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Morbidity and mortality in elderly with low total serum cholesterol
Posters 5. Epidemiology
IP47
MORBIDITY AND MORTALITY TOTAL SERUM CHOLESTEROL
A.K. Zacharof,
C. Petrogiannopoulos,
G. Chartzoulakis.
IN ELDERLY
C. Flevaris,
WITH LOW
P Paziouros,
2”d Department of Internal Medicine, Hellenic Red Cross
Hospital, Athens; 56 Andrea Papandreou, Halandri, Athens 15232, Greece Purpose of the Study: It is well known that low serum cholesterol has been associated with morbidity and mortality in the elderly. This study compared the health status, and mortality rates of hospitalised elderly patients with serum cholesterol < 160 mg/dl to age and sex-matched controls with serum cholesterol 220-240 mg/dl. Methods: We analysed and studied our Department medical records of patients with hypolipidemia in focus of a) disease history, b) any disability, c) health habits, and d) cognitive function. The data were collected from 1986 to 1999. We analysed blood samples for total serum cholesterol, triglycerides and HDL, LDL values. Results: Of the 3,874 participants, 109 (2.8%) had total cholesterol levels < 1.50 mg/dl. Seventy-five percent of the low cholesterol group were male compared to 44% in the main study population. The low cholesterol group had significantly greater smoking history, current cigarettes smoked, diabetes history, angina and COPD symptoms, and assistance needed for heavy and light work. Men in the low cholesterol group had significantly lower blood pressure. After two years, 14 (12.8%) of the low cholesterol group had died vs 16 (7.3%) in the control group. There was no relationship to specific causes of death and cholesterol level. Conclusions: A very low cholesterol level in older individuals should be evaluated carefully to determine whether it is due to genetic or life-style factors such as diet or, more likely, is a marker of disease. RISK FACTOR OF SERIOUS VASCULAR IP48 WELL-KNOWN EVENTS IN HYPERTENSIVES AND ADDED VALUE OF ENDOTHELIUM-DEPENDENT ARTERIAL RELAXATION A. Agafonov,
L. Nekroutenko,
D. Lykova. Perm Medical Academy, Perm,
Russia The purpose of study was to compare endothelial function in elder hypertensives with and without vaacuku complications. We examined 30 patients with mean age of 66.70fl .OS. Group I included uncomplicated cases, group II - patients with previous myocardial infarction and/or stroke. Common risk factors frequency (i.e., smoking, obesity, age, sex, diabetes mellitus, alcohol intake, cholesterol level, family history, social status, left ventricular hypertrophy) were the same in both groups. Endothelial function was evaluated by sonographic method as described by Celer-Major D.S. et al. Additionally intima-media thickness (IMT) was measured. Results: In group II, arterial diameter has increased by 2.51%f2.45 (nonsignificantly) post occlusion, and by 12.45%1 f2.08 after administration of nytroglycerin. In group I both reactions were significant (pcO.03): 14.10%&2.31 post occlusion and 18.13%&3.68 after nytroglycerin. IMT was greater in group II (pcO.041): 0.095f0.003 versus 0.076&0.003. Conclusion: Relaxation of artery in responce to occlusion is markedly impared in hypertensive patients with previous serious vascular events comparing to those without such events. At the same time, nytroglycerin-induced dilatation is almost the same in both groups. Impaired endothelial function and increased IMF can mark the increased risk of myocardial infarction and/or stroke independently of “common” risk factors. This impairment is possibly due to decreased production of factor(s) of relaxation, not decreased sensitivity to such factors. Donators of relaxation factor(s) could possibly decrease risk of vascular complications in these patients.
