High Coronary Risk Research Articles

Prevalencia y características clínicas de la enfermedad arterial periférica en la población general del estudio Hermex

Introduction and objectivesTo estimate the prevalence of peripheral arterial disease as measured on ankle-brachial index and evaluate the associated risk, clinical, and diagnostic factors. MethodsCross-sectional study conducted in a random population-based sample of 2833 individuals aged 25 to 79 years from Don Benito health area (Badajoz). Peripheral arterial disease was considered for ankle-brachial index<0.90. To identify symptomatic disease we used the Edinburgh questionnaire. The current screening recommendations, changes to other categories of estimated coronary risk associated with index measurements, and the association with risk factors were assessed. ResultsThe prevalence of peripheral arterial disease was 3.7% (95% confidence interval, 3.0%-4.5%), 5.0% (3.9%-6.3%) in men and 2.6% (1.8%-3.5%) in women (P=.001). The cumulative prevalence in those aged 50, 60 and 70 years were 6.2%, 9.1%, and 13.1% respectively. The disease was symptomatic in 13.3% (6.8%-19.8%) of cases and 29.6% of asymptomatic patients were not detected as recommended for high-risk groups. The use of ankle-brachial index increased the number of individuals with high coronary risk by 32.7%. Peripheral arterial disease was positively associated with age, smoking, hypercholesterolemia, sedentary lifestyle, microalbuminuria and history of cardiovascular disease, and negatively with alcohol consumption. ConclusionsThe use of ankle-brachial index for peripheral arterial disease diagnosis is advisable because of the low prevalence of symptomatic cases and the associated change in estimated coronary risk. Screening groups should be adapted to the Spanish population. Smoking and hypercholesterolemia are major associated risk factors.

Prevalence and Clinical Characteristics of Peripheral Arterial Disease in the Study Population Hermex

Introduction and objectivesTo estimate the prevalence of peripheral arterial disease as measured on ankle-brachial index and evaluate the associated risk, clinical, and diagnostic factors. MethodsCross-sectional study conducted in a random population-based sample of 2833 individuals aged 25 to 79 years from Don Benito health area (Badajoz). Peripheral arterial disease was considered for ankle-brachial index<0.90. To identify symptomatic disease we used the Edinburgh questionnaire. The current screening recommendations, changes to other categories of estimated coronary risk associated with index measurements, and the association with risk factors were assessed. ResultsThe prevalence of peripheral arterial disease was 3.7% (95% confidence interval, 3.0%-4.5%), 5.0% (3.9%-6.3%) in men and 2.6% (1.8%-3.5%) in women (P=.001). The cumulative prevalence in those aged 50, 60 and 70 years were 6.2%, 9.1%, and 13.1% respectively. The disease was symptomatic in 13.3% (6.8%-19.8%) of cases and 29.6% of asymptomatic patients were not detected as recommended for high-risk groups. The use of ankle-brachial index increased the number of individuals with high coronary risk by 32.7%. Peripheral arterial disease was positively associated with age, smoking, hypercholesterolemia, sedentary lifestyle, microalbuminuria and history of cardiovascular disease, and negatively with alcohol consumption. ConclusionsThe use of ankle-brachial index for peripheral arterial disease diagnosis is advisable because of the low prevalence of symptomatic cases and the associated change in estimated coronary risk. Screening groups should be adapted to the Spanish population. Smoking and hypercholesterolemia are major associated risk factors.

Adaptive immunity is related to coronary artery disease severity after acute coronary syndrome in subjects with metabolic syndrome

Metabolic syndrome (MetS) is an inflammatory state associated with high coronary disease risk. Inflammation and adaptive immunity modulate atherosclerosis and plaque instability. We examined early changes in anti-oxidized low-density lipoprotein (LDL) (anti-oxLDL) autoantibodies (Abs) in patients with MetS after an acute coronary syndrome (ACS). Patients of both genders (n=116) with MetS were prospectively included after an acute myocardial infarction (MI) or hospitalization due to unstable angina. Anti-oxLDL Abs (IgG class) were assayed at baseline, three and six weeks after ACS. The severity of coronary disease was evaluated by the Gensini score. We observed a decrease in anti-oxLDL Abs titers (p<0.002 vs. baseline), mainly in males (p=0.01), in those under 65 y (p=0.03), and in subjects with Gensini score above median (p=0.04). In conclusion, early decrease in circulating anti-oxLDL Abs is associated with coronary disease severity among subjects with MetS.

