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P3-14 CHARACTERISTICS OF APPARENTLY HEALTHY INDIVIDUALS WITH VERY LOW CREACTIVE PROTEIN CONCENTRATIONS. ARE THEY REALLY HEALTHY?
105
Abstract of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13–16 December, 2007
P3-14
P3-16
CHARACTERISTICS OF APPARENTLY HEALTHY INDIVIDUALS WITH VERY LOW CREACTIVE PROTEIN CONCENTRATIONS. ARE THEY REALLY HEALTHY?
SUBCLINICAL AORTIC DISEASE IN YOUNG PATIENTS WITH ANKYLOSING SPONDYLITIS: THE TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY
Itzhak Shapira, Ori Rogowski, Sharon Toker, Samuel Melamed, Arie Shirom, David Zeltser, Shlomo Berliner. Department of Medicine “D” and Institute for Special Medical Examinations (MALRAM), Tel Aviv Sourasky Medical Center, Tel Aviv, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Faculty of Management, Tel-Aviv University, Tel-Aviv, National Institute of Occupational & Environmental Health, Raanana, Israel and Sackler Faculty Medicine, Tel-Aviv University, Tel-Aviv, Israel
Il-Suk Sohn 1 , Suk-Tae Jang 1 , Eun-Sun Jin 1 , Jin-Man Cho 1 , Chong-Jin Kim 1 , Jong-Hoa Bae 1 , Sang-Hoon Lee 2 , Hyung-In Yang 2 . 1 Div. of Cardiology, Cardiovascular Center, Korea; 2 Div. of Rheumatology, Arthritis & Rheumatism Center, East-West Neo Medical Center of Kyung Hee University
Background: High concentrations of hs-CRP are used to single-out individuals at risk for future cardiovascular events. We hypothesized that apparently healthy individuals with very low hs-CRP concentrations might present an improved general health profile. Methods: The concentration of hs-CRP was determined by using the Behring BN II nephelometer. The arbitrary cut-off point of hs-CRP (≤0.16 mg/L) was determined at the lower detection level of the assay. Four thousand and fifty six apparently healthy individuals were screened following exclusion of recent infection/inflammation by using a detailed questionnaire. Results: Ninety-five (2.3%) individuals out of the above mentioned cohort presented hs-CRP concentrations of ≤0.16 mg/L. They were found to be significantly younger and lean, had an improved lipid profile and an attenuated acute phase response in terms of lower erythrocyte sedimentation rate, fibrinogen concentration as well as white blood cell count. In addition, these individuals had less atherothrombotic risk factors except from smoking habits that were as frequent as those of individuals with a higher hs-CRP concentration. Conclusions: The presence of very low hs-CRP concentrations in apparently healthy individuals is associated with an improved general health profile except from smoking habits that were as frequent as in individuals with a higher concentration of hs-CRP. The question of whether these individuals have a particular genetic background of being inflammation insensitive remains to be answered. We suggest that studies of hs-CRP concentrations in apparently healthy individuals should consider this particular group, the follow-up of which might yield valuable information.
P3-15 HEART RATE AND MICROINFLAMMATION IN MEN: A RELEVANT ATHEROTHROMBOTIC LINK
Itzhak Shapira, Ori Rogowski, Arie Shirom, Samuel Melamed, Saron Toker, Shlomo Berliner. Department of Medicine “D” and Institute for Special Medical Examinations (MALRAM), Tel Aviv Sourasky Medical Center, Tel Aviv, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Faculty of Management, Tel-Aviv University, Tel-Aviv, National Institute of Occupational & Environmental Health, Raanana, Israel and Sackler Faculty Medicine, Tel-Aviv University, Tel-Aviv, Israel Background: There is a possibility that increased resting heart rate is associated with a microinflammatory response. Such an association could explain, at least in part, the recently described worse cardiovascular prognosis in individuals with increased heart rate. Methods: We analyzed the concentration of fibrinogen and high sensitivity Creactive protein (hs-CRP) as well as the absolute number of polymorphonuclear leukocytes in a cohort of 4,553 apparently healthy men and those with atherothrombotic risk factors. Results: Following adjustment for age and body mass index, lipid profile and cardiovascular risk factors, a significant (p<0.0005) difference was noted between individuals in the first quintile of heart rate (le58 beats/minute) and the fifth one (≥79 beats/minute) regarding all three inflammatory biomarkers, the respective mean values being 251 and 276 mg/dl, 1.12 and 1.61 mg/l and 4,230 and 4,740 cells per cmm. Conclusions: Resting heart rate is associated with a microinflammatory response in apparently healthy men and those with atherothrombotic risk factors. Sympathetic activation might be a common denominator that explains such an association. If confirmed in additional studies, this association might be a relevant target for therapeutic manipulations.
