Coronary Heart Disease Risk Profile Research Articles

A Preliminary Study of the Relationship between Promoter Methylation of the ABCG1, GALNT2 and HMGCR Genes and Coronary Heart Disease

AimsTo investigate the association of ABCG1, GALNT2 and HMGCR genes promoter DNA methylation with coronary heart disease (CHD) and explore the interaction between their methylation status and the CHD patients' clinical characteristics in Han Chinese population.Methods and resultsMethylation-specific polymerase chain reaction (MSP) technology was used to examine the role of the aberrant gene promoter methylation in CHD in Han Chinese population. A total of 85 CHD patients and 54 participants without CHD confirmed by angiography were recruited. 82.8% of the participants with ABCG1 gene promoter hypermethylation have CHD, while only 17.4% of the participants without hypermethylation have it. The average age of the participants with GALNT2 gene promoter hypermethylation is 62.10±8.21, while that of the participants without hypermethylation is 57.28±9.87; in the former group, 75.4% of the participants have CHD, compared to only 50% in the latter group. As for the HMGCR gene, the average age of the participants with promoter hypermethylation is 63.24±8.10 and that of the participants without hypermethylation is 57.79±9.55; its promoter hypermethylation is likely to be related to smoking. Our results indicated a significant statistical association of promoter methylation of the ABCG1 gene with increased risk of CHD (OR = 19.966; 95% CI, 7.319–54.468; P *<0.001; P *: adjusted for age, gender, smoking, lipid level, hypertension, and diabetes). Similar results were obtained for that of the GALNT2 gene (OR = 2.978; 95% CI, 1.335–6.646; P * = 0.008), but not of HMGCR gene (OR = 1.388; 95% CI, 0.572–3.371; P * = 0.469).ConclusionsThe present work provides evidence to support the association of promoter DNA methylation status with the risk profile of CHD. Our data indicates that promoter DNA hypermethylation of the ABCG1 and GALNT2 genes, but not the HMGCR gene, is associated with an increased risk of CHD. CHD, smoking and aging are likely to be the important factors influencing DNA hypermethylation.

Beyond fasting plasma glucose: The association between coronary heart disease risk and postprandial glucose, postprandial insulin and insulin resistance in healthy, nondiabetic adults

ObjectivePrediabetes is defined by elevations of plasma glucose concentration, and is aimed at identifying individuals at increased risk of type 2 diabetes and coronary heart disease (CHD). However, since these individuals are also insulin resistant and hyperinsulinemic, we evaluated the association between several facets of carbohydrate metabolism and CHD risk profile in apparently healthy, nondiabetic individuals. MethodsPlasma glucose and insulin concentrations were measured before and at hourly intervals for eight hours after two test meals in 281 nondiabetic individuals. Insulin action was quantified by determining the steady-state plasma glucose (SSPG) concentration during the insulin suppression test. CHD risk was assessed by measurements of blood pressure and fasting lipoprotein profile. ResultsFor purposes of analysis, the population was divided into tertiles, and the results demonstrated that the greater the 1) fasting plasma glucose (FPG) concentration, 2) incremental plasma insulin response to meals, and 3) SSPG concentration, the more adverse the CHD risk profile (p<0.05). In contrast, the CHD risk profile did not significantly worsen with increases in the incremental plasma glucose response to meals. ConclusionsIn nondiabetic individuals, higher FPG concentrations, accentuated daylong incremental insulin responses to meals, and greater degrees of insulin resistance are each associated with worse CHD risk profile (higher blood pressures, higher triglycerides, and lower high density lipoprotein cholesterol concentrations). Interventional efforts aimed at decreasing CHD in such individuals should take these abnormalities into consideration.

Alternate day fasting with a high fat diet: Impact on body weight, body composition, and coronary heart disease risk profile in obese adults