Determinants of Blood Uric Acid Levels in a Dyslipidemic Arab Population

Objectives: The objective of this study was to explore the relationships between circulating uric acid and lipid levels and components of the metabolic syndrome (MetS) in Arab dyslipidemic patients, a group already at high coronary artery disease risk. Subjects and Methods: The medical records of 1,229 subjects (632 men, 597 women) referred for treatment of dyslipidemia and followed up for at least 12 months were reviewed. Serum levels of uric acid and lipids (total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein) and other variables in the National Cholesterol Education Program ATP III criteria definition of MetS were assessed at initial presentation and every 4– 6 months, under specific lipid-lowering treatment (statins and/or fibrates), in each of the subjects. Their respective associations were explored by appropriate logistic regression techniques with control for confounding risk factors, including age, gender and body mass index. Results: 306 subjects (24.9%) of the study population were hyperuricemic; they were more likely to be men, obese and diabetic. Also the serum uric acid level (mean ± SD) was greater in men with MetS compared with men without (377.0 ± 98.0 vs. 361.6 ± 83.1 µmol/l, p < 0.05), an observation not reproduced in women. Uric acid levels had significant associations with the presence of fasting hyperglycemia, hypertension and large waist circumference (WC) in men, but only with large WC in women. With statin treatment, uric acid levels decreased by 10% within 1 year of treatment; with fibrates, uric acid levels remained unchanged or slightly increased. Conclusion: The data showed that hyperuricemia is common in dyslipidemic patients in Kuwait, where its important determinants are male sex, obesity, diabetes and statin treatment.

Adenosine Stress High-Pitch 128-Slice Dual-Source Myocardial Computed Tomography Perfusion for Imaging of Reversible Myocardial Ischemia

Background— Coronary computed tomography angiography (CTA) enables accurate anatomic evaluation of coronary artery stenosis but lacks information about hemodynamic significance. The aim of this study was to evaluate 128-slice myocardial CT perfusion (CTP) imaging with adenosine stress using a high-pitch mode, in comparison with cardiac MRI (CMR). Methods and Results— Thirty-nine patients with intermediate to high coronary risk profile underwent adenosine stress 128-slice dual source CTP (128×0.6 mm, 0.28 seconds). Among those, 30 patients (64±10 years, 6% women) also underwent adenosine stress CMR (1.5T). The 2-step CTP protocol consisted of (1) adenosine stress-CTP using a high-pitch factor (3.4) ECG-synchronized spiral mode and (2) rest-CTP/coronary-CTA using either high-pitch (heart rate &lt;63 bpm) or prospective ECG-triggering (heart rate &gt;63 bpm). Results were compared with CMR and with invasive angiography in 25 patients. The performance of stress-CTP for detection of myocardial perfusion defects compared with CMR was sensitivity, 96%; specificity, 88%; positive predictive value (PPV), 93%; negative predictive value (NPV), 94% (per vessel); and sensitivity, 78%; specificity, 87%; PPV, 83%; NPV, 84% (per segment). The accuracy of stress-CTP for imaging of reversible ischemia compared with CMR was sensitivity, 95%; specificity, 96%; PPV, 95%; and NPV, 96% (per vessel). In 25 patients who underwent invasive angiography, the accuracy of CTA for detection of stenosis &gt;70% was (per segment): sensitivity, 96%; specificity, 88%; PPV, 67%; and NPV, 98.9%. The accuracy improved from 84% to 95% after adding stress CTP to CTA. Radiation exposure of the entire stress/rest CT protocol was only 2.5 mSv. Conclusions— Adenosine-induced stress 128-slice dual-source high-pitch myocardial CTP allows for simultaneously assessment of reversible myocardial ischemia and coronary stenosis, with good diagnostic accuracy as compared with CMR and invasive angiography, at a very low radiation exposure.

