- Email: [email protected]
We-P11:11 Relationship between circulating thrombomodulin levels and latent progression of atherosclerosis in type 2 diabetic patients
Pl l
348
Wednesday, June 21, 2006: Poster Session Opti.~datherosclerosis management ( lst part)
46.8±3.5 vs 55.8±11.2 years p<0.05) and their systolic blood pressure was significantly lower than in the latter group: 1st A B P M -112.3±11.9 vs 122.9±16.9 m m H g (p<0.03) 2nd A B P M 111.7±11.9 vs 122.5±25.8 m m H g (p< 0.01), respectively, while diastolic blood pressure was similar in these two groups: 1st A B P M - 75.3±9.9 and 74.5±10.3 mmHg; 2nd A B P M - 78.8±14.1 and 73.9±9.6 mmHg, respectively. ConclusionDipping status may change in up to 20% type 2 diabetes patients as a result of an antihypertensive medication change. At that time the diagnosis of impaired blood pressure variation should be made with caution. ]
W e - P 11:10 / M A N A G E M E N T O F H Y P E R T E N S I V E P A T I E N T S W I T H A N D W I T H O U T D I A B E T E S IN P I R A E U S J
I. Lentzas ], E Daskalakis-, A. Alevlzos , M. Papathanasiou ] , L. Salvanos ], B. Gizlis 2, A. Kamaxatos ], A. Katsanaki], G. B e l t s 2, A. Maxiolis 2.1Tzanio
General Hospital of Piraeus, Pireaus, Greece: 2Health Center of Vyronas, Vyronas, Greece B a c k g r o u n d a n d A i m s : This study compared the hyperten-sion management among hypertensive people of Piraeus with and without diabetes. M a t e r i a l s a n d M e t h o d s : Overall, 6.268 patients were identified with recorded hypertension, of whom 790 (12.6%) had diabetes. Results: Diabetic patients were more likely to have at least quarterly BP measurements (22.8% vs 14.3%, p<.001) and a similar proportion had no BP measurements (5.3% vs 3.9%, p=.267). First diastolic B E but not systolic B E was lower in diabetic patients ( 1 4 2 ± 1 6 / 7 9 ± 8 vs 1 4 0 ± 1 6 / 7 8 ± 8 , P = .069/.002). Diabetic patients were more likely to have exercise and weight recorded over the year (7.8% vs 4.0%; 48.2% vs 35.3%, p=.001=.001). Serum lipids were also marginally more likely to be recorded among diabetic patients (8.7% vs 5.2%, p=.004), but were less likely to be elevated = 6 mmol/1) among those with diabetes (7.9% vs 25.2%). Only 12.8% of those with diabetes and 2.9% of others had either an HbAlc or glucose recorded. Diabetic patients were more likely to be treated pharmacologically (86.9% vs 67.6%) and with more agents (1.8±1.3 vs 1.1±1.1, p<.001). Diabetic patients were significantly more likely to be treated with diuretics (34.7% vs 21.2%, p<.001), ACE inhibitors (54.3% vs 32.6%, p<.001), calcium antagonists (33.7% vs 20.5%, p<.002), lipid lowering agents (33.0% vs 16.2%) and aspirin (22.1% vs 12.7%, p<.001). Beta blocker use (17.8% vs 15.8%), Angiotensin II receptor blocker use (6.3% vs 7.8%). Conclusion: This study demonstrates that at least, hypertension among diabetic patients remains under-managed, although cardiovascular risk factors axe marginally more aggressively treated than among non diabetic patients.
