- Email: [email protected]
Mo-P1:4 Risk for cardiovascular events in a local population of diabetic patients
46
Monday, June 19, 2006: Poster Session P1
Mo-P1:1
EPIDEMIOLOGY
OF CARDIOVASCULAR DISEASE
ASSESSMENT OF CORONARY HEART DISEASE RISK IN T H E M I D D L E E A S T A R E A : D O W E N E E D T O MODIFY THE EXISTED RISK CHARTS
N. Saxrafzada2an, A. Tavassoli. Isfahan Cardiovascular Research Center;
Isfahan, h'an Objectives: W h a t h a r tha axistad risk pradiction charts for coronary heart disaasa (CHD) fit tha Middla Eastarn population or not. M e t h o d s : Studias in populations of tha Middla East area showad slight diffarant ralativa and attributabla risk for m a j o r risk factors. Ona of thasa studias is a cohort of almost seven t h o u s a n d Iranian m a n and w o m e n a g e d _>35 years w h o axa followad up for tan years in IsfaJaan Haalthy Heart P r o g r a m in Iran. In tha basalina study that was done in tha year 2000, m a n y physical and biochamical m a a s u r a m a n t s including (total, L D L , HDL), cholastarol triglacridas, a p t B/A, Diabatas, systolic and diastolic blood prassura, Waist circumfaranca, WahstAtip ratio, BMI, atc were done. Tha m a i n outcomes axa fatal and non-fatal myocardial infaxctions and strokes as well as sudden death. Tha two, four, six and tan years relative risks of these risk factors will ba datarminad. Results: H i g h e r triglycarida and low H D L cholesterol levels, tha metabolic syndrome ara more prevalent and have highar relative risk than high total and L D L cholesterol. Elevated L D L cholesterol as levels > 7 5 t h percentile of tha population is less c o m m o n than high T G or low H D L - C even in patients with coronary heart disaasa. A b d o m i n a l obesity is more prevalent s p e d f i d y in w o m e n and waist d r c u m f e r e n c e h a d higher relative risk than BMI. Gender-based differences axe different f r o m western countries as well. The results of this and other ongoing longitudinal studies in the region will datarmina tha relative risk of each or tha combination of risk factors. Conclusion: Wa conclude that there is m a j o r need to reconsider tha existed risk assessment score sheets and guidelines based on naw information obtained f r o m this part of tha world.
C O R O N A R Y R I S K A S S E S S M E N T IN S P A N I S H POPULATION ACCORDING WITH POBLATIONAL DATA: D O R I C A ' S R I S K C H A R T E R S
and diastolic blood pressure, and a corrective factor related with c H D L concentrations.
Mo-P1:3
YOUNG ASIMPTOMATIC CARDIOLOGY
S U B J E C T IN P R E V E N T I V E
C.A. Sarau I , S. Mancas 1 , D.M. D u d a - S a i m a n 1 , G. Mihalas 2, St.I. D r a g u l a s c u 1 , L. N o v a a n u 2, L. Baxbu 1 , G. Ciorica 1 , A. A v r a m 1 , L. David 1. l institute of Cardiovascular Diseases-Cardiac Rehabilitation
Clinic, Timisoara, Romania." 2 Universi~ of Medicine attd Pharmacy Victor Babes, Timisoara, Romania Objective: E v i d a n c a - b a s a d madicina dafinas atharotrombotic cardiovascular (CV) ralativa risk b y tha analyzed risk factors (RF). O u r purposa was to assas C V risk in y o u n g a s y m p t o m a t i c subjacts, and to alaborata an objact cantarad informatic m o d a l in ordar to stratify C V risk. M e t h o d : Wa u s a d tha questionnaire m a t h o d to idantify and quantify C V risk factors in y o u n g a s y m p t o m a t i c population. Wa craatad a databasa ragarding (a) CV-RF pravalanca in tha studiad population; (b) risk g r o u p dalimitation. Wa p r o p o s a d an objact cantarad informatic modal for tha stratification of C V risk. Statistical analysis: lot parcant, m a a n -4- SD, multiliniar ragrassion. Results: Studiad group: 585 subjacts, avaraga aga = 20-4-2.24 yrs., mainly