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P88 CARDIOVASCULAR FUNCTION AND PSYCHOLOGICAL DISTRESS IN URBANISED BLACK SOUTH AFRICANS: THE SABPA STUDY
78th EAS Congress
Atherosclerosis Supplements 11, no. 2 (2010) 17–108
Supported by NHF grant 2006B258 P88 CARDIOVASCULAR FUNCTION AND PSYCHOLOGICAL DISTRESS IN URBANISED BLACK SOUTH AFRICANS: THE SABPA STUDY N. Mashele1 , J.M. Van Rooyen1 , L. Malan1 , J.C. Potgieter2 , Hypertension in African Research Team (HART). 1 Physiology, 2 Psychology, North-West University, Potchefstroom, South Africa The increased prevalence of cardiovascular disease (CVD) risk factors in SubSaharan Africa has increased the prevalence of CVD in this region but whether psychological distress contributes to this observed increased risk remains largely unclear. Objective: The aim of this study was to investigate the association between psychological distress and CVD risk in urbanised black South African men (n = 101) and women (n = 99). Methods: Resting cardiovascular variables were obtained by making use of the Finometer device and 24 hour ambulatory blood pressure measurements with the Cardiotens apparatus. The psychological questionnaires assessed the perception of health (General Health Questionnaire; GHQ-28) and depression status (DSM-IV criteria). The resting ECG (NORAV PC-1200) was used to determine left ventricular hypertrophy (LVH) by making use of the Cornell product. Confounders included age, obesity, alcohol, smoking and physical activity. Results: The hypertensive group were more overweight with lower vascular compliance and higher LVH (only men) compared to the normotensive groups. In hypertensive men, perception of health (somatic symptoms) was positively associated with blood pressure, while in hypertensive women it was associated with heart rate. Major depression was associated with LVH in hypertensive men and mean arterial pressure in hypertensive women. LVH and depression showed Odds ratios of 1.02 [95% CI 0.997–1.05] and 1.15 [95% CI 1.01–1.32] respectively, in predicting hypertension in women. Conclusions: Psychological distress was associated with higher blood pressure in hypertensive African men but also with development of left ventricular hypertrophy in hypertensive African men and women. Keywords: Depression; perception of health; cardiovascular function; urbanised Africans; hypertension. P89 FATTY ACIDS IN SERUM PHOSPHOLIPIDS AND CAROTID INTIMA-MEDIA THICKNESS IN SPANISH SUBJECTS WITH PRIMARY DYSLIPIDEMIA 1 A. Sala-Vila1 , M. Cofan ´ 1 , A. Perez-Heras ´ , I. Nu´ nez ˜ 2 , R. Gilabert2 , M. Junyent1 , R. Mateo-Gallego3 , A. Cenarro3 , F. Civeira3 , E. Ros1 . 1 Lipid Unit; Nutrition and Endocrinology Survey, 2 Diagnosing Imaging Center, Institut ` d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Cl´ınic, Barcelona, 3 Lipid Unit, Hospital Miguel Servet, Zaragoza, Spain Introduction: n-3 Long-chain polyunsaturated fatty acids (n-3LC-PUFA) protect from coronary heart disease (CHD). Spain shares with Japan both low fatal and non-fatal CHD rates and high seafood intake. Objective: To investigate the relationship between n-3LC-PUFA status in serum phospholipids as biomarkers of seafood intake and carotid atherosclerosis in Spanish subjects at risk for CHD. Design: In a cross-sectional study, 451 asymptomatic subjects (261 men, 190 women, mean age 45 years) with primary dyslipidemia had fatty acids measured in serum phosphatidylcholine and carotid intima-media thickness (IMT) determined by ultrasound. Fatty food and seafood intake was evaluated in a random subsample of 70 participants. Results: Phosphatidylcholine fatty acid composition and mean daily consumption of olive oil (39 g) and seafood (76 g) were similar to those reported for Spanish populations. Multiple regression analyses showed that eicosapentaenoic + docosahexaenoic acids (b = −0.094, P = 0.015) and oleic acid (b = −0.107, P = 0.005) proportions were inversely related to mean common carotid artery IMT after adjustment for cardiovascular risk factors, statin use and other fatty acids. In similar models, a-linolenic acid related inversely to bifurcation and internal carotid artery (ICA)-IMT, while linoleic acid was directly related to ICA-IMT (P < 0.05, all). Conclusion: Increasing phospholipid proportions of n-3LC-PUFA, oleic acid and a-linolenic acid are associated with less atherosclerosis in subjects with primary dyslipidemia. High intakes of seafood and olive oil might explain in part the Spanish paradox of low CHD rates in face of a high burden of cardiovascular risk factors. P90 RECLASSIFICIATION OF 10 YEAR CHD RISK COMPARED BY PRESENCE OF CAROTID PLAQUE AND HIGH CRP V. Gudnason1,2 , S. Halldorsdottir1 , B. Thorsson1 , T. Aspelund1,2 . 1 Icelandic Heart Association Research Institute, Kopavogur, 2 University of Iceland, Reykjavik, Iceland Introduction: Carotid plaque and CIMT are used as surrogate markers for CAD. The REFINE Reykjavik Study is a population based study where the objective is to refine cardiovascular risk evaluation.
