Presence Of Atherosclerotic Disease Research Articles

Comparison of the factors that influence the pattern of procurement and usage of antithrombotic drugs

Antithrombotics are used for many indications in prophylaxis and therapeutic treatment. It is often associated with a higher risk of adverse effects; hence a drug utilization evaluation is essential. The main aim was to describe the utilization of antithrombotic drugs. The specific objectives are to compare the pattern of procurement and usage of antithrombotic drugs, estimate the Defined Daily Dose (DDD), and to compare the usage of antithrombotic drugs with the WHO recommended standard. This was a retrospective study evaluating the utilization of antithrombotics at a public tertiary care hospital in the urban city of Klang Valley, Malaysia. A defined daily dose (DDD) per 1000 inhabitants/day was calculated to estimate patients with thromboembolic disorders receiving standard treatment on a daily basis. Expenditures on all antithrombotic drugs were also assessed. The DDD was examined for correlation with gender, race, and age group. Malaysian Clinical Practice Guideline on the Prevention and Treatment of Venous Thromboembolism was used as a tool to evaluate the quality of prescribing. During the study period, among anticoagulants prescribed, warfarin was the most commonly utilized for treatment and prophylaxis in various disciplines, with 1.82 DDD. Enoxaparin was the second most utilized anticoagulant, with 1.05 DDD, followed by tinzaparin, with 0.39 DDD. For antiplatelet drugs, acetylsalicylic acid was the most utilized antiplatelet with 8.5 DDD followed by clopidogrel (1.42 DDD) and ticlopidine (0.16 DDD). The utilization pattern for all the antithrombotic drugs was in accordance with the WHO DDD guidelines. The pattern of antithrombotic drug procured was based on the demand for the drug supplies. Age, gender, and race weredeterminant factors that influenced the choice of antithrombotic drugs and further affected the antithrombotic drug utilization pattern. Still, additional information regarding patient’s status and concomitant disease condition is needed to establish the impact of utilization of antithrombotics fully. DDD analysis is an excellent practice to be conducted at planned intervals. It is a tool to update the changing or even new pattern of drug usage, which will assist in the justification of rational use of drugs. The mean difference in terms of DDDs of the studied antithrombotic drugs impacts patient demographic characteristics, smokinghistory, presence of atherosclerotic diseases and peripheral artery diseases, comorbidity, patient compliance, and bleeding history. It is useful to evaluate trends and expenditures, which will ultimately avoid untoward adverse effects and unnecessary costs.

Abstract 11993: Area Deprivation Index and Risk of Poly-Vascular Disease: Insights From Houston Methodist Cardiovascular Disease Learning Health System Registry

Introduction: Poly-vascular disease (PVD), defined as presence of atherosclerotic disease in >1 vascular territory, typically coronary artery disease (CAD), peripheral arterial disease (PAD), or cerebrovascular disease, is associated with worse CV prognosis. The impact of social vulnerability among this very high-risk subgroup has not been well studied. We aim to leverage readily available measures of neighborhood-level social vulnerability (area deprivation index, ADI) associated with increasing burden of overall and premature (<65 years) PVD in a large integrated healthcare system. Methods: Cross-sectional study using data from 1.12M patients aged 18+ years in Houston Methodist CVD Learning Health System Registry (2016-2022). Patients were ranked by ADI quintiles (Q1-Q5) as validated index of neighborhood socioeconomic disadvantage built from 17 metrics at census tract level quantified using Geographic Information Systems. CAD, PAD, and stroke were identified using ICD 10-CM codes. Results: We included a total of 1.1M adults with ADI ranking. Overall, prevalence of CAD, PAD and stroke was 5.7%, 1.7% and 3.2% respectively with 1.4% & 0.3% having vascular disease in 2 and 3 vascular beds respectively. Age-adjusted prevalence of any & premature PVD was higher with worse ADI groups ( Table ). Overall, 35% and 41% of patients with premature 2-3 PVD were in the highest 4-5 th ADI quintile (most deprived neighborhood) compared to 28% with premature single vascular CVD. After adjusting for age, sex, race/ethnicity, CV risk factors, adults in the highest ADI quintile had odds of 1.18(1.11-1.26) of PVD in 2 territories & 1.33(1.15-1.54) in 3 vascular beds compared to ADI quintile 1 (least deprived neighborhood). Conclusion: Readily available neighborhood social deprivation such as ADI is strongly associated with worsening poly-vascular CVD. It can be used to inform comprehensive preventive and management strategies for this vulnerable population at health system level.

