Results: with the 2003 criteria prevalence of IFG increases from 11.6% to 40.5% (i.e by 350%). The largest increase is observed in females with age<45 years (4.0 vs 22.0%), the smallest in males with BMI >35 kg/m 2 (24.0 vs 55.4%). Mean values of CV risk increased with increasing FPG (p<0.001 for linear trend). Age and sex adjusted OR for estimated high CV risk (i.e.coexistence of three or more among LDL cholesterol >3.4, triglycerides >1.69, HDL cholesterol <1.04 retool/l, BP>140/90 m m H g ) were 1.06;1.09;1.15. Conclusions: With the use of the new diagnostic crieria IFG prevalence increases from 200 to 500%, gender, age and adiposity are major influences on prevalence of disease. CV risk increases continually with FPG, with no evidence for a threshold effect.
I
I M o - P 1 : 2 6 Ii T H E A S S O C I A T I O N OF C A R D I O V A S C U L A R D I S E A S E RISK FACTORS WITH PULSE PRESSURE A M O N G WHITE AND BLACK MEN AND WOMEN D. Lacldand, G. Gilbert, W. Mountford, J. AbelL P. Gazes. Medical Universi~ of South Carolina, Charleston, USA Objective: To assess the attributable risks of cholesterol, obesity, smoking, diabetes, gender and race on pulse pressure. Methods: The study population was identified through the Black Pooling Project (11=26083; white males 9586; white females 12058; black males 1829; white females 2610) and included four follow-up cohort studies including the Charleston Heart Study, Evans County Heart Study, NHANES I Follow-up Study and the NHANES II Follow-up Study. Pulse pressure was determined for the all participants and analyzed with smoking, cholesterol, obesity and diabetes using multiple linear regression. Results: Pulse pressure varied significantly by race-sex groups with the proportions in the highest category of pulse pressure (_>60 nun Hg) as follows: white males 24.6%; white females 26.6%; black males 34.4%; and black females 40.0%. Multiple regression analyses identified race, gender, age, cholesterol, diabetes, and body mass index as significant predictors of pulse pressure. While smoking showed a negative trend with pulse pressure in all four race-sex groups, this association was diminished after consideration of age and different effects of smoking on systolic and diastolic blood pressure levels. Conclusions: These findings confirm the association of the traditional cardiovascular risk facts with pulse pressure in all four race-sex groups. The racial disparity in higher pressures among black men and women identifies the increased cardiovascular disease risk for this segment of the population. Funding: These analyses were supported by the Black Pooling Project funded by the National Heart, Lung and Blood Institute.
Mo-P1:27
51
T R O P O N I N T IN H O S P I T A L I Z E D P A T I E N T S - IS I T REALY A SPECIFIC MARKER FOR THE DIAGNOSIS OF ACS?
D. Planer, R. Alcalai, C. Afsin, A. Osman, A. Pollak, C. Lotan. Hadassah Tile Hebrew Universi~ Medical Center; Jerusalem, Israel Aims: To characterize the differences between patients with ACS and nonthrombotic troponin elevation in hospitalized patients. Methods: Between 1.1.2003 to 1.10.2003, all patients with elevated troponin levels (cutoff value 0.1 ng/ml) at Hadassah hospital were analyzed. Demographic and clinical data were collected and death date was recorded. The study population was divided according to the principal diagnosis to two subgroups: ACS and non-thrombotic troponin elevation (NTTE). Predictors for the diagnosis of ACS were chaxacterized by multivariate regression analysis. Short and long term adjusted mortality analysis were performed. Results: 615 patients comprised the study group. The mean age was 68-4-15; 398 patients were males (64.7%). Only 326 patients (53%) were diagnosed as ACS while 254 patients (41%) had a wide spectrum of conditions such as sepsis, respiratory failure, CVA, renal failure and surgical emergencies. In the other 35 patients (5.7%), the diagnosis could not be determined. The positive predictors for the diagnosis of ACS were age between 40-70, a history of HTN or IHD, normal renal function and troponin level above lng/ml. Hospitalization in a surgical department was a strong negative predictor for ACS. In hospital as well as long term adjusted mortality rates were significantly lower in the ACS group (P<0.001). C o n d n s i o n s : In hospitalized patients, non-thrombotic troponin elevation is common. These patients axe older, suffer from multiple medical conditions and have a poorer prognosis compared to ACS patients.
IMo-P1:281
I i
E V A L U A T I O N O F M A N D A T O R Y S T U D I E S IN D I S L I P I D E M I C P A T I E N T S AT A L I P I D C L I N I C IN HAVANA
A. Nasiff-Hadad, E. Merino-Ibaxra, A. Herrera-Gonzalez. Herntat~os Ameijeiras Hospital, Ciudad de la Habana, Cuba Introduction: A group of studies considered mandatory (glucose, ASAT, creatinine and amilase in plasma), to rule out some secondary causes of dislipidemies (DL) axe indicated to subjects with abnormal lipids profile. Objective: To evaluate the usefulness of mandatory studies to determine the etiology of DL. Materials and method: Glucose, ASAT, creatinine and amilase in plasma were determined in 1067 subjects with DL. Spearman correlation coefficient was calculated between the lipids variables and the mandatory studies. The results were confirmed through regression analysis lineal/logistic and analysis of receiver operative chaxacteristic curve (ROC). Results: Significant correlation does not exist between the total cholesterol and the cholesterol in LDL with mandatories studies, but we found correlation between the latter and the levels of triglycerides, this correlation gets lost subdividing the levels of triglycerides according to ATP III classification. Lineal/logistic regression analysis did not demonstrate influence of the madatories studies on the levels of cholesterol or triglycerides. On the other hand, in the ROC curve analysis we could not find a clear cut point from which some of the studies have enough sensibility and specificity to make dependent of its elevation the subject hypercholesterolemia or hypertriglyceridemia. Correlation was not demonstrated between serum amilase and the levels of triglycerides. C o n d u s i o n s : Mandatories studies looking for a secondary dislipidemia should be suggested by clinical data and never on routine-basis. It is not necessary plasma amilase in hypertriglyceridemic patients.
IMo-P1:291
P R E V A L E N C E OF D Y S L I P I D E M I A E S T I M A T E D FROM A SELF-REPORTED SURVEY VERSUS CLINICAL AND LABORATORY EVALUATION: C O M P A R I S O N OF S H I E L D A N D N H A N E S D A T A
H.E. Bays 1, R.H. Chapman-, S. Grandy 3 . 1L-Mare Research Center; Louisville, KY USA: "-Vahwmedies Research, Falls Church, VA, USA: 3AstraZeneca, Wihnington, DE, USA Objectives: Optimal treatment of dyslipidemia, hypertension and diabetes requires that patients know they have the diseases. Awareness of these CHD risk factors was assessed by comparing a self-reported survey, Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD), to objective data from National Health and Nutrition Examination Survey (NHANES 1999-2002).
XIV bzterTtational Symposium on Atherosclerosis, Rome, Italy, June 18-22, 2006