- Email: [email protected]
THE ROLE OF PHYSICAL ACTIVITY IN THE PREVENTION OF CORONARY HEART DISEASE
Publication Only Conclusions: In patients with in-stent restenosis, stent removal with coronary endarterectomy should be the technique of choice because it is effective and safe. 50
SKIN AUTOFLUORESCENCE, AS MEASURE OF CUMULATIVE METABOLIC AND OXIDATIVE STRESS, IN RELATION TO LIPIDS IN PATIENTS WITH SYSTEMIC SCLEROSIS
M.E. Hettema 1 , H. Bootsma 1 , R. Graaff 4 , R. de Vries 3 , C.G. Kallenberg 1 , A.J. Smit 2 . 1 Division of Rheumatology and Clinical Immunology, Department of Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands; 2 Division of Vascular medicine, Department of Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands; 3 Division of Endocrinology, Department of Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands; 4 Department of Biomedical Engineering, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
51
RESOLUTION OF ECG AND ECHOCARDIOGRAPHIC CHANGES IN YOUNG PATIENTS AFTER ST ELEVATION MYOCARDIAL INFARCTION
A. Tanrikulu, M. Agirbasli. Marmara University Medical School Department of Cardiology We report 4 young male patients ages 24, 29, 28 and 30 presented to emergency room with substernal chest pain after a stressful event. The presenting ECG revealed ST elevation. Echocardiography revealed corresponding wall motion abnormality. Blood chemistry revealed evidence for myocardial necrosis (elevated troponin T and CKMB). All patients underwent coronary angiograhy within the first week of index hospital admission, which revealed no sign of obstructive coronary artery disease. The patients were started on medical therapy including aspirin, beta-blocker, ACE inhibitor and statin. Interestingly, follow up ECG and repeat echocardiography in 6 months revealed resolution of wall motion abnormality in addition to a normal ECG. All the 4 patients had family history of early death due to myocardial infarction, 3 patients had dyslipidemia; low HDL-C (mean of 30 mg/dl), high TG and LDL-C levels. These cases may represent neurocardiogenic ECG changes in the setting of stressful event in hyperadrenergic young patients which was previously described in the elderly. Another plausible explanation may involve active endogenous fibrinolytic system in young patients which might enable spontaneous clot lysis. Our cases are similar to Takotsubo Cardiyomyopathy; ST segment and enzyme elevation with wall motion abnormalities without any
structural or spastic coronary vascular disease; the age range differs from the previous reports. All cases revealed severely low HDL-C levels which is endemic in Turkey. The series of cases indicate the functional significance of spontaneous clot lysis in young patients with low atherosclerotic burden. 52
PERIADVENTITIAL ADIPOSE TISSUE (TUNICA ADIPOSA): A FRIEND-AND-FOE CONCEPT OF ATHEROGENESIS
A. Tonchev 1 , G. Rancic 2 , M. Fiore 3 , N. Tuncel 4 , D. Kostov 1,5 , K. Valchanov 6 , P. Ghenev 1 , R. Pancheva 1 , P. Panayotov 1 , Z. Georgieva 1 , V. Nikolova 1 , V. Peneva 1 , A. Petrovic 2 , S. Stoev 1 , Y. Yamori 5 , L. Aloe 3 , G. Chaldakov 1 . 1 Medical University, Varna, Bulgaria; 2 Medical Faculty, Nis, Serbia; 3 Institute of Neurobiologogy and Molecular Medicine, CNR, Rome, Italy; 4 Medical Faculty, Eskisehir, Turkey; 5 International Center for Primary Prevention of Cardiovascular Diseases, Kyoto, Japan; 6 Papworth Hospital, Cambridge, UK The traditional thinking holds that (i) the vascular wall consists of tunica intima, t. media, and t. adventitia, and (ii) the intima is an “autonomic” territory of atherosclerosis, resulting from endothelial dysfunction and related inflammation. However, it might be more than that. A paradigm shift has emerged from recent studies in adipobiology, including (i) adipose tissue has both metabolic and secretory phenotype, and (ii) adipokines exert anti- and proinflammatory and vasculorelaxing and contracting effects. We focus here on adventitia and periadventitial adipose tissue (PAAT) of human coronary arteries obtained from autopsies and during surgery, demonstrating our immunohistochemical and biochemical (ELISA) results. To elucidate the process of atherogenesis it is essential to consider PAAT and the “classical” vascular wall as one entity. We go even further to propose that PAAT may the forth, outermost vascular coat, hence, t. adiposa. By