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P150 HIGH LIPOPROTEIN(a) LEVEL IS ASSOCIATED WITH POOR LONG-TERM PROGNOSIS AFTER CORONARY ARTERY BYPASS GRAFTING
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Atherosclerosis Supplements 11, no. 2 (2010) 17–108
Conclusion: Our results show that insulin resistance and have a significant impact on the EPC in obesity. Decreased number of EPC should be analyzed as an important factor in the complex pathogenesis of endothelium dysfunction observed in obesity. This work was supported by grant no. NN 402 253934 (2008–2010) from the Polish Ministry of Science and Higher Education P150 HIGH LIPOPROTEIN(a) LEVEL IS ASSOCIATED WITH POOR LONG-TERM PROGNOSIS AFTER CORONARY ARTERY BYPASS GRAFTING M. Ezhov1 , O. Afanasieva2 , A. Lyakishev1 , M. Afanasieva2 , R. Akchurin3 , S. Pokrovsky2 . 1 Problems of Atherosclerosis, 2 Laboratory of Problems of Atherosclerosis, 3 Cardiology Research Center, Moscow, Russia The aim of the present prospective study is to evaluate whether lipoprotein(a) [Lp(a)] concentration is a predictor of long-term adverse outcomes in patients after coronary artery bypass grafting (CABG). Methods: We followed 263 patients with coronary heart disease (233 men, 30 women, mean age 55±9 years) for a mean time 69±44 months who underwent the operation of coronary artery bypass grafting. Before the surgery blood samples were collected and lipid profile and Lp(a) concentrations were measured in all patients. The main end-points were cardiac death and nonfatal myocardial infarction, hospitalization for recurrent angina and repeat coronary revascularization. Results: Total number of coronary outcomes was 122, including death − 20 (16%), myocardial infarction − 14 (11%), percutaneous coronary interventions − 29 (24%), re-CABG − 6 (5%) and recurrent angina − 53 (43%). The incidence of death was 11.3% (11 of 93) in patients with Lp(a) 30 mg/dL and 5.2% (9 of 170) in those with Lp(a) < 30 mg/dL. Lp(a) level was an independent predictor of combined end-point (hazard ratio 3.24; 95% confidence interval 2.18–4.83, p < 0.001), cardiac death (2.89; 1.31–6.35, p < 0.01) and cardiac death plus nonfatal myocardial infarction (2.95; 1.50–5.79, p < 0.001). Other independent predictors of main outcomes were diabetes mellitus (2.89; 1.69– 4.92, p < 0.001) and triglycerides levels (1.16; 1.02–1.32, p < 0.05). Use of statins was associated with decreased risk of cardiac death: 0.33; 0.15–0.76, p < 0.01. Conclusion: Elevated levels of Lp(a) is a predictor of late coronary events including death and nonfatal myocardial infarction after CABG. P151 ASSOCIATION OF ELEVATED LIPOPROTEIN(a) LEVEL WITH PREMATURE CORONARY HEART DISEASE IN MEN AND WOMEN M. Safarova, M. Ezhov, O. Afanasieva, A. Lyakishev, S. Pokrovsky. Cardiology Research Center, Moscow, Russia Objective: To assess the relationship of lipoprotein(a) [Lp(a)] concentration with clinical manifestation of coronary heart disease (CHD) in younger age. Methods: In this cross-sectional study we recruited 1483 patients (85% male) with CHD verified by angiography. In accordance with the level of Lp(a), patients were divided into 2 main groups: I (n = 599) 30 mg/dL, and II (n = 884) <30 mg/dL. The following risk factors were recorded: hypertension, smoking, diabetes mellitus, obesity, and family history of CHD. Lipid profile, Lp(a), hsCRP concentrations were measured in all patients. Results: Among 496 men (mean age 53.7±9.5 years) from Group I, age of CHD manifestation was 49.8±8.8 years vs. 51.0±9.0 years in 767 men from Group II (mean age 54.6±9.2 years), p < 0.05. In women from Group I (n = 103, mean age 56.8±8.4 years) age of CHD onset, was 53.1±8.3 years vs. 55.8±10.0 years in Group II, p < 0.05. There was no significant difference in the classic