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PT251 Does Seasonal Variation Impacts on Acute Myocardial Infarction Induced Hospitalization and Deaths Rates in Lithuania?
POSTER ABSTRACTS
PT247 High Density Lipoprotein Cholesterol Level and Severity of Coronary Artery Disease in Asian People Sang-Hyun Kim*1, Young-Joon Seong1, Hyang Lim Lee2, Hack-Lyoung Kim1, Jae Bin Seo1, Woo-Young Chung1, Joo-Hee Zo1, Myung-A. Kim1 1 Cardiology, Internal Medicine, Seoul Boramae Hospital, Seoul National University College of Medicine, 2Internal Medicine, Seoul Bukbu Hospital, Seoul, Korea, Republic Of Introduction: Blood level of low density lipoprotein cholesterol (LDL cholesterol) is the major risk factor of coronary artery disease (CAD). Low high density lipoprotein cholesterol (HDL cholesterol) level is one of risk factors of CAD in western countries. Mean HDL cholesterol level of Korean people is much lower than those of western or other Asian countries. But the prevalence of CAD is lower than those of western or other Asian countries. Objectives: The aim of this study was to investigate impact of HDL cholesterol level on prevalence and severity of CAD diagnosed in Korean People whose prevalence of CAD was much lower than those of western or other Asian countries. Methods: The subjects were 1884 Korean patients received the coronary angiography. The severity of CAD was determined by the number of involved vessels and Friesinger Score on angiography. The effects HDL cholesterol level on the development and severity of CAD were analyzed according to stratified subgroup and mean HDL cholesterol level. Results: As HDL cholesterol level decreased, the odds ratio of CAD prevalence increased proportionally. The patients with HDL cholesterol < 30mg/dL had 3.4 times higher risk than patients with HDL cholesterol 60mg/dL. The mean HDL cholesterol level was 43.5mg/dL, 41.0mg/dL, 38.5mg/dL, 37.5mg/dL respectively in the control group (without CAD), 1-vessel disease (VD), 2VD, 3VD. Even the subgroup analysis among patients with LDL cholesterol < 100mg/dL showed the significant correlation between HDL cholesterol level and the severity of coronary artery disease. The HDL cholesterol level was found to have significant negative association with Friesinger score (r¼-0.201, P<0.001). Conclusion: HDL cholesterol level was significantly associated with the prevalence and severity of CAD on coronary angiography in Korean people whose prevalence of CAD was much lower than those of western or other Asian countries. Disclosure of Interest: None Declared PT250 Impact of Insulin Treatment vs Oral Anti Diabetic Drugs on Coronary Lesions Morphology and Severity A Preliminary Study Vekky Sariowan*1, Bambang Budiono2, Reggy Lefrandt1, Agnes L. Panda1, Janry Pangemanan1, Benny Setiadi1, Steven R. Utomo1, Hariman Kristian1 1 Departement Cardiology and Vascular Medicine, Sam Ratulangi University, Manado, 2 Departement Cardiology and Vascular Medicine, Awal Bros Hospital, Makassar, Indonesia Introduction: It had been known that diabetic patients tend to have more severe and difuse pattern of CAD as compared to non diabetic patients, but no previous study has been done to investigate the relation between type of diabetic treatment to the morphology and severity of coronary artery lesion. Objectives: The aim of this study is to investigate the association of diabetes treatment (insulin vs oral anti diabetic drugs) to the morphology and severity of coronary artery lesions in type 2 diabetes mellitus patients. Methods: This is a cross sectional study which include type 2 diabetic patients who underwent coronary angiography between October 2012 to August 2013. Patients were divided into two groups, which include oral anti diabetic drugs (OAD) group and insulin group. The association between diabetes treatment to the morphology of coronary artery lesion assessed by Society of Coronary Angiography and Intervention (SCAI) lesion class and the number of vessel disease were analyzed. Statistical analysis was done using SPSS 16.0 software. P value <0.05 was considered statistically