Prevalence Of Cardiovascular Events Research Articles

Respective roles of cortisol, aldosterone and angiotensin II during pathophysiology of atherosclerosis

The involvement of angiotensin II, cortisol and aldosterone in increased cardiovascular risk is well known but their interactions within arterial wall and during atheroma formation are not established. In fact, mild cortisol excess is associated with a higher prevalence of cardiovascular events, increased intima media thickness, a higher frequency of atherosclerotic plaques and increased mortality. Conversely, remission from hypercortisolism is followed by improvement in cardiovascular risk markers as intima-media thickness or arterial distensibility, suggesting a strong link between cortisol excess and adverse vascular remodeling. On the other hand, implication of renin-angiotensin system (RAS) in atheromatous remodeling is well documented. The RAS also includes aldosterone, a mineralocorticoid which secretion is mainly and strongly stimulated by angiotensin II, and which receptor (MR) can also be activated by cortisol given that MR affinity is similar for both aldosterone and cortisol. The role of aldosterone in arterial remodeling is still very controversial. Aldosterone treatment associated with a high salt diet induced not only hypertension but also oxidative stress, collagen synthesis and vascular inflammation. However in models without salt loading or arterial hypertension, such as the treatment with deoxycorticosterone acetate in dogs, no alterations in aortic structure were observed and moreover, the MR blockade with eplerenone did not attenuate atherosclerosis in the aorta of diabetic Apo-E KO mice. It stems that among the different effects and mechanisms described in cell experiments, it is not known which are indeed operating in situ in human vessels and thus, if local cortisol is deleterious or beneficial and, if activation of MR by aldosterone or cortisol is important in vascular remodeling and atherogenesis. RAS blocker treatment would be particularly beneficial in essential hypertensive patients with low plasma renin, to attenuate both angiotensin II and also cortisol up-regulation.

FRI0105 Impact of initiative to control cardiovascular risk factors in collaboration with local doctors in patients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is associated to a higher cardiovascular risk (CVR), prevalence of cardiovascular events and cardiovascular mortality than the general population. Adequate control of disease activity and cardiovascular risk...

Diabetes and cardiovascular events in women with polycystic ovary syndrome: a 20‐year retrospective cohort study

Women with polycystic ovary syndrome (PCOS) are potentially at increased risk of cardiovascular (CV) diseases due to well-established risk factors, including insulin resistance, obesity and type 2 diabetes mellitus (T2DM). However, data showing excess CV events in this population are still lacking. We investigated the incidence and prevalence of CV events in a cohort of women with PCOS. Retrospective cohort study (total follow-up >12,000 person-years). Leicester, Leicestershire and Rutland (Total Female population of 434,859), UK. Two thousand three hundred and one women with PCOS (mean age = 29.6 years) attending a speciality clinic in Leicestershire, UK. T2DM, myocardial infarction (MI), angina, heart failure (HF), stroke and CV-related death. Incidence of T2DM, MI, angina, HF, stroke and CV death was respectively 3.6, 0.8, 1.0, 0.3, 0.0 and 0.4 per 1000 person-years. At the end of follow-up, the prevalence of MI in the age groups 45-54, 55-64 and >65 years was 1.9%, 6.0% and 27.3% and of angina was 2.6%, 6.0% and 27.3%, respectively. Age-group-specific odds ratios for the prevalence of MI and angina compared to the local female population ranged between 2.6 (95% CI: 1.0-6.3) and 12.9 (CI: 3.4-48.6) with the highest ratio being for MI in the group >65 years old. Age, history of hypertension and smoking had significant correlations with CV outcomes in the PCOS patients. We have shown a high incidence and age-group-specific prevalence of T2DM, MI and angina in the women with PCOS, with over a quarter having had MI or angina in those >65 years. These findings should be considered in the treatment strategies and long-term planning for women with PCOS.