BackgroundAlternate day fasting (ADF) with a low‐fat (LF) diet is effective for weight loss and cardio‐protection. However, the applicability of these findings is questionable as most Americans consume a high‐fat (HF) diet. This study examined if these beneficial changes in weight and coronary heart disease (CHD) risk can be reproduced if a HF diet is used in place of a LF diet during ADF.MethodsThirty‐two obese subjects were randomized to an ADF‐HF (45% fat) or ADF‐LF diet (25% fat), which consisted of two phases: 1) a 2‐week baseline weight maintenance period, and 2) an 8‐week ADF weight loss period. All food was provided to subjects.ResultsBody weight was reduced (P &lt; 0.0001) by ADF‐HF (5 ± 1%) and by ADF‐LF (4 ± 1%). Fat mass decreased (P &lt; 0.0001) by ADF‐HF (5 ± 1 kg) and ADF‐LF (4 ± 1 kg). Fat free mass remained unchanged. Waist circumference decreased (P &lt; 0.001) by ADF‐HF (7 ( 1 cm) and ADF‐LF (7 ( 1 cm). LDL cholesterol and triacylglycerol concentrations were reduced (P &lt; 0.01) by both interventions (ADF‐HF: 18 ( 5%, 14 ( 5%; ADF‐LF: 24 ( 3%, 14 ( 4%). The proportion of small LDL particles decreased (P &lt; 0.05) in the ADF‐HF and ADF‐LF groups by 8 ( 3% and 10 ( 4%.ConclusionThus, an ADF‐HF diet produces similar reductions in weight and CHD risk as an ADF‐LF diet. These findings are important in terms of diet tolerability and long‐term adherence to ADF diets.

Abstract P410: Alternate Day Fasting with a High Fat Diet: Impact on Body Weight, Body Composition, and Coronary Heart Disease Risk Profile in Obese Adults

Background: Alternate day fasting (ADF) with a low-fat (LF) diet is effective for weight loss and cardio-protection. However, the applicability of these findings is questionable as most Americans consume a high-fat (HF) diet. This study examined if these beneficial changes in weight and coronary heart disease (CHD) risk can be reproduced if a HF diet is used in place of a LF diet during ADF. Methods: Thirty-two obese subjects were randomized to an ADF-HF (45% fat) or ADF-LF diet (25% fat), which consisted of two phases: 1) a 2-week baseline weight maintenance period, and 2) an 8-week ADF weight loss period. All food was provided to subjects. Results: Body weight was reduced (P &lt; 0.0001) by ADF-HF (5 ± 1%) and by ADF-LF (4 ± 1%). Fat mass decreased (P &lt; 0.0001) by ADF-HF (5 ± 1 kg) and ADF-LF (4 ± 1 kg). Fat free mass remained unchanged. Waist circumference decreased (P &lt; 0.001) by ADF-HF (7 ± 1 cm) and ADF-LF (7 ± 1 cm). LDL cholesterol and triacylglycerol concentrations were reduced (P &lt; 0.01) by both interventions (ADF-HF: 18 ± 5%, 14 ± 5%; ADF-LF: 24 ± 3%, 14 ± 4%). The proportion of small LDL particles decreased (P &lt; 0.05) in the ADF-HF and ADF-LF groups by 8 ± 3% and 10 ± 4%. Conclusion: Thus, an ADF-HF diet produces similar reductions in weight and CHD risk as an ADF-LF diet. These findings are important in terms of diet tolerability and long-term adherence to ADF diets.

Assessing and Managing Metabolic Syndrome and Cardiovascular Risk in Midlife Women

The components of metabolic syndrome (MetS), a major cardiovascular risk in women that includes diabetes, hypertension, and dyslipidemia, can evolve during the perimenopause transition. Lifestyle interventions have been shown to ameliorate or prevent individual components of MetS. This article will describe the hormonal and vascular changes occurring during perimenopause and discuss how they set the stage for MetS in women. The available screening tools (Framingham Assessment for Coronary Heart Disease vs Framingham General Cardiovascular Risk Profile vs Reynolds Risk Assessment) will be compared and contrasted within the context of the 2011 Updated Guidelines for the Prevention of Cardiovascular Disease in Women via case study. Target goals and interventions to reduce or ameliorate the components of MetS will be presented, with a focus on achieving ideal cardiovascular health.

Trends in the coronary heart disease risk profile of middle-aged adults

PurposeTo examine recent trends in the coronary heart disease (CHD) risk profiles of the population aged 45 to 64 in the United States. MethodsData from the National Health and Nutrition Examination Surveys (NHANES) from 2 time periods (1988–1994 and 2005–2008) are used to estimate the CHD risk functions derived from the Framingham Heart Study. The risk functions take account of levels of blood pressure (systolic and diastolic), total and high-density lipoprotein serum cholesterol, diabetes (doctor diagnosed or based on fasting glucose), and smoking status to estimate the 10-year risk of myocardial infarction or coronary death. We estimate the risk functions by gender, race, and age group (45–54 and 55–64). ResultsThe CHD risk profile of middle-aged adults has improved over time. For example, the mean 10-year risk of heart attack or CHD death among persons 55 to 64 years has declined from 7.1% to 5.2%. Declines are seen among both men and women and among non-Hispanic Blacks and non-Hispanic whites. ConclusionsDespite increases in diabetes and obesity, the CHD risk profile of middle-aged adults improved during the period from 1988–1994 to 2005–2008.