Factors associated with uncontrolled blood pressure in hypertensive Brazilians

Uncontrolled hypertension has a high prevalence and is related to numerous negative health outcomes. This study aimed to investigate the factors associated with the lack of blood pressure control in hypertensive Brazilians treated in public and private services. This is an analytical, multicentric, and national cross‐sectional study, carried out with adult hypertensive patients, monitored in 45 outpatient clinics (September 2013 to October 2015) in a prospective record interview, clinical, and anthropometric assessment. Outcome variables included uncontrolled pressure (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg). Simple and multiple logistic regression analyses were performed. Two thousand six hundred forty‐three participants were assessed with a mean age of 61.6 ± 11.9 years, 55.7% of women, and 46.4% with uncontrolled blood pressure (BP). The following were associated with uncontrolled BP: age over 60 years (OR: 1.31 [1.11–1.55]); practice of irregular physical activity (OR: 1.28 [1.06–1.55]); attending the emergency room for hypertensive crises in the last six months (OR: 1.80 [1.46–2.22]); increased body mass index (OR: 1.02 [1.01–1.04]); low adherence to drug treatment (OR: 1.22 [1.04–1.44]) and menopause (OR: 1.36 [1.07–1.72]). The following were negatively associated: fruit consumption (OR: 0.90 [0.85–0.94]); presence of dyslipidemia (OR: 0.75 [0.64–0.89]), acute myocardial infarction (OR: 0.59 [0.46–0.76]), and peripheral arterial disease (OR: 0.52 [0.34‐0.78]). Factors associated with difficult‐to‐control blood pressure are the same that increase the risk for hypertension, while the presence of atherosclerotic disease and its outcomes were associated with better control.

Particularities of multivessel disease in a diabetic patient

Atherosclerosis is a complex chronic inflammation in the large and medium arteries that is most often associated with hyperlipidemia and/or several other risk factors. Diabetes mellitus has also been shown to dramatically influence the extent and clinical complications of atherosclerosis, moreover, patients with diabetes are known to have a predisposition to develop multivessel disease. We report a case of resistant hypertension associated with multivessel disease in a diabetic patient. The presence of progressive kidney failure, initially interpreted in the context of diabetic nephropathy and found to be due to severe renal artery stenosis, and the presence of atherosclerotic disease in the previously discovered cerebral and coronary arteries and in the recently found carotid and renal artery territories, without affecting the peripheral arteries and rather unexpected in a diabetic smoker, represent particularities of this clinical case.