significant. Results: A total 49 patients were included in this study, in which 25 patients (51%) belong to the OAD group and 24 patients (49%) belong to the insulin group. The only difference found between the two group was the value of fasting blood glucose in the OAD group and insulin group (194.5 56 vs 163.2 42.7, P ¼ 0.021, respectively). Diabetic patients with insulin therapy significantly have a higher risk to develop SCAI class IV lesion classification (OR 4.2, P ¼ 0.045) and three vessel disease (OR 4.43, P ¼ 0.035). From the multivariate analysis, insulin treatment is an independent predictor of class IV SCAI lesion classification (OR 7.73, P ¼ 0.028). However, insulin therapy is not an independent predictor of three vessel disease. Conclusion: Diabetic patients with insulin therapy have a significant risk to develop class IV SCAI lesion classification and three vessel disease. Insulin therapy is an independent predictor to develop class IV SCAI lesion. This finding may explain why diabetic patients who undergo PCI and treated with insulin has the worst outcomes. Disclosure of Interest: None Declared PT251 Does Seasonal Variation Impacts on Acute Myocardial Infarction Induced Hospitalization and Deaths Rates in Lithuania? Pranas Serpytis*1,2, Jonas Misiura1,2, Egidijus Berukstis1,2, Simona Pelanyte2, Rokas Serpytis1, Robertas Katliorius1 1 Clinic of Cardiac and Vascular Diseases, Vilnius University Hospital Santariskiu Klinikos, 2 Faculty of Medicine, Vilnius University, Vilnius, Lithuania Introduction: The first data on enviromental and seasonal effect on human health was published in 1926. Though the data on the seasonal variation effect on cardiac health is very scarce.
e214
Objectives: Aim of the study was to evaluate possible seasonal variantion in men and women hospitalization and case-fatality rates of acute myocardial infarction in Vilnius University Hospital Santariskes Clinics, Cardiac and Intensive Care unit during the 2000 – 2010 years period. Methods: We analysed 15333 hospitalized due to acute myocardial infarction patients cases. Median age was 72 1,5 years. 931 patients deaths were caused by the acute myocardial infarction during the exploring period. There were estimated hospitalization and deaths from acute myocardial infarction rates through the four seasons. Results: There were observed 7 % - 10% more men died from acute myocardial infarction in spring and 8% - 11% more in autumn, rather than number of the deaths in winter or summer. In the women group 10% – 11% more died in spring and 12% – 13% in autumn, compare with other seasons. Conclusion: Study demonstrated the significant seasonal variation in the hospitalizations rates and deaths from acute myocardial infarction, with more common morbidity in March – April – May and higher mortality rate in March - April and in September – October – Noverber months. Patients older than 55 years have approximately 3,5 – 4,5 times higher mortality due to acute myocardial infarction risk, compare with younger patients. Disclosure of Interest: None Declared PT252 Independent Association of Severe Vitamin D Deficiency As a Risk of Acute Myocardial Infarction in Indians Ambuj Roy*1, D. Prabhakaran2, R. Lakshmy3, N. Tandon4, Tariq Rana3, V. K. Bahl1, K. S. Reddy5 1 Cardiology, All India Institute of Medical Sciences, 2Centre for Chronic Disease Control, 3 Cardiac Biochemistry, 4Endocrinology, All India Institute of Medical Sciences, 5Public health Foundation of India, New Delhi, India Introduction: Vitamin D deficiency has been associated with coronary heart disease (CHD). Emerging data from India has shown high prevalence of vitamin D deficiency despite abundant sunshine in large parts of India.Thus it would be useful to determine the role of this novel and potentially reversible risk factor of CHD in Indians. Objectives: To study the association of vitamin D with acute myocardial infarction (MI) in Indians by analyzing 25 hydroxy vitamin D (25(OH) D) levels in cases of MI and age and gender matched healthy controls. Methods: Consecutive cases of first incident MI (n¼120) and controls (n¼120) were recruited in the study at All India Institute of Medical Sciences, New Delhi. The clinical and biochemical risk factors were assessed for both cases and controls. 