IW e - P 1 1 : 1 2 1
I I
R E L A T I O N S H I P OF C O R O N A R Y H E A R T D I S E A S E MORTALITY TO CASUAL BLOOD GLUCOSE L E V E L A N D S E L F - R E P O R T E D PAST H I S T O R Y OF DIABETES MELLITUS
S. Kadowaki 1 T. Hayakawa 2, T. Okamura I , K. Nakamura I , Y. Murakami 1 Y. Nakamura 3, T. Kadowaki I , S. Saito 4 , A. Okayama 5, H. Ueshima I . 1Shiga
Universi~ of Medical Science, Otsu, Japan." 2Shimane Medical Universi~, Izumo, Japan." 3Kyoto Women's Universi~, Kyoto, Japan." 4Sapporo Medical Universi~, Sapporo, Japan." 5National Cardiovascular Center; Suita, Japan Objective: Diabetes mellitus (DM) and glucose tolerance abnormality axe well known risk factors of coronary heart disease (CHD) in western countries. However, there is little evidence on these relationships in the Japanese whose CHD mortality is relatively low. The purpose of this study was to elucidate these relationships with NIPPON DATAS0 which is a representative cohort of Japanese population. M e t h o d s : A total of 10,558 people over 30 years were randomly selected from all over Japan to receive the National Survey on Cardiovascular Disease in 1980 and followed up for 19 years, by 1999. A m o n g them, 9,466 participants whose vital status was confirmed in 1999 were included in the analysis. We calculated hazard ratios (HR) of CHD mortality for casual blood glucose level or self-reported DM by using Cox proportional hazard model. We evaluated blood glucose level by dividing them into quartile groups (Q1, Q2, Q3 and Q4 from the lowest to the highest). To adjust confounders, age, sex, body mass index, hypertension, total cholesterol level, smoking and drinking were included in the model. Results: The HRs of each glucose level category were 1.55, 1.64 and 1.98 in Q2 to Q4, respectively (reference level: Q1) (P for trend = 0.018). The HRs of the self-reported DM was 1.91 (P = 0.029). From these results, having the DM history was approximately equivalent to casual blood glucose level being 92 mg/dl higher than the original level. C o n d u s i o n s : Self reported DM and higher casual glucose levels were risk factors of CHD in the Japanese. Confirming DM is also very important for detecting future risk of CHD. I
I W e - P 1 1 : 1 3 I G E N E T I C S A N D O U T C O M E S O N L I P I D S IN T Y P E 2 D I A B E T E S - B A S E L I N E C H A R A C T E R I S T I C S OF A P R O S P E C T I V E STUDY O F M Y O C A R D I A L I N F A R C T I O N IN D I A B E T I C S i
M.C.O. Izar, W.G.M. Relvas, R.M.S. Povoa, N. Kasinski, L. Pinto, S.S.M. Ihara, T. Helfenstein, A.O. Santos, A.C.C. Carvalho, F.A.H. Fonseca.
Federal Universi~ of Sat Paulo, Sat Paulo, Brazil ]
We-P11:11 / RELATIONSHIP BETWEEN CIRCULATING THROMBOMODULIN LEVELS AND LATENT P R O G R E S S I O N O F A T H E R O S C L E R O S I S IN T Y P E 2 DIABETIC PATIENTS A
I. Korzh, I. Fedotova, V. Nemtsova. Kharkov Medical Universi~, Kharkov,
Ukrabte Objective: The present study was designed to test the hypothesis that circulating levels of thrombomodulin are elevated in patients with type 2 diabetes in proportion to the severity of the vascular damage. M e t h o d s : A cross-sectional study was carried out using a population consisting of 112 patients with type 2 diabetes without clinically evident cardiovasculax disease (mean age: 59 ± 11 years) and 95 healthy control subjects (60 ± 10 years). Blood was sampled and serum concentrations of soluble thrombomodulin were measured using an enzyme immunoassay method. Results: We evaluated the ratio of the concentration of thrombomodulin to that of creatinine, because soluble thrombomodulin is excreted by the kidney and the serum level of thrombomodulin was correlated with that of creatinine (p < 0.05). The assodation between the ratio and other clinical variables was investigated. The ratio of the thrombomodulin to creatinine concentrations was higher in diabetic patients (28.2 ± 9.8) than in control subjects (23.3 ± 5.1; p < 0.001). Systolic blood pressure was correlated with the ratio but the ratio showed no correlation with serum lipid levels when analyzed using data from all subjects. In diabetic patients, the ratio correlated with the grade of sclerotic, but not hypertensive, changes in the fundus oculi (Scheie's classification, p < 0.001). Furthermore, the ratio correlated with brachial-ankle pulse wave velocity (p < 0.01). Conclusions: These results suggest that circulating levels of thrombomodulin are elevated in type 2 diabetic patients as compared to control subjects and that the thrombomodulin level may be a molecular marker of the latent progression of atherosclerosis in type 2 diabetes.