MO753RELATIONSHIP BETWEEN MINERAL BONE DISEASE AND ATHEROSCLEROSIS IN NON-DIABETIC PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims The term chronic kidney disease-mineral bone disorder has the role of highlighting that the disturbed mineral and bone metabolism is a major contributor to vascular calcification and finally cardiovascular disease in chronic kidney disease (CKD), especially in hemodialysis. This relationship was less studied in peritoneal dialysis (PD). The aim of the present study was to evaluate the impact of metabolic bone disorder (MBD) on symptomatic atherosclerosis (stable angina SA, acute coronary syndrome ACS, ischemic stroke, peripheral artery disease PAD) in non-diabetic PD patients. We choose to exclude diabetic patients since they are already at increased risk for atherosclerosis. Method We performed a prospective study in non-diabetic population of patients in stable PD programme for at least 6 months. We analysed clinical and biological parameters of calcium-phosphate metabolism (calcemia Ca, phosphatemia P, CaxP product, intact parathormone iPTH), presence of atherosclerotic disease and we performed carotid ultrasound for measurement of intima media thickness (IMT) as a marker for subclinic atherosclerosis. Independent risk factors for atherosclerotic disease were identified by multivariate analysis through logistic regression using IBM SPSS ver. 20.0. Results 246 consecutive non-diabetic PD patients (pts) were included (128M, 118F), mean age 56.3 + 15.7 years (20-85), with a follow up of 6.5±1.1 years. 19 pts (7.7%) had calcemia (Ca)>10.2 mg/dl, no patient had a Ca<8.2 mg/dl, 127 pts (51.6%) had phosphatemia (P)>5.5 mg/dl, 45 pts (18.3%) had CaxtaP product>55 mg2/dl2, 68 pts (27.6%) had iPTH<150 pg/ml, 95 pts (38.6%) had iPTH>300 pg/ml. We found a weak positive correlation between IMT and Ca (r=0.283, p=0.005); pts with iPTH<150 pg/ml and those with iPTH>300 pg/ml had a higher risk of increased IMT compared to pts with iPTH 150-300 pg/ml (OR 4.1, p=0.009, for iPTH<150 pg/ml, respectively OR 3.4, p=0.01 for iPTH>300 pg/ml). Pts with atherosclerotic disease had significantly higher P and CaxP, without differences regarding Ca and iPTH (Table 1). An iPTH<150 pg/ml was a risk factor for SA, ACS and PAD, while iPTH>300 pg/ml was a risk factor for SA and ACS (Table 2). We perfomed multivariate analysis to identify independent risk factors for SA, ACS, stroke and PAD by entering in the analysis the factors identified in univariate analysis to be significantly associated with different manifestations of atherosclerosis. Among independent risk factors identified for atherosclerotic disease, iPTH<150 pg/ml was risk factor for SA (adjusted OR 11.5, p=0.007) and ACS (adjusted OR 221.4, p=0.01), iPTH>300 pg/ml was risk factor for ACS (adjusted OR 5.2, p=0.03), CaxP >55 mg2/dl2 was risk factor for ACS (adjusted OR 33.5, p=0.02) and ischemic stroke (adjusted OR 4.4, p=0.01). No parameters of calcium-phosphate metabolism were identified as independent risk factors for PAD. Conclusion We found significant independent correlations between different parameters which characterize MBD and presence of symptomatic atherosclerosis in non-diabetic PD pts. The most important risk factors identified were abnormally low or high iPTH level, and elevated CaxP. The most striking result was the low iPTH associated with SA and especially ACS, suggesting that an adynamic bone is incapable to buffer the serum calcium and phosphate, thus increasing the risk of vascular calcifications. Future studies may address the issue whether correction of these parameters may be associated with attenuation of atherosclerotic disease in this population.

Abstract P567: Postoperative Cerebrovascular Accident Following Symptomatic Carotid Endarterectomy (OSTIUM) A Retrospective Case-Control Study

