- Email: [email protected]
Muscle wasting following treadmill training of patients with intermittent claudication
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Abstracts / Atherosclerosis 235 (2014) e192–e301
(UGT1A1). Mild deficiency of UGT1A1 known as Gilbert syndrome (GS) has been associated with a lower risk of ischemic heart disease (IHD). The aim of the present study was to assess the prevalence of GS and UGT1A1*28 status in the Czech population, and their possible relationship to incident IHD. Methods: The study was performed in 717 individuals (median age¼48.5 years) recruited from the Czech post-MONICA study in 2000-2001 (M¼442, F¼275); 669 individuals attended a re-examination 6 years later. Routine laboratory tests were performed in all subjects in 2000-2001; dinucleotide (TA)n variants of UGT1A1 promoter were determined by fragment analysis. Standard statistical analyses were used to compare variables and to assess factors affecting bilirubin levels as well as IHD manifestation. Results: The median of serum bilirubin concentration in the Czech population was 9.8 umol/L [IQ range: 8-12.4 umol/L] with higher levels in men compared to women (10.7 [8.7-13.6] vs. 8.8 [7.2-10.7] umol/L, p<10-6 for males and females, respectively). The prevalence of GS (defined as serum bilirubin >17.1 umol/L) was 6.7%, UGT1A1*28 allele homozygosity was found in 13.8%, and UGT1A1*28 allele frequency was 59.4%. Serum bilirubin levels were dependent on sex, UGT1A1 genotype, and smoking (p<10-6 for all variables). Over the 6-year follow-up period, 37 (5.5%) individuals reported to have developed IHD. The major predictors of incident IHD were age (OR 1.09; 95%CI 1.05-1.13), and sex (OR for female gender 0.47; 95%CI 0.17-0.97), with serum bilirubin also contributing negatively, but to a lesser extent (OR 0.93; 95%CI 0.84-1.03). Conclusion: The prevalence of GS and frequency of GS genotypes were determined in a representative Czech population sample. In addition, serum bilirubin levels were found to have a potential for predicting incident IHD. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0334. MUSCLE WASTING FOLLOWING TREADMILL TRAINING OF PATIENTS WITH INTERMITTENT CLAUDICATION S. Vuna, C.L. Delaneya, M.D. Millerb, J.I. Sparka a Vascular Surgery, Flinders University, Adelaide, Australia; Dietetics, Flinders University, Adelaide, Australia
b
Nutrition and
Objectives: A treadmill-based supervised exercise program (SEP) is recommended first-line therapy for patients suffering intermittent claudication (IC). Despite this, little is known about the exact mechanisms behind improved walking and recurrent periods of ischemia-reperfusion (IR) may lead to atrophy of symptomatic muscle. The aim of this study was to assess the effect of SEP on lower limb skeletal muscle mass (SMM) and levels of apoptosis in symptomatic muscle. Methods: 22 patients with IC due to infra-inguinal occlusive disease underwent whole body dual energy x-ray absorptiometry (DXA) to assess lower limb SMM pre- and post- completion of a standard 12-week SEP. A sub-sample of 11 patients also underwent pre- and post-SEP core biopsy from the symptomatic calf and ipsilateral thigh to assess apoptosis using terminal deoxynucleotidyl transferase dUTP nick-end-label (TUNEL) staining. Walking performance was assessed using land-based pain-free walking distance (PFWD). Results: 22 patients (mean (SD) age: 72(10.4) years, male: 16/22 smokers: 20/22, diabetic: 6/22) with IC completed 12 weeks of SEP. In the asymptomatic lower limbs, there was no significant change in SMM of the thigh (mean difference (SD): -23.15g (187.8g), p¼0.66) or calf (-11.85g (144.9g), p¼0.77). In contrast, on the symptomatic lower limbs, SMM decreased significantly in the thigh (-106.2g (255.6g), p¼0.02) but not in the calf (-5.1g (96g), p¼0.77). TUNEL counts trended to increase in the thigh (p¼0.20) but not the calf (p¼0.84). PFWD improved significantly (60m (84), p¼0.004). Conclusion: These results suggest significant proximal muscle atrophy may result from treadmill based SEP in symptomatic legs of patients with IC. Given the importance of proximal SMM in functional mobility other than
walking, long-term outcomes from this study and future trials are required to investigate whether this is an adaptive response to treadmill training, indicates a deleterious effect of repetitive IR or if there is some other responsible mechanism. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-1068. DETERMINATION OF THE ATHEROGENIC PROFILE IMPROVES PATIENT STRATIFICATION A.R. Manaçasa, S. Jamala, A.C. Alvesa, Q. Ratob, M. Bourbona a Unidade de I&D Grupo de Investigação Cardiovascular Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge AND Center for Biodiversity Functional & Integrative Genomics (BioFIG) Faculdade de Ciências Universidade de Lisboa Lisboa Portugal, Lisboa, Portugal; b Serviço de Cardiologia, Hospital de São Bernardo Setúbal Portugal, Setúbal, Portugal