risk factors, hsCRP and fibrinogen levels between the groups. The incidence of CHD in men younger than 45 years was 36% in Group I and 28% in Group II, p < 0.01. The incidence of CHD in women before 55 years was 66% in Group I and 47% in parallel group, p < 0.01. Conclusion: Our data suggest that elevated Lp(a) is independently associated with the development of early CHD in men as well as in women. P152 AORTIC BIFURCATION ANGLE AS AN INDEPENDENT RISK FACTOR FOR AORTOILIAC OCCLUSIVE DISEASE A. Shakeri Bavil1 , R.S. Tubbs2 , M.M. Shoja1 , H. Nosratinia1 , W.J. Oakes3 , M. Nemati1 . 1 Tabriz University of Medical Sciences, Tabriz, Iran, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 St George’s University, West Indies, Grenada Introduction: Recently, there has been interest in potential geometric risk factors that might result in or exaggerate atherosclerosis. The aortic bifurcation is a complex anatomical area dividing the high pressure blood of the descending abdominal aorta into the lower limbs and pelvis. The distribution of the bifurcation angle and any asymmetry, its relation with age and its possible contribution to the risk of aortoiliac atherosclerosis are presented here. Materials and Methods: Statistical analysis was performed by SPSS version 11.0 using, Fisher‘s exact test, the Pearson and Spearman correlation tests and logistic regression analysis. The p value was set at 0.05.
Poster Presentations
Results: No correlations were found between age, bifurcation angle and angle asymmetry in the Pearson test (p > 0.05). Logistic regression analysis revealed that the bifurcation angle, but not its asymmetry, gender or age, was a significant and independent risk factor for aortoiliac atherosclerosis (model r2 = 0.662, p = 0.027). With additional study these results may have implications regarding risk factors for aortoiliac atherosclerosis. Conclusion: To our knowledge, this study is the first of its kind to indicate the potential of such an important geometric risk factor for atherosclerosis at the aortic bifurcation. P153 PREVALENCE OF THE CLASSICAL CARDIOVASCULAR RISK FACTORS IN ROMA MINORITY POPULATION OF CROATIA ˇ H.M. Zeljko1 , T. Skari´ c-Juric2 , N. Smolej Narancic2 , M. Pericic Salihovic2 , I. Martinovic Klaric2 , J. Milicic2 , M. Barbalic2 , M. Zajc2 , L. Barac Lauc2 , B. Janicijevic2 . 1 Internal Medicine, GH ‘Sv. Duh’, University of Zagreb, 2 Institute for Anthropological Research, Zagreb, Croatia Purpose: Roma are an ethnic minority of northern Indian origin. They are well known for preserved traditions and resistance to assimilation and therefore usually marginalized economically, spatially, politically and in terms of culture. Since the current knowledge about the prevention of cardiovascular diseases in Roma population is scarce, the objective of the study is to assess the prevalence of cardiovascular diseases’ risk factors. Methods: A multidisciplinary community-based study was carried out in rural areas of two regions of Croatia − Baranja and Medimurje. The sample encompassed a total of 423 randomly selected members (144 men and 279 women) of the Bayash Roma minority population aged 18−84 (41.1±15.2). The population prevalence of hypertension was assessed as SBP 140 or DBP 90 mmHg or taking antihypertensive therapy. Overweight was assessed BMI 25 (kg/m2 ). Smoking status was assessed within the course of the interview held by experienced medical staff. Blood pressure measurements and short anthropometrics were carried out using standard protocols. The lipid status and fasting glucose was determined from blood samples and standard cut-offs were used. Conclusions: Although the overall prevalence of hypertension in Roma was almost half the magnitude usually reported for general population of Croatia, the