Introduction: Despite considered being a safe and efficacious procedure in patients with moderate to severe symptomatic carotid artery stenosis, carotid endarterectomy (CEA) carries a risk of postoperative cerebrovascular accident (POCVA). There is currently a lack of evidence pertaining to the relationship between cranial vascular integrity and its interaction with intraoperative haemodynamic fluctuations and risk of POCVA. Methods: In this retrospective case-control study, we utilised data collected from patients undergoing CEA for symptomatic carotid artery disease between Dec’05 and Oct’19 in the South Mersey Arterial Centre, UK. Patients with three-dimensional CT angiogram (3D-CTA) and evidence of POCVA were considered as cases, matched with those without such evidence that were considered as controls. 3D-CTAs were analysed following a structured proforma, and haemodynamic changes were obtained from operative notes. Results: Out of 951 patients, a total of 21 cases and 55 matched controls were identified. Presence of atherosclerotic disease in the vertebral arteries (VA) in either side, intracranial atherosclerosis (ICAS) (81% vs 40% and 57% vs 27%; <0.01, p<0.05 respectively), and drop in the systolic blood pressure (mean + SD 61 + 23 mmHg vs. 44 + 20 mmHg, p<0.01) were significantly different between the cases and the controls (fig 1). A multivariate logistic regression model showed that odds of stroke were increased with VA stenosis on either side (OR 6·5, 95% CI 1·7-24·6, p=0.006) and intraoperative systolic blood pressure drop greater than 44 mmHg (OR 6·6, 95% CI 1·6-27·6, p=0.01). Conclusions: These findings highlight the importance of routinely identifying posterior circulation abnormalities during the preoperative assessment, and judicious blood pressure management during the intraoperative period, both of which have the potential to help to develop a personalised risk stratification pre-CEA and greater intraoperative monitoring during CEA.

Is ischemia a disease or syndrome, the cause of angina, and now even a trial?

The clinical manifestations of myocardial ischemia are protean in nature and include a variable combination of typical or atypical angina symptoms, electrocardiographic changes, noninvasive findings of regional wall motion abnormalities, and reversible scintigraphic perfusion defects—the changes of which, importantly, may or may not be of epicardial coronary origin. Thus, mounting evidence indicates that the presence or absence of atherosclerotic coronary artery disease (CAD) should no longer be considered a surrogate marker for myocardial ischemia, as suggested by the high prevalence of minor or absent coronary obstruction among patients with proven myocardial ischemia. Whereas the management of CAD has been largely predicated on the plausible assumption that flow-limiting obstructions of the epicardial coronary arteries are the proximate cause of both angina and myocardial ischemia, there is scant evidence from many randomized trials and several meta-analyses that treating epicardial coronary obstructions in patients with stable CAD, particularly with percutaneous coronary intervention (PCI), reduces mortality and morbidity, as compared with optimal medical therapy (OMT). A crucial scientific question for which evidence has been lacking is whether more severe and extensive myocardial ischemia is the driver of adverse cardiovascular outcomes and whether an invasive strategy with myocardial revascularization would be superior to OMT alone in such patients. The results of the recent ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), however, have failed to show—even in this higher-risk CAD subset—any incremental clinical benefit of revascularization as compared with OMT alone on cardiac event reduction.

Abstract TP131: Carotid Stenosis and Polyvascular Disease

Background: Presence of atherosclerotic disease in more than one vascular bed (polyvascular disease) is associated with an increased risk of long-term vascular events. In the setting of asymptomatic carotid stenosis, the predictors of disease in other vascular beds is not well delineated. Objective: To identify the frequency and predictors of disease in other vascular beds the CREST 2 randomized trial population with hemodynamically significant stenosis. Methods: Recorded baseline characteristics among CREST 2 participants included: demographics, past medical history, lifestyle factors, and laboratory studies. Each variable was tested against three potential definitions of disease in other beds (cardiac, peripheral arterial disease (PAD) or disease in cardiac + PAD). Statistical analysis was done with Chi square and t tests as appropriate. Results: Data from 1447 patients were available for analysis. In these subjects with carotid disease, 51% also had cardiac disease, 24% also had PAD, and 16% had disease in in both cardiac and PAD. There was no relationship between age or race and presence of disease in other beds. Those with cardiac disease were more likely to be male. Diabetes, hypertension, hypercholesterolemia, and former history of smoking were all more common in those with either cardiac and PAD (TABLE). Elevated triglyceride and low HDL levels were also associated with all three definitions of disease in other beds. Those with either PAD or cardiac + PAD were more likely to be current smokers. Conclusions: Among CREST 2 participants, several medical conditions and lifestyle factors were associated with an increased frequency of disease in other vascular beds. Smoking, in particular, appears to be more common in those with PAD. Future analyses will address whether those with disease in other beds have higher rates of stroke or death.