EUROASPIRE II: THERAPEUTIC CONTROL OF BLOOD CHOLESTEROL IN PATENTS WITH CORONARY HEART DISEASE IN 15 EUROPEAN COUNTRIES
D.A. Wood, K. Kotseva. On Behalf of the EUROASPIRE II Study Group;
Cardiac Medicine, National Heart and Lung Institute, London, UK; Department of Public Health, Ghent Universily Belgium Purpose: To evaluate established coronary goal of ~5.0 mmol/l recommendations on
Methods: The EUROASPIRE II survey was carried out in 47 centres from selected geographical areas in fifteen European countries in 1999/2000, under the auspices of the Euro Heart Survey programme. Consecutive patients < 70 years of age with the following diagnoses- coronary artery bypass grafting, percutaneous transhnninal coronary angioplasty, acute myocardial infarction, and myocardial ischaemia- were identified from hospital records and invited for an interview at leaat 6 months after hospitalisation. Results: 8,181 medical records (25% women) were reviewed and 5,556 patients interviewed 1.4 years after hospitalisation for a coronary event. A total cholesterol measurement was recorded in 67.1% of medical records and 42.4% of discharge documents. At interview 58.3% of patients had elevated total cholesterol (25.0 mmol/l). Of those on lipid-lowering medication one half (50.6%) had reached the cholesterol goal of ~5.0 mmol/l with large variations between centres, ranging from 3 1.2% in Czech Republic to 70.1% in Finland. The use of lipid-lowering therapies increased from 26.1% on admission to 42.7% at discharge and 60.8% at interview. Statin medication was 55.3% overall and ranged from 30.7% in Greece to 75.1% in the Netherlands. Conclusions: This European survey shows incomplete recording of blood cholesterol in coronary patients medical records and a majority of coronary patients still not reaching the cholesterol goal. IP50 OVERWEIGHT AGGRAVATES THE CARDIOVASCULAR RISK ASSOCIATED WITH LOW HDL-CHOLESTEROL LEVELS J.M.A. Boer, W.M.M. Verschuren, E.J.M. Feskens. Department of Chronic Diseases Epidemiology, National Institute of Public Health and the Environment, PO Box I, 3720 BA Bilthoven, the Netherlands Both low plasma HDL-cholesterol and overweight are important predictors of cardiovascular risk, but little is known of their joint effect. We used the case-cohort design to investigate the combined effect of low HDLcholesterol (co.9 mmol/l) and overweight (body mass index > 25 kg/mz) on the incidence of fatal and non-fatal cardiovascular disease in a populationbased study of 35.488 Dutch men and women, aged 20-59 at baseline. At the end of 1999, mortality follow-up was completed for all subjects. After 9.3h2.8 years of follow-up 338 subjects had died of cardiovascular disease. For the morbidity follow-up 50% of the participants received a follow-up questionnaire 611 years after baseline examinations. A first myocardial infarction, coronary bypass operation or PTCA was reported by 358 subjects. After adjustment for age, sex and town of investigation, overweight and low HDL-cholesterol predicted both cardiovascular disease mortality and non-fatal coronary heart disease. However, the cardiovascular mortality risk among overweight subjects with a low HDL-cholesterol level was higher (RR: 4.27, 2.676.82) than expected (2.3) from the additive effects of overweight (RR: 1.66, 1.19-2.32) and low HDL-cholesterol (RR: 1.64, 0.83-2.23). A similar result was observed for non-fatal coronary heart disease (observed: RR 4.74, 2.54-8.84, expected RR 2.7). The results were consistent for men and women. This population based case-cohort study showed that overweight aggravates the cardiovascular risk associated with low HDL-cholesterol levels. Control of body weight may therefore be especially important for individuals who are susceptible to low HDLcholesterol levels. Accordingly, prevention of low HDL-cholesterol levels deserves particular attention in overweight individuals. m
COMPARISON OF CAROTID ATHEROSCLEROSIS BETWEEN THE GENERAL POPULATION AND HEMODIALYSIS PATIENTS
N. Maeda’ , J. Hayashi’, Y. Sawayama’ , M. Tataukawa’, C. Shimizu’ , M. Shigematsu’, S. Kashiwagi3. ‘Department of Gene& Medicine, Kyushu
University Hospital; 2Shigematsu Clinic; ‘National Kyushu Medical Center; Fukuoka, Japan
5. Epidemiology
IP49
59
the management of blood cholesterol in patients with heart disease (CHD) with regard to the therapeutic (190 mg/dl) set in the 1998 Joint European Societies prevention of CHD.
Objective: To determine the association between cardiovascular risk factors and carotid atherosclerosis and to investigate carotid atherosclerotic risk factors in the general population and in hemodialysis patients. Methods: We investigated carotid atherosclerotic risk factors, including Chlamydia pneumoniae (C. pneumoniae) infection, in 2410 residents (697 men and 1713 women, mean age 54.5 years) and in 215 hemodialysis patients (116 men and 99 women, mean age 59.2 years). Carotid atherosclerosis was defined aa mean IMT (31.1 mm) and/or plaques assessed by B-mode ultrasound. Results: In the general population, 18.6% had carotid atherosclerosis and 67.9% had C. pneumoniae infection, whereas in hemodialysis patients
