T04-P-047 Risk factors for atherosclerosis in patients with obstructive sleep apnea syndrome

Other Topics T4 Risk factors for CHD the number of emergent cardiovascular risk factors. However, the presence of emergent risk factors substantially correlates with the prevalence of adverse gene polymorphisms. Therefore, the determination of emergent cardiovascular risk factors should he important in identifying a deleterious genetic background in cardiovascular risk assessment.

T04-P-044 l THE IMPACT OF PLASMA H O M O C Y S T E I N E LEVEL ON N E O I N T I M A L PROLIFERATION IN PATIENTS A F T E R PCI W I T H REDUCED BAROTRAUMA K. Trusinskis, A. Erglis, V. Rudzite, E. Jurika, S. Jegere, I. Narbute, U. Kalnins. Latvian Centre of Cardiology, P Stradins Clinical University

Hospital, Riga, Latvia

Results: Patients with PEM revealed, in comparison with control persons, decreased concentrations of cholesterol 0"(2, 3.60+0.26 vs. 4.69-t-0.26 mmol/1, P<0.001), HDL-C (0.94-t-0.12 vs. 1.20-t-0.04 mmol/l, P<0.01), LDL-C (1.844-0.18 vs. 3.014-0.10 mmol/l, P<0.001), apt B (0.614-0.05 vs. 0.73-t-0.02 g/I, P<0.05) and increased concentration of TG (1.80-t-0.24 vs. 1.054-0.11 mmol/1, P<0.01). Decreased content of linoleic acid (LA, 18:2n6) and increased content of palmitoleic acid (POA, 16:1n7) were observed in PEM group (all P<0.001). No significant changes were observed in concentrations of lathosterol, marker of cholesterol synthesis de novo. Conclusions: Decreased concentrations of LDL-C and HDL-C appear despite its physiological rate of synthesis. Decreased content of LA may result from either subclinical carency (i), or increased lipoperoxidation (ii), or increased demand of cholesteryl esters in periphery tissues (iii). Raised content of POA reflects increased lipogenesis.

Supported by the Research Project J13/98 1111 0000 2-1 MJMT CR.

Background: Plasma homocysteine level is an important cardiovascular risk factor that also influences restenosis rate after PCI. Elevated homocysteine levels stimulate vascular smooth muscle cell growth and collagen synthesis, which promote intimal-medial thickening. Methods: Our prospective study enrolled 183 consecutive patients from April 2000 to November 2003. Patients underwent IVUS guided or IVUS controlled barotrauma-reducing (using non-compliant or cutting balloons) bare metal or drug eluting stent implantations based on "media to media" treatment principle. Clinical, angiographic and IVUS follow-up at 6 months was scheduled. All patients received similar medical treatment. Fasting total plasma homocysteine level was measured before PCI using Abbot IMx immunoassays. Results: The bare metal stent group (n=35) showed 8% TLR and 14% TVR rates. Patients were divided into two subgroups based on fasting total plasma homocysteine levels (cut point lllxmol/1). Of 35 patients, 22 had homocysteine levels above 11 I~mol/1 (15.30+3.43)and 13 were below 11 btmol/1 (9.024-1.29). Baseline demographic and clinical characteristics did not differ significantly between study groups. Table 1. IVUS results of bare metal stent group

MLD post PCI, mm MLD at follow-up, mm Late MLD loss, mm MSA post PCI, mm2 MSA at follow-up, mm2 Late MSA loss, mm2 Lumen Voltune post PCI, mm3 Lumen Volume at follow-up, mm3 Late Lumen Volume loss, mm3

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Homocysteine < 11 Ixmol/l (n=13) 3.154-0.54 3.004-0.51 -0.164-0.35 9.004-2.24 8.164-2.75 -0.844-2.15 182.02-t-29.38 168.554-38.66 -13.484-35.83

Homocysteine P values _>lllxmol/l (n=22) 3.194-0.51 0.845 2.754-0.59 0.244 -0.464-0.39 0.034* 8.94:t:1.61 0.919 6.814-2.58 0.173 -2.274-2.01 0.068** 186.59:t:33.45 0.686 151.424-38.71 0.234 -40.944-42.60 0.068***

T04-P-046 ] AMBULATORY BLOOD PRESSURE AND T H E DESATURATION INDEX (DI) IN PATIENTS W I T H OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS) E. Vlachogiannis, D.A. Dougalis, E. Daskalopoulou, C.H. Liavvas, Z. Koukoulidou, C.H. C-erodimos. Sleep laboratory, Dept. of lnternal