35
Aims: To compare reclassificiation within categories of 10 year Reykjavik study CHD risk using presence of carotid plaque and high CRP levels. Methods: Since 2006, 4025 subjects (51% women) aged 35−69 have been recruited from a random sample stratified by sex and age from the greater Reykjavik Area, with a response rate of 70%. Carotid plaque and CIMT were measured using ultrasound. At least moderate plaque defined the presence of plaque and high CIMT >75%. 3437 apparently healthy men without CHD history or statin use were analysed for10-year CHD risk based on classical risk factor levels and then reclassified by presence of carotid plaque and having high CRP (3 mg/L). All results were population weighted. Results: The table shows estimated prevalence of plaque, CIMT, high CRP, and combinations of conditions in men. Results were comparable for women. Table: Reclassification of CHD risk in men 10-year CHD risk categories
0−3%
3−6%
6−10%
10+ %
Total
Plaque
1.2%
4.9%
10.1%
25.3%
8.4%
Plaque or high IMT (>75%)
7.8%
21.0%
45.7%
66.9%
29.6%
CRP3 mg/L
10.3%
17.0%
19.6%
28.9%
17.3%
CRP3 mg/L AND plaque
0.2%
1.1%
1.5%
9.2%
2.3%
CRP3 mg/L AND (Plaque or high IMT)
1.1%
4.2%
9.9%
21.3%
7.4%
Conclusion: High CRP is frequent in all risk categories, but has little overlap with evidence of carotid artherosclerosis in either men or women. P91 INSTABILITY OF CORONARY PLAQUES IS CLINICALLY AND ANGIOGRAPHICALLY ASSOCIATED WITH SPECIFIC CRP-RECEPTOR SUBTYPE D. Raaz-Schrauder1 , L. Klinghammer1 , A.B. Ekici2 , M. Herrmann3 , W.G. Daniel1 , A. Reis2 , C.D. Garlichs1 . 1 Cardiology and Angiology, 2 Institute of Human Genetics, 3 Medical Clinic III, University Hospital Erlangen, Erlangen, Germany Purpose: Clinical outcome in patients with acute coronary syndromes (ACS) is strongly influenced by inflammation and its central mediator C-reactive protein (CRP). Recently, Fcc receptor IIa (FccRIIa) has been identified as the receptor for CRP. The aim of our study was to assess whether patients with ACS show a specific genetic subtype for FccRIIa (i.e. the allele H131 with weak CRP binding or R131 with strong CRP binding). Additionally, analyses of patients’ coronary angiograms evaluated the association of FccRIIa genetic subtype with appearance of intracoronary thrombus. Methods: We conducted a genetic association study among 701 consecutive patients with first event of ACS compared to 467 patients with stable angina pectoris. All patients were genotyped for a frequent functional polymorphism of the mature FccRIIa. Moreover, angiographic analyses classified patients’ angiograms according to the type and grade of stenoses as well as the presense of intracoronary thrombus. Results: The FccRIIa R/R131 genotype was significantly associated with ACS as the first manifestation of CAD (P = 1.2×10−9, odds ratio 2.86, 95% CI: 2.06–3.99) compared to the non-R/R131 genotype. Coronary angiograms of ACS patients with the FccRIIa R/R131 genotype showed significantly higher frequencies of intracoronary thrombus and more complex lesions as compared to ACS patients with non-R/R131. Conclusions: Our data show a genetic association of the FccRIIa R/R131 genotype with a more frequent occurrence of ACS as the first manifestation of CAD. Moreover, coronary lesions of ACS patients with this genotype show significantly higher complexity and frequently contain thrombus. P92 ENDOTHELIAL FUNCTION ASSESSED BY PERIPHERAL ARTERY TONOMETRY IS A DETERMINANT OF CAROTID INTIMAE-MEDIA THICKNESS REGARDLESS OF FRAMINGHAM RISK SCORE R. Ferre´ 1 , G. Aragones ` 2 , N. Plana1 , J. Merino2 , M. Heras2 , B. Coll3 , R. Cos2 , L. Masana1 . 