Tratamiento y control de los factores de riesgo según el riesgo coronario en la población española del estudio DARIOS

Introduction and objectives The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk. Methods Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure <140/90 mmHg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria. Results We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension ( P < .001), 66% and 69% respectively, of patients with diabetes ( P = .03), and 39% and 42% respectively, of those with hypercholesterolemia ( P < .001). Control was good in 34% of men and 42% of women with hypertension ( P < .001); 65% and 63% respectively, of those with diabetes ( P = .626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria ( P = .092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria ( P < .001). The proportion of uncontrolled participants increased with coronary risk ( P < .001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥10% coronary risk than to men (59% vs. 50%, P < .024). Conclusions The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk. Full English text available from: www.revespcardiol.org

Risk Factor Treatment and Control in Relation to Coronary Disease Risk in the Spanish Population of the DARIOS Study

Introduction and objectives The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk. Methods Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure <140/90 mmHg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria. Results We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension ( P < .001), 66% and 69% respectively, of patients with diabetes ( P = .03), and 39% and 42% respectively, of those with hypercholesterolemia ( P < .001). Control was good in 34% of men and 42% of women with hypertension ( P < .001); 65% and 63% respectively, of those with diabetes ( P = .626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria ( P = .092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria ( P < .001). The proportion of uncontrolled participants increased with coronary risk ( P < .001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥10% coronary risk than to men (59% vs. 50%, P < .024). Conclusions The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk.

Antropometria na avaliação da obesidade abdominal e risco coronariano. DOI: 10.5007/1980-0037.2011v13n3p238

The incidence of diabetes, atherosclerosis and sudden cardiac death is high among obese individuals, with significant metabolic and cardiovascular adverse effects being observed when obesity is centered in the abdominal region. The objective of this study was to determine which of the anthropometric indicators of abdominal obesity commonly used show the highest predictive power to discriminate a high coronary risk (HCR) and to propose cut-off values for their use in clinical practice and in population studies on Brazilian adults. The studies publi-shed by the research group on non-transmissible chronic diseases of the Public Health Institute (PHI), Federal University of Bahia (UFBA), that compare different anthropometric indicators as predictors of HCR were analyzed. The evidence provided by the studies analyzed suggests the use of the conicity index for the evaluation of abdominal obesity in clinical practice, with cut-off values of 1.25 for men and of 1.18 and 1.22 for women ≤ 49 years and &gt; 50 years, respectively. The waist-height ratio should be used in population studies, with the recommendation that waist should not exceed half the height of a particular subject.

Renal-related biomarkers and long-term mortality in the US subjects with different coronary risks

ObjectiveThe objective was to evaluate the association of a panel of renal biomarkers with long-term mortalities. MethodsParticipants in the Third National Health and Nutrition Examination Survey (NHANES III) aged 35 years and above were included and Framingham risk scores were calculated. Renal-related biomarkers, including creatinine-based estimated glomerular filtration rate (eGFR), cystatin C, uric acid, C-reactive protein (CRP), fibrinogen, urinary cadmium, albuminuria, homocysteine, and vitamin D were tested by Cox-regression model for their association with all-cause, cardiovascular (CV), and non-CV mortality obtained from the 2006 NHANES III-linked follow-up data, stratified by sex and Framingham risk. ResultsIn the 4873 men and 5372 women, 36.3%, 28.1%, and 35.6% of men and 67.2%, 25.8%, and 7.0% of women were classified into low-, intermediate-, and high coronary risk groups. With an average follow-up of 13.2 years, a total of 3632 deaths and 1657 CV deaths were recorded. Albuminuria was associated with all-cause mortality in both sexes across coronary risk groups. Creatinine-based eGFR provided additional differential capacity only in the women with intermediate-to-high coronary risk. Cystatin C was associated with all-cause mortality in the men with intermediate-to-high coronary risk and with CV mortality in the women with low coronary risk. Urinary cadmium was positively related to non-CV mortality. High vitamin D was protective against cardiovascular mortality in a limited category of men and women. ConclusionsAlbuminuria is associated with long-term all-cause mortalities independent of Framingham risks. Adding the panel of renal biomarkers provides limited advantages for predicting risk when compared to FRS alone.