Objective: To evaluate the prevalence of risk factors associated with myocardial infaxction among diabetics. M e t h o d s : A case-control study, centrally coordinated, evaluated risk factors among type 2 diabetics with previous myocardial infaxction (MI) (n=386) or without any evidence of atherosclerosis (n=604) in five regions of Brazil. A case report form, an electrocardiogram, and fasting blood samples for lipids and genetic studies were collected and shipped to the central laboratory. Results: Diabetics with MI were older (62-4-0.5 vs. 59-4-0.4 y, p<0.001), predominantly of male sex (59 vs. 31%, p<0.001), had higher prevalence of current smoking (10 vs. 6%, p=0.030), left ventricle hypertrophy (35% vs. 20%, p<0.0001), had diabetes for a longer time (10.0-4-0.4 vs. 8.0-4-0.3 y, p=0.001), lower HDL-cholesterol (35-4-1 vs. 38-4-1 mg/dL, p<0.001), higher triglycerides (248-4-14 vs. 191-4-6 mg/dL, p<0.001), and a higher prevalence of the metabolic syndrome (92 vs. 86%, p=0.006). Multiple logistic regression found male sex, LVH, smoking, age, duration of diabetes, and HDL-C levels associated with MI, where male sex tripled, LVH doubled and smoking habit increased the risk by 1.8 times. C o n d u s i o n : Along with metabolic abnormalities, classic risk factors are implicated in the occurrence of myocardial infarction in diabetics. Hypertension, or obesity did not identify those at higher risk for coronary events.
I We-P 11 141 I
T H E A S S E S M E N T O F P U L S E WAVE V E L O C I T Y A N D A N K L E - B R A C H I A L I N D E X IN P A T I E N T S W I T H TYPE2 DIABETES
M. Iiyama, Y. Go, H. Kitaoka. Seikeikai Hospital, Sal~li, Osal~l, Japan Objective: The purpose of the study was to examine the usefulness of Pulse wave v e l o d t y (PWV), a indicator of the vascular stiffness and Anlde-brachial index (ABI), a subclinical marker for lower extremity arterial disease and complications in patients with type2 diabetes.
XIV bztetTtational Symposium on Atherosclerosis, Rome, Italy, June 18-22, 2006
348
Wednesday, June 21, 2006: Poster Session Opti.~datherosclerosis management ( lst part)
46.8±3.5 vs 55.8±11.2 years p<0.05) and their systolic blood pressure was significantly lower than in the latter group: 1st A B P M -112.3±11.9 vs 122.9±16.9 m m H g (p<0.03) 2nd A B P M 111.7±11.9 vs 122.5±25.8 m m H g (p< 0.01), respectively, while diastolic blood pressure was similar in these two groups: 1st A B P M - 75.3±9.9 and 74.5±10.3 mmHg; 2nd A B P M - 78.8±14.1 and 73.9±9.6 mmHg, respectively. ConclusionDipping status may change in up to 20% type 2 diabetes patients as a result of an antihypertensive medication change. At that time the diagnosis of impaired blood pressure variation should be made with caution. ]
W e - P 11:10 / M A N A G E M E N T O F H Y P E R T E N S I V E P A T I E N T S W I T H A N D W I T H O U T D I A B E T E S IN P I R A E U S J
I. Lentzas ], E Daskalakis-, A. Alevlzos , M. Papathanasiou ] , L. Salvanos ], B. Gizlis 2, A. Kamaxatos ], A. Katsanaki], G. B e l t s 2, A. Maxiolis 2.1Tzanio
General Hospital of Piraeus, Pireaus, Greece: 2Health Center of Vyronas, Vyronas, Greece B a c k g r o u n d a n d A i m s : This study compared the hyperten-sion management among hypertensive people of Piraeus with and without diabetes. M a t e r i a l s a n d M e t h o d s : Overall, 6.268 patients were identified with recorded hypertension, of whom 790 (12.6%) had diabetes. Results: Diabetic patients were more likely to have at least quarterly BP measurements (22.8% vs 14.3%, p<.001) and a similar proportion had no BP measurements (5.3% vs 3.9%, p=.267). First diastolic B E but not systolic B E was lower in diabetic patients ( 1 4 2 ± 1 6 / 7 9 ± 8 vs 1 4 0 ± 1 6 / 7 8 ± 8 , P = .069/.002). Diabetic