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P2-19 LIPID PROFILES IN THE HEMODIALYSIS PATIENTS
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Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
depression was commonly used for detection of CAD. However, more and more evidence showed that systolic blood pressure (SBP) change during and after exercise was associated with CAD severity, risk of acute myocardial infarction (AMI) and stroke, new-onset hypertension, and even cardiovascular mortality. Methods and Results: We retrospectively accessed 3054 patients with ETT performed in 1996. The blood pressure and heart rate were recorded at rest, peak exercise, 1-min and 3-min after exercise. The SBP at 3-min of recovery equal to or higher than that at 1-min of recovery was defined as paradoxical SBP elevation. These patients were divided into four groups according to formal ETT and paradoxical SBP change results. After ten years follow-up, 346 (11%) patients died, with 129 (4%) patients died from cardiovascular disease (CVD). Among four groups, patients with both positive results of ETT and paradoxical SBP elevation were at highest risk for all-cause mortality (odds radio [OR] 1.86, 95% confidence interval [CI] 1.31 to 2.65, p=0.0005) and CVD mortality (OR 3.18, 95% CI 1.94 to 5.20, p<0.0001). Patients with only paradoxical SBP elevation and negative ETT result still had higher risk of CVD mortality (OR 1.79, 95% CI 1.08 to 2.97, p=0.02), even after multivariate adjustment. Conclusions: In conclusion, not only the ST segment depression induced by ETT, but also the paradoxical SBP elevation after exercise was a significant predictor of cardiovascular mortality.
P2-18 CLINICAL DETERMINANTS OF MICROVASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: BASED ON SOUTHERN TAIWAN EXPERIENCE
Mike Lin. PingTong; KUCC-Kaohsiung; ISU-Kaohsiung; ZH Nursing School Ping-Tong, Taiwan Study Purpose: Diabetes Mellitus (DM) is the fourth leading cause of death in Taiwan. Diabetes vascular complications are one of the major causes of mortality among DM patients. Microalbuminuria is a novel athersclerotic risk factor in patients with type 2 DM and predicts future cardiovascular event. Within the framework of the early detection of asymptomatic diabetics population, we first compared the clinical lipid profiles and CV parameters between DM subgroups (DM: good control (G) vs poor control (P); retinopathy (R,+) vs (R,−); Nephropathy (normal micro albuminuria (N,−) vs (N,+).) Methods: From 2002 to 2006, 140 patients were included in this study. All patients received the biochemical (sugar, HbA1c) and lipid profile, micro albumin survey as well as retinopathy survey at fasting state. 24-hr Holter monitoring was also arranged to detect the silent ischemia or arrhythmic events. Patients was divided into good control (HbA1c<7%, n=46) and poor control (HbA1c≥7%, n=94). DM retinopathy was present in 56 subjects (40%) versus absent in 84 (60%) subjects. Subjects were also categorized as those with micro albuminuria (n=46, 32.86%), those with normal albuminuria (n=59, 42.14%), and those with macro albuminuria (n=35, 25.00%). Results: Fasting blood sugar as well as micro albuminuria showed significant difference between DM subgroup comparisons. HDL was significantly higher in DMN(–) group in contrast to DMN(+) group ( p<0.05). The longer the duration of DM, the higher the incidence of microvascular disease of DM. Hypertriglyceridemia was significantly higher in DMR(+) than in DMR(–) subgroup ( p<0.005). In terms of silent ischemic episodes and arrhythmia events, DMR(–), and DMN(–) subgroups also showed the significant lower frequency incidence than those of DMR(+), and DMN(+), respectively. Within the lipid profiles correlations, hypertriglyceridemia (HTG) was negatively correlated with the HDL, and positively correlated with the LDL. HTG and LDL levels also revealed moderate positive correlations with the TC level. Micro albuminuria was weakly correlated with the aging in either DMG or DMP subgroups. Within the DMN(+) subgroup, microalbumiauria was positively correlated with the HbA1c and DM duration. As to DMR(+) subgroup, there was positive correlation between micro albuminuria versus duration of DM and aging. Conclusions: Thus, duration and aging of DM are important factors in the pathogenesis of microvascular disease. Hyperlipidemia (HTG and HTC) also interacts with DM to affect the clinical course of microangiopathy. We may conclude that DM with the presence of either microangiopathy or microalbuminuria positively associated with elevated attacks of silent ischemic episodes and total arrhythmic events. Our data suggest that aggressive attempts to improve glycemic and lipid control may decrease the incidence of microangiopathy in type 2 DM.