Cystatin C as a Predictor of Mortality and Cardiovascular Morbidity After Cardiac Resynchronization Therapy

Cardiac resynchronization therapy (CRT) has been reported to improve symptoms and cardiac performance in patients with severe heart failure (HF), but CRT recipients with advanced HF do not always experience improved mortality rates. Cystatin C has recently been involved in HF, but the association of serum cystatin C level with adverse events and long-term prognosis after CRT is unknown. This study investigated whether cystatin C level can predict mortality and cardiovascular events after CRT. A total of 117 consecutive patients receiving a CRT device for the treatment of advanced HF were assessed according to cystatin C level and long-term outcome after implantation of the device. Over a median follow-up of 3.2 years, 34 patients (29.1%) died and 59 patients (50.4%) developed cardiovascular events. Kaplan-Meier survival analysis indicated that elevated cystatin C level was significantly associated with higher all-cause mortality and prevalence of cardiovascular events, including hospitalization for progressive HF. After multivariate Cox regression analysis, serum cystatin C level and QRS duration, but not conventional echocardiographic parameters, were found to independently predict all-cause death or cardiovascular events. Of importance, only cystatin C level was an independent predictor of all-cause mortality after CRT. Cystatin C level independently predicts cardiac mortality or morbidity in patients receiving CRT. The assessment of cystatin C level could provide valuable information about long-term prognosis after CRT.

–374 T/A Polymorphism in RAGE Gene is Associated with Onset of Diabetes Mellitus, Atherosclerosis, and Renal Dysfunction in Patients with Hypertension

Receptor of advanced glycation end products (RAGE) is reportedly linked with chronic inflammatory diseases due to aging or diabetes. The aim of this study was to show how −374 T/A RAGE has an impact on systemic vascular damage and renal function. The study subjects were a total of 468 essential hypertension patients from the Non-Invasive Atherosclerotic Evaluation in Hypertension (NOAH) study cohort. We prospectively examined the association of −374 T/A RAGE with their prognoses and investigated the correlation between −374 T/A RAGE and multiple clinical parameters. Kaplan–Meier analysis did not show a significant association of −374 T/A RAGE with total mortality or the prevalence of cardiovascular events. Carriers of the A allele showed a significantly higher prevalence of diabetes mellitus (DM) and lower estimated glomerular filtration rate (eGFR) than subjects without this allele. In subjects with DM, carriers of the A allele showed a significantly lower eGFR. These significant correlations were only seen in male subjects. Carriers of the A allele of −374 T/A RAGE show an independent risk of atherosclerosis and reduced renal function in male hypertensive patients with DM.

An Invasive or Conservative Strategy in Patients With Diabetes Mellitus and Non–ST-Segment Elevation Acute Coronary Syndromes: A Collaborative Meta-Analysis of Randomized Trials

The purpose of this study was to conduct a meta-analysis to examine an invasive or conservative strategy in diabetic versus nondiabetic patients. Diabetic patients are at increased risk of cardiovascular events after an acute coronary syndrome, yet it remains unknown whether they derive enhanced benefit from an invasive strategy. Randomized trials comparing an invasive versus conservative treatment strategy were identified. The prevalence of cardiovascular events through 12 months was reported for each trial, stratified by diabetes mellitus status and randomized treatment strategy. Relative risk (RR) ratios and absolute risk reductions were combined using random-effects models. Data were combined across 9 trials comprising 9,904 subjects of whom 1,789 (18.1%) had diabetes mellitus. The RRs for death, nonfatal myocardial infarction (MI), or rehospitalization with an acute coronary syndrome for an invasive versus conservative strategy were similar between diabetic patients (RR: 0.87; 95% confidence interval [CI]: 0.73 to 1.03) and nondiabetic patients (RR: 0.86; 95% CI: 0.70 to 1.06; p interaction = 0.83). An invasive strategy reduced nonfatal MI in diabetic patients (RR: 0.71; 95% CI: 0.55 to 0.92), but not in nondiabetic patients (RR: 0.98; 95% CI: 0.74 to 1.29; p interaction = 0.09). The absolute risk reduction in MI with an invasive strategy was greater in diabetic than nondiabetic patients (absolute risk reduction: 3.7% vs. 0.1%; p interaction = 0.02). There were no differences in death or stroke between groups (p interactions 0.68 and 0.20, respectively). An early invasive strategy yielded similar RR reductions in overall cardiovascular events in diabetic and nondiabetic patients. However, an invasive strategy appeared to reduce recurrent nonfatal MI to a greater extent in diabetic patients. These data support the updated guidelines that recommend an invasive strategy for patients with diabetes mellitus and non-ST-segment elevation acute coronary syndromes.

