Classical Cardiovascular Risk Research Articles

The correlation of lipid profile and waist circumference with phenylalanine levels in adult patients with classical phenylketonuria

Introduction and ObjectivesSome studies have pointed to a relationship between Phenyketonuria (PKU) and an increased cardiovascular risk (CVR). This study aimed to evaluate the influence of metabolic control on classical CVR factors in adult patients with PKU. Material and methodsIt was a cross-sectional study conducted in patients older than 18 years with a diagnosis of classical PKU and under strict dietary control. Demographic, epidemiological and laboratory variables related to CVR were collected. The variables of metabolic control were some parameters related to phenylalanine (Phe) plasma levels. ResultsA total of 47 patients were included with a mean age of 36±10 years of which 30 (64%) were women. Multivariate analysis revealed that range Phe (B=−2.211, P=0.044, 95%CI: −4.354–(−0.068)) levels were within the model for triglyceride concentrations, while minimum (B=−2.803, P=0.051, 95%CI: −5.612–0.007) and range (B=−1.515, P=0.039, 95%CI: −2.945–(−0.084)) Phe levels were within the model for high-density lipoprotein cholesterol concentrations. Median Phe levels showed a stronger correlation with waist circumference (WC) (B=1.216, P=0.002, 95%CI: 0.462–1.969) than with body mass index (B=0.355, P=0.052, 95%CI: −0.004–0.714). ConclusionsHigh Phe levels and wide Phe fluctuations were related to weight gain, increased WC and lipid profile abnormalities. Systematic CVR assessments and comprehensive monitoring of Phe levels may be desirable to prevent or delay cardiovascular disease in PKU patients.

The correlation of lipid profile and waist circumference with phenylalanine levels in adult patients with classical phenylketonuria

Introduction and ObjectivesSome studies have pointed to a relationship between Phenyketonuria (PKU) and an increased cardiovascular risk (CVR). This study aimed to evaluate the influence of metabolic control on classical CVR factors in adult patients with PKU. Material and methodsIt was a cross-sectional study conducted in patients older than 18 years with a diagnosis of classical PKU and under strict dietary control. Demographic, epidemiological and laboratory variables related to CVR were collected. The variables of metabolic control were some parameters related to phenylalanine (Phe) plasma levels. ResultsA total of 47 patients were included with a mean age of 36±10 years of which 30 (64%) were women. Multivariate analysis revealed that range Phe (B=−2.211, P=0.044, 95%CI: −4.354–(−0.068)) levels were within the model for triglyceride concentrations, while minimum (B=−2.803, P=0.051, 95%CI: −5.612–0.007) and range (B=−1.515, P=0.039, 95%CI: −2.945–(−0.084)) Phe levels were within the model for high-density lipoprotein cholesterol concentrations. Median Phe levels showed a stronger correlation with waist circumference (WC) (B=1.216, P=0.002, 95%CI: 0.462–1.969) than with body mass index (B=0.355, P=0.052, 95%CI: −0.004–0.714). ConclusionsHigh Phe levels and wide Phe fluctuations were related to weight gain, increased WC and lipid profile abnormalities. Systematic CVR assessments and comprehensive monitoring of Phe levels may be desirable to prevent or delay cardiovascular disease in PKU patients.

Choroidal thickness and granulocyte colony-stimulating factor in tears improve the prediction model for coronary artery disease

BackgroundCoronary artery disease (CAD) detection in asymptomatic patients still remains controversial. The aim of our study was to evaluate the usefulness of ophthalmologic findings as predictors of the presence of CAD when added to cardiovascular classic risk factors (CRF) in patients with acute coronary cardiopathy suspicion.MethodsAfter clinical stabilization, 96 patients with acute coronary cardiopathy suspicion were selected and divided in two groups: 69 patients with coronary lesions and 27 patients without coronary lesions. Their 192 eyes were subjected to a complete routine ophthalmologic examination. Samples of tear fluid were also collected to be used in the detection of cytokines and inflammatory mediators. Logistic regression models, receiver operating characteristic curves and their area under the curve (AUC) were analysed.ResultsSuggestive predictors were choroidal thickness (CT) (OR: 1.02, 95% CI 1.01–1.03) and tear granulocyte colony-stimulating factor (G-CSF) (OR: 0.97, 95% CI 0.95–0.99). We obtained an AUC of 0.9646 (95% CI 0.928–0.999) when CT and tear G-CSF were added as independent variables to the logistic regression model with cardiovascular CRF: sex, age, diabetes, high blood pressure, hypercholesterolemia, smoking habit and obesity. This AUC was significantly higher (p = 0.003) than the prediction derived from the same logistic regression model without CT and tear G-CSF (AUC = 0.828, 95% CI 0.729–0.927).ConclusionsCT and tear G-CSF improved the predictive model for CAD when added to cardiovascular CRF in our sample of symptomatic patients. Subsequent studies are needed for validation of these findings in asymptomatic patients.