P2-19 LIPID PROFILES IN THE HEMODIALYSIS PATIENTS
Moghaddam Mansoor. Jam Hospital, Iran Background: The prevelance of chronic renal failure (CRF) has been increased secondary to the high incidence of underlying diseases such as diabetes mellitus and hypertension. The incidence of coronary artery disease (CAD) is high in these patients. Because of the above mentioned risk factors and also serum lipids disturbances, to prevent the CAD in patients with CRF, it is necessary to identify the lipid profiles. Materials and Methods: This is a cross sectional study that was done and measuring triglycerides (TG), total cholestrol (TC), LDL-C, HDL-C, VLDL, LP (a), and Apo-lipoproteins A and B in patients with end stage renal disease (ESRD) in Dr. Shariati Hospital during 2004-2005. Results: 53 patients including 32 males (60%) and 21 females (40%) with average age 53±14 years were evaluated. The duration of ESRD was 3.5± 2.8 years. 28% were diabetic, 35% were hypertensive and 19% were cigarrette smokers. No patients had neoplastic disease. The average serum TG level was 143±60 mg/100, higher than normal level (normal: 100±30 mg/100) (P-value: 0.001). Serum HDL-C in the male patients was 46±13 mg/100 (normal: 35-55 mg/100) and 55±15 mg/100 in the female patients (normal: 65-45 mg/100). Serum LDLC in patients was 82±21 mg/100 (normal < 100 mg/100). Serum VLDL was 25±13 mg/100 (normal: 10-45 mg/100). Serum TC was 157.76±35.07 mg/100, which was within normal range in both sexes. Serum Apo-lipoprotein A was 112.8±14.99 mg/100 in males and 126.14±19.84 mg/100 in females, which was within normal range in both sexes. Serum Apo-lipoprotein B in males and females was 84.53±21.85g/100 and 92±15.22 mg/100 respectively, which was also in the normal range. Serum LP (a) was 57±51 mg/100 and obviously higher than normal level (15±7 mg/100) (P-value: 0.001). There were no meaningful differences between males and females. Seurm LP (a) was insignificantly higher in hypertensive than normotensive patients (But insignifcant difference). Also it was higher in nondiabetic than diabetic patients. Conclusion: Serum LP (a) is considerably higher than normal in the patients with ESRD, and because it could be accomponied with premature CAD, serum LP (a) measurement is highly suggested in patients with ESRD. Keywords: ESRD, hemodialysis, CAD, LP (a).
P2-20 TO EVALUATE THE SERO TYPES OF GROUP ‘A’ β-HAEMOLYTIC STREPTOCOCCI IN PATIENTS OF ACUTE RHEUMATIC FEVER: A CASE STUDY OF SLUM AREA OF RAJIV NAGAR, BHOPAL, M.P., INDIA
Sharad Kumar Parashar 1 , Alka Parashar 2 . 1 Chief Medical Officer, Central Health Services, LWO, Bhopal (M.P.), India; 2 Professor, Govt. Sarojini Naidu P.G.G. College, Bhopal (M.P.), India Background: Rheumatic fever (RF) and Rheumatic Heart Disease (RHD) Still Continues to be major public health problem in developing countries like India. RF and RHD are the leading cause of morbidity and mortality in India. They are the consequences of sore throat (infection) caused by group ‘A’ β-haemolytic streptococci (GAS), In our study of slum Rajiv Nagar, Bhopal have shown that the ‘M’-Serotype-5 is frequently associated with rheumatic fever. The peculiarity of this serotype M-5 is that it has caused more frequent hospitalization of patients’ congestive heart failure, and atrial fibrillation (AF). Introduction: In India, the prevalence of rheumatic fever and rheumatic heart diseases among school children is 2-11 per 1000 and the average prevalence is about 6/1000 while in developed countries it is less than 0.05/1000 because of their living standard and improved environmental sanitation. About 6 million children in the age group of 5 year to 15 year of age group with female preponderance are having RF and RHD in India. The mitral stenosis approximately 25% of all patients of RHD and with mitral regurgitation, it is the most common lesion exists. Rheumatic fever is an inflammatory disease that occurs as a delayed non suppurative sequel to group a streptococcal infection of he pharynx. It involves the heart, joints, CNS, skin and substances tissues with varying frequency. RF is a clinical syndrome for which no specific diagnostic test exists. The RHD in its acute stage rarely become fatal unless associated with complications. Strains of group A streptococci vary in their propensity to elicit acute rheumatic fever. There are more than 90 strephococci M protein types rheumotogenic strains have been strongly associated with rheumatic fever. Strains of group ‘A’ streptococci recovered from patients
Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