Chronic Kidney Disease specific cardiovascular risk factors among non dialytic patients with Chronic Kidney Disease stage-V–An experience of a specialized hospital

The study was carried out to see prevalence of Chronic Kidney Disease (CKD) specific cardiovascular risk factors and cardiovascular events among patients with Chronic Kidney Disease stage-V (CKD-V) before starting dialysis therapy in the department of Nephrology of National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh. Among CKD specific cardiovascular risk factors, anemia showed the highest prevalence (96.7%) in study population. More than fifty percent of CKD-V patients had both hypocalcaemia and hyperphosphataemia. Calcium-Phosphate Product (CaXP) was elevated among 23 percent of the population. C-reactive protein, an acute phase protein was positive in 78% of CKD-V patients. Besides, among traditional risk factors, Hypertension and Diabetes Mellitus were present in 83.3% and 23% of the study population respectively. The prevalence of cardiovascular events among CKD-V patients showed that 18.3% had ischemic heart disease, 38% heart failure, 4.7% arrhythmia and 9% left ventricular hypertrophy. Females were significantly prone to develop cardiovascular events than their male counterpart (p=0.028). Diabetes was significantly higher in patients with cardiovascular complications than in patients without cardiovascular complications (p=0.021).

Cardiovascular Complications of Patients with Aldosteronism Associated with Autonomous Cortisol Secretion

Primary aldosteronism (PA) is sometimes associated with the autonomous secretion of cortisol. Our objective was to investigate the effect of autonomous cortisol secretion on the prevalence of cardiovascular events (CVE) in patients with PA. This was a retrospective cross-sectional study of cases collected from Gunma University Hospital between 2002 and 2010. Seventy-six consecutive patients hospitalized for an evaluation of PA were analyzed. Rates of CVE dependent on autonomous cortisol secretion were examined. Of the 76 patients with PA, 21 (28%) had a history of CVE, including 14 with stroke, one with myocardial infarction, and six with atrial fibrillation. The multivariate logistic-regression and receiver operating characteristic analyses revealed that PA patients with CVE had significantly higher midnight cortisol levels than those without CVE; the adjusted odds ratio with a cutoff value of 7.4 μg/dl was 7.0 (95% confidence interval, 1.8-30.6; P = 0.006). In addition, results of the 1-mg dexamethasone suppression test with a cutoff value of 3.0 μg/dl differed significantly (odds ratio, 5.0; 95% confidence interval, 1.4-20.7; P = 0.018). Conversely, 67 and 50% of the PA patients with a midnight cortisol level of at least 7.4 μg/dl and 1-mg dexamethasone suppression test of at least 3.0 μg/dl had a history of CVE. Other factors such as age, expected glomerular filtration rate, blood pressure, glucose intolerance, the serum aldosterone concentration, plasma renin activity, and the duration of hypertension had no effect. The patients with PA associated with autonomous cortisol secretion had high incidence of CVE, and this association may further increase the risk of CVE in patients with PA.

Development of a Homogeneous Assay for Measurement of Small Dense LDL Cholesterol

Plasma concentrations of small dense (sd)-LDL are associated with the prevalence of cardiovascular events. However, the special equipment and long assay times required for sd-LDL measurement have hindered its clinical application. Herein, we report development of a simple homogeneous assay for sd-LDL-cholesterol (C) adaptable to autoanalyzers. We identified suitable surfactants and phospholipases by screening for those selective for the sd-LDL fraction (d 1.044-1.063 kg/L) and for the dissociation of other lipoproteins, including large buoyant LDL (lb-LDL). Principal characteristics of this assay were compared with ultracentrifugal isolation of LDL subfractions and with our previous heparin-magnesium precipitation assay for sd-LDL. We measured sd-LDL-C concentrations in 460 healthy, normolipidemic individuals. We used a polyoxyethylene benzylphenyl ether derivative to dissociate triglyceride-rich lipoproteins and HDLs, whereas sphingomyelinase proved most effective for dissociation of lb-LDL from LDL owing to the higher sphingomyelin content in the lb-LDL subfractions. A polyoxyethylene styrenephenyl ether derivative protected sd-LDL against the dissociative actions of sphingomyelinase and cholesterol oxidase/esterase during an initial incubation step. Next, polyoxyethylene alkyl ether dissociated sd-LDL-C and the cholesterol released from sd-LDL were subsequently measured by using cholesterol oxidase/esterase. The homogeneous method correlated excellently with ultracentrifugation for sd-LDL-C (y = 0.99x-0.09, R(2) = 0.91, n = 60) and exhibited within-run precision CVs <1.1%. The distribution of sd-LDL-C was skewed, and the central 95% of sd-LDL-C concentrations ranged from 0.24 to 0.88 mmol/L (9.4-34.0 mg/dL). The homogeneous assay allows reproducible measurement of sd-LDL-C within 10 min and appears promising in further investigations of the clinical significance of sd-LDL-C.