ESC/EASD guideline sheds light on diabetes and cardiovascular disease management

ESC/EASD guideline sheds light on diabetes and cardiovascular disease management

Investigation of arterial-cardiac-pulmonary interaction.

Pulmonary function and arterial stiffness correlate significantly, attributing to the chronic inflammation of atherosclerosis. However, through the pulmonary or systemic circulation, pulmonary and vascular functions associate hemodynamically with cardiac morphology and function. In the present study, we investigated arterial-cardiac-pulmonary interaction by examining how the pulmonary and vascular functions correlate with the heart. This study investigated 55 consecutive subjects not suffering from pulmonary, vascular and cardiac disease who underwent health screening test at our medical center. First, the presence of atherosclerotic disease (hypertension, dyslipidemia and diabetes) and smoking status of the patients were determined. Next, pulmonary function test, vascular function test including cardio-ankle vascular index, and echocardiography were performed. Then, we examined the correlation among the pulmonary, vascular and the heart. Our results revealed many correlations among these three factors. Especially left atrial dimension (LAD) and E/A ratio (E/A) were important cardiac factors associated with both pulmonary and vascular functions independently. Conventionally, inflammatory responses are known to involve in the correlation between pulmonary and vascular functions. Our study demonstrated that cardiac function and morphology were also involved in this correlation, signifying that LAD and E/A plays important roles in the arterial-cardiac-pulmonary interaction.

Abstract TP203: The Effect of Concurrent Presence of Atherosclerotic Disease in Other Arterial Distributions in Patients With Symptomatic Intracranial Stenosis

Objective: To determine the effect of concurrent presence of atherosclerotic disease in other arterial distributions (ADOAD) on risk of 30 day stroke or death and ischemic stroke in the territory of the symptomatic intracranial artery beyond 30 days after enrollment in patients with severe (70-99%) intracranial stenosis recruited in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial. Methods: Patients with known history of myocardial infarction, angina, carotid endarterectomy, coronary artery bypass surgery, previous angioplasty and stenting, or peripheral arterial disease at baseline evaluation were classified as those with concurrent presence of ADOAD. Hazards ratio (HR) for primary event during follow up was estimated using Cox proportional hazards analysis after adjusting for age, gender, location of stenosis, and treatment allocated (stent placement versus best medical treatment). Results: A total of 126 of 451 patients included had concurrent presence of ADOAD. After adjusting for potential confounders, the risk of primary endpoint was not significantly different in patients with concurrent presence of ADOAD (HR 1.14, 95% confidence interval [CI] 0.7 - 1.9). The treatment effect of stent placement (compared with best medical treatment) was not different in patients with concurrent presence of ADOAD (HR of 0.9 and 1.1, respectively) after adjusting for potential cofounders. The risk of any ischemic stroke (HR 1.3, 95% CI 0.8 - 2.3) and death (HR 1.4, 95% CI 0.3 - 7.1) during follow up was not different with concurrent presence of ADOAD. Conclusions: There was no effect on cardiovascular endpoints in patients with high grade symptomatic intracranial stenosis and concurrent presence of ADOAD from both natural history and treatment perspective.

Coronary artery calcium score and coronary computed tomography angiography for patients with asymptomatic polyvascular (non-coronary) atherosclerosis.