Medicine, 'St. Paul' General Hospital, Thessaloniki, Greece Objective:The aim of this study was to investigate the influence of DI on blood pressure profile in patients with OSAS Materials and methods: We studied 56 OSAS patients, [mean age 42-t-8 (sd) yrs, BMI 32.74-5.1 kg/m 2, waist/hip rafiol.064-0.08]. The patients underwent an overnight limited sleep study (Embletta, Somnologica), while 24hour ambulatory BP recordings (Diasys Integra) were performed in all subjects. According to the DI, the patients were separated into two groups; group A(n=8): DI <5 and group B(n=48):DI >5.None of the subjects had known hypertension. Results: During wakefulness the systolic BP(p=0.02) and the systolic load (p=0.0001), the diastolic BP (p=0.03) and the diastolic load(p=0.04), the mean BP(p=0.01) and the mean load (p=0.15) were higher(student's t-test) in group B than in A. During sleep the systolic BP (p=0.02) and the systolic load (p=0.0001), the diastolic BP(p=0.02) and the diastolic load (p=0.0001), the mean BP(p=0.02) and the mean load (p=0.19) were statistically significantly higher in Group B than in A. Linear multiple regression analysis revealed BMI as the only independent predictor of systolic BP load during sleep. Conclusions: Patients with DI> 15 present a higher 24hour blood pressure profile than the patients with DI<15.Increased obesity is associated with a rise in BP, which itself is associated with OSAS.

TO4-P-047 ] RISK FACTORS F O R ATHEROSCLEROSIS IN Late loss in MLD was significantly larger in patients with elevated homocysteine levels * (-0.464-0.39 vs. -0.164-0.35 mm, P=0.034). A strong tendency for late loss in MSA** and lumen volume*** also were detected in elevated homocysteine group. Conclusions: Elevated homocysteine level is associated with higher lumen late loss. Homocysteine levels correlate with IVUS measured MLD at 6 months in patients with low TLR and TVR rates.

T04-P-045 ] PLASMA L I P I D S A N D FATTY ACIDS IN PROTEINO-ENERGETIC MALNUTRITION E. Tvrzick~, A. ~ik, M. Vecka, E Nov~tk, B. Stankov~i, E. Meisnerovh. 1st

Faculty of Medicine, Charles University, Prague, Czech Republic Objective: Lipoprotein metabolism is significantly altered in patients with proteino-energetic malnutrition (PEM) - a combination of simple starvation and cytokine-mediated malnutrition (stress starvation). Dyslipidemia in PEM results from hormonal changes, cytokine action, reactants of acute phase and oxidative stress. The aim of our study was to assess concentrafinns of plasma lipids, apolipoproteins, non-cholesterol sterols (NCS) and fatty acid (FA) composition in patients with PEM. Methods: Group of patients consisted of 22 persons (12M/10F): relaps of Crohn's desease (5), acute pancreatitis (5), suture dehiscention (5), vascular grafting (1), acute cholecystitis (2), pneumonia (3), NSAIDgastroenteropathy (1). Control group consisted of 35 healthy persons (17M/18F). Enzymatic-colorimetric methods were used for determination of plasma lipids, EIA for apt A-I, apt B, gas chromatography forFA and NCS.

PATIENTS W I T H O B S T R U C T I V E SLEEP APNEA SYNDROME E. Vlachogiannis, C.H. Liavvas, Z. Koukoulidou, A. Dougalis, A. Mousiolis, E. Daskalopoulou. Sleep Laboratory, Dept of Internal

Medicine, "St Paul" General Hospital, Thessaloniki, Greece Objective: The aim of this study was to estimate the incidence of atherosclemtic risk factors in patients with obstructive sleep apnea syndrome (OSAS). Methods: Among 423 studied patients with OSAS, aged 23-76 yrs, 80 (18.9%) were smokers, (Group A; 70 males and 10 females), 48 (11.3%) ex-smokers (Group B; 34 males and 14 females) and 295 (69.7%) were non-smokers, (Group C; 236 males and 59 females). In all groups, dyslipidemia, diabetes mellitus (DM), hypertension and homocystein levels were estimated. Results: In group A, the incidence of dyslipidemia was 65.7%, of DM 34.3%, of hypertension 22.8% and of hyperhomocysteinemia 25.7% in males while in females 70%, 10%, 10% and 20% respectively. In group B the incidence of dyslipidemia was 58.8%, DM 38.2%, hypertension 38.2% and hyperhomocystinemia 29.4% in males and in females 21.4%, 7.1%, 7.1% and 0% respectively. In group C dyslipidemia was present in 13.1% of males and in 11.9% of females, DM in 10.2% and 10.2% respectively, hypertension in 6.8% of males and in 6.8% of females and hyperhomocysteinemia in 22.4% and 13.5% respectively. Males and females smokers had significantly higher prevalence of dyslipidemia than non-smokers, (p<0.0001 and p<0.0001) respectively. No other statistically significant differences were observed.