THE INFLUENCE OF NORMAL SLEEP AND OBSTRUCTIVE SLEEP APNEA ON CORONARY ARTERY ENDOTHELIAL CELLS MIGRATION: PP.6.237

Endothelial cells migration and proliferation play an important role in the growth and development of new blood vessels and endothelium healing. This process occurs in response to injury, inflammation and immune reactions. Endothelial function seems to play a significant role in a pathophysiology of cardiovascular complications including sleep-disordered breathing. The aim of the study was to evaluate the coronary artery endothelial cells chemotaxis induced by serum obtained from healthy and severe obstructive sleep apnea subjects. Material and Methods: 12 healthy and 12 severe obstructive sleep apnea subjects (AHI > 30) free from other co-morbidities without any treatment underwent standard polysomnography. Blood was collected at three time-points: at 21:00 before sleep,at 6:00 after arousal and at 11.00 (after five hours of normal day activity). Serum chemoattractant activity for human coronary endothelial cells was assessed using a QCMTM 24-well colorimetric cell migration assay kit (Chemicon) following the manufacturer's instructions. Results: In healthy subjects serum chemoattractant activity peaked in the morning after arousal (p = 0,02). This pattern was disturbed in severe obstructive sleep apnea subjects where serum induced chemotaxis was weaker than in normal controls (p = 0,01) and did not vary significantly in different time-points (OSA vs healthy at 6:00 p < 0,001, p = ns in the OSA group). Conclusion: Normal sleep influences chemotaxis of the coronary artery endothelial cells. The processes occurring during obstructive sleep apnea can impair endothelial cells migration activity. This phenomenon might play a role in a pathophysiology of cardiovascular complications in obstructive sleep apnea patients and might be helpful in understanding the influence of the circadian rhythm on prevalence of cardiovascular events.

CARDIOVASCULAR DISEASES AMONG EGYPTIAN PATIENTS WITH RHEUMATOID ARTHRITIS AND ITS RELATION TO TRADITIONAL RISK FACTORS: PP.2.82

Background: Rheumatoid arthritis (RA) is associated with increased mortality which is due to accelerated coronary artery & cerebrovascular atherosclerosis and researchers have not been able to clearly identify specific aspects of RA or its treatment that might higher the risk for cardiovascular (CV) disease. Aim: Prevalence of CV events in patients with rheumatoid arthritis. Effects of rheumatoid arthritis as a risk factor in developing CV diseases as well as influence of early & proper treatment on such risk. Association between RA as a risk factor and other traditional risk factors on CV diseases. Methods: 300 patients with RA & 150 controls matched with age & sex were subjected to full clinical assessment, laboratory investigations especially for rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), electrocardiography (ECG), conventional radiographs of both hands and feet to detect joint erosions and Doppler echocardiography. Results: 13.5% of patients with RA has CV events, 7% for myocardial infarction and 2% for stroke. RA-related risk factors (extra articular disease, joints erosions and presence of RF were associated with CV events, the use of disease modifying antirheumatic drugs (DMARDs) were associated with lower risk for CV events. Conclusion: our study confirm the role of traditional risk factors and their interplay with RA-related risk factors in development of CV events. It also supports the beneficial effects of some DMARD in lowering such risks.

Kidney transplant in diabetic patients: modalities, indications and results.

BackgroundDiabetes is a disease of increasing worldwide prevalence and is the main cause of chronic renal failure. Type 1 diabetic patients with chronic renal failure have the following therapy options: kidney transplant from a living donor, pancreas after kidney transplant, simultaneous pancreas-kidney transplant, or awaiting a deceased donor kidney transplant. For type 2 diabetic patients, only kidney transplant from deceased or living donors are recommended. Patient survival after kidney transplant has been improving for all age ranges in comparison to the dialysis therapy. The main causes of mortality after transplant are cardiovascular and cerebrovascular events, infections and neoplasias. Five-year patient survival for type 2 diabetic patients is lower than the non-diabetics' because they are older and have higher body mass index on the occasion of the transplant and both pre- and posttransplant cardiovascular diseases prevalences. The increased postransplant cardiovascular mortality in these patients is attributed to the presence of well-known risk factors, such as insulin resistance, higher triglycerides values, lower HDL-cholesterol values, abnormalities in fibrinolysis and coagulation and endothelial dysfunction. In type 1 diabetic patients, simultaneous pancreas-kidney transplant is associated with lower prevalence of vascular diseases, including acute myocardial infarction, stroke and amputation in comparison to isolated kidney transplant and dialysis therapy.ConclusionType 1 and 2 diabetic patients present higher survival rates after transplant in comparison to the dialysis therapy, although the prevalence of cardiovascular events and infectious complications remain higher than in the general population.