25 (OH) D assay was measured from stored samples for cases and controls using standard gold procedure radioimmunoassay. Results: The mean age of cases and controls was 51.9 11.4 and 52.1 11.0 years respectively. 25(OH) D deficiency (< 30ng/ml) was extremely common in cases and controls (98.3% and 95.8% respectively) with median levels significantly lower in cases (Table 1). The cases were more frequently diabetic, hypertensive, tobacco and alcohol consumers. They had higher mean waist hip ratio (WHR), total and LDL cholesterol (Table 1).Severe vitamin D deficiency (<10ng/ml) was strongly associated with a risk of MI with an odds ratio of 4.6 (95% CI 2.3-9.4), even after adjusting for known confounders like hypertension, diabetes, cholesterol, smoking, alcohol use and WHR. Table 1. The characteristics of the cases and controls. Cases
Controls
Hypertensive
34.2%
12.5%
p value <0.00
Diabetics
40.0%
20.0%
<0.00
Waist Hip Ratio
0.950.06
0.920.07
<0.00
Total Chol (mean) (mg/dl)
194.1 62.8
177.538.1
0.01
HDL Chol (mean) (mg/dl)
39.19.9
40.310.4
0.3
LDL Chol (mean) (mg/dl)
123.756.3
108.338.5
25 (OH)VitD levels (ng/ml) (median)
6.0(3.9-9.0)
11.1(6.5-18.3)
0.01 <0.00
* in mg/dl; Chol¼Cholesterol
Conclusion: This study shows that vitamin D deficiency is very common among patients of acute MI and healthy controls, with levels of 25 (OH) D being significantly lower among cases. It for the first time reveals that severe vitamin D deficiency is associated with a strong risk of acute MI in Indians. This association needs to be tested in larger cross-sectional and cohort studies. Population awareness of vitamin D deficiency must be created and its skeletal and possible cardiovascular harm should be mitigated by encouraging sun exposure and food fortification. Disclosure of Interest: None Declared PT253 Understanding the impact of a multifaceted quality improvement intervention to improve cardiovascular disease risk management in Australian Primary Health Care: The TORPEDO study process evaluation Bindu Patel*1,2, Tim Usherwood3, Mark Harris4, Katie Panaretto5, Julie Redfern1, Jesse Jansen2, Shannon McKinn2, Marilyn Lyford1, Anushka Patel2,6,7, David Peiris2,8 1 Cardiovascular Division, The George Institute for Global Health, 2School of Medicine, University of Sydney, Camperdown, 3Department of General Practice, Sydney Medical School-Westmead,
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
PT247 High Density Lipoprotein Cholesterol Level and Severity of Coronary Artery Disease in Asian People Sang-Hyun Kim*1, Young-Joon Seong1, Hyang Lim Lee2, Hack-Lyoung Kim1, Jae Bin Seo1, Woo-Young Chung1, Joo-Hee Zo1, Myung-A. Kim1 1 Cardiology, Internal Medicine, Seoul Boramae Hospital, Seoul National University College of Medicine, 2Internal Medicine, Seoul Bukbu Hospital, Seoul, Korea, Republic Of Introduction: Blood level of low density lipoprotein cholesterol (LDL cholesterol) is the major risk factor of coronary artery disease (CAD). Low high density lipoprotein cholesterol (HDL cholesterol) level is one of risk factors of CAD in western countries. Mean HDL cholesterol level of Korean people is much lower than those of western or other Asian countries. But the prevalence of CAD is lower than those of western or other Asian countries. Objectives: The aim of this study was to investigate impact of HDL cholesterol level on prevalence and severity of CAD diagnosed in Korean People whose prevalence of CAD was much lower than those of western or other Asian countries. Methods: The subjects were 1884 Korean patients received the coronary angiography. The severity of CAD was determined by the number of involved vessels and Friesinger Score on angiography. The effects HDL cholesterol level on the development and severity of CAD were analyzed according to stratified subgroup and mean HDL cholesterol level. Results: As HDL cholesterol level decreased, the odds ratio of CAD prevalence increased