Agreement between Framingham-DORICA and SCORE scales in estimation of cardiovascular risk in the patients suffering from metabolic syndrome in Granada (Spain)

The aim of the present study was to compare the risk stratification obtained with the Framingham function, recommended by the National Cholesterol Education Program (ATP-III), and the risk charts of the Systematic Coronary Risk Evaluation (SCORE) program, in a cohort of subjects between 20 and 75 years (mean 59 years, 70% females) with metabolic syndrome. Participants were classified as low, moderate, or high risk by ATP-III and by SCORE of risk at 10 years, respectively. 8.3% of males and 7.4% of women from our study were classified as high risk in 10 years time by Framingham-DORICA. Regarding SCORE program 50% men and 29.6% of women were considered to have high coronary risk. Risk estimation with SCORE and Framingham function shows significant gender and quantitative differences. There is no concordance between Framingham and SCORE function to estimate cardiovascular risk on subjects included on the high-risk group.

Frequency and characteristics of myocardial ischemia recorded during stress echocardiography in patients with high coronary risk

Ischemic heart disease is the major cause of morbidity and mortality in the world as well as in our country. Ischemic heart disease has the multifactorial origin and the presence of several risk factors increases the risk of myocardial ischemia. The aim of the study was to evaluate the frequency and characteristics of myocardial ischemia in asymptomatic subjects with two or more risk factors for coronary artery disease during stress echocardiography. In 240 high risk asymptomatic subjects (an absolute risk of fatal cardiovascular disease of more than 5%, according to the Systemic Coronary Risk Evaluation Chart), the exercise stress echocardiography test was performed. The criterion for myocardial ischemia was the appearance of transient segmental wall motion abnormality (WMA). The wall motion score index was calculated before and after the exercise stress echocardiography. During exercise stress echocardiography, in 36 (15%) subjects WMA occurred. Out of 36 subjects with myocardial ischemia, in 10 (27.8%) subjects WMA and ST segment depression were accompanied with the first occurrence of chest pain (the subgroup with symptomatic myocardial ischemia), in 20 (55.6%) subjects WMA and ST segment depression were detected and in 6 (16.6%) subjects only WMA occurred (the subgroup with silent myocardial ischemia). There were no significant differences between the subgroups with symptomatic and silent myocardial ischemia with regard to exercise tolerance, heart rate at the onset of WMA, and time to the onset of WMA, but the wall motion score index was significantly higher in the subjects with symptomatic myocardial ischemia (p < 0.01). In all the individuals with symptomatic myocardial ischemia, significant stenosis of the coronary arteries was found by coronary angiography. Out of 26 subjects with asymptomatic myocardial ischemia, coronary angiography was performed in 18 and significant stenosis of the coronary arteries was diagnosed in all of them. The number and grade of coronary stenosis in subjects with symptomatic and silent myocardial ischemia were similar. The obtained results presented the incidence of myocardial ischemia in 15% of asymptomatic subjects with high coronary risk during stress echocardiography. Silent myocardial ischemia was markedly more frequent than symptomatic one, but in the subjects with symptomatic ischemia, the wall motion score index was significantly higher.

Coronary Calcium Score Improves Classification of Coronary Heart Disease Risk in the Elderly: The Rotterdam Study

The purpose of this study was to examine the effect of coronary artery calcium (CAC) on the classification of 10-year hard coronary heart disease (CHD) risk and to empirically derive cut-off values of the calcium score for a general population of elderly patients.Although CAC scoring has been found to improve CHD risk prediction, there are limited data on its impact in clinical practice.The study comprised 2,028 asymptomatic participants (age 69.6 ± 6.2 years) from the Rotterdam Study. During a median follow-up of 9.2 years, 135 hard coronary events occurred. Persons were classified into low (<10%), intermediate (10% to 20%), and high (>20%) 10-year coronary risk categories based on a Framingham refitted risk model. In a second step, the model was extended by CAC, and reclassification percentages were calculated. Cutoff values of CAC for persons in the intermediate-risk category were empirically derived based on 10-year hard CHD risk.Reclassification by means of CAC scoring was most substantial in persons initially classified as intermediate risk. In this group, 52% of men and women were reclassified, all into more accurate risk categories. CAC values above 615 or below 50 Agatston units were found appropriate to reclassify persons into high or low risk, respectively.In a general population of elderly patients at intermediate CHD risk, CAC scoring is a powerful method to reclassify persons into more appropriate risk categories. Empirically derived CAC cutoff values at which persons at intermediate risk reclassified to either high or low risk were 615 and 50 Agatston units, respectively.