depression was commonly used for detection of CAD. However, more and more evidence showed that systolic blood pressure (SBP) change during and after exercise was associated with CAD severity, risk of acute myocardial infarction (AMI) and stroke, new-onset hypertension, and even cardiovascular mortality. Methods and Results: We retrospectively accessed 3054 patients with ETT performed in 1996. The blood pressure and heart rate were recorded at rest, peak exercise, 1-min and 3-min after exercise. The SBP at 3-min of recovery equal to or higher than that at 1-min of recovery was defined as paradoxical SBP elevation. These patients were divided into four groups according to formal ETT and paradoxical SBP change results. After ten years follow-up, 346 (11%) patients died, with 129 (4%) patients died from cardiovascular disease (CVD). Among four groups, patients with both positive results of ETT and paradoxical SBP elevation were at highest risk for all-cause mortality (odds radio [OR] 1.86, 95% confidence interval [CI] 1.31 to 2.65, p=0.0005) and CVD mortality (OR 3.18, 95% CI 1.94 to 5.20, p<0.0001). Patients with only paradoxical SBP elevation and negative ETT result still had higher risk of CVD mortality (OR 1.79, 95% CI 1.08 to 2.97, p=0.02), even after multivariate adjustment. Conclusions: In conclusion, not only the ST segment depression induced by ETT, but also the paradoxical SBP elevation after exercise was a significant predictor of cardiovascular mortality.
P2-18 CLINICAL DETERMINANTS OF MICROVASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: BASED ON SOUTHERN TAIWAN EXPERIENCE
Mike Lin. PingTong; KUCC-Kaohsiung; ISU-Kaohsiung; ZH Nursing School Ping-Tong, Taiwan Study Purpose: Diabetes Mellitus (DM) is the fourth leading cause of death in Taiwan. Diabetes vascular complications are one of the major causes of mortality among DM patients. Microalbuminuria is a novel athersclerotic risk factor in patients with type 2 DM and predicts future cardiovascular event. Within the framework of the early detection of asymptomatic diabetics population, we first compared the clinical lipid profiles and CV parameters between DM subgroups (DM: good control (G) vs poor control (P); retinopathy (R,+) vs (R,−); Nephropathy (normal micro albuminuria (N,−) vs (N,+).) Methods: From 2002 to 2006, 140 patients were included in this study. All patients received the biochemical (sugar, HbA1c) and lipid profile, micro albumin survey as well as retinopathy survey at fasting state. 24-hr Holter monitoring was also arranged to detect the silent ischemia or arrhythmic events. Patients was divided into good control (HbA1c<7%, n=46) and poor control (HbA1c≥7%, n=94). DM retinopathy was present in 56 subjects (40%) versus absent in 84 (60%) subjects. Subjects were also categorized as those with micro albuminuria (n=46, 32.86%), those with normal albuminuria (n=59, 42.14%), and those with macro albuminuria (n=35, 25.00%). Results: Fasting blood sugar as well as micro albuminuria showed significant difference between DM subgroup comparisons. HDL was significantly higher in DMN(–) group in contrast to DMN(+) group ( p<0.05). The longer the duration of DM, the higher the incidence of microvascular disease of DM. Hypertriglyceridemia was significantly higher in DMR(+) than in DMR(–) subgroup ( p<0.005). In terms of silent ischemic episodes and arrhythmia events, DMR(–), and DMN(–) subgroups also showed the significant lower frequency incidence than those of DMR(+), and DMN(+), respectively. Within the lipid profiles correlations, hypertriglyceridemia (HTG) was negatively correlated with the HDL, and positively correlated with the LDL. HTG and LDL levels also revealed moderate positive correlations with the TC level. Micro albuminuria was weakly correlated with the aging in either DMG or DMP subgroups. Within the DMN(+) subgroup, microalbumiauria was positively correlated with the HbA1c and DM duration. As to DMR(+) subgroup, there was positive correlation between micro albuminuria versus duration of DM and aging. Conclusions: Thus, duration and aging of DM are important factors in the pathogenesis of microvascular disease. Hyperlipidemia (HTG and HTC) also interacts with DM to affect the clinical course of microangiopathy. We may conclude that DM with the presence of either microangiopathy or microalbuminuria positively associated with elevated attacks of silent ischemic episodes and total arrhythmic events. Our data suggest that aggressive attempts to improve glycemic and lipid control may decrease the incidence of microangiopathy in type 2 DM.
