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P0571 IN-HOSPITAL MORTALITY IN PATIENTS WITH IMPAIRED FASTING GLUCOSE AND MYOCARDIAL INFARCTION
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 P0569 PREVALENCE OF METABOLIC SYNDROME IN A PORTUGUESE ACTIVE POPULATION. CAMPO MAIOR STUDY
Juan Manuel Urbano Galvez, Waildo Ribeiro Dos Passos, Maria Del Mar Barba Dominguez, Osvaldo Barbosa. Hypertension and Cardiovascular Risk Unit. Santa Luzia Hospital. Elvas. Portugal Background: The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. The Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) highlights the importance of treating patients with the metabolic syndrome to prevent cardiovascular disease. Limited information is available about the prevalence of the metabolic syndrome in Portugal. Objective: To estimate the prevalence of the metabolic syndrome by age and sex among worker adults in an East Portuguese rural area as defined by the ATP III. Methods: Metabolic syndrome-associated factors and prevalence, as defined by Adult Treatment Panel III criteria, were evaluated in a representative sample of 883 adult workers (477 men and 396 women) aged 18 to 77 years, participated in a cross-sectional study in Nabeiro’s Group Enterprises. The metabolic syndrome, defined by the ATP III, was defined as having three or more of the following abnormalities: waist circumference >102 cm in men and >88 cm in women, serum triglycerides ≥150 mg/dl (1.69 mmol/l), HDL cholesterol <40 mg/dl (1.04 mmol/l) in men and <50 mg/dl (1.29 mmol/l) in women, systolic blood pressure ≥130 mmHg and/or diastolic ≥85 mmHg or on treatment for hypertension, and fasting serum glucose ≥110 mg/dl (6.1 mmol/l) or on treatment for diabetes. Results: The metabolic syndrome was present in 24.0% of sample: 20.1% and 28.6% of men and women, respectively (P =0.003). The age prevalence was 18.5% among participants aged <50 years and 51.4% for aged ≥ 50 years (p= 0.000). The sex and age prevalence was similar for men (16.0%) and women (21.3%) in the group aged <50 years (p= 0.068). However, among aged ≥ 50 years, the prevalence was more accentuated in woman (73.7%) that men (37.4%) woman had higher prevalence that men, 73.7% and 37.4% respectively (p=0.000). Conclusions: These results from a representative sample of Portuguese adults show that the metabolic syndrome is highly prevalent. Identification and clinical management of this high-risk group is an important aspect of coronary heart disease prevention Keywords: Metabolic syndrome, epidemiology
P0570 PREVALENCE OF OVERWEIGHT AND OBESITY IN A PORTUGUESE ACTIVE POPULATION. CAMPO MAIOR STUDY
Juan Manuel Urbano Galvez, Waildo Ribeiro Dos Passos, Maria Del Mar Barba Dominguez, Osvaldo Barbosa. Hypertension and Cardiovascular Risk Unit, Santa Luzia Hospital, Elvas, Portugal Background: Overweight and obesity are leading public health concerns in the worldwide that are preventable conditions in the majority of cases. Overweight and obesity are associated with a number of serious and costly chronic medical conditions, including type 2 diabetes, cardiovascular disease, hypertension and certain cancers. The economic impact of overweight and obesity on the health care system is staggering. Objectives: The objectives of this study were to determine the prevalence of overweight and obesity in a provincial adult population of the east of Portugal (North Alentejo). Methodology: This survey was a cross sectional study in which a random sample of adults (n=883, age>18) were selected. For each individual a questionnaire was completed, in which height, weight, waist circumference and demographic characteristics were recorded. The overweight and obesity were defined by BMI=25-29.9 and BMI >30, respectively. The Obesity classes were defined: Obesity class 1, class 2 and class 3 if the BMI are between 30-34.9, 35-35.9 and >40 respectively. The abdominal obesity was defined for women and men by waist circumference >88cm and >102cm, respectively. Results: The prevalence of obesity and overweight were 19.0% (class 1: 14.9%, class 2: 3.2% and class 3: 0.9%) and 40.9%, respectively. In addition 34.3% of women and 46.4% of men were overweight; 21.3% of women and 17.2% of men were obese with the following distribution: for men 14.9% had Obesity class 1, 1.9% obesity class 2 and 0.4% had obesity class 3. In women 15.1% had obesity class 1, 4.7% had obesity class 2 and 1.5% had obesity class 3. The waist circumference was >88cm in 38.7% of women and >102cm in 20.5% of men.