presented results have shown that this population bears a high CVD risk factors load. It is related to smoking, obesity, and high glucose and lipids levels. We expect that, along with westernization of their life-style and increase of their economic power, the proportion of CVD will also increase. P154 PREDICTION OFR THE POPULATION AT RISK OF ATHEROTHROMBOTIC DISEASE IS INDEPENDENT OF BLOOD SUGAR LEVEL W. Feeman Jr. The Bowling Green Study, Bowling Green, OH, USA Introduction: Diabetes is considered to be a “CHD equivalent”. However the risk of atherothrombotic disease (ATD) is not equal for all diabetics and milder elevations of blood sugar are not in and of themselves causal for ATD. It is important to define the ATD risk, if any, in patients with blood sugar level elevations. Objective: The purpose of this submission is to show that the prediction of the population at risk of ATD is essentially independent of blood sugar level. Materials and Methods: The Bowling Green Study (BGS) has developed a multi-factorial risk factor graph for the prediction of the population at risk of ATD, utilizing the Cholesterol Retention Fraction (CRF, or [LDL-HDL]/LDL) on the ordinant and Systolic Blood Pressure (SBP) on the ordinant. A threshold line can be delineated separating the mainstream of ATD patients from a few outliers. The line coordinants of the CRF-SBP plots are (0.74,100) and (0.59,140). Results: 85% of all ATD patients in the author’s database have CRF-SBP plots abaove the threshold line. Those ATD patients with CRF-SBP plots below the threshold line are mainly cigarette smokers, leaving only 6% of the ATD population that can not be predicted by CRF-SBP plot position above the threshold line and/or cigarette smoking status. These findings are independent of blood sugar level. Conclusions: The population at risk of ATD cam be accurately predicted independently of blood sugar level. P155 EFFECTS OF RAMADAN FASTING ON CARDIOVASCULAR RISK FACTORS A. Norouzy, M. Nematy, M. Alinezhad-Namaghi, M. Shakhskalaee, M. Mozhdehifard, S. Sajjadi, M. Sabery. Dept. of Biochemisrty&Nutrition, Mashad Medical School, Mashad, Iran Introduction: Ramadan is a month for Muslims during which they abstain from eating, drinking and smoking from dawn to sunset. The recommendations regarding the safety of fasting for patients with a previous cardio/cerebrovascular event have been based on expert opinion rather than evidence based medicine and sometimes controversial. In the present study, the effect of Ramadan fasting on some cardiovascular risk factors has been investigated.
Atherosclerosis Supplements 11, no. 2 (2010) 17–108
Conclusion: Our results show that insulin resistance and have a significant impact on the EPC in obesity. Decreased number of EPC should be analyzed as an important factor in the complex pathogenesis of endothelium dysfunction observed in obesity. This work was supported by grant no. NN 402 253934 (2008–2010) from the Polish Ministry of Science and Higher Education P150 HIGH LIPOPROTEIN(a) LEVEL IS ASSOCIATED WITH POOR LONG-TERM PROGNOSIS AFTER CORONARY ARTERY BYPASS GRAFTING M. Ezhov1 , O. Afanasieva2 , A. Lyakishev1 , M. Afanasieva2 , R. Akchurin3 , S. Pokrovsky2 . 1 Problems of Atherosclerosis, 2 Laboratory of Problems of Atherosclerosis, 3 Cardiology Research Center, Moscow, Russia The aim of the present prospective study is to evaluate whether lipoprotein(a) [Lp(a)] concentration is a predictor of long-term adverse outcomes in patients after coronary artery bypass grafting (CABG). Methods: We followed 263 patients with coronary heart disease (233 men, 30 women, mean age 55±9 years) for a mean time 69±44 months who underwent the operation of coronary artery bypass grafting. Before the surgery blood samples were collected and lipid