Aktuelle anästhesiologische Aspekte bei urologischen Patienten

Patients with coronary stents should take clopidogrel and acetylsalicylic acid for 4 weeks or 12 months after stenting. Stopping this medication early, e.g., for surgery, results in a 90-fold increase in the patient's risk for myocardial infarction from stent thrombosis. The mortality due to perioperative acute coronary syndrome clearly exceeds that due to perioperative bleeding complications. If oral medication resulting in platelet inhibition has to be paused "bridging" with short-acting, intravenous GPIIb/IIIa antagonists is possible. In recent years perioperative beta-blockade has been recommended for patients with high coronary vascular risk, and recently also for those with medium or low risk. Current studies, however, indicate that patients on beta-blockers have increased perioperative mortality because of bradycardia, hypotension, and anemia. Therefore, anemia and hypotension should be rigorously avoided.Anesthetic management may have an influence on the postoperative course of cancer. Combined epidural-general anesthesia provides a benefit by minimizing the use of systemic opioids and volatile anesthetics. Presumably, this and a decreased response to surgical stress increase the ability of the patient's immune system to deal with cancer dissemination and micrometastasis.

Cardiovascular events in patients with obesity: an observational study

Overweight and obesity are positively correlated with increased risk of morbidity and mortality. To evaluate whether obesity may be considered an independent cardiovascular risk factor in patients of ages from 35 to 74 years followed-up for 10 years. Observational, longitudinal retrospective study. Primary care practices in Badajoz (Spain). A cohort of 899 patients (mean 55.7 years; 58.2% female) without evidence of cardiovascular disease was studied. A total of 33.5% of the population were obese (body mass index > or =30 kg/m2). Patients meeting the obesity criteria were more commonly female (36.6%) and were older, had higher mean values of blood pressure and triglycerides, higher percentages of diabetes, and higher coronary risk using either the original Framingham or the Framingham function calibrated for the Spanish population (Framingham-REGICOR). During the follow-up period, the rates of cardiovascular events and death in patients with obesity tended to be higher: 16.3% versus 11.7%, P = 0.056 and 4.7% versus 2.2%, P<0.05, respectively. In the final model of the logistic regression multivariate analysis, the significant predictors of cardiovascular events in patients with obesity were age, sex (male), diastolic blood pressure, diabetes, and smoking. The highest odds ratio corresponded to smoking (odds ratio 2.03; 95% confidence interval = 1.22 to 3.38). Obesity may not be considered an independent cardiovascular risk factor in patients aged from 35 to 74 years followed-up for 10 years.

Effects of Ezetimibe Added to Atorvastatin Versus Atorvastatin Up-Titration on Attainment of Single and Dual Levels for Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol, Apolipoprotein B, or High-Sensitivity C-Reactive Protein in Older Adults with High Coronary Heart Disease Risk