72nd EAS Congress
IP47
MORBIDITY AND MORTALITY TOTAL SERUM CHOLESTEROL
A.K. Zacharof,
C. Petrogiannopoulos,
G. Chartzoulakis.
IN ELDERLY
C. Flevaris,
WITH LOW
P Paziouros,
2”d Department of Internal Medicine, Hellenic Red Cross
Hospital, Athens; 56 Andrea Papandreou, Halandri, Athens 15232, Greece Purpose of the Study: It is well known that low serum cholesterol has been associated with morbidity and mortality in the elderly. This study compared the health status, and mortality rates of hospitalised elderly patients with serum cholesterol < 160 mg/dl to age and sex-matched controls with serum cholesterol 220-240 mg/dl. Methods: We analysed and studied our Department medical records of patients with hypolipidemia in focus of a) disease history, b) any disability, c) health habits, and d) cognitive function. The data were collected from 1986 to 1999. We analysed blood samples for total serum cholesterol, triglycerides and HDL, LDL values. Results: Of the 3,874 participants, 109 (2.8%) had total cholesterol levels < 1.50 mg/dl. Seventy-five percent of the low cholesterol group were male compared to 44% in the main study population. The low cholesterol group had significantly greater smoking history, current cigarettes smoked, diabetes history, angina and COPD symptoms, and assistance needed for heavy and light work. Men in the low cholesterol group had significantly lower blood pressure. After two years, 14 (12.8%) of the low cholesterol group had died vs 16 (7.3%) in the control group. There was no relationship to specific causes of death and cholesterol level. Conclusions: A very low cholesterol level in older individuals should be evaluated carefully to determine whether it is due to genetic or life-style factors such as diet or, more likely, is a marker of disease. RISK FACTOR OF SERIOUS VASCULAR IP48 WELL-KNOWN EVENTS IN HYPERTENSIVES AND ADDED VALUE OF ENDOTHELIUM-DEPENDENT ARTERIAL RELAXATION A. Agafonov,
L. Nekroutenko,
D. Lykova. Perm Medical Academy, Perm,
Russia The purpose of study was to compare endothelial function in elder hypertensives with and without vaacuku complications. We examined 30 patients with mean age of 66.70fl .OS. Group I included uncomplicated cases, group II - patients with previous myocardial infarction and/or stroke. Common risk factors frequency (i.e., smoking, obesity, age, sex, diabetes mellitus, alcohol intake, cholesterol level, family history, social status, left ventricular hypertrophy) were the same in both groups. Endothelial function was evaluated by sonographic method as described by Celer-Major D.S. et al. Additionally intima-media thickness (IMT) was measured. Results: In group II, arterial diameter has increased by 2.51%f2.45 (nonsignificantly) post occlusion, and by 12.45%1 f2.08 after administration of nytroglycerin. In group I both reactions were significant (pcO.03): 14.10%&2.31 post occlusion and 18.13%&3.68 after nytroglycerin. IMT was greater in group II (pcO.041): 0.095f0.003 versus 0.076&0.003. Conclusion: Relaxation of artery in responce to occlusion is markedly impared in hypertensive patients with previous serious vascular events comparing to those without such events. At the same time, nytroglycerin-induced dilatation is almost the same in both groups. Impaired endothelial function and increased IMF can mark the increased risk of myocardial infarction and/or stroke independently of “common” risk factors. This impairment is possibly due to decreased production of factor(s) of relaxation, not decreased sensitivity to such factors. Donators of relaxation factor(s) could possibly decrease risk of vascular complications in these patients.