proportionally. The patients with HDL cholesterol < 30mg/dL had 3.4 times higher risk than patients with HDL cholesterol 60mg/dL. The mean HDL cholesterol level was 43.5mg/dL, 41.0mg/dL, 38.5mg/dL, 37.5mg/dL respectively in the control group (without CAD), 1-vessel disease (VD), 2VD, 3VD. Even the subgroup analysis among patients with LDL cholesterol < 100mg/dL showed the significant correlation between HDL cholesterol level and the severity of coronary artery disease. The HDL cholesterol level was found to have significant negative association with Friesinger score (r¼-0.201, P<0.001). Conclusion: HDL cholesterol level was significantly associated with the prevalence and severity of CAD on coronary angiography in Korean people whose prevalence of CAD was much lower than those of western or other Asian countries. Disclosure of Interest: None Declared PT250 Impact of Insulin Treatment vs Oral Anti Diabetic Drugs on Coronary Lesions Morphology and Severity A Preliminary Study Vekky Sariowan*1, Bambang Budiono2, Reggy Lefrandt1, Agnes L. Panda1, Janry Pangemanan1, Benny Setiadi1, Steven R. Utomo1, Hariman Kristian1 1 Departement Cardiology and Vascular Medicine, Sam Ratulangi University, Manado, 2 Departement Cardiology and Vascular Medicine, Awal Bros Hospital, Makassar, Indonesia Introduction: It had been known that diabetic patients tend to have more severe and difuse pattern of CAD as compared to non diabetic patients, but no previous study has been done to investigate the relation between type of diabetic treatment to the morphology and severity of coronary artery lesion. Objectives: The aim of this study is to investigate the association of diabetes treatment (insulin vs oral anti diabetic drugs) to the morphology and severity of coronary artery lesions in type 2 diabetes mellitus patients. Methods: This is a cross sectional study which include type 2 diabetic patients who underwent coronary angiography between October 2012 to August 2013. Patients were divided into two groups, which include oral anti diabetic drugs (OAD) group and insulin group. The association between diabetes treatment to the morphology of coronary artery lesion assessed by Society of Coronary Angiography and Intervention (SCAI) lesion class and the number of vessel disease were analyzed. Statistical analysis was done using SPSS 16.0 software. P value <0.05 was considered statistically significant. Results: A total 49 patients were included in this study, in which 25 patients (51%) belong to the OAD group and 24 patients (49%) belong to the insulin group. The only difference found between the two group was the value of fasting blood glucose in the OAD group and insulin group (194.5 56 vs 163.2 42.7, P ¼ 0.021, respectively). Diabetic patients with insulin therapy significantly have a higher risk to develop SCAI class IV lesion classification (OR 4.2, P ¼ 0.045) and three vessel disease (OR 4.43, P ¼ 0.035). From the multivariate analysis, insulin treatment is an independent predictor of class IV SCAI lesion classification (OR 7.73, P ¼ 0.028). However, insulin therapy is not an independent predictor of three vessel disease. Conclusion: Diabetic patients with insulin therapy have a significant risk to develop class IV SCAI lesion classification and three vessel disease. Insulin therapy is an independent predictor to develop class IV SCAI lesion. This finding may explain why diabetic patients who undergo PCI and treated with insulin has the worst outcomes. Disclosure of Interest: None Declared PT251 Does Seasonal Variation Impacts on Acute Myocardial Infarction Induced Hospitalization and Deaths Rates in Lithuania? Pranas Serpytis*1,2, Jonas Misiura1,2, Egidijus Berukstis1,2, Simona Pelanyte2, Rokas Serpytis1, Robertas Katliorius1 1 Clinic of Cardiac and Vascular Diseases, Vilnius University Hospital Santariskiu Klinikos, 2 Faculty of Medicine, Vilnius University, Vilnius, Lithuania Introduction: The first data on enviromental and seasonal effect on human health was published in 1926. Though the data on the seasonal variation effect on cardiac health is very scarce.