analogy with “endothelial dysfunction”, we introduce the term “adipose dysfunction”, in atherogenesis. The novel, friend-and-foe (FF) concept of t. adipose (also epicardial adipose tissue) requires further efforts in basic, translational and clinical adipobiology of atherosclerosis and related diseases. For example, “no-touch harvesting technique” is applied in coronary artery bypass surgery, and imaging methods such as echocardiography and MRI are useful tools in clinical evaluation of cardiovascular adipose tissue. Our ongoing studies may shed further light into adipose FF concept of atherogenesis. Dedicated to the memory of our big friend, Dr Ivan S. Stankulov (1944-2007). 53
THE ROLE OF PHYSICAL ACTIVITY IN THE PREVENTION OF CORONARY HEART DISEASE
E. Farinaro. Department of Preventive Medical Sciences University In the last few years several studies have demonstrated the benefits of physical activity on plasma lipid levels, blood pressure, body weight and glucose metabolism; in addition, more recent results suggest beneficial effect also on endothelial function and insulin sensitivity. In some of our recent observations, people engaged in physical activity for at least 2,5 hours a week during leisure time had significantly lower plasma insulin levels both at baseline and after a glucose load, and the benefit also extended to overweight and obese people. Further observations have demonstrated that in a group of hypertensive men (60 years age) in treatment with betablocking drugs after two months of physical exercise training (thirty minutes of static bike five times weekly) all metabolic parameters improved, the most interesting finding was the increase of HDL cholesterol levels from 20 to 40 mg/dl. International organizations agree that for better health, physical activity should be performed regularly, and advise people to include a minimum of thirty minutes of moderate physical activity (requiring 3 to 6 METs) almost daily, for a total energy expenditure of 1000 kcal per week.It is important to note that when physical exercise is prescribed, the baseline individual’s physical fitness should be taken into account. In conclusion physical activity has numerous beneficial physiologic effects, particularly on the cardiovascular and musculoskeletal systems and the benefits on many other systems are also considerable; therefore, programmes to improve lifestyle should have high priority in national policies in order to implement prevention of cardiovascular diseases.
77th Congress of the European Atherosclerosis Society, April 26–29, 2008, Istanbul, Turkey
PUBLICATION ONLY
Background and aims: Systemic sclerosis (SSc) is not associated with acclererated atherosclerosis. To identify mechanisms protecting against atherosclerosis, we assessed skin autofluorescence (AF), reflecting accumulation of advanced glycation endproducts (AGEs), and a measure of cumulative metabolic and oxidative stress, in patients with systemic sclerosis (SSc), in relation to carotid intima-media thickness (IMT)and to disease-related and traditional cardiovascular risk factors (RF) in SSc. Methods: Skin AF was assessed measuring UV-A light excitationemission matrices (AF-EEMS) in 45 SSc patients and 42 age- and sex-matched controls. Carotid IMT, traditional cardiovascular RF and disease-related RF were recorded. Results: No increased prevalence of early subclinical atherosclerosis, as assessed by IMT, was found in SSc compared to controls (0.68 mm (IQR 0.61-0.79) vs 0.75 mm (IQR 0.65-0.85), p=0.110). The prevalence of dyslipidemia wa similar in both groups, CRP was higher in SSc (3.4 mg/l (IQR 1.6-7.7) vs 1.7 mg/l (0.6-2.8), p<0.001). Skin AF-EEMS did not differ in SSc patients compared to controls (1.69±0.58 a.u. vs 1.61±0.39 a.u., p=0.494). Skin AF-EEMS did not differ between SSc subsets. Skin AF-EEMS in patients was associated with CRP (r=0.38, p=0.01), Medsger’s severity scale (r=0.36, p=0.02) and total cholesterol (r=-0.31, p=0.047). In all subjects, skin AF-EEMS was associated with age (r=0.23, p=0.04) and CRP (r=0.23, p=0.03). In multivariate analysis, no independent predictors of accumulation of AGEs were found. Conclusions: Despite evidence of low-grade inflammation, the prevalence of subclinical early atherosclerosis is not increased in SSc, and neither is skin AF as reflection of metabolic and oxidative stress.