Objectives: Small dense low-density lipoprotein (sdLDL) particles contribute to an increased atherogenesis and cardiovascular (CV) risk. The atherogenic profile can be classified as pattern A, non atherogenic, or pattern Non-A, atherogenic, mainly due to a low or high concentration of sdLDL particles. The main aim of this study was to analyze the atherogenic profile of subjects from a population sample. Methods: A total of 431 participants recruited for e_COR study (without treatment for dyslipidaemia) were analysed. Atherogenic profile categories were attributed using the Lipoprint, QUANTIMETRIX System. All lipid concentrations were determined by direct enzymatic/colorimetric (Cobas INTEGRA, Roche). Statistical analysis was performed using the SPSS version 19.0. Results: The sample was divided in 3 groups: G1-low risk (all 7 lipid parameters within the recommend values in ESC/EAS guidelines); G2-high risk, with at least one lipid value increased/decreased (TC>240mg/dl, LDLc>145mg/dl, HDL<40 or 45 mg/dl, TG>200mg/dl, ApoB>120mg/dl, ApoA1<140mg/dl, Lp(a)>50mg/dl); G3-intermediate risk, participants with border line lipid values. From 431 subjects analysed only 15.3% were in G1, 62.2% were in G2 and 22.5% in G3. All subject in G1, except 1, presented pattern A profile. In G2 and in G3, 24% (64) and 15.5% (15) had pattern nonA. The atherogenic profile in G2 was observed mainly in patients with high LDL (50%), ApoB (50%) and low ApoA1 (42%). In G2 the lipid parameter that showed a more significant difference between A and nonA profile was ApoB (13.2%vs 50%). Conclusion: Only a very low percentage of the population presented all lipid values within the recommended values and a large percentage had at least one lipid CV risk factor. However the atherogenic profile in high and intermediate groups risk did not differ greatly showing that the determination of the atherogenic profile identifies high risk patients that could most benefit from lipid lowering therapy, improving this way patient stratification. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0817. CARDIOVASCULAR RISK FACTORS IN A YOUNG ADULT POPULATION J. Canilhoa, A.C. Alvesa, Q. Ratob, M. Bourbona a Unidade de I&D Grupo de Investigação Cardiovascular Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge AND Center for Biodiversity Functional & Integrative Genomics (BioFIG) Faculdade de Ciências Universidade de Lisboa Lisboa Portugal, Lisboa, Portugal; b Serviço de Cardiologia, Hospital de São Bernardo Setúbal Portugal, Setúbal, Portugal
Objectives: The early identification and control of risk factors is a crucial measure to be able to act appropriately and reduce the risk of
Abstracts / Atherosclerosis 235 (2014) e192–e301
(UGT1A1). Mild deficiency of UGT1A1 known as Gilbert syndrome (GS) has been associated with a lower risk of ischemic heart disease (IHD). The aim of the present study was to assess the prevalence of GS and UGT1A1*28 status in the Czech population, and their possible relationship to incident IHD. Methods: The study was performed in 717 individuals (median age¼48.5 years) recruited from the Czech post-MONICA study in 2000-2001 (M¼442, F¼275); 669 individuals attended a re-examination 6 years later. Routine laboratory tests were performed in all subjects in 2000-2001; dinucleotide (TA)n variants of UGT1A1 promoter were determined by fragment analysis. Standard statistical analyses were used to compare variables and to assess factors affecting bilirubin levels as well as IHD manifestation. Results: The median of serum bilirubin concentration in the Czech population was 9.8 umol/L [IQ range: 8-12.4 umol/L] with higher levels in men compared to women (10.7 [8.7-13.6] vs. 8.8 [7.2-10.7] umol/L, p<10-6 for males and females, respectively). The prevalence of GS (defined as serum bilirubin >17.1 umol/L) was 6.7%, UGT1A1*28 allele homozygosity was found in 13.8%, and UGT1A1*28 allele frequency was 59.4%. Serum bilirubin levels were dependent on sex, UGT1A1 genotype, and smoking (p<10-6 for all variables). Over the 6-year follow-up period, 37 (5.5%) individuals reported to have developed IHD. The major predictors of incident IHD were age (OR 1.09; 95%CI 1.05-1.13), and sex (OR for female gender 0.47; 95%CI 0.17-0.97), with serum bilirubin also contributing negatively, but to a lesser extent (OR 0.93; 95%CI 0.84-1.03). Conclusion: The prevalence of GS and frequency of GS genotypes were determined in a representative Czech population sample. In addition, serum bilirubin levels were found to have a potential for predicting incident IHD. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0334. MUSCLE WASTING FOLLOWING TREADMILL TRAINING OF PATIENTS WITH INTERMITTENT CLAUDICATION S. Vuna, C.L. Delaneya, M.D. Millerb, J.I. Sparka a Vascular Surgery, Flinders University, Adelaide, Australia; Dietetics, Flinders University, Adelaide, Australia
b
Nutrition and
