Cardiovascular Risk Group Research Articles

Effects of adding tocotrienol-tocopherol mixed fraction and vitamin C on inflammatory status in hypercholesterolaemic patients in the low coronary risk category

This study is designed to investigate the effects of tocotrienol-tocopherol mixed fraction (TTMF), vitamin C and combined TTMF-vitamin C supplementations on serum lipids and biochemical markers of inflammation and endothelial activation in hypercholesterolemic subjects in the low-risk category. 78 hypercholesterolaemic subjects (total cholesterol of ≥ 5.2 mmol/L and low-density lipoprotein 3.4 – 4.9 mmol/L) in the low cardiovascular risk category according to the NCEP-ATP3 criteria were recruited. They were randomized into four treatment combination groups for a period of twelve months; (1) receiving TTMF and vitamin C, (2) receiving TTMF and placebo, (3) receiving vitamin C and placebo, and (4) receiving placebo for both. Serum fasting lipid profiles and levels of high-sensitivity C-reactive protein, interleukin-6, tumour necrosis factor-ɑ, intercellular adhesion molecule, vascular cell adhesion molecule, E-selectin and homocysteine were measured at entry and multiple time points post-randomisation. There were no significant differences in percentage changes of lipid profiles and inflammatory markers between treated and placebo groups for either single or combined antioxidants supplementations. TTMF, vitamin C and combined TTMF-vitamin C supplementations have neutral effects on lipid profiles and biochemical markers of inflammation and endothelial activation in low risk subjects, suggesting that they offer no added advantage in the low cardiovascular risk group.

Distribución del grosor íntima-media carotídeo en función de la estratificación del riesgo cardiovascular según las funciones de Framingham-REGICOR y SCORE

BackgroundCarotid intima-media thickness (cIMT) has been suggested as a further tool for risk function charts. The aim of this study was to describethe relationship between cIMT and cardiovascular risk (CVR) estimation according to Framingham-REGICOR and SCORE equations. MethodsObservational, cross-sectional cohort study from 362 hypertensive subjects. Demographic and clinical information were collected as well as laboratory, ultrasonographic and CVR estimation by the Framingham-REGICOR and SCORE functions. Statistical analysis was performed using SPSS software (version 20,0). To analyze the data, statistical tests such as Chi-square, T-test, ANOVA, and Pearson correlation coefficient were used. ResultsAccording to both functions, differences on mean cIMT were found between low CVR group and intermediate to high groups. No differences were found between intermediate and high risk groups (cIMT: 0,73mm low risk patients vs. 0,89 or 0,88mm respectively according to SCORE function and cIMT: 0,73 vs. 0,85 or 0,87mm respectively according to Framingham-REGICOR function).cIMT correlated positively with CVR estimation according to both SCORE (r=0,421; P<.01), and Framingham-REGICOR functions (r=0,363; P<.01). ConclusionscIMT correlates positively with CVR estimated by SCORE and Framingham-REGICOR functions. cIMT in those subjects at intermediate risk is similar to those at high risk. Our findings highlight the importance of carotid ultrasound in identifying silent target-organ damage in those patients at intermediate CVR.

PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH PSORIATIC ARTHRITIS: ITS ASSOCIATION WITH INFLAMMATION AND SUBCLINICAL ATHEROSCLEROSIS