S189
Discussion: In The North Alentejo (Portugal), overweight and obesity levels are a very important health problem. It is necessary to analyze in further depth the factors involved in the genesis of obesity and to institutionalize community health programmes for its prevention, monitoring and treatment. Keywords: obesity, epidemiology.
P0571 IN-HOSPITAL MORTALITY IN PATIENTS WITH IMPAIRED FASTING GLUCOSE AND MYOCARDIAL INFARCTION
Mehmet Uçucu, Fatma Alıbaz Öner, Selen Yurdakul, Mecdı Ergüney. Istanbul Education and Research Hospital Objectives: Diabetes mellitus is considered to be equivalent to coronary artery disease. In addition, both IGT and IFG are risk factors for the development of diabetes and cardiovascular disease. In this study, we aimed to compare the mortality during hospitalization between IFG and diabetes in patients with myocardial infarction Materials and methods: The study consisted patients under 65 years of age, who had been diagnosed as acute myocardial infarction.After hospitalization the patients were divided into three groups as the first group having diabetes, the second group non-diabetic patients and the patients with impaired fasting glucose. These patients were evaluated for mortality during the hospitalization period of averagely 7 days, which is the acute phase of myocardial infarction. 10.0 statistical package software SPSS for Windows was used to evaluate the data. Results: A total of 375 patients were enrolled, which contains 66 women (17.6%) and 309 (72.4%) male of <65 years-old who were hospitalized with a diagnosis of MI. Of these patients, 72 (19.2%) had been previously diagnosed with diabetes, 17 (4.53%) had a diagnosis of new-onset diabetes, 56 (14.93%) showed impaired fasting glucose, 230 (61.33%) showed normal fasting glucose.During the hospitalization period, mortality rate of the patients who had an MI was found to be 6.7% in patients with diabetes, 2.6% in patients without diabetes and 7.0% in patients with an impaired fasting glucose. Therefore, mortality was substantially increased in diabetic patients compared to those without diabetes, during the acute phase of MI (first 7 days). However, no statistically significant difference was found between the mortality observed during the acute phase of MI of the patients with impaired fasting glucose and of the patients with diabetes (p = 0.192). During the early period after AMI, mortality rate of the patients with IFG and the patients with diabetes were approximately same and this rate was significantly higher than those with normal blood glucose; therefore, IFG, like diabetes, is a risk factor for CHD and it is as efficient as diabetes on mortality. These data support the fact that the hyperinsulinemia seen during the stage of impaired fasting glucose which is the period before the appearance of clear diabetes, facilitates atherosclerosis and leads to endothelial dysfunction. During the early period after AMI (period of hospitalization), the fact that mortality rate of the patients with IFG and the patients with diabetes were approximately same and that this rate was significantly higher than those with normal blood glucose is an important conclusion. Even in IFG period which is the earliest stage of the diabetes, knowing that atherosclerosis process has started and that it forms a cardiovascular risk, will be a beneficial approach in the early determination of the patients with IFG, in determining the cardiovascular risks and in the modification of the therapy. In individuals with a risk for diabetes (e.g., obesity, familial diabetes history, history of delivering a macrosomic infant, etc.), prevention or delay of diabetes development with therapeutical approaches recommended in patients with IGT confirmed by OGTT when requested, and determination of IFG, if available, by determining fasting blood glucose, seem to be beneficial in patients with, in terms of reducing the risk of CHD. Key words: IFG, diabetes, mortality
P0572 CLASSIFICATION OF THE DIABETIC ULCER AND CORRELATION OF ITS SEVERITY WITH HBA1C
Grigorios Daligkaros, Charalambos Demertzidis, Petros Kiryttopoulos. General Hospital of Veria Introduction: The diabetic ulcers of the legs are very common, as a result of neuropathy, peripheral microangiopathy and local inflammation due to diabetes. Approximately 15% of individuals with diabetes mellitus will be affected with foot ulceration at least once in their lifetime, while 59% of them will require hospitalization, which may lead to lower-extremity amputation.