patients were more likely to have exercise and weight recorded over the year (7.8% vs 4.0%; 48.2% vs 35.3%, p=.001=.001). Serum lipids were also marginally more likely to be recorded among diabetic patients (8.7% vs 5.2%, p=.004), but were less likely to be elevated = 6 mmol/1) among those with diabetes (7.9% vs 25.2%). Only 12.8% of those with diabetes and 2.9% of others had either an HbAlc or glucose recorded. Diabetic patients were more likely to be treated pharmacologically (86.9% vs 67.6%) and with more agents (1.8±1.3 vs 1.1±1.1, p<.001). Diabetic patients were significantly more likely to be treated with diuretics (34.7% vs 21.2%, p<.001), ACE inhibitors (54.3% vs 32.6%, p<.001), calcium antagonists (33.7% vs 20.5%, p<.002), lipid lowering agents (33.0% vs 16.2%) and aspirin (22.1% vs 12.7%, p<.001). Beta blocker use (17.8% vs 15.8%), Angiotensin II receptor blocker use (6.3% vs 7.8%). Conclusion: This study demonstrates that at least, hypertension among diabetic patients remains under-managed, although cardiovascular risk factors axe marginally more aggressively treated than among non diabetic patients.
IW e - P 1 1 : 1 2 1
I I
R E L A T I O N S H I P OF C O R O N A R Y H E A R T D I S E A S E MORTALITY TO CASUAL BLOOD GLUCOSE L E V E L A N D S E L F - R E P O R T E D PAST H I S T O R Y OF DIABETES MELLITUS
S. Kadowaki 1 T. Hayakawa 2, T. Okamura I , K. Nakamura I , Y. Murakami 1 Y. Nakamura 3, T. Kadowaki I , S. Saito 4 , A. Okayama 5, H. Ueshima I . 1Shiga
Universi~ of Medical Science, Otsu, Japan." 2Shimane Medical Universi~, Izumo, Japan." 3Kyoto Women's Universi~, Kyoto, Japan." 4Sapporo Medical Universi~, Sapporo, Japan." 5National Cardiovascular Center; Suita, Japan Objective: Diabetes mellitus (DM) and glucose tolerance abnormality axe well known risk factors of coronary heart disease (CHD) in western countries. However, there is little evidence on these relationships in the Japanese whose CHD mortality is relatively low. The purpose of this study was to elucidate these relationships with NIPPON DATAS0 which is a representative cohort of Japanese population. M e t h o d s : A total of 10,558 people over 30 years were randomly selected from all over Japan to receive the National Survey on Cardiovascular Disease in 1980 and followed up for 19 years, by 1999. A m o n g them, 9,466 participants whose vital status was confirmed in 1999 were included in the analysis. We calculated hazard ratios (HR) of CHD mortality for casual blood glucose level or self-reported DM by using Cox proportional hazard model. We evaluated blood glucose level by dividing them into quartile groups (Q1, Q2, Q3 and Q4 from the lowest to the highest). To adjust confounders, age, sex, body mass index, hypertension, total cholesterol level, smoking and drinking were included in the model. Results: The HRs of each glucose level category were 1.55, 1.64 and 1.98 in Q2 to Q4, respectively (reference level: Q1) (P for trend = 0.018). The HRs of the self-reported DM was 1.91 (P = 0.029). From these results, having the DM history was approximately equivalent to casual blood glucose level being 92 mg/dl higher than the original level. C o n d u s i o n s : Self reported DM and higher casual glucose levels were risk factors of CHD in the Japanese. Confirming DM is also very important for detecting future risk of CHD. I
I W e - P 1 1 : 1 3 I G E N E T I C S A N D O U T C O M E S O N L I P I D S IN T Y P E 2 D I A B E T E S - B A S E L I N E C H A R A C T E R I S T I C S OF A P R O S P E C T I V E STUDY O F M Y O C A R D I A L I N F A R C T I O N IN D I A B E T I C S i
M.C.O. Izar, W.G.M. Relvas, R.M.S. Povoa, N. Kasinski, L. Pinto, S.S.M. Ihara, T. Helfenstein, A.O. Santos, A.C.C. Carvalho, F.A.H. Fonseca.