Cardiovascular risk in cognitively preserved elderlies is associated with glucose hypometabolism in the posterior cingulate cortex and precuneus regardless of brain atrophy and apolipoprotein gene variations

Cardiovascular risk factors (CVRF) possibly contribute to the emergence of Alzheimer's disease (AD). Fluorodeoxyglucose-positron emission tomography (FDG-PET) has been widely used to demonstrate specific patterns of reduced cerebral metabolic rates of glucose (CMRgl) in subjects with AD and in non-demented carriers of the apolipoprotein ε4 (APOE ε4) allele, the major genetic risk factor for AD. However, functional neuroimaging studies investigating the impact of CVRF on cerebral metabolism have been scarce to date. The present FDG-PET study investigated 59 cognitively preserved elderlies divided into three groups according to their cardiovascular risk based on the Framingham 10-year risk Coronary Heart Disease Risk Profile (low-, medium-, and high-risk) to examine whether different levels of CVRF would be associated with reduced CMRgl, involving the same brain regions affected in early stages of AD. Functional imaging data were corrected for partial volume effects to avoid confounding effects due to regional brain atrophy, and all analyses included the presence of the APOE ε4 allele as a confounding covariate. Significant cerebral metabolism reductions were detected in the high-risk group when compared to the low-risk group in the left precuneus and posterior cingulate gyrus. This suggests that findings of brain hypometabolism similar to those seen in subjects with AD can be detected in association with the severity of cardiovascular risk in cognitively preserved individuals. Thus, a greater knowledge about how such factors influence brain functioning in healthy subjects over time may provide important insigths for the future development of strategies aimed at delaying or preventing the vascular-related triggering of pathologic brain changes in the AD.

Cardiovascular disease and ovarian function

Coronary heart disease (CHD) is the leading cause of death in the aging female population in the developed world. Ovarian endocrinology plays an important role in modulating a woman's CHD risk. We herein present an overview of our current understanding of CHD risk profile in the context of ovarian physiology and senescence. Endogenous ovarian estrogen has long been recognized to offer cardiac benefit and vascular protection against atherosclerosis. Existing data, however, do not allow for an extrapolation of the recognized cardioprotective implications of the reproductive-age endogenous estrogenic milieu to the use of exogenous estrogen in postmenopausal women. Ongoing efforts are targeting the concept that when reintroduced proximate to onset of ovarian senescence, exogenous estrogen may retard the process of atherogenesis. Until this hypothesis is substantiated, cardioprotection must not be an indication for initiating hormone therapy in menopausal women. Ovarian hormones modulate the processes of atherosclerosis and the mechanisms underlying CHD. The female reproductive hormones offer a cardioprotective milieu that is rapidly attenuated with the cessation of ovarian function (be it following natural menopause or after medical or surgical ovarian extirpation). The role of exogenous hormone therapy, and the nuances of timing and duration of exposure, are still being elucidated.

Self-monitoring of blood glucose improved glycemic control and the 10-year coronary heart disease risk profile of female type 2 diabetes patients in Trinidad and Tobago

The risk of death from coronary heart disease (CHD) in women with diabetes is more than three times that of non-diabetic women. We assessed the difference in CHD risk levels of Afro-Caribbean diabetic women provided with facilities for self-monitoring of blood glucose and their counterparts without such facilities Forty-nine patients who never used gluco-meters were studied as intervention (23) and control (26) groups. The intervention group was trained on self-monitoring of blood glucose. At baseline, BP, anthropometric indices, and fasting blood glucose of all patients were measured. Subsequently, the intervention patients were provided with gluco-meters, testing strips, and advised to self-monitor fasting and postprandial blood glucose every other day for 6 months. CHD risk was determined with the United Kingdom Prospective Diabetes Study risk engine calculator. The age, duration of diagnosis of diabetes, BP, and anthropometric indices were similar in the two groups (all, P > 0.05). The majority of the patients were unemployed or retired with only primary education. After 3 months, the HbA 1c levels of the control patients did not change (8.3 ± 0.4% vs. 7.8 ± 0.4%, P > 0.05) whereas the HbA 1c levels of the intervention patients reduced significantly from the baseline at 3 (9.2 ± 0.4% vs. 7.4 ± 0.3%, P <0.001) and 6 (9.2 ± 0.4% vs. 7.3 ± 0.3%, P <0.001) months. The 10-year CHD risk level of the intervention group was remarkably reduced from the baseline level after 6 months (7.4 ± 1.3% vs. 4.5 ± 0.9%) of the study. Provision of facilities for self-monitoring of blood glucose in Afro-Caribbean women with type 2 diabetes improves both their glycemic control and CHD risk profile.