Metabolic syndrome (MS) is a cluster of metabolic disorders giving rise to atherosclerotic cardiovascular diseases (CVD). The combination of inflammatory activity and a high spread of traditional risk factors (RF) for CVD in patients with psoriatic arthritis (PsA) permits them to be referred to as a higher cardiovascular risk group as compared to the general population. Objective: to estimate the spread of MS and its association with inflammation and subclinical atherosclerosis in patients with PsA. Subjects and methods. This investigation enrolled 128 patients with PsA (61.7% women and 38.3% men); their median age was 43 [34; 49.5] years; the duration of PsA and psoriasis – 7 [3; 13] and 15 [6; 26] years, respectively). There was a preponderance of patients with moderate (3.7 ≥ DAS > 2.4) and high (DAS > 3.7) disease activity: 33 (25.8%) and 74 (57.8%), respectively. MS was diagnosed on the basis of the 2011 National Guidelines of the Russian Cardiology Society for Cardiovascular Prevention. All the patients underwent carotid Doppler ultrasound (CDU) for the diagnosis of subclinical atherosclerosis. Results and discussion. MS was diagnosed in 49 (38.3%) patients with PsA. The most common MS criteria were abdominal obesity in 72 (56.3%) and dyslipidemia [an elevation of low-density lipoproteins (LDL) level in 101 (78.9%), and a decrease in high-density lipoproteins (HDL) level in 65 (50.8)]. Hypertension was diagnosed in 32 (25%). 65 (50.8%) patients were found to have subclinical atherosclerosis, as evidenced by CDU. The patients with MS were older than those without this condition (46 [43; 52] and 39 [31; 46] years, respectively; p < 0.0001). These groups did not differ in PsA duration (15 [7; 29] and 15 [5.5; 25] years respectively; p = 0.47). The patients with MS had higher DAS values (4.4 [3.2; 5.6] and 3.6 [2.5; 4.7], respectively; p = 0.02); mean intima media thickness (IMT) (0.78 [0.72; 0.86] and 0.73 [0.66; 0.77] mm; p < 0.0001) and maximal IMT (0.94 [0.84; 1.03] and 0.84 [0.75; 0.94] mm; p < 0.01). They were found to have significantly more often signs of subclinical carotid atherosclerosis than those without MS (33 (67.3%) and 32 (40.5%) patients, respectively; p = 0.003). There was a statistically significant relationship between IMT and RF for CVD (MS components, such as waist circumference (R = 0.41; p <0.0001), systolic blood pressure (R = 0.41; p < 0.0001), LDL (R = 0.44; p < 0.0001), and triglycerides (R = 0.36; p < 0.0001). There was also a correlation between IMT and PsA duration (R = 0.18; p < 0.03). Conclusion. Thus, the patients with PsA had a high prevalence of MS that was detected in almost 40% of them. There was a relationship of PsA activity to MS. In the PsA patients with MS, IMT was greater than in those without MS. An association was established between IMT and traditional RF for CVD (MS components), PsA duration, suggesting that both traditional RF for CVD and PsA duration may affect the development process of CVD in patients with PsA.

Exercise treadmill tests in patients with low cardiovascular risk: are we wasting our time?

INTRODUCTION The efficacy and cost-effectiveness of exercise treadmill testing for patients with low cardiovascular risk is unclear. This is due to the low incidence of coronary artery disease in this population and the potential for false-positive results leading to additional invasive and expensive investigation. AIM To investigate the value of exercise treadmill testing (ETT) as a predictor of coronary artery disease in patients with different levels of cardiovascular risk. METHODS An observational study was completed on an outpatient population from a chest pain clinic (n = 529). Cross-tabulations and binary logistic regressions were used to examine relationships between variables. RESULTS A negative ETT result was recorded for 72.5% of patients with low cardiovascular risk compared to 54.3% of those with moderate or high risk. Within the low cardiovascular risk group, patients with symptoms atypical for cardiac ischaemia were 11.1-fold more likely to have a negative ETT result. Of the patients with positive or equivocal ETT results, coronary artery disease was subsequently confirmed in only 23.1% of the low cardiovascular risk group compared to 77.2% of those with moderate or high cardiovascular risk. DISCUSSION Results show low cardiovascular risk patients are significantly more likely to return negative ETT results, particularly when associated with atypical symptoms. Similarly, positive or equivocal ETTs in this group are significantly more likely to be false positives. This suggests the ETT is not efficacious in predicting coronary artery disease in patients with low cardiovascular risk. Is it therefore appropriate to offer exercise testing to this cohort or should alternative management strategies be considered?

Mediterranean diet adherence and blood lipids in a very high cardiovascular risk group

Mediterranean diet adherence and blood lipids in a very high cardiovascular risk group

Pulse blood pressure and cardiovascular mortality in a population-based cohort of elderly Costa Ricans.