profile and Lp(a) concentrations were measured in all patients. The main end-points were cardiac death and nonfatal myocardial infarction, hospitalization for recurrent angina and repeat coronary revascularization. Results: Total number of coronary outcomes was 122, including death − 20 (16%), myocardial infarction − 14 (11%), percutaneous coronary interventions − 29 (24%), re-CABG − 6 (5%) and recurrent angina − 53 (43%). The incidence of death was 11.3% (11 of 93) in patients with Lp(a) 30 mg/dL and 5.2% (9 of 170) in those with Lp(a) < 30 mg/dL. Lp(a) level was an independent predictor of combined end-point (hazard ratio 3.24; 95% confidence interval 2.18–4.83, p < 0.001), cardiac death (2.89; 1.31–6.35, p < 0.01) and cardiac death plus nonfatal myocardial infarction (2.95; 1.50–5.79, p < 0.001). Other independent predictors of main outcomes were diabetes mellitus (2.89; 1.69– 4.92, p < 0.001) and triglycerides levels (1.16; 1.02–1.32, p < 0.05). Use of statins was associated with decreased risk of cardiac death: 0.33; 0.15–0.76, p < 0.01. Conclusion: Elevated levels of Lp(a) is a predictor of late coronary events including death and nonfatal myocardial infarction after CABG. P151 ASSOCIATION OF ELEVATED LIPOPROTEIN(a) LEVEL WITH PREMATURE CORONARY HEART DISEASE IN MEN AND WOMEN M. Safarova, M. Ezhov, O. Afanasieva, A. Lyakishev, S. Pokrovsky. Cardiology Research Center, Moscow, Russia Objective: To assess the relationship of lipoprotein(a) [Lp(a)] concentration with clinical manifestation of coronary heart disease (CHD) in younger age. Methods: In this cross-sectional study we recruited 1483 patients (85% male) with CHD verified by angiography. In accordance with the level of Lp(a), patients were divided into 2 main groups: I (n = 599) 30 mg/dL, and II (n = 884) <30 mg/dL. The following risk factors were recorded: hypertension, smoking, diabetes mellitus, obesity, and family history of CHD. Lipid profile, Lp(a), hsCRP concentrations were measured in all patients. Results: Among 496 men (mean age 53.7±9.5 years) from Group I, age of CHD manifestation was 49.8±8.8 years vs. 51.0±9.0 years in 767 men from Group II (mean age 54.6±9.2 years), p < 0.05. In women from Group I (n = 103, mean age 56.8±8.4 years) age of CHD onset, was 53.1±8.3 years vs. 55.8±10.0 years in Group II, p < 0.05. There was no significant difference in the classic risk factors, hsCRP and fibrinogen levels between the groups. The incidence of CHD in men younger than 45 years was 36% in Group I and 28% in Group II, p < 0.01. The incidence of CHD in women before 55 years was 66% in Group I and 47% in parallel group, p < 0.01. Conclusion: Our data suggest that elevated Lp(a) is independently associated with the development of early CHD in men as well as in women. P152 AORTIC BIFURCATION ANGLE AS AN INDEPENDENT RISK FACTOR FOR AORTOILIAC OCCLUSIVE DISEASE A. Shakeri Bavil1 , R.S. Tubbs2 , M.M. Shoja1 , H. Nosratinia1 , W.J. Oakes3 , M. Nemati1 . 1 Tabriz University of Medical Sciences, Tabriz, Iran, 2 University of Alabama at Birmingham, Birmingham, AL, USA, 3 St George’s University, West Indies, Grenada Introduction: Recently, there has been interest in potential geometric risk factors that might result in or exaggerate atherosclerosis. The aortic bifurcation is a complex anatomical area dividing the high pressure blood of the descending abdominal aorta into the lower limbs and pelvis. The distribution of the bifurcation angle and any asymmetry, its relation with age and its possible contribution to the risk of aortoiliac atherosclerosis are presented here. Materials and Methods: Statistical analysis was performed by SPSS version 11.0 using, Fisher‘s exact test, the Pearson and Spearman correlation tests and logistic regression analysis. The p value was set at 0.05.