EUROASPIRE II: THERAPEUTIC CONTROL OF BLOOD CHOLESTEROL IN PATENTS WITH CORONARY HEART DISEASE IN 15 EUROPEAN COUNTRIES
D.A. Wood, K. Kotseva. On Behalf of the EUROASPIRE II Study Group;
Cardiac Medicine, National Heart and Lung Institute, London, UK; Department of Public Health, Ghent Universily Belgium Purpose: To evaluate established coronary goal of ~5.0 mmol/l recommendations on
Methods: The EUROASPIRE II survey was carried out in 47 centres from selected geographical areas in fifteen European countries in 1999/2000, under the auspices of the Euro Heart Survey programme. Consecutive patients < 70 years of age with the following diagnoses- coronary artery bypass grafting, percutaneous transhnninal coronary angioplasty, acute myocardial infarction, and myocardial ischaemia- were identified from hospital records and invited for an interview at leaat 6 months after hospitalisation. Results: 8,181 medical records (25% women) were reviewed and 5,556 patients interviewed 1.4 years after hospitalisation for a coronary event. A total cholesterol measurement was recorded in 67.1% of medical records and 42.4% of discharge documents. At interview 58.3% of patients had elevated total cholesterol (25.0 mmol/l). Of those on lipid-lowering medication one half (50.6%) had reached the cholesterol goal of ~5.0 mmol/l with large variations between centres, ranging from 3 1.2% in Czech Republic to 70.1% in Finland. The use of lipid-lowering therapies increased from 26.1% on admission to 42.7% at discharge and 60.8% at interview. Statin medication was 55.3% overall and ranged from 30.7% in Greece to 75.1% in the Netherlands. Conclusions: This European survey shows incomplete recording of blood cholesterol in coronary patients medical records and a majority of coronary patients still not reaching the cholesterol goal. IP50 OVERWEIGHT AGGRAVATES THE CARDIOVASCULAR RISK ASSOCIATED WITH LOW HDL-CHOLESTEROL LEVELS J.M.A. Boer, W.M.M. Verschuren, E.J.M. Feskens. Department of Chronic Diseases Epidemiology, National Institute of Public Health and the Environment, PO Box I, 3720 BA Bilthoven, the Netherlands Both low plasma HDL-cholesterol and overweight are important predictors of cardiovascular risk, but little is known of their joint effect. We used the case-cohort design to investigate the combined effect of low HDLcholesterol (co.9 mmol/l) and overweight (body mass index > 25 kg/mz) on the incidence of fatal and non-fatal cardiovascular disease in a populationbased study of 35.488 Dutch men and women, aged 20-59 at baseline. At the end of 1999, mortality follow-up was completed for all subjects. After 9.3h2.8 years of follow-up 338 subjects had died of cardiovascular disease. For the morbidity follow-up 50% of the participants received a follow-up questionnaire 611 years after baseline examinations. A first myocardial infarction, coronary bypass operation or PTCA was reported by 358 subjects. After adjustment for age, sex and town of investigation, overweight and low HDL-cholesterol predicted both cardiovascular disease mortality and non-fatal coronary heart disease. However, the cardiovascular mortality risk among overweight subjects with a low HDL-cholesterol level was higher (RR: 4.27, 2.676.82) than expected (2.3) from the additive effects of overweight (RR: 1.66, 1.19-2.32) and low HDL-cholesterol (RR: 1.64, 0.83-2.23). A similar result was observed for non-fatal coronary heart disease (observed: RR 4.74, 2.54-8.84, expected RR 2.7). The results were consistent for men and women. This population based case-cohort study showed that overweight aggravates the cardiovascular risk associated with low HDL-cholesterol levels. Control of body weight may therefore be especially important for individuals who are susceptible to low HDLcholesterol levels. Accordingly, prevention of low HDL-cholesterol levels deserves particular attention in overweight individuals. m
COMPARISON OF CAROTID ATHEROSCLEROSIS BETWEEN THE GENERAL POPULATION AND HEMODIALYSIS PATIENTS
N. Maeda’ , J. Hayashi’, Y. Sawayama’ , M. Tataukawa’, C. Shimizu’ , M. Shigematsu’, S. Kashiwagi3. ‘Department of Gene& Medicine, Kyushu
University Hospital; 2Shigematsu Clinic; ‘National Kyushu Medical Center; Fukuoka, Japan
5. Epidemiology
IP49
59
the management of blood cholesterol in patients with heart disease (CHD) with regard to the therapeutic (190 mg/dl) set in the 1998 Joint European Societies prevention of CHD.
Objective: To determine the association between cardiovascular risk factors and carotid atherosclerosis and to investigate carotid atherosclerotic risk factors in the general population and in hemodialysis patients. Methods: We investigated carotid atherosclerotic risk factors, including Chlamydia pneumoniae (C. pneumoniae) infection, in 2410 residents (697 men and 1713 women, mean age 54.5 years) and in 215 hemodialysis patients (116 men and 99 women, mean age 59.2 years). Carotid atherosclerosis was defined aa mean IMT (31.1 mm) and/or plaques assessed by B-mode ultrasound. Results: In the general population, 18.6% had carotid atherosclerosis and 67.9% had C. pneumoniae infection, whereas in hemodialysis patients
72nd EAS Congress