1 Internal Medicine. Unitat de Medicina Vascular i Metabolisme, Hospital Sant Joan. Universitat Rovira i Virgili. CIBERDEM., 2 Unitat de Recerca de L´ıpids, Universitat Rovira i Virgili, CIBERDEM, Reus, 3 Hospital Arnau de Vilanova, Lleida, Spain Peripheral artery tonometry (PAT) seems to be a reliable clinical method to assess endothelial function (EF). Its correlation with carotid intimae-media thickness (cIMT) in patients with intermediate cardiovascular (CV) risk as assessed by the Framingham Risk Score (FRS) has not been established. Objective: To assess EF using PAT in patients with intermediate CV risk by FRS and determine its association with cIMT. Design: We studied 248 patients with intermediate CV risk and no history of cardiovascular disease. EF by PAT, cIMT and a physical exam, as well as anthropometrical and biochemical studies were performed. Results: EF assessed by PAT, along with LDL and age, was the main predictor of increased cIMT. PAT values were independent of FRS. PAT was lower in men than women (P = 0.025). Smokers also had a lower PAT (P = 0.004). In a bivariate correlation analysis, the PAT ratio was inversely associated with waist
Atherosclerosis Supplements 11, no. 2 (2010) 17–108
Supported by NHF grant 2006B258 P88 CARDIOVASCULAR FUNCTION AND PSYCHOLOGICAL DISTRESS IN URBANISED BLACK SOUTH AFRICANS: THE SABPA STUDY N. Mashele1 , J.M. Van Rooyen1 , L. Malan1 , J.C. Potgieter2 , Hypertension in African Research Team (HART). 1 Physiology, 2 Psychology, North-West University, Potchefstroom, South Africa The increased prevalence of cardiovascular disease (CVD) risk factors in SubSaharan Africa has increased the prevalence of CVD in this region but whether psychological distress contributes to this observed increased risk remains largely unclear. Objective: The aim of this study was to investigate the association between psychological distress and CVD risk in urbanised black South African men (n = 101) and women (n = 99). Methods: Resting cardiovascular variables were obtained by making use of the Finometer device and 24 hour ambulatory blood pressure measurements with the Cardiotens apparatus. The psychological questionnaires assessed the perception of health (General Health Questionnaire; GHQ-28) and depression status (DSM-IV criteria). The resting ECG (NORAV PC-1200) was used to determine left ventricular hypertrophy (LVH) by making use of the Cornell product. Confounders included age, obesity, alcohol, smoking and physical activity. Results: The hypertensive group were more overweight with lower vascular compliance and higher LVH (only men) compared to the normotensive groups. In hypertensive men, perception of health (somatic symptoms) was positively associated with blood pressure, while in hypertensive women it was associated with heart