75th EAS Congress, 23-26 April 2005, Prague, Czech Republic

0 3m 30 0 "13 (D (D

Other Topics T5 Inflammation

164

Conclusions: Patients with the combination of smoking and obstructive sleep apnea syndrome have higher prevalence of dyslipidemia than non-smokers. ]

TO4-P-048 ] LIPROTEIN (a), ITS RELATION TO PLASMA LIPIDS AND O T H E R RISK FACTORS F O R ATHEROSCLEROSIS

L. Zlatohlavek, K. Zidkova, M. Vrablik, R. Prochazkova, M. Kvasilova, R. Ceska. 3rd Dept. of Internal Med., lst Faculty of Med., Charles

University, Prague, Czech Republic

Objective: Lp (a) is a considered as a independent risk factor for CHD. The objectives of this study were to determine relation Lp (a) to blood lipids and other risk factors for CHD. Methods: Group of 3916 patients with dyslipideamia, 1880 men, 2036 women, mean age 48 ± 21.5 yeats. Lp (a) was measured by LEIA, lipids and apoproteins were assayed using automatic machines. Clinical data were available in 600 patients. Results: Lp (a) levels did not correlate with total, LDL-, HDL- cholesterol, TG and apt B in the plasma (r = 0.6036, 0.13002, 0.071, -0.08923, 0.1277). Patients with diabetes mellitus, obesity, hypertension and smokers did not have statistically different Lp (a) levels than patients without this diseases. CHD (p< 0.024) is more frequent in patients with higher Lp (a). Conclusions: Higher levels of Lp (a) are associated with manifestation of CHD in our group. There is no correlation between Lp (a) and correlated serum lipids in our group. Supported by grants." GACR 301/02/D065 and IGA MHCR NB 7392-3.

T5

INFLAMMATION

T05-P-001 ] C-REACTIVE PROTEIN IN STABLE CORONARY H E A R T DISEASE PATIENTS M. Ezhov, A. Sumarokov, A. Kambegova, I. Raimbekova, V. Masenko, V. Naumov. Atherosclerosis, Cardiology Res. Complex, Moscow, Russia

Objective: To evaluate the association of C-reactive protein concentration with coronary heart disease presence and severity. Methods: We have examined 510 patients (424 men, 86 women, mean age 56±10 years) subjected coronary angiography for suspected or diagnosed coronary heart disease (CHD). Before angiography we performed physical examination, blood chemistry. High-sensitivity C-reactive protein (CRP) was analysed by Dade/Behring method. Remits: Median CRP level was 2.4 mg/L, mean total cholesterol concentration - 6.0±1.4 mmol/L. Among all patients CRP was distributed as follows: <1 m g / L - 142 (28%), 1-3 mg/L - 151 (30%), >3 m g / L - 217 (42%). Seventy patients (14%) had normal coronary arteries, 114 ( 2 2 % ) 1 diseased coronary vessel, 127 (25%) - 2 vessels, 199 (39%) - 3 vessels. There was no difference between the groups in CRP concentration. Patients with coronary lesions had stable angina II-IV class and/or myocardial infarction. More than 70% CHD patients had CRP> 1 mg/L, and 43% patients had C R P > 3 mg/L. Of examined patients, 360 (70%) had arterial hypertension, 167 (33%) - f a m i l y history of CHD, 157 (31%) were smokers and 71 (14%) - diabetics. There was no difference in CRP level in the presence or absence of hypertension, or smoking, or family history of CHD. We have revealed that CRP level was significantly higher in diabetics than in non-diabetics (median, 95% CI): 3.3, 2.4-4.9, versus 2.4, 2.0-2.9 mg/L, p=0.03, respectively. Conclusion: C-reactive protein concentration is increased in majority of stable coronary heart disease patients, especially in those with diabetes mellitus, but not associated with coronary atherosclerosis severity. TO5-P-O02 ] CARVEDILOL DECREASES N E U T R O P H I L S SUPEROX IDE ANION GENERATION IN PATIENTS W I T H STABLE ANGINA J. Kowalski, L. Pawlicki, J. Blaszczyk, R. Irzmanski, T. Ceglinski, A. Lewinski, J. Kedziora. Dep. of lnternal Medicine and Cardiological