Background: Aortic root disease and aortitis with or without aortic regurgitation are well recognized complications in patients with ankylosing spondylitis(AS). The objective of this study was to determine the subclinical aortic disease including aortic root and descending thoracic aorta using transesophageal echocardiography (TEE) in male young patients with diagnosed AS less than 15 years and compare the results with age-matched healthy controls. Methods: Twenty-two outpatients with AS and 14 age-matched healthy volunteers underwent TEE and rheumatologic evaluations. All subjects were male. The patients with AS were all diagnosed less than 15 years. Results: Aortic root wall and mitral leaflet were more thickened significantly in patients as compared with controls (p<0.001). Ascending aortic diameter was more dilated in patients than in controls (p=0.03). No significant valvular regurgitation was seen. No differences in diameter of aortic root and descending thoracic aorta, and in terms of aortic stiffness (beta index) and elasticity (aortic strain and aortic distensibility) were observed between patients and controls. Aortic root and valve disease were unrelated to the activity or severity of AS. Conclusion: Aortic root and mitral valvular thickening are common in patients with young patients with AS diagnosed less than 15 years, but significant valvular regurgitation and abnormal aortic stiffness and elasticity were not observed. This subclinical aortic disease should be followed up to determine its prognostic implication and evolution. Table 1. Clinical characteristics Characteristics Age(years) Body surface area (m2 ) Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) Pulse pressure (mmHg) Smokers Hypertension Duration of the disease (years) Positive HLA-B27 History of uveitis Peripheral arthritis Bone bridge in spine Serum IgA level (mg/dL) ESR (mm/hr) C-reactive protein (mg/dL) BASDAI BASMI
Patients (n=22)
Controls (n=14)
28.0±5.3 1.85±0.15 125.6±16.1 78.0±9.1 47.6±10.8 7% 14% 6.1±4.5 82% 27% 41% 14% 260.0±106.4 15.5±18.3 1.1±1.8 2.4±1.4 1.2±1.8
25.7±2.7 1.81±0.14 126.4±10.0 76.7±7.0 49.6±9.0 13% 14%
Mean±SD. Table 2. Characteristics on transesophageal echocardiography Characteristics Aortic root, posterior wall thickness (mm) Mitral valve, anterior leaflet thickness (mm) Aortic diameter (mm) Cuspal separation in systole At the annulus At the sinus At the sino-tubular junction Ascending aorta Descending thoracic aorta in end-diastole Descending thoracic aorta in end-systole Aortic strain (%) Aortic distensibility (cm2 dyn−1 × 10−3 ) Aortic stiffness beta index
Mean±SD.
Patients (n=22)
Controls (n=14)
p Value
2.4±0.7 1.2±0.3
1.4±0.2 0.8±0.1
<0.001 <0.001
22.4±1.9 20.2±1.2 31.1±3.0 24.4±2.1 27.6±2.6 18.1±2.4 20.3±2.3 12.5±3.8 0.54±0.18 2.59±0.29
21.4±1.5 19.6±1.4 29.8±2.8 23.3±1.4 25.8±2.0 16.6±2.3 18.7±2.1 13.2±3.4 0.55±0.18 2.56±0.26
NS NS NS NS 0.03 NS NS NS NS NS
Abstract of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13–16 December, 2007
P3-14
P3-16
CHARACTERISTICS OF APPARENTLY HEALTHY INDIVIDUALS WITH VERY LOW CREACTIVE PROTEIN CONCENTRATIONS. ARE THEY REALLY HEALTHY?