227
SKIN AUTOFLUORESCENCE, AS MEASURE OF CUMULATIVE METABOLIC AND OXIDATIVE STRESS, IN RELATION TO LIPIDS IN PATIENTS WITH SYSTEMIC SCLEROSIS
M.E. Hettema 1 , H. Bootsma 1 , R. Graaff 4 , R. de Vries 3 , C.G. Kallenberg 1 , A.J. Smit 2 . 1 Division of Rheumatology and Clinical Immunology, Department of Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands; 2 Division of Vascular medicine, Department of Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands; 3 Division of Endocrinology, Department of Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands; 4 Department of Biomedical Engineering, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
51
RESOLUTION OF ECG AND ECHOCARDIOGRAPHIC CHANGES IN YOUNG PATIENTS AFTER ST ELEVATION MYOCARDIAL INFARCTION
A. Tanrikulu, M. Agirbasli. Marmara University Medical School Department of Cardiology We report 4 young male patients ages 24, 29, 28 and 30 presented to emergency room with substernal chest pain after a stressful event. The presenting ECG revealed ST elevation. Echocardiography revealed corresponding wall motion abnormality. Blood chemistry revealed evidence for myocardial necrosis (elevated troponin T and CKMB). All patients underwent coronary angiograhy within the first week of index hospital admission, which revealed no sign of obstructive coronary artery disease. The patients were started on medical therapy including aspirin, beta-blocker, ACE inhibitor and statin. Interestingly, follow up ECG and repeat echocardiography in 6 months revealed resolution of wall motion abnormality in addition to a normal ECG. All the 4 patients had family history of early death due to myocardial infarction, 3 patients had dyslipidemia; low HDL-C (mean of 30 mg/dl), high TG and LDL-C levels. These cases may represent neurocardiogenic ECG changes in the setting of stressful event in hyperadrenergic young patients which was previously described in the elderly. Another plausible explanation may involve active endogenous fibrinolytic system in young patients which might enable spontaneous clot lysis. Our cases are similar to Takotsubo Cardiyomyopathy; ST segment and enzyme elevation with wall motion abnormalities without any
structural or spastic coronary vascular disease; the age range differs from the previous reports. All cases revealed severely low HDL-C levels which is endemic in Turkey. The series of cases indicate the functional significance of spontaneous clot lysis in young patients with low atherosclerotic burden. 52
PERIADVENTITIAL ADIPOSE TISSUE (TUNICA ADIPOSA): A FRIEND-AND-FOE CONCEPT OF ATHEROGENESIS
A. Tonchev 1 , G. Rancic 2 , M. Fiore 3 , N. Tuncel 4 , D. Kostov 1,5 , K. Valchanov 6 , P. Ghenev 1 , R. Pancheva 1 , P. Panayotov 1 , Z. Georgieva 1 , V. Nikolova 1 , V. Peneva 1 , A. Petrovic 2 , S. Stoev 1 , Y. Yamori 5 , L. Aloe 3 , G. Chaldakov 1 . 1 Medical University, Varna, Bulgaria; 2 Medical Faculty, Nis, Serbia; 3 Institute of Neurobiologogy and Molecular Medicine, CNR, Rome, Italy; 4 Medical Faculty, Eskisehir, Turkey; 5 International Center for Primary Prevention of Cardiovascular Diseases, Kyoto, Japan; 6 Papworth Hospital, Cambridge, UK The traditional thinking holds that (i) the vascular wall consists of tunica intima, t. media, and t. adventitia, and (ii) the intima is an “autonomic” territory of atherosclerosis, resulting from endothelial dysfunction and related inflammation. However, it might be more than that. A paradigm shift has emerged from recent studies in adipobiology, including (i) adipose tissue has both metabolic and secretory phenotype, and (ii) adipokines exert anti- and proinflammatory and vasculorelaxing and contracting effects. We focus here on adventitia and periadventitial adipose tissue (PAAT) of human coronary arteries obtained from autopsies and during surgery, demonstrating our immunohistochemical and biochemical (ELISA) results. To elucidate the process of atherogenesis it is essential to consider PAAT and the “classical” vascular wall as one entity. We go even further to propose that PAAT may the forth, outermost vascular coat, hence, t. adiposa. By analogy with “endothelial dysfunction”, we introduce the term “adipose dysfunction”, in atherogenesis. The novel, friend-and-foe (FF) concept of t. adipose (also epicardial adipose tissue) requires further efforts in basic, translational and clinical adipobiology of atherosclerosis and related diseases. For example, “no-touch harvesting technique” is applied in coronary artery bypass surgery, and imaging methods such as echocardiography and MRI are useful tools in clinical evaluation of cardiovascular adipose tissue. Our ongoing studies may shed further light into adipose FF concept of atherogenesis. Dedicated to the memory of our big friend, Dr Ivan S. Stankulov (1944-2007). 53