The effect of aging on blood and plasma viscosity. An 11.6 years follow-up study

Alterations of blood and plasma viscosity can promote atherosclerosis. The relationship between viscosity and aging is still controversial. The present study evaluated the influence of aging on blood and plasma viscosity in a group of subjects followed for 11.6 years. Forty-five subjects have been evaluated twice 11.6 years apart for hemorheological parameters and coronary heart disease (CHD) risk factors. Plasma viscosity and blood viscosity have been measured with a cone-plate viscometer. Tk has been calculated as index of red blood cell rigidity. CHD risk factors, i.e. obesity, hypertension, hyperlipidemia and diabetes, have been evaluated by routine methods. Hematocrit and plasma viscosity did not change during the study, whereas blood viscosity (shear rate 225/sec: 4.46 ± 0.49 vs. 4.81 ± 0.54 cP, p < 0.0001; shear rate 45/sec: 6.19 ± 0.67 vs. 6.65 ± 0.79 cP, p < 0.0001) and Tk (0.80 ± 0.05 vs. 0.83 ± 0.06, p < 0.005) significantly increased. The percent variation in blood viscosity was not associated with the percent variation in any of the CHD risk factors. Furthermore, the increase in blood viscosity was similar in males and females and in subjects with CHD risk profile worsening or not. The present findings demonstrate that blood viscosity increases with age. This increase seems independent of classical CHD risk factors and is disjoined from haematocrit and plasma viscosity, suggesting a possible direct effect of aging on red blood cells.

Relation of Serum Osteocalcin Level to Risk of Coronary Heart Disease in Chinese Adults

Osteocalcin, a bone-derived polypeptide, was recently found to have hormonal function associated with metabolic disorders and atherosclerosis. Few studies have examined the association between circulating osteocalcin and coronary heart disease (CHD) risk. The aim of the present study was to investigate whether serum osteocalcin concentration was associated with CHD risk and metabolic profiles in Chinese adults. A total of 461 subjects (243 with CHD and 218 without CHD) who underwent coronary angiography were included. Serum osteocalcin, glucose, lipid profiles, and other biochemical markers were measured. Severity of coronary atherosclerosis was estimated by number of diseased vessels. Results showed that serum osteocalcin levels were significantly lower in the CHD group (12.2 ng/ml, 9.5 to 15.1) than in the non-CHD group (13.6 ng/ml, 10.7 to 18.0, p = 0.001) and were significantly decreased with the increasing of number of diseased vessels (p = 0.005). Serum osteocalcin concentration was inversely correlated with fasting and post load 2 hour plasma glucose and hemoglobin A(1c) (p = 0.044, 0.043, and 0.011, respectively), adjusting for CHD status. Odds ratios (95% confidence intervals) of CHD across increasing quartiles of serum osteocalcin were 0.68 (0.42 to 1.12), 0.59 (0.36 to 0.98), and 0.40 (0.23 to 0.69). The test for trend was significant (p = 0.0007). Adjusting for age, body mass index, and other conventional risk factors for CHD did not appreciably change the results. Spline regression analyses indicated a linear relation between serum osteocalcin level and CHD risk. In conclusion, our data indicate that serum osteocalcin level was associated with decreased risk of CHD and protective metabolic changes in Chinese adults.

