Vasomotor response to acetylcholine and its correlates with serum lipid levels in early postmenopausal women

Thursday June 29, 2000: Poster Abstracts P : W31 Prevention of CVD

274 I

I ThP1 5:W31 I Predicting individual risk of coronary heart disease

(CHD) on an italian sample of patients with hypercholesterolemia L. Denti, A. Cecchetti, F. Merli, R. Benedetti, G. Pasolini, G. Valenti. Chair

of Gerontology and Geriatrics- University of Parma, Parma, Italy Objective: To assess the agreement between CHD prediction algorithm, developed from the Framingham risk data, and NCEP risk stratification system in selecting patients that deserve lipid-lowering drug. Methods: 802 patients consecutively referred to an outpatient Center for metabolic diseases, which had been previously classified according to NCEP risk stratification system, have been re-evaluated for the assessment of their CHD risk, using the Framingham prediction algorithm. The model has been applied only to 573 patients, after exclusion of patients in secondary prevention or with excessively high triglyceride levels (>400 mg/dL). Patients in primary prevention with a CHD risk exceeding 20% were considered as deserving drug treatment. In addition, according to indications from the American Heart Association and American College of Cardiology, therapy was considered as justified also for some of the patients with a CHD risk of 10 to 20%. Results: While NCEP-II risk stratification indicated the need of drug treatment for 65.7% of patients inprimary prevention, using risk estimates based on Framingham algorithm, aggressive treatment was warranted fora consistently lower percentage of patients (34%). Contingency table showed that among patients deserving drug treatment by NCEP-II, the need of intervention was confirmed for 43.7% only, using Framingham risk estimates; furthermore, for a slight percentage (15.4%) of patients not deserving aggressive intervention by NCEP-II, therapy turned out to be warranted. Conclusions: In the selection of patients who need drug treatment for hypercholesterolemia, changing the procedure for CHD risk assessment can consistently modify the risk-reduction strategy for individual patients. ThP16:W31 II Relationship of obesity distribution and peripheral

arterial occlusive disease in elderly men

A. Planas, A. Clara, C. Contreras, A. Gasol, A. De Moner, F. Vidal-Barraquer, J. Marrugat, J.M. Pou. Hospital del Mar -Area Bdsica

Pubilla Casas, Barcelona, Spain The potential association of obesity and its distribution with peripheral arterial occlusive disease has been studied little. Objective: to examine the relationships between total body fatness and abdominal fat distribution with peripheral arterial disease. Methods: Design: cross-sectional; Subjects: populafion-based sample of 708 men aged 55 to 74. Measurements: body mass index to estimate total body fatness and waist-to-hip ratio for abdominal fat distribution; peripheral arterial disease defined by ankle/brachial index <0.9; cardiovascular risk factors. Results: Peripheral arterial disease was observed in 13.4% of subjects. Body mass index did not correlate with peripheral arterial disease, whereas an increased waist-to-hip ratio over 0.966 (median value) doubled the prevalence of arterial disease. After controlling for smoking, diabetes, hypertension, high-density lipoprotein cholesterol and triglycerides, increased waist-to-hip ratio was independently associated with peripheral arterial disease (odds ratio: 1.68; 95% confidence interval 1.05-2.70). Conclusion: Abdominal fat distribution, but not total body fatness, is associated with peripheral arterial occlusive disease, independently of concurrent cardiovascular risk factors. I

I ThP17:W31 II Trends in cardiovascular risk factors in iranian people

during 1994-1998

M. Rafiei, M. Boshtam, N. Sarraf-Zadegan, EA. Sayed Tabatabaei, A. Jalali.

Results: As the tables show, hypertension and hypercholesterolemia prevalence didn't change during these 5 years. In this period, the prevalence of hypertdglyceridemia and obesity have increased while high LDL cholesterol and low HDL cholesterol have decreased. The mean values of triglycerides and HDL cholesterol have increased but the results for other factors in opposite. Table 1. Trends in mean values of CAD risk factors Factors

1994 Mean + SD

I998 Mean + SD

P

"Echo (mg/dl) TG (mg/dl) LDL (mg/dl) HDL (mg/dl) BMI (kg/m 2) SBP (mmHg) DBP (mmHg)

197.0 4- 27.7 134.9 -4- 36.9 124.1-4- 24.2 40.3 ± 5.2 23.5 -4- 2.5 126. 1-4- 13.3 79,9 4- 8.4