P2-19 LIPID PROFILES IN THE HEMODIALYSIS PATIENTS
Moghaddam Mansoor. Jam Hospital, Iran Background: The prevelance of chronic renal failure (CRF) has been increased secondary to the high incidence of underlying diseases such as diabetes mellitus and hypertension. The incidence of coronary artery disease (CAD) is high in these patients. Because of the above mentioned risk factors and also serum lipids disturbances, to prevent the CAD in patients with CRF, it is necessary to identify the lipid profiles. Materials and Methods: This is a cross sectional study that was done and measuring triglycerides (TG), total cholestrol (TC), LDL-C, HDL-C, VLDL, LP (a), and Apo-lipoproteins A and B in patients with end stage renal disease (ESRD) in Dr. Shariati Hospital during 2004-2005. Results: 53 patients including 32 males (60%) and 21 females (40%) with average age 53±14 years were evaluated. The duration of ESRD was 3.5± 2.8 years. 28% were diabetic, 35% were hypertensive and 19% were cigarrette smokers. No patients had neoplastic disease. The average serum TG level was 143±60 mg/100, higher than normal level (normal: 100±30 mg/100) (P-value: 0.001). Serum HDL-C in the male patients was 46±13 mg/100 (normal: 35-55 mg/100) and 55±15 mg/100 in the female patients (normal: 65-45 mg/100). Serum LDLC in patients was 82±21 mg/100 (normal < 100 mg/100). Serum VLDL was 25±13 mg/100 (normal: 10-45 mg/100). Serum TC was 157.76±35.07 mg/100, which was within normal range in both sexes. Serum Apo-lipoprotein A was 112.8±14.99 mg/100 in males and 126.14±19.84 mg/100 in females, which was within normal range in both sexes. Serum Apo-lipoprotein B in males and females was 84.53±21.85g/100 and 92±15.22 mg/100 respectively, which was also in the normal range. Serum LP (a) was 57±51 mg/100 and obviously higher than normal level (15±7 mg/100) (P-value: 0.001). There were no meaningful differences between males and females. Seurm LP (a) was insignificantly higher in hypertensive than normotensive patients (But insignifcant difference). Also it was higher in nondiabetic than diabetic patients. Conclusion: Serum LP (a) is considerably higher than normal in the patients with ESRD, and because it could be accomponied with premature CAD, serum LP (a) measurement is highly suggested in patients with ESRD. Keywords: ESRD, hemodialysis, CAD, LP (a).
P2-20 TO EVALUATE THE SERO TYPES OF GROUP ‘A’ β-HAEMOLYTIC STREPTOCOCCI IN PATIENTS OF ACUTE RHEUMATIC FEVER: A CASE STUDY OF SLUM AREA OF RAJIV NAGAR, BHOPAL, M.P., INDIA
Sharad Kumar Parashar 1 , Alka Parashar 2 . 1 Chief Medical Officer, Central Health Services, LWO, Bhopal (M.P.), India; 2 Professor, Govt. Sarojini Naidu P.G.G. College, Bhopal (M.P.), India Background: Rheumatic fever (RF) and Rheumatic Heart Disease (RHD) Still Continues to be major public health problem in developing countries like India. RF and RHD are the leading cause of morbidity and mortality in India. They are the consequences of sore throat (infection) caused by group ‘A’ β-haemolytic streptococci (GAS), In our study of slum Rajiv Nagar, Bhopal have shown that the ‘M’-Serotype-5 is frequently associated with rheumatic fever. The peculiarity of this serotype M-5 is that it has caused more frequent hospitalization of patients’ congestive heart failure, and atrial fibrillation (AF). Introduction: In India, the prevalence of rheumatic fever and rheumatic heart diseases among school children is 2-11 per 1000 and the average prevalence is about 6/1000 while in developed countries it is less than 0.05/1000 because of their living standard and improved environmental sanitation. About 6 million children in the age group of 5 year to 15 year of age group with female preponderance are having RF and RHD in India. The mitral stenosis approximately 25% of all patients of RHD and with mitral regurgitation, it is the most common lesion exists. Rheumatic fever is an inflammatory disease that occurs as a delayed non suppurative sequel to group a streptococcal infection of he pharynx. It involves the heart, joints, CNS, skin and substances tissues with varying frequency. RF is a clinical syndrome for which no specific diagnostic test exists. The RHD in its acute stage rarely become fatal unless associated with complications. Strains of group A streptococci vary in their propensity to elicit acute rheumatic fever. There are more than 90 strephococci M protein types rheumotogenic strains have been strongly associated with rheumatic fever. Strains of group ‘A’ streptococci recovered from patients