Subgroup differences in psychosocial factors relating to coronary heart disease in the UK South Asian population

ObjectivesTo explore the differences in psychosocial risk factors related to coronary heart disease (CHD) between South Asian subgroups in the UK. South Asian people suffer significantly higher rates of CHD than other ethnic groups, but vulnerability varies between South Asian subgroups, in terms of both CHD rates and risk profiles. Psychosocial factors may contribute to the excess CHD propensity that is observed; however, subgroup heterogeneity in psychosocial disadvantage has not previously been systematically explored. MethodsWith a cross-sectional design, 1065 healthy South Asian and 818 white men and women from West London, UK, completed psychosocial questionnaires. Psychosocial profiles were compared between South Asian religious groups and the white sample, using analyses of covariance and post hoc tests. ResultsOf the South Asian sample, 50.5% was Sikh, 28.0% was Hindu, and 15.8% was Muslim. Muslim participants were more socioeconomically deprived and experienced higher levels of chronic stress, including financial strain, low social cohesion, and racial discrimination, compared with other South Asian religious groups. In terms of health behaviors, Muslim men smoked more than Sikhs and Hindus, and Muslims also reported lower alcohol consumption and were less physically active than other groups. ConclusionThis study found that Muslims were exposed to more psychosocial and behavioral adversity than Sikhs and Hindus, and highlights the importance of investigating subgroup heterogeneity in South Asian CHD risk.

Extremes of Endogenous Testosterone Are Associated With Increased Risk of Incident Coronary Events in Older Women

Several lines of evidence suggest that high levels of testosterone are atherogenic in women. The testosterone to estrogen balance in women increases markedly at the time of menopause when central adiposity and the incidence of cardiovascular disease also increase. The view that elevated serum androgen is harmful to the female heart is also supported by the occurrence of hyperandrogenemia, an adverse coronary heart disease (CHD) risk profile, and endothelial dysfunction in young women with polycystic ovarian syndrome. However, there has been no consistent increase in CHD events and mortality in women with polycystic ovarian syndrome. Moreover, recent studies have found that women with atherosclerotic disease have low serum levels of testosterone suggesting that unlike high levels, low levels of this hormone may have beneficial effects on the female heart. This prospective, population-based study evaluated the effects of total testosterone (total T) and bioavailable T (BioT) levels on the risk of incident coronary events among 639 older community-dwelling postmenopausal women. During a median follow-up of 12.3 year, 134 women had an incident CHD event; of these, 45 were nonfatal myocardial infarctions (MIs), 10 were coronary revascularizations, and 79 were fatal MIs. Multivariate regression analysis showed that age-adjusted CHD risk estimates were similar for the four highest total T quintiles relative to the lowest; this suggests a low threshold for incident events with total T. Age-adjusted analyses showed that compared to higher levels, the lowest total T quintile (≤80 pg/mL) was associated with a significant increase in the risk of incident CHD (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.10―2.39, P = 0.017). With BioT, age-adjusted quintile analyses suggested a U-shaped association for risk of incident CHD (P for quadratic trend <0.001). Both the lowest (low BioT) and the highest (high BioT) quintiles were associated with a significantly increased age-adjusted risk of incident CHD (HR for low BioT: 1. 7 9, with a 95% CI of 1.03-3.16, P = 0.046), and HR for high BioT: 1.96, with a 95% CI of 1.13-3.41, P = 0.022). Adjustment for other variables, including lifestyle characteristics, adiposity, estradiol, and ovarian status had a minimal effect on the results. These findings show that low levels of total T and high levels of BioT are independently associated with higher risk of incident CHD events in community-dwelling postmenopausal women. The data suggest that an optimal range of testosterone may exist for cardiovascular health in older women.

Coronary Heart Disease Risk Prediction in the Era of Genome-Wide Association Studies

For DNA-based tests that assess genetic predisposition to coronary heart disease (CHD) to be of clinical value, they need to provide information over and above conventional risk factors (CRFs) currently used in risk algorithms, such as the Framingham Risk Score,1 which incorporates CRFs such as age, gender, blood lipid concentrations, blood pressure, body mass index, family history, and smoking habit. To achieve this, several hurdles must be passed. The first challenge is to identify a set of common single-nucleotide polymorphisms (SNPs) at loci associated with CHD risk. Over the last 10 to 15 years, this has been done by use of a “candidate gene” approach through association studies in prospective analysis or case-control studies, ie, comparing SNP genotype or allele frequency between groups of individuals with CHD and healthy subjects. Several of the genes, chosen because of their key role in processes that predispose to atherosclerosis, have meta-analysis–confirmed effects on risk of CHD,2 the best example of which is the APOE gene, which encodes apolipoprotein E, with 3 common isoforms that are associated with strong effects on plasma lipids and more modest effects on risk of CHD.3 This “hypothesis-driven” search for useful genetic variants provides the foundation for the development of genetic CHD risk profiles, and in the last 2 years, it has been enhanced by technical advances that have allowed “hypothesis-free” genome-wide association studies (GWASs), primarily in a case-control setting. Although the list of identified CHD-risk loci and SNPs will clearly grow, we have at least the basis to start the examination of their potential clinical utility. The second set of challenges is to obtain a robust estimate of the size of the risk effects associated with these SNPs. This requires population-based prospective studies to avoid bias, because estimates in the case-control setting, although efficient for …