The primary endpoint of this study was to determine the prevalence of coronary artery disease (CAD) and coronary artery calcium score (CACS) using coronary computed tomography angiography (CCTA) among patients with polyvascular atherosclerosis (PVA). Secondary endpoints were to evaluate the prevalence of cardiovascular risk factors and determine the predictors of PVA. The presence of atherosclerotic disease was assessed using ultrasonographic vascular examination in 515 asymptomatic patients. All patients with presence of stenosis over 50% and moderate-to-severe cardiovascular risk profile underwent CCTA to identify atherosclerotic coronary disease. Among 515 participants, 143 patients had no evidence of atherosclerotic plaque. Of the 372 patients with atherosclerotic plaque, 184 patients had single-vessel disease, 111 patients had double-vessel disease and 77 patients had triple-vessel disease; among these patients, those who also presented with stenosis > 50% underwent CCTA. Coronary stenosis categories included: normal (6.4%); haemodynamically insignificant (34.6%); intermediate (28.7%); significant (26.6%); and total artery occlusion (3.7%). Based on the coronary vessel involved, the patients were categorised as having single- (41.0%), double- (42.0%) or triple- (17.0%) coronary disease. CACS was significantly higher in patients with double- or triple-vessel disease when compared to those with single-vessel disease. Our study confirmed not only the high sensitivity of CCTA for highlighting CAD, but also its negative predictive value for excluding the presence of coronary stenosis or ischaemia. We found good correlation between PVA and CACS, and were able to confirm the risk factors for PVA.

Aortic diameter at age 65 in men with newly diagnosed type 2 diabetes

Objectives. Type 2 diabetes mellitus has been linked to a decreased risk for abdominal aortic aneurysm (aortic diameter ≥30 mm, AAA) development in men. The aim of this study was to evaluate if such an effect is detectable already around the time of diabetes diagnosis. Design. We cross-sectionally compared aortic diameter at ultrasound screening for AAA in 691 men aged 65 years with incipient or newly diagnosed type 2 diabetes (group A) with 18,262 65-year old control men without diabetes (group B). Results. Aortic diameter did not differ between groups (18.8[17.4–20.8] vs. 19.0[17.5–28.7] mm; p = 0.43). AAA prevalence was 2.5% in group A and 1.5% in group B (p = .010). In logistic regression taking group differences in body mass index (BMI), smoking, presence of atherosclerotic disease and hypertension into account, the difference in AAA prevalence was no longer significant (p = .15). Among men in group A, C-peptide (r = .093; p = .034), but not HbA1c (r = .060; p = .24) correlated with aortic diameter. Conclusion. Among 65 year old men aortic diameter and AAA prevalence do not differ between those with newly diagnosed type 2 diabetes and those without diabetes. Putative protective effects of type 2 diabetes mellitus against aortic dilatation and AAA development therefore probably occur later after diagnosis of diabetes.

Association between carotid artery tortuosity and carotid dissection: a case-control study.

Carotid artery dissections have long been associated with compromise of the structural integrity of the arterial wall from heritable connective-tissue disorders, hypertension, and trauma. However, an association between spontaneous internal carotid artery dissection and tortuous or redundant carotid anatomy has not been fully explored. Patients with CTA confirmed spontaneous cervical internal carotid artery dissections were compared to a group of age and sex matched controls who also received CTA of the neck. Patients with trauma or aortic dissections were excluded. Five radiologists reviewed the CTA images to evaluate internal carotid artery tortuosity (reported as loops, kinks or coils), retrojugular and retropharyngeal courses of the internal carotid artery, presence of fibromuscular dysplasia and presence of atherosclerotic disease. Baseline data collected included demographic characteristics (sex, age, smoking history) and cardiovascular comorbidities. A total of 83 cervical internal carotid artery dissection and their age and sex matched controls were included in this study. 46% of patients were female in each group and mean age was 49.2±10.6 years. The presence of any carotid tortuosity was 53% (N.=44) and 34% (N.=28) in the per-patient analysis of dissection and control groups, respectively (P=0.02). Loops were reported in 22% (N.=18) of dissection patients and 8% (N.=7) of controls (P=0.03). Retrojugular course of the internal carotid artery were seen in 23% (N.=38) of dissection patients and 9% (N.=15) of controls (P=0.0009) in the per-vessel analysis. Our study suggests that there is an association between the presence of tortuous carotid artery anatomy and spontaneous carotid artery dissection. This finding emphasizes the importance of the presence of tortuous arteries on CTA imaging to increase the index of suspicion for a potential dissection.