w o m a n (72.47%), m a j o r RF pravalanca 34.18%. Tha assassmant of C V risk b y analyzed RF ravaals an incidanca of 7.69% for high and vary high scora, 65.8% for low risk. Tha target of our p r i m a r y pravantion p r o g r a m is raprasented b y individuals at madium, high and vary high vascular risk. Wa proposa an informatic m o d a l for individual tailoring of tha p r o g r a m w h i c h allows tha idantification of risk catagorias, and tha follow up of tha i m p l a m a n t a d p r i m a r y pravantion stratagias in risk catagorias. C o n d u s i o n s : (1)Primary pravantion of atharotrombotic C V disaasa a m o n g y o u n g a s y m p t o m a t i c subjacts is c o m p u l s o r y bacausa of tha high pravalanca of C V RF. (2)Tha scraaning of analyzed RF ravaals that 1/3 of analyzad y o u n g a s y m p t o m a t i c prasants vascular risk. (3)Tha p r o p o s a d m o d a l assuras tha avaluation accuracy for y o u n g individuals with vascular risk and confars tha possibility of corracting through lifastyla intarvantions.
~
R I S K F O R C A R D I O V A S C U L A R E V E N T S IN A L O C A L POPULATION OF DIABETIC PATIENTS
J. Millan i j. Arancata2,3, M. Foz 2, B. Gil 4, E. Jovar I , T. Mantilla I , S. M o n a r a o 5, B. M o r a n o -~' 5 . 1Soctedcul . . . de Arteriosclerosis, . Espanola Spain:
E. Pallagrini 1 M. Maurantonio 1 , R. D ' A m i c o 1 , B. M a d a o ~, I.M. G l a n m c o , D. Ganazzi 1 , L. Caxulli 1 , P. L o r i a 1 , M. Bartolotti 1 N. Carulli 1.1 Universitgl
"~SociedcM Espat~ola para E1 Estudio de la ObesidcM, Spain: ~Socie&ld Espat~ola de Nutrici6n Comunitaria, Spain: 4Socie&ld Espat~ola de Medicina Intema, Spain: 5 Socie&ld Espat~ola de EtMocrinolog{a y Nutrici6n, Spain
di Modena e Reggio Emilia, Modena, Italy: 2Azienda Usl, Modena, Italy
Introduction: Tha Multi-scientific Spanish Working G r o u p of Obesity, have done tha D O R I C A S t u d y (Dislipamia, O b a s i d a d y RIasgo CArdiovascular). D O R I C A S t u d y was carriad out with data of observational transversal apidamiological studias in Spain. That studies in adult population (25 to 60 years) with a total population of 14.616 individuals Objectives: 1) To k n o w tha prevalence of cardiovascular risk factors, 2) To calculata tha risk fraction related with every ona of risk factors, and 3) To stablish a quantitative/qualitative model M e t h o d o l o g y : 1) Estimation of prevalence of cardiovascular risk factors, 2) Estimation of risk fraction related with every risk factor, 3) D a t a analysis were adjusted b y cansal data of 1991 actualized in 1998. G l o b a l C a r d i o v a s c u l a r R i s k : B y considering relative risk for c o r o n a r y heart disaasa estimated in F r a m i n g h a n Study a n d tha prevalence of cardiovascular risk factors in D O R I C A Study, tha risk a s s o d a t a d with arterial hypertension was 18,7% m a n and 16,5% in women. Risk fraction related with h y p a r c h o l a s t a r o l a m i a was 15,7% for m a n and 12,7% in women. Risk fraction that could ba related with smoking in m a n was 13,1%. Risk fraction related with obesity is 4% for m a n and 5 % for women. C o r o n a r y R i s k C h a r t e r s : It was possible to calculate tha global c o r o n a r y risk. So, wa have designed these C o r o n a r y Risk Charters for m a n and women, with or without diabetes, to usa in p r i m a r y prevention. These charters ind u d a d tha following data: aga and gender, smoking, total cholesterol, systolic