SUBCLINICAL AORTIC DISEASE IN YOUNG PATIENTS WITH ANKYLOSING SPONDYLITIS: THE TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY
Itzhak Shapira, Ori Rogowski, Sharon Toker, Samuel Melamed, Arie Shirom, David Zeltser, Shlomo Berliner. Department of Medicine “D” and Institute for Special Medical Examinations (MALRAM), Tel Aviv Sourasky Medical Center, Tel Aviv, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Faculty of Management, Tel-Aviv University, Tel-Aviv, National Institute of Occupational & Environmental Health, Raanana, Israel and Sackler Faculty Medicine, Tel-Aviv University, Tel-Aviv, Israel
Il-Suk Sohn 1 , Suk-Tae Jang 1 , Eun-Sun Jin 1 , Jin-Man Cho 1 , Chong-Jin Kim 1 , Jong-Hoa Bae 1 , Sang-Hoon Lee 2 , Hyung-In Yang 2 . 1 Div. of Cardiology, Cardiovascular Center, Korea; 2 Div. of Rheumatology, Arthritis & Rheumatism Center, East-West Neo Medical Center of Kyung Hee University
Background: High concentrations of hs-CRP are used to single-out individuals at risk for future cardiovascular events. We hypothesized that apparently healthy individuals with very low hs-CRP concentrations might present an improved general health profile. Methods: The concentration of hs-CRP was determined by using the Behring BN II nephelometer. The arbitrary cut-off point of hs-CRP (≤0.16 mg/L) was determined at the lower detection level of the assay. Four thousand and fifty six apparently healthy individuals were screened following exclusion of recent infection/inflammation by using a detailed questionnaire. Results: Ninety-five (2.3%) individuals out of the above mentioned cohort presented hs-CRP concentrations of ≤0.16 mg/L. They were found to be significantly younger and lean, had an improved lipid profile and an attenuated acute phase response in terms of lower erythrocyte sedimentation rate, fibrinogen concentration as well as white blood cell count. In addition, these individuals had less atherothrombotic risk factors except from smoking habits that were as frequent as those of individuals with a higher hs-CRP concentration. Conclusions: The presence of very low hs-CRP concentrations in apparently healthy individuals is associated with an improved general health profile except from smoking habits that were as frequent as in individuals with a higher concentration of hs-CRP. The question of whether these individuals have a particular genetic background of being inflammation insensitive remains to be answered. We suggest that studies of hs-CRP concentrations in apparently healthy individuals should consider this particular group, the follow-up of which might yield valuable information.
P3-15 HEART RATE AND MICROINFLAMMATION IN MEN: A RELEVANT ATHEROTHROMBOTIC LINK
Itzhak Shapira, Ori Rogowski, Arie Shirom, Samuel Melamed, Saron Toker, Shlomo Berliner. Department of Medicine “D” and Institute for Special Medical Examinations (MALRAM), Tel Aviv Sourasky Medical Center, Tel Aviv, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Faculty of Management, Tel-Aviv University, Tel-Aviv, National Institute of Occupational & Environmental Health, Raanana, Israel and Sackler Faculty Medicine, Tel-Aviv University, Tel-Aviv, Israel Background: There is a possibility that increased resting heart rate is associated with a microinflammatory response. Such an association could explain, at least in part, the recently described worse cardiovascular prognosis in individuals with increased heart rate. Methods: We analyzed the concentration of fibrinogen and high sensitivity Creactive protein (hs-CRP) as well as the absolute number of polymorphonuclear leukocytes in a cohort of 4,553 apparently healthy men and those with atherothrombotic risk factors. Results: Following adjustment for age and body mass index, lipid profile and cardiovascular risk factors, a significant (p<0.0005) difference was noted between individuals in the first quintile of heart rate (le58 beats/minute) and the fifth one (≥79 beats/minute) regarding all three inflammatory biomarkers, the respective mean values being 251 and 276 mg/dl, 1.12 and 1.61 mg/l and 4,230 and 4,740 cells per cmm. Conclusions: Resting heart rate is associated with a microinflammatory response in apparently healthy men and those with atherothrombotic risk factors. Sympathetic activation might be a common denominator that explains such an association. If confirmed in additional studies, this association might be a relevant target for therapeutic manipulations.