The Association of the Components of Metabolic Syndrome in Children 12-16 Years of Age and the Presence of Atherosclerotic Diseases in Their Parents

The Association of the Components of Metabolic Syndrome in Children 12-16 Years of Age and the Presence of Atherosclerotic Diseases in Their Parents

Lack of association between epicardial fat volume and extent of coronary artery calcification, severity of coronary artery disease, or presence of myocardial perfusion abnormalities in a diverse, symptomatic patient population: results from the CORE320 multicenter study.

Epicardial fat may play a role in the pathogenesis of coronary artery disease (CAD). We explored the relationship of epicardial fat volume (EFV) with the presence and severity of CAD or myocardial perfusion abnormalities in a diverse, symptomatic patient population. Patients (n=380) with known or suspected CAD who underwent 320-detector row computed tomographic angiography, nuclear stress perfusion imaging, and clinically driven invasive coronary angiography for the CORE320 international study were included. EFV was defined as adipose tissue within the pericardial borders as assessed by computed tomography using semiautomatic software. We used linear and logistic regression models to assess the relationship of EFV with coronary calcium score, stenosis severity by quantitative coronary angiography, and myocardial perfusion abnormalities by single photon emission computed tomography (SPECT). Median EFV among patients (median age, 62.6 years) was 102 cm(3) (interquartile range: 53). A coronary calcium score of ≥1 was present in 83% of patients. Fifty-nine percent of patients had ≥1 coronary artery stenosis of ≥50% by quantitative coronary angiography, and 49% had abnormal myocardial perfusion results by SPECT. There were no significant associations between EFV and coronary artery calcium scanning, presence severity of ≥50% stenosis by quantitative coronary angiography, or abnormal myocardial perfusion by SPECT. In a diverse population of symptomatic patients referred for invasive coronary angiography, we did not find associations of EFV with the presence and severity of CAD or with myocardial perfusion abnormalities. The clinical significance of quantifying EFV remains uncertain but may relate to the pathophysiology of acute coronary events rather than the presence of atherosclerotic disease.

Is really epicardial fat a new marker of cardiovascular risk? A case-control cardiac magnetic resonance study

Background The amount of epicardial adipose tissue (EAT) has been associated with the presence of atherosclerotic disease but its role in assessing the risk of obstructive coronary artery disease (CAD) and its relationship with other cardiovascular risk factors is not fully established. We hypothesized that EAT quantified by cardiac magnetic resonance (CMR) is greater in patients with obstructive CAD and could be a new cardiovascular risk marker. Methods To assess the hypothesis, EAT was quantified in patients with ischemia detected in CMR vasodilator stress test and evidence of obstructive CAD in coronary angiogram and also in a group of control patients with similar risk profile but absence of ischemia in CMR stress test and also without diagnosis of obstructive CAD in follow up. Volume of EAT was quantified in 8-10 end-diastolic short axis slices of steady state free precession sequences, derived by Simpson method and indexed by body surface area. Results Seventy patients were included, 46 males (66%), mean age of 60 years (sd: 11.21) of them 42 had obstructive CAD in coronary angiogram. Volume of EAT indexed by body surface area was significantly greater in patients with obstructive CAD :42.43ml/m2 vs 34.35ml/m2, odds ratio: 1,034 [1,001- 1-069 ] p=0.04. Demographic data including cardiovascular risk factors are shown in the table. Conclusions

Abstract 615: Progression Of Atherosclerosis Plaque Area In Postmenopausal Women During Controlled Traditional Risk Factors