rate. Major depression was associated with LVH in hypertensive men and mean arterial pressure in hypertensive women. LVH and depression showed Odds ratios of 1.02 [95% CI 0.997–1.05] and 1.15 [95% CI 1.01–1.32] respectively, in predicting hypertension in women. Conclusions: Psychological distress was associated with higher blood pressure in hypertensive African men but also with development of left ventricular hypertrophy in hypertensive African men and women. Keywords: Depression; perception of health; cardiovascular function; urbanised Africans; hypertension. P89 FATTY ACIDS IN SERUM PHOSPHOLIPIDS AND CAROTID INTIMA-MEDIA THICKNESS IN SPANISH SUBJECTS WITH PRIMARY DYSLIPIDEMIA 1 A. Sala-Vila1 , M. Cofan ´ 1 , A. Perez-Heras ´ , I. Nu´ nez ˜ 2 , R. Gilabert2 , M. Junyent1 , R. Mateo-Gallego3 , A. Cenarro3 , F. Civeira3 , E. Ros1 . 1 Lipid Unit; Nutrition and Endocrinology Survey, 2 Diagnosing Imaging Center, Institut ` d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Cl´ınic, Barcelona, 3 Lipid Unit, Hospital Miguel Servet, Zaragoza, Spain Introduction: n-3 Long-chain polyunsaturated fatty acids (n-3LC-PUFA) protect from coronary heart disease (CHD). Spain shares with Japan both low fatal and non-fatal CHD rates and high seafood intake. Objective: To investigate the relationship between n-3LC-PUFA status in serum phospholipids as biomarkers of seafood intake and carotid atherosclerosis in Spanish subjects at risk for CHD. Design: In a cross-sectional study, 451 asymptomatic subjects (261 men, 190 women, mean age 45 years) with primary dyslipidemia had fatty acids measured in serum phosphatidylcholine and carotid intima-media thickness (IMT) determined by ultrasound. Fatty food and seafood intake was evaluated in a random subsample of 70 participants. Results: Phosphatidylcholine fatty acid composition and mean daily consumption of olive oil (39 g) and seafood (76 g) were similar to those reported for Spanish populations. Multiple regression analyses showed that eicosapentaenoic + docosahexaenoic acids (b = −0.094, P = 0.015) and oleic acid (b = −0.107, P = 0.005) proportions were inversely related to mean common carotid artery IMT after adjustment for cardiovascular risk factors, statin use and other fatty acids. In similar models, a-linolenic acid related inversely to bifurcation and internal carotid artery (ICA)-IMT, while linoleic acid was directly related to ICA-IMT (P < 0.05, all). Conclusion: Increasing phospholipid proportions of n-3LC-PUFA, oleic acid and a-linolenic acid are associated with less atherosclerosis in subjects with primary dyslipidemia. High intakes of seafood and olive oil might explain in part the Spanish paradox of low CHD rates in face of a high burden of cardiovascular risk factors. P90 RECLASSIFICIATION OF 10 YEAR CHD RISK COMPARED BY PRESENCE OF CAROTID PLAQUE AND HIGH CRP V. Gudnason1,2 , S. Halldorsdottir1 , B. Thorsson1 , T. Aspelund1,2 . 1 Icelandic Heart Association Research Institute, Kopavogur, 2 University of Iceland, Reykjavik, Iceland Introduction: Carotid plaque and CIMT are used as surrogate markers for CAD. The REFINE Reykjavik Study is a population based study where the objective is to refine cardiovascular risk evaluation.