Poster Presentations
Results: No correlations were found between age, bifurcation angle and angle asymmetry in the Pearson test (p > 0.05). Logistic regression analysis revealed that the bifurcation angle, but not its asymmetry, gender or age, was a significant and independent risk factor for aortoiliac atherosclerosis (model r2 = 0.662, p = 0.027). With additional study these results may have implications regarding risk factors for aortoiliac atherosclerosis. Conclusion: To our knowledge, this study is the first of its kind to indicate the potential of such an important geometric risk factor for atherosclerosis at the aortic bifurcation. P153 PREVALENCE OF THE CLASSICAL CARDIOVASCULAR RISK FACTORS IN ROMA MINORITY POPULATION OF CROATIA ˇ H.M. Zeljko1 , T. Skari´ c-Juric2 , N. Smolej Narancic2 , M. Pericic Salihovic2 , I. Martinovic Klaric2 , J. Milicic2 , M. Barbalic2 , M. Zajc2 , L. Barac Lauc2 , B. Janicijevic2 . 1 Internal Medicine, GH ‘Sv. Duh’, University of Zagreb, 2 Institute for Anthropological Research, Zagreb, Croatia Purpose: Roma are an ethnic minority of northern Indian origin. They are well known for preserved traditions and resistance to assimilation and therefore usually marginalized economically, spatially, politically and in terms of culture. Since the current knowledge about the prevention of cardiovascular diseases in Roma population is scarce, the objective of the study is to assess the prevalence of cardiovascular diseases’ risk factors. Methods: A multidisciplinary community-based study was carried out in rural areas of two regions of Croatia − Baranja and Medimurje. The sample encompassed a total of 423 randomly selected members (144 men and 279 women) of the Bayash Roma minority population aged 18−84 (41.1±15.2). The population prevalence of hypertension was assessed as SBP 140 or DBP 90 mmHg or taking antihypertensive therapy. Overweight was assessed BMI 25 (kg/m2 ). Smoking status was assessed within the course of the interview held by experienced medical staff. Blood pressure measurements and short anthropometrics were carried out using standard protocols. The lipid status and fasting glucose was determined from blood samples and standard cut-offs were used. Conclusions: Although the overall prevalence of hypertension in Roma was almost half the magnitude usually reported for general population of Croatia, the presented results have shown that this population bears a high CVD risk factors load. It is related to smoking, obesity, and high glucose and lipids levels. We expect that, along with westernization of their life-style and increase of their economic power, the proportion of CVD will also increase. P154 PREDICTION OFR THE POPULATION AT RISK OF ATHEROTHROMBOTIC DISEASE IS INDEPENDENT OF BLOOD SUGAR LEVEL W. Feeman Jr. The Bowling Green Study, Bowling Green, OH, USA Introduction: Diabetes is considered to be a “CHD equivalent”. However the risk of atherothrombotic disease (ATD) is not equal for all diabetics and milder elevations of blood sugar are not in and of themselves causal for ATD. It is important to define the ATD risk, if any, in patients with blood sugar level elevations. Objective: The purpose of this submission is to show that the prediction of the population at risk of ATD is essentially independent of blood sugar level. Materials and Methods: The Bowling Green Study (BGS) has developed a multi-factorial risk factor graph for the prediction of the population at risk of ATD, utilizing the Cholesterol Retention Fraction (CRF, or [LDL-HDL]/LDL) on the ordinant and Systolic Blood Pressure (SBP) on the ordinant. A threshold line can be delineated separating the mainstream of ATD patients from a few outliers. The line coordinants of the CRF-SBP plots are (0.74,100) and (0.59,140). Results: 85% of all ATD patients in the author’s database have CRF-SBP plots abaove the threshold line. Those ATD patients with CRF-SBP plots below the threshold line are mainly cigarette smokers, leaving only 6% of the ATD population that can not be predicted by CRF-SBP plot position above the threshold line and/or cigarette smoking status. These findings are independent of blood sugar level. Conclusions: The population at risk of ATD cam be accurately predicted independently of blood sugar level. P155 EFFECTS OF RAMADAN FASTING ON CARDIOVASCULAR RISK FACTORS A. Norouzy, M. Nematy, M. Alinezhad-Namaghi, M. Shakhskalaee, M. Mozhdehifard, S. Sajjadi, M. Sabery. Dept. of Biochemisrty&Nutrition, Mashad Medical School, Mashad, Iran Introduction: Ramadan is a month for Muslims during which they abstain from eating, drinking and smoking from dawn to sunset. The recommendations regarding the safety of fasting for patients with a previous cardio/cerebrovascular event have been based on expert opinion rather than evidence based medicine and sometimes controversial. In the present study, the effect of Ramadan fasting on some cardiovascular risk factors has been investigated.