Secondary prevention in early coronary disease

179

Abstracts accepted for presentation in the abstract book OVERVIEW AND A T W O - Y E A R EVOLUTION OF SOME RISK FACTORS OF ATHEROSCLEROSIS IN F I R E F I G H T E R S J. Chaloupka, P Hlrbik, L. Opltovfi, S. Pelcfik, J. Zetocha. Purk3,ne Medical Academy, Tfebegskd 1575, 500 OI Hradec Krdlood. Czech Republic

Age Clinical presentation

In a group of 864 healthy firefighters (age 385=10 years, BMI 26.85=3.5 kg/m 2) we examined frequency and distribution range of some risk factors (BMI, blood pressure, plasma cholesterol, triglyceride, HDL cholesterol, glycemia, uric acid, PWC 170) 16,6% of firefighters were obese, 4.9% of the group members had higher blood pressure levels. Cholesterol levels in the moderate risk range were found in 39.6% and in the range o f high risk danger in 13.5% o f subjects. Lower HDL levels were observed in 38.8%, higher TAG levels in 23.8%, lower fitness level (PWCI70) in 16.8%, hyperglycemia in 2.2% and hyperuricemia in 27.5% of the group members. These first results led to recommendations to improve individual health status (dietary advice and changes in physical activity and possible longtreatment for hypertension or disturbances in the lipoprotein metabolism). A follow-up examination over two years evaluated the average results in the group of 101 firefighters and in particular among men showing changes in body weight and degree of fitness. In the entire group there was an increase in body weight (+1.9 kg), body mass index (+1.2 kg/m2), and HDL lipoprotein (+0.052 mmol/I, all p < 0.001 ). A decrease in blood pressure (systolic and diastolic), uric acid, (all p < 0.001) and cholesterol levels (p < 0.05) was observed. In persons showing a stable weight (difference +0.05 kg, NS), a drop in systolic blood pressure (p < 0.001) and cholesterol levels (p < 0.01) was measured, and an increase in HDL (p < 0.001) was observed. In the subgroup with BMI gain (+1.8 kg/m 2, p < 0.001 ) only a slight decrease in systolic blood pressure INS) and uric acid blood levels (p < 0.01), a slight decrease in W170/kg (NS), and an increase in triacylglycerols (p < 0.005) were observed. No changes of cholesterol, HDL cholesterol and atherogenic index were observed. In the subgroup showing an improvement in fitness level (+0.5 W/kg, p < 0.001), a decrease in systolic and diastolic blood pressure, AST and atherogenic index (all p < 0.001) was observed. An increase in HDL (p < 0.0I ) and a lower rate of increase in the weight and TAG levels were observed. Conclusion: Our results confirmed the experience of other authors that environmental and life style factors affect the organism and can influence the expressivity of coronary heart disease risk factors. Persons showing an improvement in fitness and/or no increase in weight produce within two years better results according to the anthropometric, physiologic and biochemical indicators than persons without any improvement in fitness and/or gain in BMI. EARLY CORONARY ARTERY DISEASE AND LEVELS OF LIPOPROTEIN(a)

Vessels

Cho/HDL

HDL

<_.40 years >40 years Infarction Angina 0 I 2 3 <4 4.-5 >5 <35 rng/dl 35-45 mg/dl >45 mg/dl

n

Lp~a)(mg/dl) p

66 163 165 64 13 49 42 28 14 25 190 146 58 25

23 36 36 27 12 27 34 63 36 23 33 33 29 49

0.02 ns

0.003

ns

ns

LIPID PROFILE IN NON-VIRAL ATYPICAL P N E U M O N I A

J.J.R. Reguero, G.I. Cubero, A. Batalla t, I.S. Posada, S. Braga, E. Bustillo, A. Cortina. Department of CardioloKv Hospital Central de Asturias, Ouiedo," t Hospital de Cabue~es, Go'on, Spain Purpose: To study the lipid profile in the community-acquired pneumonia and to evaluate these changes according to etiologic agents. Methods: Sixty consecutive patients, aged between 18 and 87 years, with suspected community-acquired pneumonia were included. On admission analytical studies for total cholesterol (TChol), HDL cholesterol (HDLChol), apolipoproteins AI (Apo Al) and B (Apo B) and triglycerides were carried out. Statistical analysis was made using the Student's "t" test for parametric variables and Mann-Withney test for non parametric ones. Results:

TChol (mmoYL) HDL Chol (retool/L) TG (mmol/L) Apo AI (g/I) Apo B (g/I)

ATYPICAL(n - 8}

OTHER(n = 52)

P

4.4i I 0.74-0.3 1.8±0.8 0.74-t-0.24 0 83+0.25

4.2-t-I 1.0-4-0.4 1.34-0.9 0.84-0.24 0.74+0.29

NS <0.03 <0.01 NS NS

Conclusions: Patients with non-viral atypical pneumonia present on admission higher triglycerides and lower HDL cholesterol values than those founded in the rest of acquired-pneumonia.

A. Batalla 1. J.J.R. Reguero, G.I. Cubero, S. Hevia, S. Braga. Cardiology Department, Hospital Central de Asturias. Ouiedo; I Ho.wital de Cabue~es, Gijrn, Spain

SECONDARY PREVENTION IN EARLY CORONARY DISEASE

Purpose: To study the Lp(a) distribution in the early coronary artery disease. Methods: Two-hundred and twenty-nine patients (pts) with a mean age of

Central de Asturias, Ooiedo; I Hospital de Cabue~es, Go'on, Spain

435=5 year and diagnosed with ischaemic heart disease (angina/infarction) were prospectively evaluated. One hundred and thirty-two pts underwent coronariographic study. After 12 hours of fasting blood samples were collected and Lp(a) levels determined using ELISA. Lp(a) was correlated with age, clinical presentation, HDL cholesterol (HDLchol), total cholesterol (Tcho)/HDLchol ratio and with vessels showing stenosis greater than 70%. The Kruskal-Wallis test was used for the statistical analysis. Results: See the table. Conclusions: Patients with three vessels disease had the greatest Lp(a) levels. Patients aged <40 year old showed lower Lp(a) concentration and coronary disease as compared with those older than 40 year old

A. Batalla 1 , G.I. Cubero, J.J.R. Reguero, S. Hevia, A. Veganzones, S. Braga, E. Bustillo, A. Cortina. Department of Cardiologj; Hospital

Purpose: To determine how many patients (pts) with early coronary artery disease are discharged with hypolipidemic drugs and how many of them reach the goal standard for LDL cholesterol (LDLchol) in secondary prevention. Methods: Prospectively, 230 male patients (mean age 43+5 years) consecutively hospitalized with an acute coronary event were studied before the discharge (7+4 days of hospitalization) and aRer a follow-up of 31+ 12 months. This study was observational and did not suppose any intervention in the treatment. A determination of the lipid profile was carried out in the same laboratory al~er fastening for 12 hours in order to calculate the LDLchol fraction. Results: See the table. Conclusions: In spite of the high LDL cholesterol levels at the hospitalization only a small percentage of patients are discharged on hypolipidemic therapy showing a mild increment during the follow-up. Moreover, only the

71st EAS Congress and Satellite Symposia

71st EAS Meeting Abstracts accepted for presentation in the abstract book

180

7 per cent of patients reached LDLchol levels lower than 100 mg/dl in the follow-up.

LDLchol > 100 mg/dl

Discharge (% of pts)

Follow-up (% of pls)

92

93

LDLchol > 130 mg/dl

71

73

Hypolipidemic drut~

37

49

CORONARY RISK FACTORS: A COMPARISON BETWEEN SEXES A. BatallaI , V. Barriales, G.I. Cubero, J.J.R. Reguero, 1. Larrafiaga, J.C. Sanmartin, A. Veganzones, A. Cortina. Department of Cardiology

Hospital Central de Asturias, Ooiedo; t Hospital de Cabue~es. Gijon, Spain Purpose: To determine the prevalence for sex of the well-known coronary risk factors in a Spanish sample consecutively admitted with an acute event in the coronary unit. Methods: From a cohort of 540 patients (pts), we made a group F of 250 females with a diagnosis of angina (160 pts) and acute myocardial infarction (90 pts) and a group M of 290 males (156 angina, 134 acute myocardial infarction). The variables (in percentage) studied were as follows: age, total cholesterol > 200 mg/dl (Tchol), triglycerides > 200 mg/dl (TG), diabetes, hypertension, left ventricular hypertrophy in EKG (LVH), tobacco and alcohol consumption Results: Group F

Group M

p

Age (years)

70+8

664-9

<0.00 I

Tchol (%1

35

26

<0.005

TG (%1

10

13

ns

Diabetes 1%)

12

II

ns

Hypertension (%)

48

38

<0.05

LVH (%1

16

8

<0.05

Tobacco 1%)

14

74

<0.001

Alcohol (%)

8

25

<0.001

Conclusions: In our sample, women had a coronary event later than men. Angina pectoris was the presentation more frequent in women and myocardial infarction in men. In addition, in comparison with men, women presented a significant greater prevalence of hypertension, left ventricular hypertrophy and hypercholesterolemia.

DYSLIP1DEMIA AS A RISK FACTOR OF CEREBRAL ATHEROSCLEROSIS AND THE TARGET FOR SECONDARY PREVENTION B.M. Lypovetsky, G.A. Churakov. Institute of the Human Brain, Institute

for Experimental Medicine, Russia The aim of the study is to estimate the importance of dyslipidemia (DLP) for cerebral atherosclerosis and ischemic stroke (IS). We observed 50 patients with IS (in the history) and chronic course of cerebrovascular disease (CVD): 36 men and 14 women (average age 51-t-2). The stenoses or occlusions o f carotids or intracerebral arteries in all the patients were confirmed by methods of dopplerography or cerebral angiography. Only 4 patients were found to have arterial blood pressure > 140/90 mm.Hg, there were no patients with diabetes. The average level of plasma lipids (mg/dl) was the following: total cholesterol - 234+ 12, low density lipo-protein (LDL) - 1554-11, triglycerides (TG) - 2174-36, high density lipoprotein (HDL) - 354-2, atherogenic index (AI) - (LDL-HDL): (HDL) = 6.14-0.5. LDL > 160 or TG > 160 or HDL < 36 mg/dl, were taken as the criterion of DLP. According to this criterion only 2 patients from 50 had no DLP (4%); 38% of the patients had the type II o f DLP, 40% of the patients had the type IV, 18% of the patients had low HDL plasma level. 50 patients were divided into 3 groups: 22 patients with IS ( 1), 14 patients with CVD however they had no IS (2), 14 patients had IS or CVD combined with ischemic heart disease (3). The patients in groups I and 2 were of the same age (49 and 51), the patients of group 3 were somewhat older (564-2).

Blood lipids in the 3 groups of patients with CVD I mg/dl) Groups

LDL

TG

HDL

AI

I

1424- I0

2024-30

2

1555:14

1784-22

35+2 37+2

5.5~:O4 5 4::i:0.2

3

174:t:26

2804-89

354-5

76:t:1.1

Group I consisted of 45% of the patients with DLP of the type IV and 27% of the patients with low HDL plasma level. Group 2 included 43% of the patients with DLP of the type !1 and 29% of the patients with type IV. In group 3 there were 57% of the patients with DLP of the type II and 43% of the patients with type IV. Thus the patients with IS as a rule had hypertriglyceridemia or a low level of plasma HDL; the patients with a chronic course of CVD are usually characterized by DLP of the type lla or lib or by hypertriglyceridemia; the patients with the combined damages of the cerebral and coronary arteries were more often marked by DLP of the types II or IV and their AI was the highest (7.6+1.1 versus 5.4-5.5 in groups 1 and 2). Our data showed that DLP was found almost in all the patients with IS and CVD and these patients needed selective drug therapy: the patients with DLP of the type IV or with low level of plasma HDL should receive fibrates; the patients with DLP of the type 11 - statins. FEATURES OF STRUCTURAL AND FUNCTIONAL ORGANIZATION OF ERYTHROCYTE CELL MEMBRANES IN CHD PATIENTS WITH NON-INSULINE DEPENDENT DIABETES MELLITUS (N1DDM) I.V. Medvedeva, E.E Dorodneva, M.A. Ushakova, I.E Sholomov. Medical Academy, Internal Medicine, Sooetskava St. 84-45. 625000 ~'uraen. Russia Membrane pathological changes have an important role in atherogenesis. Eighty two CHD patients (aged from 40 to 60 years) with stable stenocardia combined with NIDDM were examined in the course of study. The trial has convincingly demonstrated the lowering of total phospholipid level (p < 0.02) caused by considerable reduction of such main fractions of phospholipids as phosphatidylcholine (p < 0.001 ) and phosphatidylethanolamine (p < 0.001) in erythrocyte memebranes of CHD subjects with NIDDM as compared with the group of healthy individuals. At the same time there was indicated statistically reliable raised total cholesterol level (p < 0.05) in erythrocyte cell membranes especially induced by elevation of free cholesterol levels (p < 0.05) wich associated with a 1.3-fold increase of total cholesterol/total phospholipid ratio as compared with healthy subjects. The highest possible changes in structural and functional organization of erythrocyte cell membranes were observed in CHD patients with NIDDM and clinically manifested hypercholesterolemia. Besides total cholesterol elevation and total phospholipid lowering (p < 0.01 ) there has been revealed the high activity of the processes of lipid peroxidation on the background of enzyme link depression and compensatory tension of antiperoxide enzyme activity of antioxidated system in erythrocyte membrane in the same group of the examined persons. Thus, structural and functional organization of erythrocyte cell membranes in CHD patients tends to detorioration when combined with NIDDM and especially with clinically manifested hypercholesterolemia. OPEN LABEL NON COMPARATIVE STUDY OF THE EFFICACY TOLERABILITY AND SAFETY WITH FLUVASTATIN (LESCOL®) 40 MG ONCE DAILY DURING 12 WEEKS IN 79 ECUADORIAN DYSLIPIDEMIC PATIENTS WITH CORONARY HEART DISEASE J. Pfiez, L. Alvarado, D. Toral, B. Delgado. Carlos Andrade Marin Hospital.

Cardiology, Ayacucho; Portooiejo Street. Quito 17 11 06201, Ecuador Objectives: To evaluate the efficacy, safety and tolerability of Fluvastatin 40 mg in dyslipidemic patients with coronary heart disease. Design: This is an open label non comparative, multicenter study. Site: Hospitals: Andrade Matin, Maldonado Carbo, Corral Moscoso. Patients: 79 Ecuadorian patients, aged 36 to 83 years that also suffered other cardiovascular risk factors (hypertension, diabetes, obesity, smoking, family history o f coronary heart disease). Treatment: Fluvastatin 40 mg once daily during 84 days, divided in three phases: Baseline, entitled to 42 days and maintenance until day 84. Principal Measurement: Total cholesterol, LDL cholesterol, HDL Cholesterol, tryglicerides, TGO, TGP creatinine, LDL/HDL index adverse events.

71st EAS Congress and Satellite Symposia