Diabetes mallitus (DM) is a m a j o r risk factor for cardiovascular (CV) events. M a n y algorithms have been devised to assass C V risk, some of w h i c h specific for diabatics. Most of them, however, axa based on data w h i c h can hardly ba extrapolated to Maditarranaan countries. A I M of tha present study was to analyze C V risk and tha incidence of C V events in a local cohort of patients with type 2 DM. M e t h o d s : Clinical charts of two Diabetes Clinics of M o d a n a in tha period 1991-1994 were analyzed. Patients a g e d 35-65 with type 2 D M and no history of C V disaasa were eligible. Global C V risk was c o m p u t e d according to F r a m ingham, R I S C A R D , Progatto Cuora and U K P D S algorithms and c o m p a r e d with tha actual rate of C V events over tha following 10 years. Results: 774 patients were screened; 473 of t h e m (61.1%) were eligible on tha basis of pradafinad criteria and completeness of data. In such population an absolute 10-yr risk rate of 10.8% was observed. W h e n c o m p a r i n g tha estimated risk rate according to tha diffarant functions, a high degree of variability was present; Italian algorithms were more consistent with tha observed data even if only 31% of patients with C V events h a d a risk > 2 0 % at initial observation. Conclusions: Estimation of C V risk is largely dependent on tha algorithm adopted and on tha basalina risk of tha reference cohort. Functions designed for a specific population should ba adopted. Tha overall performance of s u c h functions is however low. Tha algorithm derived f r o m tha present study will ba utilized for a prospective evaluation of C V risk in our local cohort. Funding: Supported b y C O F I N - P R I N grant 2004 067491.
XIV bztetTmtional Symposium on Atherosclerosis, Rome, Italy, June 18-22, 2006
Monday, June 19, 2006: Poster Session P1
Mo-P1:1
EPIDEMIOLOGY
OF CARDIOVASCULAR DISEASE
ASSESSMENT OF CORONARY HEART DISEASE RISK IN T H E M I D D L E E A S T A R E A : D O W E N E E D T O MODIFY THE EXISTED RISK CHARTS
N. Saxrafzada2an, A. Tavassoli. Isfahan Cardiovascular Research Center;
Isfahan, h'an Objectives: W h a t h a r tha axistad risk pradiction charts for coronary heart disaasa (CHD) fit tha Middla Eastarn population or not. M e t h o d s : Studias in populations of tha Middla East area showad slight diffarant ralativa and attributabla risk for m a j o r risk factors. Ona of thasa studias is a cohort of almost seven t h o u s a n d Iranian m a n and w o m e n a g e d _>35 years w h o axa followad up for tan years in IsfaJaan Haalthy Heart P r o g r a m in Iran. In tha basalina study that was done in tha year 2000, m a n y physical and biochamical m a a s u r a m a n t s including (total, L D L , HDL), cholastarol triglacridas, a p t B/A, Diabatas, systolic and diastolic blood prassura, Waist circumfaranca, WahstAtip ratio, BMI, atc were done. Tha m a i n outcomes axa fatal and non-fatal myocardial infaxctions and strokes as well as sudden death. Tha two, four, six and tan years relative risks of these risk factors will ba datarminad. Results: H i g h e r triglycarida and low H D L cholesterol levels, tha metabolic syndrome ara more prevalent and have highar relative risk than high total and L D L cholesterol. Elevated L D L cholesterol as levels > 7 5 t h percentile of tha population is less c o m m o n than high T G or low H D L - C even in patients with coronary heart disaasa. A b d o m i n a l obesity is more prevalent s p e d f i d y in w o m e n and waist d r c u m f e r e n c e h a d higher relative risk than BMI. Gender-based differences axe different f r o m western countries as well. The results of this and other ongoing longitudinal studies in the region will datarmina tha relative risk of each or tha combination of risk factors. Conclusion: Wa conclude that there is m a j o r need to reconsider tha existed risk assessment score sheets and guidelines based on naw information obtained f r o m this part of tha world.