Federal Universi~ of Sat Paulo, Sat Paulo, Brazil ]
We-P11:11 / RELATIONSHIP BETWEEN CIRCULATING THROMBOMODULIN LEVELS AND LATENT P R O G R E S S I O N O F A T H E R O S C L E R O S I S IN T Y P E 2 DIABETIC PATIENTS A
I. Korzh, I. Fedotova, V. Nemtsova. Kharkov Medical Universi~, Kharkov,
Ukrabte Objective: The present study was designed to test the hypothesis that circulating levels of thrombomodulin are elevated in patients with type 2 diabetes in proportion to the severity of the vascular damage. M e t h o d s : A cross-sectional study was carried out using a population consisting of 112 patients with type 2 diabetes without clinically evident cardiovasculax disease (mean age: 59 ± 11 years) and 95 healthy control subjects (60 ± 10 years). Blood was sampled and serum concentrations of soluble thrombomodulin were measured using an enzyme immunoassay method. Results: We evaluated the ratio of the concentration of thrombomodulin to that of creatinine, because soluble thrombomodulin is excreted by the kidney and the serum level of thrombomodulin was correlated with that of creatinine (p < 0.05). The assodation between the ratio and other clinical variables was investigated. The ratio of the thrombomodulin to creatinine concentrations was higher in diabetic patients (28.2 ± 9.8) than in control subjects (23.3 ± 5.1; p < 0.001). Systolic blood pressure was correlated with the ratio but the ratio showed no correlation with serum lipid levels when analyzed using data from all subjects. In diabetic patients, the ratio correlated with the grade of sclerotic, but not hypertensive, changes in the fundus oculi (Scheie's classification, p < 0.001). Furthermore, the ratio correlated with brachial-ankle pulse wave velocity (p < 0.01). Conclusions: These results suggest that circulating levels of thrombomodulin are elevated in type 2 diabetic patients as compared to control subjects and that the thrombomodulin level may be a molecular marker of the latent progression of atherosclerosis in type 2 diabetes.
Objective: To evaluate the prevalence of risk factors associated with myocardial infaxction among diabetics. M e t h o d s : A case-control study, centrally coordinated, evaluated risk factors among type 2 diabetics with previous myocardial infaxction (MI) (n=386) or without any evidence of atherosclerosis (n=604) in five regions of Brazil. A case report form, an electrocardiogram, and fasting blood samples for lipids and genetic studies were collected and shipped to the central laboratory. Results: Diabetics with MI were older (62-4-0.5 vs. 59-4-0.4 y, p<0.001), predominantly of male sex (59 vs. 31%, p<0.001), had higher prevalence of current smoking (10 vs. 6%, p=0.030), left ventricle hypertrophy (35% vs. 20%, p<0.0001), had diabetes for a longer time (10.0-4-0.4 vs. 8.0-4-0.3 y, p=0.001), lower HDL-cholesterol (35-4-1 vs. 38-4-1 mg/dL, p<0.001), higher triglycerides (248-4-14 vs. 191-4-6 mg/dL, p<0.001), and a higher prevalence of the metabolic syndrome (92 vs. 86%, p=0.006). Multiple logistic regression found male sex, LVH, smoking, age, duration of diabetes, and HDL-C levels associated with MI, where male sex tripled, LVH doubled and smoking habit increased the risk by 1.8 times. C o n d u s i o n : Along with metabolic abnormalities, classic risk factors are implicated in the occurrence of myocardial infarction in diabetics. Hypertension, or obesity did not identify those at higher risk for coronary events.
I We-P 11 141 I
T H E A S S E S M E N T O F P U L S E WAVE V E L O C I T Y A N D A N K L E - B R A C H I A L I N D E X IN P A T I E N T S W I T H TYPE2 DIABETES
M. Iiyama, Y. Go, H. Kitaoka. Seikeikai Hospital, Sal~li, Osal~l, Japan Objective: The purpose of the study was to examine the usefulness of Pulse wave v e l o d t y (PWV), a indicator of the vascular stiffness and Anlde-brachial index (ABI), a subclinical marker for lower extremity arterial disease and complications in patients with type2 diabetes.
XIV bztetTtational Symposium on Atherosclerosis, Rome, Italy, June 18-22, 2006