Juan Manuel Urbano Galvez, Waildo Ribeiro Dos Passos, Maria Del Mar Barba Dominguez, Osvaldo Barbosa. Hypertension and Cardiovascular Risk Unit. Santa Luzia Hospital. Elvas. Portugal Background: The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. The Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) highlights the importance of treating patients with the metabolic syndrome to prevent cardiovascular disease. Limited information is available about the prevalence of the metabolic syndrome in Portugal. Objective: To estimate the prevalence of the metabolic syndrome by age and sex among worker adults in an East Portuguese rural area as defined by the ATP III. Methods: Metabolic syndrome-associated factors and prevalence, as defined by Adult Treatment Panel III criteria, were evaluated in a representative sample of 883 adult workers (477 men and 396 women) aged 18 to 77 years, participated in a cross-sectional study in Nabeiro’s Group Enterprises. The metabolic syndrome, defined by the ATP III, was defined as having three or more of the following abnormalities: waist circumference >102 cm in men and >88 cm in women, serum triglycerides ≥150 mg/dl (1.69 mmol/l), HDL cholesterol <40 mg/dl (1.04 mmol/l) in men and <50 mg/dl (1.29 mmol/l) in women, systolic blood pressure ≥130 mmHg and/or diastolic ≥85 mmHg or on treatment for hypertension, and fasting serum glucose ≥110 mg/dl (6.1 mmol/l) or on treatment for diabetes. Results: The metabolic syndrome was present in 24.0% of sample: 20.1% and 28.6% of men and women, respectively (P =0.003). The age prevalence was 18.5% among participants aged <50 years and 51.4% for aged ≥ 50 years (p= 0.000). The sex and age prevalence was similar for men (16.0%) and women (21.3%) in the group aged <50 years (p= 0.068). However, among aged ≥ 50 years, the prevalence was more accentuated in woman (73.7%) that men (37.4%) woman had higher prevalence that men, 73.7% and 37.4% respectively (p=0.000). Conclusions: These results from a representative sample of Portuguese adults show that the metabolic syndrome is highly prevalent. Identification and clinical management of this high-risk group is an important aspect of coronary heart disease prevention Keywords: Metabolic syndrome, epidemiology
P0570 PREVALENCE OF OVERWEIGHT AND OBESITY IN A PORTUGUESE ACTIVE POPULATION. CAMPO MAIOR STUDY
Juan Manuel Urbano Galvez, Waildo Ribeiro Dos Passos, Maria Del Mar Barba Dominguez, Osvaldo Barbosa. Hypertension and Cardiovascular Risk Unit, Santa Luzia Hospital, Elvas, Portugal Background: Overweight and obesity are leading public health concerns in the worldwide that are preventable conditions in the majority of cases. Overweight and obesity are associated with a number of serious and costly chronic medical conditions, including type 2 diabetes, cardiovascular disease, hypertension and certain cancers. The economic impact of overweight and obesity on the health care system is staggering. Objectives: The objectives of this study were to determine the prevalence of overweight and obesity in a provincial adult population of the east of Portugal (North Alentejo). Methodology: This survey was a cross sectional study in which a random sample of adults (n=883, age>18) were selected. For each individual a questionnaire was completed, in which height, weight, waist circumference and demographic characteristics were recorded. The overweight and obesity were defined by BMI=25-29.9 and BMI >30, respectively. The Obesity classes were defined: Obesity class 1, class 2 and class 3 if the BMI are between 30-34.9, 35-35.9 and >40 respectively. The abdominal obesity was defined for women and men by waist circumference >88cm and >102cm, respectively. Results: The prevalence of obesity and overweight were 19.0% (class 1: 14.9%, class 2: 3.2% and class 3: 0.9%) and 40.9%, respectively. In addition 34.3% of women and 46.4% of men were overweight; 21.3% of women and 17.2% of men were obese with the following distribution: for men 14.9% had Obesity class 1, 1.9% obesity class 2 and 0.4% had obesity class 3. In women 15.1% had obesity class 1, 4.7% had obesity class 2 and 1.5% had obesity class 3. The waist circumference was >88cm in 38.7% of women and >102cm in 20.5% of men.