The onset of symptoms of coronary heart disease in women are displaced a decade compared with men after menopause, but currently there are reports in which 1 in 4 women is less than 59 years, suggesting that in the pre-menopausal period there is marked progression of vascular disease. Therefore we evaluated the presence of atherosclerotic disease in primary care menopausal women. Additionally, we hypothesized that the strict control of the traditional risk factors is not enough to prevent vascular disease progression. Methods, post-menopausal women without cardiovascular events from Argentina were evaluated. Framingham risk score with body mass index (FRSbmi) and carotid ultrasound were employed for the evaluation. Carotid total plaque area (TPA) by ultrasound was determined as previously described by Spence et al (Stroke 2002;33;2916-2922). Additionally, LDL cholesterol (LDL), triglycerides (Trig) and HbA1c were measured. All determinations were done on day 1 and after 8 months of treatment. Only patients who achieved all the therapeutic goals (blood pressure (BP)<130/80mmHg, LDL<100mg/dl, Trig<140mg/dl, HbA1c5mm2, stable group, TPA changed 5mm2. In the presence of controlled of traditional risk factors, 50% of the population continued to progressive atherosclerotic disease (Table). Conclusion, these results indicate that in the presence of controlled traditional risk factors, atherosclerosis may progress in some patients, including in menopausal women. Additional promoters of atherosclerosis should be evaluated in these progressive patients or possibly more intensive treatment should be used in such patients.

Association between endothelial dysfunction and frailty: the Toledo Study for Healthy Aging

Cardiovascular disease (CVD), both clinical and subclinical, has been proposed as one of the mechanisms underlying frailty. However, there is no evidence addressing the relationship between the earliest stage of CVD (endothelial dysfunction) and frailty. The goal of the study was to analyze the association between endothelial dysfunction, evaluated by asymmetric dimethylarginine (ADMA) levels, and frailty. We used data from the Toledo Study for Healthy Aging, a prospective Spanish cohort study. Biological samples were obtained and ADMA levels were determined using an enzyme immunoassay method. Logistic regression was used to estimate the odds ratio (OR) and 95 % confidence intervals of frailty associated with ADMA. Adjustments were made for age, gender, cardiovascular risk factors, and presence of atherosclerotic disease (assessed by ankle–brachial index; ABI). One thousand two hundred eighty-seven community-dwelling elderly were included. One hundred seven (8.3 %) were identified as frail, 542 (42.1 %) as pre-frail, and 638 (49.6 %) as non-frail. ADMAvalues were higher in frail subjects than in non-frail ones. In addition, an interaction between the presence of atherosclerotic disease and ADMA on the odds of frailty (p=0.045) was detected. After adjustments for age, classical cardiovascular risk factors, and ABI, the risk of frailty was associated with increasing levels of ADMA in subjects without atherosclerotic disease [OR for 1 standard deviation increase in ADMA=1.14 (1.01–1.28), p=0.032] but not in those with atherosclerotic disease. In our study, endothelial dysfunction, assessed by ADMA levels, is associated with frailty. These findings provide additional support for a relevant role of vascular system since its earliest stage in frailty.

Mean platelet volume predicting carotid atherosclerosis in atherothrombotic ischemic stroke

Platelets are involved in atherosclerosis. Mean platelet volume (MPV) could be a marker of platelet activation. We aim to determine whether MPV levels were correlated with the presence of atherosclerotic disease in carotid arteries of patients with stroke. We recruited 215 patients with atherothrombotic stroke. All the participants underwent ultrasonographic evaluation of their extracranial carotid arteries. MPV was measured in automated hematology analysis system. The subjects were divided according to plaques and severity of carotid stenosis. Univariate and multivariate statistical analyses and a ROC curve to predict carotid stenosis were performed. Univariate analysis showed a positive relationship between MPV and the degree of carotid atherosclerosis (p < 0.00007), and with carotid intima to media thickness (p < 0.00002). In ROC curve, a MPV cut-off of 11.25 fl was obtained for a sensibility of 70% and a specificity of 71% (p < 0.02). Multivariate analysis showed significant correlation with severity of carotid stenosis, when MPV was higher than 11.25 fl (OR: 2.9, p < 0.00007). Our results indicate that an elevated MPV could be an easily measurable marker of severity of carotid stenosis in patients with atherothrombotic stroke.