Coronary Heart Disease Risk Profile in Women Who Underwent Salpingo-Oophorectomy to Prevent Hereditary Breast Ovarian Cancer

We examined coronary heart disease risk profile in women from hereditary breast ovarian cancer families who had undergone risk-reducing salpingo-oophorectomy and compared the results to that of controls from the general population. A sample of 326 (65% of invited) women with previous risk-reducing salpingo-oophorectomy after genetic counseling provided data and blood samples (cases). Controls were 1630 age-matched women from a Norwegian population-based health study. We examined the coronary heart disease risk profile and the Framingham risk score in both groups. The cases had a lower mean (SD) Framingham total score compared to the controls (12.9 [5.1] vs 14.5 [5.2]; P = 0.02). Except for a wider waist circumference, the cases had a more favorable coronary heart disease risk profile including more physical activity, lower levels of total cholesterol, higher levels of high-density lipoprotein cholesterol, lower systolic blood pressure, and lower body mass index compared with the controls. In multivariate logistic regression analyses, the risk-reducing salpingo-oophorectomy group was inversely associated with a Framingham 10-year risk score of 5% or higher (odds ratio, 0.49; 95% confidence interval, 0.34-0.71; P < 0.001). Lower levels of education, not having paid work, a history of stroke, and a wider waist circumference were significantly associated with a Framingham risk score higher than 10% in the total sample. Self-selection of women seeking risk-reducing salpingo-oophorectomy, changes in lifestyle after surgery, and survival bias may explain that the women who underwent risk-reducing salpingo-oophorectomy had a more favorable coronary heart disease risk profile compared with the controls. Longitudinal studies are needed to further clarify the associations observed in this cross-sectional study.

Randomized trial of a computerized coronary heart disease risk assessment tool in HIV-infected patients receiving combination antiretroviral therapy

Exposure to combination antiretroviral therapy (cART) can lead to important metabolic changes and increased risk of coronary heart disease (CHD). Computerized clinical decision support systems have been advocated to improve the management of patients at risk for CHD but it is unclear whether such systems reduce patients' risk for CHD. We conducted a cluster trial within the Swiss HIV Cohort Study (SHCS) of HIV-infected patients, aged 18 years or older, not pregnant and receiving cART for >3 months. We randomized 165 physicians to either guidelines for CHD risk factor management alone or guidelines plus CHD risk profiles. Risk profiles included the Framingham risk score, CHD drug prescriptions and CHD events based on biannual assessments, and were continuously updated by the SHCS data centre and integrated into patient charts by study nurses. Outcome measures were total cholesterol, systolic and diastolic blood pressure and Framingham risk score. A total of 3,266 patients (80% of those eligible) had a final assessment of the primary outcome at least 12 months after the start of the trial. Mean (95% confidence interval) patient differences where physicians received CHD risk profiles and guidelines, rather than guidelines alone, were total cholesterol -0.02 mmol/l (-0.09-0.06), systolic blood pressure -0.4 mmHg (-1.6-0.8), diastolic blood pressure -0.4 mmHg (-1.5-0.7) and Framingham 10-year risk score -0.2% (-0.5-0.1). Systemic computerized routine provision of CHD risk profiles in addition to guidelines does not significantly improve risk factors for CHD in patients on cART.

Changes in coronary heart disease risk profile of adults with intellectual disabilities following a physical activity intervention