Rehabilitation, Medical University of Lodz, Lod~ Poland

Objective: The oxidative stress plays an important role in the pathogenesis of atherosclerosis and coronary heart disease (CHD). Increased generation of superoxide anion by PMNs leads initially to endothelial dysfunction and

then resuls in further progression of atherosclerosis. Thus, drugs that have antioxidative properties might be useful the treatment of patients with CHD. Methods: Effect of carvedflol on 02 generation by neutrophils was investigated in patients with stable angina. The study comprised 30 patients (20 men and l0 women), aged 37- 52 years (mean 47.9 years) with stable angina. The patients were administered carvedilol in increasing every four weeks doses: 12.5 mg/day, 25 mg/day, 50 mg/day. The control group consisted of 12 healthy subjects aged 39-49 years (mean 45.7 years). Blood samples were collected before, 4, 8 and 12 weeks after therapy in patients, and once in control group. Our study has been approved by the Local Ethics Committee. Superoxide anion generation by nonstimulated and OZ stimulated neutrophils was measured with Bellavite etal. method. Results: O2 generation by nonstimulated and OZ stimulated neutrophils in patients with stable angina was significantly (p < 0.05) higher than in control group. Neutrophil O2 generation did not differ 8 and 12 weeks after the therapy from that observed in healthy. Conclusions: The results of our study indicate that carvedilol inhibits neutrophil O2 generation equally effectively in both doses (25 mg/day and 50 mg/day) in patients with stable angina.

I T05-P-003 1 THE ASSOCIATION B E T W E E N PREHYPERTENSION STATUS AND INFLAMMATORY M A R K E R S RELATED TO A T H E R O S C L E R O T I C DISEASE; THE ATTICA STUDY D. Panagiotakos, C. Pitsavos, I. Skoumas, C. Stefanadis. First Cardiology

Clinic, Athens Medical School, Athens, Greece Background: The aim of this work was to evaluate the association between pre-hypertension status and inflammatory markers (C-reactive protein, white blood cells, interleukin-6, tumor necrosis factor-a, amyloid-a, homocysteine and fibrinogen), in a random sample of cardiovascular disease free adults, in Greece. Methods: The ATTICA study is a cross sectional population-based survey that conducted in Athens greater area during 2001-2002. Based on a multistage random sampling, 1514 men and 1528 women (18 - 89 years old) were enrolled. The survey included a detailed interview; blood samples collected after 12 hours of fasting and, among other clinical measurements, status of blood pressure levels was evaluated. Results: 653 men (43%) and 535 women (35%) were defined as prehypertensives. Compared to normotensives, and after controlling for several potential confounders, pre-hypertensive individuals showed a 31% relative increase in C-reactive protein, a 32% relative increase in tumor necrosis factor - a levels, a 9% increase in amyloid - A, a 6% increase in homocysteine levels and a 10% increase in white blood cell counts compared to normotensive subjects (all p < 0.05). Conclusions: We revealed a positive association between prehypertension and inflammatory markers related with the atherosclerotic process in cardiovascular disease free individuals from the general population. These associations were independent from other coexisting risk factors or unhealthy life-style behaviors, and may indicate a direct association of prehypertension with atherosclerotic disease.

I T0$-P-004 I ASSOCIATION B E T W E E N C-REACTIVE PROTEIN AND METABO LIC/HAEMODYNAMIC PARAMETERS J. Saban-Ruiz, E. Bemal, O. Sanchez, E. Sanchez-Largo, A. Ugalde, E. Femadez, D. Coca, R. Fabregate, L.M. Villar, J. Marquez. Endothelial

Pathology Unig Ramon y Cajal Hospital, Madrid, Spain Introduction: The increase of normal pulse pressure (PP) is associated with arteriosclerosis, a phenomenon considered degenerative and inactive, in contrast to atherosclerosis. Although C-reactive protein (CRP) has behaved as a marker of the insulin resistance (IR) syndrome, a marker of ED and a good predictor of acute events, all related with "atherosclerosis", it is not known if it could also he an indicator of "arteriosclerosis". Objectives: 1.To evaluate the biochemical and clinical parameters related with the CRP. 2.To determine if the ambulatory PP is independently related with the CRP. Material and Methods: N= 183, aged 57 + 12 yr, 55% f, 65% hypertensive, 35% DM2, 32% dyslipemic, and 15% active smokers. Methods: Waist; BMI, Biochemical:glucose total cholesterol, creatinine, HDL, and triglycerides, by HITACHI auto-analyzer,CRP (mg/l): Latex-

75th EAS Congress, 23-26 April 2005, Prague, Czech Republic