C O R O N A R Y R I S K A S S E S S M E N T IN S P A N I S H POPULATION ACCORDING WITH POBLATIONAL DATA: D O R I C A ' S R I S K C H A R T E R S
and diastolic blood pressure, and a corrective factor related with c H D L concentrations.
Mo-P1:3
YOUNG ASIMPTOMATIC CARDIOLOGY
S U B J E C T IN P R E V E N T I V E
C.A. Sarau I , S. Mancas 1 , D.M. D u d a - S a i m a n 1 , G. Mihalas 2, St.I. D r a g u l a s c u 1 , L. N o v a a n u 2, L. Baxbu 1 , G. Ciorica 1 , A. A v r a m 1 , L. David 1. l institute of Cardiovascular Diseases-Cardiac Rehabilitation
Clinic, Timisoara, Romania." 2 Universi~ of Medicine attd Pharmacy Victor Babes, Timisoara, Romania Objective: E v i d a n c a - b a s a d madicina dafinas atharotrombotic cardiovascular (CV) ralativa risk b y tha analyzed risk factors (RF). O u r purposa was to assas C V risk in y o u n g a s y m p t o m a t i c subjacts, and to alaborata an objact cantarad informatic m o d a l in ordar to stratify C V risk. M e t h o d : Wa u s a d tha questionnaire m a t h o d to idantify and quantify C V risk factors in y o u n g a s y m p t o m a t i c population. Wa craatad a databasa ragarding (a) CV-RF pravalanca in tha studiad population; (b) risk g r o u p dalimitation. Wa p r o p o s a d an objact cantarad informatic modal for tha stratification of C V risk. Statistical analysis: lot parcant, m a a n -4- SD, multiliniar ragrassion. Results: Studiad group: 585 subjacts, avaraga aga = 20-4-2.24 yrs., mainly w o m a n (72.47%), m a j o r RF pravalanca 34.18%. Tha assassmant of C V risk b y analyzed RF ravaals an incidanca of 7.69% for high and vary high scora, 65.8% for low risk. Tha target of our p r i m a r y pravantion p r o g r a m is raprasented b y individuals at madium, high and vary high vascular risk. Wa proposa an informatic m o d a l for individual tailoring of tha p r o g r a m w h i c h allows tha idantification of risk catagorias, and tha follow up of tha i m p l a m a n t a d p r i m a r y pravantion stratagias in risk catagorias. C o n d u s i o n s : (1)Primary pravantion of atharotrombotic C V disaasa a m o n g y o u n g a s y m p t o m a t i c subjacts is c o m p u l s o r y bacausa of tha high pravalanca of C V RF. (2)Tha scraaning of analyzed RF ravaals that 1/3 of analyzad y o u n g a s y m p t o m a t i c prasants vascular risk. (3)Tha p r o p o s a d m o d a l assuras tha avaluation accuracy for y o u n g individuals with vascular risk and confars tha possibility of corracting through lifastyla intarvantions.