Association of plasminogen-activator inhibitor 1 (PAI-1) 4G/5G gene polymorphism with survival and chemotherapy-related vascular toxicity in non-seminomatous testicular cancer (TC)

5083 Background: High PAI-1 expression by tumor has been associated with poor prognosis in different cancer types, while high systemic PAI-1 levels may increase the risk of vascular thrombosis. We investigated whether the 4G/5G del/ins polymorphism in the PAI-1 promoter (rs1799889; 4G might lead to higher transcription), is associated with differences in survival and prevalence of cardiovascular events in TC. Methods: Data were collected on survival and cardiovascular events (venous thromboembolism [VTE] and coronary heart disease [CHD]) of TC patients treated with standard platinum based chemotherapy from 1977–2004. PAI-1 genotype was determined from non-tumor genomic DNA by a Taqman SNP assay. Genotypes were compared for survival (Kaplan-Meier curves + log-rank and Cox-regression analysis), disease outcome (logistic regression) and prevalence of VTE and CHD (χ2-test). Results: Data are available for 324 patients with median follow-up of 10 yrs (range 0–28). The 3 genotypes 4G/4G (n = 84), 4G/5G (n = 164), and 5G/5G (n = 76) do not differ in age and initial chemotherapy regime. However, the 4G/4G variant shows a higher prevalence of International Germ Cell Cancer Classification (IGCCC) poor prognosis compared to 4G/5G + 5G/5G (24% vs 10%; p = 0.003), as well as a decreased TC related survival compared to 4G/5G + 5G/5G (83% vs 94%; p = 0.001) with a hazard ratio of 2.68 for TC related death (95%CI 1.26–5.72; adjusted for IGCCC p = 0.011). In addition, the 4G/4G variant shows an odds ratio of 3.35 for refractory TC and early relapses (&lt;2 yrs) (95% CI 1.48–7.58; p = 0.004). The 3 genotypes do not differ significantly in prevalence of VTE (4G/4G 11.9%, 4G/5G 8.5%, 5G/5G 7.9%; p = 0.616) and CHD during/after chemotherapy (4G/4G 6.0%; 4G/5G 4.9%; 5G/5G 2.6%; p = 0.594). Conclusions: The 4G/4G variant of the PAI-1 4G/5G gene polymorphism is associated with IGCCC poor prognosis, reduced survival and higher prevalence of refractory disease and early relapses. No effect on vascular toxicity was found. The 4G/4G variant of the PAI-1 gene may be an unfavorable prognostic factor as well as an unfavorable predictive factor for response to chemotherapy in patients with TC. No significant financial relationships to disclose.

Cardiovascular and Neurological Adverse Events Associated With Antidepressant Treatment in Children and Adolescents

A retrospective cohort design of Medicaid medical and pharmacy claims for 1996 through 2005 was employed for 14,171 children and adolescents prescribed an antidepressant medication and a random sample of 4500 children not treated with any class of psychotropic medication to compare the prevalence rates of cardiovascular and neurological adverse events. The treated cohort evinced a higher prevalence of cardiovascular events, orthostatic hypotension, seizures, insomnia, and headaches. In the treated cohort, patients were at a significantly higher risk for incident cardiovascular events when exposed to selective serotonin reuptake inhibitors and weight-inducing antidepressants, mood stabilizers, and antipsychotics. Incident orthostatic hypotension was associated with weight-inducing antidepressants and mood stabilizers. Incident seizures and extrapyramidal symptoms were unrelated to antidepressant or co-prescribed psychotropic medications, but both were significantly associated with comorbid central nervous system, organic brain/mental retardation, or preexisting cardiovascular or cerebrovascular conditions. Headaches and dizziness were significantly related to taking mood stabilizers.