S189
Discussion: In The North Alentejo (Portugal), overweight and obesity levels are a very important health problem. It is necessary to analyze in further depth the factors involved in the genesis of obesity and to institutionalize community health programmes for its prevention, monitoring and treatment. Keywords: obesity, epidemiology.
P0571 IN-HOSPITAL MORTALITY IN PATIENTS WITH IMPAIRED FASTING GLUCOSE AND MYOCARDIAL INFARCTION
Mehmet Uçucu, Fatma Alıbaz Öner, Selen Yurdakul, Mecdı Ergüney. Istanbul Education and Research Hospital Objectives: Diabetes mellitus is considered to be equivalent to coronary artery disease. In addition, both IGT and IFG are risk factors for the development of diabetes and cardiovascular disease. In this study, we aimed to compare the mortality during hospitalization between IFG and diabetes in patients with myocardial infarction Materials and methods: The study consisted patients under 65 years of age, who had been diagnosed as acute myocardial infarction.After hospitalization the patients were divided into three groups as the first group having diabetes, the second group non-diabetic patients and the patients with impaired fasting glucose. These patients were evaluated for mortality during the hospitalization period of averagely 7 days, which is the acute phase of myocardial infarction. 10.0 statistical package software SPSS for Windows was used to evaluate the data. Results: A total of 375 patients were enrolled, which contains 66 women (17.6%) and 309 (72.4%) male of <65 years-old who were hospitalized with a diagnosis of MI. Of these patients, 72 (19.2%) had been previously diagnosed with diabetes, 17 (4.53%) had a diagnosis of new-onset diabetes, 56 (14.93%) showed impaired fasting glucose, 230 (61.33%) showed normal fasting glucose.During the hospitalization period, mortality rate of the patients who had an MI was found to be 6.7% in patients with diabetes, 2.6% in patients without diabetes and 7.0% in patients with an impaired fasting glucose. Therefore, mortality was substantially increased in diabetic patients compared to those without diabetes, during the acute phase of MI (first 7 days). However, no statistically significant difference was found between the mortality observed during the acute phase of MI of the patients with impaired fasting glucose and of the patients with diabetes (p = 0.192). During the early period after AMI, mortality rate of the patients with IFG and the patients with diabetes were approximately same and this rate was significantly higher than those with normal blood glucose; therefore, IFG, like diabetes, is a risk factor for CHD and it is as efficient as diabetes on mortality. These data support the fact that the hyperinsulinemia seen during the stage of impaired fasting glucose which is the period before the appearance of clear diabetes, facilitates atherosclerosis and leads to endothelial dysfunction. During the early period after AMI (period of hospitalization), the fact that mortality rate of the patients with IFG and the patients with diabetes were approximately same and that this rate was significantly higher than those with normal blood glucose is an important conclusion. Even in IFG period which is the earliest stage of the diabetes, knowing that atherosclerosis process has started and that it forms a cardiovascular risk, will be a beneficial approach in the early determination of the patients with IFG, in determining the cardiovascular risks and in the modification of the therapy. In individuals with a risk for diabetes (e.g., obesity, familial diabetes history, history of delivering a macrosomic infant, etc.), prevention or delay of diabetes development with therapeutical approaches recommended in patients with IGT confirmed by OGTT when requested, and determination of IFG, if available, by determining fasting blood glucose, seem to be beneficial in patients with, in terms of reducing the risk of CHD. Key words: IFG, diabetes, mortality
P0572 CLASSIFICATION OF THE DIABETIC ULCER AND CORRELATION OF ITS SEVERITY WITH HBA1C
Grigorios Daligkaros, Charalambos Demertzidis, Petros Kiryttopoulos. General Hospital of Veria Introduction: The diabetic ulcers of the legs are very common, as a result of neuropathy, peripheral microangiopathy and local inflammation due to diabetes. Approximately 15% of individuals with diabetes mellitus will be affected with foot ulceration at least once in their lifetime, while 59% of them will require hospitalization, which may lead to lower-extremity amputation.