~
R I S K F O R C A R D I O V A S C U L A R E V E N T S IN A L O C A L POPULATION OF DIABETIC PATIENTS
J. Millan i j. Arancata2,3, M. Foz 2, B. Gil 4, E. Jovar I , T. Mantilla I , S. M o n a r a o 5, B. M o r a n o -~' 5 . 1Soctedcul . . . de Arteriosclerosis, . Espanola Spain:
E. Pallagrini 1 M. Maurantonio 1 , R. D ' A m i c o 1 , B. M a d a o ~, I.M. G l a n m c o , D. Ganazzi 1 , L. Caxulli 1 , P. L o r i a 1 , M. Bartolotti 1 N. Carulli 1.1 Universitgl
"~SociedcM Espat~ola para E1 Estudio de la ObesidcM, Spain: ~Socie&ld Espat~ola de Nutrici6n Comunitaria, Spain: 4Socie&ld Espat~ola de Medicina Intema, Spain: 5 Socie&ld Espat~ola de EtMocrinolog{a y Nutrici6n, Spain
di Modena e Reggio Emilia, Modena, Italy: 2Azienda Usl, Modena, Italy
Introduction: Tha Multi-scientific Spanish Working G r o u p of Obesity, have done tha D O R I C A S t u d y (Dislipamia, O b a s i d a d y RIasgo CArdiovascular). D O R I C A S t u d y was carriad out with data of observational transversal apidamiological studias in Spain. That studies in adult population (25 to 60 years) with a total population of 14.616 individuals Objectives: 1) To k n o w tha prevalence of cardiovascular risk factors, 2) To calculata tha risk fraction related with every ona of risk factors, and 3) To stablish a quantitative/qualitative model M e t h o d o l o g y : 1) Estimation of prevalence of cardiovascular risk factors, 2) Estimation of risk fraction related with every risk factor, 3) D a t a analysis were adjusted b y cansal data of 1991 actualized in 1998. G l o b a l C a r d i o v a s c u l a r R i s k : B y considering relative risk for c o r o n a r y heart disaasa estimated in F r a m i n g h a n Study a n d tha prevalence of cardiovascular risk factors in D O R I C A Study, tha risk a s s o d a t a d with arterial hypertension was 18,7% m a n and 16,5% in women. Risk fraction related with h y p a r c h o l a s t a r o l a m i a was 15,7% for m a n and 12,7% in women. Risk fraction that could ba related with smoking in m a n was 13,1%. Risk fraction related with obesity is 4% for m a n and 5 % for women. C o r o n a r y R i s k C h a r t e r s : It was possible to calculate tha global c o r o n a r y risk. So, wa have designed these C o r o n a r y Risk Charters for m a n and women, with or without diabetes, to usa in p r i m a r y prevention. These charters ind u d a d tha following data: aga and gender, smoking, total cholesterol, systolic
Diabetes mallitus (DM) is a m a j o r risk factor for cardiovascular (CV) events. M a n y algorithms have been devised to assass C V risk, some of w h i c h specific for diabatics. Most of them, however, axa based on data w h i c h can hardly ba extrapolated to Maditarranaan countries. A I M of tha present study was to analyze C V risk and tha incidence of C V events in a local cohort of patients with type 2 DM. M e t h o d s : Clinical charts of two Diabetes Clinics of M o d a n a in tha period 1991-1994 were analyzed. Patients a g e d 35-65 with type 2 D M and no history of C V disaasa were eligible. Global C V risk was c o m p u t e d according to F r a m ingham, R I S C A R D , Progatto Cuora and U K P D S algorithms and c o m p a r e d with tha actual rate of C V events over tha following 10 years. Results: 774 patients were screened; 473 of t h e m (61.1%) were eligible on tha basis of pradafinad criteria and completeness of data. In such population an absolute 10-yr risk rate of 10.8% was observed. W h e n c o m p a r i n g tha estimated risk rate according to tha diffarant functions, a high degree of variability was present; Italian algorithms were more consistent with tha observed data even if only 31% of patients with C V events h a d a risk > 2 0 % at initial observation. Conclusions: Estimation of C V risk is largely dependent on tha algorithm adopted and on tha basalina risk of tha reference cohort. Functions designed for a specific population should ba adopted. Tha overall performance of s u c h functions is however low. Tha algorithm derived f r o m tha present study will ba utilized for a prospective evaluation of C V risk in our local cohort. Funding: Supported b y C O F I N - P R I N grant 2004 067491.
XIV bztetTmtional Symposium on Atherosclerosis, Rome, Italy, June 18-22, 2006