We studied the relationships between blood pressure (BP), pulse pressure (PP) and cardiovascular (CV) death in older adults using data from 2346 participants enrolled in the Costa Rican CRELES study, mean age 76 years (s.d. 10.2), 31% qualified as wide PP. All covariates included and analyzed were collected prospectively as part of a 4-year home-based follow-up; mortality was tracked for an additional 3 years, identifying 266 CV deaths. Longitudinal data revealed little change over time in systolic BP (SBP), a decline in diastolic BP, and widening of PP. Wide PP was associated with higher risk of CV death but only among individuals receiving antihypertensive drug therapy. Individuals with both wide PP and receiving therapy had 2.6 hazard rate of CV death relative to people with normal-PP plus not taking treatment (TRT), even adjusting for SBP. Increasing PP between visits was significantly associated to higher CV death independently of TRT status. SBP and DBP were not significantly associated to CV death when the effect of PP was controlled for. Conclusion: elderly hypertensive patients with wide or increasing PP, especially if receiving TRT, are the highest CV risk group, thus must be carefully assessed, monitored and treated with caution.

Una visión actualizada del tratamiento hipolipemiante de alta intensidad en los pacientes de alto riesgo cardiovascular

Statins are highly effective drugs to decrease the plasma concentrations of atherogenic lipoproteins and prevent cardiovascular disease. The clinical practice guidelines recommend the use of high-intensity statins to lower LDL-cholesterol by at least 50% in patients with CVD and those at high cardiovascular risk. The recommendations for the treatment of hypercholesterolaemia by the ACC/AHA have led to a paradigm shift in cardiovascular prevention. These recommendations have abandoned the therapeutic goals of LDL-cholesterol, and recommend the treatment with statins of high or moderate intensity in four high cardiovascular risk groups. These recommendations are different from the European guidelines on cardiovascular disease prevention, in which their objectives are still towards LDL-cholesterol. This paper reviews this controversy from different angles and from the perspective of the Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention. Intervention studies with high intensity statins in primary prevention, in patients with acute coronary syndrome, and with stable ischaemic heart disease are also described. Likewise, treatment with statins of high intensity is addressed in terms of their effectiveness in cardiovascular prevention and in terms of their safety, with particular attention to muscle effects, as well as taking into account the pharmacological characteristics of the different statins and the increased safety of those with less potential for interactions. Finally, new agents are described for the treatment of hypercholesterolaemia, with special emphasis on anti-PCSK9 monoclonal antibodies, a new therapeutic group for the treatment of hypercholesterolaemia that will offer a huge progress in the prevention of cardiovascular diseases.

“Non-dipping” blood pressure and excessive daytime sleepiness in severe obstructive sleep apnea

Background: Non-dipping blood pressure and obstructive sleep apnea both carry an increased risk of cardiovascular events and mortality. The relationship between non-dipping blood pressure and obstructive sleep apnea has been noted. However, data on the prevalence of sleep apnea with non-dipping hypertension and the relationship with excessive daytime sleepiness are limited. Objective: The purpose of the present study was to determine the prevalence of nondipping blood pressure and evaluate the relationship with excessive daytime sleepiness. Patients and Methods: We prospectively enrolled adult patients with habitual snoring who visited our sleep clinics from November 2010 to May 2013. Polysomnography and 24-hour ambulatory blood pressure monitoring (ABPM) were used. Excessive daytime sleepiness was evaluated. The prevalence of non-dipping blood pressure and the relationship with excessive daytime sleepiness were evaluated. Results: Thirty patients were dippers (57%) and 23 (43%) were non-dippers. Nondippers had lower nighttime blood pressure and more excessive daytime sleepiness (Epworth sleepiness scale (ESS) ≥10) than dippers (p=0.045). ESS was significantly negatively correlated with dipping of systolic and diastolic blood pressure and mean arterial pressure, R=-0.313, -0.304, -0.302, respectively (p ＜ 0.05). Multivariate linear regression models for associations involving systolic blood pressure dipping showed that ESS was the only independent predictor of systolic blood pressure dipping [β=-0.005, p=0.022, R^2=0.099, 95% confidence interval (CI) of β=-0.009-0.000] in stepwise linear regression analyses. Conclusions: High prevalence of non-dippers was noted in severe obstructive sleep apnea patients. Non-dippers experienced more excessive daytime sleepiness. ESS was an independent predictor of dipping values. ABPM may play an important role in these high cardiovascular risk groups.