Synopsis: Few clinical studies have focused on the efficacy of lipid-lowering therapies in the growing population of men and women 65 years and older. Purpose: This post-hoc analysis evaluated the effect of ezetimibe added to atorvastatin versus atorvastatin up-titration on the attainment of suggested single/dual levels of low-density lipoprotein cholesterol (LDL-C; <70, <100 mg/dL) and non-high-density lipoprotein cholesterol (HDL-C; <100, <130 mg/dL) or apolipoprotein B (apoB; <80, <90 mg/dL) in patients ≥65 years of age with hypercholesterolemia, high coronary heart disease (CHD) risk, and LDL-C levels greater than prespecified targets during atorvastatin 10 mg/day therapy (<70 mg/dL for patients with atherosclerotic vascular disease [AVD], <100 mg/dL for patients without AVD). hs-CRP is a CHD risk marker, and attainment of levels <2 mg/L either alone or together with LDL-C was also assessed. Methods: A multicenter, 12-week, randomized, double-blind, parallel-arm study of 1053 participants stabilized on atorvastatin 10 mg/day for 6 weeks, and then randomly assigned to 1 of 2 treatment regimens: (1) addition of ezetimibe 10 mg/day for 12 weeks (E+A10); (2) doubling atorvastatin to 20 mg/day (A20) for 6 weeks followed by quadrupling to 40 mg/day (A40) for an additional 6 weeks. Results: Significantly more patients achieved single LDL-C <70 mg/dL, non-HDL-C <100 mg/dL, and apoB <80 mg/dL levels and dual LDL-C and non-HDL-C, LDL-C and apoB, and LDL-C and hs-CRP < 2mg/L levels with E+A10 than up-titration to either A20 or A40. The proportion of patients reaching hs-CRP <2 alone was similar for all therapies (range, 58.4%–61.5%). Attainment of less aggressive single targets (LDL <100 mg/dL, non-HDL-C <130 mg/dL, and apoB <90 mg/dL) were significantly greater with E+A10 versus A20, whereas comparison with A40 was similar. Dual attainment of LDL-C <100 and non-HDL-C <130 was significantly greater with E+A10 than A20 or A40. Attainment of LDL-C <100 mg/dL and apoB <90 with E+A10 was significantly greater than A20, and comparable with A40. Dual attainment of LDL-C <100 mg/dL and hs-CRP <2 mg/L was similar for both treatment comparisons. Conclusions: Coadministration of ezetimibe with atorvastatin 10 mg improved attainment of single/dual treatment levels of LDL-C and non-HDL-C or apoB compared with either doubling or quadrupling the atorvastatin dose, especially when evaluating the levels that are the most appropriate for the highest-risk patient. These results suggest that addition of ezetimibe to low dose atorvastatin may be a useful treatment option for dyslipidemia in elderly patients at high risk for CHD.

High Absolute Coronary Disease Risk among Turks: Involvement of Risk Factors Additional to Conventional Ones

Objectives:To confirm previous findings on excess absolute coronary heart disease (CHD) risk among Turks. Methods: The observed incident CHD risk of a representative population sample was compared with that anticipated by Fra- mingham risk scores (FRS). At 7.4 years of follow-up of 3,027 participants free of CHD at baseline, risk estimation was contrasted in the 398 cases of newly developed fatal and nonfatal CHD. Results:CHD developed at a rate 2.2 times higher than the anticipated risk. In sex-specific quintiles of FRS, the 10-year incidence of CHD events in males in the 2 highest quintiles was 2 times the anticipated levels. In women, the 3 highest quintiles displayed an incidence 2.7 times the anticipated risk. Such individuals typically had abdominal obesity and evidence of dysfunctional apolipoprotein (apo) A-I. Men had high levels of non-high-density lipoprotein (HDL) cholesterol, total apoC-III, apoB and triglycerides. In Cox proportional hazard regression analyses, the 10-year probability of remaining free of CHD was low (81.1% in men, 84.2% in women). Women exhibited C-reactive protein as an independent predictor of CHD, lack of protection by HDL cholesterol and no conferred risk from current smoking. The observed excess CHD risk was primarily attributed to central obesity and related dysfunction of HDL, apoC-III and apoA-I. Conclusion: Dysfunction of protective serum proteins associated with metabolic syndrome impacts on CHD events, in addition to conventional risk factors.

Comparison of clinical-metabolic monitoring and outcomes and coronary risk status in people with type 2 diabetes from Australia, France and Latin America

Aim To compare clinical-metabolic monitoring and coronary risk status in people with type 2 diabetes from Australia, France and Latin America. Methods Retrospective analysis of data collected at primary care (4540 participants from each population) matched for age, gender and disease duration. Measurements included participants’ characteristics, performance frequency of clinical-metabolic process indicators, and percentage of clinical-metabolic outcomes at recommended target values. Results The weighted mean of the percentage of process performance was within 68 to 81%; that of outcomes at target dropped to 29 to 45%. Although statistically significant, differences among groups were far from those in healthcare budgets, and probably only of marginal clinical impact. The percentage of patients with low, slight or high coronary risk was similar in the three groups, with most people at high or very high risk. Conclusions Despite the high difference in health per capita investment and system characteristics among countries, the study populations had striking similarities regarding the low percentage of participants who achieved cardiovascular risk factor and diabetes treatment goals. Therefore, differences in health budget and system characteristics would not be the main drivers in care quality. Diabetes education at every level and quality care registries would contribute to improve this situation and assess such improvement.