35
Aims: To compare reclassificiation within categories of 10 year Reykjavik study CHD risk using presence of carotid plaque and high CRP levels. Methods: Since 2006, 4025 subjects (51% women) aged 35−69 have been recruited from a random sample stratified by sex and age from the greater Reykjavik Area, with a response rate of 70%. Carotid plaque and CIMT were measured using ultrasound. At least moderate plaque defined the presence of plaque and high CIMT >75%. 3437 apparently healthy men without CHD history or statin use were analysed for10-year CHD risk based on classical risk factor levels and then reclassified by presence of carotid plaque and having high CRP (3 mg/L). All results were population weighted. Results: The table shows estimated prevalence of plaque, CIMT, high CRP, and combinations of conditions in men. Results were comparable for women. Table: Reclassification of CHD risk in men 10-year CHD risk categories
0−3%
3−6%
6−10%
10+ %
Total
Plaque
1.2%
4.9%
10.1%
25.3%
8.4%
Plaque or high IMT (>75%)
7.8%
21.0%
45.7%
66.9%
29.6%
CRP3 mg/L
10.3%
17.0%
19.6%
28.9%
17.3%
CRP3 mg/L AND plaque
0.2%
1.1%
1.5%
9.2%
2.3%
CRP3 mg/L AND (Plaque or high IMT)
1.1%
4.2%
9.9%
21.3%
7.4%
Conclusion: High CRP is frequent in all risk categories, but has little overlap with evidence of carotid artherosclerosis in either men or women. P91 INSTABILITY OF CORONARY PLAQUES IS CLINICALLY AND ANGIOGRAPHICALLY ASSOCIATED WITH SPECIFIC CRP-RECEPTOR SUBTYPE D. Raaz-Schrauder1 , L. Klinghammer1 , A.B. Ekici2 , M. Herrmann3 , W.G. Daniel1 , A. Reis2 , C.D. Garlichs1 . 1 Cardiology and Angiology, 2 Institute of Human Genetics, 3 Medical Clinic III, University Hospital Erlangen, Erlangen, Germany Purpose: Clinical outcome in patients with acute coronary syndromes (ACS) is strongly influenced by inflammation and its central mediator C-reactive protein (CRP). Recently, Fcc receptor IIa (FccRIIa) has been identified as the receptor for CRP. The aim of our study was to assess whether patients with ACS show a specific genetic subtype for FccRIIa (i.e. the allele H131 with weak CRP binding or R131 with strong CRP binding). Additionally, analyses of patients’ coronary angiograms evaluated the association of FccRIIa genetic subtype with appearance of intracoronary thrombus. Methods: We conducted a genetic association study among 701 consecutive patients with first event of ACS compared to 467 patients with stable angina pectoris. All patients were genotyped for a frequent functional polymorphism of the mature FccRIIa. Moreover, angiographic analyses classified patients’ angiograms according to the type and grade of stenoses as well as the presense of intracoronary thrombus. Results: The FccRIIa R/R131 genotype was significantly associated with ACS as the first manifestation of CAD (P = 1.2×10−9, odds ratio 2.86, 95% CI: 2.06–3.99) compared to the non-R/R131 genotype. Coronary angiograms of ACS patients with the FccRIIa R/R131 genotype showed significantly higher frequencies of intracoronary thrombus and more complex lesions as compared to ACS patients with non-R/R131. Conclusions: Our data show a genetic association of the FccRIIa R/R131 genotype with a more frequent occurrence of ACS as the first manifestation of CAD. Moreover, coronary lesions of ACS patients with this genotype show significantly higher complexity and frequently contain thrombus. P92 ENDOTHELIAL FUNCTION ASSESSED BY PERIPHERAL ARTERY TONOMETRY IS A DETERMINANT OF CAROTID INTIMAE-MEDIA THICKNESS REGARDLESS OF FRAMINGHAM RISK SCORE R. Ferre´ 1 , G. Aragones ` 2 , N. Plana1 , J. Merino2 , M. Heras2 , B. Coll3 , R. Cos2 , L. Masana1 . 1 Internal Medicine. Unitat de Medicina Vascular i Metabolisme, Hospital Sant Joan. Universitat Rovira i Virgili. CIBERDEM., 2 Unitat de Recerca de L´ıpids, Universitat Rovira i Virgili, CIBERDEM, Reus, 3 Hospital Arnau de Vilanova, Lleida, Spain Peripheral artery tonometry (PAT) seems to be a reliable clinical method to assess endothelial function (EF). Its correlation with carotid intimae-media thickness (cIMT) in patients with intermediate cardiovascular (CV) risk as assessed by the Framingham Risk Score (FRS) has not been established. Objective: To assess EF using PAT in patients with intermediate CV risk by FRS and determine its association with cIMT. Design: We studied 248 patients with intermediate CV risk and no history of cardiovascular disease. EF by PAT, cIMT and a physical exam, as well as anthropometrical and biochemical studies were performed. Results: EF assessed by PAT, along with LDL and age, was the main predictor of increased cIMT. PAT values were independent of FRS. PAT was lower in men than women (P = 0.025). Smokers also had a lower PAT (P = 0.004). In a bivariate correlation analysis, the PAT ratio was inversely associated with waist