Cardiovascular and Cerebrovascular Comorbidities of Hypokalemic and Normokalemic Primary Aldosteronism: Results of the German Conn’s Registry

Primary aldosteronism (PA) is associated with vascular end-organ damage. Our objective was to evaluate differences regarding comorbidities between the hypokalemic and normokalemic form of PA. This was a retrospective cross-sectional study collected from six German centers (German Conn's registry) between 1990 and 2007. Of 640 registered patients with PA, 553 patients were analyzed. Comorbidities depending on hypokalemia or normokalemia were examined. Of the 553 patients (61 +/- 13 yr, range 13-96), 56.1% had hypokalemic PA. The systolic (164 +/- 29 vs. 155 +/- 27 mm Hg; P < 0.01) and diastolic (96 +/- 18 vs. 93 +/- 15 mm Hg; P < 0.05) blood pressures were significantly higher in hypokalemic patients than in those with the normokalemic variant. The prevalence of cardiovascular events (angina pectoris, myocardial infarction, chronic cardiac insufficiency, coronary angioplasty) was 16.3%. Atrial fibrillation occurred in 7.1% and other atrial or ventricular arrhythmia in 5.2% of the patients. Angina pectoris and chronic cardiac insufficiency were significantly more prevalent in hypokalemic PA (9.0 vs. 2.1%, P < 0.001; 5.5 vs. 2.1%, P < 0.01). Overall, cerebrovascular comorbidities were not different between hypokalemic and normokalemic patients, however, stroke tended to be more prevalent in normokalemic patients. Our data indicate a high prevalence of comorbidities in patients with PA. The hypokalemic variant is defined by a higher morbidity than the normokalemic variant regarding some cardiovascular but not cerebrovascular events. Thus, PA should be sought not only in hypokalemic but also in normokalemic hypertensives because high-excess morbidity occurs in both subgroups.

Exaggerated morning blood pressure surge and cardiovascular events. A 5-year longitudinal study in normotensive and well-controlled hypertensive elderly

Cardiovascular events (CE) occur most frequently in the morning hours in hypertensive subjects. We studied the association between the morning blood pressure (BP) surge and CE in prognosis of 10 normotensive and 32 well-controlled hypertensive elderly, in whom ambulatory BP monitoring was performed and who were followed prospectively for 5 years. The morning surge (MS) of BP was calculated as mean systolic BP during 2h after awakening−mean systolic BP during 1h that included the lowest sleep BP. During an average of 60 months, five CE occurred. When the patients were divided into two groups according to MS, those in the top terzile (MS group; MS≥34 mmHg, n=14) had a higher prevalence of CE (5 versus 0, p=0.001) during the follow-up period, than the others (non-MS group; MS<34 mmHg, n=28). The logistic regression analysis showed the MS sleep-trough surge as predictive variable of CE (odds ratio, OR=0.794, p=0.022). In conclusion, in older normotensives and well-controlled hypertensives, a higher BP MS is associated with vascular risk independently of clinical and ambulatory BP. Reduction of the MS could thus be a therapeutic target for preventing vascular events also in non-hypertensive patients.

Gender and endothelial progenitor cell number in middle-aged adults

BACKGROUND: Between the ages of 45 and 65 years, the prevalence of cardiovascular disease is significantly lower in women compared with men. Circulating bone marrow-derived endothelial progenitor cells (EPCs) play an important role in vascular repair. Reduced EPC number is predictive of more cardiovascular events. It is currently unknown whether there is a sex-difference in EPC number in middle-aged adults. OBJECTIVE: We tested the hypothesis that circulating EPC number is higher in middle-aged women than men. METHODS: Peripheral blood samples were collected from 58 sedentary adults, 29 men (57 ± 1 yr) and 29 women (58 ± 1 yr). Mononuclear cells were isolated and fluorescence-activated cell sorting (FACS) analysis of cells negative for CD45 was performed for those positive for CD34, and triple positive for CD34, VEGFR-2, and CD133 according to the recommendations of the International Society for Hematotherapy and Graft Engineering. RESULTS: The number of CD45(-)/CD34(+) and CD45(-)/CD34(+)/ VEGFR-2(+)/CD133(+) were not significantly different between women and men (0.055 ± 0.006% vs 0.069 ± 0.008% and 0.0013 ± 0.0003% vs 0.0018 ± 0.0004%, respectively). CONCLUSIONS: These results demonstrate no sex-difference in EPC number in middle-age adults. Therefore, it is unlikely that differences in EPC number contribute to the gender-related differences in the prevalence of cardiovascular events in this population.