Background: Aortic root disease and aortitis with or without aortic regurgitation are well recognized complications in patients with ankylosing spondylitis(AS). The objective of this study was to determine the subclinical aortic disease including aortic root and descending thoracic aorta using transesophageal echocardiography (TEE) in male young patients with diagnosed AS less than 15 years and compare the results with age-matched healthy controls. Methods: Twenty-two outpatients with AS and 14 age-matched healthy volunteers underwent TEE and rheumatologic evaluations. All subjects were male. The patients with AS were all diagnosed less than 15 years. Results: Aortic root wall and mitral leaflet were more thickened significantly in patients as compared with controls (p<0.001). Ascending aortic diameter was more dilated in patients than in controls (p=0.03). No significant valvular regurgitation was seen. No differences in diameter of aortic root and descending thoracic aorta, and in terms of aortic stiffness (beta index) and elasticity (aortic strain and aortic distensibility) were observed between patients and controls. Aortic root and valve disease were unrelated to the activity or severity of AS. Conclusion: Aortic root and mitral valvular thickening are common in patients with young patients with AS diagnosed less than 15 years, but significant valvular regurgitation and abnormal aortic stiffness and elasticity were not observed. This subclinical aortic disease should be followed up to determine its prognostic implication and evolution. Table 1. Clinical characteristics Characteristics Age(years) Body surface area (m2 ) Systolic blood pressure (mmHg) Diastolic blood pressure (mmHg) Pulse pressure (mmHg) Smokers Hypertension Duration of the disease (years) Positive HLA-B27 History of uveitis Peripheral arthritis Bone bridge in spine Serum IgA level (mg/dL) ESR (mm/hr) C-reactive protein (mg/dL) BASDAI BASMI
Patients (n=22)
Controls (n=14)
28.0±5.3 1.85±0.15 125.6±16.1 78.0±9.1 47.6±10.8 7% 14% 6.1±4.5 82% 27% 41% 14% 260.0±106.4 15.5±18.3 1.1±1.8 2.4±1.4 1.2±1.8
25.7±2.7 1.81±0.14 126.4±10.0 76.7±7.0 49.6±9.0 13% 14%
Mean±SD. Table 2. Characteristics on transesophageal echocardiography Characteristics Aortic root, posterior wall thickness (mm) Mitral valve, anterior leaflet thickness (mm) Aortic diameter (mm) Cuspal separation in systole At the annulus At the sinus At the sino-tubular junction Ascending aorta Descending thoracic aorta in end-diastole Descending thoracic aorta in end-systole Aortic strain (%) Aortic distensibility (cm2 dyn−1 × 10−3 ) Aortic stiffness beta index
Mean±SD.
Patients (n=22)
Controls (n=14)
p Value
2.4±0.7 1.2±0.3
1.4±0.2 0.8±0.1
<0.001 <0.001
22.4±1.9 20.2±1.2 31.1±3.0 24.4±2.1 27.6±2.6 18.1±2.4 20.3±2.3 12.5±3.8 0.54±0.18 2.59±0.29
21.4±1.5 19.6±1.4 29.8±2.8 23.3±1.4 25.8±2.0 16.6±2.3 18.7±2.1 13.2±3.4 0.55±0.18 2.56±0.26
NS NS NS NS 0.03 NS NS NS NS NS