Objectives: A treadmill-based supervised exercise program (SEP) is recommended first-line therapy for patients suffering intermittent claudication (IC). Despite this, little is known about the exact mechanisms behind improved walking and recurrent periods of ischemia-reperfusion (IR) may lead to atrophy of symptomatic muscle. The aim of this study was to assess the effect of SEP on lower limb skeletal muscle mass (SMM) and levels of apoptosis in symptomatic muscle. Methods: 22 patients with IC due to infra-inguinal occlusive disease underwent whole body dual energy x-ray absorptiometry (DXA) to assess lower limb SMM pre- and post- completion of a standard 12-week SEP. A sub-sample of 11 patients also underwent pre- and post-SEP core biopsy from the symptomatic calf and ipsilateral thigh to assess apoptosis using terminal deoxynucleotidyl transferase dUTP nick-end-label (TUNEL) staining. Walking performance was assessed using land-based pain-free walking distance (PFWD). Results: 22 patients (mean (SD) age: 72(10.4) years, male: 16/22 smokers: 20/22, diabetic: 6/22) with IC completed 12 weeks of SEP. In the asymptomatic lower limbs, there was no significant change in SMM of the thigh (mean difference (SD): -23.15g (187.8g), p¼0.66) or calf (-11.85g (144.9g), p¼0.77). In contrast, on the symptomatic lower limbs, SMM decreased significantly in the thigh (-106.2g (255.6g), p¼0.02) but not in the calf (-5.1g (96g), p¼0.77). TUNEL counts trended to increase in the thigh (p¼0.20) but not the calf (p¼0.84). PFWD improved significantly (60m (84), p¼0.004). Conclusion: These results suggest significant proximal muscle atrophy may result from treadmill based SEP in symptomatic legs of patients with IC. Given the importance of proximal SMM in functional mobility other than
walking, long-term outcomes from this study and future trials are required to investigate whether this is an adaptive response to treadmill training, indicates a deleterious effect of repetitive IR or if there is some other responsible mechanism. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-1068. DETERMINATION OF THE ATHEROGENIC PROFILE IMPROVES PATIENT STRATIFICATION A.R. Manaçasa, S. Jamala, A.C. Alvesa, Q. Ratob, M. Bourbona a Unidade de I&D Grupo de Investigação Cardiovascular Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge AND Center for Biodiversity Functional & Integrative Genomics (BioFIG) Faculdade de Ciências Universidade de Lisboa Lisboa Portugal, Lisboa, Portugal; b Serviço de Cardiologia, Hospital de São Bernardo Setúbal Portugal, Setúbal, Portugal
Objectives: Small dense low-density lipoprotein (sdLDL) particles contribute to an increased atherogenesis and cardiovascular (CV) risk. The atherogenic profile can be classified as pattern A, non atherogenic, or pattern Non-A, atherogenic, mainly due to a low or high concentration of sdLDL particles. The main aim of this study was to analyze the atherogenic profile of subjects from a population sample. Methods: A total of 431 participants recruited for e_COR study (without treatment for dyslipidaemia) were analysed. Atherogenic profile categories were attributed using the Lipoprint, QUANTIMETRIX System. All lipid concentrations were determined by direct enzymatic/colorimetric (Cobas INTEGRA, Roche). Statistical analysis was performed using the SPSS version 19.0. Results: The sample was divided in 3 groups: G1-low risk (all 7 lipid parameters within the recommend values in ESC/EAS guidelines); G2-high risk, with at least one lipid value increased/decreased (TC>240mg/dl, LDLc>145mg/dl, HDL<40 or 45 mg/dl, TG>200mg/dl, ApoB>120mg/dl, ApoA1<140mg/dl, Lp(a)>50mg/dl); G3-intermediate risk, participants with border line lipid values. From 431 subjects analysed only 15.3% were in G1, 62.2% were in G2 and 22.5% in G3. All subject in G1, except 1, presented pattern A profile. In G2 and in G3, 24% (64) and 15.5% (15) had pattern nonA. The atherogenic profile in G2 was observed mainly in patients with high LDL (50%), ApoB (50%) and low ApoA1 (42%). In G2 the lipid parameter that showed a more significant difference between A and nonA profile was ApoB (13.2%vs 50%). Conclusion: Only a very low percentage of the population presented all lipid values within the recommended values and a large percentage had at least one lipid CV risk factor. However the atherogenic profile in high and intermediate groups risk did not differ greatly showing that the determination of the atherogenic profile identifies high risk patients that could most benefit from lipid lowering therapy, improving this way patient stratification. 71 - Risk factors, epidemiology, prevention and treatment of cardiovascular diseases: Miscellaneous EAS-0817. CARDIOVASCULAR RISK FACTORS IN A YOUNG ADULT POPULATION J. Canilhoa, A.C. Alvesa, Q. Ratob, M. Bourbona a Unidade de I&D Grupo de Investigação Cardiovascular Departamento de Promoção da Saúde e Prevenção de Doenças Não Transmissíveis, Instituto Nacional de Saúde Dr. Ricardo Jorge AND Center for Biodiversity Functional & Integrative Genomics (BioFIG) Faculdade de Ciências Universidade de Lisboa Lisboa Portugal, Lisboa, Portugal; b Serviço de Cardiologia, Hospital de São Bernardo Setúbal Portugal, Setúbal, Portugal
Objectives: The early identification and control of risk factors is a crucial measure to be able to act appropriately and reduce the risk of