Coronary computed tomography angiography improves coronary risk prediction in general population

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute and the European Regional Development FundAgency for Management of University and Research Grants Introduction In the next decades, it is expected an increasing incidence of acute coronary syndrome in the Spanish population. Identify high-risk patients could be the most cost-effective way to reduce its incidence and morbi-mortality burden. We studied the effect of adding coronary artery calcification (CAC) and the extent of atherosclerotic disease (SIS score) to classical cardiovascular (CV) risk factors in coronary risk prediction. Methods This was a prospective cohort study of 325 asymptomatic patients recruited between 2013-2017. Demographic characteristics and CV risk factors were obtained and all participants underwent a coronary computed tomography angiography exam in which CAC and SIS were determined. The cohort was followed-up (median= 4 years) for a composite endpoint that included CV death, myocardial infarction, coronary angiography and/or revascularization. Improvement in discrimination and in reclassification by the inclusion of CAC/SIS in the Framingham-REGICOR function were examined with the Sommer's D index and with the Net reclassification index (NRI) (categorical and continuous), respectively. Results Nine of the 251 individuals included in the study had an event in the follow-up. Of the included participants, 94 had a CAC = 0 and 85 a SIS = 0. These participants had no events. The addition of SIS or of SIS and CAC scores to the Framigham-REGICOR risk function increased significantly the discrimination capacity from 0.71 to 0.88 (Table 1). Reclassification measured by the continuous NRI also improved significantly from 69.5 to 112.4/115.5 when SIS or both scores were included (Table 2). Conclusions CAC and SIS scores were associated to 4-year CV event incidence, independently of coronary risk estimation. Discrimination and reclassification of the Framigham-REGICOR coronary function were significantly improved by both indexes, but SIS overrode the effect of CAC.

Effects of uremic toxins on hippocampal synaptic transmission: implication for neurodegeneration in chronic kidney disease

Patients affected by chronic kidney disease (CKD) have an increased risk of developing cognitive impairment. The cause of mental health disorders in CKD and in chronic hemodialysis patients is multifactorial, due to the interaction of classical cardiovascular disease risk factors, kidney- and dialysis-related risk factors with depression, and multiple drugs overuse. A large number of compounds, defined as uremic toxins that normally are excreted by healthy kidneys, accumulate in the circulations, in the tissues, and in the organs of CKD patients. Among the candidate uremic toxins are several guanidino compounds, such as Guanidine. Uremic toxins may also accumulate in the brain and may have detrimental effects on cerebral resident cells (neurons, astrocytes, microglia) and microcirculation. The present study aims to analyze the effect of Guanidine on hippocampal excitatory postsynaptic field potentials (fEPSPs) and in CA1 pyramidal neurons recorded intracellularly. Moreover, we compared these effects with the alterations induced in vitro by CKD patients derived serum samples. Our results show an increased, dose-dependent, synaptic activity in the CA1 area in response to both synthetic Guanidine and patient’s serum, through a mechanism involving glutamatergic transmission. In particular, the concomitant increase of both NMDA and AMPA component of the excitatory postsynaptic currents (EPSCs) suggests a presynaptic mechanism. Interestingly, in presence of the lower dose of guanidine, we measure a significant reduction of EPSCs, in fact the compound does not inhibit GABA receptors allowing their inhibitory effect of glutamate release. These findings suggest that cognitive symptoms induced by the increase of uremic compounds in the serum of CKD patients are caused, at least in part, by an increased glutamatergic transmission in the hippocampus.