THE ROLE OF PHYSICAL ACTIVITY IN THE PREVENTION OF CORONARY HEART DISEASE
E. Farinaro. Department of Preventive Medical Sciences University In the last few years several studies have demonstrated the benefits of physical activity on plasma lipid levels, blood pressure, body weight and glucose metabolism; in addition, more recent results suggest beneficial effect also on endothelial function and insulin sensitivity. In some of our recent observations, people engaged in physical activity for at least 2,5 hours a week during leisure time had significantly lower plasma insulin levels both at baseline and after a glucose load, and the benefit also extended to overweight and obese people. Further observations have demonstrated that in a group of hypertensive men (60 years age) in treatment with betablocking drugs after two months of physical exercise training (thirty minutes of static bike five times weekly) all metabolic parameters improved, the most interesting finding was the increase of HDL cholesterol levels from 20 to 40 mg/dl. International organizations agree that for better health, physical activity should be performed regularly, and advise people to include a minimum of thirty minutes of moderate physical activity (requiring 3 to 6 METs) almost daily, for a total energy expenditure of 1000 kcal per week.It is important to note that when physical exercise is prescribed, the baseline individual’s physical fitness should be taken into account. In conclusion physical activity has numerous beneficial physiologic effects, particularly on the cardiovascular and musculoskeletal systems and the benefits on many other systems are also considerable; therefore, programmes to improve lifestyle should have high priority in national policies in order to implement prevention of cardiovascular diseases.
77th Congress of the European Atherosclerosis Society, April 26–29, 2008, Istanbul, Turkey
PUBLICATION ONLY
Background and aims: Systemic sclerosis (SSc) is not associated with acclererated atherosclerosis. To identify mechanisms protecting against atherosclerosis, we assessed skin autofluorescence (AF), reflecting accumulation of advanced glycation endproducts (AGEs), and a measure of cumulative metabolic and oxidative stress, in patients with systemic sclerosis (SSc), in relation to carotid intima-media thickness (IMT)and to disease-related and traditional cardiovascular risk factors (RF) in SSc. Methods: Skin AF was assessed measuring UV-A light excitationemission matrices (AF-EEMS) in 45 SSc patients and 42 age- and sex-matched controls. Carotid IMT, traditional cardiovascular RF and disease-related RF were recorded. Results: No increased prevalence of early subclinical atherosclerosis, as assessed by IMT, was found in SSc compared to controls (0.68 mm (IQR 0.61-0.79) vs 0.75 mm (IQR 0.65-0.85), p=0.110). The prevalence of dyslipidemia wa similar in both groups, CRP was higher in SSc (3.4 mg/l (IQR 1.6-7.7) vs 1.7 mg/l (0.6-2.8), p<0.001). Skin AF-EEMS did not differ in SSc patients compared to controls (1.69±0.58 a.u. vs 1.61±0.39 a.u., p=0.494). Skin AF-EEMS did not differ between SSc subsets. Skin AF-EEMS in patients was associated with CRP (r=0.38, p=0.01), Medsger’s severity scale (r=0.36, p=0.02) and total cholesterol (r=-0.31, p=0.047). In all subjects, skin AF-EEMS was associated with age (r=0.23, p=0.04) and CRP (r=0.23, p=0.03). In multivariate analysis, no independent predictors of accumulation of AGEs were found. Conclusions: Despite evidence of low-grade inflammation, the prevalence of subclinical early atherosclerosis is not increased in SSc, and neither is skin AF as reflection of metabolic and oxidative stress.
227