Cardiovascular Outcomes in Patients With Primary Aldosteronism After Treatment

Experimental and human studies demonstrate that long-term exposure to elevated aldosterone levels results in cardiac and vascular damage. We investigated long-term cardiovascular outcomes in patients with primary aldosteronism after surgical or medical treatment. Fifty-four patients with or without evidence of adrenal adenomas were prospectively followed up for a mean of 7.4 years after treatment with adrenalectomy or spironolactone. Patients with primary aldosteronism were compared with patients with essential hypertension and were treated to reach a blood pressure of less than 140/90 mm Hg. The main outcome measure was a combined cardiovascular end point comprising myocardial infarction, stroke, any type of revascularization procedure, and sustained arrhythmias. At baseline, the prevalence of cardiovascular events was greater in primary aldosteronism (35%) than in essential hypertension (11%) (odds ratio, 4.61; 95% confidence interval, 2.38-8.95; P< .001), with odds ratios of 4.93, 4.36, and 2.80 for sustained arrhythmias, cerebrovascular events, and coronary heart disease, respectively. Blood pressure during follow-up was comparable in the primary aldosteronism and essential hypertension groups. Ten patients in the primary aldosteronism group and 19 in the essential hypertension group reached the primary end point (P= .85). Cox analysis indicated that older age and longer duration of hypertension were factors independently associated with the cardiovascular end point. Cardiovascular outcome was comparable in patients with aldosteronism treated with adrenalectomy vs aldosterone antagonists (P= .71). Primary aldosteronism is associated with a cardiovascular complication rate out of proportion to blood pressure levels that benefits substantially from surgical and medical treatment in the long term.

Higher Prevalence of Cardiovascular Events Among Patients With Abnormal Atrial Depolarization and Coronary Artery Disease at 18 Months' Post-Exercise Tolerance Testing

Abnormal atrial depolarization, denoted as interatrial block (IAB; P wave >110 ms), is associated with myocardial ischemia during exercise. The authors conducted an 18-month follow-up for cardiovascular events in 31 consecutive patients with IAB and 60 controls without IAB at rest; participants had coronary artery disease and hypertension and had undergone coronary angiography following positive exercise tolerance test (ETT) results. Atrial fibrillation and need for repeat ETT and coronary artery revascularization were significant with IAB (77.4% vs 20%; P<.001). In patients with such events, IAB, left atrial dilatation, left ventricular hypertrophy, increased left ventricular end-diastolic volume, poorer Duke prognostic treadmill (DPT) scores, and significant coronary artery stenoses were predominant. IAB (hazard ratio [HR], 4.9; 95% confidence interval [CI], 1.3-19.7; P=.02) and DPT scores (HR, 0.84; 95% CI, 0.72-0.98; P=.03) were independently associated with these events. At 18 months' follow-up, IAB at rest was associated with cardiovascular events among those with known coronary artery disease and hypertension.

Challenges Associated with Metabolic Syndrome

Approximately 2500 Americans die from cardiovascular disease (CVD) each day. Each year, CVD claims more lives than the next four leading causes of death combined. Direct and indirect costs of CVD are estimated to be Dollars 403.1 billion in 2006. Despite advancements in conventional therapy, the residual risk of CVD continues to rise. One component of the cardiometabolic risk is metabolic syndrome. Metabolic syndrome is a constellation of interrelated risk factors of metabolic origin including abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, elevated plasma glucose level, and prothrombotic and proinflammatory states that promote atherosclerotic CVD and increase the risk of type 2 diabetes mellitus. Approximately 47 million residents of the United States have metabolic syndrome. Abdominal obesity and insulin resistance appear to be its predominant underlying risk factors. Abdominal adiposity is considered high-risk fat, and it is associated with insulin resistance, hyperglycemia, dyslipidemia, hypertension, and prothrombotic and/or proinflammatory states. Despite notable advances in cardiovascular risk management, the prevalence of cardiovascular events and type 2 diabetes remains high. First-line therapy for individuals with metabolic syndrome should be directed to the major CVD risk factors, namely, elevated low-density lipoprotein cholesterol levels, hypertension, and diabetes, and it should emphasize lifestyle modification. Until additional research better defines the most appropriate therapies, conventional cardiovascular risk factors, such as lipid levels, blood pressure, and diabetes, should be managed in individuals with metabolic syndrome according to nationally accepted clinical guidelines.