Untargeted metabolites and vascular health in cardiovascular risk patients

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation Background The mechanistic pathways how classical cardiovascular (CV) risk factors affect macro- and microvascular health are not fully understood. The metabolome reflects a chemical fingerprint of the upstream epigenetic processes and seems to have the potential to provide insights into multiple molecular mechanisms underlying vascular health or vascular abnormalities that contribute to the pathogenesis of CV disease. Purpose We aimed to investigate the associations of CV risk factors with the metabolic fingerprint and macro- as well as microvascular health in an untargeted metabolic approach in predefined CV risk groups of aged individuals. Methods This cross-sectional study investigated the metabolic fingerprint, as well as the macro- and microvascular health from a well-characterized aged (50-80 years) cohort, based on the EXAMIN AGE study. One hundred and fifty-five participants with no to ≥three previously defined CV risk factors were analysed. Nuclear magnetic resonance spectroscopy was used to analyse the metabolic fingerprint. Carotid-femoral pulse wave velocity as well as retinal vessel diameters were analysed to quantify macro- and microvascular health. Results The metabolic fingerprint gradually changed with increasing number of risk factors. Whereas the metabolic profile of individuals with a small number of risk factors were more homogenous, the profile became more heterogeneous with increasing numbers of risk factors. There was strong evidence for a negative association of glutamine [estimate (95% CI): -14.54 (-17.81 to -11.27), p < 0.001], glycine [-5.84 (-7.88 to -3.79), p < 0.001], histidine [-0.73 (-0.96 to -0.50), p < 0.001], and acetate [-1.68 (-2.91 to -0.46), p = 0.007] with a higher CV risk profile. Tryptophan was positively associated with higher CV risk [0.31 (0.06 to 0.56), p = 0.015]. The combination of a priori defined CV risk factors explained up to 45.4% of the metabolic variation. The metabolic fingerprint explained 20% of macro- and 23% of microvascular variation. Conclusion Metabolic profiling has the potential to improve and individualise CV risk stratification. It may help better understand some of the underlying metabolic mechanisms of atherosclerotic disease development. Our findings support future preventive strategies to target specific metabolites and thereby reduce CV risk and associated vascular disease. Metabolic profiling may have added value to predict CV disease development and potentially guide future treatment strategies.

Assessment of Concentrations of Heavy Metals in Postmyocardial Infarction Patients and Patients Free from Cardiovascular Event.

Cardiovascular diseases (CVDs) constitute the first cause of death among the population of developing and developed countries. Atherosclerosis, which is a disorder with multifactorial etiopathogenesis, underlies most CVDs. The available literature includes ample research studies on the influence of classic cardiovascular (CV) risk factors. However, environmental exposure to heavy metals, among other substances, is still an unappreciated risk factor of CVDs. This study aimed to assess the concentration of some heavy metals (copper (Cu), zinc (Zn), manganese (Mn), cobalt (Co), and iron (Fe)) in the blood serum of postmyocardial infarction (post-MI) patients and patients free from myocardial infarction (MI) as well as estimate the relationship between the occurrence of MI and increased concentration of heavy metals. The concentration of heavy metals (Cu, Zn, Mn, Co, and Fe) was assessed using the inductively coupled plasma mass spectrometry technique in a group of 146 respondents divided into two groups: post-MI group (study group (SG), n = 74) and group without cardiovascular event (CVE) having a low CV risk (control group (CG), n = 72). The concentration of the analyzed heavy metals was higher in SG. All the heavy metals showed a significant diagnostic value (p < 0.001). The highest value of area under the curve (AUC) was observed for manganese (Mn) (0.955; 95% confidence interval (CI) = 0.922–0.988), while the lowest value was found for zinc (Zn) (0.691; 95% CI = 0.599–0.782). In one-dimensional models, high concentrations of each of the analyzed heavy metals significantly increased the chances of having MI from 7-fold (Cu) to 128-fold (Mn). All the models containing a particular metal showed a significant and high discrimination value for MI occurrence (AUC 0.72–0.92). Higher concentrations of Cu, Zn, Mn, Co, and Fe were found to considerably increase the chances of having MI. Considering the increasingly higher environmental exposure to heavy metals in recent times, their concentrations can be distinguished as a potential risk factor of CVDs.