Regular physical activity is one of the modifiable risk factors for coronary heart disease (CHD). With an increasing age profile and similar patterns of morbidity to the general population, persons with intellectual disabilities (ID) and their caregivers would benefit from data that indicate CHD risk factors. Knowledge of the CHD risk factors and the changes a physical activity intervention may have on theses risk factors will facilitate future intervention programmes. A cohort of 100 men and women between the ages of 21 and 73 years with ID living in a community group home in the North-West Province of South Africa was recruited. A CHD risk profile was compiled by means of a questionnaire and physical assessment that included resting blood pressure, body mass index, non-fasting glucose and cholesterol and cardiorespiratory fitness. A 12-week physical activity intervention was then conducted 3 days/week after which the baseline measurements were repeated. The results indicated that 85% of the participants were inactive, while 67% were overweight and obese. Hypertension (6.1%) and smoking (6.1%) were relatively low in this population with ID. Glucose concentrations above the recommended cut-off values were observed in 28% of the participants. Total cholesterol concentrations above normal were measured in 23% of the participants. The physical activity intervention reduced inactivity to 50% and resulted in a significant increase in cardiorespiratory fitness and a decrease in percentage body fat in both men and women. Inactivity is a major risk factor in this population with ID living in a community group setting. The implementation of the physical activity intervention significantly reduced the risk factors for CHD.

Framingham risk score after risk-reducing salpingo-oophorectomy in women at risk for hereditary breast ovarian cancer: A controlled observational study

11048 Background: Risk-reducing salpingo-oophorectomy (RRSO) effectively prevents ovarian cancer in BRCA mutation carriers and in women at risk for hereditary breast-ovarian cancer. RRSO induces immediate menopause, which may increase the risk of coronary heart disease (CHD). Our aim was to determine CHD risk using Framingham risk score and examine factors associated with this risk in women who had undergone RRSO compared to population-based controls. Methods: A sample of 326 (65% of invited) women who underwent RRSO after genetic counseling from 1980–2005 provided completed questionnaires, physical measures, and blood samples. Controls were 1,630 age-matched controls from the Norwegian Nord-Trøndelag Health Study (HUNT-2) (1995- 97). Results: Mean age in both the RRSO and control groups at survey was 54.4 years. Mean follow-up after surgery was 6.5 years (SD 4.4). The RRSO group had a more favorable CHD risk profile (higher education, more physical activity, less smoking, lower total cholesterol, higher HDL cholesterol, lower systolic blood pressure and lower BMI) and lower Framingham total score compared to controls (p&lt;0.05). In multiple logistic regression analyses RRSO was inversely associated with Framingham 10-year risk ≥5% (Odds Ratio 0.49, 95% CI [0.34, 0.71] p&lt;0.001). Conclusions: In contrast to expectation, women at increased risk of hereditary breast ovarian cancer had a favorable CHD risk profile after RRSO compared to age-matched controls from the general population, and RRSO was associated with lower Framingham risk score. Follow-up time, self-selection of women seeking genetic counseling, changes in lifestyle after surgery and survival bias are possible explanations of this finding. No significant financial relationships to disclose.

The influence of physiological and surgical menopause on coronary heart disease risk markers

To investigate the influence of physiological and surgical menopause on serum concentrations of coronary heart disease (CHD) risk markers and sex hormones. Physiological menopausal transition was investigated in two studies. In a longitudinal study, 16 women were followed from 2 years before until 2 years after physiological menopause. In a case-control study, 27 early postmenopausal women were compared with 27 age-matched late premenopausal women. Surgical menopause was investigated in 11 women undergoing a prophylactic bilateral salpingo-oophorectomy. The following parameters were measured: serum concentrations of estradiol, follicle-stimulating hormone, inhibin A, inhibin B, asymmetric dimethylarginine, lipids, leptin, homocysteine, C-reactive protein, and coenzyme Q10, as well as weight and body mass index. After physiological and surgical menopause, serum estradiol and inhibin A and B decreased, whereas follicle-stimulating hormone increased (all P values < 0.01). Serum asymmetric dimethylarginine, total and low-density lipoprotein cholesterol, and leptin concentrations were significantly higher in postmenopausal women compared with premenopausal women (all P values < 0.05). Serum homocysteine concentrations increased significantly during the physiological menopausal transition. Total and low-density lipoprotein cholesterol increased after surgical menopause (both P values = 0.01). None of the other parameters studied were influenced significantly by the menopausal transition. No difference in change in the various CHD risk markers investigated was observed between physiological and surgical menopause. The CHD risk profile was affected unfavorably by both physiological and surgical menopause. Changes in most CHD risk markers were small, despite the substantial changes in hormonal parameters.

Self-monitoring of blood glucose improved both the glycaemic control and 10-year coronary heart disease risk profile of Afrocaribbean type 2 diabetic patients in Trinidad and Tobago

Self-monitoring of blood glucose improved both the glycaemic control and 10-year coronary heart disease risk profile of Afrocaribbean type 2 diabetic patients in Trinidad and Tobago