버스운수업 종사자의 뇌심혈관질환 예방을 위한 개별상담 효과: 이차자료분석

Purpose: This study was conducted to examine the effects of individual counseling for bus-drivers on cerebrovascular and cardiovascular disease prevention. Methods: The one-group pretest-posttest design was used. This study presents a secondary analysis of data collected in 'contents of cerebrovascular and cardiovascular disease prevention program for bus-drivers in one workplace in Seoul, Korea. The data were collected from 56 bus drivers, using questionnaires from September 10th to November 20th, 2014. The analysis was conducted with <TEX>${\chi}^2$</TEX> test and paired samples t-test using SPSS/Win 21.0. Results: After the intervention, the participants showed a significant decrease in the level of systolic blood pressure (p=.003) and a significant increase in the total cholesterol level (p=.030). The distribution of cardiovascular risk groups changed after the intervention: 5.3% decreased in the high risk group, 16.1% decreased in the medium risk group, and 3.5% decreased in the low risk group, while 25.0% increased in the normal group. Conclusion: The comprehensive individual counseling including simple screening, tailored education and counseling is effective to manage their lifestyle risk factors, resulting in better maintenance of their health as well as preventing cerebrovascular and cardiovascular disease.

Regional cervical plexus blockage for carotid endarterectomy in patients with cardiovascular risk factors.

Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared. Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P &gt; .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection. Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed.

Endurance Exercise-induced Cardiac Troponin Elevations In Clinical Populations.

PURPOSE: Endurance exercise can elevate cardiac troponin (cTn) concentrations in healthy subjects. cTn is preferred biomarker for diagnosing myocardial infarction and indicates cardiac injury. Subjects with cardiovascular disease demonstrate elevated cTn-concentrations at baseline, but it is unknown how cTn concentrations change following endurance exercise. We investigated the impact of cardiovascular (CV) risk and disease (CVD) on exercise-induced cTn elevations. METHODS: We measured baseline and immediate post-exercise cTn-concentrations in 356 subjects who performed 30-50 km of walking. Subjects were classified as healthy (i.e. controls, n=133), having increased CV risk (hypertension, hypercholesterolemia, type 2 diabetes or BMI ≥30 kg/m2, n=131) or having diagnosed CVD (heart failure, myocardial infarction, stroke, n=92). cTn-subunit I (cTnI) was determined using a high-sensitive assay (ADVIA Centaur TnI-Ultra, Siemens) with a detection limit of 6 ng/L and upper reference limit of 40 ng/L. RESULTS: Subjects walked 8.0±1.4 hours at 68±10% of their maximum predicted heart rate. Baseline and post-exercise cTnI concentrations were significantly higher in CVD patients compared to controls (p<0.001 and p=0.008, respectively). The absolute exercise-induced increase in cTnI was higher in CVD patients (9.8±34.2 ng/L) compared to healthy controls (7.4±23.1 ng/L) and those with CV risk (6.5±18.7 ng/L, p=0.048). Nonetheless, the incidence of subjects exceeding the upper reference limit was similar across the healthy (7%), CV risk (7%) and CVD group (11%, p=0.512). CONCLUSIONS: Exercise-induced cardiac troponin elevations are significantly larger in subjects with cardiovascular disease, but this difference is small and does not result in a higher incidence of cases exceeding the clinical cut-off value.

Skin autofluorescence as a measure of advanced glycation end products deposition predicts 5-year amputation in patients with peripheral artery disease.

Patients with peripheral artery disease are at risk for critical limb ischemia and amputation. Accumulation of advanced glycation end products is increased and predictive for coronary and cerebrovascular events in several high cardiovascular risk groups. We hypothesized that accumulation of tissue advanced glycation end products, measured by skin autofluorescence (SAF), predicts amputation in patients with peripheral artery disease. Between October 2007 and June 2008, 252 patients with peripheral artery disease were included at the outpatient clinic. During a 5-year follow-up, 22 (9%) had an amputation because of critical limb ischemia. Competing risks regression analysis showed a subproportional hazard ratio of 3.05 (95% confidence interval [CI], 1.87-4.96); P<0.0001 for amputation per unit incease of SAF. After correction for diabetes mellitus and Fontaine stage, subproportional hazard ratio was 2.72 (95% CI, 1.38-5.39); P=0.004. In patients with Fontaine stage I and II only (n=215), SAF was the only predictor for amputation, subproportional hazard ratio 4.05 (95% CI, 2.09-7.83); P<0.0001. Fontaine stage multiplied by SAF resulted in a significant increase of the area under the curve for prediction of amputation when compared with Fontaine stage only: area under the curve increased from 0.74 (95% CI, 0.63-0.86) to 0.83 (95% CI, 0.74-0.92); P=0.003. Skin autofluorescence, as a measure of tissue advanced glycation end products deposition, predicts amputation in patients with peripheral artery disease during a 5-year follow-up, independent from the presence of diabetes mellitus and Fontaine stage. Even at lower Fontaine stage (I or II), SAF is a strong predictor of amputation. The multiplication of Fontaine stage by SAF results in a good prediction model of amputation.