194.5 -4- 30.5 150.9 -4- 30.4 120.0 ~ 24.7 44.8 -4- 7.8 22.4 -4- 2.0 114.8 -4- 10.0 74.5 ± 8.1

0.04 0.00 0.00 0.00 0.00 0.00 0.00

Table 2. Trends in prevalence of CAD risk factors Risk factors

1994

T.cho > 240 mg/dl TG > 200 mg/dl LDL > 160 mg/dl HDL < 35 rag/d| BMI > 25 mg/dl Hypertension

1998

P

No

%

No

%

741 999 744 1131 1331 616

33.7 45.4 33.8 51.4 60.5 28.0

406 607 306 31 l 844 407

34.0 50.8 29.4 26.0 71.2 28.1

0.92 0.00 0.00 0.00 0.00 0.97

Conclusion: Hence, we conclude that although non systematic preventive activities done in our population were beneficial but were not enough, so big national preventive projects especially in the case of nutrition must be conducted in this society. /

ThP1 8:W31 ] Vasomotor response to acetylcholine and its correlates with serum lipid levels in early postmenopausal women T. Haraki I , K. Ueda I , K. O-e 1, M. Noto l, H. Mabuchi 2. 1Komatsu Municipal

Hospital; 2The Second Department of Internal Medicine, Kanazawa University, Komatsu, Japan Objective: The incidence of cardiovascular disease (CVD) increases in women after menopause. We investigated the response of coronary artery to intracoronary injection of acetylcholine (Ach) in early postmenopausal women and age-matched men showing normal coronary angiogram. Methods: Early postmenopausal women (n = 23, Mean 5= SD age, 54.7 43.8 years) and age-matched men (n = 15, 54.4 4- 6.1 years) without suffering from definite diabetes mellitus nor hypertension were enrolled. To evaluated the changes in coronary diameter in response to Ach (25 to 50 /zg/ml), and followed by isosorhide dinitrate infusion, the luminal diameters in the segments of proximal and distal regions were determined by quantitatively with a computerized analysis system. Results: Serum cholesterol levels (215 4- 39 mg/dl) in postmenopausal women were relatively higher than those (203 4- 29 mg/dl) in men. There was a dose-dependent vasoconstricting response of proximal and distal segments to Ach in both postmenopausal women and men. A vasomotor response in proximal segments to Ach was negatively correlated with age (p < 0.05), serum cholesterol (p < 0.05) and LDL-cholesterol levels (p < 0.05) in postmenopausal women, however, these correlation was not found in men. Serum cholesterol levels were increased more rapidly by age in postmenopausal women (p < 0.05) than in men. Conclusions: Associations between the endothelial dysfunction of coronary arteries and serum cholesterol levels, and age in early postmenopausal women were stronger than those in men. These results could provide further evidence to support beneficial effects of lipid-lowering and hormone replacement therapy for CVD prevention in postmenopausal women.

lsfahan Crdiovascular Research Center, Isfahan, Iran Objective: Cornary artery diseases (CAD) are still considered as the first killer in h'an as well as other parts of to world. Methods: In 1994, the 1st Isfahan CVD Risk Factor Survey aimed identifying the mean and prevalence of CAD risk factors on 2200 subjects randomly selected from Isfahan clusters, was carried out. The second one was conducted in 1998 on 1200 men and women of this population. In the two projects, the same questionnaire was completed for each subject. Also, fasting blood specimens was taken from each one and were analyzed by autoanalyzer ELAN 2000 for the lipids. The blood pressure was measured by random-zero sphygmomanometer after at least five minutes of rest from right arm in sitting position. Height and weight were measured by Seca scale in light cloths and without shoes.

I ThP1 9:W31 I Secondary prevention measures profoundly lower total mortality in high risk czech population J. Pitha I , I. Podrapska I , P.H. Frost 2, R. Poledne ] , R.J. Havel 2 . 1Institute for

Clinical and Experimental Medicine, Prague, Czech Rep.; 2Cardiovascular Research Institute, University of California, San Francisco, USA To evaluate the effects of an intensive secondary prevention program on mortality after myocardial infarction MI in a population not previously treated with cholesterol-lowering drugs, we enrolled all MI survivors under age 60 (men) or age 65 (women) admitted to a coronary care unit responsible for an entire district in Northern Bohemia during 18 months in 1992-93. All subjects were invited to participate in the program, which emphasized smoking

Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000