Abstract 12811: Clinical Outcomes and Prognostic Impact of Triglyceride Deposit Cardiomyovasculopathy Among Hemodialysis Patients Suspected of Coronary Artery Disease

Introduction: Hemodialysis (HD) has been reported as a strong prognostic factor in patients with cardiovascular disease. It is unknown how much triglyceride deposit cardiomyovasculopathy (TGCV), a novel identified rare cardiovascular disorder, is associated with cardiovascular mortality among HD patients. Hypothesis: We hypothesized that comorbidity of TGCV in HD patients who suspected of CAD plays a critical role for cardiovascular outcomes in this population. Methods: We examined the data obtained from 83 consecutive HD patients suspected of coronary artery disease who underwent both [123I]-β-methyl-iodophenyl-pentadecanoic acid (BMIPP) scintigraphy and subsequent coronary angiography (CAG). The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction (MI), or non-fatal stroke up to 5 years of follow-up. The key secondary endpoint was a composite of cardiovascular death, non-fatal MI, non-fatal stroke, target vessel revascularization, or any hospitalization for heart failure. Results: A total of 83 HD patients were grouped into either the definite TGCV (17 patients), the probable TGCV (22 patients), or the non-TGCV control group (44 patients). At the end of the follow-up period for a median of 4.7 years, a primary endpoint event occurred in 58.8% of the definite TGCV patients (hazard ratio, 8.06; 95% confidence interval [CI], 2.52-25.8, Log-rank p&lt;0.001) and 27.3% of the probable TGCV patients, as compared to 9.1% of the non-TGCV control patients; the corresponding rates of the key secondary endpoint were 88.2% for the definite TGCV patients (hazard ratio, 6.36; 95% CI, 2.89-14.0, Log-rank p&lt;0.001) and 59.1% for the probable TGCV patients. In the multivariate Cox proportional hazard analyses after adjustment for confounding factors, various variables related to mortality on HD patients, or variables known as a classical cardiovascular risk, the definite TGCV was significantly and independently associated with cardiovascular mortality and outcomes in any of the three models. Conclusions: Comorbidity of TGCV in patients on HD was associated with increased risk of cardiovascular events including cardiovascular death, which might highlight the potential therapeutic target.

Enthesitis and joint erosions are disease traits associated with cardiovascular risk in psoriatic arthritis.

To analyze the prevalence of subclinical atherosclerosis (SA), as well as the factors associated with it, in psoriatic arthritis (PsA). This cross-sectional observational study included 140 consecutive patients with PsA. Systematic COronary Risk Evaluation (SCORE) risk charts and carotid ultrasound (CU) were used to estimate cardiovascular risk (CVR). The presence of plaque and/or a carotid intima-media thickness (cIMT) > 0.9mm defined SA. Disease features associated with SA were analyzed. The prevalence of SA in this study was 25%. According to the SCORE charts, 42.8%, 35.7%, and 21.5%, had low, moderate, and high-very high CVR, respectively. The best criterion to define a high CVR (by SCORE plus carotid plaques) corresponded to a cIMT > 0.63mm (area under the ROC curve 0.75 (0.66-0.82), p < 0.0001). Patients in minimal disease activity (MDA) showed less SA (cIMT > 0.9mm, 6.2% vs. 30.2% in non-MDA, p < 0.05, and carotid plaques in 23.7% vs. 32.6% in non-MDA). Disease factors associated with SA were age (OR 1.08 (1.03-1.13), p < 0.001), smoking (OR 4.26 (1.44-12.65), p = 0.01), enthesitis (OR 3.76 (1.36-10.40), p = 0.01), and erosive disease (OR 5.23 (1.33-20.50), p = 0.02). Subclinical atherosclerosis was associated with both classic CVR factors as well as others more linked to the inflammatory nature of this disease. Patients reaching the MDA showed less SA. Cardiovascular risk should be closely monitored in PsA patients who develop enthesitis and/or structural damage. Key Points • Subclinical atherosclerosis is relatively common in psoriatic arthritis. • Patients reaching the minimal disease activity response show less subclinical atherosclerosis. • Patients with enthesitis and/or structural damage are a high-risk population for subclinical atherosclerosis.

The impact of cardiorespiratory fitness on classical cardiovascular disease risk factors in rheumatoid arthritis: a cross-sectional and longitudinal study

Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). Advanced measures of cardiorespiratory fitness (CRF) are associated with CVD risk factors. The present study aimed to examine whether CVD risk factors can predict clinic-based measures of CRF, using the Siconolfi step test and to determine if exercise can improve RA patients’ cardiovascular health. Sixty-five RA patients (46 females, age 58 ± 11 years) completed assessments of CRF, CVD risk factors, body composition and RA characteristics. Ten patients participated in a follow-up 8-week exercise intervention. CRF was low (22 ml kg−1 min−1) and associated with higher diastolic blood pressure (r = − 0.37, p = 0.002), higher global CVD risk (r = − 0.267, p = 0.031) and worse body composition profile (body fat, r = − 0.48, p < 0.001; waist, r = − 0.65, p < 0.001; hip, r = − 0.58, p < 0.001). Regular exercise significantly improved CRF (p = 0.021), lower body strength (p < 0.001), agility (p < 0.001), systolic blood pressure (p = 0.021), body fat (p = 0.018), waist circumference (p = 0.035), hip circumference (p = 0.016), disease activity (p = 0.002), disability (p = 0.007) and QoL (p = 0.004). Elevated diastolic blood pressure and worse body composition profile are strong predictors of clinic-based measures of CRF. CRF is an important determinant of CVD risk and warrants inclusion in the routine assessment of RA patients. Regular exercise can improve CRF and CVD risk factors without any exacerbation of disease activity and should be offered as part of routine care.

Role of HDL function and LDL atherogenicity on cardiovascular risk: A comprehensive examination.

BackgroundHigh-density lipoprotein (HDL) functionality and low-density lipoprotein (LDL) atherogenic traits can describe the role of both particles on cardiovascular diseases more accurately than HDL- or LDL-cholesterol levels. However, it is unclear how these lipoprotein properties are particularly affected by different cardiovascular risk factors.ObjectiveTo determine which lipoprotein properties are associated with greater cardiovascular risk scores and each cardiovascular risk factor.MethodsIn two cross-sectional baseline samples of PREDIMED trial volunteers, we assessed the associations of HDL functionality (N = 296) and LDL atherogenicity traits (N = 210) with: 1) the 10-year predicted coronary risk (according to the Framingham-REGICOR score), and 2) classical cardiovascular risk factors.ResultsGreater cardiovascular risk scores were associated with low cholesterol efflux values; oxidized, triglyceride-rich, small HDL particles; and small LDLs with low resistance against oxidation (P-trend<0.05, all). After adjusting for the rest of risk factors; 1) type-2 diabetic individuals presented smaller and more oxidized LDLs (P<0.026, all); 2) dyslipidemic participants had smaller HDLs with an impaired capacity to metabolize cholesterol (P<0.035, all); 3) high body mass index values were associated to lower HDL and LDL size and a lower HDL capacity to esterify cholesterol (P<0.037, all); 4) men presented a greater HDL oxidation and lower HDL vasodilatory capacity (P<0.046, all); and 5) greater ages were related to small, oxidized, cytotoxic LDL particles (P<0.037, all).ConclusionsDysfunctional HDL and atherogenic LDL particles are present in high cardiovascular risk patients. Dyslipidemia and male sex are predominantly linked to HDL dysfunctionality, whilst diabetes and advanced age are associated with LDL atherogenicity.

Environmental stressors and cardiovascular risk: Impact of environmental noise exposure on vascular oxidative stress and damage

Epidemiological studies have demonstrated that traffic noise exposure is associated with cardiovascular diseases such as arterial hypertension, myocardial infarction and stroke. Persistent chronic noise exposure increases the risk of cardiovascular and metabolic diseases such as arterial hypertension, coronary artery disease, diabetes and stroke. Large epidemiological studies (reviewed in Münzel et al. Eur. Heart J. 2017, 38 (8):550–556) point towards a link between the incidence of ischemic heart diseases and exposure to noise, supporting its role as an independent cardiovascular risk factor. Recently, the underlying molecular mechanisms leading to noise-dependent adverse effects on the vasculature were characterized in an animal model of aircraft noise exposure identifying oxidative stress as a central player in mediating vascular dysfunction (Münzel, Daiber et al. Eur. Heart J. 2017, 38(37):2838–2849). With the present overview the mechanistic parallels in the pathophysiological processes induced by noise and classical cardiovascular risk factors/diseases will be discussed.

Involvement of mitochondrial haplogroups in myocardial infarction and stroke: A case-control study in Castile and Leon (Spain) population

There are strong evidences that common mitochondrial DNA (mtDNA) haplogroups may influence the pathogenesis of cardiovascular diseases (CVDs). In this matched case-control study, we investigate the association between mtDNA haplogroups and two CVDs, myocardial infarction (MI) and stroke, and classical cardiovascular risk factors.Data obtained show that haplogroup H constitute a susceptibility risk factor for MI (p=0.001; OR=2.379, 95% CI [1.440–3.990]). Otherwise, our data also suggest a beneficial role of haplogroup J against hypertension (p=0.019; OR=0.348, 95% CI [0.144–0.840]). These results may provide some guidance for predicting the genetic risk of these diseases in different human populations through the differences in energy efficiency between haplogroups.

Clustered Cardiovascular Risk Factors Are Associated with Inflammatory Markers in Adolescents

Background: Clusters of cardiovascular risk (CVR) factors are associated with an increased risk of developing cardiovascular diseases (CVDs). This cross-sectional study assessed the associations between classic CVR factor clusters and inflammatory markers in Brazilian adolescents. Methods: Measurements included anthropometric, clinical and biochemical parameters and selected inflammatory markers in 487 adolescents (236 boys/251 girls; 12.06 ± 1.41 years). Results: After stratifying the population by gender and adjusting for potential confounding variables, principal component analysis was performed and it produced 5 independent components in both genders: adiposity, glucose metabolism, blood pressure, high-density lipoprotein (HDL)/triacylglycerols (TG), and cholesterol/low-density lipoprotein. Glucose metabolism was inversely associated with interleukin-1β (IL-1β) in both genders (r = -0.026; r = -0.021); blood pressure was inversely associated with tumor necrosis factor alpha (TNF-α) in girls (r = -0.046); HDL/TG was positively associated with interleukin-6 in girls (r = 0.012), with IL-1β (r = 0.010) TNF-α (r = 0.045) in boys, and inversely associated with adiponectin in both genders (r = -0.015; r = -0.013). Conclusion: The results suggest that lipid metabolism alterations, as potential early events in the development of CVDs, have a strong link to the inflammatory process, in contrast to other clusters of risk factors.

Prevalence of chronic kidney disease and its determinants in coronary heart disease patients in 24 European countries: Insights from the EUROASPIRE IV survey of the European Society of Cardiology.

Aims Chronic kidney disease (CKD) is associated with the development and progression of coronary heart disease (CHD), in addition to classic cardiovascular risk factors. We analysed the prevalence of CKD in CHD patients from 24 European countries in the ambulatory setting and in a preceding hospital stay for CHD (index). Methods and results A total of 7998 EUROASPIRE IV participants (median 65 years of age, 76% male) attended a study visit 6-36 months after the index hospitalisation. CKD was classified according to stages of estimated glomerular filtration rate (eGFR) and albuminuria (urinary albumin/creatinine ratio). In stable CHD conditions (study visit), 17.3% had CKD (eGFR <60 mL/min/1.73 m2) with variation among participating countries (range 13.1-26.4%). A further 12% presented with preserved eGFR but significant albuminuria. During the hospital stay due to a coronary event, impaired kidney function was observed in 17.6% (range 7.5-38.2%). Risk factors for impaired kidney function included older age, female gender, classic cardiovascular (CV) risk factors, details of CHD history and congestive heart failure (multivariate regression). Of all patients, 38.9% had declined, 31.3% were stable and 29.8% had improved kidney function between hospital discharge and the study visit, dependent on age, gender, CV risk factors, CHD history and cardiac dysfunction (multivariate regression). Conclusions Every fifth CHD patient had CKD, while every tenth exhibited albuminuria as the sole indicator of kidney damage. These subjects are at increased risk of progression of CKD and CHD complications. After hospital stays due to CHD, there is potential of recovery of kidney function, but our findings underline the importance of identifying patients who are at high risk of developing CKD in order to counteract disease progression.

Systemic lupus erythematosus flare-up is associated with increased 5-years carotid Intima-Media thickness progression

Objectives: Patients with Systemic Lupus Erythematosus (SLE) present increased carotid Intima-Media Thickness (c-IMT) and cardiovascular mortality compared to general population. Our aim was to investigate in SLE patients the association of immunoinflammatory disease activity and of classical cardiovascular risk (CVR) factors with five years c-IMT progression (Δc-IMT).

Biomarkers in Obesity: Serum Myeloperoxidase and Traditional Cardiac Risk Parameters.

Chronic low-grade inflammation, combined with traditional cardiovascular risk factors, is common in obesity, providing systemic inflammation that is associated with increased cardiovascular risk. Studies have shown serum mieloperoxidase as a potential biomarker and its clinical applicability for evaluating cardiovascular risk. This study aimed to evaluate the MPO in obese individuals, with or without systemic inflammation and potential cardiovascular risk, as well as correlating MPO with some classic cardiovascular risk parameters. Inflammatory and cardiovascular risk markers, as well as different biochemical and hematological laboratory parameters, were analyzed. The volunteers were divided into 3 groups according to the presence (hs-CRP>3 mg/L) or absence (hs-CRP<3 mg/L) of systemic inflammation and possible cardiovascular risk. MPO was significantly increased (p<0.05) in the obese individuals with systemic inflammation. A significant increase (p<0.05) in the following biochemical parameters: glucose, HbA1c, triglycerides, non-HDL, TG/HDL was observed, and a significant decrease (p<0.01) in HDL was observed. Significant increases in the counts of total leukocytes, neutrophils and monocytes (p<0.01), as well as elevated blood pressure (p<0.05), were observed in the group of obese individuals with systemic inflammation. Serum MPO levels were correlated with classic proinflammatory and cardiovascular risk parameters. High serum levels of MPO were observed in obese individuals with hs-CRP above 3 mg/L, which is a classic biomarker for inflammation and cardiovascular risk, suggesting the potential role of MPO in clinical applicability for cardiovascular disease in this population. However, considering that inflammation in obesity appears to manifest as a non-classical mechanism, further studies are necessary to elucidate the role of MPO in cardiovascular events in the population with obesity.

Assessment of serum asymmetric dimethylarginine levels and left ventricular diastolic function in patients with ankylosing spondylitis.

To assess left ventricular diastolic functions and serum dimethylarginine (ADMA) concentrations, as well as the effect of different treatment strategies on ADMA concentrations and diastolic function parameters, in patients with ankylosing spondylitis (AS). Sixty AS patients and 40 control subjects without classical cardiovascular (CV) risk factors were included in the study. Baseline clinical and echocardiographic variables were obtained. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ADMA levels were measured. Spinal mobility, disease activity and functional status were assessed using Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. CRP, ESR and ADMA levels were significantly higher in the AS group as compared to the control group. Two (5%) control subjects and six (10%) AS patients met the criteria for left ventricular diastolic dysfunction (DD) on conventional Doppler echocardiography, but the difference was not statistically significant (P=0.36). However, using tissue Doppler imaging, 12 (20%) patients in the AS group and three (8%) subjects in the control group were diagnosed with left ventricular DD (P=0.08). The anti-tumor necrosis factor (TNF)-α group, conventional therapy group and control group were compared in terms of ADMA, CRP, ESR levels and echocardiographic parameters. ADMA levels were significantly lower in anti-TNF-α group as compared to the conventional therapy group (P<0.001). In the control group, ADMA levels were significantly lower than both treatment groups (P<0.001). Increased ADMA levels reveal impaired nitric oxide metabolism in a relatively young group of patients with AS, who have no classical CV risk factors. Anti-TNF-α may have beneficial effect on endothelial function in AS patients by reducing ADMA levels.