Patterns and determinants of temporal change in high-sensitivity cardiac troponin-T: The Atherosclerosis Risk in Communities Cohort Study

BackgroundPatterns and determinants of temporal change in highly-sensitivity troponin-T (hs-cTNT), a novel measure of subclinical myocardial injury, among asymptomatic persons have not been well characterized. MethodsWe studied 8571 ARIC Study participants, free of cardiovascular disease, who had hs-cTNT measured at two time-points, 6years apart (1990–1992 and 1996–1998). We examined the association of baseline 10-year atherosclerotic cardiovascular (ASCVD) risk-group (<5%, 5–7.4%, ≥7.5%) and individual cardiac risk-factors with change across hs-cTNT categories using Poisson and Multinomial Logistic regression and with mean continuous hs-cTNT change using linear regression. ResultsMean age was 57years and 43% were male. Mean (SD) 6-year hs-cTNT change was higher across increasing ASCVD risk-groups; +1.2 (6.1) ng/L [<5%], +2.1 (5.4) ng/L [5–7.4%], and +2.8 (8.8) ng/L [≥7.5%]. Major baseline determinants of temporal hs-cTNT increases were: age, male gender, hypertension, diabetes, and obesity. In addition, the relative risk (RR) of incident elevated hs-cTNT (≥14ng/L) was 1.46 (95% CI 1.1–2.0) for persons with sustained hypertension compared to those who remained normotensive. Results for sustained obesity (RR 1.65 [1.19–2.29]) and hyperglycemia (RR 1.76 [1.16–2.67]) were similar. These associations were generally stronger after accounting for survival bias. However, smoking, LDL-cholesterol and triglycerides were not associated with hs-cTNT change. HDL-cholesterol was associated with declining hs-cTNT. ConclusionsPersons in higher ASCVD risk-groups were more likely to have increases in hs-cTNT over 6years of follow-up. The modifiable risk-factors primarily driving this association were diabetes, hypertension, and obesity; particularly when they were persistently elevated over follow-up. Future studies are needed to determine whether modifying these risk factors can prevent progression of subclinical myocardial injury.

The effects of diltiazem and metoprolol in QTc prolongation due to amitriptyline intoxication.

Amitriptyline, a frequently used tricyclic antidepressant agent, has powerful cardiotoxic effects especially in high doses. Serum and urine levels of amitriptyline dosages are not correlated with severity of toxicity; therefore, it increases the importance of electrocardiography (ECG) abnormalities. The prolongation of QTc can be a predictive marker for cardiotoxicity. Hence, in this study, it is aimed to evaluate possible effects of metoprolol and diltiazem in amitriptyline toxicity. The rats were separated into four groups. First one was control group, the second was the amitriptyline + saline group, third one was the amitriptyline + metoprolol group, and forth one was the amitriptyline + diltiazem group. ECG were recorded on rats under anesthesia. In amitriptyline group, QTc duration was prolonged compared with all other groups. The prolongation of QTc was shorter in amitriptyline + metoprolol group and amitriptyline + diltiazem group than amitriptyline group (p < 0.01 and p < 0.01, respectively). According to the results, it is possible to report ameliorating effects of both metoprolol and diltiazem on QTc prolongation related with amitriptyline intoxication. With further studies, these agents may be used for amitriptyline toxicity and besides, they may be used for patients in cardiovascular risk groups who take amitriptyline treatment regularly.

Supplementation with a 9c,11t-rich conjugated linoleic acid blend shows no clear inhibitory effects on platelet function in healthy subjects at low and moderate cardiovascular risk: a randomized controlled trial.

The 9cis,11trans-conjugated linoleic acid (9c,11t-CLA) is reported to have anti-atherogenic properties in animal models and to modulate protein expression in unstimulated human platelets in vivo. Platelet function was therefore investigated after dietary supplementation with 9c,11t-CLA enriched oil (CLA80:20) in a randomized, baseline-controlled cross-over trial. Forty-three healthy adults at low to moderate risk of cardiovascular disease received 4 g/day of CLA80:20 or placebo for two weeks each. Platelet function, inflammation, and endothelial activation were assessed before and after each phase. Compared with placebo, supplementation had no significant effects on platelet function measured by Platelet Function Analyzer-100. Inhibitory effects on collagen-induced aggregation were sex-dependent (p=0.005) that reached significance only in women (p=0.045). Thrombin receptor-activating peptide (TRAP)-induced P-selectin expression was higher after supplementation in all subjects (p=0.017). TRAP-induced platelet fibrinogen binding was also dependent on sex (p = 0.015), with fibrinogen binding after CLA80:20 being higher in males (p=0.035). Plasma monocyte chemoattractant protein-1 was higher (p=0.041) after CLA80:20. No clear evidence was found for inhibition or activation of platelet function as well as inflammation by CLA80:20 in a low to moderate cardiovascular risk group.

Epidemiology of vestibular evoked myogenic potentials: Data from the Baltimore Longitudinal Study of Aging

ObjectiveTo evaluate whether age-related changes in vestibular evoked myogenic potentials (VEMPs) differ by demographic and cardiovascular risk groups. MethodsParticipants in the Baltimore Longitudinal Study of Aging underwent cervical and ocular VEMP testing. VEMP latency, amplitude, asymmetry ratios, and prevalence of absent responses were compared across demographic and cardiovascular risk groups. ResultsIn 257 participants (mean age 72.9, 57% female), ocular VEMP (oVEMP) n10 latency increased by 0.12ms/decade while amplitude decreased by 2.9μV/decade. Black participants had better oVEMP function (shorter latency, increased amplitude, and decreased odds of absent responses) relative to white participants. In 250 participants (mean age 72.6, 54% female), EMG-corrected cervical VEMP (cVEMP) amplitude decreased by 0.14μV/decade and p13 latency was 0.38ms longer in males. The odds of absent responses were significantly higher in individuals age ⩾80 for oVEMPs, and age ⩾70 for cVEMPs. Cardiovascular risk factors had no association with VEMP parameters. ConclusionsWe confirmed age-related declines in otolith function, and observed a protective effect of black race on oVEMP latency and amplitude. SignificanceThese results illustrate how measures of otolith function change with age in community-dwelling adults. Further investigations are needed to ascertain whether better otolith function in blacks might contribute to a lower risk of mobility disability and falls.

South Asians and Anglo Australians with heart disease in Australia.

The aim of the present study was to determine cardiovascular disease (CVD) risk tactors and compare presentation and severity of ischaemic heart disease (IHD) among South Asians (SAs) and Anglo Australians (AAs). A retrospective clinical case audit was conducted at a public tertiary hospital. The study population included SA and AA patients hospitalised for IHD. Baseline characteristics, evidence of diabetes and other CVD risk factors were recorded. Angiography data were also included to determine severity, and these were assessed using a modified Gensini score. SAs had lower mean (± s.d.) age of IHD presentation that AAs (52 ± 9 vs 55 ± 9 years, respectively; P = 0.02), as well as a lower average body mass index (BMI; 26 ± 4 vs 29 ± 6 kg/m2, respectively; P = 0.005), but a higher prevalence of type 2 diabetes (57% vs 31%, respectively; P = 0.00 1). No significant differences were found in coronary angiography parameters. There were no significant differences in the median (interquartile range) Gensini score between SAs and AAs (43.5 (27-75) vs 44 (26.5-68.5), respectively), median vessel score (1 (1-2) vs 2 (1-3), respectively) or multivessel score (37% (33/89) vs 54% (22/41), respectively). The findings show that in those with established IHD, cardiovascular risk factors, such as age at onset and BMI, differ between SAs and AAs and these differences should be considered in the prevention and management of IHD.

Abstract 9440: Prognostic Value of Stress Echocardiography in Patients With Low (&lt;10%)-Intermediate (10-20%) Framingham Risk Score (Short-Term) versus Low (&lt;39%) or High (≥39%) Lifetime Predicted Risk of Cardiovascular Disease

Background: The ideal risk assessment and management of patients with low-intermediate or high Framingham risk score (FRS, short-term) versus low or high lifetime cardiovascular (CV) risk is unclear. The purpose of this study was to evaluate the prognostic value of stress echocardiography (SE) in defined FRS and lifetime risk groups. Methods: We evaluated 4566 patients (60±13 years; 46% male) undergoing SE (41% treadmill, 59% dobutamine) with low-intermediate FRS (&lt;20%) divided into: low (&lt;39%, n=368) or high lifetime (≥39%, n=661) CV risk and third group with high FRS (≥20%, n=3537). Follow-up (3.2±1.5 years) for non-fatal myocardial infarction (n=102) and cardiac death (n=140) were obtained. Results: By univariate analysis, age (p&lt;0.001), ejection fraction (p&lt;0.001) and ≥3 ischemic wall motion abnormalities (WMA) (p&lt;0.001) were significant predictors of cardiac events. Cumulative survival in patients with low or intermediate short term risk groups were significantly worse in patients with ≥3 WMA vs. &lt;3 WMA in low-intermediate FRS and low (3.3%/year vs. 0.3%/year, p&lt;0.001) or high lifetime CV risk (2.0%/year vs. 0%/year, p&lt;0.001) and high FRS group (3.5%/year vs. 1.0%/year, p&lt;0.001). Multivariate Cox proportional hazards analysis identified ≥3 new ischemic wall motion abnormalities as the strongest predictor of cardiac events (HR 3.2, 95% CI 2.2-4.6, p &lt;0.001). Conclusion: Stress echocardiography results (absence or presence of ≥3 ischemic segments) can equally and effectively risk stratify low-intermediate or high FRS versus low or high lifetime cardiovascular risk patients. Event rate with normal SE is highest in patients with high FRS.

Estimated GFR or albuminuria: which one is really associated with resistant hypertension?

Patients with resistant hypertension belong to a very high cardiovascular risk group and have a high prevalence of target organ damage. Microalbuminuria and low estimated glomerular filtration rate are associated with resistant hypertension, and could be a cause and/or complication of hypertension. In this review, we explore the relationship between these 2 markers of kidney disease and the prevalence of resistant hypertension. We identified different phenotypes of resistant hypertension that associate with microalbuminuria and/or low estimated glomerular filtration rate. These phenotypes suggest that high sympathetic activity associated with fluid overload and endothelial dysfunction may contribute differently to the development of resistant hypertension.

Comparison of Arterial Stiffness Parameters in Patients With Coronary Artery Disease and Diabetes Mellitus Using Arteriograph

Recently an expert consensus document advised to standardize user procedures and a new cut-off value for carotid-femoral pulse wave velocity in daily practice. Our aim was to observe aortic pulse wave velocity (PWVao) and augmentation index (AIXao) in two high cardiovascular risk groups: patients with verified coronary artery disease (CAD) or with type 2 diabetes mellitus (T2DM). We also aimed to determine the cut-off values for PWVao, AIXao in CAD and T2DM patients using oscillometric device (Arteriograph). We investigated 186 CAD and 152 T2DM patients. PWVao and AIXao increased significantly in the CAD group compared to the age-, gender-, blood pressure-, and heart rate-matched control group (10.2+/-2.3 vs. 9.3+/-1.5 m/s; p<0.001 and 34.9+/-14.6 vs. 31.9+/-12.8 %; p<0.05, respectively). When compared to the apparently healthy control subjects, T2DM patients had significantly elevated PWVao (9.7+/-1.7 vs. 9.3+/-1.5 m/s; p<0.05, respectively), however the AIXao did not differ significantly. The ROC-curves of CAD and healthy control subjects explored cut-off values of 10.2 m/s for PWVao and 33.23 % for AIXao. Our data provide supporting evidence about impaired arterial stiffness parameters in CAD and T2DM. Our findings encourage the implementation of arterial stiffness measurements by oscillometric method in daily clinical routine.