e214
Objectives: Aim of the study was to evaluate possible seasonal variantion in men and women hospitalization and case-fatality rates of acute myocardial infarction in Vilnius University Hospital Santariskes Clinics, Cardiac and Intensive Care unit during the 2000 – 2010 years period. Methods: We analysed 15333 hospitalized due to acute myocardial infarction patients cases. Median age was 72 1,5 years. 931 patients deaths were caused by the acute myocardial infarction during the exploring period. There were estimated hospitalization and deaths from acute myocardial infarction rates through the four seasons. Results: There were observed 7 % - 10% more men died from acute myocardial infarction in spring and 8% - 11% more in autumn, rather than number of the deaths in winter or summer. In the women group 10% – 11% more died in spring and 12% – 13% in autumn, compare with other seasons. Conclusion: Study demonstrated the significant seasonal variation in the hospitalizations rates and deaths from acute myocardial infarction, with more common morbidity in March – April – May and higher mortality rate in March - April and in September – October – Noverber months. Patients older than 55 years have approximately 3,5 – 4,5 times higher mortality due to acute myocardial infarction risk, compare with younger patients. Disclosure of Interest: None Declared PT252 Independent Association of Severe Vitamin D Deficiency As a Risk of Acute Myocardial Infarction in Indians Ambuj Roy*1, D. Prabhakaran2, R. Lakshmy3, N. Tandon4, Tariq Rana3, V. K. Bahl1, K. S. Reddy5 1 Cardiology, All India Institute of Medical Sciences, 2Centre for Chronic Disease Control, 3 Cardiac Biochemistry, 4Endocrinology, All India Institute of Medical Sciences, 5Public health Foundation of India, New Delhi, India Introduction: Vitamin D deficiency has been associated with coronary heart disease (CHD). Emerging data from India has shown high prevalence of vitamin D deficiency despite abundant sunshine in large parts of India.Thus it would be useful to determine the role of this novel and potentially reversible risk factor of CHD in Indians. Objectives: To study the association of vitamin D with acute myocardial infarction (MI) in Indians by analyzing 25 hydroxy vitamin D (25(OH) D) levels in cases of MI and age and gender matched healthy controls. Methods: Consecutive cases of first incident MI (n¼120) and controls (n¼120) were recruited in the study at All India Institute of Medical Sciences, New Delhi. The clinical and biochemical risk factors were assessed for both cases and controls. 25 (OH) D assay was measured from stored samples for cases and controls using standard gold procedure radioimmunoassay. Results: The mean age of cases and controls was 51.9 11.4 and 52.1 11.0 years respectively. 25(OH) D deficiency (< 30ng/ml) was extremely common in cases and controls (98.3% and 95.8% respectively) with median levels significantly lower in cases (Table 1). The cases were more frequently diabetic, hypertensive, tobacco and alcohol consumers. They had higher mean waist hip ratio (WHR), total and LDL cholesterol (Table 1).Severe vitamin D deficiency (<10ng/ml) was strongly associated with a risk of MI with an odds ratio of 4.6 (95% CI 2.3-9.4), even after adjusting for known confounders like hypertension, diabetes, cholesterol, smoking, alcohol use and WHR. Table 1. The characteristics of the cases and controls. Cases
Controls
Hypertensive
34.2%
12.5%
p value <0.00
Diabetics
40.0%
20.0%
<0.00
Waist Hip Ratio
0.950.06
0.920.07
<0.00
Total Chol (mean) (mg/dl)
194.1 62.8
177.538.1
0.01
HDL Chol (mean) (mg/dl)
39.19.9
40.310.4
0.3
LDL Chol (mean) (mg/dl)
123.756.3
108.338.5
25 (OH)VitD levels (ng/ml) (median)
6.0(3.9-9.0)
11.1(6.5-18.3)
0.01 <0.00
* in mg/dl; Chol¼Cholesterol
Conclusion: This study shows that vitamin D deficiency is very common among patients of acute MI and healthy controls, with levels of 25 (OH) D being significantly lower among cases. It for the first time reveals that severe vitamin D deficiency is associated with a strong risk of acute MI in Indians. This association needs to be tested in larger cross-sectional and cohort studies. Population awareness of vitamin D deficiency must be created and its skeletal and possible cardiovascular harm should be mitigated by encouraging sun exposure and food fortification. Disclosure of Interest: None Declared PT253 Understanding the impact of a multifaceted quality improvement intervention to improve cardiovascular disease risk management in Australian Primary Health Care: The TORPEDO study process evaluation Bindu Patel*1,2, Tim Usherwood3, Mark Harris4, Katie Panaretto5, Julie Redfern1, Jesse Jansen2, Shannon McKinn2, Marilyn Lyford1, Anushka Patel2,6,7, David Peiris2,8 1 Cardiovascular Division, The George Institute for Global Health, 2School of Medicine, University of Sydney, Camperdown, 3Department of General Practice, Sydney Medical School-Westmead,
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters