STATIN THERAPY DECREASES VO2PEAK WITHOUT AFFECTING EXERCISE ENDURANCE, ENDOTHELIAL FUNCTION OR ARTERIAL STIFFNESS AMONG SUBJECTS WITH PRIMARY UNTREATED HYPERCHOLESTEROLEMIA

Abstracts

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Objective: 1) To compare VO2 peak, cardiac output (CO) and cerebral oxygenation/perfusion (COP) in heart transplant recipients (HTR) and age-matched controls (AMC) during maximal exercise (ME), 2) to study the relationships between VO2 peak, CO, COP in HTR and AMC. 27 AMC and 26 HTR were recruited. VO2 peak and cardiac hemodynamic (impedance cardiography) were measured during a ME. COP (O2Hb, tHb) was measured using near-infrared spectroscopy (NIRS). RESULTS: Compared to AMC, HTR had a lower VO2 peak (ml/min/kg of lean body mass), maximal (max) cardiac index (CImax), max ventilation, max tidal volume and max respiratory frequency vs. AMC (P<0,0001). End-systolic volume index and systemic vascular resistance index were higher in HTR (P<0,05). At 50% and 75% of peak, O2Hb was lower in HTR (P<0,05). At 100% of peak, tHb was lower in HTR (P<0,05). At recovery, O2Hb and tHb were lower in HTR (P<0,05). VO2 peak (ml/ min/kg) and CImax were correlated to DO2Hb (R¼0,33 and 0,36, P<0,05) and DtHb (R¼0,35 and 0,44, P<0,01). CONCLUSION: VO2 peak is reduced in HTR because of central, ventilator, peripheral factors and medication. Lower VO2 peak and CImax in HTR does not seem to really affect COP during exercise. During exercise, our results suggest a lower O2 saturation in HTR. In HTR, the lower tHb at ME could be due to a better physical capacity in AMC. In HTR, differences in COP during recovery could be explained by the absence of cardiac overshoot phenomenon, medication and/or endothelial dysfunction.

end-diastolic volume indexes (P<0.05), but the DHHb was lower in OB (P<0.05). Cognitive function was similar between groups when defining obesity as % body fat. VO2 peak was related to cognitive functions (short term-working memory, processing speed, inhibition and mental flexibility: R¼-0.32 to 0.43, P<0.05) but not cardiac index (CI). CONCLUSION: 1) OB subjects have a lower VO2 peak (including VO2 peak adjusted for lean body mass) compared to AMCH, indicating lower cardiorespiratory fitness. 2) Cognitive function was similar between groups when defining obesity as % body fat. However, visceral adiposity defined by % of trunk fat mass correlated significantly with short-term memory(Forward Empan), inhibition and mental flexibility (stroop 3 and stroop 4). 3) Because of similar DO2Hb during exercise between groups and because DHHb (mM) was significantly reduced in OB, these results suggest a reduced O2Hb extraction in OB. However, reduced DHHB in OB was not associated with impaired cognitive function. 4) In all subjects, parameters assessing the main executive functions were correlated to VO2 peak but not the CO or CI.

492 CEREBRAL OXYGENATION/PERFUSION, CARDIAC HEMODYNAMICS DURING EXERCISE AND COGNITIVE FUNCTIONS IN OBESE PATIENTS

P Sosner, M Gayda, G Mitchell, J Lalongé, M Juneau, J Tardif, A Nigam

METHODS:

G Lapierre, O Dupuis, S Frazer, L Bherer, V Labelle, M Juneau, V Gremeaux, M Gayda Montréal, Québec BACKGROUND:

Obesity is associated with an accelerated rate of cognitive decline in memory, attention, processing speed and executive functions resulting in a higher risk of dementia and Alzheimer’s disease (AD) in later life. In cardiac patients showing mild cognitive impairments, cerebral O2Hb correlates with VO2 peak and left ventricular ejection fraction, reflecting a link between cardiac output and cerebral O2Hb during maximal exercise. METHODS: Objectives:1) To compare cerebral oxygenation/ perfusion (COP), central hemodynamics, VO2 peak and cognitive functions in obese patients (OB) and age-matched healthy controls (AMHC) 2) to study the relationships between VO2 peak, cardiac output (CO),cognitive functions in OB. 21 AMHC and 33 OB subjects were recruited. VO2 peak (ml/min/ LBM), cardiac hemodynamics (impedance cardiography) and COP (near-infrared spectroscopy) were measured during a maximal incremental ergocycle test. Cognitive function assessments (standard battery, paper-pen tests) included: short termworking memory, perceptual abilities, processing speed, inhibition and mental flexibility and long-term verbal memory. RESULTS: Compared to AMHC, OB had a lower VO2 peak, lower ejection fraction (EF%), and higher end-systolic and

493 STATIN THERAPY DECREASES VO2PEAK WITHOUT AFFECTING EXERCISE ENDURANCE, ENDOTHELIAL FUNCTION OR ARTERIAL STIFFNESS AMONG SUBJECTS WITH PRIMARY UNTREATED HYPERCHOLESTEROLEMIA

Montréal, Québec BACKGROUND: Statin therapy may have beneficial effects on conduit vessel compliance and endothelial function. We sought to study the effect of statin therapy on endothelial function, aortic stiffness, and its potential impact on VO2peak and submaximal exercise endurance. METHODS: In this double-blind, placebo-controlled trial, 20 patients with primary untreated hypercholesterolemia and free of cardiovascular disease (5610 years, 12 men, BMI: 274 kg/m2, blood pressure: 126/7812/5 mm Hg) were randomized 1:1 to pravastatin 40 mg daily or placebo for 12 weeks. Endothelial function (flow mediated dilatation (FMD)), aortic stiffness (carotid-femoral pulse wave velocity (cfPWV)), VO2peak on a maximal exercise test and submaximal endurance time were measured. RESULTS: In pre/post comparisons in statin group, we observed a decrease in LDL-cholesterol (4.490.34 vs. 3.030.73 mmol/L, P¼0.01, g¼0.79), no change in FMD (7.03.7 vs. 10.14.7 %, P¼0.12, g¼-0.34), cfPWV (7.691.87 vs. 8.282.17 m/s, P¼0.17, g¼-0.14) or submaximal exercise duration (1326649 vs. 1230862 sec, P¼0.67, g¼0.06), but a decrease in VO2peak that was unchanged in placebo group (Figure 1). CONCLUSION: In patients with previously untreated hypercholesterolemia, 12-weeks of statin therapy had deleterious effects on cardiorespiratory fitness assessed by VO2peak.

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Canadian Journal of Cardiology Volume 30 2014 CONCLUSION:

The FFQ demonstrates good reproducibility and validity for energy and most key nutrients of the Mediterranean diet as well as low gross misclassification of subjects into quartiles of intake. Moreover, the validity of the FFQ reveals to be comparable to other largely used FFQs. Therefore, these results support the eventual use of the FFQ in clinical trials on the Mediterranean diet.

Hedge’s (g) effect size: small (0.20.8). Data are mean and SD (left) or standard error (right). Centre ÉPIC, MHI 494 VALIDATION OF A MEDITERRANEAN FOOD FREQUENCY QUESTIONNAIRE FOR THE POPULATION OF QUÉBEC J Cantin, S Lacroix, É Latour, J Lambert, J Lalongé, M Faraj, A Nigam Montréal, Québec BACKGROUND:

The Mediterranean diet has been shown to reduce all-cause and cardiovascular mortality as well as improve cardiometabolic risk profile, endothelial function and reduce markers of vascular inflammation. Since cardiovascular disease is the second cause of death in Canada, randomized clinical trials evaluating the efficacy of the Mediterranean diet in high-risk primary and secondary prevention are warranted. In order to conduct such studies, validated dietary assessment Methods specific to population and food habits are needed. Therefore, the aim of our study was to assess the reproducibility and the relative validity of a quantitative food frequency questionnaire (FFQ) focused on the Mediterranean diet to be used in clinical trials at the Montréal Heart Institute’s Prevention Center. METHODS: Fifty (50) participants (54% (27 of 50) women) aged 19 to 86 years with and without coronary disease were recruited, and randomized in 3 groups in a crossover design where the sequence of administration of questionnaires differed in each group. The FFQ includes 157 food items and was designed to measure food intake over one month. It was administered twice 3 to 5 weeks apart to assess reproducibility and was compared to a 12-day dietary record carried out over a 1-month period to assess validity. Participants were asked not to modify their diet for the duration of the study. FFQs were self-administered and reviewed by a registered dietician. All questionnaires were analyzed using The Food Processor software. RESULTS: For reproducibility (n ¼ 47), intraclass correlation coefficients (ICC) for energy and 25 nutrients ranged from 0.38 (95% confidence interval (CI), > 0.15) for folate to 0.91 (95% CI, > 0.85) for alcohol (mean 0.63). For validity (n ¼ 48), ICCs ranged from 0.36 (95% CI, > 0.14) for potassium to 0.85 (95% CI, > 0.77) for alcohol (mean 0.57). Gross misclassification of subjects in extreme quartiles of energy and nutrient intake revealed to be between 2% and 6% for energy and each nutrient assessed.

495 A CROSS-SECTIONAL SURVEY OF CARDIOMETABOLIC RISK FACTORS IN PRIMARY CARE PATIENTS WITH ABDOMINAL OBESITY IN CANADA DC Lau, LA Leiter, J Genest, SB Harris, P Selby, V Taylor, M Bujas-Bobanovic, J Stewart Calgary, Alberta BACKGROUND:

Obesity, and notably abdominal obesity, is associated with an increased risk of cardiovascular disease (CVD). The objectives of this cross-sectional study were to evaluate the prevalence and the management of cardiometabolic risk factors (CMRFs) in overweight/obese Canadians. METHODS: 10,488 subjects with increased body mass index (BMI>27 kg/) or waist circumference (WC>94 cm in men, >80 cm in women) were recruited by 468 primary care physicians across Canada (37% from Ontario, 28% from Québec and 35% from other provinces), and evaluated during a single clinic visit. The following CMRFs were assessed: hypertension (systolic >140 and/or diastolic >90); dysglycemia (impaired glucose tolerance or diabetes); low highdensity lipoprotein-cholesterol (HDL-C, <1.0 in men or <1.3 mmol/L in women); triglycerides >1.7 mmol/L; lowdensity lipoprotein-cholesterol (LDL-C>3.5 or >2 mmol/L with cardiovascular event); and smoking status. RESULTS: A total of 9,985 subjects were included in the analysis. A majority of the subjects were Caucasians (88%), with 8% Asians, 2% blacks and 2% aboriginals. 41% of subjects had postsecondary education, 42% had high school and 17% had less than high school education. The mean age was 58 years, with 52% men and 48% women, mean BMI 33.2 and 34.0 kg/m2, mean WC 113.2 cm and 106.4 cm, for men and women, respectively. Women had a median of 3 CMRFs while men had a median of 4 CMRFs. 70% of the subjects had additional CMRFs with the following prevalence: high LDL-C (82%), hypertriglyceridemia (70%), hypertension (67%), low HDL-C (52%), high LDL-C+Hypertension (63%), high LDL-C+Low HDL-C (46%), Hypertension+Low HDL-C (37%), low HDLC+High LDL-C+Hypertension (36%), diabetes (34%), high LDL-C+Dysglycemia (33%). 20% of subjects were current smokers. Coronary artery disease, peripheral artery disease and stroke were reported in 13%, 4% and 4% of all subjects, respectively. 52% of subjects with dyslipidemia, 59% of hypertensive subjects and 93% of people with diabetes were on medical therapy. However, Canadian guideline targets for dyslipidemia, hypertension, and diabetes, were often not being achieved despite treatment. Among the 74% of people with dyslipidemia treated with lipid-lowering therapies, 53% did not