El cociente perímetro abdominal/estatura como índice antropométrico de riesgo cardiovascular y de diabetes

To identify the anthropometric index that best detects cardiovascular risk (CVR) and type 2 diabetes (DM2) in the adult Spanish population and to determine its cut-off point. Cross-sectional study in the general population (n=6279). Sensitivity and specificity were estimated for the anthropometric indexes: abdominal waist, body mass index, waist to hip ratio and waist to height ratio (WtHR). The areas of these indexes under ROC curve (AUC) were obtained for the following CVR factors: high coronary risk computed with Framingham model, Hypertension, Hyperlipemia, DM2, Metabolic Syndrome (MS) and Impaired Fasting Glucose (IFG). The odds ratio, with 95% confidence interval (CI(95%)), was calculated. WtHR was the index showing the highest AUC for DM2 and the remaining CVR factors, varying between 0.65 (CI(95%)=0.63-0.68) for IFG in men and 0.87 (CI(95%)=0.86-0.89) for MS in women. RA/E reached the maximum sensitivity (0.91) and specificity (0.70) in SM and its optimal cut-off point was 0.55, which displayed the highest risks amongst indexes, varying from 2.30 (1.96-2.70) in IFG to 16'20 (13.68-19.20) in MS. RA/E is the index presenting the best ability to detect DM2 and CVR in this population, and it shows the stronger association with them. Its cut-off point, 0.55, confirms the convenience of keeping the abdominal waist to less than half the height.

Positive impact of long-term lifestyle change on erythrocyte fatty acid profile after acute coronary syndromes

The outcome of coronary diseases is influenced by lifestyle and diet. Among dietary factors, n-3 polyunsaturated fatty acids reduce mortality from cardiovascular diseases. To evaluate the impact of dietary and lifestyle advice by calculation of scores and analysis of plasmatic lipids and the fatty acid composition of erythrocyte membrane phospholipids after 1 year of patient education in 66 patients with acute coronary syndromes. The answers given by patients during questioning were transformed into scores (atherosclerosis risk, dietary habits and global scores) at inclusion and after 1 year of follow-up. Classical metabolic risk factors and fatty acid composition of erythrocyte phospholipids were determined at the same time. After 1 year of education, patients improved their different scores, particularly by changing dietary habits. The positive impact was seen in the blood lipid and erythrocyte fatty acid levels: plasma low-density lipoprotein cholesterol and triglyceride concentrations were lowered and n-3 polyunsaturated fatty acid percentages were improved in phospholipids. Global score, lipid variables and the nature of the polyunsaturated fatty acids in erythrocyte phospholipids help us to evaluate patients with high coronary artery disease risk and the benefits of long-term dietary and lifestyle advice.

Intraaortic Pulse Pressure Amplification in Subjects at High Coronary Risk

Peripheral (brachial) pulse pressure normally exceeds central (aortic) pulse pressure but is a less powerful predictor of cardiovascular risk. The difference between the 2 variables, called pulse pressure amplification, has never been specifically studied between the proximal and distal aorta in coronary patients. Our goal was to determine aortic pulse pressure amplification in subjects at high coronary risk, with emphasis on associated renal and inflammatory factors. Blood pressure was measured invasively in the ascending aorta, abdominal aorta (at the level of kidneys), and iliac artery in 101 subjects (mean age, 63+/-11 years; 61 men) undergoing coronary angiography. Independently of age, sex, and the presence of coronary stenosis, the increase of pulse pressure between the ascending and terminal aorta was over 10 mm Hg (P<0.001), whereas mean blood pressure remained unchanged. Pulse pressure amplification did not differ significantly between patients with and without coronary artery stenosis. Irrespective of confounding variables, high pulse pressure measured in the ascending aorta and at the level of renal arteries (but not in the iliac artery) was independently related to proteinuria. The increase in pulse pressure from the ascending aorta to the renal level was negatively associated with leukocyte count, even after multivariate adjustment (beta coefficient, -0.19; 95% CI, -0.39 to 0.0; P<0.05). Increased plasma creatinine and aortic pulse wave velocity were independently and positively correlated (beta coefficient, 0.36; CI, 0.18 to 0.54; P<0.001). Independently of coronary atherosclerosis, aortic pulse pressure integrates the predictive value of aortic, inflammatory, and renal factors.