Abstract P191: Carotid Intima-Media Thickness is Associated with Systolic Blood Pressure, Body-Mass Index and LDL Cholesterol in Low-Risk Individuals. A Cross-Sectional Analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Introduction: Carotid intima-media thickness (cIMT) is a noninvasive measurement of early atherosclerosis by ultrasound. Determinants of cIMT in individuals without classical cardiovascular (CV) risk factors are poorly studied. Hypothesis: We assessed the hypothesis that systolic blood pressure (SBP), body-mass index (BMI), serum glucose and LDL cholesterol (LDL-c) are associated with maximal cIMT values in low-risk individuals (no hypertension, diabetes, dyslipidemia or prior CV disease, no CV medications, no current or past smoking and a BMI &lt; 30 kg/m 2 ). Methods: We used data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline. ELSA-Brasil is a multicenter cohort of 15,105 civil servants aged 35-74 years in six Brazilian cities. Baseline assessment included cIMT measurements in both common carotid arteries. SBP, BMI, serum glucose and LDL-c values were standardized. We used multiple linear regression models to study the association of SBP, BMI, serum glucose and LDL-c with maximal cIMT (in mm). Results: We analyzed 1,569 ELSA-Brasil low-risk participants with complete cIMT data. There were 1,024 (65.3%) women and 924 (58.9%) of White race. Mean ± standard deviation (SD) for continuous variables were: age 46.1 ± 7.7 years; SBP 111.2 ± 10.8 mmHg; BMI 24.0 ± 2.9 kg/m 2 ; serum glucose 99.7 ± 7.8 mg/dl; LDL-c 105.6 ± 17.1 mg/dl and maximal cIMT 0.700 ± 0.136 mm. The table shows the beta-coefficients associated to one standard deviation increase in SBP, BMI, serum glucose and LDL-c. Conclusions: Even in a low-risk subsample, excluding individuals with hypertension, dyslipidemia or obesity, SBP, BMI and LDL-c were positively associated with higher maximal cIMT. This probably reflects a continuum of risk for atherosclerotic disease mediated by these measurements that do not evanesce with the exclusion of subjects who fulfill current diagnostic criteria for these conditions.

Hypertriglyceridemic-Waist Phenotype is a Useful Global Assessment Tool for Predicting Acute Myocardial Infarction

Background: There has been growing research interest in exploring the utility of the hypertriglyceridemicwaist phenotype as a predictor of cardio-metabolic risk. To date, prospective studies evaluating the phenotype as a predictor of cardiovascular disease have provided variable results. Objectives: To evaluate the usefulness of the hypertriglyceridemic-waist phenotype as an independent predictor of acute myocardial infarction beyond classical cardiovascular disease risk factors in a homogeneous Norwegian population. Methods: Norwegian health survey (Cohort Norway) participants (n=116,111), free of heart disease in 1994- 2003, were followed through 2009 by record linkages to The Cause of Death Registry and hospital discharge diagnoses through the Cardiovascular disease in Norway project. Cox proportional hazards analyses adjusted for conventional risk factors. Results: During a mean follow-up of 11.5 yrs (SD=2.8), 3,624 participants developed an acute myocardial infarction. Prevalence of an enlarged waist (>102 cm for men, and >88 cm for women) increased from the lowest to highest quartile of triglycerides for men (4.9% to 22.5%) and women (6.5% to 42.1%; P for trend 1.7 mmol/L) was associated with a hazard ratio for acute myocardial infarction of 1.68 (95% CI 1.48-1.90) for men and 1.95 (95% CI 1.66-2.29) for women compared to those with normal waist and triglyceride level after adjusting for age, smoking and time since last meal. However, 75% of the excess risk was mediated by HDL and nonHDL cholesterol. Conclusions: The phenotype is a useful global assessment tool but of limited value when conventional risk factors are available. Patients presenting with the phenotype should be targeted with lifestyle interventions and referred for clinical follow-up.